Subjects with psychoses have significantly increased rates of physical illnesses, but the nature of the relationship remains largely unknown.

The present study is part of the European Prediction of Psychosis Study (EPOS). Data were collected from 245 help-seeking individuals from six European centers (age 16–35) who met criteria for ultra-high risk of psychosis criteria. This paper seeks to investigate self-reported physical ill health and its associations with psychiatric symptoms and disorders, risk factors, and onset of psychosis during 48 months of follow-up.

In multivariate analysis, lifetime panic disorder (OR = 2.43, 95%CI: 1.03–5.73), known complications during pregnancy and delivery (OR = 2.81, 95%CI: 1.10–7.15), female gender (OR = 2.88, 95%CI: 1.16–7.17), family history of psychosis (OR = 3.08, 95%CI: 1.18–8.07), and having a relationship (OR = 3.44, 95%CI: 1.33–8.94) were significantly associated with self-reported physician-diagnosed illness. In the Cox proportional hazard model we found no significant differences between those who had undergone a transition to psychosis and those who had not.

The physical health of patients defined to be at ultra-high risk of psychosis seems to be commonly impaired and associated with female gender, marital status, complications during pregnancy and birth, lifetime panic disorder, and genetic risk of psychosis.

Both MMSE and MoCA are two widely used cognitive screening test. Comparison of the two tests has been done in specific populations (Parkinson) but not in general elderly psychiatric populations. In research, equating methodologies has been used to compare results among studies that use different scales, which measure the same construct.

To explore their level of agreement within a particular clinical setting.

(a) To find MoCA and MMSE agreement. (b) To derive a conversion formula between the two scales and test it in a random population of similar setting.

Prospective study of consecutive community dwelling older patients who attend outpatient clinic or day hospital. Both tests were administered from the same researcher the same day in random order.

The total sample (n = 135) was randomly divided in two. One from where the equating rule derived (n = 70) and a second (n = 65) in which the derived conversion was tested. Agreement of the two scales (Pearson's r) was 0.86 (P < 0.001), and Lin's Concordance Correlation Coefficient (CCC) was 0.57 (95% CI 0.45–0.66). In the second sample, we convert the MoCA scores to MMSE scores according to equating rule from the first sample and after we examined the agreement between the converted MMSE scores and the originals. The Pearson's r was 0.89 (n = 65, P < 0.001) and the CCC 0.88 (95% CI 0.82–0.92).

Although the two scales overlap considerably, the agreement is modest. The conversion rule derived showed promising accuracy in this population but need further testing in other populations.

The authors have not supplied their declaration of competing interest.

Urban living has consistently been associated with higher risk of developing schizophrenia when compared to rural living. Exposure to green space has been associated with better mental health outcomes and, more recently, childhood exposure to green space has been linked with lower rates of schizophrenia. The reasons for these findings remain unknown, although lower levels of pollution and psychological factors may play a role.

We aim to review the literature regarding exposure to green space and its relationship with the risk of developing schizophrenia.

We performed an updated review in the PubMed database using the terms “green space” and “schizophrenia”. The included articles were selected by title and abstract.

Growing up surrounded by non-urban environments is associated with lower schizophrenia rates. Upbringing in urban areas is associated with higher schizophrenia rates when compared with non-built-up areas. Schizophrenia risk seems to decrease with vegetation density in a dose-response relationship for urban and agricultural areas. Risk of schizophrenia has been found to be associated additively with green space exposure and genetic liability. No evidence for gene-environment interaction has been reported so far in this regard.

Exposure to green space during childhood appears to lower the risk of developing schizophrenia later in life and can be a preventive strategy. Further research in this area is needed.

It is distinctive for Kosovo population that before the war of 1999 Kosovo has had the lowest rate of suicides in Europe. Now, after the war the data and findings tell us for a considerate increase of number of suicides.

Presentation of suicide cases in Kosovo in period from 2008–2012 analyzed from aspect of social reasons that has influenced an increasing number.

Identification of social factors and their possible direct/indirect impact in phenomena of suicides and as well the reflection in their prevention.

Data on cases were collected retroactively, by the Internal Affairs of Kosovo and Psychiatry Clinic. Analysis of data was done with Excel and SPSS 14.

