The course of an eating disorder is often prolonged and can lead to enduring disability for many years, with some patients requiring lengthy periods of in-patient care. Unfortunately, there is still little evidence concerning the optimal model of in-patient care for these patients.

Self-admission is a novel treatment tool, whereby patients who have high health care utilization are offered the possibility to self-admit to an inpatient ward for up to seven days, because of deteriorating mental health or any other reason. Purposes behind the model are to increase the availability of in-patient care, to promote autonomy and agency, and to decrease total inpatient care utilization.

To investigate whether self-admission can be beneficial for patients with severe eating disorders.

Two beds out of eleven at a specialist eating disorders inpatient unit were reserved for self-admission of well-known patients. All participants were interviewed about their experiences in the program at 6 months.

Participants described an increased sense of agency and safety in their everyday lives. Suggestions were also made, such as a more active outreach approach in promoting admission, providing a continual staff contact during the brief admission episode, and offering a similar self-admission model for day treatment.

Self-admission is a viable tool in the treatment of severe eating disorders and can increase quality of life by providing a safety net and promoting agency. However, logistical obstacles must be addressed in order to promote a constructive use.

The authors have not supplied their declaration of competing interest.

Eating Disorders (ED) affect an individual's physical and mental health with abnormal eating habits. Traumatic life events may underlie the development of ED as many studies document [1]. In the present study, we examined the effectiveness of EMDR therapy that was originally used to treat Post-Traumatic Stress Disorder (PTSD) [2], on restrictive eating symptoms associated with trauma. Cases B.Ö. (18) and B.S. (20) came to the clinic consecutively for resembling complaints about the sense of food sticking in their throat, breathing difficulties, raised heart beatings, unease to swallow, and choking fear. The patients revealed past traumatic events about being out of breath while swallowing their bites. Then, they have started to restrict their food intake and the types of food consumed, which led to emaciation with health problems, interrupted daily routines, and social isolation; meeting the diagnosis of avoidant/restrictive food intake disorder (ARFID) in DSM-5. Due to traumatic experiences, EMDR therapy was applied.

After five EMDR therapy sessions, patients turned back to healthy eating habits, normal BMI, and effective daily life. As expected, EMDR therapy made significant improvements in the treatment of ARFID.

EMDR can be useful to treat ED with traumatic background.

The authors have not supplied their declaration of competing interest.

In clinical practice, insomnia is a common feature in anorexia nervosa (AN). Sleep self-reports in AN suggest that these patients report poor sleep quality and reduced total sleep time. Weight loss, starvation and malnutrition can all affect sleep. Patients with eating disorders who have sleep disturbances have more severe symptomatology.

The authors intend to review sleep disturbances observed in AN, describe possible pathophysiological mechanisms and evaluate the clinical impact of sleep disturbances on the treatment and prognosis of the disease.

In this study, a non-systematic search of published literature from January 1970 and August 2015 was carried out, through PubMed, using the following keywords: ‘sleep’, ‘anorexia nervosa’ and ‘insomnia’.

These patients subjectively report having poor sleep quality, with difficulty falling asleep, interrupted sleep, early morning waking or reduced total sleep time. Sleep disturbances found in AN using polysomnography are: reduction in total sleep time, decrease in slow wave sleep, slow wave activity and reduced sleep efficiency.

Privation of adequate and restful sleep has a negative impact on the quality of life of patients, may contribute to the appearance of comorbidities, such as depression and anxiety, and to a poor prognosis for AN.

The authors have not supplied their declaration of competing interest.

Research has shown that maternal obesity and underweight are major risk factors for reduced initiation, duration, and exclusivity of breastfeeding. This prospective, cohort study analysed the association between gestational body mass index (BMI) and symptoms of eating disorders (ED) in breastfeeding women.

