Patients with schizophrenia, and first-episode patients in particular, suffer from stigma and discrimination due to their illness. Recently, interventions have been developed addressing stigma coping and empowerment strategies within psycho-educational or therapeutic group settings.

To provide such interventions in a purposeful way, it is essential to identify those patients who would benefit most of such interventions. We propose that personal stigma experiences are a promising concept to identify such patients.

Since most existing assessments of stigma experiences are interview-based or do not consistently discriminate between experiences of and beliefs about stigma, a short self-rating instrument assessing experiences of stigma and discrimination has been developed and tested in a sample of patients with first-episode schizophrenia.

Patients with first-episode schizophrenia (N=48 participants of the multi-center 'first-episode (long-term) study” of the German Research Network on Schizophrenia) completed a 5-item self-rating assessing the burden due to experiences of stigma and discrimination. Psychopathology, global and social functioning, self-esteem, quality of life and anticipated stigma served as variables to determine construct validity of the scale.

Average score of stigma experiences was 2.3 (out of 5 points). The stigma experiences score correlated significantly with lower quality of life, lower self-esteem and higher anticipated stigma.

The self-rating scale 'Burden of stigma experiences” is a promising instrument for identifying patients with a need for therapeutic or educational interventions addressing stigma coping. Validation studies in further patient samples would be desirable.

The aim of this study is to explore the relationship between births in different season and bipolar disorder.

For this purpose, a retrospective review of all psychiatric admissions in our hospital between 2002 and 2013 was performed, as well as the date of births and the final diagnostic codes according to ICD 10 for each hospital discharge. Only the first admission was included for each subject to avoid the confounding variable in frequency, caused by readmissions. An ANOVA analysis was used to calculate the differences between the months and the frequency of the diagnosis.

Significant differences that suggest a possible relationship between month of birth and Bipolar Disorder were found.

An important limitation is the large number of cases dismissed for improper coding and the possibility of changing the diagnosis of an individual throughout their lifetime.

Conducting prospective cohort studies to confirm this hypothesis are considered necessary.

There is only one Depaartment for Child and adolescent psychiatryin Bosnia and Herzegovina

To determine the structure of psychiatric morbidity, types and prevalence of certain diagnostic entities and sociodemographic characteristics of hospitalized patients at the Department of Child and Adolescent Psychiatry of Psychiatric Clinic in Sarajevo during the period from 2010 to 2014.

The study was conducted at the Psychiatric Clinic, Clinical Center of University of Sarajevo as retrospective. It included 394 subjects that were hospitalized at the Department of Child and Adolescent Psychiatry of Psychiatric Clinic during the period of 4 yrs. Data were collected from protocols of hospitalized patients.

The total number of hospitalized patients in the observed period were 394: 232 or 58,9% were males and 162 or 41,1% were females. The most common were patients in the age group 13-18 years (45,7%). The average hospitalization duration was 44,2±21,4 days. The most common mental disorders were from the diagnostic groups F90-F98 (Behavioural and emotional disorders in childhood and adolescence) and F40-F48 (Neurotic, stress-related and somatoform disorders). Disorders from the diagnostic group F90-F98 were more prevalent in boys, while disorders from the group F40-F48 were more prevalent in girls. Disorders from both diagnostic groups were most common in patients aged 13-18 years.

There are significant gender and age differences in the distribution of disorders from diagnostic groups F40-F48 and F90-F98.

Psychoses are severe mental disorders, which place a considerable burden on the caregivers.

Families experience a lot of physical, emotional and financial distress due to a patient’s abnormal behavior, and social and occupational dysfunction.

In countries like Tunisia, where rehabilitation services are almost nonexistent, the role of the family becomes more important.

Assess caregiver burden among relatives of patients with chronic psychoses.

This is a descriptive cross-sectional study regarding 40 caregivers accompanying patients with chronic psychoses (schizophrenia, bipolar disorder and non- schizophrenic psychosis).

The burden was assessed by the European version of the scale of the burden IEQ (Involvement Evaluation Questionnaire).

The average age of our population was 48 years.

