Quis custodiet ipsos custodes? Who will watch the watchmen?

The incidence of most psychiatric disorders is higher in doctors than in the general population. Surveys have revealed that up to 25% of doctors have depressive symptoms. Suicide rates are also high with 400 doctors in the US alone lost every year lost to suicide.

Doctors are notoriously bad at seeking help for their own psychiatric problems often only presenting when a crisis arises. Reasons for this include symptom concealment owing to fears of exposure to stigmatisation.

A stigma was a scar on the skin of ancient Greek criminals. It was a sign to all that these people were unsafe, unclean and unwanted. Stigma still persists today in the attitudes towards those who have mental health challenges. Nowhere is this more apparent than in the medical profession.

To take a stand against the stigma associated with mental health challenges in the medical profession and to debunk the many myths that abound.

The primary author composed an autobiographical narrative about his personal experiences with oscillations in his mood in attempt to illustrate the factors that influence disease detection, progression, treatment and outcome.

Mental health challenges do not prevent you from realising your dreams as evidenced in this case report. Dr Hankir received the 2013 Royal College of Psychiatrists Foundation Doctor of the Year Award. It is through making it more acceptable to share our experiences with low mood that the number of suicides among medics will fall.

A proinflammatory state in a subgroup of depressed patients has been reported repeatedly (e.g. increased interleukin-6 and tumour necrosis factor-alpha). COX-2 inhibitors down-regulate increased inflammatory markers and are therefore investigated as an add-on therapy in depression. Proinflammatory cytokines and/or kynurenine metabolites may predict the outcome of treatment with COX-2 inhibitors.

To prove or disapprove the hypothesis of a better therapy response in the group of add-on celecoxib to sertraline, particularly in patients with a more pronounced proinflammatory state at baseline. The aim is to find a biological predictor (cytokines and/or kynurenine metabolites) for treatment outcome.

This is a dual-center, randomized, double-blind, placebo-controlled, parallel group phase IIa study. It investigates the mean change in clinical outcome and in serum cytokine and kynurenine levels from baseline to endpoint (week 6) in patients with major depression (HAMD-17 ≥ 22) treated with sertraline plus celecoxib versus sertraline plus placebo for six weeks. 51 depressed patients of both gender, aged between 18 and 60 years without any recent inflammatory disease were enrolled. The study comprises six study visits (6x ratings, 3x blood collections) during six weeks of treatment and a follow-up visit 10 weeks after baseline. Cytokines were measured by Enzyme-linked Immunosorbent Assay (ELISA), kynurenine and its metabolites by High Performance Liquid Chromatography (HPLC).

The study was completed quite recently and the results are in progress.

The expectative in regards achieving better therapeutic adherence related to medication compliance in schizophrenia has been shown to be greater in patients treated with long-acting injectable antipsychotics.

The purpose of the present study was to investigate whether or not the schizophrenia treatment under evidence-based clinical practice conditions with Palmitate Paliperidone in comparison with conventional depots antipsychotics, will improve the patient evolution and prognosis in schizophrenia.

This 18 months study, the patient population consisted of 30 outpatients, all diagnosed with schizophrenia, who received treatment with Paliperidone Palmitate (n=15). A comparison was conducted with the same number of patients who received treatment with depot conventional antipsychotic.

All patients were evaluated every three months and the following scales were used for assessment and measurement: Positive and Negative Syndrome Scale (PANSS) Global illness Severity (Global Clinical Impression CGI), Treatment Satisfaction Scale, Remission Criteria (Andreassen criteria,) Personal and Social Performance (PSP) and the Subjective Well-being under Neuroleptic Scale (SWN-K)

At endpoint, we found statistical differences among both study groups: The Paliperidone Palmitate group showed significantly higher remission rates (p < 0.05) and treatment satisfaction scores (p < 0.05). Also an improvement in global clinical impression (p < 0.05), PSP (p < 0.05) and SWN-K (p < 0.05)

Paliperidone Palmitate group showed lower sexual dysfunction (p < 0.05) compared to conventional depot.

