To describe principles and characteristics of mental health care in Madrid.

Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.

In Madrid, mental health services are organized into 11 zones/areas, divided into 36 districts, where there is a mental healthoutpatient service with a multi-disciplinary team. Home treatment and psychosocial rehabilitation services have been developed. Specialist programmes exist for vulnerable client groups, including Children and Adolescents, Addiction/Alcohol and Older People. The Madrid Mental Health Plan (2003–2008) is regarded as the key driver in implementing service improvement and increased mental health and well-being in Madrid. It has a meant global budget increase of more than 10% for mental health services. Results of the first 2 years are: an increase in mental health staff employed (17%), four new hospitalization units, 50% increase in places for children and adolescents Day Hospitals, 62 new beds in long care residential units, development of specific programmes for the homeless and gender-based violence, a significant investment in information systems (450 new computers) and development of best practice and operational guidelines. Mental health system was put to the test with Madrid's March 11th terrorist attack. A Special Mental Health Plan for Affected people was developed.

Unlike some European countries, public mental health service is the main heath care provider. There are no voluntary agenciescollaborating with mental health care. Continuity of care and coordination between all mental health resources is essential in service delivery. Increased demand of care for minor psychiatric disorders, children and adolescent mental health care, and implementation of rehabilitation and residential facilities for chronic patients are outstanding challenges similar to those in other European capitals. Overall, the mental health system had successfully coped with last year's increased care demand after March 11th terrorist attack in Madrid.

Burn out mainly occurs among healthcare employees. This professional category is exposed to a large load of emotional disturbance.

The aim of this work was to study the levels of burnout syndrome in caregivers who were victims to occupational accident.

This cross-sectional study was conducted during 2014-2015 in the occupational medicine department. The target population consisted of the healthcare employees who reported their exposure to occupational accident. A semi-structured self-reported questionnaire including the Maslach questionnaire was used to collect information. Data were analyzed using SPSS-20.

One hundred and sixty health professionals returned the questionnaire (58% women, mean age 31.9 years old). Occupational accidents occurred mostly in the morning (62.5%). Among the healthcare providers, 112 health professionals (70%) had had sharp injuries. Burn out was found among 23.1% of the studied population. It was defined by its three domains: a high emotional exhaustion (46.9%), high depersonalization with low personal accomplishment (36.3%) and high depersonalization without low personal accomplishment (34.4%). Professionals with less years in the function (P = 0.031) and technicians (P = 0.028) were more affected by Burnout. A significant relationship was found between traumatic accidents (P = 0.012), needle stick injuries (P = 0.009) and burnout.

The prevalence of burnout is high among health professionals which can increase the risk of occupational accidents and its subsequent risks. It seems that holding workshops and increasing healthcare givers’ awareness and skills to face these risks can be effective in mitigating them.

The authors have not supplied their declaration of competing interest.

The prevalence of internet game use among children and adolescents has been increased in the recent years.

Internet addiction has been found to cause various psychiatric symptoms and psychological problems. Internet addiction has been found to cause various psychiatric symptoms and psychological problems.

The aim of this study was to examine the association between problematic internet game use and psychiatric symptoms in a sample of the Child and Adolescent Psychiatric Clinic, Ulsan University Hospital.

We analyzed data from 447 subjects who first visit the Child and Adolescent Psychiatric Clinic of the Ulsan University Hospital. The level of Internet addiction was categorized as either high-risk (≥108; group 3), potential risk (95 to 107; group 2), or no risk (≤94, group 1) based on the total score. Data were analyzed using SPSS version 17.0 and one-way ANOVA and multiple logistic regression method were used.

Thirteen adolescents met the criteria for high risk group of internet game addiction. in the high risk group, 10 were male and 3 were female adolescents. There was an mean difference among group 3 (high risk)< 1 (no risk),2 (potential risk) in AHI ; whereas group 3 (high risk)>1 (no risk), 2 (potential risk) in BDI, BAI, inattention, hyperactivity/impulsivity and K-ARS score. with multiple logistic regression analysis, K-scale was significantly related with male sex, BDI, ARShyperactivity/ impulsivity score.

We conclude that having male sex, happiness and depressive symptoms is associated with the risk of developing internet use disorders.

Regarding the increasing number of elderly people, their quality of life.

Becomes more important. Spiritual health is one of the important aspects of health status that is often neglected. This study aims to identify the relationship between spiritual well-being and quality of life among elderly people residing in Kahrizak Senior House.

