An analysis of the multidisciplinary treatment of mood disorders used at the short stay psychiatric unit (SSPU) in Mater Dei Hospital, Malta was carried out.

The modalities considered were:

• • Pharmacological therapy

• • Electroconvulsive therapy

• • Psychological therapy

• • Occupational therapy

• • Social worker involvement

To record whether a multidisciplinary approach (MDA) was being used and whether this affected the clinical outcome.

The data used was obtained from a logbook in the SSPU and set up as an excel spreadsheet.

The patient selection criteria was:

1. 1. Diagnosed as having mood disorders (unipolar or bipolar depression)

2. 2. Admitted for the first time to SSPU (with no previous admissions to an acute psychiatric ward) in 2008

3. 3. The multidisciplinary approach was defined as the use of 3 or more modalities of treatment.

1. 1. 87 patients were selected. In group 1: 6 patients received MDA and group 2: 81 patients did not receive MDA

2. 2. 50% of patients in group 1 and 48% of patient in group 2 belonged to the age group of 46-55 years.

3. 3. 100% for group 1 and 73.3% in group 2 were females.

4. 4. 50% of patient were re-admitted in group one while 58% of patients were re-admitted in group 2.

5. 5. MDA prolonged the average duration till next re-admission by 81 days.

6. 6. The cost per bed is approximately 300euros daily, thus saving 24,300 euros per patient when MDA is used.

MDA improves patient outcome by preventing or prolonging re-admissions.

This should be emphasized in the female population and in the age group of 46-55 years.

Negative symptoms constitute an important diagnostic and therapeutic challenge (Galderisi & Maj 2008). Negative symptoms are thought to be part of schizophrenia, at least in some patients (Kirkpatrick 2014). Despite that there are few treatment trials focused on primary negative symptoms (Chue P, Lalon de JK 2014).

Open-observational study to evaluate the efficacy of SGA on negative symptoms, in according to the recommendations of Consensus Development Conference Attendes(CDCA) .

To consider the impact of SGAs in the treatment of primary negative symptoms.

We evaluated in 12-month-study efficacy of SGA in 42 inpatients with schizophrenia(DSM-5). Inclusion criteria: persistent negative symptoms with adequate antipsychotic treatment, clinically stable, minimal psychotic symptoms, depression/anxiety, EPS. Patients were treated with SGAs (clozapine; risperidone; quetiapine, olanzapine) and evaluated at baseline and after 1, 3, 6, 12 mouths with: PANSS; BPRS; Brief Negative Symptoms Scale (BNSS); CDSS. Data were collected and evaluated by EZanalize /Excel.

Data obtained with BNSS and PANSS scales show no significant differences in olanzapine and risperidone groups. Clozapine-treated patients had a significant reduction in BNSS score (p < .03) and particularly in asociality and avolition subscales. Although no significant difference was found in the PANSS and BNSS total scores in all groups; quetiapine group showed significant symptoms reduction in the PANSS and BNSS, alogia subscale (p <=.06).

There are not studies that show a superiority of a drug over another in negative symptoms therapy. However, emergine results show that some antipsychotics act preferentially on some specific items of group of symptoms.

Severe mental illness is associated with increased risk of premature death due to chronic somatic diseases. Patients with severe mental illness receive less medical care regarding these problems, than others, and that it is not well defined with whom the responsibility of treating their physical health problems lies.

There is a need for lifestyle interventions and focus on physical health in patients with severe mental illness. The patients' and staff perspective upon the problems and possibilities of change is important.

To investigate physical health problems and their causes as well as possibilities for preventing and treating them, as experienced by the staff and patients.

Focus Group Discussions with patients and staff respectively, from three out-patient clinics treating patients with schizophrenia or substance use disorder comorbid to another psychiatric disorder.

The paramount physical health problems are weight issues, cardiovascular diseases and bad physical shape in general. The main causes are lifestyle, the mental disorder and organisational issues. Possibilities for prevention and treatment includes: a case-manger, binding communities with like-minded. Furthermore less fragmentation of the treatment system and implementation of focus upon physical health into daily practice in psychiatry.

To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. There is a need for a change in clinical practice and implementation of routines regarding physical health, supported by the managements.

