Patients with factitious disorder intentionally produce or feign signs of medical or mental disorders. The only apparent objective of this behavior is to assume the role of a patient without an external incentive. The high rate of comorbidity with other psychiatric disorders together with the knowledge that factitious disorder lies on a continuum between somatoform disorders and malingering renders the early detection and diagnosis of cases with feigned psychological signs and symptoms more demanding.

Poor documentation of factitious disorder with predominant psychological signs and symptoms in the current literature reveals a blind spot in the diagnostic approach. With this in mind three cases were followed and reviewed to illustrate the elusive character of this clinical entity and demonstrate the importance of its early consideration in the differential diagnosis.

Three patients presented to our acute psychiatric department with an extensive constellation of mood and psychotic symptoms. All patients underwent a thorough neuropsychological and medical evaluation. The diagnosis of factitious disorder was mainly based on their inconclusive mental status examination which could not definitively support the presence of another psychiatric or medical disorder, on the observation that their behavior on the psychiatric unit proved inconsistent with their chief complaints and on the past history from collateral sources which confirmed a pattern of multiple hospitalizations.

Factitious disorder should be considered in patients with inconsistent psychiatric presentations and negative diagnostic results who are high utilizers of acute care facilities such as the emergency room and inpatient services.

Quality of life is an important factor in evaluating health and therapeutic problems; therefore quality of life evaluation is an important issue in medical articles. The present study investigates quality of life in 15–64 years old subjects in Kurdistan province.

Determining factors impacting quality of life in Iran.

The present study investigates quality of life in 15–64 years old subjects in Kurdistan province.

This is a cross-sectional descriptive and analytic study. The target population was 15 to 64 years old population in Iran. 700 individuals participated in this study. The information gathered with Euro His questionnaire. The data was then analyzed by using independent t test and multiple regression.

Subjects included 352 males (50.4%) and 346 females (49.6%). Quality of life mean score in all subjects was 28.18 (± 4.6). The mean score in men and women were 28.78 and 27.57 respectively. Asthma, smoking, female sex, residency in urban and low income had negative effect on quality of life in multiple regression (R2 = 0.151) but age, diabetes, hypertension and sport activity didn’t have any effect on quality of life after adjustment for other variables.

Quality of life score in women was lower than men. It is thus necessary to examine effective factors on decreased quality of life in women and making plans to eliminate the negative factors. According to the results, low income, smoking, residency in urban and asthma have adverse effects on quality of life. These factors should thus be considered in health programs.

Interdigital 2D:4D ratio has been considered as an indicator of prenatal exposure to androgens, entailing then a smaller ratio more androgenisation. Although it has been related to systemizing and empathy dimensions in the general population, it has never been studied in parents of people with Autism Spectrum Disorders (ASDs).

To analyse the relationship between the 2D:4D ratio and these psychological variables in this population.

The sample was composed by parents of both genders of people with (n = 46) or without (n = 42) ASDs. The ratio was calculated as the mean of 3 measurements of each hand evaluated by 3 different researchers. Psychological dimensions were evaluated by means of the Systemizing and Empathy Quotients (SQ and EQ, respectively).

Parents of ASDs persons showed lower scores in the EQ than controls, being these differences replicated only in men. No differences between groups for the 2D:4D ratio were found. Nevertheless, regression analyses indicated that in parents of ASDs a higher 2D:4D left ratio predicted a higher EQ. This result was also observed in men but not in women. In any case, the model was not significant in the control group.

Parents of ASDs persons showed lower EQ than controls, being this quotient predicted by the left 2D:4D ratio only in the former. When analysing in each gender, these results are only obtained in men. Among other parameters, the D2:D4 ratio (especially the left hand one) could be considered a valid indicator of the ASDs parent's idiosyncrasy.

Acute and transient psychotic disorder (ATPD; F23, ICD-10) have been described as acute psychosis with brief onset, polymorphous symptomatology and rapid resolution. ATPD is not very well studied disorder and it has not been studied in Latvia up to now.

Retrospective chart review study of all first time hospitalised patients fulfilling ICD-10 criteria for ATPD treated at the Riga Centre of Psychiatry and Addiction Disorders, Latvia during a 3-year period. Patients were assessed using standardised instruments during 4.1 years follow-up period.

During a 3-year period 294 patients were first time hospitalized with ATPD. Over an average of 4.1 years follow-up period 62% (182) of patients were not rehospitalised. In the subgroup of rehospitalised patients diagnosis in 71% (80) of them later changed to schizophrenia. Comparing ATPD subgroups we found that the percentage of patients “with schizophrenic symptoms” (F23.1) was higher 55% (161). ATPD “without schizophrenic symptoms” (F23.0) diagnosis was more frequent for “pure” ATPD patients 79% (38), than for ATPD, which later developed into schizophrenia (p < 0.001). Clinical features like affective disturbance was present in 25%, anxiety 58% and hallucinations in 53% of patients, who later developed schizophrenia and only in 24% with “pure” ATPD (p < 0.001).

