Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.

To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.

We include 9 variables from 104 first assessments carried out in our center.

48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.

As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.

It has been shown that abusive experiences in childhood may be related to specific behavior patterns manifested in adulthood, especially those that refer to negative parenting practices. The aim of this study was to assess the relationship between the use of punitive parental discipline and the childhood abuse trauma in parents.

Sixty six parents (30 males, 36 females, age 45.92±8.79 yrs, predominantly urban) completed the socio-demographic questionnaire, the Childhood Trauma Questionnaire (CTQ), and the punitive discipline self-report measure.

The frequency of use of punitive discipline between parents with and without the history of abuse was not significantly different (t=-1.298; p>0.05). The difference was not found neither among fathers (t=-0.047; p>0.05) nor among mothers (t=-1.951; p>0.05). Emotional abuse was the only type of childhood maltreatment related to the use of punitive discipline (r=0.393; p< 0.01). This relationship was found among both fathers (r=0.428; p< 0.05) and mothers (r=0.371; p< 0.05). In females, the use of punitive discipline was additionally related to the history of emotional neglect (r=0.379; p< 0.05).

The findings may emphasize the need for identification and modification of the parental discipline strategies in adult victims of child emotional abuse and neglect.

Develop a cross-cultural translation, Swedish to Spanish, of TOOL questionnaire - a previously validated instrument to assess the impact of adverse effects (AE) on the health utilities and health related quality of life (HRQoL) in patients with schizophrenia and bipolar disorder.

TOOL questionnaire has 8 attributes and 4 levels per domain: mood (anxiety and depression), function capabilities, and AE frequently associated with antipsychotics (fatigue-weakness, weight gain, stiffness-tremor, physical restlessness, sexual dysfunction, and vertigo-nausea). Firstly, 4 independent translators carried out the forward-backward translations. Next, draft version was reviewed by an experts panel (5 psychiatrists & 1 GP specialized in HRQoL) and tested in 40 stable patients (20 schizophrenic & 20 bipolar). Comprehension and importance (C/I) of each item were evaluated by a Likert scale ranging from 0 (lowest level) to 4 (highest level).

3 items should be modified to facilitate comprehension: mood, physical restlessness and vertigo-nausea. However, C/I of items mean scores were respectively: mood (3.50/ 2.37); function capabilities (2.58/ 2.03); fatigue-weakness (3.58/ 2.55); weight gain- (3.75/ 2.87); stiffness-tremor (3.65/ 2.61); restlessness (3.37/ 2.62); sexual dysfunction (3.39/ 2.51) and vertigo-nausea (3.56/ 2.44). Only 2 patients (5%) were unable to complete the questionnaire. Internal consistency was high (Cronbach α= 0.87) and neither item ceiling nor floor effects were found.

The Swedish TOOL questionaire was culturally adapted into Spanish. Psychometric analyses are needed to validate this measure in Spain. A multtiatribute utility fuction should be estimated to evaluate AE by using a patients"centered perspective.

The study is assessing the knowledge, attitudes and behaviours of the different categories of medical professionals towards the psychiatric patients.

The transversal descriptive study was developed in the hospitals from two cities of Romania: Bucharest and Targoviste. We have studied the opinions about patients with mental disorders of 8 groups of medical professionals: psychiatrists, medical doctors, trainees from psychiatry and from other medical specialities, nurses from psychiatry and from other medical specialities, medical students and student nurses. We have conceived an anonymous self-administered questionnaire with 18 items concerning knowledge, attitudes, affects and actions of the medical professionals toward people with a psychiatric disorder.

From the 450 medical professionals that were asked to complete the questionnaire, 379 returned the questionnaire completed. The comparison between the eight groups of medical professionals showed that the clinical experience is a differentiating factor in the opinions about the cognitions, affects and behaviours towards psychiatric patients. The psychiatric specialists and trainees demonstrated a more tolerant attitude towards the patients with mental disorders. The knowledge about the psychiatric illness had positive correlations with the tolerance in attitude and behavior, apart from the medical category of the respondents.

Based on the fact that the modification of the cognitions influences the attitude and behavior, the stigma-reducing campaigns between medical professionals should have the main objective of informing about the psychiatric illness and patients.