Agitation (excessive motor or verbal activity) can be associatedoften with schizophrenia or bipolar mania, and further escalate intoaggressive behavior and potentially lead to injuries in patients andstaff. A new drug is available for the acute treatment, inhaledloxapine that allows for direct administration to the lungs, resulting in rapid absorption into the systemic circulation and rapidtranquilization.

Presenting the clinical experience with Inhaled Loxapine in thetreatment of agitation.

We haveselected representative cases of patients with a psychiatricpathology, from emergency / acute unit, characterizing theircircumstances of current admission, the intensity and the evolutionof the episodes, to evaluate the applicability and practical pointsarising from the clinical experience.

Inthe era of evidence-based practice each case report for the realclinical life adds valuable new information to the medical knowledgeof new options of treatment.

Secondary mania is still an under-recognized pathology even if nowadays psychiatrist benefit from a wide range of imagistic and laboratory tools. The following case study illustrates bipolar affective disorder, manic episode with psychotic symptoms in a 36 years old female which had an abrupt beginning. At the moment of examination in the office at the medical centre she presented tachypsychia, grandiosity and interpretative delusions, positive hyperthymia, sterile hyperactivity, elevated appetency, hyperbulia, low sleep need.

The importance of having in mind the 5 most frequent causes of mania caused by generalized medical condition when presented with an atypical manic episode.

Our aim is to increase the acknowledgement of a more elaborate paraclinic approach for psychiatrists whom find themselves in front of bipolar disease case that also have somatic issues attached.

For this type of cases the laboratory and imagistic exploration are the key to an accurate diagnosis and therefore for an aimed treatment. In our case the imagistic exploration and blood tests revealed a well defined tumor in the left suprarenal gland.

The psychiatric diagnosis was bipolar affective mood disorder due to a general medical condition and the patient was transferred to the Endocrinology Clinic.

After the surgery of the tumor both the psychiatric symptoms and the secondary Cushing syndrome disappeared completely.

Monotherapy, treatment adherence and satisfaction of schizophrenic patients are essential for good prognosis and disease evolution. The use of depot treatments such as paliperidone palmitate, could be the beginning to get all these objectives in the treatment of all of our patients.

To measure in a pool of schizophrenic patients starting treatment with paliperidone palmitate, the time they take to re-enter as in-patients, if monotherapy is get and the degree of satisfaction of these patients regarding treatment is achieved.

A pool of schizophrenic patients discharged from our Short-Term Hospitalization Unit between October 2014 and February 2015 with introduction into its paliperidone palmitate treatment.

waiting to be achieved

and in the results of similar studies, we think that paliperidone palmitate is a drug of choice in many schizophrenic patients who can benefit from their use to be well tolerated, to control the disease by reducing the number of readmissions, improve the therapeutic adherence, patient satisfaction with their treatment and to get a treatment with a single antipsychotic.

Lately is increasingly frequent the use of depot antipsychotic treatment for schizophrenia at any stage of the disease. This issue is still being discussed, since the opinions of experts are occasionally contradictory without reaching a general consensus of the indications for use of depot treatment.

Description of discharge treatment at a short term Hospitalization Unit of 160 psychotic patients, analyzing the use of oral or depot therapy for 9 months in 2014.

A pool of 160 patients discharged from January 2014 up to September 2014 with a diagnosis of Schizophrenia and other psychotic disorders according to DSM-IV and DSM-5. A descriptive analysis of the number of patients on antipsychotic treatment is performed oral versus depot, making a brief description of the characteristics of patients in those groups.

Pending a more thorough analysis of the data, most of the discharged patients discharged were treated with oral antipsychotics and only a minority was discharged with depot treatment.

The use of depot treatment in the referred unit is still restricted to poorly compliant patients and poor awareness of disease abandoning the oral treatment, despite the fact that in the current scientific literature is becoming more frequent its use in early stages of disease.

The excess cardiovascular mortality associated with bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors such as obesity. Antipsychotic medication can induce weight gain or worsen other metabolic cardiovascular risk factors.

We presented two case exemples illustrating weight gain induced by atypical antipsychotics, and discuss therapeutic managements according to litterature data.

