Although there is a growing impact of psychiatric disorders and depressive disorders in cancer patients, there is scarce literature on the idiosyncrasies of antidepressants (ADs) used in those conditions and their interactions with antineoplastic agents (ANs). Sharing the same biotransformation roots enhances the risk of drug interaction between ADs e ANs, which specific pharmacokinetic properties are determinant to their nature as inducer, inhibitor or substrate of cytochromes P450 (CYP450). In cancer patient, such drug interactions (DIs) may result in less efficacy of the drug and/or increase their side effects. Therefore, the choice of AD should be cautious (safe and effective) and well supported. The main purpose of this paper is to analyse the individual pharmacokinetic properties of the most used ADs and ANs, in order to summarize the risk of possible DIs between them, anticipating the consequences of their co-administration.

The authors reviewed books, articles and PubMed on line articles, published in the last 6 years.

Most of ANs suffer transformation in CYP450 3A4 and that co-administration of ADs with inhibiting properties of this CYP isoform as fluoxetine, sertraline, paroxetine and fluvoxamine may result in loss of efficacy or higher toxicity and should be used cautiously.

Among the ADs, escitalopran, citalopram, venlafaxine, mirtazapine and milnacipran stood out regarding their weak CYP450 inhibitory potential and safety profile in those patients.

Psychoemotional state of patients receiving anticancer treatment requires doctor's attention in association with larger depth and persistence of formed mental disturbances.

To carry out screening assessment of mental state of patients with head and neck cancers being at various stages of treatment.

Investigated group consisted of 34 patients of Head and Neck Cancers Department (24 men, mean age 52 ± 6,7 and 10 women, mean age 52 ± 6,7). Number of patients having stage I of disease has constituted - 6 persons (17,4%), stage II - 8 persons (23,6 %), stage III - 13 persons (38,3 %) and stage IV - 7 persons (20,7 %). Screening of depressive disorders was conducted with Brief Symptom Inventory-18 (BSI-18).

High general index of psychopathological symptoms (GSI ≥ 0,63) was revealed in 12 persons (35,3%) of investigated group. Also, we observed simultaneous increase of clinically significant indices of anxiety and depression in 19 persons (55, 9%). We have conducted comparison of obtained indices among groups of newly admitted patients (group 1, n = 15) and patients receiving combined treatment associated with relapse of the process (group 2, n = 19). Incidence rate of clinically significant symptoms of depression and anxiety has constituted 23,08 % (n = 3), in group 2 - 76,92% (n = 10) and was reliably higher (p = 0,04730).

Methodological use of specific diagnostic tools gives a possibility of comparison data in various cohorts. Screening assessment of mental state of patients at various stages of treatment allows planning of further therapeutic and rehabilitative tactic.

To assess the quality of life in patients diagnosed with colon malignant tumors and secondary depressive disorders, during medium-term trazodone treatment.

A group of 19 patients, mean age 51.2, diagnosed with malignant colon tumor, were referred for depressive symptoms that negatively influenced their functionality and adherence to oncologic therapy. All these patients were diagnosed with major depressive episode and received trazodone 237.5 mg mean daily dose for 24 week. Patients were evaluated at baseline and every 4 weeks using Hamilton Depression Rating Scale-17 items (HAMD), Global Assessment of Functioning (GAF), Clinical Global Impressions- Severity/Improvement (CGI-S/I) and Quality of Life Inventory (QOLI). A self-rated visual analogic scale (VAS) was used as an instrument for the patient's side effects related discomfort and improvement in the quality of life.

Patients responded well to trazodone therapy, as the final HAMD (−15.2, p < 0.01) and GAF (+22.3, p < 0.01) scores reflected. Reduction of insomnia correlated highly with improvement in life quality (.52), followed by decreased anxiety (.43). Also, GAF and CGI-I scores improved, from mean baseline values of 46.9 and 4.8, to 72.2 and 2.1 respectively. The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+12.3%, +10.2% and +11.5% respectively, p < 0.01). On VAS the self-appreciation of the life quality improvement increased significantly, with 6.2 points.

Treatment of depressive episodes associated with colonic cancer increases patients' life quality and trazodone is an efficient agent for this indication.

