Anorexia nervosa (AN) is a complex and severe psychiatricdisorder. Currently, treatment has limited effecttiveness.

Articles in Pubmed and TripDatabase, using 'anorexia nervosaand therapeutics'. Also activated filters: publication date from2013/09/01 to 2014/09/31.

The update of the lastest publications on treatment of anorexia nervosa.

We select six studies (two reviews and five clinical trial)because of the topic relation and the high leve of evidence.

One review is about Neuromodulation effects and the other aboutDeep-brain stimulation on AN. Two of the clinical trials are about psycotherapyand two about pharmacological treatment.

Psycotherapy is the treatment of choice, although in that momentwe can found studies about alternative treatment for specific cases.

Neuromodulation tools havepotencial for reducing eating disorderssymtomatology and realted behaviours. Preliminary results about Deep-brainstimulation showed that may be is a option for weight restoration inotherwise-refractory and life-threatening cases. Both reviews required morereserch to evaluated the long-term outcomes in eating disorders.

Focal Psychodynamic therapy proved advantages in terms of recovery at 12-month follow up, and enhanced Cognitivebehaviour therapy was more effective with respect to speed of weighgain and improvements in eating disorders psychppathology.

Cognitive Remediation therapy study confirms the feasibility for anorexia nervosa.

Relative to pharmacological treatment, Dronabinol insevere AN induce a smal but signoficant weight gain. And Lamotrigina studyshow that maybe is useful in patients who binge eat and purge.

To examine the factors that can predict the likelihood that a patient presenting to the Emergency Room will have impaired insight.

Twenty-two independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the crisis team in the ER over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression.

Only four (employment status, history of self-harm, reason for presenting to the ER and psychotic symptoms present) of the twelfth-predictor variables on univariate analysis made unique statistically significant contributions to a logistic regression model. Patients who were unemployed or had a history of self-harm were about two and three times respectively more likely to have impaired insight compared with those who were employed or had no history of self-harm, controlling for other factors in the model. Patients who had psychotic symptoms on mental state examination were about six times more likely to have impaired insight compared to those who did not have psychotic symptoms, controlling for other factors in the model. Patients presenting to the ER with psychotic symptoms or drug/alcohol problems as chief complaints were 25 times and four times respectively more likely to present with impaired insight compared to patients presenting with a medical complaint, controlling for other factors in the model.

Patients presenting to the ER with a psychotic symptom and those with psychotic symptoms on metal state examination as well as those presenting with drug/alcohol problems are candidates for an insight-oriented psychotherapy.

having a dedicated psychiatric team embedded in a busy emergency department is conducive to providing a higher quality of mental health care, decrease the adverse occurences associated with boarding the severely mentally ill.

Aggression is common in children and adolescents on psychiatric units. Rates ofaggression are 27% to 78% on forensic adolescent units, and similar onnon-forensic units. Sometimes rapid tranquilization is needed for managing thisproblem – but no good quality systematic reviews exist for this population.

Weplanned to do a systematic review of psychotropics compared to placebo or otherpsychotropics by any route used as rapid tranquilization in aggression in childrenand adolescents with any mental disorder.

The aimis to provide evidence based and generalisable knowledge.

The‘PICO’ is as follows: Populationis children and adolescents up to the age18 with aggression and a mentaldisorder; Interventionsare psychotropics by any route; Comparisonsare placebo or other psychotropics by any route; and Outcomes are efficacyand safety. Only RCTs are eligible. A comprehensive search is carried outof Medline, Embase, Psychinfo and other databases. Articles selection anddata extraction is carried out by two reviewers independently for reliability. Articles are assessed for quality. Meta-analysis is preferred if warranted byheterogeneity assessment; otherwise narrative synthesis will be done usingGRADE evaluation.

Thereview is underway. The effect sizes would be as follows: for dichotomousoutcomes relative risk, absolute risk change and numbers needed; and forcontinuous outcomes mean difference or standardized mean difference. Thesewould be sensitivity analyzed. If meta-analysis were not warranted, thennarrative synthesis will be presented.

Conclusions will be drawn for relative efficacy and safety of thepsychotropics.

Suicide is a serious public health problem in Western countries. In Spain, suicide is the leading cause of unnatural death in front of traffic accidents. The presence of a mental disorder is referred to as a risk factor of great interest both for its presence in suicides and the possibility of being treated and thus to reduce the risk of suicide.

