Psychiatric complications during the course of surgical treatment are well recognized and may include psychosis, depression, mania, disruptive ward behavior or addiction. Postoperative psychosis is associated with increased morbidity and requires acute management. We present a case of paranoid psychosis developed after orthopedic surgery that lasted for 3 months.

A 42-year-old woman without known significant past medical or psychiatric history was submitted to surgical correction of humeral fracture. Three hours after the surgery, she exhibited disruptive behavior associated with auditory and visual hallucinations, paranoid delusions and experiences of self-reference. the patient was acutely treated with haloperidol and diazepam and discharged five days later without psychotic symptoms. Three months after discharge was admitted to a psychiatric unit presenting persecutory delusions and experiences of self-reference. She was treated with paliperidone 9mg/day with good response.

Although the exact cause of postoperative psychosis has not been identified, awareness of this diagnosis and knowledge on its management are critical to provide better care to patients.

Auditory hallucinations in deaf people are known since the XIX century. However, research in this area is scarce.

Auditory hallucinations can be caused by alterations in receptors, stimulus carrying routes or cerebral centres. Therefore, they can take place in persons without mental illness.

Bibliographical review in literature and pub med using as key words: “Auditory hallucinations, Auditory deficit,

ACBS”

1. – There is always chronic hearing loss caused by an auditory injury.

2. – Higher prevalence in females with acute or gradual onset.

3. – Usually unilateral.

4. – Most common phenomena are musical hallucinations.

5. – Not associated with other types of hallucinations.

6. – Can be modified by attention and will.

7. – It is a hallucinosis.

8. – Not accompanied by disturbances of consciousness, memory or judgment.

9. – Treatment of hearing impairment leads to healing. Results are unsatisfactory with psychotropic drugs. Psychoeducation may lead to improvements.

The existence of auditory hallucinations with consciousness of unreality rules out an organic pathology. It is important to assess hearing, because an entity has been defined by musical auditory hallucinations with unreality conscious and with preserved judgment, memory and consciousness, in patients with acquired hearing loss, mainly women and elderly, called by many professionals ACBS. Awareness of this entity by specialists in otolaryngology and psychiatry is essential.

Hypoxic ischemic encephalopathy (HIE) is a condition that occurs when the entire brain is deprived of an adequate oxygen supply, and is often a complication of cardiac arrest or profound hypotension. This can result in poor outcomes including significant impairments in memory, cognition, and attention.

In the context of sparse literature reports on chronic delirum following cardiac arrest related HIE, we report a case of a 59 year old male patient with normal premorbid functioning who developed chronic confusional state following a hypoxic insult to the brain subsequent to cardiac arrest and try to highlight the challenges encountered during his clinical course and management.

This case highlights the presence of chronic delirium following hypoxic ischaemic encephalopathy, an unfortunate consequence of cardiac arrest. It also highlights the problems encountered in managing such patients.

In Belarus in recent years cancer morbidity increased from 402 in 2007 to 413,5 per thousand population in 2010. While oncological help is provided to the patients on a rather high level their psychological needs still remain ignored. Psychiatrists are working with cancer patient only in palliative care department. Provision with psychological and psychotherapeutic help at oncological departments is inadequate. the diagnosis of cancer is considered to be “unspeakable” among most oncologists and depression is considered to be “normal” for cancer patients.

To assess the need of cancer patients in specialized psychiatric help. Objects of the study: Patients (N = 36) of specialized oncologic hospitals, departments of thoracal tumors with established diagnosis of bronchial pulmonary tract cancer.

Clinical interview, Beck Depression Inventory, Freiburg Questionnaire of Coping with Illness.

The mean age of the sample was 62,1 years, two thirds were male. the prevalence of depressive states was the following: 33%- adjustment disorders, 5,5%- major depressive disorder, 13,9% -mild to moderate depressive symptoms. None of them received psychiatric consultation before research. 25% of patients were identified as having no psychiatric disorders. the main coping illness strategy was dissimulating meaning and impact with tendency toward denial of cancer (36%). Most of them didn’t asked doctors about their diagnosis. None of them had major depression. 8,3% of sample used depressive coping with self-pity, the same number used active coping.

Improvement of psychiatric consulting of cancer patients at specialized oncologic hospitals is badly needed.

Chest pain is characteristic symptom associated with serious heart condition. Almost 10% of all cardiographs is negative and do not confirm ischemic heart disease. Except the other organic causes, the atypical pain is often associated with somatization and psychiatry disorders.

