Suicide is a leading cause of death worldwide and is largely preventable. The social media site Twitter is used by individuals to express suicidal intentions. It is not yet feasible to contact each Twitter user to confirm risk. Instead, it may be possible to validate risk by linguistic analysis. Psychological linguistic theory suggests that language is a reliable way of measuring people's internal thoughts and emotions; however, the linguistics of suicidality on Twitter is yet to be fully explored.

The aim of this study is to characterise the linguistic styles of suicide-related posts on Twitter for the purposes of predicting suicide risk.

The Linguistic Inquiry and Word Count (LIWC) program was used to compare the linguistic features of suicide-related tweets previously coded for suicide risk by humans with a set of matched controls. Logistic regression was then used for predictive modelling.

The suicide-related tweets had significantly different linguistic profiles to the control tweets. The “strongly concerning” suicide tweets were found to have fewer words than all other tweets and not surprisingly, references to ‘death’ were significantly higher in this group. A number of other results were found. The final model which distinguished “strongly concerning” suicide risk from the controls was found to have 97.7% sensitivity and 99.8% specificity.

This study confirms that the linguistic features of suicide-related Twitter posts are different from general Twitter posts and that these linguistic profiles may be used to predict suicide risk in Twitter users.

The authors have not supplied their declaration of competing interest.

The social and economic impact of mood disorders and suicide is extremely high. In depression, suicide is included among the cognitive disturbances, together with guilt, paranoid and obsessive-compulsive symptoms, depersonalization/derealization and agitation [1,2]. The aim of this report is to study a sample of depressed patients with bipolar disorder or major depressive disorder, to evaluate the level of impulsivity and dissociation in a context of a suicidal plan.

Twenty inpatients with suicidal plan were assessed with: the SCID-P for Axis I diagnosis, SCI-DER, DSS, HRSD, HAS, YMRS, GSR. We conducted a systematic literature review (PubMed, Embase, PsychInfo) using the key terms “depression”, “suicide”, “suicidal plan”, “depersonalization”, “derealization” AND “dissociation”.

An independent sample T-Test analysis suggested that the patient with high sucidal plan present significant highter score at SCI-DER TOT (P = 0.015), DSS TOT (P = 0.037), BIS-11 motor perseveration factor (P = 0.023) and inversely significant HAS TOT (P = .029).

It's suggestive that when are lost the boundaries of the self, the clarity of suicidal's purpose reduces the levels of anxiety and suicide appears the only way to achieve the liberation of the suffering of depression. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

Epidemiological studies revealed that 21 to 34 percent of women around the world have been victim of physical assault by their spouse and spouse abuse have been more prevalent in developing countries.

The most common form of violence against women is spousal abuse which is a dangerous factor and leads to serious psychological damages while it is one of the most important causes of suicide in married women.

The study of factors related to spousal abuse in the population where they attempt to suicide is important for recognizing it and preventing spousal abuse, consequently, preventing suicide.

The study was conducted cross-sectional on 360 married women who attempted suicide and referred to Shoshtari Hospital in Shiraz. Instruments for data collection comprised of about spousal abuse questionnaire and demographic cases questionnaire which were filled through interview.

A total of 43.9% of domestic violence prevalence, 61.7% of economic violence, 45.3% of psychological violence, 38.1% of social violence, 38.1% physical violence, 35.9% of sexual violence was reported. There was a relation between spousal abuse and some factors such as: age difference between spouses, wife and husband's education, husband's substance abuse, husband's medical illness, wife's psychiatry disorder, spouses’ obligatory marriage, polygamy and husband's job.

Considering relatively high prevalence of spousal abuse in people who attempted suicide and the relation between some demographic factors with violence, besides regarding spousal abuse as one causes of suicide, the women's screening, particularly those who attempt suicide in regard to spousal abuse and its related factors seems necessary.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Physical illness has been recognized as a major risk factor for suicidal behaviours, especially among females. A higher number of physical comorbidities has been associated with higher suicide- risk, thus having a greater burden among the elderly.

investigate this evidence to be able to estimate the load of physical illness on suicidality among psychiatric females of different age.

Evaluate the association between suicidal ideation, age, depression and physical comorbidities in a sample of acute females psychiatric in-patients.

