The this study was carried out to determine the anxiety and hope status of the relatives of the patients in intensive care unit.

First degree relatives of 116 patients in the intensive care unit of a hospital were involved in the present study. The data of the research was collected using a personal information form, the Spielberger State Anxiety Scale and Hope Scale.

It was found that the relatives of the patients were anxious. There was a statistically significant negative relationship between the numbers of visit by the relatives of the patients and their hope scores (r=-.357, p=.000). The more they visited the patient the more they lost hope. It was found that hope score was low in the patient's relatives who were female, spouse or parents of the patient, anxiety was high and hope was low in the patient's relatives who were literate and who had low income, hope was high in the patient's relatives who lived in a city and who had social security.

The first-degree relatives of the patients in the intensive care unit experience anxiety. As the number of visits by the relatives of the patients increases, their hopes about the recovery of the patient decrease. Therefore, continuous communication with the medical personnel and being continuously informed about the status of the patient will be helpful for the relatives of the patients in the intensive care unit to deal with the present situation.

In this study, we explored the attitudes towards Medically Unexplained Symptoms (MUS) of 500 GP's in Karachi, Pakistan. Using a questionnaire previously developed by Reid et al (2001), we aimed to investigate whether GP's attitudes towards medically unexplained symptoms are similar to those of GP's in the developed world.

500 GP's on the database of primary care centres at the Pakistan Institute of Learning and Living in Karachi, were all sent a covering letter explaining the purpose of the survey with a case vignette, a questionnaire, and a stamped addressed envelope. One month later, non-respondents received a telephone call from an investigator to remind them of the study.

Of the 429 respondents, 68.5% (294) were male and 31.5% (135) female. Although 80.2% of respondents felt that the main role of GP's was to provide support and reassurance, 76.9% of respondents also agreed that GP's had a role in referring patients with MUS for further investigations to identify a cause. 204 (47.55%) respondents agreed that somatization was useful concept, only 146 (34.03%) felt that there was effective treatment for it.

For the most part Pakistani GPs’ attitudes towards MUS are similar to those of their counterparts in the West. Both agree that the GP had an important role in providing reassurance and counselling. However, our survey also shows that Pakistani GP's are less likely to place emphasis on an underlying psychiatric diagnosis and tend to focus on looking for an underlying physical cause.

Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycaemia due to either the deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate. Depressive disorders have been found to occur at increased prevalence rates among patients with Type 1 and Type 2 Diabetes Mellitus 9. Depression has the additional importance in diabetes because of its association with poor compliance with diabetic treatment, poor glycemic control and an increased risk of micro and macro vascular complications. An accurate estimate of depression prevalence is needed to keep and gauge the potential impact of depression management in patients with co-morbid diabetes 22. Better recognition and better treatment of depression are important in themselves but they could also improve medical outcome by substantial portion in patients of diabetes

Total of 527 cases of Diabetes were screened for major depressive disorder (MDD) by using DSMIV based criteria system. Montgomeny Asberg Depression rating scale (MADRS) and Clinical Global Impression (Severity) (CGI) scale to access severity.

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1. 1. Major depressive disorder is inordinately high among the sample of adult diabetic patients occurring at the rates of 2 - 6 times greater than those observed in general population.

2. 2. Majority of patients with diabetes who have major depressive disorder have depression of moderate severity and not just mild depressive symptomatology.

3. 3. The presence of major depressive disorder is significantly associated with poorer glycemic control.

Patients with chronic pain suffer dramatic reductions in physical, psychological, and social well being, and their health related quality of life is lower. Anxiety and depressive disorders occur in 20%-25% of patients with rheumatoid arthritis.

The effectiveness of antidepressants for the treatment of major depression is well documented; however, the analgesic properties of this class of medication are under-appreciated.

This study aims to prove magnitude of association between RA and Depression along with independent effect of Fluoxetine on depression and arthritis.

100 socio-demographically matched woman attending a rheumatology clinic with a diagnosis of rheumatoid arthritis as defined by American Rheumatism Association criteria, were approached for the study along with homogenous group of controls. HADS, MADRS and CGI were applied. Both the groups were treated with anti RA drugs along with added antidepressant in depressed RA group.

Strong association between RA and depression was established. Treatment out come of RA was better and earlier in the depressed RA patients who were given antidepressant than non-depressed RA.

All chronic pain conditions warrant psychiatric evaluation to unmask the associated psychiatric disorders as treatment of psychiatric disorders prove to expedite the recovery of physical symptoms as well, thus improving productive life span of an individual with chronic painful conditions.

