Referrals for advice regarding treatment of alcohol related disorders form a large component of the liaison psychiatry workload. This study aims to demonstrate whether the addition of an alcohol liaison nurse specialist would decrease the number of patients needed to be seen by psychiatrists.

In-patient ward referrals were examined over 2 nine month periods. The first nine month period examined all alcohol related referrals when there was no liaison alcohol nurse. In the second period, the nurse was present. Data was analysed using SPSSv15.

A total of 243 referrals were examined over the 18 month period. The number of alcohol related referrals to psychiatrists dropped from 145 to 97 after the arrival of the alcohol nurse. This represented a 33% drop in the number of referrals. The alcohol nurse saw a total of 175 referrals. The psychiatrists saw a higher percentage of delirium tremens, 13.3% increased to 27.7%, p value .009. Also of note, the percentage of female referrals increased from 28.9% of all referrals to 44.3% of all referrals after the arrival of the alcohol nurse p=.027.

The addition of an alcohol nurse specialist led to a substantial drop in the number of alcohol related referrals to psychiatrists allowing additional time to be devoted to other aspects of the liaison psychiatry workload. More patients with delirium tremens and more women are being seen since the introduction of the alcohol nurse. Medical teams have a lower threshold of referral and more hazardous and harmful drinking was identified. Earlier intervention can help decrease longer term morbidity from alcohol.

Prostate and breast cancer share many similarities: high lifetime prevalence, increasing frequency, role of environmental factors, long survival also in metastatic disease and possibility of screening. The aim of this work is to evaluate the characteristics related to the patients, disease and treatment which can affect HRQoL at the beginning and after radiotherapy.

since June 2009, we have recruited patients, providing informed consent, before radiotherapy (T0). We assess demographic characteristic (age, qualification, work, marital status…); neoplastic staging and grading; radiation dose and other antineoplastic treatment (hormonal/chemio-therapy or surgery); concomitant medical disease and pharmacological therapy. We evaluate HRQoL by EORTC-QLQ-C30 and EORTC-QLQ-PR25 (prostate-specific) or EORTC-QLQ-BR23 (breast-specific). The protocol also includes HADS, Paykel Life Events Scale and EPQ-R. The work is ongoing and implies a follow-up at 6 and 12 months (T1/T2).

The majority of men have a localized disease with Gleason score between 6 and 8 and the median pretreatment PSA is 10.52 ng/mL; 70% will undergo adjuvant-RT; median age is 69.30 years. Women have a median age of 58.46 years, all underwent surgery and all have a localized disease and positive receptorial status. Global QoL is lightly higher in the man sample; both groups report a major deficit at Emotional Function and high levels of Fatigue. The personological characteristic more represented is “Extravertion”.

The results show an association between worse QoL, “Nevroticism” and high Anxiety levels only in the men sample at T0. At the moment, there is no significant relation in the women sample.

Following the matching in accordance with age, place of living, profession and marital status, 286 cases and 529 controls were interviewed looking for these parametres: death of the family member, an accident with severe consequences, the loss of work, a serious illness of a family member, divorce. Multifactorial logistic regression analysis was used for relative risk (RR), interval of cofidence (IC), attributive risk (AR), an estimation parametre vector, standard error, standard regressional coefficient, HI square test.

The study shows that the biggest emotional stress is death of child, death of mother, loss of work, disability, all of which were generally experienced two years prior to clinical diagnosis of the disease. RR for the cases is l.9 with the IC l.4 - 2.6 and AR 22%. RR for women in urban areas is higher than for those in rural areas and reads 2.2 with IC l.5- 3.l. It is interesting to point out that RR is the highest among the women aged 30 - 39 and reads 4.4, whereas for women aged 65 and beyond it is l.6.

According to the results in multifactorial etyology of the carcinogenesis we come to the conclusion that psychostress acted as a promoter two years before the illness was clinically diagnosed.

