Although discussed controversially, coercive practices during involuntary admission are common in mental health services. The impact of physical restraints on patients has not been sufficiently studied.

To investigate the subjective perception of patients during and after physical restraint.

47 patients in a psychiatric intermediate care facility experiencing belt fixation were interviewed and filled out self-assessment forms at 4 visits.

The median duration of restraint was 99 hours. Median VAS scores indicated moderate levels of anxiety. With increasing time span from the fixation, memory regarding this event decreased and patients experienced a regain of self-control. Consistently, 50% perceived high levels of coercion at admission, PTSD could be supposed in 25% of the patients.

Despite a considerable restraint of freedom, distress related to belt-fixation seems acceptable in our sample. Patients’ disapproval concerning restraint measures seems to diminish with time, probably related to decreasing memory regarding the fixation practice.

Hospitalization is a major therapeutic tool for management of psychiatric emergencies. However, the doctor does not have a specific consensus outlining the most important variables in order to sit this decision.

Our purpose was to identify the factors affecting the decision of hospitalization in a psychiatric service via emergencies.

It is a cross-sectional study conducted in the medical emergency department of university hospital in Mahdia during twelve months. The Canadian Triage and Acuity Scale (CTAS) was used to specify the degree of emergency.

Among the 513 patients referred to the emergency room, 201 were hospitalized with a prevalence of 39,5%. The most represented age group was between 25 and 34 years old in 35,3% of cases and the sexe ratio (M/F) was 2,65. The factors having an impact on the decision of hospitalization were: male gender, single status, low socioeconomic level, absence of professional activity, presence of family or personal psychiatric history, previous hospitalizations in psychiatric department, precipitating event, heteroagressivity and restlessness as reasons of consultation, demand for care from third parties and level 2 in CTAS reflecting a true emergency.

The identification of these factors contributes to make an objective decision regarding the psychiatric hospitalization.

The frequent use of psychiatric emergency poses problems due to the loss of their adaptative capacity and diagnosis, orientation and therapeutic difficulties for clinicians.

To estimate the prevalence of frequent visitors to psychiatric emergency and to describe their sociodemographic and clinical characteristics.

It is a cross-sectional study of twelve months including patients who consulted at least twice to medical emergency department in the university hospital of Mahdia. Data were collected using a predefined questionnaire.

The prevalence of recurrence was 30,2%. The main characteristics were: a mean age of 35,5 years, a male gender (64,5%), being unemployment (72,3%), a single status (71%), a request from the family (55,5%) and the presence of psychiatric personal history (91,6%). Previous hospitalizations were noticed in 69% of cases. 44,5% of the patients had problems with the primary support group and the social environment. In 78,6% of cases, patients had visited emergency twice to four times. The most encountered reason for consultation was heteroagressivity (27%) and the most frequent syndromic diagnosis was psychomotor excitation (25.2%). Hospitalization concerned 47.1% of patients. Schizophrenia and bipolar disorder were the most diagnosed disorders in 54,2% and 25% of cases.

Absence of intermediate structures and lack of coordination between the various stakeholders involved in the management of patients are the two main encountered problems.

The psychiatric emergency is real challenge in medical practice. Thus, Knowing the properties of a population attending an emergency department must improve its functioning.

To estimate the prevalence of psychiatric emergency and to describe its epidemiological and clinical characteristics.

It's a descriptive cross-sectional study of 12 months conducted in the medical emergency department of the university hospital of Mahdia. We have included patients for which a psychiatric evaluation was requested. The Canadian Triage and Acuity Scale (CTAS) was used to specify the degree of the emergency.

The prevalence of psychiatric emergency was 7,9%. The general characteristics were: an average age of 34,7 years old, a sexe ratio (M/F) of 1,38, a single status (66,4%), a secondary education level (45%) and presence of psychiatric personal history (70%). The two most common reasons for consulting were suicide attempts and heteroagressivity in 17,5 and 17,2% of cases. According to the CTAS, the level of emergency was 2, 3 and 4 in 80,9%. 40% of patients were referred to consultation while 39,5% of them were hospitalized in psychiatric departments. For those one, the diagnosis was schizophrenia in 55.7% of cases. The average period of hospitalization was 25 days.

