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The dimensioning of pressurized hydraulic systems is often carried out in a steady flow regime, then the hydraulic system operation is verified and corrected to withstand the stresses that occur in a transient flow regime. Transient flow in pressure hydraulic systems occur when the flow conditions are changing (closing or opening a valve, breaking a pipe, start or shutting down of a pump). In the absence of adequate measures, if the flow conditions are rapidly changing, in most of the cases the water hammer occurs. There are no predetermined design measures against the water hammer, all protection and design measures needed to be calculated. The article presents some aspects of modeling design and protection measures required to combat the negative effects of the water hammer, for a water supply pipeline using Bentley Hammer software.

The paper presents an EPANET model of a groundwater well field. The method used in the simulations to model the variation of the hydrodynamic levels in wells as a function of the pumped flow rate is discussed, and a comparison to previous simulations that used fixed hydrodynamic levels in the wells is performed. The case study points to a groundwater well field in Romania. The results show that the new method although requiring a more complex EPANET model, provides a solution that is closer to the actual variation of water levels in wells.

Demolition wastes may be used in different civil engineering applications as road constructions, concrete, and embankments or landfill. Regardless its application, leaching tests of the waste should be carried out to assess concentrations of pollutants. Concrete, brick and mixture of concrete, bricks, tiles and ceramics wastes were subject to percolation test—CEN/TS 14405, and batch test—SR EN 12457. The leachates were analyzed with respect to concentration of inorganic elements—arsenic, barium, cadmium, chromium, copper, mercury, molybdenum, nickel, lead, selenium, zinc, fluoride, chloride and sulfate, and organic compounds (phenol index). The concentrations of elements in leachates were compared with the limit values of European regulation for the acceptance of inert wastes at landfills. Generally, the releases of inorganic species in leachates were below limits values. Some waste leachates obtained by percolation and batch test had high values for phenol index.

Background Social anxiety disorder (SAD) is characterized by fear and avoidance in social situations where one perceives being in danger of scrutiny by others. Low self-esteem, low self-efficacy, high self-criticism and high dependency are additional potential features of SAD, and thus their examination is warranted, as is the elucidation of their inter-relationship. Method Thirty-two SAD subjects diagnosed with the Mini-International Neuropsychiatric Interview and 30 healthy controls, were administered the Liebowitz Social Anxiety Scale (LSAS), the Rosenberg Self Esteem Scale, the Depressive Experiences Questionnaire (DEQ) that assesses self-criticism, dependency and self-efficacy, and a socio-demographic questionnaire. We hypothesized that the SAD group would present higher scores of dependency and self-criticism and lower self-esteem and self-efficacy. We also hypothesized that low self-esteem, low self-efficacy, high self-criticism and high dependency will predict the severity of SAD. Results In line with the hypotheses, SAD patients had higher scores of self-criticism and dependency and lower scores of self-esteem. The social anxiety score correlated negatively with self-esteem and self-efficacy, and positively with dependency and self-criticism. Self-criticism, but not the other measures, predicted the total LSAS score. Conclusions Self-esteem, self-criticism, dependency and self-efficacy are related to SAD and their relations should be examined in future studies that will employ larger samples. It is suggested to search for ways to affect these factors through cognitive-behavioral interventions and additional psychotherapeutic treatments. Research should also focus on the specific role of self-criticism in SAD.

Romania has a good natural potential for all renewable sources: solar, wind, biomass, geothermal. To reach at economic practicability of renewable energy sources (RES), Romania needs to accelerate the development of the national RES industry and to remove several legal and administrative barriers. To develop the potential of RES and reach the targets, Romania has established a legal and institutional framework appropriate for promoting the use of renewable energy sources. According to the Directive 2009/28/EC on the promotion of the use of energy from renewable sources the target for the share of energy from renewable sources in gross final consumption of energy in the year 2020 for Romania is 24%. In Romania there is a mandatory quota system accompanied by Green Certificates (GC) system. For the period 2020-2030, the quotas shall be set through a governmental decision and cannot be lower than the quota for 2020. The research is about of renewable energy sources implemented by a photovoltaic system in a pilot project and the electricity used in in-house consumption. The objectives consist in producing of electricity from renewable sources (solar-photovoltaic sources), environment protection, using the new technology and energy efficiency having in attention for better human life.

The process of emotion recognition is thought to be negatively biased in social anxiety disorder (SAD). Ways to change this bias are needed. Forty one individuals afflicted with moderate SAD and 39 healthy controls were recruited to participate in this study. All subjects performed a vocal improvisation recognition task and half of them underwent training in happiness recognition in musical improvisations. The four groups (trained SAD, untrained SAD, trained controls and untrained controls) were then compared in terms of the extent of precise identification of one of five basic emotions (happiness, fear, anger, sadness and surprise) in spoken language. Subjects with SAD demonstrated less accurate identification of happiness in spoken language as compared to the healthy controls. However, subjects with SAD trained to recognize happiness demonstrated an improved ability to identify happiness in spoken language (in a female’s voice), similarly to that of the healthy controls. Our findings demonstrate that a brief training in happiness recognition improves the ability of individuals with SAD to recognize happiness in spoken language. Additional studies are needed to support and refine our intervention and to examine its impact on individuals with SAD over longer periods of time.

The effects of antidepressant medication on suicide risk remain unclear. This study explores any association between antidepressant medication and suicide attempts leading to hospitalization in adult depressed patients.The medical records of 103 patients admitted after a suicide attempt were examined and compared with those of a matched control group of depressed patients (n = 103) admitted without suicide attempts as well as a patient group with and without suicide attempts on separate hospitalizations (n = 25). No significant difference in antidepressant medication exposure before hospitalization was found between groups. Selective serotonin reuptake inhibitor exposure was higher in patients with suicide attempts, albeit nonsignificant, but was identical in patients admitted on two occasions with and without suicide attempts. The most common method for suicide attempt was drug overdose (52.4%). Patients in the group with suicide attempts had significantly more past suicide attempts. Study results do not confirm any relationship between antidepressants and suicide attempts. Close monitoring of depressed patients is advised especially in early treatment.

