The recent increase of immigrant population in some European countries represents a new social reality demanding an update of psychiatric clinical practice and resources. We aimed to:

1. 1. compare the clinical and demographic profile of immigrant patients admitted to a Spanish acute psychiatric ward with that of native patients, and

2. 2. detect changes over the last years regarding both the profile and the occupation of psychiatric beds.

Demographic and clinical data of immigrant patients admitted to the Doctor Peset University Hospital acute unit during 2005-2007 were retrospectively analyzed. For each case, a non-immigrant patient was assigned as a control. Immigrant subjects hospitalized during 2007 were compared to those admitted during 2000.

Over the three-year period, 38 immigrant individuals needed 45 hospitalizations (2.9-5.1% of total annual psychiatric admissions). Native patients presented similar demographics and produced a similar number of hospital stays, but had significantly more psychiatric (p=.02) and medical (p=.05) comorbid conditions. Immigrant patients hospitalized during 2007 (n= 12) were comparable to those admitted in 2000 (n=6), although the former accounted for a larger proportion of annual admissions (3.44% vs. 1.93%).

During the last seven years, the occupation of psychiatric beds by immigrant population has almost doubled but it is still in the low range. The clinical and demographic profiles of patients admitted to this acute ward were similar, regardless of their geographical origin.

The study sought to investigate the psychosocial determinants of quality of life 6 months after transplantation.

A liver transplant candidates sample (n=60), comprising consecutive patients attending out-patient clinics of a liver transplantation central unit (25% of the patients had Familial Amyloid Polineuropathy (FAP) and the remaining patents had chronic liver diseases), was assessed in the pre-transplantation period by means of Neo FFI personality inventory, HADS, Brief COPE, and SF-36, a quality of life self rating questionnaire. Six months after transplantation these patients were assessed by means of SF-36.

Psychosocial predictors where found by means of multiple regression. The physical component of quality of life 6 months after transplantation was determined by coping strategies and physical quality of life in the pre transplantation period (this model explained 32% of variance) and that mental component 6 months after transplantation was determined by depression in the pre transplantation period and by clinical diagnosis of patients (FAP patients with lower mental component of quality of life) (explained 25% of the variance).

Our findings suggest that coping strategies and depression measured in the pre-transplantation period are important determinants of quality of life 6 months after liver transplantation.

Further studies are needed to identify the extent to which early and continued psychotherapeutic interventions can improve not only mental but also physical related quality of life in patients at risk, for example patients with increased scores for depression and for non adaptive coping strategies in the pre transplantation period.

The effect of minor orthopaedic day surgery (MiODS) on patient's mood.

A prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of General Anaesthesia (GA) were included. The Medical Outcomes Study-Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and postoperatively.

The mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n = 148, p = 0.51, 95%CI = (-1.03 -1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient, r = 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with χ2 (df = 1) = 0.86 for which p = 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.

MiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.

Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet.

Patients diagnosed with chronic prostatitis at a tertiary care ID clinic are evaluated for the presence of alexithymia, with the use of the Toronto Alexithymia Scale, as part of a prospective cohort. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category. Association of psychiatric symptoms with prostatitis category was performed.

Preliminary results are reported for 30 patients (median age 43 years old; IQR= 36-52). According to the NIH Prostatitis Classification System patients were categorized as type II : 48.2%, type IIIa: 6.9 %, type IIIb: 38%, type IV: 6.9%. Median CPSI score was 16 (IQR: 11-25). Abnormal TAS score was noted in 72% of the population. Specifically, 90% had high scores in external orientation of emotions, 25% in identification of emotions and 38% showed reduced expression of emotions. It is of notice, that mean TAS scores were significantly higher in type IIIa prostatitis cases (p=0.002, ANOVA).

High rates of alexithymia were noted in prostatitis subjects especially in type IIIa cases. These findings need further prospective evaluation.

Psychiatry is considered a specialty not having a lot to do with medical emergencies. Psychiatrists are being asked to contribute to medical treatment or diagnosis after the completion of diagnostic procedures by physicians, often concluded in a diagnosis by exclusion. Having said that, emergency psychiatric issues often arise in usual clinical practice.

Thorough research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness.

There are several books, articles and guidelines that go beyond the psychiatric emergencies of mentally ill patients, aiming to provide guidelines for the providers of emergency treatment in settings that access to psychiatric treatment is limited due to obstacle of time or distance.

Although general in concept and not particularly concerned with the accuracy of psychiatric diagnosis and the description of symptoms and signs of psychopathology, there are general guidelines well described that a qualified nurse, social worker or an ambulance worker could apply. We have an obligation to disseminate knowledge about dealing with psychiatric emergencies especially to health services at remote areas. Publication of treatment guidelines that are easy to apply, could be the next step in recognition, early intervention and appropriate referral in challenging psychiatric situations at the members states of European Union.

Dhat syndrome is a widely recognized clinical condition from the Indian subcontinent characterized by a preoccupation with semen loss in urine and other symptoms such as fatigue or depressed mood. This condition has been considered to be a culture-bound syndrome, and may be considered to be a culturally manifestation of depression or anxiety.

