The study of the correlation between the insight of the patients attended by a Regional Mobile Psychiatric Unit, and various clinical and sociodemographic variables. The evaluation of the insight included the compliance of the patient to the treatment, his awareness regarding his illness as well as to the therapist notion concerning the way the patient was coming in terms with his disease.

45 psychotic patients aged 17-67 were studied. Spearman rank correlation, x2 statistical test and stepwise multiple regression analysis were used in order to determine the relation between the variables at the beginning as well as at the end of the 5-year study.

• • The subjects who had no insight of their disease prior to research were not prescribed. During the intervention, the patients’ insight as well as their compliance to the prescription was improved. However, this correlation did not remain significant at the end of the study.

• • The diagnosis of the patients as well as the family history of a mental disease was related to the degree of their insight before the intervention.

• • The more socialized a patient was before the intervention, the more insightful he was not only before, but also after the intervention.

• • The more motivated a patient was regarding his leisures on his free time after the intervention the more insightful he was before the intervention.

• • The patients’ insight was positively correlated to the duration and the number of the previous admissions prior and after the intervention respectively.

Evaluation of QOL, stress and coping strategies of people with psychiatric disorders after a one-year training course for social and occupational reintegration.

The main elements of the study focused on the SVF 120 (Stress Processing Questionnaire) and PLC (Quality of Life with Chronic Disease questionnaire).

In total a number of 20 people were enrolled in the study. Mean age of the participants was 33.4 years. The reintegration programme showed a retention rate of 100%. The PLC questionnaire showed no statistically significant results (p>0.050). The SVF 120 showed a slightly better score after one year regarding social encapsulating (p= 0.056) and trivializing (p = 0.021). After the one-year training course 60% of the participants could be reintegrated in an occupational activity and 40% could achieve a better social status.

Our results showed that participant of the programme used stress coping strategies morte than before the course. Reintegration data make clear that training courses of people with psychiatric disorders can achieve valuable results.

Evaluating the effectiveness of training courses for basic qualification for occupational re-entry, empowerment and self-determination.

Participants with psychiatric disorders attended a one-year course on basic qualifications and empowerment for occupational re-entry. The main elements of the course were empowerment topics and training of self-determination. On behalf of the psychiatric disorders data sets were collected in a narrative manner.

A total of 28 people were enrolled in the study. 57.2% of the participants were male and 42.8% female. Male mean age was 34.2a and female 33.3a (p>0.050). Among other psychiatric disorders 45.5% of the participants showed problems with alcohol. Before the programme 100% of the participants were jobless. The retention rate after one year was 9.1%. 27.3% could be placed in kind of a occupational training. The same rate of participants could get into a job after the one-year course. Participants judged self-determination significant higher after the one-year course. Training costs amounted to 4.867Euro/Person/year.

A high percentage of the study participants could be re-integrated into the working market. Basic qualification and empowerment programmes could be an effective tool for people with mental disorders regarding social and occupational issues.

The objective of our study is to determine the relationship between cyber addiction and temperament in a population of young students.

Our population was composed of 60 students belonging to 2 different colleges.

For data collection, we used:

1. - A data sheet containing demographic data, reasons for Internet connection …

2. - The test of Dr. Young to detect users suffering from an addiction to the Internet.

3. - The TEMPS-A: to assess the affective temperaments.

Our sample was formed by 60 students’ devised into 2 groups:

1. - 30 Students were cyber addicts.

2. - 30 Students witnesses.

The mean age was 22.6 years, with extremes ranging from 19 to 30 years.

The reasons for connection to the Internet were in:

1. - 43.3% to deepen knowledge.

2. - 28.3% as a hobby.

3. - 16.7% to expand the circle of friendship.

Cyber addict's students had a cyclothymic temperament in 50% cases, 26% were hyper mood, 13% were anxious and 11% had a depressive temperament.

In our sample, cyber addiction was significantly correlated with cyclothymic temperament (p = 0.024).

