Obesity is a severe global public health problem that increases from year to year. Consequently, the number of bariatric surgeries has grown significantly. Obese seeking surgical treatment have a characteristic psychological profile and a greater incidence of psychiatric disorders. Emotional meaning of bariatric surgery for such patients is not sufficiently known.

To understand the emotional experiences and the expectations of morbidly obese women candidates for bariatric surgery.

Qualitative study. Semi-structured interviews were conducted. Purposeful sampling was closed by the criterion of saturation of information. the corpus was addressed by content analysis. Results are discussed with a psychodynamic theoretical framework.

Women candidates for bariatric surgery have particular emotional experiences. They have magic expectations, believing that weight loss is certain after surgery and that their health, affective, and self-esteem problems will be resolved. They believe in social reinsertion and acceptance without prejudice, and also in improved affective relationships and sexual life. Rational understanding of postoperative difficulties conceals a veiled belief in a magic solution for personal problems. Inability to control amount of food ingested is transferred to an urgency to have surgery, perceived as a pressing need by these women.

Team in charge of preparing patients should be attentive to a strong denial about the difficulties to be faced after surgery. Previous relationship with surgery is marked by an urgency that has the same cause of the yen for food typical of morbid obesity, and the team should be prepared to suggest appropriate moment for surgery.

Eating disorders (ED) like anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) have complex psychopathological manifestation most presumably with a multifactor etiology. Abnormal feeding had long been linked to disruptions in brain dopaminergic activity. in humans, dopamine (DA) release in the dorsal striatum regulates feeding behavior and correlates with the degree of pleasure experienced while eating. Lower availability of DA could contribute to appetite dysregulation, binge eating behavior and lack of pleasure connected with meals. DA is metabolized, amongst others, by catechol-O-methyltransferase (COMT). Previous studies found an association between eating disorders and functional polymorphisms of COMT gene.

To evaluate soluble COMT activity in erythrocytes from patients with anorexia, bulimia and binge eating disorders. Diagnostic was made by a senior psychiatry using the Structured Clinical Interview for DSM-IV Axis I disorders and Eating Disorder Examination Questionnaire.

Erythrocyte COMT activity (in pmol/mg prot/h) is significantly increased in AN and BN patients (35.9±6.8 and 39.8±8.2, respectively) compared to the control group (21.2±3.6). in BED patients, COMT activity was also found higher, but due to a high variation between individual results are not significant (35.2±15.4). An interest result was also found in a group of patients with AN and BN that were being treated with a selective serotonin reuptake inhibitor (SSRI). Unexpectedly these patients presented a COMT activity level similar to the control levels.

Patients with AN and BN present higher soluble COMT activity in erythrocytes. This increase is reversed by treatment and SSRI.

Bulimia nervosa (BN) has been previously associated with impulsivity and a deficit of self-regulatory control. However, the pathophysiological mechanisms underlying such behaviors have not been clarified.

The present study was aimed to investigate, using electrophysiological techniques, whether impulsivity in BN subjects is related to hyperarousal, which might impair inhibitory control.

Event-related potentials were recorded in 17 female patients with BN and 17 matched healthy controls, during a three-tone oddball task. ERP components related to response inhibition, effortful and automatic processing were analyzed. ERP topography and tomography were analyzed by means of brain electrical microstate and LORETA techniques.

With respect to healthy controls, BN patients showed reduced amplitude and shorter latency of the N200; increased amplitude and shorter latency of the target SW; higher activity of the distracter P300 generators in left fronto-parietal-temporal cortex and bilateral cingulate; lower activity of the target SW generators in right frontal gyrus, left parieto-temporal regions, and bilateral cingulate. the electrophysiological abnormalities correlated positively with the BIS scores for impulsiveness.

The observed electrophysiological abnormalities suggest a condition of hyperarousal, with impaired suppression of irrelevant stimuli due to abnormal cortical activation and reduced signal-to-noise ratio. Our findings point to functional abnormalities within a neural system that subserves self-regulatory control and reward, which may contribute to binge-eating and other impulsive behaviors in women with BN.

