In studies of adult patients with attention deficit hyperactivity disorder (ADHD) atomoxetine (ATX) has demonstrated substantial improvements in ADHD symptomatology using Conners’ Adult ADHD Rating Scales (CAARS). The pattern suggests incremental response over time with no clear plateau of response.

To identify patterns of response to ATX in adult ADHD patients and to describe those trajectories over time

To determine if patients have distinct response trajectories using CAARS in two populations, short term (12 weeks) and long term (24 weeks) treatment data.

Data from 2502 ATX patients, who had an investigator-rated CAARS total score at ≥ short or long term time point, The numbers of trajectory clusters for short term (n=2502) and long term (n=1139) data were identified using hierarchical clustering methods. Linear mixed modelling was used to describe those different trajectories over time.

Using CAARS total, 4 trajectory clusters were identified in short term treated patients and 5 in long term. Three out of 4 short term trajectory clusters (representing 84% of patients) and 4 out 5 long term (representing 96%) showed more successful trajectories. In general clusters with less improvement were those with the worst baseline CAARS and minimal initial improvement. Distinct trajectory patterns of response were found that were incremental over time in all clusters.

Adult ADHD patients receiving atomoxetine have individual trajectories of response that can be divided into 4 short term trajectories and 5 long term trajectories. Further analysis is ongoing to describe these cohorts.

Needs of the elderly are complex and difficult to identify since connected with many different dimensions. The aim was to identify met and unmet needs of patients referred to old age rehabilitation services in Poland (Wroclaw-Wr) and Germany (Hamburg-Ha).

Patients (n=80) over the age of 60 were assessed using the Camberwell Assessment of Need for the Elderly (CANE), Mini Mental State Examination (MMSE), Global Deterioration Scale (GDS), Good Milieu Index (GMI) and Activities of Daily Living Scale (ADL). Patients were at least 2 weeks under rehabilitation due to orthopedic or neurologic reasons.

Both groups were similar concerning age, gender, education and marital status. Satisfaction of the ward was the same. Wr-patients were significantly more demented (25.1 vs.26.8; p=0.011), depressed (4.12 vs 3.0; p=0.033) and disabled (24.88 vs 76.62; p< 0.0001).

The mean number of total, unmet and met needs before rehabilitation was similar in both centers. However, significantly more needs in accommodation, eyesight /hearing /communication and benefits were reported in Wr, whereas psychological distress and food in Ha.

During rehabilitation program over twice more unmet needs were reported in Wr vs. Ha (1.38 vs. 0.57; p =0,0029) in the areas of eyesight /hearing /communication and benefits, continence, money.

Ha received twice more formal assistance than Wr before (0,0027), but Wr twice more during rehabilitation (p< 0,0001).

Assessing individuals needs may help in creating individual complete rehabilitation program within continuing care post discharge and improve quality of life.

Though interest grows in improving patient activation in general medical health services, there is little evidence from randomised controlled trials in mental health settings of how to achieve this.

We aimed to evaluate the effects of a brief pre-treatment peer-co-led educational intervention added to mental health treatment. The intervention was developed and carried out in cooperation with user representatives, peer educators and health professionals, and aimed at activating and preparing patients to participate in own treatment.

To assess the 4 months and 12 months effects on patient activation measure-13 (PAM-13) and attendance.

Patients from two community mental health centres were randomised to a control group (CG, n = 26) receiving treatment as usual, or an intervention group (IG, n = 26), consisting of four-hour group pre-treatment educational seminar (peer-support and encouragement to adopt an active role) followed by treatment as usual.

At 4 months follow-up only the IG improved significant on PAM-13. Preliminary results at 12 months on PAM-13 and attendance will be presented.

Brief pre-treatment education improves patient activation at 4 months and could potentially have an effect on attendance at 12 months follow-up.

Pre-treatment education co-led in cooperation with user representatives, peer educators and health professionals is a rational and easy way to activate and engage outpatients in their own health care process.

Clinicaltrials.gov Identifier: NCT01601587

The authors have not supplied their declaration of competing interest.

The frequent use of psychiatric emergency poses problems due to the loss of their adaptative capacity and diagnosis, orientation and therapeutic difficulties for clinicians.

To estimate the prevalence of frequent visitors to psychiatric emergency and to describe their sociodemographic and clinical characteristics.

