UNDER THE AUSPICES OF

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1 BOOK OF ABSTRACTS 14 TH INTERNATIONAL CONFERENCE OF THE A.P.P.A.C. UNDER THE AUSPICES OF The Hellenic National Commission for UNESCO The Municipality of Athens The Hellenic Ministry of Health and Social Solidarity The Hellenic Ministry of National Education and Religious Affairs The Hellenic Ministry of Tourism The Ministry of Hellenic Culture The Municipality of Amaroussion ACKNOWLEDGEMENTS: We would like to express our gratitude to our sponsors ORGANIZING SECRETARIAT: Gnostir Publications 3 Levidou str, N.Erithrea Tel: Fax:

2 TABLE OF CONTENTS English Sessions SYMPOSIA 3 Psychotherapies 3 Autism & Asperger s Syndrome 4 A Psychological Perspective for the Economic Crisis 6 Schizophrenia, Bipolar Disorders and Borderline Personalities 6 Children s Mental Health and Parental Influences 8 Women s Mental Health and Maternity Issues 10 Cognitive & Physical Impairments 12 Depression 13 Stress and Infertility 15 WORKSHOPS 17 SPECIAL SESSIONS 18 Medical Conditions & Neuropsychiatry 18 Ethics and Philosophical Issues 19 Medications and Psychoses 19 Multiple Sclerosis 20 Borderline Personality Disorder 21 Addictions 22 Students Life Issues 22 Work Stress and Occupational Support 24 Anxiety and Post Traumatic Stress Disorder 24 Relationships 25 Greek Sessions SYMPOSIA 27 Psychotherapies 27 Preschool Age 28 Mapping the Unknown: Psychological and Sociological Dimensions of the Internet Emergency Room 30 Alzheimer s Disease 31 ROUND TABLES 32 Day-Care Centre of Koropi 32 Psychiatric Modifications 33 Interdisciplinary Team and Commission for Children and Adolescent s Mental Health: Clinical Practice from the Hospital of Lesvos Island 34 SPECIAL SESSIONS 36 Preschool Age Problems 36 Parents & Grandparents 37 Psychoses 38 Ethics 38 Social Gender and Self Esteem 39 Dance Therapy 40 WORKSHOPS 41 Poster Sessions GROUP A 42 GROUP G

3 ENGLISH SESSIONS SYMPOSIA SYMPOSIUM: Psychotherapies COGNITIVE-BEHAVIOURAL HYPNOTHERAPY FOR PATIENTS DIAGNOSED WITH CANCER Prof. I. Holdevici¹ and Dr. E. Togoreanu² ¹ Prof., Psychology & Educational Sciences Dept., Bucharest University, ROMANIA ² Surgeon, specialised in Oncology. The present paper describes a model of psyhotherapy for the patients diagnosed with cancer. The model based on clinical hypnosis and cognitive-behavioral therapy, includes the following strategies: basic relaxation abilities, mental trening for the improvement of the immunologic mechanism, direct and indirect sugestions, trance induction to control pain and change of the negative thoughts and beliefs. The psychoterapy for cancer patients must have in view the following: the stage in the development of the disease, other mental and somatic symptoms, chances of survival, type of personality, the patient s degree of suggestibility, the set of values and attitudes, emotional reactions (depression anxiety, hopelessness), the support of society and family, the patient s short, medium and long term goals, the patient s life style, present or past stress factors. The objectives of the psychotherapy are: (1)The diagnosis to be accepted (2) Revive the patient s hope (3) Therapy for the emotional problems (depression, anxiety) (4)we used relaxation, hypnosis and cognitive-behavior methods (5) Make the patient accept the treatment and increase his abilities to tolerate the side effects (6) Offer the option of an alternative treatment, Reshaping the patient s life goals (7) Stimulate the immunologic system of the body by mental trening and hypnosis (8) Pain combat, using direct and indirect suggestion, metaphores, dissotiation, time distortion and self-hypnosis. A clinical case is presented. BEHAVIOURAL TREATMENT FOR LOUD NOISE PHOBIA IN THE MINIMAL RESOURCES: A SUCCESS PARENTAL INVOLVEMENT Dr. N. Mat Zin¹, A. Razali² and S. Noerdin³ ¹ Psychiatrist and Lecturer, Psychiatry Dept., International Islamic University MALAYSIA ² Audiology Unit, International Islamic University ³ ENT Dept., Kuantan Specialist Hospital, MALAYSIA Background: Loud noise phobia or ligyrophobia is one of the specific phobias occur in children. Like any other phobias, behaviour therapy is one of the effective treatments. Objectives: To illustrate a case of anxious ten years old girl who developed loud noise phobia which was triggered by explosion from firework since she was eight years old. It was severe enough to make her anxious and fearful to any sudden loud noise. It was not only disturbed her but also disrupts family routine as they have to avoid many social activities. The effectiveness and limitation of behaviour therapy and the importance of parental motivation in treatment of childhood phobic disorder will be highlighted in this paper. Methods: Behaviour therapy using systemic desensitization technique was commenced. Limited resources did not stop the treatment process as her parent was educated to act like a co-therapist. Her parent successfully exposed her gradually to the different level of noise. Her clinical progress was recorded. She was able to eliminate the phobia and felt the joy in her life. Conclusion: In the limited resources, strong motivation and support from the parent is a key success in treating children with phobic disorder. NEW TECHNIQUES TO OPTIMISE COMMUNICATION IN SHORT TERM PSYCHOTHERAPIES Prof. I. Holdevici Prof., Psychology & Educational Sciences Dept., Bucharest University, ROMANIA An efficient therapist-client communication is essential since it helps reduce resistances and facilitates both the therapy and the counselling. Some cognitive-behavioural or eclectic methods used in short term therapies are to be found bellow. These methods are based on Milton Erickson's therapeutic approach and the neurolinguistic programming (NLP): Peacing and leading. The therapist will imitate, as in a mirror, the client's non-verbal behaviour: his posture, mimic breathing and talking and speaks to him about his favorite topics. In order to make a good tandem with the client, it is highly recommended that the therapist should make use of the client's system of representations. The concept of the system of representations was elucidated by Bandler and Grinder, the founders of the neurolinguistic programming (NLP) in The above mentioned authors have noticed that when processing information, people favour unconsciously the use of one of the basic representations: sight, hearing or kinesthetic. There are two ways of finding out which is a person's system of representation: 1) To observe the predicates used by the client 2) Watching the eye-ball movement. Indirect suggestions: The indirect suggestions are addressed to the unconscious psyche, that is to suggest the client something he is not aware of. The benefit of indirect suggestions lies in the fact that they shun the client's opposition. The most important indirect sugestions are metaphores, implicit messages and double binds. Clinical case is presented. THEATRE PLAYING IN THE MANAGEMENT OF PSYCHIATRIC DISORDERS Prof. M.Y. Rakhawy Associate Prof., Ph.D., Psychiatry Dept., Cairo University, Kasr Al Aini Hospital, Cairo, EGYPT 3

4 Acting and theatre playing have been used by art therapists and mental health professionals as part of a structured, goal oriented psychotherapeutic process. This experience was applied in Egypt for the second time in a day centre that admits adolescents and adults psychiatric patients. The idea of the play and the different roles were invented by the treating staff to put different roles tailored to every sharing patient aiming at helping in his therapeutic plan. Patients shared in playing, singing, writing the script, inventing the lyrics of the songs, decorating the theatre and choosing the appropriate clothes. Participants were divided into two groups, The music and the play group. The first group consists of 2 music therapists, 2 psychiatrists and 4 patients having the following diagnoses: borderline personality disorder, residual schizophrenia, bipolar disorder and schizoid personality disorder. The second group consisted of 5 psychiatrists, 1 psychologist, 2 staff members, 2 volunteer children and 11 patients having the following diagnoses: 2 ADHD, 2 paranoid schizophrenia, 1 borderline personality disorder, 1 obsessive compulsive disorder, 1 major depressive disorder, 1 adjustment disorder with mixed depression and anxiety, 1 body dysmorphophobic disorder, 1 borderline personality disorder and schizoid personality disorder. The rehearsals and the play were video registered (quotations will be presented in the presentation). Consents were taken from all participants for registration and scientific presentations using the act. Participants were asked to write their own comments immediately and 3 months after the play. Clinical follow-up was done. Positive outcome was obtained to nearly all participants. Further future follow-up is recommended. Conclusion: theatre playing is a concentrated integrative psychotherapeutic approach that - through role playing, group interaction and task accomplishment - indirectly involves intellectual, behavioural, psychological and social domains that can encompass other individually oriented psychotherapeutic modalities. PARADOXES OF MINDFULNESS D. Masler¹, Dr. A. Suarez², and Prof. D. Kerr³ ¹ M.L.I.S., School of Applied Psychology, Counseling & Family Therapy, Antioch University., Seattle, USA ² Ph.D., M.S.C.P., Core faculty, School of Applied Psychology, Antioch University ³ Ph.D., Associate Prof., College of Psychology & Behavioral Sciences, Argosy University, Seattle, USA. Currently mindfulness and meditations are among the most used and studied bio-psychotherapeutic approaches in the West. Originally they were ancient spiritual disciplines of enlightenment. In coming to the West, the context and technical transformations suffered by these approaches has been dramatic. This presentation will address some of the paradoxes created by the translation and adaptation of mindfulness to fit into the Western intervention paradigm. The purpose of the presentation is to enable Western providers to avoid some of the common misunderstandings associated with the Western use of mindfulness. This paper will address some of the common English mis-translations of the term mindfulness from the Pali and Sanskrit, and elucidate some of the implications of Eastern encouragement of radical acceptance for a pathology-based paradigm. It will look at the differing linguistic context and its influence on the way meditation and mindfulness are used and approached in the West, particularly in its adaptation for Dialectic Behavior Therapy and Acceptance and Commitment Therapy. The fundamental understanding of the contextual differences will enable psychotherapists to avoid providing incomplete or misleading instructions to their clients and also avoid unexpected consequences of the long-term use of mindfulness interventions. SYMPOSIUM: Autism & Asperger s Syndrome EARLY INTERVENTION IN AUTISM Prof. M.J. Buceta Cancela¹ and D.G. Nedelcu² ¹ Professor, Evolutionary Psychology Dept., Psychology Faculty, University of Santiago de Compostela, SPAIN ² Investigation Scholar, Evolutionary Psychology Dept., Psychology Faculty, Univ. of Santiago de Compostela Should we use an approach of intervention of exclusive form to an early age? Having in account the diversity of manifestations that are observed inside the spectrum of the autism we give a major importance to the process of choosing the right approach of intervention. For this reason, in the Unit of Early Attention of the Faculty of Psychology of Santiago de Compostela we choose from a selection of a variety of skills (Pivotal Response Training, PECS, TEACCH, etc.) depending on the needs of the child. From this perspective we have proposed to analyze the effects of the intervention throughout one year in the case of 6 children diagnosed of Autistic Disorder (5 boys and a girl) with ages between 1 year, 7 months and 3 years. We have used analysis of video recording to know how to target the application of tests like: Gilliam Autism's application Rating Scale (Gilliam, J.M., 1995), Autistic Spectrum Inventory (Riviére, A., 1997), Battelle Developmental Inventory (Newborg and cols. 1984), and Brunete Lezine Scale (Brunet and Lezine, 1971). We have concluded that though the scientific literature does not support the eclectic methods, which are based on a continued evaluation, these interventions adjust better to the strengths, needs and characteristics of the child, the family and the services. CHILDREN S AUTISM AND DUANE SYNDROME CASE REPORT Dr. E. Fourlani¹, Dr. Th. Syriopoulou², Dr. Ch. Deseri³, Dr. E. Michael⁴ and Dr. E. Karahanidi⁴ ¹ Pediatrician, General, Maternal and Pediatric Clinic Mitera, Athens, GREECE ² Pediatrician, Consultant, Kalamata General Hospital, GREECE ³ Pedopsychiatrist, Center for differential diagnosis and counseling, Thessaloniki, GREECE ⁴ Pediatricians in training, Kalamata General Hospital, GREECE Introduction: Children s autism constitutes psychosis due to disturbance of cerebral development; it appears by birth and remains in different degree and intensity during life. It often coexists with relative ophthalmologic disorder, as the Duane syndrome (congenital retraction syndrome, a special form of strabismus). Case description: Boy four years old, 4

