Psychological processes play a mediating role in the development of psycho-pathological disorders depending on the Kinderman's model. Excessive use of emotional avoidance becomes, following the model of Barlow and Allen, the booster of emotional distress at long term. Dysfunctional meta-cognitive processes in turn influence the inadequate interpretations of life experiences.

To improve identification, expression and emotional management in patients with schizophrenia (PWS) and patients with bipolar disorder (PWBD).

Introduction of exposition for the emotional body's sensations. This work on emotional awareness by images and sounds prepare to role-playing and to exposure in real life.

Groups of psychotherapy for adults PWS and PWBD was implemented. The techniques used are those of cognitive behavioral therapy CBT (Beck) and emotional therapies (Barlow): columns Beck tailored, role-playing, psycho-emotional and breathing. Four groups of four patients participated in six therapy sessions.

An increase in emotional flexibility is observed two weeks after the group work (Wilcoxon P = 0.025). Work on emotional identification facilitates the relaxation of the avoidance process while promoting social skills. The new format includes nine sessions three additional sessions on the emotional body sensations. Meta-cognitive work on the interpretation of the delusional thinking has been inserted.

The experience of this pilot study provides encouraging results. The transdiagnostic approach referring to the alterations of this common psychological process finds use with PWS and PWBD.

The authors have not supplied their declaration of competing interest.

Somatization Disorder is more prevalent in females and is historically known as Briquet Syndrome. It is characterized by complaints in several systems, has early onset and chronic fluctuating course, but without organic substrate. When the duration of symptoms is less than two years or they are less obvious, it is called Undifferentiated Somatoform Disorder.

This study reports the case of a female patient, previously healthy and with no psychiatric history, which abruptly presented lush somatic symptoms without organic origin.

Case report of a previously healthy woman of 32 years, followed up for 14 months, by a sudden onset frame of profuse diarrhea, tenesmus, fecal incontinence, vomiting, anorexia and weight loss (18 kilos in 2 months), associated with headache and autonomic signs of anxious origin, without clear physical and/or psychogenic trigger. She had only a mild response to drug therapy and excellent improvement in symptoms after psychotherapy.

Unconscious triggers came to light only after psychotherapy starts, justifying that the magnitude of autonomic somatoform symptoms surpasses the time period established by ICD-10 for Somatization Disorder. Therefore, the rapid resolution did not allow a diagnosis of Somatization Disorder, according to ICD-10. So, it was diagnosed as Undifferentiated Somatoform Disorder.

It is suggested that the grandeur of clinical symptoms in this case is caused by psychogenic factors.

The authors have not supplied their declaration of competing interest.

We set out to determine standards that would enable the identification of persons at risk of Vitamin D (VitD) deficiency in our ward; the prevalence of deficiency in at risk patient group on a 25-bedded ward (Brunswick). Deficiencies were identified, managed according to local guidelines and care plans were updated to reflect this change.

Low VitD levels have been associated with depression, psychosis, schizophrenia, suicidality, treatment resistance and poor coping. However, serum VitD levels is not a routine investigation on inpatient psychiatric admissions. Factors associated with VitD deficiency include prolonged stay in inpatient units with limited exposure to sun; Inpatients’ diet; Self-neglect and social isolation.

Criteria for identifying patents who may be at increased risk was agreed.

These patients were approached, and consented to screening. Results of the investigation were discussed with patients and actioned according to need. Study period May 2015–July 2015.

We were unable to identify any criteria in use for identifying persons at risk in psychiatric services. The following criteria were agreed: Hospital stay for > 2 months and limited opportunities of leaving the ward (Detention); Transfer from another unit with a total of hospital stay > 2 months; Admission from the community with severe depression or history of social isolation.

7 patients (28%) were identified to be at increased risk. Of this, 6 patients (85.7%) were deficient and another 1 (14.3%) had insufficient level. Management was instituted.

If indicated, psychiatrists ought to consider monitoring VitD levels during inpatient stays and managing as appropriate.

The authors have not supplied their declaration of competing interest.

Patient's records are the most important clinical assets and tools which are required in consultations. Patient records also support the accurate continuity of care when patients return to other health providers.

