Evaluate durability of pregabalin's effect on pain associated with fibromyalgia (FM).

Randomized, double-blind, placebo-controlled trial with 1-week single-blind placebo run-in. Patients meeting ACR diagnostic criteria were randomized to pregabalin 300, 450, or 600 mg/d (BID) or placebo for 14 weeks (2-week dosage escalation; 12-week fixed-dosage). Pain was assessed with a daily pain diary using an 11-point numeric scale. Primary efficacy parameter was the LOCF endpoint mean pain score (MPS). Sensitivity analyses were assessed using the Duration Adjusted Average Change (DAAC) and a Mixed Model Repeated Measurements (MMRM).

745 randomized patients: 95% female, mean age=50 years, median FM duration=10 years, baseline MPS=6.7. Placebo-corrected differences in mean change from baseline to endpoint in MPS: 300mg/d, -0.71 (P=0.0009); 450mg/d, -0.98 (P<0.0001); 600mg/d, -1.00 (P<0.0001). Mean differences from placebo at endpoint (adjusted for treatment duration) over the entire treatment period (DAAC): 300mg/d, -.38, P=0.0200; 450mg/d, -.62; P=0.0001 and 600mg/d,-.57 P<0.0001. In the MMRM analysis, all 3 pregabalin treatment groups demonstrated pain relief by Week 1, and every weekly assessment thereafter, with the exception of 300mg/d treatment group at Week 11. Most common AEs: dizziness (all pregabalin, 35.8% vs placebo, 7.6%); somnolence (18.0% vs 3.8%). Most AEs were mild to moderate and resolved with continued treatment.

Pregabalin demonstrated significant reduction in endpoint MPS in FM patients. The DAAC sensitivity analysis confirmed the robustness of this effect. MMRM analyses demonstrated significant pain relief by Week 1 that was maintained throughout pregabalin treatment.

Study funded by Pfizer, Inc.

A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.

We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.

Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.

High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.

For the atypical antipsychotic agents, significant weight gain may occur, hampering compliance and causing adverse health effects. Few studies have investigated body composition changes with detailed methods.

To describe the effects over six months on body composition in schizophrenic patients randomized to treatment with sertindole or olanzapine.

Results from the first six patients enrolled in a 1y trial of consecutive patients (18-65y; Body Mass Index [BMI] ≤ 35 kg/m2) diagnosed with DSM-IV schizophrenia in the need of a second line antipsychotic agent. Weight, BMI, waist circumference (WC), %bodyfat (%BF) measured by 8-electrode bio-electrical impedance (BIA8) were assessed at each visit.

At baseline, moderately high median values were observed for weight (82.5kg), BMI (28.1), WC (100 cm) and %BF (25%). One subject was classified as normal weight, four as overweight and two as obese based on BMI, while four out of six were abdominally obese based on WC. Body composition values remained stable during the first month of treatment, but the median values had decreased slightly after six months (weight -0.5, BMI -0.2, waist circumference -2 cm, %BF 0%). The range was, however, fairly large for weight (-5.2 to 5.7kg), BMI (-1.7 to 1.7), WC (-5 to 7cm) and %BF (-4 to 3%).

Although there was individual heterogeneity in body composition development, the median changes were close to zero over six months of treatment with either olanzapine or sertindole. The small effects on body composition measured both by simple anthropometry and BIA8 are remarkable.

Longstanding symptoms after mild traumatic brain injury (MTBI) may be attributable to factors other than the MTBI, pretraumatic as well as posttraumatic factors. A recognised problem when assessing pretraumatic factors is underestimation due to recall bias. The aim of the study was to explore prognostic factors for the development of postconcussional disorder (PCD) after MTBI.

In a prospective cohort of MTBI patients, pretraumatic (previous psychiatric disorder, personality traits, coping ability, GAF, psychosocial stressors, medical condition), peritraumatic (duration of loss of consciousness and amnesia, GCS score at presentation, intracranial hemmorhage) and posttraumatic (posttraumatic stress, anxiety, depression) factors were thoroughly assessed within one week after the trauma, when recall bias was estimated to be negliable. Outcome (persisting symptoms and disability) was assessed at three months post injury. Logistic regression analysis was performed to calculate the independent contribution to the outcome from different factors.

