Evaluation of mood and personality interaction

Patients underwent evaluation with MCMI-III, clinical interview for psychological or non psychological reasons (4300) and Beck's or Hamilton (320). Scores of mood and personality were studied for correlation. A model of cis-action and trans-action was developed.

1. 1. Schizotypal, borderline, avoidant, dependent and self destructive personalities are more prone to mood disorders with more intense symptoms and less responsiveness to medication. P<0.03

2. 2. Schizoid, paranoid, narcissistic and histrionic personalities are less prone to mood disorders than the general population. P<0.04

3. 3. Schizoid, schizotypal, borderline and histrionic patterns show higher subclinical scores in mood disorder. P<0.1

4. 4. Major depression augments schizoid, schizotypal, borderline, narcissistic, avoidant and dependent personality symptoms. Patients showed reduced personality scores and less symptoms after treatment for mood disorders. P<0.02

5. 5. These latter personalities improve with their symptoms after antidepressants even if they do not fulfill clinical criteria for mood disorders as (MCMI-III and clinical interview). P<0.03

6. 6. Curiously, almost all personality patterns improve with their symptoms even without mood problems if treated for short courses of antidepressants. P<0.01

7. 7. Antidepressants probably disrupt persistent maladaptive neural circuits in almost all patients with different psychopathologies.

1. 1. Mood and personality interact in a cis pattern: they augment each other and trans pattern: they reduce the chance of the development or the expression and intensity of the other.

2. 2. Personality disorders are not extreme of a spectrum of points of view and … but categorically distinguishable patterns with neuro-humoral backgrounds.

Evaluation of oscillation pattern of GnRH release by the hypothalamus in different mental states

Twenty two patients were evaluated by a computer algorithm to find oscillation of LH/GnRH pulsation measured on four sessions (day 6 and 14) every 10 minutes within two consecutive cycles in addition to the MCMI-III and Hamilton test.

The pattern of oscillation was indirectly correlated with Hamilton scale and the anxiety state and showed statistically significant lowering of frequency during anxiety and depression states. Besides, the slope of GnRH between two consecutive sessions (d0GnRH0/GnRH1dt) showed also a prominent reduction and even flattening. In addition the time to ovulation was also postponed in cycles with prominent anxiety.

1. 1. Psychological stress exerts its effect through a reduction of pulsation frequency in GnRH release.

2. 2. Pattern of GnRH pulsation changes in the range of ¼ to 1/15 of the baseline and external stimuli have strength of changing hormonal milieu in this range.

3. 3. MCMI-III is an excellent tool for evaluating psychological state of the patient.

4. 4. Patients with borderline, schizoid, dependent, depressed and passive aggressive personality suffer most from irregularity of menstruation cycles.

5. 5. Patients with chronic major depression are subject to menstrual irregularity highest during stabilization of disease and in the early phases of recovery after treatment with SSRI.

6. 6. Treatment of depression/anxiety causes a reduction of menstrual cycle length.

7. 7. Measurement of GnRH, FSH, LH and Estradiol on two sessions one week apart is a nice marker for regularity and ovulation.

To study sexual problems of our patients and standardizing it for patients with or without religious and cultural restrains we developed a questionnaire with 240 phrases that were extracted from a pool of 1400 sentences addressing sexual problems. Sixty four scales under four headings (sexual general characteristics, deviations, dysfunctions and psychodynamic syndromes) (16 items each) were evaluated based on criteria of DSM-IV and ICD 10. Five validity scales (honesty, desirability, debasement, guilt feeling and overall validity) were also used for better assessment.

A total of 1300 patients in the four variants of the test were evaluated during a time span of 7 years. The questions were presented to examinees at 8th. Grade and higher in a calm environment and the results were evaluated by a computer software specifically developed for this purpose.

The last version of the test was completed by 734 patients with excellent compliance. It was of nice politeness and comprehensiveness. For almost all scales the sensitivity and specificity were around 85 and 92% respectively.

