The authors have not supplied their 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 authors have not supplied their declaration of competing interest.

Schizophrenia is clearly one of the most debilitating diseases. Luckily, in the past 20 years, there has been a wide and good change in symptomatology due to the new atypical antipsychotics. Still, there are patients who are treatment resistant after different adjustments like switching or adding antipsychotics. Most of the clinicians consider Clozapine the “last resort”. But what if it doesn’t work so well on some patients?

To determine the point when it's time to try electroconvulsive therapy in schizophrenia treatment-resistant patients or remain on conventional approach.

The aim of this work is to determine whether it's better for those patients who have residual positive symptoms to use oral/depot antipsychotics or to switch on electroconvulsive therapy.

This work presents the case of the patient C.D., 35 years, diagnosed with paranoid schizophrenia since 2008. Risperidone, Olanzapine, Aripiprazole were introduced during time, with some improvement on the positive symptomatology, but the patient developed several side-effects. At his last admission in our hospital, he came after a suicidal attempt caused by high anxiety and depression due to his false beliefs. Clozapine was introduced, but after one month of treatment, the patient still had the belief that his neighbours want to harm him somehow.

The patient and his mother definitively refused electroconvulsive therapy because of their personal beliefs. He affirmed that he can live with this “low-dose” of suspiciousness which, unfortunately, had a negative impact on his social life.

We still recommend electroconvulsive therapy in these situations, even though, there are many misconceptions regarding this approach.

The authors have not supplied their declaration of competing interest.

Most people will have romantic relationship in different periods of their life and sometimes this relationship can contain abuse. The abuse which is perceived in romantic relationships can be an important problem for university students.

This study was conducted to determine the effects of personality traits of university students in the abuse which is perceived in their romantic relationships.

The study was descriptive and analytical. The students of Marmara University Faculties of Law, Pharmacy, Nursing and Midwifery, Cinema and Television department comprised the sample. The measuring instruments consisted of a personal information form, the Basic Personality Traits Instrument (BPTI) and Romantic Relationship Assessment Inventory (RRAI). The data were analyzed with the SPSS 11.5 programme, using the “Mann–Whitney U Test”, “Kruskal–Wallis Test”, “Spearmans Correlation Test”.

RRAI mean score was 102.41 ± 33.79; subscale of BPTI's mean scores were; extraversion 28.60 ± 5.97; conscientiousness 28.30 ± 5.91; agreeableness 33.73 ± 4.29; neuroticism 26.09 ± 6.48; openness to experience 21.91 ± 3.83; negative valence 9.82 ± 3.36. There was a low level negative significant relation was obtained between subscale of conscientiousness (r = −0.196, P = 0.000), agreeableness (r = −0.168, P = 0.000), a low level positive significant relation was found between subdimensions of neuroticism (r = 0.168, P = 0.000), negative valence (r = 0.255, P = 0.000) and abuse.

In conclusion, there is a relation between personality traits and perceived abuse. Therefore, education programmes should be prepared about abusive behaviour and its risk factors and consequences.

The authors have not supplied their declaration of competing interest.

Mental health care in Bosnia and Herzegovina (BH) is changing and shows the new trends more than 20 years. In last 6 years is established strong network of community mental health centers (CMHC) as a most important service in the prevention, treatment and rehabilitation of mental illnesses.

Project of mental health in BH (PMH) is the largest reform project, supported by the Swiss Government and it is planned to be implemented in whole BH emphasizing importance of community mental health care and putting patients in the focus of the reform.

To show positive trends and practices in BH as well as obstacles in some fields of the reform.

For the last six years are made positive national mental health policies, established case management model in work with people with severe mental disorders, broad spectrum of services recognized by health insurance (validation of the work for all team members), user initiatives (organization), active role of primary mental health care, reduction of hospitalization, etc. On the other way, yet are not established protected housing, early interventions services and universal methodology or team structure in all CMHC.

Community based mental health care shown as a good choice in the reform of the mental health in BH, confirming positive results from other countries. That is a reason to continue with improvements based on daily practices of the teams in CMHC.

The authors have not supplied their declaration of competing interest.

There are an estimated 1.4 million internally displaced persons (IDPs) in Ukraine as a result of the armed conflict in Ukraine.

