To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland. In this hospital in 2003, smoking was allowed everywhere except in bedrooms and dining rooms. In 2004, smoking was prohibited everywhere except in closed smoking rooms. In 2006, smoking rooms were suppressed and smoking was prohibited everywhere inside hospital buildings.

Patients and staff were surveyed in 2003 (n=106), 2004 (n=108), 2005 (n=119) and 2006 (n=134).

Most participants (55%) answered that the total ban was too strict and preferred the partial ban. Self-reported exposure to environmental tobacco smoke (ETS) improved in dining rooms, corridors and offices after the partial smoking ban and further improved after the total ban. Exposure to ETS in bedrooms improved after introduction of the partial ban, but was not further improved by the total ban. Among patients, more smokers reported having made a quit attempt during their hospital stay after (18%) than before the total smoking ban (2%, odds ratio=10.1, p=0.01), and more smokers said that hospital staff gave them nicotine replacement medications after (52%) than before the total ban (13%, odds ratio=7.6, p<0.001).

The partial smoking ban decreased exposure to ETS and the total ban further improved the situation, even though neither the partial nor the total bans were strictly enforced. The total ban increased the proportions of smokers who made a quit attempt and received nicotine medications.

Knowing the use profile of amisulpride, as well as information about its effectiveness and resistance in our environment.

Open and prospective study of a sample of 40 patients treated with amisulpride during their admission at hospital. We will note the following variables: age, sex, diagnosis, seriousness level in admission / discharge (measured through the BPRS scale), dose, concomitant medication, side effects, suspension reason, if any, and time at hospital.

We show the results of the studied variables, noticing the efficacy of the medicine in the symptomatological control of different disorders, specially schizophrenia. Furthermore, we have information about its resistance and about the medications, with what it is more frequently associated.

We can conclude, on the basis of the obtained results, that amisulpride is effective and well resisted in the greater part of the cases.

If we consider that SGA psychopharmacological mechanism of action is heterogeneous that means we can estimate that clinical efficacy and side effects profile could be individualized. SGA represent safe and efficacious options for the treatment in schizophrenia but important step for a clinician remains to select the right drug.

There are some indications in the literature that the use of dopamine antagonists can modify the risk of developing different types of neoplasms.

We have reviewed last studies which have reported the possible relationship between cancer and neuroleptic treatment.

Antipsychotics which increase the level of prolactin, could possible increase the risk of developing breast and endometrial cancer in patients with schizophrenia. Other studies, shows a marked apoptotic effect of phenothiazines in brain-derived cancer cells.

High prolactin blood levels is an adverse effect of neuroleptic treatment. Typical antipsychotics seem to produce it more frequently than atypical ones.

To know hyperprolactinemia prevalence in our patients related with the type of antipsychotic drug used.

171 individuals, 31 male patients and 140 female ones, with a mean age of 61,67 years old and a mean hospital stay of 18,20 years.

The sample was divided in three groups:

• – Typical antipsychotics group: 37 patients.

• – Atypical antipsychotics group: 92 patients.

• – Typical and atypical antipsychotics group: 42 patients.

Prolactin serum levels were determined (normal values: 1.5-25 ng/ml for fertile age women, 0.7-20 ng/ml for post-menopause women and 0-20 ng/ml for men).

Prevalence of hyperprolactinemia for every group, for single antipsychotic drugs, for age groups, for gender and for diagnosis were obtained.

Prevalence of hyperprolactinemia was 66.1% for the global sample. Results for the different groups were the following:

• – Typical antipsychotics group: 73.0%

• – Atypical antipsychotics group: 60.9%

• – Typical and atypical antipsychotics group: 71.4%

Statistical analysis according to concrete antipsychotic drug showed the following hyperprolactinemia percentages:

• – Risperidone: 90.0%

• – Haloperidol: 69.2%

• – Olanzapine: 44.4%

• – Quetiapine: 33%

• – Aripiprazol: 14.3%

• – Clozapine: 11.1%

Our study finds lower hyperprolactinemia blood levels in patients on atypical antipsychotic treatment than on typical antipsychotic one. Haloperidol and risperidone got the worst results in this matter while clozapine and aripiprazol showed the best ones.

To evaluate the opinion of nurses and nursing students about patients belonging to sexual minorities.

