Cognitive dysfunction (CD) affects 10-36% of patients with systemic lupus erythematosus (SLE). Its pathogenesis comprise direct neurocytoxicity, vasculopathy, thrombosis, hipercholesterolemia and atherosclerosis. The aim of this study was to evaluate CD in SLE patients and to investigate whether it is influenced by selected immunological and cardiological parameters.

Thirty-two SLE patients in remission were enrolled. Anti-cardiolipin and anti-dsDNA antibodies were estimated using immunoenzymatic techniques. Transthoracic echocardiography was performed using Acuson CV70. Since at least some tests proposed by the American College of Rheumatology for neuropsychological evaluation have Polish language version, we have used the Cambridge Neuropsychological Test Automated Battery (Cantab) that employs non-verbal stimuli and requires non-verbal responses. The following Cantab tests were used: Motor screening (MOT); Big little circle (BLC); Paired associated learning (PAL); Stockings of Cambridge (SOC); Graded naming test (GNT).

In SLE results obtained in BLC, PAL, SOC PSMM, and GNT were lower than those of controls.

SOC Mean initial thinking time correlated with ACL IgG (r=0.42; p=0.42) and anti-dsDNA antibodies (r=0.47, p=0.23) and, also, with aorticdiameter (r=0.48; p=0.036). SOC Mean subsequent thinking time negatively correlated with Left-ventricular-end-systolic diameter (r=-0.5; p=0.02). GNT correlated positively with posterior-wall-systolic-diameter (r=0.45; p=0.049) and interventricular-septum-systolic diameter (r=0.61; p=0.005).

SLE patients are cognitively compromised. Immunological and cardiological correlates may indicate underlying vascular brain damage. Biological explanation of the observed correlates is, however, unclear and possible causality needs further studies to become elucidated.

The influence of socio-demographic characteristics, namely immigration, on the risk to develop schizophrenia is well known. However, the impact of these variables on its initial clinical presentation and long-term prognosis is less well established.

To compare socio-demographic characteristics, the clinical presentation of schizophrenia and other variables known to influence prognosis in immigrant and non-immigrant young patients (social performance, quality of life, psychopathology, therapeutic adherence, insight and premorbid adjustment).

A group of consecutive patients diagnosed with schizophrenia (ICD-10), aged 18 to 25, followed in our department's community-based early intervention in psychosis program were assessed using: ACECF short version for cognition, PANNS, WHOQOL short version for quality of life, ITAQ for insight, MARS for medication adherence, and PAS for pre-morbid adjustment. Information was also gathered on the following variables: gender, age, civil status, level of education, number of readmissions, and medication. The two groups (immigrants and non-immigrants) will be compared with the adequate statistical analysis.

Preliminary results demonstrated that the immigrant group showed significantly lower levels of attention and concentration, of medication adherence, and of risk of aggression compared to the non-migrant group. The two groups did not differ in any of the remaining variables studied. We are still waiting final results.

The results will contribute to a better understanding about the influence of the immigration status on the clinical picture of schizophrenia, and allow for the development of more comprehensive rehabilitative treatments.

It is difficult to differentiate whether neuropsychiatric symptoms are caused by systemic lupus erythematosus (SLE) or psychiatric background, coexisting disorders or drug-induced side effects. The aim of this paper is to present two cases of psychotic symptoms (bipolar and paranoid disorder) induced by chloroquine.

Case 1: Severe depressive episode with psychotic features appeared in the context of third SLE exacerbation and chloroquine treatment. Hydroxychloroquine was used instead and symptoms resolved. Later, manic episode (with psychotic features) emerged several days after chloroquine was prescribed for concomitant arthritis. Since that time, chloroquine has been withdrawn. Currently the patient is undergoing treatment with hydroxychloroquine and psychiatric drugs with good response.

Case 2: The second patient started to suffer from headaches and being lightheaded three days after chloroquine administration and within next few days feeling of derealization and poorly defining persecutory delusions accompanied by strong anxiety with occasional visual illusions occurred with clear consciousness. After eighteen days chloroquine was withdrawn and after two days all the symptoms resolved.