It is a cross-sectional study of twelve months including patients who consulted at least twice to medical emergency department in the university hospital of Mahdia. Data were collected using a predefined questionnaire.

The prevalence of recurrence was 30,2%. The main characteristics were: a mean age of 35,5 years, a male gender (64,5%), being unemployment (72,3%), a single status (71%), a request from the family (55,5%) and the presence of psychiatric personal history (91,6%). Previous hospitalizations were noticed in 69% of cases. 44,5% of the patients had problems with the primary support group and the social environment. In 78,6% of cases, patients had visited emergency twice to four times. The most encountered reason for consultation was heteroagressivity (27%) and the most frequent syndromic diagnosis was psychomotor excitation (25.2%). Hospitalization concerned 47.1% of patients. Schizophrenia and bipolar disorder were the most diagnosed disorders in 54,2% and 25% of cases.

Absence of intermediate structures and lack of coordination between the various stakeholders involved in the management of patients are the two main encountered problems.

The only randomized trial comparing the efficacy of disulfiram against placebo showed no differences in recovery time of alcohol consumption or total abstinence. Moreover, even if the potentially dangerous side effects are rare, their risks overcome the hypothetical benefits. Therefore, in December 2007 the division of addictology, department of psychiatry, decided to stop Disulfiram prescription. The healthcare team's perception of this decision was monitored.

An auto questionnaire (31 questions) was administered to the healthcare team in June 2009 for a 3 month period evaluating their perception of the utility of Disulfiram and of the pertinence of the decision.

Demographics: 55 participants (response rate 61.1%), 54.1% women, age (M = 43.7).

Professions: 54.8% nurses, 30.6% MD, 9.7% social workers, 4.8% psychologists.

78.7% participants already worked in the team in December 2007.

54.6% didn’t agree to stop Disulfiram prescription. While 72.2% think that the decision is based on evidence based medicine, 69.1% think that Disulfiram works because of the context of administration and 69.1% think it works because of the fear generated by its effects, 75.5% still believe that Disulfiram is useful for some patients (76.8% at the time of the decision).

Despite the fact that aversive treatments in addictology have failed to demonstrate an efficacy through EBM, the perception of its utility is still strong in caregivers. While most of them admit that it works mainly trough psychological constraints, they don’t support the fact that EBM could generate a practice change such as stopping Disulfiram prescription.

Paracetamol is one of the most frequently used drugs in intentional overdoses. Countries that limit the quantity of paracetamol available in a single purchase generally report lower rates of paracetamol related morbidity and mortality.

To determine the socio-demographic characteristics of those who intentionally overdosed on paracetamol and associated psychiatric illness (identifying high-risk groups).

To improve mental health care delivery and propose a restriction of pack sizes of paracetamol in a single purchase.

This study was a retrospective, descriptive analysis study. Cases of parasuicide in the year 2008 were identified through our database and their case notes studied by completing questionnaires pertaining to details of the act.

Of the 437 cases of parasuicide, 195 cases overdosed on paracetamol (44.6%). Indians made up 41.0% of cases, followed by Malays (31.8%) and Chinese (20.5%). Of the Malays, 63.3% overdosed on paracetamol, compared with other means of parasuicide. 72.8% of those who overdosed with paracetamol were female, 54.4% were single and 69.7% purchased paracetamol over the counter. With increasing age, the incidence of paracetamol overdose declines, being highest (55.2%) in the age group 16-25. Of those who overdosed on paracetamol, 46.2% had a diagnosis of adjustment disorder, 26.2% of acute stress reaction and 21.0% of depression. 42.1% of them had a history of paracetamol overdose.

Paracetamol continues to be commonly used in parasuicides. Legislation restricting pack sizes of paracetamol in a single purchase is the most pragmatic means of reducing paracetamol related parasuicides and suicides.

Wake therapy, during a whole night, followed by bright light therapy for 6 days has been shown in a number of studies to be effective in quickly alleviating depressive symptoms.

To evaluate the implementation of wake therapy followed by bright light treatment among inpatients with depression as an adjunct to treatment as usual.

Eligible patients with mood disorders were offered wake therapy (total sleep deprivation) followed by daily bright light therapy for one week (10,000 lux for 30 minutes). Results were registered prospectively and included patient experience, and both baseline and post-treatment Montgomery-Åsberg Depression Rating Scale (MADRS-S) and Insomnia Severity Index (ISI).

