The Munchausen syndrome describes patients with a particular form of factitious disorders: symptoms of illness or injury intentionally produced, for psychological reasons, in order to be hospitalized and even to be submitted to invasive interventions.

A 38 years-old woman, firefighter, was admitted, in Medicine Department for a transverse myelitis, (spinal thrombosis D5-D7 secondary to sepsis caused by a central venous catheter infection). Healthy up to 24 years of age, she is diagnosed Webber Syndrome-Christian and treated. Some years after appeared hypochromic microcytic anemia, whose initial cause was considered to be a rectal ulcer, with complete hematologic recovery after surgery. But some time after, there was recurrence of anemia, plenty diagnostic exams were performed and all inconclusive. Since one-year ago, she had the need to blood transfused weekly. Because of poor peripheral vessels, central venous catheter (CVC) was placed, then she developed serial infections by S. aureus with sepsis and is noticed that she got hematological recovered whenever hospitalized, leading the suspicion the catheter was being auto-manipulated. Currently she is paraplegic from D7 and when it was told her, that there was no neurological recovery, paradoxically she happily said “I already knew.” Against her will, the CVC was removed and peripheral accesses reestablished. So, for all of this, it was hypothesized Munchausen Syndrome.

Treatment of Munchausen syndrome primarily consists in treating the self-induced illness before psychiatric help can be given. Unfortunately most patients refuse psychiatric help and leave hospital even before correct diagnosis is made.

The international literature has clearly set out the importance of having an appropriate consultation liaison psychiatry service in a general hospital. There is limited data available on the quality of psychiatric consultations in those areas which are without dedicated liaison psychiatry teams.

To examine the psychiatric work in a general hospital, and to establish a baseline regarding demographics, type of referral, and management of referrals.

To assess the psychiatric needs of the hopsital with a view to introducing improved evidence-based treatments.

All referrals from medical and surgical teams and from the accident and emergency department over a 3 month period were prospectively reviewed. As there is no dedicated liaison service, the referrals are seen by the psychiatric registrar on call. The details were entered in a register and reviewed.

160 referrals were received over the 3 months studied. 90% were from the area served by the psychiatric services based at the psychiatric unit in the hospital. The most common diagnosis was depression (27%). Alcohol was an important factor in 16% overall, and in 26% of referrals from the accident and emergency department.

In the absence of a dedicated liaison psychiatry service, the liaison work is done by the team members of the general adult and psychiatry of older age teams. As 31% of the referrals seen were not deemed urgent by the assessing psychiatrist, there may be a role for a liaison nurse in the triage of referrals to this service.

Psoriasis is a common, genetically determined inflammatory and proliferative disease of the skin. Psychological stress can also exacerbate the disease. The goal of the present study was to compare depression and anxiety symptom in patients with psoriasis and control group.

One-hundred patients with psoriasis (case) referred to the dermatology department and 100 patients with Otolaryngology problems and dermatological healthy volunteers (control) who referred to the Otolaryngology department of Bouali Sina hospital in Sari/Iran in 2007 were studied. Demographic characteristics were recorded. Then the Beck Depression Inventory and Spielberger State-Trait Anxiety Scale I-II were administered to the patients in both groups. Data were analyzed using SPSS statistical software and descriptive statistical tests.

From 100 patients in each studied group, 44 (45%) were men. Patients with psoriasis and controls had depression scores of 67% and 12%, respectively. The Beck depression scores of patients with psoriasis were significantly higher than scores of the control group (P < 0.05). Based on Spielberger State-Trait Anxiety Scale, anxiety was found in 45% of patients in case group and 18% of controls.

The results revealed that Psoriasis patients reported significantly higher degrees of depression and anxiety than controls. In addition, psoriatic women were more depressed than psoriatic men.

The high comorbidity of depression in patients with diabetes mellitus type 2 has been established.

The association between Obsessive Compulsive Disorder (OCD) and diabetes mellitus type 2 is poorly understood.

The aim of the present study was to assess the degree in which diabetes mellitus type 2 is accompanied by OCD.