The research was conducted on the base of Donetsk Regional Antitumoral Center. By a random selection 450 patients with different cancer localization. For a screening of the depressive disorders we used the Hospital Anxiety and Depression Scale, in the positive case we applied the structured clinical interview with diagnostic criteria of ICD-10.

The depressive disorders were revealed in 217 (48,2%) patients with malignant neoplasms: in 69 (50,7%) patients with gastrointestinal tract oncopathology, 99 (46,0%) patients with oncogynecological and 49 patients (49,5%) with oncourological pathology. The depressive disorders were presented mainly as a reaction to severe stress and adjustment disorders (F43) as the long-term depressive (F 43.21) and the mixed anxious and depressive reactions (F 43.22) and the somatogenic depressive disorders (F 06.32). The depressed mood combines with an anxiety, sleep disturbances, tearfulness and feelings of interminableness and absence of any prospect of existence. The oncologic patients disbelieve in success of antitumoral treatment and convalescence; the circle of interests is sharply narrowed and limited to the oncologic disease alone and its manifestations.

High frequency of nonpsychotic psychic disorders of the predominantly depressive spectrum among the patients suffering from malignant neoplasms determines topicality of organization of renderings specialized help in cancer care facilities.

The United Kingdom Driver and Vehicle Licensing Agency (DVLA)regulations provides guidence to drivers affected of psychiatric conditions and/or taking psychotropic medication. These regulations place the duty in the doctor to inform the patient of the impact of the diagnosis in the ability to drive and to remind them of their responsibility to inform the DVLA. This duty is not clearly spelled for other health professionals. In the United Kingdom, “New Ways of Working” refer to a process of reviewing the traditional roles of doctors and other disciplines with a view of enhancing patient care. Many patients that in the past would have been seen by a doctor may not see one and as a result may not receive advice regarding their fitness to drive.

To explore the knowledge and attitudes of mental health nurses with regard to DVLA fitness to drive regulations.

To identify if New Ways of Working has created a gap in legislation that can put patients and the general public at risk.

A survey was conducted in South Staffordshire amongst psychiatrists and menatl health nurses to compare their knowledge and attitudes towards DVLA regulations.

Although there were difference sin knowledge regarding specific conditions and ability to drive there were also similarities in the reluctance to inform patients as a result of the potential consecuences on the patient or the therapeutic relationship.

The authors beleive that a gap has been identified in the process of informing patients with regards to their driving

Asterix is a famous comic character that has been published extensively and translated to many languages. His popularity gives the books an opportunity to present an attitude towards mental illness to a wide audience, many of whom would be children.

The author reviews 34 Asterix titles available in English and looks for behaviours or descriptions related to mental illness to see how mental illness is portrayed in these books.

The career choices of medical students change often during the course of their training. Recent changes to the UK medical training structure force graduates to specialise earlier in their careers. This would make medical school placements even more important in speciality choice. In the UK psychiatry is one of the most undersubscribed specialities.

There are many possible reasons. However, there are very few areas where the profession can exert any influence. Currently, the only available option seems to be to compete with other specialities for the limited number of medical graduates available for postgraduate training.

To assess the influence of placement experience at medical school on student speciality preference and hence subsequent career choice.

50 medical students from a UK university were asked to rank 8 medical specialities from 1–8 (1 = most preferred, 8= least preferred) before and after placements in those respective specialities. The average ranks before and after placements were then compared.

The average specialty ranks before and after placements were: Speciality (before: after), Dermatology (6.2:6.1), Otolaryngology (4.7:4.6), Geriatrics (5.0:4.8), General Practice (3.4:3.5), Obstetrics and Gynaecology (2.7:2.8), Ophthalmology (5.9:5.9), Paediatrics (3.3:3.2) and Psychiatry (4.8:5.1).

The results show that whilst placements in Geriatrics, Paediatrics and Otolaryngology led to an increases in preference +0.2, +0.1, +0.1 respectively. Psychiatry placement led to a large decrease in preference of −0.3. Therefore, specialities such as psychiatry that find it hard to attract medical graduates may benefit from focussing on improving medical student teaching and experience.