More than half of the patients were hospitalized once during follow-up period. In subgroup of rehospitalised patients most common diagnostic change was to schizophrenia. Further prospective research on the topic is warranted to understand evaluation of the diagnosis in ICD-10 and possible changes in ICD-11.

Hypothyroidism is a medical condition commonly found in a variety of clinical settings. Physical complaints of thyroid hormone deficiency are many, and psychiatric symptoms include cognitive dysfunction, affective disorders and psychosis.

To study the possible relationship between psychotic symptoms and secondary to treatment with radioiodine hypothyroidism, presenting a case report.

We report a 32 year-old woman without known significant past medical history (except Graves Basedow disease with no current treatment) that came to clinical attention due to psychotic symptoms. The patient was admitted to the hospital and laboratory values revealed hypothyroidism secondary to treatment with radioiodine (which was required six months before for a Graves Basedow disease). We considered the possibility that thyroid dysfunction was the cause of the psychiatric symptoms.

After giving neuroleptic treatment with increasing doses of risperidone (up to 9 mg/day), clinical improvement was observed, with a diminishment of psychiatric symptoms. At the same time, supplementary treatment with thyroid hormone was given, which did not manage to normalize the hormone function at the moment of discharge.

In our patient we cannot establish a definite link between psychotic and clinical thyroid dysfunction, because six months after replacement therapy the hormonal function has not yet been completely standardized. The patient was psychopathologically stable (although treatment was maintained with quetiapine 600 mg/day). There is no doubt that thyroid hormone plays a key role in the regulation of mood, cognition and behavior; we must not ignore this, and always check thyroid function in psychiatric patients.

Social humans are embedded with a variety of relationships. Satisfactory social support is crucial for having physical and psychological well being.

The purpose of the present study was to find empirical support for the connections between perceived social support and loneliness with life satisfaction.

226 students of Golestan University of Medical Sciences (in Northern Iran) participated in the study. They were assessed using demographic questions, Multidimensional scale of Perceived Social Support, Life Satisfaction Scale, and Loneliness Scale. Using SPSS (16) and Pearson correlation test, linear regression the data were analyzed.

120 male and 104 female students filled the questionnaires. 91 percents of the students were single and also 95 percents were residents of university dormitories. There was a significant relationship between life satisfaction with loneliness in the subjects (p < 0.05). The higher social support from the family and friends was also correlated with more life satisfaction and less loneliness (p < 0.05). Linear regression showed a significant correlation among social support, life satisfaction with loneliness.

Findings suggest that, in general, appropriate social support can reduce loneliness and increase life satisfaction. It is also one of the well being predictors. Therefore the universities should provide strategies to facilitate social support from family and the significant others. The empowerment of the students using teaching social communication skills may be helpful as well. The results were discussed within the context of findings from the studies conducted in eastern and western cultures.

of this 2-staged study were to assess knowledge gain of medical students following an individual episode of patient-centred teaching. Participant satisfaction was also assessed.

The education of medical students is an important role for trained medics using adabtable teaching methods, appropriate to the demands of students and medical universities. Delivery of patient-centred teaching in UK is ad-hoc, minimal and not standardised. However, medical education still tends to be delivered in the in-patient environment, where there is little supervision and students often have to identify patients on their own. Paucity exists in the evidence of whether bedside teaching assists in knowledge gain.

In Derby, a Patient-centred clinic was developed in 2008. We conducted a pre-intervention/post-intervention comparison study to measure the knowledge gained during a teaching session. Participants were medical students from University of Nottingham, and in-patients at the Unit. Following this, standards were set and assessing questions were changed to multiple choice style questions in January 2010.

show that there is an immediate knowledge gain, of an average of 22%. Students are satisfied with this method of teaching and patients have felt that their input has been valued. The second part of the study has confirmed these findings.

The study demonstrates usefulness of patient-centred education in improving clinical knowledge. Adoption of this form of teaching will benefit not only medical students in their psychiatry placement in Derby, but also the wider medical student population. This method can also be implemented in other acute medical specialties.

Clinical correspondence between general practitioners and specialists remains fundamental to the process of referral from primary care and transmission of management advice from consultants.

Discrepancies over medication records for patients with mental illness living in community were highlighted by a previous audit and recommendation for improvement were accepted and implemented by the trust.

An audit of the documentation of patient's medications in the Psychiatric clinic letters compared to the general practitioners records was done two years back and several recommendations were made to improve the communication.

The aim of this study was to examine if the recommendations from the previous audit was implemented and if the quality of communication about medication conveyed by the Psychiatrist to the General Practitioner improved.