131 diabetic patients, 55 female and 76 male were randomly enrolled and during the first assessment was administered in all participants the Zung Self Rating Scale (ZUNG) and the Maudsley O-C Inventory Questionnaire (MOCI). After one year, while an intensive effort to improve the patients’ metabolic profile was performed, the diabetic patients that were initially uncontrolled (n = 31) were re-evaluated by the same psychometric tools. From those 31 patients 10 had managed to control their metabolic profile.

MOCI and the sub-scale of slowness are statistically related with the diabetic profile (controlled-uncontrolled), with uncontrolled patients scoring significantly higher on the overall MOCI score and the factor of slowness of MOCI scale (p = 0.028). Regarding the association between the values of Glycosylated Haemoglobin (HbA1c) and the scores of MOCI it was found that they were significantly positively correlated in overall scores (p = 0,028) and in the subscale of slowness (p = 0,028). The analysis revealed a positive association between depression (p = 0.004) and obsessive compulsive disorder symptomatology (p < 0.001) and thepatient’s metabolic profile.

Diabetes mellitus type 2 is associated with obsessive compulsive disorder symptomatology and depression. Improvements in glycaemic control were found to decrease the severity of the symptoms.

Use of developed prophylactic and rehabilitative programs based on city primary care unit and psychiatric services of psychiatric institution has allowed improvement of quality of life, high clinical and economic efficacy of treatment of patients with combined mental and somatic pathology.

According to data of catamnesis (2–9 years) in group of patients in need for course therapy according to addressing, recovery has been achieved in 46,2% of cases, stable clinical improvement - in 44,1%; in group of patients in need for systematic therapy and dynamic observation, recovery has been achieved in 24,7% of cases, stable clinical improvement - in 65,5%. The most effective measures were at initial stages of mental disorders. Differentiated gradual approach to treatment of combined mental and somatic disorders under conditions of general medical institution and principle of continuum of treatment measures have allowed reducing transient disability in 1,8 times, number of not based addressing and examinations per 1 patient in 2,3 times.

Integrative approach to medical assistance rendering for patients with mental disorders, revealed in general medical network is enough effective. Successful interaction of psychiatrists of primary care unit, internists, psychiatrists of dispensary and hospital was contributed by principles: collective character of decision making, continuum in resolution of issues of treatment-prophylactic assistance, observation of principles of medical ethics and deontology oriented at interests of patients, accomplishment of treatment-diagnostic assistance, necessary in such an amount that maximum therapeutic effect was achieved during rational use of medical resources.

Patients with bipolar disorder are at risk of obesity, metabolic syndrome and diabetes mellitus. Little was known about the association of clinical characteristics of bipolar disorder and diabetes mellitus.

Investigate the clinical characteristics of patients with bipolar disorder and diabetes mellitus.

Identify the risk factors of medical comorbidity.

Patients suffering from bipolar disorder, according to DSM-IV classification, with and without diabetes mellitus were retrieved from computer database in a university teaching hospital psychiatric outpatient clinic. Patients with diabetes mellitus were compared with patients without diabetes mellitus after matching with sex and age.

One hundred and fifty patients with bipolar disorder (30 with diabetes mellitus and 120 without diabetes mellitus) were collected. All patients were Chinese and 86.7% were female. For patients with and without diabetes mellitus, the mean (SD) age were 49.9 (9.3) years and 49.4 (8.9) years respectively. Their mean (SD) duration of mental illness were 18.1 (10.9) years and 16.8 (10.6) years and the mean number of admissions were 3.4 (4.2) and 3.2 (4.3) for patients with and without diabetes mellitus respectively. The use of antipsychotics and mood stabilizer were similar between patients with and without diabetes mellitus. Hypertension and dyslipidemia were statistically significant factors associated with diabetes mellitus among patients with bipolar disorder.

Hypertension and dyslipidemia are associated with diabetes mellitus among Chinese patients with bipolar disorder. Psychiatrists should be alerted to screen and monitor for hypertension, dyslipidemia and diabetes mellitus among patients with bipolar disorder.