Three months post injury, 17 % had postconcussional disorder (PCD). Posttraumatic hyperarousal (OR 9.08), concurrent medical conditions (OR 6.19), female gender (OR 5.54) and psychosocial stressors (OR 11.93) independently predicted PCD, but injury related factors had no significant relation to the outcome.

Pre- and posttraumatic factors significantly contribute to the long term outcome after MTBI and should be taken into account in the clinical assessment of patients with PCD. The findings support an etiological model that recognises predisposing and perpetuating factors as well as the precipitating head injury as determinants for the development of PCD.

To study the correlation between adolescents' psychical disorders and their difficulties of psychosocial adaptation.

There were 63 adolescents in our study (47 girls, 16 boys), who were hospitalised in the Department of Psychiatry of Clinics of Kaunas Medical University (Lithuania) during the period from September to December, 2005 year. 27 adolescents (19 girls and 8 boys) had suicidal and self-harming behaviour. Psychical disorders were diagnosed according to ICD-10 diagnostic criterions. We used Strengths and Difficulties Questionnaire SDQ-lit. adapted for Lithuania.

While comparing the means of scales of both sexes adolescents, with diagnoses of depressive, behavioural and adaptation disturbances, we found statistically dependent difference only in emotionally disturbance scale results (p=0,016). Analysing separately girls and boys groups, girls showed to be worse psychosocially adapted and had more emotional problems. Girls, who tried to commit suicide, had more emotional (p=0,006), psychosocial problems (p<0,001). Girls, who were diagnosed affective disorders, had more expressed emotional (p<0,001) and general adaptation (p =0,031) difficulties. Parents noted that, their daughters who committed a suicide and had behaviour disturbances, had more expressed emotional (p=0,007) and general adaptation (p=0,053) problems.

1. Adolescent girls, who were diagnosed depressive illnesses, had more emotional and general adaptation problems, than girls, who were diagnosed behaviour or adaptation disorders. 2. Adolescent girls, who tried to commit suicide, had more expressed behaviour problems, emotional, general adaptation difficulties. 3. Most expressed emotional and general adaptation difficulties were typical to girls who were diagnosed depression and who tried to commit suicide.

This study is aimed to establish biological, psychological, and social risk factors for a group of patients hospitalized following a suicide attempt or suicide ideation, and controls. Patients were characterized by different degrees of severity, namely: 1)Nearly Lethal Suicide Attempt 2)Suicide Attempt with a Survival Strategy 3)Suicidal Ideation without Suicide Attempt, 4) Control inpatients without suicide ideation or history.

We evaluated nearly 100 patients using several scales for the assessment of: Personality, Reasons for Living, Axis I, Social factors and History of previous suicide attempts.

There is a higher proportion of young, adolescent, single and female patients. Most of them asked for help after the suicide attempt. The majority had a comorbid diagnosis for substance abuse. In reference to personality disorders, we found counterintuitively, that those who made a Nearly Lethal Suicide attempt were healthier than the subjects who's suicide attempt was less severe.

This finding is also reflected in the fact that those with a less severe suicide attempt rated much higher on impulsivity and also were much less satisfied with their family and friends. This last trait is probably associated with personality disorders.

Patients who made a Nearly lethal suicide attempt had much higher on the Reasons for Living questionnaire. Compared to less severe suicide attempters, they had more reasons to stay alive. This last finding might be an early aftereffect of the attempt.

To investigate cultural differences on types of coping strategies employed by male and female patients.

72 Chronic pain patients were selected over 18 months. Patients were screened out if they had any physical disability or were getting psychiatric treatment. Besides demographic data, McGill Pain Questionnaire, Coping Strategies Questionnaire and Berlin Social-Support Scales were employed to record the study variables. Age range of patients varied from 25- 58 years. All the patients were educated, working and belonged to middle class.

