The aim of Routine Outcome Monitoring (ROM) is to improve the quality of clinical treatment. Providing feedback on the outcome of treatment to both clinicians and patients is an integral part of ROM, allowing modifications to treatment. Published studies are inconsistent with respect to patient attitudes towards ROM. Clinicians, however, generally appear to be more negative than enthusiastic. Although Routine Outcome Monitoring is currently implemented throughout the Netherlands, the process is not going as smoothly as first envisaged. Research into patient and clinician attitudes towards ROM can offer a partial explanation of the difficulties involved.

The aim of this study is to gain insight into the attitudes of both patients and clinicians towards ROM and the factors that play a role in the implementation of ROM in a general, non-academic psychiatric outpatient setting.

A study was carried out into the attitudes of both patients and clinicians towards the recently introduced ROM procedure. Specifically designed attitude rating scales were presented to a group of 176 patients and their 69 clinicians in the course of their treatment.

Forty-six percent of the patients consulted and 39% of their clinicians completed an attitude rating scale. Patients were generally positive about the use of ROM during the clinical care process. They found it useful and did not find it stressful. The use of a computer during this process was considered to be a positive facet. Clinicians, on the other hand, had a negative reaction and rejected ROM. In the discussion possible explanations for the cause of these findings are offered.

The role of the consultant psychiatrist is changing in line with social expectations, service reconfiguration and resource constraints. There is a clear expectation for a responsive practice concentrating on the most complex patients with devolved responsibility for less severe cases, and the flexibility to attend to urgent clinical work .

To assess the functioning of a consultant community workload against national standards.

Review of consultant job plan and consecutive patient case records for a randomly selected week in July 2013. Data obtained was examined against standards derived from Royal College of Psychiatrists’ guidance.

The job plan was largely consistent with national standards. Time available within the job plan for emergency work was less than recommended. There was no time specified for Mental Health Act work, advice to team members, and clinical administration.

There were 27 patients (12 male and 15 female). 17 patients had a psychotic condition. There was evidence of antipsychotic polypharmacy in 2 cases. There were 5 unscheduled and 19 routine appointments, 2 discharge reviews and 2 new patient appointments. 17 patients had care-coordinators of whom 11 attended the reviews. 6 patients were classed as frequent attenders, having more than 3 appointments in the preceding 6 months. In terms of clinical interventions, 13 patients had medication adjustments, 5 patients increased monitoring, and 1 patient required admission. 4 patients missed appointments and were followed up by care-coordinators.

There is some scope for adjustments to current practice to facilitate more non scheduled clinical sessions and care-coordination.

Public hospital systems have struggled to identify ways of cutting costs while improving quality of mental health treatment, even more since the economic downturn.

To compare mental health care expenditures and quality in two large sites, Boston and Madrid, and to analyze the amount of the expenditure corresponding to pharmacy, ER, outpatient and inpatient care.

Data are mental health electronic records from three hospitals in Madrid (n=31,183 person-years) and in Boston(n=8,805). Adequacy of care was measured as four or more visits within the last year. Unadjusted comparisons of variables were conducted using t-tests. Multivariate generalized linear regression models were computed with log link and residual variance proportional to mean squared, adjusting for covariates. Results were also adjusted for World Bank Purchasing Power Parity and converted to U.S. dollars.

The annual average treatment expenditure is $4,874 in Boston and $2,693 in Madrid . Boston patients had a bigger percentage of use (13,6% vs 5,3%) and greater annual expenditure ($25,175 vs $15,470) for inpatient services (p<0,05). Conversely, Madrid patients used and spent more on outpatient treatments (87% vs 84%;$1,670 vs $1,378;p<0,05). Being in the Boston site, having a bipolar, psychotic or alcohol disorder was a significant positive predictor of total expenditure. Adequacy of care was bigger in Boston (32,8% vs 23,1%)

Emphasis on outpatient care appears to reduce inpatient stays and global expenditures. An earlier recognition due to a more open access to treatments in Spain may help decreasing costs. Bipolar, psychotic and alcohol disorders imply bigger costs.