In patients undergoing coronary-artery bypass surgery (CABG) the presence of cognitive functions deficits is frequently observed. This procedure is also associated with a danger of appearance of depression and anxiety. As the above symptoms may coexist, the purpose of this study was to observe the presence of depression and anxiety symptoms before and after the operation, and their impact on the cognitive functioning of operated patients.

It included 50 subjects in whom the intensity of depression was assessed with the use of the Beck Scale (BDI), and the anxiety as state and trait was assessed with the use of STAI scale on 1 day before the operation and on 5-7 days after the operation. At the some time cognitive functions were assessed with the use of Vienna Test System (VTS).

The change of intensity of anxiety and depression and most of the analysed cognitive functions, except learning ability, was statistically significant. However the correlation of depressive and anxiety symptoms with the cognitive deficits achieved the level of significance only with the reference to attention disorders.

The achieved results show a considerable independence of the cognitive functions examination from the present emotional state in examined patients.

Hypersexuality is an uncommon behavioral complication associated with traumatic brain injury (TBI) involving lesions to frontal basal, temporal, or diencephalic structures. Experimental brain injury in animals has produced hypersexual behaviors; however, there is comparative paucity of knowledge in humans. TBI with hypersexuality offers insights into neurological basis of aberrant sexual behaviors as well as potential treatments. This case report describes social/sexual disinhibition in a patient following neurosurgery for self-inflicted TBI.

Case analysis with literature review.

32-year-old male was admitted with TBI following an unsuccessful suicide attempt, self-inflicted nail gun injury to the occiput. CT scan revealed 6.5cm nail that had entered the skull in right occiput, right parasagittal location with nail head right of vein of Galen, coursing through splenium of corpus callosum, right thalamus-hypothalamus-midbrain, with its tip at the suprasellar cistern. Occipital craniotomy with retrieval of foreign body was performed eleven days after admission. From post-operative day eight through twenty-seven, patient made inappropriate sexual comments to female medical student: asking her out repetitively, describing her physical appearance, enquiring about her suitors, and requesting her to call him upon his discharge. Prior psychiatric history was pertinent for major depression and social anxiety (especially women) with psychotropic noncompliance. During admission, patient was diagnosed with recurrent major depression, social anxiety by history, and impulse control disorder nos. On sertraline titrated to 100mg qhs, depression resolved with increased control over newly acquired sexual/social disinhibition noted.

TBI can lead to social disinhibition and hypersexuality. Sertraline may be a beneficial treatment.

Many studies have attempted to delineate the positive relationship between anxiety and depressive symptomatology in outpatients with bronchial asthma. However, do not exist reports on the relation between the depression, anxiety and vital exhaustion in these patients.

Aim of the study is to investigate the levels and the associations between anxiety, depression and vital exhaustion in outpatients with bronchial asthma.

The study was performed in one of the largest hospitals of chest diseases in Greece. Forty (14 men και 26 women) outpatients with bronchial asthma participated in the study. Using the BDI (Beck Depression Inventory), the STAI (Spielberger Anxiety Trait Inventory) and the Maastricht Questionnaire (MQ) we assessed depression, anxiety and vital exhaustion, respectively. Age and duration of the disease were also recorded.

Means of age and of duration of the disease were 43.22±13.05 and 9.24±6.01 years, respectively. The mean STAI score was 42.47±9.9, mean BDI score was 14,16±7,54, and the mean MQ score was 21.02±11.05. Percentages of 29% and 60% of the sample were presented with significant anxiety and depressive symptoms, respectively. No correlation was observed between the demographics (age and duration of disease) and the STAI's and MQ's scores. In contrary, a positive correlation was observed between the levels of depression, anxiety and vital exhaustion (pearson correlation p< 0.001).

The study confirms the coexistence of the depressive symptomatology with anxiety and vital exhaustion in outpatients with bronchial asthma. Therefore, this comorbidity should be taken into account in order to develop specific supportive psychological interventions.

Many studies on samples of HIV-positive patient's shows correlation of psychiatric symptoms and medical and immunological symptoms of HIV infection. Also, presence of psychiatric distress was showed in some somatic diseases, especially the ones which lead to chronic.

The aim was to examine presence of psychopathological symptoms among HIV-1 infected patients which haven’t developed AIDS, in comparison to hepatitis B or C infected patients.

Sample for consisted of 60 patients: a) 30 somatic asymptomatic HIV-1 seropositive patients who constituted study group, and b) 30 patients infected with hepatitis B or C which constituted control group. All of them have been assessed on the presence of psychiatric symptoms by the SCL-90 (The Symptom Checklist 90). After the assessment those two groups were compared by student's t test on every subscale and total score.

