NRG3 is a recreational drug which is becoming increasing popular. It is widely sold on the internet as a legal substance for recreational use, under the guise of ‘plant food’ or ‘research chemicals’.

There is currently little research surrounding the effects of NRG3 in human consumption, which is marketed as a stimulant on many ‘legal highs’ websites. There is particularly little available with regards to its potential to cause psychosis.

We considered a case study of a gentleman presenting with acute psychosis, with a distinctly temporal correlation between using NRG3 and the onset and maintenance of psychotic symptoms, such as restlessness, agitation, excess activity, hearing voices, loss of appetite and inability to sleep for seventy-two hours. He presented in the exact same way on three occasions, after having purchased NRG3 on the internet. Within four days of admission, without the aid of anti-psychotics, and with much needed sleep, he returned to his normal state of being, without what appears to be in the short term, any lasting side effects.

NRG3 has been described as being a ‘GHB-type substance’, turning into GHB (Gamma Hydroxy butyric acid) in the body. These substances are known to cause euphoria and increased talkativeness in smaller doses, but can induce sleep, coma and respiratory distress in larger doses. As it is not deemed illegal to possess analogues of GHB, more varieties continue to emerge on the internet.

Whole -school approach is a mental health promotion program in schools, which will provide a framework for mental health promotion in Pakistani schools.

To find out Pakistani teacher's perception of whole - school approach to guidance and its practice.

Trainings were held at department of Psychiatry, PIMS in collaboration with British council, THET, federal directorate of education and Kings College, London. Tenure of both training workshops was four days each from 6th Apr - 13th Apr 2011.

This study involving 58 (Male & Female) teachers. Data was collected with the help of Pre and post - tests for the assessment of their knowledge regarding mental health and whole school. Study design is comparative descriptive. Results were then computed by using percentages to compare the knowledge of participants before and after receiving trainings.

Results revealed an overall mismatch between teachers’ beliefs about a whole-school approach, childhood mental health problems and their perceived school reality and mental health issues. A whole-school approach was not seen as practiced in majority of these schools.

Whole school approaches encompass how to use school policies, systems and structures to create an environment that promotes mental wellbeing.

Butler, H., Bond, L., Glover, S. & Patton, G. 2001, ‘The Gatehouse Project: Mental health promotion incorporating school organizational change and health education’, in Mental Health Promotion and Young People: Concepts and Practice.

Primary care providers are the main source of mental health services for the majority of patients around the world. Therefore providing continuous mental health education to primary care providers can positively affect health outcomes.

To develop and test creative mental health educational initiatives for primary care audience.

To enhance primary care providers’ knowledge and awareness of countertransference reactions.

A half-day workshop was designed with the emphasis on education about countertransference reactions that “difficult” patients invoke. Case examples encouraged reflection and reframing the problem from “difficult” patient to “difficult” clinician-patient interaction. Pre-, post-workshop and satisfaction evaluation questionnaire were done.

Participants were highly satisfied with the workshop. Their self-perceived knowledge of transference and countertransference and strategy to manage difficult encounters improved post workshop.

Educating primary care providers and building their skills will improve clinician-patient encounters and health outcomes.

Stigma of mental illness constitutes a major problem worldwide. And does it affect not only patients but psychiatrists as well? An international control-group study “Stigmatization of Psychiatry and Psychiatrists” was initiated by Professor Wolfgang Gaebel at the Department of Psychiatry, Heinrich-Heine-University, Duesseldorf, Germany to clarify this issue. The project was funded by the WPA with an additional grant from the German Foundation on Mental Health. This abstract presents preliminary results of Belarusian national part of the study.

The objectives of the Belarusian part of the study were to assess stigma and discrimination of psychiatry and psychiatrists in Belarus and to compare it with a control group of primary care physicians.

200 psychiatrists and 200 GPs filled paper-and-pencil questionnaires developed by research authors. Different domains of stigma were assessed.

The levels of such aspects of stigma, as perceived stigma, discrimination experience, necessity of interventions were significantly higher, whereas such aspects of stigma as stereotype agreement and intentions to change profession because of stigma were significantly lower in a sample of psychiatrists in comparison with GP.

Psychiatrists in Belarus more strongly than GP think that they are stigmatized in perspective of others and have more problems because of stigma than GP. But at the same time the level of agreement with stereotypes toward own profession among psychiatrists is significantly lower. What helps psychiatrists in Belarus to keep their professional identity and good vision of their specialty despite the higher level of stigma pressing from outside?

