An exploratory study was conducted with the aim of discovering and describing experiences of nursing students during clinical placement in a psychiatric unit in an Iranian hospital.

This hermeneutic phenomenological study was carried out in a psychiatric unit of an educational hospital in Iran. Data were produced with 13 participants using in-depth interviews to detain their full experiences in psychiatric unit. Analysis rooted in the Diekelmann manner facilitated data interpretation and clarification of frequent themes.

Four correlated themes - Anxiety, Maturation, Routine learning and Enthusiasm were recognized in the data.

These results present exclusive insight for scheduling and applying fitting clinical Education in Iran, especially in psychiatric units. The exploration and description of experiences of the nursing students will help nurse educators plan clinical learning opportunities in such a way that they are less stressful, thus ensuring that nursing students are equipped to utilize themselves as therapeutic instruments.

The World Health Organization (WHO) (1998) has proclaimed that the definition of health includes four Domains of well-being: physical, mental, social and spiritual. It is therefore suggested that nurses should prepare themselves to assist individuals and families, not only to cope with spiritual distress of illness and suffering but also to explore the meaning in these experiences. The purpose of this investigation is to explore the antecedents of spiritual distress experienced by Iranian Muslim patients in the context of Islam.

qualitative descriptive research was conducted using unstructured interviews with twenty-one patients and three relatives. The data analyzed using content analysis method.

three main categories were found: failure in communication, non-holistic care and inability to worship

The results showed that the patient's spiritual well-being could be enhanced by communication, listening and giving information. Finally, it is clear that staff members have a great deal of responsibility for the patient's well-being, facilitating the relatives’ involvement based on their wishes and limiting the stress and difficulties experienced by the family.

1. 1. Understand the concept and benefits of a collaborative care model through a case based presentation

2. 2. Become familiar with best practices for the successful implementation and ongoing service delivery of collaborative mental health care

TUHA's aim is to improve access to mental health services and strengthen each Community Health Centres’ capacity to meet the mental health needs of its clients through a “shared care model”.

This case based presentation will illustrate the benefits and promising practices of implementing such a model

A shared care model is generally utilized within a particular organization to foster collaborative work among multidisciplinary teams. The unique feature of TUHA is the partnership between six different community health centres and mental health specialists using a common set of principles and objectives to sustain and enhance the quality of service being offered in the community.

Reflections on a multi-site partnership in the delivery of a collaborative model within a large urban centre creates a platform to determine the possibility of replicating a similar model in other communities.

Mental disorders are associated with many harmful health behaviors such as smoking, abuse of alcohol or drugs, physical inactivity and overweight. Abdominal obesity has been positively associated with depressive symptoms independent of general obesity (BMI). Adult obesity has been associated with depression, especially in women. Recent evidence implies that causal link goes from depression to obesity. This study set out to investigate the relationship between depression, sleepiness, health behavior, BMI and inflammation.

The study based on a cardiovascular risk sample drawn from the participants of a population survey, (aged 45-70) which was carried out in in southwestern Finland. The subjects filled in several internationally known questionnaires: STAI-S (state-anxiety), BDI (depression), EQH5 and RAND-36 (health-related quality of life), Berlin, ESS and PSQI (sleep disorders), smoking and generic measures on health behavior (e.g. physical exercise, time spent watching TV and using PC, intake of calories and fat). Blood samples were drawn from the subjects to measure among other things hsCRP (n=1318).

We found a statistically highly significant correlation between BMI and hCRP (r=0.22, p< 0.001). Total daily minutes watching TV correlated with hsCRP (0.12, p< 0.001). Partial correlation between total minutes spent watching television and hsCRP while adjusting for depression or BMI did not render it the correlation insignificant not diminish its size.

High level of TV use was associated with silent inflammation despite BMI. Heavy use of TV may be an indicator of harmfully increased stress levels.

Study aims in describing a case of insomnia associated with Behcet's disease and responding to treatment with melatonin.

Case concerns a 59-year-old female arriving at our outpatient ward complaining of insomnia. Her sleep pattern was disturbed in a way that she has been sleeping for about an hour daily for the last two years. The problem had started five years ago, her sleep progressively deteriorating with time. She also mentioned a feeling of exhaustion being present every day during the last year and lasting all day long, difficulty in concentrating in the performance of everyday activities and also a feeling of hopelessness affecting her daily mood. All of the above were progressing as insomnia was persisting. Her medical history was significant for Behcet's disease diagnosed about 20 years before and being treated with corticosteroids.

