To explore the situation, contributing factors and management of workplace violence among nurses in the health sector the Isfahan, Iran.

A total of 250 nurses were assessed from all the health care services available in Isfahan. Quantitative and qualitative data were collected through questionnaires and interviews. Nurses were asked a series of questions about their personal experience of workplace violence in addition to their views and perceptions of violence in the workplace more generally. This can include verbal aggression or abuse, threat or harassment as well as physical violence.

Violence is a problem in the workplace for almost half of nurses. Among hospital nurses, those working in Psychiatry, Drug abuse and Screening units are more likely to report violence as a problem in their workplace. the majority of Nurses experienced form of verbal abuse and a third of them reported physical violence or abuse. Females, younger nurses, working in night shifts, having physical contacts with patients, working in crowded units and poor working experience nurses were more likely to experience violence.

Dissatisfaction of service provided and with diagnosis or planned treatment was the most frequently stated reason for work place violence. Psychological backgrounds, inability to pay for hospital bill, low social security conditions were the indirect factors.

Improved training, better security measures, including provision of a safe environment to treat known or potentially violent patients, prevention programs, and health services for both nurses and patients should be provided.

To determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviors were explored.

Data on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. the classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix.

A total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. the relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness.

Violent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence.

Évaluer la tolérance, la sécurité d’emploi et l’efficacité de doses flexibles de PP chez des patients adultes en période d’exacerbation aiguë d’une schizophrénie, après échec d’un traitement par antipsychotiques oraux.

Étude internationale, prospective, ouverte, de six mois.

Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), événements indésirables (EI), changement de poids.

Deux cent douze patients (population en intention de traiter) : âge moyen 36,4 ± 12,1 ans, 59,0 % d’hommes, 85,4 % souffrant de schizophrénie paranoïde ont été inclus. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (45,8 %). 70,3 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce ont été : le choix du patient (9,4 %), des EI (9,0 %), les perdus de vue (4,7 %), le manque d’efficacité (2,8 %). Le score total moyen à la PANSS initiale (98,5 ± 20,1) a diminué, et ce dès j8, pour atteindre 67,4 ± 24,0 à la fin de l’étude (diminution de −31,0 ± 29,0, p < 0,0001). 66,7 % des patients ont eu une amélioration de plus de 30 % du score PANSS total et le pourcentage de patients jugés manifestement malades ou pire (CGI-S) a diminué de 75,1 % à 20,5 %. Les EIs (≥ 5 % patients) : douleur au site d’injection (13,7 %), insomnie (10,8 %), trouble psychotique (10,4 %), céphalées (6,1 %) et anxiété (6,1 %). Le changement moyen de poids a été de 2,6 ± 5,6 kg (IC 95 % [1,8; 3,4]).

Ces résultats confirment que le PP à doses flexibles est bien toléré et permet une réponse clinique précoce et cliniquement significative chez des patients en période d’exacerbation aiguë de leur trouble schizophrénique, après échec d’un traitement par antipsychotiques oraux.

Évaluer la tolérance, la sécurité d’emploi et la réponse à un traitement par palmitate de palipéridone (PP) à doses flexibles chez des patients non aigus atteints de schizophrénie, après échec d’un traitement par un autre antipsychotique injectable à action prolongée : décanoate d’halopéridol (Déc-Hal), décanoate de flupentixol (Déc-Fpt), décanoate de fluphénazine (Déc-Flu), zuclopenthixol (Zuc) ou rispéridone à libération prolongée (RIS-LP).

Étude internationale, prospective, ouverte, de six mois, chez des patients atteints de schizophrénie, non aigus mais insuffisamment contrôlés par d’autres antipsychotiques injectables à action prolongée.

Taux de réponse (amélioration ≥ 20 % du score total à la PANSS [Positive and Negative Syndrome Scale]), score à la PSP (Personal and Social Performance scale), événements indésirables (EIs).

