Baby-mother unit introduction into the local and the Hungarian health service.

The aim of the program is to apply a collaborative therapeutic and rehabilitation model utilizing the multidisciplinary team work in the treatment of the pre-, peri- and post-natal period of mothers suffering mental disorders as well as to facilitate the early interactions and attachment with the baby.

Since 2007, 82 mothers, 1 father entered into the program. 54 mothers were participated as inpatient, 29 were treated only as outpatient. 24.9% of the cases were diagnosed (ICD 10 – F20–F29) schizophrenia or spectrum disorders, 27,6% were in the major affective disorders, including bipolar, (F 31, 14.5%). 38,6% were diagnosed in the anxiety disorders spectrum. 23% entered in the prenatal period (pregnancy), while 76,3% entered post-natal.

Case-management, individual, group and family interventions (psychotherapy), pharmacotherapy, case conferences, individual and staff supervision, video-feedback, mother-child consultation.

New treatment model introduction in Hungary, which may reduce the risk of the separation of the baby, enhances the mother recovery, as well as the utilization of the family's and the supportive network resources. Further research is needed to prove the higher efficacy.

Donepezil, a centrally acting acetylcholinesterase inhibitor (AChEI), is approved for symptomatic relief of cognitive impairment in patients with Alzheimer's disease and Vascular Dementia (VD). Several adverse effects were reported and the most common are gastrointestinal disturbances. Others include bradycardia, agitation and confusion. Although epileptic seizures are listed as a side effect, there are few reports.

To present a case-report of donepezil-induced epileptic seizures and a review study regarding the theme available in Medline.

Brief literature review.

A case report is presented and literature of this theme shortly reviewed.

The case involves a 62-year-old female diagnosed with VD 6 months previously. Her medical history included a cerebrovascular accident 24 months earlier. She started the treatment with donepezil 5 mg and 48 hours later she was admitted in the Emergency with convulsions. She was unconscious for 20 minutes with urinary incontinence and bitten tongue. Normal blood analyses. A contrast brain CT showed a mild degree of cortical atrophy without new structural lesions. EEG showed mild and diffuse neuronal dysfunction with no grafoelements indicative of epilepsy. Donepezil was discontinued, no therapy was instituted and the patient has been convulsion free.

The mechanism of convulsive action of AChEIs isn’t clear. There are reports about centrally acting AChEIs inducing convulsions in patients with Dementia without any underlying neurological condition. Further research is needed to delineate the frequency of this effect and to extend our knowledge of the underlying pathophysiological mechanism in order to determinate the safety profile of AChEIs.

Professional guidelines for forensic interviews of children have emphasized cognitive factors associated with children's memory retrieval and paid less attention to the emotional factors that may inhibit the cooperativeness of reluctant interviewees.

The current study explored whether an additional focus on rapport-building altered the dynamics of interviews with alleged victims of intra-familial abuse, and increased abuse disclosures.

426 4- to 13-year-old suspected victims of intra-familial abuse were interviewed using either the NICHD Investigative Interview Standard Protocol (SP) or a Revised Protocol (RP) designed to enhance rapport between the child and interviewer.

Children were more likely to make valid (corroborated) allegations of abuse when the RP was employed, with variation according to age, gender and prior disclosure. Similar patterns were evident in a larger sample of 1424 which included non-corroborated cases.

Subsequent analyses focusing on a subset of interviews (n=200) were designed to explore differences in the dynamics of the interviews using the SP or RP which may account for the increase of allegation rates using the RP.

The interviews were coded to identify expressions of the interviewers’ support and the children's reluctance and uncooperativeness in the pre-substantive portions of the interviews.

As expected, RP interviews contained more supportive comments and fewer unsupportive comments. Children interviewed in this way showed reduced reluctance, with remarkably fewer expressions of resistance and denial but also fewer omissions.

Focus on rapport-building altered the interview dynamics, rendering reluctant children more cooperative and more likely to disclose their abuse.

There are growing concerns on use of certain psychotropic medications on women's reproductive health, pregnancy and lactation. Lithium, Sodium valproate, Carbamazepine and Lamotrigine are recommended by National Institute of Clinical Excellence (NICE) in treatment of Bipolar Disorder. While treatment of Bipolar disorder is crucial, it is imperative that there is clear communication between patients, carers and health professionals to enable patients in making informed decisions about their care

NICE recommends that healthcare professionals should give relevant information at every stage of assessment and treatment. They should discuss contraception and risks of pregnancy. Furthermore, it is good practice to assess capacity of service user's to consent to treatment. This enables service user to make well-informed decision.