The study was performed using of anonymous questionnaire at the Hospital and Nursing department of Kaunas University of Medicine. 32 general practice nurses from departments of Ophthalmology, Nephrology, Thoracic Surgery and 22 nursing students took part in the survey.

It was found, that the attitude of nurses towards sexual minority was more negative (55 percent). The attitude of students was more neutral (53 percent), however there was no significant statistical difference (p=0,32). Evaluating the influence of age to the attitude, we determined that all nurses with negative attitude towards sexual minorities were more than 40 years old. When analyzing the influence of work experience to the attitude, it was found, that most of nurses (37 percent) showing negative attitude had work experience more than 15 years. Most nurses (37 percent) and nursing students (50 percent) were thinking that homosexuality is the result of nurture. When determining the influence of education level to the attitude towards sexual minorities, it was found, that nurses with negative attitude, had college and university education and most of students with negative attitude (92 percent) had secondary education.

To follow the efficiency of Olazepine in chronic patients with long-term schizophrenic disorder in three levels: cognitive functioning, positive persistent hallucinatory-delusive phenomenon and deficiency signs.

In the research we included 30 patients diagnosed by the ICD 10 with Dg. F 20.5. They were from both sexes, randomly chosen, aged 30-60 treated in an out-patient clinic as well as in the Psychiatric clinic, Skopje. The patients were with long-term treatment with conventional neuro-therapy without any significant results. During the research we included the following psychometric instruments: PANSS scale, BPRS and scale to evaluate cognitive functioning. The patients were evaluated in the beginning of the treatment and after 3 month treatment with Olazepine (Zalasta tablets) in dosages of 5-15mg per day.

Expected effects on the part of Olazepine in patients with residual schizophrenia on cognitive, hallucinatory-delusive and behavioral field.

Out of area treatments (OAT) are expensive and contribute to social isolation of individuals with intellectual disabilities and challenging behaviour.

To identify the needs of those service users who are in OATs with the view of developing a process of assessment and relocation of those service users locally where possible. Finally we aim to reinvest financial flow in each locality to develop high quality services.

We undertook a scoping project over one year in five London boroughs. We reviewed the existing literature, surveyed mental health and challenging behaviour needs of sample, reviewed current treatment and run focus groups with various stakeholders. We presented a business case

205 service users were identified costing over £1300 per week. 65.4% were in OATs costing an estimated £403,740 a week across the five boroughs. High expenditure was associated with increased perceived severity of mental illness, complex physical disabilities and presence of autism. Those detained under the Mental Health Act were also in more expensive placements. Private sector placements were used in the majority of cases.

Despite the lack of high level evidence for specialist services for challenging behaviour, a multi-stranded approach with both inpatient spot purchasing, rehabilitation facilities and high quality accommodation with flexible community with variable purchasing patterns and specialist community input could substantially reduce the financial burden.

1. To analyze different aspects related to patients that could influence on therapeutic adherence to a model of “Long Acting Injectable Clinic”(LAIC). 2. To evaluate therapeutic adherence.

Sixty patients treated with long-acting injectable risperidone (RLAI) for the previous 24 months in a community mental health center (CMHC) were retrospectively studied. Data concerning sociodemographic characteristics, diagnosis and time since diagnosis, level of insight, GCI, comorbilities, time since last hospitalization, reasons for treatment change, follow-up at the CMHC and remission criteria (according to Remission in Schizophrenia Working Group) were collected. Descriptive data are shown in the present report.

The most common diagnosis were paranoid (53.3%) and residual schizophrenia (15.9%). The main reason for a change in therapeutic strategy was to improve tolerability (29.3%) and non-compliance with previous treatment (26,8%). Retention rate to treatment with RILD were 72.67%; 27.33% of patients withdrew the treatment, mainly due to lack of response and new symptoms appearance. 74% of patients met remission criteria

Most of the patients continue being treated with RILD, while 27.3% had to withdraw due to severity, treatment resistance or adverse effects. 74% of patients met remission criteria according to Remission in Schizophrenia Working Group.

Among patients with schizophrenia, rates of non- adherence around 40-50% have been reported. Non-adherence increases risk of relapse and it is the main cause of re-hospitalization.