Postpartum depression (PPD) can occur through all the perinatal period and it is a public health problem. Positive and negative affect (at pregnancy and previous postpartum moments) are protective and risk factors for PPD. The Profile of Mood States (POMS) factor structure at pregnancy and three months postpartum has already been explored.

to explore the POMS factor structure at six and 12 months postpartum.

336 women (mean age=30,3; SD = 4,09; range=19-42 years) and 276 women (mean age=30,5; SD=3,99; range=19-41 years), respectively, filled in the Profile of Mood States (POMS), at six and 12 months postpartum.

A principal components analysis revealed, at six months postpartum, three components that explained 54,12% of the total variance: F1 Depression-Hostility (21 items; 39,5% explained variance/EV); F2 Anxiety-Anger/fatigue (14 items; 10,1% EV) and F3 Vigor-Activity (12 items; 4,8% EV); at 12 months postpartum, revealed also three components, that explained 46,16% of the variance: F1. Anxiety-anger/fatigue (13 items; explained 30,4% of the variance); F2. Depression-Hostility (6 items; 11,2% VE); F3. Vigor-Activity (14 items; 2,9% EV). At both postpartum moments, F1 and F2 can be summed to calculate Negative Affect (Cronbach Alpha, α=0,968 at six months and α=0,948 at 12 months). F3 corresponds to Positive Affect (α=0,863; α=0,875, respectively, at six months and 12 months).

The POMS factor structure at six and 12 months is robust, meaningful and can now be used to explore different aspects of the postpartum experience, at these postpartum moments.

Emerging research evidence suggested that attributional style is one of the main predictors of schizophrenia symptoms.

This study aimed to develop and validate Attribution Questionnaire on Symptom for Schizophrenia (AQSS) in response to the deficiencies in current scales.

The AQSS was developed based on subscales relating to several psychopathological domains included in diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders IV version. The test items were checked by experienced clinicians for face validity and were tested through a pilot study. The final questionnaire included nine events reflecting four dimensions in each: controllability, internality, stability and globality. Attributional Style Questionnaire (ASQ) was used to assess the concurrent validity of the AQSS.

A four factor structure was extracted from the data using exploratory factor analysis: controllability, internality, stability and globality. Internal consistency of Cronbach’s alphas ranges from 0.84, 0.89, 0.90 and 0.91 respectively, with a total Cronbach’s alpha level is 0.92. The test-retest reliability ranged from 0.72 to 0.82. Three dimensions of AQSS (i.e.internality, stability and globality) significantly correlated with the same dimensions of the Attributation Style Questionnaire, with correlation coefficients of 0.33, 0.65 amd 0.61 for internality, stability and globality respectively. Confirmatory factor analysis confirmed the excellent level of model fit in the four factor structure.

The AQSS has high level of reliability and validity. It is a satisfactory instrument to assess attributional style in patients with schizophrenia.

Psychomotor agitation is characterized by a significant increase in or inappropriate motor activity, from minimal anxiety to uncoordinated movement without purpose, accompanied by alterations in the emotional sphere.

Psychiatric causes includes schizophrenia, schizoaffective disorder and bipolar disorder

47-year-old patient with a diagnosis of paranoid schizophrenia with 25 years of evolution. Compensated during the last 5 years. She comes to the hospital with her husband.

She presents psychomotor agitation characterized by a megalomaniac delusion ('I'm a virgin', 'this is not my husband, my husband is someone else and he is dead, this is a double') delusional interpretations of the environment ('I won´t sit down, because you´re going to steal my movement'), irritability, dysphoria, vocal and behavioral disturbances such as insults or increased motor gestures like bumps against the furniture.