Les analyses ont été réalisées sur la population en intention de traiter de façon stratifiée pour chaque traitement : 53 patients Déc-Hal, 35 Déc-Fpt, 44 Déc-Flu, 42 Zuc, 56 RIS-LP. Les scores totaux moyens à la PANSS initiale variaient de 67,7 ± 20,3 [RIS-LP] à 75,7 ± 13,2 [Déc-Hal]. Entre 71,4 % [RIS-LP] et 85,7 % [Déc-Fpt] des patients ont terminé l’étude. À la fin de l’étude, 53,7 % [Zuc], 54,7 % [Déc-Hal], 59,1 % [Déc-Flu], 61,1 % [RIS-LP] et 61,8 % [Déc- Fpt] des patients ont vu leur score total à la PANSS diminuer d’au moins 20 %. Les scores moyens de PSP de base étaient de 48,7 [Déc-Hal], 59,6 [Déc-Fpt], 53,5 [Déc-Flu], 52,9 [Zuc] et 60,1 [RIS-LP], et le changement en fin d’étude était respectivement de : 5,2 ; 6,1 ; 6,0 ; 6,4 ; et 5,2 (p ≤ 0,0163 pour tous les traitements). Les EIs rapportés au moins une fois dans tous les sous-groupes : douleur au site d’injection, insomnie, trouble psychotique.

Le PP à doses flexibles a été bien toléré et a permis une réponse thérapeutique cliniquement significative chez des patients non aigus atteints de schizophrénie, après échec d’un traitement par d’autres antipsychotiques injectables à action prolongée.

Violence in psychiatric wards is common, and it is on the rise. This study examined the relationship between ward occupancy level and staff-to-patient ratio and incidents of aggressive behavior, both physical and verbal, on an acute inpatient unit in Iran.

Logistic regression was used to analyze data collected from the ward's log of adverse incidents and the ward census over a 12-month period. A physical incident was defined as an unwelcome physical contact or willful damage to property. Incidents of self-harm were excluded. Verbal aggression was any threat of physical or sexual harm.

Among 381 admissions during the study period, 58 incidents were recorded--25 incidents of verbal aggression and 33 incidents of physical violence. Logistic regression demonstrated that the occupancy level was positively associated with the occurrence of any type of violent incident. the average occupancy level when an incident occurred was 77 percent, compared with 69 percent when no incidents occurred. the average occupancy level was significantly higher when verbal incidents occurred (80 percent) than when physical incidents occurred (70 percent). No association was found between violence and staff-to-patient ratio. Incidents were significantly more likely to occur during the afternoon shifts (3 p.m. to 11 p.m.).

Crowding was found to be significantly associated with aggressive incidents, and in particular with verbal aggression.

Évaluer l’amélioration fonctionnelle chez des patients atteints de schizophrénie sous palmitate de paliperidone (PP) à doses flexibles après échec d’un traitement par antipsychotiques oraux.

Analyse menée dans deux sous-groupes de patients atteints de schizophrénie : aigus (n = 202) et non aigus (n = 593) après échec d’un traitement par antipsychotiques oraux, inclus dans une étude internationale, prospective, de six mois.

Changement du score total à la PANSS (Positive and Negative Syndrome Scale), à la PSP (Personal and Psychosocial Performance scale), et à la Mini-ICF-APP (Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses).

Les deux sous-groupes ont présenté une amélioration significative du score total à la PANSS : de 98,5 ± 20,1 à l’inclusion à 67,4 ± 24,0 à la fin de l’étude (diminution moyenne = −31,0 ± 29,0) chez les patients aigus et de 71,5 ± 14,6 à 59,7 ± 18,1 (diminution moyenne = −11,7 ± 15,9) chez les patients non aigus. Cette réponse thérapeutique était associée à une augmentation significative du score total à la PSP de 43,9 ± 15,0 à 62,9 ± 17,1 (amélioration moyenne = 19,0 ± 18,7, p <0,0001) chez les patients aigus, et de 58,1 ± 13,4 à 66,1 ± 15,7 (amélioration moyenne =8,0 ± 14,0, p < 0,0001) chez les patients non aigus. Il existait une amélioration significative du score à la Mini-ICF-APP qui diminuait de 26,8 ± 8,5 à 18,5 ± 9,8 (diminution moyenne = −8,0 ± 10,4, p < 0,0001) chez les patients aigus et de 19,8 ± 7,9 à 15,9 ± 8,8 (diminution moyenne = −4,0 ± 7,5, p < 0,0001) chez les patients non aigus.

L’amélioration symptomatique sous PP à doses flexibles chez des patients aigus ou non-aigus atteints de schizophrénie après échec d’un traitement par antipsychotique oral s’est accompagnée d’une amélioration fonctionnelle cliniquement significative.

