The Care Program Approach [CPA] envisages that patients with serious mental illness who are deemed to be at risk [of self harm, harm to others, or serious deterioration of their condition] should have an appropriate assessment of needs, an appropriate care plan and should have an allocated care co-ordinator to implement the plan.

We investigated whether patients with Bipolar Disorder, Schizophrenia and Depression, who had recorded risk factors did indeed have an allocated care co-ordinator in a typical English Community Mental Health Team [CMHT]. This issue is of importance in describing ‘Treatment as Usual’ in a CMHT when comparing it to newer forms of management, such as assertive outreach teams.

We used a database held by a CMHT in order to assess whether all patients with the above diagnoses did indeed have an appointed care coordinator.

The results show poor correlation between diagnosis, presence of risk factors, and the appointment of a care coordinator. Interestingly, patients with bipolar disorder appeared more likely to have a care coordinator appointed than patients with schizophrenia. Patients with depression were least likely to have a care coordinator appointed.

Lack of resources in the CMHT may account for the results. Another issue may be that, with treatment, patients may become less risk prone, but the work of the care coordinator may not be completed, and so the care coordinator may continue to be involved, thus being unable to move to other more needy patients in the team.

To assess the knowledge and perception of primary school teachers about Asperger's Syndrome (AS).

Structured questionnaires about AS were posted to 90 primary school principals for them to distribute to teachers in their schools.

343 completed questionnaires were returned by 54 principals giving a response rate of 60%. Of these, 49% of the teachers reported that recognition and management of emotional and behavioural disorders was covered in their undergraduate training whilst 58% said they had ever taught a child with AS. 90% said intense absorption in certain subjects was a feature of AS, 84% recognised lack of empathy and poor social interaction whilst 58%, 64% and 69.7% respectively recognised pedantic repetitive speech, clumsy or ill-coordinated movements or odd postures and poor non-verbal communication as features of AS. 71% said children with Asperger's Syndrome should be taught in mainstream classes. However, only 10.5% of the teachers believed that main stream schools in Ireland are adequately resourced to cater for children with AS. 87.2% said they saw the need for a closer collaboration between schools and psychiatric services in the management of children with AS whilst 96.2% said they would like to receive in-service training on the management of children with AS.

Most primary school teachers recognise the features of AS and want schools to have greater collaboration with psychiatric services regarding management of AS. An in-service training for teachers on the management of AS might be of benefit to children with AS.

Alopecia areata (AA) is a recurrent nonscarring type of hair loss that can affect any hair-bearing area. Clinically, AA can present with many different patterns. Although medically benign, AA can cause tremendous emotional and psychosocial stress in affected patients and their families.

To study the pattern of alopecia areata in UAE adult men’s locals.

Twenty adult men united arab emirate local patients 20 to 40 years old presented with single or multiple hairless oval smooth skin lesions in the scalp and beared area. The duration was weeks or months. Skin and hair scraping and examined with 20% potasium hydroxide (KOH) for superfacial dermatophytosis was negative. There were no septic fossi. Most of the patients suffered or complained from anixiety neurosis, emotional stress, tention and social families problems. The treated with psychosocial reasssurance and interalesional injection therapy with Trimecinilone Acetonide (TA) vials for one set and they get better.

The clinical data, investigations, psychosocial analysis revealed that the twenty UAE locals had alopecia areata in the scalp or in the beared area. The most cuases were psychosocial.

Alopecia areata in UAE adult men locals is very common hair and skin disorders. The psychological and social troubles play important role in the occurance. The governmental health departments as Dubai health organization (DOH), ministry of helath, (MOH) and Abu dhabi Health Authority (HAAD) in UAE must introduce psychological, social solutions, counciling and suporting for those patients.

The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.

To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).

Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.

We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.

A descriptive questionnaire survey using the attitudinal part of Aging Sexual Knowledge and Attitudes Scale (ASKAS).

Students of medicine and nursing of Oporto University.

We know from previous studies that little experience in the work with older people is predictive of negative attitudes towards sexuality. Nevertheless, in this sample we found a mean ASKAS score of 66 which reflects moderately positive and permissive attitudes toward later life sexuality. Medicine students were more permissive than nursing students (p< 0.01).

Undergraduate students and psychiatry residents have positive attitudes toward sexuality of older people. Later life sexuality study should be included in the curriculum of undergraduate formation of doctors and nurses.

