Nicotine dependence is significantly more prevalent in patients with mental illness, e.g. 60% in affective and 60%–90% in schizophrenia spectrum disorders, than in the general population (about 30%). Smoking not only causes physical diseases and increases mortality, but also negatively affects psychiatric disorders.

To evaluate the acceptance, practicability and efficacy of a programme to help psychiatric patients quit or reduce smoking and to characterise smoking psychiatric inpatients.

‘The smokers’ group’ is a voluntary, manualised, behaviour therapy group programme adapted to the special needs of psychiatric inpatients. It consists of six 75-minute open-group sessions. We recorded the smoking status of all psychiatric patients and evaluated the programme with standardised questionnaires.

In July 2012, 49.2% (116/236) of inpatients were active smokers (55% of men, 45% of women). From July 2012 to December 2013, 113 patients (56% women, 44% men; mean age 46 years) participated in ≥1 programme sessions. Median duration of smoking was 21 years and mean physical dependence was severe (5 on the FTND). Of those who completed ≥3 sessions, 23% (n = 26) roughly halved their cigarette consumption (from 22 to 10 cigarettes/d). Thirty-six (31%) stopped smoking, 30 with nicotine replacement. Eleven patients were abstinent after the programme, as verified by expired carbon monoxide.

Although smoking cessation is often difficult for psychiatric inpatients, they showed interest in the programme. about a third reduced or even stopped smoking. Adherence (high drop-out rate due to discharge and completely voluntary participation) and long-term followup require further attention.

World tendency towards overall age increase of the population leads to increase of elderly people among patients. Delirium (confusional state) is common in geriatric inpatients in general hospital. It is one of the most significant syndromes of cognitive dysfunction in people of senior age. The presence of delirium increases the duration of hospital stay, morbidity and mortality.

To evaluate the prevalence of delirium amongst inpatients of senior age in different departments of general hospital.

We have studied a total of 247 randomly selected inpatients. Of these, there were 113 patients in the Traumatology Department and 134 in the Neurology Department. Delirium was diagnosed based on the criteria of ICD-10. We used the Mini-mental state examination (MMSE) scale as a metric of the degree of the disorder of cognitive functions.

60 patients (24,3%) of the studied population were found to be delirious. There were 26,5% of delirious patients in the Traumatology Department and 22,4% in the Neurology Department. and the maximum prevalence of delirium was in the range of 81–85 years (39%).

We present statistically significant results showing unequal prevalence of delirium amongst elderly inpatients of the two biggest departments of the general hospital. The large amount of delirious patients forces of medical professionals to pay more attention on psychiatric condition of patients.

Subjective well-being (SW) has a strong direct relationship with quality of life. It has also been strongly associated with adherence, and with a lasting symptomatic remission. Several studies point to the SW one of the main predictors of a comprehensive response to treatment

Evaluate the subjective response to neuroleptics (both SW and attitudes towards medication) in patients with schizophrenia treated with longacting injectable antipsychotics.

20 outpatients with schizophrenia according to ICD-10 criteria. These patients were in treatment with long-term antipsychotic monotherapy during the past three months. Two treatment groups were established: paliperidone palmitate treatment group and another group with other long-acting injectable antipsychotics (constant release risperidone, olanzapine pamoate, zuclopentixol and fluphenazine decanoate).

SW was assesed by the Subjective Well-being under Neuroleptic Treatment Scale (SWN-K) The attitude towards medication was assessed by the Drug attitude inventory (DAI).

Mean scores of SWK-N were: 87.64 (16.22) in paliperidone palmitate group and 89.67 (17.19) in the other antipsychotics group. Mean score of DAI was 17.09 (SD 3.08) in paliperidone palmitate group and 18.78 (SD 1.09) in the other antipsycotics group.

We did not find significant differences between the two groups. It should be noted observational design prevent us from make relevant inferences. It is likely that with a larger sample size these data can be modified.

Pain is a frequent reason for psychiatric consultation. It is a symptom that is often associated with other mental disorders. It can have a significant impact on the quality of life of the patient. Yet pain is a complaint often underestimated by the clinician. It is considered inherent to mental illness and so poorly supported.

Studying the relationship between mental illness and pain and include means to support this co morbidity.

This is a cross-sectional and descriptive study on a population of 50 consultants who suffer from chronic pain. The evaluation consists of a questionnary on the characteristics of the pain, psychiatric illness and modality of care.