• T 0 (00 min) PEC score scale: 18

  Inhaled administration of Adasuve (Staccato loxapine)

• T1 (08 min) The psychomotor agitation stopped. PEC score scale: 7

• T2 (60 min) No adverse effects. She continued to be stable. PEC score scale: 6

Taken to the extreme, agitation in psychosis can be a serious risk to the patient, family members, health workers and the environment.

It requires immediate action to ensure patient safety, to achieve an appropriate and effective approach to agitation, aggressive or violent behavior.

An effective treatment of an episode can facilitate future interventions.

Available literature on asenapine (ASE), a new second-generation antipsychotic, consists of several randomized clinical trials (RCTs) in highly selected populations. Real-world, observational studies from acute inpatient settings are still lacking.

In a group of subjects treated with ASE (A) and an ASE-naïve control population (B):

1. 1) evaluation of differences in Length of Stay (LoS)

2. 2) re-hospitalization during the following 6 months

To highlight differences between clinical trials and real-world data.

Clinical data were collected over 2 years from 20 inpatients who met DSM-IV-TR criteria for manic episodes (ME) treated with ASE and from a control population matched for age, gender and diagnosis who underwent conventional treatments in the same setting.

LoS was 17.9 (SD ±9.0) days for group A and 14.7 (SD ±12.7) days for group B; the result of the Kruskal-Wallis test showed no significant differences (?2=2.199, p=0.138). In spite of a high discontinuation rate, only 17.7% of patients in group A were re-hospitalized in the following 6 months compared to 41.2% of those in group B (RR=0.43, 95% CI: 0.13-1.39).

In RCTs, ASE emerges as an effective compound for the treatment of MEs in highly selected populations that differ substantially from real-world clinical practice. However, on the basis of our results, ASE doesn’t appear to offer specific advantages in the clinical management of acute inpatients. In this presentation, the importance of poly-psychopharmacology, adherence and co-morbidity will be discussed to highlight the need for larger, multi-centre, observational studies with adequate follow-up in real-world settings.

Science has focused on types of treatments and their differential effects in achieving treatment outcomes. However, there is a growing body of evidence to support the investigation of clinician factors and how they affect the treatment outcomes of patients. The aim of the presented study was assess and analysis clinician therapeutic optimism in treatment of mental health disorders.

To assess therapeutic optimism we used the Elsom Therapeutic Optimism Scale (ETOS), which was designed to provide a reliable means of measuring mental health clinician optimism. The ETOS consists of 10 items to which respondents rate their agreement on a 5-point Likert scale ranging from strongly disagree to strongly agree.

A convenience sample composed of forty five mental health clinician working in a variety of settings is being collected. The results demonstrate that the most of clinicians (n=45; agree 64,4%; strongly agree, 26,7%) believe that have the capacity to positively influence outcomes for people with mental disorders, can help a lot of number of people of mental illness (n=45; agree,77,8%) and the majority of patients benefit from their intervention (n=45; agree 64,4%; strongly agree, 22,2%). We have applied additional measures to assess adherences strategies and medication beliefs.

Future research should assess the utility of the ETOS for predicting treatment outcomes. If clinician optimism does in fact have a predictive relationship with treatment outcomes, the assessment of clinician optimism using measures such as the ETOS will enable services to identify and rectify the effects of negative clinician beliefs on patient outcomes

To report a case of Lithium toxicity resulting in haemodialysis, possibly caused by multiple drug interaction amongst Lithium, Enalapril and Fluvoxamine in a patient with Bipolar affective disorder with no history of renal disease.

A 56 year-old man with bipolar affective disorder was stabilized on Lithium 400mg BD for 3 months with concurrent Enalapril therapy. He, however, developed Lithium toxicity after fluvoxamine was added. He was admitted due to poor sleep and increased anxiety. Upon admission, Lithium level was normal (0.88mmol/L). Fluvoxamine, Propranolol and Lorazepam were added subsequently with no changes in Lithium dose. No deterioration in mental status was observed. However, on Day 10, he developed significant tremors and lethargy. Repeated laboratory findings revealed deranged Lithium level (2.3 mmol/L), serum sodium (128mmol/L), serum creatinine (407 mcmol/L) and liver enzymes. Abnormal physical findings include hypotension and bradycardia. He was then admitted to the intensive care unit for close monitoring and underwent hemodialysis. Lithium was also discontinued. Subsequently, his Lithium level, renal function, and neurological signs improved.

