This literature review examines the issues facing foreign mentally disordered offenders (FNMDOs) in accessing psychiatric care in the UK.

Studies/reports relevant to FNMDOs in Healthcare, Probation services, Inspectorate of prisons, Crime reduction charities, Department of Health were examined. Keywords searched on MEDLINE and Psychinfo: ‘foreign, mental,*offender,*criminal.*’

According to 2009 statistics, 14% of UK prisons consisted of foreigners of which 80% suffered mental health problems. FNMDOs face a number of issues like negative stereotyping, racism, poor family contact, language/cultural barriers, which hinder accessing psychiatric help. Indefinite detention of foreign prisoners, post-amendment of the UK Borders Act 2007, has been found to result in increased depression and suicidal ideation. Self-inflicted deaths increased since 2006. Research on migration-morbidity hypothesis and refugees/asylum-seekers demonstrates higher psychiatric morbidity. A 2005 meta-analysis reported worse outcomes for institutionalized refugees. Detention centres often have poor healthcare provision, though prevalence of PTSD, depression, anxiety, somatoform disorders is high. FNMDOs face limitations in availability of legal aid and immigration advice across the prison system. Lack of a clear care pathway compounded by poor inter-agency communication and understanding of immigration procedures adversely affects treatment and continuity of psychiatric care.

FNMDOs are a vulnerable group with complex needs which may go unidentified. Improving care and outcomes for FNMDOs requires adequate prison staff training, ready interpreter access, facilitation of family visits/cultural contact. Effective multi-agency collaboration in early identification, intervention, clarity in care pathway and immigration advice would result in reduced psychiatric morbidity in this vulnerable group of offenders.

Traumatic injury, advanced age, concomitant somatic disorders promote the development of the elderly with hip fractures of various mental disorders.

To establish the prevalence, nosological spectrum, dynamics and prognosis of mental disorders in elderly and senile patients undergoing hip fracture or femur.

The study included 101 patients aged 60 years and older (mean age - 76.4 + 8.2 years) with a fractured neck of femur or femur, being treated at the trauma wards of several hospitals of Moscow.

A survey of patients in elderly undergoing hip fracture or femoral found that 82.2% of the patients at the time of the study had various mental disorders. Fracture of the femoral neck or the femur can be seen as provocative or etiological factors such as mental health states of confusion (19.8%), due to situational depressive disorder (8.9%), which appeared isolated sleep disorders (5.9%), alcohol delirium (3%). Depressive spectrum disorders in the background of hip fracture or hip are more common in younger persons (p < 0.03), whereas the state of confusion - in older individuals (p < 0.01). By the time catamnesis (on average, a year after the first examination) died 27.8% of persons included in the follow-up of the group.

The study confirmed the expected high rate of adverse outcome of hip fracture or femur in elderly and senile patients with a state of confusion or dementia. Probability of reduction of mental disorders occurring against hip fracture or femoral increases significantly when the surgical treatment.

Child protection guidelines within a London mental health trust state that all mental health professionals should identify patients who have dependents, if so it should be established that these dependents are safe, and any concerns should be taken forward to relevant agencies.

Establish if child protection guidelines are being followed in emergency psychiatric assessments.

Establish whether patients are being asked whether they have dependents, if the dependents are safe, and whether concerns are being discussed with child protection services.

An audit was carried out in which documentation from 3 days of emergency assessments where examined to see whether the above questions were being asked.

In cycle 1, 11 out of 18 patients asked about dependents, 7 had dependents, 4 were documented as being safe, 3 raised child protection concerns, 0 taken forward.

In cycle 2, 7 out of 17 patients asked about dependent, 6 had dependents, 3 documented as being safe, 0 child protection concerns were raised.

Obesity hypoventilation syndrome is a multifactorial clinical condition developing in obese people. The symptomatology of the disease is dominated by disorders of breathing during sleep, and hypoventilation leading to chronic hypercapnia with underlying metabolic and hormonal disorders leading to complications of the cardiovascular disease.

Here we describe a case of a patient treated for many years because of pulmonary hypoventilation syndrome accompanied by obesity and metabolic syndrome followed by a reduction in blood oxygen tension.