Latest Psychiatric clinic letter of 50 patients were randomly selected from the computer database and they were checked against the latest GP records.The expectation is that the Psychiatric and GP records would correspond 100%.

This re-audit revealed most of the recommendations from the previous audit were implemented and as a result of that, the numbers of errors were reduced. However there were still significant errors detected including wrong medication, omission and incorrect dosage, schedule and frequency.

Laboratory medical tests have different applications in the field of psychiatry. Some lab tests are done for psychiatric inpatients and outpatients as a routine basic assessment. These tests may be important for diagnosing or ruling out some possible organic causes of psychiatric symptoms and/or co morbidities, or as comparative basic data for further evaluation of some important psychotropic medications effects and/or side effects. Some other important areas of lab tests applications are monitoring serum levels of some psychotropic drugs for evaluation of patient's compliance/noncompliance to drug, for establishing and maintaining effective therapeutic blood levels of medications, for assessment of the etiology of non-responsiveness to pharmacotherapy as well as several other clinical implications.

Through an extensive and comprehensive literature review in this non-systematic review study, authors have classified the application of laboratory tests in the psychiatry practice from several aspects.

Laboratory tests were classified regarding different aspects like the frequency of prescription by psychiatrists, cost-effectiveness of some routine assessments, legal obligation and claims issues, follow up considerations, psychotropic drugs false/real interactions with some laboratory tests and some false positive /negative laboratory results with great importance in the psychiatry practice as well as several other issues.

Both psychiatrists and laboratory practitioners need to have some basic information about each other’s field of practice, concerns and needs. This review presents a more clear sense of the interactions and necessary co-operations between psychiatrists and medical laboratory professionals.

Epilepsy is a common neurological condition affecting 1–2 percent of the population. At least 3,50,000 are affected in the UK, one quarter of whom have active epilepsy. There is higher representation of epilepsy in estimated 1.2 million learning disabled population in the UK. Rough estimates predict some 5 percent of such population are in institutional care; 30 percent requiring medical attention.

Lighthouse Healthcare provides inpatient tertiary care services to Learning Disability population with complex needs. A sizeable proportion of the inpatient population has complex and refractory epilepsy. As the services are provided at various hospital sites, we wanted to review the care of all the patients with epilepsy and compare it with national standards as set by the National Institute of Health and Clinical Excellence in England and Wales (NICE).

As most of the patients were already diagnosed elsewhere, we reviewed the medical records and compared the care with the standards envisaged in the NICE guidelines on the management of Epilepsies.

We contacted the Clinicians responsible for the care of all current inpatients and identified the cohort with epilepsy. We then reviewed the medical records for their conformity with NICE recommendations.

Besides missing records, we identified that there were major deficiencies in recording the breakthrough seizure activity as well as epilepsy review on yearly basis either by general practitioner or in specialist clinics.

The care provided to this vulnerable group falls short of standards expected in a secondary/tertiary care setting.

The goal of the study is to determine the problems that the nurses tend to look and to constitute a common language in the acute care unit.

In the study, document analysis method was used. The observation forms filled by both nurses and physicians for the risky patients were examined. For the examination and categorization, a coding chart containing the problems in both forms was used. Risky patient assessment form of thirty two patients (filled by the physician) and three hundred fifty five nurse observation forms used for same patients were included into the study.

The mean of days in which observations recorded by the nurse were 15.29 ± 6.98 (min.4-max.29). The risky patient form was filled by the physician generally in the day that the patient was hospitalized. The majority of the patients for which observation form was filled had psychotic disorders. It has been seen that “self-care deficit” (70.7%) was mostly marked and, “eating the meal” (74.1%), “anxious facial expression” (44.5%) and “sleeping at night” (52.7%) were tagged mostly in nurse's form. In the physician's form, aggression and agitation was mostly marked (63.1%).

The problems declared in the nurse observation form are rather concerned with the daily life activities not including sufficient information in terms of the risk creating characteristics. It has been concluded that the changes should be assessed quickly and clearly. The observation forms do not provide practical information about the course of the disease although these are kept daily.

Hysteria is manifested by physical (conversion disorder) and/or psychical symptoms (dissociative disorder), without changes in organic basis, given that they are symbolic manifestations of repressed conflicts that return from the Unconscious. Due to frequent childish and theatrical character that accompanies those events, hysterical patients often mobilize negative attitudes and feelings in peoples of their conviviality.

to discuss the psychological meanings of living with such patients.

Clinical-qualitative method.

A typology of relatives emerged from the interviews: the ambivalent, by one side relate well with the patients wanting to take care of them and showing, by the other side that they feel emotionally overloaded, considering the remoteness; the promoter who seek to save the patient from experiences unpleasant and situations likely to produce emotional crises, thus, are more likely to be the target of the action of the patient, the responsible who wish to leave the patients, but do not because they think nobody will care of them, which would worsen the health condition of these patients.

