Alcohol dependency can cause serious complications if not managed appropriately.

To evaluate if the local guidelines (based on NICE) for the management of acute withdrawal are followed at the Bede Unit/South Tyneside. These advises a three day course of intramuscular Pabrinex and seven days reducing regime of benzodiazepine (commonly Chlordiazepoxide) with additional PRN (as required) benzodiazepine.

The project's main objective is to identify how the guidelines can be delivered more effectively.

Retrospective data collection from all kardex for all patients (21 identified) who received a reducing regime of benzodiazepines between Oct/11 & Jan/12, for alcohol withdrawal symptoms, examining if they were prescribed bezodiazepines regularly, ‘as required’ or both to treat withdrawal symptoms. Vitamin supplementation as part of their management of alcohol withdrawal was also reviewed.

All patients were prescribed chlordiazepoxide. Seventeen of these were prescribed both regular and PRN chlordiazepoxide, while one received regular only and three patients received PRN only. Period of treatment ranged from 2-11. Five received the recommended seven days reducing regimen.

Only one patient was managed in accordance with local guidelines (three days of intramuscular Pabrinex/seven days reducing chlordiazepoxide/PRN benzodiazepine)

There was inconsistency in the use of PRN benzodiazepine.

There might be doubts about patients’ knowledge regarding as required medication, and on how withdrawal symptoms are monitored.

The reducing regime of benzodiazepines is limited to the format of the kardex, which made it difficult to identify drug errors or omissions and hence increased the margin for medication errors.

There are few studies in the international and national literature exploring the association between parental rearing styles, eating habits/behaviours and symptoms of Eating Disorders (ED).

To examine the associations between the dimensions of Parental Rearing Style Questionnaire for Adolescents (EMBU-A), the dimensions of a test assessing eating disorders symptoms (Eating Attitudes Test-25/EAT-25), Body Mass Index (BMI), items assessing eating habits/behaviors and sociodemographic family and health variables; to explore which are the predictors of symptoms of eating disorders and eating habits/behaviours.

402 adolescents (girls: n = 241, 60%) between 12 and 18 years old (M = 14,2, SD = 1,62) answered a sociodemographic questionnaire, the EMBU-A and the EAT-25.

We found a negative association between Emotional Support (EMBU-A), all the EAT-25 dimensions and EAT-25 total score. There was, generally, a positive association between the Overprotection and Rejection dimensions (EMBU-A) and the same results of the EAT-25. Sports’ practice was associated with a higher mean score of Motivation for Thinness and the total score of the EAT-25. In the predictive analyses, Emotional Support showed to decrease the likelihood of adolescents manifesting ED symptoms and Rejection to increase that likelihood.

Emotional Support seems to be protective of ED symptoms and dysfunctional eating habits/behaviors appearance in adolescents, while Rejection appears to increase the risk of these two outcomes. These dimensions should be worked together with parents, eventually, by psicoeducational programs. At schools and health centers, programs can be implemented to improve eating habits/behaviors and help prevent ED development

Depression is a common, recurrent, often underdiagnosed and undertreated disorder in older people. 10-15% of the elderly present depressive symptoms and 3% of that same population meet criteria for a major depressive episode.

Several factors, such as psychosocial changes, may be related to the onset of depressive episodes. Retirement (often accompanied with feelings of loss of status, both in the family and in the society), the decrease of social contacts with a tendency to isolation, and the difficulties to adapt to new activities and routines, all lead to feelings of inadequacy, worthlessness and a poor self-esteem.

The aim of this poster is to show and discuss the importance in recognizing some psychosocial factors that can predict the onset of depressive symptoms in the elderly.

We report a case of a 66-year-old man, without previous psychiatric history, who presented a major depressive episode with psychotic features, after an important life event (retirement).

Depression in older people has severe consequences, afflicting not only patients but also the caregivers. The amplification of previous disabilities associated with medical and cognitive disorders, the increased rate of mortality by suicide and the increased costs to the health care system are common consequences.

To reduce such threats we propose a clinical and social approach that evaluates and regards the different stages of the life cycle and valorize the achieved experiences of older patients.

Subclinical hypothyroidism (SCH) occurs in 4-20% of adult population, elderly subjects have the higher prevalence. Although the impacts of overt hypothyroidism on metabolic and neuropsychiatric functions are relatively well documented the effects of SCH remain controversial. Several studies have reported that SCH was associated with increase of metabolic diseases and neuropsychiatric disorders.

The purpose of this work is to report a clinical case of coexisting dementia and subclinical hypothyroidism.

Descriptive analysis of a clinical case supported on the review of literature.