Results of the study showed that patients in both groups exhibited moderate presence of psychopathological symptoms, especially symptoms of depression, anxiety and interpersonal sensitivity. Moreover, patients with HIV exhibited obsessive-compulsive symptoms. Results showed that there are no statistically significant differences in presence psychopathological symptoms between somatic asymptomatic HIV-positive patients and patients infected with hepatitis B or C.

Based on the results of this study it could be concluded that, beside the moderate presence of psychopathological symptoms in the samples of somatic asymptomatic HIV-positive patients and hepatitis B or C infected patients, there is no statistically significant difference in those samples of patients.

The psychiatric reactions relating to Human Immunodeficiency Virus (HIV) infection cover the whole range of mental illnesses and psychosocial problems. This poses a challenge to both physicians and psychiatrists and is of immense relevance due to the rising number of HIV patients in Singapore.

To retrospectively examine the psychiatric disorders and related factors associated with HIV infected patients in a general hospital in Singapore.

To review and describe the psychiatric disorders and related factors associated with HIV patients under the care of Tan Tock Seng Hospital and Communicable Disease Centre in Singapore.

A 2-years retrospective descriptive study was performed on all HIV patients who were referred to the Department of Psychological Medicine of Tan Tock Seng Hospital for psychiatric assessment and this includes both inpatient and outpatient referrals. The data for inpatient referrals was obtained through the interdepartmental referral registry and relevant case notes. The data for outpatient referrals was obtained through the attendance and relevant case notes of the HIV psychiatric clinic. The data was collated and analyzed.

Mood disorders were the most common psychiatric disorders diagnosed and antidepressants were the most commonly used psychotropic drugs. Most patients were followed up on an outpatient basis for continuation of treatment.

Many HIV infected patients may have concomitant psychiatric disorders. Clinicians may need to actively identify patients at risk and initiate early psychiatric consult to ensure appropriate care for these treatable disorders.

Pathological anxiety is characterized by the absence of a reason for anxiety. However, the presence of fear provoking stimuli does not exclude the possibility for a pathological course of anxiety, i.e. “Pathological Realangst”. An example are hypochondriac anxieties in patients with severe somatic disorders. An open question is to what degree severity of somatic morbidity is related with anxiety.

In 209 patients (37,8% women) from a cardiology inpatient unit general anxiety, heart-related anxiety, progression anxiety, and job-anxiety were measured. Physicians rated the degree of severity of the somatic (heart-)disorder using the Multidimensional Severity of Morbidity Rating (MSM rating). Relationships between the degree of anxiety and somatic morbidity parameters were investigated.

Anxiety did not or to a very low degree correlate with objective indicators of somatic morbidity. Subjective suffering showed a moderate significant correlation with heart-related anxiety and progression anxiety, and was also correlated with sick leave duration.

Severity of somatic illness is a multidimensional phenomenon and not regularly related in a special way with anxiety, except the dimension of subjective suffering. Pathological fears, even when occurring in the context of somatic disorders, are not related to objective endangerment, but have to be described as mental problems.

The main purpose of this study is to measure the prevalence of cognitive impairments among hypertensive outpatients in the Hypertension Department of Cardiology National Institute.

A sample of 90 consecutive hypertensive outpatients was evaluated from the cohort of 217 hypertensive patients population in treatment. They were assessed by the same PhD psychiatrist using the Mini Mental State Examination.

Prospective study of a sample of 90 consecutive hypertensive outpatients was evaluated from the cohort of 217 hypertensive patients population in treatment. They were assessed by the same psychiatrist, using the Mini Mental State Examination (MMSE).

The main question, proposed by this study, if arterial hypertension causes cognitive impairment, has a negative answer, for it was observed that for each mercury millimeter increased in the Diastolic Blood Pressure (DBP), occurs a downfall of only 0.02 in the MMSE, but when adjusted according to the age of subjects, the association among DBP and the MMSE score disappears. Statistical analysis included the t test of Student or Mann-Whitney, qui-square test or Fisher's exact test and linear regression.

This study did not show any causal correlation between hypertension and cognitive impairment. According to numberless articles, the MMEE instrument demonstrated in this study, great bias associated with illiteracy and formal education.

This research aimed to evaluate the prevalence of psychic depression in patients with acute coronary syndrome (ACS) and the interdependency with risk factors for coronary artery disease (CAD).

