To assess if patients follow-up with discharge advice after psychiatric assessment and discharge from Emergency Department (ED).

All patients with psychiatric complaint who presented at three ED's in Edmonton, Alberta, Canada were identified via ED Information System (EDIS). Patients presenting complaint were entered onto the EDIS by Triage Nurse along with demographic information. All charts were reviewed and clinical data was obtained. Patients who were assessed by Psychiatry and discharged home were contacted via telephone to determine if they followed-up with discharge advice of psychiatry team.

A total of 1420 patients have been identified during April and May 2008.Chart review has been completed. Data entry and follow-up is in progress. Preliminary data of 250 patients is presented here. 55% were male. Mean age 37 years (SD 12). 47% presented voluntarily. Psychiatry was consulted for 53% of patients. The presenting complaint was “Suicidal Ideation” in 29% and “Bizarre behaviour” in 24%. Primary diagnoses for those seen by Psychiatry were mood disorder (30%) and psychotic disorder (26%). Out of those seen by Psychiatry 36% were admitted. 44% of those admitted by psychiatry were diagnosed with psychotic disorder followed by mood disorder in 31%. The patients who were discharged home by Psychiatry were advised to follow up with their family doctor 7%, psychiatrist 15%, outpatient psychiatry services 16% and addiction services 16%.

This is the first report of outcome of discharge advice and will help in developing and planning community follow-up system for psychiatric patients.

Conditions at the work place affect in many ways the well being of empoyees. One frequent reaction is anxiety because opf threads by superiors, colleagues or customers, the possibility of failing and not fullfilling job demands, accidents, or the possiblity to lose the job.

230 patients (71% female) from a psychosomatic inpatient unit were interviewed with as DSM-based half standardized interview in respect to work related anxiety.

58% of the patients reported about work related anxieties.

Across all areas generalized work related worrying is most frequent (26% service, 35% office/civil servants).

Anxieties related to specific situations at work were most frequent in patients working in schools/education (32%) and in production/construction workers (28%).

Anxiety related to feelings of insufficency and adjustment related anxiety were most often seen in office workers/civil servant (37% and 26%).

Hypochondriac anxieties were mostly reported by school/education employees (18%) and construction/production workers (17%) but to a much lower degree by health workers (6%).

Work related phobic reactions were reported by 17% of all patients and most frequent by office workers/civil servants (22%), followed by health workers (21%), service jobs (16%), construction/producrtion workers (11%) and patients working in schools and education (9%).

Work related anxieties are frequently seen in patients with mental and psychosomatic disorders. There are different types of anxieties which are differently related to different types of jobs.

According to decreased self- esteem in multiple sclerosis (MS) patients, it is necessary to utilize appropriate methods in order to improve self- esteem in MS patients. So this study was conducted on patients with MS supported by the Iranian MS society for determining the effect of self - care program on their self- esteem.

In this semi - experimental study 34 patients with MS who were not in the acute phase of disease were selected. The data were collected via personal questionnaires, problem list, Cooper and smith standard questionnaire for self- esteem and self report check lists. Self - care program(self - care for muscular spasm, fatigue, constipation and amnesia and …) was educated, then it was performed for one month period and the data were analyzed using paired t- test, wilcoxon, croscal - wallis and manwithney tests.

Application of self - care program improve the self- esteem and reduced some symptoms such as muscular spasm, fatigue, constipation and amnesia in MS patients. The mean valve of self- esteem increased from 54 before performing the program to 68 after the program ( p < 0.05).

Using self-care program can be an effective method for improving self- esteem of MS patients.

Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.

To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.

We include 9 variables from 104 first assessments carried out in our center.

48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.

As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.

It has been shown that abusive experiences in childhood may be related to specific behavior patterns manifested in adulthood, especially those that refer to negative parenting practices. The aim of this study was to assess the relationship between the use of punitive parental discipline and the childhood abuse trauma in parents.

