Although ECT is used as a modality of treatment for psychiatric patients in Singapore, there is little research documenting its use and practice.

To examine the practice of ECT in a general hospital over a one year period.

All patients who had ECT were identified retrospectively from our hospital records. The demographics and diagnoses of the patients, indications for ECT, numbers of ECT received and complications from ECT were obtained, recorded and analysed.

23 inpatients were identified retrospectively from our hospital records. The majority of the patient were above 51 years old and 96% had major depression. 51% were not responding to medication, 23 % were suicidal and 3% had catatonia. The average number of ECT given is 5.4. 82% of patients had definite improvement after ECT. The common reported side effects were headaches, bodyaches and minor memory problems. 2% were moderately confused after the ECT.

ECT is a safe, well-tolerated and effective form of treatment for major depression.

Mental Health related stereotypes are very common in literature and cinema, with a great influence on public opinion and attitudes. In many cases, a message is transmitted that reinforces prejudice towards mental diseases and people who suffer them. Prejudice often affects mental health professionals, particularly psychiatrists, thus adding to a slanted, pejorative image of those professionals. Stieg Larsson's Millennium trilogy, and its main protagonists, Lisbeth Salander and Mikael Blomkist, have got an enormous popularity, becoming a literary hit almost without precedents. The saga's success has also been fueled by cinematographic superproductions based on the novels. To examine whether Millennium trilogy transmits negative messages about psychiatry and psychiatrists that can potentially influence public opinion and contribute to misconceptions and stigmatization of those mental health professionals.

Millenium characters related to mental health are analyzed, as well as the stereotypes transmitted by the novels, especially in the case of psychiatrists, represented by ominous Dr Teleborian.

The potential of this successful trilogy for spreading negative misconceptions about Psychiatry and psychiatrists is discussed, as compared with the much more benevolent treatment of other general health and mental health professionals appearing in the novels.

Literature and cinema have a strong impact on public opinion, can potentially have the effect of increasing stigma and may also contribute to creating a distorted image of mental illness, psychiatry and psychiatrists.

The European Foundation for Quality Management (EFQM) Excellence Model is a non-prescriptive framework based on nine criteria. The aim of this work is to describe the implementation of the EFQM model as a quality framework for the improvement of an inpatient medium-stay psychiatric unit.

In 2005 a multidisciplinary performance improvement work group was convened to begin a project with these aims:

1. - The definition of the unit's mission.

2. - The identification of the unit's main processes.

3. - The identification of performance and quality results.

4. - The establishment of an audit period of clinical outcomes.

5. - The creation of a protocol for admissions.

Between 2005 and 2008 the group designed the following:

1. - A map showing the medium-stay unit process as well as the main processes.

2. - The key performance indicators.

3. - An ECT protocol.

4. - The Quality Indicators.

5. - A patient satisfaction survey.

Every year we decide the objectives of each indicator and revise them every month. Efficiency in the use of resources improved, due to an increase in annual admissions (from 190 in 2005 to 213 in 2009) as well as a decrease in length of hospital stays (from 62 days in 2005 to 48 days in 2009).

The management through processes according to the EFQM model is an instrument for the improvement of the quality of assistance. This type of management allows for the definition of the unit's mission, the measure and analysis of results and for the establishment of areas of improvement.

Primary polydipsia is a clinical disorder characterized by excessive fluid intake (polydipsia) and consequent excessive fluid excretion (polyuria). The underlying pathophysiology of Primary polydipsia is still unclear. We present a case of a 26 year-old man without any previous psychiatric or neurological history who was thoroughly investigated for severe symptoms of polydipsia and polyuria. The only finding consisted of a probable micro-adenoma on the left side of the sella turcica.

The patient was thoroughly assessed by psychiatrists and psychologists through clinical and diagnostic interviews and was administered a wide range of psychometric tools including MMPI-2, SCID, YBOCS, BDI, HAM-17 and SCL-90. Moreover, he underwent a comprehensive physical and neurological examination, blood tests, renal function tests, endocrinological assessment including hormone assays, water deprivation test and desmopressin trial and brain Magnetic Resonance Imaging (MRI).