Prospective stdy of patients consecutively admitted with ACS and screening for depression through the Beck Depression Scale, which was used within the first 5 days after admission. Patients who presented simultaneous diagnosis of severe neoplasia, use of antidepressant medication, incapability to communicate or comprehend, were excluded from the research. Statistical analysis included the t test of Student or Mann-Whitney, qui-square test or Fisher's exact test and the log-linear model to evaluate interdependency among risk factors for CAD.

98 out of the 135 patients admitted with ACS presented acute myocardial infarction, while 37 presented unstable angina, mean age of 61.8 years,of which 40% were female.Prevalence of depression in this study was 53.3%. (n=72) distributed in three groups according to the degree of intensity:28.1% with mild depression,14.1%moderated depression, and 11.1% with severe depresion. Among in-hospital deaths, 88.9% (n=8) were in patients with depression and only 11.1% (n=1) in patients without depression, with relative risk 0f 6.99 (p=0.027) Depression was more prevalent in female patients. Depression was present in association with great numbers of risk factors: dislipidemia, sedentary habits, sex (p=0.0259), family history systemic arterial disease and hypertension (p=0.0098)

The results of this study show a high prevalence of psychic depression among patients with acute coronary syndrome with elevated mortality risk and interdependency with other risk factors.

Sexuality is a crucial area of human life. A proper examination to assess and detect problems in this field, it seems imperative to intervene when transsexual patients. Therefore accurately known, the sexual practices of these patients, allows us to work directly on possible alterations in the functioning of sexual life during the therapeutic process.

Describe patterns of sexual behavior in patients diagnosed with transsexualism

Gender and Identity Disorder Unit (GIDU)

Selected by consecutive sampling, 200 transsexuals treated at GIDU Malaga, aged between 20 and 40 years and who agreed to participate in the study. Comprising 142 transgender male-to-woman (MtW) and 58 women-to-man (WtM).

Was conducted through a heterocompleted questionnaire that included questions about sexuality, personality traits and demographic characteristics. These were filled in the consultation and were anonymous.

11.6% of MtW transsexuals have never had sex. 26.8% of the MtW and 29% of WtM are more than 3 months without masturbating. 54.1% of the MtW avoid having sex due to the rejection of his genitals, lack of sexual desire and previous traumatic experience. Transgender respondents had secondary education, stable jobs and they were single.

It is vital that we explore the sex lives of transsexual patients. This information must be integrated in a systematic and rigorous evaluation process. According to the results presented, the hyposexuality would be the most significant feature that describes sexuality for this population.

Traumatic brain injury (TBI) is recently recognized as a risk factor for hypopituitarism, presented most frequently with growth hormone deficiency (GHD). GHD is associated not only with changes in body composition, but also with impaired quality of life, cognitive dysfunctions and some psychiatric sequelae, usually classified as “depression” or “atypical depression”. The impact of GH therapy on mental status is still unknown.

Psychiatric and cognitive functions were tested in six adult GHD subjects at baseline (minimum three years after TBI), reassessed after six months of GH replacement therapy as well as twelve months after discontinuation of GH therapy. Psychiatric and cognitive examinations included semi-structured interviews and three instruments: Symptom-checklist (SCL-90-R), Zung Depression Inventory and standard composite neuropsychological battery.

Six months of GH therapy in GHD TBI patients improved cognitive abilities (particularly verbal and nonverbal memory) and improved psychiatric functioning. Severity of depression decreased, as well as intensity of interpersonal sensitivity, hostility, paranoid ideation, anxiety and psychoticism. In three GHD patients who stopped GH therapy for twelve months we registered worsening of the verbal and nonverbal memory, as well as increase in Zung score and three SCL dimensions: inter-personal sensitivity, anxiety and paranoid ideation.

This preliminary data suggest that GH therapy induced reduction of depression, social dysfunction and improvement in certain cognitive domains in GHD patients after TBI. Our data support the necessity of conducting randomized placebo-controlled trials on the effects of GH therapy on neuropsychological and psychiatric status in GHD TBI patients.

Patients presenting with self harm account for a significant proportion of attendances to the emergency department. NICE guidelines recommend these patients must undergo full psychosocial and risk assessment with mental state examination.

Aims included to investigate the demographic factors of those presenting to the emergency department with self harm and explore methods of self harm. Also, to review the psychiatric history, exploration of suicide risk factors and assessment of suicidal intent, the mental state examination and referral for further treatment.

We also wished to make recommendations to improve the history taking process should this be proved necessary.

Data was collected retrospectively from February to August 2009. Twenty-five casualty cards were collated at random for patients who presented with self harm. Evidence of exploration of the objectives were investigated.

Suicide risk factors and suicidal intent were poorly documented. The mental state examination was not documented in all cases. 18 were referred for psychiatric review.

