There are above 170 PICUs in the UK, most of them being gender mix or male only. There is no specific data available about management of patients diagnosed with Borderline Personality Disorder (BPD) in PICUs.

Review of sociodemographic, clinical, outcome characteristics, care pathways and financial implications when managing BPD population in Female PICU.

To measure rates of compliance with NICE guidelines using such criteria as: comprehensive care plan provided on admission to PICU and at discharge from PICU; patient being involved in discussion about discharge plans; specialist assessment / treatment started before admission to Female PICU was continued during the admission; referral for psychological therapies was considered/made during stay in Female PICU; prescribing practice by referring and admitting teams; availability of specialist Personality Disorders (PD) services locally.

Retrospective cross sectional review of patient records.

76% of patients are admitted to Female PICU with a comprehensive multi-disciplinary care plan. 80% of patients transition from ECH was discussed carefully with the patient beforehand. Specialist assessment/treatment started before admission to ECH was continued during the admission 100%. Most of the patients would receive treatment by various psychotropic meds prior and during the admission. Referrals to psychological therapies were considered for 19% of patients. There is a lack of specialist PD services.

BPD is the most costly population in comparison with other patient groups in Female PICU which requires multidisciplinary team input, specialist services involvement, better adherence to NICE guidelines, support and training for MDT.

Set shifting provokes gender related alterations of rapid cerebral hemodynamics in large basal cerebral arteries. However, no information on frequency patterns has been reported, especially when comparing phases of set shifting and set maintenance.

In the following functional transcranial Doppler study (fTCD), we introduced spectral analysis to rapid cerebral hemodynamic changes.

To investigate signal characteristics during both phases and its correlate with sociodemographic and performance variables.

Male and female participants performed the Wisconsin Card Sorting Test during measurement of the middle cerebral arteries. Cerebral hemodynamics underwent spectral transformation during set maintenance and set shifting. Correlation analyses examined the linkage with sociodemographic and performance variables.

Scattering of frequencies was significantly increased during set shifting as compared to set maintenance (P = 0.006). Increasing age was significantly associated with increasing variability of spectral frequencies during set maintenance (P < 0.002). In males, but not in females, higher age predicted increased variability of spectral frequencies during set shifting on the right hemisphere (P = 0.002). During that phase, males showed a frequency peak near 0.1 Hz (trend level).

This study provides evidence that spectral analysis of cerebral hemodynamics is a fruitful strategy to characterize gender differences and brain behavior relationships during higher cognitive functioning. Further covariates such as age, performance and hemisphere have to be considered. In other words, signal frequency of cerebral hemodynamics may be an underreported neurobiological marker in addition to signal strength, with special relevance for psychiatric diseases with cognitive dysfunction and/or gender differences, such as schizophrenia or major depression.

Sexual dysfunction is the inability to perform satisfactory sexual activity. It is estimated that 80% of men have erectile dysfunction in dialysis and 55% of women, difficulty in sexual arousal. Men may have decreased libido, erectile dysfunction and difficulty reaching orgasm. Women have difficulty in sexual arousal, decreased vaginal lubrication, dyspareunia, and difficulty achieving orgasm.

Assess sexual dysfunction in hemodialysis patients.

A Cross-sectional analysis conducted with a randomized sample of 100 subjects from a total of 521 hemodialysis patients (20%) of both genders. Data were collected through Kidney Disease Quality of Life - Short Form (KDQOL-SF).

Most patients were female (52%), mean age 55 ± 14 years. After KDQOL-SF, the most common complaint was lack of sexual activity (82.81%). Most patients are dissatisfied with sexual performance (59%). Among them, the more dissatisfied were women, 61% (36/59), p < 0.02, and patients under 65 years, 61% (36/59) p < 0.007. Among those who report being sexually satisfied, the majority were male (58.33%). We found that sexual dissatisfaction is more common in women. Among 52 female patients, 37 were dissatisfied (71.15%), whereas among men, we have 56.25% (27/48) of sexual dissatisfaction.

