We showed previously that 31% of Swiss population (N=1002)suffers from insomnia(DSM-IV criteria) (Delini-Stula et al. 2007). We report here the results of the analysis of the causes, day-time consequences and treatments.

An 80 items questionnaire was addressed (telephone interview)to a random sample of subjects of both sexes. The recorded responses were either transformed into numerical and categorical values or expressed in percentages of observations. The results were descriptively analyzed.

The main causes of insomnia were classified into 6 categories: personal-, professional and financial problems, diseases, alcoholism and environmental factors. The most frequent were personal (32%) and professional (34%) problems. Only 1% of subjects reported financial worries as cause of insomnia. The most prominent day-time consequences were: fatigue (72%, p<0.003) reduced vitality (46%, p<0.002), irritability (54%, p<0.001) depressed mood (44%, p<002)and impaired cognition (44-51 %, p<0.001). 70% of insomnia subjects reported never to use any treatment. Only 40% of severe insomniacs used prescribed drugs. Also, of the whole population only 44% believed in the efficacy of the hypnotics, but 56% though that herbal products are effective.

In view of marked day-time consequences and obviously under-treatment, insomnia (defined by DSM-IV criteria) in Switzerland is a problem that needs more attention.

Chronic insomnia (ChI) is a common condition in Primary Care (PC). Regardless that it's often related to psychiatric morbidity it appears to be a strong predictor of future depression and a disabling disorder by itself. The aim of this study was to measure and compare clinical and psychiatric characteristics of both patients with primary ChI and secondary ChI.

A random sample of 225 subjects older than 18 years old, from 3 PC Centres of the area of Madrid (Spain) was interviewed using the Oviedo Sleep Questionnaire, a semi-structured interview for sleep disorders. The subjects completed the Patient Health Questionnaire. Data about medical conditions, drug treatments, days of work lost (last year) and use of health care services (last 3 months), were also collected. Psychiatric and clinical characteristics between groups (primary vs secondary ChI) were compared.

78 patients fulfilled criteria for ChI and 53 (67.9 %) of them were suffering from any psychiatric disorder (including subtreshold conditions). Patients with primary ChI compared to secondary insomnia patients had no significant differences in age, gender, use of health care resources and days of work lost. However, patients with secondary ChI compared to primary ChI had more somatic and depressive symptoms (U-Mann-Witney test; p=0.002 and p<0.001, respectively).

There is an important group of patients among PC attendees suffering primary ChI. Patients suffering primary ChI are comparable to patients with psychiatric disorders and insomnia in terms of days of work lost and use of health care resources.

Parents consulting the Psychology Department of the General Children's Hospital of Penteli about their children's concentrating difficulties often complain that they also present sleep problems, such as nightmares, somnambulism, difficulties to fall asleep etc. The aim of the present study is to examine the co-morbidity between ADHD and sleep disorders, as long as previous studies at our Department

The sample consisted of 173 children, who consulted the Department about the above problems, aged 6 to 14 (68,2% boys, 31,8% girls). Children were categorized into two groups: a) children diagnosed with ADHD b) children not diagnosed with ADHD. Parents were invited to completed the ADHD-IV scale, as well as the Aschenbach CBCL test. Children were submitted to BECK's Youth Inventory. In order to compare the two groups we used the t test.

Considering parents and children's reports, it was found that co-morbidity between ADHD and sleeping difficulties does exist to a significant level. More precisely, children with hyperactivity, compulsiveness and concentrating difficulties also seemed to experience low quality of sleep. Co-morbidity between ADHD and sleep disorders was not found to be affected by sex, whereas age seemed to be an important factor.

A considerable percentage of children with ADHD was also found to present significant sleep disorders. It is also important to note that children presenting not the whole syndrome but some symptoms of ADHD, also tend to have sleep difficulties.

Major Depressive Disorder (MDD) and generalized anxiety disorder (GAD) can coexist and patients may have insomnia marked by difficulty falling and/or staying asleep and potentially reduced quality of life (QoL). Eszopiclone has been shown to improve sleep in patients with insomnia comorbid with MDD or GAD. This analysis examined the effects of eszopiclone co-therapy on the HAM-D17 in these two patient populations.

