Our work is a statistical study of the service closed EHS OUED AISSI on involuntary admissions for 24 months (2010–2011), hospitalized patients “ngerous”hich requires a program of support particular.

• Analyze the different characteristics of hospitalized patients.

• Study modes most - frequent hospitalizations.

• Evaluation of the notion of repeating the conduct forensic.

• Improved quality of care for hospitalized patient’s long term.

• Study period: two years.

The department closed the EHS OUED AISSI on involuntary admissions for 24 months (2010-2011). The total sample of 58 patients.

50% of hospitalized patients are aged between 31 and 40 years and 82.75% are male.

93.10% of hospitalizations were involuntary admissions.

The majority of patients (89.65%) are not working, and 79.31% are single.

41.37% of patients have a primary education and 56.89% have a high socio-economic means.

The reason for hospitalization most common (50% of cases) is conduct disorder with straight aggression and 17.24% have a history of prison.

37.93% of patients have a history of addictive behavior.

The diagnosis of Paranoid Schizophrenia is placed in 65.51% of patients.

In society should always seek a balance between health and social justice that is to say between prison psychiatric hospital and social inclusion.

The hospital closed in the service is a means of protection and care for patients classified as dangerous for themselves and for society.

The psychiatrist must be at the interface between medicine and justice, in its psycho-social dimension.

Pseudocyesis is a rare condition in which a non-pregnant patient believes to bear a child due to psychological or somatic manifestations,or even both.Usually,there is a misinterpretation of body changes associated with emotional aspect of pregnancy or thought disorders(or chronic mental disorders),what makes pseudopregnancy a complex disorder to deal with,starting with its confusing classification in the DSM IV-TR.

To document epidemiologic aspects of false pregnancies in a Brazilian population, reporting the most prevalent psychiatric diagnosis and demographic features associated, and compare it to the literature.

Retrospective study of 20 patients diagnosed with pseudocyesis over a ten-year period in 3 hospitals of a Brazilian central region.Compare data with studies on sociodemographic, clinic, biological and evolutive correlates of pseudocyesis in PubMed.

The mean age was 33, with the majority between 20–44. The symptomology matches the literature.Of the women, 15 (83%) were in the reproductive age, but 8 (44%) of them were infertil. Two male patients with pseudocyesis had a typical psychiatric presentation. The psychiatric diagnosis were: 9(45%) affective disorders, 9(45%) psychotic disorders, 1 (2,5%) Huntington‘s Disease and 1 (2,5%) epilepsy.

In terms of Brazil, this is an unique study of the subject, with the greatest data collected so far. We found many similarities,including age, socioeconomic status, symptoms, underlying disorders and history. And we notted the frequency of psychiatric disorders in those patients (specially Bipolar Disorder and Schizophrenia)

To date, studies investigating the neurobiological basis of distinction between schizophrenia and schizoaffective disorder are rare, although patients with schizophrenia and schizoaffective disorder demonstrate different clinical and functional outcomes.

We analysed the EEG parameters (spectral power and coherence) in resting state and while performance of the arithmetical task (subsequent subtraction from 200-7) in 32 patients with first episode of schizophrenia (SCH, n = 32), 32 patients with frist episode of schizoaffective disorder (SAD, n = 32) and healthy controls (HC, n = 40).

In resting state in SCH spectral power (SP) of theta and gamma band was higher, and lower in alpha band comparing to HC. In SAD SP was higher only in beta2 band in contrast to HC. Coherence in resting state in SAD was higher comparing to HC as well as SCH in prefrontal areas in theta band and in the posterior regions in fast frequency bands (gamma1 and gamma2). Comparison of task performance with resting state in HC showed increase of SP in theta and gamma bands in anterior midline sites with synchronous increase of coherence in prefrontal areas. In SCH reduced SP of theta, alpha and beta bands and decreased coherence in all bands was obtained. In SAD we observed elevation of SP in gamma band as well as increase of coherence in all frequency bands except theta band.

Our findings indicate the neurophysiological distinction between schizophrenia and schizoaffective disorders and provide the basement for further research.

In Greece, current legislation prohibits smoking in hospitals, but not in psychiatric units, that may be associated with significant Second Hand Smoking (SHS) adverse effects on nonsmoking patients/staff.

To examine the extent of SHS, and investigate the attitude of the nursing staff regarding smoking in a psychiatric inpatients unit.

1. 1 To measure objectively indoor air pollution using PM2.5 in the Psychiatric Inpatient Unit of the University General Hospital of Heraklion, Crete (PIU/UOC).