Caregivers were as follows: siblings(35%), parents (27.5 %) and spouses(27.5 %).

Almost all of the caregivers (80%) lived in the same household as the patient.

Pathologies diagnosed in patients were schizophrenia (65%) and bipolar disorder (20%).

Most caregivers have an important sense of burden (IEQ> 15) with a percentage of 77.5%.

This burden was mainly due to the “tension” with a mean score of 5.6 and the 'supervision'with an average of 3.7.

A significant burden was found among caregivers without occupation (p = 0.028).

Patients Caregivers treated with atypical antipsychotic express less important burden (p = 0.032).

Caregivers of patients with chronic psychoses experience moderate to severe burden.

Caring for the psychotic patient need to change from a patient focused approach to a combined patient and caregiver approach.

Despite recent improvements in the Portuguese mental health services (MHS), the low priority given for a long time to mental health within the general context of the country's health services, illustrated by inadequacies in planning and funding models, led to a significant delay in the improvement of MHS, when compared to other European countries.

To compare the profile of MHS in Portugal 7 years after the launching of the National Mental Health Plan in the following dimensions: capacity (adults and child/adolescents), human resources and use of services (discharges, appointments, day hospital).

A full evaluation was conducted by the National Mental Health Programme, under the auspices of the General Directorate of Health, by means of a cross-sectional evaluation of national data.

Comparing the situation between 2005 and 2012, the most significant aspect is the reduction of the total number of beds in public MHS, mainly due to the elimination of 40% of beds in the decommissioned psychiatric hospitals. Regarding human resources, there was decrease in the number of psychiatrists working in public MHS. There was a significant increase in the number of outpatient appointments, both in child psychiatry (+30%) and adult psychiatry (+22%).

Tough the development of new MHS in general hospitals, some geographic areas are still not covered by these services, namely in the southern region of the country. There is also a significant scarcity of other professionals, which prevents the improvement of multidisciplinary and comprehensive work.

The financial crisis we are currently facing in Portugal brought additional challenges for the implementation of the national mental health strategy.

Those challenges include an increased pressure in the mental health services management that is accompanied by an increased demand by populations. The current constraints also call for the reworking of some aspects of the strategy, highlighting some of its goals.

1. To update the National Mental Health Strategy 2007-2016 considering the challenges emerged from the European economical crisis and subsequent budgetary constrains. 2. Define high priorities to proceed with the plan implementation.

A multidimensional evaluation was conducted by the National Mental Health Programme and included the following dimensions: structure of care and activity of public mental health services, SWOT analysis and WHO evaluation committee report.

Several high priorities were defined for the update, including the following: 1. Create a new financing and management model, 2. Resume the deinstitutionalisation process, 3. Proceed with the implementation of the long-term integrated mental health care, 4. Launch the project for the monitoring of human rights and promotion of care quality, to be developed in cooperation with the WHO.

Whilst the economic crises poses many challenges regarding the implementation of health policies and plans, the impact and the burden associated with mental disorders demands for a continuity in the improvement of all dimensions of care through coordinated plans.

As stated by WHO in 2003 the perspective in which services are organised helps to define the effectiveness not only of care but also of access to care. Mental Health Services organisation should be based on principles of accessibility, coordination, continuity, effectiveness and equity of care, in a clear respect for human rights.

To do this, service planners and providers have to determine the exact mix of different types of mental health services and the treatment gap levels.

1. Estimate the treated prevalence of mental disorders in the mental health specialised services. 2. Estimate the existing treatment gap.

An analysis of the patterns of use in mental health secondary care services was made using data from the national information health system, compiled by the Directorate General of Health - Information Analysis Unit.

22.146 patients were treated in the specialised services for mental health disorders, in 2013. This group represents 1,43% of the total patients treated for all health problems and 0,21% of total population. Average length of stay was 16,46 days.

Depression was the main diagnosis in 33% of all patients treated, representing 22% of total inpatient days.