(i) Measure the burden of key mental disorders (PTSD, depression and anxiety); (ii) examine rates of utilization of health and psychosocial support services; (iii) examine the patterns of utilisation of services.

The study used a cross-sectional survey design and was conducted throughout Ukraine between March and May 2016 with 2203 IDPs aged 18 years and over. Time-location sampling was chosen as a probabilistic sampling method. Outcome measures were the PCL-5 for PTSD, the PHQ-9 for depression and the GAD-7 for anxiety. Descriptive and multivariate regression analyses were used.

Of the 2203 respondents, 703 reported experiencing a mental health or emotional problem over the previous 12 months and were also screened positive with PTSD, depression or anxiety. Of these 703, 180 had sought care (with sources of care to be given in the presentation). Therefore, 523 respondents did not seek care, equating to an overall treatment gap of 74%, (74% for PTSD, 71% for depression and 70% for anxiety). Key reasons for not utilising treatment included preferring to use their own medications (n = 176); unaffordability of health services (n = 118) or medications (n = 140); poor understanding by health care providers (n = 123); poor quality of services (n = 78) and stigma/embarrassment (n = 41).

The findings support the need for a scaled-up, comprehensive and trauma informed response to provision of the mental health care of IDPs in Ukraine.

The authors have not supplied their declaration of competing interest.

People suffering from neuropsychiatric illness are often in need of caring and nursing over a long period of time. Research shows that patients suffering from such illness do not very often get enough care in practice.

To gain knowledge about nurses experiences from taking care of older people living at home and suffering from chronic and neuropsychiatric illness.

Qualitative analysis: fieldwork and qualitative interviews with 11 nurses who worked in four units in two different municipalities in Norway.

Challenges in clinical nursing explain the process nurses work in when they take care of people with neuropsychiatric illnesses living at home. This is caring for patients, taking care of family members, managing complex patient situations and the need for coaching and cooperation.

To gain a good cooperation with other health personnel to strengthen the competence is important, especially when the goal is caring. Nurses with education in neuropsychiatric care can strengthen the competence maybe and reach a better patient care. The organization of the community health system needs to be studied.

The authors have not supplied their declaration of competing interest.

Stigma restrains the life opportunities of individuals with serious mental illness. This study aimed at performing a linguistic validation of a battery for measurement of affirming attitudes; a battery that might be used to test the impact of anti-stigma and socially inclusive programs.

Three measures were considered: the Recovery Scale, Empowerment Scale and Self-Determination Scale. Two native Arabic speakers, bilingual in English, independently translated the original measures into Arabic. A collaborative pooled version of the questionnaires was then obtained from the two translations. The pooled version was back-translated into English by a professional translator. A draft Arabic version of the battery was obtained from the comparison between the original questionnaires and the back-translation and was tested on 30 Arabic-speaking medical students. We also discussed the existence of other wording that enables the meaning of statements to be expressed clearly.

The test of the different items allowed the detection of three typing errors. It also highlighted mistranslating two terms to one term that does not distinguish between them in term of the meaning: “Goal” and “Purpose”. Comments were reported on the wording of certain items in the questionnaire. These comments referred to the problems related to the grammatical and syntactical construction of certain expressions. The translation from English into Tunisian dialect is different from our dialect.

We proposed an Arabic version of a battery of measures that reflect affirming attitudes. This is a step for reliable measures that assess stigma in Arabic countries.

The authors have not supplied their declaration of competing interest.

Drama therapy is a useful therapy method for improving the life quality of psychiatric patients. Drama therapy is a rehearsal of everyday life. In this therapy method, clients actively join the creative process in order to better understand their life experiences.

Drama therapy may improve patients’ ego functions, psycho-social and self-expression abilities, problem-solving skills, real-life adaptations and contribute to patient's psychiatric treatment.

The main aims were to examine the curative effects of drama group therapy and the effects of drama therapy on functionality in psychiatric patients.

