People with intellectual disabilities (ID) present with behaviours that challenge community services. Community models of care as alternatives to hospital care exist but are often vary in their function. Certain strategies have been developed to manage challenging behaviour in people with ID. Data from a three-year period on a community-based service for people with ID and challenging behaviour that uses an objective, multi-disciplinary approach is presented.

A case note survey of adults with ID under the care of the Assessment and Intervention Team (AIT), a challenging behaviour service in the London Borough of Haringey.

Over the three-year period, 65 adults were managed by AIT. Forty-four were male and 21 were female. The age range was 21–64 years of age. The level of ID was mild ID 61%, moderate 39%. Diagnoses included psychotic disorder (25%); mood disorder (20%); developmental disorder (40%); dementia (10%); challenging behaviour (45%). Six people (11%) were admitted to hospital during their time with AIT. The length of care under AIT ranged from four to fourteen months.

AIT managed effectively people with ID living in the community who presented with complex problems putting their placement at risk. The rate of hospital admission was reduced in this period compared with the previous three years. The length of stay in in-patient services was reduced. The most common reasons for the behaviours included mental illness and ‘challenging behaviour’. People with developmental disorders were a large proportion. Community alternatives are effective with positive benefits to the person.

The authors have not supplied their declaration of competing interest.

Positive affect (PA) is correlated to several positive outcomes and might be a constituent of happiness (Lyubomirsky et al., 2005).

To investigate the correlates of PA in pregnancy and postpartum.

397 pregnant women (T0) were also followed at 3 months postpartum (T1). At both time-points, they completed a questionnaire, the Postpartum Depression Screening Scale (PDSS), the Profile of Mood States (POMS), and were also interviewed with some sections of the Diagnostic Interview for Genetic studies (DIGS). Descriptive and correlation analyses were performed.

T0/T1 PA scores were correlated (p< .01). T0 PA was associated with fewer children, and T1 PA with a concurrent better self-reported health (p< .05). PA at T0/T1 was associated with nulliparity (p< .05/p< .01), mother's age (younger) (p< .05/p< .01). PA at T0/T1 was associated with lower levels of perceived life stress (p< .01); better life quality (p< .01); more social support (p< .01); lower levels of anxiety trait, depressive/anxious emotional states (p< .01), depressive symptoms (p< .01), and suicide ideation (p< .01); less self-reported maternal sleep difficulties and lower interference of it on their mood and working functioning. Moreover, PA assessed at pregnancy was associated with these variables at postpartum. PA at T1 was associated with a better perception of the infant as having less feeding/sleeping/and behavior problems.

PA is a protective emotional trait, a good indicator of physical/mental health, and well-being in perinatal period. Mother's PA influences her perception of the infant temperament and may contribute positively to the dyadic interaction.

Psychoform and somatoform dissociation in anorexia nervosa (AN) and bulimia nervosa (BN) is yet to be studied in Portugal.

Explore the severity of psychoform and somatoform dissociation in ED; explore the differences between ED and other psychiatric disorders (PD), and between AN and BN.

From two psychiatric clinics, 29 women with ED (AN = 16; BN = 13) and 35 women with different PD (posttraumatic stress = 9; panic = 4; major depression = 4; obsessive-compulsive = 8, social phobia = 10), matched sociodemographicaly (mean age = 26.69 ± 7.31), were voluntarily assessed with the Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ-20).

ED patients had higher scores on DES (M ± SD= 28.10 ±19.76, p < 0.05) and on SDQ-20 (M ± SD= 38.41 ±13.19, p < 0.05) than PD patients (DES: M ± SD= 19.27 ±12.84; SDQ: M ± SD= 38.41 ±13.19). Comparing with PD, BN had higher scores on DES (M ± SD= 31.13 ±21.25, p < 0.05), and on SDQ-20 (M ± SD= 42.45 ±17.36, p < 0.01). Finally, there were no differences between AN (DES: M ± SD= 25.65 ±18.80; SDQ-20: M ± SD= 35.63 ±8.98) and BN (p = 0.01).