To evaluate the “Mini International Neuropsychiatric Interview (MINI)” used by family resident physicians in primary health care (PHC) in Brazil.

Training for administrating the MINI was given as part of a broad psychiatry education program, and was performed in PHC consultations. Interviews were held with 120 PHC patients. MINI was administered by 25 physicians, while the “Structured Clinical Interview for Diagnosis (SCID-I)” was administered by a psychiatrist. The physicians answered questions on the applicability of the MINI.

Concordance levels for the following diagnoses were analyzed: any mental disorder; depressive disorders in general, major depressive episode and dysthymia; anxiety disorders in general, generalized anxiety disorder and panic disorder; and substance abuse disorders. Kappa coefficients ranged between 0.65 and 0.85; sensitivity between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV) between 0.60 and 0.86; negative predictive values (NPV) between 0.92 and 0.99; and accuracy between 0.88 and 0.98. The physicians considered MINI comprehensibility and clinical relevance satisfactory; the brevity of its administration was considered satisfactory for use with previous screening only.

These good results may be related with more frequent, intensive, and diversified training in psychiatry. The MINI is a useful tool for general practitioners and should be part of the broad psychiatry education program offered to these professionals.

To evaluate the validity of three questionnaires used by community health workers and auxiliary nurses for psychiatric screening in primary health care (PHC) in Brazil.

Training for administrating the SRQ-20, WHO-5 and COOP/WONCA Charts was given by a consultant psychiatrist to community lay workers and auxiliary nurses working in four PHC teams in university community health center. The questionnaires (administered by 14 community lay workers and auxiliary nurses) and a semi-structured psychiatric interview (SCID - administered by the consultant psychiatrist blind to the patients results on questionnaires) were held with 120 PHC patients who were at least 15 years old. Predictive validities of SRQ-20, WHO-5 and individual items of COOP/ WONCA charts in relation to SCID were calculated through area under ROC curves (AUC) and total accuracy. Concurrent validities between questionnaires were calculated through spearman coefficients.

For SRQ-20 (20 questions): AUC = 0.92; total accuracy on cut-off 7/8 = 85%. For WHO-5 (5 questions): AUC = 0.90; total accuracy on cut-off 11/10 = 85%. For COOP/WONCA chart “feelings”: AUC = 0.88; total accuracy on cut-off 2/3 = 85%. Sperman coefficients between SRQ and COOP/WONCA chart “feelings” was 0.74; between WHO and “feelings” was 0.67.

Results of COOP/WONCA Chart “feelings” - an individual item of a questionnaire specifically developed for use in primary health care - were as good as more extensive questionnaires specifically developed for psychiatric screening purposes.

This preliminary study describe the experience of mental health consultation-liaison activities delivered by a psychiatric community nurse and a psychiatrist with Primary Health Care (PHC) teams in a university community health center in city of Ribeirao Preto, State of Sao Paulo, Brazil.

This is a descriptive exploratory study, carried out from March to May 2008, from the record of the activities in weekly consultation meetings with four PHC teams.

The activities developed including discussions of issues and cases, joint consultations and home visits with PHC teams. Fifty-one joint consultations/home visits and twenty-six discussions of cases/issues were made. The clients were predominantly female and aged over 18 years; diagnoses of major depressive episode, generalized anxiety disorder and alcohol unhealthy use was common. Psychotic and bipolar disorders were also discussed and evaluated. The main complaints were related to: changes in sleep, appetite and energy; difficulty in relationships (including family and work); aggression and violence (including physical and sexual abuse); difficulty of adherence to treatment, and other psychiatric symptoms. The referrals were made mostly for ambulatory psychotherapy and ambulatory adult and child mental health specialized care.

The joint activities between the specialized and PHC teams to enable full attention to health of patients and the development of interdisciplinary work. This work is challenging because it put on the agenda of health the borders between the levels of assistance, knowledge, practices and goals of different professional groups.

Despite the increasing use of the Internet to seek medical information, little is known about the web search for mental health information among psychiatric patients. We aimed to identify the patients’ demographic and clinical characteristics that better predict the search for medical information, as well as the most consulted aspects of psychiatric disorders.

Over a one-month period, a consecutive series of patients followed at one Spanish hospital psychiatric outpatient clinic completed a 13-item questionnaire about their personal Internet use.

