The first goal of schizophrenia treatment in the past was to reduce positive symptoms, because it is thought that due to psychopathology and poor awareness, patients were unable to assess themselves and their needs. Recently, the goal of the treatment is improvement of social life and emphasizes the assessment of quality of life and life satisfaction as a priority of the service providers.

Quality of life and life satisfaction assessment in schizophrenia, evidence of anxiety and depression in schizophrenia and connection between the above variables.

Exploration of quality of life and life satisfaction in patients suffering from schizophrenia.

Subjects were120 outpatients diagnosed with schizophrenia by psychiatrists. Data were obtained using: Quality of Life Questionnaire, Hopkins Questionnaire for Depression and Anxiety, Life Satisfaction Questionnaire and The McGill Illness Narrative Interview.

Data collected were analyzed with SPSS 17. Description of the results includes descriptive data, cross table for nominal data and ANOVA and T test for averages. Average age was 41.6, range 21–67. Average of education was 10.1, range 4-19. The average age of diagnosis was 25.1, range 15–39.

Frequent changes of therapy have resulted in more anxiety and depression symptoms in patients suffering from schizophrenia. Individuals with more symptoms of anxiety and depression were found to have less life satisfaction. Quality of life was found to be the highest reported in individuals treated with atypical antipsychotics.

Publication of scientific research papers is important for professionals working in academic medical centres. Quantitative measures of scientific output determine status and prestige, and serve to rank universities as well as individuals. The pressure to generate maximum scientific output is high, and quantitative aspects may tend to dominate over qualitative ones. How this pressure influences professionals’ perception of science and their personal well-being is unknown.

We performed an online survey inviting all medical professors (n=1206) of the 8 academic medical centres in The Netherlands to participate. They were asked to fill out 2 questionnaires; a validated Publication Pressure Questionnaire and the Maslach Burnout Inventory.

In total, 437 professors completed the questionnaires. among them, 54% judge that publication pressure ‘has become excessive’, 39% believe that publication pressure ‘affects the credibility of medical research’ and 26% judge that publication pressure has a ‘sickening effect on medical science’. The burn out questionnaire indicates that 24% of medical professors has signs of burn out. The number of years of professorship was significantly related with experiencing less publication pressure. Significant and strong associations between burn out symptoms and the level of perceived publication pressure were found. The main limitation is the possibility of response bias.

A substantial proportion of medical professors believe that publication pressure has become excessive, and have a cynical view on the validity of medical science. These perceptions are statistically correlated to burn out symptoms. Further research should address the effects of publication pressure in more detail and identify alternative ways to stimulate the quality of medical science

Negative attitudes towards mental illness or the psychiatrist's role have repeatedly been reported in the literature among pregraduate medical students. Although a clerkship may improve the student's attitudes, negative perceptions regarding mental illness remained unchanged in about one-third of the students. When recovery is being assumed as a central concept of care, the presence of stigma among students represents an ethical challenge that the medical schools cannot avoid.

to implement a programme aiming i. to assess the stigma towards mental illness among pregraduate medical students, and ii. to tackle negative attitudes regarding mental illness and psychiatry.

The authors, targeting the 6th year medical students, have developed a one half-day program to be held before the 4-weeks psychiatric clerkship. The program offers sequentially an initial overview about the concept of stigma, several examples from experiences reported by patients, videos and role-playing exercises. Attitudes towards mental illness were assessed by the Kassam‘s et al Mental Illness: Clinicians’ Attitudes Scale MICA-2’ self-reported questionnaire.

106 students were evaluated. The acceptance was very good, with no refusals to participate in the program. After the clerkship, perceptions about patients’ dangerousness, the need for social protection, the assets and the role of psychiatry were significantly improved.

The good acceptance from the students and the preliminary results were very encouraging, suggesting that this program could change attitudes towards mental illness favorably. Given we’ve just evaluated a time span of one month, further studies are needed to assess the temporal stability of the changes.

International literature indicates that migrants have highest incidence of mental disorders compared to natives, especially for psychotic disorders. Few studies about mental health of migrants in Italy have been published, although net migration rate grew in the last twenty years.

to describe socio-demographic and clinical characteristics of migrants attending Community Mental Health Centre (CMHCs) of Borgomanero (Piedmont, Italy) and to evaluate differences in psychiatric diagnoses and pathway to care among different ethnic groups.

Migrants attending CMHCs between 1st January 2012 and 31 August 2013 were included in the study. Data were gathered retrospectively from clinical data sets.

