Fentanyl is a potent Schedule II opioid agonist that has potency more than 80 times that of morphine. A high concentration of Fentanyl is contained in Fentanyl patches (MATRIFEN).

They should be used to manage pain for persons with chronic moderate to severe pain who are already physically tolerant to opiates.During the past years there has been an increase in misuse and abuse in the United States of Matrifen that has caused deaths from overdoses.Matrifen can also cause neurological and psychiatric adverse events such as: delirium anxiety, abnormal thinking, abnormal dreams, depersonalization and hostility.

In the literature Matrifen have not previously been associated with serious offences such as attempted murder but an association with suicide has been noted.

To describe a previously unreported and serious adverse effect of Fentanyl patches.

We followed up the clinical psychopathology of an elderly gentleman who attempted to murder his wife reportedly due to an altered mental state caused by the application of Fentanyl patch. We searched Pubmed and Google for any reported adverse effect of Fentanyl patches of a similar nature.

After ruling out all other Psychiatric, Organic and Forensic causes we came to the conclusion that Matrifen was the cause of altered mental state which led to the attempted murder.

Although adverse psychiatric effects of Fentanyl patches have been reported in the past we can add attempted murder to the list. Fentanyl patches can be dangerous particularly in the vulnerable elderly patients where they are most commonly used.

To study the presenting features and outcome of deliberate self-harm patients presenting to an accident and emergency department

Self-harm accounts for up to 170,000 hospital attendances in the UK annually. 15-25% repeat self-harm within 1 year. Self-harm repetition is reported as higher among those who do not receive psychosocial assessments and discharge themselves from accident and emergency departments.

All patients triaged within Beaumont Hospital accident and emergency department with a presentation indicative of psychiatric disorder were studied over 12 months. The following were collected on each patient: demographic variables (age, gender, marital status), clinical variables (method of self-harm including associated factors, history of deliberate self-harm, overdose agents used in self-poisoning, whether a psychiatric consultation occurred and outcome). Dates and times of presentations were recorded. Statistical analysis was performed using SPSS14 statistical package.

1,397 liaison psychiatry patients presented to the accident and emergency department over 12 months. 834 (60%) cases were deliberate self-harm, most commonly overdose (47%). 353 (35%) cases of self-harm were associated with alcohol ingestion. Most self-harm presentations (30%) occurred in March (83), April (86) and May (83). Most self-harm cases (27%) presented between 9pm-1am. 27% of self-harm cases presented between 9am-5pm when psychiatric cover was available in the accident and emergency department. 73% presented outside of these hours. 273 (20%) liaison psychiatry patients left before psychiatric consultation.

Optimisation of the management of patients who self-harm is important. The reasons why patients leave hospital before assessment has been completed should be further investigated.

Postpartum psychosis is a severe psychiatric disorder that leads to hospital admission in about one woman per 1,000 deliveries. It coincide with the vulnerable period associated with becoming a mother and may, if untreated, lead to suicide and infanticide. Some risk factors for postpartum psychosis have been identified in previous research, such as primiparity and previous psychiatric disorder.

Knowledge on how postpartum psychosis is related to obstetric factors might be helpful in the clinical risk assessment of postpartum psychosis.

The aim of this large-scale follow-up study was to examine the association between postpartum psychosis and certain pregnancy and delivery complications and other obstetric variables, after adjustment for age, year of delivery and previous hospitalization for psychiatric disorder.

1,133,368 Swedish first-time mothers were included during a 29-year period yielding 1,413 hospitalized cases of postpartum psychosis. Several obstetric variables were analyzed separately after adjustment for possible confounders.

Respiratory disorder in the neonate, severe birth asphyxia, preterm birth, caesarean section, perinatal death and SGA infant were associated with an increased risk of postpartum psychosis. After adjustment for previous hospitalization for psychiatric disorder only preterm birth and acute caesarean section remained significant risk factors for postpartum psychosis (relative risks were 1.20 and 1.31, respectively).

The relative risk of postpartum psychosis among first-time mothers with previous hospitalization for psychiatric disorder was increased more than 100-fold.

Careful clinical risk assessments of postpartum psychosis are crucial among women with a history of psychiatric disorder whereas obstetric variables have a minor importance.