The response to psychiatric emergencies depends on the type of the disorders and the diachronic aspect.

Aggression is a common consequence of traumatic brain injury (TBI). Agitation may be predictive of longer length of inpatient care and poor progress.

To evaluate the efficacy and tolerability of Antipsychotics for management of aggression in TBI.

Systematic review of RCT's to evaluate efficacy and tolerability of Antipsychotics in treatment of aggression in TBI.

MEDLINE, PubMed, Psychinfo, Embase searched from 1990 till 2014.Search terms Brain Injury, Head injury, Traumatic Brain Injury, Agitation, Aggression, Violence, Irritability, Episodic dyscontrol, Antipsychotic medication were used.

50 papers were screened based on pre-set criteria. 3 clinical trials were identified for final analysis. 1 study compared oral haloperidol and oral droperidol; the second study compared intramuscular droperidol and haloperidol. The third study compared oral Quetiapine and Chlorpromazine.

Jadad scale was used to assess the quality of trials.1 study reached a Jadad score of 3, the other two did not score.

Better tolerability reported for Quetiapine, which was effective in reducing aggression in doses of 25mg to 300mg. Time to achieve calming was significantly shorter with intramuscular droperidol (mean = 27 minutes) compared to intramuscular haloperidol (mean = 43 minutes). Single doses of droperidol controlled agitation more frequently and with less post-episodic sedation. Oral haloperidol and droperidol did not show differences in their efficacy.

Overall the clinical trials were not of sufficient quality to accurately guide clinicians in the management of aggression and agitation post-TBI. The review identifies some evidence of efficacy of antipsychotic medication group in this patient population.

This work was supported by a grant of the Romanian National Authority for Scientific Research, CNDI– UEFISCDI, PN-II-RU-TE-2012-3-44

Ethics are important in psychiatry since psychiatrydeals mainly with human conduct and behaviour. Ethics are principles, notlaws but standards of conduct, which define the essentials of honourablebehaviour for the physician. Indian Psychiatric Society approved ethical guideline in 1989Cuttack conference.

Ethical issues depend on the following theories –

Utilitarian Theory– A fundamental obligation in making decision and is to try to producethe greatest possible happiness for the greatest benefit.

Parentalism-A person performing actions for another benefit without the person's consent.

Autonomy Theory –It is based on writing of Imanuel Kant. Relationship between a physician and anadult patient is conceived as relationship between two responsible persons.

Some common causes of malpractice in psychiatry seen in India arei) Negligence in diagnosis ii) Overlooking basic human rights iii) Consent nottaken from patient iv) Risk of suicide v) Experimentation by doctor vi)Negligence in physical methods of treatment vii) Seaxual relation with clientand Exploitation.

Now a days following forces are to be considered as new ethical challenges a)Rapidly increasing cost of mental health care b) Influence of new technologies likeMRI, CT SCAN Brain c) Societal reengineering for better mental health d)Increasing pressure by patient party e) Current market forces are demandinghigh quality health care.

Apracticing psychiatrist has to take more responsibility in management of mentaldisorders. One has to take it as normal inevitable professionalhazards.

The aim of this study was to find out attitudes and convictions patients have, What are their spiritual /religious (spir/rel) needs and whether and how they want to be addressed. There we asked which professions they want to be referred to and how this could look like. We have given the options of all professions that are available.

248 Patients at admission, 228 at discharge, Mean age 39.6 ± 13.4 years, June 2010 – December 2011 all new inpatients, open, prospective, explorative, cross-sectional Standardised Questionnaires developed by Arndt Büssing et al. & Questionnaire „Expectations towards the Clinic.

