Access to mental health treatment is often negatively impacted by cultural bias. This may relate to non-acceptance of psychiatric diagnoses as true illnesses, perceived shame by patient or family, or even fear of ostracism. As a result, treatable patients remain untreated with unnecessary morbidity, direct costs, indirect costs, and potential mortality. This case addresses depression and overdose in a Chinese patient.

Case analysis with literature review.

20-year-old Chinese single female was admitted for multidrug overdose (zolpidem/acetaminophen/clonazepam). When seen in psychiatric consultation, patient met DSM-IV criteria for Bipolar Disorder NOS, Anxiety Disorder NOS, and Polysubstance Dependence and was upset that overdose was unsuccessful. Patient described how parents were focused on performance success and would not accept her emotionality or depression stating “Depression, failure and suicide are not acceptable in China.” Patient summarized parental response to overdose: “they threw me in the basement with a basin where I kept vomiting for one day…then they thought that it was serious enough. They would come to the basement periodically and ask why I couldn't stop crying. They said it was my fault.” Mother instructed medical team patient needed to “sleep, eat, and exercise” and insisted patient be told she was responsible for hospital bill and her decision. After treatment with N-acetylcysteine, elevated transaminases stabilized and the patient was transferred to an inpatient psychiatric hospital.

Cultural themes focusing on success and lack of acceptance of psychiatric illness can lead to increased morbidity and potential mortality.

eCME aims to create an electronic Continuous Medical Education system to aid the simple and cost-effective transfer of medical skills across Europe by proposing a unified integral panEuropean mechanism of accreditation for CME courses as expertise appears concentrated in a limited numbers of centers of excellence within Europe while researchers in smaller centers have difficulties in accessing information and acquiring the necessary skills.

The eCME project will produce an on-line e-learning pilot in the English and Greek languages, with a multilingual potential, blended with hands-on medical courses, which focuses on the two critical and continuously evolving domains of clinical psychiatry and neuroimaging. This is achieved with the deployment of ICTs in order to develop an advanced, multi-lingual and secure e-learning platform through which CME can be carried out remotely across Europe. eCME incorporates content of a wide variety of multimedia formats taking advantage of the ever-increasing internet bandwidth availability across Europe.

The concept of an electronic CME accreditation tool was acceptable to the Psychiatrists surveyed. The project results are expected to have a significant impact in the established practices of continuing vocational training of medical professionals, enabling them to maintain, develop and increase their knowledge, skills and professional performance, with subsequent benefits to the services they offer to their patients.

A novel electronic CME accreditation system like eCME could represent the means to addressing the European lack of access and thus gap of Psychiatric training.

Little is known about how young medical professionals view euthanasia (EUT) and assisted death activities. The aim of this study is to investigate and to compare Greek final year medical students and medical trainees' attitudes towards EUT and physician-assisted suicide (PAS).

To assess attitudes towards EUT and PAS we translated, adapted and modified, in a short version, the questionnaire developed by Ganzini et al (1996). The Greek version of the questionnaire consisted of 26 items. 251 final year medical students and 274 medical trainees completed the questionnaire. The survey was anonymous.

52% of medical students and 64% of medical trainees were for the acceptance of EUT. The view that PAS may be morally acceptable under some circumstances was endorsed by 76% of the students and by 79% of the trainees. 80% of the students and 81% of the trainees believed that withdrawing life sustaining medical treatments in terminally ill patients should be permitted. 54% and 38% of the students and trainees, respectively, believed that prescribing drugs to relieve pain in doses that may hasten death should be permitted.

A high percentage of the medical students and medical trainees were for the acceptance of EUT and PAS. Given the progress of legalization of EUT in many countries, the need for special education regarding many aspects of EUT is demonstrated.

to prove a choice of the differentiated medicament correction of psychoemotional infringements at the induced pregnancy for complex preventive maintenance of dysadaptation mother-fetus systems.

the research carried out in 2 groups - the basic group -90 patients with induced pregnancy, observed in SCOGP, the control group - 20 urban women with the spontaneously coming pregnancy in I, II, III gestational trimesters. The psycho-diagnostic testing with using of a technique of T. Nemchin, Spilberger's, modified Individual Questionnaire of Bechter's Institute and Minnesota of Multilateral Person Investigation is carried out.