Out of 72 patients (40 females: 32 males) 78% patients had impaired physical functioning. Perception of pain depended upon the age, sex, amount of perceived social support and contact with the treating doctor. Females frequently employed “religious coping” (95%) and used “self statements” (80%); as opposed to males who relied on “ignoring the sensations” (88%) and “increasing behavioral activities” (65%). None “diverted attention” through the ways they thought were not religious or culture appropriate.

The study reflected the cultural differences in type of coping strategy employed by a given patient. Female patients were somatically- focused but only 35% met the criteria for Somatization Disorder. Male patients employed techniques that allowed their control on the environment and illness whereas females patients relied on techniques that were passive in nature. Learning to live with a chronic pain is quite challenging for women who are feeling-oriented and look up to men not only to fulfill their needs but to get social approval in the context of Pakistani society.

Suicide is represented in the arts since the beginning of time. Since the time of the Roman Impire to Impressionism, Rafaelism or even Modern art, the suicide has a significant expression in the arts striking over the centuries and in various civilizations.

The authors propose to characterize the various forms of art that represented the suicide and its concept. Since classicism, the liturgical representation of suicide, almost disappeared. IT rebirth “by the new art,” were the various representations of the suicide were seen as “representative” of several current and various forms of contest the new society.

The suicide in the arts is the sociological expression how societies deal with this issue.

Alcohol is represented in the arts since the beginning of time. Since the time of Baco and Dionísio to Impressionism, alcohol, and especially the wine, is an expression in the arts striking over the centuries and in various civilizations.

The authors propose to characterize the various forms of art that represented the alcohol. Since classicism, the liturgical representation of alcohol, through rebirth and finally “by the new art,” were the various representations of alcohol, seen as “representative” of several current and various forms of being in life.

The alcohol in the arts is the sociological expression of society deal with this issue. From initial Nectar of the Gods, the wormwood that served as a refuge for expressionists, the authors want to make a brief discussion of the evolution of the role of alcohol in society and its expression in the arts

Persistent discomfort about one's sex or sense of inappropriateness is a diagnostic criterion for transsexualism (ICD-10), though mechanisms and psychopathological characteristics of these conditions are not clear enough. This investigation concerns phenomenological peculiarities of non-acceptance of one's own sex characteristics (SC).

241 persons (136 male and 105 female), who sought change of sex split into four groups. Group 1 were diagnosed as transsexuals (N=83), Group 2 as schizophrenia-spectrum disorder (N=77), Group 3 as organic mental disorder (N=22) and Group 4 as personality disorder (N=59). Average age: 24,3 years.

Clinical-psychopathological, sexological, statistical

Persons in Group 1 would not accept their primary (59%) and secondary (92,8%) SC, which expressed in discomfort, irritability and shame but no psychopathology involved. For Group 2, was more common non-acceptance of secondary SC (68,8%) with ideas of reference, depressive mood and dysmorphomanic delusions (21%). In Group 3, non-acceptance of one's SC (63,6%) combined with background asthenia (57%) and hypochondric fixation (40,1%). In Group 4 (76,3%), it was accompanied by psychopathic reactions dependent on the personality profile. Severity varied from feeling uncomfortable and distressed and trying to suppress sex-related external manifestations to ignoring or refusal to use them in sexual contacts and desire to get rid of them (including castration) and acquire the SC of the other sex.

Subjects in all groups would not accept their primary and secondary SC. This non-acceptance differed in intensity and psychopathological structure, and their qualification could be important for diagnosis of variants of gender-identity disorders.

Male and female patients with first-episode psychoses (FEP) differ in many aspects such as age at onset, premorbid level of functioning and the type of psychotic symptoms. Gender differences in factors related to outcome are less studied. The aim was to study gender differences in determinants of outcome in FEP patients.

Eighty-one male and 72 female FEP patients were followed up during 5-years with a comprehensive assessment of sociodemographic, psychiatric, and neuropsychological investigations. The 5-year outcome was dichotomized into poor and favourable outcome based on the 6-months stable functional and symptomatic outcome.