Anti-NMDA-receptor encephalitis is subacute disorder that has been recently described in young women and girls who often present neuropsychiatric symptoms as first clinical features; thus, it is common that they receive an initial assessment, diagnose or even treatment by a specialist in Psychiatry.

Presenting a case of Anti-NMDA-receptor encephalitis that was observed at our hospital and the steps taken from its initial assessment by Psychiatry to the final diagnose and treatment by Neurology, our objective is to describe this disorder in order to make it known to the specialists in Psychiatry.

The case is that of a 14 year old girl who presents altered behavior, bizarre delusions and auditory hallucinations with subacute onset. In psychiatric assessment it is noted that the patient presents fever, slight and language impairment: Medical and Neurological assessment are requested. The steps followed to rule out other disorders are presented. SPECT and the detection of specific anti-NMDA-receptor antibodies in serum were necessary for an accurate diagnose.

The detection of specific antibodies is necessary for the diagnose of Anti-NMDA-receptor encephalitis. NMDA receptors are ligand-gated cation channels with crucial roles in synaptic transmission and plasticity. Their alteration could be a pathogenic mechanism in disorders such as epilepsy, dementia and schizophrenia.

Anti-NMDA-receptor encephalitis is a recently described clinical entity that should be taken in consideration to rule out other causes of subacute onset psychiatric symptoms in young women and girls. Its well-defined set of clinical characteristics should become familiar to the specialists in Psychiatry.

The aim of the present study was to investigate clinical parameters in relation to personality characteristics and psychopathology, in patients with non traumatic osteonecrosis of the femoral head (ONFH), with and without cerebral white matter lesions (WML).

Sixty seven patients participated in the study, 48 males and 19 females. The mean age was 37.6 years (SD 10.92, range: 15–61). Seventy five healthy individuals age and sex matched, served as controls. Socio-demographic information, clinical data and brain MRI findings were collected. The following self-report instruments were used: General Health Questionnaire (GHQ-28) and Defense Style Questionnaire (DSQ).

The odds of being assessed with a psychiatric diagnosis upon interview were three times greater among patients with ONFH compared to healthy controls (p < .006). The presence of cerebral WML and secondary nature of ONFH were associated with intense symptoms of psychological distress and especially with somatic symptoms of depression and social dysfunction (p < .003). A specific personality structure was identified in patients with ONFH.

Patients suffering from osteonecrosis of femoral head, especially when white matter lesions are present, often present psychological distress and problematic personality organization. Therefore psychological support and/or psychiatric intervention can be beneficial to these individuals.

This study was performed to determine psychosocial adaptation, depression and axiety levels of patients who experienced Myocardial Infarction (MI).

A total of 86 patients who were admitted to Coronary Intensive Care Unit of Ege University with MI diagnosis between October and December 2009 and who visited Cardiology Polyclinic as outpatients were comprised the sampling of study. In data collection “Patient Introductory Information Form” involving sociodemographic characteristics of the patients, “Psychosocial Adaptation Scale”, “Beck Depression Inventory” and “Beck Anxiety Inventory” were used.

When the sociodemographic characteristics of patients were scrutinized it was identified that their mean age was 57.50 ± 10.43 years. 76.7% were males, 79.1% were married, 40.7% were elementary school graduates, 94% were living with their families. Since patients have experienced MI at early ages, singles or those are living alone, those have less income and those experiencing difficulty in coping with stress had increased mean psychosocail adaptation scores and mean depression scores and the difference was found statistically significant (p < 0.05).In patients who experienced MI, as the depression and anxiety scores increased, also the psychosocial disease-adaptation scores increased. Increased mean anxiety and depression scores will decrease individuals’ adaptation to disease (p < 0.01).

Consequently, during the process of reducing the negative effects exerted by heart failure, which is a chronic disease, on individual, family and community and increasing patients’ psychosocial disease-adaptation, nurses should consider patients’ individual and disease-related characteristics and provide support for them to develop their psychosocial adaptation.

Mr. H’ cardiac disorder had onset in 2001. When Mr. H. who was discharged after placement of stent due to myocardial infarction has returned to polyclinic for control a psychosocial orientation scale was applied. His compliance to disease was fairly good.