In the Self-rating whether clients call themselves as religious and/or spiritual the Distribution is similar to the regional general population. SPREUK-15 shows a higher percentage of patients are in a period of Reflection than in trusting in a higher guidance. Within the needs questionnaire patients significantly look for inner peace than rel/spir needs. Interestingly there is a percentage that feels it relevant that rel/spir is part of therapy (1/4), a high percentage think it is not so important and less 1/4 do not want it to be part. With whom that should happen number one are the psychotherapist followed by the chaplains.

This study provides first evidence that there might be different groups of patients who want rel/spir be part of therapy where others do not. Future studies are needed to be able to differentiate early enough and to find out what health care professionals should provide to meet these needs.

Revealing a diagnosis of cancer generates various psychological responses such as anxiety and depression which deteriorate the quality of life (QOL) of this patient.

Assess the level of both anxiety and depression in patients with cancer; assess the impact of their disease on their physical and mental QOL.

Deduct the risk factors of anxiety, depression and bad QOL.

Our study is transversal. It is conducted on patients hospitalized in the department of Carcinology CHU Habib Bourguiba in Sfax (Tunisia). The screening tool for anxiety and depression was HADS scale and the assessment of QOL was performed using the SF-36

We identified 50 patients. Concerning their psychological state, the one-quarter (23.9%) had a doubtful anxious state and the one-third (32.6%) had a certain anxious state. The depression was doubtful in 13% of cases and certain in 39.1%. The deterioration of QOL was significant (84.8%). The averages of both the physical score (PCS) and the mental score (MCS) was respectively 41.61% and 33.67%.

A bad QOL was correlated with locally-advanced to metastatic stage of cancer (p = 0.043), the time progression of the disease (>6months) (p?? = 0.01), moderate to severe pain (p ??= 0.028), radiotherapy treatment (p = 0.029) and the depression state (p = 0.023).

Our study underlines the necessity of screening both depression and anxiety in patients with cancer, in order to improve their QOL.

Treatment – both surgical and hormonal – significantly impairs the sexual function of men. Subsequently, the patients are at risk of adaptation disorders, including depression, in response to the cancer. Depression and severe chronic stress are other factors impairing sexual functioning.

The aim of this study was to determine the relationship between depression and men's quality of sexual life after prostatectomy for prostate cancer.

The study was cross-sectional and involved 112 men diagnosed with prostate cancer after prostatectomy. The study used questionnaires: the EORTC, QLQ-C30 with PR25 module, the Distress Thermometer, Sexual Life Satisfaction Questionnaire and the Beck Depression Inventory.

The level of depression in the study group was quite high (M = 27.20). The study showed a negative correlation between depressiveness and quality of life in all its dimensions. There was also a negative correlation between satisfaction of sexual functioning and distress, depression and quality of life in other dimensions. Those highly evaluating the possibility of relaxed conversation with partner about sex and satisfied with the frequency of extragenital caresses had lower severity of depression.

Psychoeducation about extragenital forms of sexual activity and also on the communication needs between partners can be an important factor in increasing the quality of life and reducing the risk of depression in patients with prostate cancer.

Beginning with classic Hollywood melodramas of the1940s, cinema has maintained a prolific output of films with their own take on mental illnesses – none more so than the rare syndrome of Dissociative Identity Disorder (DID). The DSM-5 provides criteria to diagnose dissociative identity disorder, 'two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self”, is the main one.

A brief description and discussion about the controversies surrounding the diagnosis and approaches to treatment of Dissociative Identity Disorder are presented, followed by a reflection about the use of this disorder in cinema.

A non-systematic literature review was performed in PubMed, about Dissociative Identity Disorder. Only original articles in English language were included. An informal search about films contemplating DID and their plot was also conducted.

Clinical findings suggest that DID involves an authentic mental disorder related to factors as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility and role-playing. As patients tend to switch personality states when there is a perceived psychosocial threat, the treatment goal is the fusion of the personality states while retaining the entire range of experiences contained in all of the alters. DID representations in cinema correspond closely to contemporary thinking about its phenomenology and aetiology.

