Involuntary admissions for the treatment of mental disorders affect 10% of mental health services users. Psychiatric Advance Directives (PADs) are documents that allow users notifying treatment preferences for crisis relapses. PADs have been experienced in several countries to improve users’ empowerment and reduce involuntary treatment. However, PADs take-up rate remains low and its effectiveness inconsistently evaluated. A hypothesis is that PADs should be considered as a process including its completion, registration, and honouring.

A Multi-Criteria Stakeholders’ Survey was carried out to understand what an optimal PAD process should be, and what the main hurdles are in implementing it.

102 Belgian stakeholders were selected among users and non-users groups, and face-to-face interviewed. Each interviewee scored 20 different options in designing, completing, registering and honouring a PAD. Four criteria were assessed: patient's autonomy, therapeutic relationship, mental care continuity and feasibility.

Overall, the PAD options aiming at improving access to the document and honouring statements received lower scores than options aiming its design or completion. Therapeutic relationship was a more important criterion than autonomy for the non-users than for the users group (p = 0.03). Options with the highest scores emphasized that PADs should be requested by the user, drafted in an outpatient setting, include de-escalating methods, justify treatment preferences, allow appointing a surrogate decision-maker, and need health providers training or a case-coordinator to be honoured.

PAD access and honouring are problematic steps of the process and should be developed to improve the use of PADs and its possible effectiveness

The study population is served by CMHTs and in addition (in one sector) by a Crisis and Home Treatment Team.

To evaluate the recorded admission and discharge processes in the medical and nursing notes.

To record relevant clinical characteristics of the admission and the patient.

To assess recorded admission and discharge processes against standards defined in the protocol.

A random sample of 100 records, which met inclusion criteria, was selected. A protocol evaluating the recorded processes, and relevant information re the admission was completed by psychiatric trainees and senior nurses.

51% of admissions occurred on week-ends and 58% occurred “out of hours”. In 35% of admissions a further admission had occurred within 4 weeks. 34% of admissions derived from 2 areas, highly correlated with deprivation. Alcohol or drug misuse contributed to 69% of admissions. In 77% of admissions, the patient was known to the service. 10% of patients had a diagnosis of major mental illness.

Recorded medical and nursing assessments of admission were incomplete i.e. 66% of medical records and 80% of nursing records. Assessment of discharge records indicated similar failings in record -keeping.

The recurrent pattern of admissions(33%), the association with deprivation(34%) and drug or alcohol misuse(69%), indicate the need for more effective management of these patients. The failings in recording admission and discharge information are significant. Improvements in these processes could identify those patients who require additional support and /or are at risk of futher admissions.

We have studied the treatment modes and therapies of patients with acute psychotic disorders, in a general hospital for 1600 beds

Clinicopshycopathologic, clinicotherapeutic, and statistical.

1982 patients, 18–92 years of age, 64% of them males, have been examined.All the patients have been primary admitted with acute somatic disorders:insult - 18%,skull injury - 21%,myocardial infarction - 23%,exogenic poisoning - 31%,parasuicides -4%,operations on the thoracic organs - 3%.The mental disorders diagnosed were following:amnesic syndrome, organic - F04 - 29%,depression - F43.20 - 5%,organic hallucinosis - F06.0 - 12%,organic delirium - F05 - 33%,psychotic disorder - or drug induced - F1 - 21%.

After psychiatric examination by an attending psychiatrist, the patients have been moved to the resuscitation department where they have been treated up to their recovery. No one patient has been moved to the mental hospital.

The Mental Health Assessment Unit (MHAU) isa gateway between community services and in-patient services. It aims to provide an acute setting in which to assess patients within 72 hours, with the view to reducing in-patient hospital admissions. We aimed to ascertain the number of referrals made to the MHAU and admissions over a one month period. The presentation and length of stay was investigated and the diagnosis and follow up plans made were explored.

Data was collated from a one month period. Crisis and home treatment team (CRHT) notes were reviewed.

