High rate of non-attendance in mental health treatment is a major problem in terms of lost economic resources and deteriorated quality of life for the patients.

The aim of the present study was to conduct an analysis of the influence of demographic and clinical variables on treatment attendance.

A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment. Demographic and clinical variables were registered at assessment. Bivariate and multiple logistic regression analyses of the associations between these variables and attendance were conducted.

675 (27.3%) did not show up and 289 (11.7%) dropped out of treatment. Regression analysis showed that younger age, few years of school, taking an education, unemployment, no sick leave, personality disorder, low or high GAF, no earlier treatment, no use of psychoactive medicine, and substance abuse were significant predictors for non-attendance.

No-show was predicted mainly by clinical factors, whereas drop-out was predicted by demographic variables. Results and strategies to reduce non-attendance were discussed.

This research investigated relationship between hardiness and mental disorder based on S.C.L- 90 - R.

100 university students (50 men, 50 women) by cluster sampling were randomly selected. The research instruments were mental disorder S.C.L- 90-R and Ahvaz Hardiness Inventory (AHI). Mental disorders index S.C.L- 90-R assesses depression, somatization, psychtion, anxiety, obsessive, interpersonal sensitivity, phobia, hostility and paranoia. Pearson correlation coefficient and T independent test were used to analyze the data.

The findings showed that all of mental disorders indices except obsessive and interpersonal sensitivity have significant negative relationship with hardiness. Also there is no significant differences between men and women in degree of hardiness.

Based on results it is advised to apply plans to increase hardiness components, and with more using of hardiness components and instrument can predict mental disorders and prevent the mental disorders on time.

During cultural and social upheavals including manmade environmental factors like war and violence, drastic change takes place in people's expectations, “the meaning of life” and values. The purpose of this study was to examine the prevalence of psychiatric co morbidities in traumatic amputees in Kashmir (Indian Part).

Subjects were 100 consecutive patients with traumatic limb amputation. In addition to assessments of physical factors, psychiatric interviews were administered to examine mental disorders including PTSD and major depression.

The prevalence rates of PTSD and major depression were 20% and 63% respectively. It was followed by impulse control disorder 19%, phantom limb phenomenon 14%, generalized anxiety disorder 10% and panic disorder 6%. Motor vehicle accident and blast injuries were cause for 53% and 11% of limb amputations respectively. Majority (45%) of them were males in age group of 15-30 years. 61% were illiterate from rural areas (81%).

These findings suggest that psychiatric co morbidity is very common in amputees. Most of the patients are males of younger age group. Major depressive disorder is the most common psychiatric co morbidity followed by anxiety disorders in which PTSD is most prevalent, followed by impulse control disorder and phantom phenomenon respectively. Individuals suffering traumatic limb loss at any age are likely to suffer subsequent difficulties with their body image, but these relationships are more striking in the younger age groups who have experienced traumatic injuries.

166 persons have been surveyed which professional functioning is connected with extreme conditions of labour activity and the average work experience has made 18,5 years.

A scale for self-estimation PTSD - «the Missisipy scale», technique of colour elections Lusher, the questionnaire of psychological pressure, a scale of asthenic conditions, Bakcs questionnaire of depression, integrative test of the uneasiness. The most often surveyed is to state complaints as on somatic, and mental health: physical and emotional overfatigue, feeling of alarm, pessimism. They carry to risk factors: a constant concentration of attention, a psychoemotional pressure, unevenness in production, adverse ecological conditions of industrial premises.

Infringements of emotional sphere is not revealed at 107 people (64,5%). Separate signs PTSD are fixed at 44 people (26.5%). It is diagnosed PTSD at 15 people (9 %) surveyed (р < 0,05).

59 people have low level of adaptive possibilities and the adverse forecast of adaptation in extreme conditions of activity is diagnosed: 21 people (35,6%) - depressive symptoms; 18 people (30,5 %) - affective infringements; 14 people (23,7%) - excessive psychological pressure;. 6 people (10,2 %) - high level of alarm. It is necessary to carry out psychocorrectional actions for the purpose the prevention of development a mental pathology.