The study was performed at the Istanbul University Faculty of Medicine. Patients were referred from the Psychiatry Polyclinic of this university to Art Therapy and Rehabilitation Program. Drama therapy is an applied drama-based art group therapy. The 10 subjects in our study, ranged from 20 to 50 years old. This therapy group gathered once a week for a ninety minute session. Subjects continued their medical care and received psychotherapy throughout the 24-week study. The therapy plan included an introduction, a warm-up session, a drama therapy work and a sharing session. Patients were assessed in pre and post-treatment with Global Assessment of Functioning and Wilcoxon Signed Ranks Test was used for statistical analysis. Yalom's Group Curative Factors Scale was applied.

There was a significant decrease in loss of functioning (P < .05). In Group Curative Factors, the means of hope, identification, group cohesion and altruism were determined high.

Our study demonstrates that drama therapy has positive effects on patients with severe psychiatric patients.

The authors have not supplied their declaration of competing interest.

Over the past 20 years, considerable progress was made in understanding the multiple and complex needs of patients with mental disorders and ways to organize comprehensive care. However, organizing care in inpatient, pathology-focused settings, where patients were seen increasingly as consumers of ‘inpatient psychiatric’ services is challenging.

Inspired by modern trends, we are more able to integrate recent developments in psychosocial treatments, broadly defined, into progressive treatment framework within inpatient setting.

Results of an audit of our service (psychosocial treatments) over the previous 5 years will be compared to published results of other services with a range of service delivery methods.

Excerpts from mental health care practice in Moscow based Psychiatric Hospital No 3 named after VA Hilyarovsky – are provided. The pathways of care as well as the basic principles governing the treatment (careful attention to referral sources; optimal patient-treatment matching; and psychosocial, rather than medical supremacy) are outlined. Training and development is central to the effective and efficient working of any staff group. As part of the service developments, a number of inductions (on psychosocial treatments) were provided on regular basis to all staff joining the service.

Though the opportunity for future reform remains on the horizon, some of the strengths and weaknesses of our current health care practice will be presented.

The authors have not supplied their declaration of competing interest.

Venous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system, it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.

There has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.

VTE assessment data were collected from two acute psychiatric in-patient wards within a specified, random date range in 2016. Data was collected by checking paper admission documentation. NICE guidelines also state that all patients should be assessed for VTE on admission, with a standard of 100%.

Overall, 6.25% of general adult psychiatry patients had a VTE assessment done within 24 hours of admission.

This audit shows that the necessary standards are not met. Importance of these assessments will be communicated during induction programmes for all staff and the results of this audit communicated to current staff on all in-patient psychiatry wards.

The authors have not supplied their declaration of competing interest.

The most prevalent disorders between the chronic diseases are the mental health disorders. Almost 650 million of people in the world suffer of some mental health disorders, which cause serious impact on individual abilities, family relationship and social rehabilitation.

We describe and study the sociodemographic characteristics and the diagnosis of a sample of male and female psychiatric inpatients undergoing treatment in a mental health care center in Brazil.

It is a descriptive cross-sectional study, carried out with 517 psychiatric inpatients from a Brazilian health institution – IMAS Nise da Silveira. Data was collected from January to December 2014 and occurred through consultation of the patients’ hospital notes. Univariate analysis was used for the data collection and analysis.

Our sample was composed by 52.6% (n = 272) of men and 47.4% of women (n = 245); 50.5% were over 40 years old and have a long time of hospitalization. Overall, 64.6% had schizophrenia; 27.2% mood [affect] disorders; 3.7% mental and behavioural disorders due to psychoactive substance use; 1.4% mental retartation; 0.4% personality disorders; 0.2% disorders of psychological development.

The profile could advance the mental health care and rehabilitation of these people. Although could improve public policies.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The relationship between parents and children is a complex link. In the process of pregnancy-birth-puerperium, frequent feelings such as responsibility, love, fear, uncertainty, generate strong expectations at birth. The death of a newborn may not be perceived as natural by the parents, considering the local culture and the context of great technological development of neonatology.

To explore possible guilt and fantasies in life experiences of parents during mourning process due to death of their newborn.

Clinical-qualitative design, a particularization of qualitative methods here applied in clinical assistance settings with highlight to psychological aspects. Data collection with the technique of semi-directed interview with open-ended questions, in-depth. Sample intentionally constructed, with closure by theoretical saturation of information. The participants were 7 parents, mourning by the death of their child at the neonatal intensive care unit, in a university hospital of Campinas, São Paulo State.

