Rising antimicrobial resistance (AMR) in primary care is a growing concern and a threat to community health. The rise of AMR can be slowed down if general practitioners (GPs) and community pharmacists (CPs) could work as a team to implement antimicrobial stewardship (AMS) programs for optimal use of antimicrobial(s). However, the evidence supporting a GP pharmacist collaborative AMS implementation model (GPPAS) in primary care remains limited.

With an aim to design a GPPAS model in Australia, this paper outlines how this model will be developed.

This exploratory study undertakes a systematic review, a scoping review, nationwide surveys, and qualitative interviews to design the model. Medical Research Council (MRC) framework and Normalization Process Theory are utilized as guides. Reviews will identify the list of effective GPPAS interventions. Two AMS surveys and paired interviews of GPs and CPs across Australia will explore their convergent and divergent views about the GPPAS interventions, attitudes towards collaboration in AMS and the perceived challenges of implementing GPPAS interventions. Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model and factor analyses will guide the structure of GPPAS model through identifying the determinants of GPPAS uptake. The implementable GPPAS strategies will be selected based on empirical feasibility assessment by AMS stakeholders using the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) criteria.

The GPPAS model might have potential implications to inform how to better involve GPs and CPs in AMS, and, to improve collaborative services to optimize antimicrobial use and reduce AMR in primary care.

There have been conflicting reports on the relationship between thyroid function and mood between studies in subjects on thyroxine and the general population not on thyroxine. We investigated this relationship in a large population study.

We analysed data on serum TSH levels and Hospital Anxiety and Depression Scale (HADS) scores from the HUNT 2 study (age ≥ 40 years). Following a test for interaction, analyses were performed separately in females on thyroxine (n=1,265) and in people not on thyroxine (males n=9,319 and females n=17,694).

More females on thyroxine had high depression and anxiety scores than females not on thyroxine (depression 18.4% vs 13.0%, p< 0.001, anxiety 23.4% vs 18.7% p< 0.001). In those not on thyroxine there was an inverse association between serum TSH and depression score in males (B coefficient = -0.61, 95% CI -0.91 to -0.24, p=0.001) though not in females (B coefficient = -0.07, -0.33 to 0.19), and an inverse association between TSH and anxiety score in both sexes (B coefficient for males = -0.68, 95% CI -1.04 to -0.32, p< 0.001; females -0.37, -0.67 to -0.08, p=0.01). By contrast, in females on thyroxine, TSH was positively associated with both depression (B coefficient = +0.27, 95% CI 0.02 to 0.51, p< 0.05) and anxiety (B coefficient = +0.29, 0.01 to 0.56, p< 0.05).

There is a different relationship between thyroid function and depression and anxiety in females on thyroxine compared to individuals with no thyroid disease.

There are no large scale studies on Epilepsy in populations with Learning disability in Ireland. As many as one fifth of these clients have epilepsy. Aggressive treatment may lead to diminishing returns in terms of symptomatic control, while causing unwanted effects.

1. 1. We aimed to quantify rates of epilepsy, aetiology and anti- epileptic drug (AED) use in our population.

2. 2. To look at degree of disability and correlation with AED use.

3. 3. To look at management/ quality of life issues using a validated instrument.

:

1. 1. Medline review using search terms Intellectual OR Learning difficult* OR Mental Retard* AND Epilepsy.

2. 2. Simple questionnaire used to identify all clients with Epilepsy. Database analysed using SPSS analysis.

3. 3. 11 cases selected for review looking at qualitative aspects, using Semi structured interview and GEOS scale.

1. · 210 patients found to have a history of epilepsy (42% of clients).

2. · Multiple Aetiologies identified. Commonest known Aetiology: Trisomy 21.

3. · Polypharmacy is common. Most commonly used AED: Sodium Valproate. Mean AED use: 1.595 (SD+- 1.077).

4. · Clients with Trisomy 21 aged less than 40 tended to be on more medication (2.05, SD= +-1.38) than those over 40 years (1.43, SD= +- 0.89)

5. · Greater concerns on qualitative measures regarding clients with refractory epilepsy or where epilepsy changed over time.

Our study highlights previously recognised changing patterns in aetiology of Learning Disability and also the changes over time in these clients. More study is required.

