To determine which factors are associated with compliance with outpatient follow-up plan of discharged patients from a psychiatric ward of a general hospital.

A sample of 120 patients consecutively admitted to a psychiatric general ward, and referred to an outpatient clinic after discharge formed the sample.

To explore the factors predicting whether patients attended or did not attend to the outpatient clinic, a logistic regression analysis was conducted.

After controlling for age, gender, and overall clinical case severity (assessed by the Severity Psychiatric Illness Scale), have been previously attended in the outpatient clinic was the only factor that predicted the compliance with post-discharge outpatient plan (as dichotomous variable: attended/not attended), Odds Ratio (OR) = 12.53, P=0.042. Overall clinical case severity did not predict attendance to the outpatient clinic after discharge, OR=0.937, P=0.452.

Patients who were attended in an outpatient clinic prior to admission had 12-fold more likely to adhere with post-discharge outpatient plan than patients who were not previously attended. This result highlights the importance of strengthening community-hospital liaison strategies.

To study interrelationships of indices of blood lipids with anxious and depressive disorders in IHD patients.

The investigation has included 85 patients with IHD (50,63±7,86 years). of Borderline States Department with anxious and depressive disorders of neurotic and affective level. Blood lipids: TCh, TG, Ch-LPHD have been identified with standardized methods. With calculation we assessed Ch-LPLD, Ch-LPVLD, and index of atherogeneity.

Two-factor disperse analysis has identified relationship between fraction of Ch-LPLD and depressive disorders (р=0,0083), and functional class (FC) of angina pectoris (р=0,0116). We have detected effects of interrelationship of depressive disorders, angina and level of Ch-LPLD (р=0,0072) in progressing angina against the background of a depressive episode or prolonged depressive reaction. 19 patients of FC II-III with anxious and depressive disorders were identified as having hypoalphacholesterolemia (Ch-LPHD<0,9 mmol/l; level of TG 2,44±0,5 mmol/l; level of Ch-LPLD 4,42±0,54 mmol/l, TCh 6,52±0,75 mmol/l, IA 4,5. Maximal low level of Ch-LPHD (0,74-0,82 mmol/l) has been revealed in 13 patients with IHD and anxiety disorders. In FC III and progressing angina in 23 patients with leading depressive syndrome level of TCh 7,48±0,55 mmol/l, Ch-LPLD 5,29±0,55 mmol/l, Ch-LPHD 1,04±0,13 mmol/l.

In patients with IHD we have detected effects of interrelationship of neurotic and affective disorders, FC of angina and disturbances of metabolism of lipids. Anxious and depressive disorders were associated with atherogenic dyslipidemia conditioned by imbalance of Ch-LPLD and Ch-LPHD. The most substantial reduction of level of “antiatherogenic” fraction has been revealed in patients with IHD and phobic disorders.

To study preconditions of formation of psychosomatic symptom complexes in cardiovascular diseases.

We have examined 832 patients (361 male and 471 female, age 49,5±6,4 years) of Borderline States Department with AH (700 persons), IHD (132 persons) and mental disorders of neurotic and affective level. Interrelationship of somatic, mental, psychosocial factors has been studied by methods of system statistical analysis.

In 40,8% of cases rationale of patients with AH and IHD to consult a psychiatrist was subjective non-satisfaction with his/her condition (р=0,001). Women were fixed on psychotraumatizing situation: life events, interpersonal relations, everyday factors. They perceived themselves as severe ill, experienced anxiety, depressed mood, suicidal ideation, tearfulness. Men recognized themselves as “nervous” or “somatic” patients or denied the illness as a whole (anosognostic reaction). They were characterized by fear of death, inclination to ideas of self-humiliation or self-guilt. Significant psychotraumatizing factors were medical (presence of somatic disease) and working ones.

Mental disorders in patients with HI, IHD were accompanied by somatovegetative symptoms: insomnias (86,7%; p=0.002), paresthesias (88,6%; р=0,002), inner palpitation (77,1%; р=0,001), a lump in the throat (56,6%; р=0,001), hyperventilation disturbances (41,9%; р=0,001), heart beating (29,4%; р=0,001), skin itch (15,4%; р=0,046), dysuria (10,7%; р=0,001), dysphagia (3,1%; р=0,028). Alalgical “masks”: cephalgias (92,9%; р=0,001), abdomenalgias (64,7%; р=0,012), cardialgias (60,1%; р=0,001), arthralgias (36,8%; р=0,001). Emotional lability (78,4%; р=0,037), irritability (73,9%; р=0,001), anxiousness (54,2%; р=0,001), paroxysms of fear of death (21%; р=0,001.

Variability and polymorphism of extracardial symptom complicates recognition, differential diagnosis and therapy of cardiovascular diseases.

To improve the quality of physical health care of patients on antipsychotics.