In an effort to acquire detailed overview regarding postgraduate training in psychiatry together with gaining opinions on the present and ideal postgraduate programm, our Young Psychiatrists Section in Czech Republic decided to undertake a survey.

The questionnaire was addressed to all current PhD students in the field of psychiatry and to those who finished the studies previously, maximum 10 years ago. We distributed the questionnaires via mail and e-mail to all 7 psychiatric clinics and put it also on our website. 32 participants from 5 institutions responded. The questionnaire encompasses questions related to the metodology of the project, tutor engagement, working schedule, financial situation and other funding oportunities. Second part contained requests on various aspects of ideal training programm.

The majority of the participants is satisfied with tutor involvement (92%) and the metodology of the project (85%) but less with the financial support of the project (69%) and time devoted to work on it (69%). The ideal organization of the PhD programm should be in blocks (81%), for a certain period of time for PhD project and the rest for clinical work.

The survey revealed some weak spots of our contemporary PhD studies programm in Czech Republic, e.g. lack of time for working on PhD project and poor funds for covering it. Beside various models for organizing postgraduate studies, PhD students are in sum mainly satisfied with it. Suggestions on ideal organisation of the programm are meant to serve as potential models for consideration.

In 2004, there were 11,092 presentations to Irish hospitals with deliberate self-harm, including 7,933 cases of drug overdose, of which 31% involved paracetamol. Limiting the availability of paracetamol reduces morbidity and mortality associated with paracetamol overdose. The present study aimed to determine the level of compliance with statutory regulations governing the sale of paracetamol in Ireland.

Researchers visited pharmacy and non-pharmacy outlets (newsagents, mini-markets and supermarkets) in Dublin city and attempted to purchase amounts of paracetamol that exceeded the statutory limits for a single transaction. All paracetamol tablets purchased in non-pharmacy outlets were in blister-packs and all non-pharmacy outlets sold packs with 12 tablets or fewer per pack.

Amounts of paracetamol in excess of statutory limits for a single transaction were purchased in

50.0% of pharmacies

81.8% of newsagents/mini-markets

20.0% of supermarkets.

We recommend that

1. (a) the sale of paracetamol in newsagents/mini-markets should be discontinued

2. (b) the sale of paracetamol in supermarkets should continue, but automated check-out tills should be programmed to prevent the sales that exceed statutory limits

3. (c) there should be greater efforts to ensure compliance with statutory regulations in pharmacies.

For different group of gender identity disorders were creation specific attributes, but also important to consider identify non-specific psychological attributes of gender identity.

were assessed clinically and using experimental-psychological approach with modified BSRI (MiF) and colour attitudes test (CAT) to identify characteristics of gender identity and emotional attitudes respectively.

89 male and 68 female patients following their request for gender change

The patients were divided in three groups according to their main diagnosis: 38 patients were diagnosed with histrionic personality disorder, 52 patients with transsexualism and 67 patients with schizophrenic disorders. The unspecific attributes of the first group were correspondence between gender identity and gender preferences and biological gender (92%) and absence of the negative image of the opposite gender (93%). In the second group patients didn't identify themselves with infantile male and female images (87%), gender preferences did not fit the image of own biological gender (90%) and there was no distortion in representation of male and female roles on both logical and emotional levels elicited (87%). Images of ideal and real sexual partners did not correspond with the image of gender wanted (90%) and emotionally ambivalent or negative one's image appraisal was absent (83%). It was not possible to determine non-specific characteristics in the third group as their combination was too diverse.

evaluation of non-specific psychological attributes for each separate diagnostic group can be a valuable tool in differential diagnostics of gender identity disorders.

Many authors punctuate the lack of knowledge about the evolution of autistic spectrum disorders (ASD) in adulthood (Howlin et al., 2004). This deficiency leads to an almost absolute absence of long term care structures specifically conceived for autistic adults; hence, they usually live at parental home, or they are admitted into mental institutions which are not suitable for cognitive and adaptive peculiarities of autistic disturbance (Barale & Ucelli, 2006).

Among the limited ad hoc solutions, the present research concentrated on the farmstead community model, which utilizes the rural setting in order to plan rehabilitation projects (Giddan & Giddan, 1993); the aim was to establish whether the farm community model can positively affect the long-term outcome.

