Limited research exists worldwide on medical students’ substance use patterns including alcohol and marijuana use.

The aim of the study was to examine the prevalence of substance use, including marijuana, alcohol and other illicit substances (i.e. cocaine, hallucinogens and ecstasy) in a sample of medical students in Greece.

655 students from the School of Medicine of Thessaloniki completed an anonymous, web-based survey including the CAGE questionnaire for alcohol abuse. Students were asked to report the frequency (lifetime, past year, past month) and the motive of the use.

72% percent of the students reported having never used any illegal substance and 21% reported marijuana use at least once in their lifetime. 20.9 % were nicotine smokers. No gender difference regarding marijuana use was observed. Marijuana users underestimated the risk of marijuana use on their health compared to non users. Although the relative mean Cage scores are low indicating a lack of severe alcohol related problems in our sample, there is a significantly higher mean CAGE score in students who use marijuana. The use of other illicit substances was rare (3% used inhalers, 2.3 % cocaine, 2.3% ecstasy, 2% ketamine, 1.8% amphetamines and 1.7% mephedrone). However, the use of marijuana was significantly correlated with use of cocaine, LSD, ecstasy, ketamine, amphetamine and mephedrone.

The findings represent initial data on the prevalence of substance use among Greek medical students. Nationwide studies are needed further investigating the prevalence, the motivation and the impact of this risky behaviour among this population.

The 2006-2007 Iraqi Mental Health survey (IMHS) reported surprisingly low prevalence of alcohol and drug abuse in the Iraqi population. Anecdotal suggested that abuse of alcohol and drugs has increased. To investigate this possibility, we conducted a survey of drug and drug abuse at youth centers in Baghdad.

A total of 2678 persons was included in this survey with male to female ratio of 3.8:1. They were randomly selected from youth centers located in different sectors in Baghdad. Composite International Diagnostic Interview was used to generate diagnosis. The interviewers were trained youth center staff. Data collection was carried out on Dec. 2009.

A total of 17% met criteria for alcohol abuse and 7.02% met criteria for drug abuse. In those below 18 years of age, 2.1% reported alcohol abuse and 1.1% reported drug abuse. The peak age for alcohol and drug abuse was at 24-35 years. No female reported alcohol and substance abuse. Age of onset of alcohol was 21.7 ± 3.6 years and for drug abuse was 22 ± 5.8 years. Alcohol abuse was significantly associated with high crowding index, but drug abuse was not associated with crowding index. Low educational level was associated significantly with both alcohol and drug abuse.

High rates of alcohol and drug abuse and a tendency in early age of onset in alcohol and drugs were observed. High household density and low educational level are important factors in alcohol and drug abuse.

In general, monotherapy is advocated. However, a proportion of the treatment regimens contains two or more drugs from the same class (i.e. polypharmacy) or a combination of drugs from different classes.

To investigate the prevalence of prescription patterns of psychotropic drugs to our outpatients with schizophrenia, unipolar depression or bipolar disorder.

Files of 510 outpatients were studied. A retrograde examination was done spanning for 6 months. Demographics, details of diagnosis, hospitalizations and a chart of the drugs administered were collected. A comparison was done between various characteristics of patients under polypharmacy and monotherapy.

Polypharmacy as well as combination therapy was more prevalent than monotherapy in all groups. Patients with a history of previous hospitalizations were not prone to be under polypharmacy, excluding depressives . Antidepressant prescription in schizophrenics was unusually high reflecting the easiness of use of new agents for negative symptomatology . The most commonly prescribed antipsychotics were quetiapine, olanzapine and risperidone. Classical antipsychotics had medium proportion of the treatment, mainly as combined therapy. Mirtazapine, Venlafaxine and Sertraline were the most commonly prescribed antidepressants Tricyclics were prescribed also

.. Greek clinicians' attitude for polypharmacy, regardless of the diagnosis, is prevalent. The recent changes in reimbursement policies of the healthcare System in Greece, did little to affect antipsychotics, but had an effect in the prescribing patterns of antidepressants

Despite the perception that doctors should be ‘invincible’, mental illness is common in this population. Doctors and medical students have low levels of help-seeking for their own mental health problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatization is a crucial factor to symptom concealment.