It was a descriptive, correlational study. The sample included 141 elderly people residing in Kahrizak Senior House who recruited by convenience sampling. Data was collected by Spiritual Well-Being Index (SWBI) and Short Form Quality of Life (SF36) and analyzed by Pearson correlation coefficients, ANOVA, and t-test using SPSS-PC (v-16).

The mean score of quality of life was (50.36±11.3). Women’s quality of life was Significantly lower than men (P=0.000). The mean score of spiritual well-being was (96.26±17.93). There was a positive correlation between spiritual well-being and quality of life (P=0.008).

Regarding the lower levels of quality of life especially in women elderly, more.

Attention should be paid to this group of society. Awareness of the importance of spiritual well-being in caring of these people is recommended.

The number of Korean smartphone users exceeded 40 million in 2015, in which roughly 1 in 5 university students were expected to be addicted to their smartphone. Of importance is that smartphone addiction negatively affects physical and mental well-being and health. Sleep problems associated with smartphone is also a serious public concern; but the evidence is lacking. The aim of this study is to investigate the association between smartphone addiction proneness and sleep problems in Korean university students.

We conducted an online-survey which received responses from 608 university students. All participants completed questionnaires on the Korean smartphone addiction scale (K-SAS), the Pittsburgh Sleep Quality Index (PSQI), and personal characteristics. Based on the scores of the K-SAS, university students were classified into two groups–the addiction proneness group and the normal-user group.

The addiction proneness groups had a higher PSQI score than the normal-user group (7.5 vs. 6.7, P-value < 0.0001). After adjustment for potential covariates (i.e., age, income, and smoking), PSQI scores was significantly increased in the addiction proneness groups (Beta coefficient = 0.69; 95% CI : 0.29 ∼ 1.09). The risk of sleep problems was more increased in the addiction proneness groups (odds ratio = 1.99; 95% CI: 1.33 ∼ 2.98) than the normal-user groups.

We found that the smartphone addiction proneness was associated with sleep problems in university students. Although our findings are further confirmed by elucidating causal relationships between smartphone uses and sleep habits, smartphone addiction proneness may be a risk factor for poor sleep quality.

The authors have not supplied their declaration of competing interest.

Recreational use of nitrous oxide (N20) or ‘laughing gas’ inhalation is a common phenomenon in countries like UK and US where it is associated with music festivals and parties. However, as far as we know, recreational N20 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N20 use and addiction in a young Singaporean male who was introduced to it by a friend from a Western country where its use is prevalent.

A 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N20 inhalation that escalated from infrequent low dose use to the current daily high-dose use which he was unable to control. He exhibited symptoms of dependence — including preoccupation, tolerance, withdrawal and difficulty in cutting down. No major adverse medical complications were noted so far.

The patient was assessed to have Nitrous Oxide Dependence; and is currently undergoing regular counselling sessions in an attempt to motivate him to cut down or stop his N20 use.

This case is unique for 2 reasons:

– extant literature suggests that only anectodal evidence exists for psychological dependence of N20 in Singapore; yet our patient clearly demonstrates psychological dependence;

– this is the first reported case of N20 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private.

The authors have not supplied their declaration of competing interest.

Schizophrenia research based on traditional assessment measures for negative symptoms appears to be, to some extent, unreliable. The limitations of the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS) have been extensively acknowledged and should be taken into account. The aim of this study is to show how the PANSS and the SANS conflate negative symptoms and cognition and to offer alternatives for the limitations found.

A sample of 117 participants with schizophrenia from two independent studies was retrospectively investigated. Linear regression models were computed to explore the effect of negative symptoms and illness duration as predictors of cognitive performance.

For the PANSS, the item “abstract thinking” accounted for the association between negative symptoms and cognition. For the SANS, the “attention” subscale predicted the performance in verbal memory, but illness duration emerged as a stronger predictor than negative symptoms for outcomes of processing speed, verbal and working memory.

Utilizing alternative models to the traditional PANSS and SANS formats, and accounting for illness duration, provide more precise evidence on the relationship between negative symptoms and cognition. Since these measures are still extensively utilized, we recommend adopting more rigorous approaches to avoid misleading results.

Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an exciting opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks.

To describe the amount of data collected during a multimodal longitudinal RMT study, in an MDD population.

