1st episode psychoses are a common attendance in a city mental hopital, like Calcutta Pavlov Hospital in Calcutta & they constituse approximately 35-40% of new OPD registration in a day. These data is derived from the OPD register during the period 1st Jan 08-30th june09. The average new consultation in this opd is around 38 patients/day, and old repeat consultations usually around 300 case.

Management style usually practiced in this hospital is detailed here with the proportion of different management & their type as diagonosed on the 1st day.

Here this presntation of style in a devoloping country with meagre facities may be assesed & compared with those in other countries in Europe.

1st episode psychosis in new OPD attended cases are 12-14/day.They constitutes BPMD, hypomania 40%,Schizoprenia 30%, delusional disorders10%,Brief psychotic Disorder 8%,Pshyotic behavioral disurbances 5% and other non-specified psychoses 6-7%.

50-55% of 1st episode recieve drug only and after 7 days follow up return 80-90% become calm and tranquile with majority of their positive sypmtoms like delutions, hallucination losing sharpness. In 1/3rd no. of cases, mainly with violent, aggressive or refusal to medication inj. preparations are used. Previousely 1-2 cases were given ECT treatment, but that is stopped after Govt. banned ECT in OPD setting. Inj. commonly used are Inj. haloperidol, Promethazine HCl, and lorezepam in agrresives, Inj Olanjapine in negative or positive scizophrenic group, followed by Inj. Clopixol(zupixol)aquaphase follwed by depot.

Injection in 1st 2-3 days makes the compliance better and quick.

1sd episode management is the key in sucsess of psychosisas a whole.

Several factors may predict adherence with adherence with follow-up appointment for patients seen in the emergency department by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.

To examine the factors which could predict adherence with psychiatric follow-up appointments for patients assessed in the ED by the liaison psychiatric team.

The records of all patients assessed over a three month period by the liaison psychiatric team in the emergency department of Beaumont Hospital who were then referred for follow-up were examined for relevant demographic and clinical variables. Phone contact was then made with the centres to which patients had been referred to confirm the appointments made and if the patients had attended follow-up appointments. The data was analysed with SPSS (version 17).

Overall, only 55.9% of the patients were found to have attended their follow-up appointments with lrsquo;known to psychiatric services’ being the only statistically significant predictor of adherence. Patients’ who were single, separated, divorced or widowed and those who had consumed alcohol before an act of deliberate self-ham were more likely to attend follow-up appointments compared with those who were either married or cohabiting and those who did not consumed alcohol respectively. However these were not statistically significant when controlling for other predictors.

Patients who are not known to psychiatric services prior to assessment in the emergency department may need a more proactive outreach if compliance with psychiatric follow-up appointments is to be improved.

Alcohol use and related harm is a growing problem in Ireland with far-reaching consequences for health services generally. Areas which are most affected include accident and emergency departments and psychiatric hospitals or units. The purpose of this paper is to examine the role of alcohol in psychiatric admissions to an Irish psychiatric hospital

The inpatient records for all patients admitted over a one year period were examined retrospectively. All 378 patients admitted within that time were included and their admission records were examined manually for age, gender, diagnosis of psychiatric illness, co-morbid alcohol abuse, and the role of alcohol in precipitating the admission. Data were analysed using the Statistical Package for Social Sciences, version 11.5.

21.7% of admissions had alcohol dependency syndrome and it is the primary diagnosis in 10.1%. Alcohol was a factor in the admission of 29.1% of patients. Of the 110 patients in this category, 42 did not have a primary diagnosis of alcohol dependency syndrome, i.e. 61.8% had a primary diagnosis of a psychiatric illness other than alcohol dependency syndrome.

Alcohol is a factor in a large proportion of psychiatric admissions. It has been associated with poor compliance, exacerbation of symptoms and relapse. It is important to recognise the role of alcohol in psychiatry morbidity, both as a primary diagnosis (alcohol dependency syndrome), and also where the primary diagnosis is another psychiatric illness.