5 with normal physical growth for his age and sex, avoids eye to eye contact particularly in the beginning of medical evaluation, has strabismus and slight loxia visible at the erect position, shows echolalia, presents verbal and behavioral stereotypes and walks on toes. Recessive Kinetic activity in reference to his age and growth (gross and delicate mobility). Parents described him as a shy, well perceptive child not making any sounds at 14 months of age, did not speak while 18 months, presented deceleration of stages of gross Kinetic growth walked in the age of 2, without an aggravated pre-perinatal background. Ophthalmological examination showed finding compatible with Duane I syndrome, weakness of adduction, rima palpebralis stenosis and eyeball effusion during adduction and coping with caligo which correcting hypermetropia decreased the existing esotropia in the primary position improving the compensatory position of the head as well. Hearing control showed deafness 10%. It was diagnosed with Pervasive Development Disorder. The child followed intensive and continuous educational programs (logotherapy, behavioral therapies) showing improvement in certain sectors. Conclusions: Suspicion of existence of autistic syndromes should be evoked in parents when the child reaches 14 months and does not make sounds, or reaches 18 months and does not speak. The Duane Syndrome although constitutes an individual finding, can coexist with autism and other systematic abnormalities (deafness). The coexistence of occular and systematic disorders - although not often found imposes the detailed ophthalmological and general examination of young patients. THE DEVELOPMENT OF THE ATTACHMENT IN CHILDREN WITH AUTISTIC DISORDER D.G. Nedelcu¹ and Prof. M.J. Buceta Cancela² ¹ Investigation Scholarship, Evolutionary Psychology Dept., University of Santiago de Compostela, SPAIN ² Professor, Evolutionary Psychology Dept., Psychology Faculty, University of Santiago de Compostela One of the criteria of diagnosis of the Autistic Disorder is constituted by the difficulties of social relation both with the relatives and with the children of the same age. Nevertheless, along the history, difficulties of relation have been observed between these children and their parents as they passed from speaking about the "The Empty Fortress" (Bruno Bettelheim, 1967) to speaking about a disability of understanding the mind of the others, etc. The study proposes to analyze the type of link in a sample of 6 subjects (5 children and a girl), with ages between 1 year and 11 months and 3 years diagnosed of Autistic Disorder across the recording of the " Strange Situation " used in the standard form of Ainsworth, Blehar, Waters closet and Wall (1978). It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachment insecurity. TEACHING CHILDREN WITH AND WITHOUT AUTISM LABELS FOR OBJECTS AND COLOURS: LINKS TO THEORY OF MIND PERFORMANCE I. Manola¹ and Dr. C.G. O Hanlon² ¹ Ph.D Student, Institute of Neuroscience, Newcastle University ² Lecturer, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK While several studies suggest that linguistic abilities are dependant on Theory of Mind (ToM) skills (Happe, 1993; Origgi and Sperber,2000), some recent literature reports that language can facilitate Theory of Mind skills (Dunn, 1991; Mains, 2002). The aim of the current study was to examine whether knowledge of the names for the objects used in experimental tasks facilitates making inferences about another s mental state (preference). Furthermore, we investigated whether autistic children s preference for colourful environments and objects, as known on an anecdotal level, might help perform on ToM-type tasks. Children with and without autism were either taught or not taught 3 low frequency colour labels (beige, teal, mauve) by ostensive definition. A simple game using 3 low frequency colour pencils was used to examine whether knowledge of the names for the colours facilitated inferring the experimenter s favourite colour. The same procedure was implemented with novel objects. Our results show that knowing the label of the objects of interest within context supports performance on a theory of mind type task (inferring another person s preference). Furthermore, children with autism seem to benefit from the use of colours, and are especially facilitated in this ToM-type task when provided with a label for a colour. Evidence of colour facilitation can be exploited to boost learning in children with autism. VERBAL MALTREATMENT IN CHILDREN WITH LEARNING DIFFICULTIES AND ITS CONSEQUENCES IN THEIR QUALITY OF LIFE. Dr. Th. Syriopoulou¹, Dr. E. Karahanidi², Dr. E. Michael², P. Gouveris³, Dr. P. Giannakopoulou¹, Dr. E. Fourlani⁴, S. Sereti⁵, A. Vraka 6 and Dr. N. Karli⁷ ¹ Pediatricians, Consultants, Kalamata General Hospital, GREECE ² Pediatricians in training, Kalamata G. Hospital ³ Tutor, Mental Health Center, Kalamata G. Hospital ⁴ Pediatrician, G. Maternal & Pediatric Clinic Mitera, Athens ⁷ Psychologist, Kalamata G. Hospital 6 Social worker, Kalamata General Hospital ⁷ Director of Pediatric Dept., Kalamata G. Hospital Introduction: Social epidemiology of marginalisation of children with learning difficulties changes rapidly. The UN Treaty of children s Rights establishes their rights for education and protection (verbal maltreatment, discrimination) and determines the measures that should be taken to promote and guarantee them. Aim: Investigation of frequency of children with learning difficulties that suffered verbal maltreatment and recording its consequences in their life. Methods: In cooperation with parents and health professionals (psychologist, social worker, tutor), we investigated 5

6 (interviews and information from health books) the frequency of verbal maltreatment incidents and its consequences (mental and physical) in their quality of life. Results: We focused in 83 children, 46 boys and 37 girls, 5-12 years old, with deficiency in cognitive sectors. In the behaviour towards the children verbal maltreatment was observed in 63 Children (76%). From the psychism factors that were examined, the following rates of frequency were formed: weakness in elaboration of sentiment (11%), insecurity (8%) disfunctional family relations (33,3%), stress (12,7%), low selfconfidence in relation to school courses (11,1%), unfavourable interpersonal relations (8%). Anger towards the teachers was observed (9,5%) as well as disappointment regignation (6,3%). As far as the body s concered abdominal pains were detected in (22,2%), headaches (14,3%), dermal exanthemas (3,2%), digestive problems (17,5%), nausea (11,1%), dyspnoea (3,2%). Conclusions: Increased frequency of verbal maltreatment in children with learning difficulties and wide spectrum of mental and physical symptoms were observed. Verbal maltreatment in these children has negative effect in their healthy growth. Stable and affectionate family environment, coverage of cultural needs (recognition, respect of developing skills), suitable guidance and support, freedom of discrimination and biases, contribuie to their healthy growth, which is critical for every society s future prosperity. SYMPOSIUM: A Psychological Perspective for the Economic Crisis HOW NOT TO CRASH WHEN THE MARKETS ARE CRASHING: A PSYCHOLOGICAL PERSPECTIVE. COPING STRATEGIES TO EFFECTIVELY FACE THE CRISIS. Dr. G.G. Thanopoulou Papakonstantinou¹ and M. Protopapa² ¹ PhD, EdM., MA Harvard University, Counseling Psychologist, ISA Counseling Center Dir., Athens, GREECE ² M.Sc., Counseling Psychologist, ISA, Athens, GREECE This paper presentation will focus on the psychological and social effects of the current international, financial crisis on families, individuals, children and relationships and how, we, as counseling psychologists can support through effective counseling and therapy. We can help individuals and families to face their difficulties and successfully survive the crisis by helping them to re-evaluate their priorities and old ways of thinking and acting, by supporting them to rethink their life values and relationships and to re-establish new moral life values and habits. Only through this way, individuals can face and effectively survive this, and any, crisis and develop ethically, psychologically, personally and interpersonally. We will analyze the crisis from a psychological perspective and refer to the work of important psychologists and intellectuals of our times that have examined crises and people s reactions and have suggested successful ways to cope. We will present the crisis as a warning bell, a wake up call, an opportunity for growth and development and a return to what really matters. We will emphasize on the psychological and psychosomatic effects of the crisis on adults, children, families and relationships, in general. We will propose some important coping strategies in order to overcome and survive the crisis from a psychological point of view, through effective therapy and counseling. Finally, we will close by emphasising on the importance of connection, communication, collaboration and positive exchange of energy as driving forces for dealing with crisis and bringing effective change. SYMPOSIUM: Schizophrenia, Bipolar Disorders and Borderline Personalities FACTORS OF THE EFFECTIVENESS OF PSYCHOTHERAPY WITH BORDERLINE NARCISSISTIC PATIENTS. Dr. E.T. Sokolova Neuropsychology & Pathopsychology Dept., Lomonosov Moscow State Univ., RUSSIA For the purpose of prevention premature interruption of psychotherapy, the diagnostic and screening of clients with borderline-narcissistic personality organization have to constitute independent direction of consulting practice. In particular this task may be implemented by elaborating the appeal motivation, through specifying and estimating realistic expectations of inquiry, and an opportunity of establishing working alliance serve as a clear measure for such task. Thus purpose of self-perfection and personality growth presented by a client often appears as a defensive masking of destructive self-attitude and perfectionism and indicates that the direct assistance request is impossible and therefore subjectively associates with weakness admitting and causes narcissistic wound experience. Exactly those merits of psychotherapeutic communication, that are associated with positive alterations in therapy, are seriously damaged by these patients, and therefore the reliability of therapeutic relations is impaired, their curative capability and effectiveness of psychological assistance are reduced. We mean their inability to establish and maintain relations with therapist, pending a long period of time, overt, confidential and suffused with responsibility, despite frustrations and deprivations that are native for therapeutic process and caused by its organizational and ethical frames as well as by dramatic experiences attending its dynamic. The lack of symbolization restricts capability of using transforming force of imagination and curative force of word for containing and detoxicating traumatic emotional experience. Insufficient capacity for recognition, rational thinking and reflection constrains the acceptance of figurative sense and conditionality of psychotherapeutic situation. It also provokes impulsive and poorly controlled regressive transfer of archaic infantile (and traumatic) models of self-experience and self-perception in relations with therapist that is seriously threatens preservation of psychic integrity. Extreme attitudes of sticking dependence and hostile selfisolation with primitive defenses (split, denial, projective identification, grandiosity) disrupt stability of psychotherapeutic relations, logical consistence and coherence in elaborating personality conflicts. Superiority value of self-defense over value of self-alteration throws light on one of the reasons of stubborn resistance to positive alterations ( negative therapeutic reaction ) that leads to destruction of psychotherapeutic relations and their premature breaking. Psychotherapeutic and consulting assistance to people with such identity characteristics should take into account personality features of clients, combining vulnerability of self-esteem with the limited access to assistance acceptance due to a defensive depreciation of their own efforts and distrust to other. 6

