Factitious disorder (FD) is defined by the intentional production or feigning of physical or psychological symptoms with the objective of assuming the patient role. It's frequently difficult to adequately diagnose this disorder when the faked symptoms are those of a psychological or a psychiatric disorder. In these cases, there is often high comorbidity with other mental disorders, thus making it difficult to differentiate between real and factitious symptoms.

To present a case-report of FD with hallucinations 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 23-year-old female, a psychology student, born in destructured family. She had attempted suicide many times since she was 16 years old, one of them with high lethality. One month before her admission to our inpatient clinic in order to allow a clear diagnosis to be made, she began active auditory hallucinations, persecutory delusional ideation with disorganized behavior and consequent social isolation. A suitable dose of atypical antipsychotic drug was administered but Psychotic disorder was ruled out and she was dignosed with FD. After the factitious symptoms that prevented any type of therapeutic approach disappeared, the real symptoms of the patient were those characteristic of a borderline personality disorder.

This case emphasizes the need for the careful observation of these patients in order to establish the diagnosis and to improve a specific management strategy for them.

The comorbidity of mental illness and substance abuse (dual diagnosis) can complicate both clinical picture and prognosis. It is therefore important to recognise both nosological entities and to treat them simultaneously.

Our main aim was to investigate and describe the characteristics of dual diagnosis patients who were in treatment with a community addiction service, and to assess the completeness of clinical documentation.

We created a data collection tool to measure indices of illicit substance and alcohol use, psychiatric diagnosis, and treatments received for both problems. We included measures of physical health relating to drug and alcohol use. Clinical information was collected from the electronic patient record system.

The audit is ongoing. 498 patients were under the care of the addictions service in February 2012. To date we have identified 72 patients (14.5%) with dual diagnosis. Of this group, 79% of patients were addicted to opiates and 42% were polysubstance users.

The psychiatric diagnosis included mood disorders (29%), anxiety disorders (24%) and psychosis (14%). However 28% had no formal diagnosis recorded, despite receiving treatment for psychiatric conditions.

67% were prescribed methadone. 40% of the patients were receiving medication for their mental illness.

14.5% of our addictions population had a mental health problem. We identified lapses in clinical documentation related to both illnesses. The distinction between addictions and psychiatric services can bring difficulties in communication and care provided. Quality and continuity of care is important and consideration should be given to further development of dual diagnosis services.

ECT has demonstrated to be an effective and safe biological treatment that can be considered as an alternative to pharmacotherapy, especially for treating severe, resistant and recurrent, affective, psychotic and catatonic symptoms. CECT refers to the one that is started after acute treatment and lasts for a maximum period of 6 months with the objective of preventing relapse. M-ECT is the one that is started once C-ECT has ended with the aim of preventing recurrences. The aim of this study was to explore the evidence for using C-ECT and M-ECT as an alternative to pharmacotherapy.

We performed a search in MEDLINE, PubMed and Cochrane, from 1950 until the present to identify articles in which C-ECT and M-ECT were used as alternative treatments to pharmacotherapy.

C-ECT and M-ECT have demonstrated to be an effective and safe alternative to pharmacotherapy in Unipolar Depression, Bipolar Disorder and Schizophrenia, especially in the prevention of relapse and recurrences. It reduces number and days of hospitalization. In combination with pharmacotherapy, it increases effectiveness of pharmacological treatment. It does not affect cognitive functioning.

C-ECT and M-ECT should be considered as an alternative to pharmacotherapy in the treatment of affective and psychotic, severe, resistant and recurrent symptoms. It is an effective and safe treatment, which prevents relapse and recurrences in severe mental illness, reducing hospitalization rates and health costs.

Religion and Spirituality have a close relationship with mental health throughout human history. However in the 21st century, post-modern world their roles has attracted attention and debate in the context of clinical practice.

The aim of the presentation is to reflect on the understanding of spirituality and religion in the post-modern world with their relevance to mental health and to explore the current opinions and views in their clinical application.

To present the two conflicting school of views in their clinical use.To identify training needs in psychiatric curriculum with respect to the above.

A comprehensive literature search on the subject of Spirituality and Religion in mental health was carried out. Different schools of opinions were identified and their positives and negatives was analysed. A questionnaire was compiled to highlight the important areas of conflicts in clinical practice (useful religious practices, boundaries, self-disclosure, etc) A survey was sent out online via the surveymonkey website. The results were collated and analysed for trends.