It's known that media significantly contribute to the stigmatisation of mental disorders themselves, as well as the people suffering from such ailments. The aim of our study is to provide content analysis of media messages covering the topics of mental health and psychiatry.

The study sample comprises the media messages pertaining to the topic of mental illness collected by using the database of the Newton IT monitoring system. The articles were chosen from 6 printed most widely read daily periodicals, the period under consideration were 5 separate weeks randomly selected from the year 2007.

184 articles with mental illness as main content were found, including 110 in broadsheets and 74 in tabloids. Global impression of the message was negative in 76% of articles in tabloids and in 33% in broadsheets. The most represented diagnosis were Substance use disorders that were mentioned in 22% of all articles, on the other hand the representation of Neurotic disorders was quite low - 2% of all articles, Psychotic disorders were mentioned in 7% of articles.

The results relate to only a short time period, however, suggest that the degree of stigma of mental disorders in the Czech printed media is high and should be further analysed. The main outcome is to formulate the recommendations for media in order to meet anti-stigmatising objectives and thus improve media coverage, minimalize discrimination practises and increase help seeking behavior.

This study examines the occurrence and correlates of somatization in a sample of adult Ethiopian immigrants and refugees residing n Toronto, Canada.

A random sample of 342 adult (≥ 18 years of age) Ethiopian immigrants and refugees in Toronto completed structured face-to-face interviews. The Diagnostic Interview Schedule (DIS) Somatization Disorder Module was used to collect data on somatic symptoms. The Composite International Diagnostic Interview (CIDI) was used to assess major depression and generalized anxiety disorder.

Nearly two-thirds of the study participants reported having had at least one somatic symptom, and 5% reported experiencing medically unexplained symptoms in the 12 months preceding the interview. Individuals with major depression had significantly increased number of somatic symptoms compared to those without major depressive disorder. In a multivariate linear regression analysis, controlling for major depressive disorder, a higher level of somatization was associated with older age, pre-migration trauma, and post-migration stressful life events, and limited English proficiency.

The findings of the study suggest that somatic symptoms are prevalent among individuals in cross-cultural transition and symptom level was associated with pre-migration trauma, post-migration stressors and mental disorder, particularly depressive disorder. The data also indicate a need for primary care physicians to routinely screen immigrant minority clients who present with somatic complaints for common and treatable psychiatric conditions, such as depression. In minority immigrant communities, somatic symptoms may reflect psychiatric problems.

Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.

The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.

100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:

1. 1. A quantitative questionnaire for all staff in participating wards and

2. 2. A comparison group in 20 community mental health teams and 20 crisis teams.

3. 3. Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.

4. 4. Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.

5. 5. Staff who leave the wards in the course of the first year will be asked their reasons for leaving.

6. 6. Links between rates of staff sickness and morale will be investigated.

Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.

General Motor Aptitude (GMA) was classified as Normal Low; Global Motricity, Balance, Corporal Design, Space Organization and Schedule Organization had low output; the worse execution in the TMT indicating attention deficit disorder; the increasing of the time in the execution of the TMT proportional to the increase of the age; a negative value of the correlation of the GMA and the attention, a bigger slowness in the execution of the TMT tests shows minors values of GMA.

The Convention on the Rights of the Child acknowledges that the family is the natural environment for the upbringing of a child and that the parents have the primary responsibility for the child's education. However, it also mentions the need to find adequate substitute care whenever the child is temporarily or permanently deprived of his or her family environment, or when the child's best interests cannot be secured within the family environment. This substitute care may include adoption, foster placement or, as last resort, placement in an institution suitable for child care. Although some institutions have high quality standards for child care, this is not always the case.

Institutionalized children are likely to come from unfavourable family environments, where they were victims of multiple psychosocial adversities, and studies show they present high scores of emotional and conduct disorders, together with cognitive problems.

We examined medical files of all the institutionalized children and adolescents who attended the outpatient clinic of the Department of Child and Adolescent Psychiatry in Coimbra, Portugal, between the years 2005 and 2008, in order to characterize this population.

There was a male excess in our sample. The majority of the children and adolescents were institutionalized due to abuse and/or neglect and had conduct or oppositional defiance disorder. A considerable number had cognitive deficits.

Mental health services should work closely with these institutions to identify their strengths and difficulties, facilitating prevention, diagnosis and treatment of psychiatric problems.