Understand the extent of Discharge Summaries, which conform to the set best practise guidelines on the Mental Health Service.

A cross-section retrospective study on Discharge Summary contents was conducted at Al Amal Medical Complex. Chart review of randomly selected patient files (200 of a total 495), of Discharge Summaries for Psychiatric Patients in 2014 was performed. The data was statistically analysed using descriptive statistics taking into account proportions and frequencies. Pearson chi square and Fisher's test methodologies were used.

This study found of the 200 randomly selected Discharge Summaries that documented data of mental health examination 94% (n = 188), data of discharge date 100% (n = 200) while data of social investigation and family work up 82% (n = 164). The above three categories were the only categories to conform to standard discharge guidelines. The other thirteen items studies were found not conforming to the defined standard guidelines.

There is an active challenge for clinicians to introduce good clinical practice in Mental Health. Standard guidelines must be followed by clinician's in order to reduce potential areas of concern and achieve a good clinical practise. Regular recurring audits are highly needed& recommended to ensure the alignment with standard guidelines for the writing of Discharge Summaries.

The author has not supplied his/her declaration of competing interest.

Assessment and Treatment Team (ATT) was developed to manage mental health referrals within the borough of Blackburn with Darwen (BwD). The ATT became the main point of initial referral and assessment for adults presenting with mental health needs. It acts as the gateway service for access to specialist mental health services.

To evaluate the effectiveness of ATT against the key performance indicators.

Quantitative data was collected using electronic database from June 2014–May 2015. Feedback was obtained from GPs and also from patients who attended ATT over a one-week period.

The ATT received a total of 2234 referrals. A total of 73% were seen within 10 working days of the referral. Assessment outcome letters were sent to the GPs within 48 h in 47.53% cases. Referral rates to community mental health and Crisis teams were 7% each showing an overall reduction compared to the previous service. GP satisfaction – 70% were ‘moderately satisfied’ and 30% were ‘very satisfied’ with ATT. Hundred percent felt the service was easily accessible and 90% felt that the staff were friendly. Patient Satisfaction – 96% of patients rated the team as ‘friendly and polite’. Eighty-seven percent reported that they were listened to and 91% felt their concerns were understood. Eighty-three percent felt that ATT involved them in their decision making. Ninety-two percent responded that they were likely/extremely likely to recommend ATT to their friends and family.

The establishment of ATT has led to improved satisfaction among GPs and service users and has resulted in reduction in referrals to secondary mental health services.

The authors have not supplied their declaration of competing interest.

Patient non-show to clinical appointments is a major component of nonadherence, specifically in mental health institutions, being twice that of non-show in other medical specialties, and is associated with a greater risk of morbidity and mortality.

Our study was conducted to assess the rate and factors associated with missed first appointments in an outpatient mental health clinic, in order to find correlates between the various factors and the probability of non-show among newly referred patients.

This was a retrospective study of 400 consecutive outpatients referred to a single regional mental health clinic in northern Israel during 9 months. Data was collected on sociodemographics, attendance rates, source of referral, the presence of chronic physical illnesses and time elapsed between referral to appointment. The findings were statistically analyzed to identify factors associated with patient non-show rate.

Of the 400 patients included in the study, the non-show rate was 39.6%. Patients who missed appointments were significantly more likely to be younger, to belong to the Arab sector and to wait longer for their appointment. They were less likely to be physically ill. Gender, marital status and source of referral were not significantly associated with the non-show rate.

Given the problematic potential outcome of non-show to mental health clinics, it is important to identify high-risk factors associated with non-show and unique to the population in question, so that interventions can be targeted at them, thus improving treatment outcome and reducing risk to patients.

The authors have not supplied their declaration of competing interest.

Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.

International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.

This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.

A twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.

Evaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.

The clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.

The authors have not supplied their declaration of competing interest.

Mechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. In order to implement measures to prevent agitation and therefore mechanical restraint, it is important to quantify the effects and costs of those procedures. The aim of this study is to determine whether the application of mechanical restraint in psychiatry acute unit is related to a longer stay in hospital.

We reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of our institution, between 2012 and 2015. For every discharge, the presence of at least one mechanical restraint was coded, resulting in two groups. The length of stay of the groups was then compared performing a t-test.

The number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint associated. There are significant differences between the length of stay of admissions with and without episode of mechanical restraint. The episode of mechanical restraint during an admission is associated with 5 to 9 more days of stay in the unit (P < 0.001).

The performance of a mechanical restraint is associated with a statistically significant and clinically relevant higher length of stay. These results suggest that preventing agitation, and therefore mechanical restraint, would be possible to decrease length of stay, and therefore costs related to hospitalization.

The authors have not supplied their declaration of competing interest.

Number of patients who are again unexpectedly admitted to hospital after a previous hospitalization are used to evaluating the quality of hospital care. Readmission can be represented by the total number and by readmission rate.

Understanding the risk factors that can lead to readmission is a factor for the development of interventions that can improve the quality of care.

The purpose of this study was to examine number and predictors of psychiatric readmission within 14 days, 30 days and, 3 and 6 months.

In this retrospective study, analyses were conducted in a sample of 566 discharge adult patients who were admitted to a Psychiatric Hospital of Sarajevo Canton from 1st January to 31st December 2013.

Total number of readmission was 14%. The readmission rate within 30 days was 2.8%, number of readmission quarterly was 9.1%, number of readmission within 6 months after discharge was 13%.

In the study, several factors were significantly associated with increased risk of readmission including non-compliance with drug treatment, social problems, aggressiveness, suicidality.

Our study suggesting that the prevention of psychiatric readmission requires continuous multidisciplinary work with patients and family members.

The authors have not supplied their declaration of competing interest.

The reduction of the budget allocated to community psychiatry is part of financial needs in times of economic crisis. However, the community psychiatry is based on human resources rather than on technological devices and the economic downturn affects the quality of care in a field where the social and relational capital developed by mental health workers is fundamental. Some authors such as Serge Latouche propose to stem the economic decline with the concept of “degrowth”, a constructive idea but difficult to apply.

We would like to analyze whether the economic downturn has consequences only for the organization of psychiatric services or even for people with severe mental disorders. Another issue concerns the possibility that economic downturn increases the social exclusion of vulnerable people.

People who live on social welfare or disability pension remain on the margins of society but also those supported by families feel increasingly marginalized with respect to the future.

The provision of mental health services may not meet the implicit and explicit wishes in the demand for health by citizens and society. It's therefore necessary to review the quality management within community psychiatry.

The authors have not supplied their declaration of competing interest.

Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.

To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.

Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.

All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.

Forty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).

Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).

At interview, participants (n = 12) particularly valued:

– the opportunity to ask questions of the psychiatrist e.g. about medication;

– improving self-care skills e.g. monitoring early warning signs of relapse;

– co-facilitation by a peer, which provided extra credibility and inspired hope;

– sharing experiences with peers.

The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.

The authors have not supplied their declaration of competing interest.

Between 25–50% of psychiatric patients are non-compliant with their pharmacological treatment. When differences between compliant and non-compliant patients were analyzed, differences were found in relation to their beliefs and feelings about medication. The Drug Attitude Inventory (DAI) was created to measure attitudes towards medication in adults. It predicted adherence in schizophrenia and depression studies.

Determine if psychotherapeutic and psychoeducational activities – during a partial hospitalization at the Psychiatric Day Hospital – can improve aspects related to feelings and thoughts about medication.

We gathered retrospectively a sample of 151 patients hospitalized at the Psychiatric Day Hospital, from September 2013 to June 2015. Their thoughts and feelings about medication were measured with the DAI before and after the hospitalization. From the sample of 151 patients, 94 completed both tests, excluding who did not have the final DAI score. Differences between initial and final scores were statistically analyzed with the Wilcoxon test for paired samples.

Of the 94 patients who completed the study, 52 showed an improvement in their DAI score, whereas the remaining 27 showed an equal or decreased final DAI compared to initial evaluation. The difference was statistically significant (P ≤ 0.05).

It seems that psychoeducational activities related to medication are important in order to reconsider or modify feelings and thoughts about treatment. Information on medication provided to psychiatric patients (to those who need psychopharmacological treatment), carried out in a group context, which facilitates an open and sincere communication, can be a useful strategy to improve compliance with treatment.

