1. i. To establish the sociodemographic profile of the subjects who attempted suicide in the Health Area IV of Asturias (Northern Spain);

2. ii. To determinate the mental disorders more frequently associated with suicide attempts (SA);

3. iii. To study the relationship between repetition of suicidal behaviour and severity of the SA;

4. iv. To determinate the more commonly used methods for SA.

1,633 suicide attempters who attended the Emergency Room of the University Central Hospital of Asturias during the period 2003-2005 were included in the study. Evaluation of these patients was made using the WHO/Euro Multicentre Study Protocol. Psychiatric diagnoses were made following ICD-10 criteria.

Sociodemographic data: mean age (SD) = 38.66 (15.13); females: 62%; single: 39.8%; living with their family: 83.8%; lowest educational level: 67%; economically inactive: 33.8%. More prevalent psychiatric diagnoses were affective disorders (24.1%) and anxiety disorders (21.6%). Previous SA were present in 49.2% and 40% repeat the attempt during the monitoring period. Severity of the attempt (lethality of method and intentionality) was related with repetition of the behaviour during the monitoring period (p = 0.001). More frequent methods were overdose (74.8%) followed by cutting (18.5%).

SA was more prevalent in a single woman with age between 30 and 50 years who suffering for affective or anxiety disorders. Many of the patients repeat the suicidal behaviour and this was related to the severity of the attempt. Individuals appear to use the methods that are available to them to attempt suicide.

To investigate the process of help seeking for child and adolescent psychopathology at Child and Adolescent Mental Health Service (CAMHS) in UHC “Mother Teresa”, Tirana.

Participants were 5-18years old, newly referred children/adolescents in CAMHS during 2006. Measures: Strengths and Difficulties Questionnaire for parents/children, Pathways Encounter Form. Pathway diagram was drawn showing the main routes of care seeking. Patterns of care seeking, durations and previous treatments for diagnosis within ICD-10 groups were prescribed. Analysis: Comparisons between groups, diagnosis and predictive factors influencing help seeking care.

The main pathway of seeking care resulted to be from hospital doctors or to be direct access. General practitioners have a limited role as ‘gatekeeper’ for patients. 72% of individuals resulted with conduct, hyperactivity, depressive and some anxiety disorders, but fewer than 30% of individuals with specific phobias, separation anxiety and eating disorders.

A clear picture of pathway of seeking care in mental health for children/adolescents coming in CAMHS is provided. Findings highlight areas that require further attention if aspirations for community-oriented mental health care are to be realized in Tirana and Albania. Declaration of interest: None.

This study aimed to determine prevalence and correlates of suicidal attempts in an adult primary care population in Sousse (Tunisia).

Sampling followed a stratified multistage probability cluster design from witch a representative sample of adult primary care population of Sousse was obtained. The sample was composed of 1249 subjects aged 18 years or more. Subjects were interviewed by trained clinicians using the Tunisian version of Composite International Diagnostic Interview 2.1.

General and clinical characteristics of subjects who had reported previous suicidal attempts were compared with those of the remainder using t test and Chi-2 test.

Mean age in our sample was 43.4 ± 17.62 years, with female gender (70.9%) and urban residency (67.8%) predominance. 62.3% of participants were married, 27.3% celibates and 10.4% divorced or widowed. 68.4% of them had low educational level and 70% were out of work during the last 12 months. Suicidal attempts were found in 2.9% of participants. They were correlated to less than 40 years age (p=0.036) and to the diagnosis of major depressive episodes (p< 10-3), recurrent major depressive disorder (p=0.005) and dysthymic disorder (p< 10-3). Among major depressive episodes, only severe ones were associated to higher prevalence of suicidal attempts (p< 10-3).

Prevalence of suicidal attempts in Sousse primary care population was 2.9%. It was correlated to low age and to depressive disorders.

To evaluate the relationship between depression, somatic symptoms, cognitive impairment and disability in an elderly population.

216 subjects (65-84 years) were clinically examined for somatic symptoms, and underwent a mental health examination. Depression was defined by Geriatric Depression Scale scores >11/30; cognitive impairment by Mini-Mental State Examination scores < 24/30; functional status by Instrumental Activities of Daily Living Scale. Associations between depression, cognitive impairment or somatic symptoms and disability were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI) adjusted by sex, age, education.