The domain for audit included the following items:

1. 1. Knowledge of the care coordinator

2. 2. Accessibility of the care coordinator

3. 3. Provision of a written care plan in the last year

4. 4. CPA meeting in the last year

5. 5. How well does the care coordinator organise the care and services

6. 6. Whether physical health issues were covered during the regular interviews

7. 7. Whether drug/alcohol issues were covered during interview

The care coordinators were blinded re the service users' responses.

The standard to be attained was placed at 95% positive responses by patients. In terms of staff responses, the standard was set at 100% positive responses. We have set our goal at 95%. It is clear that we have achieved our goal in three of the seven parameters covered.

The results with other parameters were less than identified goal but they were higher than those obtained from the audits done by Oxford Health trust and national NHS surveys.

There is a communication issue which needs signposting: that is evident by the difference between service users responses and their care coordinators.

1. 1. Discussing the results with the CMHT and trying to implement it into quality plan.

2. 2. Discussing ways on improving staff-patient communications.

3. 3. Re-Audit after a period of time to allow time for the changes to occur.

Venous Thrombo-embolism (VTE) can be fatal, and therefore forms a key part of the admission risk assessment. NICE guidelines give a framework for assessment and management of VTE risk, and this has recently been introduced to Oxford Health NHS Foundation Trust.

To investigate whether VTE risk is routinely assessed on admission, with the aim of developing plans around the prevention and management of VTE in inpatients.

All in-patients should have a physical health assessment on admission which should be clearly documented within patient notes and should include documentation of VTE risk.

A cross-sectional audit of all adult and older-adult wards in Oxfordshire and Buckinghamshire, September 2011.

The sample included 133 adult inpatients and 77 older-adult inpatients, across 12 wards. The admission physical health assessment was completed for 90% of general adult patients and 92% of older-adult patients. There was excellent documentation of VTE risk, 59% in general adult wards and 99% in older adult wards.

Rates of completion of VTE risk were good, particularly on older adult wards. The vast majority of patients scored as low risk for VTE. Risk assessments were completed separately to the admission physical health assessment and there needs to be greater consistency of documentation within electronic patient records. New guidelines regarding completion of physical health assessment and VTE risk have now been issued within the Trust; re-audit in 6 months will review whether good practice is maintained and that improvements occur where necessary.

Proper attitudes by medical students can impact on the quality of health care delivered to their patients. Negative attitude toward person with mental illness may form a barrier for patients to receive appropriate care.

The aim of this study is to determine the attitudes of medical students toward mentally ill and to investigate impact of medical education on attitude among medical students.

The study comprised 200 clinical &135 basic science medical students at the medical school of Shiraz university who agreed to participate. Community Attitudes towards the Mentally Ill questionnaire were used to assess attitude toward mental illness The tool focuses on measuring levels of authoritarianism, benevolence, social restrictiveness and community mental health ideology.

There was little difference in attitudes about mental illness Between basic science- and clinical medical student except for restrictiveness (p value< 0.05).This difference also was noted between male and female student with higher restrictiveness in female students . 70% of our student have familiarity with someone who have mental illness . Pearson correlation test show significant correlation between familiarity with mental illness and community ideology sub dimension p value< 0.009.

Our sample overly have positive attitude about mental illness ,but there is no significant positive correlation between years of studying in medical university and attitude about mental illness . Medical school need to develop new curricula to convey scientific information to students and implementing and evaluating suitable programs leading to appropriate attitude development.

Identify the training/ learning needs perceived by Trainees using an online questionnaire developed for the task.

1. • Literature review.

2. • Ethical Approval.

3. • Questionnaire developed, piloted.

4. • Dissemination- of the survey to all trainees with email addresses registered with the College of Psychiatry of Ireland. Anonymised and encrypted survey,

5. • 2009 survey- essentially functioned as pilot for 2010. Trainees were re-surveyed and the second national conference was held. Survey results analysed using surveymonkey tools, Excel and SPSS.

1. Response rates:

   • Survey

   • Response Rate- 2009 - 36%

   • Response Rate 2010 - 42%

2. Demographics of respondents:

   • Basic Specialist trainee response rate: 2009 - 49% 2010 =54.1%.

   • 45.6% of respondents graduated from an Irish medical school;

   • 46.8% from a non- EU medical school, the remainder from EU medical schools.

3. Current perception of training and career advice:

   • 25% of trainees indicated that they received adequate career advice on their training scheme.