The authors have not supplied their declaration of competing interest.

To supervise agents in a mutual aid experience in Motril Mental Health Day Hospital. To perform a supporting role among the agents involved in a mutual aid program to consolidate its operations autonomously.

A multidisciplinary working group, which met every two weeks for 4 months was set. Group sessions were planned. We selected mutual aid pairs individually and addressed the difficulties in the process. The experiment was performed with 4 agents setting a maximum of 5 interviews. A success criterion of 80% of the meetings planned was established. In between mutual aid group, success criterion was to maintain a 3-month experience held by 5 members. A qualitative analysis of most important issues amongst coordination meetings were also held.

Three out of 4 pairs reached 80% of the interviews successfully. The support group was developed weekly during 3 months with an average of 8 participants. The trending topics during coordination meetings were toxic consumption, acute crisis, drug intake and issues to be addressed with the psychiatrist.

Mutual aid among users is a way of intervention that needs to be further consolidated. The establishment is still unpretentious and has low weight amongst coordination objectives. The results addressed in number of sessions and satisfaction are favorable, but it is necessary to assess the experience widely and to begin developing specific objectives [1,2].

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Psychosocial interventions are an essential part of the treatment of schizophrenia and are aimed at promoting the social, family and occupational functioning of the patient and relapse prevention. They are considered proven clinical measures whenever necessary, however they tend to be underused.

Answer the question on psychosocial therapies available today for schizophrenia.

Review through PubMed by entering the following keywords: psychosocial therapy; schizophrenia; cognitive behavioral therapy, and clinical practice guidelines.

There are several psychosocial therapies used in clinical practice. The main points of approach focus on self-management of the disease, everyday problems, education, crisis intervention, and acquiring insight. The cognitive impairment is an important aspect of schizophrenia to consider. It seems that cognitive remediation therapy has been associated with both neurobiological and cognitive improvement.

The combination of different therapies along with psychopharmacological treatment appears to provide better results in the reduction of negative symptoms, positive symptoms and reduced hospital stay.

The authors have not supplied their declaration of competing interest.

Involuntary admissions continue to be a controversial topic in psychiatry. However, it is well known that psychosocial rehabilitation treatment is more successful when the patient is involved in it improving awareness and adherence to treatment.

This study examined admissions patterns, including voluntary, involuntary, and partly voluntary admissions to a subacute psychiatric hospital.

This is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Patients's basic sociodemographic and clinical data were collected and compiled in a database. Descriptive statistics were performed using SPSS Software.

A total of 88 patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Among 88 patients, 44 (50%) had voluntary admissions, 16 (18.2%) had involuntary admissions, 27 (30.7%) had partly voluntary admissions and just one patient (1.1%) had partly involuntary admissions. Seventy-one (80.1%) patients had voluntary admissions at discharge, and only one of them escape from hospital and did not finish the treatment.

In the short term involuntary hospitalization has benefits, however also can have adverse long-term consequences for the patient-therapist allegiance, breaking the psychotherapeutic relationship and making the patient abandon treatment. It's important to reassess the condition of admission and work with the patient the need to engage in treatment.

The authors have not supplied their declaration of competing interest.

The elapsed time since a patients’ disease is diagnosed till these patients come to rehabilitation centers is usually long. In this study in our sanitary area, we have checked the average length of time since the patient is diagnosed till they come to the rehabilitation center.

To calculate and analyze the years of evolution of the disease in patients who come to the rehabilitation center in the Talavera area during year 2014. Classify them by sex.

Retrospective cross-sectional descriptive study. We carried out a register of all the patients who come to the Psychosocial and labor Rehabilitation center in 2014. Classified them by sex, and the time lapsed since they were diagnosed until 2014.

From all 135 patients: 92 men (68.15%) and 43 women (31.85%). Less than 2 years of evolution: 1 patient (1%) 1 men, 0 women; between 2 and 5 years of evolution: 7 patients (5%) 5 men, 2 women; between 6 and 10 years evolution: 13 patients (10%) 7 men, 6 women; more than 10 years: 114 patients (84%).