81 psychiatric female in-patients were evaluated during their first day of hospitalization through MADRS, SSI and the presence of organic comorbidity has been collected together with demographic data. All the evaluations were carried out at the Psychiatric Clinic, University of Genova, Italy.

Mean age 48 (age–range value: 74, high variability). Pearson's Chi-squared test showed: significant association between SSI and MADRS (P = 0,027; α = 0,05); no association between SSI and age (P = 0,194; α=0,05); no association between SSI and presence medical illness (P = 0,132; α = 0,05); no association between SSI and number of medical illness (P = 0,186; α = 0,05).

Our results show that the levels of suicidal ideation in psychiatric females are independent from age, presence and number of physical comorbidities. Suicidal ideation appears to be associated only with levels of depression. Our results challenge evidence from a large number of current studies and, if confirmed by further research, would lead to reconsider major suicide risk factors. Further research to investigate these associations on larger samples is needed.

The authors have not supplied their declaration of competing interest.

Older adults with depression resist accepting depression screening and seeking treatment due to stigmatization of mental disorders and little knowledge about depression. This study was undertaken to develop and determine the psychometrics of an instrument for assessing triggers of suicidal ideation among older outpatients.

Participants were recruited from older outpatients of two hospitals in northern Taiwan. An initial 32-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. After this TSII was pre-tested in 200 elderly outpatients, 12 items were retained. The 12-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test-retest reliability.

TSII scores were significantly and positively correlated with the Beck Scale for Suicide Ideation (r = 0.45, P < 0.01), and UCLA Loneliness scores (r = 0.55, P < 0.01), indicating satisfied criterion validity. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, P < 0.01), indicating good construct validity. Cronbach's α and the intraclass correlation coefficient for the TSII were 0.70 and 0.99 respectively, indicating acceptable internal consistency reliability and excellent test-retest reliability. Receiver operating characteristic analysis revealed that the area under the curve was 0.83, indicating excellent ability to detect triggers of suicidal ideation. With a cutoff point of 2, the sensitivity and specify were 0.86 and 0.67, respectively.

The TSII can be completed in 5 minutes and is perceived as easy to complete. Moreover, the inventory yielded highly acceptable parameters of validity and reliability.

The authors have not supplied their declaration of competing interest.

The long-term associations between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) among ex-prisoners of war (ex-POWs) has recently been exemplified. Several studies have revealed the toll of war captivity on secondary traumatization’ (ST) of ex-POWs’ wives. However, a question remains regarding the possible SI among ex-POWs’ wives.

Understanding of SI phenomena among wives of severely traumatized ex-POWs in a longitudinal dyadic designed study.

Assessment of SI among ex-POWs’ wives and the longitudinal associations with their husbands’ PTSD. We also aim to assess the moderating role of the couple's dyadic adjustment in these associations.

A sample of 233 Israeli couples (142 ex-POWs couples and a comparison group of 91 veteran couples) completed self-report measures at two time points: T1 30 (2003-4) and T2 37 (2010) years after the ‘Yom Kipur’ 1973 war.

Surprisingly, no significant differences were found between ex-POWs wives and veterans’ wives, with and without husbands’ PTSD, in SI at T1 and T2. Only among ex-POW couples, an increase in the husband's level of PTSD and SI was related to a more moderate increase in their wives’ SI between T1 and T2. Interestingly, the more a wife reported positive dyadic adjustment, the more moderate the increase in her SI between T1 to T2, regardless of the study group.

Suicidal ideation among ex-POWs’ wives is closely related to their husbands’ PTSD and is moderated by their perception of marital adjustment.

The authors have not supplied their declaration of competing interest.

Mental illness stigma existed long before psychiatry, although sometimes the institution of psychiatry has not helped enough in reducing either stereotyping or discriminatory practices. Stigma of mental illness involves problems with knowledge, attitudes, and behavior and has important negative consequences for patients and their families. As new technologies become more reliable and accessible, mental health specialists are developing new and innovative methods through which they may provide services. Internet has an important role in the delivery of information because of its ability to reach a large number of people in a cost-effective manner.

In order to reduce stigma an online platform with relevant information about schizophrenia was developed. Simultaneously a social media campaign to increase awareness was launched.