Case report 1 Mr H.D is a 23 year-old university student, with medical history of seizures treated by Valproic Acid, stopped three years ago. He was diagnosed with schizoaffective disorder since 2008, treated by Olanzapine 15 mg/day. Treatment by mood stabilizers was hampered by liver cytolisis. Within three months after introducing Olanzapine, the patient experienced considerable weight gain amounting to 10 kilograms. Therefore, treatment doses were decreased.

Case report 2: Mrs I.T is a 31-year old female patient with medical history of asthma, anemia and herniated disc worsened by obesity. She was diagnosed with bipolar disorder and received Carbamazepine and Fluoxetine. But increased gamma-GT level induced by Carbamazepine led us to achieve a swith to Quetiapine, to which the patient showed weight gain amounting four Kilograms within three months (body mass index=34.5). A switch to Aripiprazole was achieved.

Psychiatrics must pay attention to concomitant medications and individual factors underlying overweight and obesity. Although several management options of weight gain are available, the best approach seems to attempt to prevent this weight gain.

The conceptual ideas coming from the Quantum Field Theory and from the work of Boston Change Process Group improve an organizational model of the teamwork, with simpler internal coherence and cohesion and lead to 'invisible” structured professional intervention adaptable also in therapeutic pathways of revolving door SMI patients.

Evaluate the effectiveness of equipe’s taking charge in order to improve compliance and clinical outcome, looking specifically the impact of IPOLT team-work organization on simplifying therapeutic process.

Looking at two different therapeutic pathways for Severe Mental Illness (SMI) we have investigated the effectiveness of our model on clinical outcome (number of hospitalizations and treatment compliance). We have considered two cohorts, matched by sex, age and diagnosis distinguished for follw-up: first group taking charge in Day-Hospital after hospitalization and second group didn’t.

Treatment compliance is significantly increased, whereas hospedalization rate is reduced in the first group compared to the second (T-test, p<0,05).

Change from rehabilitation programs towards recovery for SMI patients needs the reduction of circular phenomena (like revolving door, etc), giving rise to linear processes of care. A global integrated model of care network makes it easier.

Centro Hospitalar Lisboa Norte's Psychiatric Day Care Hospital (CHLN-PDC) offers a psychotherapeutic oriented program.

To characterize the CHLN-PDC population and to determine if the subjects' HSM-PDC treatment leads to variation in the number of re-admissions to psychiatric wards.

Retrospective analysis of all patients admitted to the CHLN-PDC between July 1, 2008 and June 30, 2011, assessing for gender, age, diagnoses, time of admittance, and number of re-admissions in psychiatric wards, three years before and three years after the program.

During this period, 71 patients were admitted (17 males, 54 females), with an average age of 33 years old (no difference between genders). Mean duration of the program was 267 days (260 for females, 291 for males). The most frequent diagnoses were Depressive Episode (N=30), Personality Disorder (N=29, in general co-morbid to other diagnoses), Obsessive Compulsive Disorder (N=5), Generalized Anxiety Disorder (N=5), Schizophrenia (N=3) and Schizoaffective Disorder (N=3).

The number of admissions to psychiatric wards reduced from 86 before to 36 after the program. The reduction was more evident for patients with Bipolar Disorder and Personality Disorder. Patients who completed the full program remained in average 303 days, but re-admissions were reduced greatly when compared to those who did not complete the full program (increase of re-admissions).

The majority of patients were women, with no difference of age between genders. Most common diagnoses were Depressive Episode and Personality Disorder. The program, when completed to its fullest extent, lead to a decrease in the number of re-admissions.

Post-partum depression (PPD) affects 10% of women after natural labor. Untreatment of PPD leads to significant emotional and physical consequences both in mother and a child. Antidepressants are among the main treatment options for PPD.

To describe safety and efficacy of Vortioxetine in the treatment of PPD

A case report of PPD in first pregnancy of a 39 year old women with no personal or family history of depression. Pregnancy period was biologically normal, only with slight sleep problems in the last trimester. Natural labor started on week 39^th, but due to weakness of labor contractions, caesarean section was performed. Afterwards, severe depression symptoms appeared such as loss of appetite and weight, insomnia, anxiety, feelings not being able to take care of the baby. Patient did not have any breast milk. Two weeks after the labor she was admitted to psychiatric hospital. Patient was assessed by Clinical Global Impression (CGI) scale. Therapy with Vortioxetine 10mg/day was initiated.