To find out if relevant steps were taken to aid women in making well-informed decision regarding their treatment i.e by verbal communication and providing written information.

We retrospectively analysed electronic patient record of women meeting inclusion criteria.

Out of 616 women, 119 met the inclusion criteria. Patients’ ages ranged from 20 to 55. 52% were on Lithium, followed by Sodium Valproate(22%), Lamotrigine(14%) and Carbamazepine(12%). There was evidence of verbal communication in only 35% and provision of written information in only 11%. Contraception advice was documented in only 24%. Documentation of assessment of capacity to consent to treatment was found only in 31%.

There is lack of adequate communication between clinicians and patients. There are several possible explanations for this finding with one of the main reasons being poor documentation.

The defining features of Type D personality, that is, tendencies to experience negative emotions and inability to express emotions, are the known risk factors of somatization tendencies.

Many depressive patients express their mental distress through somatic symptoms. Therefore, it may be worthwhile to investigate the relationship between Type D personality and complaints of somatic symptoms in depressive patients.

The purpose of this study was to evaluate the relationship between type D personality and somatic symptom complaints in depressive patients.

Eighty-two individuals diagnosed with depressive disorder were included. Type D personality was measured with 14- item Type D personality Scale (DS14). Patient Health Questionnaire 9 and 15 were used to measure depression severity and somatization tendencies.

Two-thirds of the subjects were classified as Type D personality (63.4%). The mean PHQ-15 score of the Type D individuals was significantly higher than the remaining subjects (12.7 vs. 7.2, p=8.2E-6). The best regression model included age, PHQ-9 score and NA subscale score as predictor variables. Among these, only the coefficients of age (p=0.0015)and NA score (p=1.5E-7) was found to be statistically significant.

The result showed that Type D personality was one of the strong predictors of somatic complaints among depressive individuals. The finding that alexithymia was not shown to be a significant predictors also substantiated this discrepancy. However, it might be possible that the high correlation between NA and SI subscore (r=0.65) and between NA and TAS-20 score(r=0.44) hid the additional effects of social inhibition and alexithymia.

There are only few reports on the use of aripiprazole during pregnancy. In our case, the patient was treated with aripiprazole throughout the pregnancy and delivered a healthy baby.

A 31-year-old female was admitted to our hospital for the first time in 2005 as she returned from her postdoctoral studies abroad; prior to the hospitalization, psychotic symptoms had been present for a few months. She had auditory hallucinations and was expressing paranoid delusions. After the treatment with risperidone, the psychotic symptoms subsided. Because of extrapyramidal side effects risperidone was replaced with olanzapine. While on olanzapine she experienced cognitive side effects and was switched to 15 mg of aripiprazole. She achieved good remission and started working again. She got married and in 2009 she decided to stop her medication because she wanted to conceive. Without psychotropic treatment she became paranoid again after 7 months. She resumed with 15 mg of aripiprazole and achieved remission once again. In 2010, after discussing treatment options, she decided to conceive while still on aripiprazole. She got pregnant in June 2011 and in she delivered a healthy baby in February 2012 after a normal pregnancy. She didn’t breast feed. The 6-months followup showed that the baby was developing normally; the parents intend to have another child.

In the presented case the benefits of effective and well tolerated antipsychotic treatment outweighed potential risks associated with prenatal exposure. This is the second case report of the use of aripiprazole during the whole pregnancy.

Recent studies have suggested that the deficit of glutathione (GSH), a major antioxidant, seems to play a role in the pathophysiology of schizophrenia. Moreover, oxidative stress may contribute to the development of neurological abnormalities, including tardive dyskinesia and parkinsonism symptoms.

To determine plasma glutathione levels and to explore their association with neurological soft signs (NSS) in patients with chronic and first-episode schizophrenia.

A case-control study carried-out on three groups: sixty clinically stable patients with chronic schizophrenia, twentythree patients with first-episode schizophrenia and thirty matched healthy controls. Glutathione levels: total (GSHt), reduced (GSHr) and oxidized glutathione (GSSG) were determined by spectrophotometry. NSS were assessed in three groups by a standardized neurological examination (Krebs et al., 2000).