7 CHALLENGES IN WEIGHT MANAGEMENT AND BEHAVIOURAL MODIFICATION AMONG OBESE SCHIZOPHRENIA PATIENTS. Dr. A.R. Asrenee¹ and Dr. A. Kartini² ¹ Psychiatrist and Lecturer, Psychiatry Dept., University Sains Malaysia, Kelantan, MALAYSIA ² Psychiatry Dept., International Islamic University, MALAYSIA Background: Obesity has been shown to be prevalent in adult patients with schizophrenia. Antipsychotic induced weight gain occurs in up to 50% of patients who are prescribed with these drugs. In tackling this obesity problem, weight management and behavioural modification is one of the effective treatments. Objectives: To assess the knowledge, attitude and practice towards weight management and behavioural modification among obese schizophrenia in our centre. The challenges of of this program will be highlighted in this paper. Methods: A module of wellness programme that include education about healthy eating, physical activity, self-esteem, meal planning, activity scheduling, motivation.with combination of aerobic exercise was commenced in a group of obese schizophrenia patient. The changes on knowledge, attitude and practice of the participants towards the behavioural modifications were then assessed. Conclusion: The effectiveness of the weight management programme is not only on weight change, but the change on knowledge, attitude and practice of the participants towards the behavioural modifications is equally important to make this weight management behavioural programme into a meaningful and successful programme. A COMPARISON OF LIFE EVENTS IN PATIENTS WITH ADULT-ONSET UNIPOLAR DISORDER, ADULT-ONSET BIPOLAR DISORDER AND CONTROLS Dr. N. Horesh Ph.D, Psychologist, Senior Lecturer, Psychology Dept., Bar- Ilan University, ISRAEL Objective: The present study aimed to explore the association between stressful life events (LE) and the development of affective psychopathology. Method: Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls as regards the rate of stressful LE. Assessment measures included the Beck Depression Inventory, the Adult Life Events Checklist and the Childhood Life Events Questionnaire. Results: The entire sample of affective patients had more LE in general, more negative LE and more loss-related LE in the year preceding their first depressive episode as compared to normal controls. Subjects with unipolar disorder had more positive LE and more achievement LE, whereas subjects with bipolar disorder had more uncontrollable LE in the year preceding the first depressive episode. The relationship between LE and manic episodes was prominent in the year preceding the first manic episode, with bipolar subjects reporting more LE in general and more ambiguous events in that year. Almost no significant differences on LE frequency were observed in the year prior to the last depressive and manic episodes in the unipolar and bipolar patients' groups. A significant relationship was found between childhood LE and the development of affective disorders in adulthood, with unipolar patients exhibiting less positive and achievement LE. Conclusions: The major impact of LE on the onset of affective disorders was found in the year prior to the first depressive or manic episodes, in the unipolar and bipolar groups. This suggests that the accumulation of stressful LE at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis. SYNDROME OF CAMBYSES-VAN GOGH AMONG PATIENTS WITH SCHIZOPHRENIA ASSOCIATED WITH ALCOHOLISM WHO COMMITTED HEINOUS CRIMINAL ACTIONS. Prof. O.A. Dvirsky, MD. Psychiatry Dpt., Crimean Medical State University, UKRAINE Purpose: description and evaluation of frequency of Cambyses-Van Gogh among patients with schizophrenia comorbid with alcohol who committed criminal actions. Methods: clinical, catamnestic. Results: since the interpretation of Van Gogh syndrome (H.Abram, 1966) is too wide, we suggest the term syndrome of Cambyses- Van Gogh to describe brutal hetero and/or auto aggressive actions, committed by patients suffering from schizophrenia with latent or manifested epilepsy comorbid with alcoholism. The term uses the name of Cambyses II of Persia notorious for his atrociousness. Traditions (preserved to us by Herodotus and other Greek authors) want this Persian ruler ( B.C.) as a person possessed by madness, who committed a lot of cruel non motivated crimes, murders. According to Herodotus he was a great madman and drunkard, suffering from epilepsy as a child. Cambyses tortured with particular brutality Egyptian aristocrats, spanked priests and defiled a mummy of Egyptian king. He ordered execution of his own brother Smerdis after he saw him at his own throne. Cambyses murdered his older sister, with whom he got married first. He also forced his second sister to sexual relationship. When she got pregnant he mocked and taunted her and afterwards murdered. All his behavior shows, that he suffered from schizophrenia. Mental derangement of illustrious artist Vincent Van Gogh ( ) with widely known hetero- and autoaggressive actions was qualified as schizophrenia as well (K.Jaspers, 1922, H.Gastaut, 1956; K.Leonhard, 1988; M.I.Bujanov, 1989). He also had a latent epilepsy associated with alcoholism (A.Dvirsky, 2004). We examined 74 patients with schizophrenia comorbid with alcoholism, who committed murders, inflicted grave physical injuries sexual crimes (incest) and also autoaggressive actions. At 6 patients (8.1%) these listed actions were particularly heinous and matched the profile of syndrome of Cambyses-Van Gogh. In 5 cases among those in anamnesis very rare though epileptic seizures were revealed and in 1 last case relatives had epilepsy. Conclusion: Thus we describe a new eponymic term, syndrome of Cambyses-Van Gogh among patients with schizophrenia comorbid with alcoholism who committed gravy hetero aggressive and sexual crimes. The above described syndrome seldom revealed among patients with schizophrenia who committed severe criminal actions. 7

8 SYMPOSIUM: Children s Mental Health and Parental Influences THE IMPACT OF PERCEIVED PARENT S AUTHORITY STYLE ON PREADOLESCENTS SOCIAL PERCEPTION ACT OF THE AFFILIATION GROUP Dr. R. Urea Lecturer PhD, Special Education Dept, Psychology & Educational Sciences Faculty, Bucharest Univ.,ROMANIA In the same manner as the continuum model of impression that is on based the social perception act (Fiske R,.Neuberg. L, 90) the perceived parent s authority style can be define as a manner of a continuum evaluated process realised by the children and can be reveal through the following aspects : the perceived level of autonomy allowed by mother and allowed by father, the perceive level of father s and mother s authority, the perceived level of imposed father s and mother s daily routine, the perceived father s and mother s level of children s control activities. Therefore, we made an investigation that has had the aim to reveal the specific of the influence of perceived parent s authority style on preadolescent s act of perception of the affiliation group; We used in our research the following investigation methods: Family test and three quizzes, created for Romanian preadolescent population: The T Quiz, The M Quiz, and Social Perception for Affiliations Group Quiz. The results had revealed some basic criteria of the social perception act of parent s authority style; The conclusion, which came through from this research, is a specific typology of the influences of parent s authority style on preadolescent s social perception act on the affiliation group. MENTAL HEALTH OF REFUGEE CHILDREN IN WESTERN COUNTRIES: A SYSTEMATIC REVIEW. R. Bronstein and Prof. P. Montgomery Centre for Evidence Based Intervention, University of Oxford, UK. Background: Nearly half of the worlds 9.9m refugees are children, large numbers of which claim asylum in Western countries including Australia, North America, and the European Union. These children have experienced events such as war, destruction of their homes, separation from primary care-givers, loved ones, and social networks. It is reasonable to suggest that they may experience great levels of psychological distress. While there are a numerous studies regarding the mental health of these children, as yet no systematic synthesis of the findings has been conducted. This study is the first such review concerning the mental health epidemiology of children and adolescents claiming asylum in the countries of the Organisation for Economic Cooperation and Development (OECD). It aims to systematically review the epidemiological evidence concerning the mental health of these children in order to establish an evidence base regarding their psychiatric morbidity. Methods: To generate the widest possible search, a sensitive search was employed in nine major databases covering a spectrum from psychology, psychiatry, and social studies. In addition bibliographies and grey literature were searched and experts were contacted via . Strict inclusion criteria meant that solely those studies of non-clinical samples concerning refugee children aged up to 24 years, living in OECD countries, and having made a legal claim for asylum were examined. Furthermore, studies had to be of a methodologically high standard and comply with STROBE reporting guidelines. Results: A total of 4807 abstracts were retrieved after removing for duplicates. Of these, 247 full texts were thoroughly examined revealing twenty-two studies which met the inclusion criteria. Young people originated from over 40 countries of origin and the studies were conduced in seven countries of asylum. The definition of psychological distress varied, however there appears to be some consensus regarding the existence of posttraumatic stress disorder, depressive symptoms, and internalising and externalising problems. Reporting was mixed and not all studies reported percentages above the clinical cut-off scores. Of those which did, findings reveal that 19 to 54% of the young people met clinical cut-off levels for posttraumatic stress disorder and 3 to 30% for depression. Results regarding the internalising and externalising were more varied and different levels emotional and behavioural problems were reported throughout. Cumulative risk was strongly identified with greater levels of distress, as were separation from parents, direct violence, uncertain asylum status, and low levels of support. Conclusions: There are high levels of psychological distress in the population of refugee children residing in Western countries. However, a lack of consensus exists regarding definitions and methodological approaches. Few measuring instruments exist which have been developed specifically for this population of young people. Greater investigation is needed in comparing refugee children by contextual groups of refugee status including structural support mechanisms such as their rights and entitlements, country of origin, country of asylum, and accompanied status. The majority of refugee children do not appear to experience psychological difficulty and urgent research is need to highlight and develop those resiliency factors and coping mechanisms. THE EFFECT OF EYE MOVEMENT DESENSITIZATION AND REPROCESSING ON THE PARENTS WHO HAVE MALTREATMENT IN THE CHILDHOOD AND IT REFLECTION TO THEIR CHILDREN N.N. Wadaa Ph.D. Student, Clinical Psychology Dept., University of Science, MALAYSIA Parents maltreatment to children is one of the social and health problems in many countries throughout the world. It may cause a lot of psychological problems in the child life and even it has a lot of side effects when the child grows up. The present study aims to identify the effectiveness of EMDR in reducing symptoms of maltreatment in childhood. It investigates the Arab students children whom age is range between (7-15) years old. It also looks at the relationship between maltreatment in the childhood and the way they treat their own children in the present time. The data are collected through the use of Al-Mukhamieer and Abdul Razaq (2004) questionnaire. A total of 100 university-student informants participated in the study. Their ages are range between (25-40) years old. Moreover, a semi structure interview is designed to meet the children and also they are asked to draw in order to identify whether the children are suffering parents maltreatment at the present time or not. Then 10 participants who suffered from childhood maltreatment are selected to be examined. They are divided into two groups controlled and experimental whom the 8

