The purpose of this study was to estimate the prevalence and examine the predictors of depression in patients with systemic lupus erythematosus (SLE).

This cross-sectional study was conducted in a rheumatology clinic of university hospital. All SLE patients met the revised American College of Rheumatology (ACR) classification were included in the study. Socio-demographic data and medications were recorded. Disease activity for SLE was assessed with the Mexican-SLE Disease Activity Index (Mex- SLEDAI). All subjects were screened for anxiety and depression by using the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D), respectively. Multivariate linear regression analysis was used to determine predictors of depressive disorder.

A total of 62 SLE (61 for females and 1 for male) patients participated in the study. Based on the HAM-D and HAMA, rates of depression and anxiety in the SLE patients were 45.2 and 37.1%, respectively. the multiple linear regression analysis revealed that HAM-A score and younger age were significant predictors of depression in the SLE patients.

The finding suggests that depression and anxiety are common in the SLE patients. in addition, high level of anxiety and younger age may increase the risks of depression. Because of the small sample size, further studies should be conducted to warrant these results.

Clinical symptoms, functional recovery and stressful life events of patients with schizophrenia were evaluated to investigate the relationship between life events and functional recovery.

Fifty-three subjects diagnosed with schizophrenia in the remission period were enrolled in the study. Three interviews each at 3 months interval were made with the participants. the participants were evaluated with socio-demographic data form, Positive and Negative Syndrome Scale, Calgary Depression Scale, the Functional Remission of General Schizophrenia Scale at the baseline, third and sixth month interview. the number of stressful life events were determined according to Life Events List.

There was no significant change in the PANNS scores measured at the baseline and follow interview (p>0.05). Depression scores were significantly increased at the follow interviews(p< 0.05). This significant increase mostly resulted from the difference between the baseline and final interview scores. the number of stresful life events and functional recovery were found to be negatively correlated with a medium level of significance at the third month (p< 0.05). There was a negative relationship between the number of life events and functional recovery at the sixth month but it did not reach to a statistical significance (p>0.05). A significant relationship and a negative correlation was found between functional recovery and depression scores at both the baseline and third month interviews (p< 0.05). This relationship was not significant at the sixth month (p>0.05).

Stresfull life events in remitted schizophrenia patients reduces functionality over depressive symptomatology without affecting positive and negative symptoms.

The primary aim of this study is to examine an association between apathy and frontal lobe dysfunction in patients with memory problems. We also aimed to look into the association between apathy severity and caregiver burden along with the relationship between apathy and praxis.

This was a retrospective cross sectional study. We selected 160 consecutive patients diagnosed with Alzheimer's dementia and Amnestic Mild Cognitive Impairment who had a comprehensive battery of neuropsychological tests and a behaviour rating scale of interest for this study recorded in the database. Correlation between apathy with and without depression were tested against frontal lobe test including Trail making A, Trial making B, Letter Fluency, Ideational Fluency, Category Fluency, Abstract Thinking and Executive functioning subtest of CAMGOG-R. Similarly correlation analysis was also done to look into association between apathy and caregiver burden as well as praxis.

Statistically significant relationship were found between apathy and executive function scores, ideational fluency scores, abstract thinking and category fluency scores. Relationship between apathy and caregiver burden were highly significant. Further sub analysis, found apathy to be significantly associated with caregiver burden in both AD and aMCI patients.

Apathy is associated with frontal lobe dysfunction especially impaired executive function and ideational fluency even when controlled for depression. It is highly associated with caregiver burden both in AD & aMCI .Hence early recognition and management of apathy is important in improving the prognosis of patients with AD & aMCI as well as their caregiver.

Although there are many antipsychotics, resistant schizophrenia is still to be an extremely important problem in psychiatrists' practice.

Finding a new strategy, different from the ones in daily standardized practice, could give better perspectives for the outcome of the cases of resistant schizophrenia.

Adding memantine for about six months to the last antipsychotic used in the treatment of resistant schizophrenia could be used as a method in order to induce a response to the treatment due to modulation of NMDA receptors.

