To qualitatively anaylze the use of CTO.

All CTO examined from 2008 to 2011.

Total number 89.

The age range shows a wide distribution.

This year 53.9% access to a car and unemployment was at 100%. 82% were previously on a Section (3) but 6.74% were previously on a Section (37) and 11% were on a Section (25). There does appear to be an increase in the use of Section 37s being converted over to a CTO, which does raise the issue of the role of Risk Management usage of CTOs.

On examination of the diagnosis, those with Schizophrenia on a CTO were approaching 80%. The actual diagnosis of Schizophrenia combined with drugs and alcohol misuse was that of 47.2%.

On examination of the medication used in CTOs, there appears to be a peak with the use of Depot, particularly that of Clopixol at 22% and Risperidone Consta at 23%. This year's audit also looked at combination medication, particularly that of dual anti-psychotics (23.6%) and the combination of anti-psychotic and mood stabilisers (13.5%).

Conditions of the CTO note medication use at 94%. The other conditions that scored highly was appointments with Community Mental Health Team and Assertive Outreach Team as well as Outpatients with the Consultant.

Substantial increase in variance of conditions at 14.6%

Ethos of a CTO is enhancement of engagement. It is a flexible tool both for use in different diagnostic subgroups, Risk Management as well as compliance with medication.

Mental illness is still associated with myths, prejudices and stereotypes, despite the growing investment in research and treatment in this area. The stigma still one of the major obstacle to recovery of persons with severe mental illnesses. Stigma affects an individual's self-esteem, increases dysfunction, and poses problems to patients with regard to housing and employment. Stigma is a culturally induced barrier to recovery. Although studies have examined experiences of stigma by users of mental health services and stigmatizing attitudes in the general public, little attention has been paid to the experiences and attitudes of mental health professionals.

To explore and clarify the presence or absence of stigmatizing attitudes in mental health professionals.

24 qualitative interviews to mental health professionals working at psychiatric services at a general hospital, a psychiatric specialized hospital, and a Community Association in Oporto, Portugal.

The analysis of the discursive material provided by social workers, nurses, psychiatrists, psychologists and occupational therapists reveals the presence of stigmatizing beliefs and attitudes regarding mental illness, in spite of the education or place they work. There are a few exceptions, like age and occupation that seems to influence the professionals’ perspectives.

These results might denote that changes in professionals’ attitudes are primarily a result of their personal experiences in and out their professional environment. Therefore, it is important to create programs focused on these issues, to promote training, multidisciplinary discussion and reflection allowing a greater awareness of stigmatizing attitudes and beliefs in order to minimize them.

The Nova Aurora Community Association psychosocial rehabilitation program was developed based in the most current values of Psychosocial Rehabilitation. Some nuclear assumptions were considered, such as a) suppressing the disease stigma, b) defocusing from the mental ill role, promoting empowerment and self-determination, c) developing personal competencies directly related to the individuals’ social integration specific context (readiness, cognitive, social, emotional stress management, employability).

To present the rational of this program and the outcomes of a pilot study designed to test if this psychiatric rehabilitation program effectively helps persons living with psychiatric disabilities become more successful and satisfied in living, learning, working, and social environments of their choice.

The program is being implemented for 13 months to 38 persons living with psychiatric disabilities and it is developed in 2 main levels: a) tranversal competencies (neurocognitive, stress and illness management, healthy lifestyle, self efficacy and anti-self-stigma); b) specific competencies directly related to the individuals’ social integration specific context (employability/housing, social cognition, etc). All users still frequent an empowerment center and develop sport and leisure activities. It is also available home support and family psicoeducation. The program effectiveness assessment integrated pre and post tests, evaluating all these different functional domains and life quality and program satisfaction.

Preliminary results point towards very positive outcomes, specifically regarding personal competencies development, satisfaction level with the program, reduction of relapse, and absence rates.

Although these results are promising, this research is an initial step in establishing the efficiency of this rehabilitation program.

Different psychoeducational and family-based interventions have been shown to improve chronic physical diseases, such as asthma. There is an increasing consistency of therapeutic effects in these programmes, across the literature. However, scientific validation of the benefits of each programme and what is the best model/method are required.

To evaluate the effects of Multifamily/MG and Psychoeducational/PG interventions for asthma on psychological, biological and morbidity outcomes.

