Under Canadian training requirements, psychiatry residents must demonstrate proficiency in various psychotherapy modalities such as cognitive behavior therapy and psychoanalytic psychotherapy.

Building from an earlier case study of the development of a comprehensive psychotherapy education program, the current presentation explores lessons learned from the ongoing delivery of this program to psychiatrists in training. Innovative strategies, opportunities, challenges and current outcomes on the delivery of this program are explored through a case study framework. The design, implementation and ongoing operation of the psychotherapy education program are based on the Royal College of Physicians of Canada specialty training requirements in psychiatry.

In the context of the case study framework, a Canadian psychotherapy training program for psychiatrists in training is analysed. The psychotherapy education model is designed and operated to offer a gradual and integrated educational and clinical experience in psychotherapy over four years of training.

The psychotherapy education program was investigated to explore new frameworks and innovative strategies of delivery and operation. Among the lessons learned were the need to maintain formally structured, modality specific teaching and supervision, video recording of sessions in supervision, provision of additional protected psychotherapy time, access to online training resources and utilization of non-physician mental health experts.

This presentation will investigate the ongoing insights emerging from managing delivery of different psychotherapy competencies to psychiatrists in training in a Royal College of Physicians of Canada accredited program. Implications for training, practice and future research will be discussed.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

The Japanese Society of Psychiatry and Neurology (JSPN) fellowship is a long-running programme to support early career psychiatrists from around the world to attend the society's annual conference in Japan.

To inform early career psychiatrists of the nature of the fellowship, disseminate learning from the experience and to encourage applications to the scheme.

Each member organisation of the World Psychiatric Association can nominate up to two early career psychiatrists for consideration by the fellowship committee. Applicants must submit an abstract in one of two themes, describing how services are designed in their country. Twelve early career psychiatrists are selected to participate in the programme each year.

In 2015, fellows were drawn from ten countries across three continents. The fellowship programme involved several components, including the opportunity to present the nature of psychiatric services in our home nations in dedicated seminars with other international fellows. This provided an excellent platform to compare and contrast different national approaches in key areas. Each seminar was co-chaired by an eminent psychiatrist and an early career psychiatrist from Japan, increasing the possibilities for professional exchange and mentoring.

The Japanese Young Psychiatrists’ Organisation arranged a number of activities for the fellows including a guided tour of a local psychiatric facility. This enabled fellows to gain a deeper understanding of psychiatric practice in Japan, through informal discussions and interaction with clinicians.

The JSPN fellowship is an effective mechanism for fostering improved relations and understanding between early career psychiatrists across the world.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Be a citizen means having rights but also duties and be subject to laws. Educating to legality is essential for mutual respect in the community, for the rules of social life and to exercise own rights of citizenship. A psychiatric patient can commit crimes because of mental disorders but also in absence of psycopathological problem. When a patient commits an offence, it is correct to know whether he was due and if he is actually a danger to society. The law do not allow ignorance but what patients really know about the law is not clear.

In this study, we want to investigate the legal knowledge in citizens with mental disorders. Moreover, we want to build pathways to increase compliance with the law.

We collected a cohort of 10 offenders and asked them if they were interested in an educational course on legality. We interviewed a sample of patients at risk of breaking the Penal code to assess their basic knowledge.

The reasons to undertake an educational program on compliance with the law were higher for offenders, maybe for fear of damaging sanctions. Those at risk of being sued for their behavior seemed to have more background than other group.

It is essential to develop educational programs about crime prevention within the psychiatric field through training courses that increase the knowledge and awareness of effects of the Penal code. Moreover, citizens with mental disorders at risk of crimes should be supported by specific interventions aimed to social ethics.

The authors have not supplied their declaration of competing interest.

Epidemiological studies of emergency room (ER) psychiatric settings can help monitor unmet needs and improve the quality of care.

To characterize the patients presenting to emergency department with psychiatric complaints in a medium sized health centre in oil sands region of the Northernalberta.

information on a data assessment tool designed to capture all relevant demographic and clinical characteristics of psychiatric patients in the ER was compiled as part of a clinical audit process.