2. 2 To investigate the attitude of the nursing staff towards the smoking permission in psychiatric units.

Data on smoking were collected for all inpatients between Nov’12-Sept’12. Pollution levels in PIU/UOC due to SHS were recorded by using the TSI Sidepack device. Nursing staff from the psychiatric unit, and medical and surgical units completed a short Questionnaire including demographics, smoking habits and attitude about the existing legislation on smoking.

Among 444 inpatients, 42% were non-smokers. Within the PIU/UOC, indoor pollution attributable to smoking, averaged 318 μgr/m3(range: 82–730 μg/m3). 295 nurses (mean age 39.6 ± 7.5 yrs) completed the questionnaire and only 31.2% disagreed with the existing legislation, whereas 64% responded that they wouldn’t avoid working in a psychiatric unit because of smoking permission.

SHS concentrations within a psychiatric inpatient unit are comparable to those in bars, suggesting a detrimental effect on nonsmoking patients’/employees’ health. These results suggest the need to increase awareness among nursing staff of the adverse effects of SHS and to implement measures to decrease SHS’s impact on other patients/staff, i.e. nicotine patches

First psychotic break represents a challenging differential diagnosis for psychiatrists as the clinical outcome depends on an aetiology-directed approach. There is growing focus on detection of treatable causes of psychosis because treatment can alter the natural history of disease. Anti-NMDA-receptor encephalitis is a recently described treatable neuropsychiatric disease presenting with psychiatric symptoms.

Review of epidemiology, clinical presentation, diagnostic tests and differential diagnosis, treatment and prognosis of anti-NMDAr encephalitis.

Case report of a patient diagnosed with anti-NMDAr encephalitis. Review of relevant literature collected from medical internet databases.

Male 15 year-old patient with a previous episode of involuntary movements of the limbs and loss of conscience, presented with distonic contact, behaviour disturbances, sexual stereotypies, agitation and disturbed speech, that evolved with generalized tonic-clonic seizures, global aphasia and sinking of consciousness. A diagnose of anti-NMDAr encephalitis was made and partial recovery was obtained after treatment.

Anti-NMDAr encephalitis is an auto-immune process against synaptic receptors, paraneoplasic or not, detectable by anti-body mesurement in CSF. Most patients develop a multistage illness initially presenting with psychiatric manifestations, progressing to seizures, language disintegration and catatonic states associated with abnormal movements. As patients are frequently treated with antipsychotics, motor abnormalities and catatonia are often interpreted as extrapyramidal effects or neuroleptic malignant syndrome, confounding the diagnosis.

Early recognition and treatment of anti-NMDAr encephalitis improve the outcome. Psychiatrists working in emergency departments and first psychotic break units should be aware of this severe disorder in order to start adequate treatment and prevent negative outcomes

The Psychiatric Emergency service occupies a strategic position where crucial interventions can be initiated and coordinated in linkage with other services in the mental health network. However, there is dearth of information on users of psychiatric emergency in Nigeria and sub-Saharan Africa.

To determine the clinical and socio-demographic characteristics, pattern of presentation and disposal of patients attending a Nigerian psychiatric emergency unit.

One thousand Patients consecutively presenting to the emergency unit of the Federal Neuro-Psychiatric Hospital Yaba, Lagos, Nigeria from January 2012 were prospectively assessed. Following a comprehensive psychiatric evaluation, clinical, socio-demographic and other relevant data regarding their presentation and disposition were recorded into a pro-forma and subjected to statistical analysis.

The majority were females (54.7%), single (65.6%), and unemployed (62.9%), with a mean age of 36.4 (± 14.7) years. Less than two-thirds (62.0%) were new patients. Only 10.8% of the new patients were formally referred to our facility. The most common diagnoses were schizophrenia (34.3%), depression (16.5%) and substance use disorders (11.4%). The patients were predominantly (89.4%) managed as out-patients.

The emergency room is a major port of entry into mental health care and could be prone to over-subscription by patients with non-acute problems, especially when alternatives are not readily accessible. Multipronged interventions, including community based care with relevant linkages, may facilitate appropriate utilization of mental health services and reduce the potential for overcrowding of the psychiatric emergency room.

There is a growing body of epidemiologic evidence that psychosocial factors are linked to depression.

Relations between presence of depression and traumatic experiences in adolescent’s anamnesis are presented in this research study in which 536 adolescents aged 15 to 18 years took part.

Identification connection type of traumatic experiences and depression in adolescent.