Accordingly, patients suffering from Internet addiction should be given a specific addiction treatment and monitoring taking into account the temperament.

This paper reports and reflects upon 50 years’ evolution of social psychiatry in the UK context, including internal debates, and parallel policy and service developments in the “outside”, nonhealth world. It reviews the history and development of the therapeutic community approach since the immediate post-war era, summarises the current position in emerging UK policy, and looks to the future with new conceptual tools to describe current initiatives in public mental health and community-oriented mental health.

A review and analysis of historical, research and “grey” literature (ie: especially government policy pronouncements), including discussions with clinicians and policy makers over future trends.

Two new conceptual frameworks are emerging - the “Psychologically Informed Planned Environment” and the “Enabling Environment” - which between them both embody and encourage current new thinking on the health and well-being contexts of community cohesion, and the introduction of enlightened management for enhanced well-being in hospitals, prisons, schools and workplaces, housing projects and places of faith.

From the remnants of the post-war therapeutic community movement, a new terminology is emerging to address the demands of community psychiatry for the 21st Century. Recognising the social determinants of health and the challenge to health inequalities, and the health and well-being contexts of social capital and community cohesion, this framework raises quasi-philosophical questions over shared values, and highlights the necessity to work with reflective practice and collective accountability for an inter-dependent world.

Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in psychiatric institutions. Research constitutes a part of international project funded by European Commission.

Polish language version of QuIRC has been tested in 20 psychiatric units across 3 districts in Poland. Selected facilities differed in employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.

Manager of only 1 out of 21 units refused to participate in interview. QuIRC usage was simple but time-consuming. The most common hardships in data collection referred to numbers of staff and trainings the employees participated in. It might be due to round-the-clock care in Polish units and common work in the shift system. Moreover ward managers in Poland in vast majority of the units were medical doctors and the facilities’ economics was often obscure for them. Development of web version of the toolkit will facilitate its implementation in research projects but as well internal assessments for units’ own purposes.

The Delphi exercies carried out in Poland constituted part of DEMoB.inc project founded by EC and conducted within 10 European countries. Polish part of Delphi exercise fulfils major method's assumptions and aims to define items of long-term psychiatric care in recovery model of treatment.

Delphi method has not been widely applied in research across Poland. Method is characterized by defined panel of experts (EP), information flow, regular feedback and participants’ anonymity. Delphi has proven prognostic potential in health care, social sciences, new technologies and policy forecasting. However informality of EP selection and limited complex forecasts with multiple factors and downward responses-rate tendencies in following rounds constitute its crucial shortcomings. Criticized basic statistics has been lately overcome by implementation of sophisticated fuzzy logic theory. Three stages Delphi exercise has been carried out in four groups of respondents: service users, carers, advocates and professionals. Wide range of EP representatives has promoted indication of diverse elements of care within partner sites.

Polish mental health care network varies from developed European countries. Out of 11 initially appointed domains only 2 (SPHRandA; SMA) have been underrepresented. Advocates achieved significant consensus in the largest number of items: 23 out of 104 which covered 9 domains whereas professionals in the lowest number: 11 out of 130 which covered only 4 domains. Moreover domains supported with advocates’ opinions fully overlapped with domains pointed by service users. The surprising outcome might be due to diversity of professions in “professional group”, differences in occupational responsibilities and work experience.

Folie á deux is a rare mental syndrome, firstly described by Falret in France on 1997, and renamed in the DSM-IV as shared psychotic disorder, and in the ICD-10 as induced delusional disorder; in which a paranoid or delusional belief is shared by two people with a very close relationship, and usually belonging to the same family. Social withdrawal is a common characteristic of both persons during the initial stage of the disorder.

A 16 years-old adolescent boy, born in Russia, and having this syndrome is presented in this study. After his arrival to Spain, he lived with his father with important social isolation for six months, and he begun to report delusional ideas with mystical-religious and ufological content. His father was diagnosed as having a delusional disorder with the same contents. Both patients received behavioural-cognitive therapy (CBT) with the aim of modifying their delusional beliefs, even that they went on living together. No antipsychotic medication was needed.