Taking in account that the global annual prevalence of mental disorders in Portugal is 22,9% and that 6,3% are severe mental disorders, there is still a big treatment gap in Portugal. In addition, depression still accounts for a substantial proportion of patients treated in the specialised services inpatient units.

The disturbance in the care of the patient with mental disorder after discharge is considered as one of the most significant obstacles to establishing a stable recovery. So that discharge criteria must be well studied and standardized.

To determine the kinds of criteria being used in discharging patients from a psychiatry hospital.

We conducted a retrospective study in 60 patients (mean age : 34 years ± 10,8) how have been admitted in the university mental hospital B in Sfax, Tunisia on the first 7 months of this year. Data was collected from patient files.

Patients were admitted for psychotic disorders in 67,8% of cases, mood disorders in11%, personnality disorders in 11,7% and mental retardation in 6,7% of cases.

Fourteen criteria were identified. Those criteria were dominated by the stop of agitation and decreased of aggressivity in 68.3% of cases, acceptance of treatment in 46.7% of cases, self-criticism of his disoder in 31.7% of cases, the disappearance delirium in 13.3% of cases. 10% of these patients escaped from the hospital and 8.3% came out after against medical advice.

There seems that exit psychiatric hospital criteria are subjectives and diverses. Those criteria take into consideration as well as clinical features, social conditions of the patient, making it necessary to develop a standardized list of discharge criteria and discuss uses for such criteria.

Diagnosis at first admission is an important variable in epidemiological studies but concerns regarding stability need to be adressed.

To investigate the persistence of diagnosis at first admission within 10 years in a nationwide cohort of psychiatric inpatients with 25 year follow-up.

A cohort was established from a database of all persons admitted to psychiatric wards in Iceland from 1983 to 2008. Those who became 18 during the study period 1983-2007 were selected for this analysis. The outcomes were the diagnosis at first diagnosis, and within 1, 2, 5 or 10 years, after first admission for the following diagnostic groups; substance use disorders, mood disorders, personality disorders, schizophrenia and related disorders were studied using descriptive methods.

Some 4959 were included in the study, 50.4% were men (n=2504). Mean (sd) age at first admission was 27 (± 6.1) years. Most or 51% (2542/4959) were admitted more than once during the study period. Of those who were ever diagnosed with an SUD 87% (2214/2535) received an SUD diagnosis at first admission. In mood disorders, 80% (1771/2203) and anxiety disorders 76% were diagnosed at first admission. Only 67% (372/559) of those ever diagnosed with schizophrenia or similar and 60% (663/1098) of those ever diagnosed with personality disorders received the diagnosis at first admission.

In register-based research diagnosis at first admission is a good indicator for SUD and mood disorders, but less so for personality disorders and schizophrenia or related disorders.

Strategies to implement evidence-based practices are critical to improve services. There are many barriers to their implementation, despite all available knowledge. Even geographically small countries like Portugal (92.152 km2)can have substantial regional variations in evidence-based practices implementation.

Evaluate the regional variation of mental health case management fidelity during a systematic implementation process, according to the measurement of techniques and resources used by mental health professionals.

The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a case management course, in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009).

Mental health professional’s assessment in 26 mental health public and private services (n=71) showed that there are significant differences in the proportion of case management adequate implementation between country regions (North = 35,7% / Centre = 57,5 / Lisbon and Tagus Valley = 65,3%, Alentejo 72,7% and Algarve = 50%).

The results show that even in a geographically small country there are big differences in the quality and degree of effective practices implementation. This happens despite the fact that the implementation process was developed nationwide by the same training and implementation team, working with regional groups.

Locally and regionally designed implementation programs are needed to balance the unevenness of evidence based practices fidelity and quality.

Case management is defined as an evidence-based practice used to help patients in the recovery process. The experiences of several countries show that progress towards case management implementation is slow and complex, depending not only from the degree of effectiveness or the complexity of the practice, but also from regional and local barriers to implementation.

To study the differences in the case management barriers to implementation, between Portuguese specialised mental health teams.

Data was collected in 26 public and private mental health services of mainland Portugal. Barriers were assessed using the BaFAI - Barriers and Facilitators Assessment Instrument (Peters, 2001). Services profiles were made using a specific questionnaire.

