Lead (Pb) is a confirmed neurotoxin. Clear adverse effects of blood Pb level (BLL) ≥ 10 μg/dl have been documented in children, but questions remain about Pb-associated behavioural disorders at these BLL and whether lower exposures are associated with greater disorders.

To study the behavioural disorders associated with environmental low-level Pb exposure in children living in the villages of the east coast of the River Nile located nearby Al-Minya industrial area.

Study was conducted at Al-Minya University Hospital for Obstetric, Gynaecology and Pediatrics (1st of July, 2007 - 30th of June, 2009). It included 120 children aged 7-9 years from the nearest 2 villages to Al-Minya industrial city (60 children each), namely, El-Newayrat and Al-Shorafaa, and 60 children from Talla, a village located to the west of Al-Minya city, as a control group.

BLL had been measured, and all studied children were subjected to Conners’ test.

Children BLL from El-Newayrat and Al-Shorafaa were significantly increased when compared to that of Talla children with higher affection reported with El-Newayrat. Conners’ test revealed higher affection in children from EL-Newayrat and Al- Shorafaa when compared to Talla. There was a strong negative correlation to BLL (5–10 μg/dl). The most pronounced deficits were in the areas of ADHD, psychsomatic and learning disorders.

Low-level Pb exposure in children was accompanied with behavioral disorders. It is advised to perform a national study to evaluate how big the problem is and to put Pb-toxicity in the list of the national health problems.

Dementia is a serious loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging. There are about 820,000 people in the UK with dementia (Alzheimer's Research Trust 2010).

To show whether we compiled with the Department of Health in prescribing antipsychotics for dementia patients. All the patients have an indication recorded for the prescribing of antipsychotics including target symptoms.

We included all the patients with dementia who were under the care of the MCPCT Older Adult Team (Outpatients, inpatients, and memory assessment clinics) between April 1st 2011 - June 30th 2011.

Antipsychotics were used in 11% of patients with dementia, there’re were clear guidelines as to what the indications were in each case. The initiation of treatment was almost within the scope of specialist mental health services. The review was done by consultants. The indication for antipsychotics were psychotic symptoms (delusions and hallucinations) in nearly 40% of cases. In 50% of cases we tried to stop the antipsychotics with successful cessation in half of that sample. The maximum duration was less than 3 months in 82% of cases.

It is clear that antipsychotics are infrequently used in older adult population with Dementia who are under the care of our teams (only 11%) which is much less than what the Department of Health report's figures.

This audit forms part of a wider project looking at the effective identification and management of risk of thromboembolism on psychiatric wards.

The risk of thromboembolism for psychiatric patients has been recognised as a major cause of physical co morbidity.

Thirty eight Patients were prescribed pharmaclogic venous thromboembolism prophylaxis in the last 2 years. We looked at the following points:

1. Indication for venous thromboembolism prophylaxis or treatment.

2. Documentation of the decision for initiation of treatment.

The indications were:

1. Prophylaxis of venous thromboembolism in patients who sustained lower limb/pelvic fractures.

2. The second most common cause was that patients were already on VTE prophylaxis even before admission to our psychiatric wards.

The use of Low Molecular Weight Heparin that was initiated or suggested by the psychiatric team in six inpatients (16%). In sixteen inpatients (42%) the decision was made by another medical professionals (GP, Medical team, DVT clinic etc) whose recommendation was subsequently followed.

In the 42% of cases there was no clear documentation regarding the decision to start venous thromboembolism prophylaxis. We set our goals at 100% and we have seen adequate documentation in only 20% of cases.

Proper documentation of decision making to start venous thromboembolism prophylaxis/treatment is required ain all cases.

More explicit explanation of the indication and decision to start venous thromboembolism prophylaxis is required.

To repeat this audit six to nine months after the introduction of the local trust policy that included robust assessment of Thromboembolic risk.

The purpose of this study is to compare the performance of psychotic patients in neuropsychological “Bender_Gestalt” test.

The clinical symptoms of 97 psychotic patients (49 schizophrenics, 25 bipolar and 23 psychotics due to substance) and their performance in “Bender Gestalt” test were assessed through the administration of positive and negative symptoms scale (PANSS) and demographic data.

One-way ANOVA between the three diagnostic groups in terms of errors committed by psychotic patients showed no significant differences. Post-hoc “Tukey’s test” also yielded the same results, thus three diagnostic groups can be placed in a match group in terms of overall errors.

The findings revealed evidence that the pattern of errors committed by patients was correlated differently with demographic and clinical variables in all three diagnostic groups. According to these findings treatment and rehabilitation of psychotic patients can be executed more precisely.

1. to assess the subjective perception of HRQoL in medical students’ sample; and

2. to ascertain predictors of better perception of HRQoL in medical students.

We have assessed and compared scores of Short Form Health Survey (SF-36), used for the assessment of HRQoL in sample of 561 medical students and 332 control participants. Also, we have used linear regression to identify predictors of better perception of HRQoL in the sample of medical students.