We conclude that QSAF 2009 is an excellent tool both in clinics (diagnosis and follow up) and epidemiology with high sensitivity and specificity. It has also application in cross cultural studies, medico – legal issues and medical documentation. It prevents face to face interviews, breaks patients’ resistance and is less time consuming than scheduled interviews.

To evaluate mutual interaction between sexuality and personality we tried to study 111 patients with QSAF 2009 and MCMI-III.

Hundred and eleven consecutive patients with sexual problems (76) or personality disorders (35) were examined with two tests. Only volunteer personality disorder patients were enrolled to this trial. The results were compared with 325 examinees evaluated with QSAF and 1600 patients evaluated with MCMI-III.

All patients with sexual problems showed at least two scores higher than 72 in their MCMI-III. This was more prominent in sexual deviations than dysfunctions. Homosexuals had higher scores in schizoid and schizotypal, pedophiles in schizoid and antisocial, voyeurs in schizoid and avoidant, masochists in dependent and self defeating personality scales ….

Sexually deviated persons remain clinically latent and show themselves as alien, aloof and eccentric. Almost all deviated persons show high scores in personality disorder scales. On the contrary, only a minority of personality disorder patients show prominent sexual problems in the form of deviation. They predominantly have disturbed sexual self image, show inhibited sexual desire problems (dependent, schizoid and avoidant) personality, dyspareunia and vaginism (avoidant and schizotypal personality), spouse abuse (borderline and antisocial personality) postcoital disorders (borderline, dependent and narcissistic personality) and extramarital relationship in a series of disorders including histrionic personality …. as studied by the QSAF 2009 which evaluates 64 sexual scales.

Evaluation of personality disordered patients in regard to sexuality and vice versa is essential for better understanding the pathogenesis of each disease and helps in smoother treatments.

Since January 2012, there has been an aggregation of the 36 self-care and self-sufficiency tasks into ten basic living needs, i.e. mobility, orientation, communication, food intake, putting on clothes and shoes, body hygiene, using the toilet, health care, personal activities, and household cleaning.

Transformation of the medical assessment paradigm used for dependence degree assessment for the purposes of care allowance according to the principles of personalised medicine.

A change in the medical assessment criteria for consideration of the degree of dependence level, based on the assessment of Activities of Daily Living and principles of the International Classification of Functioning, Disability and Health. So far, more than 150 thousand assessment cases have confirmed that personalised assessment of functional disabilities represents a significant improvement in the individualised approach to all clients of the social security system.

There was an increase in the number of acknowledgements of the degree of dependence by 26.6 % from 24 317 cases in 2011, to 30 809 cases in 2012; in the number of persons with the degrees of dependence III - serious (5 457 in 2011 and 7 138 in 2012) and IV – very serious (4 719 in 2011 and 6 772 in 2012).

The increase in the number of patients with confirmed dependence degrees has demonstrated that modern functional assessment is beneficial especially for patients with mental disorders. Personalised medical assessment service represents the pursuit of an improved medical assessment of clients’ functional disabilities.

The increased interest in the phenomenology, etiology, and treatment of Obsessive-Compulsive Disorder (OCD) follows the recognition that OCD is a more pervasive and serious problem that was previously thought. Family studies indicate a modest tendency for OCD to occur among biological family members. Studies on twin and family-genetic analysis show that non-heritable factors present as great and possibly greater risk to the development of OCD. Psychological and familial issues are also implicated in the development and maintenance of OCD.

This study explored the relationship between parental style and OCD among a clinical sample of children and adults in Tehran, Iran.

Subjects consisted of 190 patients who had sought treatment for OCD during the period from 2002 to 2009. Designation of parenting style was based on interviews using Baumrind typology. Two clinical psychologists assigned each subject to one of the four family styles: authoritative, authoritarian, permissive and neglectful.

The data replicate previous findings in relation to gender differences, the age of onset, family history of OCD and comorbid disorders. Patients who had experienced authoritarian, permissive, and neglectful parenting styles were significantly more likely to experience OCD. A hitherto unreported finding is the positive relationship between a mixed parenting style and OCD.