RADAR-MDD is a multi-centre, prospective observational cohort study. People with a history of MDD were provided with a wrist-worn wearable, and several apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks and cognitive assessments and followed-up for a maximum of 2 years.

A total of 623 individuals with a history of MDD were enrolled in the study with 80% completion rates for primary outcome assessments across all timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. Data availability across all RMT data types varied depending on the source of data and the participant-burden for each data type. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. 110 participants had > 50% data available across all data types, and thus able to contribute to multiparametric analyses.

RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible.

No significant relationships.

To present the epidemiology and psychological predictors of Internet Addiction (IA) among Greek University students.

This random sample consisted of 3545 students, drawn from 24 higher education institutions (1618/1927 M/F, mean age 20.12 ± 2.4 years). The survey was conducted in the 4 Greek cities: Athens, Preveza, Thessaloniki and Amfissa.

The prevalence rates of IA according to Young's Test in the four cities were: Athens (17.5%), Preveza (15.9%), Thessaloniki (19.3%), Amfissa (16.3%). There was a statistically significant association between location and IA (χ2 = 28.251, df = 3, p < 0.001), gender and IA for males and females (p < 0.001). We performed a t-test with the dependent variable S = sum of scores in the psychological features of loneliness, feeling abandoned, disappointed, aimless in life, and with low self-esteem; the grouping variable was IA. Results showed that the variable S was much lower for the non-addicted than for addicted students (t = 19.329, p < 0.005, df = 3085). Binary logistic regression was performed to assess the impact of psychological characteristics on the likelihood that respondents would be Internet Addicted. The model was statistically significant χ2(10, N = 3085) = 316.3, p < 0.001. The model classified correctly 85.1% of the cases. The strongest predictors of IA were the following: Loneliness (OR = 2.15, 95% CI = 1.67-2.71), feeling abandoned (OR = 1.63, 95% CI = 1.2-2.1), low self-esteem (OR = 1.72, 95% CI = 1.4-2.1) and fear of losing their job (OR = 1.36, 95% CI = 1.01-1.7).

Loneliness, helplessness, low self-esteem and fear of unemployment are the strongest predictors of IA among Greek university students.

To evaluate effect of Rosacea and Jasminum Sambac Sol essence on labor pain and duration of active phase.

In this randomized control trial study, which had done in Insurance hospital of Bandarabbas (2010), 240 healthy volunteer 17–35 years old primiparas during physiologic labor were involved. They randomly divided into three groups (Rosacea, Jasminum Sambac Sol, Routine physiologic labor). The essences were used in the environment by lightening the aromatherapy candle. The tools had three main parts of personal characterizes, check list of labor control chart, and Visual Analog Scale of pain score.

There were significant differences between duration of active phase in three groups (P < 0.05) and no significant differences between labor pains.

Aromatherapy during physiologic labor could promote clients’ satisfaction, useful for shortening of Lobar, which may be because of more relaxation.

Symptoms of obsessive-compulsive disorder (OCD) have been reported to increase during the COVID-19 lockdowns because of the hygiene requirements related to the pandemic. Patients with adjustment disorder (AD) may, in turn, represent a vulnerable population for identifiable stressors. In this study, we aimed at assessing potential symptoms changes in OCD patients during the lockdown in comparison with AD patients as well as versus healthy controls (HC).

During the COVID-related lockdown, we enrolled 65 patients and 29 HC. Participants were tested with four clinical rating scales (Yale–Brown obsessive-compulsive scale and Brown Assessment of Beliefs Scale for OCD patients; Beck Depression Inventory-II and State–Trait Anxiety Inventory-Y for each group) that had been also administered just before the Italian lockdown.

Our results showed that during the lockdown: (i) the symptoms of depression and anxiety increased in all groups, but this increase was most pronounced in HC (p < 0.001); (ii) OCD symptoms severity did not increase, but the insight worsened (p = 0.028); (iii) the proportion of OCD patients showing hygiene-related symptoms increased (p = 0.031 for obsessions of contamination), whereas that of patients with checking-related symptoms decreased.

The lockdown-induced psychological distress apparently changed the characteristics and the pattern of OCD symptoms expression but not their overall severity. This evidence confirms the heterogeneity and changing nature of OCD symptoms, strongly depending on the environmental circumstances.

The BFI-2-S assesses the domain level of the Big Five with three prototypical facets of each domain capturing approximately 91% of the total variance in the full BFI-2 domain scales and approximately 89% of the predictive power of the BFI-2 facets in German adaptations and their original American versions.