Violent behaviors in psychiatric emergency departments are a common problem. The aim is to study characteristics of patients who need intense preventive care measures and who act violently.

The study was conducted in a locked short term psychiatric inpatient unit and involved 172 patients admitted in a 8 months period. Sociodemographic and clinical data were obtained through a review of the medical records. Secclusion, restraint and agressive behaviors were noted on specific nurse sheets.

Aggressive behaviors or intense preventive measures concerned 34% (n=59) of the 172 patients. Among these 59 patients, 61% (n=36) are men and the mean age is 34,9 years, 28 had seclusion, 51 had restraint and 11 had physical aggression or against object aggression. The diagnosis are schizophrenic disorders for 63% (n=37), dependence or substance abuse for 11% (n=7), mania for 10% (n=6), depression for 3,5% (n=2). For 27% (n=16) of them it was first time in Emergency Department and 30,5% (n=18) were intoxicated at admission. The mean neuroleptic treatments dosis of these patients at admission were 656mg (equivalent chlorpromazine).

Patients concerned by seclusion, restraint and aggressive behavior are more frequently men with schizophrenic disorders, high neuroleptic dosis, and various past admissions in the Emergency Department.

Current treatments for agitation in schizophrenia or bipolar disorder (BD) have limitations in onset of action, invasiveness and tolerability. AZ-004 (Staccato loxapine) is a rapidly acting inhaled treatment designed for acute treatment of agitation delivering drug aerosol to the deep lung for rapid systemic absorption with intravenous-like kinetics. The objective was to evaluate the efficacy and safety of AZ-004 in the acute treatment of agitation in schizophrenia and BD.

Two randomized, double-blind, placebo-controlled trials included consenting male and female adults, 18-65 years old with DSM-IV-defined schizophrenia (N=344) or BD type 1 or mixed (314) who presented with clinically relevant agitation. Patients received a single inhalation of 5 or 10mg AZ-004 or placebo in a clinical setting with up to 2 additional doses within 24 hours if required. The primary efficacy endpoint was the absolute change in Positive and Negative Syndrome Scale Excited Component score from baseline to 2 hours following treatment.

In each trial, both 5 and 10mg AZ-004 were significantly superior to placebo for the primary endpoint (P< 0.001 for each dose in each trial). Significant improvements were noted for each AZ-004 dose versus placebo at all timepoints from 10 minutes through 24 hours. Clinical Global Impression-Improvement (CGI-I) at 2 hours post-dose and CGI-I responder analysis were statistically significant for each AZ-004 dose vs. placebo in both studies. Adverse events observed most often for all treatments were dysgeusia, dizziness, and sedation.

AZ-004 produced rapid and significant improvement in treating agitation in BD or schizophrenia patients.

Psychiatric emergency services (PES) are a main entry for patients with acute mental disorders. Most of them are voluntarily treated and a shared decision making model is implicitly used. Not much is known about decision making capacity (DMC) of patients and the utility of a shared decision making model in PES.

To assess neuropsychological abilities of DMC in a convenience sample of patients admitted to a PES.

Patients were assessed when discharged from the PES. A DSM-IV-TR diagnosis was generated. Neuropsychological abilities were assessed by the Trail Making Test (TMT), Stroop Colour-Word Test (SCWT) and the Mini-Mental State Examination (MMSE). MMSE was used a general assessment of cognitive functioning, TMT and SCWT as a more specific assessment of executive functioning. Patients with marked agitation, no cooperation or withdrawal symptoms were excluded.

47 patients were assessed. Most prevalent primary diagnoses were depressive disorder (11), adjustment disorder (8) and substance abuse/dependence (17). MMSE scores were normal in 87% of patients. SCWT and TMT differential scores were below the 20th percentile in 57% and 61% of patients respectively.