Gerai Pond is one of the last natural wetlands along the Danube, being connected to natural flooding regime of the Danube and is situated at the confluence of the Danube River, between Gârcov and Islaz localities, in Olt County. Aquatic vegetation characteristic is a favorable habitat for two species of conservation concern that nest along the Danube: red duck and pygmy cormorant. During 1961-1970, Gerai Pond has changed radically due to impoundment and draining under the program of drainage and flood meadow regulate of the Danube. These works of land reclamation for decreasing surface lakes and wetlands and water stagnation period, had reduced the breeding areas of the two species mentioned above. Ecological reconstruction of Gerai Pond project was conducted by Technical University of Civil Engineering of Bucharest in collaboration with E.P.A. Olt and W.W.F.-Romania. The project was based on a hydrological study (which included a component related to flooding) for the area analyzed, study in which were highlighted the areas which have water access to and from the Pond, surfaces and volumes of water corresponding to different rates, the optimal level of water for restoration of the nesting area. Based on this study were identified the areas of artificial feed-water discharge to and from the Danube. This paper presents the possible solutions for ecological reconstruction of Gerai Pond, identified in the project.

Chronic treatment with selective serotonin reuptake inhibitors (SSRIs) reduces the risk and severity of cardiovascular diseases. SSRIs block the serotonin transporter, thereby inhibiting serotonin (5-HT) uptake into presynaptic neurons as well as into platelets where 5-HT is stored in dense granules. When 5-HT is released in response to agonists it enhances platelet aggregation induced by injury-related signals. Chronic administration of SSRIs may thus reduce platelet aggregability secondary to depletion of platelets' serotonin stores.The study included ten DSM-IV-TR major depression (MDD) and four obsessive compulsive disorder (OCD) patients and fourteen healthy untreated age- and sex-matched controls. The patients were chronically medicated (6-108 months) with various SSRIs. Platelet serotonin content was assessed in fresh samples of platelet rich plasma (PRP) using radioimmunoassay. ADP, collagen, arachidonic acid and epinephrine were used as inducers of platelet aggregation measured in PRP by turbometric method in a microplate reader.Lower platelet serotonin content (66%; p0.05) and lower ADP, collagen or epinephrine-induced platelet aggregation (10-52%; p0.05) were detected in PRP of SSRI-medicated patients, while no such effect was obtained with arachidonic acid.The small sample size and the co-treatment with non-SSRI drugs such as benzodiazepines.Patients chronically medicated with SSRIs exhibit lower platelet 5-HT content and reduced platelet aggregation induced by ADP, collagen and epinephrine, but not by arachidonic acid. Our observations may explain the increased bleeding risk associated with chronic SSRI treatment as well as the reported beneficial effect of SSRIs in prevention of recurrent myocardial infarction.

Objective Our aims were (1) to develop 2 inventories for the measurement of cognitive and emotional attitudes toward borderline personality disorder (BPD) patients and their treatment and (2) to use these tools to understand and compare attitudes of psychiatrists, psychologists, and nurses toward BPD patients. Method Two lists of items referring to cognitive (47 items) and emotional attitudes (20 items) toward BPD patients were formulated. Fifty-seven clinicians (25 nurses, 13 psychologists, and 19 psychiatrists), who had been working in public psychiatric institutions for more than 1 year, rated their level of agreement with each item. The list of cognitive attitudes yielded 3 factors (required treatment, suicidal tendencies, and antagonistic judgment). The list of emotional attitudes yielded 3 other factors (negative emotions, experienced difficulties in treatment, and empathy). Results Psychologists scored lower than psychiatrists and nurses on antagonistic judgments, whereas nurses scored lower than psychiatrists and psychologists on empathy. Regression stepwise analyses conducted on the 3 emotional attitudes separately showed that suicidal tendencies of BPD patients mainly explained the negative emotions and the difficulties in treating these patients. All groups were interested in learning more about the treatment of these patients. Conclusions Suicidal tendencies of BPD patients provoke antagonistic judgments among the 3 professions. Nevertheless, psychiatrists, psychologists, and nurses hold distinctive cognitive and emotional attitudes toward these patients. Mapping these differences can improve the education and training in the management of BPD patients.

Fluid-fluid interfacial area plays an important role for mass- and energy-transfer processes across the interface which is relevant in several hydrogeological and engineering applications, e.g. enhanced oil-gas recovery, CO2 storage in geological formations, unconventional geothermal systems, contaminant removal, etc. Kinetic interface sensitive tracers were designed to determine the size of the interface between two fluids by undergoing hydrolysis at the fluid-fluid interface. This study investigates by means of numerical modelling the influence of heterogeneity on the KIS tracer breakthrough curves in six idealized scenarios (S1-S6). It is an extension of the previous work conducted in “one-dimensional” column experiments by Tatomir et al. (2018) [1]. The changes in interfacial area are created by inclusion of heterogeneities at the Darcy-scale. The results show that KIS tracers can be used in two-dimensional experimental setup and can provide information about the size and dynamic evolution of interfacial area. Therefore, this is a first step for the dimensioning of an experimental flume.

Introduction: Impulsivity has been shown to be a major variable in the etiology of suicide and aggression, but has not been researched as much in the schizophrenic population, which is characterized by serious suicide and aggression risks. Methods: 68 male schizophrenia patients responded to a battery of measures including the Positive and Negative Syndrome Scale (PANSS), the impulsivity control scale (IS), the Suicide Risk Scale (SRS) and the Overt Aggression Scale. Results: We divided our subjects into those who received scores above and below the median on the IS. The high- impulsivity group had higher present and past rates of suicidal ideation and showed a trend for more lifetime suicidal attempts than the low-impulsivity group. The impulsivity score correlated positively with the SRS score and with some of the scores of the PANSS (the positive symptoms score, the general psychopathology score and the total score). A multiple regression analysis revealed that an older age, higher levels of aggression, high impulsivity and an elevated score on the general psychopathology subscale of the PANSS contributed positively and significantly to the explained variance of the SRS. Conclusions: Our study supports the contention that high impulsivity in schizophrenia patients is significant in the etiology of suicide in schizophrenia. However, the relationship between impulsivity and aggression in schizophrenia patients, and also the amelioration of impulsivity by pharmacological interventions, require further study.