Study the presence of psychiatric diagnoses in subjects entering the treble unit of Huelva for attempted suicide.

We conducted a retrospective study comparing the data obtained with this material in the literature. Statistical analysis was performed using the statistical package SSPS.

In the process of data analysis.

1. - Presence of diagnosis and prevention opportunities

2. - Differences between sexes.

3. - Further exploration and increasing the sample compared to suicides

Home treatment Team deals with high turnover of patients with significant risks on daily basis. There have been complaints by General Practitioner’s that discharge letters have inconsistent information regarding medications, risks and diagnosis.

To standardise the content of discharge letter, improve the communication between primary and secondary care and to reduce medication errors eventually maintaining remission.

It is a retrospective audit done in May 2014 looking at the discharge letters to primary care in the month of October 2013. As there were no standards to compare, internal standards were set up for the purpose of audit based on the discussions with various General Practitioners.

Discharge letters were scrutinised based on the Primary and Secondary diagnosis with ICD 10 category, clear documentation of risk and details of medication including name, dose, frequency and duration. Audit tool was devised looking into this and 54 out of 108 patients were selected randomly and audited.

Although majority had diagnosis stated quality of discharge summaries were variable with lot of psychiatric jargons. Risks were documented in an unstructured manner with inconsistent management plans. Most of the letters had medications with some had no dosage or frequency documented clearly.

Results were discussed and presented in academic programme in the trust. New template was devised with all the relevant information and implemented successfully. Re audit to done after 6 months with the view of replicating trustwide.

Agitation is a broadly defined phenomenon that is associated with many physical and mental illnesses. The core features of agitation generally include: irritability, excessive or semi purposeful motor activity, heighted responsiveness to internal and external stimuli and an unstable course. Inhaled Loxapine is recently available as a new approach in the management of these episodes.

To present case reports of Inhaled Loxapine in the treatment of agitated patients in our clinic.

We have selected representative case reports form our acute unit characterizing the patients´ history and the circumstances of present admission, the evolution and the management of these episodes during the admission.

Inhaled loxapine as a new treatment option allows rapid control of agitation in these unstable patients who can suddenly turn into aggression or violence, facilitating the therapeutic alliance between the patient and physician without resorting to mechanical or physical restraint.

The financial crisis that began in 2008 affecting many European countries and mainly Greece has an ongoing impact on public mental health and quality of life. The aim of this study was to investigate the potential impact of the financial crisis on criminality verifying differences in crime rates between the years 2008 and 2011 in Greece.

Data on crime in Greece for 2008 and 2011 were provided by the Crime Analysis Section of the Public Security Department of the Hellenic Police Headquarters. In order to create a comprehensive global index of criminality we calculated an overall crime rate including the following crimes committed: homicides, financial crimes (fraud, extortion), drug-related crimes, illegal weapon possession, sex-related crimes (rape, sexual exploitation), thefts/ burglaries and robberies. The overall and the aforementioned specific crude crime rates were calculated per 100,000 residents. Paired samples t-test was used to examine the differences in the rates between 2008 and 2011.

A significant increase in the overall crime rate between 2008 and 2011 (t=5.01, p=0.001) was found. Moreover, between 2008 and 2011 there was significant increase in the crude rates of homicide (t=2.41, p=0.03), fraud (t=7.35, p=0.001), extortion (t=3.22, p=0.009), illegal weapon possession (t=5.27, p=0.001), theft/burglary (t=4.62, p=0.001) and robbery (t=3.23, p=0.007). There were not statistical differences in the crude rates of sex-related and drug-related crime.

According to the results of this study criminality in Greece shows significant increase during the current financial crisis as reflected in many crime indicators.

The term ‘revolving door (RD) phenomenon” was coined to define recurrent hospitalizations of chronically ill patients after closure of psychiatric hospitals and implementation of community treatments.

Continued readmissions require a large portion of Mental Health Departments’ resources.

To analyze the RD phenomenon in an acute psychiatric ward during a 5-year period.

We retrospectively selected all patients with 3 or more hospitalizations per year from 01/01/ 2009 to 31/12/2013 in SPDC-Modena Centro. From their medical records we collected selected variables, potential predictors of RD phenomenon. Data were statistically analyzed.