Art imitates Life, but sometimes Life can fake the Art…DID may have had its turn…

Although 85% of inpatients with Borderline Personality Disorder (BPD) receive psychotropic drug treatment, no drug is approved for this indication so far. A dysregulation of the endogenous opioid system (EOS) has been posed to underly the neurobiology of BPD. Accordingly, the opioid antagonist naltrexone might be helpful to treat symptoms of BPD. Two small studies showed limited differences of naltrexone vs. placebo on dissociation, which were not significant, perhaps due to the low power of the studies:

Naltrexone was administered in treatment-refractory patients with BPD in a university department of psychiatry. This study aimed to assess the relative contribution of naltrexone and other psychopharmacological drugs to the improvement of overall symptomatology in patients with BPD.

A retrospective analysis of the charts of inpatients (n=161) with BPD was performed. Patients were classified as either treatment responders or non-responders. As all patients received multiple psychopharmacological treatments, stepwise logistic regression analysis was performed to detect, which drug contributed most to improvement of symptomatology.

None of the drugs applied contributed significantly to improvement, with the exception of naltrexone (odds ratio, p=2,9) Patients treated with naltrexone (n=55, 34,16%) recovered significantly more often and faster and, in particular, showed highly significant reduction of self-harm and suicidal thoughts. Higher doses of naltrexone treatment were more effective than low-dose treatment; however, the latter was still better than any other treatment.

Large-scale double-blind studies are warranted to examine the efficacy of opioid antagonists (naltrexone, nalmefene) in BPD.

Perfectionism is a personality traitcharacterized by a person's striving for flawlessness and setting excessivelyhigh performance standards, accompanied by overly critical self-evaluations andconcerns regarding others' evaluations. This trait has been associated with abroad range of psychopathological conditions, starting in adolescence. In this context, prevention of its effects must start early, and the efficacyof reducing perfectionist levels in adolescents must be empirically investigated.

Toanalyse, for the first time, if one session to cope with perfectionism has theeffect of reducing the levels of this trait after two and six months later. Method:868 adolescents (610 girls),aged 15.73±1.571 years, from two secondary schools in Coimbra, Portugal, answered the Portuguese validated version of the Child and AdolescentPerfectionism Scale (CAPS). Two groups were formed: intervention group receivedone skill session oriented to reduce perfectionism (N=615); control group withoutintervention (N=253). Both groupsanswered CAPS again after two/T1 and six/T2 months.

No significant differences betweengenders were found in Total CAPS, Self Oriented Perfectionism/SOP and SelfPrescribed Perfectionism/SPP. At T1 significant mean reductions were observedin SOP at the intervention group (T0= 39.58±8.554 vs. T1: 38.44±8.676 t= 3.498,p=.001) but not at the control group (T0= 40.48±8.998 vs. T1: 39.34±7.753 t=1.894, p=.061). No differences significant differences were found in Total CAPSand SPP. At T2, SOP reduction remained in the intervention group (T1=38.44±8.676 vs. T2: 38.67±8.375 t= -.640, p=.020).

Adolescents are sensitive to short interventionsaiming to reduce perfectionism.

Patient G. D. born in 1975, trained as a textile worker, unemployed, married, mother of three children. The current hospitalization was due to suicide attempts and manifestation of depressive symptoms after a stressful event.

Our diagnostic dilemma was whether it concerns:

1. - depressive disorder with psychotic symptoms

2. - adjustment disorder in people with personality disorder

After applying diagnostic procedures and observations during individual psychotherapy sessions, as well as the response to a given therapy, psychotic depression is excluded. The stories provided from the patient were in conflict since they have changed in contact with different therapists in the same department, why we decided to consult other professionals from other departments at which the patient apparently was treated.