Sixty six parents (30 males, 36 females, age 45.92±8.79 yrs, predominantly urban) completed the socio-demographic questionnaire, the Childhood Trauma Questionnaire (CTQ), and the punitive discipline self-report measure.

The frequency of use of punitive discipline between parents with and without the history of abuse was not significantly different (t=-1.298; p>0.05). The difference was not found neither among fathers (t=-0.047; p>0.05) nor among mothers (t=-1.951; p>0.05). Emotional abuse was the only type of childhood maltreatment related to the use of punitive discipline (r=0.393; p< 0.01). This relationship was found among both fathers (r=0.428; p< 0.05) and mothers (r=0.371; p< 0.05). In females, the use of punitive discipline was additionally related to the history of emotional neglect (r=0.379; p< 0.05).

The findings may emphasize the need for identification and modification of the parental discipline strategies in adult victims of child emotional abuse and neglect.

Develop a cross-cultural translation, Swedish to Spanish, of TOOL questionnaire - a previously validated instrument to assess the impact of adverse effects (AE) on the health utilities and health related quality of life (HRQoL) in patients with schizophrenia and bipolar disorder.

TOOL questionnaire has 8 attributes and 4 levels per domain: mood (anxiety and depression), function capabilities, and AE frequently associated with antipsychotics (fatigue-weakness, weight gain, stiffness-tremor, physical restlessness, sexual dysfunction, and vertigo-nausea). Firstly, 4 independent translators carried out the forward-backward translations. Next, draft version was reviewed by an experts panel (5 psychiatrists & 1 GP specialized in HRQoL) and tested in 40 stable patients (20 schizophrenic & 20 bipolar). Comprehension and importance (C/I) of each item were evaluated by a Likert scale ranging from 0 (lowest level) to 4 (highest level).

3 items should be modified to facilitate comprehension: mood, physical restlessness and vertigo-nausea. However, C/I of items mean scores were respectively: mood (3.50/ 2.37); function capabilities (2.58/ 2.03); fatigue-weakness (3.58/ 2.55); weight gain- (3.75/ 2.87); stiffness-tremor (3.65/ 2.61); restlessness (3.37/ 2.62); sexual dysfunction (3.39/ 2.51) and vertigo-nausea (3.56/ 2.44). Only 2 patients (5%) were unable to complete the questionnaire. Internal consistency was high (Cronbach α= 0.87) and neither item ceiling nor floor effects were found.

The Swedish TOOL questionaire was culturally adapted into Spanish. Psychometric analyses are needed to validate this measure in Spain. A multtiatribute utility fuction should be estimated to evaluate AE by using a patients"centered perspective.

The study is assessing the knowledge, attitudes and behaviours of the different categories of medical professionals towards the psychiatric patients.

The transversal descriptive study was developed in the hospitals from two cities of Romania: Bucharest and Targoviste. We have studied the opinions about patients with mental disorders of 8 groups of medical professionals: psychiatrists, medical doctors, trainees from psychiatry and from other medical specialities, nurses from psychiatry and from other medical specialities, medical students and student nurses. We have conceived an anonymous self-administered questionnaire with 18 items concerning knowledge, attitudes, affects and actions of the medical professionals toward people with a psychiatric disorder.

From the 450 medical professionals that were asked to complete the questionnaire, 379 returned the questionnaire completed. The comparison between the eight groups of medical professionals showed that the clinical experience is a differentiating factor in the opinions about the cognitions, affects and behaviours towards psychiatric patients. The psychiatric specialists and trainees demonstrated a more tolerant attitude towards the patients with mental disorders. The knowledge about the psychiatric illness had positive correlations with the tolerance in attitude and behavior, apart from the medical category of the respondents.

Based on the fact that the modification of the cognitions influences the attitude and behavior, the stigma-reducing campaigns between medical professionals should have the main objective of informing about the psychiatric illness and patients.

It's known that media significantly contribute to the stigmatisation of mental disorders themselves, as well as the people suffering from such ailments. The aim of our study is to provide content analysis of media messages covering the topics of mental health and psychiatry.