The authors describe a case of an 82 year old man with an established dementia, in the three weeks before hospitalization developed a clinical presentation with increasing agitation, aggression, behavioural disorders, impaired memory and insomnia. He had several co-morbid medical conditions, including atrial fibrillation, hypertension and dyslipidemia, with treatment.

For an accurate diagnosis is important to exclude organic pathology. The elderly patients have generally been reported to have associated multiple co-morbidities and polimedications with serious implications in psychotropic medications. This overlap with other diseases is an important confounding factor in the older population. Management of these patients presents a continuous challenge in the context of a General Hospital.

Pregnancy and postpartum are periods of increased vulnerability for psychiatric disorders, such as mood disorders, anxiety and psychotic disorders, that, when left untreated, imply serious consequences for the pregnant and the fetus. Since 1995, the Psychiatric Liaison Consultation in Bissaya Barreto Maternity (MBB) is part of the Early Intervention Unit (UIP), which consists of a multidisciplinary team that ensures a specific intervention in pregnant and postpartum women with psychiatric illness.

The purpose of this study was to evaluate the effects of prenatal exposure to psychiatric medication on obstetrical and neonatal outcomes.

The authors conducted a case-control study to compare obstetric and neonatal outcomes among pregnant women exposed to psychotropic drugs (antidepressants, antipsychotics, mood stabilizers and benzodiazepines), observed at the Psychiatry - Obstetric Consultation (n= 69), with those of women followed at the Obstetric Consultation, without psychopathology during pregnancy, who were not exposed to psychiatric medication (n=69). The study was performed during a period of six months (October 2011 - March 2012).

The results were analyzed using the Statistical Package for the Social Sciences - SPSS (19th version).

Preliminary results show that obstetrical and neonatal outcomes in the group exposed to psychiatric medication are, at least, as good as in the control group, supporting that the use of psychotropic drugs during pregnancy is safe, as long as used with caution. Early psychiatric intervention during pregnancy, in conjunction with obstetrics, seems to be the best way to follow up pregnant women with mental illness.

Altered levels of phenylalanine and its metabolites in blood and cerebrospinal fluid have previously been reported in schizophrenia. This study attempted to examine whether phenylalanine kinetics is altered in schizophrenia using the 13C-phenylalanine breath test (13C-PBT).

Subjects were 20 patients with schizophrenia and the same number of controls. 13C-phenylalanine was administered and then 13CO2 concentration in breath was monitored for 120 minutes. The Δ 13CO2 at each collecting time, the maximal Δ 13CO2 (Cmax), the time to reach Cmax (Tmax), the area under the curve of time course of Δ13CO2 (AUC), the cumulative recovery rate (CRR) at each collecting time of the 13C-PBT were calculated for each subject.

Body weight (BW) and diagnostic status were significant predictors for Cmax. BW, age and diagnostic status were significant predictors for AUC and CRR at 120 minutes (CRR0-120). A repeated measures ANCOVA controlling for age and BW revealed a different pattern of change in CRR over time between the patients and controls and that Δ13CO2 in schizophrenia were lower than that in healthy control at all sampling point during 120 min, with an overall significant differences between healthy control and schizophrenia. The ANCOVA controlling for age and BW, showed that Cmax, AUC and CRR0-120 were significantly lower in schizophrenics than in controls.

Our data indicate the different change of Δ13CO2 and CRR over time and the decreased Cmax, AUC and CRR0-120 of 13C-PBT in schizophrenia patients compared to healthy controls, suggesting the altered phenylalanine kinetics in schizophrenia.

Many of patients suffering with psychiatric disorder describe significant stressful experiences from childhood. Many of them suffer as children with unsatisfactory fulfilled basic child's needs, such as security, acceptance or approbation.

We describe approach in processing these painful events during the therapy. Among basic principles in the treatment of the patients who developed psychiatric disorder and have stressful events in childhood or adolescence belongs the creation of collaborative therapeutic relation, explanation and psychoeducation what happens with the patient and reducing or correct stigmatization and guilt feelings. Therapist helps the patient to understand, how symptoms connected with the events from childhood and how they are interconnected with actual problems in life. The transcription of traumatic or stressful events follows after cognitive restructuralization of core schemas and conditional assumptions. Therapeutic process can be divided into of several steps:

1. (a) creation of therapeutic atmospheres (with feelings of security and control, acceptance, approbation);

2. (b) exposition to the painful memories in imagination;

3. (c) expression of negative emotion to the aggressors, or persons that the didn’t guard against stress or trauma;

4. (d) formulation the needs of the child to significant adult person;

5. (e) experience better end in imagination - transcription of the story;

6. (f) general calm down.

