Can identified risk factors extracted from a comprehensive literature review be developed into an evidence based check list to support risk minimized person centered withdrawal of anti-dementia drugs when considered not to be efficacious in DS?

A detailed literature review using Medline, PsychInfo, Cinahl and Embase with relevant search terms in various permutations and combinations without any date limit enquiring current evidence base on anti-dementia medication withdrawal was conducted. The review also looked to extract the common risk factors in stopping medication. All risk factors were collated, reviewed by a focus group of experts, developed into a checklist.

Thirty abstracts were obtained following the search. Six papers were short-listed. No papers identified a structured approach to medication reduction. An 18-factor checklist was applied prospectively to 30 cases. The checklist was sensitive to identify change to guide clinical decision-making.

Currently, decision to peg medication withdrawal risk is arbitrary and clinical in dementia especially in DS dementia. The evidenced based developed checklist is useful to support and structure clinical decisions. It helps clinicians and patients to focus on promoting safety, reduce harm and guide treatment.

The authors have not supplied their declaration of competing interest.

The rate of mental illness among people with intellectual disability is at least 2.5 times higher than in the general population [1].

To describe the clinical and sociodemographic characteristics of all patients with intellectual disability treated in a community mental health care center (CMH) located in a city of 120,000 inhabitants on the outskirts of Barcelona with a high poverty index.

Documents and patient records were reviewed. Clinical, sociodemographic and other treatment data of patients with intellectual disability treated at the CMH were collected.

The sample consisted of 118 patients. Mean age: 39.5 (SD: 15), 54% men. 92% single and 23.7% legally incapacitated. 46.6% never completed basic education and 44.1% completed primary school. Employment status: 14.4% unemployed, 14.4% currently active, and 50% pensioned. Patients living mainly with their family (parents:) 86%. 68.6% of patients showed aggressive behavior, but the rate of hospital psychiatric admissions was low (mean: 1.1 (SD: 2.3)). Organic comorbidity: 44.9%. Functionality measured with GAF mean: 45 (SD: 12). Level of intellectual disability was mostly mild (62%). Psychiatric diagnoses were: psychotic disorders: 49.25%, affective disorders: 6.8%, personality disorder: 3.4%, Obsessive-compulsive disorder: 3.4%, autism: 11.9% and other diagnoses: 37.3%. Patients treated with anti-psychotics: 78.8%, anti-depressants: 40.7%, and mood stabilizers: 70.5%.

Intellectually disabled patients from our sample showed high comorbidity with psychotic disorders, were highly medicated and often exhibited aggressive behavior.

The authors have not supplied their declaration of competing interest.

Foetal alcohol syndrome (FAS) is a condition that currently affects 1% of babies born in Europe and North America. It is characterised by memory impairment, developmental delay and distinctive facial features. This research uses a mouse prenatal alcohol exposure (PAE) model to explore the effects of PAE on learning, memory and to explore the potentially beneficial effects of common drugs previously shown to have cognitive enhancing effects in both humans and animals.

Sixty mice (M = 30 F = 30) C57 mice were exposed to 5% ethanol throughout pregnancy. After weaning the offspring received Losartan (10 mg/kg) via their drinking water for 8 weeks. At 3 months, learning and memory was assessed using the novel object recognition paradigm.

PAE caused a significant decrease in offspring body weight. Treatment with Losartan caused no growth impairment or renal damage. Novel object recognition indicated that PAE caused male offspring to spend significantly less time exploring the novel object than controls and that treatment with Losartan had the effect of improving awareness of the novel object both in the control and alcohol group and decreasing anxiety (P ≤ 0.05). A significant opposite effect was noticed in the female alcohol progeny when compared to the male alcohol progeny (P ≤ 0.05). Losartan in female alcohol progeny had no effect on anxiety. Male control Losartan spent more time exploring the novel object than male alcohol Losartan (P ≤ 0.05).

Losartan had no deleterious effects on the development of the animals, and was able to improve learning and memory in control animals without effect in PAE mice.

The author has not supplied his declaration of competing interest.