Coercive physical measures, such as seclusion and restraint are sometimes used in psychiatric inpatient treatment for the management of severely disturbed behaviour of patients. As part of a larger study on the use of restraint and seclusion in a psychiatric unit of a general hospital in Greece we aimed to record the patients’ and their relatives’ attitudes on coercive measures.

Data regarding patients’ and family accounts on coercive measures were collected retrospectively with chart review of all patients who had been admitted to the psychiatric ward of the University Hospital of Ioannina over a six-month period and had been subjected to restraint or seclusion. During hospitalization and after the periods of restraint or seclusion, patients and relatives had been asked whether they considered coercion as justified or not. Patients had been also asked whether they perceived this experience as harmful.

Thirty one cases of restraint and seclusion from a total of 282 admissions were recorded during the study period. In 6 cases the patients refused to answer or did not have the decision making capacity. Twenty out of 25 (80%) patients considered their coercion to be unjustified and perceived it as traumatic experience. Twenty-five out of 28 (89.3%) relatives considered justified the decision to restrain or seclude the patient.

Patients and their families have different accounts on coercion, but more research is needed. It is important for care planning to record the patients’ and families’ views and integrate them in mental health policy making.

Induced delusional disorder or folie a deux is characterized by the presence of similar delusional ideas in two or more individuals. The delusional system develops as a result of a close relationship with a person with an established psychotic disorder. Most commonly the affected persons are members of a family.

An unusual case of folie a famille involving four siblings, brother and three sisters, (folie a quatre) is presented. This case was detected in the context of a community-based psychiatric service in Greece, the Mobile Psychiatric Unit of the prefectures of Ioannina and Thesprotia.

A 46-year-old woman was referred from primary care physicians for the management of a psychotic exacerbation. On the examination it was revealed that she and her three older siblings were sharing the delusional idea of being affected by their neighbors with magic. These siblings had been living in social isolation for long and have been querulant and aggressive toward their neighbors, against whom they had undertaken a succession of lawsuits. None of the rest siblings accepted to be examined so it could not be determined who the inducer was or what the diagnoses were for each of the affected persons. The patient did not receive the prescribed medication and did not engage in follow-up.

Cases of induced delusional disorder may be difficult to be detected and treated. Mobile psychiatric units in co-operation with primary care physicians may have an opportunity to provide appropriate treatment for such patients in rural areas.

Selective Mutism (DSM-IV: 313.23, ICD-10: F94.0) is a rare phenomenon in child and adolescent psychiatry, with prevalence rates below 1%. Patients limit their verbal communication and social functioning is severely impaired. Evidence for treatment strategies is scarcely available, especially in patients with concomitant pediatric disorders.

This case report provides information on the psychotherapeutic and psychopharmacological treatment of selective mutism in an eight-year old girl with thalassemia major. The patient presented to the psychiatric department after her second (successful) bone marrow transplantation for treatment of her selective mutism which was present already prior to transplantation. As permanent medications she received penicillin prophylaxis (500.000 IE/d) and deferasirox (Exjade; 20-25 mg/kg/d), a recently approved iron chelator.

Long term psychotherapy (CBT) in a day-time clinic, supported by the use of the SSRI Fluoxetine (10 mg), led to a decrease in the Selective Mutism score from 29 to 17 points - GAF improved by 21 points. Reintegration in the school context was established. Mean levels of Fluoxetin and N-Fluoxetin were 287,8 ng/ml without significant level fluctuations.

This case adds further evidence, that a combination of psychotherapy and psychopharmacological interventions (SSRI) proves effective in treatment resistant Selective Mutism. Monitoring blood levels of the SSRI is crucial in providing treatment to patients receiving multi-pharmacological treatment.

It is known that psychiatric disorders often lead to unhealthy life styles and reduced quality of life, which can lead to weight gain, possibly enhanced by psychotropic treatment.

Solutions for Wellness (SfW) is an educational program for life style changes for psychiatric patients. This observational study evaluated the effectiveness of SfW.

30 psychiatric clinics collected data for the study. Quality of life was measured by the Subjective Wellbeing under Neuroleptics scale (SWN), at baseline and at the end of SfW participation at 3 months. Demographic, disease and treatment data were also collected. A control group consisted of patients from centers that did not offer the SfW program.

