While illegal drug abuse has been recently stabilized in western countries, iatrogenic opiod dependence is increasing. In EEUU, opioids abuse is more prevalent than other legal or illegal drug abuse. Prevention actions and strategies to optimize short and long term treatments need to be outlined.

Learning to prevent, diagnose and treat iatrogenic opioid dependence.

We review 9 cases of iatrogenic opioid dependence hospitalized in the Psychiatric department of a general hospital, considering demographic and personal data, treatment patterns and strategies followed. Pubmed bibliographic search was performed.

Patients came from different clinical resources (44,4% from pain center, 33,3% from emergency department, 22,22% scheduled admission).

N°1:48-year-old man with dependence to oral codeine (1200 mg/day). Maximum methadone dose required (MMR): 30 mg/day.

N°2:43-year-old woman with dependence to oral fentanyl (3000 mcg/day). MMR:25 mg/day.

N°3:50-year-old woman with dependence to fentanyl patches (2,25) and oral tramadol (300 g/day). MMR:20 mg/day.

N°4:55-year-old woman with dependence to oral oxicodone (60 mg/day). MMR:20mg/day.

N°5:39-year-old woman with dependence to subcutaneous meperidine (600 mg/day). MMR:25 mg/day.

N°6:61-year-old woman with dependence to oral codeine (600 mg/day). MMR:15 mg/day.

N°7:45-year-old man with dependence to transmucous fentanyl (600 mcg/day). MMR:90 mg/day.

N°8:49-year-old man with dependence to oral tramadol (450 mg/day). Progressive tramadol withdrawal until suppression.

N°9:38-year-old woman with dependence to transmucous fentanyl (2400 mcg/day). MMR:22,5 mg/day.

Classically, methadone has been the main opioid dependence treatment, as shown in almost all cases exposed. However, new treatments are being developed, e.g. monthly parenteral naltrexone. Opioid dependence treatment must be combined with other substances abuse/dependence or psychiatric comorbidities treatment and psycotherapeutical intervention.

Studies conducted in Pakistan reveal a high prevalence of depression, particularly in women. Evidence based and effective treatments are available, yet there is a significant gap between the numbers of women in need of treatment and those who receive services. This qualitative study identifies the barriers in access to mental health services for women screened for depression from primary care clinics in Karachi.

In-depth interviews were conducted with 30 women screened for depression from three purpose fully selected primary care sites in Karachi.

Interviewees reported that they mostly did not share their depressive symptoms and suicidal attempts with health care providers due to perception of these being their personal problems and health care providers also not asking about it. Interviewees perceived health care providers too busy, overburdened and not interested in their emotional problems. Those who shared their symptoms also did not receive proper diagnoses, treatment or referral from their health care providers.

The study highlights the need to increase mental health literacy about depression through mass media, community engagement, and educational institutions so that women can recognize the depression in themselves and other women around them and be able to share their symptoms with their health care providers. Religious scholars needs to be involved in raising awareness on depression as an illness for which women should seek medical treatment besides taking support from religion. It also indicates the need for a referral system to help women reach to the required mental health services.

Considering the importance of vascular disorders in AD progression, here presented are results of applying endovascular AD treatment method based on transcatheter revascularization and restoration of brain microvasculature by means of low-energy laser irradiation.

The research involved 46 patients aged 34-79 who had long had AD.

Survey plan included: CDR, MMSE, CT, MRI with subsequent calculation of the temporal lobes volume and AD stage determination using the Tomography Dementia Rating Scale (TDR), SG, REG, and cerebral MUGA.

Patients were divided into:

1. ▪ Group (TDR-0) - 4 (8.70%): preclinical AD stage;

2. ▪ Group (TDR-1) - 15 (32.60%): mild dementia, mild cognitive impairment, mild disease manifestations (medical history of up to 2 years);

3. ▪ Group (TDR-2) - 20 (43.48%): mild dementia, persistent cognitive impairment, more severe disease manifestations (history of up to 6 years);

4. ▪ Group (TDR-3) ??- 7 (15.22%): severe dementia, severe cognitive impairment, late-stage AD (7-12 years of history).

All patients had the signs of dyscirculatory angiopathy of Alzheimer's type. Transcatheter interventions were carried out against growing memory disorders in the period of 1-12 years after the symptoms onset.

