Decrease Mortality rate in all psychiatric care is an important goal. Survey on mortality patterns in different psychiatric disorder are essential for successful plan of treatment and preventive strategies. The present study describes rate and causes of mortality among psychiatric patients with a history of psychiatric hospitalization in Kashan city, Iran.

This survey was a retrospective study. The samples (cases) were all of the psychiatric patients who had died between years 2000 to2009.They were included 44 patients. Main instrument was the inventory included: Demographic questionnaire and main cause of death according to medical records and registration center of mortality in health organization.

Results showed that the highest mortality rate respectively were among patients with Major depressive disorder (n= 14, 31.8%), bipolar disorder (n=15, 34.1%), Schizophrénie (n=9, 20.5%), obsessive - compulsive (n= 3, 6.8%) post traumatic stress disorder (n= 2, 4.5%) and personality disorder (n=1, 2.3%).The most causes of mortality respectively were suicide (n= 8. 18.2%), cardio vascular disease (n= 8,18.2%), accident (n= 3, 6.8%), cancer (n= 2, 4.6%) Diabetes (n= 2, 4.6), respiratory disease (n =2,4.6%), kidney disease (n= 24.6%), Cerebrovascular disease (n=2,4.6%), Dementia (n= 1,2.2%) and 14 ones had died with unspecified causes.

Prevention of unnatural death (suicide) is an important goal for decreasing mortality rate in psychiatric patients and so attention to cardiovascular disease in this group is essential. Therefore we should consider medical problems in this group.

Cognitive functioning involves all aspects of perception, thinking, reasoning, and remembering. Cardiac surgery is associated with a decline in cognitive functions. The incidence of this complication ranges from 3% to 80%. Cardiac rehabilitation is a treatment programme designed to help heart patients manage their condition, improve their health and recover their quality of life after a cardiac event.

To evaluate the influence of cardiac rehabilitation on neuropsychological parameters of patients undergoing cardiac surgery.

Neuropsychological data were gathered from 20 patients (M=11,F= 9; mean age 66,5 ± 11,7 years) who underwent a four week cardiac rehabilitation program. To examine patients cognitive functioning following tests were utilized: Trail Making Test A and B, Stroop test A and B, FAS test and Digit Span Test (DST). Patients were qualified into two groups: Group - I after heart valve surgery. Group II - after coronary artery bypass grafting (CABG)

In TMT A and B both groups demonstrated similar improvement, though the results were below appropriate age norms. In part A of the Stroop test both groups improved their results, yet the improvement of the I group was greater. In part B of the Stroop test and in DST the results of group I improved, while the results of group II worsened. In the FAS test both groups improved their results, yet the improvement of group II was greater.

The group of patients who underwent heart valve surgery demonstrates greater improvement in processes associated with prefrontal cortex.

The objective of the present work was the investigation of the general health level and factors that influence the job satisfaction in a sample of health care workers that they serve in primary, secondary and tertiary health care in Central Greece.

500 professionals of health were administered:

1. a) a closed type questionnaire of job satisfaction evaluation, based on Likert scale, and

2. b) the questionnaire of general health GHQ-28.

Health Care Workers in the 2 general hospitals and in the health centers of Lamia and Larissa, as well as in the Regional University Hospital of Larissa participated in the study. 386 sufficiently filled in questionnaires were evaluated. Statistics was processed with SPSS (version 15.0). Level of statistical importance was considered at p < 0.05.

93 participants (24,1%) were men and 291 (75,4%) were women. The work load, the occasions of development and the collaboration with colleagues were the critical factors in which the nurses exhibited worse statistically significantly scores in comparison with the other groups of health professionals. In the factor “job satisfaction” the nurses had lower scores (intermediate =3, IQR=2-5) compared with non- nurses (intermediate = 5, IQR=3-6) p< 0,001. In the same parameters the workers in the hospitals presented with worse scores than the workers in the health centers. The anxiety level stress of nurses is high.

The nurses constitute the group of health care workers with the lower job satisfaction and the highest anxiety levels.

Increasing evidence suggests that symptoms of Attention Deficit Hyperactivity disorder (ADHD) could persist into adult life in a substantial proportion of cases. The aim of the present study is to investigate the impact of 1) adverse events, 2) personality traits and 3) genetic variants chosen on the basis of previous findings and 4) their possible interactions on adult ADHD severity in a sample of 110 Caucasian patients.