This study focuses on the use of innovative techniques to evaluate and remediate polluted aquifer layers. While environmental forensic techniques offer valuable innovative tools for site characterization and evaluation, bioremediation approaches provide innovative remedial solutions applicable to a large variety of contaminants and environmental conditions. In this study, a literature review of the main forensic techniques has been performed and their applicability for optimized site remediation was pointed out. Additionally, an innovative bioremediation approach has been tested at pilot scale for its effectiveness on a historically oil polluted aquifer on the Black Sea Coast in Romania. Specifically, an installation was designed and tested in the Laboratory of Hydraulics and Environmental Protection from the Technical University of Civil Engineering, Bucharest, in order to assess and remove contamination from impacted groundwater using reactive barriers. The barriers were comprised of layers of material ...

Introduction: Blunted, inappropriate affective-social behavior is a hallmark of early schizo- phrenia, possibly corresponding to reduced ability to recognize and express emotions. It is yet unknown if this affective deficiency relates to disturbed neural sensitivity to facial expressions or to overall face processing. In a previous imaging study, healthy subjects showed less suppression of the fusiform gyrus (FG) to repeated presentation of the same transfigured-bizarre face relative to regular face. We assumed that the FG in schizophrenia will show reduced repetition related sensitivity to transfigured-bizarre faces, while having overall normal response to faces. Methods: Ten first-episode patients with schizophrenia and 10 controls rated the bizarreness of upright and inverted faces. In an fMRI study, another group of 17 first-episode patients with schizophrenia and 12 controls viewed regu- lar and transfigured-bizarre faces in blocks. Each block contained regular- or transfigured-bizarre faces of either different or same individual, presented in an upright or inverted orientation. Results: Patients in comparison with controls rated irregular faces as less bizarre. The FG, in patients and controls exhib- ited similar response to inverted faces, suggesting normal face processing. In contrast, the FG only in patients, showed similar suppression to repeated transfigured-bizarre and regular faces. Finally, the FG in patients compared with controls showed reduced functional connectivity with the amygdala and prefrontal cortex. Conclusion: Patients with schizophrenia already at first-episode, showed reduced be- havioral and neural sensitivity to bizarre facial expressions. Possibly, this deficiency is related to dis- turbed modulations of emotion-related face processing in the FG by the amygdala and prefrontal cor- tex. Hum Brain Mapp 00:000-000, 2009. V C 2009 Wiley-Liss, Inc.

Neurobiological research has shown the potential involvement of serotonergic, dopaminergic and opioid dysfunction in the pathophysiology of pathological gambling. In this review, we present current theories of the neuropathology of pathological gambling, paying particular attention to the role of the neural circuitry underlying motivation, reward, decision-making and impulsivity. This review also presents a literature review of current pharmacological treatment strategies for pathological gambling, such as selective serotonin reuptake inhibitors (SSRIs), opioid receptor antagonists, anti-addiction drugs and mood stabilizers, and also discusses the role of nonpharmacological interventions. A hypothetical model of the clinical subtypes of pathological gambling is presented, e.g. the impulsive subtype, the obsessive-compulsive subtype and the addictive subtype. This model attempts to integrate current knowledge in the field of pathological gambling regarding neuropathology, psychiatric co-morbidity, family history, genetics, course of illness, gender and response to pharmacological treatment. Finally, it is proposed that the existence of possible clinical subtypes of pathological gambling may provide a potential framework for matching the various subtypes with specific pharmacotherapies.

OBJECTIVES: Selective serotonin reuptake inhibitors (SSRIs) are currently considered as the first drug of choice in the treatment of panic disorder (PD). The aim of this long-term, naturalistic comparison study was to compare 4 SSRIs with respect to tolerability and treatment outcome of PD. Outcome measures included relapse rates and adverse effects. METHODS: Two hundred patients with PD were enrolled in our study. All subjects met DSM-IV criteria for PD or PD with agoraphobia (PDA). All patients were assigned to receive SSRI monotherapy for 12 months with either citalopram (n = 50), fluoxetine (n = 50), fluvoxamine (n = 50), or paroxetine (n = 50) in a randomized, nonblinded fashion. Both the treating psychiatrist and the patients were not blind to the assigned treatment, but the clinician raters were blind to the study medication. The study design allowed for assignment of a particular SSRI as indicated according to the clinical judgment of the study psychiatrists. The Panic Self-Questionnaire, which is a self-report scale, was administered at baseline and then once per month during the duration of the 12-month study. The visual analog scale and the Clinical Global Impression Scale were administered at baseline and then once per month during the period of the study. Reports of sexual dysfunction were assessed using a nonstructured clinical interview at monthly visits. The body weight of study subjects was measured at baseline, and then at the 12th month visit end point. RESULTS: Of 200 patients who entered the study, 127 patients (63.5%) completed the full 12-month protocol. Retention rates were highest for paroxetine (76% [38/50]), intermediate for citalopram (68% [34/50]) and fluvoxamine (60% [30/50]), and lowest for fluoxetine (50% [25/50]). Patients who completed the 12-month protocol responded favorably to the study treatment. The paroxetine and the citalopram groups had significantly lower rates of panic symptoms as measured at visits on weeks 4 and 8. At visits on months 3, 6, 9, and 12, however, there were no statistically significant differences between the 4 groups in relapse rates (defined as the occurrence of 1 or more panic attacks during the previous week of treatment) (F1,127 = 0.17; P = 0.13 [not statistically significant]). At the 12th month end point, patients in all 4 treatment groups had a statistically significant increase in body weight. Body weight among the study population increased by 6.1 + 4.9 kg from a mean weight of 72.4 + 7.3 kg at the onset of treatment. Reports of sexual adverse effects at the 12th month visit were similar in the citalopram, fluoxetine, and paroxetine groups, but the fluvoxamine patient group reported fewer sexual adverse effects at the 12th month visit. CONCLUSIONS: Most of our PD patients responded well to 12-month treatment with either citalopram, fluoxetine, fluvoxamine, or paroxetine, and the overall response rate was equal after the first 4 weeks of treatment. Although patients treated with paroxetine had the lowest dropout rates during the initiation phase, they had the highest rate of adverse effects as measured at the 12th month visit. Conversely, patients in the fluvoxamine group had the highest dropout rate (which was primarily caused by adverse effects in the initiation phase of treatment.); however, patients who were able to tolerate fluvoxamine throughout the full course of the study were observed to have lower rates of sexual dysfunction and weight gain compared with patients treated with the other agents. Overall, when measured at the 12th month visit, monotherapy with paroxetine and citalopram was associated with a higher rate of sexual adverse effects than was treatment with fluoxetine or fluvoxamine. In addition, monotherapy with paroxetine, citalopram, and fluoxetine seemed to cause more weight gain than did treatment with fluvoxamine.