The study involved 1318 consecutive, at term, healthy mothers, who delivered at the division of Perinatal Medicine of Policlinico Abano Terme, located in a North-Eastern Italy industrialized area, supporting advanced educational levels, good socio-economic status and low and late fertility. The day of discharge mothers completed the completed the eating disorder examination-questionnaire (Fairburn and Beglin, 2008), including four subscales, restraint (R), shape concerns (SC), weight concerns (WC), eating concerns (EC) and a global score (GS). Mothers’ BMI groups were categorized as underweight, normal weight, overweight and obese, according to 2009 IOM guidelines.

EDE-Q mean values ( ± SD) significantly increased with BMI increasing categories. Compared to normal weight mothers (n = 290, 22.0%), obese women (n = 273, 20.7%) had higher significant GS (0.6 ± 0.7 vs. 0.2 ± 0.3; P = 0.006), R (0.6 ± 0.9 vs. 0.3 ± 0.6; P < 0.0001), EC (0.4 ± 0.6 vs. 0.3 ± 0.5; P < 0.0001), SC (0.9 ± 1.0 vs. 0.3 ± 0.5; P < 0.0001) and WC (0.7 ± 0.8 vs. 0.1 ± 0.3; P < 0.0001). In addition, formula-feeding adoption at discharge significantly increased with BMI increasing categories (P per trend = 0.01).

We present evidence that gestational obesity is associated with reduced breastfeeding rates at discharge and higher ED symptomatology. Women need information and support to gain adequate weight during pregnancy.

The authors have not supplied their declaration of competing interest.

Though eating disorder cases have been on the rise in Asia, little is known about them. Bulimia nervosa (BN) has been associated with poor treatment outcome and high mortality risk, and is the second most commonly diagnosed eating disorders in Singapore, after anorexia nervosa (AN), yet no report thus far has explored this condition.

The current study seeks to describe the clinical population diagnosed with BN in our hospital treatment program, as well as to compare their clinical characteristics with a previously published local study on patients with AN.

Retrospective medical records review was carried out for patients diagnosed with BN in our hospital's eating disorders treatment program. Patient records from 2003 to 2013 were retrieved and analyzed. We also further compared presenting characteristics across genders and with AN patients.

Between 2003 and 2013, 348 patients were diagnosed with BN by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). BN patients presented with high rate of self-harm behaviors (37.1%), previous suicide attempts (19.0%) and psychiatric comorbidities (67.5%), many of which require inpatient treatment. Significant differences were found between genders and in comparison with the AN patients.

Our results suggest that many patients with BN present with severe psychiatric comorbidities, in some aspects more severe than the AN population. The current study appeals for the development of more effective detection and treatment of vulnerable populations in Singapore. We further discuss about the potential roles of mental health literacy and stigmatization in influencing treatment-seeking behaviors.

The authors have not supplied their declaration of competing interest.

Suicidal behaviour remains the most common reason for presentation to the emergency rooms. In spite of identifiable risk factors, suicide remains essentially unpredictable by current tools and assessments. Moreover, some factors may not be included consistently in the suicidal risk assessments in the emergency room by either emergency medicine physicians or psychiatrists.

Step 1 involved the administration of a survey on the importance of suicide predictors for assessment between psychiatry and emergency medicine specialties. In step 2 a chart review of psychiatric emergency room patients in Kingston, Canada was conducted to determine suicide predictor documentation rates. In step 3, based on the result of the first 2 steps a suicide risk assessment tool (Suicide RAP [Risk Assessment Prompt]) was developed and presented to both teams. A second patient chart review was conducted to determine the effectiveness of the educational intervention and suicide RAP in suicide risk assessment.

Significant differences were found in the rating of importance and the documentation rates of suicide predictors between the two specialties. Several predictors deemed important, have low documentation rates. Thirty of the suicide predictors showed increased rates of documentation after the educational intervention and the presentation of the suicide RAP.