Plasmatic GSHt and GSHr levels were significantly decreased in patients with chronic and first-episode schizophrenia. All NSS scores were significantly higher in two groups of patients compared to controls. No association was found between NSS scores and glutathione levels in patients with chronic schizophrenia. However, in patients with firstepisode, a negative correlation was found between GSHt levels and involuntary movement sub-score (r= -0.62, p=0.008).

These results suggest that GSH deficit is not related to the stage of disease and may be an important indirect biomarker of oxidative stress in schizophrenia. The association between low GSHt level as a marker of oxidative stress and involuntary movements could suggest that oxidative stress may contribute to the brain damage which leads to an increased prevalence of these NSS.

Internet over-consumption can cause dysfunctional usage resulting in several deleterious outcomes. The “Internet Use Disorder” is gaining importance in diagnostic manuals as its prevalence increases.

The objective of the study was to examine how this upcoming disorder is assessed at present.

We present the actual status of Internet addiction assessment tools and develop a theoretical framework for optimizing “Internet Use Disorder” assessment tools design.

A factorial structure analysis of tools assessing Internet addiction for adolescents and adults published between January 1993 and October 2011 was performed and a theoretical framework for optimizing tools design was developed. The descriptive properties of 14 questionnaires were measured and the position of the instruments’ methodology, validity, reliability and model fit was presented, along with the preferred factorial analysis method and validation technique.

Results indicate some heterogeneity in study methodology and differences in descriptive and dimensional aspects of assessment tools. The three factor categories compulsive Internet use, negative outcomes and salience were central to Internet addiction questionnaires. Furthermore, the social dimension was often under-represented. No significant difference was observed in the distribution of factor categories across Internet addiction questionnaires and DSM-IV-TR and ICD-10 diagnostic criteria for substance dependence.

The validity and reliability of the evaluated questionnaires reflect the newness of this field. The underrepresentation of the social use of Internet is a problematic situation as it is causing considerable damages. Future research should consider that Internet addiction evaluation questionnaires need refinement. Appropriate strategies are proposed.

Suicide is a major global social and public health problem. Drug abuse is considered a significant risk factor for suicidal behavior. Research evidence suggests that some drug addicts may be more likely to engage in suicidal behavior.

The aim of this study was to describe the characteristics of drug-dependent individuals who committed suicide.

The social and demographic profiles of drug-dependent individuals who committed suicide in Belarus between 1995 and 2010 were investigated.

The use of illicit drugs has increased dramatically during last two decades in Belarus. Suicide is the fifth leading cause of death among drug-dependent population in this country. 92 suicide cases (84 males, mean age 34.9 ± 1.2 and 8 females, mean age 35.6 ± 1.4) among drug addicts in Belarus from 1995 to 2010 were registered. 92.4% of suicide victims used opiates. 53.3% of drug addicts had a criminal record. The majority of suicide victims (68%) suffered comorbid disorders. The most common disorders were viral hepatitis (30%), HIV (20%) and alcohol dependence (18%). 95.7% of drug addicts have committed suicide by hanging.

A number of risk factors for suicide such as opiates use, comorbid disorders and criminal activity among drugdependent individuals have been identified. It is important to identify those individuals with drug dependence that might be at particularly high risk for suicide.

High rates of anxiety symptoms among medical students have been observed in many studies. Autonomic symptoms are indications of anxiety somatization. Reports about gender variations in anxiety and autonomic lability are contradictory and require further researches.

To investigate changes of state anxiety, autonomic symptoms among medical students in various study periods and role of gender variations.

54 medical students (28 female and 26 male) of I.M. Sechenov Moscow State Medical University were recruited in this study. Participants were assigned unique identification codes. We used State and Trait Anxiety Inventory (STAI) and Vein’s Autonomic Symptoms Questionnaire (VASQ). State anxiety and autonomic symptoms were defined three times: 2 weeks, one day before the exam and after examination. ANOVA, correlation and t-statistics methods were used to analyze data.

Changing of study situation influenced lability of state anxiety (ANOVA, F= 3,23; p= 0,04). We found gender differences in autonomic symptoms’ penetration in 1st (p= 0.05), 2nd (p< 0.05) and 3rd (p< 0.01) periods; state anxiety varied in 2nd period (p< 0,05) only. Correlation between autonomic symptoms and gender was found in 1st (r= 0,46; p= 0,003) and 2nd (r= 0,901; p< 0.001) periods; correlation between state anxiety and gender was moderate in 2nd period (r= 0,55; p< 0.001).

