NMS is a diagnosis of exclusion that typically occurs between 24 and 72 hours. Rare after two weeks, except that the deposit may extend this period. The course is between 7 and 10 days.

We will present a case in which we see the difficulties that arise in daily clinical practice.

The most characteristic symptoms are engines, such as stiffness (”lead pipe”), dystonia, tremor, nystagmus, opisthotonos, bradykinesia, dysphagia, dysarthria, lethargy, convulsions, trismus, oculogyric crisis. Changes the state of consciousness (confusion, delirium and stupor or coma). Hyperthermia, above 38.5 ° C (up to 41). Autonomic instability (hypertension, postural hypotension and variability in blood pressure, tachycardia, tachypnea, salivation, sweating, pale skin, and urinary incontinence).

It is particularly difficult to make the differential diagnosis with malignant catatonia, by the common features that both products, which are indistinguishable in a quarter of cases, conceptualizándose the NMS as a form of drug-induced malignant catatonia. This resembles by muscle rigidity, hyperthermia, and akinesia. His appearance is preceded by emotional disorders, psychotic symptoms, depressive symptoms, impaired functioning prior patient, acute anxiety and agitation, which occurs about two weeks before. In catatonia, hyperactivity and hyperthermia typically occur prior to the administration of the neuroleptic.

To examine the factors that can predict the likelihood that patients presenting to the emergency room and referred to the liaison psychiatric team will have had a prior emergency physician examination or medical investigations

Twenty-two independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the liaison psychiatric team in the Emergency Room (ER) over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression.

Overall, an ER Physician physically examined 55.5% of patients referred to the liaison psychiatric team and 29.7% of the patients had prior medical investigations. Patients who presented to the ER with a chief complaint of low mood were about two and a half times less likely to receive a physical examination from an ER Physician or a medical investigation prior to referral to the liaison psychiatric team compared to patients presenting with a medical complaint, controlling for other variables in the model. There was no significant difference in the likelihood that patients presenting to the ER and referred to the liaison psychiatric team with an anxiety, psychotic or drug/alcohol related chief complaint received a physical examination or a medical investigation prior to referral compared to those presenting with a medical complaint, controlling for other variables in the model.

Where appropriate, patients presenting to the ER need to have organic causes to their presentation ruled out prior to referral to liaison psychiatric teams.

The purpose of this study is to determine if there are any, differences between medical and psychiatric non-compliant patients with regard to their use of the Emergency Department (ED) and the reasons for their non- compliance.

A random sample of patients who presented to the ED for medical or psychiatric illnesses who stated that they were non-compliant with their medical protocols were given the National Health Access Survey. The survey asked about sources of medical care, drug compliance and reason for non-compliance, such as access and cost of health care and medication.

There were a total of 303 participants in the study. There was no significant difference in the reasons the two groups gave for being non- compliant with their medications that resulted in their ED visit. Each group cited cost as the number one reason for not taking their medication as prescribed. The psychiatric participants, who were more likely (50%), to get admitted, stated that they could not afford mental health care (40%), were not able to get care from other places, and used the ED for their psychiatric care (60%).

There was no difference between the two populations with regards to their reasons for non- compliance that brought them to the ED. But non-compliance of the psychiatric patients led to a higher admission rate than that seen in the non-compliant medical patient population.

Although discussed controversially, coercive practices during involuntary admission are common in mental health services. The impact of physical restraints on patients has not been sufficiently studied.

To investigate the subjective perception of patients during and after physical restraint.

47 patients in a psychiatric intermediate care facility experiencing belt fixation were interviewed and filled out self-assessment forms at 4 visits.

The median duration of restraint was 99 hours. Median VAS scores indicated moderate levels of anxiety. With increasing time span from the fixation, memory regarding this event decreased and patients experienced a regain of self-control. Consistently, 50% perceived high levels of coercion at admission, PTSD could be supposed in 25% of the patients.

Despite a considerable restraint of freedom, distress related to belt-fixation seems acceptable in our sample. Patients’ disapproval concerning restraint measures seems to diminish with time, probably related to decreasing memory regarding the fixation practice.

Hospitalization is a major therapeutic tool for management of psychiatric emergencies. However, the doctor does not have a specific consensus outlining the most important variables in order to sit this decision.