Hearing-impaired adults with hearing aids or cochlear implants have been proved to suffer from social isolation and that the under-use of these devices is possibly related to its impact on one's body image. The aim of the research was to evaluate the presence of social phobia and body image preoccupation, handicap perception, social functioning and psychopathological distress in patients with hearing aids or cochlear implant.

A clinical group of 70 hearing aid and/or cochlear implant wearers was compared with a control group of 75 healthy adults (age: 18-65) referred to the ENT Clinic of Modena University from 01/01/09 to 01/ 09/09. Both groups were administered the following psychometric instruments: Social Functioning Questionnaire, Brief Symptom Inventory, Liebowitz Social Phobia Scale, Body Uneasiness Test. Hearing-impaired subjects were also assessed by means of the following tests: International Outcome Inventory for Hearing Aids, Attitude towards Hearing Loss Questionnaire, Hearing Handicap Inventory for Adults.

the case group statistically differed from the control group as to lower level of social functioning (p< .05), higher level of somatization (p< .01), obsessive compulsive behaviour (p< .01), interpersonal sensitivity (p< .01), depression (p< .01), anxiety (p< .05), phobic anxiety (p< .01), paranoid ideation (p< .01), psychoticism (p< .01), social phobia (p< .001) and body image preoccupation (p< .05).

Social phobia and body image preoccupation are critical aspects in determining the psychosocial well-being and the compliance, the benefit and the personal satisfaction of hearing-impaired subjects in using the hearing aid and/or cochlear implant.

We aimed to assess the quality of life and psychosocial factor of patients presenting with medically unexplained symptom at a private general practice in Lagos Nigeria.

A total of 150 subjects presenting with unexplained symptoms out of 1,450 G.P consulted had world health organization Quality of life (Brif) questionnaire obtained. The Quality of life score and social factors were compared with patients without unexplained symptoms.

Majority of patients with unexplained symptom were female, with mean age of 42(±8) and unemployed. Among the patients, 80% had unexplained pain symptoms. Quality of life was poor in subject with unexplained symptoms and was significantly different in comparison with those without medically unexplained symptoms.

General practice patients with medically unexplained symptom had remarkably poorer quality of life and associated sociodemographic factors include age, sex and unemployment. Early identification and prompt treatment should be encouraged.

To evaluate psychiatric features in liver post transplant HIV recipients.

An observational study was conducted. Different psychiatric rating scales to evaluate cognitive status (MMSE), anxiety and depressive symptoms (HAM-A, HAM-D), social phobia (BSPS), quality of life (SF-36), sexual satisfaction (ISS), coping strategies (Brief Cope) and alcohol-drug abuse (LDQ) were submitted to a population of 11 HIV outpatients that underwent to OLT (19% of the Italian HIV transplant recipients). Scores were statistically related to socio-demographic and clinical data.

All patients were male, aged between 33 and 54 years. In the past 8 patients were drug abusers, three suffered from depression. At the moment of the evaluation 8 patients didn't suffer from any psychiatric disease while the three youngest patients presented a mild depressive status. BASIS-32 scores were related to HAM-D and to a history of drug abuse (p< 0.01). SF-36 was related to age (p< 0.05), HAM-D (p< 0.01), BSPS and BASIS 32 (p< 0.02).

Despite the higher risk for a HIV patient of developing an anxious or mood disorder, our population isn’t affected by psychiatric diseases; this is an encouraging data considering that post transplant period can be very stressful. This result may be due to a personality organization or a coping style strengthened by a long term disease such as HIV. Further studies are needed to investigate psychosocial outcome of OLT in HIV and to improve our knowledge of this controversial issue and guarantee a better take in care of these complex patients.

This study aimed to detect and quantify depressive disorders following strokes and to follow the evolution of such patients after administering anti-depressive medication in association with the rehabilitation program.