100 referrals were made to the MHAU; 48 patients were admitted. 25 patients had care coordinators. In the majority of cases the source of referral was through the Emergency Department. There was a range of presenting complaints.Diagnoses included a wide variety of nature and severity. Average length of stay was 2 nights. Patients deemed to require in-patient management had shorter length of stay with swift transfer to treatment units. Shorter stays were also associated with milder degrees of illness. Longer length of stay was associated with more complex illness.

37 patients were discharged home, 11 were transferred to in-patient treatment units. Most patients discharged home were followed up by the CRHT.

5 patients were admitted to the MHAU more than once. This may represent a subgroup of more complex patients.

We recommend study into patients’ experiences with care coordinators at times of need. We also plan to re-audit for a longer time frame.

There is a growing concern about the potential risk that the use of certain antipsychotics may have on the QTc prolongation, electrocardiographic parameter key to assess the potential risk of developing a potentially lethal ventricular tachyarrhythmia:“Torsade de Pointes”. Previous studies highlights the existence of low levels of potassium in severely agitated patients versus moderately agitated ones (1). So if we take into account that seriously agitated patients tend to receive higher antipsychotic doses, and mainly antipsychotic with a more sedative profile, we face a hotbed for causing a potentially lethal tachyarrhythmia.

Evaluate the presence of hypokalemia in agitated psychiatric patients.

We chose a random sample of 31 agitated psychotic patients attending emergency room and we make a determination of potassium level at that time, compared to a sample of 33 others randomly as control who donate their blood in the hospital blood bank group. Final results, showed that agitated patients presented potassium figures significantly lower than the control group. (3.88 average in agitated versus 4.14 control group), (p = 0,048).

These data confirm our hypothesis of work and the relationship between hypokalemia and psychomotor agitation in psychotic patients attending the emergency ward, increasing notably the risk for “Torsade de Pointes”.

Research suggests that trust is vital for quality healthcare and effective outcomes. Trust becomes necessary in conditions of vulnerability and uncertainty. These conditions may be especially relevant to the experience and treatment of mental illness - not least psychosis. There currently exists a paucity of research into trust and mental health services.

To develop an understanding of trust as it relates to psychosis services and their users. To identify practical contexts where trust may be particularly relevant and where research may inform policy, service organization and individual practice.

Semi-structured interviews were carried out with 21 stakeholders - service-users, professionals, managers, carers - across 3 different types of service working with people experiencing psychosis: early intervention; assertive outreach; and a more standard community mental health team.

Trust appears to be salient and yet problematic for mental health services, not least in terms of approachability, disclosure and cooperation with treatment programmes. Organizing services around understandings of trust, rather than risk, may be more effective both at meeting need and managing risk.

Through an improved understanding of trust and its effect on the engagement of service-users, there are clear potential benefits for mental health services through an enhanced ability to facilitate access and develop effective cooperation towards healthcare outcomes.

The Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.

To examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.

To propose amendments to the legislation, based on the experiences elicited.

This cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.

317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.

Nursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.

Current clinical practice excludes placebo usage on ethical grounds. No attempt was made to clarify the viewpoint of the general population regarding the matter.

To evaluate the opinion of young-adults towards the use of Placebo in clinical practice.

1. 1) Investigate the willingness of our study population to receive placebo for the treatment of depression or other general medical conditions, and

2. 2) assess whether prescribing placebo would affect the study population's view regarding doctor-patient relationship or patient's autonomy.

We enrolled 344 students from five academic institutes in Israel, and briefed them thoroughly about the effects of placebo, its efficacy and limitations in treating depression. Understanding was verified and only then did the subjects complete a 32 item self-report questionnaire (include sociodemographic, health related data, past experience in medical encounters and willingness of subjects to be treated with Placebo medication).

In contrast to our main hypothesis 70% (N = 243) of the subjects expressed consent to be treated with placebo as a first line treatment had they suffered from depression, and 73% (N = 248) agreed to receive placebo for other general medical conditions. Eighty-eight percent of the subjects (N = 297) did not perceive a physician using placebo as a deceiver or the act of prescribing it a deceit.

The majority of our study population was willing to use placebo medication in general, and in particular, as first line treatment for depression. This study results should promote physicians to rethink and discuss the legitimacy of using placebo in clinical practice.