There is evidence of high prevalence of dissatisfaction in the hemodialysis patients sexual performances. Further studies are needed on their sexual function, as well as therapeutic interventions that may offer improvement in this negative scenario.

Nicotine addiction is common among people with schizophrenia and is associated with significant morbidity and mortality. This rate is a much higher than among the general population, where the percentage of smokers varies between 25-47%.

This study aims to characterize nicotine dependence in schizophrenics compared to smokers not having mental health problems. The research was also to determine whether the affective psychological factors (anxiety and depression) and the level of distress are important predictors of smoking in a group of psychotic patients.

204 smokers participated in the research, including 104 people with schizophrenia and 100 healthy persons. Participants were interviewed and asked to complete five questionnaires: Fagerström Test for Nicotine Dependence, Test of Motivation for Smoking Cessation, Hospital Anxiety and Depression Scale and Distress Thermometer.

The study has shown that the schizophrenics smoked more, took a greater number of puffs, showed a higher level of dependence and were less motivated to give up smoking than the mentally healthy persons. The results show the important role of affective factors and feeling of distress in nicotine dependence. The study also confirmed a significant relationship between distress and the number of cigarettes smoked. Affective factors and distress explain 34% of variance of the number of cigarettes in the group of schizophrenics and 56% in the control group.

This study showed that psychological treatment should be implemented into programs for nicotine dependence to improve the functioning schizophrenics in terms of coping with stress and maintaining good mood.

In adolescents, Socially Prescribed Perfectionism/SPP has been consistently associated with depression. Findings on Self-Oriented-Perfectionism/SOP and depression are equivocal. Self esteem/SE has been found to play a significant role between SPP and depression.

To analyse the relationship between perfectionism, SE and depression in a Portuguese adolescents sample.

963 adolescents (59.2% girls), aged 15.80 ± 1.510 answered the Portuguese versions of the Children Depression Inventory/CDI, Rosenberg Self-Esteem Scale and Child and Adolescent Perfectionism Scale.

CDI and SE mean scores were significantly different between genders (CDI-Girls:10.84 ± 6.025 vs. Boys:8.90 ± 6.477; SE- Girls:20.11 ± 4.953 vs. Boys:20.48 ± 4.856; p < .001). SOP was not significantly correlated with CDI and SE in both genders. In both genders SPP was positive correlated with CDI and negatively correlated with RSES (r = .20, p < .01). RSES was negative correlated with CDI (Girls, r = -.70; Boys, r = -.63; p < .01). Girls with high SPP (>M+1SD) had CDI total mean scores significantly higher than girls with low SPP ( < M-1SD) (12.61 ± 6.79 vs9.75 ± 5.24, p=.003). Gils and boys with high SE vs. low SE had significantly higher CDI total mean scores (Girls:18.49 ± 5.98 vs. 4.91 ± 3.05; Boys:17.02 ± 7.65 vs.5.80 ± 5.62; p < .001). Linear regression showed that the model composed by SPP and RSES explained 49.5% of the CDI variance in girls and 40.0% in boys (p < .001). In both genders, SPP and SE were significant CDI predictors (p < .05). The mediation analysis revealed that in the Girls sub-sample SE partially mediated the relationship between SPP and CDI (IC 95% .036-.126).

High SPP and low SE are associated with depression in adolescence.

The ongoing global economic recession has impacted most severely on the more vulnerable sections of society. The policy of economic austerity being pursued by the British government - 2011-2012 saw the first decline in spending on mental health in 10 years - has placed further strain on the underprivileged.

This paper will examine the impact of the recession and British government policy on gender mental health inequality and recommend corrective action as appropriate.

Examine impact of recession and British government policy on

1. a) negative social determinants of mental health of women

2. b) how they contribute to mental health inequity and

3. c) what measures might be adopted to tackle these negative social determinants.

1. 1/ Analyse arguments on impact of social determinants on mental health inequities.

2. 2/ Review available hardcopy and internet literature on recession and government policies as they pertain to women and mental health inequalities.

3. 3/ Determine optimal approach on behalf of government to prevent gender mental health inequalities.