Significant differences between mental health teams were found in the following barriers to implementation: 1. Resistance to use treatment protocols was higher in teams that routinely don’t use clinical guidelines (p=0,028). This barrier was also higher in services without research activity (p=0,034); 2. Barriers linked with space availability to implement the practice were higher in teams without liaison with the primary health care (p=0,045). 3. Barriers associated with professional’s difficulty to change were found in less specialised mental health teams (p=0,006).

Special attention is needed to regional and local barriers to implementation in the process of mental health services quality improvement and innovation. Implementation protocols should include prior barriers assessment so that implementation plans can incorporate the strategies to tackle differences between mental health teams.

Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization and low personal accomplishment. It concerns all professions especially healthcare staff.

A cross-sectional study conducted among medical residents working in hospitals located in Tunis. Three instruments are used: an anonymous self administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment.

A total of 149 résidents participated in the survey. 17,4% of participants had a severe Burnout. 42,26% reported a severely high score for emotional exhaustion, 46,92% reported a severely high score for depersonalization and 26,14% had a severely low score of personal accomplishment. Among stress factors significantly correlated to burnout: Lack of hobbies (p<0,001), bad job conditions (p=0,031), poor conditions of the workplace (p=0,046), relationship problems in workplace (p=0, 01), relationship problems with patient’s families (p=0,016), work-family conflicts (p<0,001) and far distance between home and hospital (p=0,026). Consequences of occupational stress associated with burnout: Antecedents of specialty change (p=0,017) and desire to specialty change (p<0,001).

Medical residents in all specialties are at risk of burnout. Nevertheless, it is shown that some specialties are more exhausting, which is consistent with the results reported in the literature. This syndrome deserves to be studied further in junior doctors to develop appropriate means of preventions.

The assessment of needs among patients with severe mental disorders is one of the most studied measures in treatment planning and monitoring of mental health services. Nevertheless, studies on this subject are scarce in Brazil, even following the recent expansion of community services.

To investigate the prevalence and correlates of unmet needs among outpatients with psychotic disorders in Brazilian community mental health services.

This is a cross-sectional study with a random sample of 401 outpatients with psychotic disorders in the city of Santos, Brazil. Needs were assessed through interviews with patients using the Camberwell Assessment of Needs (CAN), which investigates 22 clinical, social and basic needs. The Positive and Negative Symptom Scale (PANSS) was used to assess symptoms. Data were analyzed with multiple linear regression, using p < 0.05. Independent variables were introduced in hierarchical levels, as follows: 1) demographic variables; 2) history and severity of illness; and, 3) service utilization.

The most reported needs were psychotic symptoms (67.0%), information needs (55.0%), psychological distress (41.8%) and money (41.5%). The mean number of unmet needs was 2.91 (+-2.56). A greater number of unmet needs was significantly associated to lower education, more negative symptoms and general psychopathology, all with p = 0.001.

The most reported needs were clinical and social. The number of unmet needs was consistent with the results of international studies. Furthermore, the association of greater unmet needs with lower education and higher symptoms severity may indicate the need for further and comprehensive psychosocial interventions.

Over the past decades, the organisation and management of mental health services in Portugal underwent an evolution similar to that of other European countries, going from an initial psychiatric hospital-centred phase, gradually establishing integration with primary healthcare, to the adoption of the current model, based on the principles of community psychiatry.

To assess the implementation of the Mental Health Plan 2007-2016 in Portugal trough the perspective of the involved stakeholders.

A SWOT analysis was carried out by professionals working at public, private and social institutions in mainland Portugal. Participants focused on structural reforms and on the identification of barriers to implementation.

The SWOT analysis showed (in short summary): Strengths - Plan based on solid scientific and epidemiological grounds, collaboration with social sector; Weaknesses - Lack of dedicated task force, budget allocation; Opportunities - Integration with other health reforms, link with primary care, link with WHO, participation in the EU Joint Action; Threats - Stigma, reduced autonomy, political priorities.