The purpose of this paper was to perform a systematic review of published literature on Dhat syndrome.

A review of the literature on Dhat syndrome until July 2008, without any language restriction was conducted by a search of the MEDLINE and PsycLIT indexing services using the following key words:Dhat syndrome, semen loss anxiety and loss of semen syndrome. Inclusion criteria were any case-control or cross-over study.

Twenty-three studies were identified, of which 10 met the inclusion criteria. There were 8 cross-over and 2 case-control studies. The reviewed studies included a total number of 680 cases and 93 controls. Patients included in these studies were mostly unmarried, young males (25.4 years old;18-45 years) from a poor socio-economic status. Majority of the studies involved patients from the Indian subcontinent. Some studies reported concomitant depressive symptoms (50%), anxiety (40%), fatigue (30%) and sexual problems (40%). Only 4 studies reported information about treatment (psychotherapy and pharmacotherapy).

There was a high degree of heterogeneity among the studies reviewed. In conclusion, Dhat syndrome appears to be commonly associated with depression, anxiety and somatic symptoms. More studies are warranted related to the various treatment approaches for this condition.

The purpose of this study was to examine the relationships in early adolescence between self-reported reading difficulties (RD) and psychosocial and socio-demographic factors in a large representative population sample of 2464 adolescents (50.8% girls) with a mean age of 13.7 (SD: range: ) in Norway.

Sub-sample: Students with self-reported RD; 7.5% (N = 191) of the total sample, 7% girls (N= 88) and 8.5% boys (N =103).

Standardized self-report measures of depressive symptoms based on DSM-IV symptom criteria, (The Mood and Feelings Questionnaire), and on self esteem (The Self-Perception Profile for Adolescents) and attachment (The Inventory of Parent and Peer Attachment) were used.

Adolescents with RD were compared to classmates. In univariate analyses RD adolescents demonstrated higher levels of depressive symptoms, more school stress, had lower school grades and lower attachment to parents. They also scored lower on Global Self-worth and on Social Acceptance scales. Further, they reported reduced levels of psycho-functioning during the previous year because of mental health problems. They also had received more help and had used more medication for such problems.

In the multivariate logistic regression analysis, receiving help for mental health problems and reduced psycho-functioning showed the strongest association with student RD status (OR=2.32 and OR=1.75, respectively). No gender differences were found.

The study demonstrated important differences between adolescents with and without RD. Adolescents with RD might be more at risk for mental health problems than others.

The aim of the study was to evaluate the response of different monoaminergic systems to psychostimulant treatment in children with mild form of hyperkinetic syndrome (HKS).

The levels of N-methylnicotinamide (end product of kynurenine pathway of tryptophan metabolism), 5-hydroxyindoleacetic (product of serotonin pathway of tryptophan metabolism), homovanillic and vanillylmandelic acids were measured in daily (3 days) urine samples of children (30 patients, 7-11 years old) with mild HKS with normal intellect or borderline mental insufficience. Biochemical measurements were performed before and 3 weeks after sydnocarb medication (5-15 mg sydnocarb daily). (Sydnocarb is a psychostimulant introduced into the clinical practice in the Soviet Union in the 70th of XX century).

After 3 weeks of sydnocarb therapy there were found the improvement of children's clinical status in both groups. It was followed by a significant decrease in the excretion of homovanillic (by 45 %), vanillylmandelic (by 35 %) and 5-hydroxyindoleacetic (by 50 %) acids but by a significant increase in N-methylnicotinamide excretion (by 30%).

Psychostimulant medication has revealed the involvement of kynurenine and serotonin in HKS pathogenetic mechanisms. There were found a reciprocal relationship between serotonergic and kynurenine systems. It is proposed the kynurenine hypothesis of pathogenesis of HKS. It is characterized by the decreased activity of kynurenine system in HKS children. Clinical improvement of HKS children under psychostimulant medication is connected with activation of kynurenine system along with the decrease of serotonergic activity.

Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.

Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.

We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.

In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.

Videoconferencing (communicating with a two-way sound/picture system) may help reduce travelling and may save time and money for patients and the health care system. Despite the fact that studies have found videoconferencing as good as face-to-face interactions for certain therapies, few in Norway use this tool routinely for consultations with patients. We examine clinicians’ experiences with videoconferencing and their attitudes to using this tool for psychiatric consultations.

Qualitative interviews were carried out with five MDs and six clinical psychologists with videoconferencing experience. They were asked about their experiences with videoconferencing and about their thoughts about using videoconferencing for consultations. Data analysis was inspired by Grounded Theory.

While they generally were positive to the idea of conducting consultations by means of videoconferencing, they had little experience in doing so and were worried that videoconferencing may be less effective than face-to-face consultations. A central worry was that communicating is more difficult by means of videoconferencing and that subtle signals may be missed. They were also concerned about how they will be able to perform such tasks as demonstrating empathy. They expressed concern about possible technical problems and an increased total work-load. Some thought that establishing a system for training and assisting clinicians in their videoconsultations will increase use.

