Age-related cataract is the major cause of blindness in humans throughout the world. The majority of previous studies of cataract in Down's syndrome have reported a prevalence that is higher for a given age range than in the general population. The aim was to study the prevalence of cataract in a well-defined population of adults with Down's syndrome.

An in-patient population of 68 adults (35 males and 33 females) with Down's syndrome, aged between 28.9 and 83.3 years, underwent ophthalmological examination for the presence of cataracts.

Overall, the prevalence of cataract was 16.2%, with no significant difference between males (17.1%) and females (15.2%). In those aged between 45 and 64 years, the prevalence was 16.7%, rising in those aged between 65 and 75 years to 28.6%.

Compared with the general population, the prevalence of cataract in Down's syndrome was raised in those aged 45 to 64, but not in those aged 65 to 75 years; the latter might be a function of the relatively small number of patients in this age group. The increased prevalence of cataract found in those in the 45- to 64-year-old age group may be the result of increased levels of CuZnSOD, in turn resulting from the location of the associated five exons of SOD1 on chromosome 21. These elevated levels of superoxide dismutase may give rise to increased levels of reactive species, including hydrogen peroxide and hydroxyl radicals, which may increase the risk of cataractogenesis.

The relationship between immigration and psychopathology is increasingly understood to be indirect and moderated by the stressors related to the migratory process. Empirical study of acculturative stress has been hindered by the lack of an instrument sensitive to the local immigration context. The Barcelona Immigration Stress Scale (BISS) was developed for as a response to this lack. A four factor model is hypothesized as constituting acculturative stress: (1) stress related to the migratory process (homesickness); (2) stress related to the acculturative process (culture shock); (3) stress related to perceived discrimination; and (4) general psychosocial stress. The objective of this study was to evaluate the internal validity of the BISS.

The BISS was administered to 500 immigrant patients who participated in a study concerned with psychopathology and immigration. Internal consistency was estimated on the basis of the Cronbach alpha and a maximum likelihood factor analysis was carried out with a prior direct oblim rotation.

The BISS has satisfactory internal consistency. Preliminary findings confirmed the four factor model which explained a significant proportion of the common variance.

The BISS is internally valid and supports the hypothesized model of acculturative stress. Future studies will establish the external validity of the BISS comparing the scale to related instruments and to determine if acculturative stress is predictive of psychopathology.

To examine the occurrence of suicide in urban and rural regions of Belarus in the post-Soviet period. Design: Unlinked cross-sectional study using data drawn from four time points.

Age and sex-specific suicide data for urban and rural regions of Belarus were obtained from the Ministry of Statistics for the years 1990, 1995, 2000 and 2005. The data were recalculated into seven age categories and then directly standardized. Poisson regression models were used to assess changes in urban-rural suicide rate ratios.

Between 1990 and 2000 the suicide rate rose sharply in Belarus and by 2005 it remained much higher than its initial level. After 1995 there was a divergence between sex-specific rates in urban and rural areas. By 2005 although suicide rates had fallen from their 2000 level for both sexes in urban and rural locations, the fall was much smaller in rural areas. These changes resulted in a deteriorating rural/urban suicide ratio across the period 1990 to 2005 with suicide rates among nearly every rural male age group remaining extreme after 1995. Although it is probable that a deteriorating social and economic situation has underpinned increasing suicide rates in all regions, there may be factors that are specific to rural locations such as social isolation, alcohol abuse and the poor provision of medical services.

By 2005 Belarus had one of the highest suicide rates in the world. This now requires urgent intervention by the necessary authorities to ameliorate this situation in urban and especially rural locations.

The study aimed at exploring prevalence and risk factors of attempted suicide and suicidal thoughts before hospital admission.

40.451 episodes of inpatient care from 1995 to 2004 were included. Last admission of each patient (n=20.543) was extracted to investigate attempted suicide and suicidal thoughts before admission, which were recorded by the German Basic Documentation System (BADO). Univariate analyses and multivariate logistic regression analyses were performed to explore predictors of suicidality before hospital admission.