The presented data demonstrated that Paliperidone Palmitate was an efficacy and safety treatment and could improve the outcomes prognosis and the clinical course of the illness in schizophrenic patients when compared with conventional depot

Dyfunctions of prefrontal neuronal circuits contribute to the pathophysiology of depression. Previous studies showed increased functional MRI and EEG connectivity in patients with depression. In this study we investigated a large sample of patients with major depression (n=228) and healthy subjects (n=215).

Spectrotemporal dynamics during resting state with closed eyes were analyzed in sensor and source space to examine functional EEG connectivity (fcEEG) alterations between groups. Quantitative measures of delta, theta, alpha, beta and gamma power, hemispheric asymmetry, coherence, phase and current source density (CSD, eLORETA) analyses were calculated from artifact-free EEG recordings.

EEG theta power was increased in all brain regions in the group of patients with a focus in frontal regions and increased frontal theta and alpha power. Excessive coherence differences were detected in the delta, theta and alpha-bands in frontal, frontal-temporal and frontal-parietal regions. There were changes in phase differences in the delta, theta, alpha-bands between patients and healthy subjects. Differences in CSD were found for the delta, theta, alpha-band in the (rostral and subgenual) anterior cingulate cortex (ACC) with increased CSD in the patients.

The main finding of the present study was an increase in cortical slow-wave activity in sensor and source space in patients with depression revealing marked differences in prefrontal cortical networks. Functional delta, theta and alpha connectivity (coherence and phase) were altered with a predominance in the left hemisphere. Dysfunctions of the ACC, together with alterations in fcEEG may contribute to the pathophysiology of major depression.

Alcoholism is a family disease. Many studies confirm that family history of alcoholism is associated with the development of later alcohol dependence.

To analyse the family's impact in the development of alcohol addiction in children grown up in these families.

To create and distribute a questionnaire on family environment among group of alcoholic dependent and the control group and statistically analyse the results.

The research study was based on authors' anonymous questionnaire including questions referring to family structure, parents' divorce, prevalence of alcoholism of alcoholism in the family, parents' attitude towards alcohol and parent-child relationships. The study group consisted of 125 people, 83 men and 42 women, aged from 22 to 68 participating in treatment programs for alcohol addiction. The control group consisted of 231 people, 136 men and 95 women, aged from 17 to 65, with no history of alcoholism.

The study group participants stated less frequently that they had been raised by both parents (78% vs. 87%;p<0.05). In this group one of the parents significantly more frequently abused alcohol (43% vs. 19%; p<0.05) or both parents abused alcohol (15% vs. 1%;p<0.05). The participants claimed to be more often punished for their failures, abused physically/verbally and could less often depend on their parents.

Based on these result we concluded that patients addicted to alcohol were more often raised by a single parent, they were more likely to have alcohol-dependent parents and relationship with their parents were more often impaired.

Placebo effect has been a controversial and hot topic within psychoneuroinmunology. However recent studies have shed considerable light on the potential mechanisms of placebo responses and their role in health outcomes.

This study aims to provide a new and integrative look at the neurobiological mechanisms underlying the placebo effect.

A systematic review was conducted for articles published in peer-review journals in the last decade.

The two most evidence-based neural pathways for placebo effect: dopamine-related and endorphine-related; are fully explained and integrated in a comprehensive view.

The placebo effect represents an example of well-documented mind effect on the body. Implications for stress-related diseases are discussed.

The psychological modulation of stress-related disorders, such as type 2 diabetes is a well-established phenomenon in psychoneuroimmunology.

This study analyzes if health outcomes in a type 2 diabetes case are modulated by exposure to psychosocial stressors.

A single case study was conducted for a 38 year-old woman diagnosed with a history of unregulated type 2 diabetes.

Lack of control and predictability, lack of outlet for frustration, marital conflict, lack of social support and type A personality were associated with increase in clinical complications.

Results of this study point out the role of perceived intensity and chronicity of stressors in the health outcomes in our patient. In particular, interpersonal relationship, social support and personality played a key role in type 2 diabetes.

Because blind patients with schizophrenia are not so many, we don't have much information about their psychotic symptoms, neither about their treatment.

The hallucinations of blind schizophrenic patients could be different from unblind patients, due to impairment of their visual function.

Analysis of psychotic symptoms and antipsychotic treatment of blind schizophrenic patients could provide new information about their features and treatment.