Among the patients with induced pregnancy two groups are selected:

• • first - (57,3%) - with the moderately expressed level of psychological voltage, high jet and personal uneasiness, with sensitive type of attitude to pregnancy, the features of the person which are coming nearer a psychopathic circle;

• • second - (42,7%) - with low levels of psychological voltage, average level jet and personal uneasiness, with a melancholic type of attitude to pregnancy, with astheno-neurosal person reactions.

The interrelation between features of current, outcomes of induced pregnancy and type of psychoemotional infringements are revealed, where frequency and spectrum of obstetrician pathologies at patients of second groups were authentically above (p <0,05), than at patients of first group.

Obtained data prove application of sedative (?agne ?6) and nootrops (EGb 761) preparations for correction of psychoemotional infringements at induced pregnancy for complex preventive maintenance of dysadaptation mother-fetus systems.

This subanalysis of the Switch to Risperidone Microspheres (StoRMi) clinical trial, an international, 6-month, open-label investigation of long-term efficacy and safety of risperidone long-acting injectable (RLAI), focuses on a subset of non-acute schizophrenic adult patients switching from oral or depot conventional antipsychotic.

Efficacy assessments included Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), quality of life, treatment satisfaction, hospitalization rates, and treatment-emergent adverse events (TEAEs).

Patients switching from oral (n=100) or depot (n=565) conventional medication were identified. Total PANSS scores decreased by 15.3 +/- 17.5 (SD) points for patients switching from oral conventional (n=96) and 9.1 +/- 19.5 points for those switching from depot conventional medication (n=550) (P=0.0001 for both). Improvements were noted for patients switching from either oral or depot agents for PANSS subscales, GAF score, quality of life, and hospitalization. Treatment was completed by >70% of patients. About 25% of patients were satisfied with their treatment at baseline compared with about 70% at endpoint after switching to RLAI. Overall RLAI was well tolerated. The most frequent TEAEs (>5%) were: anxiety (11.0%), insomnia (9.0%), weight increase (6.0%), extrapyramidal disorder (5.0%), depression (5.0%) and disease exacerbation (5.0%) for patients switching from oral conventional, and weight increase (6.0%) and disease exacerbation (5.3%) for patients switching from depot conventional medication.

In this open-label study, patients with schizophrenia who were unsatisfactorily treated with oral or depot conventional antipsychotics showed improvement in symptom control, tolerability, and patient satisfaction after switching to RLAI.

To assess the dosing patterns for risperidone long-acting injectable (RLAI) in patients with schizophrenia, participating in the 6-month, open-label Switch to Risperidone Microspheres (StoRMi) trial.

Treatment was initiated at RLAI 25 mg intramuscularly every 2 weeks, although higher (starting) doses were permitted if clinically necessary. Efficacy was evaluated using the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI) and Global assessment of functioning (GAF). Treatment-emergent adverse events (AEs) were monitored.

A total of 1,849 patients were included. The mode dose was 25 mg for 52.9% of patients, the remainder evenly distributed among 37.5 and 50 mg doses. At baseline, patients treated with lower RLAI doses were more likely to be female, have shorter disease duration, milder symptoms, and be using less polypharmacy. The strongest predictors that a patient would remain on 25 mg RLAI were baseline PANSS hallucinatory behaviour item (OR = 0.78), baseline CGI (OR = 0.69), gender (OR = 1.56) and country (P< 0.001 for all). Efficacy measures improved for all dosage groups, with the greatest improvement in patients treated with lower doses. AEs were more frequent in patients treated with 50 mg RLAI (68% vs. 57% with lower doses, P<0.0001). Most AEs were mild to moderate in severity.

In this large, European sample, most patients were treated with 25 mg RLAI. Patients treated with lower doses tended to have milder baseline symptoms. Dosing patterns varied among different countries. RLAI was effective and well tolerated over the full range of allowed doses.

attitudes towards suicide among health science students will influence their future encounter with suicidal patients. The aim of the present study is to describe the attitudes towards suicidal behaviours among medical and nursing students from the University of Oviedo, and to identify the parameters (demographic, personal experiences and believes) that influence such attitudes.

medical (3° and 5° year) and nursing (1° y 2° year) students at the University of Oviedo who attended to class a regular day were asked to participate in the survey. Those who participated filled in the Attitudes Towards Suicide Questionnaire.

a total of 162 students were included in this study. The mean age was 21 years (SD 2.4); 84% were women; 63% had religious believes; 15.6% had had at least once suicidal thoughts or ideas. An empathetic and optimistic view towards suicidal patients appeared to be mostly prevalent among health science students. Age, type of studies, previous information about suicide and history of previous suicidal thoughts influence some of these attitudes.

older, medical students and those who have received specific information about suicidal behaviours have attitudes more determined by a medical perspective. Previous history of suicidal ideation is associated with a more pessimistic view of these behaviours.