One hundred and ten individuals diagnosed with adult ADHD were evaluated for occurrence of adverse events in childhood and adulthood, and personality traits by the Temperament and Character Inventory (TCI). Common polymorphisms within a set of nine important candidate genes (SLC6A3, DBH, DRD4, DRD5, HTR2A, CHRNA7, BDNF, PRKG1 and TAAR9) were genotyped for each subject. Life events, personality traits and genetic variations were analyzed in relationship to severity of current symptoms, evaluated by the Brown Attention Deficit Disorder Scale (BADDS).

Genetic variations were not significantly associated with severity of ADHD symptoms and life stressors displayed only a minor effect as compared to personality traits. Indeed, symptoms’ severity was significantly correlated with the temperamental trait of Harm avoidance and the character trait of Self directedness.

The results of the present work are in line with previous evidence of a significant correlation between some personality traits and adult ADHD. However, several limitations such as the small sample size and the exclusion of patients with other severe comorbid psychiatric disorders could have influenced the significance of present findings.

The job of an engine driver appeared ideal for research studies because of its extremely high responsibility coupled with a high level of permanent concentration.

The main elements of the study focused on applying the EQ-5D (Quality of Life Questionnaire), SVF 78 (Stress Processing Questionnaire) and FBL-R (Freiburg Complaint List; revised version).

It turned out hat exactly fifty percent of all train drivers regret having chosen their job and judged their professional strain very high (p< 0.001). The SVF 78 reveals the following: persons of the First Group achieved much higher values in the scales regarding “escape” (p=0.029), “mental preoccupation after work” (p=0.003), “resignation” (p=0,011) and in the total amount of negative strategies (p=0.004), while Group 2 presents only higher values in the scale concerning the “playing down” (p=0.039) effect.

There were also a wide-ranging differences between the two groups, especially in the scales about “general state of health” (p< 0.001), “cardiovascular complaints” (p< 0.001), “pain” (p< 0.001), “sensory perception” (p< 0.001), “emotional reactivity” (p=0.001) and “total sum of complaints” (p< 0.001). The EQ-5D showed that train drivers who are content about the choice of their job judge their quality of life much higher than those regretting their choice (p< 0.001).

The results make clear that the dissatisfaction about the chosen job has negative effects on both the physical and psychological well-being.

In 1950, Kurt Schneider proposed that a considerable number of schizophrenic patients develop first-rank symptoms (FRS). In such cases, patients experience third-person auditory verbal hallucinations, audible thoughts, made experiences, replaced control of will, thought insertion, broadcast and withdrawal. This group of symptoms might therefore be seen as pathognomonic of schizophrenic psychopathology. Although a number of studies tend to explain these symptoms in terms of neurobiological and neuropsychological processes, the cause and development of FRS still remains unknown.

The method applied for the development of an explanatory model of FRS consists first in the overview of psychiatric and philosophical literature and secondly in the further development of the concept of disturbed intentionality and its implication to the FRS in schizophrenia. Intentionality is understood as a basic characteristic of conscious experience as being directed towards its object and, at the same time, implying a sense of mineness. This report also reviews and discusses some generally accepted views of FRS.

Current psychiatric research shows a significant increase of interest phenomenological explanations of FRS. In this contribution we introduce a phenomenological model of FRS based on the concept of intentionality. We also show that this concept offers an insight into the interrelatedness between particular FRS.

We propose that the experience of FRS in patients with schizophrenia is rooted in the disturbed and inverted intentionality of their mental and bodily actions. This theoretical model of FRS will open up new directions in psychiatric research.

The stress -vulnerability model is an extremely useful model for identifying and treating relapses of mental illness. We accept that human persons carry genetic and other predisposition to mental illness. However, the question arises as to how stress impacts on a person in order to cause mental illness to develop. Furthermore there arises the issue as to what other effects such stress has on the human body beyond the human brain.

To research and integrate the current literature in order to establish how stress impacts on the brain at the cellular level, and to establish whether there are other consequences for the human body brought about by the impact of stress on the human brain.

MethodLiterature Search.

The present literature describes a complex set of interactions involving stress induces elevated levels of cortisol, immune responses, enhanced production of corticotrophin-releasing factor (CRF), glucocorticoid receptor tolerance thus impairing the negative feedback mechanism of the HPA axis, neurodegenerative changes in the hippocampus, and balance between trophic and atrophic factors within neurons, thus affecting neurogenesis and brain plasticity. The poster explores the interrelationship between all these factors, and the genetic component which in large part constitutes the ‘vulnerability’ part of the model.

We also show that the effects of heightened cortisol levels are not confined to the brain. but also cause metabolic problems including the ‘Metabolic Syndrome’.