Among the 144 participating patients (72% women), 61% reported having ever used the Internet, with lower search rates for general health (34%) and mental health (22%) data. There were no differences by sex, but Internet use was more frequent among younger and higher-educated patients, as well as among those with eating disorders and personality disorders. Patients were most interested in diagnosis and treatment facets. A model with age (exp.β=1.05; p=.001) and high-school education (exp.β=5.55; p=.004) predicted searching for general medical information and correctly classified 75% of the sample (R2=0.3; p=0.004). Age was the only variable predicting specific search about mental health (exp.β=1.05; p=.001), and correctly classified 76% of patients (R2=0.2; p=0.001).

The results of this one-site pilot study went in the anticipated direction and suggest that possible differences in the access to Internet according to the diagnostic group merit further research with multi-centre, larger samples.

Aim of this article is to explore the ways in which, over the last 25 years, knowledge about HIV/Aids and Mental Health co-morbidity has been represented within medical and social sciences literature.

The study has been conducted on the texts of 1101 published manuscripts abstracts within from 1984 to 2008, referring to 379 different journals and retrieved on PUBMED database. It was used the following database search string: ("mental health"[Title/Abstract]) or ("mental illness"[Title/Abstract]) AND (("aids"[Title/Abstract]) or ("hiv"[Title/Abstract]))). A Computer Aided Text Analysis was conducted with dedicated software: T-Lab (Lancia) using Cluster Analysis.

Cluster Analysis allowed to identify five different main dimensions: 1:(27,68%) Health-care Service organizational development; 2: (22,10%) Mental health as empowering precursor of infection risks. 3: (8,58%) Quality of life; 4: (19,17%). Therapies and treatments’ research; 5: (22,46%) Psychological issues, emotions and distress correlated to seropositive patients and their caregivers. Figure 1 it is a way to outline the five clusters literature trends over the time of 25 years.

Our review could help to identify particular areas in need of change, to provide a baseline against which to assess future changes and to provide data for use in research health planning and policy analysis.

Fibromyalgia is an entity with idiopathic etiology affecting 2-4% of population. It is a frequent cause of disability, its most usual symptoms being diffuse pain and fatigue. There is evidence that alterations in several chemical and hormonal factors could explain changes in pain perception mechanisms, accounting for some of the symptoms. However, the high incidence of comorbid psychiatric disorders tends to indicate there is an associated psychopathology in fibromyalgia patients, especially regarding affectivity. Some authors believe fibromyalgia could be considered an evolution of the concept of neurasthenia already defined by Beard in 1860.

Comprehensive review of the scientific literature (Medline, Psychoinfo, Medex) on fibromyalgia and pain mechanisms published over the last three years.

Mood regulation has been linked to pain perception through neurotransmitters and brain structures. Also, several studies state that depression changes the neuroendocrine, immune and processing regulation of pain.

However, some researchers believe there is enough evidence for a psychiatric approach to fibromyalgia, as there is a relationship between depression and fibromyalgia. Thus, fibromyalgia could be considered an affective disorder.

Current research does not clearly show whether pain precedes affective alteration or the other way round, or whether mood and pain depend on common mechanisms.

To verify whether nursing personnel working at a general hospital change their attitudes after a brief training course on suicide prevention and if these newly acquired attitudes persist over a 6-month time.

317 nursing personnel attended a 6-hour training program. They answered anonymously pre- and post-training the Suicide Behavior Attitude Questionnaire (SBAQ) which comprises 21 visual analogue scale items divided in three factorial sub-scales. The scores on each SBAQ sub-scale (dependent variable) were compared along the time using ANOVA for repeated measures with rank transformation. The time of the measurement and characteristics of the nursing staff were considered as independent variables.

There have been positive changes in the attitudes and these gains were significantly maintained at the 6-month follow-up evaluation. Improvement was in the Feelings and Professional Capacity factorial subscales (p = 0.0001 and 0.01, respectively). There was no change on the Right to Suicide subscale.

It was possible to demonstrate positive changes in the attitudes of nursing personnel as assessed six months after a brief training course on suicide prevention. As attitudes influence the effectiveness of the health care personnel interventions our findings may have important implications for the development of suicide prevention programs.

Neuroscience has been a growing revolutionary field of scientific knowledge. The increasing recognition of the importance of emotional processes and subjective experience in several aspects of human behaviour parallel the growing amount of research in the field of affective neuroscience. Affective neuroscience studies the brain mechanisms subjacent to emotional behaviour.

To discuss the relevance of affective neuroscience research in social and biological sciences, namely within psychiatric and psychological researches.