Overall, 477 patients were assessed by the psychiatric team over the 12 month period, comprising 230 (48.2%) males and 247 (51.8%) females. There was a fairly balanced distribution by age, ethnic background, and relationship status between the male and female patients. The majority of patients with a history of self-harm or childhood sexual abuse were female while male patients were significantly more likely to report medication non-compliance.a higher proportion of the female patients had depressive disorders and personality disorders while a higher proportion of male patients had anxiety disorders, bipolar and related disorders, schizophrenia spectrum disorders, and substance-related disorders.approximately half of all the patients had an impaired clinical insight. Majority of the patients had a G aF score of 70 or less. Nearly one in five patients were admitted for inpatient treatment with a significantly higher proportion of male patients being admitted involuntarily.

There are sex-specific differences in many of the demographic and clinical measures collected in our ER psychiatric sample.

The authors have not supplied their declaration of competing interest.

To conduct a three-arm partial randomised controlled trail to evaluate the effectiveness of expedited regular supportive psychotherapy and assertive case management for patients presenting with suicidal ideation or self-harm to the emergency department (ED).

we expect expedited regular supportive psychotherapy plus assertive case management will reduce the suicidality and/or suicidal behaviour in patients by at least 20% at 4 weeks compared to patients receiving only assertive case management or routine care and these differences will be sustained at 6 months.

This will be a longitudinal, prospective, three-arm controlled single-rater-blinded partial randomized clinical trial with a recruitment period of 12 months and an observation period of 6 months for each participant. Patients in the intervention group will receive regular face-to-face or over the phone brief supportive psychotherapy during weekdays following presentation to the ED with suicidal ideation or self-harm until patients are actively enrolled in regular community mental health services with active case management by the therapist. Patients in the control and the assertive outreach arms will each receive the usual follow-up services offered routinely to regular patients and assertive outreach patients respectively who present to the ED with suicidal ideation or self-harm.

Recruitment will commence in February 2016 and we expect the results of the study to be available by September 2017.

If our hypothesis is proved correct, our intervention will be a new model for caring for patients with self-harm and suicidal ideation and is expected to reduce suicide rates.

The authors have not supplied their declaration of competing interest.

Parasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.

we report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack.after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.

in this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.

Parasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.

The authors have not supplied their declaration of competing interest.

Hyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia.in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.

we report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms.an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.

in this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.

Hyperthyroidism is very common in general population, being infradiagnosed most of times.in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder.in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.

The authors have not supplied their declaration of competing interest.

aggressive behavior in wards is associated to poor treatment compliance and low clinical insight. Most studies focused on the clinical and cognitive dimensions of insight, while the relationship between metacognitive dimension and aggressive behaviors was not investigated. Our aim was to understand what relationship occurs between dimensions of insight (metacognitive, cognitive, clinical), and specific aggressive behaviors in acute patients.

we recruited 75 acute schizophrenic patients using:aQ; MO aS; IS; P aNSS; BCIS.

a positive correlation between the IS score and the hostility, angry and physical aggression sub-scores of theaQ was highlighted, while no correlation between the score of IS and MO aS total score was found. No correlation between the score of the P aNSS G12 item and theaQ scores and MO aS was found, and no correlation between BCIS scores, MO aS andaQ scores was found.

in our patients, a higher level of metacognitive insight, but not clinical nor cognitive insight, was associated to higher levels of hostility. we suggest that a higher ability to monitor and appraise one's own altered processes of thought and related discomfort, feeling of destabilization and loss of control, could contribute to enhance resentment and suspiciousness. Findings help develop specific therapeutic strategies to enhance metacognitive and self-monitoring abilities, helping patient's understanding of the illness, improving compliance with treatment, and patient's quality of life. Our results support the multidimensional nature of insight in schizophrenia, confirming that clinical, cognitive and metacognitive dimensions are independent though related facets of the phenomenon of insight in schizophrenia.

The authors have not supplied their declaration of competing interest.

The DSM-5 defines psychomotor agitation as excessive motor activity associated with a feeling of inner tension. The activity is usually nonproductive and repetitious and consists of behaviors such as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still. This kind of behavoir occurs in up to 25% of psychiatrics patients who consult in emergency medical services.

The main objective was to determine the efficacy of loxapine inhalation powder in acute agitation.

Ten agitated psychiatric patients scored Positive and Negative Syndrome Scale – Excited Component (P aNSS-EC) baseline and ten minutes after the administration ofaD aSUVE®.

The efficacy of loxapine 10 mg in the acute treatment of agitation was established in a short-term (10 minutes).

Loxapine is the first and only orally inhaled medication for the acute treatment of agitation associated with psychiatrics disorders, which is a tool easy-to-use in emergency medical services.