Risperidone is the first atypical antipsychotic available in long acting injectable form. To gain clinical experience in our local services, Hollins Park Hospital, UK we designed this study to obtain information regarding its tolerability, efficacy and compliance

Data was collected from 28 patients started on RLAI over a period of one year were: patients' age, sex, diagnosis, previous medication, reason for prescribing, dose started on, side effects and clinical outcome after 6 and 12 months. The clinical outcome was obtained from case note entries and rated as improved, same or deteriorated.

Out of the 35 patients who were considered for RLAI, 28 were commenced, no data was available on 3 subjects. Hence 25 were followed up.

The mean age was 38.84 years, with majority male (72%)and with a diagnosis of Schizophrenia (72%), who received several antipsychotics (mean 4.2). The reasons for prescribing RLAI ranged from non-compliance to polypharmacy.

During the first 6 months they received between 25 to 50mg. Overall 52% of patients discontinued RLAI, the main reasons being patient's unwillingness to continue on RLAI.

At the end of 12 months 10(40%) patients maintained improvement and 2 patients had deteriorated, 3 patients stopped RLAI, 2 of them due to deterioration of mental state. The doses used were mostly 50mg. None of the 9 patients who stayed on RLAI received any further antipsychotic medication.

RLAI was well tolerated and efficacious in 36% (9/25) of our patient cohort over one year period, with no antipsychotic coprescription.

Life style intervention has shown in the general population to influence weight gain and delay metabolic complications.

ENERGIE is a lifestyle program adapted for psychiatric patients. Interactive open group sessions of 1h/week provide information about healthy food and physical activities. Additionally healthy activities are organized. Patients can give their consent for anonymous data collection.

194 patients (56% male) of all age categories have sent their follow up sheet for data entry. The median duration of the program was 80 days (0-223). The majority of patients were treated for psychosis (55%), 23% for mood disorder and 22% for other psychiatric conditions. Most patients were taking an antipsychotic drug (90%), 57% an antidepressant and 29% a mood stabilizer. BMI at baseline was normal in 25%. 33% of the patients showed overweight and 42% obesity. More females then males were obese. 66% of the patients did complete the program and only in 2% interruption was due to dissatisfaction.

Mean weight was 84.4 kg at start of the program and 83.3 kg at the end. 7% had changed BMI category from obese to overweight (from 42% to 35%). Patients (74%) and nurses (50%) judged that it helped in controlling weight.

Lifestyle programs can be adapted for patients with psychiatric disorders and contribute in the short term to control weight.

After the year 2000, external legal and illegal circulatory migration from Romania reached huge proportions. Germany and Austria, France, then Italy and Spain became major destination countries for emigration.

The present study will describe the socio-demographic profile of the migrants who have developed mental illness, discuss the possible implications of migration on the mental health status.

50 patients were assessed by a semi-structured interview investigating the immigration conditions, BPRS.

Most of the patients were young, single, had no previous experience abroad, with few social ties in the host country. Their level of education entitled them for better jobs, but due to the fact that most of them were illegal immigrants with poor language skills, they had to accept lower paid, unqualified and insecure jobs. The most frequent diagnosis indicated the schizophrenia spectrum.

The vulnerability of migrants for mental health problems, especially for schizophrenia is still debated. The patients included in the present study fit the general profile of the emigrant. Discrimination, social isolation, insecurity may increase the risk for mental illness.

QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG) Increased QTd, found in various cardiac diseases, reflects cardiac instability and risk for lethal cardiac arrhythmias. Research suggests a link between psychotropic treatment, ECG abnormalities (QT prolongation) and increased sudden cardiac mortality rates. Reports of sudden death in children treated with psychotropic drugs have raised concerns about cardiovascular monitoring and risk stratification. QTd analysis has not been investigated in very young children treated with antipsychotic drugs. In the present retrospective chart review study we calculated QT interval, QTd and their rate-corrected values in very young children treated with antipsychotics.

The charts of 12 children (aged: 5.8 ± 0.98 years, 4 - girls, 8 - boys) were examined before initiation of antipsychotic treatment [risperidone (n = 7), clotiapine (n = 1) and propericiazine (n = 4)], and during the maintenance period after achieving a positive clinical response. Three children were concomitantly maintained on methylphenidate. QT interval, QTd and their rate-corrected values were calculated.

