To develop a physical health care policy within the Rotherham Doncaster and South Humber NHS Foundation Trust (RDASH NHS FT) and shared care policy with Primary care, for adult psychiatric patients. To carry out a physical health care pilot in community mental health team of adult psychiatric patients.

To achieve a baseline of physical health status of the patients.

To present the findings to the trust governance committee.

Plan further pilot in Primary care to ensure action plan.

Arrange systems in place within IT to store and share information.

Pilot was carried out in Ferham clinic in Rotherham.

Number of patients: 247

A physical health pro-forma was devised which was completed by patients.

Time period: May2013-September2013

Patients identified: 247, Respondents: 225

Type of pre-existing physical illness

Side effect profile

The results were presented at Trust Governance Committee and the pro-forma has been agreed as a trust wide minimum standard.

Pilot in primary care has been agreed with Kivetonpark Medical practice.

A system has been agreed with IT to store and share information in electronic case notes.

Pending the results of primary care pilot, a policy for physical health care will be agreed.

Psychotic symptoms such as hallucinations and delusions are common in patients with Parkinson's disease (PD). The estimated prevalence of hallucinations ranges from ~10% to 48%, and the prevalence of delusions ranges from 3% to 80%(ref 1–9). The various of the prevalence depends of the diagnostic criteria used. The etiologies of these symptoms are multiple and treatments are different. Through a clinical observation of a patient treated for a Parkinson disease (PD) and who develop two years ago a behavior disorder, irritability, visual hallucination and illusion, we suggest discussing the etiologies and the therapeutic difficulties of this disorder.

Y.N., a 64 year-old man, with family history of dementia, and personal history of diabetes and tuberculosis. He is followed for Parkinson's disease since the age of 57 years. He received Trihexyphenidyle (5 mg per day), Piribedil (200mg per day) and levodopa (500mg per day) with a progressive increase and excessive consumption of levodopa (more than 1000mg per day). Since the age of 62 years old, he presented with elaborated and invalidating auditory hallucinations with ideas of persecution and prejudice. The neuropsychological evaluation showed no other signs of dementia (MMSE=30/30). The diagnosis of dopaminergic psychosis was established. Levodopa was decreased; Trihexyphenidyle and Piribedil were discontinued with a notable improvement of hallucinations.

The psychotic symptoms in PD should be searched, such as systemic illness and other psycho-active medications. If none are identified or can be eliminated, the PD medications should be reduced to the lowest levels that allow tolerable motor function. Once this level has been reached we can use either acetylcholinesterase inhibitors or typical anti-psychotics

Previous studies concerning early experiences in childhood show that these play a crucial role in the individuals’ development and may lead to a decrease in the vulnerability to show psychological problems. Mindfulness skills and feelings of hope seem to function as mechanisms that promote adjustment and psychological well-being.

The aim of this study was to explore the relationship between early positive emotional memories, hope, and mindfulness skills, as well as their role in the psychological well-being.

A sample of 402 adolescents with ages ranging from 12 to 18 years old completed four self-report instruments: the Early Memories of Warmth and Safeness Scale, the Children and Adolescent Mindfulness Measure, the Children Hope Scale and the Positive and Negative Affect Schedule.

Girls exhibited more negative affect when compared to boys. Age and years of education were not correlated with any of the study variables. Students with no school disapprovals showed more positive emotional memories and more hope. Mindfulness skills, hope, warmth and safety memories, and positive and negative affect were significantly correlated in an expected way. The set of variables that better predicted positive affect was: hope, early warmth and safety memories, and mindfulness skills. For negative affect, mindfulness was the best predictor followed by hope and lastly by positive emotional memories.

The current study heightened the role of positive emotional memories, mindfulness, and hope in affective states, suggesting that they may be addressed in intervention programs for the adjustment or the psychological well-being of the adolescents.

Social relationships (e.g. family, friendships and romantic relationships) are fundamental to human development and well-being.

The current study aimed to explore the psychometric properties of the Social Values Questionnaire (SVS; Blackledge & Ciarrochi, 2006) in a sample of Portuguese adolescents. Furthermore we sought to understand motives for and commitment to social values and how these elements are associated with well-being across age and gender.