By using BDI and RADS is found that 12 -18% of adolescents confirm clinical level of depression sypmptoms. On LSCL-R questionary 415 adolescents (77,4%) had stress life events. The most of them had death of close person, catastrophe, or had been witness of catastrophe or severe accident, while small number of them had had severe accident, or were witness of violence in family, experienced divorce of parents, emotional, physical and sexsual abuse, severe financial difficultys etc.

There is strong connection between type of trauma and depression.

The deepest depression of adolescence was caused by physical and sexsual abuse, death and illness of family member, violence, conflicts and heavy disagreement in family. It is important to seek and discover adolescents who are under the influence of various stress factors, because it decreases risk of developing depression disorders. Support and help of family members defend adolescent of depressive answers on various traumatic experiences.

Schemas are self-defeating life patterns of perception, emotion, and physical sensation. Borderline personality disorder patients are characterized by a negative self-image and pronounced vulnerability to negative stimuli activating schemas, which leads to strong negative emotions and conflict in social situations.

We hypothesized that emotional faces and words stimuli will activate amygdala and limbic structures. The activation will be higher in patients compared to healthy controls subject

The aim of our study is to find the differences of schemas orientate words and emotional faces processing in borderline personality disorder compared to healthy controls. To identify neuronal correlates of negative self-image in BPD patients.

Fifteen patients suffering from BPD and healthy controls (HC) were studied in fMRI during the exposition of negative schemas related words compared with positive schemas related words and emotional faces (anxious, angry, neutral) compared with fixation points. Psychopathology was assessed using Clinical Global Impression rating scale (CGI), Beck Anxiety Inventory (BAI) and Borderline personality severity index (BPDSI).

Schema-oriented words showed right amygdala activation and strong precuneus and dorsal cingulum activation in BPD group compared with HC. Emotional faces Activations differ in both groups, BPD patient activated more anterolateral brain regions, HC activated more posteromedial areas.

Schema-oriented words are very hurtful for BPD patients and our fMRI findings confirmed this clinical experience. Processing of emotional faces in patients with borderline personality disorder involve multiple brain regions.

By the project IGA MZ CR NT 11047-4/2010

Attrition can pose significant barriers to treatment success of depression; its contributing factors and impacts on treatment outcome need further clarification. Current study aimed to describe patterns of treatment attrition, to examine associated demographic and clinical determinants and to test whether and how attrition affects outcome of depression in a national cohort of adults treated for depression.

All adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified from the National Health Insurance Research Database in Taiwan. Based on individuals’ clinical visit and antidepressant prescription, three attrition types, i.e., non-attrition, returning attrition and non-returning attrition, and their demographic/disease characteristics were identified. The relationships between attrition type and remission outcome over an 18-month follow-up period were further explored.

Factors pertaining to disease characteristics (severity of depression, comorbidities, painful physical symptoms and past treatment history) and clinical practice (physician specialty and choice of antidepressants) were associated with attrition and remission outcome at 18-month follow-up. Patients remaining in treatment within the first three months were associated with higher odds of having sustained remission (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having relapses/recurrences (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those returning attriters.

Early attrition has significant negative impacts on antidepressant treatment outcome; it hence needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication. Based on current understanding, further efforts to reduce early attrition are highly warranted.

In the open population of men aged 25-64 in Novosibirsk personal anxiety significantly associated with specific polymorphisms of genes DRD4, DAT.

Grant ? 11-16-54001 a/T

Long acting injectable “depot” preparations of antipsychotic medications have been used as an alternative to oral medication therapy for patients with low adherence to therapy. Nowadays the use of long acting second generation antipsychotic therapy is focused on improving quality of life and patients’ subjective experience of drug therapy.

To evaluate the impact of long acting second generation antipsychotic therapy on patients’ psychopathology, quality of life, subjective experience of drug and cognitive performance.

20 adult male and female outpatients aged 21-53 attending the Psychiatric Unit of the University of Florence under therapy with oral second generation antipsychotics were recruited and were switched to long acting second generation antipsychotics (Zypadhera, Risperdal depot and Xeplion). Patients were assessed by means of Psychometric Tests, Neurocognitive Tests and blood tests at recruitment, after 6 months and after 12 months.

A first clinical evaluation is indicating an improvement in quality of life especially regarding patients’ subjective experience of drug and a decrease of side effects like sedation and blunted affect. Furthermore, preliminary data show a reduction of bodyweight in patients who initially gained weight during oral antipsychotic therapy.