Objective: Self-injurious behaviours (SIBs) are widespread among prisoners and are sometimes classified as potentially calculated acts intended to control others. Access to a psychiatrist may be valued by imprisoned soldiers seeking immediate release from service. The main goal of the study was to assess the effects of a new mental health regulation in the Israel Defense Forces (IDF) prison system, which requires ordering an immediate interview with a psychiatrist for inmates performing SIBs. Method: Frequency of SIBs in 2 military prisons was examined and compared for 11 months before and 10 months after the implementation of the regulation. Severity of injuries and rates of release from service were examined for 4 months. Results: The frequency of SIBs significantly increased after the implementation of the regulation in one prison, but not in the other. No effect was found for rate of release from service or for severity of injuries. Conclusions: Increased accessibility to a psychiatrist for military prisoners may have resulted in increased motivation for inmates to perform SIBs. These effects are limited to the prison that serves a higher proportion of highly stressed soldiers.

Affective disorders are a major cause of morbidity and disability among middle-aged and older people. Thus, the prophylaxis of both unipolar depression and bipolar disorder in this patient subpopulation is an important task of psychiatrists and other physicians. Although lithium remains an effective prophylactic and treatment agent in younger individuals with bipolar disorder, its prophylactic efficacy and tolerability has not been thoroughly investigated among middle aged and older people with unipolar depression and bipolar disorder. Our study is based on a mirror-image design that compared the clinical course with lithium treatment and the clinical course prior to lithium treatment based on a retrospective chart review. We examined the results obtained with long-term lithium maintenance in a group of 60 middle-aged and older adult patients (age >60 years) with unipolar depression and bipolar disorder. More specifically, we analyzed changes of frequency, severity, and duration of depressive or manic relapses, rate and duration of hospitalizations and suicidal behavior (thoughts or attempts), and various assessments of outcome. A significant reduction was found on all indices during lithium therapy compared to before lithium treatment, attesting to the prophylactic efficacy of long-term lithium in unipolar depression and bipolar disorder. The range of side effects in our sample was similar to that found in other reports in this age group. The probability of relapse and recurrence in patients with bipolar disorder and with unipolar depression can be significantly decreased by lithium prophylaxis. Further investigation is mandated to confirm these findings under double-blind conditions.

This study aims to show that the specific use of sad music in patients with major depressive disorder can circumvent the verbal barrier they typically experience when asked to express their emotions. We examined the effect of four emotionally distinctive types of music (i.e. happiness, fear, anger, and sadness) on 14 hospitalized patients with major depressive disorder (MDD group) and 31 healthy controls (HC group). Participants were asked to choose emotional descriptors that expressed the feelings that were induced in them by each excerpt. We hypothesized that in the specific case of sad music, patients with MDD would describe the music more vividly than HC participants. Patients with MDD chose fewer emotional labels than controls in response to angry, scary, and happy excerpts. Patients with MDD and controls chose similar emotional labels in response to sad music, but patients with MDD chose more labels in response to sad music than to any other excerpt, while controls demonstrated the exact opposite pattern. These findings are in line with clinical descriptions of patients with MDD as demonstrating difficulties in verbalizing their emotions. Their intensified response to sad music is in accordance with their focus on sad cues. The use of sad music in psychotherapy is thus recommended as means of bypassing the verbal barrier experienced by patients with MDD.

Social Anxiety Disorder (SAD) is characterized by fear and avoidance in social situations where one is exposed to scrutiny by others. It is possible that automatic thoughts either cause the disorder or maintain it, and thus their examination is warranted.30 SAD subjects diagnosed with the MiniInternational Neuropsychiatric Interview (MINI) and 30 healthy controls were administered the Liebowitz Social Anxiety Scale (LSAS), the Automatic Thoughts Questionnaires (ATQ-Negative and ATQ-Positive), the Sheehan Disability Scale (SDS) and the Beck Depression Inventory (BDI). It was hypothesized that the SAD subjects would display more depression and disability, more negative automatic thoughts and fewer positive automatic thoughts than the healthy controls, and that the automatic thoughts will predict the severity of SAD.SAD patients had higher scores of depression and disability, higher scores on the ATQ-Negative questionnaire and lower scores on the ATQ-Positive questionnaire. The scores of the LSAS subscales were predicted by the scores of the ATQ-Positive and the BDI questionnaires.Moderate sample size and limits of the questionnaires used in the study.Automatic thoughts may be an important area of research with larger samples. Further studies should be carried out in order to examine if strengthening positive thinking and ablation of negative thinking can reduce SAD symptoms during cognitive behavioral treatment.

