The National Board of Health and Welfare in Sweden has recently published regional comparisons and assessment o the psychiatric care in Sweden. More than 30 health care quality indicators are used that comprises processes and results of the care for the mentally ill. There are indications that psychiatric patients do not receive adequate treatment of their somatic illness. The study exemplifies that.

To investigate whether patients with mental disorders are more likely to die after being hospitalized for acute myocardial infarction or stroke.

To pinpoint possible disparities in physical health outcomes/mortality among patients with mental illness.

Patients were identified in the National Patient Register and Cause of Death Register. Mental illness was defined as having a registered psychiatric main diagnose at least once in the past five years.

In 2007 30% of the patients in total that had an acute myocardial infarction died witin 28 days. Among patients that also had psychiatric diagnose 44% died within 28 days. Case fatality within 28 days after a stroke was 22% and 34% respectively. There are differences in outcome between the regions.

Our study indicates that the case fatality after a cardiovascular event is much higher in patients with comorbid psychiatric disease. Many reasons can be plausible, including bad compliance to treatment. But the higher case fatality might also be an indicator of non-optimal processes within the health care system for mentally ill people.

Despite of the evidence of high psychopathological disorders in patients with ATSCI, few data are available on their psychiatric morbidity prior to the injury.

Identify psychiatric morbidity pre-post ATSCI in a sample of patients admitted in the Spinal Injuries Unit of the Vall d’ Hebron University Hospital in Barcelona (Spain).

54 patients with ATSCI patients were admitted between 1st. October 2009 and 1st. October 2010. SPSS (version 16.1) was used to analyze the data.

Seventy-six percent of the inpatients with ATSCI (41 cases) were evaluated by the psychiatrist and constitute the study sample. Twenty-seven (66%) were male and 14 (33%) female. The average age of the sample was 41 years with younger males (p < 0.05).

Reasons for ATSCI in males were traffic accident (26%), accidental falls and sports accidents (both 18.5%). In women were suicidal attempt by precipitation, fall accident (28.6% both) and traffic accident (21.4%).

41% of men versus 14% of women had a history of substance misuse (p < 0.01) while 64% of women versus the 14.8% of males had a prior psychiatric disorder (p < 0.01). 72.5% of men with ATSCI caused by traffic accident had used substances prior to the accident, those association was not found for women.

91% of patients underwent psychopharmacological intervention.

ATSCI patients exhibit high psychiatric morbidity and require specialized assessment. The high incidence of substance use associated with road traffic injuries suggests the need to identify risk groups in order to establish effective preventive measures.

It is known that patients with chronic and life - threatening diseases often presents anxiety and depressive symptoms.

The comparison of the levels of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and in patients with lung cancer.

The completion of the HADS scale was requested in 42 randomly selected patients (21 with lung cancer and 21 with COPD).

Higher rates appeared in the subscales of anxiety and depression of the HADS (12.88 SD 5.03 and 13.45 SD 5.60, respectively) compared to the general hospitalized patients. Pathological rates of anxiety appeared at the 59.5% of the sample, while pathological rates of depression were found at 45.2%. Patients with lung cancer presented higher total score at HADS against patients with COPD (29.48 SD 9.3 vs 23.19 SD 8.26, t test p < 0. 05). In the subscale of anxiety appeared statistically higher average rate in patients with cancer against patients with COPD (14.43 SD 4.97 vs 11.33 SD 4.33, t test p < 0.05). Among the demographic factors, only age seemed to participate to the anxiety variation.

Patients with COPD such as patients with lung cancer are presented with high rates of anxiety and depressive symptoms. Patient's age seems to be a significant factor at the variation of the anxiety symptoms.

Imperial County is designated as medically underserved and one of the poorest counties in CA. Our practice started in 1994 and serves the gap between the County Mental Health Services (CMHS) that treats the severely and chronically ill and the general medical community that faces the unmet need of specialty care for “less” severe patients.

A plan was started to provide both psychiatric care and liaison activities. The community has 2 community general hospitals. Contracts were established with CMHS and private insurers to assure coverage of services. The plan was extended to dialysis units and long term facilities. Systematic collection of consult data was started in 1998.

An electronic medical record was established with specific fields designated for research purposes. Working in association with UCSD, we established a number of IRB approved protocols. In addition, we contracted with a number of pharmaceutical companies to become a research site for mult-center trials.

Over 300 consultations were performed yearly. The most common consultations involved assessments of: elderly agitated patients, conservatorship evaluations and suicide attempts.