There is a growing appreciation that depression may be a presenting syndrome of dementia.

This study intends to show that the presence of cognitive impairment in a depressive episode in older people may have important prognostic implications in developing dementia.

In this study a first group of 17 depressed patients with mild cognitive impairment (MMSE over 26) was compared with a second group of 18 depressed patients with mild to moderate cognitive impairment (MMSE bellow 26). The mean age for both groups was 68. The depression was measured using the MADRS scale. All the patients included were severely depressed at the inclusion. Both groups showed important improvement of the depressive episode, following the treatment with antidepressants (escitalopramum, sertralinum, venlafaxinum).

Both groups were followed for 2 years after the depression resolution.

In the first group of patients the MMSE was 26 at baseline and 26 or over at discharge.

In the second group of patients the score of MMSE had a value of minimum 17 at baseline and a maximum of 26 at discharge.

Five patients (three in the first group and two into second group) did not complete the 2 years follow up period.

Over the period of 2 years, 37% of patients from the second group developed a dementia, comparing with only 14% of the patients from the first group.

After 2 years, the patients with depression and significant cognitive impairment had twice the risk of developing dementia as those who had only depression.

Low and middle-income countries experience an expressive growth in the number of circulating motorcycles, paralleled by an increasing number of traffic accidents. Delivery motorcycles drivers (“motoboys”) are generally perceived as accountable for this scenario. Although traffic accidents have a multivariate etiology, mental disorders, such as substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD), are often involved. This paper aims at investigating the prevalence of ADHD, SUD and other mental disorders in a sample of Brazilian motoboys, and additionally, to evaluate the association between psychiatric diagnoses, motorcycle accidents and traffic violation tickets.

A convenient sample of subjects was invited to participate in a cross-sectional assessment including an inventory of traffic accidents and violations. Psychiatric diagnoses were based on semi-structured and clinical interviews.

A sample of 101 motoboys was assessed. Overall, 75% of subjects had a positive lifetime history of at least one psychiatric disorder. SUD was the most frequent diagnosis (43.6% for alcohol, 39.6% for cannabis). ADHD was associated with a higher number of traffic accidents (p = 0.002), and antisocial personality disorder (APD) was associated with a greater number of traffic violations (p = 0.007).

The prevalence of mental disorders was much higher in our sample than in the general population. ADHD and APD, but not SUD, were associated with negative traffic outcomes. These findings have implications for public mental health planning since mental disorders can be both prevented and treated, improving driving behavior and increasing road safety.

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.

Receiving and understanding the psychological and sociocultural aspects associated to both health problems and difficulties to make the eating behaviour changes are relevant issues when treating individuals with Metabolic Syndrome.

The reports given by chronic individuals in the present study allowed for analyzing the subjective expressions related to food, treatment management and patient adherence to self care propositions.

In-depth semi-directed interviews with open-ended questions, with psychodynamic orientation in the conducting dialogues were performed with nine patients from the endocrinology outpatient service of a public university hospital located in Southeast Brazil. From this broader objective, a selection was made of some experiences reported by the subjects, which were related to the process of managing treatment and eating behaviour, implied in chronic metabolic disorders.

In this work, elements that mediate the process of developing autonomy in eating habits, living with the illnesses and vulnerability factors experiences by Metabolic Syndrome patients are identified in this study.

The interdisciplinary character of the present study promoted the valorisation of the practice of listening to the psychological and cultural meanings of eating behaviours, hence offering contributions regarding the nutritional care of individuals with Metabolic Syndrome.

1. 1. Study on the association between health and risk behaviours and psychosocial variables: The better the self-concept, the better the behaviours; The higher the satisfaction with social support, the better the behaviours; The higher the assertiveness, the better the behaviours; The association between control locus and healthy and risk behaviours is not significant.

2. 2. Study on the association between health and risk behaviours and cognitive variables: The more favourable the attitudes towards health, the better the behaviours; The more adequate the health beliefs, the better the behaviours.

