Low level of ability to endure discomfort, hardship and distress, which are integral parts of adverse life events, may lead to loss of mental stability and maintenance of psychological disorder.

Review of literature and case descriptions.

The patient often tries to cope with their suffering through avoidance and compensatory behavior which may relieve his suffering immediately; however, in the long term, it leads to the deterioration in the quality of his life and the persistence of suffering. Cognitive behavioral approaches focused on increasing the ability to endure unpleasant and distressful life experiences, allow the patient to better bear the inevitable losses in life, which he is exposed to, endure his anxiety, sadness, and the urge to impulsive action or escape; so the patient have more possibilities to act more freely, functionally and purposefully. Modern cognitive behavioral approaches, such as Dialectic Behavioral Therapy, Mindfulness Based Cognitive Therapy, Acceptance and Commitment Therapy and Compassion Focused Therapy developed and applied therapeutic methods designed to increase the patient's resistance to suffering and his ability to cope it better. These approaches are applied not only in patients with chronic psychiatric disorders, but also in patients with chronic physical illnesses and permanent disability.

The modern CBT strategies can help patients to increase his/her resistance to the distress, discomfort and suffering.

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.

The authors have not supplied their declaration of competing interest.

Tinnitus is defined as the subjective or objective perception of a hearing sensation in the absence of a corresponding external stimulus. It is a very common medical symptom, and some studies show that 5 to 15% of adults had tinnitus in life. It is a condition that could be chronic and for some patients could be very debilitating. Anxiety and depression are common findings in patients with tinnitus. Tinnitus can also interfere with sleep and concentration and affect the quality of life of patients. The heterogeneity of the etiology, pathophysiology and clinical features of tinnitus probably exacerbate the variability of response to treatment of the population and the decision on the best treatment option could be complex.

The purpose of this study is try to understand how the psychotherapeutic interventions may be useful in the treatment of tinnitus.

Bibliographic research in Pubmed.

Currently there are no available effective pharmacological treatments. In some cases, surgical interventions may be effective with respect to ear pathology, but not to tinnitus. Most studies show that psychological interventions are needed to reduce the distress and the impact caused by tinnitus in patients’ lives and the cognitive-behavioral therapy is the primary therapeutic intervention in chronic tinnitus.

Although cognitive-behavioral techniques demonstrated to be effective in the treatment of the distress and impact caused by tinnitus, little is known about the mechanisms by which this technique achieves this effect, therefore most authors suggest that further studies should be conducted in this area.

The authors have not supplied their declaration of competing interest.

Little is known about trauma or treatment of trauma with Eye Movement Desensitization and Reprocessing (EMDR), in adults with ASD. Neither is it clear on how ASD influences the expression of posttraumatic stress.

(1) To increase knowledge about treatment of trauma, and trauma related symptoms in adults with ASD. (2) To provide directionsfor research into the effects of EMDR on the expression of autistic and trauma related symptoms in adults with ASD.

Review of the literature using Cochrane Collaboration Centre, Embase, Medline, PsychINFO, PubMed and Web of Science.

Clinicians often overlook trauma related symptoms in people with a severe mental illness like ASD, due to diagnostic overshadowing (Grubaugh, Cusack and Zinzow, 2008), caused by the overlap between Post Traumatic Stress Disorder (PTSD) and ASD. In the case of diagnostic overshadowing, symptoms like avoidance, hyperarousal and reduced ability to mentalize (Plana, Lavoie, Battaglia and Achim, 2014) are attributed to ASD, while in actual fact they are manifestations of stress reactions related to perceived traumatic events. However, when symptoms are correctly attributed to negative experiences, clinicians tend to withhold treatment because of fear of aggravating symptoms (Frueh, Cusack, Grubaugh, Sauvageot and Wells, 2006). The literature suggests that trauma in adults with ASD is undertreated.

To our knowledge, the effects of EMDR in adults with ASD have not yet been studied, except at case level. A study protocol will be presented to assess the efficacy of EMDR treatment for trauma related symptoms in adults with ASD.

The authors have not supplied their declaration of competing interest.

Athena possesses a special place among the Greek Gods, as she was born from her father, according to an extreme patriarchal model with a marked depreciation of the maternal role. Zeus had swallowed and absorbed the mother of Athena, Mites, because of an oracle that if Mites gave birth to a boy, the boy would take his throne. When the time comes, Zeus commands Hephaestus to cleave his forehead with an axe, and then Athena leaps fully armed and shouting her cry of war, in front of the astonished Gods. The next moment she puts her weapons down, as a token of obedience and devotion. The exceptionally close bond between father and daughter is evident through their uniquely confidential relationship. The ancient myth is paralleled, from a psychodynamic aspect, with the case of a narcissistic patient receiving psychodynamic psychotherapy.