The interaction between Enalapril with Lithium is well established. However, reported interactions between Lithium and Fluvoxamine are mainly cases of serotonin syndrome. An objective causality assessment using the Naranjo Probability Scale revealed a score of 7 – probable relationship between concomitant use of the drugs and the resulting symptoms.

This episode suggests that fluvoxamine- Lithium interaction may result in raised Lithium level. Clinicians should be aware of this severe adverse event and take steps to minimize its occurrence.

The absence of diagnostic criteria were need further study of short and long-term syndromes termination of the different classes of antidepressants and the development of methodological recommendations for their prevention.

In Russian clinical tradition and psychological research of Vygotsky-Luria school much consideration is given to relationships between the doctor and the patient, regarding it as an efficiency factor of treatment and rehabilitation.

To evaluate the concordance with treatment adherence and those psychological factors that affect the treatment compliance in patients with essential arterial hypertension (EAH).

A questionnaire-based study was undertaken with EAH patients attending public hospitals in Moscow, Russia. There were applied a Questionnaire for Interpersonal Relationships Assessment (Sobchik, 2005), Questionnaire for Assessment of Types of Attitudes Towards the Disease (Wasserman, 2005), Psychodiagnostic Interview for Treatment Adherence, Drug Attitude Inventory, and Multidimensional Scale of Perceived Social Support (Zimet et al., 1988). 170 EAH patients took part in the study, the mean age was 46.7±4.1 years, EAH duration was 7.2±2.6 years.

It was found that 75.3% of the patients defied the doctor's prescriptions. Forgetfulness, lack of tendance, and negligence were ranked as the top three reasons for this non-compliance.

A statistically significant relationship with non-compliance was found for anxious, melancholic and neurasthenic types of attitude towards the disease, as well as predominance of distrustfully-skeptical interaction style in a dyad 'doctor-patient' and the lack of social support, and such characteristics, as age and education level.

Patients with high compliance have predominantly sensitive type of attitude towards the disease, high intensity of social support, and dependent-obedient style of interaction with doctor.

These results indicate the need to consider the psychological factors to improve treatment adherence in EAH patients.

aggression and self-harm are often encountered in daily clinical routines. A better understanding of these behaviors is important.

We investigated with self-report measures the kind of relationship between aggression, impulsivity, self-harm, suicide attempts and third party observation of staff.

We Aimed at a nalyzing whether there is a relation between: impulsivity, self-harm aggression (self report measures) and similar reported behavior by third party observations of staff.

patients were assessed using the Barrett-Impulsivity-Scale (BIS-15), the Aggression Questionnaire (AQ), the Non-Suicidal Self-Injury (QNSSI). Recent patient health records were analyzed for aggression, self-harm and suicide attempts.

N=34; 12 male, 22 female; mean age: 45.26 sd.: 9.54. Recent suicide attempts (RSA) N=7 and impulsivity were not significantly related (U= 90, p=.87), also recent self-harm (RSH) N=9 and impulsivity (U= 112 p=. 984) showed no relationship on a statistically significant level. Statistically significant correlations were found between the AQ sum scale and impulsivity (r=.38 p=.027) and for the AQ subscales: anger (r= .34 p= .049) and physical aggression (r= .36 p= .04). Verbal aggression was also significantly correlated to impulsivity (r= .342, p= .048). Surprisingly no sex differences could be found for AQ and BIS-15. Recent self-harm and recent suicide attempts were not significantly correlated to any of the scales.