The aim of therapist is to help the patient memorizing the stressful events and expressing affective experience and then help him/her to rescript experience to less painful.

There are some case examples of traumatic rescription in the article.

MZ CR NT 11047-4/2010.

In the past, the first goal of schizophrenia treatment was to reduce psychotic symptoms, mainly positive symptoms. Recently, as a result of an emphasis on patient needs, the concept of quality of life (QoL) has been brought into the treatment. The goal has therefore changed from the alleviation of symptoms to improvement of the patient's satisfaction with social activities. Self-evaluations by people with schizophrenia were previously thought to lack reliability because of the presence of psychopathological symptoms and poor awareness of the disease. Recently the importance of evaluating the satisfaction of patients themselves, however, has been recognized in schizophrenia. Studies on this field showed us, that QoL data from patients with chronic mental illness were reliable and concluded that subjective QoL evaluation was applicable to such patients.

The purpose of the present study was to compare the QoL in patients suffering from schizophrenia in clinical remission with healthy controls and examine the extent of the effects of subjective cognitive functioning on QoL in these patients.

Data were obtained using the quality of life questionnaire (Quality of Life Enjoyment and Satisfaction - Q-LES-Q), and subjective questionnaire for cognitive dysfunction (Cognitive Failures Questionnaire - CFQ) for 40 schizophrenia patients in clinical remission and 40 healthy controls.

Cognitive function correlates negatively with subjective QoL in patients with schizophrenia.

Supported by grant IGA MZ ČR NT11047.

Executive functions (EF) are associated to frontal lobes and cognitive decline (CD) with worse results on EF tests.

Analyze if the Frontal Assessment Battery/FAB assessing EF discriminates elders with CD (vs. with no CD; Montreal Cognitive Assessment/MoCA), and if the results obtained with the Rey Osterreith Complex Figure Test/ROCF (copy's quality, immediate, and delayed memory) are associated with the CD presence/absence. Moreover, we wanted to assess if copy's quality and 3 minutes memory test are associated with FAB results, since these two tests are supposedly associated with EF and with frontal lobes assessed by the FAB, contrarily to the 20 minutes memory (supposedly related to the temporal area).

556 institutionalized elders (age: M ± SD =80.2 ± 5.23; range=60-100) filled in voluntarily a sociodemographic questionnaire, ROCF, MoCA and FAB.

FAB and all ROCF tests were associated with the absence/presence of CD. Regarding variables stratified by age and education, FAB was associated with immediate memory but not with copy's quality nor with delayed memory. With no stratified ROCF and FAB, correlations confirmed the previous associations, but also between FAB and copy's quality.

Results follow the literature regarding the association between immediate memory and EF (associated to frontal lobes), in contrast to the long-term memory which is associated with the temporal area and that was not associated with FAB. Results concerning copy's quality (ROCF) are not consensual.

The literature recognizes differences in the prevalence, eating disorders (ED) symptoms and eating habits/behaviours by sex, but few studies in Portugal considered this subject.

To explore associations between sex, Body Mass Index (BMI), Eating Attitudes Test-25 (EAT-25) dimensions and items, the EAT-25 score dichotomized by the cutoff of 19 (a score equal/above 19 indicates “possible” ED) and, finally, some items about eating habits/behaviors; to verify possible associations between sociodemographic variables and items assessing eating habits/behaviours.

308 adolescents (M = 14,5 years; DP = 1,67; girls, n = 184, 59,7%) answered a sociodemographic questionnaire and the EAT-25.

There were no significant associations between sex, categorized and dimensional BMI, EAT-25 dimensions, categorized EAT-25 (cutoff of 19) and items assessing eating habits/behaviors. However, some items of the EAT-25 revealed a significant association with sex. Most adolescents from both sexes presented a score below the cutoff of 19. The frequency with which young people drink sodas and eat vegetables is associated with father's educational level. The frequency with which adolescents eat vegetables and fast food is associated with the school area they attend.

Eating habits/behaviours are not as much negative as documented in some literature. There does not seem to exist significant sex differences regarding eating attitudes, “possible” ED, BMI and eating habits/behaviours. However, there are sex differences regarding some of the specific symptoms of EAT-25. It is good to verify that both sexes reveal a low prevalence of “possible” eating behaviour disorder, although girls reveal a higher value.

The purpose of writing letters is to experience and to understand their own feelings, to cope with strong emotional experiences, which are related to the injuries in the childhood. We present specific examples of the letters from our patients in last 15 years of our experience, when this technique is mainly used in patients with personality disorders, affective and anxiety disorders in the therapy and also using internet.