3.643 (17.7%) of 20.543 inpatients attempted suicide or had suicidal thoughts before admission. 1.478 (7.2%) attempted suicide before admission. Most had diagnoses F43 (36.5%), F32/33 (19.2%) or F60/61 (8.8%). According to regression analysis risk of attempted suicide increases with life time suicide attempt, diagnosis F43, admission due to doctor´s recommendation, diagnosis F32/33, diagnosis F60/61 and period of onset of present episode less than one week. 2.165 (10.5%) had suicidal thoughts before admission without concomitant suicide attempt. Most frequent diagnoses were F43 (23.5%), F32/33 (22.7%) and F10 (11.7%). Risk of suicidal thoughts increases with diagnosis F43, diagnosis F32/33, life time suicide attempt, diagnosis F60/61, supportive psychotherapy before admission, period of onset of present episode less than one week, being younger and being not rehospitalized.

Basic rate of suicidality before admission of psychiatric inpatients is high. Therefore, risk of suicide should be carefully examined at admission but also during inpatient care. Especially, inpatients with adjustment disorder and depression seem to be a high risk groups regarding suicidality before admission and require special attention.

Sleep disorders are significant problem in hemodialysis patients, contributing to psychosocial disability and decline in qualiy of life. Aim of this study was to assess the quality of sleep disorders in relation to various clinical and sociodemographic factors in patients undergoing hemodialysis.

The preliminary study group included 55 persons selected at random from 150 patients treated by hemodialysis. The mean age was 60,31±12,14, mean time of dialysis 3,49 ± 4,53 years. 20 women and 35 men were interviewed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) sleep disorders section and additional sociodemographic interview. In each case psychiatric examination has been performed. Medical comorbidity including restless legs syndrome (RLS), suffering from pain, blood and urine tests were analyzed for potential impact on sleep disturbance.

In studied group sleep disturbences did not show significant correlation with presence of mental disorders, somatic comorbidity other than RLS or most laboratory data (blood or urine tests). The following differences were observed:

1. 1. Positive correlation between overall sleep impairment, night wakefulness and nPCR index related to nutrition and metabolism (p-value 0.047),

2. 2. Greater sleep satisfaction in the group with higher calcium level before hemodialysis (p-value 0.045),

3. 3. Higher nightmares occurence in the group with lower calcium level before hemodialysis (p-value 0.023).

In the population of patients with end-stage renal disease after adaptation period to hemodialysis more important role in sleep disorders may play factors related to the somatic state and metabolism rather than psychiatric comorbidity.

Domestic violence especially from intimate partner, is the most common type of violence against women that has many psychological, social and economic adverse effects. Domestic violence in pregnancy causes serious problems for the infant and mother. Considering the importance of this matter, the present study investigated the frequency and intensity of intimate partner violence against pregnant women.

This study is a cross- sectional research. Two hundred and ninety inpatient mothers in post-delivery sections in educational hospitals were assessed using Iranian version of "Conflict Tactics Scale"(CTS2) after establishing the validity and reliability of this scale.

Results showed that 92.4%, 6.9% and 0.7% of women experienced very mild, mild and moderate intimate partner violence in their pregnancy, respectively. Verbal violence was rated as 40.9% and 0.7%, emotional violence as 81.1% and 1.7%, physical violence as 93.1% and 0.3% and sexual violence as 95.2% and 0.3%, as very mild and severe, respectively. Findings showed that there was a significant difference between the violence against pregnant women and their neonates' low birth weight (W< 2500 grams).There was not a significant difference between education of men and violence against their wives (P= 0.614).

This research shows that many pregnant women experience the very mild forms of violence and mostly as the sexual violence. The rate of neonates' low birth weight has a significant relationship with the intimate partner's violence against Iranian pregnant women. These findings show the importance of this problem and the necessity of considering preventive strategies for that.

This study aimed to evaluate prevalence rate of burnout syndrome in three aspects dimensions of emotional exhaustion, depersonalization, and decrement of personal accomplishment and also determining degrees of vocational satisfaction, work load, social support, and self –respect in medical service providers.

In this descriptive study we listed all of the hospitals of Mashhad University of Medical Sciences and selected 660 staffs by stratified cluster sampling. They have filled up demographic information forms and self-respect, social support, work load, vocational satisfaction and burnout questionnaires of Maslach Burnout Inventory (MBI). Data has been analyzed by spss and statistical tests (Pearson Chi-Square …).

Results have shown that 91.2% of study units have high self-respect, 67.1% have high social support, 54.8% have moderate vocational satisfaction, and 67.7% have high work load. In the light of three burnout aspects, 38.6% have low level of dimensions of emotional exhaustion, 58% have low levels of depersonalization, and 62.9% have high levels of decrement of personal accomplishment. Also, findings have depicted considerable direct relation between dimensions of emotional exhaustion and depersonalization feeling and work load, between decrement of personal accomplishment feeling and social support, and between emotional exhaustion feeling and self-respect degree.