No major psychiatric disorder was detected apart from the presence of mild depressive symptoms. A brain MRI revealed a 4-5 mm diameter lesion on the left side of the sella turcica with lower contrast enhancement than the rest of the gland, which was suggestive of pituitary micro-adenoma.

We considered the patient's depressive symptomatology as secondary to his condition. There is no other report of pituitary microadenoma in patients with symptoms of polydipsia and polyuria. We hypothesize that the location of the lesion may be related to the hypothalamic centre of thirst.

1. 1. Inform European colleagues about current transformational changes in the organisation and delivery of care services in England to a vulnerable group of individuals with both intellectual impairment and multiple complex needs.

2. 2. Compare and contrast English strategic direction /policy with European Union commitments

3. 3. Stimulate debate on how such trends compare with the experiences of colleagues across Europe.

Examination of key English policy drivers including:

1. 1. Valuing People Now (Intellectual Impairment).

2. 2. New Horizons (Mental Health).

3. 3. Putting People first (Social Care)

Review of the implications of:

1. 1. Demographic factors

2. 2. Economic considerations

3. 3. Diagnostic uncertainty

4. 4. Scandals as catalysts

5. 5. Personalisation

6. 6. People being cared for away from their home areas

1. 1. Cost, access and quality considerations are the priority areas under review.

2. 2. Though care systems vary enormously across Europe, public expenditure as a share of Gross Domestic Product is unlikely to increase in the short to medium term and this irrefutable fact will challenge strategic intentions and citizens’ expectations, especially in England.

3. 3. Both English and European Union strategic directions/policy contexts could be cynically viewed as being strong on principle and weak on implementation.

4. 4. There is a profusion and confusion of existing terminology.

5. 5. For individuals with intellectual impairment and complex needs and for their carers and families, what they all want is more choice, control and flexibility.

6. 6. Affected individuals in England appear more satisfied with the strategic direction than are their carers and families.

Internet addiction disorder is excessive computer use that interferes with daily life. There is debate over whether or not to include it as a diagnosis in the next DSM edition.

We present a case of a 24-year-old woman who although not meeting criteria for addiction was referred to our clinic due to excessive use of social networks which severely interfered her daily life.

A woman presented to our clinic accompanied by her parents because she had been spending approximately 5 hours/day checking her facebook webpage. She had subscribed to facebook 8 months before her examination and already had over 400 webfriends. During the previous 7 months, she ceased several of her activities, remained home most of the day in order to check her facebook and lost her job as a waitress because she repeatedly left her post in order to go to the nearest internet café. Noteworthy, during her examination she took out her mobile phone and tried to establish an internet connection and check facebook. On clinical examination mild anxiety, sleep disturbances were present, but she refused any further psychotherapeutic or pharmacotherapeutic help.

According to the prevailing view regarding addiction, facebook addiction can be considered as an “urge-driven disorder” with a strong compulsive component. Although our patient had been using internet for the past 7 years she had never been previously addicted to internet use. We suggest that facebook addiction may be another subcategory of the internet spectrum addiction disorders.

India, with its rich and distinct socio-cultural heritage, bestow diverse impact over individual symptom complexes, coloring the picture and causing wide variation in presentation and prognosis of psychiatric illnesses. With the widespread use of atheoretical categorical diagnostic systems such as DSM-IV, ICD-10, etc. and success of psychopharmacological treatment approach, psychiatrists in developing and underdeveloped countries have tended to overlook the role of psycho-social and cultural factors and their interplay with neurobiological factors in governing illness patterns, and are reluctant initiators of non-pharmacological treatment measures.

The study aims to descriptively analyze and compare the use of pharmacological to non-pharmacological intervention initiation in outpatients in a general hospital setting.