PM strategies added value in the provision of psychiatric services and contract negotiation in this rural community. Applying an academic model decreased the gap between CMHS and the medical community. Patients appeared satisfied to see the same psychiatrists at different treatment settings (i.e. general hospital, dialysis unit, NSF). All interventions were covered by the diverse payment sources.

Risk health behavior can influence coronary syndromes outcome, especially associated with undesirable psychological reactions. Anxiety and depressive syndromes could be associated with higher frequency of smoking, alcohol consumption and lack of physical activity.

Assesment of differences in psychological and behavior parameters between acute coronary and healthy controls and influence on 6 months re- hospitalization rate.

Comparation between K group = 33 of first myocardial infarction patients and E group = 30 healthy persons at baseline and after 6 months. Instruments applied:

Semistructured psychiatric interview, M.I.N.I., Beck Anxiety Inventory (BAI) for anxiety level, Beck Depression Inventory (BDI) for depression level, KON-6 sigma Aggression Scale and Holms-Rahe (H-R) Stress Life Events Scale and Questioner for risk health behavior. Parameters differences were assessed by t-test chi square test, for p< 0,05. Regression analysis for 6 months re-hospitalization.

Anxiety-depressive and Anxiety syndromes were present at 23% of K group and 10% of E group. Anxiety level of K group was higher than E: (BAI = 8,15 ± 4,37:4,83 ± 2,60; t = −3,62), for p < 0.01, depression level was also higher (BDI = 8,67 ± 3,94: 4.63 ± 2.04; t = −5,02). Lack of physical exercise, was more present at K group. After 6 months there were 11 rehospitalization in K group. Family history of coronary disease and alcohol consumption had significant influence on 6 months re-hospitaization of infarct patients.

Anxiety and depression levels are mild in K group. Risk health behavior has been present at bouth groups but alcohol consumption and family disposition are important for re-hospitalization

INTERMED is a method to assess biopsychosocial case complexity and a screening instrument to identify patients with multiple care needs. It is based on an interview, brief and easy to use, that can be conducted also by a nurse. Various studies in the last 10 years have confirmed its face-validity and reliability as a clinimetric tool. Its self-assessment version (IM-SA) was developed for further implementation in clinical settings.

To evaluate language, structure and fluency of the IM-SA questionnaire.

IM-SA, Italian version 1.0, was administered to 25 patients admitted to an internal medicine ward and to other 25 in the waiting room of a Primary Care outpatient clinic. At the end of the questionnaire, nine extra-questions were specifically added to evaluate comprehension and difficulties encountered by patients while filling in the questionnaire.

Patients admitted to the hospital scored higher and were found to be “more complex” (p < .01). 90% of respondents found the questionnaire easy to answer and 96% answered that the structure of the sentences was not too complex. The majority of patients found IM-SA useful and/or interesting. Contradictions in results also were found, suggesting need for improvement of structural and linguistic properties of the tool.

IM-SA seems to be a feasible and reliable self-assessment method to evaluate biopsychosocial complexity. Further similar studies in different languages are being organized to reach a final version of IM-SA, which will be afterwards compared to the IM professional interview.

Patients suffering from Functional Gastrointestinal Disorders (FGD) experience a high degree of psychological discomfort difficult to measure with current psychometric tools.

- To describe the presence of affective symptoms measured with the Hospital Anxiety Depression (HAD) Scale in FGD inpatients.

- To analyze the differences in HAD subscales scores between motor functional gastrointestinal disorders (MFGD) and non-motor functional gastrointestinal disorders (NMFGD).

46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the HAD scale and results from the two HAD subscales - Anxiety subscale (HAD-A) and Depression subscale (HAD-D)- were analyzed.

The mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. Thirty-one patients met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both diagnoses. The mean scores of the HAD were: HAD-A = 8.12 ± 5.23) and HAD-D = 5.20 ± 4.20. MFGD patients’ HAD results were: HAD-A = 7.00 ± 5.74 and HAD-D = 4.55 ± 4.52 while NMGFD HAD results were: HAD-A = 8.21 ± 4.98 and HAD-D = 4.96 ± 3.77. No statistically significant differences were found between both groups.

According to our findings, MFGD patients do not meet HAD criteria of anxiety or depression while NMFGD patients only fulfill criteria for probable anxiety or depression. New psychometric tools should be developed in the future to study the psychological discomfort these patients usually complain of.

Alexithymia is said to be an important feature of functional gastrointestinal disorders (FGD). Most studies focus on the presence of alexithymia in patients suffering non-motor FGD (NMFGD) but few studies have analyzed its occurrence in motor FGD (MFGD) patients.