Notwithstanding multiple efforts, some issues remain unresolved and pose powerful and persistent challenges to the advancement of mental health care in Portugal. These include problems related to a funding system that encourages institutionalisation and rejects the promotion of care provided within the community, as well as those resulting from a management model for mental health services that continues to hamper the rational and responsible management of existing resources.

Most studies on the consequences of psychiatric illnesses for caregiver relatives of patients involve only one relative, predominantly a parent and most often the patient’s mother. Studies that focus on the gender-specific differences between caregiver relatives are very sparse. In order to rule out possible differences in the level of burden depending on the particular patient both parents of the same patients were included in this study.

To analyse the differences in the level of burden put on mothers and fathers of patients diagnosed with schizophrenia according to ICD-10. To analyse the correlation between the unmet needs of caregivers and the level of burden put on them.

Both parents of 101 patients with schizophrenia were included in this study. The different aspects of caregivers’ burden were assessed by means of the 'Involvement Evaluation Questionnaire”. Unmet needs of caregivers were assessed with the 'Carers’ Needs Assessment for Schizophrenia”.

Mothers showed significantly higher scores in the dimensions 'Tensions” and 'Urging” than fathers. Multiple linear regression analysis showed positive correlation between unmet needs and the level of burden in both mothers and fathers.

Unmet needs of caregiving parents of patients suffering from schizophrenia are in correlation with higher levels of burden. The differences between mothers and fathers in the level of burden indicate the importance of considering the caregiver´s gender in clinical work.

Female sexual dysfunction (FSD) has been increasingly recognized as an extremely important public health issue. It has direct impact on the health, well-being and quality of life of women. Cultural factors and deeply embedded health beliefs may play a decisive role in defining the health seeking behavior for sexual problems among Egyptian women.

the aim of the study was to estimate the prevalence of Female Sexual Dysfunctions among married women attending Family Health Centers (FHCs) in Alexandria and to investigate help seeking behaviors among them.

A cross-sectional study was conducted in Alexandria targeting 369 married women attending Family Health Centers in Alexandria. Female Sexual Dysfunctions were assessed using the Arabic version of Female Sexual Function Index (ArFSFI) and help seeking behaviors were assessed using a pre-designed structured questionnaire.

The prevalence of (FSD) was estimated to be 72.4%,13.3% of women had one type of sexual disorders while 59.1% had multiple sexual disorders. Although 77.9%of women reported feeling distressed by their sexual problems, none of them had thought professional help, The most common cause for not seeking help identified as “The topic is embarrassing” and believing that “No treatment for such problems”.(84.1% and 4.9% respectively). Educational level and occupational status of of women were significant predictors for seeking help.

The study findings indicated that FSDs were highly prevalent and many women didn't seek help for their sexual problems.“The topic is embarrassing” and “No treatment for such problems” were the most reported reasons for not seeking help among Egyptian women.

Limited research exists worldwide on medical students’ substance use patterns including alcohol and marijuana use.

The aim of the study was to examine the prevalence of substance use, including marijuana, alcohol and other illicit substances (i.e. cocaine, hallucinogens and ecstasy) in a sample of medical students in Greece.

655 students from the School of Medicine of Thessaloniki completed an anonymous, web-based survey including the CAGE questionnaire for alcohol abuse. Students were asked to report the frequency (lifetime, past year, past month) and the motive of the use.

72% percent of the students reported having never used any illegal substance and 21% reported marijuana use at least once in their lifetime. 20.9 % were nicotine smokers. No gender difference regarding marijuana use was observed. Marijuana users underestimated the risk of marijuana use on their health compared to non users. Although the relative mean Cage scores are low indicating a lack of severe alcohol related problems in our sample, there is a significantly higher mean CAGE score in students who use marijuana. The use of other illicit substances was rare (3% used inhalers, 2.3 % cocaine, 2.3% ecstasy, 2% ketamine, 1.8% amphetamines and 1.7% mephedrone). However, the use of marijuana was significantly correlated with use of cocaine, LSD, ecstasy, ketamine, amphetamine and mephedrone.