Case report.

A case of a woman with narcissistic personality features and depressive symptoms is described, presenting with the complaints of withdrawal, self-depreciation, passivity, and agoraphobia. Psychodynamic factors defining her pathology are her narcissistic and sexualized relationship with her father, whereas the relationship with her mother has been depreciated. The patient experiences an intrapsychic conflict of reciprocal idealization, against her anger and fear for her father, resulting in the symptoms of agoraphobia and passivity.

Like Athena, who puts her weapons down, the patient resigns from her will for autonomy and moves to a passive position, as a result of her entrapment in her idealized relationship with the father.

The authors have not supplied their declaration of competing interest.

Psychological processes play a mediating role in the development of psycho-pathological disorders depending on the Kinderman's model. Excessive use of emotional avoidance becomes, following the model of Barlow and Allen, the booster of emotional distress at long term. Dysfunctional meta-cognitive processes in turn influence the inadequate interpretations of life experiences.

To improve identification, expression and emotional management in patients with schizophrenia (PWS) and patients with bipolar disorder (PWBD).

Introduction of exposition for the emotional body's sensations. This work on emotional awareness by images and sounds prepare to role-playing and to exposure in real life.

Groups of psychotherapy for adults PWS and PWBD was implemented. The techniques used are those of cognitive behavioral therapy CBT (Beck) and emotional therapies (Barlow): columns Beck tailored, role-playing, psycho-emotional and breathing. Four groups of four patients participated in six therapy sessions.

An increase in emotional flexibility is observed two weeks after the group work (Wilcoxon P = 0.025). Work on emotional identification facilitates the relaxation of the avoidance process while promoting social skills. The new format includes nine sessions three additional sessions on the emotional body sensations. Meta-cognitive work on the interpretation of the delusional thinking has been inserted.

The experience of this pilot study provides encouraging results. The transdiagnostic approach referring to the alterations of this common psychological process finds use with PWS and PWBD.

The authors have not supplied their declaration of competing interest.

Somatization Disorder is more prevalent in females and is historically known as Briquet Syndrome. It is characterized by complaints in several systems, has early onset and chronic fluctuating course, but without organic substrate. When the duration of symptoms is less than two years or they are less obvious, it is called Undifferentiated Somatoform Disorder.

This study reports the case of a female patient, previously healthy and with no psychiatric history, which abruptly presented lush somatic symptoms without organic origin.

Case report of a previously healthy woman of 32 years, followed up for 14 months, by a sudden onset frame of profuse diarrhea, tenesmus, fecal incontinence, vomiting, anorexia and weight loss (18 kilos in 2 months), associated with headache and autonomic signs of anxious origin, without clear physical and/or psychogenic trigger. She had only a mild response to drug therapy and excellent improvement in symptoms after psychotherapy.

Unconscious triggers came to light only after psychotherapy starts, justifying that the magnitude of autonomic somatoform symptoms surpasses the time period established by ICD-10 for Somatization Disorder. Therefore, the rapid resolution did not allow a diagnosis of Somatization Disorder, according to ICD-10. So, it was diagnosed as Undifferentiated Somatoform Disorder.

It is suggested that the grandeur of clinical symptoms in this case is caused by psychogenic factors.

The authors have not supplied their declaration of competing interest.

We set out to determine standards that would enable the identification of persons at risk of Vitamin D (VitD) deficiency in our ward; the prevalence of deficiency in at risk patient group on a 25-bedded ward (Brunswick). Deficiencies were identified, managed according to local guidelines and care plans were updated to reflect this change.

Low VitD levels have been associated with depression, psychosis, schizophrenia, suicidality, treatment resistance and poor coping. However, serum VitD levels is not a routine investigation on inpatient psychiatric admissions. Factors associated with VitD deficiency include prolonged stay in inpatient units with limited exposure to sun; Inpatients’ diet; Self-neglect and social isolation.

Criteria for identifying patents who may be at increased risk was agreed.

These patients were approached, and consented to screening. Results of the investigation were discussed with patients and actioned according to need. Study period May 2015–July 2015.

We were unable to identify any criteria in use for identifying persons at risk in psychiatric services. The following criteria were agreed: Hospital stay for > 2 months and limited opportunities of leaving the ward (Detention); Transfer from another unit with a total of hospital stay > 2 months; Admission from the community with severe depression or history of social isolation.

7 patients (28%) were identified to be at increased risk. Of this, 6 patients (85.7%) were deficient and another 1 (14.3%) had insufficient level. Management was instituted.

If indicated, psychiatrists ought to consider monitoring VitD levels during inpatient stays and managing as appropriate.

The authors have not supplied their declaration of competing interest.

Patient's records are the most important clinical assets and tools which are required in consultations. Patient records also support the accurate continuity of care when patients return to other health providers.