A 48 months follow-up study was performed; the sample, recruited from the community “Cascina Rossago”, was composed of 10 adults (1F, 9M; mean age: 29.4 years) affected by ASD and mental retardation (APA, 2000). The construct of adaptive behaviour, assessed by Vineland Scales (Sparrow et al., 1984), was chosen to achieve a fitting measure of global functioning; data survey was both retrospective (chart review) and prospective.

Paired samples t-tests showed significant differences between T1 and T2 with regard to “Composite Scale” (t(9)=3.354; p<.01), “Communication” subscale (t(9)=2.449; p<.05) and “Socialization” subscale (t(14)=2.613; p<.05); the “Daily Living Skills” subscale demonstrated a borderline p-value (t(9)=2.250; p=0.0510).

These results indicate that farmstead community environment can produce a favourable effect on adaptive behaviour, especially in those areas which represent the chronic core of autistic symptoms.

A mobile psychiatric unit is an outpatient, community-based psychiatric service, alternative to mental hospital, with proven effectiveness and efficacy. This study presents the development of the Mobile Psychiatric Unit of the prefectures of Ioannina and Thesprotia (M.P.U. I-T), and the results of its operation during the first six-month period of its establishment.

The M.P.U. I-T is a specialized multidisciplinary team which provides psychiatric services and promotes mental health in a rural population of about 100.000 people. A close cooperation with all health care providers within the catchment area has been established. Patients were examined by the M.P.U. staff and medical data were collected in order to identify the needs of the patients living in these remote areas.

344 therapeutic actions have been recorded. 106 (30.8%) were visits at the patients' homes, which indicates their difficulty in accessing the mental health system. During this six-month period the number of the patients was gradually increased, reaching currently a total of 132 patients, whereas 42 patients are permanently followed-up by the M.P.U. In addition, 58 education and promotion activities, 55 meetings with members of primary care services and 27 meetings with members of the local authorities and other corporations have been recorded within the same period.

These preliminary findings provide initial evidence about the increased needs of the rural areas for the development of community-based mental health services. A community-orientated programme based on mobile psychiatric units offers quite satisfactory results in this direction.

Analysis of effectiveness and costs of day hospital in relation to stationary treatment. Study constitutes part of project carried out within 5th EC Framework Program-EDEN.

Out of 1089 patients admitted to Psychiatric Hospital in Wrocław(PHW) 238 patients were randomly assigned to either day hospital(n=l15) or inpatient ward(n=123). Patients were interviewed at 6 time-points comprising hospitalization, 3 and 12 months after discharge. Psychopathological symptoms and QoL were expressed in BPRS subscales and MANSA. Costs of treatment were assessed from clients' perspective–according to CSRI questionnaire, from payer's perspective– the National Health Fund(NHF) databases and from economic reports of PHW.

Day hospital was superior in alleviating negative symptoms, depression and anxiety. No statistical differences in effectiveness 3 months after discharge were found. One year after discharge higher level of psychopathology was reported amongst inpatient group and day-care group had higher number of rehospitalizations.

Costs were higher for NHF in day-care due to longer overall patients' hospitalization. However according to economic reports mean financial deficit of PHW generated by day patients was significantly lower. Comparison of length of hospitalization assessed with CSRI and NHF databases showed significant quantitative differences .

Superiority of treatment effectiveness in inpatient ward over day-care was not confirmed using BPRS, MANSA and rehospitalization index. Simultaneously significantly lower mean financial deficit generated by day hospital due to lower indirect costs and underestimated NHF's rates for inpatients treatment showed superiority of day treatment in terms of CEA. Costs estimation based on clients' perspective may lead to significant misconception.

To use a single national data source to discern trends in the prevalence of office-based visits resulting in a diagnosis of attention deficit/hyperactivity disorder (ADHD) among girls, and trends in the prescribing of stimulant pharmacotherapy for its treatment in the United States (U.S.).

Data from the U.S. National Ambulatory Medical Care Survey were utilized for this analysis. The number and rate of office-based physician visits resulting in a diagnosis of ADHD (ICD-9-CM code 314.00 or 314.01) were discerned for the years 1991 through 2004, for children and adolescents aged 5 through 18 years. Gender-specific trend analyses were conducted using seven two-year time intervals.