There were anxiety, lack of social support, reduced income level and various psychosocial factors which progress up to fear. Mr. H. is a 54-year old married man and he is a secondary school graduate, and is working in a restaurant since his present financial situation is not efficient. He demonstrated behaviors of anxiety, panic, uneasiness, gabbing and restlessness and an increase in tendency toward violence, irritability, isolation from society and timid behaviors were observed. Patient had a history of difficulty in establishing friend-relationships and there was an anxiety caused by gabbing and difficulty in expressing himself. During interview his actions were restless and just like he wanted to leave right away. He had fears of being disgraced in front of strangers. He said he was afraid of being ostracized from public because he was stammering. Nurses taking place in health team to arrange training programs related to issues such as appropriate diet toward MI, regular intake of medications, quitting smoking, reducing weight, increasing social support, coping with stress and anger control facilitate individuals who undergone MI compliance to disease and decrease their anxiety.

To evaluate the validity of nurses’ reports as a screening tool for anxiety and depression in hospitalized patients admitted for Coronary Artery Bypass Graft.

Within 72 hours of admission, the patients were assessed using the Hospital Anxiety and Depression Scale (HADS). Simultaneously, the nurses who provided care for the patients were asked whether they believed the patients had significant levels of depression or anxiety. They were also asked to rate the degree of depression and anxiety of their patients in a 5 point Likert scale. Assessments were completed for 150 patients.

According to HADS score, 67 (44.66%) patients had probable depressive disorders (HADS-D score > 7) and 57(38%) had probable anxiety disorders (HADS-A score>7). Nurses recognized 31(20.66%) patients had depressive disorder and 24(16%) had anxiety disorders. The correlation coefficient between nursing diagnosis and diagnosis according to HADS was small (phi = 0.24, P < 0.01). No significant correlation was observed between HADS scores and the nurses’ assessment of severity of depression and anxiety. Comparing with HADS, the sensitivity, specificity and positive predictive value for nursing reports was 0.25, 0.55 and 0.41 for depression and 0.66, 0.57 and 0.72 for anxiety respectively.

This study indicates nurses’ reports may have not enough validity and sensitivity to be used as the only way for screening anxiety and depression in patients admitted for cardiac surgery. A consultation-liaison psychiatry service that include an active case finding strategy by using standard instrument and educational program for nurses may be helpful.

Pegylated-interferon (pegIFN) plus ribavirin (RBV) is for the moment the licensed therapy for chronic hepatitis C. Neuropsychiatric symptoms are frequent side effects due to the treatment with pegIFN, registered in 30 to 80% of instances, with mood rather than psychotic disorders usually observed.

A manic profile with psychotic symptoms in a HCV infected patient receiving pegIFN-RBV is presented to discuss management strategies and outcome.

A 47 year-old male patient, former IDU and alcohol abuser, without past psychiatric history, was under therapy for chronic hepatitis C (genotype 1a, HCV-RNA 6.2 log IU/mL, Child A5). After 14 weeks of pegIFN-RBV treatment the patient attends ER with insomnia, uneasiness, expansive mood, irritability, extravagant and disinhibited behaviour, and detrimental and self-referential delusion.

The patient was admitted at the Psychiatric Unit to receive amisulpride (400 mg/12h) plus lorazepam (1 mg/8h), with psychotic symptoms regressing over following days. It was agreed that psychotropic drugs would be maintained at the same doses until the end pegIFN-RBV therapy, intended for 48 weeks.

Antipsychotic therapy may be effective and allows VHC infected patients with manic symptoms related to pegIFN-RBV therapy to continue their treatment.

The main purpose of mental health, prevention of the occurrence of adversity and minor behavior disorders and health promotion, mental health is the best form.

This study reviews the relationship between mental health and its impact on family aggression male and female students Payam Noor University is the center of Babol.

Descriptive study methods - is solidarity. Statistical Society study male and female students of Babol University of Payam Noor Centre in 89–88 school year are studying make up. Sample consisted of 100 male and female students to simple random sampling method chosen. Data collected in this study were two questionnaires: General Health Questionnaire (GHQ) and the aggression questionnaire (AQ) is. And to analyze the data and the correlation coefficient R. The T method through SPSS software was used.

