The term, care pathway, has been used to describe multidisciplinary/ multi-agency outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes. In practice, a multitude of disparate projects have produced outputs ranging from pages of interconnected boxes and arrows with rather basic entries to thick and indigestible wads of paper. Certainly the idea of a ‘mental health care pathway’ accessible and used by the general public, service users, carers, primary and secondary care has seemed overwhelmingly complex and unworkable.

To make relevant service and clinical information available when and where in a person's progress or a clinician treatment path it was needed.

Website hyperlinks allow linkage within websites and to other websites with relevant information (e.g. ICD10, NICE guidelines, and Patient information leaflets). A development prototype funded by the UK NHS has been established to form the basis for a website to be launched in mid-2011 (www.mentalhealth.southcentral.nhs.uk).

The prototype contains links to evidence-based information on maintaining mental health and on ‘coping with problems’. Service Pathways describe detail of processes occurring in mental health care. Diagnostic care pathways start as broad categories [Kingdon et al, 2010] with links to diagnosis, medication (e.g. connects to the National Formulary) and psychological management sites.

Web technology allows information about mental health care pathways to be accessed more systematically and readily and has application internationally.

Home treatment models in treating severe chronic mental disorders including crisis intervention show more and more evidence to offer an excellent alternative to hospital treatment. In Germany, having higher hospitalization rates than almost any other country in Europe, it is even more necessary to evaluate such alternative option to hospital treatment.

After establishing a home treatment model based on Swedish, Finnish and Italian experiences in cooperation with a big German health insurance in Berlin, we present data evaluation after the first year of implementation.

150 Patients out of a model region in Berlin being included in the first year of the project are evaluated with respect to their socio-demographic data and diagnostic spectrum, psychopathology ratings and quality of life assessments, as well as to health economic dimensions (different financial positions of spending economic treatment resources). Using an advanced statistical method of predictive modeling, we can compare the actual hospitalization rates to the statistically predicted ones.

There are predominantly patients with psychosis (50%), depressive disorders (30%) and BPD (15%). Actual hospitalization rates are extremely low compared to the statistical prediction. Health economic balance is difficult, mainly due to high starting expenses of a treatment setting which had to be built completely new.

The model in the meantime is being applied to the entire city of Berlin as well as to 4 other German counties (Schleswig-Holstein, Bremen, Bayern, Niedersachsen), other regions will follow shortly.

165 Korean American undergraduate and graduate students (M age = 23.3, SD = 4.1) participated in this study. They submitted the most recent dreams and assessed acculturative stress scale. Total 165 dreams were coded by “Lee Acculturation Dream Scale” (Lee, Sang Bok, 2005: Psychological Reports, 96, 454–456). The hypothesis was that the group members having higher acculturative stressscale would have lower acculturation dream scale than the group members with lower acculturative stress scale.

The first generation Korean American students group (n = 80, M age = 23.4, SD = 4.2) had higher acculturative stress level and lower acculturative dream scale when compared with the second generation Korean American college student group (n = 85, M age = 23.6, SD = 4.3). The t-test on the two group comparison was significant on acculturative stress level (p < 0.001) and “Lee Acculturation Dream Scale” (p < 0.001). It was proven that day time acculturative stress situation had an effect on the night-time dreaming neurocognitive activities, i.e., unconscious acculturation process (Lee, Sang Bok, 2006: “Acculturation Scale for Korean American College Students,” Psychological Reports; Lee, Sang Bok, 2006: “Asian Values Scale - Comparisons of Korean and Korean-American High School Students,” Psychological Reports).

The multiple domains of acculturative processes need to be explicated in terms of “multicultural hermeneutics” (Lee, Sang Bok, 2003: “Working with Korean-American Families - Multicultural Hermeneutics,” The American Journal of Family Therapy, 31, 159–178) and of real life experience mapping.