Overall, the annualized number of office-based visits documenting a diagnosis of ADHD increased from 1,302,632 in 1991-92, to 6,513,479 in 2003-04. The annualized mean number of office-based visits documenting a diagnosis of ADHD among girls increased five-fold between 1991-92, and 2003-04 (from 296,389 to 1,473,854). The U.S. population-adjusted rate of office visits documenting a diagnosis of ADHD among girls increased 4.3-fold (from 12.3 per 1,000 girls to 52.6). Documentation of a diagnosis of ADHD and the prescribing of stimulant pharmacotherapy increased 4.2-fold for girls, from 7.5 per 1,000 girls in 1991-92, to 31.4 in 2003-04.

Although the number and rate of office-based visits among boys documenting a diagnosis of ADHD still far exceeds that of girls (3.4:1), the magnitude of the increase was as great among girls as boys during this time period, and contributed significantly to the overall upward trend.

To evaluate whether the trend in adults seeking medical care for the treatment of attention deficit/hyperactivity disorder (ADHD) reflects the upward pattern seen among children.

Data from the United States (U.S.) National Ambulatory Medical Care Survey (NAMCS) were utilized for this analysis. The NAMCS is an ongoing annual survey of a representative sample of U.S. office-based physician practices. The number and rate of office-based physician visits resulting in a diagnosis of ADHD (International Classification of Diseases, 9th Revision, Clinical Modification code 314.00 or 314.01) among patients age 20 years or older, were discerned for the years 1995 through 2004. Trend analysis was conducted using five time intervals: 1995-96; 1997-98; 1999-00; 2001-02; 2003-04.

Over the time-frame, national estimates of the number of annualized office-based physician visits documenting a diagnosis of ADHD among adults increased 4.7-fold; from 582,728 in 1995-96, to 2,738,285 in 2003-04 (p < 0.05). Adjusted for population growth, the rate per year of office visits per 1,000 U.S. population ≥$20 years old resulting in a diagnosis of ADHD more than quadrupled; increasing from 3.1 per 1,000 in 1995-96, to 13.0 in 2003-04. The majority of office visits documented a prescription for stimulant pharmacotherapy or atomoxetine (available since late 2002), increasing from 61.7% in 1995-96, to 77.8% in 2003-04.

As with children, the rate of adults seeking medical care for ADHD has increased significantly. By 2003-04, adults accounted for more than 1 in 4 (28.8%) office visits resulting in a diagnosis of ADHD.

In different areas of Therapy, included Psychiatry, herbal medicine has had an increasing interest during the last years. Plants are traditional uses, but only a few have been approved therapeutically. However, we do not know any bibliometric analysis about herbs that are used in Psychiatry.

We have conducted a bibliometric study regarding scientific publications related to phytotherapy in the Psychiatry area during 1986-2006 period. Using the platform Embase.com (Elservier, Amsterdam), including EMBASE and MEDLINE database, we selected those documents whose included the descriptors plant, herb, phytotherap, and psychiatr (with all diagnostic criteria). Plants' indications had been selected according to PDR for Herbal Medicines. As bibliometric indicator of the production, Price's Law was applied.

A total of 21.409 original documents were obtained. Our data confirm a fulfilment of the Price' Law related to scientific production about medicinal plants in Psychiatry. We had observed it after carring out a lineal adjustment (y=135,08x-466,38 r=0.92) an another adjustment exponential curve (y=132,26e0.1497x; r=0.99). The plants more mentioned in the psychiatric literature have been St. John's Wort (Hypericum perforatum; n=937) and Ginkgo (Ginkgo biloba; n=694). The countries with more percentage of documents were the Unites States (29,44%), Germany (9,41%) and Japan (8,75%), and the country with highest Index of Participation (number of documents per country / number of documents in our repertory) was India (IPa= 0,935) and China (IPa=0,721).

Productivity medicinal plants in the Psychiatry area increased during the period 1986-2006. Nevertheless, documents about therapeutic herbs in this field are rather little.

To study role of psychosocial factors in formation of mental disorders (MD) in patients with diabetes mellitus (DM).

We examined 210 patients (age 48.57±8.65 years) with DM of type 2 and glucose tolerance disturbance (GTD) at Borderline States Department.