‘The Wounded Healer’ is an anti-stigma intervention that has been described as an innovative method of pedagogy that blends science with the humanities. The Wounded Healer has been delivered to more than 5000 medical students and doctors in countries all over the world.

We conducted a cross-sectional, mixed methods study. Immediately following the intervention we distributed paper questionnaires to participants who attended the Wounded Healer that contained stigma constructs. Answers were on a Likert-type scale and there was also space for free-text comments.

303/378 (80%) of participants recruited for the study responded. 246/303 (81%) of respondents either agreed or strongly agreed that the talk made them more accepting of medics suffering from psychopathology. 223/303 (73%) of respondents either agreed or strongly agreed that they were more aware of the importance of engaging in help-seeking behavior when under mental distress.

Many respondents reported in the free-text comments that the Wounded Healer was inspirational and that every medical student should receive this intervention.

A majority of respondents responded positively to the stigma constructs. This may have implications for medical students and doctors in mental distress by helping to reduce stigma and by encouraging help-seeking behavior.

The law of mental health service in modern Russia as during N.M. Karamzin's period (XVII-XVIII centuries) “works” at paper. Anybody doesn't protect the social and economic rights of patients. For full citizens of schizophrenics don't consider. Them were deprived of a basal human right - on work, on active social life.

Human has always required making a healthy and ethical relationship with the environment and this has been one of the basic human needs. According to Islamic view, Islamic morality seems as like as another accepted religions such as christianity fundamental to doctor and patients relationship to govern relations with God who is very confident . Moral virtues and its knowledge are required for the effective and suitable confidentiality whose study affects the pattern to introduce the Islamic ethics.

Therefore, the study has been carried out to evaluate physician/patient relations with emphasis on the confidentiality principle. The study aims to present an appropriate step in the pattern of ethics of physician/patient relationships.in comparision of Islamic view and world accepted principalistic medical ethics rules.

This research was carried out by library method and using books (including holy Quran),facts and declrations and articles from

confidentiality. In this study, necessity to new legislation for ethical rules and need for more researches is explained . Also, in order to more explanation this talk few application examples of confidentiality in doctor and patient relationship is mentioned. Ethical decision making in cases of such as psychiatric patients as like as Tarrasof low I-II cases or in cases of AIDS anger patient who will contaminate another by needle stick needed to clear support,. Our final result and home massage is 'Both two views medical & specialized psychiatry ethics and Islamic ethics are very closely similar for saving human basic rights of course each of them has exceptions’.

Articles and studies were identified throughPubMed, Web of Science and Scopus databases as well as existing reviews. Thesearch terms included “transference”, “cognitivebehavioral therapy”, “acceptance and commitment therapy”,“schema therapy,” “dialectic behavioral therapy” Compassiontherapy“, ”ethics “in different combinations. Other relevanttexts were searched by references found articles.

Transference relationship can work inconjunction with therapy and helps to achieve its objectives, or restricts thetherapy, distorts it or blocks. For uncomplicated psychiatric disorders and tosolve simple problems CBT doesn´t address the therapeutic relationship. Conversely, therapeutic relationship becomes the focus of the therapy in clientswith personality disorders. It can be used to identifying automatic thoughts, dysfunctional assumptions and core beliefs well as to their changing. Transferencemay also be misconduct in favor the therapist at the expense of the client. Thecrossing of the borders can be done unconsciously or consciously. Ethicalreflection of the therapeutic relationship is possible only when the therapistconceptualizes recognized transference of the client and also owncounter-transference reactions. Self-reflection, however, must be supplementedby asking the relevant ethical questions.

The practice of psychiatry throws multitude of ethical challenges and dilemmas for a clinician in making decisions. Historically, doctors follow the well-established principles of medical ethics – namely justice, autonomy, beneficience and non-maleficience in medical practice. Along with these, clinical practice in psychiatry in England and Wales is governed by the principles outlined in the Mental Health Act 1983.