Though a surfeit of information regarding patient risk factors for suicide is available, clinicians and mental health professionals face difficulties in integrating and applying this information to individuals. Based on the result of this study suicide RAP and educational intervention could be helpful in improving the suicidal risk assessment.

The authors have not supplied their declaration of competing interest.

There has been significant increase in prescription of antipsychotic medication in the community for females in childbearing age the problem is we do not have clear guidelines because we do not have a control group.

To evaluate maternal psychiatric, medical and perinatal outcomes associated with antipsychotic drugs in pregnancy.

To use wisdom when the risk is minimal for both mother and child.

We study 3 pregnant women, one with a 6 years old, one with a 2 years old child and one still pregnant. We measure their blood sugar, blood pressure, fetal heart, movement, ultrasound using first generation antipsychotic (FGA).

Patient became less psychotic then back to normal and fetal development is normal till now, no diabetes mellitus or hypertension, no malformation or abortion.

It is still too early to reach a clear and absolute use of safe antipsychotic drugs in pregnancy. A large sample is needed for a study and a control should be needed.

The author has not supplied his/her declaration of competing interest.

Neuroleptic Malignant Syndrome (NMS) is a rare life-threatening idiosyncratic reaction associated with the use of neuroleptics. It is characterized by delirium, muscular rigidity, fever and autonomic nervous system dysregulation. Its diagnosis represents a significant challenge for clinicians and many aspects regarding its epidemiology, etiopathology and nosology remain controversial.

Summarize current knowledge to facilitate NMS diagnosis and allow a fast onset of therapeutic and life-saving interventions.

Non-systematic review of the literature–scientific publications from Pubmed and a Psychiatry Textbook.

NMS typically develops during the first week after the neuroleptic is introduced, although it may also appear after years of treatment. Its incidence is of 0.02 to 3% in patients taking antipsychotics; the mean age of its patients is 50 years. Typical symptoms are muscle rigidity and temperature greater than 38hC in a patient on antipsychotic; however, recent reports indicate that these core symptoms may not always be present. Several risk factors have also been identified and must be addressed. NMS may be fatal in 10 to 20% of cases or may produce residual sequelae, like cognitive dysfunction or neurological deficits. NMS must be managed by aggressive use of supportive measures, as well as specific interventions. It recurs in 30% of patients, which can be diminished by specific measures.

NMS requires timely and accurate diagnosis and treatment. Antipsychotics should be used cautiously in patients at increased risk. When recognizing this condition, prompt withdrawal of the offending agent is the most important step. Wise approaches can diminish morbidity, mortality and recurrence.

The authors have not supplied their declaration of competing interest.

Clinical practice in emergency room and crisis unit is often fraught with pitfalls (Immediate demands, accelerated temporality, difficulties working with family and care network). This practice contains specific clinical therapeutic interventions based on recognized theoretical frameworks. These theoretical frameworks constitute “formal knowledge”. They help to diagnose but have got limitations. In fact, clinical competence requires also technical and interpersonal skills (“know-how”) as well as reasoning skills and clinical intuition (“Informal knowledge”). All these knowledge and skills are built over clinical experience based on trainings and supervisions, continued clinical reasoning and exchanges with colleagues.

Our research aims to capture therapeutic processes in clinical crisis intervention by illustrating what experts really do in their clinical practice and above all, how they do.

Our study illustrates several crisis situations, moment-by-moment, by analyzed experts’ voices.

Our method is grounded in a first person epistemology and used a qualitative methodology focused on explicitation interview. Ten crisis interviews were analyzed in a micro and macro perception.

Our research based on experts’ voices has identified a series of therapeutic techniques and principles who are essential to better intervene in clinical crisis intervention. A model of intervention was developed to train debutant clinician.

We believe that reflexivity is a powerful attitude to understand and transform practices in a lasting way.

The authors have not supplied their declaration of competing interest.