97 Migrants attended the CMHCs. The most represented ethnicity is East European (36%), the less one is Asian (4%). Most frequent diagnosis is adjustment disorder (33%). In most cases, access to the service follows the family doctor's referral (46%), except for patients with schizophrenia, whose access is most frequently direct (they are usually brought to the service by family members) (33%). The majority of those migrating for working reasons suffers from adjustment disorder, schizophrenia or anxiety. Pathway to care and diagnosis seem to be statistically related (p-value 0,00052), as well as migration reason and diagnosis (p-value 0,0452). Lack of regular residence permit seems to be related to non-medical pathways.

Pathways to CHMCs are complex and influenced by many factors. Most of the sample received a diagnosis of adjustment reaction. More attention should be paid to developing psychiatric consultation liaison models that encompass the physician and social services.

Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries is a non-invasive technique that allows monitoring of cerebral hemodynamics during cognitive performance with a high temporal resolution. There is ample evidence that age impacts on performance and cerebral hemodynamics. This study investigated those associations between a sample of young adult healthy subjects performing the Trail Making Test (TMT), a means of selective attention and complex cognitive functioning.

We examined cerebral hemodynamic parameters in the middle cerebral arteries (MCA) using fTCD while healthy subjects (mean age 31.5 years) simultaneously performed the TMT.

There was a significant slowing with older age (age 30 years or older) for both selective attention and complex cognitive functioning, and older age was associated with significantly lower mean cerebral blood flow velocity (MFV) in males during complex functioning. Young age (younger than 30 years) was associated with initially bilateral and then significantly left sided lateralization, and older age with a bilateral pattern.

These novel results suggest that, in a relatively young age continuum sample, older age results in slowing and decreased brain perfusion, though in a diverse manner. Younger age is associated with alternating pattern of lateralization implying a diverse cognitive style with age as covariate. It adds to the notion that fTCD is a substantial tool to significantly link age related modulation of performance with dedicated parameters of brain perfusion.

The scarcity of human resources is a factor that hampered the improvement of mental health (MH) services in Portugal. MH teams continue to rely on a small number of psychologists, nurses, social workers, occupational therapists and other non-medical professionals, with most teams maintaining traditional models care delivery. Nevertheless teams continue to evolve to ameliorate MH care considering present patients needs and effective treatments.

This study aims to describe services and workforce profiles in Portuguese MH services.

The study was carried out at public and private MH services in mainland Portugal. Profiles were assessed by survey method related with two dimensions: 1 - services characteristics and 2 - workforce profile.

Assessment of services showed: liaison with primary health care (56%), routine use of guidelines (57%), use of individual care plans (46%), inservice research (25%). Regarding workforce, 19% of the teams still rely on 2 professional groups (Psychiatrist and Nurse), 88% do regular training, 60% reported use of case management models, but only 16% had formal training on the model.

Despite the incremental inclusion of MH care essential components associated with services modernisation, Portuguese mental health teams still struggle to provide integrated care with the contribution of multiple professional groups in a multidisciplinary framework. This is specially true in the interior and rural areas of the country. Training programmes need to be maintained as a special priority by national and regional authorities to assure effective delivery of care.

The identification of factors that may facilitate or hinder the implementation of evidence based practices and subsequent innovation in mental health (MH) settings is an area of recent development. Studies regarding organisational culture of services are widespread in economical and managerial areas but very few evaluate MH care contexts. Most of these studies aim to help in the management of human resources.

Assess the organisational culture and leadership profiles in the Portuguese MH services.

Cross-sectional study, made in public mental health services. Evaluation was made by means of the competing values framework tool (Quinn, 1990) (Portuguese version - MJ Felício, 2007), which includes dimensions such as organizational culture and leadership profiles in the framework of more open or closed systems and with more control or flexibility strategies.

The leadership profile clearly outstanding in the Portuguese MH services was the Mentor profile (45.6%), followed by the Broker and Producer profiles (12.8%). Innovation profile, linked with the ability to cope and manage change, had the lowest score (3.5%).

Further studies are critical to develop a clearer view regarding the influence of organisational culture and leadership profiles in the organisation of MH services. Low scores on innovation components may influence the way evidence based practices are welcomed and implemented in services. Organisational culture may have an important role in the implementation of best practices, namely for the design of programmes that aim to translate evidence into everyday care.

Official reports indicate that the overall prevalence of lifetime childhood maltreatment has been estimated to be 30% in population-based samples and the association between childhood trauma, suicide behaviors and psychiatric disorders was previously shown.

