Epidemiological studies reveal higher rates of psychotic disorders among immigrants of ethnic minorities. However, the variation in prevalence of psychosis differs, and the proposed explanations and risk factors vary across the literature.

1) to examine the prevalence of psychotic symptoms in a sample of immigrants and native-born in a primary care setting context

2) to explore the effect that certain socio-demographic characteristics have in the difference in prevalence.

It is expected that the presence of psychotic symptoms will be greater for the immigrant population than for the native-born population. Low educational level, a low socio-economic status and the presence of a physical illness will partly explain these differences.

3000 patients (1500 immigrants and 1500 native-born outpatients paired in age and gender) were interviewed in a primary care setting. They completed the Mini International Neuropsychiatric Interview, including the psychotic disorders sections, and a questionnaire that probed demographic characteristics and physical health status.

Immigrants showed significantly higher rates of psychotic symptoms than native-born patients in both sections of diagnosis: life-span psychotic symptoms only (9.8% in immigrants and 5.3% in native-born) and life span with current psychotic symptoms (7% of the immigrants and 4.8% of the native-born). Immigrants also showed a lower education level, and a lower socio-economic status. When controlling for these factors, a relationship between these factors and the symptoms was found.

Findings are discussed in the context of culture and etiology of psychotic symptoms, and suggestions with regard to future research are made.

Information about the relationship between personality disorder and ethnicity or migration is sparse. The few studies regarding the prevalence of borderline personality disorder (BPD) in immigrants compared to an indigenous population are inconsistent.

The aim of the present study was to compare the frequency of a BPD diagnosis in psychiatric inpatients with and without an immigrant background.

2494 consecutive patients over a 3-year period at a psychiatric university hospital were reviewed. Data included socio-demographic and clinical variables and also information about an immigrant background. The psychiatric diagnosis was limited to information available from the digital documentation system of the psychiatric clinic and additionally from discharge letters. The diagnosis of borderline personality disorder was based on ICD-10 criteria.

374 individuals (15%) of the study population had an immigrant background. The rates of BPD were 6.5% in the indigenous group (n = 2120) vs. 3.5% in the immigrant group (n = 374). The difference between the indigenous and the immigrant group regarding the rates of BPD-diagnoses was statistically significant (chi2 = 5.02, df = 1, p = 0.025).

The findings suggest that in a clinical sample BPD was diagnosed less frequently in the immigrant group than in the indigenous group. Therefore, our results do not support the concept of immigration as a risk factor for BPD. However, future investigations with a prospective study design and at epidemiological levels need to be conducted in order to get more precise information about the prevalence of BPD in different immigrant groups.

London Borough of Waltham Forest is composed of an ethnically diverse population. In some ethnic groups, mental illness may prevent access, or influence non-attendance when referred to Mental Health Services.

To examine referrals received by our service and first appointment attendance with respect to gender and ethnicity.

To assess the characteristics of referrals and first appointment attendance when accessing mental health services during August 2009 and compare with ethnic demographics of the borough.

We retrospectively analysed psychiatric referrals received. Data was collected from electronic patient record.

Of the 159 referrals evaluated, 39% referrals were White, 13% Asian, 13% Black, 3% mixed and 4% other. Majority of referrals were from general practitioners. In 28%, ethnicity was not recorded. 60% were female and 38% male. 52% were referred for mood symptoms. 24% Whites attended their first appointment as opposed to 9% of Asians and 8% Blacks. While referrals reflected the wider population, there was a higher rate of non attendance amongst ethnic minority groups than Whites. Interestingly a higher number of females attended their first appointment compared to males. This may explain for lower number of female admissions compared to males.

We found several possible explanations for the above findings from literature which highlighted stigma as a major determining factor. Our trust has an Equality and Diversity Work plan to promote engagement of minority ethnic groups. However there seems to be a relative poverty in accessing services in our Borough.

Ekbom syndrome is a delusional parasitosis in which the patient has the delusion of infestation by parasites. This condition might occur in concordance with senile dementia or cerebrovascular disease, but it is also present in mood disorders or schizophrenia.

To present a clinical description of a delusional parasitosis that appeared in a young nigerian women after she immigrated in France.

Our case is suggestive for showing that delusional parasitosis might develop in circumstances of social vulnerability such as the immigration and might have different cultural aspects.

We present the case of a 29 years old nigerian women that developed a delusional parasitosis 3 years after her arrival in France. The diagnosis was based on a carefully detailed clinical history, an MMSE was also applied. In order to exclude secondary causes an extensive laboratory evaluation was performed including: complete blood cell count, liver, renal and thyroid function tests, serum electrolytes and glucose levels, vitamin B12, folate, iron studies, coproanalysis, neuroimaging.