Clear changes were observed in their delusional system, particularly in the degree of conviction, as well as in distress, thought interference, and anxiety, and also an improvement was observed in the understanding of their beliefs, and in their social relationship with peers.

Social withdrawal as well as cultural differences associated to their immigrant condition played a critical role in the establishment of the induced delusional disorder, and CBT modified the delusional system, even father and son continued living together.

Health problems are often associated with activity limitations and participation restrictions (ICF, WHO, 2001). An example are problems at work or sick leave. The research question has been whether in these cases activity limitations and participation restrictions refer only to the workplace, or whether and to which degree other areas of life are similarly affected.

Type and degree of participation restrictions in different domains of life were assessed in 382 primary health care patients (aged 18-65) with the IMET, a questionnaire which measures participation restrictions across several domains of life. Additionally, the patients were interviewed about health-related problems at work. IMET scores were compared between patients with and without health related problems at work.

27% of 299 presently employed patients were suffering from workplace problems. These patients had significantly longer durations of sick leave than patients without problems at work and also reported significantly more problems in functioning in general daily activities.

Workplace problems are a frequent topic in primary health care and related to sick leave. Health related problems at work are indicative for problems in functioning in other areas of life as well. Participation restrictions in non-work areas can be early indicators for participation problems at work.

In this workshop, Dr. Nakajima will discuss position statements that the American Psychiatric Association (APA) has taken concerning gay and lesbian issues and mental health.

A review of position statements by the American Psychiatric Association and European psychiatric organizations about gay and lesbian mental health issues.

The APA was the first psychiatric organization to delete homosexuality as a mental illness from its nosology, DSM-II back in 1973. When homosexuality was deleted the APA also passed a resolution affirming the civil rights of gay men and lesbians. These position statements in 1973 were the first of a long number of positions statements that the APA has taken concerning mental health issues for gay men and lesbians. In 1987 the APA voted against keeping egodystonic homosexuality in DSM-III R and currently there is no diagnoses related to homosexuality in DSM-IV. The APA has also taken position statement concerning adoption and co-parenting of same-sex couples as well as discrimination of gay and lesbians in the US military. In the past few years the APA has developed position statements against therapies to change sexual orientation, which is sometimes referred to as “conversion or reparative therapy,” and in support of same sex marriage. Some European psychiatric associations including Norway's and the United Kingdom's have followed the APA in passing position statements against conversion therapies.

We will discuss the importance of Psychiatric Organizations to make formal position statements to advance the mental well being of lesbians and gay men.

An important target of the antipsychotic treatment in schizophrenia is the regaining of the social functionality, correlated with the decrease of the positive and negative symptoms, the improvement of cognitive competence and social cognition.

We have done research on a lot consisting in 20 male patients, aging between 25-30 years, with paranoid schizophrenia diagnosis according to DSM IV and a maximum 3 years period of evolution of disease from the first psychotic episode. The lot we are studying consists of two subdivisions: 10 patients treated with Flupentixol depot in the last 12 months (20mg/14 days) and 10 patients treated with Risperidone long-action (37.5mg/14 days). Admission scores were PANSS ≤45 and >4 on CGI. 12 months later the patients were evaluated using the same scales and the Social Cognition and Object Relations Scale for the level of social cognition, the scores being correlated with others social risk factors.

The patients treated with Flupentixol depot presented a lower level of amelioration of positive symptoms and a dysfunction of the social cognition, while the patients treated with Risperidone longaction have shown the amelioration of the positive and negative simpthomatology and improvement of the social cognition.

The long action antisychotics present an increased adherence at the treatment, being by far a better treatment option then the standard medication. Risperidone long-action has a better action against positive and negative sympthoms and improves the social cognition in a significant way, compaired to the first generation antipsychotics.