Taste is a hereditary trait and affects eating and dietary behavior. Nearly 70% of the population is sensitive for 6-n-propylthiouracil (PROP) which is typified as moderately-to-extremely bitter by this population group. It has been hypothesized that PROP-tasters are more sensitive to other bitter tastes, sweet taste and the texture of fats. Recently we could show that food preferences in healthy adolescents are associated with the number of the tongue's taste papillae and the sensitivity for PROP. the impact of PROP status in eating disorders is unknown.

The aim of the present study was to evaluate the food consumption in PROP-tasters and nontasters of remitted female patients with anorexia nervosa (AN).

20 remitted female patients with AN were included and tested for PROP-sensitivity. 10 patients were PROP-nontaster (aged 22,9 ± 3,0 yrs., BMI 20,5 ± 2,0 kg/m2, remission period 6,7 ± 2,9 yrs.) and 10 patients with AN were PROP-taster (24,9 ± 2,9 yrs., BMI 22,3 ± 3,5 kg/m2, remission period 5,3 ± 2,2 yrs.). Taste perception was evaluated using taste strips (sweet, sour, salty, bitter). Food practice and choice were assessed by self-report. Several blood parameters including hormones and leptin were analyzed. for psychological evaluation SIAB-S, EDI-2 and ASR were used.

Remitted PROP-taster with AN consume significantly more often ice cream, dumpling, lemonade, potato chips, candies and sweets.

We hypothesize that PROP status may influence eating behaviour in eating disorders. the sensitivity for PROP possibly improves the course of AN.

Anti-NMDA-receptor encephalitis is a ttreatabel but potentially fatal syndrome that has been recently identified as a neuropsychiatric presentation. We describe the case of a 19 year old woman referred with an acute psychotic presentation that deteriorated to catatonia an other problems requiring intensive care.

To review the presentation of anti-NMDA-receptor encephalitis and its implications in emergency psychiatry.

Case report and review of the literature.

A 19 year old female university student was referred to an acute in-patient psychiatric unit following a 3–4 days history of delusional beliefs with fluctuating episodes of aggression and agitation. She was initially treated with oral quetiapine up to 600 mg daily but became catatonic after few days. She then deteriorated quickly developing hypoventilation and aspiration pneumonia that required admission to a medical intensice care unit and intubation. Anti-NMDA-encephalitis was diagnosed.

Anti-NMDA-receptor encephalitis is a syndrome that can present as an acute psychotic disorder before developing more organif symptoms. Awarenes of the disorder can potentially bring an earlier recognition and treatment and improve outcome. Implications in care models provision are discussed due to the severity of both physical and psychiatric symptoms.

Generalized epilepsy is a chronic disorder characterized by recurrent seizure which can increase the content of reactive oxygen species and super oxide generation in the brain. the aim of the present study was to estimate the plasma level MDA as marker of oxidative stress in patient with epilepsy of in two entirely geographical different regions of Iran, Ardabli (North West) & Alborz (Central).

Thirty epileptics patients from those referred to neurology department with age limitation of 20–50 years(from each mentioned geographical regions as the case group) and sixty normal subjects aged between 20–50 years referred to Blood Donation Organization (as the control group) were involved in the study. MDA Plasma level of the above mentioned groups were determined by spectrophotometric assay.

The analysis of the plasma from epileptics revealed: increased MDA level and in comparison to control persons and these differences were statistically significant. the increased MDA level of Alborz province epileptics was statistically higher than Ardabil.

Our results indicate on the oxidant disturbances in epileptic patients, particularly in larger cities of stressful life which can play an important role in the pathophysiology of epilepsy.

Suggestion: We suggest that further studies should be done on the role of oxidative stress in patients with epilepsy especially socio-economically lager cities.

The psychiatric emergency would be one situation or medical condition that a given moment generates a demand for attention and resolution assistance immediately as requested by the patient, family, other specialists… in the last decade has objectified a change in the profile of patients attending psychiatric emergencies in Spain. Research papers published recently on this subject have an overwhelming agreement to maintain a change in the demand for care at psychiatric emergency units, characterized not only by the increase in these, but also by a series experienced as negative aspects (patients 'frequent repeaters'). (Teijeiro 2003, Centeno 2002, Vila Grifoll 2002).