The patient had all laboratory and neuroimaging tests normal. She presented a delusional parasitosis and she described an infestation with multiple intestinal worms. She was capable of describing them and their movements under the skin and also in all the organs. She described dracunculiasis and three more different species that are commonly present in Nigeria, she never mentioned lice or mites.

Ekbom syndrome is a delusion of hallucinatory mechanism that might have different cultural presentations and could be favored by social vulnerability such as immigration.

Roma attribute a great value at the family life. For them the family is the basic axis around which their community structures and their personal relationships are developed.

The present study aimed to evaluate the family relationships, the personal growth and the family system maintenance in male and female Roma.

145 individuals (105 male and 89 female), residents of the general area of Greece, participated in the present study. The measures used were: a) The Family Environment Scale (Form R-FES) and b) A questionnaire concerning socio-demographic information.

The mean age of men was 35.31 ± 11.21 years old, while the mean age of women was 32.43 ± 11.70 years old. According to the findings, the men scored higher in certain factors which were studied. In particular, they reported significantly greater Achievement Orientation (P=.000), Moral-Religious Emphasis (P = .000), Family Control (P = .000), Family Organization (P=.016) and Family Incongruence Score (P=.011).

Male Roma hold a special place in the Roma family, whereas the female's Roma place in the society of Roma in Greece is underestimated. Based on the measures used in the present study, the male Roma are characterised by greater ethics, religiousness, tendency to achieve their goals and generally to do things. Also, the male Roma seem to have a greater control over the family, in comparison to the female Roma.

The relationship between immigration and mental health may in part be affected by factors related to social context in general and in relation to specific ethnic groups in specific social contexts. A growing body of research is exploring the impact of neighborhood context on the well-being of immigrants. The specifics, however, have yet to be identified.

To analyze the impact of social context on stress and acculturative stress in a hospitalised Latin American immigrant sample.

The study was part of a larger project concerning stress, coping, and psychosocial well being in Latin American immigrants hospitalised in both internal medicine and obstetrics in a large public hospital in Barcelona (Spain). 290 participants were evaluated with the PSS-10 for general stress, the BISS for acculturative stress and a sociodemographic questionnaire elaborated ad hoc for social context.

Neighborhood socioeconomic level is related to general stress and acculturative stress. A lower socioeconomic level is associated with higher levels of stress and acculturative stress. High levels of ethnic density of Latin American immigrants is moderately associated with lower levels of homesickenss and intercultural contact stress, but are not related with perceived discrimination.

Social context is an important factor that should be considered in the acculturative process of Latin American immigrants and its impact on their mental health status. A low socioeconomic neighborhood level increases levels of stress and acculturative stress, increasing the risk of psychosocial distress.

Own group ethnic density would appear to function as a protective factor.

The study was triggered by the first author's own experience on an undergraduate elective at the National Mental Wellness Centre in St Lucia. This was an eye-opening experience of psychiatry in a less economically developed environment. It highlighted disparities between practice in the developed and the developing world. Notably significant differences were apparent in facilities, epidemiology of presenting complaints, the interaction of cultural beliefs as well as the method of assessment and management.

To review the literature on the educational impact of electives in psychiatry.

A literature search using Ovid MEDLINE was conducted using the keywords’medical student’ AND’elective’ AND’psychiatry’. A total of 229 results were returned. These were then analysed for their relevance.

Only one paper was found emphasising the importance of electives in psychiatry. This reported on one individual's personal experience. There also were reports highlighting the importance of undergraduate elective experience and the need to increase exposure to psychiatry to improve the uptake of postgraduate training programmes. There were no papers objectively assessing the educational quality or impact of a psychiatric elective experience.

An overseas elective experience was subjectively beneficial for the author but there is a lack of objective research to show the educational benefit of psychiatry electives on a wider scale. Further research regarding the educational benefits of electives in psychiatry is needed.

Migratory mourning has specific features and migration is itself a risk factor for mental health. Basic grieving relate to seven areas: family and friends, language, culture, land, social status, contact with the national group and physical risks, as well as general mourning the failure of the migration project.

We intend to trace the process of acculturation seeking to distinguish its symptoms from those of most common psychiatric disorders.

We conducted a literature review using the National Library of Medicine and PubMed search system.