Cognitive functioning in patients, admitted to a PES, seems impaired when assessed by the TMT and SCWT. When replicated in further trials (larger study population, use of more extensive assessment of different components of DMC, careful consideration of ecological validity of these assessments), the implicit idea of a shared decision making model of care should be questioned.

To understand those factors which facilitate or hinder resolution of Mental Health Crises in order to inform future development of Crisis Resolution and Home Treatment (CRHT) Teams.

Qualitative Interview study conducted by service users trained in research techniques. Home based interviews were conducted with 36 randomly selected patients who had used the services of one of nine CRHT teams across the East Midlands, United Kingdom, which serves a catchment population of 1.2 million people during a two week census period in October 2007.

Participants reported different levels of satisfaction with the treatment and professional responses they received. We identified three themes leading to successful resolution of mental health crises: being enabled to feel safe, to feel accepted and to feel understood. Participants did not identify specific treatment interventions such as medication or formal psychotherapy as important contributors to recovery. Unhelpful experiences included professional responses which resulted in participants feeling misunderstood or ignored, unsafe, vulnerable or anxious, or that they were being judged.

The quality of relationship between the patient and members of the CRHT team is critical to any therapeutic effect. Therapeutic effect is optimum when it is based upon an adult to adult relationship which can provide a holding function allowing the service user to feel safe, accepted and understood while the crisis resolves. These findings have important implications for commissioning and managing such teams, and theoretical implications for medical practice morewidely.

The aim of this work was to identify factors associated with homelessness status in patients admitted to the psychiatric emergency ward of a French public teaching hospital over the 6-year study period (2001-2006).

The study was based on a retrospective review of the psychiatric emergency ward's administrative and medical computer databases. Each emergency care episode had accompanying data including demographic, financial, clinical, and management information.

During this 6-year study, the psychiatric service recorded 16,754 care episodes concerning 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were non-homeless (93.3%). The mean ± SD number of visits to the psychiatric emergency service was higher for homeless (4.9±12.3) than for non-homeless patients (1.7±2.4) (p< .001). A total of 331 homeless patients (56%) had more than one care episode, versus 2,180 (26%) for non-homeless patients. Factors associated with homelessness included male sex, single status, and the reception of social financial assistance. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most frequent disorders in homeless patients. Aggressive behaviour and violence were reported equally in homeless and non-homeless patients. Homeless patients were hospitalized less often after having received care in the emergency ward.

Although there is near-universal access to free mental health care in France, our findings suggest that the quality and adequacy of subsequent care were not always guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of homeless patients.

The Crisis Resolution Home Treatment team (CRHT) provides comprehensive care and support to individuals experiencing acute mental health difficulties in the community. It offers a same day assessment and provides an alternative to hospital admission by providing intensive intervention in the community. In case of hospitalisation, the CRHT can assist in minimising inpatient stay.

Handsworth and Ladywood are two major residential areas in Birmingham with high level deprivation and a population of approximately 9000. The study reviews the completeness and efficacy of CRHT intervention.

The study retrospectively examined 100 consecutive referred case notes during June and July 2008. That period was about four months prior to the start of the study which provided enough time for the completion of a home care episode. Data was gathered and assessed statistically.

62% of referrals were assessed on the same day and 27% within one day of referrals. 11% of referrals were new to psychiatric services. Referrals were from Accident and Emergency (32%), Community Mental Health Teams (22%) and general practitioners (8%). There were three and two assessors in 60% and 100% of cases respectively. A doctor was always present for all the assessments. Eighty-three percent of the referrers were notified of the assessment outcome the same day and 14% the following day.

The CRHT provides an effective care to psychiatric patients with acute needs. The organised nature of this service reduces hospitalisation and ensures that needs of patients experiencing acute mental health difficulties are met in the community.

To analyze, for all the pediatric consultations in 2008 in the emergency ward of the Pediatric Hospital of the University of Campinas, the clinical and demographic profile of the consultations in which there was a possible psychiatric diagnosis.