4. Training needs trainees wished to cover in a short course/ conference:

   • More than 20 areas of training were identified by trainees

Trainee views of training is increasingly recognised as a significant factor in long term career planning and in career choices.

Cannabis is the most widely used illicit drug and its use is associated with several adverse mental and physical health effects and negative social outcomes. Cannabis has the lowest initiation age of any drug, and earlier use increases risk of adverse effects and later use of hard drugs. Attitudes and perceived risk towards drugs are regarded as strong influences in determining cannabis use.

To investigate the attitudes of Irish adolescents towards the risks associated with cannabis use. To evaluate their awareness of its associations with adverse health and social outcomes.

This was a descriptive, cross-sectional study using a structured, anonymous questionnaire. The study was undertaken in nine public and private secondary schools in Cork City and suburbs. Students aged 15–18 were included.

39.3% of students (n = 199) reported previous cannabis use. There were significantly lower levels of perceived risk of cannabis among those who had used it compared with those who had not for all categories of social, mental and physical health risks (p < 0.01). There was a notable lack of awareness of a potential increased risk of schizophrenia with cannabis use. Frequent cannabis users were significantly less likely to report an association with anxiety, paranoia and schizophrenia. The great majority of teenagers (n = 382; 75.8%) believe that they are not given enough information about cannabis.

Teenage cannabis users perceive low risk associated with its use. Students are uncertain of its mental and other effects, and feel uninformed about its use.

There is little published literature on medical student exchanges in psychiatry.

To use a two-week student exchange between Modena, Italy and Norwich, UK to highlight some of the meaningful differences in psychiatric practice between the centers.

White coats - English doctors in general and especially psychiatrists do not wear white coats; in Italy these are almost always worn. Psychiatric nurses in English hospitals likewise do not wear any uniform.

Locations of services - Italian acute psychiatric wards are sited in general hospitals; in England they are usually in a separate location.

Nursing role - Psychiatric nurses in English hospitals are required to play a significant role in decision making around patient care. For example, nurses make almost all decisions regarding admission to hospital. It is also common for nurses to challenge doctors on decisions regarding patient treatments. The role of nurses in Italy is often not a decision-making one, but rather following doctors' orders and providing information.

Wearing white coats can promote a sense of professionalism and help orient patients in a hospital environment, but without these the ward may look less like a hospital and be more comfortable for patients.

Locating psychiatric wards within general hospitals makes consultation between specialties straightforward and may help reduce stigma, but psychiatry-only hospitals may create opportunities for economic efficiencies and improved facilities.

Enhanced nursing roles may be perceived as a possible threat by psychiatrists, yet may strengthen mental health teams and enhance quality of care.

There is a little of awareness about the existence of different methods for teaching undergraduate psychiatry in European countries.

To compare two methods of teaching psychiatry through a medical student's eyes during a student exchange.

Comparison of personal experience with traditional education at Modena (Modena University, Italy) and experience with Problem Based Learning (PBL) classes and didactic teaching in Norwich (UEA - Norwich,UK).

Group size- The traditional education system prefers lectures: one professor usually teaches more than 100 students. The PBL model assigns one tutor per group of 10 students. Intensity of work during the year - The traditional education system requires efforts to be concentrated on exams since clinical sessions and lessons can be attended passively. The PBL course requires that each student produce written work and teach this to the other group members weekly. Skill development- Facing comprehensive oral exams forces students in traditional education to focus learning sources and time. The PBL approach enhances debating abilities and improves skills in team working.

Professors' role- Traditional education professors are usually highly qualified in their subject. PBL professors do not necessarily have to be specialists in the subject because their role is mostly as supervisors of the peer-group learning process.

Although at the moment there is no evidence that interactive education methods are more effective in changing doctors' performance it is undeniable that PBL based courses offers more experience in teamwork and in working with a wide range of different colleagues.

In primary care, anxiety and depression, often occurring together, are the most prevalent mental disorders in the general population. The National institute for health and clinical excellence (NICE) guidelines on anxiety and depression outline how to manage these mental health disorders in primary and secondary care. In order to manage these patients effectively, good communication between GPs and community mental health teams is a key and that everyone follows the same framework.

To assess appropriateness of GP referrals to community mental health services of patients with anxiety/depression in line with NICE guidelines.