Understand the extent of Discharge Summaries, which conform to the set best practise guidelines on the Mental Health Service.

A cross-section retrospective study on Discharge Summary contents was conducted at Al Amal Medical Complex. Chart review of randomly selected patient files (200 of a total 495), of Discharge Summaries for Psychiatric Patients in 2014 was performed. The data was statistically analysed using descriptive statistics taking into account proportions and frequencies. Pearson chi square and Fisher's test methodologies were used.

This study found of the 200 randomly selected Discharge Summaries that documented data of mental health examination 94% (n = 188), data of discharge date 100% (n = 200) while data of social investigation and family work up 82% (n = 164). The above three categories were the only categories to conform to standard discharge guidelines. The other thirteen items studies were found not conforming to the defined standard guidelines.

There is an active challenge for clinicians to introduce good clinical practice in Mental Health. Standard guidelines must be followed by clinician's in order to reduce potential areas of concern and achieve a good clinical practise. Regular recurring audits are highly needed& recommended to ensure the alignment with standard guidelines for the writing of Discharge Summaries.

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

Assessment and Treatment Team (ATT) was developed to manage mental health referrals within the borough of Blackburn with Darwen (BwD). The ATT became the main point of initial referral and assessment for adults presenting with mental health needs. It acts as the gateway service for access to specialist mental health services.

To evaluate the effectiveness of ATT against the key performance indicators.

Quantitative data was collected using electronic database from June 2014–May 2015. Feedback was obtained from GPs and also from patients who attended ATT over a one-week period.

The ATT received a total of 2234 referrals. A total of 73% were seen within 10 working days of the referral. Assessment outcome letters were sent to the GPs within 48 h in 47.53% cases. Referral rates to community mental health and Crisis teams were 7% each showing an overall reduction compared to the previous service. GP satisfaction – 70% were ‘moderately satisfied’ and 30% were ‘very satisfied’ with ATT. Hundred percent felt the service was easily accessible and 90% felt that the staff were friendly. Patient Satisfaction – 96% of patients rated the team as ‘friendly and polite’. Eighty-seven percent reported that they were listened to and 91% felt their concerns were understood. Eighty-three percent felt that ATT involved them in their decision making. Ninety-two percent responded that they were likely/extremely likely to recommend ATT to their friends and family.

The establishment of ATT has led to improved satisfaction among GPs and service users and has resulted in reduction in referrals to secondary mental health services.

The authors have not supplied their declaration of competing interest.

Patient non-show to clinical appointments is a major component of nonadherence, specifically in mental health institutions, being twice that of non-show in other medical specialties, and is associated with a greater risk of morbidity and mortality.

Our study was conducted to assess the rate and factors associated with missed first appointments in an outpatient mental health clinic, in order to find correlates between the various factors and the probability of non-show among newly referred patients.

This was a retrospective study of 400 consecutive outpatients referred to a single regional mental health clinic in northern Israel during 9 months. Data was collected on sociodemographics, attendance rates, source of referral, the presence of chronic physical illnesses and time elapsed between referral to appointment. The findings were statistically analyzed to identify factors associated with patient non-show rate.

Of the 400 patients included in the study, the non-show rate was 39.6%. Patients who missed appointments were significantly more likely to be younger, to belong to the Arab sector and to wait longer for their appointment. They were less likely to be physically ill. Gender, marital status and source of referral were not significantly associated with the non-show rate.

Given the problematic potential outcome of non-show to mental health clinics, it is important to identify high-risk factors associated with non-show and unique to the population in question, so that interventions can be targeted at them, thus improving treatment outcome and reducing risk to patients.

The authors have not supplied their declaration of competing interest.

Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.

International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.

This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.

A twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.

Evaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.

The clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.

The authors have not supplied their declaration of competing interest.

Mechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. In order to implement measures to prevent agitation and therefore mechanical restraint, it is important to quantify the effects and costs of those procedures. The aim of this study is to determine whether the application of mechanical restraint in psychiatry acute unit is related to a longer stay in hospital.

We reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of our institution, between 2012 and 2015. For every discharge, the presence of at least one mechanical restraint was coded, resulting in two groups. The length of stay of the groups was then compared performing a t-test.

The number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint associated. There are significant differences between the length of stay of admissions with and without episode of mechanical restraint. The episode of mechanical restraint during an admission is associated with 5 to 9 more days of stay in the unit (P < 0.001).

The performance of a mechanical restraint is associated with a statistically significant and clinically relevant higher length of stay. These results suggest that preventing agitation, and therefore mechanical restraint, would be possible to decrease length of stay, and therefore costs related to hospitalization.

The authors have not supplied their declaration of competing interest.

Number of patients who are again unexpectedly admitted to hospital after a previous hospitalization are used to evaluating the quality of hospital care. Readmission can be represented by the total number and by readmission rate.