Adaptation process traces a U-shaped curve. In the second stage called crisis stage may appear rejection or isolation, sadness, crying, sleeplessness, irritability, distrust, recurrent and intrusive thoughts, psychosomatic symptoms (headaches, fatigue, musculoskeletal pain), dissociative and somatoform symptoms. Stress reactions can occur with cognitive fatigue, role and personal shocks.

Ulysses syndrome has features in common with acute stress disorder or adjustment disorder. Differential aspects regarding DSM-IV are: multiple identifiable stressors of high intensity, long duration, cultural interpretations and association of dissociative and somatoform symptoms.

Main observed pathologies are: PTSD, schizophrenia and paranoia, somatization and affective disorders, whose clinical expression is primarily determined by cultural factors.

Professionals should know the different manifestations of mental illness in immigrant population to distinguish them from experiential reactions and to avoid upset psychiatrization and therapeutic nihilism. Ulysses syndrome seems closer to preventive health and psychosocial support areas.

The ability to solve problems and make decisions creatively has become paramount to new nursing graduates, as these skills assist them with recognizing and evaluating situations that require prompt attention. This study was done to determine nursing student’s problem solving skills in various years of their four-year program.

This is a cross-sectional study. Three hundred and twenty two undergraduate nursing students in BSc nursing program participated in this study. The study setting was Nursing School of Iran University of Medical Sciences. The Problem Solving Inventory (PSI; Heppner & Petersen, 1982) was used to data gathering. The scale was divided into three subscales including: problem-solving confidence, approaching avoidance style, and personal control. Low scores were representative of a positive judgment and high scores indicated a poorer judgment of problem-solving abilities. Students involved in the study signed the study Informed consent.

Findings showed that the mean score of problem solving skill was 89.5 ± 21.51. First year students were found to have a mean score of 89.13 ± 18.71, second year students had a mean of 91.57 ± 1.87. The mean score of third year was 91.52 ± 20.8 and for fourth year students was 84.18 ± 27.47. When these results are compared, no significant differences occurred among the student in different years, as well as no difference between nursing students in 3 subscales of problem solving was seen.

It is expected that Nursing school produce practitioners who have the ability to solve problems and make decisions.

Community psychiatry is to be acknowledged as evidence based psychiatric treatment in Slovenia with some decades of lag behind other EU countries. Nevertheless some community psychiatric programmes were developed by four Slovenian psychiatric hospitals, one of them covering the most deprived region regarding BDP and service provision region with 220000 population. Team work of psychiatrist, two nurses and social worker covers only several patients and families with most severe disability and social deprivation. Communication and cooperation with other community agencies is, regardless their scarcity, crucial. Community work has to be adapted to specific cultural environment defined by multiethnicity and prevailing protestant ethics that influence workers, patients and carers alike.

Revolving door patient with severe mental illness living in extreme poverty in suburb area was approached with family visits. Her mother also presented signs and symptoms of mental disorder and was strongly reluctant to treatment. A number of interventions applied targeted to their living circumstances. Their needs were different from those defined by health and social workers, which resulted in absence of any community care in previously. With personal involvement of team workers, consensus was made and continuity of psychopharmacological treatment with the patient was achieved after many years of non-compliance. Further steps were planned regarding their actual local and social circumstances.

Community psychiatric interventions need to be culturally and socially adapted to the needs of their consumers. The case presented is to reflect special cultural, individual and social particularities that define specific community psychiatric work.

Aspects of lifestyle are a key component to successful ageing and reducing the risk of cognitive impairment. Many developing countries, including India, currently have a much lower rate of dementia in people of the same age in the UK (Alzheimer’s Disease International 2008), in contrast to the higher prevalence rates of cardiovascular risk factors (reviewed in Misra and Kurana, 2009).

Compare lifestyle choices in a developed and a developing country, that show contrasting dementia prevalence rates.

Identify protective factors that may reduce dementia prevalence.

A total of 251 participants at public meetings (123 in Newcastle and 128 in Chennai) on ageing completed a questionnaire voluntarily regarding their lifestyle, health status, 4-item GDS, and their subjective perception of their mental and physical health. The two groups had similar sociodemographic characteristics.

Diabetes was three times more prevalent in the Chennai group (p = 0.001) but a significantly higher proportion of the Chennai population reported receiving treatment for diabetes (p = 0.012). Vegeterian diet was more frequent in the Chennai cohort (p = 0.000), as well as curry consumption (p = 0.000). The Newcastle group consumed more alcohol (p = 0.000) and practiced exercise less often (p = 0.005). Not surprinsingly, 95% of the Indian is religious, in contrast to 59.7% of the English (p = 0.000).