The aim of this study is to describe a sample of outpatients treated with long-acting injectable risperidone (RLAI), as well as to define the retention rates to the treatment.

Outpatients treated with RLAI for some psychotic disorder during 2005 have been included in the study. Age, gender, diagnosis, drug abuse, hospitalizations, previous treatments, coadyuvant treatments, compliance with treatment and reasons for treatment withdrawal have been analyzed. Descriptive data are shown.

Seventy-six out-patients treated with RLAI have been analyzed. 55.3% of them were male, and mean age was 41.33±11.33 years. Main diagnosis were schizophrenia and schizoafective disorder (45 and 10 patients, respectively). More than 40% of patients were taking some drug of abuse. Around 75% of patients had some hospitalization in the previous 5 years, and 10.8% of them were hospitalized in 2005. Almost half of the patients were receiving oral risperidone before the start of treatment with RLAI, and 20% had been receiving depot medication. After one year, 73.7% of patients were still under RLAI treatment. The main reason for treatment withdrawal was the loss of follow-up.

Retention rates in RLAI treatment found in the present study were similar to those previously reported. Hospitalizations seem to be reduced after the start of RLAI treatment.

To evalute men change in PANSS positive subscale in patients hospitalized for active psychosis treated with oral risperidone.

Observational retrospective study conducted at Acuted Unit Care, in 24 patients hospitalized with active psychosis treated with Risperidone. Patients were evaluated basal, 24, 48, 72, and 96 hours, and 7 days after the initial dose of risperidone, and at discharge. Efficacy was assessed using PANSS positive subscale. Dose of risperidone, use of other antipsychotic, benzodiacepines, anticholinergic drugs, and medication previous to hospitalization were recorded.

At 24 hours, PANSS mean score decreased by 17,4% and a reduction of 45,9% was observed at discharge.

During the first 24 hours, the items that showed the largest decrease were Hostility (from 6,4 to 4,3) and Excitement (from 6,2 to 4,3).

Mean dose of risperidone during the first week was 15,1 mgs / 24 hour. No other antipsychotic medication was used. Benzodiacepines were used in 79,2% of patients. Anticholinergic medication was used just in 1 patient. The mean number of days in institutional care was 12,8 days.

High doses of risperidone are able to achieve significant reduction in PANSS positive score whit a minimal incidence of adverse events. These results suggest that oral risperidone is effective and well tolerated in treating acute agitation and active psychosis.

Hooliganism has become recognised by governments and the media as a serious problem since the 1960s. Scientists have been offering explanations of football hooliganism mainly from a psychosocial approach.

The primary objective of this study was to collect measurable data of violence risk in football hooligans.

We used the Plutchik and van Praag's Past Feelings and Acts of Violence (PFAV) Scale to measure the risk of violent acts in three samples: hooligans from a professional football team, standard football supporters, and a control sample.

We found an increased risk of violent behaviour in all the individuals from the hooligan sample, but not in the standard supporters' sample.

Football hooligans have extremely high risk of committing violent acts. Standard football supporters are not more violent than general population.

Run away Behavior in young girls is a complex social problem in Iranian adolescents. Psychiatric disorders may play an important role in run away behavior in young girls.

Homeless young girls between the ages of 12 and 18 years (n = 100) referred to Zanjan Welfare Organization conducted structured clinical interview for DSM and personality questionnaire (MMPI-2) to assess the Axis I and II disorders.

Most common Psychiatric Disorders were mood disorders (89%), Adjustment disorders (56%), Conduct disorder (36%), substance related disorders (12%), schizophrenia and other psychotic disorders (6%), in Axis I and, Cluster B Personality Disorders (53%) and mental retardation (6%) in Axis II.

Prevalence of mental disorders is high among young homeless girls that runaway from home and service providers should consider this important issue. A focus on familial problems may lead to other important reasons being overlooked. Services and supports need to take into account whether young girls leave home because of family problem or because they suffer mental disorders.

To compare the efficacy of aripiprazole and haloperidol for the treatment of acute relapse in chronic schizophrenia.