Feelings of guilt - conscious or not - lead to an internal and particular movement so that mourning can be lived. The participants showed certain embarrassment, accompanied by natural suffering facing to the cultural pattern that permeates the emotional experience. It predicts types of psychological meanings that the experience will give to the person.

Health professionals working with bereaved parents should consider more deeply the moment these one experienced, with emphasis on the details of the death scenery, beside the problems of illness and death properly so called.

The authors have not supplied their declaration of competing interest.

Adherence to practice guidelines for diagnosing and treating attention-deficit/hyperactivity disorder (ADHD) by primary care providers (PCPs) is important for optimizing care for many children and youth. However, adherence is often low. To address this problem, we implemented an intensive intervention in 2009 aimed at improving diagnosis and management of ADHD among PCPs.

The study objective is to assess the sustainability of intervention-attributable outcomes.

The study aims are to assess the sustained effect of the intervention on PCP intentions to implement, attitudes toward, and obstacles to implement ADHD practice guidelines.

During November 2009, 48 PCPs from 31 clinical practices completed a 3-day training, 6 months of biweekly telephone peer group reinforcement, and baseline questionnaires; follow-up questionnaires were completed at 12 months. To assess sustainability, we tracked PCPs and administered the questionnaire in 2016.

Intentions to implement ADHD guidelines remained stable over seven years, with all mean values ranging from “probably will” to “definitely will” implement guidelines.

Generally, favorable self-reported intentions (see Exhibits 1 & 2), attitudes and obstacles to implementing ADHD guidelines were sustained seven years after the intensive training and follow-up intervention.

The authors have not supplied their declaration of competing interest.

To examine the role and scope of practice of community mental health workers (CMHWs) as well as the impact and challenges associated with of work of CMHWs within Ghana's mental health delivery system.

A cross sectional survey of 11 psychiatrists, 29 health policy directors and 164 CMHWs as well as key informant interviews with 3 CMHWs, 5 psychiatrists and 2 health policy directors and three focus group discussions with 21 CMHWs. Results of quantitative data were analysed with SPSS version 20 whilst the results from qualitative data were analysed manually through thematic analysis.

In addition to duties prescribed in their job descriptions, all the CMHWs identified several jobs that they routinely perform including jobs reserved for higher level cadres such as medication prescribing for which most of the CMHWs have no training. Some CMHWs reported they had considered leaving the mental health profession because of the stigma, risk, lack of opportunities for continuing professional development and career progression as well as poor remuneration. Almost all the stakeholders believed CMHWs in Ghana receive adequate training for the role they are expected to play although many identify some gaps in the training of these mental health workers for the expanded roles they actually play. All the stakeholders expressed concerns about the quality of the care provided by CMHWs.

The study highlights several important issues, which facilitate or hinder effective task-shifting arrangements from psychiatrists to CMHWs and impact on the quality of care provided by the latter.

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

The authors have not supplied their declaration of competing interest.

The fit note, introduced in England, Wales and Scotland in 2010, was designed to radically change the sickness certification process from advising on individuals’ inability to work to what they could do if adjustments were made available. Our review aimed to evaluate: (1) the percentage of fit notes utilizing the new “may be fit for work” option or advising on work adjustments, (2) the impact of the fit note on sickness absence and return to work, (3) demographic variation in fit note use.

We systematically searched in Embase, Cochrane CENTRAL, Pub Med, Worldcat, Ovid and PsychInfo from 1 Jan 2010–30 Nov 2016 for studies on working aged adults which included the search terms “fit note” or “fitnote”. Relevant abstracts were extracted and we assessed the quality of the papers and assessed bias using the modified Newcastle Ottawa Scale.

Nine papers met the inclusion criteria, four of which were based on the same cohort. Maybe fit notes made up just 6.6% of all fit notes. Work adjustments were most often recommended for patients who were less deprived, female and patients with physical health problems. Fit note advice for patients with physical health problems increased over time, but the opposite was seen for patients with mental health problems.

Further research needed to evaluate the use, impact and potential of the fit note, especially for patients with mental illness.

The authors have not supplied their declaration of competing interest.