Whilst general ethical guidances are available as principles mentioned above, there are no clear directives in a complex clinical presentation when the various principles are in conflict themselves. Example, it is difficult to assess whether autonomy takes precedence over beneficience or vice versa when they are in conflict. In such cases, clinicians are left to exercise their own judgment.

We undertook a literature search to look for instances of published cases about hierarchy in different principles of medical ethics in the context of complex clinical presentations in psychiatry that pose conflict in the aforementioned principles. The results are outlined. We illustrate this in relation to a complex clinical presentation we came across in our practice that deals with detention, capacity and consent. The case exemplifies conflict is different ethical principles.

Psychiatric practice is complex without set rule. No clear consensus exists in the application of ethical principles specifically when they appear to be conflict. It is imperative there is a debate to agree on a hierarchy of ethical principles such that practitioners bias and prejudices are not brought in to practice in times of ethical conflicts.

Evaluation of knowledge on Section 136 of mental health act in Police officers in Cheshire

Section 136 allows a Constable to remove a mentally disordered person from a public place to a place of safety for up to 72 hours. There has been an increasing rise in the use of section 136 of mental health act with recent reviews showing that in 2005-2006 there were 11000 detentions under section 136 in police stations and about 5500 detentions in hospitals. More recent data has shown a significant increase in the number of those detained under Section 136 in hospital. The data for England found 7035 such assessments in 2007 rising in successive years to 8495 and 12038 (Care Quality Commission, 2010). In this context it would be imperative to evaluate the knowledge on Section 136 of mental health act amongst the police personnel. Only one relevant study was found after an extensive literature search in this domain and this showed that the knowledge among the police on this area was poor (Lynch et al 2001)

A structured questionnaire based on code of practice of mental health law on section 136 was outlined. Mental health law experts and legislators have been consulted in formulation of this questionnaire. This questionnaire has been distributed within the police force of Warrington city, Cheshire.

The results are still awaited but would be obtained in few weeks time and this could be sent over to the submission Panel as addendum.

Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. The desire to amputate one’s healthy limb seems to be related to a disturbance in the person’s perception of one’s own identity. Patients suffering from BIID have a mismatch between their actual and perceived body schema, and they feel that being an amputee is a necessary and important aspect of their identity.

More investigations are needed in order to develop noninvasive treatment strategies in this domain in order to reduce the subjective symptoms and the physical discomfort of patients.

BIID is not listed in the current DSM-V as an official disorder. Transability spectrum exists, but there is no diagnosis, it has no legal status. In order to recognize and reduce significant psychological suffering of people with BIID (anxiety, depressive symptoms, suicidal behavior etc.) the authors of this paper recommend the following:

• • the need for establishing clear diagnostic criteria and

• • therapeutic protocols in dealing with BIID

Respectively the disorder should be better described so as to develop further and more specialized treatment strategies.

Considering the fact that there is a relative increase in the number of people with BIID, there is a need for setting precise diagnostic criteria. Also, a comparison with the transgender spectrum could be a good example- in terms of setting clear guidelines, such as there are in dealing with persons with GID.

The relationship of tattoos to the diagnosis of personality disorders was explored in a forensic psychiatric inpaitent hospital setting. It was hypothesized that a greater proportion of forensic inpaitents possessing tattoos had higher criminality and had personality disorders in compairison to the people with tattoos without criminal history. In this study we compared also the important sociodemographic caharctersitics of criminals with tattoos and the normal population with tattoos without criminality.

Forensic male and female psychiatric paitents (N=42) were administered a semi-structured interview to determine the presence of tattoo. Personality disorder was determined after clinical psychiatric examination by 5 different spychiatrists and aditionally personality disorders criteria acording to DSM-5 were cehcked out. The same semi-structured interview was appilied on th control group withou personality disorder evaluation.

Paitents with tattoos had a significantly less number of tattoos but tattoos on different areas of their body, and were more likely to have histories of substance abuse, sexual-abuse, unhappy childhood, enduring violence, taruamtic life-experiences, and suicidal attempts than non-criminals.

This is the first study of which compares the forensic psychiatric paitents with normal controls in means of tattoos, personality disorders and other demographic charactersitics performed in Turkey. We concluded that there is an interaction between criminality and tattoos but the reverse is not always true at least in our control sample.