In the controlled and uncontrolled studies, community care as alternatives to in-patient care yielded similar or better outcomes. The aim of this study is to compare the direct cost of in-patient and home based care of acute mental illness from the health care provider's perspective.

82 patients exclusively treated as in-patient and 80 patients exclusively treated at home in 2008 on account of acute mental illness, in the psychiatric department of an Irish general hospital were suitable for stratified randomisation in each group. 32 patients were selected from each group. Micro-costing technique was used to retrospectively estimate from the clinical record, the direct costs of treatment for each patient (n=64).

The average direct cost per patient treated in the hospital was €5,579 (range, €1,668 - €24,048, 95% confidence interval (CI) of €3808 to €7350), compared to €3,977 (range, €779 - €10,355, 95% CI of €3034 to €4921) for each patient treated at home. The average daily in-patient admission cost was €343 (95% CI of €332 to €354), compared to €147 (95% CI of €142 to €152) per day for each patient treated at home.

Home based care of adult patients presenting with acute mental illness, that could have been admitted in the absence of a home based treatment unit incurred lower daily costs to the health care provider compared to in-patient care (Mann-Whitney U test, z=6.876, p=0.000). This underscores the need for more researches to further develop Home based models of acute mental illness care.

The purpose of this study was to examine the relationship between affect and short-term life satisfaction (LS) taking into account the dimension of activation for positive affect (PA) and negative affect (NA) and the balance of PA and NA.

The study included 398 students (184 men and 214 women) who completed six questionnaires three of which were used for another study. The Positive and Negative Affect Schedule was utilized for assessing activated PA and NA. Two subscales of the Multiple Mood Scale were used to measure deactivated PA and NA, and the Short-term Life Satisfaction Scale for LS. Correlation analyses and hierarchical multiple regression analyses were conducted to mainly examine the relationships between affect balance (PA-NA and PA/NA) and LS.

The results of correlation analyses showed that LS was positively associated with affect balance in both activated and deactivated dimension. Additionally, the hierarchical multiple regression analyses showed a significant interaction between activated PA and NA, which indicated that the relationship between activated PA and LS in women was strengthened when the level of activated NA was relatively lower.

The findings in this study suggested that students who have stronger PA compared to NA might feel high LS in both activated and deactivated dimension. Moreover, it was suggested that the profitable effect of activated PA on LS in women would be larger when their activated NA was relatively weakened.

The ‘sick-quitter’ hypothesis states that mental disorders associated with alcohol abstinence are accounted for by people who stop consuming alcohol because of poor health.

We investigated the association between alcohol abstinence and symptoms of common mental disorder and personality disorder, distinguishing between lifelong abstinence and abstinence following previous consumption.

Analyses were based on the British National Survey of Psychiatric Morbidity 2000, which sampled 8580 residents aged 16 to 74 years. Heavy consumers of alcohol were excluded, using the Alcohol Use Disorders Identification Test Questionnaire. Symptoms of common mental disorder (depression/anxiety) were identified by the Clinical Interview Schedule. The screening questionnaire of the Structured Clinical Interview for Axis II Personality Disorders was used to identify potential personality disorder. Self-reported alcohol abstinence was divided into lifelong abstinence and previous consumption. Previous consumers were asked why they had stopped. Covariates included socioeconomic status, social activity and general health status.

After adjustment, alcohol abstinence was associated with both common mental disorder symptoms and any personality disorder, but only for previous consumers (respective odds ratios 1.70 (1.23-2.34) and 1.45 (1.09-1.94)). Associations were non-specific, being apparent for most individual mental disorder symptoms and personality disorder categories. More detailed analysis indicated that associations were limited to previous consumers who reported ceasing alcohol consumption for health reasons.

The results were consistent with the ‘sick-quitter’ hypothesis and should be taken into account when interpreting associations between moderate alcohol consumption and beneficial health outcomes.

To study patients’ preferences and evaluation of treatment and its consequences for outcome.

Data come from 723 primary care patients with a DSM-IV diagnosis of anxiety disorder and/or affective disorder. Patients were included in a primary care setting. During inclusion, patients’ psychiatric status was assessed with the CIDI, patients preferences for treatment were measured by the Perceived Need for Care Questionnaire and their evaluation of current treatment was assessed by the Quality of Care through the Eyes of the patient scale, designed for this study. Severity of depression and anxiety symptoms was assessed by the Inventory of Depressive Symptoms (IDS) respectively the Beck's Anxiety Inventory (BAI). After one year, these instruments were assessed again.