In the period 2008–2012, 270 persons were found to have committed suicide. This is an increase compared to before the war. In over 80% of cases come to the expression of social factors: unemployment level (44.9%), low income per capita, the population on average 26 years old, enormous growth of drug users and alcohol (20.000), low budget for mental health, dominance in rural settlements, debt, domestic violence, inability to buy drugs, the inability of the education of the children, war trauma/PTSD, large number of people who are missing or dead after the recent war in Kosovo (8 cases).

The number of suicide cases has increased. Social factors play a major role in this.

Studies point to an adverse effect of detention on the mental health of asylum seekers, yet the use of detention has been rising in several recipient countries. In general, many asylum seekers suffer from psychological disorders and symptoms, and a large percentage has been subjected to torture. The UNHCR recommends that torture survivors generally should not be detained. Due to a lack of systematic screening it is often unknown whether the asylum seeker is a torture survivor. This causes several hindrances for the protection of this vulnerable group from potentially harmful factors such as deprivation of liberty.

To examine the impact of detention on the mental health of adult torture survivors.

To produce a comprehensive review of the literature and bring attention to a potentially harmful praxis.

The systematic review follows the PRISMA guidelines. The search was made in PubMed (Medline), PsychINFO, PILOTS and IBSS. A screening of reference lists identified additional studies. The search was broadened to ‘asylum seekers’ as very few studies were found on torture survivors specifically.

Presently (Oct. 2012) the review is in the stage of analyzing, thus results are preliminary. Currently the identified studies amount to 26. All studies report mental health problems among the asylum seekers and some identify detention itself as a contributing factor to these problems.

Detention does pose a risk factor in regard to deteriorating the mental health of asylum seekers. Although torture survivors might be an especially vulnerable group, research is almost non-existent.

There is a lack of evidence regarding which kind of psychotherapy that is the most effective when treating traumatized refugees. Studies on the effect of psychotherapy among other patient groups with PTSD suggest a good effect using cognitive behavioural therapy (CBT). The competence center for transcultural psychiatry (CTP) has specialized in the treatment of traumatized refugees. The objectives were to study the effect of CBT with a focus on either stress management or cognitive restructuring in a clinical sample of traumatized refugees with PTSD and to identify predictors for the treatment effect.

All patients (n = 143) referred to CTP from June 2011–March 2012 and fulfilling the inclusion criteria were offered to participate in the study. Participants were offered combined treatment with a psychiatrist (psycho-education and psychopharmacological treatment when needed) and a psychologist (CBT). The duration of the treatment was 6–7 months. The participants were randomized to either CBT with a focus on stress management or cbt with focus on cognitive restructuring. The primary outcome was PTSD measured by the Harvard Trauma Questionnaire.

The results are presently being analyzed and will be presented at the congress.

Both research results and the clinical experience at CTP suggest, that cognitive restructuring is not always a useful tool and that stress reducing techniques could be more useful. This hypothesis was tested in the present study.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The PHQ-9 has been recommended as the best available screening and case-finding instrument for primary care based on its brevity, and ability to inform the clinicians on both depression severity and diagnostic criteria.

Our study evaluated the reliability and the validity of the Tunisian version of the PHQ-9 in detecting major depression in general population.

We undertook a cross-sectional and analytical study. A total of 134 participants, representative of the Tunisian general population, were enrolled. The PHQ-9 was validated against the HAD reference standard. The types of validity determined for the PHQ-9 in this study were: translation validity, internal reliability and criterion validity.

Test-Retest reliability was determined by intraclass correlation. This scale is stable over 2 weeks (ICC = 0.97). The Tunisian version of the PHQ-9 was found to have good internal reliability (Cronbach's alpha = 0.84). As for criterion validity of the PHQ-9, the Pearson's correlation coefficient between the PHQ-9 and HAD was 0.94 and the Spearman's correlation coefficient was 0.81. This indicated a positive association of good strength between the two instruments. A cut-off score of 10 or higher on the PHQ-9 had a sensitivity of 86.2 and a specificity of 83.8. The VPP was 0.6 and the VPN was 0.9.