Disability was common among depressed individuals (OR(95%CI)=3.60(1.63-7.96)) and among cognitively impaired subjects (OR(95%CI)=7.35(3.07-17.60)). An increasing number of somatic complaints increased the probability of functional impairment: compared with presence of 1-2 somatic symptoms, complaint of 3-6 and 7-12 symptoms were related to disability with OR(95%CI)=3.30(1.11-9.80) and OR (95%CI)=4.20 (1.17-15.09) respectively. Distinguishing pain, gastrointestinal, pseudo-neurological and general symptoms, only general somatic symptoms (palpitations, fatigue, sleep disturbances) were associated with disability (OR(95%CI)=1.81(1.25-2.62), independently by medical conditions (OR(95%CI)=1.57(0.98-2.52)). An additive effect toward disability was observed when general somatic complaints and cognitive impairment were co-existing (OR(95%CI)=23.68(5.50-101.86)). Including simultaneously cognitive impairment, somatic complaints and depression in the model, only cognitive impairment was still significantly related (OR(95%CI)=5.87(2.66-12.96)).

Among many possible causes of disability in the elderly, an important role could be attributed to cognitive deficits.

The aim of this study was to investigate the prevalence of sexual dysfunctions and its relationship with depression and anxiety in a sample of patients underwent bone marrow transplantation (BMT).

A cross-sectional study was conducted in 135 married patients who underwent BMT at least 1 year before evaluation. Sexual dysfunctions assessed by a questionnaire that was derived from Sexual History Form and Sexual Problem Measure. Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety in patients.

Questionnaires were completed by 128 (82.5%) participant. Fifty three percents of participants was male. The mean age of participants was 39.57±8.74. Sexual dysfunctions in post BMT period were significantly more frequent than period prior to the beginning of oncologic malignancy (P< 0.05). Sexual activity was decreased significantly after BMT (P< 0.01). The three most prevalent sexual dysfunctions in male group were premature ejaculation(56%) and problem in orgasm(40%) and desire(32.7%), and in female group were problem in arousal(77%) and desire(77%) and painful intercourse(77%). Sexual dysfunction was more prevalent in female group.

According to HADS score, 42(32.8%) patients had clinical depression (HADS-D score>14) and 12 (9.8%) patients had clinical anxiety (HADS-A score>14). There was not any significant relationship between mean HADS-A and HADS-D scores and scores of sexual dysfunctions questionnaires.

This study showed that sexual function and activity may be adversely affected by BMT. Factors other than anxiety and depression may have correlation with sexual dysfunction in these patients, of course limitation of this study should be considered.

To compare the psychosocial profile and suicidal behavior of 110 pregnant teenagers (PT) with 110 non-pregnant teenagers (NPT).

Subjects were matched by age and residential district. A structured interview and psychometric scales were used. Uni-and multivariate logistic regression were performed.

Prevalence in the PT and the NPT groups were: attempted suicide (20.0% vs 6.3%); depression (26.3% vs 13.6%); anxiety (43.6% vs 28.0%). Univariate analysis revealed the following significant associations with pregnancy: relocation in the previous 3 years (odds ratio (OR) = 6); years of schooling ≤7 (OR = 3.4); dropping out of school (OR = 5.2); death of a parent during childhood (OR = 2.9); use of alcohol/drugs in the family (OR = 2.5); previous attempted suicide (OR = 3.6); suicide by a relative (OR = 2.1); threats of physical/sexual abuse (OR = 3.5); depression (OR = 2.2); low level of social support (OR = 4.2), psychosocial difficulties (OR = 4.4); prior use of marijuana (OR = 4.8); weekly intake of alcohol over the previous 12 months (OR = 4.2). Multivariate analysis identified the following associations: relocation (OR = 6.4); prior use of tobacco (OR = 2.9); dropping out of school (OR = 2.3); suicide by a social acquaintance (OR = 2.5).