Clinicians should be vigilant for possible psychiatric disorder when using chloroquine in patients with SLE. Such cases are probably rare and may include both paranoid and bipolar spectrum disorders. Studies on interactions of chloroquine with brain neurotransmitter systems are needed. Hydroxychloroquine may represent lower risk considering psychiatric complications. Mechanism of the difference is currently not known.

There is growing literature regarding the controversial subject of the placement of early intervention in psychosis programs (EIP) in the psychiatric services network.

To review the literature concerning the different organizational models in early intervention in psychosis and their positioning with local psychiatric services.

To describe our community based early intervention program, integrated in a general adult psychiatry service. We intend to reflect about our experience, on the weaknesses and strengths of our service's model.

A non-systematic literature review about different models of service organization in early intervention in psychosis was performed, using Medline database and Google Scholar search-engine as well as reference textbooks.

The current debate is centered on whether EIP should be organized as autonomous services or integrated in broader psychiatric services.

The PSIC Programme is an assertive community-based programme for patients with a first psychotic episode. It was developed by the Psychiatric Department of Prof. Doutor Fernando Fonseca Hospital in 2001 through the cooperative use of the existing human and financial resources.

The integration of early intervention programs in general psychiatric services, allows for the delivery of specialized rehabilitative treatments while maintaining the continuity of care even after the critical period.

Early intervention programs encapsulate a new optimism within community mental health teams. Inevitably the high standards imported from early intervention, begin to be benchmarks for all services for psychotic individuals.

The corticosteroid-induced neuropsychiatric symptoms may occur at any time of corticosteroid use and include depression, mania, psychosis and delirium.

To present corticosteroid-induced neuropsychiatric symptoms of patient with atopic dermatitis.

A case report of acute manic episode induced by a short course of dexamethasone.

A thirty-six year old female was referred to the Department of Dermatology and Venereology, Medical University of Lodz because of insufficient clinical improvement of a treatment regimen ordered, and due to psychiatric problems associated with the use of dexamethasone.

History of any other skin disease, psychiatric problems or internal disorder was not relevant. After two days of treatment with dexamethasone 8 mg, the patient developed progressively increasing symptoms of psychomotor agitation, elevated mood, distractibility and early waking up. Six days later she started to experience increasing sensitivity to acoustic stimuli, startle response, feeling of being almighty and anxiety. On the ninth day dexamethasone was withdrawn. After a psychiatric consultation she was prescribed sodium valproate from 75 mg to 300 mg. The patient was also taking perazine 25 mg in the evening together with valproate. All the symptoms resolved two weeks after administration of antipsychotic treatment.

Understanding the neurobiological mechanism involved in glucocorticoid-induced affective disorders is crucial for effective prevention and treatment of these complications. Further studies are needed to elucidate if patients with atopic dermatitis represent a special risk group considering psychiatric complications of systemic steroid treatment.

Impulse control behaviours (ICB) are repetitive and excessive activities that are subsyndromal, unfulfilled the diagnostic criteria but potentially challenging problem. Impulse control disorder (ICD) on contrary is an established diagnosis which requires clinical attention.

To determine the proportion of patients with ICD among those screened positive with ICB among patients with Parkinson's disease in an Asian population. The factors associated with ICB were also examined.

Eighty consecutive patients attending neurology clinic who fulfilled the inclusion criteria i.e. diagnosis of idiopathic Parkinson's, on stable dopaminergic medication for at least 3 months were recruited in this prospective cross-sectional study. ICB were identified using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson's disease (QUIP). Those who were screened positive, with controls, then underwent semi structured interview based on SCID-ICD.

11.3% were screened positive for ICB; these were significantly associated with higher education (p=0.022), advanced stage of disease (p=0.026) and higher levodopa dosage (p= 0.01). The most frequent ICB was compulsive medication use (7.5%), followed by hobbyism (6.25%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.25%). 50% of those with positive QUIP (section1) fulfilled the criteria for ICD (50% positive-predictive value) while none with negative QUIP had ICD (100% negative predictive value).

About 1 in 10 patients with Parkinson's disease displayed ICB, half of which might have a diagnosable ICD. The risk should alert the physicians of the need for routine assessment of impulse control problems in patients with Parkinson's disease.