A multidisciplinary team of psychiatrists, web-developers, IT specialists and designers developed the platform www.schizophrenia.ro. The platform is intended to be simple and with a great visual impact and it gathers general information about schizophrenia. The social media campaign used emotional messages like “Diagnosis is not the end of the road” or “I’m a person not a diagnosis” combined with high impact images.

From 1st January to end of September 2015 the platform had about 22,500 users and about 70,500 page views. The social media campaign had a reach of approximately 9700 people in just 2 months.

The World Wide Web is increasingly recognized as a powerful tool for prevention and intervention programs and could also play an important role in destigmatization campaigns.

The authors have not supplied their declaration of competing interest.

Cognitive-behavioural therapy (CBT) is the first-line psychological treatment for obsessive-compulsive disorder (OCD). However, most individuals suffering from OCD do not receive CBT. An innovative approach to improve access to evidence-based care is the use of the Internet to deliver effective treatments. Therapist-guided Internet-based cognitive-behavioural therapy (iCBT) involves the administration of structured online lessons that provide the same information and skills typically taught in clinician-administered CBT, often with email support from a therapist. Accumulating evidence on iCBT for OCD has been produced, but a meta-analysis has not been conducted.

Through meta-analytic methods, the present study summarized evidence on iCBT for OCD.

Efficacy on OCD symptoms and comorbid depression versus control conditions at post-treatment and follow-up was evaluated.

A PRISMA meta-analysis was performed on randomized controlled trials. Treatments were classified as iCBT if they included CBT components for OCD (eg, exposure and response prevention) delivered through the Internet with or without email/phone support from a therapist.

Four trials were included (n = 238), which were classified at low bias risk. At post-treatment iCBT outperformed control conditions with a high effect size on OCD symptoms (d = 0.85, P<.05) and a medium on comorbid depression (d = 0.52, P<.05). Treatment effects were stable at 4-month follow-up with a high effect size on OCD (d = 1.45, P<.05), but not on comorbid depression (d = 0.33, P<.05).

iCBT seems a promising treatment modality for OCD. Further trials should assess log-term outcomes and effects on quality of life.

The authors have not supplied their declaration of competing interest.

The therapeutic alliance might be the most important part of beginning clinical relationship and may have an important impact in treatment adherence. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome.

To assess clinical skills and attitudes in mental health professionals(MHP).

This study explore the impact of clinical skills and socio-demographic factors related MHP may have on treatment adherence of patients with mental health disorders (MHD).

In this cross sectional study, we use a convenience sample of MHP working in the mental health departments of three general hospitals in Lisbon great area. Data is being collected through individual interviews. We used a optimism scale (ETOS), Medication Alliance Beliefs Questionnaire (MABQ), and socio-demographic and clinical questionnaire.

A convenience sample composed of sixty-five mental health clinician working in a variety of settings is being collected. We don’t found statistically significant differences between the therapeutic optimism and the socio-demographic and clinical characteristics of MHP. The average values of optimism found in MHP with additional training in skills training it was higher (t test = 1,64). The results demonstrate that the most of clinicians (n = 42; agree 64,6%; strongly agree, n = 19; 29,2%) believe that have the capacity to positively influence outcomes for people with mental disorders.

This topic, along with a detailed examination of the relationship between therapeutic alliance and treatment adherence, will be the subject of future research projects.

The authors have not supplied their declaration of competing interest.

Prescribing more than one antipsychotic at the same time is becoming common in the treatment of patients with severe mental illness (SMI), although most guidelines recommend monotherapy.

The aim of this study was to examine the prevalence of antipsychotic polypharmacy and to compare the practices of polypharmacy and monotheraphy in terms of the rationale and compatibility of the treatment.

This study included 235 patients with SMI between 18 and 65 years of age who were followed at KTU Psychiatry Department Schizophrenia-Bipolar Disorder outpatient clinic between January 2007 and December 2014. The sociodemographic and clinical data were evaluated by a chart review form which was prepared by the researcher and designed according to American Psychiatric Association treatment algorithm and National Associated Mental Health Program Directors polypharmacy classification.

138 patients (58.7%) were diagnosed with schizophrenia, 75 patients (31.9%) were diagnosed with bipolar disorder and 22 patients (9.4%) were diagnosed with schizoaffective disorder. 62 patients (26.4%) were receiving antipsychotic polypharmacy. Combinations of two second-generation antipsychotics were most common. Anticholinergic drug use was significantly more common in patients on antipsychotic polypharmacy. Reported adverse events were more common in patients on polypharmacy but did not reach the level of statistical significance. Patients on antipsychotic polypharmacy were more likely to be diagnosed with schizophrenia. Polypharmacy patients were also more likely to receive clozapine and amisulpride whereas monotherapy patients were more likely to receive olanzapine.