The stigma of mental illness is a complicating feature of psychiatric treatment, especially in schizophrenia. A detrimental consequence is internalized stigma-the inner subjective experience of stigma resulting from applying negative stereotypes and stigmatizing attitudes to oneself. The empowerment and recovery oriented program of the day clinic might contribute to a reduction in internalized stigma. Until now the influence of day clinic treatment on internalized stigma has not been studied.

Data from two groups of patients had been collected at baseline and after five weeks. The experimental group attended the day clinic treatment (TKL-group, 20 patients), the control group waited for the day clinic treatment (KO-group, 20 patients). At both times the Internalized Stigma Of Mental Illness scale, the CES-Depression Scale, the WHOQOL-BREF questionnaire capturing the subjective quality of life and the Positive and Negative Syndrome Scale were applied. Furthermore, sociodemographic and clinical data were collected.

Changes during the five weeks within the TKL-group showed a significant reduction of internalized stigma and psychopathology and a significant improvement in quality of life. Within the KO-group it was only a significant reduction of depression. Significant differences between the two groups concerned changes in the quality of life and psychopathology with a clear advantage for the TKL-group. However, with regard to changes in internalized stigma, no significant differences between the TKL- and the KO-group could be observed.

Exploring a sample size of two groups each of 110 patients appears to be a feasible and valuable research plan with regard to internalized stigma.

The ‘MORES’ (MOdena RESidenze) project was a naturalistic study designed to assess clinical outcomes and to investigate psychosocial needs in two groups of patients currently admitted in two residential facilities characterized by different intensity of care (“low protection” vs. “high protection”).

32 patients (62%) in a Sheltered Housing (SH, low protection) and 20 patients (38%) in a Psychiatric Residence (PR, high protection) were assessed by means of a multi-dimensional and multiaxial system. Socio-demographic and clinical data were collected from patient charts. Clinicianadministered instruments (BPRS, GAF, CAN) and self-rating scales (LQL, VSSS, Empowerment Scale) were administered to all 52 patients. Chi-squared test and Mann-Whitney U-test were used to compare the two groups.

The most frequent diagnosis was Schizophrenia (n=41; 79%). No differences were found in socio-demographic and clinical characteristics between the two groups, as well as in psychometric scores. Scores at the BPRS, GAF, CAN and Empowerment scales revealed in both groups a medium-low degree of psychiatric symptomatology, low global functioning, high level of care needs (many of them satisfied, 73%) and a low level of empowerment, respectively. Self-perceived quality of life was poor (LQL: SH=4,57±0,31; PR=4,4±0,33), specifically related to the housing situation and VSSS (SH=3,81±0,85; PR=3,52±0,82) suggested poor satisfaction with mental health services.

Though no difference were found between the two groups, patients’ needs emerged clearly, suggesting need for further investigation to tailor more specific rehabilitation programs.

Stigma is a major stressor for many individuals with mental illness. Recent stigma models highlight the role of cognitive stress appraisal, emotional and cognitive coping responses, and their impact on outcomes such as self-esteem and social interactions. We tested this model, applying it to mental illness stigma.

In 85 people with mental illness, stigma stress appraisal and stress predictors (level of perceived stigma, rejection sensitivity, ingroup perception) as well as emotional reactions (anxiety, shame) and cognitive coping responses to stigma-related stress were assessed. In addition to selfdirected outcome (self-esteem, hopelessness), social performance in contact with outgroup members (i.e. members of the general public) was assessed by role-play and seating distance measures.

Higher levels of perceived stigma, rejection sensitivity and holding one's ingroup in low regard predicted high stigma stress which in turn was associated with anxiety and shame, but not with cognitive coping responses. Anxiety and shame predicted lower self-esteem and more hopelessness; the coping mechanism of ingroup comparisons predicted poorer social performance.