Rate of burnout in staffs in dimensions of emotional exhaustion and depersonalization and decrement of personal accomplishment was low but because most of dimentions of burnout were higher among women it is important to increase support of them.

the HCPU provides intensive care with 2 consulting visits per day by the psychiatric staff (including family interviews), for 5 patients at a time, with a maximum duration of 40 days.

Socio demographic data:

58% of the patients were female (n=195).

Mean age was 40,2 years with a range 18-80.

76,5% of the patients had family support at home.

The mean duration of home care was 24,2 days.

According to ICD 10 criteriae, 46% (n=150) of the patients were assessed a diagnostic of psychotic disorder, 42% (n=141) were assessed a diagnostic of mood disorder, 8,3% (n=31) were assessed a diagnostic of personnality disorder and 3,9% (n=13) a diagnosis of neurotic disorder.

At discharge, psychotropic drugs were prescribed to 93,5% (n=315) of the patients.

In 71,7% of the cases, 1or 2 molecules were prescribed ; in 26,3% of the cases, 3 or 4 molecules were prescribed.

At one year following discharge, 314 patients were regularly consulting either their psychiatrist or general practitioner and exhibited a satisfactory clinical status.

22 patients (6,5%) only had been rehospitalized within one year after discharge.

The clinical lecture of the patient in the natural environnment is an ecological one summoning a tranversal approach, with no exclusion criteria regarding the diagnosis.

The utility of questionnaire based self-report measures for non-clinical psychotic symptoms is unclear and there are few reliable data about the nature and prevalence of these phenomena in children. The study aimed to investigate psychosis-like symptoms (PLIKS) in children utilizing both self-report measures and semi-structured observer rated assessments.

The study was cross-sectional; the setting being an assessment clinic for members of the ALSPAC birth cohort in Bristol, UK. 6455 respondents were assessed over 21 months, mean age 12.9 years. The main outcome measure was: 12 self-report screening questions for psychotic symptoms followed by semi-structured observer rated assessments by trained psychology graduates. The assessment instrument utilised stem questions, glossary definitions, and rating rules adapted from DISC-IV and SCAN items.

The 6-month period prevalence for one or more PLIKS rated by self-report questions was 38.9 % (95% CI = 37.7-40.1). Prevalence using observer rated assessments was 13.7% (95% CI = 12.8-14.5). Positive Predictive Values for the screen questions versus observer rated scores were low, except for auditory hallucinations (PPV=70%; 95% CI = 67.1-74.2). The most frequent observer rated symptom was auditory hallucinations (7.3%); in 18.8% of these cases symptoms occurred weekly or more. The prevalence of DSM-IV ‘core’ schizophrenia symptoms was 3.62%. Rates were significantly higher in children with low socio-economic status.

With the exception of auditory hallucinations, self-rated questionnaires are likely to substantially over-estimate the frequency of PLIKS in 12-year-old children. However, more reliable observer rated assessments reveal that PLIKS occur in a significant proportion of children.

SES and neighborhood characteristics often confound the association between race/ethnicity and psychiatric problems. We investigate differences in depression among people from two adjacent census tracts that differed by race but had similar levels of poverty, income, and education. Restricting the sample to these two census tracts allows studying possible race disparities with a sharpened focus, because many potential confounders are held constant.

The Community Health Urban Project (CHUP) is a survey carried out with a sample of adults ages 18 and above, living in two SES adjacent census tracts in a mid-size metropolitan area in the mid-Atlantic region of the United States of America. A total of 1,425 adults were interviewed using standardized measures and provided information that was useful for the present analyses. GEE models were used to accommodate interdependence of observations by household.

One in 10 participants had symptoms of depression. Compared to Blacks, whites had higher depression prevalence (7.5% vs. 13.3%). Participants who had smoked in the past year had a higher odds of depression (OR=3.0; 95% CI, 1.5, 5.8 for whites, and OR=2.1, 95% CI=1.1, 4,1 for Blacks) controlling for gender, age, education, working status, and seeking health care in the past two years. Comment. In spite of overall racial/ethnic differences in rates of depression, tobacco users had higher odds of depression, regardless of race. Acknowledgements: Grants 5P60MD000217 (National Center for Minority Health and Health Disparities), 5R24DA019805 (National Institute on Drug Abuse), and Pfizer, Inc.