A sample with 299 outpatients with asthma diagnosis from a University Hospital was recruited consecutively. Patients with moderate/severe asthma were included in a five-month randomized controlled study with simple occultation. There was a balanced inclusion of 141 patients allocated to three groups: MG, PG and control group/CG. All patients continued usual pharmacological treatment. Anxiety (SAS/STAIY), depression (BDI), coping mechanisms (WCAEL), quality of life (MiniAQLQ), asthma control (ACQ), lung function (FEV1/PEF), airway inflammation (FeNO), asthma severity and morbidity were assessed at the beginning and the end of the study.

Both MG and PG improved asthma control. The overall quality of life score increased in MG (0.5 U) and PG (0.8 U), but not in the CG. A significant decrease was also found in the use of oral steroids in MG and in the hospitalization in PG. The behavioural changes improved psychological parameters (anxiety, depression, coping), and lung function.

Multidisciplinary group interventions seem to improve physical/psychological parameters in asthma, and assessment of efficacy is necessary after a longer follow-up period, as is identification of patients’ clusters which benefit the most from each intervention.

Link et al. (2001) recognise stigma as a significant barrier to recovery and quality of life for people with mental illness. There is increasing awareness that they receive poorer medical care in general hospitals (Liggins and Hatcher, 2005) and poorer health care generally (Thornicroft et al., 2007).

Deliver lectures addressing:

1. - Nursing patients with mental illness in medical settings.

2. - The WHO's recognition of mental illness as a disability.

3. - The detrimental effect of depression and anxiety on co-morbid medical disorder prognoses.

Reduce stigma in first year adult nursing students so:

1. - They do not avoid those with mental illness.

2. - Recognise co-morbid depression and anxiety so they can be treated.

A 2 part questionnaire is delivered pre and post lecture. Questions for the pre-test, post test component are based on the Office of National Statistics (ONS) stigma survey (Crisp et. al., 2000, 2005). Additionally part 1 includes questions on nurses' patient group preference based on Brinn (2002). Part 2 includes questions on perceived attitude change post lecture. Ethics has been discussed with UWE's ethics' committee.

Data is analysed using SPSSv13. Differences on the ONS questionnaire are not significant but post lecture attitude change is, reaching a confidence level of 95%. The mental illness patient group is least preferred; further analyses in the ongoing larger study are necessary to ascertain significance.

Psychoeducation delivered through lectures can change attitude towards mental illness. However stigma is complex and careful consideration of how attitude translates into behaviour is necessary.

Depression-associated cognitive impairments often persist following mood improvement, worsen with repeated episodes and may precipitate depression relapse. Addressing cognitive deficits conjointly with mood symptoms could help recovery and optimise functioning. Neurocognitive remediation therapy (NCRT) has been shown to improve attention and memory in patients presenting various disorders affecting cognition but its efficacy has not yet been tested in depression.

We aimed to assess the feasibility, in St.Patrick's University Hospital (Ireland), of a randomised controlled trial (RCT) that would test the NCRT efficacy to improve cognition in depression. Following recommendations for good practice in piloting of RCT designs, the feasibility study tested the research protocol, determined recruitment and compliance rates, and provided preliminary efficacy data. Patients admitted for depression were randomised to either receiving computer-assisted NCRT (n = 7) or completing computer games (control condition, n = 7) twice-weekly for ten consecutive weeks.

Seventy-eight percent of eligible patients agreed to participate. Recruitment rates were of two participants per week. No patient refused randomisation. Compliance rates were 79% for the first five weeks, 64% completed eight weeks, but only 14% completed the ten weeks. Non-parametric between-groups comparisons showed that the NCRT group improved significantly in three out of five targeted cognitive domains relatively to the control group. This was independent from pre-intervention levels of cognitive functioning.

Performing a RCT for NCRT in depression is feasible. However, our intervention protocol needs to be refined to optimise compliance rates. Weekly frequency might be increased to ensure NCRT completion within five weeks.

The empowerment and quality of life oriented program of the day clinic might contribute to the recovery process in people with schizophrenia. The aim of the study was to evaluate the effect of day clinic treatment on recovery.

Data from two groups of patients were collected twice, at baseline and after five weeks. The experimental group attended the day clinic treatment (N = 20) and the control group waited for the day clinic treatment (N = 20). At both times measures of recovery (RAS), hope (IHS), quality of life (WHOQOL-BREV), psychopathology (PANSS) and demographic and clinical data were collected. Additionally at the end of the study patients were interviewed about subjectively experienced changes concerning recovery in the last five weeks. T-test and general linear model were conducted to analyze longitudinal data.

