The incidence of DSM-IV conversion disorder in outpatients is 4.5-32 %, with childhood trauma being an important etiological factor. This study aims at investigating the symptom pattern, comorbidity, suicidal behavior in this patient group.

Outpatients who were diagnosed as DSM-IV Conversion Disorder were included in the study except those with a neurological disorder, mental retardation, alcohol and subtance abuse/ dependency, bipolar, schizophrenic and other psychotic disorders and tardive dyskinesia. The assessment instruments are Demographic and Clinical Questionnaire developed by the authors, Childhood Trauma Questionnaire ( CTQ-28), ve Hamilton Anxiety and Depression Rating Scales (HARS-HDRS).

25 female outpatients’ mean age 34.48 (SD ± 10,21). 76% were married, 24% had no formel education. 48% (n=12) were physically, 28% (n=7) were sexually abused. 36% (n=9) of the patients had attempted suicede at least once. There was no significant link between childhood trauma and suicide attempt. There was a significant relationship between pseudoepilepsy symptom and suicidal tendency ( p: 0,021). Mean HDRS score was 7,88 (SD: 4,43), mean HARS score 13,56 (SD: 7,42). There was a significant relationship between HARS scores and suicide attempt (p:0,037). CTQ-28 subgoup mean scores were: emotional neglect 2,86 (SD:1,32), physical neglect 2,04 (SD:0,52), emotional abuse 2,25 (SD:1,26), physical abuse 1,98 (SD:1,56), overall 10, 98 (SD:4,15).

Conversion disorder patients are a neglected group in health care system. Past traumatic experiences, comorbidity rate and suicidality have to be addressed in assessment and treatment for a better prognosis.

Patient-related factors and physicians’ attitudes leading to the decision which particular treatment is prescribed for attention-deficit/hyperactivity disorder (ADHD) have not been investigated in detail. We assessed the reasons for choice of medication and the socioeconomic status of treatment-naïve ADHD patients when initiated on ADHD medication.

Multicenter, prospective, 6-month observational study in children and adolescents with ADHD (ICD-10 or DSM-IV). Demographic, disease, and socioeconomic characteristics, and ADHD-related symptoms (ADHD-RS, CGI-S, GIPD) were captured at baseline, and compared between two medication groups (non-stimulant vs. stimulant). Physicians’ reasons for choice of medication were recorded. Correlations between those reasons were explored by Pearson"s correlation coefficient, Cohen"s Kappa, and cluster analyses.

Overall, 504 patients, mean age 9.6 years (range 6-17), 27.4% female, were included. Non-stimulant medication was prescribed in 50.0% and stimulant in 49.0% of patients (1% received both). In the non-stimulant group, patients were significantly older (0.6 years), had significantly more problems with regard to their psychosocial situation, and had more concomitant psychiatric disorders. There were no significant differences in questionnaire scores. Physicians’ reasons for prescribing medication differed for non-stimulant vs. stimulant treatment: duration of action (73.4%/28.7%), beneficial for compliance (60.3%/40.1%), and patient/parent decision (33.7%/26.3%) were reasons in favor of non-stimulant treatment; good efficacy (93.1%/73.0%), good tolerability (66.4%/44.1%), and well-priced (38.1%/2.8%) in favor of stimulant treatment.

Patients initiating stimulant or non-stimulant ADHD treatment differed significantly on some points according to their baseline characteristics. Physicians’ reasons for choice of medication clearly differed between the two medication groups.

Tobacco smoking is one of the major preventable causes of premature death and disease in the world. Adolescents are amongst the most vulnerable group of individuals in society and are highly susceptible to cigarette smoking. Sixth Formers being the most senior members of the school act as role models to younger pupils and could influence smoking behaviour.

In a cross sectional and comparative study we aimed to determine the differences in smoking prevalence and patterns between Sixth Form students in Pakistan (a developing country) and the United Kingdom (a developed country).

A self-administered questionnaire, adapted from the WHO questionnaire, about tobacco smoking for health professionals was distributed amongst the students. The responses were anonymised to encourage truthful answers; there was no pressure to respond.