Female patients with an early onset, a lower level of education and still living with parents at baseline had more often a poor outcome than male patients. Among female patients, those with a low level of education had a poorer Wechsler's Adult Intelligent Scale (WAIS; the full-scale and the verbal and performance subscales) score. Among males, no such associations were found. A poor pre-morbid level of functioning and a long duration of untreated psychosis (DUP) were related to a poor outcome both for male and female patients.

The results indicate that, for male and female FEP patients, there are different predictors of outcome. In addition of risk factors of a poor outcome in both genders such as a low level of pre-morbid functioning and a long DUP, a low level of education, living with parents and an early onset of illness should be noticed as risk factors for female patients

This paper explores ethical complexities that underlie resident-faculty relationships. The faculty-resident relationship is as complex as that between a therapist and his/her patient, but it has been far less well studied.

From data obtained from psychiatry residents and faculty members regarding their experiences in this relationship, we present five vignettes that illustrate unethical conduct in the faculty-resident relationship.

Ethical lapses described in this paper are problematic for two reasons: first, personal and professional harm may come to individual residents who find themselves interacting with an errant faculty member; and second, ethical lapses have the potential to damage the overall training environment itself. Once the terms of the faculty-resident relationship are discussed and accepted by all participants, unintentional or inadvertent ethical problems will be prevented, and residents will be in a position to identify faculty behaviors that do not conform to these agreed-upon expectations

This paper highlights the importance of incorporating education about ethical responsibilities and faculty-resident boundaries into the training curriculum. We offer suggestions for understanding faculty members' responsibilities to residents in their training programs.

Fentanyl is a potent Schedule II opioid agonist that has potency more than 80 times that of morphine. A high concentration of Fentanyl is contained in Fentanyl patches (MATRIFEN).

They should be used to manage pain for persons with chronic moderate to severe pain who are already physically tolerant to opiates.During the past years there has been an increase in misuse and abuse in the United States of Matrifen that has caused deaths from overdoses.Matrifen can also cause neurological and psychiatric adverse events such as: delirium anxiety, abnormal thinking, abnormal dreams, depersonalization and hostility.

In the literature Matrifen have not previously been associated with serious offences such as attempted murder but an association with suicide has been noted.

To describe a previously unreported and serious adverse effect of Fentanyl patches.

We followed up the clinical psychopathology of an elderly gentleman who attempted to murder his wife reportedly due to an altered mental state caused by the application of Fentanyl patch. We searched Pubmed and Google for any reported adverse effect of Fentanyl patches of a similar nature.

After ruling out all other Psychiatric, Organic and Forensic causes we came to the conclusion that Matrifen was the cause of altered mental state which led to the attempted murder.

Although adverse psychiatric effects of Fentanyl patches have been reported in the past we can add attempted murder to the list. Fentanyl patches can be dangerous particularly in the vulnerable elderly patients where they are most commonly used.

To study the presenting features and outcome of deliberate self-harm patients presenting to an accident and emergency department

Self-harm accounts for up to 170,000 hospital attendances in the UK annually. 15-25% repeat self-harm within 1 year. Self-harm repetition is reported as higher among those who do not receive psychosocial assessments and discharge themselves from accident and emergency departments.

All patients triaged within Beaumont Hospital accident and emergency department with a presentation indicative of psychiatric disorder were studied over 12 months. The following were collected on each patient: demographic variables (age, gender, marital status), clinical variables (method of self-harm including associated factors, history of deliberate self-harm, overdose agents used in self-poisoning, whether a psychiatric consultation occurred and outcome). Dates and times of presentations were recorded. Statistical analysis was performed using SPSS14 statistical package.

1,397 liaison psychiatry patients presented to the accident and emergency department over 12 months. 834 (60%) cases were deliberate self-harm, most commonly overdose (47%). 353 (35%) cases of self-harm were associated with alcohol ingestion. Most self-harm presentations (30%) occurred in March (83), April (86) and May (83). Most self-harm cases (27%) presented between 9pm-1am. 27% of self-harm cases presented between 9am-5pm when psychiatric cover was available in the accident and emergency department. 73% presented outside of these hours. 273 (20%) liaison psychiatry patients left before psychiatric consultation.