It is only intuitive to link mental health with Spirituality and Religion. However it is crucial to identify the spiritual and religious beliefs of the patient and use it effectively in their care plan.

Clinician to be aware of his own prejudices and how this might affect his practices.

It is important to separate from Religion and Spirituality, though overlapping, they are diverse and unique to every individual.

To differentiate clinical practice and research evidence. Clearer guidance and better training advocated for practice.

According to WHO data it is expected that by 2030 depression will become the most common disease of mankind. As of fairly recent a time, began the use of agomelatine as an antidepressant, a drug which operates through different mechanisms than the pharmaceuticals used before. However, the effects of agomelatine on the elderly patients is still not well researched. On the other hand, the demographics of Europe show that the percentage of elderly population will be increasing.

Within this clinical study, we examine the effect of a 25-50 mg per day dose admited to persons over 65 years of age. The examinees all suffer from depresive disorders the efect on which is the primary subject of this study, regardless of other physical and psychological comorbidities. Exclusion criteria for participation in the study include liver disease (elevated serum transaminases) and combination with CYP1A2 inhibitor drugs. The study included fifty patients who are monitored over a course of six weeks. The following measuring instruments are used in the study: HAM-D17, GDS-30, Beck D. Q, SHAPS scale, PSQIand the Elderly's Quality of Life Questionnaire. Each participant is tested twith the battery of questionaires listed above prior to admission into the study, and once again after six weeks of agomelatine teraphy.

The study is currently in progress, so there are no deffinitive results as of yet.

Is the agomelatine an efficient antidepressant treatment in elderly patients.

The prevalence of mental disorder and addiction in any prison population is higher than for the general public. Mental health in-reach and addiction services were developed to treat this complex population. We identified the need to evaluate the service provided in a local prison, and make suggestions for improvement.

Our main aim was to investigate the need for dual diagnosis services in a local male community prison.

Our data collection tool consisted of five parts;

1. 1) Demographic Data,

2. 2) Addiction problems and input received,

3. 3) Psychiatric diagnosis and input received,

4. 4) Physical health including medical problems related to substance use

5. 5) Other comments including risks identified.

The data were collected from the prison's patient record system.

From the 134 inmates that were under the care of the addictions service in January 2012, 26 had a dual diagnosis (19%). From the dual diagnosis population, 24 inmates (92%) were mainly addicted to opiates. The main substitute prescribed was methadone (n=14).

The most common psychiatric diagnoses was schizophrenia (35%) and anxiety disorders, with or without a personality disorder.

We found a big proportion of the addictions population with a psychiatric diagnosis (19%). As both illnesses can be interlinked and affecting prognosis it is important that we treat both simultaneously. The distinction between addictions and mental health services can bring difficulties in communication and care provided. A dual diagnosis service is therefore needed to assure quality and continuity of care in prison and to assist smooth transition after release.

Socially prescribed perfectionism has been associated with long-term sleep disturbances (Azevedo et al., 2010).

To investigate the association between perfectionism dimensions and insomnia in pregnancy.

581 pregnant women, mean age 29.8 years (SD=4.5), average weeks of gestation 32.6 (SD=3.5), mostly married (75%) and nulliparae (64%) participated in the study. The multidimensional perfectionism scale (Hewitt and Flett, 1991; Soares et al., 2003) was used to assess total levels of perfectionism, self-oriented perfectionism (SOP) and dimensions of socially prescribed perfectionism (SPP): others high expectations (OHE) and conditional acceptance (CA) (Macedo et al., 2009). Insomnia symptoms and related daytime impairment were assessed with an insomnia questionnaire (Marques et al., 2011). Objective estimations of sleep were obtained through actigraphy in a small group (n=60).

In comparison to good sleepers, insomniacs showed higher levels of SPP (M=53.4, SD=13.0 versus M=49.6, SD=12.3, p< .05) and SPP-CA (M=19.6, SD=6.1, versus M=18.0, SD=5.5, p< .05). Women with difficulties initiating sleep reported higher levels of SPP-CA than good sleepers. Analyses of actigraphy revealed that SPP-CA was associated with less sleep time (r=-.45, p< .05), less sleep efficiency (r= -.34, p< .05), more time awake during sleep (r= .43, p< .05) and more mean activity asleep (r= .38, p< .05).

Conditional acceptance is the SPP perfectionism sub-dimension particularly associated with self-reported insomnia and sleep alterations measured objectively with actigraphy in pregnancy.

Portuguese foundation for science and technology (POCI/SAU-ESP/57068/2004).