Behcet's disease (BD) is a heterogeneous, multisystemic, recurrent, inflammatory disorder with a chronic course and an unknown cause. Mental disorders (MD) occur quite often with BD. The influence of childhood experience, relations traumatic events with BD and MD, specificity of MD still have not investigated carefully.

55 BD patients (44 male and 11 female mean age 33,1±10,1) were included. ICD-10 criteria were used for MD diagnostic. Severity levels of stress, anxiety, depression found by PSS, HAM-A, MADRS.

Early traumatic childhood experiences observed in 29(52,7%) patients. Among this patients BD started before 18 years in 13(44,8%) cases whereas in patients without early traumatic childhood experiences in 7(26,3%). The severe stress factors were preceded first BD symptoms in 12(21,8%) cases, prolonged low-intensity stressors in 24(43,6%). Most patients 45(81,8%) self-reported connection between stressful life events and exacerbation of BD. MD were diagnosed in 47(86%) BD patients: dysthymia 19(34,5%), recurrent depressive disorder − 14 (25,4%), depressive episode (mild, moderate) − 8 (14,5%), generalized anxiety disorder − 4 (7,3%), adjustment disorder − 2 (3,6%). MD preceded BD in 20% cases. Depression scores showed a clinically normal level in 13 BD patients (23,6%), mild level in 34 (61,8%), and moderate level in 8 (14,5%). Mean severity levels of anxiety, stress were 14,3±5,4 and 16,1±5,9 accordingly.

The received data show, that individual history of stressful life events is important for the beginning of the rheumatic disease and MD in BD patients. Depression and anxiety spectrum disorders are the most common MD in BD patients.

A series of clinical studies demonstrated that QEEG (quantitative electroencephalography) prefrontal theta cordance value decreases after one week of treatment in responders to antidepressants and precedes clinical improvement. Ketamine, a non-competitive antagonist of NMDA receptors, has a unique rapid antidepressant effect but its influence on QEEG measures is still unknown. To date wasn’t studied predictive value of cordance in response to single infusion of ketamine in depressive subjects.

In a double-blind, cross-over, randomized, placebo-controlled experiment we studied the influence of ketamine (0.54 mg/kg) on theta cordance in a group of 27 right-handed hospitalized depressive patients on stable antidepressant medication. QEEG cordance values in theta frequency band were calculated according to UCLA algorithm.

Responders (n=11) to ketamine in compare to non-responders (n=16) showed significant difference in cordance values at the end of ketamine infusion (Spearman, p= 0.039). The cordance decrease, measured between the end of infusion and next day, positively correlated with ketamine antidepressant response (MADRS decrease) fourth day after infusion (two-tailed Fisher's Exact test, df=1, p=0.0076) with NPV 90.9% (95% CI 64.3%-99.5%) and PPV 62.5% (95% CI 44.2%-68.4%).

Our data indicate that ketamine infusion immediately induces similar changes as monoaminergic-based antidepressants do gradually after a series of downstream signalling steps. The reduction in theta prefrontal cordance could serve as a biomarker of sustained antidepressant response, a hypothesis that should be tested in larger depressive population.

Several factors influence the emotional behavior, including environment, genetic and the interaction between them.

The aim of this work is to investigate the interaction between environmental and genetic influences in the divergent behavior of Carioca High and Low Freezing (CHF and CLF) rats - a genetic model to study fear and anxiety. The Carioca rat lines were produced from selective breeding method, from animals with the highest and lowest levels of freezing behavior in the contextual fear conditioning, a model to study anxiety-like behavior.

To investigate the gene-environment interplay, we employed the cross-fostering procedure, which CHF rat pups were raised by CLF dams, and vice-versa, since pos natal day (PND) 1 until weaning at PND21. The litters were culled in 8 pups, and we fostered only 2–3 male pups per litter. We also maintained CHF and CLF control, no-fostered litters. On PND60, male animals of the four groups (CHF (n=7), CHF-CLF (CHF pups raised by CLF dams) (n=6), CLF (n=4) and CLF-CHF (n=3)) were exposed to the contextual fear conditioning.