The authors have not supplied their declaration of competing interest.

Emergency situations related to mental disorders represent a significant proportion of all medical emergencies. Over the last years we have been witness to an upturn in the incidence of psychiatry emergency service because to change of mood.

To determine the profile of the patient who requires psychiatric attention with changing of mood in our area in different seasons.

This is a prevalence and prospective study in which the dependent variable is taken as change of mood and we also use three more independent variables that are age sex and seasonality. The seasonality (spring period and summer period) will be at the same time the form of divided the population in two groups to compare.

Out of all the consultations for changing of mood in the emergency service during the first period (113 patients), 34% were men and 66% were women. The age range of 36–50 years was more frequent for women and the age range of 51–65 years was more frequent for men.in the second period (with 162 patients), 137 women (86%) and 25 men (14%).in this case, the most common age range was 36–50 years, both for women and for men.

The epidemiological and clinical characteristics of patients with changing of mood assessed by the emergency service are described from a naturalistic approach.

Which Chi2 we will discover if the population who has been taken between woman and man is significant and with the median, we will also determine if the age ranges are enough significant to confirm our hypothesis.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Over the past 40 years, services for psychiatric patients have become increasingly deinstitutionalized, shifting away from inpatient facilities.as a result, patients seek other avenues for treatment, including outpatient facilities and community resources. Unfortunately, those resources have also become increasingly constrained by widespread budget cuts, leaving patients with the health care system's last remaining safety net—the emergency department (ED).

Because EDs are seeing increasing numbers of patients, hospital administrators have recognized the importance of improving throughput and the quality of care delivered in EDs.

The aim of this report is to investigate the gender difference among patient's profile in psychiatric emergency room, assessing the socio-demographic and clinical characteristics, reasons for attendance and practices.

Retrospective and observational study, conducted at Centro Hospitalar e Universitário de Coimbra, during a three month period. Statistical analysis of data with “SPSS 21”.

During the three months period, a total of 2309 patients were admitted in Psychiatric ED, 1485 female and 824 male.

Regarding clinical data, the authors are expecting to find different psychopathology among male and female, as well as psychiatric comorbidities, diagnoses after discharge, treatment conducts, social support and different rates of psychiatric comorbidities.

Factors such as patient's vulnerability, defined by socio-demographic elements, characteristic as the type and severity of their mental illness, social support, treatment adherence, with significant implications of prognosis, costs and care. The conducted study enabled us to outline a profile of male and female psychiatric patients in ED.

The authors have not supplied their declaration of competing interest.

New psychoactive substances (NPS) are drugs that have recently become available, are not worldwide regulated, and often intend to mimic the effect of controlled drugs. α-Pyrrolidinopentiophenone ( alpha-PVP) is a potent stimulant cathinone that is thought to act inhibiting dopamine and noradrenaline reuptake. It has been associated with hallucinations, psychosis and death.

To explore the presence ofalpha-PVP from the samples handled to, and analyzed by energy control.

To determine whether it is a new trend in recreational settings.

all samples presented to energy control were analyzed.

Samples in which alpha-PVP was detected using Gas Chromatography-Mass Spectrometry were selected for study.

a Google trend analysis was also performed to asses the media impact of alpha-PVP.

From a total of 20,062 samples, 33 contained alpha-PVP (0.16%). The samples containing alpha-PVP were mostly sold as such (40%) despite a significant proportion being sold as MDM a (15%). Google trend analysis showed an abrupt increase of alpha-PVP searches in 2015 reaching 50% of the MDM a-ones.

Our results suggest presence ofalpha-PVP in the drug market may be increasing, especially as adulterant of other drugs. Severe side effects might be even more serious considering that a significant proportion of users may ignore which substance they are actually using. However, the total amount of alpha-PVP analyzed remains small, and does not support the alarming reports published in media.

The authors have not supplied their declaration of competing interest.

Frequent attenders (F a) are patients who attend a health care facility repeatedly. The frequency of frequent attendance at emergencies department has been defined as 4 or more attendances/annum. F a are few in number but they produce a high number of attendances.

To determine prevalence of F a, mean attendances/year generated by F a and frequency of visits by months.

a retrospective study was performed on psychiatry's emergency department database from January until December 2013. F a was defined as those with ≥ 4 attendances at emergency services in a year.

