Sexuality is a crucial area of human life. A proper examination to assess and detect problems in this field, it seems imperative to intervene when transsexual patients. Therefore accurately known, the sexual practices of these patients, allows us to work directly on possible alterations in the functioning of sexual life during the therapeutic process.

Describe patterns of sexual behavior in patients diagnosed with transsexualism

Gender and Identity Disorder Unit (GIDU)

Selected by consecutive sampling, 200 transsexuals treated at GIDU Malaga, aged between 20 and 40 years and who agreed to participate in the study. Comprising 142 transgender male-to-woman (MtW) and 58 women-to-man (WtM).

Was conducted through a heterocompleted questionnaire that included questions about sexuality, personality traits and demographic characteristics. These were filled in the consultation and were anonymous.

11.6% of MtW transsexuals have never had sex. 26.8% of the MtW and 29% of WtM are more than 3 months without masturbating. 54.1% of the MtW avoid having sex due to the rejection of his genitals, lack of sexual desire and previous traumatic experience. Transgender respondents had secondary education, stable jobs and they were single.

It is vital that we explore the sex lives of transsexual patients. This information must be integrated in a systematic and rigorous evaluation process. According to the results presented, the hyposexuality would be the most significant feature that describes sexuality for this population.

Traumatic brain injury (TBI) is recently recognized as a risk factor for hypopituitarism, presented most frequently with growth hormone deficiency (GHD). GHD is associated not only with changes in body composition, but also with impaired quality of life, cognitive dysfunctions and some psychiatric sequelae, usually classified as “depression” or “atypical depression”. The impact of GH therapy on mental status is still unknown.

Psychiatric and cognitive functions were tested in six adult GHD subjects at baseline (minimum three years after TBI), reassessed after six months of GH replacement therapy as well as twelve months after discontinuation of GH therapy. Psychiatric and cognitive examinations included semi-structured interviews and three instruments: Symptom-checklist (SCL-90-R), Zung Depression Inventory and standard composite neuropsychological battery.

Six months of GH therapy in GHD TBI patients improved cognitive abilities (particularly verbal and nonverbal memory) and improved psychiatric functioning. Severity of depression decreased, as well as intensity of interpersonal sensitivity, hostility, paranoid ideation, anxiety and psychoticism. In three GHD patients who stopped GH therapy for twelve months we registered worsening of the verbal and nonverbal memory, as well as increase in Zung score and three SCL dimensions: inter-personal sensitivity, anxiety and paranoid ideation.

This preliminary data suggest that GH therapy induced reduction of depression, social dysfunction and improvement in certain cognitive domains in GHD patients after TBI. Our data support the necessity of conducting randomized placebo-controlled trials on the effects of GH therapy on neuropsychological and psychiatric status in GHD TBI patients.

Patients presenting with self harm account for a significant proportion of attendances to the emergency department. NICE guidelines recommend these patients must undergo full psychosocial and risk assessment with mental state examination.

Aims included to investigate the demographic factors of those presenting to the emergency department with self harm and explore methods of self harm. Also, to review the psychiatric history, exploration of suicide risk factors and assessment of suicidal intent, the mental state examination and referral for further treatment.

We also wished to make recommendations to improve the history taking process should this be proved necessary.

Data was collected retrospectively from February to August 2009. Twenty-five casualty cards were collated at random for patients who presented with self harm. Evidence of exploration of the objectives were investigated.

Suicide risk factors and suicidal intent were poorly documented. The mental state examination was not documented in all cases. 18 were referred for psychiatric review.

Psychosocial and risk assessment of those presenting to the emergency department with self harm is poor. As a result of this study, We have designed and introduced a proforma to be completed by doctors in the emergency department. This incorporates the mental state examination and is to aid the assessment of suicidal intent in patients presenting with self harm. The effectiveness of this proforma will be assessed with a re-audit planned in 3 months time.

Following a previous audit conducted at Bedford Hospital we found no formal screening tool for depression was used in post-stroke patients. The prevalence of depression in the sample of 63 patients was 28%. We recommended the implementation of the PHQ-9 questionnaire as a screening tool for depression in these patients.

To assess the effectiveness of the PHQ-9 as a screening tool for depression in stroke patients. To review whether implementing this screening tool has increased the prevalence of depression within this patient population.