Across two 52-week double-blind studies, 1294 patients with acute relapse of chronic schizophrenia were randomized to aripiprazole 30 mg/day (n=861) or haloperidol 10 mg/day (n=433). The mean change in (Positive and Negative Syndrome Scale) PANSS Total score, PANSS Positive score were secondary endpoints in both studies. Post-hoc, a measure of excitement and hostility was derived from PANSS score items by factor analysis. The scales were administered at baseline and at each double-blind study visit (Weeks 1-8, 10, 12, 14, then every 4 weeks to Week 52).

Aripiprazole produced similar improvements to haloperidol in PANSS Total score (last observation carried forward, LOCF). Among those patients who completed the study, aripiprazole showed a significantly greater improvement in PANSS Total score compared with haloperidol at Weeks 26 and 52. A similar improvement in PANSS Positive score was seen with aripiprazole and haloperidol (LOCF and observed cases [OC]). Symptoms of excitement and hostility also improved similarly with both agents throughout the study (LOCF and OC).

Aripiprazole showed similar efficacy to haloperidol over the 52-week study, and significantly greater efficacy among those patients who stayed on treatment. Thus, aripiprazole is a useful agent for long-term maintenance therapy in schizophrenia.

Maximization of response with minimization of adverse effects is central to successful oncology chemotherapy. Since psychiatric comorbidity is significant in cancer patients, psychotropic co-administration with chemotherapy requires assessment of drug-drug interactions and cumulative adverse effects. Arsenic trioxide (ATO), indicated for treatment of relapsed acute promyelocytic leukemia (APL), prolongs QTc and has “black-box” warning regarding co-administration with medications with potential QTc prolongation. ATO administration is to be held if QTc > 500 milliseconds. This case describes ATO and olanzapine co-administration.

Case analysis with literature review.

43-year-old Caucasian male presented with relapsed APL characterized by non-traumatic bruising, anemia, and thrombocytopenia confirmed by bone marrow biopsy. Psychiatric comorbidity included Obsessive-Compulsive Disorder, Panic Disorder, and Bipolar NOS treated with fluvoxamine and benzodiazepines. Chemotherapy consisted of ATO, 0.15 mg/kg IV infusion over 2 hours. Fluvoxamine and fluconazole were discontinued early in treatment; olanzapine (2.5 mg bid) initiated thereafter effectively controlled obsessive-compulsive/affective features. Serial EKGs were performed; serum K and Mg were monitored daily and supplemented with intention of maintaining K>4.0 and Mg>1.8. EKG findings revealed: mean QTc on fluvoxamine and fluconazole, before ATO, 447 (431-464); mean QTc after ATO initiation, before discontinuation of fluvoxamine and fluconazole, 474 (445-500); mean QTc after discontinuation of fluvoxamine and fluconazole, while on ATO, 466 (441-496); mean QTc after olanzapine initiation, while on ATO, 479 (450-497). No adverse cardiovascular events occurred during treatment with ATO.

This case suggests olanzapine can be safely co-administered with ATO. Further studies are indicated.

Access to mental health treatment is often negatively impacted by cultural bias. This may relate to non-acceptance of psychiatric diagnoses as true illnesses, perceived shame by patient or family, or even fear of ostracism. As a result, treatable patients remain untreated with unnecessary morbidity, direct costs, indirect costs, and potential mortality. This case addresses depression and overdose in a Chinese patient.

Case analysis with literature review.

20-year-old Chinese single female was admitted for multidrug overdose (zolpidem/acetaminophen/clonazepam). When seen in psychiatric consultation, patient met DSM-IV criteria for Bipolar Disorder NOS, Anxiety Disorder NOS, and Polysubstance Dependence and was upset that overdose was unsuccessful. Patient described how parents were focused on performance success and would not accept her emotionality or depression stating “Depression, failure and suicide are not acceptable in China.” Patient summarized parental response to overdose: “they threw me in the basement with a basin where I kept vomiting for one day…then they thought that it was serious enough. They would come to the basement periodically and ask why I couldn't stop crying. They said it was my fault.” Mother instructed medical team patient needed to “sleep, eat, and exercise” and insisted patient be told she was responsible for hospital bill and her decision. After treatment with N-acetylcysteine, elevated transaminases stabilized and the patient was transferred to an inpatient psychiatric hospital.

Cultural themes focusing on success and lack of acceptance of psychiatric illness can lead to increased morbidity and potential mortality.