The study sample will comprise of consecutive patients referred to psychiatry outpatient department from February to July 2009. The socio-demographic and clinical profile will be analyzed using a semi-structured proforma and diagnosis will be made as per ICD-10-DCR. An analysis of pharmacological and non-pharmacological intervention initiation will be made and compared. Descriptive statistical analysis for continuous and categorical variables will be done as needed.

The study is currently been undertaken and the results and conclusion will be presented at the conference.

To evaluate whether a variable number tandem repeat (VNTR) in the human PER3 gene is linked with sleep or circadian phenotypes.

Seventy three people (age: 23-71; 41 males and 32 females) volunteered for this study. They completed a questionnaire containing the Romanian translations of the Composite Scale of Morningness, the Sleep Disorders Questionnaire, the Pittsburgh Sleep Quality Index, the Pittsburgh Insomnia Rating Scale, the Epworth Sleepiness Scale, the Multidimensional Fatigue Inventory, the Alcohol Use Disorders Identification Test and the Beck Depression Inventory II. Genotyping was performed on genomic DNA in blood.

Sixteen subjects had the shorter allele (PER3 4/4), thirty one the longer one (PER3 5/5), while the rest were heterozygote (PER3 4/5). We found no statistically significant differences between the genotypes on any of the scales used.

In this small population, PER3 genotype predicted none of the investigated variables.

Health is not only the absence of disorders also it needs a good feeling of well-being: Quality of life. The relation between QOL and the psychobiology, genetics, development and evolution of thoughts, emotions and temperaments should not be ignored. In this study we investigated how affective temperaments effect quality of life (QOL) in ‘healthy’people.

72 healthy subjects (33 women, 39 men) with no physical and psychiatric diagnosis assessed with SCID-I are included to the study. The subjects were examined using TEMPS-A for affective temperaments and WHO-QOL Brief for QOL.

Depressive temperament (DT) scores was negatively correlated with psychological and environmental domains of quality of life (p< 0.05) and anxious temperament (AT) was negatively correlated with physical, psychological and environmental domains of QOL (p< 0.05). Marital status was associated with QOL as singles had higher QOL in physical, psychological and environmental domains (p< 0.05). In linear regression analysis with AT and DT and marital status as independent variables; AT scores predicted low QOL in Physical Health and marital status predicted Environmental Health.

DT had significant correlations with psychological and environmental domains of QOL and higher AT scores predicted lower QOL scores in Physical Health so this study suggests that healthy subjects may have lower QOL only due to higher scores in anxious temperament. A clear understanding of the association between Affective Temperaments and QOL may support a step to provide a better well-being in healthy people.

Future research & treatment, as aspired by a psychiatrist from a devoloping country should address not only the Biological or pharmacoligal way cure only, where ultimately drug maintanance remains an obligatory factor for long time. It should blend Psych-analyssis in a modern way & other therapies, those were shown in past by the legendary European Psychiatrist, spcialy from German, France & Ausria etc. in a way toobtain a change in the person.

Mission should bekept also to amalgamate the spiritual depth, Indian & other Asian Philoshoper's view on mind distress & their way to conquire the mind through Meditation. Attachment was viewed by Budha or other Hindu philoshopers as cause of misery & thier advocation of dispassion/meditation practice should be viewed in modern light.

Ultimately lowering the sufferings of the mentally ill in efficient &in best economic way without not adding adverse effects will be there.

Problems those are to be addressed with special emphyasis are Adolescent & child mental & bevavioral disorder, the giganticaly fast growing mental illnesse of geriatric population, those of Womens Mental health problems like, post-parum, intrapartum & menopausal phase & prementrual Dysphoria. Sresses in working class women, alone women or desertet women's mental health issue needs new research.

A suitable less harmful mood disorder in early stage of pregnancy, in lactating period, or a suitable regimen in ac.depressivephase of BPMD with suicidal-urges, or in mixed & non classified stages of BPMD sould be elaborated.

Apart from Litium & Clozapin other drugs is to be hunt with proven anti-suicidal properety.

Excellents is scope.

A less arena of discussion & evalution in the patients overall recovery in mentalstates seldom adrress the libidonal status or it's change or loss in the course of treatment.