Despite the exacerbation of the underlying disease (parameters on admission 66mmHg pCO2, pO2 29mmHg, SaO2 43%) our patient showed no signs of a mental disorder. Slight short-term memory problems, decreased mood and drive relevant to the degraded state of somatic were present. During the hospitalization, the use of oxygen therapy led to the improvement of blood parameters, however the mental state became more complicated. The patient started to develop symptoms of delirium with a delusional interpretation of reality. Despite administered pharmacotherapy and further improvement in respiratory parameters (at discharge pCO2 62mmHg, pO2 59mmHg, SaO2 89%) the patient's cognitive dysfunctions showed no further improvement and delusions of persecution were still present. This required further psychiatric care alongside with patient's somatic treatment.

A strong link exists between disorders of cognition, and chronic respiratory failure (hypoxia with concomitant hypercapnia). This may be also accompanied by psychiatric symptoms, which may become difficult to treat even if the somatic parameters are successfully improved.

The shift work has various negative influences on health, performance, activity, and social relationships as well as causing impairment in cognitive functions.

We aimed to investigate the effects of shift work on participants’ cognitive functions in terms of memory, attention and learning, and on oxidative stress indicated by total oxidant status, total antioxidant capacity, and oxidative stress index.

90 health workers participated in the study (45 subjects were night shift workers). The neuropsychological tests were applied to the participants for assessing the cognitive functions and blood samples were taken to detect their total antioxidant capacity and total oxidant at 8.00 in the morning. Depression, anxiety, chronobiological characteristics, cognitive functions were assessed by using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Morningness- Eveningness Questionnaire (MEQ), Wechsler Memory Scale- Revised (WMS-R), Auditory-Verbal Learning Test (AVLT) and Stroop Test.

Night shift workers reported significantly lower scores on the verbal memory, the attention-concentration, and the digit span forward sub-scales of the WMS-R as well as the immediate memory and the total learning sub-scales of the AVLT. Oxidative stress parameters were significantly associated with some types of the cognitive functions in both groups.

The findings suggest that health workers in night shift generally revealed significantly poorer performance in cognitive assessment as compared to day shift workers. The oxidative stress indicators associated with the cognitive functioning.

The review the successfulness of efforts to decrease suicides in Finland in the light of scientific studies.

The rate of suicide has decreased considerably and its association with the use of alcohol has weakened. Although the use of alcohol increased in the 1990's the rate continued to decrease. Two studies have linked the decrease in rate of suicide with the sale and use of antidepressants. This trend appears to be especially pronounced among men. Additionally, evidence shows that the replacement of hospital-based services with outpatient care has had a positive impact on suicide mortality of patients, who have received care in psychiatric hospitals. The decrease in suicide rate is associated with intensive outpatient care.

In the long run, the national suicide prevention project has been successful, although other factors, such as increase of standard of living and general wellbeing among citizens of Finland, have been likely contributors.

Structured diagnostic interviews performed by non-clinicians are today frequently used for research purposes and are increasingly common in clinical practice. The validity of such interviews is theoretically unexamined and only poorly empirically studied.

To assess the validity of structured psychiatric diagnostic interviews using the SCID (Structured Clinical Interview for DSM-IV) as a representative.

A sample of 100 diagnostically heterogeneous, first-admitted inpatients were interviewed and diagnosed by a forthe- purpose trained non-clinician rater using the SCID. The DSM-IV diagnoses yield from the SCID interviews were compared with consensus Life-Time Best Estimate DSM-IV diagnoses. These diagnoses were assessed by two experienced research clinicians based on multiple sources of information, which included videotaped comprehensive semi-structured narrative interviews.

The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by the SCID were 19% and 100% respectively.

Structured diagnostic interviews in a first-admission inpatient sample are not a valid way of allocating psychiatric diagnoses and are not recommendable for clinical work. These interviews should only be used in research on the condition of certain prior precautions. It is suggested that a revival of systematic theoretical and practical training in psychopathology is an obvious way forward in order to improve the validity and hence, a therapeutic utility, of the psychiatric diagnosis.

Previous research has linked OCPD with increased distress levels that may lead to differences in treatment response.

The present study aimed to investigate the influence of pre-treatment distress on patient's response to groupbased cognitive-behavioral therapy (CBT) for OCPD.