Bioethics in psychiatry is a research area that is gaining more relevance each year. To understand what bioethics is we need to clarify some concepts.

Morals are the rules that govern the behaviour of humans being in relation to society and themselves but that does not imply alone the concept of good or bad.

Ethics consider what is moral, how to rationally justify a moral system and how it is applied then to different areas of our social life. We therefore conclude that bioethics is responsible for studying what is moral in the field of human behavior.

We provide a historical review of bioethics in psychiatry from the Middle Ages to the present day.

Having reviewed documents we will cover the key historical events which changed the course of bioethics in psychiatry as well as in other areas of medicine.

In our field, Psychiatry, Bioethics is a relatively new discipline which has changed over the centuries to find a model based on patient autonomy and beneficence. These two basic ethical principles were specially established since the Belmont Report was published in the 70s.

Despite the changes and evolution through the history, bioethics is a subject that still requires more research and analysis. There are still few professionals who have an adequate training in bioethics.

Stigmatizing attitudes regarding mentally ill people are common (Rusch et al., 2010). Study result suggest that the degree of stigmatization may depend on concepts of psychiatric diseases (Crisafulli et al., 2008).

We aimed to investigate the impact of a sole neurobiological vs. a sole sociodynamic disease concept on the attitudes of students towards the alcohol dependent patients (Crisafulli et al., 2008).

200 students were randomly assigned to read information explaining alcohol dependence sole neurobiologically/sociodynamically. Subsequently, the students completed a series of questionnaires (adapted from Crisafulli et al. (2008)) regarding their attitudes towards the alcohol dependent patients. Attitudes were compared to attitudes of students not exposed to any disease concept.

Consistent with former study results we found increased blaming and decreased willingness to finance therapy in those students exposed to the sociodynamic explanation. Attitudes regarding blaming and harmfulness of the alcohol dependent patients were increased in the neurobiological and sociodynamic group compared to the un-exposed control group.

Information regarding possible causalities regarding the development of alcohol dependence is associated with more negative attitudes towards alcohol dependent patients in the questioned students compared to unexposed controls. This may be reasoned by the recognition of alcohol dependence as a manifestation of mental illness and the subsequent inclusion of the alcohol dependent patients in the prejudices and acts of discrimination commonly leveled against the mentally ill. Therefore, multimodal interventions rather than medicinal information seem to be necessary in order to decrease stigmatization of the alcohol dependent patients.

The misuse of psychiatry by politics during dictatorships has mainly happened in the first half of the last century during the Third Reich and Stalinist period in Soviet Union. Even today the psychiatric diagnoses may be changed in an abusive way for politic purposes as they were in the past. This may undermine the credibility of psychiatry. The psychiatric professional organizations only recently start to discuss and investigate this issue.

The authors made a literature review in historic and psychiatric books. They also visited some memorial sites were psychiatry and dictatorship were sadly connected in history. Using as main example the abuse made by psychiatrists as a politic instrument in the Third Reich period, the authors aim to make a historic review about the relationship between psychiatry and politics.

Abuse and misuse in psychiatry may also easily be done nowadays. Psychiatry is a science with not so clear boundaries, what is normal or abnormal may be sometimes unclear mainly if not seen in a serious and ethic perspective. Because of this psychiatrists should be very clear about their position in ethics, science and society.

The psychiatric professional organizations should face the facts of the tragic relationship between psychiatry and politics in history, discussing this issue more openly for an appropriate understanding of the past and for preventing new errors in the future.

A diagnosis of mental illness has been associated with weight gain, particularly among patients suffering from schizophrenia1.

This study aims to establish trends in weight gain among inpatients and the effects of several public health interventions between 2006 and 2009.

A body mass index (BMI) was calculated on admission and one of the authors has routinely measured the BMI of all inpatients on an annual basis since 2005 as part of a regular audit cycle.