3. 3. Study on the psychosocial variables interaction effects with cognitive variables in health and risk behaviour prediction: The interaction variable was revealed as the best health and risk behaviour predictor is the variable resulting from Factor 1 - behavioural aspect (Self-Concept) and Factor 4 - preventive attitude (Attitudes Towards Health) interaction, with a determination coefficient (R2) of .409. The patterned coefficient analysis Beta (beta=.427) indicates that the higher this interaction effect (F1 - behavioural aspect * F4 - preventive attitude) the better the behaviours.

The increasing prevalence of concurrent eating and substance use disorders has been well documented in both the eating disorders and in substance use disorders literature. Despite evidence for the important role of families and wider social networks in addiction and eating disorder treatment, concurrent eating and substance use disorder therapy has focused on treating the concurrent disorders, and largely overlooked the needs of families. This study explores the impact of concurrent eating and substance use disorders on family members to identify the family's needs in order to direct future intervention.

A series of semi-structured interviews were completed with family members of patients with concurrent eating and substance use disorders. A qualitative grounded theory approach was used to analyze the data and involved the coding of transcripts and the development of emerging themes.

Three major themes emerged from the analyses: 1) Families’ inability to cope; 2) Inadequate communication and involvement of family in therapy; 3) Lack of information about the disorders themselves.

Data suggest that greater emphasis in service provision must be placed on family members and wider social networks to: 1) help assist clients to engage and stay in treatment; 2) improve both disorder outcomes and family functioning, and 3) reduce impacts and harm for family members and others affected. Suggestions for helping clinicians and new avenues for service provision and research are presented.

Explore the prevalence of lifetime suicide attempts in women with bulimia nervosa (BN), and compare eating disorder symptoms, general psychopathology, impulsivity, personality, and genetic variants in four candidate genes of the serotonin pathway: the serotonin transporter (SLC6A4), serotonin receptors 1A (HTR1A) and 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) between individuals who had and had not attempted suicide. Determine the best predictors of suicide attempts.

566 consecutively admitted BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN). Patients completed a comprehensive assessment battery.

Lifetime prevalence of suicide attempts was 26.9% CI 95%: 23.2 to 30.5). BN subtype was not associated with lifetime suicide attempts (p=0.36). Compared to non-attempters, attempters exhibited higher unemployment, eating disorder symptomatology, general psychopathology, previous eating disorder treatment, impulsive behaviors, and lower educational level (p<0.004). In relation to personality traits, suicide attempters exhibited significantly (p<0.002) higher Harm Avoidance and lower Self-directedness, Reward Dependence and Cooperativeness. No significant differences in any of the genetic variants between attempters and non-attempters. The best predictors of suicide attempts were (p<0.006): lower education, minimum BMI, previous eating disorder treatment, family history of alcoholism and self-directedness.

Suicidality in BN patients appears to be within the range previously found. Our results support that internalizing personality traits combined with impulsivity may increase the probability of engaging in suicidal behaviors in these patients. Our data do not support the hypothesis that variants of SLC6A4, HTR1A, HTR2A or TPH1 are associated with suicide attempts in BN individuals.

The diagnostic frontiers of social anxiety disorder (SAD) are still controversial, since it could be described as part of a continuum of severity rather than as a disorder based on an arbitrary threshold with qualitative distinctions. The present study aims to investigate possible differences among subjects along the social anxiety spectrum using the Simulated Public Speaking Test (SPST), an experimental model of human anxiety. Afterwards, the anticipatory measures of SPST among groups were correlated with different volume of gray matter areas by MRI using the voxel-based morphometry method.

We evaluated patients with generalized SAD (n=25), subjects with subclinical SAD (with fear of a social situation without avoidance or impairment; n=14) and healthy controls (n=22).

The subjective SPST findings showed that avoidance and functioning impairment were due to a negative self-evaluation in SPST and not to the level of anxiety experienced. When all groups were pooled together, there was a positive correlation between levels of anxiety experienced and the volume of the right amygdala. The negative self-evaluation of performance in the SPST was associated with a reduction in the volume of the anterior cingulated complex (ACC) only in the SAD group.

These results suggest that the association between anxiety and amygdala volume may be a part of a continuum of social anxiety. However, the correlation between self-evaluation of performance with reduced ACC volume only in the SAD group does not support the idea that this association may be also part of a continuum.