The study sample comprises the media messages pertaining to the topic of mental illness collected by using the database of the Newton IT monitoring system. The articles were chosen from 6 printed most widely read daily periodicals, the period under consideration were 5 separate weeks randomly selected from the year 2007.

184 articles with mental illness as main content were found, including 110 in broadsheets and 74 in tabloids. Global impression of the message was negative in 76% of articles in tabloids and in 33% in broadsheets. The most represented diagnosis were Substance use disorders that were mentioned in 22% of all articles, on the other hand the representation of Neurotic disorders was quite low - 2% of all articles, Psychotic disorders were mentioned in 7% of articles.

The results relate to only a short time period, however, suggest that the degree of stigma of mental disorders in the Czech printed media is high and should be further analysed. The main outcome is to formulate the recommendations for media in order to meet anti-stigmatising objectives and thus improve media coverage, minimalize discrimination practises and increase help seeking behavior.

This study examines the occurrence and correlates of somatization in a sample of adult Ethiopian immigrants and refugees residing n Toronto, Canada.

A random sample of 342 adult (≥ 18 years of age) Ethiopian immigrants and refugees in Toronto completed structured face-to-face interviews. The Diagnostic Interview Schedule (DIS) Somatization Disorder Module was used to collect data on somatic symptoms. The Composite International Diagnostic Interview (CIDI) was used to assess major depression and generalized anxiety disorder.

Nearly two-thirds of the study participants reported having had at least one somatic symptom, and 5% reported experiencing medically unexplained symptoms in the 12 months preceding the interview. Individuals with major depression had significantly increased number of somatic symptoms compared to those without major depressive disorder. In a multivariate linear regression analysis, controlling for major depressive disorder, a higher level of somatization was associated with older age, pre-migration trauma, and post-migration stressful life events, and limited English proficiency.

The findings of the study suggest that somatic symptoms are prevalent among individuals in cross-cultural transition and symptom level was associated with pre-migration trauma, post-migration stressors and mental disorder, particularly depressive disorder. The data also indicate a need for primary care physicians to routinely screen immigrant minority clients who present with somatic complaints for common and treatable psychiatric conditions, such as depression. In minority immigrant communities, somatic symptoms may reflect psychiatric problems.

Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.

The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.

100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:

1. 1. A quantitative questionnaire for all staff in participating wards and

2. 2. A comparison group in 20 community mental health teams and 20 crisis teams.

3. 3. Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.

4. 4. Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.

5. 5. Staff who leave the wards in the course of the first year will be asked their reasons for leaving.

6. 6. Links between rates of staff sickness and morale will be investigated.

Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.

General Motor Aptitude (GMA) was classified as Normal Low; Global Motricity, Balance, Corporal Design, Space Organization and Schedule Organization had low output; the worse execution in the TMT indicating attention deficit disorder; the increasing of the time in the execution of the TMT proportional to the increase of the age; a negative value of the correlation of the GMA and the attention, a bigger slowness in the execution of the TMT tests shows minors values of GMA.

The Convention on the Rights of the Child acknowledges that the family is the natural environment for the upbringing of a child and that the parents have the primary responsibility for the child's education. However, it also mentions the need to find adequate substitute care whenever the child is temporarily or permanently deprived of his or her family environment, or when the child's best interests cannot be secured within the family environment. This substitute care may include adoption, foster placement or, as last resort, placement in an institution suitable for child care. Although some institutions have high quality standards for child care, this is not always the case.

Institutionalized children are likely to come from unfavourable family environments, where they were victims of multiple psychosocial adversities, and studies show they present high scores of emotional and conduct disorders, together with cognitive problems.

We examined medical files of all the institutionalized children and adolescents who attended the outpatient clinic of the Department of Child and Adolescent Psychiatry in Coimbra, Portugal, between the years 2005 and 2008, in order to characterize this population.