While the presence of comorbid anxiety disorders such as obsessive-compulsive disorder and panic disorder have been well described in schizophrenia, comorbid social anxiety disorder (SAD) has been less emphasized. The goal of this study was to examine the prevalence of SAD in our ambulatory population of patients with schizophrenia.A group of 50 outpatients with schizophrenia randomly selected from our public mental health outpatient population was evaluated with the Structured Clinical Interview for DSM-IV (SCID)-schizophrenia section, the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Quality of Life Scale (SQLS), the Liebowitz Social Anxiety Scale (LSAS) and the Global Assessment of Functioning Scale (GAF). After completion of assessments, a retrospective chart review was conducted on all study patients who met criteria for a diagnosis of SAD in order to determine how many of these patients had been previously given a diagnosis of SAD.Based on a cutoff score of 29/30 on the total LSAS score, 38% of our sample had a comorbid diagnosis of SAD. Compared to patients who did not suffer from comorbid SAD, patients with schizophrenia and comorbid SAD had lower ratings of quality of life, but similar GAF and PANSS scores. According to the results of the chart review, none of the affected patients had been previously diagnosed with SAD.According to the results of our study, SAD as a comorbid condition is highly prevalent in schizophrenia and may be under-detected in the outpatient mental health care setting. Furthermore, the presence of SAD may lead to a decreased quality of life for patients with schizophrenia. Further studies should evaluate whether the diagnosis and treatment of comorbid SAD would improve the treatment and quality of life of patients with schizophrenia.

Pathological gambling is classified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition as an impulse-control disorder. In the International Classification of Diseases of the WHO, pathological gambling is coded under the heading of 'Habit and Impulse Disorders'. Pathological gambling is a chronic, progressive disorder, which has a prevalence of 1-3.4% among western civilizations. The enormous personal and social consequences of this disorder include a high rate of suicide attempts, job loss, marital and family problems, legal problems, and criminal behavior. Recent studies have demonstrated that pathological gambling patients respond well to treatment with selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. These findings support the idea that pathological gambling and other disorders of impulse control may be conceptualized as part of the obsessive-compulsive spectrum disorders or addictive disorders. This article will discuss possible treatment strategies according to different behavior patterns in pathological gambling and also remind the physicians who intend to treat this disorder of the possible diagnosis of pathological gambling.

Objectives: The aim of this naturalistic follow-up study was to examine the effect of pregnancy as a predicting factor of relapse in patients with panic disorder (PD). Methods: Eighty-five female patients with PD (between the ages of 20 and 35 years) were included in this study. They were divided into 2 groups based on whether the onset of PD had been during pregnancy (PD-pregnancy [PD-P]) or whether the onset of PD had been while not pregnant (PD-nonpregnant [PD-NP]). Patients were treated with paroxetine up to 40 mg/day for 12 months, and the full responders were tapered off their medication and were monitored for an additional 6 years. Treatment response was assessed using the Panic Self-Questionnaire (PSQ) with full response being defined as "0" panic attacks. Assessments using the PSQ were made at baseline and every 4 weeks for the first twelve months. During the 6-year drug-free follow-up period, patients were assessed using the PSQ every 3 months. Relapse was defined as the occurrence of a panic attack in any phase of the study. The effect of group membership (PD-P vs. PD-NP) and new pregnancies as risk factors for relapse were explored. Results: Sixty-eight patients completed the 6-year follow-up, and each of the study groups (PD-P and PD-NP) was composed of 34 patients. Twenty-six of 34 (76.6%) patients in the PD-P group had another pregnancy, and 15/26 (57%) in this group experienced a relapse during the subsequent pregnancy. Three of 8 (37%) PD-P patients experienced a relapse without pregnancy. Among the second group (PD-NP), 18/34 (52.9%) became pregnant and 8/18 (44.4%) experienced a relapse at the time of pregnancy, whereas 4/16 (25%) experienced a relapse while not pregnant. Patients who relapsed during pregnancy had a more severe relapse (as defined by the severity of the PSQ score) compared with nonpregnant relapsers. Conclusions: Our naturalistic follow-up study demonstrated that pregnancy might confer an increased risk of relapse in PD. Moreover, when compared with patients who develop PD while not pregnant (PD-NP), patients who develop PD during pregnancy (PD-P) appear to have a higher risk of relapse at the time of a subsequent pregnancy (P < 0.001).

Background Eating disorders have been reported to increase in frequency, but it is yet unclear what psychological characteristics increase the proneness toward the development of eating disorders. Alexithymia (AL; a difficulty in awareness to one's emotions) and dissociation proneness are 2 such plausible features. Method In this study, we evaluated the efficacy of a combined intervention (group therapy, individual therapy, and pharmacologic therapy) in a group of soldiers with eating disorders (n = 30) in the Israel Defense Forces. Moreover, we examined whether AL and dissociation proneness were frequent in this group and whether clinical improvement was associated with an improvement in these factors as well. Results High scores on the AL and dissociation measures were noted. The intervention was associated with a 50% decrease in the Eating Attitudes Test and Eating Disorders Inventory scores, consistent with our clinical impression of improvement in the eating symptoms. However, the decrease observed on the Dissociative Experiences Scale and Toronto Alexithymia Scale scores was minimal. Conclusions The combined intervention was efficient in our sample of patients with eating disorder despite the small sample size. The aforementioned specific psychometric change may be indicative of the lack of importance of changes in AL or dissociation proneness in the short-term improvement in patients with eating disorder.

Brain vesicular monoamine transporter 2 (VMAT2) has a critical role in the regulation of monoaminergic neurotransmission. In our previous study we have found decreased platelet VMAT2 density in healthy habitual smokers. Schizophrenia is associated with high rate of cigarette smoking. In the present study we assessed platelet VMAT2 pharmacodynamic characteristics in a population of medicated schizophrenia patients (n=36) comparing smokers (n=23) vs. non-smokers (n=13). A significant decrease in platelet VMAT2 density (24%, p=0.005) was found in the smokers compared to the non-smokers . This decrease was not ascribed to the pharmacotherapy. An inverse correlation was found in the smokers between the platelet VMAT2 density and the severity of schizophrenia as assessed by the positive and negative syndrome scale (PANSS). Our observation in schizophrenia patients is consistent with that found in healthy smokers. The complex relationship between VMAT2 expression, cigarette smoking and schizophrenia merits a further large scale study.