Current British government policies risk adversely impacting upon the social determinants of mental health of women in Britain, with negative consequences in terms of gender mental health equity. This is particularly true for women in economically disadvantaged circumstances.

Urgent action is required to address this situation by

1. a) reversing policies that negatively impact upon women and risk provoking mental health inequalities and

2. b) introducing gender-proofed policies that will not negatively impact upon the social determinants of mental health of women in Britain.

Two parameters for assessment compliance in HD patients are interdialytic weight gain (IWG) and absences, both influenced by psychological and nutritional aspects.

Achieve greater compliance by using Water Control Dynamic (Bucket Dynamic - BD) to clarify risks of excessive IWG.

BD was performed during HD session by nutritionist and psychologist in 48 HD patients to show that HD doesn’t eliminate fluids as a healthy kidney. Two buckets (B) are presented; one filled with water (B1) another empty (B2). Professional holds an 250 mL glass (represents fluids someone ingests), the other holds a 50 mL glass (represents HD fluid removal capacity). The 250 mL glass, one professional takes water from B1 and places it in the B2. Meanwhile, the other uses the 50 mL glass to take water from B2. This analogy demonstrates that HD doesn’t remove all liquid someone can drink. Hence, water intake control necessity. Nutritionist clarifies patients’ nutritional concerns, while the psychologist addresses emotional issues. We compared percentage of IWG and absences in two months before and after BD.

After BD, we observed decreases in absences (7,2% X 5,7%) p < 0,05 and IWG (4,9% X 4.1%) p < 0,05. IWG was within recommended levels (3.5% to 5% of dry weight) before and after BD, but, before BD, IWG was at the upper limit of the recommendation.

We believe this experience fostered self-control, resulting in better compliance, and allowed us to benefit from an innovative work interaction between health professionals from different areas.

An antidepressant drug treatment (ADT) may be associated with adverse effects such as manic switch or chronic irritable dysphoria. These adverse effects have been highlighted in patients with bipolar disorder but never in the general population. They may lead to prescription of sedative treatment, particularly antipsychotic drugs.

To assess whether the prescription of ADT is subsequently associated with an increased probability of prescription of an antipsychotic treatment, in the general population.

A nested case-control study was carried out in a cohort of subjects initiating a new ADT registered in the national insurance database (n = 28,145). Cases were defined as subjects receiving a new antipsychotic drug treatment. Controls did not receive any antipsychotic drug until the index date. They were compared for the probability of receiving an ADT during at least two weeks in the four weeks prior to antipsychotic initiation.

2558 subjects received an new antipsychotic drug over the follow up. After adjustment for gender, age, chronic disease status, welfare benefit, specialty of the ADT prescriber, co-prescription of other psychotropic drugs, a new antipsychotic dispensing was associated with exposure to ADT during at least two weeks in the four weeks (OR 1,42 ; IC95% 1,29-1,58 ; p < 0,0001).

The dispensing of ADT increases the risk of receiving an antipsychotic treatment, which may be a proxy for manic switch, in the general population.

National and international research has shown the association between depression and anxiety disorders with the risk of planned and impulsive suicidal behavior. Patients with depression may have severe anxiety or agitation associated with their depression with or without comorbid additional anxiety disorder diagnoses.

1. 1. Evaluate differences between self rated overall suicide risk of inpatients on a treatment resistant depression unit based on presence or absence of comorbid anxiety disorder.

2. 2. Evaluate association of pharmacogenetic testing results with self-ratings of suicide risk.

1. 1. To determine if suicide risk of psychiatric inpatients is higher in patients with depression and comorbid anxiety disorder.

2. 2. To determine utility of pharmacogenetic testing with suicide risk assessment and patterns of use in patients with treatment resistant depression at a large academic medical center.

This is a retrospective records review study of a sample of over 700 inpatients on a treatment resistant depression unit at the Mayo Clinic. Patients overall suicide risk self-assessments will be analyzed for differences in suicide risk assessment controlling for diagnoses, age, and sex. Pharmacogenetic testing results, including serotonin transporter and p450 2D6 testing results, will be analyzed for their association with suicide risk.