Review of all forms of consultations for children enrolled in the unit during 2008, selecting those with the possibility of a psychiatric diagnosis.

Of 21,811 consultations in 2008, 95(0.43%) included psychiatric complaints - 60(63.2%) girls and 35(36.8%) boys, aged 1-13 years(9±0.4). 70(73.7%) were white, 18(18.9%) mixed and 7(7.4%) black. A psychiatric evaluation was called for in 39(41.0%) cases. In 35(36.8%) sexual abuse was suspected. Other forms of violence were reported in 8(8.4%) cases. There were 6(6.31%) suicide attempts, 10(10.5%) cases of extreme agitation, 14(14.7%) consultations for extreme anxiety/dissociative symptoms, 5(5.3%) for depressive symptoms and 4(4.2%) for a psychotic condition. Twenty(21.1%) children were already using psychotropic drugs at the time of evaluation and in 29(30.5%) evaluations there were subsequent psychiatric interventions, with drug prescriptions in 11(37.9%). Nine(9.5%) children had clinical/pediatric conditions.

Children may need psychiatric care in emergency situations for various conditions. Despite the small percentage among the total number of pediatric emergency consultations, psychiatric evaluation, when necessary, can be useful and have an impact on diagnostic and therapeutic procedures. The plight of these children can be intense, demanding prompt and effective action. A psychiatrist can provide assistance that may help the pediatrician in the management of severe pathological conditions that affect the mental lives of children.

To examine associations between gender and diagnostic profiles of life events among patients admitted to a general hospital after attempted suicide.

Participants (n = 86) were patients consecutively admitted to a general hospital emergency care unit over the inclusion period of 26 months after an act of attempted suicide. They were interviewed within 2 days using the EPSIS protocol, the MINI and SCID-II interviews and a range of scales measuring life events (Brugha's scale) and alcohol abuse (AUDIT). Logistic regression was used in data analyses. Results are given in Odds Ratios with 95% Confidence Intervals.

Men reported more unemployment, [23.5(2.8-197.6)], loss of work, [4.7(1.2-17.3)], serious economic problems, [2.7(1.1-6.8)], problems with police and presented in court, [8.6(2.2-30.3)]. Major depression (MD) was associated with the separation from spouse due to interpersonal conflict [3.6(1.1-11.7)], however, when adjusted for gender, it tended towards significance only in men and was non-significant for women. Comorbidity of MD with anxiety disorders, alcohol abuse or borderline personality disorders were not associated with any specific life event.

Irrespective of diagnostic profile, life events related to legal problems and loss of job/work and marriage were significant for men who were admitted to a general hospital after a suicide attempt, irrespective of diagnostic profile.

Immigrant population has been growing up in Spain in the last decades. The immigration process constitutes a vulnerability factor for the development of psychological issues. Moreover, ethnicity determines a great variability in the symptomatic expression of psychiatric diseases. The objective of this study was to investigate the demographical characteristics and clinical profiles of immigrant patients that visit the emergency services of general hospitals.

An epidemiological study was conducted to evaluate profiles and demographical characteristics of immigrant population attended at the emergency services of the “Hospital 12 de Octubre” Madrid, during 2007. The data were acquired through a protocol developed for this study and applied to all foreign patients attended.

2976 patients were attended during 2007. Immigrant patients were 10% of the sample. There mean age was 29.46 years. 42.1% were men and 57.9% were women. The nationalities of the sample were as follow: 47.8% were Latin American, 23.7% Eastern Europeans, 16.1% were Maghribian and 4.7% were Africans. 48.2% were attended because of suicide attempt (the 59% of Latin Americans and the 54.5% of Eastern Europeans) and 14.3% had psychosis (the 42.9% of Africans and the 36.2% of Maghribians). 30% were diagnosed of a current Substance Use Disorder (the 16.9% of Eastern Europeans).