Kleefstra syndrome [OMIM: 610253] is caused by a 9q34.3 micro-deletion or an intragenic mutation in the EHMT1 gene. Its core phenotype comprises intellectual disability, childhood hypotonia and distinct dysmorphisms. The syndrome can be associated with congenital anomalies, epilepsy, cardiac arrhythmias and a typical sleep pattern. Starting from adult age, a regressive phenotype may develop.

Further delineation of the neuropsychiatric phenotype.

Formulating a comprehensive treatment approach.

Detailed examination of two patients with EHMT1 mutation.

Patient 1, male aged 34 years, showed recurrent behavioral problems with aggression and self-injuries as well as obstipation. Elsewhere, a diagnosis of autism was established. Aged 24, he suffered from some epileptic seizures. Recently, paroxysmal atrial fibrillation was diagnosed. Neither treatment with pipamperone and risperidone nor with valproate was effective for behavioral control. Array analysis and metabolic screening did not reveal abnormalities. Whole exome sequencing revealed an intragenic EHMT1 mutation. Patient 2, female aged 53 years, was known with childhood epilepsy and developed gradual decline of general functioning with motor slowing from her third decade. In her thirties, a mood/anxiety disorder was suspected for which several antidepressants were given without any effect. Array analysis was normal. A pathogenic nucleotide deletion was identified resulting in a frame-shift in exon 21 of the EHMT1 gene. In both patients marked apathy was observed (AES = 62 and 64, respectively).

Apathy syndrome in Kleefstra syndrome should be differentiated from depression and autism. Apart from treatment with selected psychotropics, individually targeted contextual measures should always be implemented.

The authors have not supplied their declaration of competing interest.

There is a significant service gap in provision of essential treatment to patients with severe mental disorders in low-income countries, which leads to increased mental health disability and bigger disease burden on the families and society. The SOUL programme is a first of its kind in the country, which utilizes assertively engaging patients at their homes.

The key objectives are early recognition, treatment and psychosocial support to patients with the diagnosis of schizophrenia. Additional objectives include social recovery of the patients, psycho education to family members and generating clinical and functional outcomes.

Programme design developed by host psychiatry department through stakeholder consultation. Training was undertaken for programme team and included training on use of outcome measures namely Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF). Hosting carers and families meetings on regular intervals serve the purpose of family psycho-education and receiving informal feedback about the service.

Preliminary findings on clinical and functional outcomes of cohort of 125 patients recruited over continual basis over 5 years are presented. Complex community intervention shows significant change in all outcome scales (with good effect size) with before and after analysis at one year. The programme demonstrated excellent engagement with patients and very low dropout rate.

Low cost community intervention involving trained doctor and psychiatric nurses working under close supervision of a senior psychiatrist is feasible and achievable and can lead to robust improvements in symptoms and functional outcomes for patients with schizophrenia.

The author has not supplied his declaration of competing interest.

Poor oral health can have a serious impact on quality of life, social inclusion and self-esteem. There is evidence to suggest that people with serious mental illness have a greater risk of experiencing oral disease and have greater oral treatment needs than the general population. Oral health problems are not well recognized by mental health professionals. We therefore conducted a retrospective study to review oral health care monitoring within the community mental health team.

To review the oral health care monitoring for patients accessing the community mental health team.

Audit tool was developed based on oral health care guidelines outlined by the department of health, and literature review. We then retrospectively review medical records of 25 patients against following standards:.

– every client should have the most basic of oral hygiene equipment–toothbrush;

– clients should have basic oral hygiene knowledge, (i.e. brush twice or at least once a day);

– every client should be registered to a dental practitioner;

– every client should have at least one dental check-up per year;

– clients with dentures should have their dentures checked up at least once in five years;

– have a tooth brush less than three months old.

Out of the 25 patients none had met the standards. It could be a reflection of lack of documentation rather than not providing appropriate information.

Oral health care advice should be part of care plan for people accessing mental health service.

The authors have not supplied their declaration of competing interest.