DM patients were diagnosed as having neurotic, stress-related (44%), and affective (14%), organic (35%), personality (7%) disorders. Method of logistic regression has identified totality of prognostic signs in values (Concordant; Somers'D) of Hosmer and Lemeshow's test (0,7-0,9). We studied significance of psychogenic factors (life events, medical, working, family-housing ones) in formation of mental disorders. Predictors were as follows: level of glycemia (p=0.0001), body mass index (p=0.0001), diabetic retinal angiopathy (p=0.02), family history (p=0.044). Psychosocial predictors: duration of MD (p=0.0001), age of onset of MD (p=0.0001), ratio of age of onset and duration of MD and DM (p=0.0001), disorders of neurotic and affective level (p=0.0001). Anosognosia DM was combined with anxiety, fears and fear of death, inappropriate assessment of their abilities, hypothymia, anxiousness, and vegetative dysfunctions.

Two-factor disperse analysis has identified relationship between level of glycemia on an empty stomach, MD (p=0.0001; p=0.007) and DM (p=0.003). Instability of blood glucose (4.63-19.3 mmol/l) was observed in 40% of patients with leading syndrome of depression. Depressive disorders contributed to quicker development or decompensation of DM 2 for the first six months.

High risk of complications of DM was associated with influence of psychostressors and depressive disorders. Treatment of patients requires interaction of therapist (endocrinologist), psychiatrist, and psychotherapist.

Some previous studies have demonstrated an early effect of caffeine administration on subjective state, but none of them has explored its existence after the administration of decaffeinate coffee, nor the possible differences according to the gender. The aim of the present work was to investigate, using a realistic design (non-research settings and naturalistic administration of the drug), the early effects (10-30 min post-consumption) of a single low-moderate dose of caffeine (100 mg) and decaffeinate coffee on sleepiness and subjective activation.

A random double-blind informed placebo controlled procedure was applied to a group of 688 healthy undergraduate volunteers (238 men) mean age 22.03 ± 2.21 years. Measures were recorded in two experimental sessions: morning 11:00-13:00h or afternoon 16:00-18:00h, in three moments before (30, 20 and 10 min.) averaged as a stable baseline, and three after (10, 20 and 30 min.) consumption.

Caffeine administration induces fewer somnolence (F= 159.776, p<0.0001) and greater activation (F= 43.516, p<0.0001) in all post-consumption records, while the decaffeinated drink only induced arousing effects in the 10 min. post-consumption record. Caffeine effects were greater in men and the decaffeinated beverage produced greater effect in women (sleepiness: F= 14.893, p<0.0001; activation: F= 4.229, p=0.038).

Future works should study more accurately the early effect of caffeine and decaffeinate coffee and the influence of gender, using other parameters which have proven to be sensitive to their administration, as well as several caffeine doses.

The Summary of Product Characteristics (SPC) specify how to use a medicinal product safely and effectively. They are mandatory documents approved by the regulatory authority (EMEA). The content is compiled based on available evidence and is updated as new information becomes known. The safety of paediatric medicines is of paramount importance and the SPC's specify where a treatment should not be used through the contra-indications section. ADHD is a condition affecting 4-8% of the paediatric population and medicinal treatments are commonly used.

A systematic review of the contra-indications for the licensed treatments for ADHD in the UK was undertaken. Data was extracted from the Electronic Medicines Compendium. Categorisation of contra-indications was done using relevant body systems. Where appropriate, language was reported verbatim. Atomoxetine is defined as a non-stimulant, methylphenidate and dexamfetamine as stimulants.

There are eight licensed treatments (1992-2007) falling into two categories; non-stimulants and stimulants.(1:7) Most SPC's (75%) have been amended from February to July 07.

Numbers of contra-indications; all treatments 3-20, all stimulants 9-20, methylphenidate formulations 10-20. There are inconsistencies in the specific contra-indications between the various formulations of methlyphenidate. The only contra-indication common to all treatments is glaucoma. All forms of methylphenidate are contra-indicated in marked anxiety/tension, diagnosis/family history of Tourettes, severe angina, arrythmias and hyperthyroidism. Atomoxetine is the only treatment with no cardiac or neurological contra-indications.

The contra-indication section (4.3) of the SPC is a valuable tool when assessing the safety of comparative ADHD medications.