Changes during the five weeks within the day clinic group showed significant improvements in two RAS-subscales, hope, two quality of life domains and positive symptoms. Within the control group no significant changes occurred. Subjectively experienced changes concerning recovery were reported by 90% of the day clinic group and by 40% of the control group. Significant differences between the two groups concerned changes in the RAS-subscale “goal and success orientation” and psychological and global quality of life.

In this small sample changes in recovery between both groups were significantly different only for one RAS-subscale. A randomized controlled study with a sample size of 76 for each group should be performed to assess the effectiveness of day clinic treatment on recovery.

To study the influence of neurocognitive training on higher cortical functions in schizophrenia patients and to evaluate their effectiveness in the treatment of schizophrenia.

All patients received adequate pharmacotherapy with atypical neuroleptics. Patients of the main group (102 patients) additionally participated in the training of cognitive deficits. Patients in the comparison group (48 patients) received only pharmacotherapy.

Study design:The assessment of long term data means prospective follow-up study after 1-year trainings.

Neurocognitive training is a psycho correctional training which aim is to improve the disabled cognitive functions such as memory, attention and executive functions.

All patients took part in the prospective follow-up study. There was a good compliance as well as in group with trainings and in group without them.

During the prospective follow-up study we observed data on compliance and number of re-hospitalizations.

The analysis of follow-up study showed that,

1. 1) Number of patients with drug compliance is higher in group with neurocognitive trainings

2. 2) Number of patients with partial drug compliance is higher in comparison group

3. 3) Number of patients who stopped taking medication was the same in both groups

The neurocognitive training showed itself as an effective method of correcting neurocognitive deficits. Inclusion trainings in the rehabilitation program helps to reduce the term of the patients stay in hospital.

Self-stigma is a personal response to perceived mental illness stigma (Corrigan & Watson, 2002). Applying recovery to persons with mental illnesses such as schizophrenia, implies working with Self-Stigma, in the sense that is one of the major obstacles to social integration and to active life (Brohan et al., 2011; Corrigan & Kleinlein, 2005; Goffman, 1991). Research on strategies for changing self-stigma can be focus on new and innovative programs, like the one we will present, based on group intervention (sociodrama) and individual intervention (e-learning).

To describe results of a 4 months anti-self-stigma program, developed to reduce self-stigma in persons with schizophrenia.

Data collected with portuguese versions of Helpful Aspects of Therapy Form (Llewelyn, 1988; Elliott, 1993; Sales et al., 2007), Change Interview - FIT (Elliott, 1999; Sales et al., 2007), Internalized Stigma of Mental Illness Inventory (Ritsher et al., 2003; Oliveira & Gonçalves Pereira, 2008) and CORE-OM © CORE System Trust (1995; Sales et al., 2007), with 17 persons with schizophrenia (15 male and 2 female; mean age 38; mean years of disease 15) followed in a psychiatric department. The program includes, beside the 15 e-learning sessions, 15 weekly sessions of sociodrama.

Main changes imply decrease in self-stigma, better interpersonal relationships, more knowledge about mental illness, and better cope with social anxiety and more subjective well-being.

This program is an approach that seems to empower persons with schizophrenia, allowing them to achieve significant changes, promoting reduction of self-stigma.

Women with IHD demonstrate lower quality of life and higher tendency to IHD related depression. Current CR programs are not as well suited to women's as men's needs. Men expect practical while women social and emotional assistance.

Use of Tai Chi exercises in outpatient CR of women with IHD increases its effectiveness leading to essential improvement of mental state.

Valuation of effectiveness of different CR programs in quality of life (QoL) and depression level (DL) in women with IHD.

Randomized, clinical trial included 68 women between 50 to 71 (average 62,07 ± 6,00) with IHD confirmed by angiography and/or at least 1–2 months after myocardial infarction in stable disease, 24 MMSE points, EF > 45%, no pharmacologically treated mental disorders. Patients participated in 12 weeks’ CR program, in three groups: C - classical CR, P - classical CR and cognitive behavior psychotherapy, T - Tai Chi training.

I - 1–4 week - trainings 3 times/week, II - 5–12 week - therapy in previous form, 2 times/week and 1 time/week cycloergometer.

Evaluation of QoL and DL before the intervention, after 4th and 12th week, using Beck Depression Inventory and SF36 test examining physical (PCS) and mental (MCS) component summary of QoL.

In all valuations no statistical differences between the groups in DL and QoL. Only in T group confirmed improvement in both tests. MCS improved after 1st and PCS after 2nd CR stage.