The goal of this poster is to discuss a brief pilot study in which mindfulness – and yoga-based practices were utilized with a group of adult ADHD patients.

A sample of 10 adults participated in a pilot group which utilized the use mindfulness-based and yoga practices to address ADHD. This group was a single 2 hour session which was a pilot for a future 6-week psycho-educational group. The participants completed the following questionnaires: the Cognitive and Affective Mindfulness Scale (CAMS-R), the Freiburg mindfulness inventory and the Mindful Attention Awareness Scale (MAAS) in addition to a survey regarding levels of knowledge of yoga and mindfulness prior to the beginning of the session. The participants completed a survey at the end of the session.

In our small sample group, all respondents reported that they found the session helpful (43% strongly agreed; 57% agreed). When asked if the participants were likely to explore and learn more about ADHD and meditation on their own based on what they learned in the session, most indicated that they were likely to (43% strongly agreed; 43% agreed and 14% were neutral).

The use of treatment modalities involving the use of meditation and mindfulness-based techniques in a group setting are thought to be helpful in addressing some of the target symptoms of ADHD. Based on the preliminary data collected in our small pilot study, our group intends to further explore the efficacy of meditation-based groups in the form of a 6-week training program in 2017.

The authors have not supplied their declaration of competing interest.

Nurses are the most important contributor of care during patients’ hospitalization and have become an important source in the delivery of mental health care. However, the attitudes and ability of many nurses in providing this care have been shown to be deprived, and this may have a negative effect on providing patients’ care. There is a little is known about the attitude of nurses toward people with mental illness in Saudi Arabia.

This study has a qualitative research design. The main aim of this study is to explore the attitude of nurses toward people with mental illness in Saudi Arabia.

Data were collected through semi-structured fact to face interviews with nurses. Thematic analysis was used for data analysis.

Data analysis identified three main themes that affect nurses’ attitude toward people with mental illness. The identified themes are: 1) personal factors, 2) social factors, and 3) factors related to the view of mental illness.

This study concluded that there are a number of factors that affect nurses’ attitude toward people with mental illness. Several recommendations were discussed related to nurses’ education, continuous mental health training courses, public education about mental health and mental health nursing, and mental health care and resources.

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

The authors have not supplied their declaration of competing interest.

Community mental health centers (CMHC) are established for providing services to individuals with serious mental illness. In these centers, individual's need of treatment and care are expected to be met with a mental illness in the community as possible. The process of community mental health service creation in Turkey is relatively new and gaining popularity in last 7–8 years. First CMHC was established in 2008. After this date CMHCs’ have been opened and the target of 2016 is reaching across 236 CMHC in Turkey.

In this context, this study aims to provide views of psychiatrists, nurses, social workers, psychologists and occupational therapists who work in CMHC for the services that provided to individuals in these CMHC's and learn how to define their professional roles and responsibilities in CMHC.

This paper used qualitative research design. Data was collected from 7 CMHC in Ankara through in-depth interviews with a total of 30 people consisting of psychiatrists, nurses, social workers, psychologists and occupational therapists.

The participants look positively about given services, however, financial pressure in the creation process of services, problems in employee personal rights and lack of policies and services related to mental health forced employee and reduce the quality of services provided.

Through understanding perspectives of the professional staff toward community-based services will help to determine current problems in CMHC for policy makers.

The authors have not supplied their declaration of competing interest.

Addressing the interaction between mental and physical health to provide more integrated healthcare has been highlighted as an international priority for health and education systems. Educational interventions focusing on multi-disciplinary, interprofessional approaches to integrated mental and physical healthcare are an essential part of transforming health systems. Simulation training is one tool by which such training can be delivered, in contrast to traditional teaching methods. However, simulation training can be high-cost and clarity over the impact is required.

To compare simulation training for integrating mental and physical health to role-play and didactic teaching, on their effect on confidence, knowledge, and attitudes of participants.

Participants in simulation training (n = 24) and role play plus didactic teaching (n = 87) both completed self-report measures of confidence and knowledge in working with mental and physical health needs, as well as the Readiness for interprofessional learning scale (RIPLS) collecting attitudes towards interprofessional collaboration. All participants also completed post-course qualitative feedback form with open questions.