Interpersonal sensitivity can be explained as a personality trait in which there is an excessive and expanded awareness of the behavior and emotions of others. Individuals having high interpersonal sensitivity are sensitive to interpersonal relationships and self-deficiencies in comparison to others. Studies report that high interpersonal sensitivity can cause low self-esteem and feelings of insecurity.

The objective of this study was to examine the level of interpersonal sensitivity in individuals with an at-risk mental state (ARMS) for psychosis compared to the individuals not at risk for psychosis.

A total sample of 50 individuals was recruited from Bahria University, Karwan-e-Hayat and Karachi Psychiatric Hospital: 25 with ARMS for psychosis and 25 participants who were not ARMS, according to scores on Schizophrenia Proneness Inventory-Adult (SPI-A). All of the participants then responded to self-report questionnaire on Interpersonal Sensitivity Measure.

Results showed that the group with ARMS had a significantly higher interpersonal sensitivity on average (112.5) as compared to healthy individuals (91.8). Results show significant difference in both of the groups (t = –5.049; P < .0001) indicating that interpersonal sensitivity in people with ARMS was relatively high compared to those who were not at risk.

This study suggests that being ‘hypersensitive’ to interpersonal interactions is a psychological feature of the potentially prodromal phase of psychosis. Addressing difficulties in interpersonal relationships and offering early psychotherapeutic interventions can be beneficial, not only in averting serious illness, but preventing loss to individual and national productivity.

The authors have not supplied their declaration of competing interest.

In the entire world, restraint and seclusion are common interventions in psychiatric in-patient settings due to aggressive behavior.

Our objective was to test for the immediate anti-aggressive property of clozapine compared to other antipsychotic treatments in an enriched cohort with high rates of restraint during early hospitalization.

We present a retrospective chart review in all involuntary admissions with schizophrenia during 2011–2014 in Psychiatry and Neurology Hospital, Brasov, Romania. Timing and number of restraints in addition to clinical, demographic and treatment characteristics were extracted. Based on our earlier observation of clinical efficacy of early, fast titration of clozapine, we tested the hypothesis that clozapine treatment was associated with reduced use of restraint, and with longer restraint-free periods.

In 115 patients with schizophrenia (age = 39.7 ± 11.1 years; male = 59%) involuntarily admitted due to externalized (74.78%) or self-directed violence (25.22%), restraint was used in 89.6%; with a median duration of 3 hours until restraint past admission. Antipsychotics used immediately after hospitalization included haloperidol (70.4%), clozapine (11.3%), olanzapine (10.4%) and other second-generation antipsychotics (7.9%). Comparison of restraint characteristics favored immediate clozapine use with highly reduced rates of restraint (38.5% vs.95.6%. P < 0.001) and significantly extended hours until restraint ([118 h,24 h, 426 h] vs.[3 h,0.25 h, 48 h]; median; 25th, 75th percentile; P < 0.001) relative to the remaining cohort. These effects remained highly significant after controlling for potential moderators of restraint use in multivariate models.

These retrospective data suggest an early anti-aggressive effect of clozapine during the immediate use of clozapine in highly problematic patients.

The authors have not supplied their declaration of competing interest.

In 2002, the Department of Health (United Kingdom) introduced a 4-hour target due to long waiting times. It is expected that 95% of patients who attend the A&E (Emergency) Department should be registered and admitted/discharged within 4 hours. Exceeding this is termed a “breach”.

The aim of this re-audit was to assess for a response following recommendations after an initial audit with concerning results. Forth Valley Royal is an acute public hospital in Central Scotland with 860 in-patient beds, covering a population of 300,000. It contains two general adult wards (42 beds), one IPCU (12 beds) and two Elderly wards (40 beds).

Referral data was sourced across 4 consecutive months: April–July 2015 (initial audit) and October 2015–January 2016 (re-audit). These included all referrals from A&E to Psychiatry. Times were calculated for the 4 subprocesses listed in Table 1 below.