The study aims to investigate the psychometric properties of the Arabic adaptation of the BFI-2 short form.

The Arabic version of the BFI-2-S a 30-item with 15 and NEO Five-Factor Inventory (NEO–PI-R) were administered to 1560 (576 males, 984 females) Kuwait University undergraduates with a mean age = 22.75 ± 3.81. The internal consistency reliability, factor structure, and convergent validity of the BFI-2-S with NEO–PI-R were assessed.

Cronbach’s alpha was satisfactory for N (0.79), E (0.73), O (0.73), A (0.76) and C (0.77). Results revealed significant gender differences in O, C & E with a favor for males and in N a favor with females. PCA showed that BFI-2-S five factors explains 64.38% of the total variance. However, the high mean correlations between the BFI-2-S and NEO–PI-R scales, with coefficients of (0.67) for the N, (0.66) for the E, (0.56) for the C, (0.61) for the A, and (0.58) for the C. The convergence between each BFI-2-S domain correlated substantially with the relevant NEO-PI-R domain scales, with the average correlation being .62.

The findings support the psychometric properties of the Arabic adaptations of the BFI-2-S as useful instruments for assessing the Big Five.

No significant relationships.

First-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. The majority of existing studies about FEP only address schizophrenia spectrum psychosis (SSP), which may limit the capacity to fully characterize this entity.

Report the clinical and socio-demographic characteristics of patients with FEP in real-world setting, and compare the differences among SSP and affective FEP.

Retrospective analysis of clinical files of patients admitted to our hospital unit with FEP diagnosis from January/2012 to April/2015. Clinician-rated dimensions of psychosis symptom severity scales (DSM-5) were applied.

Annual incidence of FEP was 11,3/100,000. From a total of 755 patients, 57 (7,5%) corresponded to FEP; 38 (66,7%) were diagnosed with SSP, 11 (19,3%) affective psychosis, 3 (5,2%) toxic psychosis and 5 (8,8%) organic psychosis. Most were female (61,4%), with a mean age of 49 years. The majority were unemployed (66,7%), lived with family (57,9%), and presented with moderate-severe delusions (80,1%), but without hallucinations (57,8%), disorganized speech (59,6%) or negative symptoms (85,9%). Affective FEP patients were older (61 vs 45 years), presented with less severe psychotic symptoms (7,2 vs 8,3 points), but with higher hospital admission (26,1 vs 21,1 days).

Regardless the growing interest concerning FEP, its conceptualization and characterization remains controversial. Our results differ from pre-existing literature data, especially concerning gender and age. By including all the possible etiologies of FEP, we aimed to obtain a more realistic characterization of this entity in a real-world setting.

The authors have not supplied their declaration of competing interest.

B-vitamin insufficiency is associated with depression but it is uncertain if treatment with these is effective in prevention or treatment.

1. 1. To determine if daily supplementation with B-vitamins enhances response to antidepressants.

2. 2. Systematic review and meta-analysis of randomised, placebo-controlled trials of B-vitamins for depressive symptoms in adults.

1. 1. The B-VITAGE trial is a 52 week randomised, double-blind, placebo-controlled trial of citalopram together with vitamin B12, B6 and folic acid in older adult participants with major depression.

2. 2. Systematic review of 13 eligible trials of B-vitamin supplementation for the reduction, remission and prevention of clinically significant depressive symptoms.

Remission was achieved by 78.1% and 79.4% of participants treated with placebo (n=76) and vitamins (n=77) by week 12 (p=0.328), and by 75.8% and 85.5% at week 52 (effect of intervention over 52 weeks: odds ratio, OR=2.49; 95% confidence interval, 95%CI=1.12,5.51). The risk of subsequent relapse among those who had achieved remission of symptoms at week 12 was lower in the vitamin group (OR=0.33, 95%CI=0.12,0.94).

Short-term use of vitamins did not improve depressive symptoms in adults with major depression treated with antidepressants (standardised mean difference=-0.12, 95% CI=-0.45,0.22), but more prolonged consumption decreased the risk of relapse (OR=0.33, 95%CI=0.12,0.94) and the onset of clinically significant symptoms in people at risk (risk ratio=0.65, 95%CI=0.43,0.98).

Short-term use of B-vitamins does not appear to benefit depressive symptoms although longer use may enhance and sustain antidepressant response and decrease the risk of relapse or onset of clinically significant depression.