- To describe the presence of alexithymia, measured with the Toronto Alexithymia Scale (TAS-20), in a sample of FGD inpatients.

- To analyze the differences in alexithymia, measured with the TAS-20, between MFGD and NMFGD inpatients.

46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the Toronto Alexithymia Scale (TAS-20).

The mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. With regard to their diagnostic condition, 31 met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both disorders. The mean TAS-20 total score was: 46.24 ± 13.60. MFGD patients obtained a mean score of 45.45 ± 12.53, and patients with NMFGD had a mean score of 45.75 ± 12.53. No statistically significant differences were found between both subtypes with regard to alexithymia.

Alexithymia, measured with the TAS-20, may not be present in FGD. Discordances of our results with previous findings in FGD may be due to complex psychosocial factors and to psychometric difficulties in assessing alexithymia in this group of patients.

We report a 49 year old man who received an orthotopic liver transplantation in May 2010. He received tacrolimus. Ten days later, while he was still in Hospital, he suffered behavioural disorders, being psychotic with delusions of persecution; he called the police thinking that he was being poisened by the staff of the Hospital. Although his Tacrolimus blood concentration had been kept in the normal range, his symptoms improved dramatically when the Tacrolimus was changed into Cyclosporine and Haloperidol was introduced at high doses (7 mg/day) for 10 days when the dose was reduced to 4 mg/day.

Chronic hepatitis VHC 1a in 1994. Received treatment with Interferon alfa in 1997 with no antiviral answer. In 2001 new treatment with pegylated Interferon and Ribavirine with positive virological answer but had to be stopped because of psychoses secondary to treatment. New treatment in March 2006 to March 2007 with Pegasys+Ribavirine with rapid virologycal answer with prophylactic Olanzapine 5 mg during a year with no psychotic symptons. In May 2009, Child Pugh C10, in list for liver transplantation.

We discuss the implications of these findings and the relevance for future clinical care in these patients.

The syndrome confusional acute (SCA) is one of the most frequent mental disorders in patients hospitalized by medical diseases. It is characterized by acute onset symptoms fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Though it is considered to be a reversible disease, often it is a sign of future deterioration of the cognitive functions.

To determine delirium prevalence and risk factors in a cohort of hospitalized patients. To know the characteristics of this population and the psychopharmaceuticals used.

A descritptive and retrospective study was conducted, based on the review of 2642 medical records of hospitalized patients in the Clinical University Hospital of Valladolid between July, 2007 and February, 2010.

893 (33,8%) presented delirium. 63,3% were men and 36,7% were women. The mean of age was 77 years. Turned out as significant predictive factors with highest percentages: cardiovascular disease (18,3%), traumophaty (15,1%). The principal motive of consultation was surgical pathology (48,1%). 30% presented cognitive deterioration also. They were medicated with tiaprizal (75%), olanzapina (24%), quetiapina (22,5%) and other medications.

The SCA is a frequent syndrome and has a negative impact on morbidity, as well as in resource use. It is possible to identify risk patients. The SCA can be the form of presentation of a physical serious disease or appear as a serious complication of a disease or of treatment. The treatment must divide in three principal aspects: prevention, treatment of the causal disease and symptomatic treatment of the delirium.

As the heart is a vital organ, diagnostic and therapeutic heart procedures can cause fear and anxiety not only in patients, but also among their relatives.

This is a descriptive study conducted to determine pre-procedural and post-procedural coronary angiography anxiety among patients’ relatives.

The relatives of 141 coronary angiography patients were included in the study. A personal information form and Spielberger's State-Trait Anxiety Inventory were used for data collection.

The average age of the patients’ relatives who participated in the study was 44.64 ± 13.22 years. 85.8% of the study participants were married and 61.0% were first-degree relatives of the patients. It was found that patients’ relatives had a moderate level of pre-procedural anxiety (mean = 53.333 ± 15.678), and that they had a low level of post-procedural anxiety (mean = 37.184 ± 18.528). State anxiety scores were higher among relatives who were married, and among those related to a patient who underwent a diagnostic procedure and previously underwent coronary surgery. Post-procedural state anxiety scores were higher among participants related to a patient who was recommended to undergo by-pass.

It was found that pre-procedural anxiety was higher than post-procedural anxiety among the relatives of patients who underwent coronary angiography. Therefore, prior to angiography, patients’ relatives should be informed about the procedure, and efforts should be made to reduce their anxiety.

Psychiatric illnesses have a high prevalence in the general population. Psychiatric illnesses affect the way other medical processes develop: age of onset, distribution by gender, type an evolution, and the training of the psychiatrists in caring for them.