9 EMDR is applied. After three months the children are met again, it is found that the EMDR has a successful effect on the parents and the way they treat their own children. A WEBSITE PARENTING PROGRAMME TO SUPPORT RESPONSIVENESS TO INFANTS EMOTIONAL NEEDS Prof. C. Curtolo Child & Adult Psychotherapist, Adj. Professor, Clinical Psychology, Verona Univ., ITALY Introduction: The Key Focus of this Parenting Programme is to promote information about Infant Mental Health and to engage caregivers in prevention and promotion projects by a free web-access. According to this purpose, the Recognition Project is a guideline that is based on the discovery of the mother s function in the neuropsychological development so that it aims to improve maternal responsiveness to the infant s stress signals. Aim: To determine whether this Project offered universally in a website can improve a better awareness of infantile vulnerability in mothers and consequently to increase time and emotional quality in their responsiveness. Method: Mothers who connect to the mental health site are given explanation about the issue and the workings of the Programme then they are asked to provide baseline sociodemographic details. Once this has been submitted they can join the Recognition Project for babies and called Ten Emotional Thoughts where the steps are explained. First of all, mothers are asked to complete a questionnaire (baseline parenting style and maternal representation) before they can download the guideline. In the second step, three months later, mothers are asked to fill a self evaluation questionaire of the efficacy of the Ten Emotional Thoughts, particularly about their perception of attuned interactions with the child and their feeling of enjoyment. Results and Conclusions: The study is still in progress. A previous research in a clinical setting has showed the efficacy of the Recognition Project with respect to an increase to a different distribution of maternal interest and sensitivity. TWINS PROJECT: PSYCHOLOGICAL SUPPORT FOR TWINS AND PARENTS Prof. P. Brustia¹, Dr. L. Rollè², C. Garbarini³, E. Gerino³ and E. Marino³ ¹ Professor of Dynamic Psychology, Psychology Dept., University of Turin, ITALY ² Ph.D, Holder of Research grant, Psychology Dept., University of Turin ³ Ph.D Students in Health Psychology, Psychology Dept., University of Turin We know that twin pregnancy percentage is increasingly because twin motherhood is often the result of assisted reproduction or higher maternal age. Therefore Progetto Gemelli (Twins Project) funded by Regione Piemonte gives information to twins and their families and delivers psychological support to mothers and fathers to prevent to risks of being twin, like the couple effect (Zazzo, 1984). Many authors (Agnew, Klein, 2006; Piontelli, 2002) emphasize to the need of a support to twins and their families, right from the start of pregnancy, because it is precociously medicalized and monitored as being risky both for mother and children. To understand what is happening in the minds of twin parents is fundamental (Brustia Rutto, 1996). After a screening about twins (by a questionnaire to all schools of Piedmont), our project involved the activation of informative meetings for parents and for all the people who participate in the family life and it provided educational and informative events for territorial service operators, including nursery, primary and secondary schools. We believe that rightly conducted prevention can remedy a great deal of parental problems, resulting in better quality of couple life and better opportunities of affective and cognitive development for children. Our research work is meant as an indispensable theoretical and methodological foundation to the setting of prevention, information, education and intervention programmes on territory with the collaboration among psychologists and gynaecologists, obstetricians of the Ambulatorio Gravidanze Gemellari at Clinica Universitaria Sant Anna of Turin. DELAYED SELF-SUFFICIENT ADULTHOOD AMONG VICTIMS OF FORCED DISPLACEMENT: CASE OF ADULT CHILDREN IN THE RESETTLEMENT COMMUNITY OF CIBOMBO CIMUANGI (EASTERN KASAI PROVINCE, DEMOCRATIC REPUBLIC OF THE CONGO) Prof. N.K.Z. Bukonda¹, Prof. T.G. Disashi², Prof. J.R. Njue³ and Prof. K. Lee⁴ ¹ PhD MPH,Associate Prof., Public Health Sciences Dept, College of Health Professions,Wichita State Univ,USA ² MD, Prof. and Dean, Medical School, University of Mbuji Mayi, DEMOCRATIC REPUBLIC OF THE CONGO ³ Ph.D., Assistant Professor, Family and Child Studies, School of Family Consumer and Nutrition Science, Northern Illinois University, USA ⁴ Ph.D., Assistant Professor, School of Social Work, Wichita State University, Wichita, USA. Introduction: Numerous publications exist on peoples forcibly displaced from their initial communities and then resettled in brand new or other pre-existing communities, but very little is known on the extent to which forced displacement affects the normal process of human development and particularly sets up victimized families for failure, in the long run, in their role of prompting their children into self-sufficient adulthood. Aims: We assess the extent to which adult children still cohabit with their parents in a resettlement community for peoples of Kasai origin who were forced out of the Katanga province in the mid-1990s. Methods: A descriptive cross-sectional survey of households was conducted in 2005, providing, among other things, data on number, age, and gender of household members. Results: Records from 388 households in which 2589 individuals lived were assembled, representing 13.7% of the population of Cibombo Cimuangi health catchment area (2005) and including 778 parents (32.8%), 997 non-adult children (40.8%) and 628 adult children (26.5%). The average size of each household was 6.7; and the average number of children by household was 4.2. Overall 54.6% of subjects lived in households where adult children were present. The overall average number of adult children in each household was 1.62 (n = 628; S. D. = 2.52). More than half of internally displaced peoples live in highly crowded environment. Households with adult children show a pattern of severe 9

10 crowdedness than households without adult children. Conclusion: A large number of adult children still live with their parents, an indication of their failure to achieve self-sufficient adulthood. COMMUNICATION IMPAIRMENTS IN CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER W.A. Helland¹, Dr. E. Biringer², Prof. T. Helland³ and Prof. M. Heimann⁴ ¹ Ph.D. Candidate, Division of Medicine, Stord Hospital, Helse Fonna, Stord, NORWAY ² Division of Psychiatry, Haugesund Hospital, Helse Fonna, Haugesund, NORWAY ³ Associate Professor, Biological and Medical Psychology Dept., University of Bergen, NORWAY ⁴ Ph.D., Professor, Behavioural Science and Learning Dept., Linköping University, SWEDEN Centre for Child and Adolescent Mental Health, University of Bergen, NORWAY Introduction: Communication disorders are often described in children with Attention Deficit Hyperactivity Disorder (AD/HD), but language related problems are neither among the cardinal features nor required to fulfil diagnostic criteria of AD/HD. Aim: The aim of the present study was to investigate communication impairments in a group of children with AD/HD compared to a group of Typically Developing (TD) children. Method: Fifty-eight Norwegian children aged 6-15 years (M=10.3; SD=2.3) participated. The AD/HD group consisted of 29 children (22 boys) and was matched on age and gender with a TD group. The parents of the children completed a Norwegian translation of the Children s Communication Checklist Second Edition (CCC-2) which consists of 10 subscales. Two composite scores are also derived, the General Communication Composite (GCC) and the Social Interaction Deviance Composite (SIDC). Results: In the AD/HD group communication impairment, as measured by the GCC, was identified in 24 out of 29 children (83 %) compared to only one child in the TD group (3 %). The two groups differed significantly on all subscales of the CCC-2, except the one measuring syntax, as well as on the GCC (MANOVA, p.001). Conclusions: Children with AD/HD are likely to exhibit communication problems relative to typically developing children. These results add to the growing body of research showing that communication disorders are frequent among children with AD/HD. They underline the importance of routine screening of communication to be performed as part of the assessment procedure in children with AD/HD. CHILDREN S MENTAL HEALTH AND THE CONVENTION ON THE RIGHTS OF THE CHILD Prof. K. Covell and Prof. R.B. Howe Children s Rights Centre, Cape Breton University, Sydney, CANADA The year 2009 marks the 20 th anniversary of the adoption of the UN Convention on the Rights of the Child (CRC) by the General Assembly of the United Nations. As the most widely and quickly ratified Convention in world history, the CRC provides a global consensus on what childhood should be. It is a childhood where children are secure in their right to protection from abuse, violence, and exploitation, their right to provision of their basic needs for healthy development, and their right to participation in matters affecting them. The purpose of our presentation is (1) to describe the general relation between the implementation of the rights of the child under the CRC and the mental health of children, and (2) to describe the specific linkage between the education of children in their basic rights and mental health outcomes. We will present the findings from our three-year study of a program of children s rights education in England that demonstrates the health benefits of educating children about their rights under the CRC. In essence, our data demonstrate that when children s rights in education are appropriately implemented and when children learn that they are bearers of rights, there are significant improvements in children s social relationships, self-esteem, hope for the future, school engagement, and academic achievement. The improvements appear particularly strong among children at risk of adolescent delinquencies, early school leaving, drug use and depression. The implications of our findings for the general link between the CRC and positive child development will be discussed. SYMPOSIUM: Women s Mental Health and Maternity Issues BABY BLUES: A RESEARCH IN PIEDMONT S HOSPITALS. Prof. P. Brustia¹, Dr. L. Rollè², A. Ambrosoli³ ¹ Professor of Dynamic Psychology, Psychology Dept., University of Turin, ITALY ² Ph.D., Holder of Research grant, Psychology Dept., University of Turin ³ Ph.D. Student, Psychology Dept., University of Turin. The aim of this study was to explore the level of baby blues, (which is) a mild and transitory moodiness suffered by up to 11% - 85% (O Hara et al. 1990) of mother during two weeks after delivery. Data were gathered from 215 mothers 4 days postpartum in a sample of women in Piedmont. Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden, Sagovsky, 1987) was used to screen the depressive postpartum symptomatology. First analysis show that 36,4% of women presented an high score to the EPDS (Benvenuti et al. 1999). Total score at EPDS significantly correlated to others events of depression (r Pearson = 0,208, p<0,05). Past events were associated to depressive symptoms fundable in relatives (r Pearson = 0,316, p<0,01) and in partner (r Pearson = 0,440, p<0,01). Both these factors were significantly correlated to a high score at the EPDS (respectively: Tau-b = 0,240, p<0,01 e Tau-b = 0,165, p<0,01). The 58.1% of women have not received any support by their mother during pregnancy and delivery. Beside 44.7% of the women with an high score at the EPDS received support by their mother. In relation to data is clear the importance of taking charge soon, in a moment so delicate as puerperium. These charges could have positive effects on different levels in Health Care like the primary prevention. 10