Neurosyphilis can develop at any stage of syphilis despite of previously recieved treatment, and it can mimic any neuropschychiatric disorder. The psychopathology of neuroborreliosis is less described.

To describe the cases of schizophrenia - like psychosis in patients with these hronic neuroinfections.

Retrospective chart review study of five inmates (four with neurosyphilis and one with neuroborreliosis) was performed.

Psychiatric histories of two females (45 and 49 y.o.) and three males (31, 40, 45 y.o.) are achieved. In four cases they were initially misdiagnosed as paranoid schizophrenia and in one case - as a persistent alcoholic hallucinosis. The diagnosis of meningoencephalitis was verified by immunologic analysis of cerebrospinal fluid. Main psychiatric and neurologic features, radiologic findings and clinical outcomes of the desease are described.

Authors emphasize the significance of screening analises and neiroimaging data performed in psychiatric facilities and draw attention to a „new great masquerader” - neuroborreliosis.

The phenomenon of homelessness is steadily increasing in urban centers, including in Porto, Portugal, which is a reality not well characterized yet. Some studies have been conducted on this issue, although few focus on the homelessness lifestyle. However this topic seems to be of great interest to study, since it is known that lifestyle affects health and long term patterns of morbidity and mortality.

The purpose of this study is to characterize homelessness and their lifestyles, exploring correlations with psychopathological symptomatology.

29 homelessness of Porto, Portugal, were inquired by the Brief Psychiatric Rating Scale (BPRS - 18 items) and a lifestyle questionnaire (Valente et al., 2009), adapted from the “Dartmouth Assessment of Lifestyle Inventory” (Ford, 2002) and the “Questionário de Atitudes e Comportamentos de Saúde” (Ribeiro, 2004).

Homelessness profiles are in majority male, single, with Portuguese nationality and with low education level. Most of them have unhealthy behaviors, such as smoking and absence physical exercise. However they care about personal hygiene, and demonstrate good sleeping patterns. In terms of psychopathological symptomatology it were identified anxiety, somatic concern, and depressed mood negatively correlated with diverse lifestyle indicators (e.g. stress, sleep hygiene, nutrition, insight, and socialization).

These results reveal that Porto's homelessness profile is similar to general homelessness profiles described by recent international studies. It was also possible to conclude that homelessness lifestyles are characterisd by risky behaviours as well as by psychopathological symptomatology, which seems to be directly correlated.

Alopecia areata is a frequently encountered hair disorder characterized by the rapid hair loss, usually from the scalp. It has few physically harmful effects, but may lead to psychological consequences, including high levels of anxiety and depression.

This case-control study was undertaken to determine the psychiatric morbidity among patients with alopecia areata.

The study included 50 patients diagnosed with alopecia areata and 50 age-sex matched individuals selected from a general population without any hair loss (control group). For evaluating psychological distress, we used Hospital Anxiety and Depression Scale (HADS). Severity of the disease was evaluated by Severity of Alopecia Tool (SALT).

Patient's mean age was 32.92 years. Fifty-two percent of patients were females. Patients were single in 52% of cases, divorced in 2% of cases and married in 46% of cases. Depression and anxiety were detected respectively in 38% and 62% of patients. There was statistically significant difference between the patients and control group in terms of depression (p = 0.047) and anxiety (p = 0.005). Depression was statistically higher in women with alopecia areata (p = 0.016). Disease severity was higher in psychiatric morbidity cases.

The results of this study indicate that alopecia areata is associated with psychiatric morbidity. Dermatologists should be aware of the psychological impact of alopecia areata, especially as current treatments have limited effectiveness.

Alopecia areata is a frequently encountered hair disorder characterized by the rapid hair loss, usually from the scalp. Alopecia areata may have a negative impact on patient's life.

The aim of our study was to assess the impact of alopecia areata on the quality of life of patients.

The study included 50 patients diagnosed with alopecia areata and 50 age-sex matched individuals selected from a general population without any hair loss (control group). Quality of life was evaluated using the Short Form-36 health survey (SF-36). Severity of the disease was evaluated by Severity of Alopecia Tool (SALT).

Patient's mean age was 32.92 years. Fifty-two percent of patients were females. There was statistically significant difference between the patients and control group with regard to general health, vitality, social functioning, role emotional and mental health scores. Of the eight subscales on SF-36, general health and role emotional scores were lower in women who suffered from alopecia areata. Impaired mental health was correlated to age (p = 0.017) and severity of alopecia areata (p = 0.015).