116 out-patients who met DSM-IV-TR diagnostic criteria for OCPD completed a pre-treatment assessment including BDI, STAI, STAXI-2, GRAI and Rosemberg Self-Esteem Scale. Pre-treatment distress was operationalized as depression and anxiety levels.

Intervention was comprised of ten group sessions including psychoeducation, specific CBT techniques and relapse prevention. in order to assess treatment response after intervention, the sample was divided in two groups:

1. 1) discharged patients -responders and

2. 2) patients who needed to continue treatment -non responders.

Assessment scores were compared using t test in order to analyze differences between groups. The extent to which potential predictor variables were related to treatment response was assessed using logistic regression.

Results showed statistically significant differences (p < 0.05) in depressed mood and state anxiety scores between responder and non-responder groups. Initial variable selection for logistic regression model included age, sex, depression, anxiety, anger, assertiveness and selfesteem scores. The final model included state anxiety as a significant predictor of treatment response.

Our findings indicate that responder patients had lower pre-treatment distress levels than non-responder patients and that state anxiety score is a significant predictor of group-based CBT response in OCPD. According to this, pretreatment distress levels might be considered for treatment planning, despite more research in this direction would be necessary.

Acupuncture, as complementary medicine, has been used since many years ago in china and many researches have proved its effect separately or combined with other treatment methods.

To compare therapeutic effects of Acupuncture plus estazolam and Cognitive - Behavioral Therapies plus estazolam on insomnia.

To determine the efficacy of acupuncture as complementary medicine in treating insomnia.

64 insomnia patients were randomly divided into an acupuncture group and a behavioral group, 30 cases in acupuncture group and 18 cases in behavioral group completed research. The acupuncture group was treated by administration oral estazolam before sleeping each day and needling, three times a week, the behavioral group received Stimulus control as Cognitive - Behavioral Therapy plus oral estazolam before sleeping each day. Treatment course was 3 weeks. The insomnia severity index (ISI) scores before and after treatment were observed in the both groups.

The total effective rate was 86.7% in the acupuncture group and 50% in the behavioral group with statistically significant difference (P < 0.05). The cured rate of 30% in the acupuncture group was significantly higher than 16.7% in the behavioral group (both P < 0.05).

The therapeutic effect of Acupuncture as a complementary medicine on insomnia is better than stimulus therapy as a Cognitive - Behavioral Therapy.

To evaluate severity of suicide intents and its connection to some clinical characteristics in men and women.

Clinical examination, The Pierce Suicide Intent Scale (SIS), Brief Psychiatric Rating Scale (BPRS), Beck Suicide Ideation Scale (SSI), Beck Hopelessness Scale (BHS), Beck Depression Inventory (BDI), The Symptom Checklist 90 Revised (SCL 90 R), Global Quality of Life Self - Rating Scale.

Suicide attempters over 15 years admitted to the psychiatric hospital within one month after parasuicide (N = 264; 114 men, 149 women).

Based on SIS rating of intent to die patients were divided into three groups (low, intermediate, high intent). The scores of hopelessness (BHS), depression (BDI), SCL-90-R in general, suicide ideations (SSI) and intensity of psychosis (BPRS) increased with the severity of intent to die in the whole sample not taking into account gender.

In women separately general SCL-90-R score, suicide ideations (SSI) and intensity of psychosis (BPRS) correlated positively with increase of intent to die score. Besides, only in women elder age was associated with stronger intent to die.

Exceptionally in the sample of men the lower quality of life was associated with the higher scores on SIS scale. Other characteristics (general SCL-90-R score, suicide ideations and intensity of psychosis) were significantly higher in men with the stronger intent to die.

Our findings confirm that socioeconomic status is connected to men's pattern of suicidality. Psychiatric disorders together with the strong suicide ideation bring people to more dangerous suicide attempts.

Advance statements are expressions of wishes made by an individual anticipating future mental incapacity to express treatment choices, spiritual or cultural needs and to nominate someone to be consulted in the event of future incapacity.Advance statements about medical treatment are usually positively-framed treatment choices or requests. An advance statement could also inform the process of determining a person's best interests under the Mental Capacity Act 2005 procedure. Advance Directives project was initiated at Langdon Hospital(Regional Secure Unit with medium and low secure as well as open Forensic wards) in early 2011 and rolled out across site by late 2011.