Our purpose was to identify the factors affecting the decision of hospitalization in a psychiatric service via emergencies.

It is a cross-sectional study conducted in the medical emergency department of university hospital in Mahdia during twelve months. The Canadian Triage and Acuity Scale (CTAS) was used to specify the degree of emergency.

Among the 513 patients referred to the emergency room, 201 were hospitalized with a prevalence of 39,5%. The most represented age group was between 25 and 34 years old in 35,3% of cases and the sexe ratio (M/F) was 2,65. The factors having an impact on the decision of hospitalization were: male gender, single status, low socioeconomic level, absence of professional activity, presence of family or personal psychiatric history, previous hospitalizations in psychiatric department, precipitating event, heteroagressivity and restlessness as reasons of consultation, demand for care from third parties and level 2 in CTAS reflecting a true emergency.

The identification of these factors contributes to make an objective decision regarding the psychiatric hospitalization.

The frequent use of psychiatric emergency poses problems due to the loss of their adaptative capacity and diagnosis, orientation and therapeutic difficulties for clinicians.

To estimate the prevalence of frequent visitors to psychiatric emergency and to describe their sociodemographic and clinical characteristics.

It is a cross-sectional study of twelve months including patients who consulted at least twice to medical emergency department in the university hospital of Mahdia. Data were collected using a predefined questionnaire.

The prevalence of recurrence was 30,2%. The main characteristics were: a mean age of 35,5 years, a male gender (64,5%), being unemployment (72,3%), a single status (71%), a request from the family (55,5%) and the presence of psychiatric personal history (91,6%). Previous hospitalizations were noticed in 69% of cases. 44,5% of the patients had problems with the primary support group and the social environment. In 78,6% of cases, patients had visited emergency twice to four times. The most encountered reason for consultation was heteroagressivity (27%) and the most frequent syndromic diagnosis was psychomotor excitation (25.2%). Hospitalization concerned 47.1% of patients. Schizophrenia and bipolar disorder were the most diagnosed disorders in 54,2% and 25% of cases.

Absence of intermediate structures and lack of coordination between the various stakeholders involved in the management of patients are the two main encountered problems.

The psychiatric emergency is real challenge in medical practice. Thus, Knowing the properties of a population attending an emergency department must improve its functioning.

To estimate the prevalence of psychiatric emergency and to describe its epidemiological and clinical characteristics.

It's a descriptive cross-sectional study of 12 months conducted in the medical emergency department of the university hospital of Mahdia. We have included patients for which a psychiatric evaluation was requested. The Canadian Triage and Acuity Scale (CTAS) was used to specify the degree of the emergency.

The prevalence of psychiatric emergency was 7,9%. The general characteristics were: an average age of 34,7 years old, a sexe ratio (M/F) of 1,38, a single status (66,4%), a secondary education level (45%) and presence of psychiatric personal history (70%). The two most common reasons for consulting were suicide attempts and heteroagressivity in 17,5 and 17,2% of cases. According to the CTAS, the level of emergency was 2, 3 and 4 in 80,9%. 40% of patients were referred to consultation while 39,5% of them were hospitalized in psychiatric departments. For those one, the diagnosis was schizophrenia in 55.7% of cases. The average period of hospitalization was 25 days.

The response to psychiatric emergencies depends on the type of the disorders and the diachronic aspect.

Aggression is a common consequence of traumatic brain injury (TBI). Agitation may be predictive of longer length of inpatient care and poor progress.

To evaluate the efficacy and tolerability of Antipsychotics for management of aggression in TBI.

Systematic review of RCT's to evaluate efficacy and tolerability of Antipsychotics in treatment of aggression in TBI.

MEDLINE, PubMed, Psychinfo, Embase searched from 1990 till 2014.Search terms Brain Injury, Head injury, Traumatic Brain Injury, Agitation, Aggression, Violence, Irritability, Episodic dyscontrol, Antipsychotic medication were used.

50 papers were screened based on pre-set criteria. 3 clinical trials were identified for final analysis. 1 study compared oral haloperidol and oral droperidol; the second study compared intramuscular droperidol and haloperidol. The third study compared oral Quetiapine and Chlorpromazine.