To describe the characteristics and the medical problems of patients who have been consulted by an Internal Medicine Liaison Unit while hospitalized in the Psychiatric Unit of a third level hospital. Comparison of the general profile of these patients and their consultations with that done to patients hospitalizad in the rest of the hospital.

Descriptive retrospective study from September 2007 to May 2010. Use of a centralized database created with of all the administrative and clinical details regarding the consultation. A p ≤ 0.05 has statistical significance.

648 patients were identified (40,7% men). Mean age 52.4 years. Mean stay 3 days. 34,4% were solved in one visit. Mortality rate 0,3%. 94,1% of discharges were due to recovery, the rest were transfered to another service.

Distribution by major diagnostic groups: infectious 16,2%, cardiorespiratory 15,4%, mental illness 12,9%, metabolic 10,4%, tumoral 8,5%, digestive 8,2%, not defined 8,2%, hematologic 5%, others 15,2%.

The psychiatric patient is clearly younger and the female gender is slightly higher (59,3%) than in the control group. In this group the infectious and cardiorespiratoty illnesses predominate. The percentage of psychiatric consultations (34,1%; 648) over our global (1906) is impressive since the number of psychiatric inpatients is not proportional to this number.

Psychiatric illness complicates physical medical care and prolongs hospital stay.

To implement and measure the effect of a multidisciplinary (psychiatry, nursing and social work) team in an academic medical center general hospital.

To test the hypotheses that early recognition and management of co-morbid mental illness threatening to interfere with hospital level care for physical illness will reduce the fiscal burden of hospital level care.

Before and after comparison of patients on three medical units examining conventional consultation liaison approach vs the Behavioral Intervention Team (BIT) on four outcome measures: length of stay (LOS), denied days (uncompensated days waiting on medical service for hospital level care of psychiatry when the patient no longer requires hospital level medical care), constant companion use, and thirty day readmission rate.

Consultation liaison patients from August 1, 2008 through June 30, 2009 were compared to BIT patients on the same three units from August 1, 2009 through June 30, 2010; the BIT patients had a lower length of stay (9.99 days vs 11.33 days, Wilcoxon Two Sample Test = 200953, p < .01, two tailed) with a reduction of constant companion use by 8.7%, and elimination of denied days altogether. Thirty day readmission was reduced 2.5% but was not statistically significantly different.

Conservative economic analysis demonstrates that the intervention begins to generate a profit when the hospital reached budgeted census at least 3.5% of the time.

Interdisciplinary care can be feasible, effective and efficient in a hospital based consultation liaison setting.

The chronic diseases are increasing in all around the world. As the members of the health team, nurses are in an important position in protection from chronic diseases and maintenance of those diseases.

The present study was carried out in order to determine the empathic inclination and the job satisfaction in the nurses working with patients with chronic diseases.

In the study, 259 nurses working with patients having chronic diseases were included. Data for the study were gathered by using questionnaire form, empathic inclination scale and job satisfaction scale. In the assessment of the research data, percentage distribution, Pearson correlation analysis, Mann Whitney U test and Kruskall Wallis tests were used.

It was found that there are positive correlation between empathic inclination and job satisfaction; the ages of nurses and empathic inclination; and working years of the nurses and the empathic inclination (p < 0.05).

As the empathic inclination in the nurses working with patients having chronic diseases, the job satisfaction increases. As the ages and working years of the nurses increase, their empathic inclinations increase, too. The high level of empathic inclination and job satisfaction in nurses maintaining the patients with chronic disease will contribute to the sustainability of the maintenance both for the patients and nurses.

Coronary Angiography (CA) allows life saving diagnosis and treatment methods. However, because of its being an invasive intervention, it causes patient to live through fear and anxiety due to the process.

The present study was carried as a descriptive study in order to determine the anxiety condition in patients before coronary angiography.

296 patients to be subjected to the coronary angiography were included in the study. The research data gathered with individual information form and State Trait Anxiety Inventory of Spielberger.

It was found that the anxiety points of the patients changed between 28 and 55 and the average anxiety score was 41.22 + 6.16. It was determined that the anxiety scores were high in the patients with a body mass index of 25 and above, using cigarette, having another chronic disease, previously diagnosed with heart disease, having someone in his/her family who has heart disease story, not being introduced to the angiography team before the operation, having angiography story, having angiography complication story and not having health insurance.

It was found that patients lived through anxiety either at small or medium levels before coronary angiography. It is needed that the anxieties of the patients should be determined before the angiography and the approaches to decrease anxiety should be applied, the patients should be introduced to the angiography team before the operation.