Before October 2012 there was no service level agreement for psychiatry cover in Whiston Hospital, an acute trust in the UK. The Crisis team would visit on goodwill to assess patients. This changed when a Liaison Psychiatry (LP) service was commissioned to provide 24 hour cover, Monday to Sunday for the Emergency Department (ED) for adults.

To quantify waiting times to be assessed by psychiatry, comparing the new LP Service (intervention group) to its predecessor (control). The null hypothesis being that the waiting time for the control and intervention group are the same.

The authors prospectively collected data on all referrals received by the LP service in the first three months of operation n=305 and retrospectively collected data on a random sample of 50 patients referred from ED in the same months 2011 (control).

The median time from referral to the time of psychiatric assessment in the control group was 162.5 minutes [IQR 130–330], the mean time was 246.16 [95% CI 180 to 312]. The median time from referral to the time of psychiatric assessment following the introduction of the LP service was 30 minutes [IQR 15-90], the mean time was 79.63 [95% CI 65 to 93]. When the two samples were compared using an independent t test they were significantly different p<0.002.

The new LP service has decreased the median wait for a psychiatry assessment by 132 minutes. The team currently seeS 82% of referrals within 60 minutes. This improves patient safety and encourages appropriate and timely discharge.

to evaluate sleep modifications induced by chronic benzodiazepines (BDZs) abuse.

cohort study, comparison of sleep measures between BDZs abusers and controls. Drug Addiction Unit (Institute of Psychiatry) and Unit of Sleep Disorder (Institute of Neurology) of the Catholic University in Rome. Six outpatients were enrolled, (4 men and 2 women, mean age 53.3±14.8, range: 34 - 70 years) affected by BDZ chronic abuse; 55 healthy controls (23 men and 32 women, mean age 54.2 ±13.0, range: 27–76 years). All patients underwent clinical evaluation, psychometric measures, ambulatory polysomnography, scoring of sleep macrostructure and microstructure (power spectral fast-frequency EEG arousal, Cyclic Alternating Pattern - CAP), Heart Rate Variability.

BDZs abusers had relevant modification of sleep macrostructure and a marked reduction of fast-frequency EEG arousal in NREM (Patients: 6.6±3.7 events/hour, Controls 13.7±4.9 events/hour, U-test: 294, p=0.002) and REM (Patients: 8.4±2.4 events/hour, Controls 13.3±5.1 events/hour, U-test: 264, p=0.016), and of CAP rate (Patients: 15.0±8.6%, Controls: 51.2±12.1%, U-test: 325, p<0.001).

BDZs abusers have reduction of arousals associated with increased number of nocturnal awakenings and severe impairment of sleep architecture. The effect of chronic BDZs abuse on sleep may be described as a severe impairment of arousal dynamics; the result is the inability to modulate levels of vigilance.

Skin Picking behavior is characterized by repetitive episodes of digging, squeezing or picking the skin causing tissue damage, functional impairment and distress.

The aim of the study was to investigate the skin picking frequency and the picking episodes’ characteristics in the Polish students’ population.

The participants were 436 university students, 297 (68,11%) women and 139 (31,88%) men. The age of participants ranged from 19 to 30 years (M=23,21 (SD=8,84). All participants were assessed by the Skin Picking Scale and the Skin Picking Impact Scale translated into Polish by authors. They also completed the list of items concerning skin picking site, picking frequency, methods of picking and affective consequences of picking.

Two hundred ten (48,16%) of the participants reported that they currently pick their skin. One hundred thirty students (29,81%) endorsed the functional impairment caused by picking, ninety three of them (21,33%) felt distressed as a consequence of picking. Most participants, who endorsed the picking behaviors, pick from their faces, fingers and scalps, but numerous other sites were endorsed. Participants usually pick with their fingers and nails and were aware of picking during picking episodes. Forty three participants (20,47%) reported that their picking was preceded by an urge always or in most cases; however 66 participants (31,43%) claimed that they had never felt urge prior to picking. The commonest consequences of picking reported by participants were the experience of relief and the feeling of anger.

