Suicide is the most serious complication of mental disorders at all. Prevalence of suicidal risk is estimated in wide range from 5 to 15% according to the diagnostic cathegory. Suicidal behavior in seniors is not a rarity at all - it is existing, serious and usually undiagnosed problem of clinical practice.

The study evaluates the prevalence of suicidal risk in seniors with any mental disorder admitted to psychogeriatric ward and compares the difference between prevalence of suicidal risk in admitted seniors and suicidal risk reported by an outpatient physician who ordered hospitalization.

Descriptive cross-sectional study monitoring suicidal risk in seniors who have been admitted due to any mental disorder to psychogeriatric ward of Mental hospital in Kroměříž. Instruments of evaluation: Neuropsychiatric questionnaire for suicide risk assessment (M.I.N.I.). Medical records reported by outpatient physician who ordered hospitalization.

Suicidal risk was detected in 14.7% of seniors with any mental disorder admitted to psychogeriatric ward when objectively evaluated by Neuropsychiatric questionnaire for suicide risk assessment (M.I.N.I.) - compared to outpatient physician's estimation of suicidal risk which has been reported in 5.9% of these seniors (significant difference at 0.01 p-level).

Suicidal risk in seniors with psychiatric morbidity seems to be underestimated but serious problem in routine clinical practice. Active awareness and better knowledge of suicidal risk in seniors with psychiatric morbidity is recommended to all the physicians.

Coercive measures (mechanical restraint, physical restraint, seclusion, protective beds, unvoluntary application of medication) are used in protection of a patient or his/her surroundings in case of autoagressive or heteroagressive behavior which is resistant to all other therapeutic modalities (Švarc J, 2008).

Our study is mapping the use of coercive measures in women seniors who have been hospitalized in Mental hospital Kroměříž from 2009 to 2011 due to any psychiatric disorder.

Study focuses on clinical reasons for indication of coercive measures and types of coercive measures which have been used.

Retrospective study (2011).

Medical records in written and electronic form.

The most common reason for application of coercive measures is autoagression of the patient (62.2%) followed by heteroagression (31.8%). the most common coercive measure was unvoluntary application of medication (58.9%), followed by mechanical restraint (37.6%), physical restraint (3.5%). No seclusion and no protective beds were used in management of agression in our senior patients.

Coercive measures is the ultimum refugium in management of agression in our patients. When applying them, all the medical, legal, psychological and ethical aspects must be taken into account.

Countertransference encompasses the complex feelings of a psychotherapist toward their patient. It can also be conceptualized as a tool that a psychiatrist can access to assist in the diagnosis and treatment of their patients. as countertransference is very personal and individual to each psychiatrist, its impact on diagnosis, treatment and patient safety is difficult to measure, despite the important role it plays in each patient's care. the case of interest is a 74 year old woman with a past psychiatric history significant for major depressive disorder and attention deficit hyperactivity disorder who initially presented to the outpatient clinic for medication refills of citalopram and methylphenidate and found to have a cognitive disorder.

Behavioral health care professionals will be able to discuss countertransference and its impact on the diagnosis, treatment and safety of geriatric patients. They will also be able to identify and examine the complex factors that contribute to countertransference in treating geriatric psychiatry patients.

Educate behavioral health care providers and stimulate discussion of the occurrence of countertransference and its impact on diagnosis, treatment and safety of geriatric patients.

Use case-based approach and literature review to achieve objectives and aims above.

Countertransference impacts diagnosis, treatment and safety in geriatric patients.

Behavioral health care providers must remain vigilant in self-evaluation and seeking supervision when treating geriatric patients.

The population around the world is getting older making the health of the elderly a meaningful priority. One of the common diseases in this population group is the confusional state.

Determine the contribution of different risk factors (age, injury or cerebrovascular severity, hemoglobin level, weight pathology) to the development of the confusional state in geriatric patients with traumatic injuries and cerebrovascular diseases.