Two study cases: patients diagnosed with schizophrenia paranoid type, many years ago, with many hospitalisations for psychotic episodes admitted into the hospital for a psychotic relapse. the patients were treated with 2 antipsychotics (each for 8 weeks and adequate dose) without response. Both cases had a common approach from the moment of failure of the second antipsychotic: adding memantine 20 mg per day to the second antipsychotic, maintained with the same dose from that moment.

Adding memantine to the last antipsychotic induced the remission in both cases of resistant schizophrenia. This association was made for a period of 6 months and after that the dose of memantine was progressively reduced in 2 weeks. We kept the antipsychotic as a main treatment. the remission was kept during the period of association and one year after the withdrawal of the memantine.

We think that memantine modulation of NMDA receptors in combination with antipsychotic D2 receptor blockade can improve the response of resistant schizophrenia.

Physical health of people suffering from severe mental illness is a neglected area. They suffer more than general population and they die earlier. Looking after such disadvantaged group of people is mandatory, to improve their outcome and quality of life. Monitoring current clinical practice is essential to try to improve it.

37 Records of patients who were on long acting injectable antipsychotics, attending the Taylor centre were selected and reviewed to establish their physical care arrangement check against the POMT-UK. Type of antipsychotics, whether they suffer from metabolic syndrome or not, other physical illness was recorded.

Records lacked any reference to baseline arrangements of physical monitoring. Although they demonstrated high level of physical morbidity, care and records didn’t reflect adequate clinical care to this important problem.

This study demonstrated that Physical care of people with severe mental illness is still substandard and needs to be developed in order to prevent or identify physical problems earlier, to reduce morbidity of these patients and improve their life expectancy and quality of life.

Physical care is an important aspect of care of people who suffer from severe mental illness total care. This study has demonstrated that this area is still neglected. Improvement in this area will improve the global outcome of these disadvantaged people.

The aim of this study was to compare the effectiveness of attribution retraining group therapy (ARGT) versus selective serotonin reuptake inhibitors (SSRI) in the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD).

109 patients with MDD, GAD and OCD were recruited from the outpatient department of a tertiary referral hospital between 2007 and 2008. Subjects were sequentially recruited and randomized into ARGT group (n=63) and SSRI group (n=66) for an 8-week treatment period. 54 outpatients in ARGT group and 55 outpatients in SSRI group completed the study. All subjects were assessed using Hamilton Depression Scale, Hamilton Anxiety Scale before and after treatment. Yale-Brown Obsessive Compulsive Scale was employed only for OCD subjects. Plasma hormone levels of serotonin, norepinephrine, cortisol, adrenocorticotropic hormone, and brain-derived neurotrophic factor (BDNF) were measured at baseline and at 8 weeks.

Symptom scores were reduced significantly in both ARGT and SSRI treatment groups (p< 0.001) at the end of the treatment course. However the patients in the ARGT group had significantly lower plasma cortisol concentrations compared to baseline (p< 0.05). on the other hand, patients receiving the SSRIs showed significantly increased plasma levels of serotonin (p< 0.05) and BDNF (p< 0.01).

Our findings suggest that ARGT may modulate plasma cortisol levels and take effect to the HPA axis as opposed to SSRIs which may up-regulate plasma serotonin and BDNF levels via a different pathway to produce an overall improvement in the clinical condition of patients.

The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.

683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I (Modules A-E), urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.

22% of the sample fulfill the diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses.

Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly schizophrenic patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.

683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I module for schizophrenia, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.

22% of the sample fulfill the diagnosis of dual diagnosis. 28.99% of the sample were schizophrenic, 16.67% among the later were fulfilling diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses.

Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly mood disorder patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.

683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I module for mood disorder, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.

22% of the sample fulfill the diagnosis of dual diagnosis. 39.68% of the sample had mood disorder, 17.71% among the later were fulfilling diagnosis of dual diagnosis. No difference between MDD and Bipolar disorder regarding rate of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses.

Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly personality disorder patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.

683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-II for personality disorder, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.

22% of the sample fulfill the diagnosis of dual diagnosis. 12% of the sample had personality disorder, 57.32% among the later were fulfilling diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. No difference between different personality disorder subtypes as regarding rate of dual diagnosis.

Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

The Centre for Suicide Research, Odense, Denmark has since 1990 registered all suicide attempts and suicides in patients residing in the County of Funen, Denmark.

The Pain Clinic, Odense University Hospital's receives patients with chronic pain from the whole region of Southern Denmark. This study is part of two studies from the Pain Clinic.

The aims of the study have been

• To investigate whether patients treated in the Pain Clinic in the period 1/1 2004-31/12 2010 have an increased risk of suicide attempts compared with the background population

• To investigate whether the frequency of suicide attempts before the treatment in the Pain Clinic differs from the frequency of suicide attempts after treatment.

Data about age, sex and time of treatment on patients treated in the Pain Clinic in the period are registered. Time and method of the suicide attempts are registered in Centre of Suicide Research. By registry linkages between patient registers from the Pain Clinic and the Registry of Suicide Attempt in the County of Funen it was possible to calculate any excess risk of suicide attempts in chronic pain patients in the study period.

The Incidence rate ratio for suicide attempts in our study for both sex and all age group are about 1 or lower, which means that the pain population in our study does not have an increased risk of suicide attempts.

Center for Mental Health in Kotor was opened in 2005. year. in the center we apply modern methods in the treatment of substance addiction.

Objectives of this project are to understand the current way of functioning and the possibility of making new decisions.

Raise awareness on the harmful effects of heroin, for their own health care and social functioning.

Formed by a group which has eleven members. Two females, nine males. Age from 25 to 33 years. the paper applied the new method of treatment decisions. Before and during treatment was carried out satisfaction surveys using Manchester Short Assessment of Quality of Life (MANSA).

Members of groups that are unrealistic estimate the degree of satisfaction with life have left the program or had the resistance of the group. Other members who have had a more realistic self-assessment, regularly participated in the program. Their results MANSA at the start of treatment, pointed to dissatisfaction with social functioning, economic status and interpersonal relationships. At the end of treatment, MANSA indicating satisfaction personal safety, satisfaction with people with whom they live, physical pleasure and mental health. Three members have found employment.

Group psychotherapy of dual disorder has effect on the level of social functioning. Members of the group have gained the insight that the concern for physical and mental health and social functioning is personal choice. Because group work and group work principles, the members have become more realistic in creating new life decisions.

Treatment with antipsychotic drugs is associated with an increased risk for glucose dysregulation.Hyperglycemia that does not fulfil diagnostic criteria for diabetes mellitus (DM) is known as prediabetes (preDM). PreDM is a strong risk factor for the development of DM and cardiovascular events.

To assess the prevalence of preDM and DM in patients on antipsychotic treatment.

To compare cardiometabolic parameters between patients with normoglycemia, preDM and DM. in addition, incidence and reversal rates for preDM and DM were calculated in a one year follow-up.

In a naturalistic cohort of 383 patients the fasting glucose and hemoglobin A1c criteria were applied. in addition, cardiometabolic parameters were measured. After one year, a second assessment was performed in 169 patients out of the total sample.

In the total sample, preDM and DM were present in 39% and 6% of antipsychotic treated patients, respectively. as compared to patients with normoglycemia, cardiometabolic parameters were more prevalent in patients with preDM. Although the majority of patients were diagnosed by the fasting glucose criterion, hemoglobin A1c contributed significantly to the number of patients identified. in a one-year follow-up, it was shown that the course of glucose metabolism can be dynamic.

Systematic evaluation of glucose parameters in antipsychotic treated patients is warranted, in order to recognize glucose abnormalities at an early stage. Especially since fasting laboratory assessments are not required, including hemoglobin A1c as a diagnostic test is of additional value in identifying psychiatric patients (at risk for) DM.

Lack of adherence to recommended treatment poses major clinical and economic challenges for psychiatry, and requires further study.

We aimed to prospectively investigate the association between the level of understanding of psychiatric emergency department (ED) discharge recommendations and presence of a companion with short term treatment adherence.

Sixty subjects were evaluated twice: upon ED discharge and a month later. Instruments included a structured questionnaire based on the MacArthur Competence Assessment Tool for Treatment, MMSE, and corroboration of data with the computerized hospital medical file.