Many mental disorderly patients present the important symptom in the change of their libidonal status, as an increase in BPMD mania or hopomaniac state or diminished or lost in Depression, in Schizophrenia, in alcohol abuse or in substance abuse or even in dementia or on ongoing treatment of it is further alttered by the use of several drugs. In the evalutation of the patient's mental status folow up this part of the history is not enquired unless reported by the patient or spouse discloses.

AIIMS: Here is a small study where only 120 patients were evaluated for their libidonal present status or a change i& the same was analysed.

60 male & 60 female in the age group of 20-40 those were register for OPD treatment in Calcutta Pavlov Hospital, during Jan09-March09 was given a simple 3point quisenaiere to asses their libidonal state or it's change.

It was astonised to find mainly a diminution in their sexual abilities in >60% inmale &>than 30% in female patients irrespective of their diagnosis.

Drug treatment mostly important were Ttihexyphenidyl in concurrent use with Haloperdol Or Respiredone, Reperidone itself,other drugs like proponolal or TCA antidepressant and the most SSRIs.Our observation are mainly clinical based due to lack of sophistacated labarotary infrasrtuctre.

Libidonal changea/ssesement would remain as a new arena of research in future.

This study emphasised the nurses’ assistance practices and conceptions in order to understand how they perceive and live with all the complexity that underlies this phenomenon.

With the articulation of qualitative methods (interview) and quantitative (structured questionnaire), the study focused on a group of 78 nurses aged between 22 and 60 years (average: 40.15) being 61% women and experience either in the hospital or in primary health care.

We found that violence against women was perceived as a complex phenomenon and present, with strong socio-cultural, marked by abuse of power and disregard for human rights. We note also that nurses generally experience negative feelings associated with the aggressor, but also the victim. On his practice emphasizes the desire to help and, paradoxically, a strong sense of powerlessness. The lack of competence / training to effectively tackle the problem is also a reference, supplemented with special needs to progress in this area.

The evidence presented here should be taken into consideration by health professionals in a reorientation of care model in this area.

The Diabetes Mellitus is a chronic disease whose treatment requires strict clinical care and continuing education such as medication, nutrition and physical activity. Education is a decisive factor in preventing complications that may arise from the failure of therapy. Therefore, the therapeutic adherence must include a psycho-social approach.

To study the degree of adherence to the pharmacologic treatment and dietary habits in patients with type I and type II diabetes mellitus and to evaluate the influence of the level of education, sex and type of diabetes.

A cross-sectional study was conducted of the descriptive-correlational type. The sample consisted of 100 diabetic type I and type II individuals and was obtained by convenience at the health center of S. Martinho do Bispo, in Coimbra - Portugal, during the period from May till June 2009.

The results indicate a high adherence to therapy, reflected trhough the diet and also the pharmacological treatment. However, the higher adherence found was related to prescription of medication. The demographic variables such as sex and level of education of patients, seem to positively influence the adherence to treatment.

Despite the clinical guidelines regarding the use of combined antipsychotics and the limited evidence for its benefits, the use remains high in psychiatric practice.

To measure the prevalence and examine the reasons for initiating and continuing combined antipsychotics in psychiatric illnesses.

A cross-sectional study was carried out using medical records in a psychiatric community rehabilitation service. A representative sample (n= 75) of patients with chronic and enduring psychiatric illnesses was studied. The age, gender, diagnosis and prescribed antipsychotics were examined. The prevalence and documented reasons for combined antipsychotic prescribing were analysed.

Seventy-three of the seventy-five patients were prescribed antipsychotic mediations. Of these, 44 (60%) received a combination of 2 or more antipsychotics. The most common reason for combined prescribing was a switch of antipsychotic (n=18; 41%). No reason was documented in 19 cases (43%).

In-complete switching of antipsychotics contributed to a high prevalence of combined antipsychotic use, and lack of adequate documentation on reasons for the combination was common.