This study looks at the current practice in a town area especially in relation to primary care management of anxiety and depression, specifically looking at stepped care approach of NICE guidelines so that improvements can be made to patients care in the future.

We looked at all GP referrals during the period of June 2008-March 2009 and monitored standard of stepped care approach designed by NICE guidelines for patients suffering from anxiety and depression.

We received in total 204 referrals from GPs and included 64 referrals that mentioned problems such as anxiety and depression. Only half of the referrals followed the steeped care approach recommended by NICE guidelines.

There seemed to be a definite lack of counselling and CBT services for patients falling into the category of mild-moderate anxiety/depression. Not all practices had an internal practice counsellor and even if they did there was often a long waiting list.

Service users and carers have a vast amount of expertise and experience which is a valuable but largely, under-utilised resource in training of mental health professionals. This teaching programme was aimed at junior psychiatric trainees and enabled users and carers to be actively involved in training.

We aimed to gauge the feasibility of integrating service user led training into routine curriculum by designing and implementing a pilot programme. The objectives were:

1. 1. To identify a group of service users and carers who were willing and able to participate in teaching.

2. 2. To design and implement a teaching programme which would provide an opportunity to the trainees to understand the perceptions of service users/carers and to improve clinical interview techniques.

3. 3. To obtain and provide feedback to the medical education committee about whether such a programme could be incorporated into routine training.

User and carer workshops were organised to mutually agree on the contents of the teaching programme. Formal and informal feedback was collected from both the trainers and trainees at various stages in the process.

The service users/carers were appreciative of the pilot programme and recommended that this programme should continue as it helps improve doctor-patient relationship. Most trainees felt that, along with improving their own communication skills, they now better understood the significance of empathy in a psychiatric consultation.

Detailed planning was crucial for deciding the course content, recruiting participants and ensuring the smooth running of the programme.

The relationship between epilepsy and psychiatric illness are well documented, as epilepsy patients have a high prevalence of psychiatric disorders, including psychosis. This linkage may be reflected in various ways, as shared pathophisiological mechanisms, genetic, psychosocial and iatrogenic factors.

The authors report a case study in which they describe a young adult with an epilepsy resistant to treatment that developed a psychosis episode, questioning the possible underlying causes and mechanisms. A review of literature concerning the comorbidity between epilepsy and psychosis is taken.

A case report is presented in sequential detail and a literature review of the theme is shortly surveyed.

The case report is about a 31 years old young man who have been referred to psychiatric yard with initial delusions of reference that later evolved to grandiose and religious delusions with the changing in the antiepileptic treatment. He also presented aggressiveness and impairment in his daily activities and functioning, worsening his epileptic clinical picture. The literature points out the role of generalized epilepsy, intellectual function and family history as factors that may contribute to development of psychosis in epileptic patients, particularly in the case of the temporal lobe epilepsy.

The treatment in epilepsy goes far beyond seizures control, once the psychiatric comorbidity may appear any time during the evolution and create great clinical impact. Clinicians should be aware of psychiatric symptoms in order to optimize care and treatment.

Because it has clinical, ethical and legal implications.

The current practice including teaching new doctors at induction.

To compare the two audits which are done three months apart after first audit was presented.

Capacity assessment forms were checked from the inpatients ‘notes from three general adult wards and one old age ward (Functional ward) at local psychiatric Hospital.• First audit was carried out in August 2010 and second audit was in November 2010. • Data gathered was reviewed and results of two audits were compared.

Among 66 inpatients in August 2010, 50 patients were General Adults and 16 were Old Aged Patients. 64 ((97%) completed the capacity assessment forms.In second audit in November 2010, 46 General Adults patients and 20 Old Aged patients made up the total 66 inpatients. All patients completed capacity assessment form.

The second audit revealed that 100% of total inpatients completed capacity assessment compared to 97% in first audit. The difference between the results of two audits was not significant. However assessment of patient capacity to consent to treatment is a fundamental component of shared psychiatrist-patient decision making. In addition, when the Care Quality Commission comes to check quality service of our psychiatric Hospital they expect 100% capacity assessment to consent to treatment for inpatients. Participation of mental capacity assessment at induction lecture to new doctors are effective. However regular audit and presentation may be able to meet the 100% target.