Among the patients studied, 80% were female. The mean age was 47.33 years. Predominant type of pain was headache in 78 % of cases, followed by stomach pains and diffuse arthralgia. The impact on daily life was average for most patients. Radiological exploration was performed in 35% (without abnormalities in 100% of cases). Depressive disorders were present in 60 % of cases. The most prescribed analgesics was Tier 1 (paracetamol) with a positive trend in 65 % of cases.

The pain, especially headaches are a common complaint in psychiatry. Their association with depression is classic. But it can also accompany other mental illnesses and worsen their prognosis. A better understanding of causality of pain and its management is essential to improve the quality of life of patients.

Sleep is a basic physiological need for the health and well being. Aging brings many changes in sleep holding the advance in age, multiple comorbidities and changes in lifestyle.

Describe the quantity and quality of sleep in the elderly.

Prospective and descriptive study involving 40 people aged over 65. The sleep evaluation was done over a period of four weeks with a sleep diary (daily self-assessment tool of sleep and wakefulness).

In our study, we found an average of hours of sleep in elderly subjects 8 to 9 hours per day. The sleep time was in 60% of cases before 10 pm and the wake-up time was in 52% cases at or before 6 am. The sleep latency did not exceed 30 min in 68% of cases. Sixty pourcent subjects have had nocturnal awakening for more than an hour. Sleep quality was considered poor by 55% of sujets and disturbance was attributed significantly to somatic diseases.

Sleep disorders in the elderly are common. The effective treatment must take account of psychological, psychosocial and somatic factors specific to age.

Film wields an extraordinary power and can both influence and be influenced by society. Given that 1/4 people suffer from a mental illness at some point in their lives, mental health issues play huge roles in our society and on our screens.

The medical film festival Medfest operates under the auspices of the RCPsych and the aim of the festival in 2012 was,’To stimulate debate of the social and political implications of portrayals of health and illness on our screens’.

Waltz with Bashir is a film that vividly depicts the 1982 Lebanon War through the lens of an Israeli veteran.

The former Prime Minister of Lebanon stated,’…that Lebanon would be the last Arab state to have peace with Israel…’

To demonstrate how the power and synergy of film can be utilised to deliver the peaceful message of co-existence.

The WPA announced that it would be holding the 2012 Cultural Psychiatry Conference in Tel Aviv. I submitted an abstract on Medfest and the portrayal of PTSD in Waltz with Bashir.

I received an invitation from the Scientific Committee to deliver a Keynote Lecture in Israel.

RCPsych initiatives like Medfest inspired me to challenge preconceptions and prejudices. Most importantly, however, whilst I have no misgivings that it will take more than a lecture to resolve the on-going Arab-Israeli conflict this experience has given me, a Lebanese early-trainee psychiatrist, and others that glimmer of hope that one day the two people may live in peaceful co-existence.

Adequate pathways to care are a prerequisite for early detection and intervention in First Episode Psychosis (FEP). Two systematic reviews examined the influence of ethnicity, social and clinical factors on psychosis care pathways. Accessibility to health services differs for under 18s, yet differences in care pathways between age groups and the impact of family factors have not been investigated.

To investigate the influence of family factors in help-seeking pathways for adolescents with FEP.

Naturalistic crossectional study of 1351 FEP (14-35 years) referred to Early Intervention Psychosis teams (London, UK; 2003-2009). Care pathways included accounts on who initiated help-seeking process, initial contact points (GP, emergency services, education, social services, police and court/prison), and family factors (social support, living arrangements and family load of mental illness).

For the majority of adolescents (n=118) and adults (n=1232), first and second contact points were GP (30% vs 42%) and emergency services (18% vs 23%). However, these two services accounted for less than half of the adolescents’ sample. Adolescents made higher use of education (p<0.001). Family factors, such as good social support (p=0.036), living with carers (p<0.001) and family load of mental illness (p=0.018), were associated with family taking a leading role in problem recognition.

Adolescents with psychosis differ from adults in their contact points when seeking help. Problem recognition is a complex process which involves identifying and legitimizing mental health concerns. Parental awareness and perception of problems revealed as a key step in seeking help for adolescents.

Gender Incongruence (GI) is a rare condition in adolescence characterized by a marked incongruence between one's experienced gender and the assigned sex. It presents as a combination of: a strong discomfort and/or intense rejection of the behavior/attributes of the born gender, a strong desire to live (and be treated) of the experienced gender, and/or a determination to follow the process of transition (i.e. hormonal therapy, sex reassignment surgery). Psychological functioning and treatment outcome has shown significant variation across transgender individuals.