Our findings point out to the need to of watchfully assessing ED for dissociative symptoms and, accordingly, include the treatment of dissociation.

Death is a daily, several and important occurrence in nursing. Nurse's death anxiety is effect agent on quality of communication and caring of patients especially dying patients. Death Anxiety has excellent effect on job satisfaction and mental health of nurses. Only few studies have been done in this issue.Aim of this preliminary study was compare of death anxiety in special and general ward's nurses.

This was a cross-sectional analytical study that 387 practitioner nurses in census method were recruited from selected Hospital of TUMS 2007. The data were collected using a personal - social questionnaire and Templer Death Anxiety Scale. The data were analyzed using descriptive & inferential (Pearson, ANOVA, Regression…) statistical.

Results show significant difference between mean score of Death anxiety in special (8/262/1) and general (8/302/4) ward's nurses and was correlated with some variables such as marriage statues (p< 0/04), education level (p< 0/03), organizational situation (p< 0/001) and the ward which nurses now worked (p< 0/02). But has not significantly correlated with age, sex, shift, care of end stage patients, partnership in CPR and etc.

Death anxiety effect physical and emotional aspects of nurse's life and so effect process of caring present by them. Results show death anxiety was higher in special ward nurses and they faced more than general ward nurses to dying and death so they need special attention to death anxiety and investigation causes of it, development of institutional support to enable nurses to provide good quality care for patients.

Clinical applications of mindfulness have become widespread since the introduction of the mindfulness-based stress reduction (MBSR), a treatment program originally developed for the management of chronic pain. Neuroimaging techniques have allowed uncovering the neural mechanisms behind Mindfulness techniques.

To review some of the psychological and neural mechanisms behind mindfulness practice in order to explore the unique factors that account for its positive impact on emotional regulation and health.

Psychological and neural mechanisms behind mindfulness practice are reviewed.

A literature review of the theme is surveyed. Several articles were searched on Medline with the keywords “mindfulness”, “meditation”, “neurobiology” and “neurocognitive”.

Mindfulness may achieve effective outcomes in the treatment of anxiety, depression, and other psychopathologies through the contribution of emotional regulation. Cognitive reappraisal has been suggested as a core cognitive control skill whereby mindfulness practice may regulate emotions. It seems that a neural circuit comprising the prefrontal cortex (PFC), the anterior cingulate cortex (ACC), the amygdala (A), and the insula (I) are involved in the unique processes of mindful emotion regulation.

Recent models of mindfulness allow for more rigorous examination and operationalization of the method to guide research. Increasingly investigators are focusing on the impact that mindfulness has on emotional regulation, which accounts for the effects on mental health.

The authors have not supplied their declaration of competing interest.

To review current practice of lipid monitoring for patients prescribed colzapine and to improve the health of patients taking clozapine.

This was a retrospective audit targeting all patients who were taking Clozapine from May 2008 to April 2009 inclusive. Data was collected from pharmacy records, the heath centre records and patients’ personal care records. Current practice within the hospital was then compared with the standards proposed by the Maudsley Guidelines.

The total number of patients who were prescribed clozapine between May 2008 to April 2009 was 65. Of these patients 54 met the identified standards. We identified two patient groups; 56 patients were taking clozpaine for more than one year and nine patients were taking clozapine for less than one year. Out of those patients who were taking clozapine for more than one year, standards were met for 89% of patient (n = 50) compared to only 44% (n = 9) of those patients who were taking it for less than 1 year. Also, of those patients who had been taking clozapine for less than one year and do not meet the standard, none of them had lipid monitoring at three monthly intervals.

Although the vast majority of patients in the hospital who were prescribed Clozapine had their lipids monitored appropriately, a small percentage did not. Monitoring of lipid levels was particularly lacking in the first year of treatment.

Orgasm is the most powerful reinforcer of behavior. Feelings can be spiritual in miniorgasm and sensational in complete orgasm. Orgasmic conditioning act as underlying mechanism of development of paraphilias and sex addiction.