Background: Despite the previously accepted notion that panic disorder (PD) is rare in the elderly, recent data have shown that late-life PD may be more common than previously thought. Paroxetine is a selective serotonergic reuptake inhibitor which has had clear efficacy in the treatment of PD in the general adult population. In this study we aimed to examine the treatment outcome of paroxetine pharmacotherapy for late-life PD. Method: In this long-term naturalistic follow-up study, a group of 61 elderly (aged 59 years or older) PD patients were compared with a group of 95 younger (aged between 18 and 59 years) PD patients in terms of treatment response to paroxetine pharmacotherapy. The two groups were followed during both the initial short-term treatment phase (first 3 months) and throughout long-term (month 4–12) maintenance treatment. The two groups were also compared for side effects of paroxetine therapy. Results: No differences were found between the two patient groups in terms of response rate, si...

The assessment of various symptoms in schizophrenia has received much interest, although few studies have compared evaluations by clinicians to those of their patients. Self-report tools may improve service delivery, data collection, and possibly also treatment adherence. We constructed the Positive and Negative Symptoms Questionnaire (PNS-Q), a self-report measure, after items from the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). The PNS-Q contained 68 items and was administered to 61 schizophrenic inpatients. We examined its psychometric properties and utility as a self-report tool in schizophrenia. The PNS-Q exhibited high internal consistency for both its positive and negative subscales. External validity with the SAPS and SANS was low. The positive symptoms subscale correlated significantly with the SAPS (r = .341, P < .01), whereas the negative symptoms subscale did not correlate at all with the SANS (r = −0.086, P > .1). The correlation between patients' insight and scores of the PNS-Q was mixed. A partial correlation analysis failed to confirm a relationship between the rating of the patients' level of insight (measured by the Amador Scale to Assess Unawareness of Mental Disorders [SUMD]) and the disparity between the PNS-Q and the SAPS and SANS. However, the PNS-Q correlated highly with McEvoy's Vignettes, a measure of self-perception of symptoms. The results of this study are discussed in light of current research and methodologic issues. The PNS-Q reflects schizophrenics' self-perception, an important, yet neglected, aspect of schizophrenia. Using this new measure, we believe that clinicians and researchers will be able to gain insight to the inner world of these patients and improve their condition, as well as enhance patients' involvement in treatment planning.

OBJECTIVE To compare long-term lithium patients who developed renal insufficiency (RI) with those who did not, and to examine what characterized these groups. METHOD One hundred fourteen subjects with DSM-IV bipolar, major depressive, or schizoaffective disorder who had been taking lithium for 4 to 30 years from 1968 to 2000 were studied retrospectively. Subjects with blood creatinine levels > or = 1.5 mg/dL were defined as RI patients, and creatinine levels < 1.5 mg/dL indicated no renal insufficiency (NRI). Ninety-four unmedicated subjects, matched for sex and age, served as a comparison group and had 2 measures of creatinine with a mean interval of 11.88 years. RESULTS Twenty-four (21%) of the lithium-treated patients were defined as RI patients. These subjects exhibited the "creeping creatinine" phenomenon as their creatinine levels increased progressively. The NRI subjects showed no increase of creatinine levels in up to 30 years and remained comparable to the comparison group. RI was associated with episodes of lithium intoxication and diseases or medicines that could affect glomerular function, but not with sex, psychiatric diagnosis, age at onset of diagnosed disorder, duration of lithium therapy, serum lithium concentration, and cumulative lithium dose. CONCLUSIONS Long-term lithium therapy did not influence glomerular function in an overwhelming majority of patients. However, about 20% of long-term lithium patients exhibited "creeping creatinine" and developed renal insufficiency.

Panic disorder is one of the most common anxiety disorders and has a lifetime prevalence of 3-5%. Panic attacks can begin at any age, but commonly have their onset in early adulthood between the ages of 20 and 40 years. Naturalistic data has shown that panic disorder has a chronic and relapsing course. Panic disorder is reported to be associated with an increased risk of suicidal behavior and comorbid psychiatric diagnoses such as depression and substance abuse. Currently, recommended treatment modalities for panic disorder include the use of antidepressant pharmacotherapy and/or cognitive behavioral therapy. Paroxetine is unique among the selective serotonin reuptake inhibitors since, in addition to its effect on the CNS serotonergic neurotransmission, it also has mild noradrenergic properties demonstrated to be effective in the treatment of anxiety disorders and depression. Paroxetine treatment has the potential to cause weight gain and sexual dysfunction, primarily anorgasmia and ejaculatory dysfunction for the long term. In the short-term, treatment causes nausea, gastrointestinal disturbances, irritability, headaches and eating and sleeping difficulties. Paroxetine is an example of an selective serotonin reuptake inhibitor agent, which has been well studied in the treatment of panic disorder and is efficacious and well-tolerated. Paroxetine pharmacotherapy has been recommended to be continued for 1 year as specified in the treatment guidelines set by the American Psychiatric Association in the treatment of panic disorder.

Objectives: Kleptomania, defined by DSM-IV as the inability to resist the impulse to steal objects which are not needed for personal use or for their monetary value, may reflect a form of obsessive-compulsive spectrum disorder and/or affective spectrum disorder. Methods: Twenty-one kleptomanic patients and 57 first-degree relatives completed a semistructured DSM-IV-based interview and questionnaires. Questionnaires are: the HDRS-17 (the Hamilton Rating Scale for Depression), the HARS (Hamilton Rating Scale for Anxiety), the Y-BOCS (Yale-Brown Obsessive Compulsive Scale), the YMRS (Young Mania Rating Scale). The two groups were compared to demographically matched normal controls (n = 64). Results: We found a high prevalence of affective and anxiety disorders in our sample of kleptomanic patients and their first-degree relatives. In addition, the scores on the HDRS, HARS, and Y-BOCS were significantly higher in the study group than in the control group. Conclusions: Our finding of a high prevalence of psychiatric comorbidity in kleptomanic patients could lead to the development of new treatment strategies for this disorder. Furthermore, the pattern of psychiatric disorders seen in the first-degree relatives can lead to new insights about the nosology and etiopathology of kleptomania.