We had two case studies, both diagnosed with schizophrenia, multiple episodes, currently in acute episode according to DSM V. Both patients were treated with olanzapine 10mg/day.

The psychotic symptoms of both patients had the same particularity, the presence of tactile hallucinations (both patients describe insects moving on and in the skin, with repeated attempts to remove them, producing secondary skin lesions). Both patients had a good response and remission of this symptoms after 14 days of treatment with olanzapine 10mg/day. The PANSS score had a reduction on hallucinatory behavior item from 5 to 1 for the first patient and from 6 to 2 for the second patient, for both after 14 days of treatment.

We presume that tactile hallucinations could be specific for these two cases. Treatment with olanzapine (an antipsychotic with a large receptoral spectrum) was a good choice in these cases.

A history of drug and alcohol use influences various aspects of inpatient care. It is important to ascertain the history of drug and alcohol use in new admissions. This knowledge ensures the appropriate detoxification of patients. It also allows the management of various risks such as the risk of violence, of escape, of drugs being brought onto the ward and of drug use amongst other patients. It can explain the lack of therapeutic progress in patients.

To ascertain whether new patients admitted to an acute ward on a medium secure unit in London are being asked about their drug and alcohol usage history.

To establish what proportion of 18 male inpatients on a medium secure unit have their drug and alcohol history documented in their admission notes.

The notes of all 18 patients on an acute ward in a medium secure unit were scrutinised. An audit tool was used to record whether the admission notes contained an entry about the history of drug and alcohol use.

There were 18 male patients. Four were under a section 3, four under a section 47, four under a section 48, one under a section 38, five under a section 37 of the Mental Health Act 1983. Only 5 of 18 patients had been asked about their history of drug and alcohol use on admission.

An important part of the history is being missed in a large proportion of new male admissions to a medium secure unit.

The psychological changes caused by trauma reflect the difficulty of overcoming the traumatic event. This study is a trial to approach the clinical and evolutionary aspects of post traumatic pathology through an observation of a recently hospitalized patient in our military psychiatric department.

Mr M., 28 years old, was surprised by the sound of distant gunshots. Going on site, he found six of his friends killed and his best friend dying. Developing severe symptoms of acute stress disorder, he was hospitalized and treatment by an antidepressant and anxiolytics has been established. Two weeks after, anxiety and nightmares decreased but repetition and avoidance syndromes did not improve.

Meanwhile, the patient was obliged to face major confrontations consisting of interrogations and legal proceedings concerning his conduct after the accident. He was suspended from his job and all his professional papers were confiscated. The patient developed consequently a major depressive episode; however, an important event occurred: the repetition syndrome disappeared. Thereafter, the mood disorder has improved and we have seen a more combative attitude from the patient.

In this case, how can we explain the relatively early disappearance of the repetition syndrome? Is it the confrontation with facts of reality even more traumatic than the trauma itself? The long-term evolution towards recovery or towards a new relapse will clarify us on this issue.

Violent behavior and association with alcohol abuse or other substance is a common problem in emergency psychiatry. Assessment, diagnosis, management and treatment of this symbiosis is very difficult. Such an association affects the severity of symptoms of mental illness, progress and prognosis.

To review the association of violent behavior with alcohol and substance abuse.

Improve assessment, management and treatment of patients with violent behavior, accompanied with alcohol and substance abuse in psychiatric ward.

Prospective cohort study, during 24 weeks. Psychiatric evaluation based on structural clinical interviews and questionnaires related to violent behaviors and risk factors were conducted to patients admitted in psychiatric hospital on UHC'Mother Tereza' Tirana.

According to our data, there are strong links between alcohol consumption, substance abuse and an individual's risk of being either a perpetrator or victim of violence. So 20% of males and 16% of female admitted to our service had reported alcohol consumption and substance abuse, (out of 159 male and 77 female patients) 66% of them had shown violence episodes. At the discharge from hospital 3.8% of men and 1.2% of female patients had diagnosis of axis I related to alcohol or substance abuse.

There is a close correlation between the Violence and abuse of Alcohol and other substances. The comorbidity affects the progress of treatment and prognosis of the disease. The abuse of alcohol and other substances is a good indicator to predict future violence.