The sample included 268 adolescents (150 girls and 118 boys) with ages ranging from 14 to 18 years old, attending high school. Participants completed a set of self-report measures: the SVS, the Positive and Negative Affect Schedule (PANAS-C; Sadin, 1997), the Students’ Life Satisfaction Scale (SLSS;Huebner 1991) and the Children's Hope Scale (CHS; Snyder, Hoza, Pelham, Rapoff, Ware, Danovsky, Highberger, Rubinstein & Stahl, 1997).

The Portuguese version of the SVS showed high internal consistency: Intrinsic motivation (α=0,91), extrinsic motivation (α=0,90), commitment (α=0,79). It also showed adequate test retest reliability. Gender revealed a relevant role with girls presenting more intrinsic motivation, less extrinsic motivation and a higher degree of commitment when compared with boys. Age was positively correlated with intrinsic motivation and commitment. Significant and expected relationships were also found between SVS subscales and positive and negative affect, life satisfaction, and hope.

The SVS seems to be a valid and reliable instrument for the assessment of social values in adolescents. This construct is an important one in the context of mindfulness and acceptance based therapies and thus its assessment is pertinent.

We analyzed the first visits carried out by a local mountain psychiatric service in 9 months from January to September 2013.

Analyze the mode of access to the service, and the continuation of the course of treatment.

Different variables were considered: sex, how to access, the level of urgency, the prescription drug, the previous psychiatric history, duration of taking charge and sending to other facilities of the Mental Health Department.

The total number of patients was 176, of which 64% were female; scheduled visits were the most (146), the remaining (30) were urgent. The majority (110) were sent from their GPs, among these, more than half (63) are still in load. Half had a positive psychiatric history, and most (92) had a positive psychiatric drug history. It was set to a drug therapy to the majority of patients visited (147), especially anxiolytics (112) and secondarily antidepressants (109). A small part was hospitalized (3) or sent to Psychogeriatrics (11) or Pathological Addictions or Clinical Psychology; about one-third (57) were discharged.

According to the literature the women access more frequently than men. From the data it can be inferred that submissions by GPs have become more appropriate in the course of time and that send to the specialist after trying a first drug therapy. The use of anxiolytic drugs remains an issue of clinical practice.

The concepts of well-being and hope are associated with life satisfaction. Public policies should include the promotion of quality of life in the elderly.

The current study sought out to address the concepts of hope and well-being in the elderly, analysing the role of socio-demographic variables. It also aimed to characterize this population in terms of other quality of life indicators such as perception of general health status, loneliness and degree of activity.

The sample included 130 elderly people, both from the community and institutionalized, with ages between 65 and 94 years old. Participants answered questions about socio-demographic data, quality of life indicators, cognitive functioning and measures of hope (HP; Snyder et al.; 1991), life satisfaction (SWLS; Diener et al, 1985), and positive and negative affect (PANAS; Watson, Clark, & Tellegen, 1998).

The majority of participants perceived their health status as reasonable and mentioned feelings of loneliness. Only 20% considered themselves active. Men presented higher levels of hope when compared with women. Participants who were not institutionalized showed higher levels of hope and positive affect, considering themselves more active when compared to the ones living in nursing homes or attending day centres. Hope showed to be positively correlated with life satisfaction, positive affect, health status perception and degree of activity, and negatively correlated with negative affect. Negative affect showed to be correlated with the perception of loneliness.

This study enhances the importance of socio-demographic and psychological variables in the promotion of well-being in the elderly.

Immigration involves significant changes in the psychosocial context, due to losses, relationship breakdowns, lack of social support, not feeling at home, novelty, discrimination, resettlement demands (occupation, language). These life stressors might lead to psychological distress, including depression.

To explore if there are differences in the prevalence of depression and depressive symptoms in immigrant and Portuguese women during the perinatal period.

The sample comprises 397 women. 348 (87.7%) of them were Portuguese and the remaining 49 (12.4%) were born in other Countries (5.8% Other/European, 3.8% African, 2.8% South America). They were both interviewed at the last trimester of pregnancy (T0) and at 3 months postpartum (T1), using the Diagnostic Interview for Genetic Studies, which allows CID-10 and DSM-IV diagnoses of depression. Both at T0 and T1, they also completed the Postpartum Depression Screening Scale (PDSS) to evaluate depressive symptoms.