Supplementation of cardiac rehabilitation programs with Tai Chi elements has positive impact on QoL and depression level in women with IHD.

Various studies have shown that between 8%–47% of schizophrenic patients suffer from OCD.

The objective of this study is to measure the symptoms of OCD in hospitalized schizophrenic patients.

96 inpatients (56 men and 40 women) with DSM -IV schizophrenia diagnostic criteria were selected from a training hospital. These patients screened for OCD using SCID(Structured Clinical Interview for DSM) and Maudsley Obsessive-Compulsive Inventory. The majority of patients (88.5%) suffered from Paranoid Schizophrenia.

47 patients (49%) were diagnosed obsessive-compulsive on clinical interview and the total MOCI scores of 27 patients (29%) were above the given cutoff score.

Obsessive-compulsive disorder is a prevalent disorder in schizophrenic patients. The comorbidity of these two clinical entities has both etiological and therapeutic importance. Despite the high specificity of MOCI, the clinical interview is preferred over MOCI because of its higher sensitivity and the number of true- positive diagnosis.

Diabetes has reached pandemic proportions. The prevalence of diabetes is higher in patients with schizophrenia when compared to the general population. Besides the traditionally recognized risk factors, this population also suffers from an increased BMI and a high use of second generation anti-psychotic drugs. Poor living conditions and unhealthy life styles may also play a role. The International Diabetes Federation estimates that 300 million people suffer from prediabetes worldwide. The presence of prediabetes in patients with schizophrenia has not been well studied.

To evaluate HbA1c levels in non-diabetic schizophrenics.

To confirm the expected high prevalence of prediabetes in patients with schizophrenia.

We retrospectively reviewed the HbA1c results of 62 consecutive patients with schizophrenia seen in our office for medical reasons. Prediabetes was diagnosed if the A1c was 5.7% – 6.4% (39 – 46 mmol/mol).

Of the 62 patients studied (ages 24 to 74 years), 46 were males (M) and 16 were females (F). 12 (8M; 4F) patients had HbA1c above 6.5 or were known diabetics. Of the remaining 50, 24(48%); (20M; 4F) had HbA1c in the prediabetic range, while 26 (52%); (18M; 8F) had HbA1c in the normal range.

Almost one half of our non-diabetic schizophrenia patients were found to suffer from prediabetes. Besides progressing to overt diabetes, these patients are at a high risk of experiencing adverse cardiovascular events later in life. Early intervention with life style changes and tailored therapeutics may favorably alter the medical course in these patients.

Schizophrenic patients suffer from much higher rates of physical morbidity and mortality. Smoking related illnesses such as lung cancer and cardiovascular disease are several times more common in patients with chronic psychiatric disorders. However, lung function has not been well studied in this population.

To evaluate lung function in schizophrenics using computerized spirometry

To confirm clinical suspicion that schizophrenics have significantly more lung disease.

We retrospectively reviewed the records of 75 consecutive patients with schizophrenia. All patients had undergone spirometry.FVC, FEV1, FEV1/FVC ratio and other parameters were recorded.

Of the 75 patients (ages 23 to 74), there were 52 males (M) and 23 females (F). 18 patients had normal FEV1 and 57 patients had reduced FEV1. All 18 patients with normal FEV1 had normal spirometry (15 M, 3 F). Of the 57 with reduced FEV1, 36 had restrictive lung disease (19 M, 17 F). Of these, 3 had mild, 7 had moderate and 26 had severe restrictive lung disease. 21 had obstructive lung disease (18 M, 3 F).Of these 3 had mild, 4 had moderate and 14 had severe obstructive lung disease.

Reduced FEV1 is extremely common in patients suffering from schizophrenia. Reduced FEV1 is associated with premature death from both respiratory and non-respiratory causes. It increases need for more health care services and raises health care costs. Although smoking remains a major factor, other etiologies may play a role. Strategies to preserve and improve lung function in schizophrenics need to be aggressively pursued.

The objective of the present study was to examine the predictive value of clinical and cognitive -including the cognitive reserve (CR) - variables on the severity of the patient's illness at one year of follow-up.

A study was held with 45 patients with first episode psychosis (FEP) from 3 main hospitals in the Basque Country (Spain). All patients underwent cognitive, clinical, and functional assessments at baseline and at 6 months follow-up. The cognitive measures included were: the Stroop test, Vocabulary sub-test from WAIS-III, the WCST, and Trail Making Test. The clinical and functional measures included were: Positive and Negative Syndrome Scale (PANSS), Young Mania Scale, Montgomery-Asberg Depression scale, and CGI (Clinical Global Impression).