To audit the opportunity for patients at Langdon Hospital to have Advance Statements in place and its recording on Rio electronic system.To find out areas within the procedure that need improvement and changes.

Data was collected from Rio electronic records of all patients of all wards at Langdon Hospital during a 3 week period.

Most wards had offered above 80% of patients a chance to make Advance Statements. 2 wards achieved 100%. The uptake by patients who were offered an opportunity was high at 70%. Most patients prefer to have a named advocate.In some cases patients specifically asked for a relative not to be involved.Improvement needed in using recommended format and uploading it to Rio. Some staff were concentrating mainly on physical health/end of life decisions. Improvement needed in including questions related to management of future aggression and violence.

Recent genetic findings suggest shared genetic risk between autism, epilepsy and schizophrenia. A sodium channel subunit gene, SCN2A, exhibits de novo stop-codon mutations in individuals with autism and a stop-codon mutation in an individual with a seizure disorder. Our recent exome-sequencing study of schizophrenia cases identified a de novo splicesite mutation at SCN2A and further mutations may exist.

To examine a role for rare, protein damaging mutations at SCN2A in the aetiology of schizophrenia.

We aim to show an excess of coding sequence mutations in schizophrenia cases when compared to controls.

Mutation screening of the coding sequence of SCN2A in 993 Caucasian individuals with DSM-IV schizophrenia. We employed High-Resolution Melt Analysis(LightScanner™), followed by dye- terminator sequencing to confirm allele carriers. We compared our results to an exome-sequencing dataset of 4300 Caucasian individuals (NHLBI Exome Sequencing Project).

34 variants were identified; 15 intronic, 13 synonymous and 7 non-synonymous. One of the non-synonymous variants introduces a stop codon at amino acid 169 (169 E>X). No stop-codon variants were identified in the control dataset. Burden analysis did not show an excess of protein damaging changes in the UK dataset when compared to controls.

A total of 4 stop-codon mutations have been identified at SCN2A; all in individuals with a neuropsychiatric disorder. Our data do not suggest a general role for protein coding mutations at SCN2A in the pathogenesis of schizophrenia; however there may be a role for very damaging alleles at SCN2A in several neuropsychiatric disorders.

Although patients with inflammatory bowel disease (IBD) are commonly described as psychorigid and scrupulous, studies about obsessive-compulsive disorder (OCD) in patients with IBD remain few.

To examine the links between OCD and IBD, in general, and Crohn's disease, in particular.

A case report and review.

A twenty-one-year-old man was referred to the psychiatric outpatient clinic for obsessive ideas mainly about dirt associated with compulsive washing as well as compulsive masturbation.

Since childhood, the patient was diagnosed with Crohn's disease that led to failure to thrive. His medication included azathioprine and sulfapyridine. He developed perianal complications as well as bronchiectasis.

Obsessive-compulsive symptoms gradually dissipated on fluoxetine 30 mg qd along with supportive psychotherapy.

This paper discusses the possible links between Crohn's disease and OCD. Obsessive-compulsive symptoms in patients with Crohn's disease might be due to immune-complex formation, but might also be explained from a psychodynamic point of view: association between fixation at the anal stage in OCD and lesions affecting the bowel and the perianal region in Crohn's disease.

The prescription of psychotropic drugs in the elderly is more common. Doses are increasingly high, with frequent recourse to a combination therapy.

Our purpose was to describe treatment strategies in elderly patients consulting in psychiatry, in order to confront them with the latest recommendations.

Our study was retrospective and descriptive. It involved all elderly patients aged more than 60 years, who had consulted for the first time in psychiatry since January 2010 until December 2011. We collected, for each patient, the sociodemographic data, the diagnosis(es), the treatment(s), the side effects and the illness evolution under treatment.

We collected 159 cases of elderly patients, representing 6.07% of all the consultants in psychiatry during the period of the study. Their average age was 73 with a sex-ratio (M/F) of 1.13.

Dementia and mood disorders were the most common diagnoses (respectively 40.2% and 34.6%).