11 THE DOMESTIC VIOLENCE EXPERIENCES OF WOMEN IN LIMPOPO PROVINCE OF SOUTH AFRICA Prof. L.B. Khoza¹ and F.C. Madzimbalale² ¹ Professor, Professional Registered Nurse, Head, Advanced Nursing Science Dept., Venda Univ., S. AFRICA ² Nursing Tutor, Health and Social Development Dept., Limpopo College of Nursing, SOUTH AFRICA Introduction: Literature provides evidence that violence against women is present in every country, cutting across boundaries of culture, class, education, income, ethnicity and age. Literature and the media report that women suffer physical violence, socio-economic, sexual and psychological trauma from their male partners. Males who are or have been in positions of trust, intimacy and power usually perpetrate violence in the domestic sphere. They can be husbands, boyfriends, fathers, stepfathers or other relatives. Women are exposed to domestic violence particularly in the rural communities of Limpopo Province where this study was conducted. Aim: The aim is to increase understanding of women s experiences in the context of domestic violence and how it affects their mental health. Methodology: The study followed qualitative exploratory design to seek answers on the research question: What are the domestic experiences of women in the Vhembe district of Limpopo Province, South Africa? And what psychological effects do they experience as a result of domestic violence? In this study 12 women admitted in Unit A of a particular hospital were individually interviewed. Results: From the data that was collected the following types of violence emerged as experiences of physical violence; psychological/emotional; economic; social and sexual violence that affected their mental health. Participants expressed that their experiences resulted in imbalance in health and wellness that were characterised by depression; post-traumatic stress disorders; anger; anxiety and humiliation. Conclusion: The study findings provide an indication that prevention of domestic violence is critical to seek to change cultural norms and laws that encourage violence against women. WHO ARE THEY? ABUSERS OR STRESSED MOTHERS? Prof. D.O.B. Lam Associate Prof., Social Work and Social Administration Dept, Univ. of Hong Kong, H.KONG Introduction: In Hong Kong, parents could be prosecuted for physical punishment applied to the children. Yet to many Chinese parents, physical punishment is just a matter of child discipline. A study was done on parental anger which often precedes use of violence. Aim: The study was launched to understand what triggers parents anger and the possible factors that influence abusive parental behaviour. Method: In depth interviews were used for data collection in this study. Thirty mothers were interviewed on their anger experience in parenting. They came from three sources: ten mothers not known to have any parenting problem were recruited from a community centre, ten mothers who had sought voluntary counselling on parenting problem were recruited from family service centres, and ten mothers were recruited from organizations serving abusive parents. Results: All interviewees reported angry experiences in parenting and some use of physical punishment. Only some were known for intervention while some were not. Anger triggers and forms of anger expression were shared in the interviews. From the stories of the respondents, the stress of these mothers was well reflected and the stressors were very much cultural based. Abusive mothers tended to be heavily stressed and they had less support. Different effects of different influencing factors were analyzed. Conclusion: Many mothers who are considered abusers due to the application of physical punishment are very responsible mothers. To help the children, we need to render more support to these mothers so that the children could be ultimately benefited and a healthy parent child relationship restored. RELATIONSHIP OF PREGNANCY ANXIETY IN ITS DIFFERENT PERIODS AND SEXUAL SATISFACTION F. Hosseini Tabatabaee¹ and M.M. Ghadimi Moghaddam² ¹ Faculty Member, Prash Research Institute, Islamic Azad University Torbat-e-Jam, Mashhad, IRAN ² Managing Director, Prash Research Institute Objectives: The aim of this research was to study the pregnancy anxiety in its different periods cosidering the related demographic factors. Method: In a descriptive cross-sectional study, 384 pregnant women in the city of Mashhad, Iran, were selected using convenience sampling. This sample was evaluated using Pregnancy Related Anxiety Questionnaire (PRAQ), Golombok-Rust Inventory of Marital Status (GRIMS), and Demographic Information Questionnaire. The gathered data were analyzed using descriptive statistics, univariate analysis of variance, Pearson correlation coefficient, T-test and stepwise regression analysis. Results: the rate of pregnancy anxiety was high in the first and third trimester and low in the second trimester. Stepwise regression of analysis showed that pregnancy anxiety has a relation with sexual satisfaction (P<0.001), age (P<0.001), and education (P<0.001). Having unsuccessful pregnancy increases the pregnancy anxiety rate. Conclusion: Planning preventive and supportive programs for pregnant women is necessary. THE INTER-RELATIONSHIP BETWEEN ANXIETY AND DEPRESSION DURING PREGNANCY AND THE EARLY POSTPARTUM: A PROSPECTIVE STUDY Dr. H. Skouteris¹, ², Prof. E. Wertheim¹, ³, S. Rallis⁴, Prof. J. Milgrom¹, ³ and Prof. S. Paxton¹, ³ ¹ Psychologist, Melbourne ² Research Fellow, Psychology Dept., Deakin University, Melbourne, AUSTRALIA ³ Professor, Psychology Dept., Deakin University ⁴ Research Assistant, Deakin University Introduction: Whilst antenatal anxiety has been shown to be a risk factor of postnatal depression, it is not clear whether antenatal depression predicts the development of anxiety. Given that antenatal anxiety is a risk factor not 11

12 only for postnatal depression but also for greater fetal activity, low birth weight, and poorer child development, understanding risk factors of antenatal anxiety is of clinical importance. Aim: To explore the prospective relationship between depressive symptoms and anxiety across pregnancy and the early postpartum. Method: Participants were 207 pregnant women who completed the State-Trait Anxiety Inventory Trait subscale, the Beck Depression Inventory, a social support measure and a sleep quality measure at two time points during their pregnancy (mean gestation weeks:18.32 and 34.63) and once in the early postpartum period (mean weeks post birth: 7.05). Results: After accounting for the relative stability of anxiety and depression over time, depressive symptoms earlier in pregnancy predicted higher levels of anxiety in late pregnancy and anxiety in late pregnancy predicted higher depressive symptomatology in the early postpartum. A bi-directional model of depression and anxiety in pregnancy was supported. Conclusion: Our findings suggest the a cycle of co-morbidity exists whereby depressive symptoms earlier on in pregnancy precede the development of higher levels of anxiety latter on in pregnancy and that anxiety at this time, even at non clinical levels, predicts higher depressive symptoms soon after birth. Clinicians are advised to screen for anxiety and depression concurrently during pregnancy. SYMPOSIUM: Cognitive & Physical Impairments CHALLENGES OF INTERNATIONAL COGNITIVE, PSYCHIATRIC, GENETIC, IMAGING RESEARCH: THE PREDICT-HD STUDY Prof. J.S. Paulsen Prof. of Psychiatry, Psychology, Neurology & Neurosciences, Carver College of Medicine, Iowa University, USA Introduction: Despite genetic and pharmacological progress in our understanding of the brain, few advances have been made in treatments. Clinical research is being conducted to more rapidly translate scientific findings into making differences in health care. Aim: PREDICT-HD is a clinical research study initiated in 2002 that follows over 1000 healthy persons at risk for a dominant genetic neurodegenerative disorder, Huntington disease. To provide the most relevant research sample, sites were recruited from around the world, and the study is currently being conducted in seven countries. The primary aim of the study is to examine and develop methodologies, measurements, and designs for future clinical trials in brain disease. Method: Each study site recruits participants and conducts annual standardized assessments of cognitive neuroscience, neuroimaging, behavior rating scales of psychiatric symptoms, clinical outcomes, and daily functioning, as well as structured interviews for the same. Blood and urine samples provide data for a repository of possible biosamples. Results: Findings will be presented in two components. First the author will share the lessons learned about multi-site research conducted at 32 sites around the world and how various challenges to reliability, validity, language and cultural translations were addressed. Next, findings will be reported that show how such careful, thorough assessment strategies revealed that brain disease is apparent decades earlier than previously thought. Findings show impairments in brain volume, cognitive skill, mood, olfaction, and subtle motor signs with severity of outcomes associated with proximity to traditional diagnosis. Conclusion: Findings will be addressed in terms related to the conference theme and will emphasize how mental health professionals can advance our field in both science and practice. THE COGNITIVE PROFILE OF THE PERSONS WITH ASPERGER S SYNDROME D.G. Nedelcu¹ and Prof. M.J. Buceta Cancela² ¹ Investigation Scholar, Evolutionary Psychology Dept., Psychology Faculty, Univ. of Santiago de Compostela ² Professor, Evolutionary Psychology Dept., Psychology Faculty, University of Santiago de Compostela, SPAIN As it was demonstrated in the previous studies, the persons with Asperger's Syndrome have a normal or top quotient and in few cases low. Our study proposes to realize a detailed analysis of the cognitive profile of 3 males diagnosed with Asperger's Syndrome with ages of 7 years and 11 months, 11 years and 12 years and 3 months across the Wechsler's Intelligence Scale for children - the IVth (Wechsler, D., 2005). We compare the cognitive profile of our participants after a year of adapted intervention. We observe that the analyzed profile is kept constant in its general characteristics (top development of the memory, of the visual thought centred on details, as well as a low level of the speed of processing, etc.). Simultaneously, the improvement observed in tests that were implying the establishment of similarities, the aptitude to generalize, etc has made us think that though the coefficient of these persons is kept in general lines constant, the changes that are observed after the process of intervention constitute important factors for a better integration and quality of life of these persons. FRONTOTEMPORAL DEMENTIA AND MILD COGNITIVE IMPAIRMENT IN MOTOR NEURONE DISEASE Dr. S. Tsermentseli Research Fellow, Institute of Psychiatry & King s MND Care and Research Centre, King s College London, UK Introduction: Motor Neurone Disease (MND) is a terminal neurodegenerative disorder which causes muscle wasting throughout the body. For many years, MND was thought to affect only the body, with the mind and senses remaining intact. Indeed, much of the patient literature and information in medical textbooks continues to promote this myth. Recent evidence however suggests that MND is a multisystem disorder with a varying presentation and with widespread extra-motor involvement. Aims: The current study sets out to provide a summary of what is known about the cognitive consequences of this neurodegenerative disorder. Methods: A Medline and PsycLit search and a manual search was undertaken, for the years to extract literature on the cognitive changes that occur in MND. Results: Support for a concept of MND as a multisystem disorder has some basis in reports that have highlighted the 12

13 existence of frontotemporal dementia in at least a small percentage of MND patients. A larger subgroup of MND patients however show mild deficits on executive tasks of frontal lobe function such as verbal fluency or set shifting, whereas abnormalities in language and memory are rare but increasingly reported. Cognitive impairment occurs in sporadic and familial forms of MND but not in progressive lateral sclerosis. Patients may present with cognitive deficits before, after, or at the onset of motor neuron disease. Neuroimaging studies have also shown extra-motor cortical degeneration corresponding to levels of frontal executive impairment on neuropsychological testing. Conclusions: The potential clinical and theoretical implications of cognitive impairment in MND patients will be discussed. Understanding of this condition will lead to better care for patients and provide valuable insights into the pathogenesis of neurodegeneration. COMPARISON OF COGNITIVE PROFILE OF NORMAL CHILDREN, MIDDLE AGED AND ELDERLY PEOPLE WITH AND WITHOUT COGNITIVE IMPAIRMENTS. Dr. E. Tsantali¹, Dr. D. Economides² and Dr. S. Rigopoulou³ ¹ Cognitive Neuropsychologist, School of Medicine, B Pathological Clinic, Geriatric Unit of Ippokration Hospital of Thessaloniki / Aristotle Univ. of Thessaloniki, Panagia Hospital, Neurological Clinic,Thessaloniki, GREECE ² School of Medicine, B Pathological Clinic, Geriatric Unit of Ippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, GREECE ³ Panagia Hospital, Neurological Clinic, Thessaloniki, GREECE Background: According to the literature cognitive development increases rapidly in the early years of life, slow down and reach a stable level until 40 decade, after which begins a slow and progressive decline more evident after the age of 65 (Crook, 1989). Aim: Our aim was to investigate the cognitive profile of 7-10 years old normal children and middle aged and elderly people, with no cognitive disorders, cognitive impairment no dementia, or dementia. Method: We assessed the participants cognitive status addressing a brief interview and the Mini Mental State Examination (Folstein, Folstein, & McHugh,1975). Mini-Mental State Examination has been used as a cognitive screening tool not only for elderly people but for children too (Ouvrier, Goldsmith, Ouvrier, & Williams, Rubial-Alvarez, et al.,2007). Our sample was 1265 participants % of the total sample was normal, 16% was demented patients and 25.5 % Mild Cognitive Impairment (MCI) patients. According to the age we separate the participants in 9 subgroups. Results: According to the MMSE performance normal children showed statistically significant difference with normal middle aged and elderly participants aged years old who performed better than children [F(7, 433)=27.9, p=.000]. Though we observed no statistically significant difference between normal children and MCI patients aged years old (p>.050). Additionally, we observed statistically significant difference between the normal children and AD patients [F(8, 262)=15.7, p=.000]. Normal children achieved better performance than AD patients independent of age (MMSE Mean=24.8 and 20.2 respectively). Conclusion: Our results suggest that children s cognitive development, as prospected, has not integrated until 10 years old. Cognitive deficits in MCI patients are objective and not subjective but even more they have a similar cognitive profile with 7-10 years old children. So MCI is a separate clinical entity from mild dementia despite the disagreement of the literature and it is worthwhile to study the rate and range of cognitive decline in elderly MCI and mild dementia people. SYMPOSIUM: Depression PREVALENCE AND SEVERITY OF DEPRESSION IN MOTOR NEURONE DISEASE (MND) Dr. P. Wicks¹, Dr. S. Abrahams², Prof. P.N. Leigh³, Prof. L.H. Goldstein¹ and Dr. S. Tsermentseli¹ ¹ Psychology Dept., Institute of Psychiatry, King's College London, UK ² Psychology Dept., The University of Edinburgh, Edinburgh, UK ³ Clinical Neuroscience Dept., MRC Centre for Neurodegeneration Research, King's College London, UK Introduction: There is an impression both in clinical practice and in research literature that patients with Motor Neurone Disease (MND) possess 'heroic stoicism with a low frequency of depression'. This impression has been reinforced by reports that the prevalence of depression is lower in MND than in several other neurological conditions. Aims: To compare prevalence rates of depression and anxiety in MND using different assessment tools. Method: The Beck Depression Inventory (BDI), The Hospital Anxiety and Depression Scale (HADS) and the Spielberger State-Trait Anxiety Inventory (STAI) were sent to a 12-month consecutive sample of 190 patients with MND attending a tertiary referral Motor Nerve Clinic in London, UK. Results: Using BDI scores, 44% were categorized as not depressed, 37% were mild-moderately depressed, 13% were moderately-severely depressed, and 6% were severely depressed. In contrast, the HADS depression subscale identified 75% as not depressed, 13% were in the borderline range, and 13% were categorized as meeting 'caseness' for depression. Twenty-five percent of the patients were using antidepressant medication. Conclusions: The estimated prevalence of mood disorder amongst patients with MND may vary significantly depending on the measure used. The current findings contradict the impression that patients with MND have a low prevalence of depression. Given the negative impact of depression on quality of life and the potential impact of mood on both patients acceptance of life-prolonging measures and prognosis, the possibility of depression in people with MND should be given due consideration. VAGUS NERVE STIMULATION FOR DEPRESSION: SYSTEMATIC REVIEW AND META-ANALYSIS Prof. J.L.R. Martin¹, E. Martin-Sanchez², S. Lurueña Segovia² and L. Olmo Remesal³ ¹ Head of Clinical Research Dept., Castile-La Mancha Health Research Foundation (FISCAM), Toledo, SPAIN, Applied Research Dept., National Hospital for Paraplegics, Toledo, SPAIN 13