During the first two weeks CGI-S score decreased from Severely to Moderately ill, with CGI-I score much improved. Vortioxetine dose was increased to 15mg/day. At week 4 CGI-S was borderline ill and CGI-I very much improved. There were no sideffects observed. During the first 3 weeks patients received concomitant Quetiapine was reduced to 50mg/day next week and stopped at discharge.

Vortioxetine was safe and effective in the treatment of post-partum depression.

The fear of deleterious effects of psychotic drugs on the fetus is a major concern for women who need this therapy, damaging the medication adherence at the time of pregnancy.

The non-adherence to therapy can take to disease recurrence which will bring additional risks for the pregnancy and the postpartum. So, it is extremely important to evaluate the psychotic drugs safety during pregnancy.

Literature review on the use of anitpsychotic drugs during pregnancy.

Literature review of the subject, using available database in the Central Library of CHUC

All the antipsychotic drugs cross the placenta and the fetus is always exposed to these. When choosing the antipsychotic drug, the possible morphological teratogenesis must be taken into account, particularly between the third and the eighth week of pregnancy.

The typical antipsychotic drugs do not seem to bring a significant risk of malformations and the antipsychotic drugs with sedative properties can represent an increased risk of non-specific teratogenic effects during the first three months of pregnancy.

In the pregnant woman the atypical antipsychotic drugs cause weight gain, hyperglycemia and dyslipedemia. These disturbances are associated with the considerable risk increase of fetal complications.

No drug is considered completely safe and no antipsychotic drug was approved to be used during pregnancy or breastfeeding by the Food Drug Administration.

Though there is no clear evidence of malformations risk, there is evidence of risks related with the pregnancy and the neonatal period.

Studying abroad is a growing trend in higher education. Culture shock is a form of psychological distress associated with migration. Social support has been identified as significantly related to the onset and outcome of psychological disorders. There are studies investigating the processes of acculturation of the students as temporary migrants, with particular attention to medical studies. In Romania there is virtually no research addressing processes of acculturation of temporary immigrants.

The aim of this study was to examine the relationship between culture shock, social support, personality factor and psychological adaptation in foreign medical students studying at University of Medicine “Iuliu Hatieganu” Cluj-Napoca, Romania

A total of 167 first year foreign students from English Section, completed 5 self-administered questionnaires: Culture Shock Questionnaire, Social Support Questionnaire, STAI, NEO-FFI and a questionnaire about alcohol, smoking and illicit drug use.

Gender and the quality of support received were found to be strongly associated with culture shock. Furthermore, culture shock was significantly positively related to the level of state anxiety. There are personality characteristics like extraversion and openness that influence the drug taking and drinking habits of students.

Social support is an important factor associated with the degree of culture shock and should be taken into consideration in order to protect against or help to overcome this kind of psychological distress experienced by foreign students. Adequate counseling should be provided by educational institutions, taking into consideration the way social factors and personality are associated with migrant students’ mental health.

Although there is an ongoing discussion about variation of clinical characteristics of Generalized Anxiety Disorder (GAD) across different cultures and immigrant populations, there is great paucity of evidence regarding this area.

That study was aimed to compare clinical characteristics of the GAD between Turkish immigrants, native Turkish and German patients.

Turkish immigrants (Hannover-Germany) (n=36, F/M=27/9), Turkish (Ankara-Turkey) (n=52, F/M=40/12), German patients (Hannover-Germany) (n=35, F/M=20/15) were diagnosed with GAD according to the ICD-10 Criteria. Groups were assessed by Composite International Diagnostic Interview (CIDI), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Penn State Worry Questionnaire (PSWQ), Generalized Anxiety Disorder Severity Scale (GADSS).

German patients' educational level (years:13.4±3.1) was significantly higher and their age (35.4±11.3) was significantly lower than the other groups. Table summarises clinical characteristics of the groups (covariates:age&education).

Moreover, data on comorbidity structure, differential symptomatology will be reported.

That study shows that Turkish immigrants with GAD had more severe anxiety and depression than the Turkish and German GAD patients. Worry contents in GAD vary widely based on the cultural backrounds. Suggestions for future research based on the results will be discussed.