Background:Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome.Objective:An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries.Method:For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed.Results:A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%).Conclusion:The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

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The suicidal behavior is regarded as the act by which a person seeks to take his life, being aware of the consequences of his action. In our review, besides describing the main introductory aspects for the concept of suicide, we focus our attention on the main neurophysiological and genetical mechanisms relevant for this extremely difficult to manage and controversial behavior. Moreover, considering the latest interests in the current literature on the relevance of central oxytocin to various superior cognitive behaviors, we will also make a short description on how important effects of oxytocin could be in the context of suicidal behavior.

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Thirty-five years after Brescia et al. (N Engl J Med 275:1089-1092, 1966) realized the first peripheral autogenous arteriovenous fistula, the "Achilles' heel" of chronic dialysis is still the absence of a good-quality permanent vascular access. The number of patients depending on hemodialysis is increasing. Until 10 years ago, in Romania, there was a need to treat isolated critical cases. Nowadays, every dialysis center needs algorithms for a standardized approach, adaptable for each case. We reviewed 171 consecutive arteriovenous fistulas (132 patients) performed in adults in identical standard conditions: use of an inflatable tourniquet during the vascular dissection, microsurgical techniques, and use of only autogenous tissues. We analyzed our results, the technical difficulties encountered, and their management in long-term follow-up. The aim of this study was to set up the basic principles of our algorithms. Our approach, based on our education as plastic surgeons involved in hand surgery and microsurgery, might present the advantage of sparing renal patients vascular capital.

The Oxford Handbook of Psychiatry covers all major psychiatric conditions and sub-specialties, and provides practical and comprehensive guidelines and in-depth coverage of psychiatric assessment, psychopathology, evidence-based practice, therapeutic issues, and transcultural psychiatry.

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Abstract.In this mini-review we were interested in describing the main genetic, biological and mechanistic aspects of the aggressive behaviour in human patients and animal models. It seems that violent behaviour and impulsive traits present a multifactorial substrate, which is determined by genetic and non-genetic factors. Thus, aggressivity is regulated by brain regions such as the amygdala, which controls neural circuits for triggering defensive, aggressive or avoidant behaviour. Moreover, other brain structures such as the anterior cingulate cortex and prefrontal cortex regions could modulate circuits involved in aggression. Regarding the genetic aspects, we could mention the mutations in the monoamine oxidase or the polymorphisms of the genes involved in the metabolism of serotonin, such as tryptophan hydroxylase. Also, besides the low levels of serotonin metabolites, which seem to be associated with impulsive and aggressive traits, there are good evidences that deficiencies in glutamate transmission, as well as testosterone, vasopressin, hypochloesterolemia or oxytocin modifications could be related to the aggressive behaviour. Regarding oxytocin we present here in the last chapter the controversial results from the current literature regarding the various effects exhibited by oxytocin administration on the aggressive behavior, considering the increased interest in understanding the role of oxytocin on the main neuropsychiatric disorders. Introducing the concept of aggressionBased on the etymological analysis, the word aggression comes from Latin, from aggressio, signifying attack, and also from the verb aggredior, which can be translated as "to go against something or someone", "to approach someone with a purpose ", or "to assault" [1]. Thus, aggression basically describes a state of the psychophysiological system that allows the individual to respond with a set of hostile behaviours in the conscious, unconscious, or phantasy plan towards the destruction, coercion, degradation, humiliation of a meaningful thing or being, that the abuser perceives as such and represent a challenge for him/her [2].Moreover, according to a general dictionary of psychology, the term aggression is defined as: 1. the tendency to display hostility by manifestation of aggressive acts; 2. the tendency to overcome any encountered oppositions; 3. the tendency of self-assertion by unswerving manifesting of self interests; 4. hiperenergy in one's attitudes and reactions; 5. the constant tendency of domination within the social group or community [3].In addition, from a psycho-sociological perspective, the aggressiveness as physical expression of the aggressive impulses is perceived by the existence of the behavioural intent to cause moral or psychological suffering to others. The human aggressive behaviour has on one hand an innate feature and, on the other hand, is acquired during the course of anthropogenic evolution. Also, if in the primitive societies the aggression consisted only in physical attacks as violence, in modern society ...