Jadad scale was used to assess the quality of trials.1 study reached a Jadad score of 3, the other two did not score.

Better tolerability reported for Quetiapine, which was effective in reducing aggression in doses of 25mg to 300mg. Time to achieve calming was significantly shorter with intramuscular droperidol (mean = 27 minutes) compared to intramuscular haloperidol (mean = 43 minutes). Single doses of droperidol controlled agitation more frequently and with less post-episodic sedation. Oral haloperidol and droperidol did not show differences in their efficacy.

Overall the clinical trials were not of sufficient quality to accurately guide clinicians in the management of aggression and agitation post-TBI. The review identifies some evidence of efficacy of antipsychotic medication group in this patient population.

This work was supported by a grant of the Romanian National Authority for Scientific Research, CNDI– UEFISCDI, PN-II-RU-TE-2012-3-44

Ethics are important in psychiatry since psychiatrydeals mainly with human conduct and behaviour. Ethics are principles, notlaws but standards of conduct, which define the essentials of honourablebehaviour for the physician. Indian Psychiatric Society approved ethical guideline in 1989Cuttack conference.

Ethical issues depend on the following theories –

Utilitarian Theory– A fundamental obligation in making decision and is to try to producethe greatest possible happiness for the greatest benefit.

Parentalism-A person performing actions for another benefit without the person's consent.

Autonomy Theory –It is based on writing of Imanuel Kant. Relationship between a physician and anadult patient is conceived as relationship between two responsible persons.

Some common causes of malpractice in psychiatry seen in India arei) Negligence in diagnosis ii) Overlooking basic human rights iii) Consent nottaken from patient iv) Risk of suicide v) Experimentation by doctor vi)Negligence in physical methods of treatment vii) Seaxual relation with clientand Exploitation.

Now a days following forces are to be considered as new ethical challenges a)Rapidly increasing cost of mental health care b) Influence of new technologies likeMRI, CT SCAN Brain c) Societal reengineering for better mental health d)Increasing pressure by patient party e) Current market forces are demandinghigh quality health care.

Apracticing psychiatrist has to take more responsibility in management of mentaldisorders. One has to take it as normal inevitable professionalhazards.

The aim of this study was to find out attitudes and convictions patients have, What are their spiritual /religious (spir/rel) needs and whether and how they want to be addressed. There we asked which professions they want to be referred to and how this could look like. We have given the options of all professions that are available.

248 Patients at admission, 228 at discharge, Mean age 39.6 ± 13.4 years, June 2010 – December 2011 all new inpatients, open, prospective, explorative, cross-sectional Standardised Questionnaires developed by Arndt Büssing et al. & Questionnaire „Expectations towards the Clinic.

In the Self-rating whether clients call themselves as religious and/or spiritual the Distribution is similar to the regional general population. SPREUK-15 shows a higher percentage of patients are in a period of Reflection than in trusting in a higher guidance. Within the needs questionnaire patients significantly look for inner peace than rel/spir needs. Interestingly there is a percentage that feels it relevant that rel/spir is part of therapy (1/4), a high percentage think it is not so important and less 1/4 do not want it to be part. With whom that should happen number one are the psychotherapist followed by the chaplains.

This study provides first evidence that there might be different groups of patients who want rel/spir be part of therapy where others do not. Future studies are needed to be able to differentiate early enough and to find out what health care professionals should provide to meet these needs.

Revealing a diagnosis of cancer generates various psychological responses such as anxiety and depression which deteriorate the quality of life (QOL) of this patient.

Assess the level of both anxiety and depression in patients with cancer; assess the impact of their disease on their physical and mental QOL.

Deduct the risk factors of anxiety, depression and bad QOL.

Our study is transversal. It is conducted on patients hospitalized in the department of Carcinology CHU Habib Bourguiba in Sfax (Tunisia). The screening tool for anxiety and depression was HADS scale and the assessment of QOL was performed using the SF-36

We identified 50 patients. Concerning their psychological state, the one-quarter (23.9%) had a doubtful anxious state and the one-third (32.6%) had a certain anxious state. The depression was doubtful in 13% of cases and certain in 39.1%. The deterioration of QOL was significant (84.8%). The averages of both the physical score (PCS) and the mental score (MCS) was respectively 41.61% and 33.67%.