Of the 235 participants in the UK, 38 (16%) were regular smokers. Of the 297 participants in Pakistan, 20 (7%) of participants were regular smokers. In both countries there was a significant difference between the genders, with males being more likely to smoke. In Pakistan it was identified that the main reason for smoking was due to peer pressure, where as in the UK it was for recreational and social purposes.

The prevalence of smoking was higher in UK compared to Pakistan. There was a significant difference in the smoking behaviour patterns in the two countries.

To describe the characteristics of a group of HIV positive psychiatric patients on highly active antiretroviral therapy (HAART).

All mentally ill patients admitted to the psychiatric unit at CHB that were HIV positive where included in the audit. Patients that met the following criteria where initiated on HAART: CD4 of 200 or less cells/mm3; diagnosis of a WHO Stage 4 condition.

Since the inception of the service, the hospital admitted 573 mentally ill patients of which a group of 42 (7.3%) where confirmed as HIV positive. The mean age of the group was 39.2 years with a male: female ratio of 1:4.3. 42.9% of the patients presented with maniform symptoms. For 20 patients this was their first episode of mental illness. Only 11 (26.2%) patients were subjected to a CT scan and 18 (42.9%) to a lumbar puncture. In this group of HIV positive patients, 30 met the eligibility criteria and were commenced on HAART: 28 were treated with regimen 1b and 2 with regimen 1a. 16 patients had subsequent CD4 counts and 14 follow up viral loads performed. The viral loads of 13 patients had reached the required decrease in Log value at six weeks of HAART.

A significant percent of all mentally ill patients admitted to the psychiatric unit at CHB are found to be HIV positive despite the fact that HIV screening is not done routinely on all patients. The majority of these patients have advanced disease and are eligible for HAART.

Until the last 2 decades, spiritual care was a vital, but invisible, aspect of nursing care. Spirituality and spiritual care have entered the mainstream, and the literature in this area has burgeoned. In addition, there is minimal information in the literature documenting the expressed spiritual needs of patients in general and specific subgroups of patients in particular, thus this article aimed to present spiritual needs of Iranian Muslim patients. Therefore, this study is of significance to nursing in general and to transcultural nursing in particular because of the high priority associated with increasing the nursing knowledge through research that investigates and describes care practices in diverse cultures. This paper reports an investigation into the spiritual needs of hospitalized Iranian Muslim patients.

A qualitative study with a sample of 24 patients using semi-structured interviews. The sample selected from three different cities of Iran.

Although not clearly distinguishable, we found two main spiritual needs include religious and existential needs in Iranian Muslim patients.

With regard to holistic approach in Islamic philosophy, holism is a relevant concept in the care of Iranian patients.

Understanding how different cultures perceive illness and treatment are fundamental elements of cultural competence in medicine. Knowledge alone is not sufficient; physicians must be open to these cultures and, as appropriate, inclusive of such in comprehensive treatment plans. Medical schools increasingly address this important issue by accepting student bodies with broad cultural diversity and focus education on attaining cultural competence. This paper addresses the unusual circumstance when medical students’ cultures are in direct conflict with western medicine and analyzes the perception of appropriate intervention.

Composite case analysis with literature review.

A 24-year-old male medical student of Asian heritage was asked to comment on how he would treat cancer patients who were expected to die without chemotherapy. He responded: “teach alternatives/benefits/risks; patients can be persuaded with knowledge but one must accept their decisions; patients may have had enough and want to start anew.” This last point addressed the Hindu concept of “peaceful death with reincarnation” which was consistent with his heritage. He had not considered refusal of chemotherapy in the context of western cultures wherein reincarnation may not be a belief and the desire to die may be secondary to depression.

Cultural knowledge and diversity may lead to inappropriate approaches toward medical care in western cultures. As much as medical schools need to diversify, learn about other cultures, and incorporate such in patient-care, it is critical that medical schools teach students from other cultures about western culture.

To develop an interview version of the HOME assessment tool and compare the interview version of the HOME with the home visit version.

Families whose child under 10 years of age attending the Mater CAMHS, with first attendance in the past two years were contacted. 100 of the 247 contacted agreed to participate and consented to a family visit. The study had prior ethics approval. A brief interview version of the HOME devised by substituting questions for the observer rated part of the HOME questionnaire was administered prior to the home-visit, where the home-based version of the HOME was performed. Both interviews were then compared and statistically analysed.