14 ² M.Sc.., Ph.D Candidate, Clinical Research Dept., FISCAM ³ Ph.D Candidate, Applied Research Dept., National Hospital for Paraplegics, Toledo, SPAIN Introduction: Vagus Nerve Stimulation (VNS) therapy involves the implantation of a pulse generator, which is surgically implanted in the chest and connected to a stimulating electrode which is attached to the vagus nerve in the neck. VNS, an already approved treatment for refractory epilepsy, is the first US Food and Drug Administrationapproved somatic clinical intervention for treatment-resistant depression. Short-term open data suggest a sustainable antidepressant response. Aim: To determine the efficacy of VNS in the treatment of depression. Method: We conducted a systematic review and meta-analysis of analytical studies. Two reviewers independently extracted data and assessed quality. Efficacy was evaluated according to severity of illness psychometric scales and by percentage of responders. Results: We identified 135 references, from which we excluded 121. Thirteen before and after studies and one randomized controlled trial met the inclusion criteria. The meta-analysis of efficacy showed a reduction of scores at the endpoint for the Hamilton Depression Rating Scale of -9,281 (95% CI -12,699 to -5,863), p< 0,0001 and the percentage of responders were 31,7% (24,5% to 39,8%), p< 0,0001. Interventions lasted an average of 18,08 weeks. None of included studies reported withdrawals due to side-effects or lack of efficacy. Conclusion: This review detected a significant positive short-term effect of VNS in the treatment of depression in terms of improving the severity of illness. Due to studies design (before and after) it is impossible to quantify the risk of placebo-effect bias. Therefore the results found in this review should be confirmed by randomized controlled trials. COMPARING OF THE FIRST AND SECOND LANGUAGE METAPHORS' APPLICATION FOR COGNITIVE BEHAVIOURAL THERAPY IN BILINGUAL WITH DEPRESSION DISORDER S. Alizadehfard¹, Dr. H. Ahadi², Dr. H. Eskandari² and Dr. H. Ashayeri³ ¹ Ph.D Student of Allameh Tabatabaie University, Tehran, IRAN ² Allameh Tabatabaie University, Tehran ³ Iran University of Medical Sciences, Tehran As a part of a series of studies conducted for a PhD thesis, this research examined the difference between application first and second language metaphors through Cognitive Behavioral Therapy (C.B.T) in bilinguals. C.B.T employs both behavioral and cognitive methods to promote positive changes in depression. Recently there is an increased attention to using metaphors as a key factor. Some theories claim that this affecting is due to the conceptual nature of the metaphor. Conceptual information were deeper processed than perceptual. Thus, metaphors were applied as an effective therapeutic tool. On the other hand, metaphors are strongly dependent to culture. Question remains, however, about the effectiveness of different metaphors from different languages. To answer this question, in this present research, two groups of depressed bilingual (Iranian Azary Turkish) patients were selected to conduct the complete cognitive therapy protocol. The percentage of recovery in two groups, one which received the mother language's metaphors (Turkish) only (n=11) and one which received the second language's metaphors (Persian) only (n=8), was compared. Findings showed that there is a statistically significant difference in the percentage of recovery of two groups and the first one (therapy with first language's metaphors) showed a greater recovery. The implications of these results are discussed with respect to the utility of applying cultural congruent metaphors in cognitive therapy for depression. FLUOXETINE USERS: PSYCHIC AND SOMATIC PERCEPTIONS Prof. J.A.Fantini¹ and E.Biasoli Jorge Vieira² ¹ Professor, Psychology Dept., Universidade Federal de São Carlos, BRAZIL ² Psychologist, Ph.D Student, Universidade Federal de São Carlos According to World Health Organization (WHO), depression affects about 121 million people worldwide. Nowadays, fluoxetine has become extremely popular in the treatment depression. It is also prescribed for treating patients with obsessive-compulsive disorders and it is increasingly accepted as a means for promoting weight loss. This study presents an analysis of university students reflections on the psychic and somatic effects of fluoxetine, based on the literature in the area of psychoanalysis. Participants lived in a town in the interior of Brazil and who had used the drug. The data were collected during two different meetings, using the focus group methodology. It was possible to investigate high expectations regarding the drug using discourse analysis. The data seem to be in agreement with the scientific literature which affirms that emotional feelings derive from chemical reactions that take place in our brain. It is also noteworthy that the subject reported that fluoxetine acts as an emotional damper, considerably decreasing the intensity of the individual s emotional responses. However, with time, the individual feels anxious about not having strong feelings, because emotions are part of what define us as individuals. DISSEMINATION OF COGNITIVE-BEHAVIOURAL THERAPY FOR DEPRESSION TO COMMUNITY MENTAL HEALTH CLINICS: LESSONS FROM TEXAS Prof. M.R. Basco¹, Dr. M. Lopez² and C.R. Thomas³ ¹Ph.D., Assistant Professor of Psychology, University of Texas at Arlington Clinical Associate Professor of Psychiatry, University of Texas Southwestern Medical Center, USA ² Ph.D., Adjunct Professor, Center for Social Work Research, University of Texas at Austin ³ M.S.S.W., Counseling Specialist, Psychology Dept., University of Texas at Arlington Introduction: Evidence-based psychotherapies, such as cognitive behavioral therapy (CBT), have been effective both as individual and adjunctive treatments for major depression, but are not readily accessible. Researchers have attempted to overcome the barriers to dissemination of CBT by examining the feasibility of training community based clinicians in 14

15 the performance of CBT at a level of quality similar to research therapists. Aim: This presentation summarizes efforts to disseminate CBT to 350 therapists in the Texas community mental health system. Therapist competency, patient response, therapeutic alliance, and homework adherence were assessed through questionnaires and direct observation of audiotaped therapy sessions. Results: Master s degree prepared clinicians learned to provide CBT at a level similar to doctoral level research clinicians. The initial pattern of session attendance predicted drop-out. Number and type of homework (cognitive vs. behavioral) were related to outcome with greater adherence for behavioral homework assignments than cognitive assignments. Collaborative working style, based on direct observation of therapy sessions, was a better predictor or treatment outcome than homework adherence. Conclusion: Patient responded well to community-based CBT. Therapy process variables contributed to the prediction of outcome. SYMPOSIUM: Stress and Infertility THE EFFECT OF INFERTILITY DIAGNOSIS AND NEED OF IVF TREATMENT ON THE PERSONAL AND SOCIAL RELATIONSHIPS AS PERCEIVED BY STUDENTS Prof. M.S. Venetikou¹, E. Politi² and A. Vasiliadou² ¹ MD, DipEndo, Ph.D, Endocrinologist-Neuroendocrinologist, Professor of Pathophysiology & Nosology, Faculty of Health and Caring Professions, TEI Athens, GREECE ² RN, Community Nurses, School of Health Visitors, Faculty of Health and Caring Professions, TEI Athens The diagnosis of infertility and the recommendation of IVF treatment, may affect both personal and social relationships of the involved couple. Our aim was to study the beliefs of our students on the above. We developed and assessed a questionnaire on the psychological aspects which may be involved in infertility and the need of IVF treatment. 100 students answered the questionnaire. 53.5% of the students believe that the couple s relationships are negatively affected and 11.3% positively. Only 2% think that it may not be affected at all, and 19% could not answer. The infertility diagnosis, according to 11.3% of the students can affect very much and according to 22.7% much, the ability in work performance. 43.3% of the students believe that work performance can be affected enough. Only 10.3% think that they may be affected only to a lesser degree. 34% think that social relationships are enough affected, 17.5% a lot, 12.4% very much, and 23.7% only a little. 54.6% believe that one of the involved couple may fell anger towards the responsible partner, while 41.2% doubted this. 51.5% believed that infertility diagnosis cannot ameliorate the couple s relationship, while 32% think that this could be possible. 59% of our students believe that involved couples do not separate after the diagnosis of infertility, while 27% think that this may lead to divorce.in conclusion, the majority of students believe that the personal and social relationships after infertility diagnosis and recommendation of IVF treatment, can be affected negatively, the ability and work performance may deteriorate, social relationships may be poisoned, anger towards the responsible partner may be felt. Despite this, most of the students think that couples do not usually separate after the infertility diagnosis. STUDENT S PERCEPTION OF COUPLES NEED FOR PSYCHOLOGICAL HELP AFTER DIAGNOSIS OF INFERTILITY AND SUGGESTION OF IVF TREATMENT Prof. M.S. Venetikou¹, A. Vasiliadou² and E. Politi² ¹ MD, DipEndo, Ph.D, Endocrinologist-Neuroendocrinologist, Professor of Pathophysiology & Nosology, Faculty of Health and Caring Professions, TEI Athens, GREECE ² RN, Community Nurses, School of Health Visitors, Faculty of Health and Caring Professions, TEI Athens The diagnosis of infertility and the recommendation of IVF treatment, has been reported to be associated with stress and to affect both personal and social relationships of the involved couple. Our aim was to study the beliefs of our students about the couple s need for psychological help after infertility diagnosis. We developed and assessed a questionnaire on the psychological aspects which may be involved in infertility and the need of IVF treatment. 100 students answered the questionnaire. Results show that 71% of our students believe that when a couple visits for the first time an IVF clinic for evaluation and treatment, apart from the usual physical and laboratory tests, a psychological interview is definitely needed. Only 8.2% think that this is not indispensable. 67% of the students believe that meeting the psychologist helps the couple to face their personal needs better. 13.5% though, do not consider this possible. 68% of the students believe that couples facing IVF may need more than the initial psychological interview. 12.4% think that one interview may be enough. 74% of the students think that the initial psychological interview of IVF couples involves a lot of stress and only 5.2% seem not to agree. 80% of the students think that if they had to face IVF, they would need psychological help themselves, the rest doubt this. 62% believe that psychological help is in fact offered to the couples, while the rest of the students think that this is not the case. 62% of the students think that psychological help is better offered in the European Community and in the USA. In conclusion, the majority of our students believe that psychological help is needed in these couples, it may face better people s individual needs, may be needed more than once during evaluation and treatment and that initial interviews may be stressful. Most of the students think that if they had to face IVF themselves, they would also need psychological help. They also feel that it is not really given in practice as it should, and that in EEC and USA it is better offered than in Greece. STUDENTS PERCEPTION OF STRESS IN COUPLES AFTER INFERTILITY DIAGNOSIS AND SUGGESTION OF IVF TREATMENT Prof. M.S. Venetikou¹, E. Politi² and A. Vasiliadou² ¹ MD, DipEndo, Ph.D, Endocrinologist-Neuroendocrinologist, Professor of Pathophysiology & Nosology, Faculty of Health and Caring Professions, TEI Athens, GREECE ² RN, Community Nurses, School of Health Visitors, Faculty of Health and Caring Professions, TEI Athens 15