This study aimed to investigate the diagnostic stability of GI in adolescents across ICD-10, DSM-IV-TR, DSM-5, and ICD-11.

Case series of four adolescents aged 16-17 (3 female-born and 1 male-born) with GI seen at Child and Adolescent Mental Health Services (London, UK) in 2012, who completed clinical assessments and questionnaires (Utrecht Gender Dysphoria Scale and Gender identity/GD questionnaire for adolescents and adults).

GI diagnostic criteria varied across diagnostic systems regarding: (1) number of indicators required, (2) symptoms duration, and (3) presence of clinical distress/impairment. In our case series, the latter led to diagnostic instability: two adolescents did not fulfill DMS-IV-TR and DSM-5 criteria. Nonetheless, the dimensional approach supported the GI diagnosis for the four adolescents.

Classification systems evolved in their conceptualization of GI over time evidenced by a shift in the condition name and diagnostic criteria. Diagnostic instability across classification systems may have an impact on their clinical utility. Evidenced-based investigations are required to further assess the clinical utility of the new classification systems.

Everyday clinical routine is frequently challenged by difficulty to choose among differential diagnostic options, since many psychiatric disorders share similar phenotypes. E.g., borderline personality disorder (BPD) and schizophrenia (SZ) can both be associated with psychotic syndromes.

Our objective was to evaluate the effectiveness of combining sMRI data and pattern classification methods to differentiate between BPD and SZ.

We aim to introduce objective diagnostic measures to improve the reliability of clinical evaluations.

sMRI data of 114 female patients were used to train a multivariate disease classifier.

MR images were processed using voxel-based morphometry and high-dimensional registration to the MNI template. Grey matter volume maps were fed into a machine learning pipeline consisting of adjustment for possible age effects, PCA for dimensionality reduction and linear ν-support vector classification. Diagnostic performance of the classifier was determined by repeated nested 10-fold cross-validation.

We were able to correctly classify unseen test subjects’ diagnosis with 74% accuracy. Classification sensitivity and specificity was 74%. Volume reductions in SZ vs. BPD were predominantly located in the left peri- and intrasylvian regions, orbitofrontal regions, the nucleus caudatus and the right cerebellum. Volume reductions in BPD compared to SZ were found predominantly in the left cerebellum, in limbic areas and the left inferior occipital gyrus.

Our results suggest that SZ can be differentiated from BPD at the single-subject level using sMRI and pattern classification methods. In future, this method might enhance clinical evaluations and improve accuracy and reliability of differential diagnosis.

Cannabis use has demonstrated an association with earlier onset of psychosis. Investigation of sociodemographic and clinical characteristics in association with cannabis use in adults with first-episode psychosis (FEP) has resulted in inconsistent findings. The clinical profile of cannabis users amongst adolescents with FEP remain widely understudied.

To investigate the frequency of cannabis use, and its association with sociodemographic and clinical characteristics in adolescent-versus adult-onset FEP.

Naturalistic cross-sectional study of 1363 FEP cases aged 14-35 (136 with adolescent-onset psychosis) referred to Early Intervention Services for psychosis in London (UK) (2003-2009). Sociodemographic and clinical data (age of psychosis onset, symptom domains, substance misuse, insight, violence, global functioning, and duration of untreated psychosis [DUP]) were collected at entry to EIS.

Cannabis users were more likely to be male (78.2%), White (43.0%) and unemployed (72.0%). No significant difference was found in cannabis abuse/dependence frequencies between adolescents (28.4%) and adults (24.7%). Cannabis abuse/dependence was associated with an earlier onset of psychosis by 2 years (p<0.001), greater manic and positive symptoms (p<0.001), increased violence (p=0.011), and poorer functioning (p=0.013) and insight (p=0.003). For adolescents, cannabis abuse/dependence was associated with greater positive symptoms, poorer functioning and longer DUP.

Cannabis use shapes the clinical presentation of FEP individuals. Similar frequencies of cannabis use between age groups suggest that substance misuse services should be provided to all, aiming to reducing consumption. Greater vigilance amongst clinicians would enable earlier detection of psychosis in substance misusing adolescents, to reduce DUP and minimise associated poor outcomes.

In Tunisia, the number of suicide attempts (SA) leading to a psychiatric follow-up seems to increase.