Review of the literature. MEDLINE and PubMed databases searches for peer-reviewed studies, published between 1994 and 2008, using combinations of the Medline Subject Heading terms affective neuroscience, emotions, affective sciences and psychiatry, psychology, biological sciences, social sciences.

Several studies addresses brain functions and how emotions relate to genetics, learning, primary motivations, stress response and human behaviour. Some actual areas of research within affective neuroscience include: emotional learning, affective behaviour, emotional empathy, psychosomatic medicine, functional and structural biomarkers, emotional disorders and stress response, among others.

In Psychiatry, affective neurosciences find application in understanding the neurobiology of mood disorders, the neural control of interpersonal and social behaviour and the emotional systems that underlie psychopathology. Affective neuroscience reflects the integration of knowledge across disciplines allowing a broader understanding of human functioning. The field of affective neuroscience is an exciting field of future psychiatric research and it provides an investigational framework for studying psychiatric morbidity.

Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism and inefficacy. Resident physicians have intense work demands, limited control and high responsibilities in the workplace, making them more vulnerable to job burnout.

To review studies in the medical literature that address the theme of burnout in residents and discuss relevant resources and interventions for residents with burnout.

MEDLINE and PubMed databases searches for peer-reviewed studies, published between 1990 and 2008, using combinations of the Medline Subject Heading terms professional burnout and internship and residency.

The studies report high levels of burnout among residents. The reported residents’ strategies for coping with stress are diverse and include talking with family, significant others or other residents and practicing physical activity. Some studies investigated the role of stress management workshops for residents, reporting decline of emotional exhaustion levels in residents after the workshops.

The literature on resident burnout is still sparse. The reviewed studies suggest that residents from various specialties, internationally, experience burnout. Understanding resident burnout can be enhanced by more rigorous research, studying different intervention strategies. Burnout prevention and management can contribute to better personal outcomes and ultimately provide better patient care.

The Psychiatric Emergency Service (PES) is an important part of the mental health care system for the management of acute conditions requiring prompt intervention representing also a significant part of workload of specialists and trainees. The objective of this study was to characterize the clinical features of patients observed in PES of Coimbra University Hospitals.

During the first 6 months of 2008, demographic and clinical data were obtained for all patients observed by the first author of the study, together with a specialist in Psychiatry.

The sample consisted of 159 patients, 103 females and 56 males. Mean age was 45,9 ± 18,367 years. The majority of patients presented in the emergency room either alone (56,6%) or with a first degree relative (34,6%) by self-initiative and having a past psychiatric history (71,1%). Disturbing mood symptoms (depression, anxiety or both) were the motive of assessment in 58% of patients but several other causes were reported including behavioural symptoms, agitation, psychosis, drug or alcohol related disorders, sleep and cognitive disorders. Average Clinical Global Impression was 4,12 ± 1,177. After the psychiatric assessment, several diagnosis were made namely Major Depressive Episode (14,5%), Adaptation Disorders (13,9%), Schizophrenia and related disorders (13,8%), Anxiety Disorder Not Otherwise Specified (11,9%) and Drug or Alcohol related disorders (8,2%). Most patients were discharged without referral (50,3%).

A significant percentage of patients went to the PES for conditions that could have been treated by a primary care physician or in an outpatient clinic setting.

Chronic pain irrespective of its origin can be a major factor of significant distress inducing high levels of anxiety, depression and sleep disturbance. These symptoms can, by their turn, aggravate the perception of pain. The objective of this study is to characterize mood, anxiety and sleep pattern in patients with chronic rheumatic pain.

Patients observed in the Psychosomatic Consultation of Coimbra University Hospitals from January 2008 with chronic rheumatologic pain were included in the study. They were prospectively assessed (twice in average) by a Psychiatrist for mood, anxiety, sleep, general status and levels of pain with standardized rating scales.

Thirty-two female patients were included in the study. Mean age was 51,22±7,37 years. Depression and levels of anxiety both correlated positively with Clinical Global Impression Scale but not with the level of pain reported by the patient. Moreover, although a significant proportion of the patients reported sleep disturbance, especially in the beginning and in the middle of the night, this was not correlated with levels of pain.

This study suggests that chronic pain is not a predictor of depression and anxiety and does not fully explain the distress reported by patients with chronic rheumatic disorders. Assessment of other factors such as personality traits, coping styles and maladaptative health behaviours should be part of the routine intervention in these subjects.