Positive outcome accompanied by microcirculation restoration, dementia decline, memory improvement, cognitive disorders reduction was obtained in all cases; its degree depended on AD stage.

In early AD stages, transcatheter laser irradiation can restore cognitive functions and relieve patients from dementia. In late AD stages, the treatment helps not only halt further disease progression but also causes its regress. The process is accompanied by brain tissue regeneration.

Due to increasing lifespan, the number of patients with Binswanger's disease is growing.

The study of the effectiveness of brain transluminal laser revascularization in the treatment of Binswanger's disease.

6 patients, 4 male (66.7%) and 2 female (33.3%), aged 58-81 (average age 76) with Binswanger's disease were examined. Each patient underwent CT, MRI, SG, REG, cerebral multi-gated angiography (MUGA).

Single postischemic microcysts (3-5 mm) of brain's white matter were detected in 1 case; multiple microcysts including the merged ones - in 5 cases. All the patients had leucoariosis, inovolutive changes of the cerebral cortex, unocclusive hydrocephalus.

Intracranial atherosclerotic lesion type was detected in all cases. Multiple arteriovenous shunts of brain's white matter were detected in all cases.

All the patients underwent transluminal laser revascularization.

Low-energy laser systems were used for revascularization of distal intracranial branches. Postoperatively, the patients underwent desagrigatory, anticoagulatory and vasodilator therapy following advanced interventional radiology schemes. Clinical evaluation of postoperative results was carried out using the Index Bartels (IB).

Good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization was obtained in all cases.

Good clinical outcome (IB-90-100) was obtained in 4 (66.7%) cases; satisfactory clinical outcome (IB-70-80) - in 2 (33.3%) cases. No negative effect was observed after the interventions.

The method of brain transluminal laser revascularization is an effective one in the treatment of atherosclerotic lesions of brain's white matter accompanied by the development of Binswanger disease.

To describe a new framework ‘SENSO’ (sensitivity to social signal) that emphasizes that acute depressed patients show abnormal cognitive, emotional and biological responses to positive and negative social signals with impaired monitoring of social acceptance.

We will review evidence that Major Depression is associated with increasing vulnerability to social rejection and social stress. We will also discuss a recent meta-analysis realized by our group evaluating neural correlates of social exclusion tasks in healthy subjects.

Major Depression is clearly precipitated by major social life-events. These social events increase the need for subjects to monitor their level of social acceptance and induce stress response. Self-propagatory processes (i.e. excessive reassurance seeking, negative feedback seeking) generate in depressed patients a vicious circle leading to increase sensitivity to social rejection. Social exclusion tasks in healthy subjects induce increased activation in ventromedial prefrontal cortex, subgenual cortex and insula, regions implicated in self-processing and production of negative emotion.

Results of our literature review and of our meta-analysis stress the importance of studying interpersonal processes and their neural correlates in depressive phenomena. They emphasize the role of salient and default mode networks in the pathophysiology of major depression.

Major Depressive Disorder (MDD) is a common health problem characterized by low mood, sadness and irritability. Sleep disturbances are a central feature of depression and adolescence is a period of rapid change in sleep physiology.

To evaluate the categorization of sleep change in three of sleep elements : REM changes; Slow weave sleep changes and fragmentation of sleep. We evaluated this as a tool to detect depression

To assess features of sleep macro architecture as markers for evaluating and detecting adolescent depression

Adolescents completed a two-week protocol that included a formal psychiatric interview, standardized scales, polysomnographic (PSG) assessment, actigraphy, salivary melatonin sampling, and holter monitoring.

Depressed adolescents (n = 22) differed from controls (n = 20) on features of sleep macroarchitecture measured by PSG. 59% of the depressed subjects had more than one PSG marker from each category as compared to control (N = 20). This indicates that subjects who were depressed on clinical assessments using the standardized scales and evaluations had changes in sleep suggestive of depression

The categorization of sleep change in three categories of sleep components (see above) can be a useful tool to detect depression. The results suggests that the individual markers of depression in children and adolescents may not be as effective as the categorization of sleep changes into three categories and using this general approach

It is estimated that 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year. Patients admitted to Old Age Psychiatric units clearly posses numerous risk factors relating to developing VTE.