Recent cross-national research by Levecque et al (Journal of Health and Social Behavior, in press) has shown that the health effects of social experiences are attenuated, boosted or even reversed by the sociopolitical context. More specifically, it was found that the link between economic hardship and depression varies between different welfare state regimes in Europe.

Currently, we assess whether this variation in depressing effect is totally attributable to differences in welfare state arrangements or whether welfare state attitudes play a significant role as well. Is economic hardship more depressing when the individual considers the state as the main provider for an adequate standard of living, or is the risk of depression higher when emphasis is put on self-provision and individual responsibility?

Analyses are based on data for 23 countries in the European Social Survey 2006–2007 (N = 41686). Multilevel linear regressions are performed. Depression is measured using the Center for Epidemiologic Studies Depression Scale (CES-D 8).

We find that experiencing economic hardship is significantly more depressing for individuals who consider the state as the main responsible for providing an adequate standard of living. This pattern is observed in all welfare state regimes and remains significant when controlling for gender, age, having a partner, educational level, social support and locus of control.

The link between economic hardship and depression is dependent on both structural welfare state arrangements and welfare state attitudes.

Comorbidity of anxiety and depression is common and frequently poses diagnostic and treatment challenges in the clinical setting and are associated with significant morbidity.

The aim of this study was to analyze the comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a clinical sample of a Bosnian population.

Randomly selected subjects (aged between 18 and 64 years, N = 2202) which were hospitalized at the Psychiatric clinic in Sarajevo was analyzed. Subjects were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses.

The prevalence of generalized anxiety disorder, agoraphobia and social phobia was the highest among bipolar II patients (18.8, 32.5 and 18.7%), simple phobia was most prevalent in (nonbipolar) major depression (20.6%). The rate of panic disorder was almost the same in the (nonbipolar) major depressive and bipolar II subgroups (11.2 and 10.5%). Bipolar I patients showed a relatively low rate of comorbidity.

The findings support previous results on the particularly high rate of comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness, which has significant negative implications for both the course of these disorders and levels of dysfunction.

To estimate impact of PTSD on frequency of various forms of alcohol induced disorder.

Research conducted during 2006 at Psychiatric Clinic in Sarajevo. It included: first group (I) of 50 patients with PTSD and alcohol induced disorders and second (II) group of 50 patients with alcohol induced disorder without PTSD.

Comparing results these two groups, we found:

• Alcohol intoxication: I group 11 (22%) vs. II group 15 (30%)

• Alcohol withdrawal: 3 (7%) vs. 4 (8%)

• Psychotic disorder with hallucinations: 11 (22%) vs. 9 (18%)

• Psychotic disorder with delusions: 7 (14%) vs. 5 (10%)

• Delirium: 6 (12%) vs. 9 (18%)

• Amnesic disorder: 9 (18%) vs. 4 (8%)

• Blackouts: 1 (2%) vs. 1 (2%);

• Seizures: 2(4%) vs. 3(6%).

It seems that PTSD frequently caused more severe clinical forms of alcohol disorders, which should be prove in larger sample. This could be considered in prevention alcohol and PTSD as well.

Research shows that mental patients are usually the most difficult to be managed in terms of adherence to treatment. Antipsychotic drugs does reduce their symptoms, but at least half of people given these drugs do not comply with the treatment regimen prescribed.

To explore the way that treatment options affects compliance in patients with mental disorders.

155 (61,5%) males and 97 (38,5%) females participated in the study. DASS42 and SQR29 questionnaires were administered to all patients in admission and at the end of the treatment. Good compliance to the treatment required low scores to both of them at the end of the treatment and the consent of the psychiatrist and psychotherapists who were responsible for each patient.

172 of them had a good compliance, 32 medium and 26 did not comply at all.184 received pharmacotherapy, 21 CBT therapy and 26 combined therapy. Regression analysis indicates that better compliance to the treatment is significantly affected by CBT therapy (β = .44**), antidepressants (β = .37**), Typical antipsychotics (β = .25*) and sex (β = .24*) (*<, 05 **<, 0001). These variables accounted for 38 percent of the variance in compliance.