This is a prospective study on 36 patients suffering from post stroke hemiplegia, situated in an interval of two to twelve months after the stroke. The patients have been randomly divided into two groups, the study group consisting of 21 patients who received anti-depressive medication in addition to the rehabilitation program, and the control group (15 patients) who only received the rehabilitation therapy. All patients were evaluated for depression using the Hamilton depression scale (HAM-D) at the beginning of the study and after two months of anti-depressive medication. Their clinical and functional evolution was evaluated using standardized scales and quality of life scales (FIM). Other parameters were noted such as age, sex, level of education and family support.

As expected, both the depression and the functional scores improved significantly after two months of rehabilitation treatment associated with anti-depressive medication in the study group compared to the initial evaluation. Also, improvement was noted when compared to the results of the control group.

1. . in accordance with others published studies, this analysis shows the importance of early detection and treatment of post stroke depression

2. . A multi disciplinary team that includes a psychiatrist must be assembled for the treatment of stroke patients, as such a team brings the most benefit to the patients.

The this study was carried out to determine the anxiety and hope status of the relatives of the patients in intensive care unit.

First degree relatives of 116 patients in the intensive care unit of a hospital were involved in the present study. The data of the research was collected using a personal information form, the Spielberger State Anxiety Scale and Hope Scale.

It was found that the relatives of the patients were anxious. There was a statistically significant negative relationship between the numbers of visit by the relatives of the patients and their hope scores (r=-.357, p=.000). The more they visited the patient the more they lost hope. It was found that hope score was low in the patient's relatives who were female, spouse or parents of the patient, anxiety was high and hope was low in the patient's relatives who were literate and who had low income, hope was high in the patient's relatives who lived in a city and who had social security.

The first-degree relatives of the patients in the intensive care unit experience anxiety. As the number of visits by the relatives of the patients increases, their hopes about the recovery of the patient decrease. Therefore, continuous communication with the medical personnel and being continuously informed about the status of the patient will be helpful for the relatives of the patients in the intensive care unit to deal with the present situation.

In this study, we explored the attitudes towards Medically Unexplained Symptoms (MUS) of 500 GP's in Karachi, Pakistan. Using a questionnaire previously developed by Reid et al (2001), we aimed to investigate whether GP's attitudes towards medically unexplained symptoms are similar to those of GP's in the developed world.

500 GP's on the database of primary care centres at the Pakistan Institute of Learning and Living in Karachi, were all sent a covering letter explaining the purpose of the survey with a case vignette, a questionnaire, and a stamped addressed envelope. One month later, non-respondents received a telephone call from an investigator to remind them of the study.

Of the 429 respondents, 68.5% (294) were male and 31.5% (135) female. Although 80.2% of respondents felt that the main role of GP's was to provide support and reassurance, 76.9% of respondents also agreed that GP's had a role in referring patients with MUS for further investigations to identify a cause. 204 (47.55%) respondents agreed that somatization was useful concept, only 146 (34.03%) felt that there was effective treatment for it.

For the most part Pakistani GPs’ attitudes towards MUS are similar to those of their counterparts in the West. Both agree that the GP had an important role in providing reassurance and counselling. However, our survey also shows that Pakistani GP's are less likely to place emphasis on an underlying psychiatric diagnosis and tend to focus on looking for an underlying physical cause.

Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycaemia due to either the deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate. Depressive disorders have been found to occur at increased prevalence rates among patients with Type 1 and Type 2 Diabetes Mellitus 9. Depression has the additional importance in diabetes because of its association with poor compliance with diabetic treatment, poor glycemic control and an increased risk of micro and macro vascular complications. An accurate estimate of depression prevalence is needed to keep and gauge the potential impact of depression management in patients with co-morbid diabetes 22. Better recognition and better treatment of depression are important in themselves but they could also improve medical outcome by substantial portion in patients of diabetes

Total of 527 cases of Diabetes were screened for major depressive disorder (MDD) by using DSMIV based criteria system. Montgomeny Asberg Depression rating scale (MADRS) and Clinical Global Impression (Severity) (CGI) scale to access severity.

