1

Liliana Baroiu , Lucreția Anghel , Caterina Dumitru , Alina Viorica Iancu , Miruna Drăgănescu , Anamaria Ciubara

Clostridium difficile infection (CDI) is a new pathology, but increasingly common in the elderly patient, with multiple comorbidities that often alter his quality of life and aggravate his vital prognosis. Material and method: The study is a prospective, observational, controlled active study, performed on 706 patients admitted to the Hospital "St. Parascheva Galați Infectious Diseases Clinical Hospital " between 1.01.2017 ÷ 31.12.2018 with the diagnosis of CDI, of which 69 patients were associated with psychiatric disorders (PD).

Results: The demographic, clinical and paraclinical characters that differentiated the group with CDI and PD from the group with CDI and various comorbidities, statistically significant, were:female sex, predominant in the group with PD, older age in the group with PD, Charlson score with values higher in the PD group, Atlas score with higher values in the PD group, the number of deaths that occurred in the first 30 days after the CDI episode, as well as the number of deaths that occurred in the first 6 months after the CDI, higher in the group with CDI and PD compared to the group with CDI and various comorbidities.

2

Giangennaro Coppola , Grazia Pastorino , Francesca Felicia Operto

Depressive disorders are the most frequent psychiatric disturbances associated with epilepsy in adolescents and include a broad and heterogeneous spectrum of conditions that share hallmark features and symptoms such as sadness, irritability, decreased motivation or interests, fatigue, withdrawal, hopelessness, anhedonia, changes in appetite and weight, and sleep disturbances that are persistent and pervasive most days for at least 2 weeks. Using generic self-report depression surveys and current diagnostic codes, clinical and surveillance studies have revealed prevalence rates of 20—25% for depression in youth with epilepsy, with adolescents showing particular vulnerability. Furthermore, 20% of youth with epilepsy endorse suicidal ideation, and youth endorsing suicidal ideation do not necessarily have clinical symptoms of depression. Considering that depression in youth with epilepsy is a common comorbidity, characterized by poorer psychosocial and healthy-related outcomes and increased risk of suicide, a brief, free measure of specific depressive symptoms in youth with epilepsy would be beneficial. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and validated in many countries. NDDI-E-Y showed reliable and construct validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care.For the management of depressive symptoms in adolescents, interventions can be distinguished in non-pharmacological and pharmacological. The first includes psychoeducation which should clarify to adolescents and parents the main features of epileptic disorder, side effects of antiepileptic drugs, treatment modalities, how to cope with learning and social difficulties, in order to improve quality of life. Concurrently, a cognitive-behavioral therapy (CBT) including individual therapy, supportive and family therapy and school services, should be carried on. Psychopharmacology for depressive symptoms should be deserved to moderate to severe depressive symptomatology, only after deep assessment of prior and current antiepileptic and/or psychopharmacologic treatment. SSRIs including fluoxetin, sertraline, fluvoxamine and escitalopram should be first considered. Data coming from experimental studies in animals and humans seem to confirm no decrease of seizure threshold by SSRI adjunctive therapy.

3

Ana Fulga , Bogdan Alexandru Ciubara , Anamaria Ciubara

This paper presents a fully documented rare case of school bullying in which one of bullies has suffered traumatic injuries which were incompatible with life. The authors present judicial, social, clinical, morphological, somatic and mental medical data. The data from specialized literature of high scientific quality is analyzed, the aim being to improve the prediction and prophylaxis of the phenomenon.

4

Mendo Henriques

Consciousness is, probably, the most common and the most mysterious experience in human life. It encompasses a stream of mental activities that include knowledge and recognition, emotions and feelings, organic dispositions, and linguistic acts, as well as altered states such as those provoked by drugs and pathologies, and mystical moments.

The philosophy of mind is habitually reprimanded for neglecting to characterize exactly what consciousness is. In this regard there has been little change over the previous decades because consciousness has a wide assortment of meanings according to authors and disciplines.

Consciousness is analysed in scientific perspectives such as neurosciences, psychology, linguistics, physics, and cybernetics. Each science highlights special features of consciousness' rooting in the subject, according to specific interpersonal contexts, biological developments and always as a mirror of the brain's complexity.