The PT case group exhibited a psychosocial profile whose characteristics clearly differentiate this group from the NPT control group. Preventive mental health care is needed to help pregnant teenagers because their behavioral pattern exposes them to high risk for suicide.

Gender differences in mental health disorders may serve as a useful heuristic for integrating epidemiological and psychobiological data. The vast majority of mental disorders may express major gender-related variations in prevalence, natural history, symptoms, prognosis, and treatment outcome.

To compare demographic and clinical characteristics of women and men admitted to a psychiatric unit.

Retrospective data of all the patients admitted to a psychiatric inpatient unit, from January 2004 to December 2007, were reviewed. The demographic and clinical characteristics of the two genders were compared.

Of a total of 1114 patients admitted, 53.1% were women. They differed significantly from male inpatients in being older (46.7 vs. 40.7 years), less frequently black (14.6 vs. 25.4%), more frequently diagnosed with bipolar and delusional disorders, and in receiving fewer diagnosis of schizophrenia. Women had a longer average length of stay, a different seasonal pattern in admissions, with a much lower rate of admissions than men in December (38.6 vs. 61.4%), and a lower percentage of patients with three or more readmissions. Only 37.2% of the 180 compulsory admissions were of women.

There are significant differences in clinical and demographic characteristics of female and male psychiatric inpatients. While some results may be explained by gender specific biological factors (as in the type of diagnosis), others are probably associated with different gender roles (as in the seasonality of admissions).

Some community surveys in Italy have shown that a proportion of subjects without lifetime psychiatric diagnosis (anxiety/depression) used antidepressants. The prescription of AD in bipolar depression appears to be another largely underestimated problem in the clinical practice and is difficult to recognise by means of traditional epidemiological methods (lay interview and structured diagnostic tools).

The purpose is to use defined and validated international semi-structured interview as diagnostic instrument administered by expert clinicians to evaluate appropriateness and amount of over and under prescription of psychotropic drugs in different Italian community areas. The focus is on general antidepressant use and use in subjects with bipolar disorder and in subsyndromal depression.

Study design: Community survey. Study population: sample randomly drawn, after stratification by sex and age, from the adult population of Municipal records in 6 Italian Regions: about 4000 persons will be interviewed. Tools: Questionnaire on psychotropic drugs consumption, prescription, health services utilisation;diagnostic Structured Clinical Interview np version;Mood Disorders Questionnaire; Short Form Health Survey. Ethical aspects: a signed informed consent for each candidate. The study was approved by the ethical committee of theItalain National Health Institute.

The study aims to identify the frequency of over and under prescription of psychotropic drugs in different Italian regions and the determinants of prescription related to physicians, patients, comorbidity and symptoms and to establish the basis for a cohort prospective study to assess the future changes.

In over 60 years little has changed in children's mental health and the flag waving continues: It is time for action in the trenches. It is imperative to focus health policy on the need to provide basic mental health succor to children and their families. A failure to alter the situation related to children's mental health will no doubt have catastrophic consequences for our society. We review the level of progress made in reforming regional mental health services since 2002.

Using population-based representation of regional service utilization capacity permits comparison of regional, provincial and national rates of child and adolescent mental disorder.

Regional services in the last 6 years have served at most approximately 1% of the 0-18 year old population annually. This rate represents an increase from about 0.6% in 2002.

Rationing the scant professional resources that exist to serve children's mental health will become increasingly difficult. For example, it is estimated that three percent of 0-18 year-olds are estimated to suffer a debilitating mental problem. Implication for policy are that our results point to service gaps in need of immediate policy development to meet basic needs of children. Several strategies are considered.

For developing suicide prevention interventions, epidemiologic, socio-economic and demographic factors influencing suicide rates are of high interest. One considerable factor in this respect is gender, as in most countries male suicide rates are much higher than female suicide rates with a global average male/female ratio of 3.6:1. The present study seeks to contribute to the clarification of the question what underlies the different suicide rates of men and women by analyzing gender-specific lethality of suicide methods.