The objectives of our study were to explore difference in pain characteristic between coronary patients and those without diagnose of coronary disease and presence of psychiatric syndromes.

We have compared 30 out patients with angina pectoris (C group) to 30 patients with atypical chest pain (A group) and normal results of cardiac examination. the other medical pain causes were also excluded. Applied instruments were: Visual Analog Pain Scale, Questionnaire for affective and sensorial characteristic, M.I.N.I.,for psychiatric diagnose SCL-90-R, for psychological dimensions, Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) for anxiety and depression level.

Atypical chest pain was mild, les intensity than ischemic pain, accompanied with panic affect and sharp sensitive features. there were no difference in other pain characteristics: localization, propagation, duration, between groups. Panic and somatoform disorders were present at A group (23%:0%, p < 0,01), significant somatization was present at A group (50%: 10%, p < 0,01), anxiety level was mild and significant different from C group (20.47 ± 11.93: 9.63 ± 3.86). Depression was not elevated at both groups.

There is slight difference in chest pain expression between coronary and noncoronary patients, presence of associated panic and somatization disorder and elevated somatization and anxiety level, indicates possible psychogenesis.

In Egypt, the total number of persons with diagnosed and undiagnosed Diabetes is expected to increase more than double from 3.80 million to 8.80 million by the year 2025. Compared with the prevalence of depression among normal subjects. These reports indicate that >25% of patients with diabetes reach clinical criteria for depression, a rate far higher than in the general population. the comorbidity of diabetes and depression is associated with adverse diabetic outcomes, compared with nondepressed diabetic patients.

To evaluate the knowledge of family physicians concerning occurrence, early detection and management of depression in type II diabetic patients attending family health centers in Alexandria.

A sample size of approximately 303 adult diabetic cases of type II in the age category of (20–60) years old based on a prevalence of 27% of depression in diabetics, degree of precision of 5% and confidence level of 95%, will be randomly selected from the attendees of the studied family health facilities. Two days of the week will be selected randomly to visit the studied primary health care facilities till the allocated sample size is reachedA self-administered questionnaire was designed for family physicians to assess their knowledge about early detection & management of depression in type II diabetic patients.

Statistical analysis shows poor knowledge about depression among primary health care physicians in Diabetes Mellitus outpatient service.

Depression is a common disorder in chronic hemodialysis.

We intended to determine the positive correlation between depression and quality of life in one year follow up study. Our hypothesis was that quality of life indicators measured by SF 36 questionnaire were directly correlated with depression.

We used SF 36 questionnaire, Beck questionnaire two times, one at the beginning of the year, and one at the end for 102 patients who were undergoing hemodialysis three times a week, for 4 hours in St Joan Emergency Hospital, Bucharest.

The linear correlation between depression at the revaluation and score SF 36 total is very, very weak, square of the coefficient of regression is 0.35 (by the linear model we can explain only 35% of the dates). We followed other models (logaritmic, polinomial, exponential), but we couldn’t notice better correlation results. P value for Wald test (0.000000) proves an influence of the variable depression on SF 36 total. We noticed the same conclusion for the media of depression at the two moments.

Statistical interpretation didn’t prove our hypothesis. From the medical point of view there is an influence of depression on quality of life, but without a linear correlation. It is not clear if depression has a direct causal role in the negative evolution of patients or depression represents a marker of comorbidities or indicator of severity. We have to consider cardiomiopathy, vascular pathology, artropathies in determining the indicators of quality of life.

Mentally ill patients have rates of medical comorbidity and mortality higher than the rest of the population. They require adequate medical care that isn't usually.

Emphasis on physical health problems affecting the mentally ill patients, analyze situations that may motivate and possible solutions.

Bibliographical review in the literature and pub med using key words: “medical comorbidity, severe mental illness, psychopharmacological treatments”

Mentally ill patients have greater medical comorbidity and higher mortality rate than the general population. in patients with schizophrenia life expectancy is 20% lower and mortality risk of 1.5–3 times higher than the rest of population. Affective disorders are associated with a standardized mortality ratio for medical reasons also high. Studies show that excess mortality in patients with severe mental illness is 60% due to natural causes and 40% to unnatural causes (28% suicide and 12% accidents). This increased mortality is mainly due to cardio-respiratory and infectious disease. Low socioeconomic class, lack of social care, poor medical care, bad habits (poor diet, sedentary, toxics) and adverse effects of psychopharmacological treatments are the main factors. Despite this, detection and treatment of physical illness is low. It is estimated that between 30% and 47% of these patients are untreated.