Following the initial audit, interventions such as training A&E staff to better manage psychiatric patients and encourage earlier referrals, led to a positive response in the re-audit (Subprocess 1). Breach rates reduced to 28% (from 35%) on re-audit. Less breaches (81% compared to 88%) were referred after 2-hours by A&E. Overall, the breach rates have reduced and they are less attributable to the A&E referring patients late. The outcome of patients leaving A&E without being seen by a psychiatrist was unknown – adverse outcomes would strengthen the debate to enforce the 4-hour window.

The author has not supplied his/her declaration of competing interest.

Table 1

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.

To review the incidence, clinical characteristics, diagnosis and treatment of NMS.

We have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.

A literature review of the NMS was performed using the PubMed database.

The frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.

NMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.

The authors have not supplied their declaration of competing interest.

People, who have tried to commit self-injurers or suicidal attempts, refer symptomatic presence of disorders of humor and numerous problems social as factors precipitant to suicidal thoughts and actions. It is important recognition of the signs of suicide and self-inflicting behavior to help prevent suicide.

The study includes a period of 3 years of cases hospitalized in the psychiatric clinic UHC, since 2013–2015. The data are taken from the records of admissions at the Psychiatric Clinic at the University Hospital Center. Results are grouped and studied issued by mood disorders, sex, age, place of residence and social status.

The influence of mood disorders is recently estimated very important in causing suicide attempts compared with other mental illnesses, similar values with contemporary literature.

The majority of suicide attempts do not result in death. Many of these efforts are made in a way that makes salvation possible. These efforts are often a cry for help. Suicide is a social phenomenon different cognitive aspect such as ethical, philosophical, legal, psychiatric, etc. Employees of psycho-social care should be informed about this phenomenon and finding the diagnosis, prevention and treatment of suicidal attempts by persons at risk of suicide.

The authors have not supplied their declaration of competing interest.

Attention is focused on providing care to the relatives (identifying the bodies of the perished, talking to investigators, filling out the requisite documentation, etc.), resolving social issues (organizing funerals, informing various services of what had happened, etc.).

Special attention is paid to the victims with burns at the inpatient facilities of hospitals.

Provision of care depends on the duration of the emergency and the number of people involved; in the case of a continual stress, in the phase of isolation the medical-psychological care is provided to victims’ relatives. At later stages–it is provided to the victims and their relatives.

Are of a special nature, as they are always sudden and there exists a threat that a great number of people may become victims.

Organizational measures in the acute period of an emergency:

– coordinating the work of specialists of the local, regional and federal level;

– interacting with non-governmental organizations;

– setting up a 24-hour “hotline” service (“HL”) on the basis of a medical institution;

– deploying facilities for providing care to victims, their relatives, and to “secondary victims”.

Principles of medical-psychological care:

– urgent care must be provided jointly with psychiatrists/psychotherapists at the places, where the victims are located;

– individuals with the most severe stress reactions must be identified and observed by psychiatrists/psychotherapists;

– appropriate and prompt intervention should be made to relieve acute stress disorders;

– therapeutic interventions should not be a hindrance to victims’ participation in the urgent evacuation and interrogation expedients as well as completing social tasks.

The author has not supplied his declaration of competing interest.

When other options fail, physical restraint is used in inpatient psychiatric units as a means to control violent behavior of agitated inpatients and to prevent them from harm. The professional and social discourse regarding the use of restrictive measures and the absence of the inpatients’ attitudes towards these measures is notable. Our research therefore tries to fill this gap by interviewing inpatients about these issues.

To assess the subjective experience and attitudes of inpatients who have undergone physical restraint.

Forty inpatients diagnosed with psychiatric disorders were interviewed by way of a structured questionnaire. Descriptive statistics were conducted via use of SPSS statistical software.