Little is know about fracture risks in mentally ill adults. We aimed to estimate risks of fracture at any site, and at sites linked with osteoporosis, in this group versus the general population.

We created a population-based cohort using the UK General Practice Research Database (GPRD), with follow-up during 1987-2005. We investigated age and sex-specific fracture risks in psychotic illness (N=4283), non-psychotic affective disorder (N=95,228), and any other psychiatric conditions (N=49,439). Controls were all subjects with no psychiatric code (N=182,851) against which age-stratified relative risks were estimated: 18-44, 45-74, 75+ years. Outcomes were incident cases of fracture at any site, the hip and distal radius.

Among all mentally ill women, the highest relative risks of fracture at any site were in the youngest age group, whereas the strongest effects in men were with older age. The highest raised risk of any fracture occurred in younger women with psychotic disorders (RR 2.5, CI 1.5-4.3). Hip fracture rates were raised in elderly women and men with psychiatric illness, and were especially high in women (RR 5.1, CI 2.7-9.6) and men (RR 6.4, CI 2.6-16.1) with psychotic disorders at 45-74 years. Data were sparse for estimating relative risk of distal radius fracture, although risk was modestly (but significantly) higher among women with any mental illness in each age group.

These elevated risks are likely to be explained by a range of mechanisms. Further research is needed to elucidate these and to inform the development of targeted interventions.

Population-based evidence is lacking for risk of major birth defect with parental psychopathology, and how effects vary by maternal and paternal diagnosis. We aimed to investigate this risk in offspring of parents admitted for psychiatric treatment in a 26-year national birth cohort.

The study cohort was created using several linked Danish national registers. We identified all singleton live births during 1973-98 (N=1.45m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1st Jan. 1999. Linkage and case ascertainment were virtually complete. Relative risks were estimated by Poisson regression.

Fatal birth defect risk was elevated with any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population (RR 2.34, 95% CI 1.45-3.77); this also represented a significant excess risk versus all other admitted maternal disorders (P=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis.

There are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication, and gene-environment interactions. Further research is needed to elucidate the causal mechanisms.

Shared Mental Health care between Psychiatry and Primary care has been developed to improve the care of common mental health problems. Following a consultation-liaison intervention, this study evaluated one-year outcome for patients following the intervention to obtain objective data reflecting the “real-world” of shared mental health care.

95 patients from September 2006 to September 2007 (follow-up rate: 66%) were invited one year after the intervention to complete a paper questionnaire and a telephone short questionnaire about their mental health status, their care during the last year and their satisfaction with care.

89% of patients evaluated their current mental health as better then in the previous year. 44.5% were still managed by their GP as the psychiatric care provider (13.8% with a psychologist), 27.8% by a private psychiatrist, 11.1% by public psychiatry and 16.7% had no care anymore. 78.3% of patients evaluated the intervention as helpful for them.

The intervention was helpful for primary care patients with common mental health problems, supporting primary care without GPs’ de-motivation or disqualification. This study conducted among patients confirmed a previous study conducted among GPs.

The primary objective of this study was to determine who are the psychiatric patients that utilize the Emergency Departments for their care. The secondary purpose was to identify reasons for the change in utilization.

A convenience study was conducted in an urban, Level I pediatric and adult trauma center 45,000 annual visits. The National Health Access survey was administered to all consenting psychiatric patients who presented to the Emergency Department between May of 2006 to April of 2007. The study was IRB approved.

Out of 310 patients 294 agreed to answer the survey. There was a difference between two types of psychiatric patients that utilize the ED for care. One that gets its care from a PCP or clinic, the other group that presents to the ED being primarily self- family-or police referred. The significant difference found between within the variables of those with a regular having a regular physician and regular health source, delay in getting mental healthcare, used emergency department services in the last twelve months, type of payment for services, and has condition gotten better or worse.

There appears to be two different types of psychiatric patients using the ED for care. One group who primarily gets its care from a PCP or clinic and presents to the ED with a higher level of prior hospitalization. The second group did not have a PCP had a lessor number of prior hospitalizaions.

One of the partial solved issues in the treatment of depression is somatic pain. Most antidepressants can reduce the intensity of affective symptoms, but somatic pain, if present, is unfortunately, the last which disappears.

to estimate the clinical efficacy of SSRI (paroxetine) compared to venlafaxine XR, a dual action antidepressant, in patients with Major Depressive Disorder (MDD) and somatic pain.