A bad QOL was correlated with locally-advanced to metastatic stage of cancer (p = 0.043), the time progression of the disease (>6months) (p?? = 0.01), moderate to severe pain (p ??= 0.028), radiotherapy treatment (p = 0.029) and the depression state (p = 0.023).

Our study underlines the necessity of screening both depression and anxiety in patients with cancer, in order to improve their QOL.

Treatment – both surgical and hormonal – significantly impairs the sexual function of men. Subsequently, the patients are at risk of adaptation disorders, including depression, in response to the cancer. Depression and severe chronic stress are other factors impairing sexual functioning.

The aim of this study was to determine the relationship between depression and men's quality of sexual life after prostatectomy for prostate cancer.

The study was cross-sectional and involved 112 men diagnosed with prostate cancer after prostatectomy. The study used questionnaires: the EORTC, QLQ-C30 with PR25 module, the Distress Thermometer, Sexual Life Satisfaction Questionnaire and the Beck Depression Inventory.

The level of depression in the study group was quite high (M = 27.20). The study showed a negative correlation between depressiveness and quality of life in all its dimensions. There was also a negative correlation between satisfaction of sexual functioning and distress, depression and quality of life in other dimensions. Those highly evaluating the possibility of relaxed conversation with partner about sex and satisfied with the frequency of extragenital caresses had lower severity of depression.

Psychoeducation about extragenital forms of sexual activity and also on the communication needs between partners can be an important factor in increasing the quality of life and reducing the risk of depression in patients with prostate cancer.

Beginning with classic Hollywood melodramas of the1940s, cinema has maintained a prolific output of films with their own take on mental illnesses – none more so than the rare syndrome of Dissociative Identity Disorder (DID). The DSM-5 provides criteria to diagnose dissociative identity disorder, 'two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self”, is the main one.

A brief description and discussion about the controversies surrounding the diagnosis and approaches to treatment of Dissociative Identity Disorder are presented, followed by a reflection about the use of this disorder in cinema.

A non-systematic literature review was performed in PubMed, about Dissociative Identity Disorder. Only original articles in English language were included. An informal search about films contemplating DID and their plot was also conducted.

Clinical findings suggest that DID involves an authentic mental disorder related to factors as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility and role-playing. As patients tend to switch personality states when there is a perceived psychosocial threat, the treatment goal is the fusion of the personality states while retaining the entire range of experiences contained in all of the alters. DID representations in cinema correspond closely to contemporary thinking about its phenomenology and aetiology.

Art imitates Life, but sometimes Life can fake the Art…DID may have had its turn…

Although 85% of inpatients with Borderline Personality Disorder (BPD) receive psychotropic drug treatment, no drug is approved for this indication so far. A dysregulation of the endogenous opioid system (EOS) has been posed to underly the neurobiology of BPD. Accordingly, the opioid antagonist naltrexone might be helpful to treat symptoms of BPD. Two small studies showed limited differences of naltrexone vs. placebo on dissociation, which were not significant, perhaps due to the low power of the studies:

Naltrexone was administered in treatment-refractory patients with BPD in a university department of psychiatry. This study aimed to assess the relative contribution of naltrexone and other psychopharmacological drugs to the improvement of overall symptomatology in patients with BPD.

A retrospective analysis of the charts of inpatients (n=161) with BPD was performed. Patients were classified as either treatment responders or non-responders. As all patients received multiple psychopharmacological treatments, stepwise logistic regression analysis was performed to detect, which drug contributed most to improvement of symptomatology.

None of the drugs applied contributed significantly to improvement, with the exception of naltrexone (odds ratio, p=2,9) Patients treated with naltrexone (n=55, 34,16%) recovered significantly more often and faster and, in particular, showed highly significant reduction of self-harm and suicidal thoughts. Higher doses of naltrexone treatment were more effective than low-dose treatment; however, the latter was still better than any other treatment.

Large-scale double-blind studies are warranted to examine the efficacy of opioid antagonists (naltrexone, nalmefene) in BPD.