The results indicate that medical students had statistically significantly higher total score of SF-36. The statistically significant predictors of better perception of HRQoL in medical students were: male gender, younger age and higher grade year of studies and non-medical students was male gender. The other sociodemographic and academic variables did not emerge as possible predictors of better perception of HRQoL.

Medical students perceive their health much better than other university students do but female, older and second year medical students have worse perception of their HRQoL. In non-medical university students females had worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better quality of life of medical students and life of nonmedical students.

High frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) has been shown effective for reducing persistant negative symptoms of schizophrenia. Intermittent theta burst stimulation (iTBS) is a new paradigm of rTMS that allowed more sustained facilitation effect.

The aim of this study is to investigate the effect of theta burst in reduction of persistant negative symptoms in schizophrenia.

24 adult schizophrenia outpatients were assigned to receive iTBSat 80% motor threshold, or sham TMS over the left DLPFC, daily; for 20 sessions. The primary outcome measure was the Scale for the Assessment of Negative Symptoms (SANS).score. Secondary outcomes included depression as measured with the Calgary Depression Scale (CDS), and cogntion as assessed with digit span and trail making test. Patients were followed-up 6 months afterwards.

The primary outcome measure (change in Scale for Assessment of Negative Symptoms score) showed a statistically significant drop at month 1, 3 and 6 for the iTBS group, but not ther placebo groups. Digit span and trail making test score were also significally improved after treatment in iTBS group. Calgary depression scale score did not demontrate any significant change.

iTBS may serve as a relatively noninvasive treatment of the negative and neurocognitive deficits associated with schizophrenia.

ClinicalTrials.gov Identifier: NCT00875498

Dementia is severe mental disorder which should be treated both with pharmacological and nonpharmacological approaches.

To evaluate the effectiveness of non-pharmacological approaches influencing cognitive functions we used in routine practice in inpatient women psychogeriatric ward in Mental hospital in Kromeriz and satisfaction with these activities in hospitalised patients.

At the beginning and at the end of hospitalisation was used range of Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) to make an indicative assessment of cognitive functions, and at the end of hospitalization was used a controlled interview.

At the end of hospitalisation there was no significant evidence of improving cognitive functions (short period of research is the most probable reason). Nevertheless, psychotherapeutic activities were evaluated by clients positively.

Non-pharmacological approaches have important position in treatment of dementia, together with pharmacological and support therapy.

As aging of population is actual demographic trend, incidence of dementia increases. Thanks to effective treatment plenty of patients with dementia live longer and end in terminal stages of dementia. Therefore palliative approach in psychogeriatry comes to the fore.

To determine key points in psychogeriatric palliative care to maintain quality of life in terminal stages of dementia and to develop complex model of palliative care in psychogeriatry.

Content analysis of focus group interviews and expert opinions among psychogeriatrists and palliative care specialists.

As a result of focus group interviews and expert opinions among specialist we propose “PANSS” model in psychogeriatric palliative care - Pain relief, Autonomy, Nutrition support, Skin to protect bedsores, Spiritual and Social support.

PANSS model could be suitable model of complex psychogeriatric palliative care in routine clinical practice.

Both serotoninergic antidepressants and anticoagulants are widely udes in psychogeriatry. These drugs can develop drug interactions with subsequent risk of bleeding.

To determine risk of potential drug interactions between serotoninergic antidepressants and anticoagulants serotoninergic antidepressants and anticoagulants with subsequent risk of bleeding.

Retrospective analysis of medical records and laboratory checks (INR values) in senior patients treated with serotoninergic antidepressants and anticoagulants (Mental hospital Kromeriz, Czech republic, year 2011).

In 15.5% of patients treated with combination serotoninergic antidepressant / anticoagulant the dosage of anticoagulant had to be decreased due to unwanted elevation of INR value. In 0.6% of patients the risk of bleeding was clinically evident.

Serotoninergic antidepressants and anticoagulants are common drugs used in treating seniors with mental disorder and potential drug interactions between them should be taken into account.

Dependence on alcohol is no more tabu in senior population. Prevalence of dependence on alcohol in this population ranges from 3–12% according different authors.

To compare the prevalence of dependence on alcohol among seniors admitted to treatment in Mental hospital Kromeriz (Czech republic) between years 2001 and 2011.

Retrospective analysis of medical records from years 2001 and 2011.

In year 2001 dependence on alcohol was detected in 2.8% admission psychiatric diagnoses, in year 2011 dependence on alcohol was detected 6.8% admission psychiatric diagnoses. Gender played no role in increase of prevalence.

We detected 2-times increase in prevalence of dependence on alcohol between years 2001 and 2011 in seniors hospitalized in Mental hospital Kromeriz.

Differentiating Lewy Body Disease from dementia of Alzheimer's type might be difficult in clinical practice. Althought the clinical signs in both cathegories are well known, difficulties may occur in patients with incomplete clinical picture.

Description of the case with incomplete clinical picture (women with unspecified dementia) and benefit of the DatCAN in differential diagnosis of clinically unclear dementia.

Case report.

DatCAN helped in differential diagnosis of unspecified dementia. As the clinical picture of the case was incomplete and clinical diagnosis could not been done according diagnostic criteria, DatSCAN proved benefit in diagnostics of Lewy Body Disease.