Patients with insomnia comorbid with MDD and baseline HAM-D17>14 (excluding insomnia items; n=545) received morning fluoxetine and were randomized to nightly eszopiclone 3mg or placebo for 8 weeks. Patients with insomnia comorbid with GAD and screening MADRS≤20 (n=593) received daily escitalopram oxalate and were randomized to nightly eszopiclone 3mg or placebo for 8 weeks. Clinician-administered HAM-D17 was evaluated at baseline and Weeks 4 and 8 in both studies.

Baseline HAM-D17 median scores were 22 and 15 in the MDD and GAD populations, respectively. Change from baseline HAM-D17 scores were significantly improved (p<0.02) with eszopiclone co-therapy at Weeks 4 (−10.0±7.6) and 8 (−13.6±7.7) relative to fluoxetine monotherapy (−8.4±6.8 and –11.5±7.1) in the MDD population. Similarly, change from baseline HAM-D17 scores in the GAD population were significantly improved (p<0.002) with eszopiclone co-therapy at Weeks 4 and 8 (−5.8±4.9 and –6.7±5.4) relative to escitalopram monotherapy (−4.3±5.1 and –5.4±5.6).

Treatment of insomnia with eszopiclone was associated with significant improvements in HAM-D17 scores relative to fluoxetine or escitalopram monotherapy in patients with insomnia comorbid with MDD or GAD, even after removal of insomnia items from the scale.

Cerebral palsy (CP), a long-term disease, may change parents' attitude towards ill child and may cause certain differences in everyday functioning between children with CP and healthy persons to increase. The aim of the study was to estimate the quality of sleep habits in children with CP.

93 boys and girls with CP aged 1-18 years participated in the study. A control group included 300 healthy children matched in age. The study was conducted using internally developed questionnaires of sleep disorders and sleep habits in the Department of Developmental Neurology of the Poznan University of Medical Sciences.

The health status of a child with CP was most frequently estimated as fairly good. In our study, 53.7% children with CP slept with another person in the same bed, 78,5 % of children slept in one room with other family members. Almost 53,3% of children with CP needed over 20 minutes to fall asleep, while in the CG only 35.0%; it was statistically significant difference. Day naps occurred in 41.9% of CP children and 27.7% of healthy ones. The statistical analysis shows a significant correlation between CP and the sleep habits.

The quality of sleep habits in children with CP was significantly different than in the CG children. Additional research on larger group of patients with CP is needed to correlate the prevalence of sleep disorder symptoms with motor impairment, Gross Motor Function Classification System (GMFCS) level and epilepsy.

The purpose of the study was to investigate the sleep habits and sleep disorders in children and adolescents with headache.

Three hundred children and adolescents with headache and 284 children without headache were investigated using a questionnaires developed by the authors.

In Our study we observed difference is all the more important as some phenomena like bed co-sleeping (27.7%) and watching TV (20.3%) during falling asleep and sleep disorders awakenings from night sleep (43.7%), sleep talking (48.3%), snoring (27.3%), bruxizm (23.3%), nightmares (16.7%), sleep terror (9.0%) are observed statistically more frequently in children with headache.

Sleep habits described by parents in the children with headache are significantly different than those in healthy. Sleep disorders are very common in the group of children with headache. There is a need of additional research to find correlation between the different types, frequency of headache and sleep habits and disorders.

The Emergency Department serves a population of over 300,000 people.This comprise a mix of different nationalities such as Irish, Other EAA citizens and non-EAA nationals.

Presentation to the Emergency Department after deliberate self harm is quite common.Although patient assessment do not reliably predict risk of future self harm(Hawthorn et al, 1995), they can identify treatable psychiatric disorders and other psychosocial problems.

All records of patients aged 16 years and over, presenting to the Emergency department with deliberate self harm between 1st January 2006 to 31st December 2006 were examined. The quality of assessments analysed using an audit protocol developed from the Royal College of Psychiatrist guidelines for assessment following self harm in adult (RCPsych Council report 2004).