We found several clinical and demographical differences within the ethnic groups studied. Latin Americans and Eastern Europeans consult for suicide attempt, whereas Maghribians and Africans are attended for psychosis. Psychiatrists should consider cultural and ethnic factors when interviewing foreign population.

Revealing of clinical features of anxiety in victims of disaster for definition of the treatment and forecast.

Clinical, psychological testing, statistical. Clinical features of anxiety are investigated at 471 victims of disaster -- were staying in hostages (women -- of 68,4%, men -- of 31,6%) in the age of 18-60 years. Diagnostics of ASR was carried out according to diagnostic criteria МКБ-10.

Clinical variants of anxiety are allocated within the framework of ASR with: vegetative symptoms - 34,2%; asthenia - 52 (11,0%); emotional instability - 9,5%; somatoform symptoms - 8,7%; phobia - 11,3%; depressive symptoms - 17,0%; apathy - 3,1%); the others - 8,1%. On behavioural features with: hyperknezia - 60,9%; hypoknezia - 22,7%; mixed condition -- 16,3%. On current: undulant - 59,9%; constant - 30,8%; attack - 9,3%. After 1 year of dynamics of a mental condition has revealed formation of PTSD at 40,1% of injured, adjustment disorder at 24,2% anxiety disorder - at 18,7%, at 17,0% - recovery.

The least favorable forecast was marked at hostages with prevalence of somatoform symptoms (р≤0,001), emotional instability (р≤0,001) and apathy (р≤0,05). Favorable forecast -- at persons with vegetative (р≤0,05) and depressive symptoms (р≤0,05).

We have studied the treatment modes and therapies of patients with acute psychotic disorders, in a general hospital for 1600 beds.

Clinicopshycopathologic, clinicotherapeutic, and statistical.

1982 patients, 18-92 years of age, 64% of them males, have been examined.

All the patients have been primary admitted with acute somatic disorders:

• insult - 18%,

• skull injury - 21%,

• myocardial infarction - 23%,

• exogenic poisoning - 31%,

• parasuicides -4%,

• operations on the thoracic organs - 3%.

The mental disorders diagnosed were following:

• amnesic syndrome, organic - F04 - 29%,

• depression - F43.20 - 5%,

• organic hallucinosis - F06.0 - 12%,

• organic delirium - F05 - 33%,

• psychotic disorder - or drug induced - F1 - 21%.

After psychiatric examination by an attending psychiatrist, the patients have been moved to the resuscitation department where they have been treated up to their recovery.

None of the patients has been moved to the mental hospital.

The immigrant population in Italy is currently increasing, particularly, foreigners in East Piedmont raised by 16,8 % last year. We aim to compare immigrant and Italian patients’ Emergency Room (ER) admissions due to psychiatric symptoms.

Of the 658 admissions we observed, 13.1 % of ER contacts concerned immigrants mostly coming from Russia, Albania, Morocco and Romania, consistently with migration streams in East Piedmont. Compared to the Italians, immigrant patients were younger (35.70; SD = 10.56 versus 44.78; SD = 16.57) and more frequently admitted for alcohol and substance abuse/withdrawal. Italians had a higher probability of having a psychiatric history including previous hospitalizations and contacts with Mental Health Services (OR = 2.60; CI 95 %: 1.64-4.12). The presence of social/relational problems associated with admission was significantly lower among the Italians (OR = 0.55; CI 95 %: 0.35-0.88).

Preliminary data suggest that ER utilisation by immigrants may represent their main way to primary health care. Monitoring ER contacts may provide relevant information for the development of culturally sensitive Mental Health Services.

We considered Italian and immigrant patients with psychiatric symptoms who were admitted to the ER Department of Novara during a period of 13 months. We compared sociodemographic (gender, age, education, occupational history, marital status, living circumstances) clinical-anamnestic (history of psychiatric illness, presentation symptoms, previous contacts with Substance Abuse/Mental Health Services, social/relational problems) and admission (type of admission, intervention and discharge) characteristics of the two groups (Italians versus immigrants).