In this disorder the patient is aware that he is exaggerating and faking illness, but in core of the disease is irresistible urge for pointing attention, and the cause is most likely a lack of love and affection in childhood.

In psychoterapic process was included family therapist also. Family therapist confronted patient with family members, which resulted in a real insight into the mental state and allowed us to confirm a diagnose of histionic personality disorder with tendency to pathological lying- Munchausen syndrome.

In this presentation, we wanted to point out the necessity of cooperation of a psychiatrist with other specialists, considering that patients with this disorder are prone to change therapists, hospitals and faking the results of diagnostic tests.

Pathological narcissism, described by two dysfunctional phenotypic forms – grandiosity and vulnerability – has often been connected to suicidal tendencies in theoretical and clinical literatures. Furthermore, shame-proneness has been implicated as a key mechanism that links these two constructs. However, empirical evidence for the presumed relationship between narcissism and suicidal tendencies is sparse, and no prior research has investigated the role of shame experiences in this relationship.

The goal of the present research was to investigate the relations between pathological narcissism (grandiose and vulnerable narcissism) and suicidal ideation in psychiatric outpatients. The potential mediating role of shame experiences in the pathological narcissism – suicidality relationship was examined.

A sample of 190 adult psychiatric outpatients (64% female; mean age 40.34 years), heterogeneous in terms of psychiatric diagnoses, was gathered between January and April 2014. The participants filled out the Pathological Narcissism Inventory (PNI), the Experience of Shame Scale (ESS), and the Suicide Assessment Scale – self-rating (SUAS-S).

Narcissistic vulnerability was found to have unique positive association with acute suicidal ideation, whereas narcissistic grandiosity exhibited no relation with the same construct. Moreover, two dimensions of shame – characterological and bodily shame – mediated the relationship between narcissistic vulnerability and suicidality.

Narcissistic vulnerability seems to be more strongly related to suicidal ideation than narcissistic grandiosity, while experience of shame represents one of the underlying mechanisms of this relationship among psychiatric outpatients. These findings have relevant implications for the diagnostic classification of pathological narcissism as well as its treatment.

Temperament and mental illnesses are considered to be varying degrees along the same continuum of neurotransmitter imbalance in neurophysiological systems of behavioural regulation. Three studies investigated relationships between temperament traits and clinical scales measuring five groups of symptoms of mental illness: Depression, Anxiety, Antisocial behaviour, Dominance-Mania and Borderline/Schizophrenia.

The intake records of 395 (Study 1), 331 (Study 2), and 214 (Study 3) clients of a private psychological practice were examined, including their scores on the Structure of Temperament Questionnaire (STQ-77); Study 3 used the Personality Assessment Inventory (PAI). The sample was divided into four age groups (17-24, 25-45, 46-65, and 66-84).

Study 1 and 2 found changes in the dynamical aspects of behaviour, such as endurance, plasticity and impulsivity in patients suffering from anxiety and depression. Study 3: Scores on the Depression- and Anxiety-related scales of PAI correlated with temperament scales of the STQ in a pattern similar to Studies 1 and 2. Anti-social scales of PAI correlated positively with Sensation Seeking and Impulsivity of the STQ-77. Higher Anxiety and Anti-social symptoms appeared to be more prominent in the younger age (unlike Depression symptoms), and declined with age. Dominance-Mania scores of PAI correlated positively with the Social-verbal Endurance and Tempo, Empathy and Self-confidence.

The analysis of age differences in association between temperament and mental illness showed age-sensitive patterns. Strong concurrent validity between the STQ-77 and the PAI scales suggests links between temperament traits and disposition for the main group of mental illness.

Dysphoria is a complex emotional state that seems to be present in many psychiatric disorders (especially in BPD), but whose psychopathological core is still surrounded by a halo of vagueness, so that measuring its construct empirically is difficult and suitable tests to do that do not exist in Italy.