Measure the importance of psychiatric problems in the emergency services of the CHUA and to describe the characteristics of patients who have access to these emergency services for the purpose of psychiatric treatment.

634 patients (52% females, mean age 35.4 +/-12.8 years) consecutively attended in June and July 2011 in emergency psychiatric service were assessed to sociodemographic variables, diagnosis and treatment plan.

62.4% were referred from primary care, 65.4% were domiciled in Albacete, 42.1% had a psychiatric history. 21.3% not included in DSMIV diagnosis. 9.62% were admitted for observation, 12.61% admitted to an inpatient psychiatric ward. 1.1% came to more than 4 times the psychiatric emergency service. Treatment plan was not significantly related to the sociodemographic variables studied.

An average of 10.39 patients per day is attended in emergency psychiatry CHUA. 1.1% would qualify as “frequent repeaters”

In the last decade has objectified a change in the profile of patients attending psychiatric emergencies in Spain. Research papers published recently on this subject have an overwhelming agreement to maintain a change in the demand for care at psychiatric emergency units, characterized not only by the increase in these, but also by a series experienced as negative aspects: patients 'frequent repeaters', demands urgent assistance is not even considered not as a crisis. (Teijeiro 2003, Centeno 2002, Vila Grifoll 2002)

Measure the importance of psychiatric problems in the emergency services of the CHUA. Describe the characteristics of patients who have access to these emergency services.

634 patients (52% females, mean age 35.4 +/-12.8 years) consecutively attended in June-July 2011 in emergency psychiatric service of CHUA were assessed to sociodemographic variables, diagnosis and the treatment plan.

62.4% were referred from primary care, 65.4% were domiciled in Albacete, 42.1% had a psychiatric history, 70% lived with a partner, 60.2% were being treated with psychotropic drugs. 21.3% received no diagnosis included in DSM-IV. 9.62% were admitted for observation, 12.61 admitted to an inpatient psychiatric ward. 1.1% came to more than 3 times the psychiatric emergency service. the treatment plan was not significantly related to the sociodemographic variables studied.

An average of 10.39 patients per day is attended in emergency psychiatry CHUA. 1.1% would qualify as “frequent repeaters”.

Psychiatric emergencies are usually complex processes rather than discrete events, in which most clinicians have only two tools to deal with: hospital admission or crisis intervention in the emergency department followed by referral to low-intensity outpatient treatment. the triage model for psychiatric emergency services (PES), described by Gerson and Bassuk in the 80s, advocated “rapid evaluation, containment and referral (…), minimizing subtle diagnostic considerations. This model has been replaced by more comprehensive services, capable of providing comprehensive assessment and a broader range of services. This treatment model highlights the importance of establish a diagnosis, even if provisional, that allows a plan for immediate treatment. the literature suggests that reliable diagnostic assessments can be performed in emergency settings.

To evaluate the validity of psychiatric diagnosis made in the PES of an university hospital.

Retrospective study, in which data from all the patients admitted to Psychiatry Service of Coimbra University Hospitals between January and June of 2010, from the emergency department, were analyzed for socio-demographic and clinical characteristics, namely the diagnosis before psychiatric inpatient hospitalization (PES) and at discharge.

From the 4.537 psychiatric episodes observed in the PES during this period, 8.1% where admitted to inpatient treatment. the most frequent diagnostics at admission were Major Depression (17.2%), Affective Disorder (17.1%) and Schizophrenia (13.1%).

Although the study is still running, preliminary results point to a good level of agreement between the diagnostics made in the PES and those established in the inpatient assessment.

Delirium (Del) is an emergency in psychiatry, which can occur after long-term alcohol use (abusus) or after surgical procedures and being fostered by deprivation of interpersonal and social stimulation.

To prove incidence of socio-demographic and psychopathological differences in patients with delirium (alcohol withdrawal-AWDel and postoperative-PODel genesis).