It appears unlikely that alopecia areata seems to have a partly negative impact on the health related quality of life. These results can encourage dermatologists to give patients the treatments and the psychological help they require.

There is limited understanding of the health and treatment-related experiences of adults with Attention Deficit Hyperactivity Disorder in England.

To explore the experiences of adults with ADHD regarding impairment, accessing diagnostic and treatment services, and to compare experiences between patients diagnosed during adulthood and childhood.

Semi-structured face-to-face interviews were conducted with 30 adults with ADHD, recruited across England. Half of the participants were diagnosed during childhood and the remainder during adulthood. Data was analysed using Thematic Analysis and data saturation was achieved.

Getting a diagnosis and accessing ADHD services in adulthood was an ‘uphill struggle’, often due to negative and sceptical attitudes towards ADHD by healthcare professionals. Many patients struggled for years with misdiagnoses of depression and anxiety, and severe difficulties accessing care and treatment caused a downward spiral into functional impairment in some. Accumulated psychosocial burden was evident as living with undiagnosed ADHD had resulted in a chronic sense of failure and missed potential in many diagnosed from late adolescence onwards. Positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many deemed pharmacological treatment by itself as inadequate. Additional support, especially psychological therapies/psycho-education was strongly desired, yet few patients had access to non-pharmacological treatment.

This study suggests that the unmet needs of adults with ADHD are substantial, particularly in those diagnosed from late adolescence onwards. The findings suggest there is a wide gap between policy and practice in England.

The ICD is being revised for its 11th revision, and empirical efforts are being made to assess the use of the ICD-10 and how it can be improved.

Our aim was to investigate the use of the ICD-10 in Japan, which is to be presented in comparison to its use at a global level.

1) We investigated the frequency of use and the perceived importance of every diagnostic category in the ICD-10. 2) We asked about more specific issues that were being debated at that time, e.g. incorporation of disability component, approaches to the high rate of NOS and co-morbidity.

1) 80 university-based hospitals and 147 councilors of the Japanese Society for Psychiatric Diagnosis (JSPD) were contacted for participation, of which 49 (61%) and 53 (36%) responded respectively. 2) 452 members of the JSPD and 80 chief professors from every department of psychiatry were contacted and 245 individuals in total responded (46%).

1) “Unspecified” and “other” items were generally neither used frequently nor considered as important. Other trends pertaining to more specific diagnostic categories were also observed. 2) Overall psychiatrists in Japan appeared to be conservative about radical changes, and they tended to accept NOS and co-morbidity cases as a necessary condition for operational diagnosis instead of a flaw of the classification system itself.

The results presented here come from Japan only, but they can be informative in further investigating issues related to diagnosis and classification elsewhere as well as globally.

The application of recovery principles within everyday mental health services is understudied.

We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in an Irish community mental health service.

Eighty service attenders with severe and enduring illness were randomized into groups

1. (1) receiving a programme of ICM,

2. (2) receiving treatment as usual (TAU).

Groups were compared before/after the programme for general psychopathology using the Brief psychiatric Rating Scale [BPRS] (clinician rated) and How are You? Scale (self-rated). The Functional Analysis of Care Environments [FACE] scale provided assessment of functional domains.

The overall group [mean age 44.5 ± 13.2 years; 60% male] had mean total Health of the Nation Outcome Scale [HoNOS] scale scores 10.5 ± 4.6 with impaired social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p < 0.01) with higher baseline scores on the HoNOS social subscale and BPRS (p < 0.05). An analysis of covariance, controlling for these baseline differences, indicated greater improvement in BPRS scores (p = 0.001), How are You? scores (p = 0.02) and FACE domains for cognition, symptoms and interpersonal relationships (all p < 0.001) in the ICM group. The ICM group underwent greater changes in structured daily activities that were linked to improved BPRS scores (p = 0.01).

A programme of ICM emphasizing recovery principles allowed significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.

Primary and secondary care communication is the cornerstone of patient's care. In order to improve communication, proper dialogue should be done. The shared care protocol was an attempt to try to fill gaps and build bridges for more efficient integrated care.

A special form was designed. Each item was marked as essential, useful or irrelevant. This form was sent to 150 local GPs with a stamped addressed envelope. 106 response were received. It was input on Excel data sheet and was analysed.

The majority agreed that date, place of clinic. Majority agreed that date, place of the clinic, diagnosis, current medication, mental state, risk assessment, current social situation, investigation arranged, other therapeutic interventions, involvement of other professionals, date of follow up and information given to patients are essential information in the letter. 100% agreed that change of medication and who will prescribe is essential.