Our results confirm previous reports that indicate patients with SMI are most likely to receive antipsychotic polypharmacy.

The authors have not supplied their declaration of competing interest.

Influential protocols in the treatment of schizophrenia recommend the use of antipsychotics in monotherapy, although combination is common in clinical practice.

To compare cognitive performance of patients with schizophrenia treated by antipsychotic monotherapy or polytherapy; secondly, to analyze clinical and sociodemographic differences.

Ninety-eight outpatients between 18 and 65 years, diagnosed with schizophrenia, based on the DSM-V were recruited. Seventy were in monotherapy and 28 in antipsychotic combination. Patients with comorbidity, moderate to severe motor impregnation, abuse-substance dependence or serious somatic illness were excluded. Both groups were compared in sociodemographic, clinical and cognitive measures: PANSS scale, short Akathisia Scale Simpson-Angus Scale, State-Trait Anxiety Inventory (STAI), face emotion recognition (FEIT) and global Functioning (GAF), speed processing - through the Trail Making Test, parte A, subtest of symbol coding of the Brief Assessment of Cognition in Schizophrenia (BACS) and Verbal fluency (animals)- and sustained attention (SA)–through the Continuous Performance Test (CPT).

Both groups showed similar age, gender, number of hospitalizations, score in STAI-Trait, STAI-State, ANGUS, GAF, TMT-A, verbal fluency and face emotion recognition. Patients in politherapy had more years of evolution (P 0.047), higher score in positive PANSS (P 0.007), negative PANSS (P 0.008), general PANSS (P 0.001); they showed more detection errors in the CPT (P 0008), and a trend towards less processing speed through the symbol coding (P 0.063), compared to patients in monotherapy.

Antipsychotic polipharmacy is associated with an impairment in sustained attention in patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

Effectiveness of shared decision making in treatment planning at discharge of inpatient with schizophrenia: interim analysis.

Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Hamann et al. conducted a few years ago a randomized controlled trial with schizophrenic inpatients and found increased knowledge and perceived involvement in decisions about antipsychotic treatment at discharge by the experimental group, but not clear beneficial effects on long term outcomes. The present communication introduces the DECIDE study.

Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge in a simple of schizophrenics hospitalized after an acute episode of their disorder. Of the oral presentation: to present preliminary conclusions with more of the half of the sample.

Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.

At discharge, increased scale score COMRADE, both subscales (Satisfacción in communication and trust in the decision) statistically significant. At 3 months follow-up, intensification of these differences in effect size and statistical significance and shows trends in health outcomes. We will present results for 6 and 12 months.

The authors have not supplied their declaration of competing interest.

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric chronic disorder of childhood that persists into adolescence and adulthood in the most part of cases. There are various ways of treating ADHD.

Assess the effectiveness and tolerability of atomoxetine long-term and routine clinical practice in adult ADHD treatment. Study the clinical profile of the patients who take atomoxetine.

The aim of this is to study the treatment of ADHD in adults with a non-stimulant drug atomoxetine.

We obtain results from 126 patients recruited from July 2009 to May 2013 who have been prescribed Atomoxetine as a treatment for ADHD from the hospital pharmacy.

Comorbid disorders were presented in 57.1% of the patients included at the study (25.3% of which belong to the group of anxiety disorders). The use of other psychotropic drugs associated with atomoxetine was observed in 54.8% of patients. The 62.7% of the patients concerned continued treatment beyond 225 weeks (4 years 3 months) of observation. The Clinical Global Impression Improvement scale (CGI-I) and side effects determine monitoring treatment. A total of 61.9% of patients responded satisfactory to treatment with atomoxetine getting the CGI-I scale a score of 1-2. The duration of therapy and patient age are factors that influence the response. Furthermore, the clinical profile of patients treated with atomoxetine is characterized by different comorbidities, anxious symptomatology and personality disorders. Atomoxetine treatment with has also been shown its effectiveness and safe despite the presence of concomitant comorbidities and psychopharmacological treatment.