Such problems occur in many Psychiatric illnesses, including Depression, PTSD, as well as Schizophrenia.

The main objective of the present study was to compare the coping strategies used by adolescents with and without subclinical psychotic symptoms.

The sample was composed of 1,713 Spanish adolescents, 881 (51.4%) females, with a mean age of 14.7 years (SD = 1.7).

The results showed that the adolescents with subclinical psychotic symptoms used Avoidance-type coping strategies more frequently and Positive-type coping strategies less frequently in comparison to the control group.

These findings indicate a pattern of deficit in the strategies used to cope with stress similar to that of patients with schizophrenia, which is very interesting with a view to establishing lines of intervention within early detection and treatment programs for high-risk individuals aimed at modifying these patterns of deficit in coping with environmental stimuli in these populations.

Patients treated with olanzapine may experience substantial weight gain. This may result in metabolic abnormalities and contributes to lack of compliance. Recent findings indicate that the weight gain associated with Olanzapine is mediated by hypothalamic blockade of the Histamine H1 Receptor. Betahistine (Histalean™) is a centrally acting Histamine 1 receptor agonist used for the treatment of vertigo. We herein report the effect of Betahistine on Olanzapine induced weight gain.

To evaluate the safety, tolerability, pharmacokinetics of this drug combination.

48 healthy women were randomized in a double blinded manner to receive Betahistine 144 mg/day or matching placebo. One week later, all subjects began 3 weeks Olnazapine (7.5 mg or 10 mg/day) treatment period.

Overall the combined treatment was well tolerated. No difference was observed between treatment and placebo groups in adverse events rate or type. In the ITT population, the average weight gain in the Betahistine group was 1.2±1.3 Kg and 1.9 ± 0.9 Kg in the placebo group (p=0.0489). 52% of the placebo group gained more than 2.0 Kg versus only 23% in the treatment group (p= 0.043).

These results indicate that Betahistine is safe and effective in preventing Olanzapine associated weight gain.

[Absolute Weight change (kg) per visit, by Treatmen]

The effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy resistant major depression and schizophrenia has been shown for all age groups. Nevertheless, age specific side effects such as greater cognitive impairment and higher somatic risks due to medical comorbidities and concomitant medication may be limiting factors in geriatric patients.

We retrospectively evaluated 4457 treatments in 380 patients. Clinical variables, treatment modalities, ictal and postictal neurophysiological parameters were analysed. For modelling the influence of age on these varibles of interest, linear regression models, if necessary logistic regression models, were performed (statistical software package R 2.8.1).

We found a considerable clinical improvement over all age groups. Higher severity of disease at admission came up with a better clinical response. In comparison of the whole patient sample versus the elderly over the age of 60, there were no significant differences in need and number of concomitant psychotropic, but in medical co-medication. Ictal and postictal EEG parameters were only in part predictive for clinical outcome, but age had a significant influence on most of them. Cardiovascular side effects and cognitive disturbances were more frequent in the elderly but were only transient, and in most cases there was no need for any specific treatment.

The outcome results show excellent effectiveness and tolerability of ECT in all age groups. The very old are more prone to adverse events, but nonetheless tolerate ECT well and are likely to benefit.

To compare treatment effects between AchEI (galantamine, GAL) and antipsychotics (risperidone, RIS) in patients with BPSD.

Open randomized trial in 100 patients (mean 78.7years, 67% females) using the NeuroPsychiatric Inventory score (NPI)>10 on patients (73% mild to moderate AD and 27% other dementias, treated with GAL (n=50) or RIS (n=50) for 12 weeks. Neuropsychiatric symptoms (NPI, CMAI, FAST), caregivers stress (PGWB), cognition (MMSE) and severity (CIBIC) were assessed at baseline and 12 weeks.

91 patients completed the trial. Safety and tolerability were good. 58% were APOEɛ4 carriers. At baseline MMSE was 20.1±4.6, and NPI 51.0±25.8. After 12 weeks NPI total scores had improved significantly (GAL: 16.6±16.1, RIS: 16.2±16.2).

In both groups there were statistically significant improvements after 12 weeks. In several of the NPI-domains galantamine and risperidone were equally effective. RIS showed a significant treatment advantage in the NPI-domains irritation (p=0.02), agitation (p=0.02) and a trend in aberrant motor behaviour (p=0.08). GAL showed a ppositive trend in apathy/indifference (p=0.09), night time behaviour (p=0.07) and appetite (p=0.06). GAL improved MMSE scores with 2.8 p (p< 0.001) and RIS with 1 p (p< 0.07).