:

1. 1. Major depressive disorder is inordinately high among the sample of adult diabetic patients occurring at the rates of 2 - 6 times greater than those observed in general population.

2. 2. Majority of patients with diabetes who have major depressive disorder have depression of moderate severity and not just mild depressive symptomatology.

3. 3. The presence of major depressive disorder is significantly associated with poorer glycemic control.

Patients with chronic pain suffer dramatic reductions in physical, psychological, and social well being, and their health related quality of life is lower. Anxiety and depressive disorders occur in 20%-25% of patients with rheumatoid arthritis.

The effectiveness of antidepressants for the treatment of major depression is well documented; however, the analgesic properties of this class of medication are under-appreciated.

This study aims to prove magnitude of association between RA and Depression along with independent effect of Fluoxetine on depression and arthritis.

100 socio-demographically matched woman attending a rheumatology clinic with a diagnosis of rheumatoid arthritis as defined by American Rheumatism Association criteria, were approached for the study along with homogenous group of controls. HADS, MADRS and CGI were applied. Both the groups were treated with anti RA drugs along with added antidepressant in depressed RA group.

Strong association between RA and depression was established. Treatment out come of RA was better and earlier in the depressed RA patients who were given antidepressant than non-depressed RA.

All chronic pain conditions warrant psychiatric evaluation to unmask the associated psychiatric disorders as treatment of psychiatric disorders prove to expedite the recovery of physical symptoms as well, thus improving productive life span of an individual with chronic painful conditions.

In patients undergoing coronary-artery bypass surgery (CABG) the presence of cognitive functions deficits is frequently observed. This procedure is also associated with a danger of appearance of depression and anxiety. As the above symptoms may coexist, the purpose of this study was to observe the presence of depression and anxiety symptoms before and after the operation, and their impact on the cognitive functioning of operated patients.

It included 50 subjects in whom the intensity of depression was assessed with the use of the Beck Scale (BDI), and the anxiety as state and trait was assessed with the use of STAI scale on 1 day before the operation and on 5-7 days after the operation. At the some time cognitive functions were assessed with the use of Vienna Test System (VTS).

The change of intensity of anxiety and depression and most of the analysed cognitive functions, except learning ability, was statistically significant. However the correlation of depressive and anxiety symptoms with the cognitive deficits achieved the level of significance only with the reference to attention disorders.

The achieved results show a considerable independence of the cognitive functions examination from the present emotional state in examined patients.

Hypersexuality is an uncommon behavioral complication associated with traumatic brain injury (TBI) involving lesions to frontal basal, temporal, or diencephalic structures. Experimental brain injury in animals has produced hypersexual behaviors; however, there is comparative paucity of knowledge in humans. TBI with hypersexuality offers insights into neurological basis of aberrant sexual behaviors as well as potential treatments. This case report describes social/sexual disinhibition in a patient following neurosurgery for self-inflicted TBI.

Case analysis with literature review.

32-year-old male was admitted with TBI following an unsuccessful suicide attempt, self-inflicted nail gun injury to the occiput. CT scan revealed 6.5cm nail that had entered the skull in right occiput, right parasagittal location with nail head right of vein of Galen, coursing through splenium of corpus callosum, right thalamus-hypothalamus-midbrain, with its tip at the suprasellar cistern. Occipital craniotomy with retrieval of foreign body was performed eleven days after admission. From post-operative day eight through twenty-seven, patient made inappropriate sexual comments to female medical student: asking her out repetitively, describing her physical appearance, enquiring about her suitors, and requesting her to call him upon his discharge. Prior psychiatric history was pertinent for major depression and social anxiety (especially women) with psychotropic noncompliance. During admission, patient was diagnosed with recurrent major depression, social anxiety by history, and impulse control disorder nos. On sertraline titrated to 100mg qhs, depression resolved with increased control over newly acquired sexual/social disinhibition noted.

TBI can lead to social disinhibition and hypersexuality. Sertraline may be a beneficial treatment.