Atomoxetine treatment with has been effective and has proven good tolerability profile during treatment.

The authors have not supplied their declaration of competing interest.

The rates of postnatal depression (PND) in British South Asian (BSA) women are higher than the general population. PND is known to cause disability and suffering in women and negative consequences for their infants and their family with huge costs to society. Due to linguistic and cultural barriers, BSA women do not access health care services.

To conduct an exploratory trial to test the feasibility and acceptability of a culturally adapted group Cognitive Behavioural Therapy (CBT) intervention (Positive Health Programme (PHP).

We aimed to determine if depressed BSA women receiving the PHP intervention will show significant improvements in terms of severity of depression, marital support, and social support as compared to the control group.

We used a two-arm pragmatic single-blind randomised controlled design. Women meeting the inclusion criteria were randomised either to the experimental group receiving PHP or treatment as usual (TAU) that is standard care usually provided by the GP.

A total of 615 mothers were screened for participation in the trial, of these 137 were assessed further to determine eligibility. Eighty-three mothers were randomized to receive either PHP (n = 42) or treatment as usual (TAU) (n = 41). Mothers found the intervention to be acceptable and felt an overall positive change in their attitudes, behaviour and confidence level.

The recruitment and retention figures (70%) highlight the ability of the research team to engage with the population. The findings suggest the acceptability of the culturally adapted PHP intervention for British South Asian women with postnatal depression.

The authors have not supplied their declaration of competing interest.

To assess the prescription of benzodiazepines (BZD) in elderly patients, and to explore any gender differences.

Six hundred and fifty-four patients (≥ 65) admitted in an emergency service of a general hospital due to a fall. BZD use information was collected (dose, half-life profile).

BZD are significantly more prescribed to women (47.6%) than men (36.1%) (X2 = 8.097, P = 0.004). We conducted a logistic regression analysis using as dependent variable taking or not BZD and sex as the independent one, covariating the model by age. We noted that sex remains significant despite enter the age variable in the model (OR = 1.5, P = 0.013). A total of 21.6% of patients consumed intermediate or long half-life BZDs, appearing a greater tendency to prescribe such BZD to women (X2 = 3.606, P = 0.058). In the 58.0% of prescriptions, prescribed dose was higher than the recommended for the elderly. The percentage is significantly higher for men (70.0%) than women (53.1%). Furthermore, a total of 54 prescriptions (15.8%) were even higher than the recommended adult dose, with no significant differences between men and women.

We found evidence of a higher prescription of BZD in women independently of age. Despite not being recommended, prescription of intermediate or long half-life BZD continues, in a slightly higher manner in women. BZD are prescribed above the recommended dose for elderly in a large number of patients, especially in men. A considerable proportion of elderly patients (15.8%) consume BZD doses even higher than the recommended for adults.

The authors have not supplied their declaration of competing interest.

Postpartum depression has a prevalence of 15% and has consequences for mother and baby (delayed physical, social and cognitive development). It's essential to prevent the illness with an early identification of Risk Factors (RF).

Five hundred and seventy-two women in 3rd trimester of pregnancy were evaluated and selected those with ≥ 1 RF (n = 290). We re-evaluated in the postpartum with Edinburgh Depression Scale and selected those with subsyndromal depressive symptoms (≥ 7.5) (n = 57). Clinical, demographic and functional data were collected.

A total of 50.7% had RF. A percentage of 48.6 had family history of mental illness (MI), 34.1%had personal history of (MI) and 34.1% had some pregnancy associated illness. Twenty percent had needed some assisted reproductive technique, 14.1% had little family support and 15.2% had little couple support, 3.8% showed anxiety-depressive disorders during pregnancy, 19.7% had depressive symptoms after delivery. The mean age was 33.67. No significant differences between patients with and without RF (T-1858, P 0.064). Among women with RF, 59.6% were married, 35.1% single and 3.0% had other situation. 89.5% live with their own family, 8.8% with their family of origin, 1.8% alone. 50.8% had university studies.

Assessing RF during pregnancy can help these women, since we see that the 19.7% will have serious risk of developing postpartum depression. The RF to take more into account are not those related to social-academic development, neither the presence of anxiety-depressive symptoms during pregnancy, but the family or personal history of (MI) and the presence of a pregnancy associated illness. Early detection and treatment may prevent the development of this disease improving the quality of life of mother and babies’ development.