The freezing behavior on the day after foot shocks was analyzed. A two-way ANOVA showed that, although CHF rats had a higher time in freezing in this task comparing to the CLF (p<0.01), as expected, no one cross-fostering effect was observed: CHF = CHF-CLF > CLF-CHF = CLF. On PND120, the same male rats were exposed to a 12-minutes-session, two-session extinction paradigm, in the same context. In these sessions, no foot shock was used. Comparing the freezing time in the context session on the conditioning paradigm to the freezing time on the first extinction session, we observed a significant decrease in this behavior for the CHF-CLF group, but not in the CHF group (p<0.05). This difference between groups was not observed between CLF and CLF-CHF animals. Our previous work has showed that there isn’t a memory deficit in the CHF animals.

This data suggest an existence of an early environment influence in the anxiety behavior extinction, but it was dependent of the genetic background.

Memantine has been registered worldwide for the treatment of moderate to severe dementia of Alzheimer's type (AD). However, both historical experiences and contemporary research showed its possible utility also in other types of dementia, including that of vascular origin (VaD) and Lewy body pathology-related (DLB/PDD). Maximum labelled dosing of memantine for patients with AD and the same was used in studies with VaD and PDD/DLB. Memantine seem to be well tolerated in AD patients, less is known considering other dementias.

Naturalistic observation of the group of 120 AD, 65 VaD and 30 DLB/PDD patients from the memantine initiation with a maximum one year observation period. Drop-out or dose reduction due to adverse effects where analyzed.

Considerably lower fraction of patients with other that AD diagnoses achieved maximum dose of 20 mg/day and needed dose-reduction due to adversity. Moreover, numerically more patients with DLB/PDD than both VaD and AD did not tolerate any dose of memantine; this difference, however, due to small numbers did not reach statistical significance. The most common symptoms which resulted in dose-reduction or drug discontinuation included agitation, excessive sedation and gastrointestinal complications.

Similarly to previously known observations with cholinesterase inhibitors, patients with dementia due to AD tolerated memantine better than those with other dementias. The phenomenon underlying mechanism is currently unknown. Nevertheless, despite obscure nature, it may have important pragmatic consequences and may lead clinicians to both greater vigilance and possibly targeting at lower memantine doses in patients with dementias other than AD.

of this study are evaluation the diagnosis rate of mental health clients in ED of general hospital, evaluation of rate of referrals to recommended.

The current study is aimed to analyze (a) the rate of mental health diagnosis in ED clients from general hospitals and (b) rates of referrals to recommended psychiatric services and other specific treatment.

This is an observational study performed within the EDs from five different East European countries: Romania, Serbia, Moldova, Bulgaria and Albania. The data collected from every ED include the number of recorded patients with psychiatric diagnosis, characteristics of these patients (age, gender, rural/urban origin, and professional status), number of recommended referrals to psychiatric settings and specific treatment and covers the 3 months’ period. The identification data were not collected from patients as for the ethical reasons.

estimate level of diagnosis of mental health disorders in ED patients in general hospitals in East European countries and find gaps in needs and services received in ED for mental health clients.

All countries involved in project are in the period of mental health services development and identification of the specific unmet needs for mental health clients in ED that can contribute for further strategy development based on study's findings.

Treatment-resistant schizophrenia (TRS) presents serious problems and unmet needs for clinicians, families, social, and legal services. Existing preliminary neurophysiological and clinical data confirm the hypothesis that ECT and dibenzodiazepine antipsychotics may have synergistic effects in TRS.

To evaluate efficacy and tolerability of two combination therapy options (ECT with clozapine [CLZ] and ECT with olanzapine [OLZ]) in TRS, as well as to differentiate clinical indications of the aforementioned methods in TRS.

80 TRS patients were randomised into four treatment groups: CLZ+ECT (n=19); OLZ+ECT (n=19); OLZ (n=21); CLZ (n=21), with dosage ranging 10–20mg OLZ and 200–900mg CLZ. ECT was administered 8-18 times in a twice weekly regimen. Patients (44 male, 36 female; mean age 32.2±11.6) were treated for 10 weeks and assessed using PANSS (total score [TS] and subscores), CGI and MOSES scales.