Psychosocial and risk assessment of those presenting to the emergency department with self harm is poor. As a result of this study, We have designed and introduced a proforma to be completed by doctors in the emergency department. This incorporates the mental state examination and is to aid the assessment of suicidal intent in patients presenting with self harm. The effectiveness of this proforma will be assessed with a re-audit planned in 3 months time.

Following a previous audit conducted at Bedford Hospital we found no formal screening tool for depression was used in post-stroke patients. The prevalence of depression in the sample of 63 patients was 28%. We recommended the implementation of the PHQ-9 questionnaire as a screening tool for depression in these patients.

To assess the effectiveness of the PHQ-9 as a screening tool for depression in stroke patients. To review whether implementing this screening tool has increased the prevalence of depression within this patient population.

All patients admitted to the stroke ward in Bedford Hospital between 10/09/09 and 13/12/09 were included in the audit. Patients were screened two weeks after admission. Exclusion criteria were met if patients lacked mental capacity to be screened; the patient declined or was discharged or deceased within 2 weeks.

Of 83 patients admitted, 18 (23%) were screened. Of these, 10 patients (53%) scored 5 or above, indicative of depression. One patient scored 10 indicative of moderate depression, and one patient scored 19 indicative of severe depression.

The PHQ-9 questionnaire is useful as it clearly increased the prevalence of post-stroke depression. However noticeably there are a significant proportion of patients who could not be screened using this tool as it is a self report assessment. This includes those who lack capacity or have communicative difficulties as is common after a stroke.

To determine the prevalence of depression and quality of life in patients with epilepsy, and its associated risk factors.

This was a cross sectional study where 120 patients with epilepsy and 60 controls who were the patients’ sibling, were recruited. Socio-demographic data (age, sex, race, marital status, education level and employment status) and clinical variables (age at onset, duration and type of seizure, seizure recency, type of antiepileptic drug used, family history of epilepsy and depression) were recorded. Both patients and the control subjects were given the “Hospital Anxiety and Depression Scale” and “Mini International Neuropsychiatric Interview” to screen and diagnose for depression respectively. The Quality of Life Inventory of Epilepsy (QOLIE-31) was used to assess quality of life.

The prevalence of depression in patients with epilepsy was higher than in controls (9.2% as compared to 3.3%), though it was not statistically significant. There were also no significant differences between the depressed and non depressed patients in terms of socio-demographic and clinical variables. However, patients with younger onset of epilepsy were more likely to report depressive symptoms on HADS (p = 0.02). Patients with epilepsy who were depressed also had poorer quality life as compared to those without depression: p< 0.001.

Patients with epilepsy had higher rates of depression as compared to controls. Furthermore they had significantly poorer quality of life as compared to those without depression. Therefore, epileptic patients should be regularly screened for depression to prevent unnecessary suffering and poorer quality of life.

To find the prevalence of different Somatoform Disorders (SDs) in psychiatric consultations to inpatients and outpatients of Farabi General Hospital(Kermanshah-Iran) in 10 years (from 1994 to 2004) and to define their demographic variables.

Any patient, who received an SD diagnosis by the consultants, was further assessed, using a two-phase design, for DSM-IV SD criteria.

A total of 801 patients fulfilled diagnostic criteria for a DSM-IV SD. Among these 493(61.5%) had Conversion Disorder, 127(15.9%) Somatization Disorder, 117(14.6%) Hypochondriasis, 41(5.1%) a Body Dysmorphic Disorder and 23(2.9%) a Pain Disorder).Most of the patients were young, female, married and not educated more than primary school.

Somatoform Disorders are common in psychiatric consultations of General Hospitals. Internists, surgeons and other specialists need to be aware of these disorders.

To assess treatment-seeking behaviour in psychiatric patients with co-morbid infertility.

METHODology: This hospital-based prospective study was conducted on out-patients, consulted at NMI (Neuro-spinal & medical Institute), Karachi.All consecutive and consenting cases were interviewed using a semi-structured proforma. Results were tabulated and analyzed through SPSS Version 11.0. Fisher Exact test/Chi-square test were used to compare variables.

One hundred five cases (62.85% Men and 37.14% Women) that fulfilled the criteria of infertility were evaluated. More than half (51.42%) of the cases had sought alternative type of treatment including treatment from Faith Healers (19.04%), Hakeems (Eastern/Indigenous Practitioners=18.09%) and Homoeopathics(14.28%). The rest of the cases had history of multiple consultations with Allopathic medical practitioners.

The impact of Infertility is serious especially in the east making a person vulnerable to seek help from the various available source of treatment particularly traditional/ alternative mode.