314 patients were enrolled in SfW group, 59 in the control group. 54% of the total group had schizophrenia, 67% received atypical antipsychotics. The baseline mean BMI in the SfW group was 31.7 kg/m2.

SWN scores for the SfW group improved significantly from baseline to the end of the program (mean increase 3.3 ± 12.2), but not significantly more than for the control group (mean difference 1.4, p = 0.4158 (t-test)). The SfW group demonstrated a significant decrease in BMI, weight and waist circumference from baseline. The decreases were significantly larger compared to the control group for BMI (p = 0.0018) and weight (p = 0.0027) (t-tests).

Patients in the SfW program improved in BMI, weight, waist circumference and SWN total score. Changes in weight and BMI were significantly larger in the SfW group compared to the control group.

To examine the perceived needs by patients and radiotherapists using a modified by us version of the Camberwell Assessment of Need (CAN).

We eliminated 4/22 areas of the CAN scale -ideated for psychotic patients- in order to adapt it to oncological subjects (naming it CANo). Each of the scale areas values: the existence of a specific need; the help received from care-givers; the help coming from social services; the completeness of the help received. CANo was administrated to 30 solid cancer subjects consecutively admitted in 2007 to the Radiotherapy Department of Novara Hospital (Italy), and to their respective treating radiotherapists. Patients with cognitive impairment were excluded. Patients were also administrated the following protocol: HADS (Hospital anxiety and depression scale); Paykel's list of stressful events; MBTI (Mayer-Briggs Type Indicator); EORTC QLQ-C30.

Anxiety and depression occurred at any level in 15/30 of cases. There was a significant correlation (Spearman coefficient: SC) between the numbers of needs on CANo scale and anxiety (SC:0.4; p=0.002) or depression (SC:0.48; p=0.006) levels. Higher scores in all functional EORTC scales corresponded to lower needs detected by CANo. Patient needs were perceived less important by patients themselves than their physicians (mean satisfied need scores: 1.87 vs. 3; unsatisfied need scores: 0.63 vs. 1.03). The staff overestimated patient physical health needs (7/30 vs 3/30), psychological distress (20/30 vs 5/30), relationship difficulties (9/30 vs 2/30), received information correctness (7/30 vs 2/30).

The CANo scale may be useful to detect oncological patient needs and to improve the quality of care.

A deficit in the theory of mind has been identified, although without univocal results, in various pathologies, such as schizophrenia, bipolar disorder and some personality disorders. Aim of the study was to evaluate, in a non- psychiatric population, the correlation of personological characteristics and symptoms with theory of mind and emotion recognition tasks.

The following protocol was administrated to 130 voluntary students from Novara (Italy) School of Medicine: EPQ-R test for personality analysis; an intention-inferencing task for theory of mind (adapted from Happè's version); the emotion recognition test (adapted from Blair's version); and SCL-90 for symptoms evaluation. Spearman correlation coefficient (SC) was calculated; p< 0.05 was considered statistically significant.

No statistically significant correlations were found between the EPQ-R (psychoticism, estroversion and nevroticism) and theory of mind test scores. Better performances in the theory of mind test corresponded to lower scores in SCL-90 subscales: obsessive-compulsive disorder (SC:-0.248; p=0.004); depression (SC:-0.280; p=0.001); anxiety (SC:-0.276; p=0.001); hostility (SC:-0.178; p=0.042); phobic anxiety (SC:-0.197;p=0.025); paranoid ideation (SC:-0.191;p=0.03); and psychoticism (SC:-0.189; p=0.032). A lower capacity in the recognition of the happiness emotion corresponded to higher scores in the hostility (CS:-0.194; p=0.027) and phobic anxiety (CS:-0.211; p=0.016) SCL-90 subscales, while higher scores in the EPQ-R subscale psychoticism and somatisation SCL-90 subscales were respectively related to lower skills in the recognition of fear (CS:-0.226; p=0.01) and envy (CS:-0.193; p=0.028) emotions.

Theory of mind skills seem independent from personological traits, but are inversely correlated to various symptomatological subscale scores. The recognition of specific emotions correlates selectively with various personological traits and symptomatological subscales.