Six-months follow-up data were available for 29 patients. Regression analysis was performed with the 6-month follow-up CGI measure as a dependent variable. Results showed that after controlling for CGI at baseline, -PANSS Negative Symptoms Scale (B = 0.47, p ≤ .05) and the CR measure -Vocabulary from WAIS-III- (B = 0.36, p ≤ .05) were the only two which significantly predicted severity of illness after 6 months (R2 = 0.44) and remained significant when CGI at base line was controlled in the regression analysis. The rest variables did not reach statistical significance.

These findings emphasize that CR have a role on outcome in first episode psychosis, and enhance that exist a relation between cognition and clinical measures in psychosis.

Basque Government, Health Department (2008111010); EITB-Maratoia (BIO 09/EM/015).

Schizophrenia (SCZ) patients are reported to present significant abnormalities in lipid and glucose metabolism, that increase the risk for cardiovascular disease and diabetes, possibly induced by antipsychotic therapy (APT) and lifestyle.

Characterize a sample of SCZ patients relating APT and biochemical laboratory profile.

We conducted a retrospective longitudinal study of SCZ patients’ records from Psychiatry Service of Hospital S.João (Porto, Portugal) from 2009 to 2011.

The study included 51 SCZ patients of which 82.4% (n = 42) were male, presenting a mean age of 39.3 ± 9.2 years. The most frequent subtype of SCZ was paranoid (90.0%). The average age of diagnosis was 24.5 ± 8.4 years old. Oral APT was prescribed to 48 patients. Depot APT were prescribed to 40 patients. Haloperidol and risperidona were in both cases the most frequent drugs. 50% of patients presented high total cholesterol values (≥200 mg/dL), 25% high LDL cholesterol (≥160 mg/dL), 81% low HDL cholesterol (≤40/50 mg/dL) and 44% presented high triglycerides results (≥150 mg/dL). 27% of patients presented impaired fasting glucose values (110 to 125 mg/dl) and 27% presented at least one plasma glucose result that meet the criteria for diabetes diagnosis (≥126 mg/dl). There was an overall increase in hepatic enzymes (54% ALT, 36% AST and GGT).

Hepatic metabolism of APT may explain elevated liver enzimes. Lipid and glucose profiles in our sample clearly indicate the need of monitoring SCZ patients, managing APT side effects and lowering risk. We encourage clinicians to record metabolic monitoring and to establish corrective measures (food, lifestyle and medication).

Abuse of alcohol and other substances is a very common problem of schizophrenic patients. Schizophrenic patients consumes alcohol and other substances to reduce stress, anxiety, boredom, emptiness.

To determine the prevalence of drug abuse in hospitalized schizophrenic patients.

This retrospective study included hospitalized patients in Special Hospital for Psychiatric Disease “G.Toponica” the twelve-month period, the diagnosis categories F20 by MKB-10 classification. Data were obtained from medical records and based on special structured questionnaire.

The data will be presented on the poster.

Frequency of consumptions psychoactive substance in schizophrenic patients is high, and consumption of alcohol between is much higher then other substance.

Schizophrenia is a severe and debilitating disorder compromising multiple aspects of everyday functioning and quality of life, such as independent living, interpersonal relations and vocational functioning. Apart from premorbid functioning and psychopathological symptoms, social and non-social cognitive factors negatively influence functional outcomes in patients. On the other hand, recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions, liberal acceptance) in at least some clinical dimensions of schizophrenia. So far, the impact of such cognitive biases on the functional outcome of the disorder has not been investigated.

The present study aimed to assess the relative contribution of cognitive biases and other well established factors, including psychopathology and neuropsychological deficits, on functional outcomes in patients with schizophrenia.

Participants were 160 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder, recruited from the inpatient units of two University hospitals (Hamburg and Heidelberg). Key exclusion criteria were current substance dependence, severe brain damage, and IQ < 70. Patients were assessed at baseline on measures of

1. (a) premorbid IQ,

2. (b) psychopathology and severity of illness,

3. (c) cognitive biases,

4. (d) attention and verbal memory, and

5. (e) social cognition/Theory of Mind. Functional outcome at six months consisted in a composite factor computed from a quality-of-life measure (WHOQOL), as well as information on marital, housing and vocational status.

A multiple linear regression analysis was performed with functional outcome as dependent variable and the above-mentioned factors assessed at baseline as predictors. Results will be discussed.