The authors have not supplied their declaration of competing interest.

Pathologic aerophagia is characterised by excessive swallowing of air resulting in significant abdominal distension or belching. This is a relatively rare condition in general population but has been reported in up to 8.8% of institutionalized patients with intellectual disability (ID). In severe cases, this can cause volvulus and ileus, and even intestinal perforation. Currently, there is limited information on this potentially life-threatening condition, particularly for people with ID.

To review the up to date literature on the pathophysiology, clinical features and management strategies of pathologic aerophagia in relation to people with ID.

A literature search of electronic database was performed using specific keywords. Review articles were selected using pre-defined criteria.

Apart from a few small controlled trials on pharmacotherapy, most of the studies were case series or uncontrolled studies. The understanding on pathophysiology is incomplete but is thought to involve a reflex-induced movement of upper oesophageal sphincter and may be associated with anxiety or stress. A comprehensive history and physical examination as well as an abdominal radiograph may be helpful in diagnosis. The mainstay of treatment is reassurance and behaviour therapy. Medications that are helpful include antacids, anti-reflux drugs and benzodiazepines. Surgical treatment is recommended for patients who do not respond to conservative treatment.

Pathologic aerophagia is not uncommon in people with ID and can present with severe challenges in the assessment and management. Further studies are necessary to provide evidence-based treatment guidelines for the management of this condition particularly in patients with ID.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Involuntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.

The purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.

Three hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.

Two hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).

The best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.

The authors have not supplied their declaration of competing interest.

Every theory that explains psychopathology refers to different aspects of mental pain whether it regards annihilation anxiety, fragmentation of the self or feelings of intolerable anguish. The concept of mental pain has proved to be an important symptom in mood disorders in general and suicide in particular (Orbach et al., 2004; Levi et al., 2010; Levinger et al., 2015). Combining the understanding that mental pain is as a part of all forms of psychopathology with the growing interest in assessing therapeutic processes via outcome measures has led to the assumption that the tolerance and severity of mental pain could become powerful outcome measurement. The aim of this study is to assess the Mental Pain Scale (OMMP) and Tolerance to Mental Pain Scale (TMPS) as outcome measurement and to learn about their capabilities to distinguish between different psychopathologies.

The first objective would be to examine patterns of mental pain subscales in different psychopathologies. The second objective is to assess the OMMP and TMPS as outcome measurements.

Two hundred and thirty outpatients were administered a clinical questionnaire battery composed of eight questionnaires. The patients were to fill these questionnaires every 3 months for one year or until the end of their therapy.

We will present preliminary findings regarding the expressions of mental pain in different kinds of psychopathology and results of 3 months follow-up.

Tolerance and severity of mental pain are a vital to the assessment of psychopathology and should be used as outcome measurement of therapeutic process.

The authors have not supplied their declaration of competing interest.

Clinician's attitudes are an important consideration in implementing adherence strategies and that these attitudes can be successfully improved as a result of training. The 22-item Medication Alliance Beliefs Questionnaire (MABQ; Byrne et al.2008) was used to assess clinician attitudes towards non-adherence. The MABQ contains five subscales reflecting the clinician's self-efficacy (adequacy), the satisfaction (work satisfaction); their appraisal of their self-worth (self-esteem), their outcome expectancies (pessimism) in relation to non-adherent patients, and the extent to which they understand the difficulties patients might experience in trying to adhere to treatment (empathy).

To develop the Portuguese version of the MABQ.

The MABQ was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. After pre-testing, the final version of the Portuguese translation was produced.

A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in MABQ was 80.06 (SD 9.5). The value of internal reliability coefficient α was 0.80. The intraclass correlation coefficient of total MABQ score was 0.35. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (80.4 vs.76.2; P = 0.02).

The attitudes of mental health professionals may have a predictive relationship with treatment outcomes of patients with mental health disorders. The validation of the Portuguese version of MABQ will provide professionals with a new tool to evaluate crucial issues related to medication beliefs.

The authors have not supplied their declaration of competing interest.

Non-adherence is a problem throughout medicine and there are many strategies that are used to improve antipsychotic adherence. A review of the literature identified 33 commonly cited strategies for enhancing consumer adherence. Three core themes were identified: Information/Education; Behavioural strategies; and Cognitive/Motivational strategies.

To develop the Portuguese version of the DIAS.

The DIAS was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. The participants were asked to rate how often they had difficulties using each of the 33 strategies with consumers who were non-adherent. A four point Likert scale was used (1 = never; 4 = always) such that higher scores indicated more frequent difficulty using the strategy.