The present study indicates that the positive relationship between parenting styles and OCD extends beyond cultural boundaries. The psycho-social and cognitive dynamics of family-styles in relation to development and maintenance of OCD and treatment implications are discussed.

The problem of interaction between physicians and parents is very acute for child psychiatrists in Russia (Semenova S, Iakovleva I., 2012, Kupriyanova T, Koren E., 2013). The risk of stigmatization is one of the main reasons of treatment refuse.

To identify the reasons for resorting to a psychiatrist, agreement with the diagnosis and methods of treatment.

80 parents of mental disease's children were examined by special questionnaire.

We found that the 28 parents (35%) took their children to psychiatrist by their own initiative, some other professionals (pediatrician, neurologist or psychologist) encouraged applying to a psychiatrist in 44 cases (55%), 8 parents (10%) asked for advice after strong recommendations from teachers. Examination of the child by psychiatrist and an explanation of symptoms persuaded 20 parents (25%) only. 53 parents (66,3%) were convinced that a doctor for a diagnosis of mental disorder had to examine the child several times, 21 (26,2%) agreed with the diagnosis after several evaluations of different mental health professionals. 72 parents (90%) were not satisfied with the medical information about the child's illness that was provided and were needed to supplement that.

All of those factors hamper the effective interaction between the doctor and the parents of patients, which leads to delays in providing necessary assistance and negatively affects the health of children.

The authors present the outcomes of a new disability assessment paradigm, which ran for three years and concerns patients with autism.

Introduction of a new paradigm for assessing the state of health, decrease in the working capacity, and disability in patients with mental and behavioural disorders.

The evaluation reflected functional health state assessment and working incapacity in relation to the International Classification of Diseases and the International Classification of Functional Abilities, and principles of personalised medicine. Assessment of a patient's ability to undergo work rehabilitation is also part of personalised medicine.

In 2009, there were 28 741 of acknowledged cases of disability due to mental illnesses, out of which, 1 262 were cases of autism. In 2012, there were 32 326 cases of disability due to mental illnesses, with autism patients representing 1 866 cases. There was an increase in the number of acknowledgements of the degree of disability due to autism by 47% from 1 262 cases in 2009 to 1 866 cases in 2012; the proportion of persons with disability due to mental disorders increased between 2009 and 2012 by 12.4%.

The new paradigm of disability assessment represents a personalised evaluation of patients’ ability with special emphasis on their social integration. The increase in the number of disabilities due to autism significantly outweighs the total increase of disabilities caused by a mental illness.

Reward and punishment alterations are observed in depressed patients (Taylor Tavares et al., Neuroimage, 2008). Reward hyposensitivity and punishment hyper-sensitivity can be studied in humans and animals using operant tasks, such as the probabilistic reversal learning (PRL) task (Ineichen et al., Neuropharmacology, 2012).

To determine the effects of the new antidepressant agomelatine (AGO), a MT1/MT2 melatonergic receptor agonist and 5-HT2C receptor antagonist on reward and punishment processing as well as to evaluate its mechanism of action.

Mice learned spatial discrimination for sucrose-pellet reward in an operant apparatus. In the PRL task, mice were assessed on rewardstay, negative feedback sensitivity (NFS) and reversals completed. Using latin-square designs, agomelatine (AGO 10 or 25 mg/kg), melatonin (MT 10 or 25 mg/kg), the 5-HT2C antagonist S 32006 (2.5 or 5 mg/kg) or vehicle (VEH) were administered acutely i.p. An additional group of mice was treated acutely i.p. with the MT1/2 antagonist S 22153 (20 mg/kg) + VEH or S 22153 (20 mg/kg) + AGO (25 mg/kg).

Data underwent a median-split (high vs low performers) according to PRL behaviour under VEH. In low-performing mice specifically, AGO at 25 mg/kg increased reward-stay, decreased NFS and increased reversals completed, relative to VEH. There were no effects of MT or S 32006. Agomelatine effects were counteracted by prior administration of the MT1/2 antagonist S 22153.