Admission BMIs are comparable to the male general population2. The vast majority of patients are prescribed antipsychotic medication, approximately 50% receiving clozapine or olanzapine at any given time. There is a wide range of weight change from admission to discharge (−8.5 kg to +60 kg) but the average BMI of each sample exceeds the general population such that a majority of patients in each sample are clinically obese (BMI ≥30).In response to the audit findings the unit promoted public health and individual care plans (2006–09) aimed at addressing the high rates of obesity. Despite these initiatives there was a substantial rise in mean BMI between July 2007 and February 2008.

Admission to a medium secure unit results in substantial weight gain for the majority of patients. The causes of weight gain in a relatively closed institution are probably multi-factorial in origin.

To review current practice of lipid monitoring for patients prescribed colzapine and to improve the health of patients taking clozapine.

This was a retrospective audit targeting all patients who were taking Clozapine from May 2008 to April 2009 inclusive. Data was collected from pharmacy records, the heath centre records and patients’ personal care records. Current practice within the hospital was then compared with the standards proposed by the Maudsley Guidelines.

The total number of patients who were prescribed clozapine between May 2008 to April 2009 was 65. Of these patients 54 met the identified standards. We identified two patient groups; 56 patients were taking clozpaine for more than one year and nine patients were taking clozapine for less than one year. Out of those patients who were taking clozapine for more than one year, standards were met for 89% of patient (n = 50) compared to only 44% (n = 9) of those patients who were taking it for less than 1 year. Also, of those patients who had been taking clozapine for less than one year and do not meet the standard, none of them had lipid monitoring at three monthly intervals.

Although the vast majority of patients in the hospital who were prescribed Clozapine had their lipids monitored appropriately, a small percentage did not. Monitoring of lipid levels was particularly lacking in the first year of treatment.

Nigeria has a predominantly youthful population living in an adverse social environment created by a combination of factors, which creates a situation for a large number of children to be exposed to life of want, danger, abuse and social isolation. Such children are known to have a higher risk of coming into contact with the juvenile justice system (JJS). An ideal JJS should provide statutory guardianship for children in need of care, protection or reformation. There are reports that Nigerian JJS may have some shortcomings.

To review internationally accepted standards of care for children within the JJS and compare this with the current practices in Nigeria with a view to make recommendations for improvement.

To examine the level of compliance of the Nigerian JJS with international standards.

Information and data on the history, structure, facilities, current practices and enabling laws of the Nigerian JJS were obtained by review of literatures, perusal of available records, on-site visits and direct interview of officials of the Nigerian JJS.

The Nigerian JJS was modelled after the British system, with few modifications to accommodate local customs. The current state may have deviated beyond customary differences to include systematic ones. For instance, incarcerating forms of custodian care is the norm in Nigeria as non-incarcerating methods are not well developed. These facilities are also in deplorable states. Furthermore, the current enabling laws are obsolete.

Nigerian JJS currently have major shortcomings that may preclude serving its intended purpose. Recommendations were made.

The research was applied in a methodological type in order to develop a scale for the purpose of determining the nurses’ attitudes related to forensic psychiatry patients and to determine the availability and reliability of the scale developed.

The research was carried out with 650 nurses accepted to participate the research.Evaluation of the data was carried out over 536 questionnaires.In the research, Information Form, Belief Towards Mental Illness Scale(BMIS) and Nurse's Attitude Towards Forensic Psychiatric Patients Scale(NAFPPS) were used. NAFPPS was developed in two processes as qualitative and quantitative. In theoretical process, “focus group discussion” and “composition forms” and various attitude scales developed in psychiatry field in literature were used.In experimental process, validity and reliability analysis was built up.

Content validity index(CVI) was found .69, concurrent validity with BMI was found as .44, Cronbach Alpha coefficient determining the internal consistency was found as .86 and cluster correlation coefficient was found as .86, ön-test ile son-test arasındaki tutarlılığı belirleyen stability factor determining the consistency between pre-test and post-test was found as .69. It was determined that NAFPPS consisted of four lower dimensions.The highest point that can be acquired from the scale is “125”, the lowest point is “25”.High point shows the positive attitude towards the forensic psychiatry patient.

In the direction of these data, it was determined that Nurse's Attitude Towards Forensic Psychiatric Patients Scale was a valid and reliable scale.