The objective of the current study was to assess the presence and severity of ‘male’ depressive symptoms and suicidal behaviors in psychiatric patients who reported history of child abuse and neglect on the Childhood Trauma Questionnaire (CTQ)

To study the association between childhood trauma, suicidal behaviors and non-typical depressive symptoms.

163 adult inpatients were enrolled in the current study and completed the Mini International Neuropsychiatric Interview, Gotland Scale of Male Depression, the Childhood Trauma Questionnaire and the Suicidal History Self-Rating Screening Scale.

The group with no or minimal history of child abuse and neglect (N = 98) was characterized by lower scores on all the dimensions of the CTQ and higher scores on minimization/denial than the group with moderate to severe history of child abuse and neglect (N = 64). Furthermore patients with moderate to severe history of child abuse and neglect were more often females (62.5%), reported more severe ‘male’ depressive symptoms (20.82±10.12, t160 = −3.675, p-value < 0.001) and higher SHSS scores (6.90±4.49, t160 = −2.68, p-value 0.01).

Our data highlight the association between several childhood trauma and ‘male’ depression in both male and female patients. Furthermore Childhood trauma may be a risk factor for suicide attempts. Further researches are needed to clarify this issue.

Primary and secondary care communication is the cornerstone of patient's care. Proper dialogue should be established. The shared care protocol was an attempt to try to fill gaps and build bridges.

A special form was designed to collect information about psychiatrists’ opinion on GPs’ referral letter to psychiatric services. It contained 14 items, each item was marked as essential, can be included or irrelevant. This form was sent electronically to psychiatrists in Southessex University NHS Trust. They are 98 in total. It was input on Excel data sheet and was analysed.

43 psychiatrists responded

All respondents agreed that reason for referral is essential.

Concise description of the condition, risks and current medication were rated as essential in more than 90 %.

Past medical history, past psychiatric history and current physical health were essential in 79 %.

All professionals involved should participate in evaluating and refining communication. Psychiatrists’ opinion in GPs letters is paramount as they are the recipients and their assessments and future management plan should be geared to address the GP's concerns. This is shown clearly by the psychiatrists agreeing that reason for referral should be included in all letters, followed by what the GP has already done and what risks the patient presents.

Improving communication between health professional, improve patient's care, saves time and money, in addition to prevent duplication of investigation and procedures.

Worldwide, trends in life expectancy and ageing-related diseases as Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) are increasing, having a rising impact on patients’ quality of life, on caregivers’ distress and on economic burden.

The purpose of this study was to review the use of modern technologies in medicine, usually known as Tele-Medicine, to improve quality of life of MCI and AD patients and their caregivers

–A systematic literature review was conducted of all published studies examining the relationship between Tele-Medicine and Alzheimer or MCI listed in the PubMed databases from January 1995 to December 2012. The inclusion criteria were the use of technological instruments and a Mild Cognitive Impairment or Alzheimer's diagnosis by a standardized diagnostic procedure.

A total of 69 articles met inclusion criteria. Overall, 21 suggested how to make a remote (10) or earlier (11) diagnosis; 31 described different type of patient's support during the stages of the disease; 9 described how to support patients’ caregivers and 8 showed multiple scopes.

The rising use of Tele-Medicine could actively improve conditions of AD and MCI patients and their caregivers, and could offer good instruments to make early diagnosis and screening even if patients live in remote places.

An international group developed the GRID-HAMD to address critiques of the HAMD and improve its administration. The GRIDHAMD provides novel grid scoring, structured interview guide and scoring conventions, and revised anchor points for problematic or inconsistently rated items.

To conduct a survey of clinicians’ experience using the GRID-HAMD.

To evaluate the clinical acceptability of GRID-HAMD.

A survey distributed to 74 clinical trial raters covered usability and ease of use of the GRID-HAMD, including 20 statements rated from strongly disagree to strongly agree, and listed four statements asking raters to compare the GRID-HAMD with the SIGH-D.

Fifty-seven questionnaires were completed (77%). Most raters agreed that wording of GRID-HAMD questions made it easy to administer (77%), the conventions were clear (82%) and helpful (86%), and guidelines for rating symptom intensity were clear (79%). Fewer rated it ‘easy to decide on a frequency level’ (61%). A large majority (89%) thought ‘having the scoring conventions integrated into the interview guide has made scoring easier.’ More than half (54%) of 44 raters who had used both preferred the graphical layout. However, slightly more preferred the SIGH-D for its ‘ease of use’ (50% vs. 45%) and ‘efficiency’ (39% vs. 36%), and expressed ‘overall preference for the SIGH-D’ (45% vs. 43%).