A total of 319 patients presented within this period of which 284 case notes were traceable.Alcohol consumption prior to deliberate self harm was documented in only 75% of cases.

Also majority of precipitating factors for deliberate self harm were social issues but patients' social circumstances were assessed in only 57% of cases.

At the end of the assessments, over 70% of patients were discharged home, some without proper details of social support network. Also alcohol consumption need be assessed in all patients presenting with deliberate self harm (Royal college of Physician guidelines).

In conclusion, the assessments within this period fall short of the Royal College of Psychiatrist guidelines.

Describe and analyze the sequence of facts that families and patients have to cope with during the admission process at the hospital.

Based on a simple questionnaire applied to patients and relatives at the entrance of the hospital we obtain some interesting information about expectations and fears that may interfere in the relationship between users and staff. This information is very useful in order to plan not also the sequence of persons that may talk to the patient and/or their relatives but the content of the conversation to aim the best relationship and minimize stressors during hospitalization.

We list the main fears that appear in the process classified in four topics:

1. 1. Fears previous to admission

2. 2. Fears at first contact

3. 3. Fears in proper admission process

4. 4. Fears in relationship with the therapists

We also list main expectations in two topics:

1. 1. Relative's expectations

2. 2. Patient's expectations: related to diagnosis, therapeutic process, staff, structures and rooms of the hospital and other circumstances.

Fears and expectations of patients and relatives interfere in admission process but also in hospitalization and post discharge period.

It is very useful to know those fears and expectations in order to plan the hospitalization process.

This information is also useful to plan staff training and edit an information guide given at the entrance. This may also improve quality care parameters at Hospital.

Assess the sources of patients' knowledge of medication side effects and the effects of their knowledge on compliance with prescribed medication.

476 patients attending psychiatric services were randomly selected and asked to fill a questionnaire designed to assess parameters relevant to the objectives of the study.

Overall, 44% said they had learnt of side effects of their medication from multiple sources including doctors (52.31%), leaflets (54.2%), internet (14.29%), books (13.02%), chemist (11.34%), other patients (5.67%), friends/relatives (7.35%), self-help groups (2.94%) and other sources (4.2%). 8% said they were not aware of any side effects of the medicines they are taking presently.

13.44% of patients reported that they never find out about side effects of their medication before taking it for the first time with a high proportion of these being males (17.93%vs.10.69%, p = 0.0366). 46.2% reported that they have had concerns about taking medication because of their knowledge of side effects with females more likely to have such concerns than males (49.83% vs.40.76%, p = 0.0269). Finally, when asked if they would have taken the medicines prescribed for them now if they were told initially of all the side effects, 51.05% answered ‘more likely’, with a higher proportion of these being males (56.67% vs. 49.46%, p = 0.06)

Doctors and information leaflets are the leading sources of patients' knowledge about side effects of medication. The knowledge of side effects of medication has a potential to impact more on the compliance of female patients compared to males.

Culture is defined as the sum total of the way people think, feel, and act as members of a social group. Culture is learnt. Cultures can overlap and individuals can belong to several cultures. cross-cultural psychopharmacological studies have mainly focused on differences in the pharmacokinetics and pharmaco-dynamics of psychotropic medications among various ethno-cultural groups and research on many socio-cultural non-biologic contextual factors in psycho-pharmacotherapy is sporadic and often not widely known. In this paper, the authors review the relevant literature in all these areas.

Searching the recent thirty years studies on cultural issues in psycho-pharmacology in a wide area and then screening them systematically, fifteen relevant studies were selected and evaluated. Results were conceptually re-arranged and re-classified and are presented in the format of a narrative review.

In a general aspect, cross-cultural factors affecting psycho pharmacotherapy can be divided in two groups i.e. primary variables which directly influence pharmaco-dynamics and pharmaco-kinetics and confounding variables which indirectly interact with drug treatment, selection, usage and response. In another point of view, trans-cultural psychopharmacological issues are classified in the domains of patient variables, doctor variables and environmental variables, each including many different factors and considerations which are elaborated and discussed in the full-text of this material.