Many studies have attempted to delineate the positive relationship between anxiety and depressive symptomatology in outpatients with bronchial asthma. However, do not exist reports on the relation between the depression, anxiety and vital exhaustion in these patients.

Aim of the study is to investigate the levels and the associations between anxiety, depression and vital exhaustion in outpatients with bronchial asthma.

The study was performed in one of the largest hospitals of chest diseases in Greece. Forty (14 men και 26 women) outpatients with bronchial asthma participated in the study. Using the BDI (Beck Depression Inventory), the STAI (Spielberger Anxiety Trait Inventory) and the Maastricht Questionnaire (MQ) we assessed depression, anxiety and vital exhaustion, respectively. Age and duration of the disease were also recorded.

Means of age and of duration of the disease were 43.22±13.05 and 9.24±6.01 years, respectively. The mean STAI score was 42.47±9.9, mean BDI score was 14,16±7,54, and the mean MQ score was 21.02±11.05. Percentages of 29% and 60% of the sample were presented with significant anxiety and depressive symptoms, respectively. No correlation was observed between the demographics (age and duration of disease) and the STAI's and MQ's scores. In contrary, a positive correlation was observed between the levels of depression, anxiety and vital exhaustion (pearson correlation p< 0.001).

The study confirms the coexistence of the depressive symptomatology with anxiety and vital exhaustion in outpatients with bronchial asthma. Therefore, this comorbidity should be taken into account in order to develop specific supportive psychological interventions.

Many studies on samples of HIV-positive patient's shows correlation of psychiatric symptoms and medical and immunological symptoms of HIV infection. Also, presence of psychiatric distress was showed in some somatic diseases, especially the ones which lead to chronic.

The aim was to examine presence of psychopathological symptoms among HIV-1 infected patients which haven’t developed AIDS, in comparison to hepatitis B or C infected patients.

Sample for consisted of 60 patients: a) 30 somatic asymptomatic HIV-1 seropositive patients who constituted study group, and b) 30 patients infected with hepatitis B or C which constituted control group. All of them have been assessed on the presence of psychiatric symptoms by the SCL-90 (The Symptom Checklist 90). After the assessment those two groups were compared by student's t test on every subscale and total score.

Results of the study showed that patients in both groups exhibited moderate presence of psychopathological symptoms, especially symptoms of depression, anxiety and interpersonal sensitivity. Moreover, patients with HIV exhibited obsessive-compulsive symptoms. Results showed that there are no statistically significant differences in presence psychopathological symptoms between somatic asymptomatic HIV-positive patients and patients infected with hepatitis B or C.

Based on the results of this study it could be concluded that, beside the moderate presence of psychopathological symptoms in the samples of somatic asymptomatic HIV-positive patients and hepatitis B or C infected patients, there is no statistically significant difference in those samples of patients.

The psychiatric reactions relating to Human Immunodeficiency Virus (HIV) infection cover the whole range of mental illnesses and psychosocial problems. This poses a challenge to both physicians and psychiatrists and is of immense relevance due to the rising number of HIV patients in Singapore.

To retrospectively examine the psychiatric disorders and related factors associated with HIV infected patients in a general hospital in Singapore.

To review and describe the psychiatric disorders and related factors associated with HIV patients under the care of Tan Tock Seng Hospital and Communicable Disease Centre in Singapore.

A 2-years retrospective descriptive study was performed on all HIV patients who were referred to the Department of Psychological Medicine of Tan Tock Seng Hospital for psychiatric assessment and this includes both inpatient and outpatient referrals. The data for inpatient referrals was obtained through the interdepartmental referral registry and relevant case notes. The data for outpatient referrals was obtained through the attendance and relevant case notes of the HIV psychiatric clinic. The data was collated and analyzed.

Mood disorders were the most common psychiatric disorders diagnosed and antidepressants were the most commonly used psychotropic drugs. Most patients were followed up on an outpatient basis for continuation of treatment.