In the 5-year period, a sample of 105 patients (47 females, 58 males) with an average age of 40.25 years (± 13.47 SD), 5.68 % of all inpatients (n = 1850), realized 778 hospitalizations, 23.94 % of all admissions (n=3250). The most frequent reason for admission was ‘worsening of psychiatric symptomatology” (55.27%). The most frequent diagnoses at discharge were ‘Schizophrenia” (41.26%) and ‘Personality Disorders” (25.32%). Most of RD patients (87%) were Italian, only 15 % were employed and 50 % lived with family. The mean duration of RD hospitalizations (12.23 days ± 18.37 SD) was statistically significantly different from all others in the 5-year period (10.39 days ± 11.09 SD, p=0.0008, t test) as was the frequency of compulsory admissions (RD hospitalizations 18% vs. 26% all others, chi2, p<0.001).

Our RD patients represented a small percent of all inpatients but required many and long hospitalizations, probably due to severe and disabling illness.

In the last years in Greece, one the most controversial issues has been the probable increased rate of suicides in the middle of a financial and social crisis. The purpose of this study was to see the change of the profile (type and frequency) of suicide attempts referred to a big General Hospital in the years before and during the financial crisis.

Data were collected both from the Emergency and the Outpatient Departments of the Psychiatric Sector of our Hospital between the years 2008 and 2013. Data were analyzed with a SSPS package using t-test, ANOVA and Multiple Regression analyses.

The number of suicide attempts recorded didn’t differ significantly in the years before i.e. 2008 and 2009 and during the financial crisis, between 2010 to 2013. During the deepening of the crisis (2012), a statistical difference was found as for the reason stated. This has been,as reported by the patient, financial difficulties, correlating (p<0.01) with the degree of GDP decline . In the half of 2013 there was no correlation of the attempts with the financial difficulties.

The suicide rate change in Greece has been a topic for an ongoing discussion. These results are inconclusive regarding the change in the profile or in the number of suicide attempts before and after the 2010 debt crisis. The yearly number in suicide attempts didn’t differ significantly between 2008 and 2013 . The patients’ reason of the suicide attempt was financial insecurity during the worst year of the crisis, i.e. 2012.

Social support networks, with greater support from families, friends and communities are linked to better health. Also, due to the present economic condition they might be the only solution for rehabilitation in patients with lower income.

Aim: To investigate the way that social support network can help patients with rehabilitation after hospitalization.

All patients that were referred to the social workers network from 2012-2013 were assessed in order to find those who seek rehabilitation programmes. Analysis was performed with SPSS21.

143 patients, 100(69.9%) males, 81(71.7%) with lower education were referred for rehabilitation and poverty reasons. 117(81.8%) were Greeks 75(52.4%) single, 99(69.2%) had no insurance and 125(87.4%) unemployed. The referrals were made mostly from social hospices (N=71) and the hospital clinics(N=59), while the amount of patients was almost identical for the two years(47.6% for 2013 and 50.4% for 2012 respectively). The main reason for the referral was poverty(N=117 81.8%), poverty and health problems(N=22 18.4%), psychiatric problems(N=2 1.4%) and HIV(N=2 1.4%). In the majority of the cases(N=106 74.1%) there was a successful result in finding a rehabilitation hospice. Finally, there was a statistical significant difference between those that had family-support(N=47) and those that didn't(N=96) in the referrals amount (x2=10.894 p=.02).

Results indicates that family is a protective factor against social support need, but due to the economic condition and new family bonds, a growing number of people still needing help, even if they have a family that could support them, something that should be further investigated.

There is a growing evidence for clinical effectiveness of Home Treatment for <a name="OLE_LINK2"></a><a name="OLE_LINK1">patients with severe psychotic disorders</a>. Here we present the development and implementation of a manualised assessment-based Home Treatment in Germany.

We compared the 6-month effectiveness of an assessment-based Home Treatment in patients with schizophrenia spectrum disorder to standard care in a catchment area design.

The primary outcome criteria was the rehospitalisation rate. Secondary outcomes comprised improvement of symptoms, functioning, quality of life, medication adherence and satisfaction with care.

Assessments were carried out at baseline and at 3 and 6 month. Inpatient admission and treatment contacts were assessed from the hospital database.