Results showed that families with mental health among students, male and female aggression significant relationship exists. The results also show that between family and mental health scores of aggressive students, and significant negative relationship is seen. Whatever the mental health students is more aggressive than they would be.

The Role of Family Mental Health Dreaming family undoubtedly provides mental health and prevents distractions behavior has a major role.

One of the objectives of nursing education is helping nursing students acquire the knowledge, skills, and behaviors needed to deal with various problems.

The study is descriptive.

To determine the “problem solving skills” of the 1st-year and 4th-year students.

The study is a descriptive one. The study sample comprised a total of 153 students in their 1st-year and 4th-year in Department of Nursing, Cumhuriyet University, Turkey. The research data were collected by means of the “Personal Information Form” developed in light of the relevant literature review and the “Problem Solving Inventory” which was developed by Heppner and Peterson (1982) and tested in Turkey in 1990 by Taylan in terms of fist validity-reliability properties.

Of the first year students, 84.9% lived in a nuclear family, 61.6% lived in a city, 39.5% were first-born children. Of the fourth year students, 81.0% lived in a nuclear family, 67.2% lived in a city, 37.3% were first-born children. All of the students financial needs were met by their parents. There was no difference between the total “problem solving confidence” scores of the first year students (85.942 ± 16.649) and the fourth year students (81.866 ± 19.168) (p > 0.05). According to the sub-scales of the inventory, the first year students received higher scores than the fourth year students in “problem solving confidence”, “approach-avoidance behavior” and “personal control” (p > 0.05).

The education received by the students did not make a difference in the development of their problem solving skills.

Symptoms of physical pain can indicate a current depressive episode. The study aimed to assess pain symptoms among physically ill general hospital patients and to explore if pain symptoms are more prevalent among physically ill patients with a depressive episode than among those without a depressive episode.

Pain symptoms were assessed by a modified version of the Patient Questionnaire (Spitzer et al1). Diagnosis of a current depressive episode was made by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version2).

Of the 290 patients included in the study 247 (85.2%) indicated at least one pain symptom. About a fifth of the patients suffered from a current depressive episode. Physically ill patients with depression suffered significantly more often from pain and reported significantly more often three or more symptoms of pain than those without depression.

Headaches, stomach pain and chest pain were significant independent predictor variables for depression in a multiple logistic regression analysis controlled for age, gender and primary somatic diagnosis.

Patients in general hospital who suffer from pain symptoms should be checked physically and psychologically in order to detect a comorbid depressive episode.

1Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:1749-56.

2Wittchen, H.U., Pfister, H., 1997. DIA-X-Interviews. Manual für Screening-Verfahren und Interview; PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt, Swets & Zeitlinger.

Each year around 1/10,000 of general population sustain a traumatic brain injury (7,000 individual in UK) and as a result have an increased risk of epilepsy in the long term.

To the best of our knowledge there is not much literature available on incidence and prevalence of epilepsy following ABI in the group of patients who develop psychiatric presentation as a result.

To ascertain the prevalence of epilepsy in a group of in-patients with neuropsychiatric presentation admitted in a tertiary Brain Injury Neuropsychiatry Centre.

A cross sectional survey of healthcare records of 125 in-patients was carried out to ascertain the diagnosis of epilepsy. The current diagnosis of epilepsy and frequency of these patients’ seizures as well as history of early seizures following ABI were noted.

Out of 125 patients studied, 40 (32%) were diagnosed with epilepsy at some point following their brain injury or at the time of survey. Out of these, 35 patients had active epilepsy at the time of the survey with definite seizures witnessed and documented in the in-patients notes. Fifteen patients had had seizures in early phase following their ABI and no seizures reported since.

Patients who present with either cognitive impairment, challenging behaviour or and psychiatric illness are at a higher risk of epilepsy compared to those reported in general Brain Injury Neuro-rehabilitation setting. This could be explained by severity of ABI or the areas of brain damaged which may be involved in neuro-psychiatric presentation also causing epilepsy.