Clinical open study including 48 patients (28-56 years), both sexes, with MDD (DSM-IV), mean scores MADRS=28 and somatic pains at baseline (at least 1 symptom moderate-severe)

MADRS, Depression Checklist (developed by University of Michigan Depression Center), CGI-Severity, CGI-Improvement, side effects, somatic conditions and relapse (follow-up: 6 month).

The patients were divided in 2 groups: Group A: paroxetine (40mg/day), 23 patients; Group B: venlafaxine XR (225mg/day), 25 patients. After 8 weeks: responders in Group A=56%, in Group B= 59%; partial responders: Group A=21% and Group B=15%, non-responsive: Group A=12% and Group B=11%. Drop-outs: Group A=11% and Group B= 15%. Somatic symptoms: 36% of the Group A patients and 28% of the Group B presented at least 1 somatic symptom with moderate to severe intensity. The 6 month follow-up period we evaluated the relapses in all groups and the outcome of the somatic symptoms.

1. 1. In MDD patients both paroxetine and venlafaxine XR demonstrated a good therapeutic effect.

2. 2. The somatic symptoms were less influenced by both antidepressants, till the end of the study.

3. 3. The group B was more responsive to these important aspects.

It has been suggested that mECT reduce relapse rates in chronic/recurrent depression. We aimed to study its efficacy in this group.

A retrospective analysis of 19 patients who received mECT following a successful course of acute ECT. We compared admission rates and bed occupancy during the mECT period with periods of 2-4 years before and after mECT. Information was gathered from case-notes and hospital records. This group was then compared with a similarly matched group, who received a successful index aECT followed by other non-ECT maintenance therapies to compare for secular trends.

19 patients - average age 70.6 (44-88) received mECT (ave. 37 (12-89) applications, mean interval-2.5 weeks). Admission rate fell from 1.02 admission/year to 0.316 (p < 0.001) and acute in-patient stay from 15.24 weeks/year pre-mECT to 7.05 during mECT, p = 0.055 . This was maintained once mECT was stopped. This compared well with comparison group who went on to receive other mentainance therapy (for the same period to control for secular changes), where both admission rates and bed occupancy went up. The change in duration of hospital stay between the two groups were statistically very significant (p<0.001) in favour of the mECT group.

The findings suggest that mECT may have a role in reducing the rate and duration of hospital stay of patients with major depressive disorder. The main weaknesses are the small sample size. This may translate in to socio-economic benefits both for the patients and the health services.

a 69 year old man with drug resistant catatonic schizophrenic disorder was treated at the psychiatric clinic of a general hospital with courses of ECT. In the past he had also responded positively to the same treatment.

Course of the treatment: patient was admitted because of catatonic symptoms such as immobility, mutism and negativism. During his two hospitalizations, a total of 48 ECT sessions was given with encouraging results. Namely after the first hospitalization the patient left the hospital in excellent condition, where as in the second occasion results were fair.

ECT is one of the first somatic therapies in the history of psychiatry. In 1938 Cerletti and Bini administered the first successful treatment of schizophrenia inducing epileptic seizures via electricity. Today ECT is given under general anaesthesia including muscles relaxation, in organized hospital units and thus it is a safe and well tolerated therapy.

our case report confirms the fact that in elderly ECT seems to have good results and few side effects.

This study is a retrospective analysis of the clinical use of ECT at a county hospital in Norway. Our aim was to determine the ECT- parameters, effect and side effects of patients that received ECT and compare standards of ECT practice with similar studies conducted elsewhere.

The study is based on data collected from specific ECT journals and the patients’ hospital journals. We investigated treatment characteristics, side effects (headache, memory problems and others), and effect which was measured as either present or not present. The number of necessary sessions before effect was achieved was also registered.

210 patients received ECT in the study period. The mean number of ECT treatments was 7.9. Bilateral electrode placement was used for 63.3%. The analyses suggest that a unilateral placing of electrodes tended to increase the average number of treatments compared to the bilateral placing of electrodes. The level of energy compared to the placement of electrodes seemed to indicate that unilateral treated received higher energy than those who had the bilateral placing of electrodes. We found that high stimulus dosage required shorter cramps. Common side effects included headache (N=86), retrograde amnesia (N=31) and others (N=17), no side effects (N=28), missing data (N=65).

82.2% of patients improved with treatment, 51.1% experienced improvement between treatment 4 and 7, 17.8% patients did not respond to the treatment, missing data 35.7%.

Our findings are mainly in concordance with previous reports of ECT use in public funded hospitals.