Improved medical care of these patients would improve their performance and quality of life. A system for each type of mental health to screening, assessment, diagnosis and treatment of somatic diseases, and a protocol for referral to appropiate medical/surgical centers are required.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease and it preferably affects more women. the state emotional is obviously an important factor in the quality of life of tem. It is important for health professionals to know how these patients reframe their lives during an asymptomatic period of the disease.

To discuss life experiences of women with SLE in clinical remission of their disease.

Qualitative design conducted with semidirected interviews applied to a intentional sample at a rheumatology outpatient service.

The speech presented in the interviews suggest that these patients experience the clinical remission, as a normality phase for their lives and they may perform any activity, which during the active phase of the disease they could not accomplish, giving thus they feature a cure for the disease: “… I keep doing things, but not as fast as before. What did you do ten things in one day, today I … “while still” Ah! I feel normal! I have no problem with lupus! I do not P'ra difference. Normal! “Yet another”. Today I feel good. But I have a problem! I did everything I ever wanted. (…)”. there is certain difficulty in dealing with the possibility of exacerbating disease at any time.

Patients with SLE have difficulty in dealing with the phase clinical remission of the disease, to the point of use as coping with the disease ‘Denial’. in this case, the denial is suggested when patients discredit the return of specific clinical lupus.

Normally described in settings of neurologic injury, pseudobulbar affect (PBA) is characterized by uncontrollable outbursts of laughing, crying, or both, that are unrelated to, or disproportionate to the subjective emotions felt by the patient. We describe here, a unique case of PBA occurring in the context of chemotherapy use.

To introduce awareness of this possible complication with the use of chemotherapy, and to consider PBA as a differential in the setting of consultation liaison psychiatry.

We describe a 52 year-old Chinese lady, without significant past psychiatric history, who was admitted to our hospital for the initiation of a course of chemotherapy in the treatment of recurrent breast carcinoma. She was referred to the Consultation Liaison Psychiatry team, presenting with episodic emotional lability. the symptoms were observed to last 6 days at the most, and always occurring on the second day post-chemotherapy. the affective dysregulation was out of proportion to her actual reported mood. We will discuss briefly about PBA and review the relevant literature.

After a short regime of benzodiazepines and reassurances given, she completed her planned course of 6 cycles of chemotherapy.

Pseudobulbar affect is known to occur in a variety of diseases of the central nervous system such as multiple sclerosis, cerebral vascular disease, as well as brain tumours. This case illustrates that medications could also cause PBA, albeit a transient course. We advocate further studies to investigate the pharmacodynamics which may be a clue to the mechanisms mediating this difficult condition.

Children being treated on pediatric wards may have co-existing psychiatric disorders that require psychiatric consultation, however, the range of this problem within Polish pediatric population has not been assessed.

The aim of this study is to analyze the reasons for psychiatric consultation in children admitted to pediatric wards of different specialties and to propose a model of application form as a useful tool in everyday clinical practice.

The medical records of 243 patients (164 girls and 79 boys) consulted by psychiatrists working at the Children's and Adolescent's Psychiatry Department at the Children's Hospital in Warsaw between 2007 and 2010 were analyzed. the specialty of the ward which directed the patients, the primary disease and the reason for consultation were analyzed.

The most frequent wards directed patients for consultation were Endocrinology, Nephrology and Out-Patient Department. the most frequent disorders were: substance abuse (21%), suicide attempt (17%), eating disorders (15%), depression (8%) and adaptive disorders (8%). there was no direct connection between the type of disorders and specialty of pediatric department.

The children directed for psychiatric consultation presented a variety of serious disorders but the substance abuse was the most frequent. in children, this type of behavior may be a symptom of other problems requiring further psychiatric consultation and treatment. the symptoms of the most important disorders were included into a new application form which should be available in all children hospitals and fulfilled by pediatricians before psychiatric consultation.

The appearance of psychotic and affective symptoms in the patients treated with steroids has been described in the literature; however, there are limited data on factors affecting development of these disturbances.

38 year-old female with past medical history of depression, long-standing hypothyroidism and adrenal insufficiency on both thyroid and adrenal hormone replacement therapies (RT), was admitted to psychiatric ward due to psychomotor agitation, tangentiality of though and labile affect. the manic episode was diagnosed. the significant hyponatremia was found and corrected. After the reduction of the doses of hormone replacement therapy, and the treatment with valproic acid and haloperidol the manic symptoms were eliminated.