The Tunisan version of the PHQ-9 has several potential advantages. It was found to be a valid and reliable casefinding instrument for detecting depression in general population.

The authors have not supplied their declaration of competing interest.

Sleep is the most important biological circadian rythm. Researches have shown that sleep deprivation causes reduction of hypothalamus function, decrease glucose tolerance and increase cardio-vascular diseases, hypertension and also decrease their mental and intellectual activity of human. This research investigate insomnia in adult people (Kashan city,Iran.)

This cross-sectional research has been done in Kashan,2008 by using classified randomized sampling in 39 health centers among persons with 18 years old and over (N= 1155). Written consent was taken from subjects, and all of them answered to demographic questionnaire,and researcher-made insomnia questionnaire. Test-retest Reliability of this test was 99% and its internal consistency was 82% by using α kronbach. Data was analyzed by using Fisher exact test.

Prevalence of insomnia was (n=684, 59.2%). The highest rate of insomnia were found among adult with age of 42 to 65 years old (n=266, 67.9%) and then in sex of feminity (n=387, 56.5%). There was significant relationship between insomnia and psychiatric history [PV< 0/0001, OR=2.24], sleep disorder in family [PV< 0/0001, OR=4.67] and drinking caffeine before sleep [PV< 0/001, OR=1.64].

The majority of adult person suffer from insomnia and most sleep problems are observed among middle age group. Since sleep disorders can be related to social, psychological and physical problems, paying attention to quality and hygiene sleep in general population is essential.

Classical homocystinuria (cystathionine beta synthase deficiency) is a rare autosomal recessive disease of methionine metabolism that causes accumulation of homocysteine in the blood and cysteine deficiency. It is characterized by intellectual disability, ectopia lentis, skeleton abnormalities resembling Marfan syndrome and thromboembolic episodes. The majority of patients have psychiatric disturbances as depression, behavioral disorders, personality disorders, obsessive-compulsive disorder and, less commonly, bipolar disorder and psychosis.

To briefly review psychiatric disturbances in patients with homocystinuria and present a case report.

Literature research and analysis of patient's clinical data.

A 22-year-old male was diagnosed with classical homocystinuria at age 4 due to intellectual disability and renal alterations. With aging, other problems emerged: epilepsy; postural tremor; dysesthesia; ectopia lentis; orofacial myofunctional disorder; asthma; and patellar instability. He went to a special education program. At age sixteen, he initiated Child Psychiatry consultations due to anxiety and behavioral changes, as difficulty in controlling impulses, establishing relationships and in the perception of the self. Nowadays, the patient is followed in psychiatric consultations, where he has demonstrated high difficulty to empathize. He is being treated with vitamin supplements; betaine; levetiracetam; clobazam; and propranolol, combined with a special diet.

It is not practical to screen every psychiatric patient for Homocystinuria, but this disease should be considered when there is a family history, early and/or acute onset, intellectual disability, atypical symptoms, unusual response to treatment, progressive cognitive change and other organic disturbances present in this disorder.

The authors have not supplied their declaration of competing interest.

While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization.

DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol.

Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization.

Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.

Academic procrastination is a specific sub-type of procrastination, assessing the tendency to delay academic tasks in connection with the preparation of courses or exams.

To determine the impact of academic procrastination on studies and academic performances and identify associated factors.

We conducted a cross-sectional descriptive study in students from three different universities: a medical school, a law school and an engineering school. Socio-demographic, clinical and academic data were collected. Procrastination was assessed using the Academic Procrastination Scale. We further administered the Short Version of the impulsive behaviour scale, the Satisfaction with Life Scale, the Perfectionism scale, and the one item Self-esteem Scale.

Our sample consisted of 1019 students. The mean age was 22 ± 2.25 years, and 62% were females. About one third of study participants used tobacco or alcohol, and 10% used drugs (cannabis or others). We found a significant positive correlation between procrastination and academic failure (r=0.22 p= 0.00) and a negative correlation with academic success (r= -0.27 p=0.00). Multivariate regression analysis showed the following risk factors for academic procrastination: alcohol consumption (ORa= 1.74 [1.14; 2.67]), study field (with reference to medicine: law ORa= 1.50 [1.02; 2.19], engineering studies ORa= 2.01 [1.34; 3.02]), and impulsivity (ORa= 2.11 [1.55; 2.86]).