We studied 98 patients with delirium (F05.x.) according to ICD-10 including: 59 with traumatic injuries, 29 with cerebrovascular accidents, 10 with both conditions. Laboratory analysis included blood tests, magnetic resonant tomography, Doppler ultrasound, X-ray. We used Mini-Mental State Examination (MMSE) scale to assess the disorder of cognitive functions, Hachinski Ischemic Score (HIS) scale to evaluate the cerebrovascular pathology, Abbreviated Index Severity (AIS) to measure the severity of injuries, and Body Mass Index (BMI) to determine the weight. We used logistic regression method for statistical analysis.

• 1) In patients with traumatic injuries, the risk of delirium grows with the severity of the injury and weight disorders. Other risk factors include hemoglobin level, vascular factors and increasing age.

• 2) In patients with cerebrovascular accidents, the risk of delirium is determined by the severity of the cerebrovascular insufficiency. Other important factors are weight disorders, increasing age and the hemoglobin level.

Our statistical results show unequal significance of different risk factors in the development of delirium. It allows developing individually oriented strategies for prevention of delirium and care for elderly with various somatic diseases.

A case report of a 55 year old male, previously diagnosed with Parkinson's Disease(PD), presenting cognitive deficit and psychotic features on admission, is presented. Aripiprazole, despite not being first choice for this indication, was the only antipsychtoic drug to improve psychotic symtoms without worsening motor movement and improving cognitive functioning. A literature review on treatment options in PD psychosis is presented.

Describe the triad Parkinson's Disease/Cognitive Decline/Psychosis and review treatment options.

To explain the unique activity of aripirazole in PD Psychosis on the grounds of existing reasearch evidence and neurotransmitter activity.

A case report is described and literature reviewed.

Due to its unique receptor binding profile, specifically on 5HTA1 receptors, M1 receptors and its affinity for D2 receptors, aripiprazole seems a promising drug in the treatment of PD psychosis when cognitive decline is equally present. Future prospective studies are needed to test this hypothesis.

Motor tics are part of Tourette syndrome (TS), which usually develops at childhood. Tic disorders are rarely described in adults.

To report a case of isolated, spontaneous adult-onset motor tics treated successfully with pimozide.

To stress the importance of careful assessment of abnormal movements developed at adulthood.

A sixty-four year old lady presented with a 13-month history of abnormal trunk movements preceded by a feeling of tightness in her shoulders. She had repetitive flexor jerks of the trunk, was able to partially suppress it with a sense of rising inner tension. She presented long-term symptoms of anxiety. There was no family or personal history of psychiatric illness or tics. She had never received any neuroleptic. There were no significant findings on physical, neurological, and mental state examination apart from anxiety and tics. Laboratory, electrophysiological, and brain imaging investigations were within normal limits. with a suspected diagnosis of psychogenic myoclonus, she was taking bromazepam 18 mg daily. She had improved her anxiety symptoms, but the jerks kept worsening and she felt sedated. She was started on pimozide 1.0 mg daily.

Notwithstanding the atypical presentation, it is a case of new onset adult tic disorder. She became virtually free of abnormal movements during the eight-week follow-up.

Tic disorders newly presenting during adulthood have occasionally been described, mostly in relation to another neurological or psychiatric disease. There are few descriptions of idiopathic adult onset tics. Treatment attempts are generally not successful, but this patient improved with pimozide.

Behavioral disorders, such as agitation and disability in daily skills, include symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia. These behavioral disturbances rather than cognitive disorders are the main reason why caregivers place patients in a nursing home.

The participants (103 patients) age 55 years or more had diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to a general medical condition (DSM IV-TR criteria) from the psychogeriatric units of the psychiatric hospital of Attica. They were all assessed using the Neuropsychiatric Inventory (NPI) and Katz Instrumental Activities Scale (KATZ) to evaluate agitation, irritability and daily skills functionality.

Of the sample of 103 Greek long term inpatients, 32% had clinical manifestation of aggression, 43.7% had severe daily skills dysfunction (with KATZ score 1–2), 19.4% moderate (KATZ score 3–4) and 36.9% had no dysfunction. NPI detected agitation in 55.3% of the sample and irritability in 49.5%.

Behavioral disturbances, agitation and disability in daily skills are common among older hospitalized patients, and psychometric scales like NPI and KATZ are valuable instruments that could prove to be an easy way to detect early signs of behavioral manifestations and exacerbation of a variety of mental disorders in elderly populations. They should be implemented in the usual clinical practice.