Agomelatine acutely is able to increase reward sensitivity and decrease punishment sensitivity in mice. The results suggest a potential synergy between its melatonergic agonist and 5-HT2C antagonist properties.

To date 56 reciprocal microdeletion/microduplication syndromes have been described. Due to intensive application of microarray technologies new submicroscopic rearrangements are being published. The reciprocal rearrangements are particularly valuable, since they allow to determine the dosage-sensitive pathogenic genes.

To improve ID diagnostics.

To identify novel candidate loci of ID.

We performed the genome-wide analysis for 79 patients with idiopathic ID using CGH Microarray Kits 4×44K and 8×60K (Agilent Technologies, USA). Pathogenically significant cases were confirmed by qPCR.

We present two patients with microdeletion (369 kb) and microduplication (766 kb) at 3p26.3 containing the only gene - CNTN6. The microduplication was inherited from apparently healthy father. The child with microdeletion was an orphan. Recently, the microduplication in 3p26.3 (containing CNTN6) has been shown to be associated with autism spectrum disorders (ASDs). Contactin 6 is also suggested to play a neuroprotective role in ischemic injury and contribute to granule cell maturation and/or synaptic formation in the developing cerebellum.

Considering the experiments with mice we found myotonic syndrome, late development of sit and walk ability in the anamnesis, current fine motor skills impairment and dysarthria in patient with dup3p26.3. His IQ is 47. Dysarthria was also observed in the patient with del3p26.3 (IQ 55).

Obviously, CNTN6 can be a novel pathogenic gene associated with ASDs, ID, and motor functions impairment. This study was supported by EU Seventh Framework Program, CHERISH project no. 223692 and by Federal Program of Ministry of Education and Science of Russian Federation no. 8727.

Major symptoms evidenced by patients with Attention Deficit Hyperactivity Disorder (ADHD) have been linked to deficiencies in cognitive control, especially when conflicts in information processing occur.

We wanted to define neural correlates of impairments in conflict monitoring in ADHD using the ERP technique. Unlike previous ERP studies that focused on brain potentials following incorrect responses in ADHD, we investigated a brain potential, the N2, which reflects conflict monitoring before a correct response.

Participants were 33 adult ADHD subjects, and 29 matched healthy controls. We recorded 128-channel EEGs for ERP responses during a Go/NoGo Task with a prepotent GO response, where subjects had to withhold response to repeated stimuli.

Using age and gender as covariates in the analyses, subjects with ADHD evidenced significantly larger N2 amplitudes than healthy controls. The extent of N2 enhancement showed a significant association with the number of errors in the incongruent condition of the Stroop Task. With regard to scalp topography, the differences were manifested over the frontal areas, with the most pronounced difference appearing at the midline areas.

Patients with ADHD evidence a marked enhancement in N2 amplitude in a Go/NoGo task with prepotent response tendency. The fact that N2 enhancement is directly related to incongruent errors in the Stroop task suggests that behavioral deficits in conflict processing in ADHD may be underlied, at least partially, by the ‘hyperreactivity’ of neurobiological processes that generate this brain potential.

Supported by the Hungarian Scientific Research Fund (OTKA), Grant NN103325

Emerging evidence suggests that disturbances in emotional processing in ADHD may interfere with executive functioning, and account for impairments in life functioning.

To investigate whether patients with ADHD evidence deficits in processing emotionally-valenced inputs, and to delineate the neurobiological correlates of these deficits.

Using event-related potentials from 128-channels, we tested 33 adult ADHD subjects and 29 individually-matched healthy controls (HC) in a cognitive control task of response inhibition. The task was performed by presenting valenced pictures (positive/negative/neutral) of the International Affective Picture System. The pictures were shown in random sequence, and repeated occasionally. Participants were asked to respond to each stimulus, and to withhold response for the repetition.