There was a significant association between patient understanding and adherence with medication instructions (p< .01) and adherence to psychiatric follow-up (p< .05). There was also an association between the presence of a companion and adherence to medication instructions (x2(1)=7.0, p< .01).

Ensuring patients' understanding of treatment recommendations and encouraging the company of patients are achievable, practical strategies that may improve adherence and thereby promote better outcomes.

Bipolar disorder (BIPD) is a chronic and disabling illness with frequent comorbid addictive disorders (ADD). Little is known about the prevalence and correlates of cannabis use disorders (CUD) in that population.

We sought to characterize clinical, sociodemographic, childhood trauma and psychological correlates associated with CUD in bipolar patients.

Our main hypothesis was that BIPD + CUD patients would be more impulsive and affectively unstable than those without.

Patients enrolled in a French national network underwent a thorough assessment including lifetime diagnoses using the SCID-IV questionnaire and measures of current symptomatology (Altman and MADRS), impulsivity (BIS-10), emotional instability (AIM and ALS), hostility (BDHI) and history of childhood trauma (CTQ). Univariate and multivariate analyses were used to identify specific associations between several correlates and CUD status.

Among the 718 patients included, 414 (57.7%) were women, with a mean age of 43 years, and 546 (76.4%) were diagnosed with type I bipolar disorder and 190 (26.9%) had at least one lifetime substance use disorder. CUD were associated with lifetime history of suicidal behavior, psychotic symptoms during an affective episode, rapid cycling and CTQ sub-scores, clinical and psychological dimensions. Parts of these associations remained after controlling for comorbid alcohol use disorders.

These results suggest a high prevalence of CUD in BIPD, which was associated with a higher severity and worse outcomes of illness. Although the retrospective nature of this study prevents causal interpretations, our results suggest that at-risk traits among CUD+BIPD patients may induce these clinical features.

To explore the situation, contributing factors and management of workplace violence among nurses in the health sector the Isfahan, Iran.

A total of 250 nurses were assessed from all the health care services available in Isfahan. Quantitative and qualitative data were collected through questionnaires and interviews. Nurses were asked a series of questions about their personal experience of workplace violence in addition to their views and perceptions of violence in the workplace more generally. This can include verbal aggression or abuse, threat or harassment as well as physical violence.

Violence is a problem in the workplace for almost half of nurses. Among hospital nurses, those working in Psychiatry, Drug abuse and Screening units are more likely to report violence as a problem in their workplace. the majority of Nurses experienced form of verbal abuse and a third of them reported physical violence or abuse. Females, younger nurses, working in night shifts, having physical contacts with patients, working in crowded units and poor working experience nurses were more likely to experience violence.

Dissatisfaction of service provided and with diagnosis or planned treatment was the most frequently stated reason for work place violence. Psychological backgrounds, inability to pay for hospital bill, low social security conditions were the indirect factors.

Improved training, better security measures, including provision of a safe environment to treat known or potentially violent patients, prevention programs, and health services for both nurses and patients should be provided.

To determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviors were explored.

Data on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. the classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix.

A total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. the relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness.

Violent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence.

Violence in psychiatric wards is common, and it is on the rise. This study examined the relationship between ward occupancy level and staff-to-patient ratio and incidents of aggressive behavior, both physical and verbal, on an acute inpatient unit in Iran.

Logistic regression was used to analyze data collected from the ward's log of adverse incidents and the ward census over a 12-month period. A physical incident was defined as an unwelcome physical contact or willful damage to property. Incidents of self-harm were excluded. Verbal aggression was any threat of physical or sexual harm.

Among 381 admissions during the study period, 58 incidents were recorded--25 incidents of verbal aggression and 33 incidents of physical violence. Logistic regression demonstrated that the occupancy level was positively associated with the occurrence of any type of violent incident. the average occupancy level when an incident occurred was 77 percent, compared with 69 percent when no incidents occurred. the average occupancy level was significantly higher when verbal incidents occurred (80 percent) than when physical incidents occurred (70 percent). No association was found between violence and staff-to-patient ratio. Incidents were significantly more likely to occur during the afternoon shifts (3 p.m. to 11 p.m.).

Crowding was found to be significantly associated with aggressive incidents, and in particular with verbal aggression.