At present, four patients (all female ranging 24 to 60 years in age) have undergone wake therapy followed by bright light therapy. All patients received treatment with antidepressants along with the intervention. MADRS-S decreased by 12 points at average (range 0-22) for the four patients and ISI by 5 (range 2-12). All patients expressed gratefulness for the treatment and no severe side-effects were reported. At the conference, results from the first 10 patients will be presented

The first experience of the implementation of wake therapy followed by bright light therapy as an adjunct to treatment as usual has been positive. All patients improved and no side-effects were noted. The case-series will include at least 10 cases which will be presented at the conference.

The prevalence of eating disorders has been increasing in the Asian countries. Malays in Singapore are at the crossroads because they are largely traditional in practice and almost all are Muslim, but are exposed to western culture. Studies found that Malays at increased risk of eating disorders but yet those that present for treatment are very small, and this study aims to study Malays with eating disorders to unveil this contradiction.

All Malay patients presenting to Singapore General Hospital (SGH), which hosts the only specialized eating disorder programme in Singapore, between 2003 and 2014 were identified and medical records studied retrospectively.

Malays constitute only 42 out of 1340 patients treated in the same period. The mean age at presentation is 18.81 years (SD = 5.54) and the majority are students (78.6%). A total of 92.9% are single. There are more cases of bulimia nervosa than anorexia nervosa (45.2% vs. 26.2%). In total, 54.8% have psychiatric comorbidities, the most common is depression (31.0%), 38.1% have a history of deliberate self-harm and 21.4% attempted suicide. A total of 52.4% reported teasing as a trigger, while 16.7% were triggered by being overweight.

There is only a small number of Malays that presented. Fasting is commonly which may be confused with restriction. Other factors could be lack of awareness. The higher prevalence of bulimia nervosa suggests that purging is recognized as abnormal. High prevalence of comorbidities suggests that family members recognize comorbidities better. Outreach programs for Malay will help increase awareness.

The authors have not supplied their declaration of competing interest.

There seems to be geographical differences in decisions about breast conserving surgery (BCS) in breast cancer patients. This study was to evaluate patients’ attitude to BCS and to assess the factors affecting cancer practice in West China.

A structured questionnaire was distributed to 184 patients, eliciting information about the patients’ characteristics, occupation, education, family life, recognition of illness, knowledge about BCS, the main means of gaining surgery information, selecting surgery approaches, preferences to breast reservation.

In all, 163 patients completed the questionnaire. The results indicated that only 7.4% of patients received BCS and 23% of the remaining patients desired to have BCS and the affecting factors were significantly associated with their family life, recognition of illness and the main means of gaining surgery information (P < 0.05). No associations were between BCS selecting and the other variables studied. The most frequent reasons for selecting BCS were keeping the female shape and improving quality of life (71%), the second most were postoperative recovery, minimal influence of physical function (47%) and patients’ knowledge about BCS (42%). The most frequent reasons for not selecting BCS were uncertainty about BCS results and worry about recurrence (81%), the second most was the elderly age unnecessary for BCS (40%).

The findings indicate that breast cancer patients in West China do not take BCS as the first choice as the best treatment method. It is warranted that further study of more patients, attitude of patients’ partners and physicians to BCS.

Anxiety disorders are one of the most frequent disorders. The main goal is the estimate the half-year prevalence of Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) in Slovak population.

The design of EPIA study is cross-sectional. The subjects in common population were identified by age,sex,education,region, nationality.We used anxiety section of MINI(Mini-International Neuropsychiatric Interview), part for GAD and SAD. Data were collected by trained interviewers (students of Comenius University in Bratislava). Different statistical methods were used for data analyses.

1251 subjects (a representative sample) were involved into the study, 48,2% men and 51,8% women. Mean age of whole sample was 42,82+-17,1 years. The 6-months prevalence of GAD was 4,0%, of SAD 1,7%. The prevalence of GAD and SAD was slightly higher in women than in men. Most participants with GAD were in age between 40 and 49 years. Participants with SAD were equally distributed in age group 18-39 years as in the age group 40-59 years. We compared our results with some similar findings in EU and USA.

The prevalence of GAD is slightly higher than in ESEMED study(GAD=2,8%). Prevalence of SAD is slightly lower. (ESEMED SAD=2,4%).