It seems that patients show better compliance to treatment when they are under psychotherapy and are receiving antidepressants and typical antipsychotics.

Health literacy (HL) measures the ability of an individual to use health-related information in order to make appropriate health-related decisions and to navigate the healthcare system. It influences a variety of behaviors such as breastfeeding, medication adherence, or the use of screening tests. Research has shown that it is related to the treatment outcome of conditions such as HIV and diabetes.

It is the assumption of this study that health literacy also plays a role in psychiatric patients’ adherence to treatment; in particular, to outpatient psychiatric appointments.

We hypothesized that patients with different health literacy levels would have different adherence rates to outpatient psychiatric appointments.

The study was conducted in 2006 in the Outpatient Psychiatry Department (OPD) of Temple University School of Medicine in Philadelphia, Pennsylvania. All English and Spanish-speaking patients of the OPD (potential N = 150) were invited to complete the short version of the Test of Functional Health Literacy in Adults (sTOFHLA), yielding three HL groups: adequate, marginal and inadequate. We explored the demographic and clinical correlates of HL and compared the three literacy groups with respect to their adherence to appointments during a 12-month period.

Our study showed that, for our patient population, HL was not significantly related to any of the demographic and clinical variables included in our analysis except appointment adherence.

Patients with lower HL had lower adherence to appointments. These findings invite further research to explore the significance of HL.

It is interesting to note somatic comorbidity of psychiatric patients that attend an outpatient Mental Health Unit (MHU). In medical literature there are few studies that reflect which diseases make these patients go to an Emergency Room (ER).

To determine the percentage of patients presenting to an ER in the year prior to psychiatric consultation in a MHU, noting which is the most common assitance and the differences regarding sex, age and marital status.

Retrospective and descriptive study of ER assistances at the Hospital Clínico de Santiago in the previous year of patients attending our MHU. Time period: from February 1st 2010 to August 31th 2010. Once collected the data, these are analyzed using the Excel 2008 Statistical Package for Mac.

From 577 patients studied (68.3% women), 224 had gone at least once to the ER in the last year (72.3% women): 19.6% consulted for psychiatric conditions and 80.4% for somatic causes. Among the predominant somatic complaints we found musculoskeletal causes (24.4%), cardiovascular (8.8%), respiratory (9.4%) and gynecological (2.7%). 3% of them were hospitalized in medical or surgical services and 3% in psychiatric units. There was not statistically significant differences regarding their age. Married and divorced patients went to the ER more than bachelors or widowers.

Profile of the studied patient: “Woman, 53 years old, married, user of an outpatient MHU and that has consulted at least once in the last year to an ER due to musculoeskeletal cause.”

In Portugal, a new National Mental Health Plan has been launched with the following objectives: equal access to care, decentralisation of mental health services and integration of mental health services in the general health services. In order to change the operational model for mental health teams, a case-management training program has been launched by the Ministry of Health.

This study aims to evaluate:

1. a) the feasibility of implementing the program on a national level,

2. b) the quality of the training program and

3. c) the satisfaction of the trainees.

The study was carried out at 36 public mental health services in mainland Portugal. The professionals attended a case management course (SAMHSA procedures), in which they were trained by means of guidelines, demonstrative audios, scenarios and role-playing. The assessment was conducted with a questionnaire addressing logistics, program content, acquisition of skills, usefulness and overall satisfaction.

135 professionals from the whole country have been involved. The trainees’ acquisition of competences was found rather satisfactory. Results of the training were impressive regarding satisfaction and motivation of the trainees (69% were highly satisfied). Dimensions such as organization (35% highly satisfied, 52% satisfied), program content (41% highly satisfied, 43% satisfied), practical skills gaining (35% highly satisfied, 58% satisfied) and usefulness (58% highly satisfied, 31% satisfied) were also very well rated.