Social anxiety disorder is a mental condition with anxiety and avoidance in social settings and is frequently accompanied by self-medication with alcohol. Epidemiological studies demonstrate that the risk that patients with social anxiety disorder will develop alcohol dependence is more than two-fold. We will discuss epidemiological research findings about this comorbidity, as well as reasons for the comorbidity and the various treatments available for these conditions. Very few studies have analyzed the efficacy of treatments for the combination of these disorders and it is not yet clear whether to treat the social anxiety disorder first, to treat the alcohol use disorder first or to treat both conditions simultaneously. Nevertheless, we propose to treat the symptoms of social anxiety disorder and alcohol use disorder in combination with the hope of achieving maximal improvement in these patients. Disclosure: I received financial assistance from Lundbeck Israel.

Antiepileptic drugs might be effective in the treatment of patients with Posttraumatic Stress Disorder, a condition with unmet pharmacologic needs. We review the literature on the efficacy and tolerability of antiepileptic drugs in Posttraumatic Stress Disorder, both case reports and open studies, as well as controlled studies if available. The results of the studies will be presented together with their methodological limitations (e.g., open trials, use of additional medications, and lack of use of standardized scales for Posttraumatic Stress Disorder). The effects of antiepileptic drugs on kindling, a suggested pathogenesis for Posttraumatic Stress Disorder are overviewed, and suggestions for further research are raised.

Background: Schizo phreni form dis or der (SFD) has an un clear di ag nos tic and prog nos tic status within the psy chotic spec trum. Method: We stud ied 36 in pa tients ad mit ted to our ward be tween 1983 and 1993 due to SFD. The pa tients were con tacted an av er age of 12 years af ter in dex hos pi tali za tion, and we noted the course of their ill ness, as well as their pres ent di ag no sis. Results: Of the sam ple, 84% had ad di tional, mostly psy chotic, epi sodes dur ing the follow-up, and 70% had di ag no ses in the schizo phrenic spec trum (that is, schizo phre nia and schizoaf fec tive dis or der). A sur vival analy sis re vealed that con fu sion and the pres ence of at least 2 good prog nos tic fac tors (GPF) at in dex hos pi tali za tion pre dicted bet ter out come. Conclusions: SFD seems to be an early mani fes ta tion of schizo phre nia. Only a few of those sam pled did not ex pe ri ence ad di tional re lapses—a pes si mis tic find ing at 12-year follow- up. The find ings of this study ac cord with DSM- IV cri te ria and the lit era ture regard ing the long- term prog no sis of SFD and the im por tance of the GPF.

Background and Objective Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line treatment for panic disorder, although up to 30% of patients either do not respond to SSRIs or withdraw due to adverse events. Reboxetine, a selective norepinephrine reuptake inhibitor (selective NRI), is effective in treating depression and may alleviate depression-related anxiety. This study aimed to investigate the efficacy of reboxetine in the treatment of patients with panic disorder who did not respond to SSRIs. Method In this 6-week, open-label study, 29 adult outpatients with panic disorder who had previously failed to respond to SSRI treatment received reboxetine 2 mg/day, titrated to a maximum of 8 mg/day over the first 10 days. Efficacy was assessed using the Panic Self-Questionnaire (PSQ), the Hamilton Rating Scale for Anxiety (HAM-A), the 17-item Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning (GAF) Scale. Results The 24 patients who completed the study responded well to reboxetine treatment. Significant improvement (p

The aim of our study was to evaluate the effectiveness of a self-information booklet (SIB) in decreasing anxiety and panic attacks in Panic Disorder (PD) patients. Eighty-four patients attending an outpatient clinic due to panic disorder were randomly chosen to receive paroxetine with/without a friendly-designed brochure. Follow-up was done by a masked rater after 1, 3,and 12 weeks in order to evaluate whether the co-administration of paroxetine and the brochure (Group A) had a beneficial effect over the administration of paroxetine alone (Group B). After 3 weeks of therapy, Group A patients had significantly greater improvement and lower scores on the Hamilton Anxiety Scale, the Panic Self Questionnaire, and the Visual Analog Scale. After 12 weeks, the differential improvement was not statistically significant and both groups had improved as compared to baseline. The administration of a psychoeducational brochure (SIB) to PD patients at the initiation of therapy had beneficial effects during the first weeks of treatment. Although this effect fades away, the role of the SIB is overstressed in its ability to increase well being and compliance, and reduce anxiety and panic attacks.

Hyperhidrosis is a reason for treatment by many specialists in medicine, such as dermatologists, family medicine doctors, surgeons and also psychiatrists. Hyperhidrosis causes considerable distress and disability. Despite the fact that the condition has been known for thousands of years, it is yet unclear whether excessive sweating derives from emotional" activation of the central nervous system, whether the emotional symptoms evolve due to local dysfunction of the sweat glands, or a combination of the two problems. In this article, we will present two conditions: hyperhidrosis and Social Anxiety Disorder, a mental condition with anxiety and avoidanrce in social settings that is frequently accompanied by sweating. We will discuss the similarities and differences between these disorders and the various treatments available for these conditions. Research shows that social anxiety does not explain hyperhidrosis, but that excessive sweating reduces the threshold for social anxiety. Among people with hyperhidrosis, the functional disability and the emotional problems are mediated by the social anxiety. We propose treating the symptoms of hyperhidrosis and social anxiety disorder in combination in order to achieve maximal improvement in these patients.

This study examines the relationship between psychiatrists׳ fear of death and negative emotions toward patients with borderline personality disorder (BPD). A survey (N=120) demonstrated that fear of death is associated with stronger negative attitudes toward BPD patients, after controlling for attitudes toward suicide. Our findings emphasize the importance of psychiatrists׳ awareness to their fear of death as a relevant factor for their emotions toward BPD patients.

