Irritable Bowel Syndrome (IBS) is one of the common gastrointestinal disorders considered as an psychosomatic disorder. the purpose of this study was to compare behavioral activation system and behavioral inhibition system between patients with irritable bowel syndrome and normal individuals.

In a case-control study, a group of 160 people, 80 IBS patients diagnosed by gastroenterologist selected from two gastroenterology clinics in city of Esfahan; and 80 healthy people (With regard to age, sex and education) filled out brain/behavioral questionnaires of Carver and White.

The ANCOVA analysis has shown that the activity of behavioral inhibition system in IBS patients is significantly higher than the control group. in spite of the high rate of behavioral activation in healthy people, the difference was not significant.

The results has shown that the IBS patients tend to have more negative emotions.

Broken heart syndrome (BHS) is a stress-induced cardiomyopathy. Individuals usually present with a clinical picture that mimics myocardial infarction. in many of these cases the precipitating factor is emotional distress. Commonly consult/liaison psychiatrists are involved in their management.

To examine the current evidence that links BHS with psychiatric disorders.

To familiarize psychiatrists with BHS.

Literature review and case description of a patient with BHS.

Ms C a 31 year old female previously healthy was admitted with severe left ventricular dysfunction.

Psychiatry was consulted since overdose was suspected as the day of her admission was also the 11th anniversary of her brother's death and she had a prior history of depression. After careful evaluation her suicide risk was considered low and psychiatric hospitalization was not pursued. Two weeks later her angiography showed resolution of cardiac dysfunction, no coronary artery disease was identified. A diagnosis of BHS was given.

Ms C had minimal cardiovascular risk factors but significant psychosocial stressors and premorbid psychiatric disorders. Articles linking psychiatric disorders with BHS, include 2 retrospective studies and 10 case reports. A history of anxiety and depressive disorders are prevalent among BHS patients, particularly for postmenopausal females.

Psychiatrists should have a high suspicion for diagnosing anxiety and depressive disorders in patients with left wall myopathy. Aggressive treatment of psychiatric conditions is warranted to prevent recurrence. Particular attention should be paid to elderly females undergoing electroconvulsive therapy that develop acute coronary syndrome.

There have been conflicting findings on the relationship between Thyroid function and psychiatric diagnosis, in particular Mood- and Anxiety-disorders.

Our aims were: to evaluate the incidence of thyroid dysfunctions in a psychiatric sample studying their association with psychiatric diagnosis and, for Bipolar Disorder (BD), to study the association of thyroid disorders with its sub-types, phases and cycling-patterns, weighing up Lithium-therapy effect.

Carrying-out a retrospective analysis (period 2000–2010) we selected 1012 patients admitted to a University Psychiatric-Service who underwent a thyroid-hormones analysis (fT3, fT4, TSH) with or without anti-thyroid-antibodies dosage. Thence we studied the association between these laboratory-values and diagnostic categories, lithium-therapy and subtypes, phases and cycling-patterns of BD.ResultsBoth “hormonal situation” (p < 0.001) and “presence of auto-antibodies” (“Ab+”) (p = 0.001) were associated with “Diagnostic categories”; in particular “hypothyroidism” and “Ab+” were associated with BD and Borderline Personality Disorder (BPD). “Previous lithium-therapy” was associated with “hypothyroidism” (p < 0.001). Multivariate analysis showed BD, BPD and Lithium-therapy to be predictors of “hypothyroidism” and “Ab+”. We found no association between hormonal/autoimmune dysfunctions and subtype, phase or Cycling-pattern of BD.

The most relevant and novel finding of our study is that thyroid dysfunctions are associated with psychiatric disorders characterized by “high affective instability”, such as BD and BPD. Lithium could be a “trigger” of thyroid dysfunction, but it seems to play a collateral role in BD.

Becoming aware of being HCV positive has a very negative impact on quality of life and IFN therapy is also responsible for the development of neuropsychiatric side effects (Pariante 2002).

This prospective study aims to determine the role of IFN in psychopathological symptoms experienced by patients in treatment, in particular it deals with its impact on quality of life and determines which patients can be safely treated with Peg-interferon α, because the therapy is expensive, has significant side effects and prolonged psychiatric that unfortunately cannot be predicted with absolute certainty.

The sample includes 32 patients, including 18 males and 14 females of mean age of 48.19 years (DS. = 9.660) hepatitis C affected, evaluated before the start of peg-interferon antiviral therapy using the interview semi-structured SCID-I and II and self-administered tests Scl90, BDI, SF36 and followed up at first and third months by HAM-a, HAM-D, CGI, YMRS, and sixth months of therapy through Scl90, BDI, SF36, HAM-A, HAM-D, CGI, YMRS.