Initially patient was prescribed lorazepam at a dose of 2.5 mg and melatonin 5mg, both once daily before bedtime. After 10 days, patient has started responding, sleep having increased from 1 to 2.5 hours daily. At that time, dose of lorazepam was halved. After altogether 25 days, patient was sleeping for about 5 hours daily, lorazepam was stopped and melatonin was increased at 10mg before bedtime. By the end of the 3rd month and whilst making no further adjustments in medication, patient was sleeping for 6 to 6.5 hours per night.

Melatonin seemed effective in treating insomnia associated with Behcet's disease, arising either from disease itself or corticosteroid treatment.

We measured oxyHb and totalHb in the prefrontal cortex during the performance of original version TMT by multichannel NIRS using sensitive for detecting changes of oxyHb and totalHb.

Sixteen healthy student volunteers performed four different screens of TMT-A, and then two different screens of TMT-B.

OxyHb increased while in the prefrontal cortex during the performance of TMT-A and TMT-B. The changes were prominent during the TMT performed at first. OxyHb significantly increased in the right lateral prefrontal cortex during TMT-A while it significantly increased in the bilateral prefrontal cortices during TMT-B.

The results suggest that blood flow increases in the prefrontal cortex during the performance of TMT, and that the bilateral prefrontal cortices are involved in the performance of the original version TMT.

We showed an increase of oxyHb during the performance of TMT in the prefrontal cortex. The increase of oxyHb was more prominent in TMT-B than in TMT-A.

The present study suggests that the simultaneous use of the paper version TMT and multichannel NIRS may provide evidence to disclose neuronal mechanisms related to cognitive functions.

The Community Mental Health Team (CMHT) in Singapore provides home-based psychosocial rehabilitation services for people with severe mental illness (SMI). Besides the direct clinical intervention to the patients and their caregivers, the multidisciplinary team also collaborates with social and non-governmental organizations in the community. It provides training, consultation and support to these agencies so as to strenghten their capability in the understanding and management of people with SMI.

Since the inception of CMHT in April 2007, it has networked with family service centres, non-governmental mental health service providers, police, religious groups and other community partners. CMHT provides 2 types of mental health training programmes - basic and skill-based mental health training. The former programme introduces the participants to common mental disorders and the clinical services of CMHT. The latter programme is customized for the community partners and would entail the management of violent, aggressive and suicidal behaviours encountered in the settings of the community partners.

Effectiveness of the training is assessed by a pre- and post survey of the participants. Satisfaction score were also obtained from the participants.

Pre-knowledge of the participants were assessed to be of the range of 22.5% to 29.8%. This improves to 95.6 to 97.8 % after the training. At least 81 % of the participants were satisfied with the training.

It is important to train and engage social agencies and community partners so that people with SMI can experience a coordinated and seamless care in the community.

The objective of this study was to differentiate ordinary dreams from traumatic and PTSD-related dreams, by using The Sang Bok Lee Neurocognitive Dream Orientation Scales assessing the narrative dream contents.

1248 dreams were collected from 416 Korean college students, Yongin, South Korea - 198 males (M age=20.46 years, SD=1.32) and 218 females (M age=20.17, SD=1.26). The collected dreams were evaluated to find traumatic and PTSD-related dreams by using The Sang Bok Lee Neurocognitive Dream Orientation Scales, designed by Sang Bok Lee. These scales particularly asked about the dreamers a series of cognitive orientations that cover location, person, event, the dreamer's perception and coping action in the dream narratives. The PTSD-related dreams were hypothesized as having (1) frequently recurrent, (2) unfamiliar, (3) unexpected and accidental, (4) emotionally dreadful or fearful, and (5) not actively coped by the dreamer.

392 dreams (31%) of 1248 collected dreams were found as traumatic or very/extremely anxious dreams according to The Lee Anxiety Dream Scales (Mean=4.56). 36 dreams (0.9%) of 392 traumatic dreams were frequently recurrent and evaluated as PTSD-related. Strong positive correlation was found between 392 traumatic dreams and independent variables (unfamiliar: r=.85, p=0.0001; accidental: r=.82, p=0.0001; dreadful or fearful: r=.95, p=0.0001; not coped by the dreamer: r=.87, p=0.0001).

In this study, the traumatic and PTSD-related dreams were associated with unfamiliar, accidental, emotionally dreadful or fearful, not coped by the dreamer, and recurrent events.

The aim of the present study was to examine if patients’ expectancy after bariatric surgery was related to improvement of body appearance, health, physical fitness, or ability to work. Further, the relationship between psychiatric comorbid disorders and outcome expectancies after surgery was investigated.

The study population consisted of 94 patients (F/M:74/20) age 22 to 62 years (mean 41.1, SD=10.2), with BMI from 33.4 to 64.7 kg/m2 (mean 44.9 kg/m2, SD=5.5). Psychiatric assessment was done prior to bariatric surgery, and included structured psychiatric interviews (M.I.N.I. International Neuropsychiatric Interview and Structured Clinical Interview for DSM IV Axis II disorders). The patients were asked to identify their most important expectancies after surgery.