The authors have not supplied their declaration of competing interest.

Chronic rhinosinusitis (CRS) is a condition of inflammation of the nose and paranasal sinuses affecting 6.8 million Britons. It has a great impact on quality of life and productivity. CRS is currently subdivided into two main types – with and without nasal polyps (CRSwNPs and CRSsNPs respectively. Allergic fungal rhinosinusitis (AFRS) is severe subtype of CRSwNPs.

This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors influencing onset and severity of CRS.

To determine whether those with CRS are more likely to report mood disturbance compared with healthy controls.

CRES is study-specific questionnaire asking about demographic and socioeconomic factors and past medical history as well as a nasal symptom score (SNOT-22) and SF-36 (QoL – quality of life tool). Questionnaires were distributed to patients with CRS attending ENT outpatient clinics at 30 centres across the United Kingdom from 2007–2013.

A total of 1470 participants were recruited (Table 1). Differences between those with CRS and controls were found; those with CRSsNPs reported significantly more consultations with their GP for depression and anxiety. Patients with CRS also showed significantly poorer mental well-being than controls across the mental health and emotional well-being domains of the QoL tools used. Those with CRSsNPs scored significantly worse than those with nasal polyps across all domains.

Mood disturbance is significantly more common in patients with CRS compared to healthy controls, especially in those with CRSsNPs. This added mental health morbidity needs consideration when managing such patients.

The authors have not supplied their declaration of competing interest.

“Viaje del Parnaso” is a volunteering project developed at the Day Center Aranjuez2 (CD2) for helping adults with SMI to get a satisfactory and responsible occupation through their implication in a volunteering work in the community, while involved in the maintenance of a green area in the city of Aranjuez.

The aim of this study was to evaluate the impact of the project on the volunteers’ lives in terms of personal growth and environment conservation and compare its results with non-volunteers also attended at the CD2.

The project was carried once a week during 45 weeks. 11 volunteers participated on the project, plus 5 non-volunteers were considered as cuasi-control group. The instruments applied were an item on “environment conservation” and 2 subscale items of “Personal Growth” from the Ryff Scales of psychological well-being. Measures were applied at baseline, 6 and 12 months after.

Significant differences were found on the environment conservation item between volunteers at baseline and 6 months after (P < 0.05). Results also revealed a significant difference (P < 0.05) between volunteers and non-volunteers at both variables (“environment conservation” and “Personal Growth”) in baseline and 6 months after treatment.

The data from this study suggest that a volunteering program seems to be an effective intervention for bringing about improvements in well-being of people with SMI, and also for increasing their environmental awareness. These improvements may also help to change the stigma of SMI reinforcing mental health patient's contributions to society.

The authors have not supplied their declaration of competing interest.

To assess the general cardiac health of inpatients in acute psychiatric units and to evaluate the practice of ECG use in this setting.

Overall cardiac risk is assessed using QRISK2. Clinically significant ECG abnormality detection by psychiatric teams are compared with same by cardiologist.

Ten percent of patients (n = 113) admitted to five acute psychiatric wards during a period of 13 months across three hospital sites, covering a population of 1.1 million, were randomly selected. Electronic health care records were used to collect all data, in the form of typed entries and scanned notes. An experienced cardiologist, blind to the psychiatrist assessments, performed ECG analysis. The QRISK2 online calculator was used to calculate 10-year cardiovascular risk as recommended by NIHR, UK.

A score of 10% or more indicates a need for further intervention to lower risk.13.5% of patients had a QRISK2 score of 10–20%, 5.2% had a score of 20–30%, and 1 patient had a QRISK2 score > 30%. In total, 19.7% had a QRISK2 of 10% or greater. A total of 2.9% had prolonged QTC interval (> 440 ms), with 2.9% having a borderline QTC (421–440). A total of 34.3% of ECGs were identified by the ward doctors as abnormal, with action being taken on 41.6% of these abnormal ECGs. Cardiologist analysis identified 57.1% of ECGs with abnormalities of potential clinical significance.

One in five patients admitted to psychiatry wards have poor cardiac health requiring interventions. Though QTC interval prolongation is rare, half of patients may have abnormal ECGs that require further analysis.

The authors have not supplied their declaration of competing interest.