Clinical observation is very important to manage risk of people who are acutely ill on psychiatric wards. It is always an area of dispute between different specialities and disciplines in serious untoward incidents(SUI). Three levels of observations have been applied on acute psychiatric words. Assessing practice is important to help identifying positive and negative aspects of clinical practice.

A questionnaire was developed by HN to collect demographic. Medical notes on Westley and Grangewater wards were reviewed. Excel Microsoft Office World Computer Programme was used to analyse the results.

57% were men.

62% were above 41 years of age.

Majority were suffering from schizophrenia and schizoaffective disorders 61%.

64.28 % were admitted as formal patients.

31.42 % were on level I observation.62.53 were informal.

54.76% were risk to themselves, 28.57 % risk to others.

82.3% were on level II observation, 31.42% formal and 68.50% informal.

21.32% were on level III observation. 66.66% were formal and 66.66% had an incident before this level.

This study have shown that patients are assessed properly before they go on any level of care. Some patients need to go on level III as they pose a risk mainly to other people. Regular reviews of patients, especially on high level of observation should be done more promptly, as being on observation is not a comfortable experience to go through and applying the least restrictive practice should always be sought and adopted.

In the Multidisciplinary Melanoma Group (MMG) of Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil, physicians of different specialties (plastic surgery, dermatology, oncology, pathology and psychiatry) work in an integrated way and weekly provide care to outpatients with melanoma. They hold monthly meetings to: discuss administrative issues; update diagnoses, therapies and treatment protocols; discuss research projects, and bring members together.

To present, based on a clinical case report, a reflection about the MMG’s teamwork.

To understand the teamwork of different specialties physicians in providing care to people with melanoma.

Case report and reflection.

Woman, 35 years-old, white, divorced, two sons (11 and 7 year-old). Primary melanoma operated 5 years before and inguinal metastases resected one month prior to the follow up at MMG. Psychiatric approach: tense, dissociated, with no knowledge about the illness’ meaning, worried about the children. Adjuvant oncologic treatment and support psychotherapy were implemented. After few months, she complained of mild fever and fatigue that interfered in relationship with her children. With change in the adjuvant treatment protocol, patient’s situation was discussed and, after risks and benefits evaluation, it was chosen to discontinue her treatment. Patient got closer to her children and more involved in psychotherapy and outpatient treatment.

The proper use of a uniform language, the definition of roles, clear communication and concern with the aim of taking care of people with melanoma in their clinical and emotional needs facilitate the adjustment and cohesion in the MMG.

Dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment within episodic-autobiographical domain, occurring without evidence of significant brain damage on conventional structural brain imaging.

This work’s objectives are establishing greater recognition of possible relations between memory performance and social cognition in patients with dissociative amnesia.

We review data on social cognition (affective and cognitive theory of mind, simulation, empathy, social judgment, moral judgment) from our own patients with dissociative amnesia.

Patients were investigated medically, psychiatrically and with neuropsychological and neuroimaging methods.

Patients with dissociative amnesia show variable degrees of impairments of components of social cognition, based on their comorbid conditions (e.g. concurrent clinical or subclinical depression), types of memory impairments (e.g. extent of retrograde amnesia, presence of autobiographical semantic deficits), pattern of brain metabolic changes, personality characteristics, neuropsychological profile (performance on executive functions or emotional processing) and testing paradigms.

The impairment in dissociative amnesia seems to go beyond the conscious mnemonic deficit, encompassing various aspects of social information processing. Knowledge about the pattern of metabolic and micro-structural brain changes in patients with dissociative amnesia as well as a fine-grained analysis of the neural correlates of various aspects of social cognition might provide an understanding of when and how episodic-autobiographical memory contributes to social cognition. As several studies emphasized, some structures involved in mnemonic processing may also play a role in social perception, cognition and behavioural regulation, including future-minded choice behaviour.

Suicidal behaviours are major public health concerns, associated with many risk factors that vary with sociodemographical features.

To compare the differences between patients visiting the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, as far as their occupational and accommodation status are concerned.

To evaluate the influence of the economic scenery on suicidal behaviours.

Determinants of ER psychiatric consultations were studied prospectively from 2008 to 2011 at the “Maggiore” Hospital in Novara. Comparison of qualitative data was performed by means of the x2 test, or the Fisher’s Exact test in case of expected frequencies less than 5. All tests were two-sided and a P value less than 0.05 was considered as statistically significant.