Statistical analyses results are pending at time of abstract submission.

At a population level, the interplay between anxiety disorders and depressive symptoms is felt to be key to understanding the progression from suicidal ideation to suicidal behavior. Factors complicating this at an individual patient level along with results of research study will be discussed.

rTMS is a non invasive technique, used for the stimulation of the Dorsolateral Prefrontal Cortex (DLPFC) by means of coil-generated magnetic fields [1,2]. The present study was aimed to assess efficacy and tolerability of augmentative low and high frequency rTMS in TRD patients, with current moderate-severe major depressive episode.

24 patients with a diagnosis of drug-resistant Major Depressive Episode (Unipolar or Bipolar Depression) were treated with 4 weeks of rTMS. Subjects were randomly assigned to one of the following treatments: right DLPFC, 1 Hz, 110% of motor threshold (MT), 420 stimuli/day; right DLPFC, 1 Hz, 110% MT, 900 stimuli/day; left DLPFC, 10 Hz, 80% MT, 750 stimuli/day, according to safety guidelines [3]. Analyses were performed using t-test and ANOVA.

3 subjects dropped out at the 1st or 2nd weeks of stimualtion. 21 patients completed the treatment, showing a statistically significant score reduction at HAM-D, MADRS, HAM-A e CGI-s (tr = 9.05, p < 0.005; tr = 7.93, p < 0.005; tr = 6.81, p < 0.005; tr = 4.37, p < 0.005). Response (reduction of HAM-D score of 50%) was achieved by 2 patients, one of whom considered remitter (HAM-D≤8). Partial response (reduction of HAM-D score between 25-50%) was obtained by 12 patients. No significant difference was observed in terms of efficacy between high vs low frequency. With respect to tolerability, only mild and transient side-effects were reported (discomfort, headache, insomnia). One patient withdrew because of hypomanic switch.

Both augmentative low and high-frequency rTMS appeared to be equally effective and well tolerated in the treatment of TRD.

Discussions about the limitation of the prescription and dispensing of buprenorphine hight dose (Subutex ®) emphasize the need for a systematic and formalized cooperation between the various contributors in health.

Describe the course of caring for patients addicted to Subutex followed at the outpatient service of Razi hospital.

A retrospective study was conducted on the records of patients who consulted the outpatient service of Razi hospital during a six-month period and whose diagnosis of dependence to Subutex was retained.

Twenty three patients were addicted to Subutex. 100% male. The mean age of the patients was 32.13 years. Almost 82.6% of patients had a low socioeconomic level and 78.3% of them did not have insurance. 16 were unemployed. A history of incarceration was found in 82.6% of patients. The duration of use of Subutex ranged between 2 and 168 months. Places of acquisition of this molecule were precised only by 26% of consumers. Fifteen consultants do not have any history of detoxification cure and 8 of them had 1 or 2 cures. In addition, 78.3% of patients reported being motivated to stop their addiction. Regarding collaboration of physicians, 8 patients (34% of the patients) were referred by generalist physicians, 7 patients by specialist physicians, 4 patients by emergency and 2 by psychiatrists.

The management of patients addicted to Subutex in our country is deficient. These results argue for the necessity of general measures of support dependent on psychoactive substances.

Social phobia is one of the most common psychiatric disorders. There is a lack of knowledge on the relationship between social phobia and cognitive functioning among older adults.

To examine cognitive functioning, prevalence and psychiatric comorbidity of social phobia in an elderly population.

A general population sample of non-demented 75-year olds (N = 768) and 85-year olds (N = 432) was investigated in 2005-2006 (75-year olds) and 2009-2010 (85-year olds) by psychiatric nurses. The procedure was identical with semistructured psychiatric examinations including the Comprehensive Psychopathological Rating Scale, and the Mini International Neuropsychiatric Interview. Social phobia was diagnosed according to the DSM-IV criteria. Cognitive function was measured with the Mini-Mental State Examination, and eight different psychometric tests measuring short- and long-term memory, nonverbal memory, logical reasoning, visuospatial and executive ability.