Patients preferences and evaluation of care were related: patients whose preferences were met had a more positive evaluation of the psychiatric competence of the GP, GP's patient-centeredness, GP's attitude towards the patient, the quality of self help advices and the quality of information. However, patients whose preferences for treatment were met, showed no greater improvement after one year, compared with those whose preferences were only partly or not met. On the other hand, patients who evaluated different aspects of GPs care positively showed more improvement after one year than patients who evaluated these aspect neutral or negatively.

The “match” between provider (GP) and patient appears to be more important than the content of interventions and patients’ preferences regarding these interventions.

We examined the effects of affect and emotional suppression (ES) on short-term life satisfaction (LS). In doing so, we considered the dimension of activation for positive affect (PA) and negative affect (NA).

The final sample included the data collected from 398 students (184 men and 214 women). The mean ages were 19.15 yrs for men and 19.84 yrs for women. Participants answered six questionnaires two of which were used for another study. The Positive and Negative Affect Schedule was utilized for assessing activated PA and NA, two subscales of the Multiple Mood Scale to measure deactivated PA and NA, respectively, one subscale of the Emotion Regulation Questionnaire for gauzing ES, and the Short-term Life Satisfaction Scale for LS. All of them were Japanese versions, answered on the past week.

Results showed that LS was positively associated with PA and negatively with NA, but that its positive association was stronger in activated PA than deactivated PA while its negative association was stronger in deactivated NA than activated NA. The interaction between deactivated NA and ES was significant in men, whose post-hoc tests suggested that deactivated NA was more negatively associated with LS when ES was higher.

This study suggested that activated and deactivated affect differ in their relations to life satisfaction. Moreover, it is likely that the detrimental effect of NA on life satisfaction is larger when the expression of NA is more strongly suppressed.

On the road to DSM-V, instruments are demanded which provide clinically meaningful information, e.g. predictions about psychotherapy utilization. One interesting and promising personality assessment method is the Shedler-Westen-Assessment Procedure-200 (SWAP-200) providing dimensional and prototypical assessment possibilities for personalty disorders.

The study compares the predictive power of the Shedler-Westen-Assessment Procedure-200 with the Structured Clinical Interview for DSM-IV on engagement in (psychoanalytic) psychotherapy.

297 patients with personality disorders were assessed with both instruments in a 4-year-follow-up study. Multinomial logistic regression showed small differences between the prediction rates in the cross-validated data.

Both instruments showed clinically useful prediction rates for treatment rejecters: SWAP scales led to correct predictions with dysphoric traits as semi-stable predictors for rejecters, while SCID scales led to correct predictions with Negativistic, Depressive and Schizotypal PD as stable predictors.

Results are discussed under the aspect of advantages and disadvantages of the SWAP-200 diagnostic procedure, which includes the assessment of affect-experience, defence-organisation, and object-relation-style.

Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).

IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.

Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).

Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).

Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.

Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.

The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.

The AMDP -system (Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie) consist of a psychopathology scale (100+15 items) and of a somatic scale (40+7 items), It is widely used in the German-speaking and French-speaking countries.

To describe the development and italian validation of the (AMDP), designed to assess psychopathology in psychiatric patients.

Diagnosis of 125 patients were assessed according to DSM-IV using SCID (Structured Clinical Interview for the DSM-IV) and AMDP.

To assess sensitivity to change, 24 patients were involved in a 4-week rehabilitation program and then reassessed at the end of 4 weeks.

To evaluate inter-rater reliability, all patients were assessed by two clinicians in a joint rater session.

All AMDP-subscales showed significant improvement after 4-week rehabilitation program (P< 0.05).

Inter-rater eliability was substantial (intraclass correlation coefficient, ICC > 0.70) in all subscales of AMDP.

The AMDP is a valid, reliable instrument to evaluate severity and treatment response in psychiatry. Given its simplicity, and clinical validity, AMDP is appropriate for use in observational studies and routine clinical practice.

There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM density in PTSD in relation to trauma load.