Psychosocial treatments, broadly defined, refer to the use of human interactions for therapeutic purposes. Psychosocial treatments, in conjunction with pharmacotherapy, are increasingly utilized in treating schizophrenia. Reference is made to recent literature and research, showing that - although a number of current psychosocial treatment approaches address motivation to varying degrees, treating motivation as a primary target is needed to maximize functional outcomes in schizophrenia.

The paper describes a group-based intervention designed for persons with schizophrenia-spectrum disorders, to be administered as an add-on module to supplement ongoing psychosocial treatment in an outpatient setting in Moscow Research Institute of Psychiatry. The intervention is designed to enhance motivation to change maladaptive patterns of behavior, and to facilitate engagement in psychosocial treatments.

Individuals diagnosed with schizophrenia were recruited as they entered outpatient psychosocial rehabilitation programs. Patients completed interview-based measures of motivation. The conductor's work is, in first instance, to turn the group into an effective therapeutic tool.

Inclusion and exclusion criteria of patients, therapeutic team, setting, methodology, techniques, strategies and therapeutic factors - will be presented. We will discuss the modification of motivational enhancement techniques needed at different points in the treatment\rehabilitation process and the evidence for effectiveness.

Potential psychosocial treatment implications are suggested, especially those that emphasize motivational enhancement. Implications for the theoretical understanding and psychosocial treatment of intrinsic motivation in schizophrenia are outlined.

In bipolar disorder affective status is significantly associated with subjective well-being. That relationship is particular significant for depressive symptoms.

The purpose of the present study was to analyze whether it is appropriate the use of the Subjective Well-being under Neuroleptic Scale (SWN-K) among patients with bipolar disorder.

50 outpatients with bipolar disorder were recruited. Subjective well-being was evaluated using the SWN-K. Current symptomology was rated using the Hamilton Depression Rating Scale (HAM-D) and the Young Mania Rating Scale (YMRS).

In our sample, there is a strong inversely correlation (/r/ > 0.7. p <0.01) between the score on the HAM-D and the total score on the SWN-K. HAM-D and SWK are linearly related and that relationship is inverse, this strong inversely correlation is maintained between each subscales of the SWN-K and the HAM-D.

There is a modest direct correlation (0, 30≤ r ≤0, 70. p<0.01) between the total score on the YMRS with the total score on the SWN-K. Both variables are linearly related and this relationship direct. In each subscale of the SWN-K is detected this relationship with the YMRS.

According to previous studies, our results suggest that affective status is associated with subjective well-being in bipolar patients and this relationship is particular significant for depressive symptom. In contrast to previous studies, we found a modest but direct correlation between YMRS score and SWN-K. Further investigations are necessary in patients with acute mania in order to determine whether SWN-K is a good tool for it.

The psychological modulation of stress-related disorders, such as gastrointestinal complications, is a well-established phenomenon in psychoneuroimmunology. Recent studies of stress have highlighted the effects of chronic psychological and environmental stressors to health and well-being, but the evidence is still minimal.

This study analyzes health outcomes in a clinical case modulated by exposure to psychosocial stressors, focusing on gastrointestinal function, but also evaluating how those stressors are related to anxiety, depression and hypochondria.

A single case study was conducted for a 66 years-old woman diagnosed with gastric carcinoma. In addition, stressful life events and social support were registered.

Characteristics of stressors, such as intensity and chronicity, and type A personality were associated with increase gastrointestinal complications.

Results of this study point out the role of perceived stress in health outcomes.

Bipolar affective disorder in the elderly is a complex entity not only in its clinical dimension but also in its therapeutic management. Elderly patients are very sensitive to pharmacological secondary effects.

The objective of this study is to longitudinally analyze the pharmacological route of a sample of outpatients above 65 years old.

Review of clinical histories and data collection from a sample of 12 patients over 65 years old.

Most of the patients experienced at least three drugs prior to their current treatment. The fundamental reason for changes were intolerable adverse effects and, in one of them, irreversible (kidney failure). The trend is to replace drugs by atypical antipsychotic or antiepileptic ones. The prescription of gabapentin is not based on scientific evidence but with a positive response. The available literature is still limited to justify these decisions based on clinical experience, somatic background and tolerance of the patient.