As far as drug therapies are concerned, an antidepressant was prescribed to 95 patients (59.7%); an antipsychotic was prescribed to 55.3%. A tranquillizer was prescribed to 40.8%. A combination therapy made of at least two different families of psychotropic drugs was prescribed to 55.9% of the patients. None of the patients benefited from psychotherapy.

Our study showed that the treatment strategy of the elderly consulting in psychiatry in the area of the study was not in accordance with the latest recommendations.

Most eldery patients with dementia are cared for at their home by family members, usually elderly spouses.

Important mission at associations for help at dementia is to facilitate public access to the most credible and up-to-date information on home caring of patients with dementia.

To determine how much Slovenian community health workers and other adults know about home caring of patients with dementia.

Hundered and twenty adult Slovenian e-mail users participated in a survey using a questionnaire consisting of 12 questions regarding dementia during May and August 2009. Questionaires were filled-out by 60 community health workers (mean age = 40.00, SD = 11.77, range 22–67), and 60 other adults (mean age = 44.27, SD = 16.20, range 23–83; t = 1.651; p > 0.05).

Community health workers were more knowledgeable and the other adults were the least knowledgeable on the subject of home caring of patients with dementia (3.03 v. 2.18, p < 0.01). Differences in responses between community health workers in other adults are shown in order of significance:

1. (a) finding help and professional support (49.6% v. 35.6%);

2. (b) setting a positive mood of interaction (28.8% v. 33.9%); and

3. (c) responding with affection and reassurance (7.2% v. 11.6%).

Findings suggest that there appeared to be gaps in knowledge in dementia among the community health workers and general public. As care of eldery patients with dementia shifts into their home, education is needed to increase the public awareness of dementia.

A number of studies have investigated white matter abnormalities in patients with bipolar disorder (BD) using diffusion tensor imaging. However, tractography studies yielded heterogeneous results partly due to small sample sizes.

In this work we aimed to study white matter abnormalities using whole-brain tractography in a large multicenter sample of patients with BD I with and without psychotic features.

To compare mean generalized fractional anisotropy (GFA) along deep white matter tracts between patients with BD with a positive history of psychosis during illness phases, no such history and healthy controls.

We acquired diffusion-weighted MRI for 118 patients with BD I and 86 healthy controls using the same acquisition parameters and scanning hardware. We used Q-ball imaging tractography and an automatized segmentation technique to reconstruct 22 known deep white matter tracts and to obtain the mean GFA along each tract.

Patients with BD had lower GFA values than controls along the corpus callosum (body and splenium), the left cingulum and the left arcuate fasciculus, when controlling for age, gender and acquisition site. All results with an exception for the long fibers of the left cingulum were driven by patients with a positive history of psychotic symptoms.

We demonstrated a reduced integrity of interhemispheric, limbic and arcuate white matter tracts in patients with BD I. Further, interhemispheric pathways were more disrupted in patients with psychotic symptoms, underscoring the role of interhemispheric connectivity in the pathophysiology of BD with psychosis.

A challenging medicine dissertation: to design a psychiatric therapeutic community.

A medical student winning a grant addressed to architects and farm laborers aimed to convert a rural area through Social Innovation programmes, a group of young enthusiastic psychiatrists and a donor involved in psychiatric circumstances are the actors of the project for turning a rural building located in the small village of “Villa San Bartolomeo” (Reggio Emilia, Italy) into a psychiatric social-rehabilitation community.

The project started reviewing the literature concerning community-based psychiatry residential facilities. Later, a structured interview has been carried out with the village's inhabitants in order to investigate both their perception of stigma towards mental illness and the perceived needs of their city. The answers have then been used to organize the activities within the psychiatric community, ranging from recreational through sportive until occupational ones, such as farming vegetable gardens, breeding domestic animals, producing handiworks. These labors are intended both to satisfy the village demands and realize a greater integration of the community itself within the surrounding social network.

The therapeutic interventions that are going to be realized within the residential home will be aimed to promote patients’ personal growth and adapting capacity. These interventions are intended to allow the accomplishment of a greater housing independence of the hosts by restructuring their affective, relational and social backgrounds.

This is an ambitious project, started by chance, representing the desire and the hope for curing mental illness by establishing a contact with the natural environment.