Our findings support the stress-coping model of stigma when applied to people with mental illness. Emotional reactions to stigma stress as well as coping responses predicted largely negative outcomes. Trade-offs between different stress reactions may render them helpful for some, but harmful for other outcome domains. Predictors of stress appraisal and poor outcomes could be useful targets for interventions that aim to reduce the impact of stigma on people with mental illness.

Meritocratic worldviews that stress personal responsibility, such as the Protestant ethic or general beliefs in a just world (“People get what they deserve”), are typically associated with stigmatizing attitudes and could explain the persistence of mental illness stigma. Beliefs in a just world for oneself (“I get what I deserve”), however, are often related to well-being and can be a coping resource for stigmatized individuals. Despite these findings in other stigmatized groups, the link between worldviews and mental illness stigma is unknown.

We measured just world beliefs for self and others as well as endorsement of the Protestant ethic in 85 people with affective, schizoaffective, or psychotic disorders and 50 members of the general public. Stigmatizing attitudes toward people with mental illness were assessed by self-report. Using a Brief Implicit Association Test, we also examined guilt-related implicit negative stereotypes about mental illness.

We found a consistent link between endorsing the Protestant ethic and more stigmatizing selfreported attitudes in both groups. Protestant ethic was associated with negative implicit stereotypes only among members of the public. Among people with mental illness, stronger just world beliefs for self were related to reduced self-stigma, but also to more implicit blame of persons with mental illness.

Meritocratic worldviews are associated with mental illness stigma. Just world beliefs for self among stigmatized individuals may reduce self-stigma, but could increase implicit blame among people with mental illness. This should be taken into account in interventions meant to reduce self-stigma.

It has often been claimed that mental illness stigma is a barrier to service use and treatment participation among people with mental illness (Corrigan 2004). Empirical findings to support this assertion, however, are scarce (Schomerus and Angermeyer 2008). We therefore studied stigma and stigma-related cognitions as predictors of service use over six months in people with serious mental illness.

At baseline, we measured the level of perceived stigma, self-stigma, group identification and perceived legitimacy of discrimination in 85 people with schizophrenia, schizoaffective or affective disorders. After six months, 75 participants reported whether they had used individual counseling/psychotherapy, mutual-help/peer-support groups, or psychiatric hospitalization after baseline assessment.

Controlling for baseline psychopathology and perceived stigma, low perceived legitimacy of discrimination, but not self-stigma or group identification, predicted use of counseling or psychotherapy. Participation in mutual-help groups was predicted by strong group identification. High self-stigma at baseline was associated with subsequent psychiatric hospitalization. Results were independent of diagnosis.

Cognitive stigma-related variables may predict use of outpatient mental health services, whereas self-stigma may be a risk factor for psychiatric hospitalization. Distinct aspects of stigma appear to predict use of different mental health services.

Similar to members of the public, people with mental illness may exhibit general negative automatic prejudice (e.g., general dislike) against their own group. However, it is unclear whether more specific negative stereotypes (e.g., danger or guilt) are automatically activated among diagnosed individuals and how such automatic stereotyping may be related to self-reported attitudes and emotional reactions.

We studied automatically activated reactions toward mental illness among 85 people with mental illness and 50 members of the general public using a Lexical Decision Task (LDT) as a measure of automatic stereotyping and a Brief Implicit Association Test (BIAT) as an index of automatic prejudice. Deliberately endorsed attitudes and emotional reactions were assessed by self-report.

In the LDT, but not the BIAT, diagnosed individuals showed less negative automatic reactions toward mental illness than members of the public. Among members of the public, stronger automatic stereotyping in the LDT was associated with more self-reported shame about a potential mental illness and more anger toward stigmatized individuals.

Reduced automatic stereotyping in the diagnosed group suggests that people with mental illness may not entirely internalize negative stereotypes. Automatic prejudice, on the other hand, among stigmatized individuals could reflect dislike of one's ingroup as well as associations with non-stigmatizing negative attributes such as the pain of having a mental illness. Among members of the public, automatic stereotyping may predict negative emotional reactions to people with mental illness.