Aggressive behavior coincides with impulsivity whereas self-harm and suicide attempts are not related to self-harming behavior in psychiatric inpatients.

The Flow experience in job result in increasing the internal interest to job and it is so enjoyable that causes people do that job for itself. So, designing the effective methods and programs for treatment has important role in increasing this features, especially in nursing staff in the psychiatric units that confront to high stress.

the present study has been done by the purpose of effectiveness of the Mindfulness-Based Cognitive Therapy of the Flow experience in nursing staff at the Psychiatric Hospital in Tehran Iran.

This study is a semi-experimental with pretest-posttest plan along with control group. 30 nurses in the Psychiatric Hospital with score less than 108 in the questionnaire of the Flow State Scale (FSS) of Jackson and Marsh (1997) were selected randomly and then they were divided in two groups of control and experimental. The period of training was 8 sessions with duration of 2 hours for each session once weekly. One week after completion the sessions of Mindfulness-Based Cognitive Therapy, the above mentioned questionnaire was performed for both two groups.

The results demonstrated that the Mindfulness-Based Cognitive Therapy meaningfully has been effective on the flow experience, Action-awareness merging, the clear goal, Unambiguous feedback, Concentration on task at hand, sense of control and also it has the most effect on the mini-scale of the Loss of self-consciousness (P<0.05).

Mindfulness-Based Cognitive Therapy can be effective in increasing the flow experience of nurses who work in the psychiatric hospitals.

Anabolic Androgenic Steroids (AAS) are typically used by athletes, sports coaches and recreational sports users in an attempt to improve muscle mass and enhance sporting regimes. Despite a myriad of health problems associated with using AAS, no research to date has considered whether AAS use has a detrimental impact upon cognition.

This study considered putative links between regular AAS use in gym users and prospective memory (PM: remembering future intentions and activities) and executive function (EF: memory organization and attentional control).

To compare a group of regular AAS gym users with a group of regular gym users who do not use AAS on measures of PM and EF.

35 young adult regular gym users who use AAS to enhance muscle/training (the AAS group) were compared with a group of 35 young adult gym users who do not use AAS (the Non-AAS group). The Prospective and Retrospective Memory Questionnaire was used to measure self-reported PM and the Executive Function Scale measured self-reported EF. Other drug use and mood were also measured since these can impact upon memory independent of AAS use.

After observing no between-group differences on other drug use and mood, the AAS group reported significantly more PM lapses and EF deficits when compared with the Non-AAS group.

These findings suggest that the use of AAS in sporting contexts may compromise everyday memory in the form of PM and EF. The findings and their implications will be considered at conference.

Injecting Drug use is a major risk factor for the acquisition and transmission of HIV and accounts for approximately 5-10% of HIV infections worldwide. Opiate Substitution Treatment using Methadone and Buprenorphine reduces the HIV risk for people who inject drugs by up to half. Therefore proper diagnosis and treatment of opiate dependence are essential. Both Methadone and Buprenorphine have been shown to interact with a lot of anti-retroviral medications. This may lead to potentially toxic drug interactions. This could also lead either to withdrawal symptoms or to morbidity/mortality by overdose if these medications are not prescribed carefully.

Our objectives were to look for the relationship between substance abuse and HIV and to analyze the interactions and adverse reactions when combining Methadone/Buprenorphine and Antiretrovirals.

Using MEDLINE, English literature was reviewed from 1990 to June 2014. The search strategy was 'Substance abuse” OR 'Drug abuse” OR Methadone OR Buprenorphine AND HIV OR AIDS OR HAART.

Subjects who use drugs are more prone to acquire HIV because of increased risky behaviours. Substitute Opiate treatment may improve adhesion to the antiretroviral treatment and also leads to a reduction in risk-taking behaviours. In the poster, we will be presenting the interactions of each Anti-Retroviral agent with both Methadone and Buprenorphine.