T-tests found statistically significant increases in confidence and knowledge following both educational interventions. T-tests showed statistically significant increases in attitudes to interprofessional collaboration (RIPLS) following simulation training, while there were no statistically significant changes after role-play and didactic teaching. Thematic analyses of post-course open questions demonstrated differing learning outcomes.

Simulation training appears to have a different and beneficial impact to role play and didactic teaching alone, when training participants on integrating mental and physical health.

The authors have not supplied their declaration of competing interest.

UK healthcare policy has highlighted a shift in mental health services from hospital to community, stressing the importance of training for professions not traditionally associated with healthcare. Recommendations have been made to introduce training for the police force designed with experts. Similarly, the value of further training for ambulance clinicians in assessing mental health, capacity, and understanding legislation has been highlighted.

To investigate the effect of simulation training on the confidence, knowledge, and human factors skills of police and ambulance service personnel in working with people experiencing mental health conditions.

On completion of data collection from 14 training courses, approximately 90 police and 90 ambulance personnel (n = 180) will have completed the human factors skills for healthcare instrument, confidence and knowledge self-report measures, and post-course qualitative evaluation forms. A version of the hfshi for non-clinical professions will hopefully be validated following data collection. Results will also be compared by profession.

Analyses have not been fully completed, although preliminary statistical analyses demonstrate promising findings, with increases post-course for human factors skills, confidence and knowledge. Furthermore, qualitative feedback initially illustrates valuable learning outcomes and interesting findings from comparisons by professions.

Mental health simulation training appears to have a promising impact on the confidence, knowledge, and human factors skills of police and ambulance personnel for working with people experiencing mental health conditions.

The authors have not supplied their declaration of competing interest.

Intervention with informal caregivers (IC) of psychiatric patients is internationally recognized as relevant and a priority. However, the existing responses in this area are still insufficient, especially regarding caregivers of individuals with mood disorders (MD). Mindfulness and compassion focused therapy have proven to be an effective approach in stress reduction and in improving emotional and social well-being of caregivers of patients with other conditions. However, no studies testing these new approaches in IC of patients with MD have been carried out. The objective of this work is to present a research project that aims to develop, implement and empirically test the effectiveness of an innovative group program to help informal caregivers of individuals with mood disorders to cope with the negative impact of the disease and reduce caregiver burdens.

The design of this experimental study to test the program's efficacy is a non-randomised controlled trial (nrct) with 12 months follow-up, with a mixed assessment methodology (quantitative and qualitative analysis). A sample of 60 informal caregivers of individuals with chronic MD will be constituted (n = 30 Control group; n= 30 Experimental group).

We expect the program to promote significant changes in participants in terms of several emotional variables (eg: burden, stress, resilience, compassion and quality of life).

Further efforts to continue studying the impact of interventions in caregivers should be carried out, as a way to improve the quality of life of caregivers and their ability to provide informal care to MD patients.

The authors have not supplied their declaration of competing interest.

Though sleep disturbances are common among psychiatric patients, some patients may trivialize their problem and not discuss it with their doctors. This study thus aimed to assess patient profile that is associated with help seeking for sleep problems among psychiatric patients.

Outpatients from a tertiary psychiatric hospital were recruited for this study (n = 400). The pittsburgh sleep quality index was administered to identify cases of probable insomnia, and daytime impairment due to sleep disturbances was recorded. Participants were asked if they have ever consulted a doctor or any health professionals for their sleep problems. Sociodemographic information was recorded and clinical profile was obtained from the patient's medical records. Multivariate logistic regression was used to examine correlates of help-seeking behaviour among patients with probable insomnia.

275 cases of probable insomnia were identified. Among this group of patients, 38.9% had never sought help for their sleep problems. Participants who were single were less likely to seek help as compared to those who were widowed/separated/divorced (OR= 0.319, P = 0.023). Having a comorbid psychiatric condition was independently associated with increased odds of help seeking (OR= 1.952, P = 0.027). Participants who perceived greater daytime impairment due to sleep problems were more likely to seek help (OR= 1.465, P = 0.007).