A short state of the art of consciousness' studies is useful if it searches for constant issues beyond the variety of explorations of conscious experience. Beyond the psychology's self, the psychoanalysis' ego and the mental maps of neurosciences, we observe trends in the philosophy of mind that search for a dialogical ground; what relates us to the other as we say "˜I', "˜Thou' and "˜We', is an essential aspect of human experience and a permanent challenge.

5

Liliana Luca , Stefan Lucian Burlea , Mihaela Carausu , Ana-Catalina Chirosca , Ioana Maria Marin , Petronela Nechita , Ginel Baciu , Anamaria Ciubara

This research was structured as a descriptive study based on a questionnaire with seven questions, addressed to the medical personnel involved in the medical assistance of the patient with mental disorders (psychiatrists, family doctors, physicians from other specialties, psychologists). This study refers to the relationship medical team — psychiatric patient from the point of view of the health professionals. The main appreciation criteria refer to the lack of knowledge or minimizing the importance of patients' rights, aspect that can influence the voluntary addressability of psychiatric patients to treatment and therapeutic success.

The lot of this study had a number of 217 subjects from which are part psychiatrists, family doctors, physicians from other specialties and psychologists, who work in therapy centers and hospitals from the following counties: IaÅŸi, BotoÅŸani, Suceava, Vaslui.

6

Francesca Felicia Operto , Grazia Maria Giovanna Pastorino , Giangennaro Coppola

Objective: To assess maternal and paternal stress inparents of children with epilepsy, at the time of diagnosis, after one year of follow-up and after therapy withdrawal.

Methods: We investigated parental stress in a sample of 85 children aged 2-14 years, divided into two groups based on the diagnosis: Group 1 (50 patients) with Childhood Absence Epilepsy or Idiopathic Focal Epilepsy with Rolandic discharges; Group 2 (35 patients) with different forms of drug-resistant Epilepsy. Every parent completed the Parental Stress Index-Short Form at Time 0, when they received the diagnosis and patients started therapy, at Time 1, after 1 year of follow-up. Only parents of Group 1 completed the same questionnaire after 2 years therapy withdrawal.

Results: We found high levels of stress in both mothers and fathers at Time 0, without statistically significant differences between the two groups.At Time 1, stress values were unchanged in Group 1 mothers; conversely, the levels of stress in Group 1 fathers were reduced, with average values that fell within the "normal range". In group 2, stress levels were reduced both in mothers and fathers at Time 1, compared to Time 0, but equally fell into the "clinical range", for both parents.In Group1, even one and two years after therapy withdrawal, parental stress did not normalizeand all scores persisted in the "clinical range" in both mothers and fathers.

Conclusions: Our study revealed that, the diagnosis of epilepsy itself tended to increase parental stress, apparently regardless of the severity of the disorder; even after a period of follow-up, when epilepsy was better controlled, overall parental stress remained high. Parental stresslevels remained higher than expected, even 2 years after the suspension of therapy and the absence of seizures. This was probably due to concerns with the reappearance of new seizures or a more severe type of epilepsy with the suspension of drug(s), and feelings of inadequacy with their parental role(s).

7

Dorina Stan , Dragos F. Voicu

The fear of the dentist, dental anxiety and dental phobia continue to concern the medical world, seeking to elucidate the causes, calculate the prevalence and its implications on the oral health of the population, as well as identify the most effective methods to combat it. The survey included 208 patients, who were treated and investigated, in the period 2018-2019. The questionnaire consisted of 15 questions, structured in 3 sections: socio-demographic data, oral hygiene habits and past experience, during dental treatment, with analysis of dental anxiety, using modified MDAS.

The mean value of MDAS in the study group was 11.7 ± 4. Most of the respondents (80%) had medium or low dental anxiety. High levels of anxiety were observed in 20% of patients, including 12% with dental phobia. A statistically significant correlation was found between the mean values of the MDAS and sex (p = 0.030), age (p <0.0005), place of residence (p = 0.016), socioeconomic status (p = 0.040), subjective assessment of oral health (p <0.0005), frequency of dental appointments (p <0.0005) and negative dental experiences in the past (p <0.0005). No correlation was observed between anxiety, education, or habits related to oral hygiene. As methods of combating dentist fear, it resorted, somehow differentiated and personalized, to progressive muscle relaxation techniques, desensitization and cognitive behavioral therapy, the therapeutic act being carried out in a "tell-show-do" manner. These applied methods have meant the extension of the working time, but without additional costs. We consider our experience in using them as positive, with stable results and with increasing efficiency over time.