In a sample of 1888 psychiatric consultations, 281 (14.9%) were due to self-inflicted injuries. The preliminary analysis of socio-demographical features showed that self-harm behaviours are significantly more frequent among employed vs unemployed or disabled subjects (20.1% vs 13.2%; p=0.0005) and among those living in their immediate or own family vs those living alone or in therapeutic facilities (17.0% vs 13.0% vs 8.4%; p=0.012).

In contrast to current literature, our study shows that individuals living in more favourable conditions are at greater risk of attempting suicide. These results might be associated to the current Italian economic scenery, and to emerging difficulties as far as keeping an income to adequately maintain a family are concerned.

Ginkgo biloba extract EGb 761® improved neuropsychiatric symptoms (NPS) in patients with dementia in a series of trials.

To explore the effects of EGb 761® on NPS in patients with mild cognitive impairment (MCI).

A randomized, placebo-controlled, double-blind, 24-week, multi-center trial was conducted, including 160 patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI). Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory (STAI-X1) and the Geriatric Depression Scale (GDS). Further outcome measures were the Trail-Making Test (TMT, Forms A and B) and global ratings of change. Descriptive statistical analyses followed the intention-to-treat principle.

The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761®-treated group and by 5.5 ± 5.2 points in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761® and in 55.7% of those receiving placebo (p = 0.002). Significant superiority of EGb 761® over placebo was also found for the STAI-X1 score, the informants' global impression of change and both TMT scores. There were statistical trends favoring EGb 761® in the GDS and the patients' global impression of change. Adverse events were reported by 37 patients taking EGb 761® and 36 patients receiving placebo; there were no serious adverse events.

EGb 761® improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.

Chronic pain more than a symptom expresses a complex situation in pathophysiological and therapeutic terms. It can become the center of one’s life and be a reflection of suffering experienced in other areas of life. Support through group psychotherapy can enhance a better experience with pain and encourage healthy behaviors in this clientele.

To characterize the groups with chronic pain patients regarding the subjects discussed and the impact of pain on their lives.

Understand the life circumstances of people who suffer from chronic pain.

This is a qualitative participant observation study. 48 group meetings conducted with 12 patients with chronic pain were analyzed. The groups were weekly, lasting an hour, and were coordinated in co-therapy by a psychiatrist and a psychologist.

Themes discussed: health problems; vulnerability to diseases; limitations and perspectives of people with chronic pain; preparation for submission to procedures (surgeries, exams, analgesic blocks); relationship problems with family and friends; unconscious conflicts that feed physical problems; difficulties in interacting with professionals and treatments; economic problems; and sexuality. When patients were able to provide support to colleagues, they felt valued; when they received such support, they felt understood and protected.

It was possible to observe a personal development of participants who stopped complaining or blaming others for their relationship problems and their consequent suffering, going to take responsibility and find solutions more adaptive than the recurrent pain behavior.

Anxiety disorders have been historically described as a feature of Bipolar Disorder (BD), and Obsessive-compulsive-bipolar disorder (OCBD) comorbidity has been referred in literature. A survey reports that 55,8% of obsessive-compulsive patients may develop BD in their lifetime. Another survey estimates it at 21%. Mania in Obsessive-Compulsive Disorder (OCD) can occur either as an independent comorbidity or as a result of an antidepressant-induced switch in a patient in anti-OCD drugs.

The aim of this poster is to describe and discuss some aspects of this psychiatric comorbidity, with emphasis on its diagnosis and management, based on a case report.

This case report describes a 38-years-old married male with 5 years history of OCD treated with an antidepressant, admitted at our psychiatric ward due to a manic episode. Its management and therapeutic approach are described.

A baseline of “neurosis” (versus “psychosis”) in some BD presentations has emerged from recent scientific evidence, which prompts its better understanding. As a complex comorbidity, OCBD represents a diagnostic and therapeutic challenge implying further systematic exploration.

Stigma on psychiatric patients is frequent not only among common people but also in healthcare professionals. Cinema might be useful tool for medical educational purposes and might help reduce negative attitudes towards mental illness.

In the first place, to develop a pilot project of cinemeducation aimed at enhancing awareness and thinking over about psychiatry and stigma in medical students; secondly, to investigate students’ stigmatizing attitudes, empathy, personality and self-esteem and the impact of the cinemeducation intervention on some of these variables.