The raters evaluated clarity and ease of use of the GRID-HAMD positively. Surprisingly, they did not indicate overall preference for the GRID-HAMD over the SIGH-D. Several areas of improvement were indicated for both, and the ‘most difficult’ items were highlighted.

Bipolar patients have an increased risk of cardiovascular diseases for lifestyle habits and the use of antipsychotics that correlates with endothelial dysfunctions, in particular the decrease of eNOS activity and plasma NO levels. We aimed to examine the effects of the new atypical antipsychotic Asenapine on NO release and oxidative stress in porcine coronary endothelial cells (CEC).

NO production was measured in CEC isolated from coronary arteries of pigs and plated in 0.1% gelatin-coated dishes with starvation medium overnight at 37 °C with 5% CO2. Cells were treated with asenapine 10 pM-100 μM and asenapine+inhibitors. Oxidative stress was generated with 200 μM hydrogen peroxide in the presence of asenapine for 15 min. The cells undergoing apoptosis were measured and proteins extracted from cell lysates were quantified and used for electrophoresis and immunoblotting studies.

Asenapine increased NO release in CEC in a time-dependent way (p<0.05) by the phosphorylation of eNOS and plateau was reached at 120s stimulation; no effect was observed on iNOS activation. The association of asenapine and inhibitors suggested the involvement of cAMP/PKA, PLC, p38MAPK, PI3K and ERK1/2 in the intracellular signaling and the β2 adrenergic receptors-related pathway. Data were confirmed by Western blot analysis. Pre-treatment of CEC with asenapine prevented cell death and mitochondrial membrane potential collapse caused by hydrogen peroxide (p<0.05) and counteracted the activation of apoptotic markers.

Asenapine could play a protective role on endothelial function and cardiac cell survival, reducing the risk of cardiovascular disease in maniac patients.

The prodrug lisdexamfetamine dimesylate (LDX) is licensed in several European countries for treating attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with an inadequate response to methylphenidate (MPH) treatment.

To evaluate post hoc the impact of ADHD medication history on the efficacy of LDX.

In this 7-week, dose-optimized, double-blind, study, patients (6–17 years) were randomized 1:1:1 to LDX, placebo or osmotic-release oral system methylphenidate (OROS-MPH). Efficacy assessments included ADHD Rating Scale IV (ADHD-RS-IV) and Clinical Global Impressions-Improvement (CGI-I) scores.

The full analysis set (FAS) comprised 317 patients. Baseline characteristics were similar across treatment groups and previous treatment subgroups. At endpoint, the mean change from baseline in ADHD-RS-IV total score and proportions of responders based on a CGI-I of 1 or 2 for LDX, OROS-MPH and placebo are presented below.

LDX and OROS-MPH were associated with clinically relevant improvements in ADHD symptoms irrespective of ADHD medication history.

Study funded by Shire

Implementation research is crucial in the mental health field given that evidenced-based care still lack implementation, even in developed countries. In Portugal, the National Mental Health Plan included actions to change the operational model for mental health teams and a case-management (CM) training program was launched by the Ministry of Health.

This study aims to evaluate the fidelity of a CM programme implementation process, according to the measurement of intervention 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 CM course (SAMHSA procedures), 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 professionals assessment (n=71) showed a 15% good implementation rate and a 43% fair implementation rate, but still not enough implementation in 42%. Mean use of the model resources (e.g. duration and family involvement) was lower when compared with the use of techniques (e.g. goals definition, psychoeducation and relapse prevention).

Despite the fair global implementation rate of the CM model in the Portuguese mental health services, the rate of good implementation is still low. Implementation science may help to reduce the gap between evidence-based practices and their use in routine care, and thus contribute to improve the fidelity of evidence based care models for patients with severe mental illness.

According to Torre's approach, dynamic images from movies may help to reflect on empathy-related issues, to develop a compassionate approach to patients and their sufferance, and to enhance awareness about stigmatizing attitudes. Since its development this method has been used by the Psychiatric Institute of the Università del Piemonte Orientale Amedeo Avogadro, Novara, for the education and training of medical students and, broadly speaking, of people involved in helping professions.