The aim was to study inpatients admitted to the old age psychiatric unit and see if NICE and Department Of Health guidelines are being followed in relation to VTE (Venous thromboembolism) risk assessment and prophylaxis.

A prospective opportunistic sample of all the inpatients in the old age psychiatric unit during a 2 week period was audited. Standards were based on the NICE and Department Of Health guidelines.

13% of patients developed a deep vein thrombosis during the admission period audited. No patients had a VTE risk assessment completed on admission. Every patient had at least one risk factor for developing DVT (deep vein thromboembolism) due to being over 65 years old.

93% had at least 2 risk factors and 63% had at least 3 risk factors. Despite this no patients were treated prophylactically with graded compression stockings or enoxaparin.

It was evident that VTE risk assessment and prophylaxis was not something that was being considered for patients admitted to the old age psychiatric inpatient unit. However due to the risk factors this group of patients possess it is something vitally important. As a consequence of presenting the audit across the trust a service change was recommended with a VTE risk assessment planned to be introduced across the trust.

The association between major depressive disorders and personality disorders is an important factor to consider due to its clinical, therapeutic and prognostic consequences.

The aims of the present study were to determine the prevalence of comorbid personality disorders in patients with major depression, and to evaluate the relationship between some personality traits and outcome of depression.

A descriptive and comparative study was carried in the unit ‘E’ at the Razi Hospital. Only men were included. We collected the records of thirty six patients in whom the diagnosis of major depressive disorder was retained in axe I and personality disorder in axe II (as the diagnostic criteria of DSM IV). Assessment was based on demographic characteristics, medical history, clinical aspects of the index episode and outcome characteristics.

17 patients (47.22%) had personality disorder (which 23, 5% histrionic, 35,3% antisocial, 17,7% passive-dependent, 23,5% borderline). The patients with comorbid personality disorder had an earlier age at onset of their depression and more previous suicide attempts. Comorbid personality disorders were correlated to an impaired outcome, with more recurrences and more persistent symptoms.

The impact of personality disorder in the outcome of depression is evident. A taking into consideration of this comorbidity as well as a medicinal and psychotherapeutic care are necessary.

Codeine Induced Psychotic Disorder is a poorly characterized illness but is increasingly being reported amongst cough mixture abusers. A study done in Hong Kong found that substance induced psychotic disorder is the most common psychiatric diagnosis amongst cough mixture abusers.

We aim to describe the clinical characteristics of patients referred to our National Addictions Management Service with a diagnosis of Substance Induced Psychotic Disorder secondary to Codeine cough syrup use.

A retrospective audit of clinical records was done for patients seen at our National Addictions Management Service from Apr 2007 to Mar 2013 with a diagnosis of Substance Induced Psychotic Disorder secondary to codeine use. Patients with a prior primary psychotic disorder diagnosis were excluded from the study.

11 patients (9 male, 2 female) out of a total of 48 patients with substance induced psychotic disorder had used codeine cough syrup. 4 of the patients had concomitantly used other substances as well. The age range of the patients was 28-45 yrs with a mean of 37.3 yrs. The duration of hospitalization during their psychotic episode ranged from 4-38 days with a mean of 13.5 days. 10 out of 11 patients were started on antipsychotics at baseline. At the end of a one year follow up period, two patients had their diagnosis revised to that of schizophrenia.

Codeine Induced Psychotic disorder is increasingly being seen amongst codeine abusers and more research is needed to better characterize this condition and determine the biological mechanisms behind it.

To examine the associations between personality traits, measured as Murray's psychological needs, and mortality over 41 years in men and women and among the young and the old.

We used a general population sample aged 18-65 (n = 1094) examined in 1970 according to the Cesarec-Marke Personality Schedule (CMPS). Mortality data came from national vitality registers up to 2011. The associations between eleven traits - achievement, affiliation, aggression, defence of status, guilt feelings, dominance, exhibition, autonomy, nurturance, order, and succorance - were examined using factor analysis, and their associations with mortality in Cox proportional hazard models.