16 The diagnosis of infertility and the recommendation of IVF treatment, has been reported to be associated with stress. Our aim was to study the beliefs of our students about the involvement of stress after infertility diagnosis. We developed and assessed a questionnaire on the psychological aspects which may be involved in infertility and the need of IVF treatment. 100 students answered the questionnaire. Of these, 46.5% believed that the diagnosis of infertility and the need to undergo IVF, is an extremely stressful and 22.7% a very stressful experience. Of the students, only 14.4% believed that it is only enough stressful and none that it involved no stress at all. 57% of the students believed that the recommendation for IVF is less stressful than the diagnosis of AIDS and cancer. 20% believed that such a diagnosis may be equally stressful and only 8.5% that it can be more stressful than AIDS and cancer diagnosis. 30% of the students believe that most couples overcome the stress of the diagnosis while 22% think that this is not possible. The rest were unable to comment on the above. According to 34% of our students, the infertility diagnosis adds stress to the couple, 31% depression, 11.3% isolation, 15.5% reduction of self esteem, and 37% all the above feelings. 25% of the questioned students think that women are more affected than men, 14.5% men more than women and 43.3% believe that both sexes are equally affected. 33% of the students think that older couples can handle stress better than younger ones, while 52.6% think that this is not true. In conclusion, most of the questioned students associate infertility diagnosis and need for IVF treatment with stress, although most believe that diagnosing AIDS or cancer is much more stressful. The majority think that both sexes are equally affected by stress and that age does not affect the ability to handle stress levels better. 16

17 WORKSHOPS WORKSHOP: TEACHING VERBAL BEHAVIOUR TO AUTISTIC CHILDREN T. Balazs M.Sc. BCBA, Consulting Behaviour Analyst, London UK The focus of the workshop will be language intervention in autism and other developmental disorders, using Skinner s analysis of verbal behaviour. We will discuss the verbal operants and the skills needed to identify their absence and to teach them. We will consider language training, IEP development, skill tracking, all paying attention to the development of verbal operant behaviour in the learner. The importance of mand training will be demonstrated, explained and emphasized. The roles of motivating (establishing) operations, verbal conditional discriminations, multiple and joint control, and of automatic reinforcement, in verbal behavior will be discussed. Possible strategies will be discussed for intervening when a learner has advanced verbal skills and can already use emotion-referencing and/or imaginative language. Training will be given in the fundamentals of using all of the above discussion topics. WORKSHOP: DIAGNOSING ALZHEIMER S DISEASE AT THE EARLIEST STAGES Dr. J.J. Andrikopoulos Clinical Neuropsychologist, Ruan Neurology Clinic, Mercy Hospital Medical Center, Iowa, USA Researchers predict the global prevalence of Alzheimer s disease (AD) will be 100 million by This possibility, along with the popularization of the term mild cognitive impairment (MCI) over the last decade, has resulted in a desire to diagnose AD early before the signs of dementia become apparent. This could have implications for early treatment, especially in the event that a disease-modifying agent is developed. This workshop will focus on the practical approach to diagnosing AD before the dementia becomes obvious and differentiating it from other dementias. The assessment of cognitive function via both brief sensitive screening measures and neuropsychological testing will be discussed followed by the non-cognitive aspects of the disease (i.e., personality changes). Special attention will be paid to the critical importance of the informant interview. In meeting this objective, in addition to the published research, data from the speaker s own AD registry (N=380) will be presented. The workshop will conclude with a critical discussion of the term MCI. It has been 10 years since the pivotal study (Petersen et al., 1999) that defined MCI was published. The MCI literature has since increased exponentially. It will be argued that the practical significance of this research has been negligible in assisting clinicians diagnose developing AD. The very definition of MCI serves to undermine early detection of AD. At the conclusion of the workshop participants should have a working knowledge of the clinically critical issues and techniques that will allow them to diagnose patients in the earliest stages of AD. WORKSHOP: THE DSM-V AND ICD-11: DEVELOPING DIAGNOSTIC TOOLS FOR A GLOBALIZED WORLD Prof. J.S. Paulsen Professor of Psychiatry, Psychology, Neurology & Neurosciences, Carver College of Medicine, University of Iowa, USA The DSM and ICD are currently being revised to be published as the DSMV and the ICD11 in upcoming years. Efforts are being made to develop a dimensional system useful across disciplines, health care systems, cultures, ages, research, policy, and countries. Challenges currently being addressed by the DSM Task Force members will be discussed in an effort to elicit feedback in this worldwide mission. This talk will emphasize three primary aspects of diagnosis: 1) usage of DSM and ICD across disciplines and from Primary Care to mental health specialists; 2) separation of functional limitations secondary to mental disorders from criteria to diagnose mental disorders; 3) utility of clinically significant distress criterion. Discussion will be encouraged to develop and foster world wide collaboration to benefit international health care as well as translation of clinical research. 17

18 SPECIAL SESSIONS SPECIAL SESSION: Medical Conditions & Neuropsychiatry PURE CENTRAL SLEEP APNEA AS A SIDE-EFFECT OF VAGAL NERVE STIMULATION Dr. E.S. Papathanasiou, P. Myrianthopoulou and Prof. S.S. Papacostas, MD. Clinical Neurophysiology Dept., The Cyprus Institute of Neurology & Genetics, CYPRUS Purpose: Vagal nerve stimulation (VNS) is an adjunctive therapy for reducing the frequency of seizures in patients over 12 years of age with partial seizures, who are refractory to antiepileptic medications. Common side-effects include voice alteration and increased coughing. A previous study has shown that sleep apnea can also be seen, without a detailed analysis of apnea type. We show that pure central sleep apnea is one side effect of VNS. Methods: CM is a 23- year-old female who started having complex partial seizures at 2.5 years of age. Various antiepileptic medications were used over the years with varying success. Two years before VNS therapy, she experienced five seizures per month. A VNS device was installed with less intense seizures occurring four times per month about a year later. Ten months ago the mother noticed nocturnal choking episodes with cessation in breathing and frequent arousals. A standard polysomnogram was performed. Results: 72 central sleep apneas (CSA) were recorded lasting seconds each, mostly during stage IV sleep, with an apnea/hypopnea index of 9.7. No obstructive sleep apneas or oxygen desaturations occurred. Decreasing her VNS parameters has resulted in less frequent and less severe apnea episodes. Conclusions: This is the first known report of pure CSA being a symptom of VNS, and has important implications for sleep hygiene and quality of life for the epilepsy patient. Reflections: The occurrence of CSA with VNS is important to recognize, which if left untreated could lead to heart problems, stroke, lack of concentration and decreased performance at work and school. A STUDY OF CHRONIC KIDNEY FAILURE PATIENTS OF AFRICAN DESCENT ATTENDING DIALYSIS AT POLOKWANE HOSPITAL RENAL UNIT, LIMPOPO PROVINCE, REPUBLIC OF SOUTH AFRICA S.E. Nkoana Clinical Psychologist, Researcher, Psychology Dept., University of Venda, S. AFRICA Chronic Kidney failure is fats becoming one of the major health problems in South Africa. People who are diagnosed with this condition are simultaneously faced with life-threatening challenges because of the many limitations it imposes upon them. In this paper the author focuses on the psychological consequences associated with kidney failure in a group of Black African chronic renal patients. Accordingly, a Quality of life Interview (QOLI) will be conducted with 8 (eight) patients attending dialysis at the Polokwane Hospital Renal Unit, Limpopo Province. Furthermore, a Sickness Impact Questionnaire will be administered with the same group of patients. The results will be analyzed and discussed in the context of the relationship between culture, health and chronic illness. EFFECTS OF NEUROFEEDBACK ON EXECUTIVE FUNCTIONS &QUALITY OF LIFE IN TRAUMATIC BRAIN INJURY R. P. Reddy¹, Prof. J. Rajan², Prof. I. Bagavathula³, Prof. T. Kandavel⁴ ¹ M.Phil, Ph.D Scholar, Mental Health and Social Psychology Dept., National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, INDIA ²Assistant Professor, Mental Health & Social Psychology Dept., N.I.M.H.A.N.S. ³ Prof. of Neurosurgery, N.I.M.H.A.N.S. ⁴ Ass. Prof. of Biostatistics, N.I.M.H.A.N.S, Bangalore, INDIA Introduction: Traumatic Brain Injury (TBI) constitutes a significant burden on health care. A vehicular accident is reported every 3 minutes. It is estimated that 1.6 million sustain head injuries annually in India. Cognitive disturbances are reported in TBI. The recovery of TBI would be maximized by appropriate rehabilitation using Neurofeedback. Aim: The aim of the study was to examine the effects of Neurofeedback in 1. Executive Functions 2. Quality of Life in patients with TBI. Research design: Pre-post Interventional study design was adopted. Participants and procedures: Ten patients, with the diagnosis of TBI in the age range of years were assessed on Edinburgh Handedness Inventory, Rivermead Post Concussion Symptoms Questionnaire, Rivermead Head Injury Follow up Questionnaire, Quality of Life Scale, Visual Analog Scale and NIMHANS Neuropsychological Battery, after obtaining the informed consent. Patients were given 20 sessions of neurofeedback, 5 sessions per week. Training focused on theta inhibition and enhancement of alpha waves frequency. Data were analyzed individually to evaluate the deficits and changes in the performance of the training using the standardized manual procedure. Results: Patients showed improvements in executive functions and quality of life post intervention. Conclusions: Results are encouraging for the incorporation of neurofeedback into treatment programs for patients with TBI. KNOWLEDGE AND ATTITUDE OF RURAL PEOPLE TOWARD EPILEPSY AND THE PERSONS AFFECTED BY THE DISORDER, VHEMBE DISTRICT LIMPOPO PROVINCE (LP) OF SOUTH AFRICA. Dr. M.L. Mangena-Netshikweta University of Venda, SOUTH AFRICA Objective: The purpose of this study is to explore the knowledge and attitude of rural people toward epilepsy and the persons affected by the disorder. Methods:Within the rural areas of Vhembe district, where the prevalence of epilepsy is high, a survey was undertaken amongst 250 sampled households to assess the knowledge and attitude of the respondents towards epilepsy. Data was collected using a self-administered questionnaire after informed consent had been obtained. Participants were assured of anonymity and confidentiality. Results: One hundred and sixty (64%) of the respondents were in the age group of 25 to 60 years whilst 150 (60%) were females. Two hundred and thirty five 18