All patients admitted to the stroke ward in Bedford Hospital between 10/09/09 and 13/12/09 were included in the audit. Patients were screened two weeks after admission. Exclusion criteria were met if patients lacked mental capacity to be screened; the patient declined or was discharged or deceased within 2 weeks.

Of 83 patients admitted, 18 (23%) were screened. Of these, 10 patients (53%) scored 5 or above, indicative of depression. One patient scored 10 indicative of moderate depression, and one patient scored 19 indicative of severe depression.

The PHQ-9 questionnaire is useful as it clearly increased the prevalence of post-stroke depression. However noticeably there are a significant proportion of patients who could not be screened using this tool as it is a self report assessment. This includes those who lack capacity or have communicative difficulties as is common after a stroke.

To determine the prevalence of depression and quality of life in patients with epilepsy, and its associated risk factors.

This was a cross sectional study where 120 patients with epilepsy and 60 controls who were the patients’ sibling, were recruited. Socio-demographic data (age, sex, race, marital status, education level and employment status) and clinical variables (age at onset, duration and type of seizure, seizure recency, type of antiepileptic drug used, family history of epilepsy and depression) were recorded. Both patients and the control subjects were given the “Hospital Anxiety and Depression Scale” and “Mini International Neuropsychiatric Interview” to screen and diagnose for depression respectively. The Quality of Life Inventory of Epilepsy (QOLIE-31) was used to assess quality of life.

The prevalence of depression in patients with epilepsy was higher than in controls (9.2% as compared to 3.3%), though it was not statistically significant. There were also no significant differences between the depressed and non depressed patients in terms of socio-demographic and clinical variables. However, patients with younger onset of epilepsy were more likely to report depressive symptoms on HADS (p = 0.02). Patients with epilepsy who were depressed also had poorer quality life as compared to those without depression: p< 0.001.

Patients with epilepsy had higher rates of depression as compared to controls. Furthermore they had significantly poorer quality of life as compared to those without depression. Therefore, epileptic patients should be regularly screened for depression to prevent unnecessary suffering and poorer quality of life.

To find the prevalence of different Somatoform Disorders (SDs) in psychiatric consultations to inpatients and outpatients of Farabi General Hospital(Kermanshah-Iran) in 10 years (from 1994 to 2004) and to define their demographic variables.

Any patient, who received an SD diagnosis by the consultants, was further assessed, using a two-phase design, for DSM-IV SD criteria.

A total of 801 patients fulfilled diagnostic criteria for a DSM-IV SD. Among these 493(61.5%) had Conversion Disorder, 127(15.9%) Somatization Disorder, 117(14.6%) Hypochondriasis, 41(5.1%) a Body Dysmorphic Disorder and 23(2.9%) a Pain Disorder).Most of the patients were young, female, married and not educated more than primary school.

Somatoform Disorders are common in psychiatric consultations of General Hospitals. Internists, surgeons and other specialists need to be aware of these disorders.

To assess treatment-seeking behaviour in psychiatric patients with co-morbid infertility.

METHODology: This hospital-based prospective study was conducted on out-patients, consulted at NMI (Neuro-spinal & medical Institute), Karachi.All consecutive and consenting cases were interviewed using a semi-structured proforma. Results were tabulated and analyzed through SPSS Version 11.0. Fisher Exact test/Chi-square test were used to compare variables.

One hundred five cases (62.85% Men and 37.14% Women) that fulfilled the criteria of infertility were evaluated. More than half (51.42%) of the cases had sought alternative type of treatment including treatment from Faith Healers (19.04%), Hakeems (Eastern/Indigenous Practitioners=18.09%) and Homoeopathics(14.28%). The rest of the cases had history of multiple consultations with Allopathic medical practitioners.

The impact of Infertility is serious especially in the east making a person vulnerable to seek help from the various available source of treatment particularly traditional/ alternative mode.

The complaints such as weakness, difficulty swallowing and speaking that worsening at evening, may be easily supposed neurotic disorders, in a twenty-two year old male patient, has started about two months ago. In neurology clinic, in requested psychiatric consultation; there were complaints like inability to breathe, sweating, palpitations, reluctance, pessimism and unhappiness.