A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in DIAS was 85.0 (SD14.6). The value of internal reliability coefficient α was 0.93. The intraclass correlation coefficient of total MABQ score was 0.45. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (84.5 vs.90.5; P = 0.04).

Interventions to improve antipsychotic adherence would benefit from further research. However, it is important always to bear in mind that none of these strategies can be a substitute a positive therapeutic alliance. The Portuguese version of DIAS will provide professionals with a new tool to evaluate the frequency how strategies are implemented and the impact of each strategy in treatment adherence.

The authors have not supplied their declaration of competing interest.

Despite mounting evidence that non-injury-related factors have an important role in recovery from injury; specific variables associated with surgery outcomes are poorly understood. This lack of knowledge complicates efforts to improve the care of work-related hand injury (WRHI) patients. However, substantial research and investigation have still not clarified these underlying relationships, which merit further attention.

The purpose of this study was to evaluate the Health-Related Quality of Life (HRQL) outcome for WRHI patients after the impact of event and to investigate the moderated mediation analysis associated with their decision trust and regret.

A cross sectional study design was used to investigate the impact of event and the associated HRQL in 53 WRHI patients following severe and major hand injury. All consenting patients completed the Impact of Event Scale Revised, the Symptom Checklist-90-Revised, Decisional Trust scale, Decisional Regret scale and Short Form-36.

In the result of mediation analysis, patients affected HRQL via decisional trust and decisional regret, respectively. In addition, our data suggest that certain decisional trust and decisional regret (partial) characteristics significantly moderate this association. These findings may aid in the development of clinical interventions to enhance HRQL for WRHI patients. Overall, it is important for clinicians to consider the notion that more decisional trust or less decisional regret may sometimes, but not always, be better.

The authors have not supplied their declaration of competing interest.

Studies have documented that drug prevention centers in Greece have been through an era of turmoil and uncertainty (EKTEPN, 2015, Tsounis, 2012, Kiritsi and Tsiotra, 2004) underlining the staff's hard work all over Greece.

The aim of this study was to investigate the effects of the current fiscal crisis on the operating conditions as described by the staff of the Attica substance prevention centers with the emphasis on main problem areas and solutions.

Statistically reliable questionnaires were used by the research team investigating participants views on the aforementioned areas of enquiry.

Two Questionnaires were administered to 59 psychologists and social workers working at the centers of Attica, Greece during the summer of 2015.

The majority (85%) of those working at the centers mentioned the main problems as following:

– issues concerning the institutional role of the centers, the education and supervision of the staff;

– fiscal issues as a result of the economic austerity, which undermine the operation of the centers and the morale of the staff.

Our empirical study is actually the first one which delves into the inner workings of the drug prevention centers in Attica, Greece:

– the extent the phenomenon of drug dependence in Greece, examining the epidemiology and the influence of the financial crisis, as well as the strategies and action plans developed in a national and EU level;

– the most significant innovative and standard European and Greek prevention programs.

Finally, research methodological issues are discussed in the light of the main findings of the empirical research.

The authors have not supplied their declaration of competing interest.

Switzerland is a very attractive country for workforce brain drain in the field of psychiatry, with work, academic and financial conditions identified as pull factors; resulting in long-term migration and high level of satisfaction [1].

To enlight the phenomenon by reporting a personal experience of migration from France to Switzerland for work reasons as a psychiatrist.

To describe the main characteristics of the Swiss Mental Health Care in the Canton of Vaud focused on ambulatory cares in addictology.

Self-report description from the Centre Saint-Martin for drug addictions of the Community Psychiatry Department in Vaudois Teaching Hospital (CHUV) of Lausanne.

The Centre Saint-Martin is an ambulatory center providing cares, support, treatment and harm reduction for adult drug addictions within a multidisciplinary team. The striking point of this model is the intense support made towards the community (general practionners, somatic and psychiatric cares) in order to maintain and develop addiction cares in the general health system. The case management model, still rare in France, is being implemented in the center resources management. Detailed descriptions are proposed.

Lack of psychiatrists in the French speaking Canton of Vaud makes it very attractive for European specialists. Work and academic facilities, including psychotherapy training are accessible to foreign psychiatrists.

Work migration is a unique way to experience different practices in psychiatry within Europe. Living and working conditions in Switzerland make it a country particularly attractive.

The author has not supplied his/her declaration of competing interest.

Quality in mental healthcare is a complex, multifaceted construct. It can be categorized into structures, processes and outcomes. In the past decade, there have been many initiatives on the assurance and improvement of process quality through the development, evaluation and implementation of process indicators for several important process domains including, for example, continuity and coordination of care. Moreover, outcome measurement, focusing on the extend to which intended outcomes of mental health service provision are achieved, is receiving growing interest and should be pursued through a systematic approach.