Steroid RT may have a significant effect on the development of psychiatric symptoms in that patients; however, presence of hyponatremia and simultaneous thyroid RT could be important contributing factors. Severity of the symptoms requiring antipsychotic medication did not allow verifying the hypothesis that reduction in the dose of steroids might be only necessary treatment in steroids-induced psychiatric disturbances. However as the only one depressive episode in the past history was connected with the significant adrenal insufficiency with hypothyroidism, the current episode in that patient was diagnosed as mania related to hormonal replacement therapy rather than to bipolar affective disorder. This case points out an increased risk of psychotic disturbances in the course of the treatment with steroids and a need to identify additional risk factors in the past history, somatic state and metabolic abnormalities.

Training in Psychiatry is especially debated since the biological, psychological and social perspectives need to be integrated in the education of Early-Career Psychiatrists (ECP).

To describe the opinion of ECP about the training received and to evaluate their self-confidence in therapeutic interventions.

A training event for ECP from all over Italy takes place in Rome yearly. A 30-item ad hoc questionnaire with both yes/no and rating scale answers has been administered to all the participants in the event.

Over the past three years 224 questionnaires were collected from 216 last-year trainees and 8 recently qualified psychiatrists (68.5% women, mean age 30.5 ± 3.5). Only 13% of participants was globally satisfied with his/her training program in psychiatry, the most of them were only partially or a little satisfied (51.4% and 32.0% respectively). the most critical training areas were Forensic Psychiatry and Psychotherapy followed by Psychiatric Rehabilitation. Conversely, Clinical Psychiatry and Psychopharmacology were the most satisfying areas of training. Likewise, ECP felt themselves most confident in Clinical Psychiatry (87.9%) and Psychopharmacology (48.7%); whereas the most uncomfortable areas were Forensic Psychiatry (62.5%), Child and Adolescent Psychiatry (37.2%), and Dual Diagnosis/Substance-Abuse Related Disorders (33.9%).

The 45% of ECP complained that Psychotherapy is a critical issue. Despite the 46.4% of participants had supervision within the training program (less than two hours per week), the 87.4% seek help from external psychotherapeutic training programs.

To achieve a satisfactory educational standard and an adequate self confidence, network programs (within Italy and/or Europe) might be helpful.

In migrants, alcohol becomes a frequent problem in particular from the age of 50 onwards. Preventive behaviour is influenced by cultural differences in terms of how alcohol consumption is evaluated and dealt with. But migrants are not sufficiently reached by offers of help in combating addiction. Aim of the study was to improve the sensitisation regarding alcohol consumption.

Cluster-randomized controlled multicenter study with immigrants (n = 268) comparing a transcultural prevention measurement (one event and migration sensitive transcultural brochures; TPC) against an usual prevention measurement (event and information brochure; TAU). Main outcomes were attitudes towards alcohol and alcohol consumption after 6 months.

Overall the immigrants accept the transcultural prevention concept better (TPC > TAU; p = .023). Attitudes towards alcohol are more difficult to change. Only regarding talking openly about alcohol problems (TPC > TAU; p = .021) and willingness to seek for help (TPC > TAU; p = .001) we found an effect of the TPC. 6 months after the participants in TPC reduced their alcohol consumption markedly (I drink less/I don't drink at all: TPC 45,9% vs. TAU 16,7%; p = .004).

The consideration of cultural, migration-related and linguistic factors in health care is important to change health related behaviour. Therefore the sensitization of health care providers for transcultural perspectives and diversity is necessary.

Analysis of the health care utilisation of migrants with mental disorders compared to Germans with mental disorders under consideration of migration-related and socio-economic factors.

Reanalysis of the supplement survey “Mental Disorders” of the “German Health Survey” 1998 with a matched sample of migrants (n = 151) and Germans (n = 151) with a positive 12-month prevalence of mental disorders.

Regarding the prevalence rates for mental disorders and health care utilisation no differences in the sample between Germans and migrants could be found.

The migration background alone does not explain the differences in health care utilisation which are found in many studies. It is assumed, that differences arise multifactorial, and can be explained through migration-related factors but especially through socio-economic factors. to provide a better understanding of health care utilisation of migrants it might be necessary to set the focus on socio-economic factors. in addition a differentiated measurement of cultural and migration-related factors is needed in future studies.