The patient has diagnosed according to DSM IV-TR as “Agoraphobia without panic disorder” and “Major Depression, Single Episod”. Escitolopram titrated by 20 mg/day has started. Depressive and agoraphobic symptoms have disappeared at the end of four weeks (HAM-A-D:24;11-21;9).

MG patients, especially during the beginning of disease symptoms in almost all patients with the appeal was referred to the psychiatric services and 1/3 of it has been reported as psychiatric mis-diagnosis [1,2]. Choice of psychotropic drugs is important that do not affect the respiratory center and neuromuscular transmission. Agents, used in the treatment of MG, can inflame psychopathology and can create resistance to psychotropic treatment. Therefore, cooperation of neurologist and psychiatrist is important.

The complaints such as weakness, difficulty swallowing and speaking that worsening at evening, may be easily supposed neurotic disorders, in a twenty-two year old male patient, has started about two months ago. In neurology clinic, in requested psychiatric consultation; there were complaints like inability to breathe, sweating, palpitations, reluctance, pessimism and unhappiness.

The patient has diagnosed according to DSM IV-TR as “Agoraphobia without panic disorder” and “Major Depression, Single Episod”. Escitolopram titrated by 20 mg/day has started. Depressive and agoraphobic symptoms have disappeared at the end of four weeks (HAM-A-D:24;11-21;9).

MG patients, especially during the beginning of disease symptoms in almost all patients with the appeal was referred to the psychiatric services and 1/3 of it has been reported as psychiatric mis-diagnosis [1,2]. Choice of psychotropic drugs is important that do not affect the respiratory center and neuromuscular transmission. Agents, used in the treatment of MG, can inflame psychopathology and can create resistance to psychotropic treatment. Therefore, cooperation of neurologist and psychiatrist is important.

Sjögren's syndrome (SS) is a common medical condition which may produce psychiatric disturbances. Psychoactive medications treat psychiatric symptoms, but leave the underlying process unaffected.

To emphasize that psychiatric disorders in primary SS constitute an indisputable clinical reality that each practitioner must be able to recognize and treat.

A systematic review on psychiatric manifestations of SS and two case-reports of mental disorder as clinical presentation of primary SS.

Psychiatric manifestations in primary SS are common and can occur not only during its course, but also at onset of the autoimmune syndrome. A better adapted prescription of corticosteroids and/or immunosuppressive agents (together with specific psychotropic traetments) can induce to a rapid relief of psychiatric dysfunction.

Psychiatrists should keep in mind that primary SS is a potential cause of mental disorders when examining patients with multiple somatic complaints and psychiatric symptoms.

The Munchausen's Syndrome, first described by the English doctor Richard Asher in 1951, refers to a factitious disorder present in patients who are repeatedly admitted in medical emergencies for apparent serious diseases and are looking forward to intensive medical care. The authors present a challenging case report, highlighting the importance of a thorough medical investigation before setting into Munchausen's Syndrome stigmatizing diagnosis.

The authors present a case studied in an Oncological Center, with emphasis on the medical data, diagnostic process, multidisciplinary approach, family-social-occupational implications and outcome. A review on Munchausen's Syndrome, using Medline database, focusing on the last decade publications on the subject, was carried out.

The clinical presentation initially led to strong suspicion towards Munchausen's Syndrome, since it was an young adult, single, health related profession (doctor), with life event triggers (family and social isolation; affective rupture).With the on going diagnostic process, it ended out on an atypical presentation of Crohn's Disease. However, the stigmatizing label had already been set, adding psychological damage to the patient (adjustment depressive disorder).

From the Munchausen's Syndrome review in recent literature, the authors conclude that this rare diagnosis is even rarer on oncologic settings. It should always be an exclusion diagnosis, made after a careful medical screening carried on by an expert and multi-disciplinary team, which should include a liaison psychiatrist. The patient presented classical Munchausen's clinical profile, which can be misleading by it self, incurring into a misdiagnosis.

Multiple Sclerosis (MS) is an acquired chronic neurological disorder. Studies have shown that prevalence of MS is more in some areas of Iran like as Azarbaijan(Tabriz) and Isfahan. General health problems are prevalent in MS patients. Written Emotional Expression (WEE) is one of the cost-effective self helpers' methods that its efficacy has been studied on mental health, but this method has never been studied on MS patients in Iran.