Primary caregivers are more likely to have a higher risk of depression and a lower quality of life (QOL). Multiple sclerosis (MS) can adversely affect the psychological and physical function of patients as also of their caregivers. Our aim was to assess the perceived psychological burden and QOL in a sample of primary caregivers of patients with MS under natalizumab treatment.

20 males and 10 females primary caregivers (mean age 50.6±12.9 years) of an equal number of patients with MS completed the Greek validated version of the Hospital Anxiety and Depression Scale (HADS) and the EuroQOL (EQ-5D), an instrument measuring health outcome and QOL.

Our sample experienced higher degree of anxiety than depression. The mean score on the 7-item HADS-A subscale (range 0-21) was 10±3.8 and the mean score on the 7-item HADS-D subscale (range 0-21) was 7.8±3.4. Twenty-one caregivers were diagnosed as manifesting anxiety (7 mild/14 moderate anxiety), whereas 13 of them also had depression (5 mild/8 moderate depression). The increased psychological distress was supported further by the responses on the anxiety/depression dimension of health of the EQ-5D. Sixteen persons reported moderate and 5 extreme degree of anxiety/depression. Mean EQ-VAS scores were 60.2±14.5 (range 40-100). Ten caregivers rated their health status with a score of 50 or lower.

Our study revealed that caregivers of patients with MS are psychologically burdened in a significant degree, a fact that obviously deteriorates their QOL. Appropriate psychopharmacological interventions are warranted to reduce caregivers’ burden.

The impact of Idiopathic Parkinson Disease (IPD) in patient’s sexual health is still a matter of debate. Clinicians should have a concern about the sexual function of their patients with IPD.

To evaluate sexual health of patients with IPD.

We randomly select a group of IPD patients and a group of healthy controls. We used the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) to assess sexual function. To evaluate depression and anxiety we used Brief Symptom Inventory (BSI) and Beck Depression Index (BDI).

We had 83 IPD patients, and 69 controls. Male patients had lower total IIEF scores than controls (p< 0,001). The analysis of linear regression shows a relationship between the IIFE and the duration of the disease, the patient age and the BDI score (R=0,72; Adjusted R square=0,49, p< 0,001) when adjusted to the variables: realization of deep brain cirurgy of subthalamic nucleus (DBS-STN) stage of the disease, BSI score, dopaminergic treatment, treatment with antidepressives and antipsychotics. The IFSF didn’t show differences between the cases and the controls. Patients had higher BSI and BDI scores than controls (p< 0,001).

Male IPD patients had an impairment of sexual function predicted by disease duration, patient age and BDI scores. Sexual function should be assessed in these patients

The aim of this work was:

• • to understand and measure the emotional effects of chemotherapy-induced alopecia by exploring self-esteem, body image, anxiety and depression in cancer patients

• • to analyse the strategies used to cope with hair loss.

This was a cross-sectional study. It involved the use of a questionnaire with patients from the medical oncology unit of the Habib Bourguiba University Hospital. The questionnaire included Socio-demographic data, type and stage of cancer, data concerning the alopecia (partial or total) and its impact on social life, work, and sexuality.

Four measurement scales were used:

1. - Rosenberg's Self-Esteem scale,

2. - Bruchon-Schweitzer's Body image questionnaire (QIC)

3. - Hospital Anxiety and Depression scale (HAD)

4. - Brief cope

Preliminary study

It was a population of 24 patients. 55.2% were males. The mean age was 45.9 years. 75.9% were married.

Alopecia was the most distressing side effect of chemotherapy in 30.4% of cases. 45.8% were suffering from the stigma of the alopecia which disturbed their social interaction. It led to a loss in self-confidence in half of patients and altered sexuality in third. Self-esteem was low in 34.5%.

The average score of the scale body image was 61. 41.4% of patients were anxious and only 27.6% were depressed.

The religion was the major strategy used to cope with alopecia.

The findings suggest that the chemotherapy-induced alopecia has the potential to affect various aspects of patient's life, but Tunisian cancer patients seems to be less affected compared with literature.