The one-month prevalence of social phobia was 2.5% (N = 30), this was more common among women than among men (3.2% vs. 1.3%). Individuals with social phobia more often had major depression compared to individuals without symptoms of social phobia (33.3% vs. 4.3%). MMSE-score did not differ between individuals with and without social phobia. Individuals with social phobia had worse visuospatial and executive ability measured with Clock Test, compared to individuals with no symptoms of social phobia.

Our results indicate that social phobia is not unusual in old age and that comorbidity with depression is common. Social phobia does not have an impact on global cognitive functioning. Social phobia influenced visuospatial and executive ability but not performance on several other cognitive tests.

It has been shown that perfectionism constitutes a risk factor both for insomnia and postpartum depression.

To analyse the relationship between perfectionism, depressive symptoms and insomnia in the postpartum.

201 3-months postpartum women (M=12.27 ± .91 weeks postpartum) completed the Portuguese versions of Postpartum Depression Screening Scale (PDSS) and Multidimensional Perfectionism Scale (MPS). Three MPS dimensions derived by factorial analysis with data from this sample were used: Self-Oriented Perfectionism/SOP, Social Prescribed Perfectionism-Conditional Acceptance/SPP-CA and SPP-Others Highs Standards/OHS. Women also answered 5 questions about sleep, considering the previous month, based on which three insomnia groups were formed: Good Sleepers/GS (women without insomnia symptoms or daytime impairment); Insomnia Symptoms Group (women with at least one insomnia symptom but no daytime impairment); Insomnia Syndrome Group/ISG (women with at least one insomnia symptom and sleep related daytime impairment).

Insomnia and PDSS were correlated (r = .39, pr < .01). SOP was not correlated with insomnia neither with PDSS total score. SPP-CA was significantly correlated with insomnia and with PDSS (rr > .25, pr < .01). SPP-OHS was only significantly correlated with insomnia (r = .14, pr < .05). SPP-CA mean scores were significantly higher in ISG than in GS (23.45 ± 3.032 vs. 18.98 ± 8.81, p = 002). Considering insomnia as a quantitative variable, linear regression showed that SPP-CA (β = .20, p = .005) and PDSS (β = .17, p = .021) were both significant predictors of insomnia, explaining 8.7% of variance (pr < .001). The mediation analysis revealed that SPP-CA partially mediated the relationship between PDSS and insomnia (IC 95% .008-.005).

SPP-C is a relevant correlate of postpartum insomnia.

Fatigue and depression are among the most frequent symptoms in multiple sclerosis (MS), affecting up to 90% of patients at onset or during the course of the disease. Repetitive transcranial magnetic stimulation (rTMS) has proven safe and efficacious for treating depression.

To perform a randomized, sham-controlled pilot study to evaluate effects of deep rTMS on fatigue and depression in patients with multiple sclerosis.

28 MS-patients underwent 18 sessions of deep rTMS over 6 weeks. 10 patients underwent sham stimulation, 9 patients stimulation of the left prefrontal cortex (PFC) (18 Hz, 120% motor threshold (MT)) and 9 patients of the motor cortex (MC) (5 Hz, 90% MT). Following the treatment, patients were observed for further 6 weeks. Effects on fatigue were evaluated with the Fatigue Severity Scale (FSS) Depression was assessed by Becks Depression Inventory (BDI).

There was no significant change of BDI or FSS in sham group, as well as in PFC group over all time points. However BDI in MC group showed a significant decrease already in early treatment phase (-25.74% ± 24.36%, p = 0.013) and continued decrease over treatment period with maximum in follow up phase (-39.23% ± 21.57, p = 0.001). In FSS, MC group showed a trend to decrease during treatment period and the effect becomes significant in follow up phase (-26,72% ± 16.30%, p = 0.001).

Our data suggests that deep rTMS may have positive influence on depression and fatigue. Intrestingly, comparable effects on both symptoms were observed in MC group but not in PFC or in sham group.