With regard to behavioral measures, ADHD subjects showed more commission and omission errors. In terms of ERPs, both groups displayed a pronounced P300 component for all emotional valences in the frontal regions in the NoGo vs. the Go condition (‘NoGo P300’). However, compared to HC's, ADHD subjects showed a significant P300 reduction for negative, but no reduction for positive, or neutral stimuli.

Regarding the frontal NoGo P300, HC's were able to overcome the intrusion of negative emotion, and showed the same waveform when presented with negative as they showed with positive or neutral stimuli. By contrast, while ADHD subjects did not differ from HC's regarding positive and neutral inputs, they exhibited a pronounced P300 reduction for negative pictures, which may constitute a neurobiological correlate of emotional dysregulation.

Supported by the Hungarian Scientific Research Fund (OTKA), Grant NN103325

Schizophrenia is generally a lifelong condition. Despite high mortality, most survive into old age. Few prospective longitudinal studies have analysed trajectories from early-mid adulthood into old age.

Systematically review longitudinal studies of the progression of schizophrenia into old age, focusing on cognition, functioning, co-morbidity, mortality and quality of life.

Advance understanding of the course of schizophrenia and highlight interventions that improve outcomes and even achieve a state of wellbeing in later life.

Electronic search of PubMed, PsychINFO and Scopus. Search terms: (ageing OR ‘older adult’ OR elderly OR geriatric OR ‘late life’) AND (schizophrenia OR schizoaffective OR schizophreniform’). Articles and books searched manually.

The course in later life is variable. Many remain symptomatic and mortality and somatic comorbidity increase. Higher rates of decline in cognitive functioning affect ability to function independently. However, many individuals have a favourable clinical course and may stop receiving treatment altogether. 18–27% achieve recovery in old age. Growing evidence base for interventions that alleviate symptoms, improve social and cognitive functioning and quality of life. Inequalities remain in the quality and range of treatment interventions available to older people with schizophrenia.

Early introduction of regular psychiatric and somatic assessments and prompt and adequate treatment of symptoms and comorbidities throughout the life course are essential. Cases of remission/recovery are often excluded in clinical research. This risks presenting a biased, somewhat pessimistic description of the illness course into later life. Evidence base for interventions needs improvement and future trials must include older participants.

In spite of good development of laboratory and instrumental methods of diagnostics of brain and mental disorders, there remains an insufficiency of methods for etiology differentiation, especially clinical-psychopathological in psychiatry.

is to evaluate the differential diagnostic's opportunities in estimation of clinical phenomena's complexity for identification of neurotic, organic or endogenous genesis of disorders.

expert estimation, statistical.

As the experts 7 certified specialists (psychiatrists, psychologists and others) were involved.

In the research the academically definitions and the clinical case descriptions of the following clinical phenomena were estimated:

1. - Conversion, obsession, neurasthenia, phobia, derealisation/depersonalization, anxiety (partly specific for neurotic, stress-related and somatoform disorders);

2. - True hallucinations, confusion, amnesia, fixation hypomnesia, anecphoria (partly specific for organic mental disorders);

3. - Pseudo hallucinations, delusion of control, automatism, paralogia, emotional withdrawal, autism, ambivalence (common symptoms of schizophrenia);

4. - Inability to feel, sadness, lassitude, euphoria, excitement as the signs of endogenous affective disorders.

5. - Mainly non-specific phenomenon - persecutory delusions.

Thus were obtained 14 estimates for each item on a 100-point scale.

Dispersion of majority ranges was too high to get significant differences. But 6 from 7 experts significantly (p<0.05) and 1 tendentionally (p<0.01) rated 3 symptoms (autism, conversion and paralogia) as relatively more complex as compared with 7 more simplex phenomena (anxiety, confusion, euphoria, excitement, neurasthenia, phobia and sadness) by U-Wilcoxon-Mann-Whitney criteria.

established ranges of psychopathological phenomena's complexity reveal non-linear relations to etiology but in some cases they can be useful instrument of differential diagnostics of mental disorders.