Data on completed (fatal) and attempted (non-fatal) suicides from 2000 to 2004 were collected in two cities in the region of Bavaria, Germany. This data sample offers the opportunity to compare data of suicidal acts including completed as well as attempted suicides of the same region during the same time. The lethality for each suicide method was estimated by dividing the number of fatal episodes by the total episodes and then related to gender and age.

Lethality per method was higher for men than for women; significant differences could be shown for the majority of methods. Regarding age, lethality rising with age could be shown. Still, in higher age groups, differences in lethality between men and women were significant.

Results stress the importance of gender-specific suicide prevention. Male-specific suicide-prevention should be concerned with improving access to and treatment of men under risk for suicidal behaviour. Addressing the problem through multifaceted programs therefore is a promising approach.

Ramón y Cajal Hospital is the reference medical centre for Madrid-Barajas airport. Passengers arriving at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to be admitted into the ward for a certain length of time.

Perform a descriptive analysis of the socio-demographic and clinical variables of inward psychiatric patients referred from Madrid-Barajas airport.

Revise retrospectively clinical histories of inward psychiatric patients referred from Madrid-Barajas airport in the last 5 years.

Data is analyzed using the SPSS software 15.0 version.

We collected 99 patients, 54 of them (54.5%) are males. The 38.4% of the sample is in the age range between 25 and 34 years, and the 26.3% are between 35 and 44 years old. The most frequent countries of origin are European countries (57.6% of the sample). 28 patients of that group (49.1%) are Spanish citizens. Other 26% percent of the patients are from Centre or South-America. The most common syndromic diagnosis at discharge is psychotic disorder (62.6%) followed by affective disorder (22.2%).

We can deduce from these data that the usual patient referred from Madrid-Barajas airport to the emergencies department for psychiatric attention is a male, between 25 and 34 years of age, from a European country, with a psychotic disorder that usually ends up in an admission into the psychiatric hospitalization unit.

Suicide and suicidal behaviours are a growing concern among adolescents.

Describe discriminating characteristics of adolescents with suicidal behaviours followed by our psychiatric consultations.

A cross-sectional sample of 100 adolescents (aged 12 to 21), from the adolescent psychiatry and youth suicide consultations, at Hospital Santa Maria Psychiatry Department, were submitted to a semi-structured interview. The sample was divided in two groups: with and without suicidal behaviour (the first being defined has previous suicide attempt, parasuicidal gestures or self-mutilation). Demographic, psychosocial and psychopathological data was taken and compared.

98 completed protocol. Suicidal behaviour group included 48 subjects. Age, years of education, family type, sex differences, psychosocial difficulties (school, family, peers, affective), therapeutic objectives (exception on family relations) were not statistically discriminating. Suicidal ideation as consultation motive, emergency room referral, previous attempts of follow-up, not having as objective improvement of family relationships, were highly associated to the suicidal behaviour group (p≤0.001). A non significant tendency was observed towards depressive syndrome in the latter.

Identifying adolescents at risk for suicidal behaviours isn't an easy task, most characteristics are not discriminating. The most effective way seems to be asking directly about suicidal ideas. Awareness should increase in emergency room referrals motivated by suicidal ideas, in adolescents who tried multiple follow-ups and that seem to be disappointed by family support.

Studying inpatient clinical population's features allows a better understanding of readmissions. Factors associated with higher levels of readmission may give clues concerning better treatment planning and follow-up.

To detect psychosocial and clinic factors associated with readmissions in an inpatient general psychiatric population.

107 patients consecutively admitted to an inpatient unit were characterized in terms of psychosocial, clinical, treatment and discharge plan features. Readmission was defined as the number of previous admittances in the last two years.

Patients characteristics: Average age 44 (SD: 16); 58% female; 10 (SD:5) years of education; average disease duration of 128 (SD:115) months. Main diagnosis: 30,8% schizophrenia; 14% bipolar I disorder; 13,1% major depression; 11,2% recurrent major depression; 5,6% cluster B personality; 3,8% bipolar II disorder and 2,9% schizoaffective disorder. From more to less frequent diagnosis implicated in readmissions were schizophrenia, schizoaffective disorder, recurrent major depression, bipolar I, bipolar II and major depression episode. Readmissions were not associated with inpatient treatment or disease duration, nor toxics or axis II diagnosis. Nonetheless, beginning a depot antipsychotic medication was related to an increase in previous admissions.