Karnofsky score is used in oncology and APACHE II score in critical care to estimate prognosis of patients with severe health conditions. In psychogeriatric palliative care such indicators are still missing althought it can be usefull to have such instrument.

To determine whether Karnofsky score and APACHE II score can be also used in psychogeriatry.

Prospective study done in 2011 in psychogeriatric wards, Mental hospital Kromeriz. Karnofsky score and APACHE II score were measured in patients with severe dementia (MMSE bellow 6) at the beginning of the hospitalisation. Lethality was prospectively followed in relation to Karnofsky score and APACHE II score.

Correlation between Karnofsky score, APACHE II and lethality in patients with severe dementia was strong (r = 0.64 for Karnofsky score, r = 0.72).

Both Karnofsky score and APACHE II score can be used in psychogeriatry as well to estimate prognosis in patients with severe dementia.

Depression is the most prevalent psychiatric disease that affects 15% of men and 25% of women in general population. It is reported that depression has higher tolls between the staff of the Intensive Care Units (ICUs) and Operation Rooms (ORs) due to their occupational circumstances.

To evaluate the status of depression among health care's of intensive care units

The present study examines the prevalence of depression in the staff members of ICUs and ORs in the Ilam province of Iran.

In this cross-sectional study, 48 random staff members from hospitals’ ICUs and ORs in Ilam province (western Iran) were evaluated. The data was collected using the standard Beck questionnaire and analyzed by SPSS software (ver. 17.0).

The mean age of samples was 31.86 with standard deviation of 7.95. More than half (52.1%) of participant's study were male. 50% of the them were married, 10.4% smoking, and 29.2% exercising regularly. The mean Depression score in the study was 33.6 with the standard deviation of 8.0. According to beck questionnaire, 66.7% of participants show signs of major depression. Prevalence of depression was higher in women, married, smoker, and those that having sedentary lifestyle. However, this difference was not significant (P>0.05).

The prevalence of depression among participants study is significantly higher than the general population. We expect that decreasing the agreed total number of work hours, providing educational resources to improve their lifestyle, as well as holding consulting therapy groups in the hospitals are recommended.

Neurosyphilis is a complication of syphilis, due to invasion into the central nervous system of Treponema pallidum, subspecies pallidus. Although neurosyphilis may remain asymptomatic, symptoms can develop at any time after initial infection. Early forms include syphilitic meningitis, meningovasculitis and ocular disease. Dementia paralytica, or “general paralysis of the insane”, and tabes dorsalis used to be the most frequent forms of late neurosyphilis. Several reports, however, suggest a changing clinical presentation of neurosyphilis. Atypical neuropsychiatric syndromes seem to be more prevalent than in the past. Inadvertent treatment with antibiotics prescribed for unrelated diseases and improved serological methods are probably the most important contributing factors. Accelerated progression from syphilis to neurosyphilis in HIV seropositive patients has also been reported.

This prospective study aims to investigate the clinical spectrum of neurosyphilis in patients whose cerebrospinal fluid was tested positive for neurosyphilis by the Laboratory for Infectious Diseases, a large reference laboratory in the North-East part of the Netherlands.

From 2004 to 2013 all patients with a new diagnosis of neurosyphilis, proven by cerebrospinal fluid serology, were included. Each patient’s clinical record was reviewed for demographic, clinical and laboratory data.

Our inclusion criteria were met by 24 patients, all male. The clinical spectrum ranged from asymptomatic to dementia paralytica. Age varied from 31 to 71. At the time of neurosyfilis diagnosis, 7 patients were HIV seropositive.

Further analysis is currently being done and definite results and conclusions will be presented at the meeting.

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited metabolic disease characterized by mutations in the porphobilinogen deaminase gene. This mutation may provoke neurotoxic levels of delta-aminolevulinic-acid and porphobilinogen, potentially resulting in an acute life-threatening clinical syndrome, characterized by psychiatric, in particular atypical psychotic, symptoms as well as severe neurological and gastrointestinal symptoms. Since the clinical presentation varies and symptoms are nonspecific, diagnosis is often made late.

Naming of alarm symptoms based on a recent case study.

Description of a recent case supplemented with data from the literature.

The patient is a 46 year old woman who was admitted in 2007 with abdominal pain, an epileptic seizure and weakness, interpreted as a Guillain-Barre syndrome. In 2011 she was readmitted with severe abdominal pain, diarrhea, volatile psychotic symptoms and seizures, following a short period of excessive alcohol consumption. During admission she developed progressive weakness in the upper arms, shooting pains in the limbs and a feeling of tightness. Impaired abdominal breathing was suspected. Again, Guillain-Barré syndrome was considered, but additional studies did not support this diagnosis. Because of the recurrent character of symptomatology following alcohol abuse, acute (intermittent) porphyria was considered diagnostically. The dark-colored urine indeed contained significantly increased delta-aminolevulinic-acid and porphobilinogen concentrations. Additional (genetic) diagnosis follows.

A recurrent disease course with severe gastrointestinal, neurological and psychiatric symptoms, following alcoholabuse, is suspect for AIP.