The clinicians had little experience with using videoconferencing for consultations. Despite some worries relating to relational, practical and technical matters, most were positive. Establishing a system for training and assisting clinicians may increase the use of this tool for consultations.

British Chinese have a low uptake of mental health servcies. Poor symptom recognition, language difficulty and mental illness stigma are the key barriers to accessing services. This study aims to explore their help seeking behaviours when they experience mental illness.

About 96% of Chinese in Northern Ireland worked in catering business. Questionnaires (both in Chinese and English) were sent to ninety-one addresses occupied by catering businesses in Belfast. A bilingual covering letter was enclosed to encourage recipients to ask their families and friends to return the questionnaires.

Twenty-four questionnaires were returned. 66.6% reported that they visited their GP within the year prior to the study. Only one person visited the GP becasue of a mental / psychological problem. All others visited their GP for their physical illness. Racism (58.3%), physical ill health (50%) and lack of social support (41.7%) were the key stressors. 21% would visit their GP if they had a mental health problem and 45.8% would contact the GP if someone they knew became mentally unwell. Poor recognition of mental illness (41.7%) and mental illness stigma (25%) were the reasons for not seeking medical advice.

Findings revealed that the Chinese do seek help from their GP. However, little evidence suggests that the community will approach their GP when they or someone they know actually become mentally unwell. Further investigation is needed to explore diifferent ways to provide information about mental illness symptoms and mental health services for the community.

The medium stay unit of the hospital of Zamudio is a psychiatric hospitalization unit where serious patients are admitted, specially those with psychotic and affective disorders. The complexity of the pathology extends the average stay of hospitalization with an average of 60 days to improve.

There are 2 derivation units from which medium stay takes patients:

• • Short stay unit from the Hospital of Cruces;

• • Short stay unit from the Hospital of Zamudio.

It is analyzed, retrospecitvely, the profile of patients in a medium stay unit comparing the derivation unit they come from in 2007.

There are no statistically significant differences in the number of patients derived from the diverse units.

The sociodemographic and administrative profile of the patients is similar in both groups: a single middle aged (between 45-50 years old) that is hospitalized knowlingly (63%). The average stay at hospital is 55 days.

Attending to the clinical profile we concluded that patients derived from the Hospital of Zamudio suffer from Bipolar disorder as main diagnosis. The rest of disorders remain similar comparing both units.

A medium stay unit is a psychiatric hospitalization unit where serious patients are admitteded, basically those with psychosis and affective disorders. The complexity of the pathology extends the average stay of hospitalization with an average of 60 days to improve.

The general profile of patients in a medium stay unit is characterized by:

• • Psychotic and affective disorders that need longer hospitalization.

• • Disorders that are resistant to treatment and need specific strategies.

• • Patients that give up the treatment.

• • Patients that require sessions of electoconvulsive therapy.

It is analyzed, retrospectively, all admission to a medium stay unit in 2007 and described the clinical and sociodemographical features of each patient entering the unit.

209 people enter the unit in 2007, most of them single and in average they are 47 years old. The relation between men and women is similar.

The 65% of the patients agree about being hospitalized with an average stay in hospital of 54 days.

Schizophrenia is the most frequent diagnosis, followed by Major Depression.

The 56% of the patients are referred to an outpatients' department.

What we observed in our study fits in with the general profile of patients that entered a medium stay unit.

Atypical Antipsychotics(AAPS) have been found to be effective in various psychiatric conditions however evidence of treatment emergent hyperlipidemia limit their clinical benefits.

To determine the treatment effects of AAPS onTriglyceride.

Patients with schizophrenic and non-schizophrenic conditions were randomly started on AAPS. Weight, BMI, and triglycerides were measured every 3 months from base line for one year.

121 enrolled, 119 completed 1 year follow up.

Olanzapine =51 Risperidone = 59 Quetiapine = 8 Clozapine = 1

Descriptive and inferential analysis was carried except Clozapine to examine effects on weight, BMI and triglycerides.

WEIGHT GAIN more than 7%

Males :

Risperidone 46% > Quetiapine 33% >Olanzapine 16%

Females:

Quetiapine 40% >Olanzapine 35% >Risperidone 9%

BMI:

OBESITY:

Males:

Quetiapine 33.33% >Olanzapine 32.26%> Risperidone 16.22%

Females:

Risperidone 50%> Quetiapine 20% >Olanzapine 20%

MEAN TRIGLYCERIDES:

Male:

Risperidone 1.92> Olanzapine 1.7

Females:

Olanzapine 1.97 > Risperidone 1.78

HYPERLIPIDEMIA:

Male:

Olanzapine 54.84% >Risperidone 43.24%>Quetiapine 33.33%

Female:

Quetiapine 80% > Olanzapine 65% > Risperidone 45.45%

Higher incidence with Risperidone in 20 to 40 age group; with Olanzapine in 61 plus. Higher incidence in Schizophrenia obesity 42.42% and hyperlipidemia 37.10%.

Results show that AAPS do affect weight, BMI and Triglycerides in varying degree to age, gender and disease, having significant clinical implications that warrant close monitoring with ongoing education on life style, diet and exercise in a heuristic manner.