From October 2012 to January 2013, students will attend six cinemeducation lectures focused on helping relationships. Sociodemographic data will be collected at baseline only, and so will the Temperament and Character Inventory. In order to investigate attitudes towards psychiatry, self-esteem, alexithtymia and empathy, students will be asked to fill in some self-administered scales, both at baseline and at the end of the six lectures. These scales will include: Attitudes Towards Psychiatry Scale, Social Distance Scale, Dangerousness Scale, Mental Illness: Clinicians’ Attitudes Scale, Interpersonal Reactivity Index, Rosenberg Self-Esteem Scale, Toronto Alexithymia Scale.

The correlation among the variables assessed will be investigated in order to understand whether certain personality traits, self-esteem and empathic attitude influence students’ beliefs about psychiatry. The impact of the cinemeducation lectures on stigmatizing attitudes will be investigated as well.

It is known that antipsychotic lower seizure threshold, cause EEG abnormalities and put the patients in the risk for additional seizures. Due to changes in organic substrate, psychosis is very common comorbidity in epilepsy. There is no consensus about treatment options. The purpose of this research was to compare effects of risperidone and olanzapine in treatment of psychotic episode in verified Grand-mall epilepsy. Treatment with bout antipsychotic was parallel.

Psychotic episode in 100 adults (67 males) with epilepsy, Grand-mall type, were measured with BPRS scale. History of diagnosis of epilepsy, Grand-mall type was verified clinically and by EEG. Subject were treated either with olanzapine (n=53) 14.7±2.4 mg per day or with risperidone (n=47) 8.6±3.8 mg per day, orally.

The total BPRS scores in olanzapine group at baseline, in 1st, 2nd and 3rd week were 139.6±34.2, 91.3±21.4, 81.5±19.8, and 72.3±11.1, respectively (p< 0.05). The total BPRS scores in risperidone group at baseline, in 1st, 2nd and 3rd week were 137.1±32.4, 101.6±30.9, 98.4±26.6, and 90.3±19.1, respectively (p< 0.05).

Results of our research showed that risperidone is more effective and comfortable drug than olanzapine in the treatment of psychotic episodes in epilepsy.

Psychiatric symptoms occur quite often in epilepsy and are an important prognostic factor in quality of life of patients with this neurological condition. The psychotic disorders occurring in epilepsy are classified according to their chronological relationship with the seizures. The peri-ictal psychoses occur before (pre-ictal), during (ictal) or after (postictal) the emergence of a seizure. Inter-ictal psychoses occur independently of seizures. Postictal psychosis (PP) episodes are typically of short duration.

Our aim is to show the great importance of seizures control as a way to prevent the onset of psychotic symptoms, thereby improving patient’s prognosis and quality of life.

In this paper we describe a case of a 44-year-old man, with post-traumatic epilepsy and postictal psychotic symptoms.

The search and the recognition of psychiatric symptoms in epilepsy allow a better understanding of the overall clinical case and, therefore, a more effective treatment.

While there is increasing evidence on the association between cannabis use and schizophrenia, it is still unclear whether schizophrenia patients with a cannabis history have another prognosis, with regard to relapse and hospital duration, compared to those without a cannabis history.

A cohort study of 50000 Swedish men with data on cannabis use at ages 18–20. A total of 350 cases of schizophrenia were identified from inpatient care records and followed up from 1970 through 2010. Records of schizophrenia patients with and without a history of cannabis use were investigated with regard to types of diagnoses, duration of first admission, rate of re-admission and total duration of hospital stay.

Schizophrenia patients with history of cannabis use had a higher median duration of first hospital episode (59 days vs 30 days). Patients with a history of cannabis had a higher median rate of re-admission (10 times vs 4 times). Also total number of hospital days was higher in patients with cannabis history compared to those without (547 days vs 184 days) The distribution of types of schizophrenia was difficult to assess since many received a “unspecified” diagnosis, and there was no significant difference between the groups.

Schizophrenia patients with history of cannabis used had significantly higher burden of inpatient care than non cannabis users. Not only does cannabis increase the risk of schizophrenia, but our findings indicate that the type of schizophrenic psychosis may be more severe than schizophrenia cases in general.

Health-Related Quality of Life has been considered suitable for outcome measurements in chronic illnesses.

Feasibility of collecting routinely data on health gains during treatment was assessed during a outpatient service development project in Satakunta hospital district. Finland. Patients contacting the outpatient services for the first time were asked to fill in scales during their first visit. The sacles were sent by mail three months, one year and two years after the first visit. The instruments used were AUDIT-5, BDI-21 and 15D. 15D is a scale developed for purposes of estimating QALY’s in health economic research. It has been widely used in Finland in general population and patient populations including psychiatric patients. Previous studies have defined a population standard (0.9402 out of a score of 1) for 15D assessments and a universal cut-point (change of 0.03) for clinically significant change.