Immigrants compared with Portuguese women did not differ in respect to a CID-10/DSM-IV depression diagnosis and in respect to PDSS total scores at T0 and T1. Being immigrant is associated with higher levels of passive suicidal ideation (death seem the only way out of this nightmare) (rs=.116, p<.05), feelings of loneliness (rs=.118, p<.05) and being overwhelmed by anguished (rs=.134, p<.01) at pregnancy and with feelings of being inadequate as a mother (rs=.128, p<.05) at the postpartum.

Being immigrant might contribute to higher levels of depressive symptoms during the perinatal period, including suicidal ideation. These findings have clinical implications, while working with immigrants.

Leber hereditary optic neuropathy (LHON), an inherited mitochondriopathy, can result in progressive degeneration of retinal ganglial cells and thus in worsening and even loss of vision. Smoking is probably the most important risk factor for the onset and progression of the disease.

To assess the smoking history and status of LHON patients to determine the need for tobacco cessation programmes in this collective.

From November 2011 to January 2012, 27 LHON patients completed a standardised questionnaire including Fagerström Test for Nicotine Dependence (FTND), age when smoking started and quit attempts. Smoking history was confirmed by measuring expired carbon monoxide and saliva levels of nicotine and cotinine.

Twenty men (74%) and 7 women (26%) were evaluated. The average age at disease onset was 29 years. Fifteen (56%) of the participants were smokers at the time of the evaluation, 3 (11%) had quit smoking after diagnosis of LHON and 9 (33%) had never smoked. Saliva nicotine and cotinine concentration correlated significantly with the degree of physical dependence (p<0.05), but carbon monoxide did not.

Even after being informed of the probability of blindness if they continued to smoke, only 3 of 18 patients quit smoking. Further studies need to assess the effects of integrating smoking cessation programmes into the treatment offered to patients with manifest LHON. Also, the role of smoking in the onset and progression of the disease needs to be validated to optimise prevention and treatment measures for carriers and LHON patients.

General population surveys of the prevalence and associations of common mental disorders are necessary for the organization of effective mental health services.

To present data on the pattern and correlates of 12-month use of services by persons with common mental disorders from the recently completed general population survey of psychiatric morbidity in Greece.

The sample (n=4894; multistage random sample drawn from population of both mainland and insular Greece) can be regarded as representative of the Greek population aged 18–70. Participants were interviewed at their households by trained lay interviewers. Common mental disorders were assessed according to the ICD-10 criteria with the revised Clinical Interview Schedule (CIS-R), a fully structured diagnostic interview.

73,9% of participants with at least one common mental disorder (CMD) do not receive any treatment for their psychological health, 52% have never spoken to the family physician and 73.3% has not spoken to a mental health professional in the past year. The disorder associated with the most frequent use of general health services for any reason (>4 visits to any physician in the past year) was depression (43.7%). Regarding use of family physician services for a mental health issue, patients with panic disorder (54.4%) and generalized anxiety disorder (52.8%) were more likely to consult compared to other CMDs. The overall percentage of patients with CMDs that choose to talk to a priest or other spiritual for their mental health problem was comparable to that who talked to a mental health professional. Overall, 46.5% of all participants who meet the criteria for a common mental disorder had not spoken to a doctor or mental health professional, with men showing significantly higher rates of no use compared to women (54.6% men vs. 41.5% women).

The findings of the present study can help in the better organization of services with the aim to improve prevention and treatment of common mental disorders in Greece especially in a time of economic hardship.

Prescribing guidelines advise against long-term benzodiazepines prescriptions. This poses challenges to Addiction services, as patients often present with high risk factors: comorbid psychiatric disorders (which respond poorly to other interventions); physical disorders; high dose, risky and erratic use; and polysubstance misuse.

The main objective was to gain an understanding of the associated factors that influence treatment outcomes and beneficial effects (if any) of treatment in individuals prescribed benzodiazepines.

The aim of the study was to look at characteristics of these individuals who are prescribed benzodiazepines in a specialist addiction service.