Optimisation of the management of patients who self-harm is important. The reasons why patients leave hospital before assessment has been completed should be further investigated.

Postpartum psychosis is a severe psychiatric disorder that leads to hospital admission in about one woman per 1,000 deliveries. It coincide with the vulnerable period associated with becoming a mother and may, if untreated, lead to suicide and infanticide. Some risk factors for postpartum psychosis have been identified in previous research, such as primiparity and previous psychiatric disorder.

Knowledge on how postpartum psychosis is related to obstetric factors might be helpful in the clinical risk assessment of postpartum psychosis.

The aim of this large-scale follow-up study was to examine the association between postpartum psychosis and certain pregnancy and delivery complications and other obstetric variables, after adjustment for age, year of delivery and previous hospitalization for psychiatric disorder.

1,133,368 Swedish first-time mothers were included during a 29-year period yielding 1,413 hospitalized cases of postpartum psychosis. Several obstetric variables were analyzed separately after adjustment for possible confounders.

Respiratory disorder in the neonate, severe birth asphyxia, preterm birth, caesarean section, perinatal death and SGA infant were associated with an increased risk of postpartum psychosis. After adjustment for previous hospitalization for psychiatric disorder only preterm birth and acute caesarean section remained significant risk factors for postpartum psychosis (relative risks were 1.20 and 1.31, respectively).

The relative risk of postpartum psychosis among first-time mothers with previous hospitalization for psychiatric disorder was increased more than 100-fold.

Careful clinical risk assessments of postpartum psychosis are crucial among women with a history of psychiatric disorder whereas obstetric variables have a minor importance.

In an effort to acquire detailed overview regarding postgraduate training in psychiatry together with gaining opinions on the present and ideal postgraduate programm, our Young Psychiatrists Section in Czech Republic decided to undertake a survey.

The questionnaire was addressed to all current PhD students in the field of psychiatry and to those who finished the studies previously, maximum 10 years ago. We distributed the questionnaires via mail and e-mail to all 7 psychiatric clinics and put it also on our website. 32 participants from 5 institutions responded. The questionnaire encompasses questions related to the metodology of the project, tutor engagement, working schedule, financial situation and other funding oportunities. Second part contained requests on various aspects of ideal training programm.

The majority of the participants is satisfied with tutor involvement (92%) and the metodology of the project (85%) but less with the financial support of the project (69%) and time devoted to work on it (69%). The ideal organization of the PhD programm should be in blocks (81%), for a certain period of time for PhD project and the rest for clinical work.

The survey revealed some weak spots of our contemporary PhD studies programm in Czech Republic, e.g. lack of time for working on PhD project and poor funds for covering it. Beside various models for organizing postgraduate studies, PhD students are in sum mainly satisfied with it. Suggestions on ideal organisation of the programm are meant to serve as potential models for consideration.

In 2004, there were 11,092 presentations to Irish hospitals with deliberate self-harm, including 7,933 cases of drug overdose, of which 31% involved paracetamol. Limiting the availability of paracetamol reduces morbidity and mortality associated with paracetamol overdose. The present study aimed to determine the level of compliance with statutory regulations governing the sale of paracetamol in Ireland.

Researchers visited pharmacy and non-pharmacy outlets (newsagents, mini-markets and supermarkets) in Dublin city and attempted to purchase amounts of paracetamol that exceeded the statutory limits for a single transaction. All paracetamol tablets purchased in non-pharmacy outlets were in blister-packs and all non-pharmacy outlets sold packs with 12 tablets or fewer per pack.

Amounts of paracetamol in excess of statutory limits for a single transaction were purchased in

50.0% of pharmacies

81.8% of newsagents/mini-markets

20.0% of supermarkets.

We recommend that

1. (a) the sale of paracetamol in newsagents/mini-markets should be discontinued

2. (b) the sale of paracetamol in supermarkets should continue, but automated check-out tills should be programmed to prevent the sales that exceed statutory limits

3. (c) there should be greater efforts to ensure compliance with statutory regulations in pharmacies.