Skin picking is a common behavior among the Polish students.

Trichotillomania is a psychiatric disorder characterized by an urge to pull out hair from the scalp or other parts of the body (Impulse Control Disorder) relatively uncommon in children.

The following two clinical vignette highlight varying presentation of trichotillomania in children from two differing age groups (>6 yrs and <12 yrs)

To showcase 2 cases of trichotillomania with differing co-morbidities.

ICD 10 (WHO) was the primary diagnostic tool used here. MGH Hair Pulling Scale was used for rating the severity of Trichotillomania. As both patients had suspected mental sub normality, WISC was used for IQ assessment.

Case 1: Trichotillomania with OCD and ?Secondary depression with MR

14 year old female, presented with compulsive eyebrow pulling for 1 year. For last 6 months showing OCD and depressive symptoms. She scored 32 on YBOCS with main obsession – excessive concerns with germs and main compulsions - excessive or ritualized hygiene. On MGH hair Pulling scale she scored 21. Her IQ score was 65, suggesting Mild Intellectual Disability.

Case 2: Trichotillomania with Pica and MR

5 year old female, presented with compulsive hair pulling and ingesting it (Trichophagia) for 18 months. Also eating non edible things like soil and paper (Pica). No major physical illness found. On MGH Hair Pulling Scale, she scored 17. X-ray of GIT showed no Trichobezoar (hair ball). Her IQ was 60, (Mild Intellectual Disability).

The study illustrates how trichotillomania can be a part of a more complex psychiatric presentation with co-morbidities

The use of clozapine (CLZ) for treatment-resistant schizophrenia is well established in adults. However, it is seldom used in children and adolescents with early onset schizophrenia (EOS) largely because of lack of clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS with the aim to assist clinical decision-making.

We conducted a systematic review of the primary the literature on the clinical efficacy and adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance.

CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up. No fatalities linked to CLZ treatment were reported. Sedation and hypersalivation were the most common complaints (90% of patients). Other common ADRs (10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Neutropenia was reported in 6-15% while agranulocytosis was rare. Seizures were also uncommon. Metabolic changes were relatively common (8-22%). Overall the rate of discontinuation was low (3-6%). Current guidelines recommend the use of CLZ in treatment-resistant EOS patients and provide detailed schedule of assessments to evaluate and assess potential ADRs both prior to initiation and throughout CLZ treatment.

Available data is consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored.

Culture-bound syndromes are defined as 'episodic and dramatic reactions specific to a particular community'. 'Dhat' syndrome or 'loss of semen' leading to weakness, is a culture bound sex neurosis in the Indian subcontinent not common in rest of the world.

To highlight how Culture Bound Syndromes can transcend geographical boundaries.

A detailed history of the presenting complaints, past and family history and use of ICD 10 (WHO) for diagnosis/excluding other major mental illness.

15 year old unmarried, Afghani male whose family migrated to Australia before his birth (never went back to Afghanistan), presented with anxiety, difficulty in falling asleep, poor appetite, and weakness for 6 months. His symptoms started after being introduced to pornographic films by friends. He began masturbating 3-4 times everyday which soon became a concern to him, believing it to be 'excessive and harmful' (masturbatory guilt). For the next 3 months, he tried to abstain from masturbation, leading to problems like passage of 'whitish' discharge in urine (?precome) and nocturnal emissions, leading to more anxiety and low mood. He did not fulfil ICD 10 criteria for depression.

Fluoxetine 20 mgs daily was started with sexual counselling,(psycho education about masturbation). He showed improvement within 6 weeks and at follow-up 6 months showed complete resolution.

'Dhat Syndrome' a Culture Bound Syndrome, not normally reported in Modern Western world may still present in 2nd generation immigrants, with no overt contact with their original culture, possibly due to deep rooted trans-generational cultural ties.

For some adolescents surfing the web can turn into a psychological defense and to be in contrast with a healthy mental development. It happen if the internet surfing becomes a compulsive need (Drusian, 2005). Massive use of the internet can promote the development of behavioral addictions such as pathological gambling (Cantelmi, D’Andrea, 2000).