To analyze the psychometric properties of the Italian version of the Nepean Dysphoria Scale (NDS; Berle & Starcevic, 2012), a self-report questionnaire that measures dysphoria, reflecting its multidimensional nature.

To validate the Italian version of the NDS for using it in routine clinical practice and to assess dysphoria in a more conceptually coherent way.

The NDS was administered to 132 university students, along with other conceptually similar (Beck Depression Inventory II, Dysfunctional Attitude Scale – Form A and Toronto Alexithymia Scale) and conceptually distinct (Anxiety Sensitivity Index – 3) instruments. Then, its characteristics (internal consistency, factor structure, convergent and divergent validity) were examined, comparing them with those of the original version.

The 22-item NDS demonstrated excellent internal consistency (alpha = 0.94). A four-factor solution was confirmed, with factors pertaining to irritability, discontent, surrender and interpersonal resentment. There were medium to strong correlations with the Beck Depression Inventory II, and weaker but still significant correlations with Dysfunctional Attitude Scale – Form A, Toronto Alexithymia Scale and Anxiety Sensitivity Index – 3.

The Italian version of the NDS shows good psychometric properties, maintaining a high equivalence with the original version. Further research on clinical samples is needed.

In the present study, Cloninger's dimensions of temperament and character have been investigated in patients with bipolar mood disorder-I (BMD-I), and obtained results were compared to those of healthy control participants from the general population.

This cross sectional study investigates 96 patients with BMD-I, selected based on DSM-IV-TR criteria, who are admitted into a psychiatry hospital due to an acute episode of mania, depression or mixed episode in year 2011 in Iran. After stabilization of acute phase, patients completed the 125-item Persian version of Temperament and Character Inventory (TCI). Seven dimensions of temperament and character were compared between the designated bipolar group and 1212 healthy individuals via independent samples t-test. Moreover, the correlation between age, duration of disorder, and mood variables (depression and mania scores) with temperament and character inventory scores were assessed by Pearson's correlation coefficient.

Bipolar patients showed significantly higher harm avoidance (P=.001) and lower reward dependency (P=.001), persistence (P=.044), cooperativeness (P=.001), self-directedness (P=.001) and self-transcendence (P=.004) in comparison with healthy individuals. In females, Reward Dependency (P=0.001), Self-Directedness (P=0.001) and Cooperativeness (P=0.001) scores were lower. Furthermore, TCI scores had no significant correlation with scores related to depression and mania, duration of the disorder and marital status.

Personality profile of patients with BMD-I differ from those of healthy individuals. Lower scores on Self-Directedness and Cooperativeness in bipolar patients seem to be related with more immature personality traits.

Recently the need for modern psychiatrists to have strong psychopathological bases has been repeatedly affirmed.

To provide a general overview on the current status of training and practice in psychopathology across Europe.

1. 1) to describe the current status of training on psychopathology;2)to identify the unmet needs of European residents in psychiatry;3)to suggest future perspectives of training in psychopathology.

An online survey, promoted by the EPA Section on Philosophy and Psychiatry, was carried out during the period July-December 2013. Forty-one representatives of early career psychiatrists of their national associations were invited to participate. Each respondent was asked to provide the collective feedback of the association rather than that of any of its individual officer or member.

Thirty-two associations returned the questionnaire out of the 41 contacted (response rate: 78%). All respondents recognize psychopathology as a core component of training in psychiatry. The primary aims of psychopathology are to assess psychiatric symptoms, to understand patients' abnormal experiences, and to make nosographical diagnoses. A formal training course in psychopathology is available in almost all surveyed countries. In most countries:1)there is not a defined number of hours dedicated to psychopathology;2)teaching is mainly theoretical;3)a structured training on psychopathological rating scales is missing. At the end of the training, about half of respondents is not satisfied with received training in psychopathology.

European early career psychiatrists clearly recognize the need to rediscover psychopathology, which represents the heritage of European Psychiatry. Initiatives to improve training and practice of psychopathology should be addressed by national and international psychiatric organizations.