We visited 20 patients with severe psychotic disorder (ICD10: F2.x) almost 400 times in twelve months. The median was 15.5 visits per patient. The intervention resulted in a highly significant reduction of the rehospitalisation rate (−51%, P<.01) and we found a significant improvement in Medication Adherence within the first 3 months using the Morisky-Score (P<.01). There wasn´t any significant change in clinical outcome regarding variables from Psychopathology with the Positive and Negative Syndrom Scale (PANNS), Global Assessment of Functioning (GAF), Quality of Life (The World Health Organization Quality of Life, WHO-QUOL) and client satisfaction (ZUF-8).

Applying assessment-based Home Treatment for patients with severe psychotic disorders is an alternative treatment compared with standard care resulting in a significant lower rehospitalisation rate with an equivalent clinical outcome.

Endorsing self-stigmatizing thought per se needs not produce chronic distress. Only when it occurs frequently and automatically as a mental habit does this create constant mental turmoil. The cognitive content and the habitual process of self-stigma should be assessed independently among people with mental illness. Although existing measures can assess the content of self-stigma (i.e., the extent of self-concurrence with negative stereotypes of mental illness), none of them assesses the process (i.e., the habitual quality of self-stigmatizing thinking).

The present study aims to develop and validate a measure of the habitual process of self-stigma, that is, the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale.

Ninety five people with mental illness completed an initial version of the STAR together with a measure of the cognitive content of self-stigma (i.e., the Self-Stigma Scale—Short Form [SSS-SF]).

Exploratory factor analysis suggested a 2-factor structure of the STAR (i.e., repetition and automaticity of self-stigmatization). The four highest-loading items on each factor were selected to constitute the final version of the STAR. The 8-item STAR and its subscales demonstrated excellent internal consistency. The STAR showed significant but moderate correlation with the SSS-SF.

With the validation of the STAR, the time is ripe to move beyond a global evaluation of self-stigma as a content-oriented construct and to understand both the content and process of self-stigma, so that the diversity and complexity of its impact on people with mental illness can be more fully captured.

One in three people detained in Italian Penal Institutions suffer from mental disease. The rate of suicide among prisons’ population is higher than among general population. The high prevalence of mental disturbs and the comorbidity with infectious diseases and drug addiction is well recognized. The conditions of Judicial Psychiatric Hospitals, institutions for criminals judged social dangerous and unable to understand and act, are even more critical. Therefore, the Right to Health in jails is constantly questioned.

The aim of this work is to analyse Italian penitentiary situation in order to understand the causes of these inequalities in Health, with the perspective to promote mental health and to ensure the Right to Health.

This paper is the result of the first step of the International Project ‘Caught From Inside – The Other Side Of Life”: a one-year research led by the Research Group of SISM – Segretariato Italiano Studenti in Medicina, Italian Member of IFMSA (International Federation of Medical Students’ Association), starting from a bibliography provided by Academic Supervisors.

It results that mental health and illness, as well as health and illness in general, are determined by multiple social, biological and psychological factors. In order to obtain significant gains in prisoners’ mental well-being may be useful to forge interdisciplinary collaborations between those working in socio-political and health domains.

Virtuous examples are those Countries where Penitentiary System is not merely custodialistic and the Institutions are closer to inmates, much more customised, targeted, linked to outside healthcare facilities, preventive.

Counseling and psychotherapy are among the recommended forms of treatment for major depressive episodes (MDE). In this population-based study, we examined individuals’ receipt of these services during acute treatment in a Canadian setting.

We identified a cohort of individuals who initiated MDE treatment between October 10, 2010 and October 9, 2011 in British Columbia, Canada using data from physician claims, hospital separations and community mental health treatment registries. To be included individuals must have at least one of the following: two or more outpatient MDE diagnoses; one or more inpatient MDE diagnosis; one or more MDE diagnosis in the community registry. We excluded individuals who were: a) diagnosed with schizophrenia or bipolar disorder in the previous 12 months and during the first 12 weeks of treatment; b) hospitalized or received outpatient treatment for MDE 12 weeks prior to initiating treatment; and c) under 19 or over 65 years of age. We tracked this cohort’s receipt of counseling/psychotherapy for 12 weeks starting from the day MDE was diagnosed. We performed multivariable regression analyses to examine factors associated with use of counseling/psychotherapy.