At the 10-week end-point, the number of responders (>30% PANSS TS reduction) in combination treatment groups was significantly higher compared to antipsychotic monotherapy: CLZ+ECT 53%, CLZ 14% (p<.05); OLZ+ECT 58%, OLZ 19% (p<.05); as was the mean PANSS TS reduction: CLZ+ECT 28.3%, CLZ 25.7% (p<.05); OLZ+ECT 37.6%, OLZ 26.3% (p<.01). Moreover, in combination groups the response threshold was generally observed 2–4 weeks earlier than in monotherapy groups.

Combining ECT with CLZ or OLZ improves and accelerates treatment response, and its efficacy is directly correlated with the number of ECT sessions. Specific indications include TRS with predominant catatonic, hebephrenic, negative and depressive symptoms. Combination options also demonstrated similar tolerability as CLZ and OLZ monotherapy.

The internet is an important source of information and exchange for patients and can exert considerable influence on their health-related behaviors. Internet-based therapy typically involves the interaction between a consumer and therapist via the Internet and incorporates the use of a structured Web-based treatment program for consumers to access in conjunction with therapist assistance (usually by email.

The purpose of this open study will be to test the efficacy of therapist-assisted internet 12 module 4 month long self-help program based on cognitive behavioral approach (IB-CBT) with the treatment as usual (TAU) for bipolar affective disorder patients who are medicated with thymostabilisers.

66 participants suffering with bipolar affective disorder, who recruit from the patients of the Psychiatric clinic Olomouc at time of start the maintenance pharmacological phase of the treatment of bipolar affective disorder will be randomized to the TAU (treatment as usual) and IB-CBT (12 modules of internet based CBT+ TAU). All participants will complete a clinical diagnostic interview, and a set of questionnaires to assess affective symptoms at four time periods (start of the maintenance treatment period and at follow up: 6 month, 12 month and 24 month. The study will be done in open conditions

The results from the start of the maintenance treatment period will be present. 31 paticipants finished psychoeducational program, 30 collaborated in TAU group. The comparison of both group according the rate of relapses and re-hospitalizations didnot significally differ in 6-moth follow up.

Supported by grant IGA MZ CR NT11047

Three methods are used to make a diagnosis: medical history, examination and laboratory-instrumental analysis.

With advances in modern medical technology, laboratory instrumental analysis is gaining increasing importance and trust, while classical methods are neglected: a thorough review of the medical history and a detailed examination.

To point out the significance of making a timely and correct diagnosis.

Report the case of 47 year old female patient with no previous psychiatric history. Her symptoms appeared suddenly in the morning, developed a clinical picture with psychotic symptoms. A CT scan of her brain, was normal findings. She went to a neurologist, who produced an orderly neurological report and recommended a screening test for psychoactive substances (PAS). The test was positive for heroin, morphine and benzodiazepine. Since she is disoriented and has incoherent speech and neologisms, she was hospitalised at the Psychiatry hospital. Abuse of the PAS was excluded because she used analgesic contains codeine. On the seventh day of her stay a CT scan of her brain was made and showed a large ischaemic lesion in the left temporoparietal area.

Laboratory-instrumental analysis is not without objective and subjective errors and must not guide the diagnosis without a sufficient clinical basis, and it must be preceded by a review of the medical history and an examination. A timely and correct diagnosis is important in order to provide adequate therapeutic treatment to a patient as soon as possible and in order to avoid needless hospitalisation in the psychiatry ward.

Post-partum depression is the most common complication of pregnancy in developed countries, affecting 10–15% of new mothers (McDonald et al., 2012). PPD can negatively impact a woman's wellbeing, maternal–infant interactions and child developmental outcomes from infancy through school age (Avan et al., 2010). Such conditions may be exacerbated by co-occurring anxiety symptomatology and perinatal stress (Brand, Brennan, 2009; Tambelli, Odorisio, 2013).

Nevertheless, empirical data show incongruent effects of perinatal maternal mental health upon mother-child relationship and the child's health. We believe that maternal representations may contribute to understand such differences.

On such basis, the purpose of our research was to evaluate the influence of maternal representations on emotional availability during a free play interaction in the context of perinatal depression and anxiety comorbidity.