The acute inpatient ward is regarded as a key component of mental health care in the UK. Recently there has been more focus towards community based treatments leading to a decrease in the numbers of available beds and closing down of in-patient wards. the acute care model of service delivery was implemented in East Cheshire, United Kingdom as a way of delivering modern mental health services in line with the national programme “New Ways of Working”.

The main objective of this study was to look at several key indicators such as the average length of stay, total number of admissions and discharges, total number of incidents and the number of re-admissions.

The aim of this study was to evaluate the effectiveness of a new service model in older peoples in-patient services.

The authors looked at both qualitative and quantitative measures comparing the objectives one year before and after inception of the acute care approach.

Our study shows that the average length of stay of patients has reduced by approximately 7 days with the acute care approach. There was no significant change in the total number of admissions and discharges. There was a significant reduction the total number of incidents across all categories. Results from the qualitative survey are being evaluated currently.

The results will inform and improve further development of in-patient psychiatric services for older adults.

Volunteers polled 250 older people on the topic of abuse; 250 persons of both sexes, age 65 or above participated in the survey.

The survey result that demonstrates that 44% of all the polled people have learned of the existence of abuse. It is also clear that there is a cause for alarm after learning that as high as 32% of older people have been exposed to some form of abuse, with the most frequent form being verbal abuse (11.2%) the polled older people have stressed that they hate being called names, made fun of and called stupid or illiterate. It takes place not just within families but in the general communities too. as for prevention, 52% of the polled older people think that ’everybody‘, meaning both public and civil sector should play a role in prevention.

The problem of abuse of older people has to be approached from a multi-sector and multi-disciplinary perspective. the emphasis should be on new, deeper surveys, education of professionals as well as family members and other care takers.

The old aging has created a higher incidence of dementia. There is a high degree of patient dependency, considering the need of domestic caregivers. We consider the assumption that this new reality is very difficult for the contemporary family group, particularly in managing the patient's body. It can be more psychologically problematic when it occurs to parental figure of the opposite sex of the caregiver - son or daughter.

To interpret the psychological meanings given by son/daughter of parental figure of opposite sex regarding taking care his/her body.

Qualitative method conducting semidirected interviews in-depth.

Two profiles of son/daughter caregivers emerged from the analysis of the set of interviews. A group of caregivers who have demonstrated sufficient psychological resources in their inner world in order to properly manage the physical intimacy of their parents. They seem to use good psychological defense mechanisms such as rationalization. in this case, they seem to put yourself in the position of health professionals. One subject shows this speech: “I left a little the condition of daughter and now I am in the position of a nurse”. Another group of respondents, due to many personal reasons, does not have developed an adequate emotional mechanisms. Faced the tasks of healthcare of their parents, they react with certain feeling of embarrassment and shame.

Health professionals should seek to identify the emotional resources of caregivers of dementia patients to better assess whether these caregivers would be able to perform this role at this time.

Psychotic symptoms are a major source of morbidity in the elderly.

We conducted a study to determine their prevalence and correlates in search of plausible risk factors/prevention.

Determine those objectives in a representative sample of non-demented community-dwelling elderly at the province of Granada, Spain.

A cross-sectional study was performed in a 562 participants sample, aged 60–84 years, without dementia. We determined psychotic symptoms prevalence (SCID-I), quality of life (WHOQOL-OLD), subjective body complaints (GBB-24), perceived social support (MSPSS), anxious-depressive symptoms (HADS) and medication use with validated instruments.

Prevalences: Any psychotic symptom 13%, delusions 11.4% and either auditory or visual hallucinations 5,5%. Both delusions and hallucinations 3.9%.

Women had more psychotic symptoms. Psychotic symptoms correlated negatively with lower quality of life scores (p < 0.002). Psychotic symptoms correlates positively with higher scores in GBB-24 (p < 0.05), depression subscale (p < 0.02) and increased use of drugs (p < 0.024). Delusions correlated positively with higher anxiety subscale scores(p < 0.046).

This is the first specific study developed in a Spanish representative population.

The prevalence of non-demented community-dwelling individuals is slightly higher than expected if compared with other non-demented community-dwelling Europeans. That may be due to hardship conditions in current Spanish elderly up-bringing and over-estimation by SCID instrument which is not specifically designed for elderly subjects.