Although psychiatric disorders worsened or manifested during the peg-interferon α + ribavirin therapy, only 2 out of 32 patients did not come to the end point of our study because of a psychopathological disease. Despite the predominantly psychopathological depressive symptoms and the marked quality of life reduction, with adequate support, even patients predisposed to mood disorders or anxiety, can take the peg-interferon α, and the presence of a life-time psychiatric diagnosis is not an a priori therapy exclusion criterion.

Vestibular disorders can trigger the onset of psychiatric disorders in predisposed individuals: these comorbidities are often underestimated, untreated and may consequently result in chronicization and poor quality of life. there are still few studies concerning the type and the prevalence of psychiatric disorders in patients with benign paroxysmal positional vertigo (BPPV).

To evaluate psychiatric comorbidities, in particular anxiety, depression, somatisation disorder and alexithymia in a group of BPPV, patients compared to healthy subjects.

Case-control study. We compared for psychiatric morbidity 92 BPPV patients and 141 controls (not suffering from BPPV) recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010. Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI) and Toronto Alexithymia Scale (TAS-20) were used to assess psychiatric symptoms.

BDI and STAI scores, BSI subscales for somatization, anxiety and phobic anxiety, DPCR subscales for disease phobia, functional somatic symptoms secondary to a psychiatric disorder and demoralization were significantly different between patients and controls. Conversely, significant differences between the two groups were not found for alexithymia scores.

Affective disorders, such as depression, demoralization, phobia and anxiety, and somatisation appeared to be significantly prevalent in BPPV patients. Contrary to expectations, alexithymia was not found to be more common in these subjects. Further studies are needed, in order to identify psychiatric sufferings at early stages in this population.

The INTERMED method was created to identify patients with multiple care risks, needs and negative health outcomes, in order to assess their biopsychosocial complexity as a first step towards integrated care. Until now, it was based on a face-to-face interview (IM-CAG). Several studies in the last decades have confirmed its face-validity and reliability. A self-assessment version was derived (IM-SA) providing a complementary tool for clinical and research applications.

Preliminary evaluation of IM-SA's predictive validity, in comparison to IM-CAG's.

29 outpatients with liver disorders referred to the consultation-liaison psychiatry service of the Modena University Hospital underwent the protocol of evaluation, including: IM-SA, IM-CAG, CIRS, HADS, SF-36, EuroQol. Clinical and socio-demographic data were also collected for all patients.

Both INTERMED instruments, IM-CAG and IM-SA, were able to identify complex patients (with a total score higher than 21/60) and showed similar correlations to the other measurements (with a mean difference between correlations of 24%). Discrepancies were also suggested by preliminary data, particularly related to the prognostic assessment (“vulnerability”).

Preliminary results suggest that IM-SA is able to predict complexity of health care needs. the IM-SA Study, an European multicentric project supported by the INTERMED Foundation and including different clinical populations, will provide stronger evidence about generalizability of data.

• One in four people who attend hospital for physical health needs will have a mental health problem. the figures for patients over the age of 65 are significantly higher with 60% requiring mental health care during their hospital stay. (No Health without Mental Health, Academy of Medical Royal Colleges 2009).

• Psychiatric co-morbidity affecting older people admitted to general hospitals is an independent predictor of poor outcome, including, increased mortality, length of stay, loss of independent function and discharge to care homes (Royal College of Psychiatrists, 2005).

• To evaluate the quality of delivery of inpatient liaison psychiatry service to Mid Essex Hospitals.

• To examine the referral pattern and reasons for referral.

• To assess the timeliness of response and the effect of the consultation on the duration of stay.

• To introduce measures to ensure better practice in the future.

• All referrals to Old Age liaison psychiatry consultation service from August 2010 to February 2011 were identified from the computer database.

• 50 patients were randomly selected and their medical and psychiatric notes were analysed.

• Information ‘s including Patient demographics, referring team, medical reason for admission, duration of stay, referral reason, clinical diagnosis, medical comorbidities, Psychiatric comorbidities and management by the liaison psychiatry team were collected using an audit tool.

• The results have been collected and is currently being statistically analysed. They would available in the next few weeks.