It is evident that the number of patients increases proportionally to the number of years since the diagnosis. The majority of patients who come to the center (84%) were diagnosed more than 10 years ago. This leads us to wonder why the patients in our sanitary area with recent diagnosis of diseases such as schizophrenia do not come to the mentioned centers earlier.

The authors have not supplied their declaration of competing interest.

People with schizophrenia exhibit deficits in neurocognitive and social cognitive (SC) processes which limit their social reintegration. SC was found to mediate in part the impact of neurocognitive dysfunctions on real-life functioning.

The purpose of this study was to implement a new intervention for patients with schizophrenia, the Social Cognition Individualized Activities Lab (So.C.I.A.L.) which trains both social cognition and neurocognitive functions.

To determine the efficacy of the So.C.I.A.L in improving SC by a comparison with a validated cognitive remediation (CR) intervention: the Social Skills And Neurocognitive Individualized Training (SSANIT).

Nine stabilized patients accepted to participate in this pilot study. Five were randomized to So.C.I.A.L. and 4 to SSANIT. The two programs were matched for the overall treatment duration (20 weeks), as well as frequency and duration of the sessions. Both interventions included individual sessions of neurocognitive individualized training; So.C.I.A.L included group sessions on Emotion Recognition and Theory of Mind, while SSANIT group sessions of Social Skills Individualized Training.

No group difference was found for changes in neurocognition, while a significant group effect was observed for changes in SC, due to improvement only in the So.C.I.A.L. group.

The study results showed a specific effect of the So.C.I.A.L. on SC, beyond the effect on neurocognition. Further studies are needed to assess the impact of So.C.I.A.L. on real-life functioning in a larger group of subjects.

The authors have not supplied their declaration of competing interest.

Case management (CM) is accepted as the most recommended approach for the treatment of people with severe mental illnesses (SMI) in Community Mental Health Centers (CMHC) in whole Bosnia and Herzegovina (BH) in the last 3 years.

All team members of CMHC Prijedor are certificated case managers. Part of our daily activities is work with and for the users included in CM (mostly with schizophrenia or similar disorders) using multidisciplinary approach to find best possible solutions of both treatment and rehabilitation for users that we are in charge. In this moment CMHC cares for 12 mostly younger users involved in the CM.

To show advantages as well as obstacles of the CM.

Case study of young user with schizoaffective disorder included in the CM in the last 2 years.

Improvements in user's daily activities and using of the remaining capacities with confrontation of partial or entire poor responses of most other community services.

CM has many advantages for the user involved in it, mostly medical and psychological (adequate treatment followed by users wishes, avoidance of hospitalization, improving existing or building new skills, use of remaining capacities, planed activities, minimize of the psychopharmacological treatment, social skills and more new contacts with people, etc.). But, still are existing the obstacles in the community mostly considering employment and social care as an part of the stigmatization of the people with SMI.

The authors have not supplied their declaration of competing interest.

Crisis prevention and management of the psychiatric patient have obtained a central role in the policies of Mental Health Services. In this context, Mental Health Centre of Ravenna has launched a “Crisis Center”, a rehabilitation group project applied to three types of users: users in an early stage of crisis, users in a post-critical stage and users at high risk of crisis. Intervention was based on the Illness Management and Recovery practice, an evidence-based program which consists in social skills training activities, emotions management, symptom management, coping skills training, psycho-education and, more generally, supporting users in their personal recovery process.

Objectives of this project is to prevent crisis and hospitalization and to provide an alternative to institutionalization for mental health users.

The aims of this study was to analyze and show effects and results of the project, in its first three years of life.

Through the database “Infoclin”, we analyzed data of 94 users who took part in the project between January 2012 and December 2014.

Analysis showed, primarily, that out of 94 users, 64 (68%) have not needed hospitalization in the following two years after intervention. Furthermore, out of 39 users with a history of one or more hospitalizations at time of entry, 22 (56.4%) have not needed hospitalization in the next two years.

Despite the low number of users analyzed, it is believed that this study should be considered a further evidence of the positive effects of the IMR practice within mental health services.

The authors have not supplied their declaration of competing interest.