Statistical significance was achieved between a level of anxiety and various studying situations. Correlation between gender and both state anxiety and rate of autonomic symptoms was found. State anxiety and degree of autonomic symptoms was significantly higher in female.

Cerebral activity during can be approached by the measurement of functional activity in healthy young people. Functional activity reflects the statistical dependencies among near and distant brain regions by generalized partial directed coherence (GPDC).

Sleep stages of 9 healthy young subjects without somatic, psychiatric and sleep disorders were defined in accordance with the Rechtschaffen and Kales criteria (Wake, stages 1 to 4 and REM sleep). In regard of specific sleep EEG frequencies (delta, theta, alpha, sigma and beta), the first 20 epochs of each sleep stage were used for analysis. GPDC was applied between each electrode and each other of the 19 EEG electrodes.

In comparison to wake and REM sleep, GPDC showed increased interdependencies across each NREM sleep stage. Lower sleep EEG frequencies increased these changes. Moreover, during slow EEG rhythms, differences observed across stages were more pronounced. In addition, differences between bands were more marked during wake and sleep stages 1 and 2. None differences were observed for GPDC values between both sides of human brain. In the right hemisphere as well as in the left one, GPDC is similar between sleep stages in delta frequency while GPDC differed from wake to other sleep stages in theta, alpha, sigma and beta EEG frequencies.

A different mapping in the three classical sleep states (Wake, NREM and REM sleep) is showed by generalized partial directed coherence in sleep EEG frequencies. Additional studies investigating the directional information flow should be performed to complete our results.

Absconding from a psychiatric ward (leaving without permission) is a costly event in many ways.

Some risks of absconding include missed treatment which results in longer rehabilitation time or lack of treatment altogether.

To investigate the motivation and characteristics of patients absconding from a psychiatric ward in Iran.

A prospective study was conducted for patients who absconded from psychiatric ward in the period between July 2010 and July 2011. The variables were patients’ age, gender, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. All patients were interviewed to assess their motivation for absconding.

Over a one-year period of data collection 56 absconding events were recorded, with the incidence rate of 4.24%. The mean age of absconders was 31+8.4 years, 47 (83.9%) absconders were males, 28 (50.9%) absconds happened through the park fence.

Bipolar mood disorder or schizophrenia was the diagnosis of 23 (41%) absconders. The mean number of days of hospitalization in patients who left the wards was 11 days. The main motivation to abscond was boredom from the ward environment and missing the family.

The risk of absconding is highest in the early days of admission especially in male, young patients with diagnosis of bipolar mood disorder or schizophrenia.

Attention Deficit/Hyperactivity Disorder (ADHD) has been linked to substance use disorders later in life. However, the unique contribution of ADHD is not clarified yet. Insufficient research in this area has considered first substance use, associated behavioral problems and female gender in longitudinal and community settings.

To study the association between childhood attention problems and substance use 18 years later.

Using a French community sample of 1103 youths followed from 1991 to 2009, we tested associations between childhood attention problems (dimensional constructs) and substance use between ages 22 and 35, adjusting for potential childhood and family confounders.

Individuals with high levels of childhood attention problems presented higher rates of substance use (regular tobacco smoking, alcohol abuse/dependence, cannabis problematic use, cocaine lifetime use). However, when taking into account other childhood behavioral problems, early substance use, academic difficulties and family adversity, childhood attention problems were only related to regular tobacco smoking and cocaine lifetime use.

This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood attention problems and substance use is confounded by a range of early risk factors.

Attribution style bias, such as a greater tendency to perceive hostility, has been reported to be presented in multi-episode and chronic schizophrenia patients.

The aim of this study was to investigate whether adolescents with Early-Onset-Schizophrenia (EOS) exhibited a perceived hostility bias and whether this bias was correlated with adolescents' clinical characteristics (positive and negative symptoms of schizophrenia, anxiety, depression, self-esteem) and social competence (social behavior, communication, imagination).