Most patients (70%) discontinuing tobacco smoking will relapse within 6 months. A major challenge is the understanding of the processes involved in relapse. High cigarette craving has been proposed as a predictor of relapse. A recent study suggests that low inhibitory control capacities (low ability to inhibit prepotent responses) were correlated with high nicotine dependence. In this study, we focused on the link between inhibition capacity, craving, tobacco dependence and relapse.

134 smokers willing to quit smoking were consecutively included and followed prospectively. Tobacco dependence was assessed with the Fagerstorm test. We used the Hayling task to measure their inhibitory capacity and a specific questionnaire to measure tobacco craving (TCQ 12). Assessments were performed at baseline, 1, 3 and 6 months after smoking cessation. Any relapse in smoking during the follow-up was evaluated.

There was an association between lower inhibition capacities and higher dependance level at baseline. Low inhibition capacities were an independent predictor of relapse at 6 months (logit R 2 = .08, F (2,134) = 10.851, p <. 004). In contrast, although level of tobacco dependence and craving predicted relapse in the short term (first month), they did not predict relapse at 6 months.

These results suggest that inhibition capacities may predict smoking relapse in the long term (6 months) better than usual measures of craving. In clinical practice, an inhibition test, which is short and feasible, could be of interest to identify smokers at higher risk of relapse.

The case group consisted of 29 CAH girls and 11 CAH boys. The typically developing group consisted of 35 girls and 25 boys. K-SADS was used to screen the children for co-morbid psychiatric diseases. Progressive Coloured Matricies was used to determine their IQs. The play activity questionnaire to study their sex-typed play. Hormonal profile (testosterones, progesterone and delta 4 androgens) was done for the cases.

we hypothesized that elevated prenatal exposure to testosterones will cause masculinization of behavior and play in girls with CAH but will not affect boys.

Girls exposed to high levels of androgen prenatally, because of the genetic disorder congenital adrenal hyperplasia, show increased male-typical play. They preferred to play with masculine object items (cars and trucks), rough-and-tumble play and war play. They were less interested in pretend play than the typically developing girls. No differences were seem in the active and adventurous play. CAH girls showed preference for boys as playmates.

CAH boys showed the same pattern of behavior as the typically developing group but with restricted (less) interest in most of the play items.

All cases were on glucocorticoid treatment so the hormonal levels were within range.

Depressive disorders have the highest inpatient utilization rates in German health care. The aim of this study was to evaluate response, remission and non-response rates as well as predictors of response in depressive inpatients.

Consecutively admitted inpatients with a depressive episode (F32.0-2, F33.0-2) were assessed at admission and at discharge for depression (Beck depression inventory II, BDI-II) and general psychopathology (Brief Symptom Inventory, BSI). Most frequent cause for admission was nonresponse to prior outpatient treatment.

A total of 2323 inpatients with depression (M=48.02 years, SD=11.79) was included. 46.7% of patients received concomitant antidepressants. Mean duration of inpatient treatment was 53.16 days (SD=23.31). For completers, BDI-II decreased from 29.36 (SD=9.36) at admission to 14.00 (SD=10.96) at discharge (Effect size: 1.64). Response rates were 75.5% (BDI-II) and 68.7% (BSI) and remission rates 62.2% (BDI-II) and 40.8% (BSI). Non-response rates, also including minor responders, varied between 23.4% (BDI-II) and 27.4% (BSI). A comparison between patients with and without concomitant antidepressants showed a significant time and group effect, but no significant interaction effect.

Responders showed significantly higher depressive symptoms (BDI-II) and higher scores on the scales anxiety and phobic anxiety (BSI) at admission. They had fewer inpatient pretreatments before index admission. Furthermore, therapy motivation was identified as predictor for response.

The results demonstrate that about two thirds of depressive patients show response after a multimodal inpatient treatment. Future studies should focus on early identification of non-responders as well as on the development of treatment strategies for these patients.