This indicates that GAL could be beneficial in the treatment of neuropsychiatric and behavioural symptoms underlying AD unless aggressive symptoms are prominent.

Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees.

A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice.

Tables 1 summarise choices.

Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance.

No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.

To assess in a naturalistic setting the effectiveness of olanzapine within 12-month follow-up, in schizophrenic and bipolar outpatients.In this abstract, baseline patient characteristics are provided and compared between the olanzapine coated (OC) and orally disintegrating (OD) formulations to investigate prescribing patterns.

ZEN is a 1-year prospective, observational study, carried out in France, Germany and Greece from April’07 to May’09. Baseline patient characteristics were compared using Students-t, Chi2 or Fisher's-exact tests. Patients who started olanzapine prior to 60 days before the study or for whom the olanzapine formulations could not be determined were excluded from the analysis.

903 of the 927 enrolled patients were analyzed (45.2% paranoid schizophrenia, 32.2% bipolar disorder). 410 patients received the OC form and 493 the OD form. Distribution of gender was comparable across groups (55.1% male).OC patients were older than OD patients (43.1 vs 39.1 years, p< 0.001) and had a longer mean duration of illness (14.4 vs 11.2 years; p< 0.001). OD patients were more severely ill irrespective of diagnosis (p< 0.006, mean CGI schizophrenia=4.2 vs 3.8, CGI bipolar disorder=4.1 vs 3.7). At initiation, daily dose in OD patients was higher (15.0 vs 10.6 mg, p< 0.0001). Based on the 6-level SUMD scale, more OC patients were clearly aware of having a mental disorder (44.7% vs 32.9%; p< 0.001). OC patients were more compliant at baseline (mean MARS score 6.6 vs 5.5, p< 0.001).

Baseline characteristics show that the utilization of each oral form of olanzapine in outpatient setting is associated with different patient profiles.

In the Federal Republic of Germany about 3 million people suffer from tinnitus/are hit by tinnitus, numerous of them depend on intensive medical care. The repetitive transcranial magnetic stimulation is considered to be an innovative and promising therapy in tinnitus treatment. Low frequency stimulation is meant to reduce the abnormal neural activity in the auditory cortex. This study focuses on the efficacy of rTMS with tinnitus patients in the course of a multi disciplinary / an interdisciplinary therapy concept.

From November 2008 to June 2009 29 outpatients with chronic tinnitus were treated by low frequency rTMS (1 Hz frequency, 2000 impulses, intensity 110%) for 10 proceedings, stimulating the sinistral auditory cortex with a figure-of-eight-coil. Prior to and afterwards the proceedings questionnaires and assessments of a psychologist took place, afterwards statistical analyses were conducted, the data was explored and systematically discussed.

The severity index of the tinnitus as well as the depression symptoms of the subjects improved significantly. The average reduction rate of the tinnitus score is set at 7 points. With a response criterion at the minimum of 5 points, 57% were declared as responder, 29% as non-responder and 4 patients (14%) described an increase of the tinnitus loudness/annoyance.

The results show that the rTMS works as a helpful treatment tool with tinnitus patients and should be considered as an option in the routine tinnitus treatment.

Body dysmorphic disorder (BDD) is characterized by a preoccupation with misperceived defects in appearance. Neuropsychological studies and neuroimaging studies of face perception suggests visual processing abnormalities in individuals with BDD, which may involve focus on details at the expense of configural elements.

The objective of the current functional magnetic resonance imaging (fMRI) study was to determine whether individuals with BDD have abnormal patterns of brain activation when visually processing non-face objects (houses).

Fourteen medication-free subjects with BDD and fourteen matched healthy controls engaged in a matching task of photographs of houses that were

1. a) unaltered,

2. b) high spatial frequency (high detail elements only), or

3. c) low spatial frequency (low detail elements only).

The main outcome measure was group differences in blood oxygen level-dependent fMRI signal changes.

BDD subjects demonstrated lesser activity relative to controls in left parahippocampal gyrus, left lingual gyrus, and bilateral precuneus for low spatial frequency images and relatively greater activity in the frontal pole, left superior frontal gyrus, bilateral anterior cingulate gyrus, and bilateral paracingulate gyrus for high spatial frequency images (Figure 1).

Individuals with BDD have abnormal brain activation patterns when viewing houses for both detailed and configural/holistic visual elements. These results suggest general abnormalities in higher- and lower-order visual processing in individuals with BDD, beyond that for appearance-related stimuli.