Psychotic symptoms are associated with female sex, poorer quality of life, higher subjective somatic complaints, medication use and higher anxiety and depression scores.

We thank all the ABUEL STUDY GROUP for their collaboration.

The elderly suicidal rate in Hong Kong is alarmingly high comparing with other western countries. the main caregiver experienced great stress after their old relatives had attempted suicide. Thus, an educational program for caregivers of older patients with history of suicidal ideation or suicidal was conducted in psycho-geriatric ward in Hong Kong.

The study aims to evaluate the effectiveness of an educational program for caregivers of target patients.

1. To assess the care needs of subjects so as to develop and implement an educational program for them.

2. To evaluate the effectiveness of educational program.

8 caregivers of the patient who presented with suicidal idea or attempted suicide before current admission, and were diagnosed depression in study ward were recruited by convenience sampling. According to literature review, an educational program was developed and conducted. the pre-and-post quiz paper of education contents, caregiver strain index (CSI) and evaluation form of program arrangement were used to evaluated the program.

The CSI were significantly dropped in physical and psychological aspects and slightly dropped in future plan adjustment and financial burden. the post quiz scores revealed that most subjects had increased in knowledge about elderly suicide, depression and caring techniques. the evaluation forms results showed all subjects were satisfied with the program arrangement, educational contents and teacher, who was a registered nurse.

The educational program was able to empower the caregivers of depressed elderly and ensure their contingency care in community after discharge.

Objective of the study was to determine attitude of people towards opting a treatment modality for mental illnesses and factors affecting it in Psychiatric Outpatient department at Hamdard University Hospital, Karachi from 1st January 2008 to 31st May 2009.

Patients/caregivers presenting at Psychiatric OPD of Hamdard University Hospital, Karachi from 1st January 2008 to 31st May 2009 were interviewed according to a standard questionnaire. Consent was taken from each and every patient/caregivers. Data was analyzed using SPSS 16 version.

The study comprised 531 patients of which 42.4% were males and 57.6% females. Mean age was found to be 32.1 years (S.D= +/−12.1). Regarding mode of treatment opted first, 64.4% resorted to medical treatments while 28.8% used spiritual forms of treatment. 33.9% patients said that they consulted family physician for their problem first. 37.3% consulted a psychiatrist first followed by 18.7% who consulted various moulvis, Aalims and peers. Other forms of traditional healers consulted include hakims (6.8%) and homeopaths (3.4%). Only 17.1% patients said that they had psychiatric treatment alone. 65.7% thought Rohani ilaaj to be part of religion or both religion and culture. and only 12% thought that Rohani Ilaaj has no role in treatment of mental illnesses.

Strong belief still exists in traditional healing in our society. Although psychiatric treatment is becoming increasingly popular and acceptable, work needs to be done to increase awareness.

Delirium tremens (DT) is a life threatening manifestation of alcohol withdrawal that occurs in about 5% of patients. the presentation of alcohol withdrawal syndrome (AWS) often overlaps with the acute medical problem and compounded by the underlying co-morbidities. Appropriate therapy administered in a timely fashion by clinicians with a high index of suspicion in patients with alcohol dependence can prevent DT.

This retrospective case series was undertaken to understand the clinical features and management decisions of patients presenting with alcohol related disorders (ARD) in Singapore.

To describe the difference in demographics, clinical presentation, co-morbidity, length of stay, management decision (pharmacotherapy administered, psychosocial intervention, resource allocation) and outcome of DT versus mild to moderate AWS.

28 patients with a total of 31 visits were referred to the Department of Psychological Medicine of Tan Tock Seng Hospital from 1 Jan 2011 to 30 Oct 2011 for the management of ARD. These records were obtained from computer generated hospital database for case description.

Majority of patients presenting with ARD are male and of Indian descent. Most have significant concurrent co-morbidity. the mean age of patients who develop DT is higher than those with mild to moderate AWS.

A simple assessment of the patient's acute presentation and past medical illness which may be easily evaluated in clinical settings can allow clinicians to readily identify patients who are at high risk of developing DT and reserve more intensive therapies for the selected cases.