Long acting second generation antipsychotic therapy seems to be a valid alternative in patients who have been stabilized on oral antipsychotics, since it has a similar efficacy and furthermore it offers a better quality of life by reducing side effects of oral antipsycotics.

Standardized scales are a helpful and objective way to measure outcomes in clinical practice. However,previous surveys have revealed that only a small percentage of psychiatrists use them in clinical practice. Time-saving and cost-efficient tools are needed for daily clinical practice. A few successful experiences using online resources have been recently described and have been positively evaluated by patients. Still,it is an underdeveloped resource.

1. 1. 1.Evaluate psychiatrist’s perception regarding use of scales in Spanish clinical practice facilities.

2. 2. 2.Measure patient satisfaction using online tools.

Evaluate the need and potential use of online tools in routine clinical practice.

We conducted a survey among psychiatrists working in local clinical facilities to evaluate use of scales in daily clinical practice and their perception on the subject. We conducted a survey among patients who have used experimental online tools to evaluate their satisfaction with this method.

We wrote an email to 54 psychiatrists asking to answer an online-survey about the subject. 47 psychiatrists answered.Among them, only 40% use them always or frequently. 47% of them felt limited resources and time to administer as a difficulty to use scales. Furthermore, 34% suggested that online implementation could be helpful. 24 patients answered the satisfaction survey. 80% of them found online scales easier and more comfortable while 63% found them faster than traditional methods.

Scales are a useful and objective way to follow-up patients and evaluate clinical outcomes. However, psychiatrists find difficulties to use them in clinical practice, mainly by limited resources and time. Online implementation of scales is perceived as a potentially helpful and efficient tool for both psychiatrists and patients.

It is well known the relationship of manic episode with the consumption of different drugs organic diseases, and psychiatric drugs, such as mood stabilizers and antidepressants. There are several commonly used substances, mainly psychostimulant, potentially inducing psychiatric pathology.

To study other possible causes of substance-induced manic episode.

We report a case of manic episode with psychotic symptoms without previous psychiatric background, after consumption of Korean Ginseng.

It is necessary to scrutinize other possible substances, not usually described in the literature related to the onset of psychiatric illness, being necessary to ask about this use during the clinical interview.

The objective of this study is to investigate the quality of life of patients receiving oral corticosteroids, his impact on the occurance of depressed or hypomanic mood and on the adherence to corticosteroids.

This descriptive study was held in the department of Internal Medicine, during 04 months (From July to October 2012). We included 50 patients, having corticosteroids with a dose equal or greater than 10 mg of prednisone per day for a period exceeding one month. We used, the HAD scale, the SF-36 to investigate the quality of life of these patients, the ANGST scale of hypomania and Morisky scale for the dherence to treatments.

The average age was 43.43 + / -16.11 years. The age of discovery of the disease was 38.24 + / -14.28 years. An average score of anxiety was 10.6 + / -3.89. An average score of hypomania was 8.43 + / -4.025. We noted that 53.7% of patients belong to level 3 of anxiety, and 40.56% have some level depression by the HAD score. Psychiatric complications were noted in 58.5% of patient with a major depressive state in 12.2%. Patients reported sleep disturbances in 24% with behavioral problems in 9.6% of cases.

The average score of SF36 was 56.55 + / -15.21, and 74% of patients had distorted quality of life, mainly affecting psychic health (92.54%).

Our results suggest the interest of a psychiatric examination before the introduction of corticosteroids, in order to detect patients requiring special supervision.

In psychiatric emergencies, there is a high premium on rapid assessment, acuity categorization and objectivity in decisions regarding the disposition of patients. The Crisis Triage Rating Scale (CTRS), a 3-item clinician-rated instrument, has demonstrated validity in determining the disposal of patients in psychiatric emergency settings. However, its utility has not been evaluated in Nigeria.

This study aimed to assess the validity of the CTRS in predicting the disposal (need for hospitalisation or out-patient treatment) of patients presenting to a psychiatric emergency unit in Nigeria.

The CTRS was administered to consecutively presenting patients (N=247) at the Emergency Unit of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos. Following a comprehensive psychiatric evaluation, clinicians blinded to the CTRS scores made appropriate decisions regarding the disposal of the patients. The ability of the CTRS to predict the need for hospitalisation at different threshold scores, compared with clinical judgement as criterion, was determined statistically.

The optimal threshold on the CTRS for detecting the need for hospitalisation is a cut-off score of 9 as it has the best trade-off with a sensitivity of 0.94 and specificity of 0.89. At this threshold, the overall misclassification rate is 0.09, while the area under the Receiver operating characteristics curve is 0.95. The positive predictive validity for the assessment of disposal at the optimum threshold is 0.91.