Magnetic Resonance Imaging (MRI) scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were performed. The self-rated Trauma Antecedent Questionnaire (TAQ) was administered to assess lifelong trauma load and resilience. TAQ includes two scales (“trauma and neglect” TAQ−, and “resilience factors” TAQ+) further divided into four subscales measuring trauma load and resilience in four different age periods: zero to six, seven to twelve, thirteen to eighteen and adult. Regression analyses between the two sub-scales and GM density were performed on all 43 subjects by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM2.

The analyses showed that GM density negatively correlated only with adult TAQ- in bilateral posterior cingulate, left anterior insula, and right anterior parahippocampal gyrus.

Irrespective of the PTSD diagnosis, trauma load was found to correlate with GM density in several limbic structures suggesting a high vulnerability of these structures to the effects of stress and trauma, These regions are implicated in integration, encoding and retrieval of autobiographical and episodic memories, emotional processing, interoceptive awareness and self-referential conscious experience. Thus, our study supports lower GM densities in limbic and paralimbic cortices as a potential structural basis for memory and dissociative dysfunction in PTSD.

We created an experimental adaptation of the REF scale (Lenzenweger et al., 1997), in a Likert format for discriminate between frequency and intensity of referential thinking (Rodríguez-Testal et al., 2008).

We try to verify if the Likert format of the REF discriminates between controls and patients, and also in patients with different diagnoses. We predict that there will be differences in frequency and intensity between patients and controls.

Participants: 108 subjects, 40 patients from a private center of clinical psychology, 55% women, mean age = 35.70 (SD = 12.42) and 68 controls selected from the normal population, 50% women, mean age = 36.35 (SD = 12.99).

It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.

No differences in referential thinking between patients and controls with Likert format in frequency (t = 1.496, P = 1.14), although there were differences in intensity (t = 2.30, p =.023). No significant differences in referential thinking between types of diagnoses with the Likert format (X2 = 6.63, p =. 249).

The Likert format of the REF scale adequately discriminates between patients and controls in intensity but not in frequency. This format doesn't discriminate between different diagnoses. The Likert format induces and overestimates the response.

Having been tasked with developing Standards for integrated care pathways for mental health (ICP), successfully publishing in 2007, NHS Quality Improvement Scotland (NHS QIS) now supports NHS Boards in developing and implementing these standards. Support is available via three National ICP Coordinators and local ICP facilitators.

The main objective is for Boards to achieve ICP accreditation, resulting in demonstration of a robust and responsive mental health system through implementation of their local ICPs supporting continuous cycles of quality improvement embedded in a culture that ensures delivery of person-centred care and reflective practice.

A model of and process for accreditation was developed considering: § Developing the project plan§ Reaching consensus on the goal of the accreditation initiative.§ Defining incentives for stakeholders in having ICPs accredited § Reviewing literature on existing accreditation systems in UK and internationally § Developing a range of options§ Carrying out an option appraisal§ Agreeing one preferred option § Obtaining NHS QIS and Scottish Government approval for preferred option§ Further development of support mechanisms and implementation of a longer term accreditation framework

A phased and incremental accreditation system was developed.

The first phase - “foundation level” - focuses on ensuring that appropriate infrastructures are in place to support full ICP development and implementation in NHS Board.

All 14 NHS Boards in Scotland achieved foundation level accreditation.

Reflection on this first phase are helping to inform NHS QIS on how best to structure future levels of accreditation and ongoing support over the next few years.

Alexithymia represents a personality trait construct encompassing difficulty identifying and describing feelings, distinguishing between feelings and the related physical sensations, and an externally oriented cognition. A self-report 20-item Toronto Alexithymia Scale (TAS-20) is a commonly used tool to measure alexithymia. It has been translated into more than 20 different languages, crossing the cultural and language barriers. TAS-20 has a factorial structure: factor 1 assesses difficulty identifying feelings; factor 2 assesses difficulty describing feelings; factor 3 assesses externally oriented thinking.

The objective of the study was to validate a Serbian translation, including the factorial structure, of the TAS-20.