To discuss a case of zolpidem-induced galactorrhea.

The prevalence of insomnia can be as high as 32 to 33%. Non-benzodiazepines (such as zolpidem) have become more commonly used to treat insomnia.

The patient is a 29-year-old woman with a history of (PTSD) who presented with PTSD associated insomnia. She was started on zolpidem 5 mg po qhs. Two months after the initiation of zolpidem treatment, the patient presented with breast tenderness and galactorrhea. Zolpidem was discontinued and the galactorrhea resolved after two weeks. A serum prolactin level drawn shortly after discontinuation of zolpidem was 15.67 mg/ml.

Zolpidem has a high affinity at the α1 containing GABAA receptors, with reduced affinity for those containing the α2- and α3- GABAA receptor subunits and minimal affinity for α5 receptor subunit. Psychotropic drugs have been well recognized to produce hyperprolactinemia. However, there has been no reported case of zolpidem-induced hyperprolactinemia. Specifically, zolpidem has been noted to activate GABAergic neurons within the ventral tegmental area (VTA), where there is a sizable population of GABAergic neurons. These GABAergic neurons regulate the firing of dopaminergic counterparts, also located in the VTA, which send projections throughout the brain. This inhibition results in a decrease in the dopaminergic inhibitory influence on prolactin and an increase in prolactin releasing factors which act on the anterior pituitary, leading to hyperprolactinemia and thus galactorrhea.

Pharmacologically induced hyperprolactinemia may be a problem of underestimated prevalence due to the lack of externally visible symptoms.

Research has shown that ADHD symptoms and functional impairment often persist beyond childhood into adulthood. Thus an effective therapy that can be tolerated over long-term use in adults is needed. This is the first long term safety and tolerability study of an adult ADHD medication in Asia.

Assess long-term safety, tolerability, and efficacy of atomoxetine (ATX) in adult Japanese ADHD patients.

Demonstrate the safety and tolerability of long-term ATX.

ATX (40-120 mg/day) was evaluated based on integrated analyses of a 10 week double-blind (DB) study and a 48 week open-label long term (LT) extension study. Long-term safety and tolerability were assessed by adverse events, discontinuation rate, and vital-signs. Efficacy measures included change from baseline in Conners’ Adult ADHD Rating Scale- Investigator Rated (CAARS-Inv:SV) total symptoms score, behavior Rating Inventory of Executive Function (BRIEF-A), and Adult ADHD/QoL Measure (AAQoL).

233 patients took ATX (LT mean final prescribed dose: 108.3 mg/day). AEs leading to discontinuations were seen in 37 (15.9%) patients, the most common being nausea in 10 (4.3%) patients. Statistically significant baseline-to-endpoint reductions in mean CAARS-Inv:SV total symptoms score during in the DB study continued throughout the LT study. Similar reductions were seen in BRIEF-A Self Report scores. These findings along with AAQoL results indicated that patients perceived improvements in both QoL and Executive Function.

Long-term ATX treatment was shown to be generally safe and tolerable in Japanese adult ADHD patients. Results also suggested ATX improved ADHD core symptoms, QoL and Executive Functions.

Le trouble bipolaire est une maladie psychiatrique caractérisée par une alternance d’épisodes de dépression et/ou de manie, ainsi que de périodes de rémission plus ou moins partielles. Des études ont observé des déficits cognitifs chez les patients bipolaires, qui seraient présents dès le premier épisode et qui persisteraient tout au long de leur vie [4]. Ces troubles auraient un impact sur le fonctionnement psychosocial des patients [1]. Il n’existe actuellement aucune thérapie ciblant les déficits cognitifs des patients bipolaires. La remédiation cognitive est une thérapie permettant un entraînement des capacités cognitives et un apprentissage de stratégies de résolution de problèmes. Plusieurs études concluent à un effet bénéfique persistant de la thérapie chez les patients schizophrènes [3]. De nombreux auteurs suggèrent que la thérapie de remédiation cognitive pourrait également être bénéfique aux patients bipolaires [2].