As the hysterical patient has clinical manifestations in order to attract attention to themselves and to manipulate the people around them so that they act in their favour, the attitude of the relative can be both stimulating and repressing of those behaviours, possibly interfering in the clinic evolution of the patients. It is, therefore, important that the doctors and nurses know the relationship between caregivers and patients, in order to instruct them on how to better act with those patients.

Psychiatric intensive care is supposed to offer treatment and to hold patients with psychiatric illness, if they pose a threat to themselves or to others.

A chart review was performed including 100 consecutive inpatients (52% females, age: 45.7 ± 17.8 years) treated at the Viennese psychiatric intensive care unit (PICU) in the years 2008 and 2009. Clinical key features and the distribution of mental disorders (according to ICD-10) in these patients are reported here.

The mean duration of stay was 18.9 ± 14.8 days. 52% of patients were admitted involuntarily. 18% suffered from organic mental disorder (12% from delirium), 20% were diagnosed with mental disorders due to psychoactive substance use (9% alcohol dependency, 6% benzodiazepine dependency, 5% multiple drug use), 16% had a diagnosis of schizophrenia, 10% of schizoaffective disorder and 5% of transient psychotic disorder. 20% suffered from recurrent depressive disorder, 15% from bipolar affective disorder and 3% from a single depressive episode. 8% fulfilled diagnostic criteria of a neurotic, stress-related or somatoform disorder. 12% had eating disorders, 9% had personality disorders and 1% was diagnosed with mental retardation. Only 15% of patients had a first episode of psychiatric illness. 4% were admitted after an accident and 21% after a suicide attempt (45% poisoning, 25% jumping from height, 20% cutting/piercing with sharp object, 5% vehicular impact, 5% self-immolation).

All major psychiatric diagnoses can be found at the Viennese PICU, either if patients are in a life-threatening condition, or if additional somatic illnesses require intensive care management.

Intensive care at a psychiatric intensive care unit (PICU) traditionally includes the treatment of severely ill psychiatric patients with suicidal or violent behavior [1].

A chart review was performed including 100 consecutive inpatients (52% females, age: 45.7 ± 17.8 years) treated at the Viennese PICU between 2008–2009.

Psychopharmacotherapy and the rate of electroconvulsive therapy (ECT) in these patients is reported here.

87% of patients were treated with antipsychotics: 44% with quetiapine (447.7 ± 421 mg), 32% with risperidone (4.3 ± 2.3 mg), 25% with olanzapine (16.9 ± 7.5 mg), 20% with haloperidol (10.5 ± 5.4 mg), 16% with aripiprazole (15 ± 8.4 mg), 6% clozapine (416.7 ± 147.2 mg) and 3% ziprasidone (120 ± 56.6 mg). 36% of patients received treatment with mood stabilizers: 15% with valproic acid, 8% with lamotrigine, 6% with lithium, 4% with pregabaline, 3% with topiramate, 2% with gabapentine and 2% with oxcarbazepine. In 49% of patients antidepressants were prescribed: in 23% selective serotonin reuptake inhibitors, in 12% selective dual acting reuptake inhibitors, in 5% tricyclic antidepressants and in 33% other antidepressants (mostly trazodone or mirtazapine). 84% of patients were treated with benzodiazepines (30.3 ± 22.4 mg diazepam equivalents), in 17% the opioid nalbuphin was applied. Intravenous psychopharmacotherapy was used in 31% of cases. 10% of patients received ECT.

Psychotropic compounds with sedative properties are frequently used at the Viennese PICU. However, the dosages for antipsychotics do not appear to be higher than on normal psychiatric wards.

To assess the use of SWN in the acute phase of psychiatric disease as a predictor of clinical outcome.

This study started in June 2009 and at the moment we have recruited 150 patients. The patients were divided into 4 groups according to their psychiatric diagnosis (schizophrenic psychosis, mood disorders, personality disorders, acute stress reaction) and each diagnostic group into three subgroups according to length of stay (T1< 7 days, T2 = 7–14 days, T3> 14 days). The subjective well-being indicators (subscales SWN: emotional regulation; self-control; mental functioning; social integration and physical functioning) and the severity of illness (CGI-S) were evaluated at admission and discharge.

At discharge there is a statistically significant difference in the SWN subgroups among the four diagnostic groups except for social integration and total score with equal CGI-S scores. Schizophrenic patients and personality disorders show a subjective improvement at T2; mood disorders at T3; acute stress reactions T1 = T2. CGI shows a statistically improvement regardless of the length of stay.

Preliminary data suggest that SWN represents a predictor of clinical outcome and remission and together with the clinical evaluation it can help clinician to settle therapeutic programs.