Recently, increasing prevalence of obesity has been elucidated for a major public health problem. Previous research propose that obesity may be significantly associated with psychological distress, considerable disturbances of sleep and health-related quality of life (HRQL). The aim of this study is to examine the psychological distress, subjective sleep quality and HRQL in a group of patient diagnosed with obesity.

A total of 57 obesity patients and 53 healthy control subjects were involved in the study and self-administered questionnaires was submitted to measure by using the General Symptomatic Index of Symptom Checklist (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), HRQL (Short-Form 36). Several clinical and socio-demographic data were also recorded.

HRQL was significantly reduced in obesity as compared to healthy controls. The obesity group exhibited greater psychopathology and suffered greater disturbed sleep quality than did controls. In particular, psychopathological distress was positively correlated with global PSQI scores.

Obesity is associated with psychopathological distress, poor subjective sleep quality and reduced perceived health status. Recognition of sleep disturbances in obese patients is also relevant to management, because effective strategies to improve sleep in this patient group might also lead to vast improvements in their psychopathological distress and perceived health status.

The purpose of this study was to assess the factors that influence attitudes of people neighbouring to residential care facilities that host chronic psychiatric patients formerly hospitalized in a psychiatric hospital, 2 years after their deinstitutionalization.

One member of at least 30 households neighbouring to 8 community-based psychiatric facilities (hostels and sheltered apartments) was interviewed by a group of specially trained social workers. The structured interview used was compiled specifically for the needs of this study.

Less than 25% of our sample had adequate knowledge of the term ‘deinstitutionalization’ and in particular people with higher education and that have been visited by a psychiatric resident. Nevertheless, their attitudes were in general positive. In a regression analysis, attitude towards deinstitutionalization was found to be positively correlated with having visited a psychiatric facility, years of education, and living near 4 out of the 8 psychiatric hostels [R-squared=0.20]. Female neighbours were generally more favourable, but this effect was only marginally significant. Attitude towards the psychiatric patient was best predicted by years of education, having visited a psychiatric hostel and living near 2 out of the 8 psychiatric hostels [R-squared=.21]. Age was generally negatively correlated with attitudes towards the patient [r=-0.23]. There were also significant differences among the attitudes of the various hostel neighbourhoods.

Apart from education, age, and gender the most important factors in influencing attitudes towards deinstitutionalization and patients are local. Choice of favourable locations for psychiatric facilities and cultivation of a positive neighbourhood climate are important.

The study of the impact of deinstitutionalization on a Psychiatric Hospital staff's perceptions regarding the sources of conflict at work, the presence of injustice, and their job satisfaction.

A questionnaire specially made for the purpose of this study was anonymously completed by the working staff two years before and two years after the closing of the chronic wards of their hospital.

The staff felt that there are more conflicts between nursing staff and patients as well as between colleagues themselves. The lack of staff was the greatest cause for conflict reported [t(346) =2.735, p<0.01], as was before the deinstitutionalization, while female gender, younger age [r=−0.117] and closer contact with patients were correlated with perception of more conflicts. The opinions about justice in the work environment were not significantly influenced by the deinstitutionalization, but by younger age [r = 0.150] and the female gender, as well. Finally, the staff reported higher levels of general satisfaction from their work [t(343) = 2.923, p<0.01] and especially that they felt safer in their new workplaces, than in the chronic wards of their hospital [t(349) = 1.976, p<0.05]. This effect was independent of gender, age or job type [F(5, 231) = 2.361, p<0.05].

This follow-up study verifies the previously found effects of the staff's demographic characteristics on perceptions of conflicts, justice and job satisfaction. The relocation of patients to community-based psychiatric facilities, which are smaller, with less staff and more responsibilities has created more opportunities for conflict; nevertheless has considerably increased the staff's job satisfaction.

There have been concerns about people with mental health problems living in the community in Iran experiencing harassment.

This study measures the prevalence and nature of harassment experienced by people with mental health problems and compares them with the general population.

Face to face interviews were conducted by trained interviewers to ascertain experiences of harassment. Interviews were carried out with 112 people with mental health problems and with 104 people from the general population.