There was a prospective cohort study in setting of 12 bed surgery intensive care unit in university hospital. Patients were 140 consecutive delirious patients of mean age 68.21 ± 12.07 years. the main outcome measure was duration of SICU delirium. We evaluated time, person, place orientation, situation and aggression at least 6 times a day.

Some of the somatic parameters was measured continually - blood pressure (IBP), heart rate, respiratory rate, peripheral blood oxygen saturation. Other parameters such as body temperature were monitored every 1 – 4 hours. the laboratory blood tests were taken every day, they included: sodium, potassium, chlorides and phosphorus level, urea and creatinine level, hematokryt, red and white blood cell count, CRP, proteins, albumin, laboratory markers of renal and liver dysfunction.

Delirium occurred in 140 of 5642 patients (2.48%). Most subjects with delirium had improvements in delirium following treatment in range of 12 to 240 hours with median of 48 hours and mean 65.61 + 38.09 hours. Statistical analysis shows that hyperactive subtyp of delirium, using of antipsychotics, alcohol abuse anamnesis, low level of potassium, were associated with increased delirium duration. Nevertheless there were statistically significant differences between duration of delirium in patients with and without hypotension and with and without alcohol abuse.

By grant IGA MZ ČR NT11047.

Insomnia, the most common sleep disorder, is 40% more likely to occur in women than in men. However, insomnia often remains unnoticed in general hospitals and only scant data exists regarding insomnia's sex-differences in hospitalized patients.

This study explored in medical inpatients potential sex differences in insomnia and investigated which, if any, self-reported insomnia-related complaints were most sex-differentiated.

Five-hundred patients admitted to medical wards of three general hospitals were randomly selected during 2010–2011. All patients completed the Athens Insomnia Scale (AIS), a standardized self-assessment instrument based on ICD-10 criteria for insomnia. A mixed regression model of ordinal data explored potential sex differences in specific AIS questions.

As expected, total AIS scores, controlled for age, were significantly higher in hospitalized women, which were 1.5 times more likely to score above the AIS cut-off score than men. the statistical analysis indicated significant sex differences in self-reported insomnia complaints. in the entire patient sample, women were generally more likely to complain about frequent awakenings during the night, reduced sleep duration and quality, reduced functioning and well-being during the day and increased sleepiness. the observed sex differences specifically in awakenings during the night, reduced sleep quality and sleepiness during the day were also identified in the sample of patients who screened positively for insomnia.

Women admitted in general hospitals complain heavier than men regarding frequent awakenings during the night, reduced sleep quality and day sleepiness. These findings should be taken into account when assessing insomnia in medical inpatients.

Chronic poor metabolic control of type 2 diabetes is characterized by elevation of plasma homocysteine and there is a evidence of both hypothalamic-pituitary-adrenocortical(HPA) axis and cognitive dysfunction in type 2 diabetes.

Recent research indicates an association between cortizol and homocysteine and psychological factors in diabetes type 2 however the nature of this relationship remains unclear.

The aim of this study was to investigate the association of cortizol and homocysteine with trait and state psychological factors in diabetic patients.

In this study cortizol and homosysteine and psychological data were analyzed from 86 controlled diabetic patients (Glycosylated Haemoglobin HbA1c < 7) and from 45 uncontrolled diabetic patients (HbA1c ≥ 7). Trait psychological characteristics were assessed with the Eysenck Personality Questionnaire (EPQ)and Hostility and Direction of Hostiity Questionnaire(HDHQ) while state psychological characteristics were measured with the Symptom Checklist 90-R (SCL 90-R). Blood samples were taken for measuring cortizol and homocysteine of both subgroups, during the initial phase of the study (T0).

One year later (T1), the uncontrolled diabetic patients were re-evaluated with the use of the same psychometric instruments and with an identical blood analysis.

Uncontrolled diabetic patients type 2 with high levels of cortizol score lower in the extraversion subscale of EPQ. in the controlled diabetic patiens high levels of homocysteine are correlated with high scores in the psychotism subscale of EPQ.

These findings give credence to the idea that cortizol and homocysteine in association with personality traits may be implicated in diabetes type 2.

The major reason for lack of knowledge in outpatient treatment in mental health, is that research on clinical decision making (CDM) in health care has primarily focused upon well-defined situations in physical conditions, while there has not been researched in clinical decision making in people with severe mental illness with its high demands on treatment adherence and therapeutic relationships.

This study is about clinical decision making in outpatient mental health care with specific focus on patients diagnosed with schizophrenia.