Thirteen adolescents with EOS (mean age: 14.7) and 17 healthy adolescents (mean age: 14.2), matched on age and total IQ, completed the Ambiguous Intentions Hostility Questionnaire (AIHQ) and several clinical measures of anxiety, depression, social competences and self-esteem. The AIHQ is a self-report questionnaire about negative outcomes that varied intentionality in different situations (i.e., ambiguous, intentional and accidental situations). The perceived hostility, composite blame and aggression bias scores were calculated.

In comparison with healthy adolescents, adolescents with EOS attributed more hostile intentions to persons in accidental situations (hostility bias); they also exhibited a higher level of negative emotions (blame bias) toward persons in accidental situations. Both, hostility bias and blame bias were associated with a higher level of anxiety and a lower selfesteem in EOS adolescents.

These results suggest that cognitive and emotional biased attribution style in EOS may constitute an important factor of vulnerability to social impairments in adolescents with EOS and suggest that these attributional biases should constitute the targets of early psychotherapeutic intervention with these patients.

Circadian rhythm pathways are highlighted in a number of etiological models of bipolar disorder (BD). More than 25% of bipolar patients may present seasonal pattern (SP). However, there is very limited scientific data on the prevalence of SP, its clinical manifestations and any gender influence.

Caucasian individuals who met DSM-IV criteria for BD I or II were recruited from three university-affiliated psychiatric departments in France (Paris, Bordeaux, Nancy). SP was defined according to DSM-IV criteria. Clinical and socio- demographic variables were obtained from structured interviews with the patients and their relatives.

Four hundred and fifty-two bipolar patients (n=452) in euthymic state were included in the study, 102 of them (23%) were considered as having SP according to DSM-IV criteria. Multivariate analysis showed a significant association of BD patients with SP for bipolar II subtype (OR=1.99, p=0.013), rapid cycling (OR=2.04, p=0.02), eating disorder (OR=2.93, p=0.003) and the total number of depressive episodes (OR=1.12, p=0.002). 71% of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR=2.89, p=0.02) and total number of depressive episodes (OR=1.21, p=0.002) in males but with rapid cycling (OR=3.02, p=0.003) and eating disorders (OR=2.60, p=0.02) in females.

The high prevalence of SP in BD, its associated clinical characteristics and the observed differences between genders, suggest that SP represents a potentially important specifier of BD.

The purpose of this study was to determine the effect of education on anxiety and depression in patients with myocardial infarction in selected hospitals of Urmia hospitals in 2009.

This study was a quasi-experimental study that comprised 124 patients selected randomly and divided into two groups. The experimental group was educated by a face to face training and educational booklet. Control group did not receive any intervention. The level of anxiety and depression was evaluated by using HADS questionnaire at 3 intervals. After 48 hours of admission, discharge day and 2 months after discharge.

The findings suggest that MI patients worried about their social role, interpersonal relations and personal health, which can exacerbate symptoms and complicate their future care. There was no significant difference between control and experimental groups before the intervention, But after the intervention, anxiety and depression in the experimental group was significantly less than control group (P < 0.05).

Considering the beneficial effect of intervention on reducing anxiety and depression in such patients, the patient's education should be one of the health care goals. Most researches may also be required toconfirm the results in other groups of patients.

Across various cultures, dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment, occurring without evidence of significant brain damage (as detected by conventional structural brain imaging). In a substantial number of cases, the memory impairment follows a chronic course. Sometimes dissociative amnesia occurs on a background of a personality disorder (narcissistic or borderline). Other times, amnesia itself triggers long lasting personality changes.

This work’s objectives are establishing greater recognition among health care providers of the spectrum of the personality changes that may accompany chronic forms of dissociative amnesia.

We review data from own patients with chronic forms of dissociative amnesia.

Patients were investigated medically, psychiatrically, neuropsychologically and and neuroradiologically.

Changes in personality dimensions occur after the onset of amnesia. These may involve affectivity, perception (e.g. impaired self face or face-emotion processing), cognition (e.g. social cognition) and behaviour (e.g. changing in eating, smoking, drinking or working habits).

The observed personality changes may represent a consequence of amnesia. Functional imaging studies show metabolic changes in dissociative amnesia in brain areas involved in conscious mnemonic processing. Several structures engaged in processing within episodic-autobiographical memory system were also implicated in self and reward-related processing. Alternatively, the personality changes may be viewed as being pivotal in the development and maintenance of dissociative amnesia; this personality shift may subsequently lead to enduring changes in ways of cognitive processing, self-processing, perception and affect.