The second purpose of our study was to look at the administrative and clinical issues that hinders physical health assessment in outpatient clinics.

Severe mental illness (SMI) is associated with high risk of physical co-morbidity and mortality and as such is a major public health concern.

Current guidelines are described, and adherence to the standards is audited

Retrospective case note audit.

New patients seen in the outpatient Clinic between January 06 – August 06 and were prescribed antipsychotics were included in the study.

The audit included 30 patients, seen in the Collingwood Court Outpatient clinic between February 06 – August 06. The majority of patients were male (59%) and were between the age group 30 – 49.Depression was the main diagnosis (10 patients) closely followed by Bipolar Affective Disorder & Psychosis. Out of the 30 Patients, no patient had complete base line investigation. Only 13(43%) patients has some investigation and of this only 10 (33%) had the results recorded in the notes. In around 50% of the patients there was request made to the GP for this investigations but no further corresponded from the GP or any records of this being done was noted in the notes. No patients has BMI or BP monitoring done at any time

This audit identifies shortcoming in physical health monitoring and possible reasons.

Superstitious, the beliefs in supernatural causes of events are common all around world. In our society (Iran) many psychiatric patients especially in rural areas attribute their mental illness to supernatural causes. In previous study, authors showed 77.8% of patients in Beheshti psychiatric hospital, Kerman, Iran had superstitious beliefs. Many of our patients come from southern parts of province Kerman. This study was carried out in Jiroft, one of the important cities in the south part of Iran, we tried to evaluate the relationship between superstitious beliefs and anxiety and depression amon them.

In this research 388 individuals whom were randomly selected were evaluated with Beck's inventory for depression assessment, Cattel's questionnaire for evaluation of anxiety and, superstitious inventory which was standardized for research in Iran.

The mean score of depression ±SD was 15.1±10.8 and the mean score of anxiety were 6.7±1.6 in men and 6.4±21 in women respectively. Spearman's regression test showed that an increase in score of depression and anxiety results in an increase of score of questionnaire of superstitious beliefs (P<0.0001).

Superstitious beliefs could result in medication non compliance in psychiatric patients. From other point of view people with superstitious beliefs showed more depression and anxiety, so these patients are prone to be treated by local traditional healers than psychiatrists. Depression and anxiety are supposed to be 2 important factors in strengthening of superstitious beliefs.So depressed an anxious patients are more prone to delay treatment and seeking superstitious treatments.

Dissociative identity disorder (DID) is one of the dissociative disorder which was difficult to be treated completely. These patients created several identities to be protected from experiencing the pain of inescable and unrelieved trauma and abuse.Engaging these patients in meaningful activities is one of the treatment tools. In this report we presented a young female patient with impression of DID whom had treated with psychodynamic oriented psychotherapy associated with promoting her in painting abilities.

A 19 years old woman with 15 separate identities was described. In the first sessions, therapist identified her famous ability to draw. (one of her first paintings was associated with this abstract). During four years treatment, gradually she became an amateur painter. At the end of therapy she drew famous paintings instead of childish ones (induced in article). At this time she had nearly full integrated personality.

Painting could play a role not only as an useful instrument to discover patient's conflict, but also a complementary tool for integrating patient's personality in one strong personality.

the collection of treatment modalities implemented by multidisciplinary team may serve as a guide to treat severe SMB. In addition, the association of drugs with different site of action, but all for impulse control, may contribute for the efficacy observed here.

Bereaved individuals are at high risk for suicidal behavior, a fact well-known since antiquity as indicated by the Greek myth of Aegeas, who in his grief jumped into the sea in the mistaken belief that his son, Theseus, had been slain.

We report the experience of our recently established Consultation-Liaison Psychiatric Unit in the management of bereaved patients who attempted suicide.

Between December 2006 and August 2007 we accepted 36 requests for consultation with patients who had attempted suicide. Five patients (13.8%) reported the loss through death of a beloved one 3 to 22 months prior to the attempt. The most common reasons for attempted suicide were hopelessness, loneliness and meaninglessness of life, which they attributed to the bereavement. All patients had suicidal ideation for weeks or months prior to the attempt and two patients had revealed it to a close person. Only one patient had been assessed by a psychiatrist. Patients as well as their relatives reported that they considered these feelings as part of the normal grief process, even if they were prolonged or overwhelming. Two patients denied any further psychiatric intervention, one dropped out after one month's follow-up and two patients display a good outcome after a period of more than 4 months' follow-up.

When assessing patients in the Consultation-Liaison context, consultants should bear in mind the impact of bereavement, especially in cultures where complicated grief is easily misconstrued as a normal process than as a condition which merits psychiatric evaluation and care.

revealing of pathogenetic mechanisms of gender dysphoria at women with organic mental disorders.