Choosing the best therapeutic intervention in each case, particularly considering those drugs with least interactions and adverse effects is crucial for the success of Opiate substitution programme and also to combat the HIV infection.

was to establish the impact of injecting drug use on cellular immunity and to evaluate the significance of drug useas a factor contributing to HIV infection and affectingthe course of disease in HIV-positivepatients.

The study included 144 subjects: 109patients (49 – with drug addiction, 23 – withHIV infection, 37 – with drug addiction and HIV infection) and35 virtually healthy individuals.

Thetotal amount of T-lymphocytesdoes not depend on HIVstatus, drug addiction orgender, aswell as on the combinedeffect of these factors. The total number of lymphocytes, the percentage and the absolute countof B cells (CD19 + lymphocytes) and CD4 +25+ cells (mainly T-regulatorylymphocytes) in blood was significantly lower in HIV-positive patients comparedto HIV-negative ones; drugaddiction andgender do not havea significant effect onthese parameters. Injecting drug use potentiatesthe effects caused by HIV infection: reducedpercentage of T-helpercells (CD4+lymphocytes), number of T-NK-cells(CD3+16+56+ lymphocytes),percentage and absolutecount of NK cells (CD3-16+56+ cells), increasedpercentage of cytotoxicT lymphocytes (CD8+cells), percentageand absolute number of T-lymphocytes with signs of activation(CD3+HLA-DR+ cells).

Injectingdrug use increases therisk of infection inHIV-negative IDUs andreduces the antiviralresponse in HIV-positivepatients, significantly potentiatingeffects of HIVinfection: reduced blood levelof T-helpers, T-NKand NK cells, regulatorycells, immunehyperactivation – allof this may contribute tothe disease progression.

is HIV-positive andHIV-negative injection drug addicts.

– study of social functioning, quality of life and alienation of injection drug addicts with HIV-infection and without HIV-infection with establishment ofinterrelation of factors of clinical and psychosocial characteristics and further development of the evaluation methods of the alienation level and treatment efficacy of injection drug addicts.

While performing the research were studied the regularities of drug addiction spread in the Republic of Belarus, developmentof epidemical HIV-infection process and the state of immune system among injection drug addicts. It is shown, that the spread of drug abuse and HIV-infection is followed by the increase of HIV-positive injection drug addicts, who has shown the symptoms of immune deficiency, which are marked with comorbidity with HIV-infection.

Were developed and clinically tested diagnostic technique of alienation level of injection drug addicts and evaluation method ofefficiency treatment of drug addicts, which distinguishes the main criterion of conducted research and its research and practice importance.

This work focuses on the identification of features that differentiate the onset, course, and complications of alcohol dependence in women and men.

854 people participated in the study: 181 women and 403 men with alcohol dependence (AD) were qualified to the study group. Controls were healthy 100 women and 170 men.

Standardized diagnostic tools were used to assess psychological predispositions and behavioral features. AUDIT, STAI, Anton's OCDS and Lesch's typology (computer version) were used to assess psychopathological symptoms of the addiction. Alcohol biomarker results were a valuable help in the diagnostic process and differential diagnosis. Liver enzyme assays, including GPT, GOT, GGT and CDT, were done. Some genetic polymorphisms were examinesd – DRD2, DAT, 5HTT.

1. 1. Psychological predispositions that determine AD in women include anxiety and depressiveness.

2. 2. Environmental risk factors of alcoholism in women include guardianship in childhood by grandparents and widowhood.

3. 3. Women with AD revealed more health problems associated with markers of liver damage. AD in men progressed at a faster pace, with early onset, greater incidence of psychiatric and neurological complications, coexistence of other addictions, and indicators of personality disorders.

4. 4. While the clinical picture of female alcoholics corresponds to types 2 and 3 according to Lesch, the clinical picture of male alcoholics correlates to types 1 and 4 according to Lesch.

5. 4. No differences were found both in male and female patients with regard to genes polymorphisms in the subtypes of alcoholism according to Lesch.