To describe the clinical and environmental profile of suicidal patients addressed to the outpatient psychiatry department.

It was a retrospective and descriptive study. Data were collected from the files of 29 suicidal attempters referred in 2012 to the outpatient psychiatry department at the Hedi Chaker University Hospital of Sfax in Tunisia, after one or more SA.

SA accounted for 2.4% of new patients referred to the outpatient unit during the year 2012. The sex ratio (M / F) was 0.7 and the mean age was 28.8 years. They were single in 51.7% of cases. Their school level didn’t exceed the primary education in 62% of cases and they didn’t have any occupation in 51.7% of cases. Some relational problems, especially family ones were identified in 69% of cases and the quality of family and / or social support was considered poor in 41.4% of cases. The SA was reactional in 24.1% of the cases; 34.5% of suicidal attempters presented a personality disorder and 17,2% presented a major depressive episode.

A young single person with no profession, a limited educational attainment and low social support, such is the profile most frequently encountered among suicidal attempters. The presence of underlying mental disorders and socio-familial dysfunction seems to be important risk factors for suicide and should be considered in the prevention of recurrence.

Valproic acid is a broad-spectrum drug used in neurological disorders but also in psychiatric disorders such as mood stabilizer in bipolar or schizoaffective disorders.

Despite being a usually well tolerated drug, valproic acid may be associated with some adverse effects. Most of which are mild and transient, however some adverse reactions may be serious like encephalopathy. In fact, valproic acid induced encephalopathy is an unusual but serious complication, characterized by decreasing level of consciousness, focal neurological deficits, cognitive slowing, vomiting, drowsiness and lethargy, with or without hyperammonemia.

The aim of this work is to describe a case report of a woman who developed valproic acid induced encephalopathy during her hospitalization in the Coimbra's Psychiatric Department.

This is a woman, 46 years old, diagnosed with a bipolar disorder who was hospitalized for stabilization of their depressive symptoms.

At the entrance, a confusional state was found with fluctuating state of consciousness, psychomotor slowing and incoherent speech.

An analytical study was conducted which showed a hyperammonemia of 70μg/ dL.

Immediately the valproic acid was suspended on suspicion of encephalopathy induced by this drug.

Gradually, in about 2 or 3 weeks, confusional state disappeared, and the patient discharged from the hospital oriented in time and space, with coherent speech, euthymic mood and regularized sleep.

Valproic acid induced encephalopathy, is a reversible but potentially fatal adverse reaction that requires a high index of suspicion. Organic brain damage and polytherapy appear to be important risk factors for its occurrence.

A 23 year old woman with an established diagnosis of eating disorder was analysed for multiple personality traits in the background of a multifactorial etiology.

1. 1) Establishing secondary complications in the case

2. 2) Diagramatically representing the findings

1. 1) Identifying the personality traits

2. 2) Etilogical analysis

1. 1) Retrospective analysis of all medical and psychiatric events.

2. 2) Interviewing the patient and relatives.

3. 3) Research

4. 4) Analysis of all medical investigations carried out.

5. 5) Response to multidisciplinary management.

It was confirmed that multiple factors played their roles in the development of the condition including both familial and environmental agents.

53 patients and 47 matched controls were studied using a new questionnaire (SEXSAM Scale) measuring relevance of sexual and emotional relationships in patients’ daily life. A specific Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX Montejo 2001-2008), Sexual Activity Assessment Scale modified from Kinsey (Montejo 2006) and the HONOS Scale measuring bio-psychosocial functioning were also applied.

Sexuality (physic and emotional) was scored as high valuable and the main motivation for sexual activity was looking for love and fondness in both groups. No differences were found in the value of more affective behaviours such as kissing, caressing, hugging or massaging. Global satisfaction in sexual and emotional life was significantly superior in control group and linked to the higher frequency of sexual relations. Many patients suffered for sexual dysfunction related to the treatment use and many of then were dissatisfied with their sexual life. Just a few numbers of patients had regular sexual intercourses. Patients describe an improvement in the self-perception of mood, appetite, sleep, anxiety level, humour sense and self-esteem when they have sexual relations. Predominant sexual activity for patients was masturbation. Prostitution use was higher in patient group. All these findings are negatively influencing personal satisfaction and quality of life.

Relevance of sexual and emotional life in patients is as high as in normal population. These patients are more concerned about affection and companionship than about physical pleasure.