Systematic compilation of outcome domains in mental healthcare.

Identification of the full range of outcome domains in mental healthcare.

Systematic literature review on outcome domains in mental healthcare.

A whole range of outcome domains can be identified and categorized onto a continuum ranging from ‘traditional’, objective outcome domains, such as mortality and symptomatology, to more subjective outcome domains, such as quality of life and well-being. Moreover, outcome measures in different outcome domains can be assessed taking different perspectives into account, including either the provider or the patient.

In order to develop and implement systematic outcome measurement in mental healthcare, a first step is the identification and systematization of outcome domains in mental healthcare. This will provide a basis for identifying important outcome domains from the perspectives of both, patients and professionals. In a next step, appropriate and important outcome measures can be identified.

The author has not supplied his/her declaration of competing interest.

The Integrated Care Process of Anxiety, Depression and Somatization (ICP-ADS) lays out the cooperation between primary care (PC) and mental health (MH) as basic premises. Showing this model improves patient detection, inadequate patient referrals, adherence and response to medical treatment.

The Therapeutic Program (TP) established in PC includes low intensity psychological and psychosocial interventions, pharmacological treatment, and use of collaborative space with MH combining consultations, case tracking and educational activities. Our rotation as MH residents in the Community Mental Health Unit (CMHU) has focused on this framework, encouraging the use of a collaborative space.

Three training sessions were used to deal with the process as a whole. PC professionals were given self-help handbooks for low intensity interventions and clinical practice handbooks for psychopharmacological treatment. The referral space was established afterwards, where we took part in the TP founded by the PC doctor. In case the demand would continue, we opened consultation one day a week for co-therapy. With brief interventions of 3–4 sessions we continued the work with self-help guides, which also optimized psychopharmacotherapy.

Referrals were sufficient in many cases. Sixteen procedures were completed in co-therapy, half of which required referrals to encourage adherence. Only a referral to MH had to be done. Three months later, a follow-up showed that no patient in co-therapy had to be referred to specialized care.

The amount of referrals was reduced in comparison to previous months, adherence to interventions of low intensity was improved and was useful in both detection and prevention of new cases.

The authors have not supplied their declaration of competing interest.

This study was to evaluate the effect of an assertive community treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness.

Thirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS).

According to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the group × time interactions between groups were not statistically significant.

In this study, we observed that ACT was significantly better at improving the GAF than case management. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. ACT, however, may have some advantages over a standard-case management approach.

The authors have not supplied their declaration of competing interest.

In 2008, the province of British Columbia, Canada introduced financial incentives to encourage general practitioners (GPs) to assume the role of major source of care for patients seeking mental health treatment in primary care. If successful, this intervention could strengthen GP–patient attachment and consequently improve continuity of care. The impact of this intervention, however, has never been investigated.

To estimate the population level impact of physician incentives on continuity of care (COC).

This retrospective study examined linked health administrative data from physician claims, hospital separations, vital statistics, and insurance plan registries. Monthly cohorts of individuals with depression were identified and their GP visits tracked for 12 months, following receipt of initial diagnosis. COC indices were created, one for any visits (AV) and another for mental health visits (MHV) only. COC (range: 0–100) was calculated using published formula that accounts for the number of visits and number of GPs visited. Interrupted time series analysis was used to estimate the changes in COC before (01/2005–12/2007) and after (01/2008–12/2012) the introduction of physician incentives.

The monthly number of people diagnosed with depression ranged from 7497 to 10,575; yearly rates remained stable throughout the study period. At the start of the study period, mean COC for AV and MHV were 75.6 and 82.2 respectively, with slopes of –0.11 and –0.06. Post-intervention, the downward trend was disrupted but did not reverse.

Physician incentives failed to enhance COC. However, results suggest that COC could have been worse without the incentives.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Assertive community treatment (ACT) has become the standard for integrated care for people with severe mental illnesses. Limitations of ACT are the lack of flexibility, the limited feasibility in rural areas, the limited population and the time-unlimited nature. These limitations can be overcome by flexible assertive community treatment (Flexible ACT), developed in the Netherlands and introduced in several European countries.

Three studies were done between 2006 and 2015 on the results of the introduction of Flexible ACT, two in The Netherlands and one in the UK.