During the 41-year follow-up, 513 persons died (47%). In men aged 26-45, achievement and affiliation were associated with mortality: HR = 1.19, 95% CI 1.04-1.36 and HR = 1.16, 95% CI 1.01-1.33 per step on a stanine scale. In men aged 18-25, nurturance was protective: HR = 0.77, 95% CI, 0.64-0.98 per stanine. In women aged 18-25, feelings of guilt increased the risk of mortality, while dominance was protective: HR = 1.38, 95% CI 1.09-1.75 per stanine, and HR = 0.74, 95% CI 0.55-0.99 per stanine, respectively. In women aged 46-65, exhibition increased the risk of mortality: HR = 1.09, 95% CI, 1.00-1.18 per stanine. There were no significant associations when all age groups were combined.

Our findings suggest that personality traits, measured as Murray's needs, are associated with an increased risk of all-cause mortality, but the associations differ according to age at assessment and sex.

Memory services provide assessment to patients with memory difficulties. One important topic discussed is driving. This audit looks into whether discussions surrounding driving are documented in the patient's notes.

The objective was to see if discussions are held about driving with patients at memory clinics.

A similar audit was carried out in the south of the county. It was hoped that the findings and recommendations had been implemented in the North of the county, and improvements made.

Standards were set that 100% of patients seen by memory services would have a documented discussion about driving at the initial and/or disclosure appointment. A period of 6 months, August 2012 to January 2013 was selected. 423 patients were referred and 60 patient's notes were randomly selected using a random integer set generator to look at.

We are currently in the process of collecting and analyzing results. The results will be available before the conference.

By the time people with memory impairment access memory services they are likely to have been driving for most of their lives; it has provided them with independence and access to means. Despite this, requirements are set out by Driver and Vehicle Licensing Agency UK that they must be informed when the licence holder has been diagnosed with dementia. They can suspend a licence based on their assessment, for the safety of the patient and the public. It is therefore of vital importance that these discussions are taking place.

The violence experienced in everyday life by vulnerable men, women and children, including intimate partner violence (IPV) and child maltreatment (CM), is one of the main risk factors for mental disorders in Europe and worldwide. Resilience is described by the PreVAiL network <www.prevailresearch.ca> as 'A dynamic process in which psychological, social, environmental and biological factors interact to enable an individual at any stage of life to develop, maintain or regain their mental health despite exposure to adversity'. The experience of violence is significantly different in men and women and we may expect for this and other reasons including the social position of women that patterns and determinants of resilience will also vary by gender.

To review the factors contributing to resilience and evidence about effective means to promote resilience in women and men with experience of violence.

A narrative review of literature and a systematic review of studies on the effectiveness of interventions to promote resilience in adults with experience of IPV and CM.

Twenty studies of complex and simple interventions in community, welfare, employment, prison, and substance abuse and mental illness service settings were identified for review. Several studies emphasise the value of people with this history participating in design, conduct and reporting of the studies.

Better evidence is needed on how to promote resilience with clinical and public health interventions among women and men affected by violence. Obtaining this evidence is critical alongside work towards preventing the violence.

The front-line nature of mental health crisis services and the complex and acute presentations of their clients, require rapid decisions in response to medication requests. Prescribing is conducted by a combination of non-medical prescribers, advanced practitioners and medical professionals, with individual variation in prescribing habits and trends. This leads to an impact on the prescribing budget with spiraling costs evident.

We undertook an audit of the prescriptions issued for emergency medications over 6 months. We incorporated audit standards, from NICE guidelines for prescribing of psychotropic medications and local trust prescribing advice. We audited data to examine whether cost of medication had been considered, in the context of the efficacy and safety of medications.

Of 138 prescriptions issued, 72 (52%) were prescribed by advanced practitioners, 7 by non-medical prescribers (5%) and the remainder by doctors (43%). 213 items were prescribed costing £2828 during this period. We demonstrated, by introducing smarter prescribing methods, a reduction in the number of prescription items by 27.7% (59 items), resulting in a financial efficiency of 94.6% (£2677). We recommended implementing an acute care formulary acting as a guide to smarter prescribing.

The guide includes recommending generic versions of medications instead of trade brands, asking primary care to initiate medications, reducing quantities of drugs prescribed, increased accountability for prescribing decisions and stopping use of expensive psychotropics, where cheaper alternatives with similar efficacy and side effect profile are available. To assess impact, we would reaudit in 6 months, before consideration towards adopting the policy trustwide.