A total of 86,264 individuals met inclusion criteria, composed mostly of women (67%) and individuals between 36 and 55 years of age (52%). Around 57% had at least one and 27% had at least two counseling or psychotherapy visits during the first 12 weeks of treatment. We will present results from multivariable regression analyses that examine factors associated with receipt of counseling/psychotherapy and discuss their policy implications.

The recent economic recession and the subsequent strategy of austerity have deceased the amount of resources devoted to health care. They may also have contributed to the deterioration of the population health.

To assess the impact on mental health of the economic recession in the district of Sassuolo (Modena), by collecting and analyzing opinions of local Occupational Physicians.

METHODS Qualitative survey, by focus groups, conducted in Sassuolo (Modena), industrial center of ceramics, involving 8 Occupational Physicians active in the area. Rough descriptions analyzed independently by GU and GM using MAXQDA, with the independent supervision of a third researcher (SF), according to the principles of the General Grounded Theory. The second focus groupwas intendened as respondent validationof the first, yet it gathered further data, up to theortical saturation.

Two focus groups, about one hour long, attended by 8 Occupational Physicians, 7 during the first focus group, 4 during the second (of these, 3 attending both focus groups). The coding process yielded 261 segments, divided into four main areas: “changes in contemporary world” (16 coded segments), “social area” (82 coded segments), “medical area” (94 coded segments), “working area” (69 coded segments).

The impact of the economic crisis on health produced mainly negative consequences, locally, consistently with national data. Psychiatrists should work together with Occupational Physicians to develop targeted interventions, addressing social, political and medical needs. A more structured liaisonbetween Psychiatry and Occupational Medicine is an interesting and useful tool for future action and advocacy.

Although many people with mental illness (PMI) may self-concur with negative stereotypes of mental illness ('stereotype self-concurrence”) at some point, they may have different degrees of habitual recurrence of such self-defeating perceptions ('habitual self-stigma”), which could further exacerbate the experience of self-stigma and perpetuate its adverse effects on mental well-being. The present study evaluated the prevalence of stereotype self-concurrence and habitual self-stigma in a community sample of 187 PMI in Hong Kong.

Stereotype self-concurrence was assessed using the Self-Stigma Scale—Short Form. The 9-item SSS-SF was rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Categories of minimal (<3), mild (3-3.5), moderate (3.5-4), and severe (>4) levels of stereotype self-concurrence were defined based on the mean scores of SSS-SF.

Habitual self-stigma was assessed using the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. The 8-item STAR was rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Categories of minimal (<2), mild (2-3), moderate (3-4), and severe (>4) levels of habitual self-stigma were defined based on the mean scores of STAR.

Stereotype self-concurrence was minimal in 40.1% of participants, mild in 9.1%, moderate in 16.6%, and severe in 34.2%. Among participants with mild-to-severe stereotype self-concurrence, the prevalence of minimal, mild, moderate, and severe habitual self-stigma was, respectively, 2.7%, 33%, 56.3%, and 8%.

Self-stigma appears to be a common experience among PMI. The development of interventions to target stereotype self-concurrence and habitual self-stigma deserves high priority in research efforts.

Meeting patients’ needs is of great importance for ensuring quality of life and reducing social disability in severe mental disorders, such as schizophrenia. However, the degree of agreement between patients and their therapists in the assessment of needs warrants further investigation, regarding that high patient-therapist agreement is associated with improved outcomes.

Current symptomatology might differentially affect the self-report and clinician-rated appraisal of schizophrenia patients’ needs.

To examine the potential impact of current symptoms on patients’ and therapists’ assessment of patients’ needs.

Fifty-three schizophrenia patient–staff pairs were interviewed using the Greek research version of the Camberwell Assessment of Need (CAN-R). Patients’ symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS).

The degree of agreement between staff and patients in the assessment of needs was high. Significant correlations were found between the total number of needs and all the dimensions of PANSS (positive, negative, general psychopathology) in the staff group but not in the patient group. In both groups, the total number of unmet needs was significantly correlated with the general psychopathology and the total PANSS scores.

The constancy of the therapeutic context might contribute to a high rate of agreement between patients and staff about needs of the latter. The severity of symptoms may influence clinicians’ assessment of schizophrenia patients’ needs. Nevertheless, according to both patients’ and therapists’ assessments symptom severity is associated with greater number of unmet needs.