We administered to 120 first time mothers (mean age= 33.57; s.d.=4.82) and their babies (mean age=6.55; s.d.=.63), the following measures: the Edinburgh Postnatal Depression Scale (Cox, et al., 1987); the State-Trait Anxiety Inventory (Spielberger, 1983); the Parent Stress Index – Short Form (Abidin, 1993) and the Maternal Representation Interview at Child's Birth (Tambelli et al., 2006). Finally, all mothers were video recorded during a free-play interaction with their child, assessed according to Emotional Availability Scales (Biringen, 2000).

Results showed significant different quality of maternal representations and mother-child interaction according to presence/absence of depression and/or anxiety.

The study shows the need to acknowledge the woman's emotion-regulation style that needs to be supported in the context of psychological malaise during the perinatal period.

110 patients who fulfilled the DSM-IV diagnostic criteria for a major depressive episode treated on an outpatient basis at the Eginition Hospital were assessed with the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale and the Global Assessment Functioning. The questionnaires were administered at the beginning of the medication period and thereafter every week over a 6-week period. Descriptive statistics are used for the presentation of the results.

Mean age ± SD of the sample was 52.5 ± 9,3 years. Mean score ± SD on the HDRS, HARS and GAF at the different time points of assessment are shown below.

Baseline (1) 1st week (2) 2nd week (3) 3rd week (4) 4th week (5) 5th week(6)

(mean±SD) (mean±SD) (mean±SD) (mean±SD) (mean±SD) (mean±SD)

HDRS 37.2±2.4 32.5±1.8 28.4±2.6 14.4±2.8 6.8±2.6 6.1±1.8

HARS 34.6±7.7 32.3±1.4 27.3±2.5 14.2±2.1 6.4±1.8 6.2±2.1

GAF 45.6±8.2 47.1±2.2 57.7±2.1 72.2±2.1 88.5±2.4 91.1±1.7

Psychopathology significantly subsided by the end of the study period; improvement was marked already from the third week of treatment.

The main finding of the present study was that monotherapy with agomelatine had a positive effect on symptoms of depression, anxiety, and global functioning in depressed patients.

DSM 5 (2013) solicits more empirical data on Internet Addiction (IA) before its inclusion in the Manual.

The objective of the present study was to deepen the relation between internet use and abuse among adolescents and attachment variables. AIMS The aim of the study was to define a psychological profile of adolescents that may enable to discriminate the variables that mark the border between internet use and abuse.

435 adolescents (F=221; M=214) aged 13 to 18 years (mean=15,25; S.D.=1,75) completed the following measures: BFAS -The Bergen Facebook Addiction Scale (Andreassen, et. Al. 2012); SPQ - Shorter Promis Questionnaire (Italian adaptaation Baiocco et.al. 2005); MPIQ - Mobile Phone Involvement Questionnaire (Walsh et.al., 2010); UCLA - Loniless Scale (Russel, 1996); Self Disclosure Online (Schouten et.al. 2007); IPPA – Inventory of Parent and Peer Attachment (Armsed e Greenberg, 1989; SCL-90 - Symptom Check List (Derogatis, 1980) Camir (Pierrehumbert 1996).

Data showed that ‘digital’ identity is common within the new multitasking generation of not-clinical adolescents, whereas internet abuse is linked to psychic vulnerability and to emotional neglect.

Attachment security, as manifested by secure perception of attachment to parents and friends, the capacity to express emotions, the ability to balance online and offline friendships and psychological wellbeing predict an adequate use of Facebook, preventing internet abuse.

Chronic pain is a prevalent condition worldwide. Opioids have beneficial effects when treating pain, but also involve risks. Opioid iatrogenic dependence(OID) is becoming more prevalent in western countries. Co-occurring psychiatric disorders are both among its predisposing factors and its complications.

To review factors predicting response to opioid treatment, especially those related with psychiatric comorbidities. We describe a case of OID as an example of the patient-type.

Attention needs to be paid to OID considering its growing health impact.

Throughout the case of a patient with chronic pain due to post-radiotherapic proctalgia, who suffered from depression and showed maladaptive personality traits, we describe a case of OID.

All patients assisted at our Pain Clinic have current or previous psychiatric disorders, and in almost half of the cases is major depression, as it happens in our case-example. Concomitant psychopharmacological treatment of opioid dependence and psychiatric comorbidities (including other drugs abuse/dependence) improves outcomes.

A global view of the opioid-consumer that includes comorbid psychiatric conditions is needed.