The overall prevalence of current psychiatric disorders was 47%, with Social Phobia (18%, n=17), Dysthymic Disorder (14%, n=13), and Avoidant Personality Disorder (17%, n=16) as the most common ones. Thirty-six percent (n=34) rated improvement of health, 34% (n=32) physical fitness, 22% (n=21) improvement of body appearance, and 7% (n=7) ability to work as their most important expectancy after surgery. Patients with psychiatric comorbidity rated significantly more frequent improvement in body appearance as their most preferred outcome than patients without psychiatric comorbidity (34%/ 12%, p= .01, chi-square test).

Patients with psychiatric disorders rated improvement in body appearance as their most preferred outcome after surgery more often than patients without psychiatric comorbidity. Future studies should examine whether patient expectations predict outcomes and satisfaction after surgery.

To analyze psychiatric symptoms in relation to a case of Hallervorden-Spatz disease (neurodegeneration with brain iron accumulation (NBIA) or pantothenate kinase-associated neurodegeneration - familial brain degeneration with iron deposition in brain).

Pubmed revision on behaviour alteration and its relation to brain iron accumulation. Review of patient medical records, including image studies.

A 52-year-old female with diagnosis of mental retardation and psychosis was treated and followed since 1999. Severe behaviour alteration motivated hospital admission in 2009. Over the last two years, the patient had developed progressive dementia, choreoathetosis, mutism, ideomotor apraxia, urinary and fecal incontinence, and corticospinal signs.

A brain MRI (2008) revealed iron deposits in basal ganglia, hypointensity with an area of central hyperintensity (“eye-of-the-tiger”-sign) in both globus pallidi on T2. Based on clinical and MRI findings a diagnosis of Hallervorden Spatz Disease was made.

Classic form of the disease is characterized by early onset and rapid progression, culminating in early death. Atypical disease, as in our case report, has a later onset and more slowly progressive course.

Systemic chelating agents have not proved beneficial. Treatment remains symptomatic. Our patient has experienced a favourable response to low-dose trazodone and quetiapine.

At times, behavioral changes may predate neurologic manifestations, whereas at other times disturbances in mental status and physical functioning may coexist. Among patients with NBIA, those with atypical disease are much more likely to have psychiatric symptoms with cognitive decline. These features present in our case report usually make a difficult and late diagnosis and treatment.

Jealousy and attachment share some characteristics: both can be interpreted as dynamics aimed at maintaining the subjects/partners together, appear to be triggered by the separation from the attachment figure/partner, involve the same basic emotions, such as fear, anger, sadness, and, finally, both they elicit a sense of safety when the other is close and responsive, or the opposite when he or she is distant. Some studies showed that differences in attachment styles seem to influence both the frequency and the patterns of jealousy expression. However, jealousy is a quite heterogeneous phenomenon, even within the normality domain, and it would be more valuable to ascertain the impact of attachment styles on specific jealousy features. The present study explored the possible relationships between romantic attachment and jealousy in 100 healthy subjects.

The romantic attachment and jealousy were evaluated by means of, respectively, the “Experiences in Close Relationships” questionnaire (ECR), and the “Questionario della Gelosia” (QUEGE).

The ECR anxiety scale was related to all QUEGE dimensions, while the ECR avoidance scale to the self-esteem, fear of loss and suspiciousness dimensions. Individuals with the preoccupied, fearful-avoidant or dismissing attachment styles showed higher scores than secure subjects at all QUEGE dimensions, while dismissing individuals had lower scores at all dimensions.

Taken together, these findings suggest that the two phenomena, attachment and jealousy, are intertwined.

Concern has been expressed about the number of medical students who are not choosing psychiatry as a career.

We describe the methods used by one teacher to teach medical students psychiatry in a medical school in England.

The teacher describes methods which he has found worthwhile in teaching psychiatry.

An important method is one to one working with a student and a patient during clinic. The student takes the patient's history and the teacher sits with him, intervening when necessary, thus making the environment ‘safe’.

Socratic questioning is frequently used in order to enable the student to think for himself.

Students are encouraged to take the opportunity of the attachment to carry out an audit or a piece of research or an in depth case report of their choice using literature searches or the database of patients and conditions held by the teacher's team. If successful, the student is helped by the teacher to publish the work in a pubmed journal or as a poster in a major conference.

Most important is debriefing students after seeing patients. Opportunity is taken to teach about Michael Balint's understanding of communication skills, and the value of the student's own personality in the doctor-patient relationship and the importance of this in aiding patients to recover from illness.

Experience is that these methods are appreciated by students. Students are likely to be influenced in their career choices by meeting doctors who can demonstrate that they value the student's own worth.