US primary care clinicians (PCCs) are increasingly assuming the medical management for psychiatric disorders. Clinical practice guidelines (PCGs) remain gold standard for professional care, yet physician adoption is not universal. We sought identification of methods to increase evidence-based mental health practices for the most commonly diagnosed pediatric behavioral condition, attention deficit hyperactivity disorder (ADHD).

Test two psychiatric interventions of different intensity levels, both designed to increase primary care clinicians’ use of PCGs for managing ADHD.

Increase PCCs’ use of PCGs for managing ADHD.

Participants: 70 North Carolina (NC) PCCs ; 70 case managers; 35 to 40 pediatric resident physicians; 420 pediatric government-insured patients ages 6-18 years (chart abstraction only).

Procedures: PCCs were randomized to:

1. (1) PCC training and follow-up support only; or

2. (2) PCC, case manager, and office staff training (collaborative) and follow-up support interventions.

Differences in knowledge, skills, attitudes, and ADHD assessment and treatment practices assessed by participant selfcompleted surveys at baseline, 6, and 12 months. Six of their patient charts were abstracted to determine the extent they followed American Academy of Pediatrics (AAP) treatment guidelines. NC Medicaid (government insurance) claims for children and adolescents of participating practices and a group of control practices were reviewed for diagnostic documentation.

For collaborative trained PCCs:

1. (1) increased use of ADHD symptom screeners and greater frequency of F/U visits;

2. (2) greater identification of children with ADHD, but decrease in the probability of receiving an ADHD medication

3. (3) lower rate of prescribing above dosing guidelines.

Specific phobia (SP) is prevalent in the population but its clinical relevance is unclear.

There are few prospective population studies of SP.

To study the prognosis of SP in a sample of elderly with special reference to SP as a risk factor for depression.

A representative sample of 70-year old men and women (N=558) without dementia were examined by psychiatric nurses, using a semi-structured interview based on the Comprehensive Psychopathological Rating Scale (CPRS). Symptom algorithms were used to diagnose SP and other disorders of mood and anxiety according to DSM-IV. At a 5-year follow-up 418 (74.9%) persons were re-examined.

The prevalence of SP had declined significantly from 10.2% to 6.1% at follow-up. Of those with SP at baseline, 28.6% met diagnostic criteria also at follow-up, 52.4% had sub-clinical symptoms and 19.0% had no symptoms at follow-up. The prognosis of SP was not influenced by psychiatric comorbidity or type of fear. SP at baseline increased the risk for depression at follow-up in a logistic regression model also including gender and other anxiety disorders.

Less than a third of those with SP meet criteria at a 5-year follow-up, indicating substantial fluctuation of symptom levels of SP. The marked reduction in prevalence of SP over time suggests that age in itself may have a positive influence on the prognosis. The increased risk for depression in this study calls for more prospective studies in younger samples.

To assess quality of life through self-administered KDQOL-sf (Kidney Disease Quality of Life - short form) by patients on hemodialysis (HD) classified according to age.

We randomly 159 hemodialysis patients and applied the KDQOL-sf between February/10 and March/11. We evaluated the quality of life based on scores below or above 50, on all scales, according to age < 60 years (n = 85) and ≥ 60 years (n = 74).

In patients < 60 years, the scales in which they had poorer quality of life were: physical function 47/85 (55.3%), Chronic Kidney Disease (CKD) burden 46/85 (54.1%), professional role 57/85 (67.1%) and sexual function 47/85 (55.3%). In patients ≥ 60 years, the scales with poorer quality of life were: physical functioning 47/74 (62.2%), physical function 51/74 (68.9%), general health 38/74 (51.3%), energy / fatigue 45/74 (60.8%), CKD burden 56/74 (75.7%), professional role 49/74 (66.2%) and sexual function 60/74 (81.1%).

While patients younger than 60 years have a quality of life decrease in 4 scales, patients with more than 60 years have worsened in 7 scales, with significant worsening of sexual function. We conclude that the quality of life is more impaired in the elderly undergoing HD.