The findings represent initial data on the prevalence of substance use among Greek medical students. Nationwide studies are needed further investigating the prevalence, the motivation and the impact of this risky behaviour among this population.

The 2006-2007 Iraqi Mental Health survey (IMHS) reported surprisingly low prevalence of alcohol and drug abuse in the Iraqi population. Anecdotal suggested that abuse of alcohol and drugs has increased. To investigate this possibility, we conducted a survey of drug and drug abuse at youth centers in Baghdad.

A total of 2678 persons was included in this survey with male to female ratio of 3.8:1. They were randomly selected from youth centers located in different sectors in Baghdad. Composite International Diagnostic Interview was used to generate diagnosis. The interviewers were trained youth center staff. Data collection was carried out on Dec. 2009.

A total of 17% met criteria for alcohol abuse and 7.02% met criteria for drug abuse. In those below 18 years of age, 2.1% reported alcohol abuse and 1.1% reported drug abuse. The peak age for alcohol and drug abuse was at 24-35 years. No female reported alcohol and substance abuse. Age of onset of alcohol was 21.7 ± 3.6 years and for drug abuse was 22 ± 5.8 years. Alcohol abuse was significantly associated with high crowding index, but drug abuse was not associated with crowding index. Low educational level was associated significantly with both alcohol and drug abuse.

High rates of alcohol and drug abuse and a tendency in early age of onset in alcohol and drugs were observed. High household density and low educational level are important factors in alcohol and drug abuse.

In general, monotherapy is advocated. However, a proportion of the treatment regimens contains two or more drugs from the same class (i.e. polypharmacy) or a combination of drugs from different classes.

To investigate the prevalence of prescription patterns of psychotropic drugs to our outpatients with schizophrenia, unipolar depression or bipolar disorder.

Files of 510 outpatients were studied. A retrograde examination was done spanning for 6 months. Demographics, details of diagnosis, hospitalizations and a chart of the drugs administered were collected. A comparison was done between various characteristics of patients under polypharmacy and monotherapy.

Polypharmacy as well as combination therapy was more prevalent than monotherapy in all groups. Patients with a history of previous hospitalizations were not prone to be under polypharmacy, excluding depressives . Antidepressant prescription in schizophrenics was unusually high reflecting the easiness of use of new agents for negative symptomatology . The most commonly prescribed antipsychotics were quetiapine, olanzapine and risperidone. Classical antipsychotics had medium proportion of the treatment, mainly as combined therapy. Mirtazapine, Venlafaxine and Sertraline were the most commonly prescribed antidepressants Tricyclics were prescribed also

.. Greek clinicians' attitude for polypharmacy, regardless of the diagnosis, is prevalent. The recent changes in reimbursement policies of the healthcare System in Greece, did little to affect antipsychotics, but had an effect in the prescribing patterns of antidepressants

Despite the perception that doctors should be ‘invincible’, mental illness is common in this population. Doctors and medical students have low levels of help-seeking for their own mental health problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatization is a crucial factor to symptom concealment.

‘The Wounded Healer’ is an anti-stigma intervention that has been described as an innovative method of pedagogy that blends science with the humanities. The Wounded Healer has been delivered to more than 5000 medical students and doctors in countries all over the world.

We conducted a cross-sectional, mixed methods study. Immediately following the intervention we distributed paper questionnaires to participants who attended the Wounded Healer that contained stigma constructs. Answers were on a Likert-type scale and there was also space for free-text comments.

303/378 (80%) of participants recruited for the study responded. 246/303 (81%) of respondents either agreed or strongly agreed that the talk made them more accepting of medics suffering from psychopathology. 223/303 (73%) of respondents either agreed or strongly agreed that they were more aware of the importance of engaging in help-seeking behavior when under mental distress.

Many respondents reported in the free-text comments that the Wounded Healer was inspirational and that every medical student should receive this intervention.

A majority of respondents responded positively to the stigma constructs. This may have implications for medical students and doctors in mental distress by helping to reduce stigma and by encouraging help-seeking behavior.