Of upmost relevance, it was possible to implement a case management training program at a national level, with no particular difficulties. The impact of courses on trainees was overall impressive.

Past research has demonstrated the high prevalence of depression in elderly. However, the most of studies followed the symptom trajectory of individuals diagnosed with depression in a clinical setting and few longitudinal studies have characterized the patterns of depression in older adults population-based.

To describe changing of depressive disorder in an elderly population-based over a 12-month period and to examine the influence of medical and psychosocial factors on the outcome.

Data come from a longitudinal ESA Study (Enquête sur la Santé des Aînés) of elderly community persons (n = 2752). Depression, including major and minor depression, measured using the DSM-IV criteria. Generalized estimating equations (GEE) were used to assess relations between participant characteristics at baseline and depression, 12 months later.

Among the 164 (5.9%) participants, who are depressed at baseline, 19.5% were continuously ill cases and 80.4% had recovered, 12 months later. Multivariate analyses showed that the risk of depression over the 12-month period was higher among for participants who were separated; living in rural region; with a great number of daily hassles, with high level of stress intensity, great number of chronic disease and with fair/poor perception of mental health.

Results support the hypothesis about medical and psychosocial factors as predictors over time of depression, in old persons. Using readily available prognostic factors (for example, high level of stress intensity, living in rural region, great number of chronic disease) could help direct treatment to elderly at highest risk of a poor prognosis.

There are complex associations between work and mental health. Self-efficacy, experience of own abilities and appropriate challenges are important prerequisites of mental health. Availability of these factors is specifically decreased in the elder long term unemployed and results in higher vulnerability for mental impairment.

Investigation on mental health of elder long term unemployed persons

To examine incidence of mental disorders in elder long term unemployed persons

Senior long term unemployed participants in a vocational reintegration program were examined. Clients were allocated by choice to the study by their placement officers. An extensive psychiatric examination including structured clinical interviews (SKID) and clinical and personality questionnaires (BDI, STAI, MSWS, SCL 90-R, SF36, AUDIT, FTNA) was performed with each subject.

90 subjects were included into the study so far and 42 completed the psychiatric examination. The mean age was 54.7 years and gender ratio was balanced. 94% were diagnosed with a psychiatric disorder and 80% were diagnosed with more than one disorder according to ICD-10. In particular, 78.6% of the subjects had depression, 40.5% anxiety disorders, 35.7% combined personality disorders, 26.2% posttraumatic disorders, 21.4% addiction disorders, 16.7% single personality disorders and 7.1% psychotic disorders.

A large proportion of the long term unemployed persons examined is affected by mental disorders. Along with the high incidence of depressive, anxiety and addiction disorders there was a considerable number of personality and specifically trauma-related disorders. Accordingly, personality disorders may be a risk factor for unemployment in elder people too.

War is a major effective factor on general health and its morbidity and mortality have constant psychosomatic effects. In this study we aimed to assess psychological signs of Iranian elderly veterans in order improve their health.

In this cross -sectional -descriptive study, we analyzed the psychological signs of elderly veterans of khorasan Razavi province in 2009.

We studied 123 old veterans under coverage of Marty and Veteran Foundation.

Our cases were selected randomly and data were gatherer using SCL-90-R, MMSE and GDS questionnaires we also had a total medical examination and a Psychiatric interview form all of the participants.

The most prevalent psychological signs according to SCL-90-R Questionnaires were the following: moralization 84.4%, anxiety 66.7% and Hostility 57.8% According to GDS test the prevalence of depression sings among old veterans were 50.4%, and according to MMSE test the prevalence of cognitive disorder in this old population was 17.1%. There was a significant relationship between the prevalence of respiratory and vestibule- auditory diseases with the rate of psychological signs. We also found a relationship between the prevalence of respiratory and skin diseases with depression, and prevalence of neurological diseases with cognitive impairment.

36.6%prevalence of psychiatric signs in the old veterans shows the need for special attention to this group of society.