Many HIV infected patients may have concomitant psychiatric disorders. Clinicians may need to actively identify patients at risk and initiate early psychiatric consult to ensure appropriate care for these treatable disorders.

Pathological anxiety is characterized by the absence of a reason for anxiety. However, the presence of fear provoking stimuli does not exclude the possibility for a pathological course of anxiety, i.e. “Pathological Realangst”. An example are hypochondriac anxieties in patients with severe somatic disorders. An open question is to what degree severity of somatic morbidity is related with anxiety.

In 209 patients (37,8% women) from a cardiology inpatient unit general anxiety, heart-related anxiety, progression anxiety, and job-anxiety were measured. Physicians rated the degree of severity of the somatic (heart-)disorder using the Multidimensional Severity of Morbidity Rating (MSM rating). Relationships between the degree of anxiety and somatic morbidity parameters were investigated.

Anxiety did not or to a very low degree correlate with objective indicators of somatic morbidity. Subjective suffering showed a moderate significant correlation with heart-related anxiety and progression anxiety, and was also correlated with sick leave duration.

Severity of somatic illness is a multidimensional phenomenon and not regularly related in a special way with anxiety, except the dimension of subjective suffering. Pathological fears, even when occurring in the context of somatic disorders, are not related to objective endangerment, but have to be described as mental problems.

The main purpose of this study is to measure the prevalence of cognitive impairments among hypertensive outpatients in the Hypertension Department of Cardiology National Institute.

A sample of 90 consecutive hypertensive outpatients was evaluated from the cohort of 217 hypertensive patients population in treatment. They were assessed by the same PhD psychiatrist using the Mini Mental State Examination.

Prospective study of a sample of 90 consecutive hypertensive outpatients was evaluated from the cohort of 217 hypertensive patients population in treatment. They were assessed by the same psychiatrist, using the Mini Mental State Examination (MMSE).

The main question, proposed by this study, if arterial hypertension causes cognitive impairment, has a negative answer, for it was observed that for each mercury millimeter increased in the Diastolic Blood Pressure (DBP), occurs a downfall of only 0.02 in the MMSE, but when adjusted according to the age of subjects, the association among DBP and the MMSE score disappears. Statistical analysis included the t test of Student or Mann-Whitney, qui-square test or Fisher's exact test and linear regression.

This study did not show any causal correlation between hypertension and cognitive impairment. According to numberless articles, the MMEE instrument demonstrated in this study, great bias associated with illiteracy and formal education.

This research aimed to evaluate the prevalence of psychic depression in patients with acute coronary syndrome (ACS) and the interdependency with risk factors for coronary artery disease (CAD).

Prospective stdy of patients consecutively admitted with ACS and screening for depression through the Beck Depression Scale, which was used within the first 5 days after admission. Patients who presented simultaneous diagnosis of severe neoplasia, use of antidepressant medication, incapability to communicate or comprehend, were excluded from the research. Statistical analysis included the t test of Student or Mann-Whitney, qui-square test or Fisher's exact test and the log-linear model to evaluate interdependency among risk factors for CAD.

98 out of the 135 patients admitted with ACS presented acute myocardial infarction, while 37 presented unstable angina, mean age of 61.8 years,of which 40% were female.Prevalence of depression in this study was 53.3%. (n=72) distributed in three groups according to the degree of intensity:28.1% with mild depression,14.1%moderated depression, and 11.1% with severe depresion. Among in-hospital deaths, 88.9% (n=8) were in patients with depression and only 11.1% (n=1) in patients without depression, with relative risk 0f 6.99 (p=0.027) Depression was more prevalent in female patients. Depression was present in association with great numbers of risk factors: dislipidemia, sedentary habits, sex (p=0.0259), family history systemic arterial disease and hypertension (p=0.0098)

The results of this study show a high prevalence of psychic depression among patients with acute coronary syndrome with elevated mortality risk and interdependency with other risk factors.