Less than 50% thought that inclusion of involvement of other agencies is essential.

Clear, up to date communication between primary and secondary care is vital for good patient care. All people involved should participate in evaluation and refining ways of working. As GPs are the main recipients of new patients assessment letters, for that reason, their opinion should be taken.

Change of medication and risk assessment are the most important information GPs highlighted as they help them in patient management.

Improving communication between health professionals, improve patient's care, saves time and money, in addition to preventing duplication of work.

Complaining of psychiatric symptoms is more common among individuals suffering from tinnitus. The aim of this study is to determine the psychiatric diagnosis and symptoms of patients with chronic tinnitus.

Four hundred patients with chronic tinnitus were enrolled from the registry of Otorhinolaringology Research Center of Rasoul general hospital, Tehran, Iran. The study instruments were Structured Clinical Interview for DSM-III-R, axis I psychiatric disorders, Tinnitus Handicap Index (THI) and Symptom Check List-90-Revised.

The life-time and current psychiatric disorders among patients with chronic tinnitus were 60% and 55% respectively. Depressive and anxiety disorders were the most common type. Females with severe THI were 75.6% versus 63.9% in men.

The comorbidity of chronic tinnitus with depressive and anxiety disorders is more common. This may have treatment implication to alleviate the stress and dysfunction resulted from chronic tinnitus.

Rare diseases are chronically debilitating, possibly impairing the quality of life both of the patient and of his parents.

To examine the quality of life and the coping strategies of the parents of children affected with rare diseases comparing 30 mothers and 25 fathers of children affected by rare diseases with 30 mothers and 26 fathers of non-rare chronic diseases. Anxiety, depression, coping strategies, satisfaction about their life are assessed.

All the subjects are interviewed and undergo an evaluation with the self-report tools Satisfaction With Life Scale, Profile of Mood States, COPE, Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety. The data are analyzed using the statistical package SPSS.

Our results show that subjects having children with rare diseases experience more anxiety, but not a more severe depression, worse psychological well-being and have more difficulties to face the daily living. Comparing the mothers and the fathers of children with rare diseases, the first group show higher scores in HRSA.

So the feature of uncertainty of a rare disease in terms of aetiology, course and treatment can be associated with a more severe impact on the parents’ psychological end emotional well-being.

Access to oral health services is a basic right. It is recognized that psychiatry patients have a greater risk for dental problems. This is often due chaotic lifestyles, avoidance of health care and inability to engage with treatment. To this end the department of health has recommended this group of patients warrants particular attention.

To ensure basic oral health promotion in this group, identify implementations to facilitate this promotion and access to oral health care. Specifically to assess need for special dental clinics, automatic recall reminders or support for registering with a dental practitioner.

To assess the need for and access to basic oral health care among a group of psychiatric in patients in Mersey Care NHS Trust.

Audit tool was a questionnaire, researcher administered, developed from British Society for Disability and Oral Health guidelines (2000).

From a sample of 97 service users, 80 participated. 51% had not been to a dentist in over a year, 56% were not registered with a dentist, 12.5% did not own a toothpaste, 51% brushed less than once a day, 71% smoked, 56% felt they needed treatment and 45% had oral side effects from prescribed psychotropic medication.

Oral health within service users of mental health services should be a priority. Oral health promotion should be encompassed within the care we provide, steps to promote better oral health should include the provision of toothbrushes on admission, teethbrushing advice, frequency of brushing and registration with dentists should be addressed.

Popularly called erotomania, this syndrome was first described by G.G. De Clérambault in 1885, and is characterized by the delusional idea, usually in a young woman, that a man whom she considers to be of higher social and/or professional standing is in love with her. The patient develops an elaborate delusional process about this person, the love for her/him and the inability to escape his/her “affectionate clutches.” This syndrome may persist for a period of a few weeks to a few months in the recurrent form and be replaced by a similar delusion about another person. In the fixed form it may persist for several years.

Both primary and secondary types of erotomania have been identified, the latter being associated with evidence of an aetiologically significant organic or psychiatric condition. The aetiology of primary erotomania is not yet fully understood.

To describe two case studies of patients diagnosed with De Clérambault Syndrome and make a review of the literature.

Search in the PubMed/MedLine and Medscape databases with the following key words: Clérambault; Erotomania.

The aetiology of primary erotomania is not yet fully understood, being the psychodynamic explanations the most accepted, but neuroimaging, genetic studies and findings from evolutionary psychopathology may help us in the near future to understand this condition.