Antipsychotic therapy is the cornerstone of the treatment of schizophrenia and other psychoses. Although clinical guidelines tend to recommend the use of antipsychotics in monotherapy, combination of two or more antipsychotics (that is, polytherapy) is a common habit in clinical practice.

To assess differences in antipsychotic combination profile between patients with schizophrenia and patients with other psychoses.

A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.

145 (60.2%) patients were diagnosed with schizophrenia while 96 patients (39.8%) were diagnosed with other psychoses (schizoaffective disorder n = 35, delusional disorder n = 8, schizophreniform disorder n = 8, brief psychotic disorder n = 13, psychotic disorder not otherwise specified n = 27, and other psychoses n = 5). Out of the total sample, polytherapy was used in 150 (62.2%) patients. A total of 100 (69.0%) patients with schizophrenia were on polytherapy, compared to 52.1% of those with other psychoses (p = 0.008). After controlling for age and gender, the association between a diagnosis of schizophrenia and being in polytherapy remained significant (p = 0.046).

Patients diagnosed with schizophrenia are more prone to be in polytherapy than those with other psychoses.

Sense of coherence (SOC) is a resource for health and quality of life (QoL) in adults. Aim of this investigation was to evaluate the association of SOC and QoL in adolescents with congenital heart defects (CHD).

Observational study among 770 adolescents aged 14 – 17 years from a national CHD register. SOC was measured at baseline with the SOC-L9 questionnaire. At baseline and at 12-months follow-up, QoL was measured with the KINDL-R questionnaire, evaluating overall well-being and six subscales. The association of SOC with QoL was evaluated in multi-level linear models separately for overall well-being and KINDL-R subscales. Initial models comprised SOC as only fixed effect while the final models were adjusted for age, gender, medical and socioeconomic status and behavioral factors.

Overall well-being, self-esteem and school-related well-being was significantly higher at follow-up compared with baseline. SOC at baseline (median 50 [range: 16 – 63] points) was positively associated with overall well-being and all KINDL-R subscales. There were significant negative interactions between SOC at baseline and time to follow-up for overall well-being and all KINDL-R subscales except psychological well-being. But even in fully adjusted models associations of SOC at baseline with overall well-being and all KINDL-R subscales at follow-up remained significant.

SOC is an independent predictor of QoL in adolescents with CHD. Except for psychological well-being, this effect attenuates over one year but remains positive inoverall QoL and sub-dimensions. Further studies should evaluate whether interventions aimed to increase SOC in children with CHD improve QoL.

Mental illness has great influence on the possibility of regular education, employment, sometimes cause temporarily or definitive work disability.

Current diagnostic criteria divide mental illness in two categories: psychotic disorders which consider more severe and nonpsychotic disorders as less severe disorders. Aims: The aim of this pilot study was to test the influence of quality of the mental disorder (psychotic/ nonpsychotic) on education completion and professional abilities.

Investigation involves 141 patients who were treated in two months period at CCS at the Psychiatric Clinic. Patients were divided in two groups according to ICD X criteria: group A- psychotic, group B- nonpsychotic disorders. Groups were equalized in sex and age. We compared groups in educational level (years of completed school), profession (employed, unemployed, retired, disability pension) and the age when the mental illness has begun.

Λ square test was used for the statistical analyses.

Results showed that there were no statistical significant differences between groups in educational and professional performance. Groups differ only in the time of illness onset (earlier in group A).

A group, in spite of earlier onset of the illness and more severe simptomatology, is equally successful in education and professional performance, as B group. This may be the consequence of the great support of the family and the society. It also gives us hope that something is changing in relation to psychiatric patients and that stigma, shame and exclusion is not, or will not be everyday experience this group of patients.

Inner-city youth suffer a high burden of mental illness and seek health care on an episodic basis (McCreary, 2001).

These youth tend to receive limited support services due to a lack of continuity of care as they move from child to adult services. Other barriers include homelessness and substance use.