These are preliminary results of a small sample, but they point towards the usefulness of a systematic evaluation of inpatient populations, mainly in what concerns complex clinical situations like major pathology readmissions.

The South Asian Earthquake of 2005 had a devastating impact on family lives; almost 76,400 people lost their lives, and thousands more sustained disabling injuries.

An epidemiological study, to study psychiatric morbidity amongst parents of deceased children, was carried out at Balakot, Pakistan. The area was chosen due to much lesser migration of the original inhabitant to other part of the country. The study was carried out in April-May 2006, six months after the earthquake.

80% of the eligible population participated in the study. The psychiatric instruments that were used in the study included, Pakistan Anxiety & Depression Questionnaire, Hopkins Symptoms Check list- 25 (Urdu-Version) and Rater administered DSM-IV, PTSD questionnaire (Urdu) for diagnosis of Post Traumatic Stress Disorder. The assessment schedules were administered by medical students, trained to administer above instruments and questionnaires.

133 subjects participated in the study. Participants mean age was 39 years. Amongst the participants, 20% lost their spouse in the earthquake. There was statistically significant difference in the prevalence of probable diagnosis of depression or anxiety disorder between the male and female population as assessed by PADQ (P< 0.01). Mean HSCL-25 anxiety and depression sub-scale scores also showed a statistically significant gender difference (P< 0.01). 49% met the DSM-IV criteria for diagnoses of PTSD. A higher proportion of female population suffered from PTSD (P< 0.01).

The recognition of gender difference in psychiatric morbidity in disaster affected areas has important implications for emergency serviced delivery and long term planning of service provision.

The present study aimed to investigate psychiatric comorbidity rates and patterns in a sample of clinically referred school-aged children with High Functioning Autism (HFA).

All cases were taken from children and adolescents who consecutively referred to Istanbul Faculty of Medicine, Department Child and Adolescent Psychiatry, Autism Unit. Participants were 30 children and adolescents (29 male, 1 female), aged 6-15 (10y 2m ± 2y 2m) year-old, who met DSM-IV criteria for Autistic Disorder and had a Performance IQ over 70 on WISC-R. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL).

90% (n=27) of the children had at least one comorbid psychiatric disorder, and 76.6% (n=23) had two or more. In 76.6% (n=23) of the cases at least one Anxiety Disorder was present, and in 63% (n=19) of the children criteria for at least one Disruptive Behavior Disorder was met. The most frequent Axis I psychiatric diagnoses were ADHD (60%), SP (53.3%), Oppositional Defiant Disorder (30%) and OCD (20%).

A very high rate of psychiatric disorders was detected in a small group of clinically referred children and adolescents with HFA. These results underscore the importance of detailed assessment of behavioral and emotional problems in ASDs.

Chronic idiopathic urticaria (CIU) is a frequently occurring disease that seems to be associated with a number of psychological factors. This study aims to determine the frequency of psychiatric disorders and to assess the depression and anxiety symptom severity in a group of children with chronic idiopathic urticaria (CIU).

The study group included 30 children, ranging in age from 8 to 16 years, with CIU who attended to the Pediatric Allergy Clinic of the Istanbul Faculty of Medicine and 30 healthy subjects matched for age and sex. The psychiatric disorders were evaluated by using Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL). State-Trait Anxiety Inventory (STAI), Children’s Depression Inventory (CDI) and Child Behavior Checklist (4-18) were used to examine the levels of depression and anxiety.

The K-SADS-PL revealed a psychiatric diagnosis in 63% of the patients. In terms of the distribution of psychiatric diagnoses, the most frequently occurring diagnosis was anxiety disorders (33%), namely simple phobia (21%) and social anxiety disorder (18%). State anxiety scores were significantly higher in children with CIU than controls but not trait anxiety and depression scores. No significant relationships were found between urticaria activity score, duration of illness, age onset and depression and anxiety scores.

Psychiatric disorders were frequent in the group children with CIU. Clinicians should be more aware of accompanying psychiatric symptoms in this group of cases.