The study investigates the correlation between social introversion, modality of the internet surfing and propensity to pathological gambling in a sample of Italian adolescents.

The research used a questionnaire divided into four areas: school performance, use of the internet, social introversion (SI scale of the MMPI-A); experiences of gambling (LIE/BET Questionnaire). 583 adolescents (45% males and 54% females, mean age 17 years) responded to the questionnaire.

Adolescents with high social introversion (high scores on Si scale) are 7.4% of the sample. These teenagers use the Internet many hours per day. They state that surfing the internet is a way to drive away negative thoughts about their lives. They think that life would be boring without the internet. Many adolescents with social introversion have high scores to LIE/BET Questionnaire. The study does not show a correlation between school performance and the others variables (social introversion, use of internet and propensity to pathological gambling).

Social introversion seems to be a predictor of psychological disease such as internet addiction and pathological gambling.

Attention-deficit hyperactivity disorder (ADHD) affects not only children but persists for up to 4.4% in the general population. Comorbidity is common among adults with ADHD, including substance abuse. Patients who have both ADHD and SUD have to cope with the interrelated consequences of both disorders. Substance-dependent subjects have greater health, economic, work, and legal problems

The aim of this study was to estimate effect of co morbidity of adult ADHD with substance use disorders on being prone to legal problems.

This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) and Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist were used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Past history of legal problems was assessed using hospital records and self report questionnaire. Data were fed to the computer using the Predictive Analytics Software (PASW Statistics 18). Significance of the obtained results was judged at the 5% level.

Thirty sex patients fulfilled the DSM – IV TR criteria for adult ADHD. Fourteen patients of the ADHD group had history of legal problems (38.9%), while only 12 patients of the non ADHD group gave such history (18.2%) and the difference was statistical significant (c2 = 5.259, p = 0.022).

Presence of adult ADHD was associated with significant increased risk of legal problems.

Pathological skin picking (PSP) is a repetitive picking of skin which leads to tissue damages and significant distress. According to the emotion regulation hypothesis, picking behaviors are initiated in order to regulate pathologically high or abnormally low stimulation level associated with various emotional states.

The aim of the study was to investigate the relationship between different activation levels, negative affective states and skin picking of various picking styles.

Participants, 51 university students with PSP symptoms selected on the basis of the Skin Picking Scale and 62 students without the history of PSP filled out questionnaires concerning activation levels, positive and negative affect, anxiety, depression and boredom. The participants with skin picking were also assessed by The Milwaukee Inventory for Dimensions of Adult Skin Picking in order to determinate whether they represent automatic or focused picking style.

The hierarchical regression analysis indicated that skin picking is positively predicted by general activation, and negatively by high activation (tension). Individuals with skin picking are also characterized by low level of calmness.

The results obtained in the study show that skin picking could play an important role in coping with negative emotional states, especially those related to low tension, and could reveal itself once the level of calmness is particularly low. Skin picking can also be initiated when one experiences high activation associated with high energy level. The focused and automatic picking style are engaged in the general activation and high activation regulation, whereas the general deactivation could be modified predominantly by the focused picking.

Depression may occur as a result of cerebrovascular disease in a significant subpopulation of elderly persons. Recent studies indicate a high frequency of depression in older patients with cardiovascular and cerebrovascular diseases, and the possibility of a bidirectional relationship between depression and vascular disease.

Our research included 62 post-stroke patients above age 60 undergoing post-stroke treatment in department of Neurology and 30 elderly patients who had suffered stroke one year ago and underwent psychiatric treatment. Each patient were given scales for assessment of depressive symptomes (Hamilton depression rating scale HAM-D), suicidality (Columbia suicide severity rating scale CSSR-S) and the list for assessment of borderline personality symptoms (Borderline Symptom List BSL) with examination of mental state (MMSE). These scales were given prior to antidepressant treatment and two weeks following the treatment.