The CTRS is a useful tool in determining the disposition of patients presenting to psychiatric emergency service in Nigeria

The influential role of family in the outcome of chronic mental illness is well documented; however there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP).

To investigate possible differences in family environment between FEP and chronic patients with schizophrenia and bipolar disorder.

To compare family measures between relatives of FEP and chronic psychotic patients.

Family functioning (FACES-IV), expressed emotion (FQ), family burden (FBS) and psychological well being (GHQ- 28) were assessed in relatives of 30 FEP and 30 chronic patients.

Multivariable linear regression models adjusted for confounders revealed that relatives of chronic patients scored significantly lower in balanced cohesion (β coefficient -4.27, 95% CI: -08.03, -1.71) and balanced flexibility (β coefficient -4.01, 95% CI: -6.91, -1.10), as well as communication (β coefficient -6.61, 95% CI: -11.70, -1.50) and satisfaction scales (β coefficient -7.32, 95% CI: -13.23, -1.41). Relatives caring for a chronic patient had significantly higher scores in critical comments (β coefficient 7.81, 95% CI: 3.95, 11.68) and emotional overinvolvement (β coefficient 3.70, 95% CI: 0.24, 7.16). They, also, reported higher objective (β coefficient 12.23, 95% CI: 3.76, 20.71) and subjective (β coefficient 2.79, 95% CI: 0.45, 5.14) burden, as well as poorer psychological well being (β coefficient 12.23, 95% CI: 3.76, 20.71).

These findings suggest that chronicity adversely affects patients’ family. Early intervention strategies are needed to reduce family burden which in turn may adversely affect the course of the patient’s illness.

Systemic lupus erythematous (SLE) is the paradigm of chronic systemic diseases. It has a strong impact regarding patient’s quality of life and the ability to work, which carries high direct and indirect costs. Intervention strategies promoting appropriate coping seem to have an important positive effect on quality of life. Neuropsychiatric symptoms are common.

To review the literature on psychosocial impact of SLE, understand which coping strategies are more often used, and to know what are the most common SLE neuropsychiatric manifestations.

The authors have conducted an online search in PubMed with the terms “SLE + Psychiatry” and “SLE + Mental health” from 1995 until 2012. From the outcome were collected, analyzed and summarized the articles considered to be relevant.

Indirect costs represents 2/3 of the total cost associated with SLE. Inability to work is common (23%) and it is related to multiple factors. Patients with SLE tend to use coping skills that are generally adopted for events perceived as nonmodifiable. The immune system might play a role in the aetiopathogenesis of psychiatric diseases. Neuropsychiatric SLE symptoms are frequent (20-75%), especially depression (10.8-39.6%) and cognitive deficits (>40%).

SLE is a chronic systemic disease with a high psychosocial impact. Using active coping strategies seems to improve patient’s quality of life. Neuropsychiatric manifestations are common. A detailed study on disease impact will probably allow an earlier screening that lead to a more accurate diagnosis and treatment, promoting better mental health and prognosis in SLE patients

Neonates born in the winter and those with hypovitaminosis D levels exhibit a higher propensity to develop schizophrenia. Several reports have suggested that adult schizophrenics have lower vitamin D levels.

This study was done to evaluate the presence of hypovitaminosis D in institutionalized schizophrenics.

To compare vitamin D levels in institutionalized patients with schizophrenia.

We retrospectively reviewed the vitamin D results on all schizophrenic patients seen in our office during a period of six months. Vitamin D was measured as 25-hydroxyvitamin D in the blood and reported as ng/ml. The levels were recorded and classified as follows: more than 30 ng/ml: normal; 21 to 30 ng/ml: mild deficiency; 11 to 20 ng/mL: moderate deficiency; 10 ng/ml or less: severe deficiency.

Total of 83 patients, 63 had vitamin D levels measured. 46 (73%) had low Vitamin D levels, while 17 (27%) had normal vitamin D levels. Of the 26 females, 20 (77%) had low vitamin d levels and of the 37 males, 26 (70%) had low vitamin D levels. 10 of the 63 had severe deficiency, 22 of the 63 had moderate deficiency while 14 of the 63 had mild deficiency. No difference was noted between the males and females.

It is estimated that as much as 60% of the adult US population suffers from vitamin D deficiency. Our population of institutionalized schizophrenia patients had a 73% incidence of hypovitaminosis D. It may contribute to the higher morbidity and mortality noted in this population.