The use of routine-based outcome measurement has been well feasible in outpatient care. So far 949 patients have undergone the first measurement point, 590 the second assessment point and 312 the third assessment point. The data collection is still on-going and numbers of responses at later intervals are likely to increase. At the first assessment the mean 15D score was 0.7616, at three months 0.7857 and at one year 0.7995. Scores increased especially concerning anxiety and depression, but considerably less regarding sleep.

Routine measurement of health gains is feasible within the context of public psychiatric services. Measurement implied also need for development of insomnia treatment.

Across various cultures, dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment, occurring without evidence of significant brain damage (as detected by conventional structural brain imaging). In a substantial number of cases, the memory impairment follows a chronic course. Sometimes dissociative amnesia occurs on a background of a personality disorder (narcissistic or borderline). Other times, amnesia itself triggers long lasting personality changes.

This work’s objectives are establishing greater recognition among health care providers of the spectrum of the personality changes that may accompany chronic forms of dissociative amnesia.

We review data from own patients with chronic forms of dissociative amnesia.

Patients were investigated medically, psychiatrically, neuropsychologically and and neuroradiologically.

Changes in personality dimensions occur after the onset of amnesia. These may involve affectivity, perception (e.g. impaired self face or face-emotion processing), cognition (e.g. social cognition) and behaviour (e.g. changing in eating, smoking, drinking or working habits).

The observed personality changes may represent a consequence of amnesia. Functional imaging studies show metabolic changes in dissociative amnesia in brain areas involved in conscious mnemonic processing. Several structures engaged in processing within episodic-autobiographical memory system were also implicated in self and reward-related processing. Alternatively, the personality changes may be viewed as being pivotal in the development and maintenance of dissociative amnesia; this personality shift may subsequently lead to enduring changes in ways of cognitive processing, self-processing, perception and affect.

The meeting of families who share the same problem enables the creation of a new therapeutic space that allows a rich exchange regarding solidarity and mutual aid. The presence of others allows reviewing each family’s beliefs, questioning the secrets, incomplete information and taboos, and raises questions about assumptions maintained over time.

To characterize group meetings of chronic mental patients and their families regarding thematic and interaction of participants.

Understand the interaction between chronic mental patients and their families.

This is a qualitative participant observation study. Five weekly outpatient groups with 15 patients and their families were analyzed.

The subjects discussed were related to symptoms of mental illness, treatment options and cures, expectations of patients and families facing the reintegration of those in work and other activities, and the group concern with the difficulty of expressing feelings. Emotions had resonance in these meetings and, among them, feelings of gratitude, recognition and reconciliation, as well as anger, boredom, disappointment or discomfort. The possibilities of group contention expanded, and each person was accompanied and stimulated the expression of his/her own feelings, for being a witness and co-participant of expression of affection from others. When psychotic patient gather with their families, deep and unwieldy anxieties are mobilized.

The importance of including the family is in the fact that we can confront patients with the real objects of their family history and make corrective emotional experiences of primitive distorted object relations.

To study the effect of personal anxiety on relative risk of myocardial infarction (MI) and stroke and its relation with awareness and attitude towards the health in female population of 25–64 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” program random representative sample of women aged 25–64 years (n=870) were surveyed in Novosibirsk. Levels of personal anxiety were measured at the baseline examination by means of Spilberger’s test. From 1995 to 2010 women were followed for 16 years for the incidence of MI and stroke.

High level of anxiety (HLA) in studied cohort revealed in 60% of women. Women with HLA had 1.5-3-fold growth of negative self-rated health (87.5%), about 90% had health complaints, more likely had negative behavioral habits and higher levels of job and family stress compared to those with lower levels of anxiety. Risk of MI development in women with HLA over 16 years of study was higher in 4.2 times (95%CI=1.946-18.583; p=0.05), risk of stroke was higher in 3.5 times (95%CI=1.020-12.015; p< 0.05). MI and stroke incidence rates were higher in married women having HLA with low and high educational level who being in both “middle executives” and “hard manual labor” social classes.

There is high prevalence of HLA in female population aged of 25–64 years. Women with HLA had poor selfrated health and awareness about their health and it associated with higher risk of MI and stroke over 16 years of follow-up.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a small-vessel disease of the brain that is genetically transmitted and often is diagnosed in middle adulthood. It can lead to progressive cognitive deterioration, emotional and personality changes. The disorder is often erroneously diagnosed as it may mimic other neurological or neuropsychiatric conditions (such as multiple sclerosis).