The obtained results shown positive correlation of depressive symptoms, suidical ideation and cognitive impairment in the group of post-stroke patients in psychiatric (with higher positive correlation in women). While in the group of elderly patients in psychiatric treatment (> than 1 year) the depressive symptoms were highly correlated with positive bordeline personality features and these specific personality features were highly correlated with suicidal ideation.

Our research showed how depressive symptoms are variable and highly correlated with personality features along with cognitive functioning. However, suicidal ideation was more correlated with specific personality features than depression itself. We have also concluded that concept of suicidality in the elderly seems unjustifiable neglected and should be more vigorously identified.

The harmful use of alcohol was identified as a major contributor to premature deaths toll in Russia. Research evidence has suggested that the consumption of different types of alcoholic beverage may have a differential effect on alcohol-related mortality rate.

The aim of this study was to examine the relation between the consumption of different beverage types and alcoholism/alcohol psychoses mortality rates in Russia.

Age-standardized male and female mortality data for the period 1970–2005 and data on beverage-specific alcohol sales were obtained from Russian State Statistical Committee. Time-series analytical modeling techniques (ARIMA) were used to examine the relation between the sale of different alcoholic beverages (vodka, wine, beer) and alcoholism/alcohol psychoses mortality rates.

The analysis suggests that of the three beverages vodka alone was associated with alcoholism and alcohol psychoses mortality in Russia. The estimated effects of vodka sales on the alcoholism and alcohol psychoses mortality rates are clearly statistically significant for both sexes: a 1 liter increase in vodka sales would result in a 32.5% increase in the male alcoholism and alcohol psychoses mortality rate and in 37.7% increase in female mortality rate.

The present study indicates that alcoholism and alcohol psychoses mortality tends to be more responsive to changes in spirits consumption per capita than to the wine or beer consumption. The findings from this study suggest that public health efforts should focus on both reducing overall consumption and changing beverage preference away from distilled spirits in order to reduce alcohol-related mortality rates in Russia.

The study will assess the risk factors and protective of psychoactive substance misuse in a population of Maghreb immigrant adolescents, Foreign Non Accompanied Minors (FNAM), in juvenile wards of Catalonia.

The research hypothesis is that the presence of psychiatric psychopatholy, personality traits related to impulsivity, stressors related to migration, and several sociodemographic factors such as family dysfunction, poor schooling in the country of origin, etc., are related to psychotropic substance misuse.

Risk Factors: acculturative stress, impulsiveness, mental health/ psychopathology, family dysfunction, uprooting (social and family), etc. Protective Factors: social support network, social stigma of substance misuse, etc.

1- Substance misuse prevalence and pattern, misuse predictors / risk factors / protective factors

Determine the prevalence and pattern of substance misuse (abuse and dependence) in a sample of FNAM aged 12 to 17 years and hosted in juvenile facilities in Catalonia.

Detect those predictor variables (demographic, psychopathological and social) associated with the substance misuse.

1. 1 study the prevalence of substance abuse (tobacco, alcohol, cocaine, amphetamines, benzodiazepines, hallucinogens, solvents / glue / inhalants, MDMA and heroin) pre and post migration

2. 2 study the presence of psychiatric disorders, ADHD, personality traits and impulsivity as risk factors associated with substance misuse

3. 3 Study the temporal distribution often used for each of the substances

4. 4 Identify the risk factors and / or protective socio-demographic variables such as place of origin, idiomatic level, family and social network, hosting conditions, family dysfunction, acculturative stress and migration experience.

1. 1 The presence of psychiatric illness is a risk factor for substance misuse in the studied population

2. 2 high impulsivity levels, sensation seeking traits and ADHD is associated with a higher risk for substance misuse

3. 3 the coexistence of high impulsivity levels (above average expected for age and origin group), presence of psychopathology and unfavorable sociodemographic conditions predict greater severity in substance misuse

4. 4 low idiomatic level, a reduced family and social network, difficulties in relationships during youth custody, the family dysfunction in origin, acculturative stress and complications in the migration process are associated with increased risk for substance misuse

Prior studies have suggested that patients suffering from schizophrenia and ADHD may process certain sound stimuli in the brainstem in an unusual manner. When these patient groups have been examined with the electrophysiological method of brainstem audiometry, some studies have found illness-specific aberrations. Such aberrations may also exist for patients suffering from bipolar disorder.