150 subjects with delirium have been divided into two groups: AWDel (N = 75) and PODel (N = 75) and examined in multicentric, longitudinal and prospective study conducted in Bosnia and Herzegovina during the two-year follow-up period (2008 – 2010). Following instruments were used: ICD-10 Criteria, EPQ, BAI, HDRS and MMSE followed with descriptive and analytical statistical processing of patients (α-level: 0.05 with 95% reliability).

Socio-demographic: AWDel patients are unemployed, divorced with abusus of alcoholic drinks, while PODel subjects are the elderly with acute stress. EPQ test in AWDel group indicates pronounced psychoticism opposite to neuroticism in PODel group, while total HDRS and MMSE scores are pathologically significant in group of participants with AWDel.

Sociodemographic differences between alcohol whithdrawal delirium and postoperative delirium vary in duration, age and family status. Also, there are differences in psychopathological characteristics considering the level of cognitive impairment, as well as the diversity of psychopathological characteristics of both types of delirium. Therefore delirious condition in both group require intensive care and multidisciplinary approach.

Violent and agitated behaviour are common causes of admission in a psychiatric emergency center. According to medical literature, these individuals are often patients with serious mental illness.

The authors conducted an observational and retrospective study aiming to characterize individuals who were brought to the psychiatric emergency room presenting disturbed behaviour and aggressiveness.

The authors conducted a survey from computer medical records of 4537 psychiatric emergency events. This number accounts for the total observations occurred in psychiatric emergencies from January 2010 till June 2010. the authors analyzed socio-demographic and emergency episode data (admission motive, patient's diagnosis and orientation). the selected individuals were compared to the remaining patients brought to the psychiatric emergency service. Statistical analysis was performed with SPSS program, chi-square's, Fisher's and Mann-Whitney's tests.

15% of psychiatric emergency patients, were brought by violent and agitated behaviour. Approximately 65% were male. Schizophrenia, delusional disorders and dementias were more associated with violent and agitated behaviour (p < 0.001). 25% of all schizophrenias, 50% of all dementias, 15% of all delusional disorders, 9.5% of all personality disorders,7.5% of all bipolar disorders, 6.4% of all addictions and 1.1% of all anxiety/depressions had violent behaviours. Violent and agitated patients were more frequently admitted to psychiatric nursery and submitted to compulsory admission (p < 0.001).

The majority of patients with violent and agitated behaviours were psychotic males with schizophrenia or dementia. However it is primordial excluding a physical illness causing a confusional state before considering a psychiatric diagnosis.

Psychiatric intensive care units (PICU) are rarely described since it is secluded from external insight. At the same time, it is highly intensive since staff and patients interact around the clock in the most acute phase of psychiatric illness. the PICUs admit patients who are considered extremely unmanageable within psychosis units or acute psychiatric wards, and who often demonstrate aggressive or other forms of severe behaviors.

This raises the question: What is going on in these units and what constitutes nursing care?

Spradley's 12-step ethnographic methodology was applied. Data was collected through more than 200 hours of field work on three PICUs including 16 hours of formal interviewing and numerous of informal interviews; data also consisted of writing memos and field notes. the field work aimed to understand the staff member's way of interact with the patients and what they did to care for these patients who was considered as unmanageable.

The findings presented here describe how and when nursing care is provided in PICUs. the findings are presented in relation to themes, as these emerged within the psychiatric intensive nursing care. Six themes emerged as frames for nursing care: providing surveillance, soothing, being present, trading information, maintaining security and reducing.

These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. as the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest.

Assess current monitoring standards of vital signs, agents in rapid tranquilization, and adverse events related to poor monitoring.

Retrospective audit. 136 Physical restraints reviewed. 92 case notes examined. Gold standard: All physical restraints requiring rapid tranquilization had immediate and regular monitoring every 5 – 10 minutes for the first hour then every 30 minutes for next two hours. in repeat rapid tranquilization, same monitoring standards were examined. Adverse effects or clinical incidents were recorded along with agents used in rapid tranquilization.