19 (86%) were illiterate whilst 223 (89%) had either heard of the word epilepsy before or witnessed a case of seizure. Two hundred and twenty (88%) of the respondents believe that epilepsy is contagious through physical contacts during an attack, especially by touching the saliva. Although there was evidence of sympathetic concern in the community for the person suffering from epilepsy, negative attitudes were strong on matrimonial associations, sharing of accommodation and physical contacts with the affected persons, particularly when there were obvious signs and frequent attacks by seizures. Conclusion: The study demonstrates that rural communities have very poor knowledge of the causes and nature of epilepsy; and have poor attitude towards epileptic patients. SPECIAL SESSION: Ethics and Philosophical Issues PROBLEMS OF HUMANISTIC ETHICS, VALUES AND SPIRITUALITY: REVERSING CUMULATIVE COSMOLOGICAL VIOLATIONS AND THEIR CONSEQUENCES ON RANDOMISED EVOLUTION A.V. Parmenidou MMedSci in Psychiatry, University of Sheffield, UK, The British Psychological Society-EFTA Member, GREECE Overview: The natural propensity of the universe is its tendency to construct systems of evolving complexity and since there is neither single nor simple answer to the mental health of a population by the continuous violation of laws of natural necessity and economic progress has not been secured or evenly distributed; prevention continues to gain importance among the strategies open for governmental development of social policy. Objectives: This study aims to be an important policy-oriented contribution to the analysis and the solution of the problems of mental health in a macroeconomic dimension. It draws attention to factors related to the, shortcomings of educational policies, negative impact on educational outcomes, and the necessity of innovative platform in research and application. We specify our methodology taking into account the unpredictability of human factor. Method: This could be based on convergent validity (exploratory and confirmatory factor analyses) and divergent validity assessments of a range of widely used measures, which are included in the Quality of Life Panel Survey (Headey, B., Kelley, J. and Wearing, A. 1993); using as dependent variables: social pathologies and as independent variables: a focus on structural determinants. Conclusion: This study contains the specific implications and the interesting contribution of the changing conception of science οn the problems of humanistic ethics, values and spirituality. This contribution with its macroeconomic orientation to the theoretical and practical analysis of the mental health problems of a population is not only an interesting and useful piece of research on conceptual and measurement issues, but could also help in the formation of better policies by facilitating understanding of the diverse and difficult current social realities and unprecedented challenges in a comparative way. A CRITICAL INVESTIGATION OF THE CONCEPT OF AUTHENTICITY: BETWEEN PSYCHOLOGY AND EXISTENTIAL PHILOSOPHY O. Rognerud Ph.D. fellow, Faculty of Social Sciences, University College of Lillehammer, NORWAY. This paper addresses the theoretical foundations of authenticity by introducing insights from the tradition of existential philosophy and ethics. The perspectives upon authenticity offered by Charles Taylor constitute the main focus of this paper. The concept of an ethic of authenticity is also illustrated by existentialist thinkers such as Kierkegaard, Nietzsche, Heidegger and Sartre. The sources of individual authenticity might be said to be one of the major challenges in a globalized world, where different value systems are informing the authenticity of individuals from different cultural spheres. Using the perspectives outlined by Wood et al. in the Journal of Counseling Psychology Vol 55(3), Jul 2008, the paper aims at a broader theoretical definition of authenticity than the tripartite construction presented in this article. By introducing terminological concepts as strong/weak evaluations, moral horizons, significant others and essential/dynamic perceptions of the self, the paper will open up a field of theoretical reflection about what authenticity might be said to consist of. Applying methodologies from both phenomenological and hermeneutical approaches to the human endeavour, light is cast on analytical problems concerning the definition and measuring of authenticity. The paper concludes by questioning whether the items of the final Authenticity Scale presented by Wood et al. really can be said to measure authenticity, and by criticizing the close connection between Subjective Well Being (SWB) and authenticity that is presented in the article. SPECIAL SESSION: Medications and Psychoses SIBUTRAMINE INDUCED PSYCHOSIS: A CASE REPORT AND REVIEW OF LITERATURE. Dr. S.R.K. Naik¹, Prof. S. Kang², Ch. Ling³ and Regina⁴ ¹ Medical Officer, General Psychiatry Dept., Institute of Mental Health (I.M.H.), SINGAPORE ² A Professor, General Psychiatry, I.M.H. ³ Pharmacist, I.M.H. ⁴ Advanced Practitioner Nurse Trainee, I.M.H. Introduction: Sibutramine is an oral anti obesity drug, which acts as an appetite suppressant. Sibutramine acts as an mono-amine reuptake inhibitor, having action on the epinephrine and dopamine reuptake and on serotonin reuptake to a lesser extent. Current evidences are in the form of case reports showing psychiatric complications of the drug. Case Report: We report a case of 42 year old Chinese female, who developed psychosis after being prescribed Sibutramine. Method: Nine case reports included in review after searching Pubmed with keywords of Sibutramine, psychiatry and complications. Result: Evidence for psychiatric complications of Sibutramine are available only in the 19

20 form of case reports which show occurance of psychosis, Mania, panic attacks and catatonia. Most commonest complication being psychosis followed by manic episode. Conclusion: Evidence show possibility of psychiatric complication with Sibutramine. It should be used with caution in individuals at risk of psychiatric morbidity and it should be used at lower doses to avoid such complications. The evidences have to be read with caution as the psychiatric complications were not only seen with use of Sibutramine, but also with significant weight loss. LEPONEX VS OLANZAPINE: HOW ABOUT SLEEPING? Dr. S. Kaludjerovic Spec. of Neurology and Psychiatry, Lazarevic Hospital, Belgrade, SERBIA Introduction: 12 weeks comparative study of Leponex and olanzapin in patients with schizophrenic disease with negative symptoms (PANNSSS scale). Despite of availability of atypical antipsychotics the treatment of negative symptoms (according to PANSS scale) in sch remains a challenge. This study was designed to compare effects of 2 atypical drugs Leponex and olanzapin among 58 patients during 12 weeks. All of them was ill and diagnosis was schas defined by ICD 10 and DSM iv who scored at least 20 points on the negative subscale of PANSS and underwent 8 days washout of prior medicaments, then received Leponex in daily dose 250 mg and olanzapine in daily dose 10 mg. Background: Atypical antipsychotics such as Leponex,olanzapine, quetipin, risperidon, amisulpirid, sertindol are now used more and more in treatment with schizophrenic patients, specially who unfortunately have negative symptoms (apathia, alogia, social withdrawal, lack of motivation, affective blunted, disorganisation, motor retardation, suicidal thoughts) and most of them are hard to cure. Disease began early, and in this study all of patients from start was defined as such with negative symptoms, the worst form of severe sch. This medicaments Leponex and olanzapin can help by their blocking receptors in brain Leponex blocked D1, D2type,preedominantly afinitet for D1 type change D1/D2relations so different of other drugs have high afinitivity for D4 receptors don t change prolactin level blocked serotonergic 5HT 2a,5HT2c(good effect on negative symptoms) antagonism on M1,M2,M3muscari. rec.(noeps) agonism on M4 9 hypersalivation) effect on histamin receptors (sedation is noticed) effect on alpha adrenergic rec (hypotnesion art). Methods: 30 patients age years, with sch neg, type received Leponex in daily dose 250 to 300mg,and 29 patients same age got olanzapine in 10 mg daily dose.male was 30, females 29. Although study was 12 weeks, open label, after just 1 week sleeping problems noticed in olanzapin group, and they needed teraphy and all of that patient had to get midazolam.after 8 weeks of study olanzapin group,precisely 5 persons got suicidal thoughts. and they wanted to stop or to get another drug. They got Leponex. Results: During this study, olanzapin group discontinued,due to sleeping disturbance and suicidal risk.they needed midazolam tablets 15 mg for sleeping in evening dose despite this addition after 12 weeks all of them gave up and continue treatment with Leponex. Improvements of negative symptoms of sch disease was noticeably in both groups after 4 weeks, but after that period Lepoenex repeated lybeen shown to be more affective than olanzapine in decreasing pathology, and marked reduction in the incidence of suicidality. THE ASSOCIATION OF WEIGHT DISSATISFACTION IN PATIENTS WITH FIRST EPISODE PSYCHOTIC DISORDER AND MEDICATION ADHERENCE Dr. M.C. Wong Resident, Psychiatry Dept., Castle Peak Hospital, Hong Kong, HONG KONG Background: The association between the distress of antipsychotic induced weight gain and medication adherence has not been properly looked into. Distress associated with body weight may not be reflected by the actual body weight, instead it is more related to how the individual perceives his/her weight. Aims: This study aimed to investigate the association between the actual body weight, perceived body weight and medication adherence in patients with first episode psychotic disorder who has been on antipsychotic medication for one year. Methods: This cross sectional study recruited 160 patients from outpatient services within the New Territories West cluster in Hong Kong. Figure rating scale assessing body size satisfaction was compared with the actual body mass index. The association between medication adherence and dissatisfaction with weight as well as other factors including insight, drug attitude, severity of symptoms, satisfaction with service, and other medication side effects were analysed. Results: 32.1% of female and 10% male patients overestimated their weight and the difference is statistically significant. 85% of those who perceived themselves overweight believed that antipsychotics caused it and 45.8% patients has stopped antipsychotics as a result. Distress of weight gain, negative attitude towards medication and poor insight were associated with poor adherence ( R 2 =62% ). Conclusion : Weight concern of patients is an important issue in patients with first episode psychotic disorders and proper weight management programme should be implemented in the early stage of the illness. SPECIAL SESSION: Multiple Sclerosis MULTIPLE SCLEROSIS AND EPILEPSY: EVIDENCE OF PREFERENTIAL INVOLVEMENT OF UPPER LIMB SOMATOSENSORY EVOKED POTENTIALS. Dr. E.S. Papathanasiou, S.S. Papacostas MD., P. Myrianthopoulou, E. Kolou and M. Pantzaris. The Cyprus Institute of Neurology & Genetics, Nicosia, CYPRUS. Purpose: The prevalence of epilepsy in patients with multiple sclerosis (MS) has been of interest for many years. Electroencephalography has been of limited value in determining the relationship between the two. This analysis focuses on the relationship of evoked potential abnormalities & epilepsy in MS patients. Method:Patients with MS who have had evoked potentials (EPs) performed (visual, brainstem, upper & lower limb somatosensory) were retrospectively included. Result: Seventy-four MS patients were divided into three groups. I: Patients (n=34) with no epilepsy and not 20

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