To explore the use of the method of brainstem audiometry as a diagnostic tool in psychiatry.

5 individuals with confirmed clinical diagnoses of schizophrenia, ADHD, and bipolar disorder, respectively, were examined with brainstem audiometry in a non-blind, comparative study. The data derived from the patient groups was compared to data from a control population according to a previously arranged data algorithm (SD-BERA).

There was a full match between clinical diagnosis and diagnosis by means of brain stem audiometry for 4 of the 5 patients suffering from schizophrenia (1 mismatch), 4 of the 5 patients suffering from bipolar disorder (1 patient was given a second audiometric diagnosis of schizophrenia), and 3 of the 5 patients suffering from ADHD (1 patient was given a second audiometric diagnosis of bipolar disorder and 1 patient was a mismatch).

Brainstem audiometry shows promise as a diagnostic tool, but blinded studies are needed to examine the diagnostic properties and validity of this method.

There is no doubt that cannabis abuse contributes to the development of schizophrenia. However, the influence of cannabis on schizophrenia psychopathology remains unclear.

This study aimed at investigating the association between life time diagnosis of cannabis abuse (LTCA) and psychopathological manifestation of first-episode schizophrenia (FES).

We recruited 45 FES patients. Schizophrenia was diagnosed based on DSM-IV and ICD-10 criteria, and confirmed using Operational Criteria for Psychotic Illness (OPCRIT). Additionally, all patients were assessed using Positive and Negative Syndrome Scale (PANSS). Patients with drug and/or alcohol abuse within one year of onset of psychotic symptoms were excluded.

Assessment with OPCRIT revealed that LTCA is associated with longer duration of excessive (p = 0.044) and reckless activity (p = 0.023), reduced need for sleep (p = 0.023), other primary delusions (p = 0.046), as well as thought withdrawal (p = 0.01) and thought broadcast (0.01). There was no significant difference in the total score of PANSS subscales (i.e. positive, negative and general). However, FES patients with LTCA experienced significantly more severe excitement (p = 0.031) and grandiosity (p = 0.018), as well as poorer impulse control (p = 0.008).

Our results indicate that LTCA has a differential influence on psychopathology of FES exacerbating delusions of thought broadcast and withdrawal, affective symptoms and behavioural manifestation of experienced psychotic symptoms.

Delirium is an acute disorder of attention and cognition with a fluctuating course caused by physiological abnormalities. The syndrome is common, serious, under-recognised, and can be fatal.

There are very few studies concerning mortality of delirious patients in psychiatric departments, just as there is a lack of literature on delirium in psychiatric patients in general.

To determine the psychiatric co-morbidity profile of Danish psychiatric inpatients diagnosed with delirium, and to analyse the standardized mortality rate ratio and predictors of mortality in the same patients from 1995 through 2012.

All first time-ever diagnoses of delirium among psychiatric inpatients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 through 2012. The delirium diagnoses include 1) delirium unspecified, 2) delirium in dementia, and 3) delirium drugrelated, all in accordance with ICD-10. The mortality rates were age-standardized and the statistical analyses performed with STATA 12.

A total of 7,246 persons diagnosed with delirium was identified in the DPCRR between 1995 and 2012.

Dementia was present in 7% before a diagnosis of unspecified delirium, and about one sixth was diagnosed with dementia after the episode of delirium. A dementia-diagnose before, co-occurring, and after delirium in dementia was seen in 39.8%, 61.9%, and 54.5% respectively.

Drug-related delirium co-occurred most often with another substance-use related disorder. Sedatives or hypnotics cover the majority of substance use at the time of drug-related delirium.

Further analyses are presently in progress.

In progress.