There was a male excess in our sample. The majority of the children and adolescents were institutionalized due to abuse and/or neglect and had conduct or oppositional defiance disorder. A considerable number had cognitive deficits.

Mental health services should work closely with these institutions to identify their strengths and difficulties, facilitating prevention, diagnosis and treatment of psychiatric problems.

Coercive physical measures, such as seclusion and restraint are sometimes used in psychiatric inpatient treatment for the management of severely disturbed behaviour of patients. As part of a larger study on the use of restraint and seclusion in a psychiatric unit of a general hospital in Greece we aimed to record the patients’ and their relatives’ attitudes on coercive measures.

Data regarding patients’ and family accounts on coercive measures were collected retrospectively with chart review of all patients who had been admitted to the psychiatric ward of the University Hospital of Ioannina over a six-month period and had been subjected to restraint or seclusion. During hospitalization and after the periods of restraint or seclusion, patients and relatives had been asked whether they considered coercion as justified or not. Patients had been also asked whether they perceived this experience as harmful.

Thirty one cases of restraint and seclusion from a total of 282 admissions were recorded during the study period. In 6 cases the patients refused to answer or did not have the decision making capacity. Twenty out of 25 (80%) patients considered their coercion to be unjustified and perceived it as traumatic experience. Twenty-five out of 28 (89.3%) relatives considered justified the decision to restrain or seclude the patient.

Patients and their families have different accounts on coercion, but more research is needed. It is important for care planning to record the patients’ and families’ views and integrate them in mental health policy making.

Induced delusional disorder or folie a deux is characterized by the presence of similar delusional ideas in two or more individuals. The delusional system develops as a result of a close relationship with a person with an established psychotic disorder. Most commonly the affected persons are members of a family.

An unusual case of folie a famille involving four siblings, brother and three sisters, (folie a quatre) is presented. This case was detected in the context of a community-based psychiatric service in Greece, the Mobile Psychiatric Unit of the prefectures of Ioannina and Thesprotia.

A 46-year-old woman was referred from primary care physicians for the management of a psychotic exacerbation. On the examination it was revealed that she and her three older siblings were sharing the delusional idea of being affected by their neighbors with magic. These siblings had been living in social isolation for long and have been querulant and aggressive toward their neighbors, against whom they had undertaken a succession of lawsuits. None of the rest siblings accepted to be examined so it could not be determined who the inducer was or what the diagnoses were for each of the affected persons. The patient did not receive the prescribed medication and did not engage in follow-up.

Cases of induced delusional disorder may be difficult to be detected and treated. Mobile psychiatric units in co-operation with primary care physicians may have an opportunity to provide appropriate treatment for such patients in rural areas.

Selective Mutism (DSM-IV: 313.23, ICD-10: F94.0) is a rare phenomenon in child and adolescent psychiatry, with prevalence rates below 1%. Patients limit their verbal communication and social functioning is severely impaired. Evidence for treatment strategies is scarcely available, especially in patients with concomitant pediatric disorders.

This case report provides information on the psychotherapeutic and psychopharmacological treatment of selective mutism in an eight-year old girl with thalassemia major. The patient presented to the psychiatric department after her second (successful) bone marrow transplantation for treatment of her selective mutism which was present already prior to transplantation. As permanent medications she received penicillin prophylaxis (500.000 IE/d) and deferasirox (Exjade; 20-25 mg/kg/d), a recently approved iron chelator.

Long term psychotherapy (CBT) in a day-time clinic, supported by the use of the SSRI Fluoxetine (10 mg), led to a decrease in the Selective Mutism score from 29 to 17 points - GAF improved by 21 points. Reintegration in the school context was established. Mean levels of Fluoxetin and N-Fluoxetin were 287,8 ng/ml without significant level fluctuations.

This case adds further evidence, that a combination of psychotherapy and psychopharmacological interventions (SSRI) proves effective in treatment resistant Selective Mutism. Monitoring blood levels of the SSRI is crucial in providing treatment to patients receiving multi-pharmacological treatment.