To identify the style of decision making between patient and clinician (paternalistic, shared and informed). Investigate the patient's understanding of the decision making and identification of factors leading to this understanding. Furthermore the study will include an analysis of style of decision making as a possible predictor of adherence to treatment.

The study is an open, explorative study using a combination of both qualitative and quantitative methods. the study population consists of severe mentally ill outpatients diagnosed with schizophrenia. Data consist of questionnaires, field observation and patient interviews.

Specifications of primary areas for further improvement in CDM is an expected result of the study. Recommendations will be extracted and formulated from the study data to implement elements of best practice in CDM in the routine care for people with schizophrenia in particular and severe mental illness in general. the explicit focus will contribute to strengthening of the patient perspective.

EEG Biofeedback is a technique that enables the recognition and modification of the bioelectrical activity of the brain which can be used to improve the patient's concentration, control of impulses and reduce disturbance of emotions.

The aim of this research is to show the case of the patient with post-traumatic cerebrasthenia who was treated with a combination of both pharmacotherapy (tianeptine) and neurotherapy using mainly EGG BF in the bilateral module training SMR/beta + beta/delta.

This research is based on a case history of a patient with an implantable cardioverter-difibrillator (ICD) who suffered from blood circulation obstruction caused by catecholaminergic polymorphic ventricular tachycardia. Due to a transient cerebral hypoxia the patient later showed symptoms of posttraumatic cerebrasthenia: problems with concentration, short-term memory and depressive symptoms.

The therapy resulted in increasing of the SMR and beta potential as well as the stabilization of the cognitive dysfunction and emotional disorders.

Biofeedback is a useful and effective technique and can be also used in therapy of the patients with posttraumatic cerebrasthenia.

Multiple Sclerosis (MS) is an inflammatory disease of the central nervous system. the variety and unpredictability of the course of the disease leads to decreased quality of life as well as various psychological reactions, including anxiety disorders and depression.

A 55-years-old women with a 10 years history of MS was admitted to the psychiatric ward with anxiety, unjustified fear of the future, memory deterioration, drowsiness, weeping and debility in pleasure sensation. the patient suffers from paresthesia, has a right side hemiparesis. She walk susing support. Several neuropsychological tests were done. Tests and examination allowed to reach the diagnosis of organic anxiety disorder. the second patient is a 51-years-old male with 25 years history of MS was admitted to the psychiatric ward with low mood, low self-esteem, problems with concentration, loss of interest and pleasure in normally daily activities and weeping for a few years. His main problem were has suicidal thoughts he had for a few years. the patient suffers from stiffness of muscle, sometimes he has a little problems with walking but he moves by yourself. Patient's symptoms indicate depression.

The cases show that MS can have a different course. the first patient has a dominance of motion disorders, while second has a dominance of mental disorders. there also is a serious need in differentiation anxiety disorders with depression. the exact diagnosis allow to deal better with symptoms of MS and get better quality of the patients life.

The aim of this paper is to determine the effect of EEG Biofeedback training in order to improve cognitive functions of patients with organic cognitive disorders confirmed in imaging and psychological studies.

Data used in the paper were collected from patients detailed medical history about laboratory tests, imaging, neurological (including EEG) and psychological. the diagnostic tests have been performed as well as set of psychological tests:

Wechsler Intelligence Tests WAIS - R

Trail-Making Test: TMT A, TMT B

With no negative factors certified, the patient was put in the EEG Biofeedback (Brain Feedback III ver. 10.09 - 3D) training session and then was classified to EEG Biofeedback trainings. the trainings took place 3 times a week (10 sessions for 3 minutes, in the left hemisphere).

In the trainings the focus was on the bioelectric activity of beta and delta waves.

The patient performed 52 out of 60 sessions of EEG Biofeedback.

Throughout the whole training the variations could be observed in the beta wave amplitude, which was connected to the variable patient motivation (decreased motivation after hospitalization).

After the set of psychological tests containing psychoorganic tests no improvement of cognitive functions were observed. This result is negatively correlated with the subjective feeling of the patient.

We conducted a preliminary study, despite the progression of beta waves showed no significant effect after 60 training EEG Biofeedback for improvement in cognitive function. We have obtained preliminary results that will be reviewed after a course of 90 sessions.

Study of prevalence of mental disorders in somatic network with development of complex rehabilitative programs and assessment of their efficacy.

Analyzed material - 3200 patients with mental disorders associated with somatic pathology. We have formed a basic model of psychiatric assistance with distinguishing of basic stages and differentiated medical programs. Assessment of efficacy of therapeutic programs was conducted with use of “Scale of efficacy of therapy of patients with borderline states” (Semke V. Ya., 1981), questionnaires of quality of life - SF-36, economical evaluation.