The mean score for the home visit HOME was 46.93 ± SD. The comparison of the telephone data with the home visit data suggested that there is a small significant difference between total score for the telephone and the home visit HOME score, with a difference of 0.96 - 3.20 (95% CI), when each of the assessments were scored out of 100. Bell- curves and T-Pairing scores of subscales and individual questions of both interviews suggest similarity.

These results suggest that an interview version of the HOME assessment can be administered in the clinic or by telephone.

To assess if patients follow-up with discharge advice after psychiatric assessment and discharge from Emergency Department (ED).

All patients with psychiatric complaint who presented at three ED's in Edmonton, Alberta, Canada were identified via ED Information System (EDIS). Patients presenting complaint were entered onto the EDIS by Triage Nurse along with demographic information. All charts were reviewed and clinical data was obtained. Patients who were assessed by Psychiatry and discharged home were contacted via telephone to determine if they followed-up with discharge advice of psychiatry team.

A total of 1420 patients have been identified during April and May 2008.Chart review has been completed. Data entry and follow-up is in progress. Preliminary data of 250 patients is presented here. 55% were male. Mean age 37 years (SD 12). 47% presented voluntarily. Psychiatry was consulted for 53% of patients. The presenting complaint was “Suicidal Ideation” in 29% and “Bizarre behaviour” in 24%. Primary diagnoses for those seen by Psychiatry were mood disorder (30%) and psychotic disorder (26%). Out of those seen by Psychiatry 36% were admitted. 44% of those admitted by psychiatry were diagnosed with psychotic disorder followed by mood disorder in 31%. The patients who were discharged home by Psychiatry were advised to follow up with their family doctor 7%, psychiatrist 15%, outpatient psychiatry services 16% and addiction services 16%.

This is the first report of outcome of discharge advice and will help in developing and planning community follow-up system for psychiatric patients.

Conditions at the work place affect in many ways the well being of empoyees. One frequent reaction is anxiety because opf threads by superiors, colleagues or customers, the possibility of failing and not fullfilling job demands, accidents, or the possiblity to lose the job.

230 patients (71% female) from a psychosomatic inpatient unit were interviewed with as DSM-based half standardized interview in respect to work related anxiety.

58% of the patients reported about work related anxieties.

Across all areas generalized work related worrying is most frequent (26% service, 35% office/civil servants).

Anxieties related to specific situations at work were most frequent in patients working in schools/education (32%) and in production/construction workers (28%).

Anxiety related to feelings of insufficency and adjustment related anxiety were most often seen in office workers/civil servant (37% and 26%).

Hypochondriac anxieties were mostly reported by school/education employees (18%) and construction/production workers (17%) but to a much lower degree by health workers (6%).

Work related phobic reactions were reported by 17% of all patients and most frequent by office workers/civil servants (22%), followed by health workers (21%), service jobs (16%), construction/producrtion workers (11%) and patients working in schools and education (9%).

Work related anxieties are frequently seen in patients with mental and psychosomatic disorders. There are different types of anxieties which are differently related to different types of jobs.

According to decreased self- esteem in multiple sclerosis (MS) patients, it is necessary to utilize appropriate methods in order to improve self- esteem in MS patients. So this study was conducted on patients with MS supported by the Iranian MS society for determining the effect of self - care program on their self- esteem.

In this semi - experimental study 34 patients with MS who were not in the acute phase of disease were selected. The data were collected via personal questionnaires, problem list, Cooper and smith standard questionnaire for self- esteem and self report check lists. Self - care program(self - care for muscular spasm, fatigue, constipation and amnesia and …) was educated, then it was performed for one month period and the data were analyzed using paired t- test, wilcoxon, croscal - wallis and manwithney tests.

Application of self - care program improve the self- esteem and reduced some symptoms such as muscular spasm, fatigue, constipation and amnesia in MS patients. The mean valve of self- esteem increased from 54 before performing the program to 68 after the program ( p < 0.05).

Using self-care program can be an effective method for improving self- esteem of MS patients.