Prevalence of F a, attendances’ prevalence, diagnosis’ prevalence, Mean attendances generated by F a and frequency of visits by months were analysed.

among 4824 attendances we found 181 F as (5.98%). Men represented 50.80% and women 49.20%. F a presented a mean of 6.33 attendances/year, while non-F a presented a mean of 1.29 attendances/year.

in accordance with frequency of visits by months, it was observed that number of attendances was increased inapril and May, in both F a and non-F a.

Prevalence of F a was 5.98%, F a generated a 23.74% of attendances. Most prevalent F a’ diagnoses were: anxiety disorder, personality disorder non-specified and schizophrenia.

F a at emergency department contributes to overcrowd them.for this reason, it is important to take into account these results to develop new strategies to improve F a’ attention and prevent its occurrence.

The authors have not supplied their declaration of competing interest.

This is a two years retrospective study conducted on a total of 1000 patients (56.9 females, 43.1 males) randomly selected, admitted in acute psychiatric hospital. From these on 100 patients restraining techniques were applied.

Out of the restrained patients male, younger usually suffering of personality disorder were more frequent restrained. Statistical analysis of restrained group characteristics comparing with larger group of the total patients admitted showed no significant differences between these two groups. Regressive analysis on different clusters found a higher risk to be restrained for patients with agitation and recurrent depressive disorder, male, from urban area. This study draws attention to the importance of a good study design and proper methodology.

The factors which influence the risk of being restrained in acute psychiatric setting are more related with behavior characteristics than diagnosis or demographical items.

The authors have not supplied their declaration of competing interest.

The intention of this study is to show the frequency of the burnout syndrome among the population seen at psychiatric ER for the most severe complication of the burnout, the suicide attempt.

(a) To demonstrate the frequency of burnout among the population examined at psychiatric ER for suicide attempt.

(b) To establish a correlation between the frequency of burnout and:

– the socio-demographic characteristics;

– the psychiatric follow-up;

– the type of personality found.

Descriptive study on a sample of 92 patients examined at psychiatric ER between 01/02/2014 and 01/06/2014 after a suicide attempt, seen by a single doctor. The patients received the Maslach Burnoutinventory (MBI).

The frequency of burnout among the population consulted for suicide attempts is 8.7%. The limitations of this study were: the use of MBI questionnaire only by one doctor and a collection of data carried on a certain period of time.

I managed to characterize the population seen after the suicide attempt induced by the burnout: 88% women; 25% foreign population working in a context with many responsibilities; the predominance of obsessive personality – 50%, followed by anxious personality type – 25%; the suicide attempt was done by a population without psychiatric history and without psychiatric follow-up – 75%; the studied population is divided between patients working in a high responsibility environment – 36% and patients working in the social or the public environment – 63%.

Eighty-eight percent of patients were brought in after their first suicide attempt.

Despite the fact that until now a unanimous definition has not been formulated on the CIM-10, the burnout syndrome is one of the most popular disorders.

The problematic is real, considering that this syndrome, which starts with a psychological distress, can escalade to a self-aggressive behaviour.

The authors have not supplied their declaration of competing interest.

autointoxication with nutmeg in an emergency setting is a rare, but potentially a life-threatening event. Despite the low incidence of ‘tentamen suicidii’ (TS) with nutmeg, this substance is cheap and readily available. Early recognition of a suicide attempt with nutmeg poisoning can be extremely difficult, especially when nobody witnessed the nutmeg intake. Worldwide there are only a few cases reporting TS with nutmeg.

To present a case of TS with nutmeg committed by a suicide attempter.

To review available literature on TS with nutmeg.

a case report is presented and discussed, followed by a literature review.

Five published cases of suicide attempts with nutmeg were found while searching through PUBMED and Embase. Our case describes a 57-year-old female, diagnosed with borderline personality disorder, who has been admitted to the emergency department in a state of agitation, diminished cognition, respiratory difficulties and hemodynamic instability. Electrocardiography showed a fast sinus arrhythmia with no uschemic or hypertropic changes. Blood sampling, serum and urine toxicology did not reveal any abnormalities.in view of the complexity of her condition, she admitted to have taken a large dose of nutmeg. The patient was kept for observation, offered reassurance, and rehydratation.

The presentation of inexplicable clinical state accomplished by disturbances of central nervous, respiratory and hemodynamic systems in the population of patients with attempting suicide should alert the physician to the rare but probably underreported possibility of nutmeg autointoxication.

The authors have not supplied their declaration of competing interest.