Self-image is developed by the way in which adolescents think, feel and behave and it arises from the person's body image during preadolescence. problematic A considerable amount of literature published so far on Internet addiction reveals that it is a worldwide phenomenon.

Internet use involves an individual's inability to control his or her use of the Internet, negative consequences (e.g., failing in school, decreased productivity), and marked distress and/or functional impairment Until now, no studies were performed to investigate the relationship between Internet addiction and self-image.

The aim of this study was to evaluate Internet addiction among adolescents and to examine the correlation between problematic Internet use and self-image.

We assessed 1912 high school students, aged between 14 and 18 years. Internet Addiction Test (IAT), Offer Self- Image Questionnaire (OSIQ), and a sociodemographic query form were used in the collection of data.

According to the IAT, 201 students (10.5%) were found to be a ‘problematic Internet user’ or an ‘Internet addict’. The students with Internet addiction scored lower on all subscales of OSIQ (impulse control, emotional tone, body image, social Relations, vocational and educational goals, family relations, mastery of the external world, emotional health and superior adjustment), except sexual attitudes. A significant negative correlation between daily OSIQ subscales and IAT and weekly Internet use was found.

The results of this study showed that Internet addiction was related to the development of the self-image, which is a crucial psychological structure gained in adolescence.

To explore different longitudinal patterns of social functioning before onset of psychotic illness and how they relate to clinical presentation, substance use and acute treatment response.

Inclusion criteria: Drug-naïve first-episode psychosis, 18-50 yo, criteria for Schizophrenia or Other Psychotic Disorders (DSM-IV), excluding Psychotic Disorder due to a General Medical Condition and Substance-Induced Psychotic Disorder.

Mental Retardation, neurological disease, brain injury or drug dependence.

Premorbid Adjustment Scale (PAS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS).

Ward cluster analyses were carried out to differentiate three longitudinal patterns of social premorbid adjustment from childhood to late adolescence: stable good (N=75), stable bad (N=44) and deteriorating (N=35). Chi-square and ANOVA tests were used.

154 subjects (64.5% male, mean age 26.81, SD=6.98) participated in the study.

At baseline the socially stable good group had more positive symptoms, SAPS 13.85 (3.99), than the stable bad group, SAPS 11.82 (3.93) (p=0.023).

At six weeks post-treatment the socially deteriorating group had more negative symptoms, SANS 8 (4.89), than the stable good, SANS 3.85 (4.11), and the stable bad, SANS 5.23 (5.45) (p=0.000).

The stable good group had the highest rates of substance use, followed by the deteriorating group.

A good premorbid social life was related to higher substance use and more positive symptoms at presentation. A social deteriorating pattern was associated with more negative symptoms at baseline and six weeks post-treatment. These differences would argue for different pathogeneses of psychosis.

Response styles theory postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate.

To evaluate the relationships between rumination, neuroticism and depression in a naturalistic prospective cohort of primary care patients with depressive disorders with life-chart methodology.

We hypothesized, that rumination would correlate with severity and duration of depression and with concurrent anxiety, gender and neuroticism.

In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II. Of the 137 patients with depressive disorders, 82% completed the five-year follow-up with a graphic life chart. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).

Rumination correlated significantly with Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.

Rumination correlated with current severity of depression, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.

The authors have not supplied their declaration of competing interest.

Happiness has been associated with a number of individual and societal factors, but much of the individual-to-individual variation in happiness remains unexplained. The purpose of this paper is to examine a broad range of social and psychological correlates of self-rated happiness in Europe.

We used data from the European Social Survey to determine levels of happiness in individuals (n=30,816) from seventeen European countries and to identify associations between happiness and age, gender, family relationships, satisfaction with income, employment status, community trust, satisfaction with health, satisfaction with democracy, religious belief and country of residence.

Self-rated happiness varies significantly between European countries, with individuals in Denmark reporting the highest levels of happiness and individuals in Bulgaria reporting the lowest levels. On multi-variable analysis, happiness is positively correlated with younger age, satisfaction with household income, being employed, high community trust and religious belief. Overall, these factors account for 22.5% of the individual-to-individual variation in happiness in Europe.

For the individual, this study highlights the strength of association between happiness and the individual's attitudes towards various aspects of their personal, household and societal circumstances. For social policy-makers, this study confirms the potential usefulness of civic measures to increase community trust and social capital. Further studies of the inter-relationships between individual and community-level variables would assist in further explaining the variance in happiness between individuals and countries.