The relationship between sexuality and schizophrenia is complex. The prevalence of sexual dysfunctions is higher in persons with mental disorders and may be related to both the psychopathology and the pharmacotherapy. On one hand the negative symptoms of schizophrenia limit the capability for interpersonal and sexual relationships; on the other hand several mechanisms can cause sexual dysfunction during antipsychotic therapy. Although it is a troublesome side effect, information on antipsychotic-induced sexual dysfunction is limited. The aim of this study was to evaluate the sexual dysfunction and its impact in patients with a psychotic disorder treated with various antipsychotics under routine clinical conditions.

Subjects included were sexually active male and female patients 18 years of age or older with the diagnosis of Schizophrenia, Schizophreniform disorder, Schizoaffective disorder or other psychotic disorder. In addition to sexual functioning, was recorded demographic data, psychiatric diagnosis and medication history. The instrument of evaluation used was the Pyschotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SalSex).

All the analyses were performed in the 101 evaluable patients. Most patients were males (76%) and the most common diagnosis was Schizophrenia.Overall, the patients exhibited sexual dysfunction according to the assessment with the SalSex. Among the patients exhibiting sexual dysfunction, a third reported to have poor tolerance to the disturbance.

Sexual dysfunction is very common in patients receiving long-term treatment with antipsychotics and it is associated with a great impact in a substantial proportion of patients.

Item Response Theory (IRT) allows for dimensional scaling of the severity of a disorder, and comparison of symptoms’ properties across different measures of the same trait and across groups. IRT has never been applied to Posttraumatic Stress Disorder (PTSD).

To determine discrimination and severity parameters of PTSD symptoms measured with two instruments, and to examine gender- and age-related Differential Item Functioning (DIF) of PTSD indicators.

To inform the dimensional scaling of PTSD in youth.

IRT was applied to PTSD items measured with the DPS and the PTSD-RI in 6,733 9/11-exposed youths. DIF analysis was performed in the sample stratified by gender and age (8-13; 14-21).

DPS and PTSD-RI items are most informative at intermediate and severe levels of PTSD, respectively. Across instruments, discrimination was greatest for insomnia and nightmares, and lowest for 9/11-related thoughts. Severity parameters were highest for avoidance and numbing symptoms, and lowest for 9/11-related thoughts. The majority of PTSD symptoms showed significant DIF across subgroups.

DPS and PTSD-RI criteria are informative at different levels of PTSD severity. PTSD symptoms differentially discriminate among individuals along the PTSD continuum, and are most informative at different levels of PTSD severity. These results could inform dimensional scaling of PTSD, and allow for flexibility in assigning cut-off points for facilitating clinical decision-making. PTSD criteria do not provide the same information across subgroups defined by gender and age, suggesting that symptoms differ in the way they represent severe post-traumatic stress reactions across groups.

Agenesis of the corpus callosum is a congenital anomaly consisting of a failure in the development of the transverse fibers of white matter that connect the two cerebral hemispheres. It may be partial or complete and is often associated with learning disabilities and epilepsy. More recently, a link was established between agenesis of the corpus callosum and several neuropsychiatric disorders, including psychotic phenomena.

Case report and literature review using PUBMED.

The authors describe the case of a 43 year old patient with no previous psychiatric history that presented with behavioral problems and persecutory delusions. CT scan and MRI showed partial agenesis of the corpus callosum. Neuropsychological investigation revealed mild mental retardation. EEG was normal. The literature review allowed the authors to conclude that, although there are only a few cases reported, there is an established connection between agenesis of the corpus callosum and the onset of psychotic symptoms. This connection can be explained by the fact that corpus callosum is an important structure not only in allowing communication but also in regulating the activity established between the two hemispheres. In this case, a regulation loss could predispose to psychosis.

Studies of adolescents in the field of school disruption and its determinants are still scarce, which reinforces the need for further investigations. In this assumption, the present study's main objective was to know the effect of context variables sociodemographic, family, school and in the different domains of psychosocial school disruption.

We conducted a cross-sectional quantitative study, which was attended by 94 students of Secondary Education Portuguese, mostly women (59.57%) with a mean age of 17:19 years. To measure the variables used the following instruments: Family Apgar Scale, Scale School Climate, Piers-Harris Children's Self-Concept Scale and Scale Disruption professed by School Students.