Background Social Anxiety Disorder (SAD) has been repeatedly shown to be very prevalent in the Western society and is characterized by low self-esteem, pessimism, procrastination and also perfectionism. Very few studies on SAD have been done in the Middle East or in Arab countries, and no study tackled the relationship between social anxiety symptoms and perfectionism in non-Western samples. Methods We examined social anxiety symptoms and perfectionism in a group of 132 Israeli Jewish (IJ) and Israeli Arab (IA) students. Subjects completed the Liebowitz Social Anxiety Scale (LSAS), the Multidimensional Perfectionism Scale (MPS), the Negative Automatic Thoughts Questionnaire (ATQ-N), the Positive Automatic Thoughts Questionnaire (ATQ-P) and a socio-demographic questionnaire. Results The rate of SAD in our sample according to a LSAS score of 60 or more was 17.2% (IJ = 13.8%, IA = 19%, ns). The correlation between perfectionism and the LSAS was high in both groups, and in particular in the IJ group. The IA group had higher scores of social avoidance, of ATQ-P and of two of the MPS subscales: parental expectations and parental criticism. Concern over mistakes and negative automatic thoughts positively predicted social fear in the IJ group, whereas in the IA group being female, religious and less educated positively predicted social fear. Negative automatic thoughts and age positively predicted social avoidance in the IJ group. In general, the IJ and IA subjects showed higher social anxiety, higher ATQ-N scores and lower parental expectations as compared with non-clinical US samples. Conclusions Social anxiety symptoms and perfectionism are prevalent in Arab and Jewish students in Israel and seem to be closely related. Further studies among non-western minority groups may detect cultural influences on social anxiety and might add to the growing body of knowledge on this intriguing condition.

Background Negative attitudes towards patients with borderline personality disorder (BPD) may affect their treatment. We aimed to identify attitudes toward patients with BPD. Methods Clinicians in four psychiatric hospitals in Israel (n = 710; psychiatrists, psychologists, social workers and nurses) were approached and completed questionnaires on attitudes toward these patients. Results Nurses and psychiatrists reported encountering a higher number of patients with BPD during the last month, and exhibited more negative attitudes and less empathy toward these patients than the other two professions. The whole sample evaluated the decision to hospitalize such a patient as less justified than the decision to hospitalize a patient with Major Depressive Disorder. Negative attitudes were positively correlated with caring for greater numbers of patients with BPD in the past month and in the past 12 months. Nurses expressed the highest interest in studying short-term methods for treating patients with BPD and a lower percentage of psychiatrists expressed an interest in improving their professional skills in treating these patients. Conclusions The findings show that nurses and psychiatrists differ from the other professions in their experience and attitudes toward patients with BPD. We conclude that nurses and psychiatrists may be the target of future studies on their attitudes toward provocative behavioral patterns (e.g., suicide attempts) characterizing these patients. We also recommend implementing workshops for improving staff attitudes toward patients with BPD.

To evaluate the prevalence of suicidal behavior in patients with panic disorder (PD) and to study the role of alexithymia (AL), an affect component, as a predictor of suicidal behavior in PD, we compared 42 patients with PD with or without agoraphobia with 24 healthy controls with regards to depression, AL and suicide risk. Only 5% of the PD patients reported previous suicide attempts. A higher frequency of positive AL (score > 73) was found among the PD patients (39% v 4% among the controls). PD patients had a higher suicide risk and AL as compared to controls, but only the increased suicide risk reached statistical significance. AL subjects had higher suicide risk scores as compared to non-AL subjects. Significant correlations were found between the AL score and suicide risk, although the most significant correlation was, as expected, between the depression level and the suicide risk. A low rate of previous suicide attempts was found in the PD group, perhaps reflecting the low comorbidity in our sample. We suggest that AL may have a role in the causation of suicidal behavior in PD patients, although further studies should re-examine this issue with larger samples.

Preventive intervention after exposure to traumatic events is a subject of increasing interest among mental health professionals. Psychological debriefing, which aims to reduce the risk of posttraumatic stress disorder and other psychopathological sequelae of traumatic experiences, is an example of such an intervention. The authors review the history of psychological debriefing and examine its efficacy. They conclude that psychological debriefing might be an effective intervention after extreme stress, although more support from controlled studies is required.

Background: Although negative affect in general has been widely associated with suicide, the role of specific emotions and affect features in depression and suicidality is unclear. This study examined the potential of three major components of the affect structure as predictors of suicidal behavior. Methods: Twenty suicidal depressed (SD) inpatients were compared with 20 nonsuicidal depressed (NSD) inpatients and 20 healthy controls for alexithymia, emotional range (ER; i.e. variety of emotions experienced by the subjects) and affect intensity (AI; i.e. the intensity of their emotional responsiveness). Results: Both the SD and the NSD patients had a narrower range of emotions, a stronger AI and a higher degree of alexithymia than did the healthy controls. No differences were found between the scores of the two inpatients groups. Conclusions: The three affect components examined (alexithymia, AI and ER) did not prove to represent sensitive predictors of suicidal behavior. Hopelessness and depression severity were found to be more reliable in the prediction of suicidal risk. We discuss the implications of this study, particularly the possibility of early detection and intervention in patients at risk.

Kleptomania is characterized by an irresistible impulse to steal objects not needed for personal use or for their monetary value. Several recent case reports have shown that Serotonin Specific Reuptake Inhibitors (SSRIs) could be effective in the treatment of kleptomania just as it is in other obsessive-compulsive spectrum disorders. We report five cases of kleptomania patients who were successfully treated with fluoxetine or paroxetine in combination with a psychotherapeutic intervention. In one case, the discontinuation of the medication repeatedly led to the resurgence of the kleptomanic behavior. Our case series illustrates the effectiveness of SSRIs in kleptomania. It thus supports the assumption that this syndrome involves a dysfunctional serotoninergic mechanism.

Providing treatment and support to special-needs populations can decrease psychopathology and suicide rates. Because service in the military is an important socializing force in Israeli society and most Israelis serve, the Israeli Defense Forces (IDF) makes special efforts to identify, treat, and support soldiers with emotional, behavioral, and cognitive problems. This column describes the IDF's efforts for three groups of soldiers with special needs, with a focus on those with the most severe problems who receive support throughout their service to address psychopathology and suicidality. Suicide rates for the IDF population and for the three groups are reported.