The Vancouver Inner City Youth Mental Health Program (ICYMHP) is a psychiatry led initiative to provide psychiatric services and further collaboration between inner-city youth agencies providing care to at risk youth.

To introduce and review a collaborative model of care between psychiatric services and community based organizations.

To review the demographics, presentations and outcomes of youth assessed through the ICYMHP.

A chart review of all clients assessed through the program from its inception (November 2007) to May 2009 (18 months).

Results from clients seen between November 2007 and June 2008 indicate an incidence of psychosis of 40% in men and 21% in women. Mood disorders were the primary diagnosis in 18% of men and 29% of women. Active substance misuse is high (71% of men, cannabis as drug of choice; 54% of women, methamphetamine as drug of choice). Length of stay at Covenant House nearly tripled for those under the care of the ICYMH versus the general shelter population, a positive outcome (21 days versus 9).

Inner-city homeless youth suffer from a high burden of mental illness. A collaborative model of care exists to improve health care quality and delivery to this population.

Mental illness remains highly stigmatized in society. Cinematography is a potent source of psychiatric images. Research has concentrated on mental illness portrayals in Hollywood; neglecting European cinematic perspectives.

We systematically examined European cinematic depictions of psychiatric illness and treatment. Award-winning European films were screened for psychiatric content using the International Movie Database. Two assessors independently viewed shortlisted films and compared findings. Stigma markers were derived from Link. Attributes, affective responses, attitudes and behaviours towards designated mentally-ill characters were identified through content and dramatic character analysis.

40 films between 1964 and 2009 were identified. Psychopathologies included schizophrenia, delusional disorder, epileptiform psychosis, depression, somnambulism, learning difficulties, autism, sado-masochism and transsexualism. Frequent attributions were ‘odd’, ‘inappropriate’, ‘dangerous’, ‘unstable’, ‘frightening’ or ‘perverted’. Core affective responses comprised a cluster of ‘shame’, ‘pity’, ‘disgust’ and ‘fear’. Attitudes and corresponding behaviours occurred on a spectrum of ‘benevolent’, ‘ambivalent’, ‘distant’ and ‘hostile’. Stigmatisation of psychiatric treatment included portraying home treatment within traditional societies as misguided; institutional confinement as common; and medication as dominating daily routine. Religious dimensions to psychiatric illness and care were depicted positively and negatively. Anti-stigma themes included redemptive sacrifice or artistic genius in madness; madness as a natural manifestation of industrial alienation; and madness as unjust political labelling. Stigmatising reactions were depicted as cruel; even driving sufferers to gain sympathy through faking suicide. Psychiatrists were often characterized as empathic. One film charted humane Italian psychiatric reforms.

European cinematic psychiatric perspectives are complex; both propagating and deconstructing stigmatising stereotypes.

Individuals with mental health problems, especially those hospitalized in mental health institutions, are particularly vulnerable to violations of their Human Rights. There are a number of special laws and regulations in different European countries and on the international level regarding the rights of people with mental health problems, however there are many instances in which their rights continue to be violated. In order to respect their Human Rights, it is necessary to study and to address the negative attitudes that the general (or even professional) public may hold toward the people with such problems.

This research aims to reveal and compare the attitudes toward mentally ill people in different countries (Romania, Czech Republic, Nigeria and Serbia). Also, within the project we will develop a workshop to address these attitudes.

The Opinion about Mental Illness Scale (OMI) for measuring attitudes was used. We used the pre-post study design to evaluate changes of attitudes because of the involvement in the intervention workshop. Students in the area of psychology, medicine or similar or general public took place in 90-minutes workshop, which was developed from the stories of people suffering from mental illnesses (e.g. schizophrenia), and their family perceptions and attitudes.

The pilot study showed a great acceptance of this kind of interventions among students. Besides, the structure of the workshop, the response of the audience, participation rate and first results of the evaluation will be presented.