Notre étude a pour objectif d’observer l’intérêt que peut présenter la remédiation cognitive pour les patients bipolaires, à travers l’étude du parcours de Monsieur V., un patient bipolaire de type I, qui a suivi une thérapie individuelle de remédiation cognitive durant trois mois. Nous avons administré avant et après la thérapie un bilan clinique, un bilan neuropsychologique et le test de Rorschach.

Les résultats indiquent une amélioration des capacités cognitives et fonctionnelles du patient. Nous avons observé des améliorations comportementales, mais également un changement plus profond dans la manière dont le patient mobilise des capacités cognitives.

Ces résultats suggèrent que des patients bipolaires pourraient bénéficier d’une thérapie de remédiation cognitive, et nécessiteraient d’être reproduits sur une plus large population.

In some cultures, including ours, direct explanation of inner psychic world is inhibited and stigmatized, therefore finding alternative modes of expression.

The aim of this cross-sectional study was to reach to an estimation of the frequency of somatization in the depressed patients.

500 patients with major depressive disorder referred to the outpatient clinic of Shiraz University of Medical Sciences were recruited and diagnosed based on DSM-IV-TR. Through psychiatric interview, we assessed the presenting complaints of these patients. the presenting symptoms were divided into three main categories namely: mental symptoms, pain, and physical symptoms other than pain. Statistical analysis (chi-square and logistic regression) were performed to assess the relationship between presenting symptoms and some demographic variables such as age, gender, marital status, educational level and cultural background.

Physical symptoms other than pain in 193 (38.6%), mental symptoms in 186 (37.2%) and pain in 121 (24.2%) of the patients were seen. Pain and physical complaints were more common in patients with rural cultural background, lower education, women and the married ones. Headache (15.2%), irritability (10.6%) and pain in other areas of the body (10.4%) were the most frequent chief complaints the patients had stated. the symptoms of hypochondriasis, suicidal idea, crying, irritability and insomnia were significantly associated with the complaint of somatization.

Somatic symptoms, especially pain, have a significant weight in the chief complaints of depressed patients. Physicians need to pay proper attention to this important issue in order to better understand their patients.

The prevalence of psychiatric disorders in the general population in Portugal is estimated to be 30%. It is already known that many patients who present a psychiatric disorder do not seek a medical doctor, in part because they do not recognise their illness but also because of stigma associated to these disorders. Mental health promotion programs for schools are believed to help overcome these difficulties.

To analyse the knowledge on mental health issues and psychiatric disorders of Portuguese school students from the 7th to the 12th grade, and to assess their contact and interactions with patients who have a psychiatric disorder.

Five students from each class at Pedro Alexandrino high school were selected and they were asked to answer to a questionnaire. Data collected from the questionnaires was then statistically analysed.

The sample collected for this study included a total of 145 students, 60% male and 40% female, with a mean age of 15years-old. Global knowledge about mental health and psychiatric disorders among students was poor and it was primarily acquired through the media. A comparatively high percentage of students in our sample (46%) knew at least one patient with a psychiatric disorder, and in most cases those patients were from their family group or circle of friends.

Education on mental health and psychiatric disorders should be implemented at schools and within the context of health education, in order to promote mental health and also to help reduce stigma usually associated to psychiatric disorders.

The prospective study design included baseline two follow-up assessments within a year. Follow-up sample included a total of 708 adolescents from schools throughout Israel. the students completed self-report questionnairesregarding suicide ideation and attempts, psychopathology, life style, socio-demographic background, non-suicidal self-injury, life events and social support.

Results indicate that interpersonal distress and internalizing disorders at baseline predicted later levels of suicidal ideation. the effects of interpersonal factors on ideation were partly or fully mediated by internalizing symptoms. We also found that increases in suicidal ideation and in engagement in risk behaviors and NSSI over time were associated with the occurrence of a suicide attempt within the follow up period.

The model identifies the different phases along the path to suicidal behavior, and risk factors associated with each phase. Hopefully this model will improve our understanding of the short-term course of suicidal behavior among adolescents, which may lead to potential improvements for intervention and prevention.

Between the risk factors for developing a first episode psychosis, social functioning is considered to be one of the most important factors.

The aim of the study is to compare social functioning in schizophrenia offspring and controls, and to determine possible associations between social functioning and prodromal symptoms.

The study examined social functioning (by using the Social Functioning Scale) in 25 Schizophrenia offspring seeking psychiatric help for different problems, and 25 healthy controls.