Academic procrastination has a negative impact on academic achievement and performance. This impact appears to differ depending on the field of study. It also seems closely related to impulsiveness and alcohol use. Our findings might contribute to find new ways of helping students to improve academic performance.

No significant relationships.

Depression is difficult to diagnose in schizophrenic patients although it represents a frequent motive for suicide. In clinical practice nonspecific sadness is more often observed than major depressive episodes. Our analysis of these states led us to the concept of demoralization.

The objective of our study was to demonstrate the existence of demoralization in psychotic patients as a real entity and to see how it could be correlated with other dimensions.

A total of 55 ambulatory patients diagnosed with a schizophrenic disorder were included and distributed in 2 groups according to the level of demoralization. The correlation with residual psychotics symptoms (PANSS), depression (CDSS), despair (BHS), and quality of life (SQoL) as well as the sociodemographic characteristics and past history of suicide attempts was assessed.

More than 94% of our patients were found demoralized, 16,36% of them severely. The degree of demoralization was correlated with the intensity of positive symptoms (p = 0.016), depression (p < 0.001), despair (p = 0.015), suicidality (p < 0.01) as well as poor quality of life (p = 0.007) and low self-esteem (p < 0.000).

Demoralization appears to be a relevant concept during schizophrenia, bound in schizophrenic and depressive process, and impacting the suicidal risk. It could represent an important stake in the care of schizophrenic patients especially for the prevention of relapse and suicidal risk.

Although there is general consensus that only prolonged and intensive psychotherapy can provide real recovery from Borderline Personality Disorder (BPD), almost nothing is known about the relative effectiveness of different approaches. The present study compared the (cost-)effectiveness of two psychotherapies for BPD aiming at a fundamental change: a modern psychodynamic approach (Transference-Focused Psychotherapy, TFP) and schema-focused cognitive therapy (SFT).

In a multicenter trial 86 patients were randomised to either TFP or SFT and treated for max. 3 years. In Maastricht, patients also participated in fundamental studies on emotion regulation (attentional bias, fMRI, peripheral nervous system responses).

TFP had more (early) drop-outs than SFT. SFT was about twice as effective as TFP in terms of recovery from BPD. This effect could not be explained by differences in drop-outs. SFT was superior to TFP on all other measures. On cost-effectiveness ratios, SFT was superior with respect to recovery, and equivalent when quality-of-life was considered. Functional MRI and other indices indicated that recovery from BPD was associated with normalizing of emotion regulation.

The results indicate that it is possible to successfully and cost-effectively treat these difficult patients by prolonged psychotherapeutic treatment. Assessment of attentional bias and amygdala/hipocampal responses to threat cues indicates that ‘symptomatic’ cure is accompanied by normalizing of these processes, suggesting a deep and fundamental change. Moreover, results of a 1-year follow-up indicate that recovery continues.

People with severe mental illness (SMI) die prematurely, mostly due to preventable causes.

To examine multimorbidity and mortality in people living with SMI using linked administrative datasets.

Analysis of linked electronically captured routine hospital administrative data from Northern Ireland (2010–2021). We derived sex-specific age-standardised rates for seven chronic life-limiting physical conditions (chronic kidney disease, malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, myocardial infarction, and stroke) and used logistic regression to examine the relationship between SMI, socio-demographic indicators, and comorbid conditions; survival models quantified the relationship between all-cause mortality and SMI.

Analysis was based on 929,412 hospital patients aged 20 years and above, of whom 10,965 (1.3%) recorded a diagnosis of SMI. Higher likelihoods of an SMI diagnosis were associated with living in socially deprived circumstances, urbanicity. SMI patients were more likely to have more comorbid physical conditions than non-SMI patients, and younger at referral to hospital for each condition, than non-SMI patients. Finally, in fully adjusted models, SMI patients had a twofold excess all-cause mortality.

Multiple morbidities associated with SMI can drive excess mortality. While SMI patients are younger at referral to treatment for these life-limiting conditions, their relatively premature death suggests that these conditions are also quite advanced. There is a need for a more aggressive approach to improving the physical health of this population.