The majority of psychiatry patients with sleep problems sought professional help, though there remained a substantial group that did not do so. There is a need to educate and create awareness of potential sleep problems among psychiatric patients, and to inform them of the availability of treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The history of mental health in Moldova has been centered on psychiatric institutions. Current reform goals are centered on the reduction in psychiatric hospital beds, shifting the focus towards outpatient therapy, where community mental health centers have a central role in coordinating recovery and social reintegration.

to collect different data according guidance for establishing a situational analyses about Moldova.

we elaborated a guidance with outline: the historical perspective:

– a. back a 5–10 years events/developments; epidemiologic data;

– b. the service delivery system;

– c. mental health system: laws/regulations, role of the government as well as civil organizations, mechanisms for data collection, monitoring of performance, costs, quality of care and outcomes;

– d. opportunities, barriers, and needed changes/innovations needed to address these.

The current focus is on moving from a relatively centralized system towards a more community-based approach to psychiatric care and community supports, as well as deinstitutionalization and integration of mental health care with primary care. Besides over reliance on institutionalization, the Moldovan mental health care system faces other challenges, including access to care, workforce limitations, and stigma.

Looking forward, success in these efforts will require continued strong political will to bring domestic law, policies and practices into line with international standards in the field of human rights for persons with disabilities. By supporting deinstitutionalization and improving the accessibility of mainstream services, more people will have the opportunity for social inclusion and the ability to contribute to the communities’ social and economic growth.

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

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The formation of nursing professionals requires a dynamic teaching that provides the acquisition of skills and abilities to execute care, management, teaching and research activities. In this perspective, the operative groups are a teaching and nursing care strategy, performed by a knowledge exchange and collective interventions.

Discuss the experience in nursing care to the person with mental disorder.

It is about a fourth year undergraduate nursing students’ experience report. The activities were developed at a center of psychosocial attention in João Pessoa, Paraíba, Brazil. Once a week, four operative group sessions were held under the theme “men's health”. In the first session were agreed norms of behavior and activities plans on which the participants chose the subjects.

The operative group provided a friendly environment to exchange knowledge, in which the contents where addressed from the participant's acquirements and experiences. There was a good group interaction. The students conducted the activities under the teacher and monitor's supervision.

This report provided experiences that contributed to the students’ teaching-learning process as well as for understanding the nurse's insertion in the care scenario and the use of soft technologies to an efficient care to the person with mental disorder. The students also noticed the operative group's impact in the user's lives though sentences such as “It was fun”, “I won gifts”, “liked it”, “I learned”.

The authors have not supplied their declaration of competing interest.

Brazilian's humanization policy offers the extended clinic as acting tool in health services, which advocates the use of soft technologies to provide care to its clientele.

Discuss the interdisciplinary mental health residents approach to the care of the person with mental disorder.

Experience report, accomplished by experiences of mental health's multidisciplinary residency members, which is in a lato sensu postgraduate linked to the study center of collective health, of the Federal University of Paraíba, Brazil. Structured on two axes: face meetings; and singling out actions in the daily work.

From the understanding of the extended clinic as a light technology interdisciplinary approach, in which different professional specialties share knowledge and co-responsible themselves for the mentally disordered patients’ care, Residents have used it as a articulation tool and insertion in the different care scenarios. When developing activities, the residents use guidelines indicated by the extended clinic in order to leverage the work done by the person with mental disorders. Among which stands out: the host, building links, qualified listening, the sensitization for the care co-responsibility, construction of the unique therapeutic project, intersectional actions and sharing care with other services that make up the health system.

Experiences like these made it possible to perceive the applicability of the National Policy of Humanization through its main tool, which is the extended clinic that contributes to the work process of a health team, promoting interdisciplinarity and raising the prospective to the look of transdisciplinary.

The authors have not supplied their declaration of competing interest.