Our study shows that most of the respondents were without any special fear of dental treatment, one in five patients had a high level of anxiety, and one in ten suffered from dental phobia. Middle-aged women seem to have higher rates of dental anxiety, compared to men.

Practitioners need to be aware of the common occurrence of fear, in order to combat it being required knowledge of behavioral psychology and, first of all, establishing a relationship based on trust with the patient, from the beginning.

8

Roxana-Georgiana Tauser

The broad arsenal of psychotropic medications is characterised by significant interindividual variability in clinical response and adverse effects, stringent monitoring requirements, potential drug-drug interactions, difficult long-term adherence and high costs. Pharmacogenomics investigates the correlation between genetic polymorphisms and responsiveness to drugs and could provide a valuable guide to fulfill the promise of personalized therapy in the context of the genomic medicine era, by tailoring treatment based on the patient's specific genetic markers. The present paper overviews the current advances in the clinical applications of pharmacogenomics to individualized psychotropic therapy.

Material and methods. The relevant recent pharmacogenomics literature is selected and analysed in order to illustrate the impact on the clinical outcomes and quality of life in psychiatric patients of the genetic variants in the neurotransmitter receptors (dopamine and serotonin), metabolic pathways of drugs (cytochrome CYP450 2D6 and 2C19) and   the human leukocyte antigen system. The paper focuses on some of the major psychotropic drug classes, such as: antipsychotics, antidepressants and mood stabilizers. Validation of statistically significant pharmacogenomics relationships has enabled the development and market approval of some predictive tests which are already integrated into some psychotropic drugs label. Results and discussions. Predictive pharmacogenomics tests have changed the classical approach of prescription   "trial-and error" and "one dose fits all patients" towards personalized therapy. In addition, in new therapeutic candidates' clinical development, pharmacogenomics practically guides the clinical studies design, by substantially reducing the failure rates, costs and exposure risks of non-responders patients to new drugs. Current translation barriers of predictive pharmacogenomic tests from bench to clinical practice are also discussed. Conclusion. The paper emphasizes the current progress and future prospects in the field of pharmacogenomics as a guide to personalized therapy of psychiatric disorders, by: a) pretreatment selection of the right drug, prescribed in its optimized dose, to the right patient, according to one's specific genetic biomarkers; b) by improved clinical trials design based on genetic stratification of patients' population into responders versus non-responders, especially in the costly phases III and IV.

9

Olga Vasovic , Marina Nikolic-Djurovic , Vladimir Djukic

Aim: It is well known that hypothyroidism is associated with poorer quality of life. Still, there are more studies nowadays that also report low health-related quality of life (HRQol), more depression, and anxiety in euthyroid Hashimoto thyroiditis (HT). We hypothesized that autoimmunity itself is associated with low HRQoL and a high prevalence of mood disorders in euthyroid HT. Patients and methods: We examined 130 euthyroid patients with HT (90% females) and 111 matched euthyroid, healthy controls. The groups were subdivided per age: 20-49 yrs. and 50 years. We conducted a cross-sectional analysis. We took blood samples for thyroid hormone levels and thyroid autoantibodies. We examined HRQoL via the health questionnaire (SF-36) short-form version 1 and the presence and degree of mood disorders with the Hospital anxiety and depression scale (HADS) questionnaire. Significant associations between variables were examined with ANOVA analysis and partial correlations. Results: Patients were significantly more depressed than control subjects (p 0.001), and have had more anxiousness, but only in the younger group (p 0.05). Quality of life was significantly better in the older control group comparing to patients with Hashimoto (p 0.01). The overall SF-36 score was in a significant negative correlation with antibodies (TPOAb, TgAb). Depression was positively associated with TSH and TPOAb levels. Conclusion:   Our study indicated that euthyroid patients with HT had worse HRQoL and showed more symptoms of anxiety and depression. We also have found that levels of thyroid antibodies were crucial in terms of neuropsychological wellbeing. More studies with longitudinal observations could explain a possible causal relationship.