Regarding the effect of context variables on sociodemographic school disruption, we found that age and socioeconomic level do not get statistical significance. Variable sex exerts a significant effect, specifically on the factor 2 - “aggression colleagues” and factor 3 “school authority aggression,” where are the adolescent males to produce higher scores. The data reveal that there are also significant influences of family functionality in all factors of school disruption (p < 0.05). With regard will influence school climate, we infer that, generally, with statistical significance, the better the school climate, school less disruption manifested by adolescents. In the area of influence of self-concept, we found that there are statistically significant correlations on some dimensions of school disruption.

The evidence found in this study invite us to prepare and reflect on new strategies that allow obtaining a better understanding, multidimensional adolescent inserted in middle school.

Anxiety disorders are abnormal states in which the most noticeable features are mental and physical symptoms of anxiety. They are of the most common psychiatric disorders in the general population with the lifetime prevalence approaching a 21%.

The evidence based medicine lacks research on patients’ experience of medication for psychiatric disorders, especially of medication for anxiety disorders.

This research involves patients referred to secondary care because of their anxiety symptoms and diagnosed as suffering with anxiety disorders.

To illuminate the subjective experiences of patients diagnosed with anxiety disorders and their experience of taking medication. Therefore qualitative methodology was appropriate.

All the potential participants in two Mental Health Trusts in the UK were informed about the research from their consultant psychiatrist or care coordinator if different, and provided with an information sheet. In depth interviews were used to explore patients experiences and phenomenological approach to analyse the data.

The patients we interviewed presented with a range of anxiety disorders. There were participants that suffered from generalized anxiety disorder, others with panic disorder, obsessive compulsive disorder, agoraphobia or social phobia. Furthermore, the pharmacological treatment they were receiving varied. The overall treatment varied as treatment with medication was combined with any talking therapy or other support.

In this presentation we share some of our patients’ feelings and thoughts about living with an anxiety disorder, their attitudes about the chosen treatment, their subjective perceptions about their medication and their perceptions around the effectiveness of such a treatment.

It is well known that impulsivity and stress are risk factors for the development of addictive disorders, and more specifically alcohol dependence. Impulsivity has two dimensions: behavioural inhibition and delay of reward. The Fear- Conditioning paradigm of the Startle response (SR), which refers to the potentiation of the startle amplitude after the exposure to aversive stimulus, can be used as a stress test. The aim of this study was to explore the correlation between impulsivity laboratory tasks and the Fear-Conditioning (FC) paradigm of the SR as risk factors for the development of alcohol dependence.

The sample included 40 abstinent alcoholic men, who met DSM-IV criteria for Alcohol Dependence and had been abstinent for at least one month. Impulsivity was assessed using two laboratory tests: Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). The FC paradigm of the SR was used as a stress test. Patients were compared to 40 matched controls.

We found a positive correlation between SST tasks and the FC paradigm of the SR (p < 0,05) and a negative correlation between the DRL6 tasks and the FC paradigm of the SR (p < 0,05) in the patient's group. This significant correlation was not found in controls.

Impulsivity and stress are significantly correlated in alcohol dependent patients. This means that while healthy subjects cope with stress, alcohol dependent patients react with higher impulsivity when they are exposed to stress situations and this could lead them to drink alcohol to relieve anxiety and depressive symptoms.

Adolescence and early adulthood are the most vulnerable period of life for exposure to traumatic experiences (70% of their deaths are due to external causes). The Post Traumatic Stress Disorder (PTSD) is characterized by dysfunctional symptoms that cause distress or social, academic and occupational impairment, and results from exposure to a traumatic stressor. There is no consensus in the literature about why some individuals experience PTSD after traumatic events and not others. The aim of this multicentre study is to describe clinical and socio-demographic characteristics and academic performance in college student's population in the Northeast of Brazil, identifying traumatic experiences exposure patterns, and investigating the impulsivity's influence in the development of PTSD, as well as the impact of early traumatic experiences in vulnerability or resilience in this population.

2282 subjects completed the protocol between April and July 2011 in a sample census of seven (public and private) college institutions in three metropolitan regions of the Brazilian Northeast, aiming to cover different academic areas (exact, biological, humanities /arts). All students aged 18 or older, enrolled and attending to the first and last theoretical period were eligible, and accessed by previously trained researchers. The self applied protocol consisted of socio-demographic questionnaire and validated scales of: Impulsivity (BIS-11), PTSD (PCL-C) and Trauma History Questionnaire (THQ). Data were entered into SPSS 15.0. Prevalence Ratio and Logistic Regression technique will be used to analyze the association between dependent and independent variables of the study, that was approved by Bahia and Paraiba's ethics committees.