Type of diet, curry and alcohol consumption, and religious or spiritual beliefs, were the most significantly different, and may therefore confer protective advantages for dementia. Other explanations could be a higher proportion of uncontrolled diabetes and inactive people in the Newcastle sample.

Depression is a common psychiatric disorder in Parkinson's disease (PD). It has been proposed that antidepressant drugs may bust brain production of trophic factors, such as brain-derived neurotrophic factor (BDNF) and glial cell derived neurotrophic factor (GDNF), an effect associated with improvement of clinical symptoms. However, BDNF and GDNF play also a role in the maintenance of dopaminergic neurons, which undergo to neuronal death during PD course.

Based on these findings we explored the hypothesis that PD depressed patients may have altered BDNF or GDNF serum levels and that antidepressant drugs may restore them and potentially have beneficial effects not only for depressive but also parkinsonian symptoms.

We measured by enzyme linked immunosorbent assay (ELISA) the serum levels of BDNF and GDNF in depressed PD patients, non depressed PD patients and healthy subjects and correlated them with clinical observations.

We found:

1. (1) BDNF serum levels were decreased in PD depressed as compared to non depressed patients and control subjects;

2. (2) antidepressant therapy restored BDNF serum levels to those of controls; and

3. (3) antidepressant therapy in association with Parkinson's therapy significantly ameliorated motor performance in PD depressed patients.

Our data suggest that PD patients are characterized by a reduction of BDNF serum levels and that depression may exacerbate this effect and worse PD symptoms. It is proposed that association between anti-parkinsonian treatment and SSRI could be a good therapeutic chance not only for treating depression in PD but also for improving PD symptoms.

Stroke is a disorder that has great prevalence, defined vascular territories and psychiatric signs generally emerge in association with specific cognitive deficits.

Dementia occurs frecquently after acute ischemic stroke. The incidence of dementia six months after stroke is about 42%. Fortunately, in recent years, more attention has been paid to organic disorders provoked by strokes, especially to dementia.

To follow up the occuring dementia after stroke and also to follow the various psychiatric disorders with the onset during or after an acute ischemic stroke.

Altogether 110 patients were recruited to this observational and non-interventional study, patients who were suffering from a psychiatric disorder after an ischemic stroke (according to DSM IV TR). The screening was followed by four visits during six months, when CGI, 17-HAMD, CROCQ and MMSE scales were used.

Of 110 patients, 39,09% has been diagnosed with dementia. A number of these patients (n = 26) developed an onset like paroxistic disorder (60,46%), or an acute syndrom (20,93%) and 8 patients were considered “de novo” (with the onset of cognitive impairement after 60 days). There were various acute disorders occuring in the onset of dementia, that includes: amnestic syndrom, organic delirium, organic anxiety syndrom and a small number of patients (n=2) who developed mild cognitive disorder.

The literature considers vascular dementia occuring after an ischemic stroke and increasing step by step mnestic deficits; our study releaved a metamorphosis of various types of onset (anxiety, depression, delirium) or cognitive impairement could occurs after 30 days.

Although multiple sclerosis (MS), a demyelinating disease of unknown aetiology, is primarily a white matter disease, it may also involve the grey matter, a feature not often demonstrated in vivo by means of magnetic resonance imaging (MRI). The involvement of cortical grey matter in MS may account for cognitive dysfunction and behavioural abnormalities.

The purpose of this report is to present the case of a patient with MS and clinical features mimicking dementia of the frontal type due to clear-cut cortical grey matter involvement in the left frontal lobe.

A 55-year-old woman with relapsing remitting MS developed a clinical picture characterized by frontal deficits (e.g. attention, verbal fluency, and speed processing), disinhibition, loss of insight, perseveration, abnormal eating behaviour, agitation, insomnia, and depersonalization phenomena. Neuropsychological evaluation also revealed abnormal performance on the Trail Making and the Stroop tests. Besides typical demyelinating lesions and “black holes”, MRI showed a striking pattern of left frontal opercular involvement including cortical thinning, focal knife-edge appearance of the gyri, and marked gliosis in the adjacent white matter.

Cognitive deficits in MS are typically subcortical, due to the expected predominance of white matter lesions. Nonetheless, the involvement of grey matter structures may contribute to a different pattern of cognitive dysfunction. For example, hippocampal involvement has been linked to memory impairment. This particular case report additionally illustrates how cortical grey matter involvement in the frontal lobe may lead (not unexpectedly) to a clinical condition mostly characterised by frontal deficits and psychiatric symptoms.