The result is a profound change in beliefs about themselves and others. The basic types of therapeutic letters are these four: not censured letter, emphatic letter from the “other side”, the letter to the “inner child” of the significant person and the letter “visit-card”. In not censured letter the patients primarily reflect the negative feelings that hurt them in childhood. The emphatic letter from the “other side” is the ideal answer the patients would have wanted to get away from the significant person; patients formulate the particular wishes and expectations, which meet in a fictional response (encouraging selfconfidence, assurance of love, respect). The “visit-card” letter is the censured letter in “adult to adult” mode, written with respect for oneself and significant person, directed towards reconciliation. Fonetický přepis

MZ CR NT 11047-4/2010.

Differences in eating habits/behaviours and eating disorders (ED) symptoms in adolescents from rural and urban schools has not been very considered, particularly in Portugal.

explore differences between students who attend rural and urban schools in eating habits/behaviors and ED symptoms; verify if there are differences regarding Body Mass Index (BMI) by school area.

282 adolescents students (mean age = 14,5; SD = 1,69; variation = 12-18 years old; urban subsample = 126, 44,7%), studying in two schools, one from an urban area and another from a rural area answered sociodemographic questions, eating habits/behaviours items and EAT-25 (Eating Attitudes Test-25).

Most of the adolescents from both schools have breakfast and drink milk daily. Moreover, they eat vegetables and fruits daily or weekly and only rarely fast-food. Adolescents that practice a sport eat more fruits/vegetables. Adolescents attending a rural school ingest more vegetables and less fast-food. ED symptoms (EAT-25) present a lower prevalence, comparing to a young adults sample. There were no significant differences in all the EAT-25 dimensions, EAT total score and BMI by school area.

Eating habits/behaviours seem to be positive in both schools (e.g. most adolescents have breakfast daily). There were only some small differences between the two schools in particular eating habits but adolescents from the two areas do not seem to differ in ED symptoms and BMI, which is not in accordance with the literature that tends to signal urban areas as a “risk factor” for dysfunctional eating behaviors.

Positron emission tomography (PET) detects indirect signs of higher or Loir neuronal activity and we suppose relation between the activity and the brain fiction. Though the anxiety disorders have many common characteristics, but there are also some differences. In our work we compare silent regional brain requirements in some anxiety disorders.

Patients suffering from anxiety disorders were studied with 18FGD PET during rating state before systematic treatment. We studied 25 patients with agoraphobia, 21 with panic disorder, 40 with OCD and eleven with PTSD. Data were analyzed using SPM 99.

There was higher uptake of FDG in patients suffering with OCD compared with PD and AP patients in left side basal ganglia. There was also higher uptake of FDG in patients with PD and AP compared with OCD in right frontal areas. The patients with OCD developer higher uptake compared with PTSD in middle temporal gyrus bilaterally. PTSD patients showed higher uptake of FDG in comparison of OCD in right anterior cingulate. There was higher uptake of FDG in PD an AP patients in comparison with PTSD patients in right inferior temporal gyrus.

There were differences in regional brain activities in FDG between various types of anxiety disorders.

MZ CR NT 11047-4/2010.

In comparison with postnatal depressive symptoms, few studies considered antenatal depressive symptoms risk factors/correlates.

In a multidimensional work our aim was to explore the associations/predictive role of lifetime and current pregnancy variables for antenatal depressive symptoms.

Two hundred and thirty six women (M = 30.5; SD =4.02; variation = 19-41), at the third pregnancy trimester were interviewed with the DIGS/OPCRIT (to make lifetime/current depression diagnoses) and answered a booklet about sociodemographic variables, lifetime/current insomnia, current stress perception, perception of being an anxious person, gynecological variables, past health perception and pregnancy health problems, among others. They filled in the Profile of Mood States to assess anxious symptoms, Negative and Positive affect and the Postpartum Depression Screening Scale (PDSS) to assess antenatal depressive symptoms at pregnancy. Women with a depression diagnosis (DSM-IV/ICD-10, n =5) and on sleep medication at pregnancy were excluded from the analyses.

We found significant associations between antenatal depressive symptoms (PDSS total score), current job situation, perception of being an anxious person, lifetime history of depression (DSM-IV/ICD-10), past health perception, health problems at current pregnancy, stress perception at pregnancy, lifetime and current insomnia, anxious symptoms at pregnancy, Negative and Positive affect. In an hierarquical multiple regression past health perception, negative affect, positive affect and current insomnia were significant predictors of antenatal depressive symptoms.