Aim of this study was to evaluate efficacy of WEE on general health of MS patients.

With experimental study, 40 (8 male, 32 female) MS patients who had completed informed written consent and filled General Health Questionnaire (GHQ-28) were asked to write their negative feeling for 30 minutes daily for 4 consecutive days. After 15 days they filled GHQ again. Finally the Statistical analysis was done.

After intervention of Written Emotional Expression, general health score in patients with multiple sclerosis decreased significantly. (p< 0.01)

Written Emotional Expression may be effective on general health of multiple sclerosis patients.

Psychological problems like anxiety in patients who are candidate for coronary artery bypass graft (CABGs) may increase mortality and morbidity. The effect of reassurance and preoperative information in decreasing anxiety is uncertain.

This study was designed to address the effect of preoperative information and reassurance in decreasing anxiety patients who are candidate for CABGs.

With experimental study and random sampling 85 (55male and 30 female) of 238 patients who were candidate for CABGs were included and completed spilberger anxiety test on the day of admission. Preoperative information and reassurance was done and test was completed again a day before the surgery. At last the Statistical analysis was done.

The Mean score of anxiety in patients with mild anxiety disorder (21 patients) was 34± 4.2 before and 39±5.8 after intervention. In patients with moderate anxiety disorder (39 patients) the score decreased from 52.61±3.8 to 50.76±56. Twenty five patients had severe anxiety disorder formerly with score of 63.88±2.8 which decreased to 53.88±7.6. All of differences were significant statistically.

In patients with mild anxiety intervention of preoperative information and reassurance resulted in increasing of anxiety but in patients with moderate or severe anxiety disorder such intervention decreased the level of anxiety significantly.

Sudden cardiac death (SCD) is responsible for 300,000 deaths annually. The use of ICD has improved survival rates following SCD episodes. However ICD may causes anxiety in patients. ICD shock is suspected as cause of enhanced anxiety.

The aim of present study was to evaluate the prevalence of anxiety disorders in patients with ICD.

In a case- control study with random sampling of 57 patients with ICD (at least 6 month after ICD implantation) they were compared with 57 patients without ICD as control group. In this study the SADS questionnaire and DSM- IV structured interview were used. The relation of gender, age, marital status and shock with anxiety was determined. The analysis was done using descriptive and qualitative statistics.

Frequency of anxiety disorders in ICD patients was 47.4%. 19.3% panic disorder, 47.4% GAD, 12.3% phobia and 5.3% OCD. PTSD was not seen in ICD patients in this study. There was a significant difference in frequency of anxiety disorders between ICD patients and control group (P= 0.001). The most frequent disorders in patients with ICD were GAD. The incidence of anxiety disorders in patients with and without ICD discharge was 84% and 18% respectively. Anxiety disorder was significantly related to the ICD discharge (P< 0.0001).

Among the anxiety disorders GAD was observed to be the most frequent in the patients with ICD discharge rather than patients without ICD.

Medical patients construct schematic representations of illness which may impact on their recovery and adjustment with their medical condition. The purpose of the present study was to examine relationship between the history of myocardial infarction (MI) and illness representations among post-MI patients.

One hundred seventy six consecutive patients following MI admitted to the CCU wards were selected based on the inclusive and exclusive criteria. The patients completed demographic questionnaire and Brief Illness Perception questionnaire (B-IPQ). Their medical data were obtained from medical records and history of MI was confirmed by cardiologist based on one of the following criteria: clinical symptoms, Enzima indices, electrocardiographic changes, echocardiography, and angiography. Therefore, the patients were divided into two groups with and without previous MI. Chi-squared test, Student's t-test, MANCOVA and Covariance were used to analyze the data.

The findings showed that 30.1% had previous MI. The results of MANCOVA indicated that Significant difference between two groups in B-IPQ scores (F= 2.653, P= 0.025). Also, the results of covariance showed that significant differences in three domains of illness perception including identity (F= 4.776, P= 0.03), consequences (F= 70671, P= 0.006) and timeline (F= 10.092, P= 0.002). However, there were no significant differences in controllability (F=0.165 P= 0.687) and treatability (F=0.26, P=0.611) between two groups.