Sixty-one per cent of people with mental health problems reported experiencing harassment, nearly ten times more frequently than those in the general population (7%). Among the people with mental health problems, being female, having higher levels of education, or being unemployed were significantly associated with experiencing harassment. The harassment commonly involved verbal abuse, often made reference to individuals' mental health problems and was primarily committed by family members.

A significantly higher prevalence of harassment was reported among individuals with mental health problems living in the community than in the general population sample. Mental health professionals should proactively ask their service users about their experiences in the home, and educational interventions are recommended, particularly for families of people with mental health problems.

This project was funded by Psychiatric and Psychological Research Center of Tehran University of Medical Sciences

There is a high prevalence of psychiatric disorders in dermatological patients.

To evaluate the prevalence of this problem and to find a set of variables associated with the presence of psychiatric disorder.

414 adults attending the outpatient clinics of a dermatological hospital or in inpatient ward were given a questionnaire comprising the DLQI and the 28-item General Health Questionnaire (GHQ-28).

In total, 414 questionnaires were given at admission. Of these Using a stringent cut-off threshold (5<) for psychiatric case identification with the GHQ-28, the overall prevalence of psychiatric morbidity was 51.3% . We found a higher prevalence of psychiatric disorders in married and low educated patients. Higher score of GHQ-28 accompanied with higher score of DLQI. High prevalence rates were observed among patients with vitiligo, psoriasis, pemphigus. There was not significant difference in psychiatric co-morbidity between men and women.

Our study has shown the situation that is actually faced by dermatologists in their everyday practice, where they are in an especial situation to detect psychiatric morbidity and to take appropriate measures. The GHQ-28, being easy for patients to compile and for physicians or nurses to score, may be a practical instrument to increase identification of patients with prominent psychological distress or formal psychiatric disorder in order to provide more appropriate intervention.

Dissociative disorders have comorbidity with conversion disorder, borderline personality disorder, depression and somatization disorder. Though dissociative disorders and medical illness comorbidity is not investigated enough, epilepsy, cronic pain such as headache, pelvic pain and backpain are frequent with childhood trauma and dissociative disorders. Few studies indicated that headache is more frequent in people with childhood trauma but the relationship between dissociative experiences and headache, childhood and other traumas is not investigated enough.

The aim of this study is to investigate the frequency of childhood trauma and dissociative disorders and the relationship between them among patients with cronic headache.

DIS-Q, SDQ, DES and Childhood Trauma Questionare is given to 90 patients presented to Neurology headache unit. Patients scored DIS-Q>2 or SDQ>30 or DES>25 are called for another session to apply DDIS and SCID-D.

46,7% of the patients had comorbid psychiatric illness. In this population the percentage of childhood trauma was 58,9% (34,4% neglect; 24,7% physical abuse; 22,6% emotional abuse; 10,8% sexual abuse). 21,1% of the patients had at least one suicide attempt; 17,8% had self destructive behaviour. DDIS was applied to 33 and SCID-D to 19 of 90 patients. Any type of dissociative disorders is diagnosed in 31 of 33 patients evaluated with DDIS.

We found high prevelance of childhood trauma and dissociative disorders among patients who present to neurology headache unit. These findings may indicate that childhood trauma can play a role in the development of dissociative disorders and somatic symptoms such as headache.

Clinical experiences.

Patients with haemophilia often experience high level of anxiety for the risk of bleeding and difficulty in coping with the situation. Comparison between the clinical data and the ESCHQoL Study results showed us, that patients with haemophilia initially tend to denial anxiety, which manifest itself more often through the body symptoms. Some of our patients experienced stigmatised behaviours during their childhood, which, of course is very traumatising.

The ESCHQoL Study results, especially the part, which evaluate the social and psychological problems of patients with haemophilia should be interpret with the caution. Clinical experiences in working with patients with haemophilia have shown that they have difficulties in expressing feelings. During the long-term psychological work with the patients they progresivelly start to open emotionally and the level and quality of their defence mechanisms start to change. As a consequence the management of haemophilia often improves.