49 women with organic mental disorders (F06, F07 in ICD-10) and sexual development disorders (F52, F64, F65, F66 in ICD-10): the basic group with gender dysphoria (28 examinees), the group of comparison without gender dysphoria (21 examinees). Middle age in the basic group was 24,9 years, in group of comparison - 22,6 years.

sexological (including the scale of gender identity disorders developed by Vvedenskij G.E., Medinskij E.V., 2006), statistical (cluster and correlation analysis).

in the basic group physical's “I” disorder at the stage of sex self-consciousness (preference of external attributes of the opposite sex, negative perception of own corporal shape) have appeared are connected as among themselves, and with physical's “I” disorder on the following, sexual role stage (negative perception of the physiological displays one's anatomic sex) that has led to disorder at the stage of psychosexual orientations (choice of the opposite sex social and gender role). Infringements of development mental “I” on gender-role stage (preference of interests and hobbies more peculiar to the opposite sex in our culture and elements of musculan behaviour) have appeared are caused by infringements mental “I” at a stage of sexual consciousness (preference of game activity in the group of opposite sex) in the group of comparison.

pathogenesis of gender dysphoria at women with organic mental disorders connected with physical's “I” disorder at the stages of sex self-consciousness and sexual role.

To date, the Calgary Health Region Child and Adolescent Mental Health Program (CAMHP) has triaged 23,883 referrals of which 14,034 have been enrolled and 9,849 have been referred at the time of triage to usually non-affiliated community-based programs or to the primary care referral source with recommendations. This paper reports on the results of a survey of those not accepted directly to CAMHP services in order to examine whether or not the recommendations made to the families seeking services were perceived as being appropriate.

A survey was developed and a list of those who had been declined service and given recommendations to seek service in the community was generated and these were contacted based on random selection.

Highlights include that a rating of 3.5/10 with respect to being satisfied with the service received on a scale of 1-10, with one being the best and ten being the worst. Additionally, when asked if AMH matched an appropriate mental health service to meet their child's needs, respondents replied Yes (56/69), No (11/69), Don't Remember (1/69), or Did not utilize the service (1/69).

The vast majority of clients surveyed were satisfied and felt that the recommendations made by AMH were appropriate. Implications for Practice or Policy AMH services appear to be appropriately aware of and linked with community serves to the extent that clients report a high level of contextual endorsement of the recommendations that are made.

Electronic literature databases are important tools when searching for medical information but the selection and coverage of databases affects the search results. In the case of health science, the choice of databases is not always easy, as some of the material may be scattered in databases focusing on different fields. Often PubMed is the only database used in medical research. The aim of this study is to examine the coverage of literature databases and to identify the best databases or combinations of databases in different topics in psychiatry.

We performed database searches on four different topics. The topics were ADHD prevalence, schizotypal personality, brain MR imaging studies in schizophrenia and recovery in schizophrenia. A systematic retrieval of studies was performed in three databases (PubMed, Web of Science and PsycINFO). We studied also if publication years or language of the articles affect database coverage.

PubMed was most comprehensive database in ADHD (85% coverage of total results) and in MRI studies (71%), whereas PsycINFO was most effective in recovery (62%) and in schizotypal personality (72%). The most comprehensive combination of two databases found 78-91% of the articles in the different topics.

When choosing databases for information search the extent of coverage should be taken into account, as there is no database that covers all information needs. The used literature databases should be selected bases on the topic. In psychiatry, especially in topics related to psychology also PsycINFO should be considered. In all, use of several databases is recommended.

There is a clear association between mental illness and poor physical health. Standardized mortality ratio shows an increased risk of death for many psychiatric illnesses. Physical illness may cause or exacerbate psychiatric symptoms. Psychotropic medications can cause iatrogenic diseases such as diabetes and cardiac arrhythmias. In view of these psychiatric population needs effective physical health monitoring but such monitoring requires equipment. Our primary aim was to examine psychiatrist's access to medical equipment.

A non-random sample of 181 consultant psychiatrists from the West Midlands were asked to complete a postal questionnaire detailing medical equipment accessibility, as well as their views on monitoring physical health in patients using psychiatric services.

98 (54%) consultant psychiatrists from a wide range of psychiatric specialties responded to a single mailing. In general, psychiatrists did not have ready access to commonly used equipment even if hospital based. Psychiatrists who were predominantly community based were even more disadvantaged. Less than half the sample undertook routine monitoring of patients on atypical antipsychotics and a similar proportion believed this to be a primary care responsibility.

Poor access to medical equipment is common and must impede psychiatrist's ability to provide physical healthcare for their patients. Lack of equipment may reflect the view that physical healthcare is not the psychiatrist's responsibility but increasing concerns about psychotropic side effects and lack of access to physical healthcare for mentally ill patients challenge this belief.