Past health perception, negative affect (anxious and depressive symptoms) and insomnia at current pregnancy seem to be risk factors/correlates for the outcome. Positive affect seems to work as a protective correlate.

When cognitive decline (CD) is present, attention is one of the impaired mental functions. CD is also associated with anxious/depressive symptoms and with some demographic variables, particularly, age.

Investigate the associations between selective attention (Stroop Test: Stroop_Word, Stroop_Color, Difference between Stroop_Word and Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color and Difference between Stroop Ratio_Word and Stroop Ratio_ Color) and CD (Montreal Cognitive Assessment/MoCA) in institutionalized elders; explore the predictive value of Stroop variables for CD, controlling anxious/depressive symptoms and sociodemographic variables.

140 institutionalized elders (mean age, M = 78.4, SD = 7.48, range = 60-97) voluntarily answered to sociodemographic questions, the MoCA, the Geriatric Anxiety Inventory/GAI, the Geriatric Depression Scale/GDS and Stroop test.

73 elders (52, 1%) had CD. Dichotomized MoCA was associated with Stroop_Word, Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color, GDS and the sociodemographic variable schooling × profession. Age and education were not tested, since MoCA was stratified according to those variables. GDS, Stroop Ratio_Word and Stroop Ratio_Color showed to predict CD.

There was an association between Stroop_Word, Stroop_Color, Stroop Ratio_Word and Stroop Ratio_Color and CD, confirming that selective attention is smaller when the elderly reveal CD. GDS and CD were, also, associated. However, there was no association between MoCA dichotomized and differences between the correct answers (Stroop_Word and Stroop_Color) and Ratios (Stroop Ratio_Word and Stroop Ratio_Color). Selective attention and depressive symptoms predicted CD. It would be important to intervene through cognitive rehabilitation with the elders to improve their attention.

The PubMed, Web of Science and Scopus databases were searched for articles containing the following keywords: “bipolar disorder” and “psychoeducation”. The resources were confronted with our own experiences with psychoeducation in bipolar patients and only most relevant information was included in the text.

The most important target of the psychoeducation is to prevent a relapse by increasing compliance with medication usage, increasing social rhythms, reducing emotional expressivity in the family and increasing coping skills against stress. Studies on psychoeducation in bipolar disorder demonstrate significant effects on rehospitalization rates, compliance and knowledge. Compared with mood stabilizer treatment alone, combination treatment of CBT and mood stabilizers has been shown to reduce the number of bipolar episodes, reduce the duration of episodes that do occur, and reduce the number of hospital admissions due to episodes. The aim of the group psychoeducational program of the Psychiatric clinic in Olomouc is to familiarize patients with the essence of bipolar disorder, the part and principles of pharmacotherapy, the recognition of the warning signs of relapse, to advice about improper and stressful stereotypes in communication within families, and finally the training of social skills. Patients consider this program as a meaningful and helping them to better understanding what happened in their life. Supported by grant IGA MZ CR NT 11047-4/2010.

1. 1) Depression was associated with self-reports of increased impulsivity and rigidity of behavior.

2. 2) Depressed patients reported significantly lower physical energy, tempo of physical activity and plasticity of behavior. The presence of comorbid anxiety further worsened these effects.

3. 3) The ability to sustain attention on a mental task and to learn new information was lower in depressed patients than in other groups.

Comorbid depression and anxiety might be associates, decreasing adaptivity and the self-regulatory balance of behavior, leading to the development of extremes in behavioral reactivity (impulsivity and rigidity).

Patient and visitor violence (PVV) is increasingly recognised as being widespread in General hospital setting, more so in medical wards. Recent International studies showed that it's a worldwide problem. There is little data available detailing prevalence of PVV in UK. The national NHS annual violence data only focuses on physical assaults on staff.

To measure PVV with parameters of verbal abuse, threats and physical assaults over a four week period.

The aim of the study is to identify the prevalence of PVV in high risk medical wards in North Wales

A cross sectional study was conducted with a validated tool (abbreviated SOVES) in six high PPV risk medical wards in three North Wales General District Hospitals.

Of the 158 staff responded 83% were subjected to verbal abuse in the preceding four weeks. 50% reported being threatened and 63% reported being physically assaulted. 56% of those assaulted sustained an injury with three needed medical assessment and/or treatment.

Nurses and Health care support Workers reported being subjected to all forms of PVV more than other staff groups. Direct patient contact correlated more to overall incidence of PVV. Our study could not find any correlation between amount of training received by staff in the management of aggression and the experience of PVV.

PVV is a significant problem in medical wards inspite of regular staff training programmes. Means to communicate risk should be considered by all staff working in high risk medical wards.