Clinical-dynamic and pathogenetic assessment of neuro-mental disorders allows developing of specialized psychiatric assistance with account for its stage (diagnostic, treatment, rehabilitative) - six complex differentiated rehabilitative programs adapted for contingent of patients of somatic network (for individuals with neurotic, somatoform, depressive, organic, pathocharacterological disorders and individuals of gerontological age).

Use of differentiated rehabilitative programs under conditions of somatic network allows achieving of recovery in 12,0% of patients, stable clinical improvement 74,7%, reducing of temporary disability as many as 1,8 times, number of unjustified addressing and examinations as many as 2,3 times, improving of indices of quality of life and social functioning.

Persons diagnosed with mental disease have usually inadequate lifestyle, especially sedentary life, lack of physical exercise, cardiac diseases, diets with sugar, lipids, coffee, and also tobacco or drugs abuse (Citrome & Yeomans, 2005; Chuang et al., 2008; Messias & Rondina, 2007). They have also high risk of mortality (Osborn et al., 2006).

To identify the prevalence of cardiovascular risk and others co-morbidities in persons diagnosed with mental illness.

Data were collected by consulting processes of 100 patients of the Department of Psychiatry at Hospital de S. João, Oporto, Portugal, diagnosed with depression (55%), bipolar disorder (14%), and schizophrenia (31%). They were aged between 24–77 years old (M = 48.4), with low education level (30% with 4 years; 39% with 6 years, 7% with high school level), 44% male, 45% workers, 26% un-employers and 30% pensioners.

The results reveal a higher prevalence of cardiovascular risk factors, smoking habits, and obesity compared with the general population. 68% have obesity, 71% smokes, 5% are drug addicted, 5% are alcoholic, 11% are diabetics, 27% are hypertensive, 12% have cardiac disease, 40% have cholesterol, and 94% have at least one cardiac risk factor.

Results highlight the need to develop new strategies to prevent co-morbidities on mental health, helping mentally ill persons to have a better quality of life.

The Lasting Power of Attorney (LPA), under the Mental Capacity Act 2008, came into effect in Singapore on March 2010. as more people become aware of the LPA and the demand for making one rises, it is imperative for healthcare professionals to be knowledgeable about it, in order to provide sound and timely advice to the public.

This study aims to assess the Knowledge, Attitudes and Practices of doctors and medical social workers (MSWs) in Tan Tock Seng Hospital, Singapore, with regards to the making of an LPA.

209 structured questionnaires were distributed and analyzed across seven medical and surgical disciplines between January-April 2011.

Only 8.89% of surgeons, 29.3% of physicians and 29.2% of MSWs have ever encountered an LPA before. 51% of respondents felt that they knew little or nothing at all about the LPA. Only 67% knew the difference between an LPA and an Advanced Medical Directive (AMD). Only 26% were aware of the information sources available for the making of an LPA.

The results of the study revealed limited knowledge and inconsistent attitudes. This resulted in misconceptions, leading to non-standard practices amongst doctors and medical social workers surveyed with regards to the LPA document, in Singapore. It is crucial to address and rectify this deficiency in knowledge. Hopefully in time, this will translate to better practices and the public would be more comfortable approaching their doctors for advice regarding creating a Lasting Power of Attorney for themselves and their loved ones.

Mental capacity is crucial to legal and ethical debates in a psychiatric context. Capacity assessment has become a distinct field of study as it is increasingly important in clinical practice. A patient's decision-making ability regarding their treatment options and management plans are vital in providing the patient with the best possible care.

To evaluate the capacity assessment referrals made to a liaison psychiatry service in a general hospital.

To examine the most common reasons for referral and the most common underlying diagnoses of the patient population for whom capacity evaluations were requested.

A retrospective analysis was undertaken on data collected from referrals to a liaison psychiatry service between May 2011 to July 2011 from medical and surgical teams at a general hospital in Singapore.

A total of 594 patients were referred to the psychiatric service over 3 months, of which 59 (9.93%) were assessments for capacity. the patients ranged from 26 to 91 years of age. of these patients, 17 (28.8%) were female, 42 (71.2%) were male. the mental capacity issues were mainly placement and treatment. Incapacity was mainly associated with delirium and cognitive impairment.

In acutely ill medical inpatients, lack of mental capacity is not uncommon. Specialist liaison teams have an essential role in facilitating management planning for these patients.