To describe the preliminary results about the impact of this intervention in a sample of medical students.

cinemeducation seminars lasted 6 months, and included 12 meetings. Movies were discussed from a psychological perspective in a group setting and experiences were integrated with the help of the group-leader. Data were collected anonymously via self-report questionnaires from 40 randomly selected participants. Assessment scales (Attitudes Towards Psychiatry, ATP-30; Social Distance Scale, SDS; Interpersonal Reactivity Index, IRI; Rosenberg Self-Esteem Scale, RSES; Toronto Alexithymia Scale, TAS) were administered both before and after the workshops.

a significant increase was found in the ATP-30 score (p = .034), and a reduction of the SDS (p = .022) and IRI-PD (p = .010) scores.

although these results are preliminary, an improvement in students’ attitudes towards psychiatry was found, together with an increased ability of students to tolerate their own anxiety when experiencing others’ distress. This approach to movies allows developing both cognitive and emotional knowledge, which should be considered particularly important in medical education.

was to study familiar and cytogenetic risk factors of depressive disorders in children.

Genealogical and cytogenetic analysis has been carried out in 50 children and adolescents with depressive disorders, aged 6 to 16 years. Statistical treatment: Excel, SPSS Statistics 17,0.

It has been found that 48% of the patients’ families had DD cases among relatives to the third degree. Non-infectious diseases such as mental disorders, DD included, were more frequent in the first-degree relatives (17,2%) as compared to the second- and third-degree relatives (4,3% and 2,6%, ?<0,001). Neurological diseases also prevailed in the first-degree relatives (19,7%) as compared to second- (8,7%) and third- (0,8%) degree relatives. Endocrine diseases (thyroid gland pathology, diabetes mellitus type 1 and type 2, obesity) and oncopathology (lung, stomach, uterine, breast cancer) occurred with the same frequency.

Cytogenetic analysis has shown that the occurrence of chromosomal abnormalities in the patients with DD is 13,1% which is 6,7-fold as compared to the level of spontaneous mutations in healthy peers (1,95%). The occurrence of chromatid (6,9%) and chromosomal (3,4%) aberrations was higher than their level in healthy peers (1,5% and 1,2%).

Socio – cultural factors play an important role in people’ s perception of child mental health problems and services.

To measure the perception of child and adolescent psychiatry in a small town, from the south-western part of Transylvania, Romania.

To analyze whether the level of medical training influences the addressability to psychiatric services.

The 90 respondents of the study included 27 doctors (other than psychiatrists), 32 nurses from the local hospital and 31 teachers. We randomly selected the participants, by consulting the list of the two institutions’ employees, in a specific day.

The questionnaire consisted of 12 questions about demographic profile and perception of pediatrics psychiatry, as a medical specialty. Participation was voluntary and anonymous. Two questionnaires were precluded because of not having all the items answered. To examine the statistical significance of the differences, one way ANOVA and nonparametric Kruskall Wallis test were used.

More than half (51%) considered that psychiatric medication may both diminish the symptoms, but can also have side effects on subjects. 68% of respondents said that a child is stigmatized when being in psychiatric service evidence. There was a valid statistical correlation between the medical level of training and the addressability to psychiatric services (r +0.39, p<0.001). Doctors would take their child to psychiatric services, as a personal decision, while teachers would apply to psychiatric services at recommendation of general practitioner/pediatrician (p<0.05).

The addressability to psychiatric services is related to the level of medical training.

The use of best practice guidelines had an exponential growth in the last 15 years, including in mental health. However the dissemination and use of guidelines has not always been followed by the critical appraisal of the their quality, specially when translation and cultural adaptation for other countries is involved. To increase the odds that a guideline will generate a better practice, they must be evaluated and strategies to their improvement need to be developed.

This study aims to evaluate a clinical guideline used to implement a case management model in the Portuguese mental health services.

The guideline was assessed by two health experts working in the field of evidence based practices implementation: one from the mental health field and one from the communicable diseases field. The assessment was made with the AGREE Instrument 2 (second Portuguese version). Scores were calculated according with the rules of the AGREE Collaboration Group, 2011. Results

The assessment of the guideline on case management for people with sever mental illness showed good scores on the domains 1-Scope and Purpose (72%) and 4-Clarity of Presentation (77%), medium score for the domain 5-Applicability (54%) and low scores in the domains 2- Stakeholder Involvement (41%) and 3-Rigour of Development (28%).

Critical appraisal of guidelines is crucial for the development of best care. The identification of faulty domains in guidelines offers an opportunity to improve and to shape recommendations considering national and local needs. New guidelines can be organised by considering AGREE II dimensions.