The outcomes in the Netherlands data show the effectiveness of Flexible ACT. Remission of schizophrenia increased form 19% to 31%. Bed use was reduced and quality of life increased. Effectiveness of FACT was also shown in the UK, where total patient time in hospital declined by half, even though the average time service providers spent with patients also declined. Collected data of the digitalized boards show that the board is used in accordance with the FACT model. Transition rate to primary care is 5–10% per year.

The introduction of Flexible ACT has been shown to benefit patients with severe mental illness and indicate the ability of to allocate human resources in mental health care more efficiently. Introduction to other countries will be accompanied by research on the effectiveness and feasibility within other cultures.

The author has not supplied his/her declaration of competing interest.

To investigated the Greek social representations towards harmful factors of health.

Cross-sectional questionnaire survey.

Two hundred and eighty healthy individuals participated to the present study from different region in Greece. The age range was 19–65 years old. The questionnaire included:

– question for the recording of social representations based on free association methods;

– The Greek version of the Revised Experiences in Close Relationships (ECRI);

– The Symptom Checklist 90-revised (SCL-90);

– question for the social-demographic parameters.

One factor and multifactor analysis was used for statistical analysis. Results showed significant differences in social representation of diet in terms of age and marital status. Place of region and chronic disease were found to affect the development social representations, such as exercise and disease, respectively. Exercise, night out and health were found like positive social representations, smoking and disease were characterized as negatives, whereas diet, alcohol and lifestyle were found controversial enough. Moreover, the results highlight the significant relationship between social representations towards harmful factors of health, psychopathology and attachment style (P < .05).

The results of the current study highlighted the importance of studying on social representations and provided more support to the representations theory context. But more crucially, our study highlighted functional domains of them related to psychopathology.

The authors have not supplied their declaration of competing interest.

An ongoing challenge for the behavioral health field in the United States is ensuring access to culturally and linguistically responsive treatments for the growing number of monolingual Spanish speakers. The limited availability of services further compromises mental health outcomes given the unique psychosocial stressors often experienced in this population, such as language barriers, family separation and inadequate social support, unemployment, trauma, and poverty.

In response to the local demand for services, the authors describe a specialized group program for monolingual Spanish speaking adults with chronic and persistent mental illness.

The program aims are two-fold:

– to reduce exacerbation of psychiatric symptoms for individuals presenting in an acute state of distress through the provision of recovery-oriented mental health services in a familiar setting and preferred language;

– to offer a specialized behavioral health training experience for bilingual psychology doctoral students.

The group is led by the psychology fellow and is offered twice per week for a total of six hours, and includes elements of interpersonal and cognitive behavioral therapy; motivational interviewing; spirituality; coping skills training; and art/music.

The described mental health group program is the only one available in Spanish in the local community and has reduced utilization of the hospital emergency room. Consequently, it fills an important gap in the service system and offers care that would otherwise be unavailable for individuals in need.

The program is a cost-effective alternative to hospitalization for Spanish speaking Latinos and a unique professional experience for psychologists in-training interested in a career in the public sector.

The authors have not supplied their declaration of competing interest.

Treatment adherence has a vital role in the patient's health outcome as poor adherence rates can reduce, even diminish, the effectiveness of the treatment as well as lead to a waste of the health care system's valuable resources. Previous research has shown that perceptions of treatment strongly affect adherence in psychiatric patients.

To investigate how the perceptions of treatment affect adherence during hospitalization in psychiatric patients.

Fifty psychiatric patients participated in this research, 21 (42%) males and 29 (58%) females. Out of them, 25 (50%) had been diagnosed with depression, 15 (30%) with psychosis, 6 (12%) with psychosis and depressive symptomatology and 4 (8%) with bipolar disorder.

The findings showed a significant effect of psychotherapy on treatment adherence (χ2 = 4.915, P = 0.027), with 7 out of 11 patients who undertook psychotherapy reporting good adherence rates compared to 12 out of 39 patients who did not. Gender had a significant effect on adherence (χ2 = 5.96, P = 0.05), with females reporting better adherence compared to males. Perception of treatment did not correlate significantly with adherence (χ2 = 0.439, P > 0.05) and neither did education (χ2 = 2.22, P > 0.05). Also, neither age (F(2,47) = 1.535, P > 0.05) nor hospitalization time (F(2,47) = 1.131, P > 0.05) correlated significantly with adherence to treatment.

Even though there was no significant correlation between perceptions of treatment and adherence, psychotherapy seems to improve adherence to therapy during hospitalization and is also correlated with positive perceptions of treatment, something which will be valuable for the patient even after the hospitalization.

The authors have not supplied their declaration of competing interest.

The Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.

To develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.

Fifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.

The theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.

Whilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.

The authors have not supplied their declaration of competing interest.