An electronic search was made on various database websites including, pubmed, science direct,and etc using key words orgasm, conditioning, paraphilias. It was followed by study of literature in journals and books.

Professional websites produced only couple of studies on orgasmic conditioning. This indicates this topic is not well taken by researchers.

Orgasmic center in brain is located in para ventricular nucleus of anterior hypothalamus and medial preoptic area. Intraorgasmic EEG exhibits visible changes. Orgasm produces euphoria and alleviate anxiety, pain, muscular tension and stress. Orgasm is mediated by dopamine which also act on nucleus accumben. During that process serotonin, endorphin and oxytocin are released. Oxytocin secretion start with arousal and during orgasm reaches its climax. It induces cuddling behavior which serve as basis o f physical and emotional intimacy. Orgasmic conditioning can bring about pairing of neutral stimuli with erotic sensation. Both male and female are capable of achieving multiple orgasms after some training. Prolongation of arousal and multiorgasmic capacity can pronounce its effects. For treatment of paraphilias like fetishism and pedophilias orgasmic condition is utilized. Positive association with healthy objects and activities can be used for treatment of various addictions.

With advanced biological understandings, orgasmic conditioning can be used in novel ways.

Although physical restraint (PR) is a non-rarely practice on psychiatry there are few studies that focus the attention on the risk factors for this intervention. PR is a legitimacy practice when is needed and well applied but is not free from side effects. Knowing risk factors might be useful to improve the application of PR.

Study the risk factors involved with the use of PR at patient's home in individuals with schizophrenia before the involuntary transport (IT) to a psychiatric facility.

Is a descriptive and observational study of 267 psychotic patients that were assisted by a psychiatric home care unit (EMSE) in Barcelona during their IT. The sample was divided in two groups, depending on the need of PR. Socio-demographic data were collected as well as positive and negative syndrome scale (PANSS), WHO disability assessment schedule (WHO/DAS), global assessment of functioning scale (GAF), Scale to assess unawareness of mental disorder (SUMD). Aggressiveness was assessed by PANSS-EC consisting of 5 items: excitement, tension, hostility, uncooperativeness and poor impulse.

From the 267 psychotic patients 109 required PR. 154 were male and the average of age was 47. The results were significant in the PR group versus no PR for PANSS-EC (P = 0.000), as well as WHO/DAS (P = 0.017), GAF (P = 0.042), Positive PANSS (P = 0.000), age (P = 0.001) and substance use (P = 0.012). Were no significant for gender, insight or Negative PANSS.

Aggressiveness and violence were the most important PR related factors followed by positive symptoms, age, substance use and global functioning.

The authors have not supplied their declaration of competing interest.

Bipolar disorder is a frequent condition in the general population with a high morbimortality, which consists in dysfunctional temporal fluctuations between different mood phases during which frequently there is a lack of insight. Besides the pharmacological treatment, psychoeducational programs have proved to be a cost-effective approach to help patients recognize early signs and symptoms in order to prevent full-blown episodes, although its broad implementation is still difficult and costly [1].

The main aim of this study is to develop and clinically validate a smartphone application to monitor symptoms and signs in stable bipolar patients along with customized embedded psycho-education contents and empower the self-management of their disorder to avoid relapses and hospitalizations.

The study will be carried out in three different but complementary phases in order to fully include patients and therapist's preferences: 1. Feasibility study using SIMPLe 1.0 app (subjective information only). 2. Feedback-based improvement process which will incorporate the objective information. 3. Randomized controlled trial with two arms of 74 patients each (SIMPLe 2.0+TAU vs. TAU).

After the collaborative development of clinical algorithms to ensure adequate sensibility and specificity to detect relapses and personalize psychoeducational messages, a technical pilot test of SIMPLE 1.0 app is underway and the first patients are being recruited to start the 1st phase of the study in Mid-October of 2014.

The possibility to deliver personalized psychoeducation contents based on monitoring signs and symptoms through a smartphone seems a promising cost-effective method, although a clinical validation is necessary.