Understanding the risk factors that can lead to readmission is a factor for the development of interventions that can improve the quality of care.

The purpose of this study was to examine number and predictors of psychiatric readmission within 14 days, 30 days and, 3 and 6 months.

In this retrospective study, analyses were conducted in a sample of 566 discharge adult patients who were admitted to a Psychiatric Hospital of Sarajevo Canton from 1st January to 31st December 2013.

Total number of readmission was 14%. The readmission rate within 30 days was 2.8%, number of readmission quarterly was 9.1%, number of readmission within 6 months after discharge was 13%.

In the study, several factors were significantly associated with increased risk of readmission including non-compliance with drug treatment, social problems, aggressiveness, suicidality.

Our study suggesting that the prevention of psychiatric readmission requires continuous multidisciplinary work with patients and family members.

The authors have not supplied their declaration of competing interest.

The reduction of the budget allocated to community psychiatry is part of financial needs in times of economic crisis. However, the community psychiatry is based on human resources rather than on technological devices and the economic downturn affects the quality of care in a field where the social and relational capital developed by mental health workers is fundamental. Some authors such as Serge Latouche propose to stem the economic decline with the concept of “degrowth”, a constructive idea but difficult to apply.

We would like to analyze whether the economic downturn has consequences only for the organization of psychiatric services or even for people with severe mental disorders. Another issue concerns the possibility that economic downturn increases the social exclusion of vulnerable people.

People who live on social welfare or disability pension remain on the margins of society but also those supported by families feel increasingly marginalized with respect to the future.

The provision of mental health services may not meet the implicit and explicit wishes in the demand for health by citizens and society. It's therefore necessary to review the quality management within community psychiatry.

The authors have not supplied their declaration of competing interest.

Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.

To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.

Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.

All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.

Forty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).

Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).

At interview, participants (n = 12) particularly valued:

– the opportunity to ask questions of the psychiatrist e.g. about medication;

– improving self-care skills e.g. monitoring early warning signs of relapse;

– co-facilitation by a peer, which provided extra credibility and inspired hope;

– sharing experiences with peers.

The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.

The authors have not supplied their declaration of competing interest.

Between 25–50% of psychiatric patients are non-compliant with their pharmacological treatment. When differences between compliant and non-compliant patients were analyzed, differences were found in relation to their beliefs and feelings about medication. The Drug Attitude Inventory (DAI) was created to measure attitudes towards medication in adults. It predicted adherence in schizophrenia and depression studies.

Determine if psychotherapeutic and psychoeducational activities – during a partial hospitalization at the Psychiatric Day Hospital – can improve aspects related to feelings and thoughts about medication.

We gathered retrospectively a sample of 151 patients hospitalized at the Psychiatric Day Hospital, from September 2013 to June 2015. Their thoughts and feelings about medication were measured with the DAI before and after the hospitalization. From the sample of 151 patients, 94 completed both tests, excluding who did not have the final DAI score. Differences between initial and final scores were statistically analyzed with the Wilcoxon test for paired samples.

Of the 94 patients who completed the study, 52 showed an improvement in their DAI score, whereas the remaining 27 showed an equal or decreased final DAI compared to initial evaluation. The difference was statistically significant (P ≤ 0.05).

It seems that psychoeducational activities related to medication are important in order to reconsider or modify feelings and thoughts about treatment. Information on medication provided to psychiatric patients (to those who need psychopharmacological treatment), carried out in a group context, which facilitates an open and sincere communication, can be a useful strategy to improve compliance with treatment.

The authors have not supplied their declaration of competing interest.

To supervise agents in a mutual aid experience in Motril Mental Health Day Hospital. To perform a supporting role among the agents involved in a mutual aid program to consolidate its operations autonomously.

A multidisciplinary working group, which met every two weeks for 4 months was set. Group sessions were planned. We selected mutual aid pairs individually and addressed the difficulties in the process. The experiment was performed with 4 agents setting a maximum of 5 interviews. A success criterion of 80% of the meetings planned was established. In between mutual aid group, success criterion was to maintain a 3-month experience held by 5 members. A qualitative analysis of most important issues amongst coordination meetings were also held.

Three out of 4 pairs reached 80% of the interviews successfully. The support group was developed weekly during 3 months with an average of 8 participants. The trending topics during coordination meetings were toxic consumption, acute crisis, drug intake and issues to be addressed with the psychiatrist.

Mutual aid among users is a way of intervention that needs to be further consolidated. The establishment is still unpretentious and has low weight amongst coordination objectives. The results addressed in number of sessions and satisfaction are favorable, but it is necessary to assess the experience widely and to begin developing specific objectives [1,2].

The authors have not supplied their declaration of competing interest.