Clinical status was assessed with the Brief Psychiatric Rating Scale, HAM-D and HAM-A.

Schizophrenia offspring had significantly more social functioning deficits than controls. Social functioning was most strongly associated with depression and anxiety symptoms and less with minor psychotic symptoms.

Social functioning deficits precede the onset of first episode psychosis, especially in persons at risk and, therefore, it could represent an early detection sign. Association with depression and anxiety symptoms should be an early intervention point.

To estimate the risk of developing autism-spectrum disorder (ASD) in children born to immigrants as compared to children of Dutch-born parents.

Retrospective, population-based cohort study of all live births (N= 106,953) between 1998 and 2007 in a circumscribed geographical region in the Netherlands. Cohort members were linked to the Psychiatric Case Register to identify diagnosed cases.

518 cases of ASD were identified, including 150 children with autism and 368 children with Asperger syndrome or PDD-NOS. Children born to migrants from developing countries were at significantly lower risk of ASD (rate ratio (RR)= 0.6, 95% (CI) 0.5-0.9) than children of Dutch-born parents. Within the ASD group, the risk for the subgroup with Asperger syndrome and PDD-NOS was reduced (RR= 0.4, 95% CI 0.3-0.6), whereas that for narrowly defined autism was nonsignificantly increased (RR= 1.4, 95% CI 0.9-2.4). Migrant groups did not differ in age at diagnosis.

The results echo Swedish findings indicating a reversal of risk gradient in children of parents from developing countries, specifically a decreased risk for high-functioning and increased risk for low-functioning autism.

Study of suggestibility in persons with schizophrenia to ascertain whether it is advisable to use hypno-suggestive methods in the system of psychotherapeutic help to them.

As a method of study we used Barber's Creative Imagination Scale. to subjects of the experimental group this method was applied from 2 to 5 times, during 6 months.

In the experimental group the subjects have been distributed in the following way:

1. (0) lack of suggestibility - 12.68%;

2. (1) weak degree of suggestibility - 20.56%;

3. (2) average degree of suggestibility - 13.8%;

4. (3) high degree of suggestibility - 24.51%;

5. (4) very high degree of suggestibility - 28.45%.

In the control group we have obtained the following percentage distribution of subjects:

1. (0) lack of suggestibility - 6.76%;

2. (1) weak degree of suggestibility - 17.18%;

3. (2) average degree of suggestibility - 22.25%;

4. (3) high degree of suggestibility - 27.89%;

5. (4) very high degree of suggestibility - 25.92%.

We also have studied changeableness of suggestibility during 6 months in the experimental group: invariable indices of suggestibility were shown by 27.95% of subjects; 37.26% of subjects had slight changeableness; suggestibility was considerably changed in 26.09% of subjects; and radical change was obtained in 8.7% of subjects.

The obtained results point to the advisability of applying hypno-suggestive methods in the system of psychotherapeutic help of individuals suffering from schizophrenia.

To investigate whether 1) pregnant smokers with mental disorders are less likely to accept referrals to smoking cessation services compared to pregnant smokers without disorders; 2) they experience specific barriers to smoking cessation.

Cohort study supplemented by cross-sectional survey and nested qualitative study.

Three maternity services, London, UK

Pregnant smokers with and without mental disorders.

Case notes were examined on a cohort of 400 consecutive pregnant smokers; data were triangulated with routinely collected data on 845 pregnant smokers at 2 other sites; 27 pregnant smokers were interviewed using qualitative methods.

Acceptance of referral to smoking cessation services; Perceived barriers to quitting.

Pregnant smokers with a mental disorder recorded by midwives were a quarter of the cohort (97, 23%), were more likely to accept referral to smoking cessation services (69% vs 56%, AOR 1.70), but more likely to still smoke at delivery (69% vs 56% AOR 2.63). Discussion about smoking was documented in 7.7% of subsequent antenatal visits in women with or without mental disorders. Pregnant smokers with diagnosed mental disorders reported that they and health practitioners did not prioritise smoking advice due to concern about adversely impacting mental health.

Pregnant women with mental disorders appear more motivated, yet find it more difficult, to stop smoking. Prioritisation of mental health over smoking may thus lead to increasing health inequality for this group. Research into effective smoking cessation interventions is required for those with mental disorders.