Perfectionism is a personality traitcharacterized by a person's striving for flawlessness and setting excessivelyhigh performance standards, accompanied by overly critical self-evaluations andconcerns regarding others' evaluations. This trait has been associated with abroad range of psychopathological conditions, starting in adolescence. In this context, prevention of its effects must start early, and the efficacyof reducing perfectionist levels in adolescents must be empirically investigated.

Toanalyse, for the first time, if one session to cope with perfectionism has theeffect of reducing the levels of this trait after two and six months later. Method:868 adolescents (610 girls),aged 15.73±1.571 years, from two secondary schools in Coimbra, Portugal, answered the Portuguese validated version of the Child and AdolescentPerfectionism Scale (CAPS). Two groups were formed: intervention group receivedone skill session oriented to reduce perfectionism (N=615); control group withoutintervention (N=253). Both groupsanswered CAPS again after two/T1 and six/T2 months.

No significant differences betweengenders were found in Total CAPS, Self Oriented Perfectionism/SOP and SelfPrescribed Perfectionism/SPP. At T1 significant mean reductions were observedin SOP at the intervention group (T0= 39.58±8.554 vs. T1: 38.44±8.676 t= 3.498,p=.001) but not at the control group (T0= 40.48±8.998 vs. T1: 39.34±7.753 t=1.894, p=.061). No differences significant differences were found in Total CAPSand SPP. At T2, SOP reduction remained in the intervention group (T1=38.44±8.676 vs. T2: 38.67±8.375 t= -.640, p=.020).

Adolescents are sensitive to short interventionsaiming to reduce perfectionism.

Patient G. D. born in 1975, trained as a textile worker, unemployed, married, mother of three children. The current hospitalization was due to suicide attempts and manifestation of depressive symptoms after a stressful event.

Our diagnostic dilemma was whether it concerns:

1. - depressive disorder with psychotic symptoms

2. - adjustment disorder in people with personality disorder

After applying diagnostic procedures and observations during individual psychotherapy sessions, as well as the response to a given therapy, psychotic depression is excluded. The stories provided from the patient were in conflict since they have changed in contact with different therapists in the same department, why we decided to consult other professionals from other departments at which the patient apparently was treated.

In this disorder the patient is aware that he is exaggerating and faking illness, but in core of the disease is irresistible urge for pointing attention, and the cause is most likely a lack of love and affection in childhood.

In psychoterapic process was included family therapist also. Family therapist confronted patient with family members, which resulted in a real insight into the mental state and allowed us to confirm a diagnose of histionic personality disorder with tendency to pathological lying- Munchausen syndrome.

In this presentation, we wanted to point out the necessity of cooperation of a psychiatrist with other specialists, considering that patients with this disorder are prone to change therapists, hospitals and faking the results of diagnostic tests.

Pathological narcissism, described by two dysfunctional phenotypic forms – grandiosity and vulnerability – has often been connected to suicidal tendencies in theoretical and clinical literatures. Furthermore, shame-proneness has been implicated as a key mechanism that links these two constructs. However, empirical evidence for the presumed relationship between narcissism and suicidal tendencies is sparse, and no prior research has investigated the role of shame experiences in this relationship.

The goal of the present research was to investigate the relations between pathological narcissism (grandiose and vulnerable narcissism) and suicidal ideation in psychiatric outpatients. The potential mediating role of shame experiences in the pathological narcissism – suicidality relationship was examined.

A sample of 190 adult psychiatric outpatients (64% female; mean age 40.34 years), heterogeneous in terms of psychiatric diagnoses, was gathered between January and April 2014. The participants filled out the Pathological Narcissism Inventory (PNI), the Experience of Shame Scale (ESS), and the Suicide Assessment Scale – self-rating (SUAS-S).

Narcissistic vulnerability was found to have unique positive association with acute suicidal ideation, whereas narcissistic grandiosity exhibited no relation with the same construct. Moreover, two dimensions of shame – characterological and bodily shame – mediated the relationship between narcissistic vulnerability and suicidality.

Narcissistic vulnerability seems to be more strongly related to suicidal ideation than narcissistic grandiosity, while experience of shame represents one of the underlying mechanisms of this relationship among psychiatric outpatients. These findings have relevant implications for the diagnostic classification of pathological narcissism as well as its treatment.