Generally, post MI patients with previous MI likely develop negative schema about MI. Also having previous MI may impact on perception of identity, consequences and timeline of MI.

The aim of this study was to assess the course of quality of life and emotional status outcomes during the six months after elective CABG.

In a prospective study, we followed up for 6 months 138 of the original 147 CABG patients. A series of psychometric self - rating scales were administered.

The ratings obtained from the BDI reflected significant decreases in levels of depression from preoperative to 6 - month follow - up assessments (before surgery = 6.5 ± 4.9; at 6 - month follow - up = 4.6 ± 4.7; p < 0.001). The PTSS - 10 ratings from the whole sample reflected significant decreases in levels of PTSD symptoms from preoperative to 6 - month follow - up evaluations (before surgery = 18.2 ± 6.7; at 6 - month follow - up = 17.3 ± 8.0; p < 0.01). The measurements of health - related quality of life indicated significantly higher SF - 36 values on all of the eight health - related domains from preoperative to 6 - month follow - up. However, at 6 - month follow - up, patients with clinical depression and posstraumatic stress symptoms had significantly lower SF - 36 values on a variety of SF-36 domains.

Elective CABG is associated with significant improvements in HRQOL relative to the preoperative period, but impairments in HRQOL were found in a subgroup of post - CABG patients with evidence of PTSD, or depression at 6 - month follow - up.

To present a case of Huntington's Disease and discuss neuropsychiatric management.

Case presentation.

We would like to present a case of Huntington's disease in an adult asian-indian male. The poster consists of a case report followed by a discussion on Huntingtons. We discuss the aetiopathogenesis, presentation and recent management trends of this neuropsychiatric condition.

Mr. H was an Asian Indian immigrant in the United Kingdom. He presented with gradually worsening chorea, personality change and cognitive decline. Psychiatric symptoms closely followed with the development of aggression, paranoid delusions and visual and auditory hallucinations.

Management included a multidisciplinary approach involving psychiatrists, neurologists, the local Huntington's disease service and a host of Para clinical teams.

In the discussion, we trace the aetiology of Huntington's disease, the epidemiology and regional variations in Incidence and prevalence rates. The presentation, disease process and prognosis of Huntington's Disease is discussed. We present recent trends in management including the use of Omega 3 Fatty Acids.

Though there has been a significant increase in the amount of research on the condition, this appears to have been concentrated mainly on those populations with a higher prevalence. Studies on the causes of lower prevalence in Asian, especially Indian populations are still few in number. Such research could provide valuable clues including detection of protective factors in these populations. These in turn could prove useful in the management of the disease on both an individual and wider socio-economic level.

Treatment of medical catatonia sometimes requires management of presenting psychiatric syndrome as well as treatment of causative medical illnesses. Treatment response to these approaches may, however, differ even in the same patient suffering a relapse of a similar clinical picture, and this presents a therapeutic challenge for physicians. We therefore report a case of medical catatonia due to Graves’ disease which responded to antithyroid therapy in the first episode but required electroconvulsive therapy (ECT) when relapsed, then discuss the possible mechanism which caused different treatment response.

We describe the clinical course with the laboratory findings of recurrent catatonic episodes of a patient with Graves’ disease.

A 25-year-old woman manifested stupor, catalepsy and echolalia accompanying goiter, proptosis and tachycardia. Laboratory findings on thyroid function were consistent with Graves’ disease. Treated with thyamazole (TMZ), her psychiatric and physical symptoms gradually subsided. She had remained euthyroid and symptom free for 10 years on TMZ 5 mg every other day. However, at age 35, she exhibited stupor with mannerism and stereotypy. Laboratory findings revealed mild exercerbation of thyroid function. Though antithyroid therapy regained euthyroid, her psychiatric symptoms persisted. Further treatment with neuroleptics did not ameliorate her symptoms. She was thus administered bitemporal ECT and recovered after 7th trial.

Aggravation of thyroid function associated with catatonic symptoms when relapsed was milder compared to the first episode. This suggested that dysregulation of thyroid homeostasis in the central nervous system might have persisted despite the peripheral euthyroid and could affect the treatment response.