QT interval, QTd and their rate-corrected values were all within normal values both before and after successful drug treatment.

This preliminary naturalistic small-scale study suggests that antipsychotic treatment, with or without methylphenidate, in very young children is not associated with significant alterations QT interval and dispersion, indicating the safety of these agents in this unique age group.

Acute behavioural disturbance in psychiatric patients often requires urgent treatment. National guidelines in England indicate that olanzapine is a suitable alternative to older antipsychotics due to a beneficial side effect profile.

A retrospective study that looked at the case notes of 32 patients on an acute adult and psychogeriatric ward. Information was gathered on patient gender, diagnosis, incidence of acute behavioural disturbance in the preceding 3 months and the type of medication and route of administration chosen.

Of the patients assessed 56.2% (18/32) were male and 43,8% (14/32) were female.

62.5% (20/32) were aged between 18-65 years and 37.5% (12/32) were aged over 65yrs.

43.8% (14/32) had a diagnosis of schizophrenia and 21.9% (7/32) had a diagnosis of bipolar affective disorder.

Pharmacological intervention for acutely disturbed behaviour was necessary in 46.9%(15/32) of patients. In 86.6% (13/15) of these cases the oral route of administration was chosen. Haloperidol was used in 46.6%(7/15) of cases while the other cases necessitated the use of lorazepam only. Although oral and im preparations of olanzapine were available neither were chosen in any of the above cases. Vital signs were monitored in only 6.6% (1/15).

Surprisingly haloperidol, an older antipsychotic, is still preferred over olanzapine which has fewer extrapyramidal side effects and is widely acknowledged to be effective in the acute setting.

To report a case of status epilepticus in a patient receiving olanzapine, with no previous history of seizure and no confirmed underlying cause for seizure.

A 48-year-old woman with low weight and psychotic disorder not otherwise specified, was admitted because of provoked vomiting and anorexia. She developed generalized tonic-clonic seizures that progressed to status epilepticus during her hospitalization. Two days earlier, treatment switched from mirtazapine 30 mg plus quetiapine to mirtazapine 30 mg plus olanzapine - with quick titration up to 30mg. No other toxic, metabolic, electrolyte or anatomic abnormality was identified. Olanzapine was discontinued and the patient was started on intravenous phenytoin, which was discontinued without complications one month later. The patient remained seizure free.

To our knowledge this is the second case of status epilepticus described that has been associated with the use of olanzapine, in a patient with no other confirmed predisposing factors for seizure. Olanzapine is an atypical antipsychotic that shares many pharmacological properties with clozapine. However, clozapine has been noted to induce dose-dependent seizures in about 10% of patients, whereas manufacturer's trials gave a seizure rate of 0,88% for olanzapine, similar to other antipsychotics. In our patient it is possible that seizures were induced due to the abrupt change in pharmacotherapy and the quick titration to high dose.

Although olanzapine has infrequently been associated with epileptogenic risk, it should be used cautiously especially when other predisposing factors exist.

Depression is the most common mental disease in patients hospitalized with physical illness. Disorders of anxiety and depression in general hospitals are frequently underdiagnosed and inappropriately treated. Our objective was to assess the prevalence of undiagnosed anxiety and depression in surgical inpatients and assess the referral rate and utilization of liaison psychiatry services.

A prospective multi-centre study of surgical admissions (n=96) to two surgical services at two separate institutions between 1/01/05 and 31/12/05. The surgical services included general surgery and cardiothoracic surgery. Data was collected prospectively utilizing the computerized hospital inpatient system (HIS) and supplemented with data from medical records. The Hospital Anxiety and Depression (HAD) scale was used to evaluate all patients in the study cohort. Patients with a documented psychiatric history and established psychiatric diagnosis were excluded.

We had 96 individuals in our patient cohort. The mean age was 59.6 years. There was a slight female predominance with a female: male ratio of 1.18:1. Surgical procedures were performed in 68.75% of our patient cohort. 12.5% of patients were discovered to suffer with significant depression. 18.75% of patients suffered with significant anxiety. 8.3% of patients had significant mixed anxiety and depression. 22.9% of patients warranted referral to liaison psychiatry services for further assessment and management.

Disorders of anxiety and depression are highly prevalent in surgical inpatients. There needs to be an increased awareness of the possibility of undiagnosed psychiatric disorders in such patients along with prompt and appropriate use of liaison psychiatry services.