Inpatients reported that physical restraint evoked an experience of loneliness (77.5%) and loss of autonomy (82.5%). Staff visits during times of physical restraint were reported as beneficial according to 73.6% of the inpatients interviewed. Two thirds of the inpatients viewed the use of physical restraints as justified when an inpatient was dangerous. Two thirds of the inpatients regarded physical restraint as the most aversive experience of their hospitalization.

Our pilot study explored the subjective experience and attitudes of psychiatric inpatients towards the use of physical restraint. Inpatients viewed physical restraint as a practice that was sometimes justified but at the same time evoked negative subjective feelings. We conclude that listening to inpatients’ perspectives can help caregivers to evaluate these measures.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Psychomotor agitation is the most common behavioural disorder observed in emergency and psychiatry departments. This syndrome is characterized by excessive or inappropriate motor or verbal activity and important emotional tension. Psychomotor agitation may be associated with medical conditions, substance intoxication/withdrawal and in a significant number of cases with schizophrenia or bipolar I disorder.

The objective of this protocol was to provide up-to-date guidance to identify, manage and treat patients with an episode of acute agitation, considering the consensus clinical knowledge, current ethical standards and available therapies. This protocol is aimed to be a patient-centric tool helping to anticipate and prevent the escalation of agitation symptoms.

The method followed to elaborate this document was through a combination of comprehensive bibliographical review (complied in the article “Assessment and management of agitation in psychiatry: expert consensus” by Garriga M. et al. (World J Biol Psychiatry, 2016), interaction with patients, and the clinical experience in our centre.

The elaboration of this protocol resulted in a document that contains guidelines to identify, manage and treat patients efficiently, ethically and safely. One of the novelties of the protocol is the addition of dichotomies based on the patients’ willingness to cooperate. The information is summarized in easy-to-use algorithms for non-specialized healthcare professionals.

This protocol may provide the basis of a new standardized treatment paradigm for psychomotor agitation which may help improve the patient's experience and therapeutic alliance with the healthcare professional and optimize resources in healthcare centres.

COI: The preparation of the protocol was funded by an unrestricted grant from Ferrer International. The company had no say on protocol content. Dr Vieta has received funding for research projects and/or honoraria as a consultant or speaker for from the following companies and institutions: AB-Biotics, Allergan, AstraZeneca, Bial, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Elan, Eli Lilly, Farmaindustria, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Shire, Solvay, Sunovion, Takeda, Telefónica, Institute of Health Carlos III [Instituto de Salud Carlos III], Séptimo Programa Marco (ENBREC), Brain and Behaviour Foundation (NARSAD) and Stanley Medical Research Institute.

Internet use has increased broadly worldwide. There are growing concerns about problematic Internet use (PIU) among youth. Among undergraduate students, excessive Internet use can adversely affect their interpersonal relations and academic achievements.

To estimate the prevalence of PIU among Zagazig university students, and to identify the possible associations between sociodemographic and Internet-related factors and PIU.

A cross-sectional study included a total of 732 undergraduate students, aged 17–34 years, from various colleges in Zagazig University. Participants were randomly selected and assessed for their internet use and abuse using the Internet Addiction Test (IAT), along with a semi-structured questionnaire for sociodemographic and Internet-related factors.

Maladaptive Internet use was found in 37.4% of respondents, and addictive Internet use was found in 4.1% of respondents. Logistic regression showed the predictors of PIU were: using the Internet throughout the day (OR 3.34, 95% CI: 1.75, 6.38), the number of hours spent daily using the Internet (OR 1.17, 95% CI: 1.10, 1.25), the number of days/week using the Internet (OR 1.28, 95% CI: 1.04, 1.58), accessing the Internet using multiple devices (OR 1.55, 95% CI: 1.21, 1.98), and accessing the Internet both indoors and outdoors (OR 1.57, 95% CI: 1.13, 2.19).

This is the first prevalence study of PIU at an Egyptian university. PIU was common among university students. Addressing this issue and its predictors could eventually help to enhance academic performance and achievement among those students.

The authors have not supplied their declaration of competing interest.