Prospectively recorded clinical and demographic information was manually extracted from clinical notes and analysed using SPSS version 12.0

52 patients were prescribed benzodiazepines (mean age of 42.21 years: M: F = 3:1). The average duration on prescription was 4 years and the majority of the scripts were non-reducing. 96% of individuals were also opiate dependent and on Opiate Substitute Treatment. Mental health comorbidity was very high (80%), the commonest diagnoses being Anxiety & Depressive disorders. Only 7% were linked with mental health services. Psychological interventions were offered to 78% but found to be beneficial in only 12%, with significant drop-out rates. 1/3rd had physical health problems, and 13% had pain issues. 94% found benzodiazepine prescriptions to be of ongoing benefit.

There was clear evidence that engagement with the service and treatment programme resulted in benefits with regard to drug misuse and associated risky behaviour such as intravenous injecting.

Addictions epitomize the relationship between body and mind. Addiction to nicotine disproportionally affects underserved populations but only few interventions have demonstrated effectiveness in real-life situations.

To test an intervention with experimental methodology using Community-Based Participatory Research.

Residents of low-income communities were randomized to either of two group-based interventions. Outcome was self-report smoking abstinence, verified via CO test. Interventions included 12 sessions with tobacco cessation education, motivational exercises, and NRT and were implemented by Peer Motivators, with different contingency behavioral management programs for session attendance and landmark achievements (Group ‘A’ had monetary rewards only and Group ‘B’ combined monetary and non-monetary rewards). A total of 352 participants were recruited (58% men; 65% African Americans; 82% were 40 years or older, 78% jobless; and 75% with 3 or more health problems).

Intent to treat analyses revealed that 27% of participants in Group ‘A’ and 29% in Group ‘B’ were able to quit smoking (Pr=0.675). Cessation was associated with higher health problems (RR=1.2 per reported problem, 95%CI = 1.0–1.4, p <0.024), controlling for attendance and potential confounders.

Our holistic approach addressing both body and mind needs with attention to the social context seems to have generated a successful smoking cessation intervention for low-income populations. Community engagement in the design, implementation and evaluation of smoking cessation programs is paramount.

Placebo efect has been a controversial and hot topic within psychoneuroinmunology. However recent studies have shed considerable light on the potential mechanisms of placebo responses and their role in health outcomes.

The objective of this study is to analyze the effects of a process of classical conditioning on the evolution of the symptoms present in a case of multiple sclerosis.

Case study in a 40 years woman diagnosed with relapsing-remitting multiple sclerosis treated with natalizumab (Tisabri©).

The results support the consideration of multiple sclerosis as a stress-related disorder.

The role of expectations of improvement in the treatmente of multiple sclerosis is further discussed.

Cognitive symptoms in depression are associated with high distress, poor functional outcome and more relapses. Variability in cognitive deficits in depression is often reported, and may originate from numerous factors; one rarely examined factor is psychiatric history.

To assess the effects of depression and severe psychiatric history on old-age cognitive performance.

From a sample of non-demented participants (60+ years) in a population-based study receiving neuropsychological testing, three groups were formed based on information from the Swedish national inpatient register (1969-2005): current unipolar depression (ICD-10)/no psychiatric history (n=49), current unipolar depression/psychiatric history (n=16; F10-F45, F31-31.9 excluded), remission/history of mood disorders (n=35, F31-31.9 excluded). In addition, a group of healthy controls (n=98) was randomly selected.

Currently depressed participants without psychiatric history performed at a lower level compared to healthy controls in processing speed, attention, executive function, verbal fluency, episodic free recall and vocabulary. However, remitted participants performed at the same level as healthy controls, and outperformed currently depressed with psychiatric history in verbal fluency. No group differences were observed for short term memory, episodic recognition, general knowledge or spatial ability.

Currently depressed without psychiatric history consistently performed at the lowest level. The proportion receiving psychopharmacological treatment in this group was low, 6.1% compared to 56.2% and 37.1%, which may partially account for this finding. Additional factors potentially explaining why remitted participants and healthy controls perform at the same level cognitively will be examined. These findings may have important implications for preventing residual cognitive deficits in depression.

The progressive increase in the prevalence of anxiety disorders in advanced ages advises the extensive use of of screening measurements in this population, that, everywhere in the world, has raised numerically.

The aim of this study was to examine the psychometric properties of a Portuguese version of the Geriatric Anxiety Inventory-Short Form (GAI-SF, 5-item format) in a sample of 932 elders.