This work’s objectives are establishing greater recognition among health care providers of this relatively common, but yet underestimated cause of cognitive and emotional changes.

We present a middle aged patient with genetically confirmed Cadasil.

The patient underwent extensive neuropsychological testing. In addition, he underwent comprehensive medical, neurological, neuroradiological and genetic investigations.

Neuroimaging data showed significant changes in both white and gray matter. Neuropsychological investigations revealed variable degrees of impairments in executive functions, emotional and social information processing and conscious mnemonic processing (episodic-autobiographical memory).

Impairments in episodic-autobiographical memory, executive functions and social and emotional processing may represent early neuropsychological changes in Cadasil. Identifying both the early neurological and neuropsychological features of this condition, in order to enable early accurate diagnosis is a crucial task for future research.

In a public elementary and secondary education school, in the interior of São Paulo state, an Extension Project of the University of São Paulo that aims to invest in the promotion of physical, mental and social health of a group of students is developed. Structured activities, including games, group activities and experiences are offered, coordinated by nursing students and supervised by a faculty member responsible for the project.

To verify the opinion of a group of students about the school and the roles of significant people; to identify existing conflicts, according to the type of violent acts.

To know the circumstances of the interaction of a group of young students with the school and family.

This qualitative study with participant observation analyzed 3 group meetings conducted with twenty 6th grade students of the elementary school.

Students’ perceptions about the school and its professionals were different. They considered family members as important people, who take care, place limits, scold and beat. They struggled to establish their role and that of colleagues at school. Colleagues are friends to play with. The following types of violence were identified: physical, psychological and negligence.

To work on self-esteem, tolerance and cooperation; alleviate conflicts with affective attitudes that express respect; offer educational spaces where young people can take positions, facilitate their interaction and exercise their creativity and reflection preventively collaborate to decrease violence at school. Thus, it may be easier to build models of peaceful coexistence in other social environments.

Periods of financial crises have been associated with impairment of mental health and increased suicidality. The purpose of this research is to study the potential impact of the consequences of the financial crisis, such as unemployment, job insecurity, debts, poverty, social exclusion on the suicidality in the Greek population.

The records of patients who were hospitalized in the Internal Medicine Clinics of a general hospital after attempting suicide in the years 2007 and 2011, before and during the financial crisis respectively, were studied. Demographic data, methods of suicide attempt, psychiatric history and severity of psychopathology at the time of suicide attempt, were recorded for each patient.

The statistical analysis showed that during the financial crisis there is an increase in the number of suicide attempts. Most affected are those who are unemployed, married, who are reaching the age of retirement or are already retired and have no history of psychiatric disorder or suicide attempt. Furthermore, there was evidence suggesting that a decreased threshold of psychopathology was adequate for individuals to exhibit suicidal behavior.

It seems that the economic crisis in Greece has a negative impact on the mental health of its population and causes an increase in suicidal behavior. Consequently, mental health promotion and suicidality prevention programs are essential for the accurate and timely identification and the immediate and effective management of high risk individuals.

The type D personality (negative affectivity and social inhibition) has been associated with increased risk for adverse cardiovascular outcomes. The prevalence however of type D personality appears to vary significantly among different societies and cultures.

The objective of the present study was to verify the prevalence of type D personality in Greece.

To identify the prevalence of social inhibition, negative affectivity and personality type D, as measured by the DS-14 scale, in Greek patients.

A randomly selected sample of 100 patients with acute myocardial infarction and 100 patients with hyperparathyroidism were recruited. All patients were asked to complete the Hospital Anxiety and Depression Scale, the Athens Insomnia Scale and the DS-14 scale.

Social inhibition was present in 43% of patients suffering from hyperparathyroidism and in 55% of patients suffering from acute myocardial infarction. Negative affectivity was present in 51% of patients with hyperparathyroidism and in 68% of patients with myocardial infarction. As a result, type D personality was found to be present in 29% of patients with hyperparathyroidism and in 46% of patients with acute myocardial infarction.

Prevalence of personality type D was found higher in Greek patients when using the translated DS-14 scale and in comparison to other european studies. Interestingly, Greek patients with acute myocardial infarction had a higher type D personality prevalence than those suffering from hyperparathyroidism, confirming that the construct of type D, however variable, might play a role in the development of cardiovascular events.