TAS-20 was expertly translated from English to Serbian and given to a bilingual non-clinical sample fluent in both English and Serbian (n=47, age 18-60). The subjects were assigned to complete Serbian version (TAS-20-SRB) at week one, and the English version (TAS-20-ENG) at week two (7-14 days apart). The collected data were analysed using a paired samples correlations and paired samples t-test.

There were no statistically significant differences in paired samples comparisons of means of total score and scores on each of three factors of TAS-20-ENG and TAS-20-SRB (p>0.05). The results of correlations of total scores and scores on factors show the statically significant correlations (p< 0.001), and also that the correlations were very high (from 0.87 to 0.95).

Bilingual subjects showed temporally and quantitatively congruent scores on both TAS-20 and TAS-20-SRB, suggesting that the Serbian translation of TAS-20 was valid, and that the factorial structure remained stable.

There is a considerable body of literature suggesting that standardized rater training is a critical element to achieving inter-rater reliability. With the advance of clinical and research trials to worldwide locations there have been challenges in tailoring instruments not only in terms of language but also culture. In this study we compare different cohorts of raters receiving training from seven different countries. We asked if there was any consistent by-country impact on certain items, factors, or subscales on the instrument.

The data set comes from rater training events held in Russia, India, Singapore, Austria and the United States including participants from seven different countries. Raters (n=221) scored videotaped interviews of schizophrenic patients using the Positive and Negative Syndrome Scale (PANSS). Results were compared across countries and intraclass correlation coefficients (ICC) compared by total score, subscale score and by item.

There were no significant differences between rater cohorts in terms of PANSS total score. Differences emerged in terms of the assessment of negative symptoms in general and the assessment of unusual thought content in particular.

The lack of differences in rater performance across countries indicates that standardized rater training is broadly effective in cohorts selected to participate in clinical trials. By item analysis indicated that there are some important differences in the way that different groups conceptualize items. This suggests a need to tailor training to those items that are less reliable in certain groups to ensure reliability and validity in the use of this instrument.

The importance of rater training for reliability and validity in clinical trials is well documented. In this study the authors examined data from several large training events that used standardized training procedures and raters with similar levels of education and experience to determine if there were any differences between rater performance at baseline (before training) and endpoint (after training) that emerge independent of these factors.

Results from multiple training events held internationally were analyzed to determine if differences between baseline and endpoint scores were significant. Raters scored videotaped interviews of the Positive and Negative Syndrome Scale (PANSS).

Three subgroups of raters emerge based on concordance with gold-standard ratings: raters that score high at baseline and endpoint; raters that score fair at baseline and good at endpoint; raters that do not appear to improve. For the stronger initial raters that continued to perform well after training there was a less substantial change (t(96)=2.953, p< .005) than those raters that did less well at baseline but improved after training (t(160)=4.037, p< .001).

Within training groups there appear to be three groups of raters that emerge independently of rater qualification and training received: those that performed well initially and well at endpoint; another group that performed marginally at the beginning of training and showed improvement by the end; and a third group that did not improve as a result of training. Analysis of ICCs suggests targeted training for individuals that perform less well at baseline could be beneficial.

Functional brain activity has been only studied marginally in schizoaffective disorder (SAD), a disorder whose nosological status is controversial. The present study investigated the prefrontal cortex (PFC) activity of schizomanic patients during performance of a working memory task.

13 schizoaffective patients, with current schizomanic episode (Young> 18); and 26 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) while performing baseline, 1-back and 2-back versions of the n-back task. Linear models were used to obtain maps of activations and deactivations in the groups.

During performance of the n-back task, controls showed activation in a cluster of frontal areas and de-activation in the medial orbitofrontal and anterior cingulate cortex. The SAD patients showed significantly less activation in prefrontal areas than the controls. They also showed a marked failure to de-activate in medial frontal cortex. The SAD patients’ impaired task performance was associated with both reduced activation of the dorsolateral PFC and reduced de-activation of the medial frontal areas.

Schizomanic patients show failure of activation in a network of cortical regions, and also a failure to de-activate the ventromedial PFC and anterior cingulate cortex. This latter area corresponds to the one of the components of the 'default mode network´. This pattern of abnormality is similar to that found by our group to characterise schizophrenia (failure to activate and failure to de-activate), but different from that which characterises manic patients (failure to de-activate only).