Medical education in the UK has undergone dramatic change in recent years with both content and methodology being reviewed, assessed and updated in an iterative revolution. The aim has been to provide graduates with an educational experience more relevant to clinical practice.

To present the reflections and experiences of some students learning through these new educational approaches.

The effects of these changes are felt keenly by students. Here, in comparison with the views of senior collogues, two medical students nearing the end of their training reflect upon their own experiences.

They present a brief explaination of the structure of medical and psychiatric training in the UK followed by an exploration of one individual medical school's course.

The course structure will be detailed with reference to the guidance document “Tommorrow's Doctors” and to the school's own literature.

Medical students were consulted and an amalgamated “week in the life” based on their experiences produced.

The integration of psychiatric education throughout preclinical and clinical courses, coupled with individual attention and encouragement in gaining useful transferable skills, were seen as most useful.

Reforms have been successful and show that the delivery of both a basis in psychiatry and additional transferable skills (such as audit, research and publication) is best achieved by individual mentorship from an experienced clinican.

A continued reflection on how current practices may be modified to improve student experience is essential, but should also seek ways (such as more indivdualised attention) to improve recruitment and retention.

UPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.

Description of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.

Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.

Retrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.

47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.

19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.

Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.

10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.

Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.

Psychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.

Patients with psychotic or mood disorders often undergo electroconvulsive therapy (ECT) while receiving antipsychotic and/or other pharmacological agents. Paliperidone (PLP) -a benzisoxazole derivative and the principal active metabolite of risperidone- is a second-generation antipsychotic which has been developed in an osmotic controlled-release oral-delivery system. Thus the peak-through fluctuations of its concentration in plasma are minimized, with consequently decreased incidence of side-effects. To the best of our knowledge, there are, as yet, no reports on the safety of ECT-PLP co-administration.

Nine female inpatients suffering from affective disorders (N=7) or schizophrenia (N=2) underwent ECT while receiving PLP (3-12 mg/d). Patients’ regimen included other psychotropic medications as well (mainly antidepressants and/or antipsychotics). All patients were monitored closely for recovery time, post-ictal delirium, cardiological and EEG status for at least one hour after each ECT session. In addition to their clinical evaluation, patients’ cognitive -especially memory- functioning was regularly assessed by the Mini Mental State Examination. Overall, patients underwent 83 sessions of bilateral ECT.

ECT-PLP combination was well tolerated and even in cases where cognitive side-effects were of moderate severity (three cases; all were also receiving venlafaxine), they were transient.

Although anecdotal and thus in need of replication in well-designed large studies, our preliminary findings suggest that ECT and PLP can be safely combined whenever both indicated.

A questionnaire, which was sent to the 33 German University Hospitals, was evaluated. Furthermore, we have evaluated the demographic data and diagnosis of the patients that presented themself at the Specialists Service for adults with Autisms spectrum disorders at the RWTH Aachen University “Aachen Autism Clinic for Adults” (AACA) within the first 18 months after it has been established.

At the time of the evaluation, only 9 University Hospitals offered a Specialists clinic for diagnostics and/or treatment for adults with ASD in Germany. A total number of 73 patients were seen at the Aachen Autism Clinic within the first 18 month after establishing this service.

There is still great need of Specialists services at University Hospitals in Germany for adults with ASD.

Evidence is accumulating that mitochondrial dysfunction is involved in the pathophysiology of some psychiatric disorders such as Bipolar Disorder and Schizophrenia. In addition, among their other symptoms, people diagnosed with mitochondrial disease have high rates of psychiatric disorders. Leigh syndrome is a heterogeneous disorder, usually due to a defect in oxidative metabolism. The symptoms begin in the childhood by neurological troubles. Few reports mention psychiatric disorders. The objective of this work is to study relations between mitochondrial dysfunction and psychiatric disorders through a case of Leigh Syndrome.

It was a 20 year-old male patient, who had taken L-Dopa to treat severe extrapyramidal symptoms caused by Leigh syndrome. He developed, four months ago, acute psychotic symptoms such us audio-visual hallucinations, persecution and mystic delirium. The cerebral MRI had shown signal abnormalities in Basal Ganglia. This aspect was similar to those observed in the MRI having been practiced five years ago. The EEG recording was normal.The CSF and blood lactate levels were normal. The hypothesis that drug (L-Dopa) caused psychiatric disorders was possible. But, the digression of medicine was impossible due to the severity of extrapyramidal symptoms. The evolution under atypical antipsychotic was only partial.

In this case, the CSF lactate levels mean that mitochondrial dysfunction is not an overall explanation for these psychiatric disorders but may at least play a partial role. Psychiatric disorders may be induced by drugs or may just be a simple comorbidity.