Quantitative and cross-sectional study with descriptive and correlational planning. Translation and back-translation was performed by language proficiency experts. The reliability was assessed through Cronbach's alpha coefficient and the factorial validity through Principal Components Analysis. The convergent validity was conducted with the Geriatric Depression Scale (GDS) and the Positive and Negative Affects Scale (PANAS-Negative sub-scale), while discriminant validity was performed with the PANAS-Positive sub-scale and the Satisfaction With Life Scale (SWLS). A Confirmatory Factor Analysis, using a structural equation modeling, was performed to test the fit of the model with the five items.

The GAI-SF showed good internal consistency (α = 0.77), good convergent, and discriminant validity (p < 0.05). The factorial structure presented a single factor that explained 52% of the variance. The model showed a good fit to the data (χ2= 1.233, TLI = 0.997, CFI = 0.999, RMSEA = 0.020).

The GAI-SF, a brief self-report scale, has good validity and reliability, and factorial qualities adequate to measure anxiety symptoms in epidemiological surveys and in geriatric settings.

In the recent years, interest of researchers has been focused on exercise as a possible way to efficiently influence brain functions and plasticity. Several studies concluded that exercise can change brain morphology by affecting synapses, neurogenesis and angiogenesis and improve efficiency in working memory and executive performance. In schizophrenia, white matter integrity is compromised and to what extent exercise affects white matter integrity is unclear.

To investigate the effect of 6 months exercise therapy on white matter integrity in healthy controls and patients with schizophrenia.

A total of 33 patients with schizophrenia and 48 healthy controls, matched for demographic characteristics, were randomized into exercise or occupational therapy/life-as-usual. 3T-DTI data were acquired twice. After susceptibility-artifacts and ECC correction, TBSS was used for registration to standard space and computation of the FA-skeleton. The JHU-ICBM-tract atlas was used to define regions of interest (ROI) for the various fiber tracts. Mean FA values for the FA-skeleton within the separate tract ROIs were calculated. GLM-repeated measures design was done with time as within-subject factor, group and therapy as between-factors, and compliance as covariate.

Significant increases in FA were found for time by randomization in the left corticospinal tract (LCST) (F=4,15, p=0,045), left superior longitudinal fascicle (LSLF)(F=5,092, p=0,027) and forceps major (F=5,687, p=0,02).

Exercise positively affects FA of tracts involved in primary motor functions (LCST), regulation of motor behavior, spatial attention, oculomotor functions and transfer of somatosensory information (LSLF) as well as interhemispheric connections (Forceps major) in both groups.

Antidepressants such as SSRI and SNRI are associated to sexual dysfunction (SD). Agomelatine, an antidepressant with an unique and different mechanism of action, didn’t produce SD in patients and healthy volunteeers (Montejo et al, 2010).

To evaluate the effectiveness of switching to agomelatine in patient's experiencing SD related to previous antidepressant treatment (AD-SD).

Observational prospective study of 2-6 months follow-up. Adult sexually active patients presenting AD-SD and switched to agomelatine monotherapy were included. SD was evaluated with the change at endpoint in the validated and specific questionnaire PR-Sex-DQ-SALSEX (Montejo et al, 2001).

51 patients were included. All of them presented moderate to severe SD at inclusion. Previous AD treatment was an SSRI (63.4%) or SNRI (36.6%). Mean time of follow-up was 10.38 weeks (Sd: 5.20). Mean dose of agometine was 28.43 mg/day (Sd: 10.02). Sexual dysfunction (sexual interest, orgasm delay, anorgasmia and arousal problems) improved after switching to agomelatine, as shown by the significant reduction in PR-Sex-DQ-SALSEX score (global and by items) at endpoint (p<0.001, Wilcoxon test). At endpoint 44.9% of the sample had resolved their SD. Moderate-severe SD was present only in 18.4%. 13.9% discontinued agomelatine due to lack of efficacy and 9.7% because tolerability issues, specially associated to discontinuation syndrome.

In our sample global and every domain of SD improved significantly after switching to agomelatine, what makes it an apparent successful option to manage Antidepressant-related Sexual Dysfunction. A gradual switching is suggested in order to avoid treatment failure due to discontinuation syndrome.