Of 92 physical restraints, 62 required rapid tranquilization. of 62 rapid tranquilizations, 12 were repeat rapid tranquilizations. No rapid tranquilizations had adequate monitoring. Adverse events seen in 19% of cases, of these 40% were seen in repeat rapid tranquilization events. the most commonly used agents were a combination of benzodiazepine + antipsychotic (52%). Single agent use was associated with a higher risk of repeat physical restraint and rapid tranquilization (32%) versus combination of agents (18%).

Adequate monitoring of vital signs could have prevented many of the adverse events seen in this audit. Evidence suggests training of staff in both monitoring of patient and the use of de-escalation techniques can sometimes prevent the need for rapid tranquilisation or if required, ensure that it is done so in a safe manner. Recommendations included the proposal of a document for vital sign monitoring along with guidance on managing common adverse events. Training for all staff members,in use of de-escalation techniques, monitoring equipment, resuscitation skills and equipment training.

Neuroleptic malignant syndrome is a rare but potentially life threatening idiosyncratic complication of neuroleptic drugs. Levenson criteria do help guide in diagnosis of NMS and the major manifestations of the syndrome are muscular rigidity, fever, autonomic dysfunction and altered consciousness. NMS mortality is approximately between 10 to 20%.

The authors present and discuss the case of a patient with mental retardation who developed neuroleptic malignant syndrome after receiving haloperidol and zuclopenthixol for agitation.

Supportive therapy including rehydratation, electrolyte restoration, paracetamol, dantrolene and biperideno were given to the patient.

Supportive therapy, dantrolene and biperideno yielded clinical benefits for neuroleptic malignant syndrome. However the patient developed acute hepatic failure probably secondary to dantrolene with need of admission to an intensive gastroenterological care unit, where he stayed for approximately one month.

Although neuroleptic malignant syndrome and acute liver failure due to dantrolene are rare emergencies, the patient presented in this case developed theses two idiosyncratic, rare and potentially fatal reactions due to haloperidol, zuclopenthixol and dantrolene administration. This report clearly represents a successful clinical outcome only possible due to an early diagnosis and prompt treatment interventions.

In psychiatry, the many instruments for assessment are all dependent on collecting information.

Assessments should characterize the patients and less just a product of evaluations. GAF is an assessment instrument known worldwide and rates severity of illness. for GAF, we find problems with reliability, validity, sensitivity and generic properties (Aas 2010; 2011).

To indentify factors concerning collection of information relevant for rating GAF.

Systematic literature review with an encompassing hand search and search in the databases: PubMed, PsycINFO and Google Scholar.

1. (1) Sources of information. Every single source of information can diverge substantially from every other potential source. GAF's anchor points show relevance for all sources of information.

2. (2) Methods for information collection are interviews of patients and informants, self-report version for GAF, reading of medical records, observation and a combination of methods. Research concerning the importance of sources and methods of information collection for scored GAF value is difficult to find.

Rating GAF is open to interpretation of information, subjectivity and synthesis. Differences in information can explain some of the discrepancy in scored GAF values. Use of several sources have the potential to corroborate, complement or correct each other.

Although disasters differ widely, they usually have some common psychological and social consequences. Psychological symptoms can range from mild and transient ones, such as altered behaviour or acute distress, to severe such as major depression and suicidality. Studies following those collective traumatic events have shown reduced levels of Quality of Life (QoL) in the affected populations.

To investigate the QoL in individuals who had experienced severe exposure to a wildfire disaster in a part of Greece three years after the disaster.

A) to examine the QoL of the victims, b) to compare the quality of life of those affected by the disaster (cases) with the quality of life of those who were not (controls) and c) to examine factors which may have a significant effect on the quality of life (psychological factors, losses, and demographics).

A Cross sectional case control study of adult population (18–65 years old). the measured variables were: A) quality of life using the WHOQOL-BREF measure, b) previous psychiatric caseness as identified using the SCL-90-R and c) demographics.

364 participants (184 victims and 180 controls).Victims of the wildfires had a statistically significant poorer quality of life in the three domains of physical health, psychological health, and environment compared to controls. After adjusting for other variables, the only difference between victims and controls was in the environment domain.

Disasters have long lasting effects on victims. Psychological and physical health may improve after some time but environmental quality of life may need longer.