The first psychiatric intensive care unit (PICU) opened in the early 1970's in New York. This ward was designed to manage patient that did not respond to treatment in open psychiatric wards. There are about 15 PICUs in Sweden but the concept has not been specified by any public organs. In many county hospitals, both acute and intensive care units exists parallel.

Therefore, the aim of this study was to describe the core characteristics of PICU in Sweden and to describe the care activities provided for patients admitted to PICU.

Critical incident technique was used. In the study, eighteen caregivers at a PICU participated by completing a semi-structured questionnaire. Additional, in-depth interviews with three nurses and two assistant nurses also constitute the data.

Four categories were identified that characterise the core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours and temporarily coercive measure. Care activities for PICU were also analysed and identified as controlling - establishing boundaries, protecting - warding off, supporting - giving intensive assistance and structuring the environment.

PICU were interpreted as a level of care as it is composed by limited structures and closeness in care.

To examine the effects of chlorpromazine for psychosis-induced aggression or agitation.

We searched the Cochrane Schizophrenia Group Trials Register (2008) for randomised control trials or double blind trials implying randomisation, comparing chlorpromazine with another drug or placebo for people thought to be acutely aggressive due to psychotic illness. For selected studies we extracted data and calculated relative risks (RR) and 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed-effects model.

118 studies were identified, two met inclusion criteria. One compared oral chlorpromazine with oral thioridazine and one intramuscular chlorpromazine with intramuscular haloperidol.Those allocated chlorpromazine did not remain on medication (RR 2.00 CI 0.94 to 4.26), or stay in hospital (RR 1.87 CI 0.70 to 4.95) longer than those allocated thioridazine. No differences were found for adverse effects.Those allocated chlorpromazine were no more likely to have one (RR 3.00 CI 0.13 to 68.26), 2-4 (RR 0.90 CI 0.52 to 1.55) or 5+ (RR 0.75 CI 0.20 to 2.79) injections than those allocated haloperidol. Two patients allocated chlorpromazine had, serious hypotension (RR 5.00 CI 0.26 to 96.13), one developed status epilepticus (RR 3.00 CI 0.13 to 68.26), no one allocated haloperidol had these effects

Overall the quality of evidence is limited and dated. Chlorpromazine was just as effective as similar medicines, but it may be associated with more side effects. Where better, more evaluated drugs are available it may be best to avoid using chlorpromazine. Carefully designed clinical trials are urgently needed.

Psychiatric morbidity of a community could be assesed by a community survey as to the incidence & prevalance of different disorders in a particuler period. A more scientific approach is for a cohort study for a long period of a geographic population.

Another simpler way to get a ready hand account of approximate prevelance&incidence of disorders could be viewed by analysing a clinics attendance patterns of psychiatric patients.Ofcourse it focuces on the tip of an iceberg.

A quick sample survey of prevelance & incidence of disorders those are being brought in that particuler day.

Here is analysis of this authors 105 cases, those were examined & treated in 2 rural clinics of a district Midnapore those are even 75 k.ms & 60 k.ms from the capitol city of Calcutta.72 cases in one clinic in morning session lasting from 6a.m-1-15 p.m & 33 cases in afternoon session in another clinic from 2.30p.m-6.30 p.m on 15th of november 2009 on a sunday.

Age group range varies from 5 years-78 years with a maximum no. in the age group of 21-55years range.Affective disorders predominately,depressive disorder inBPMD,MDD,Anxiety disorders, schizophrenia,Hypomanic psase in BPMD &Behavioral disorders associated with Mental retardation/low intilligence &other mental retardation,Hysteria,Senile dementia Of alzhiemers,vasculer &mixed are most diagnostic presentation.Students & youth with tension headache associated with anxiety disorders were in sizable number.Women patients in depression were mostly presented with pain in lower extremeties.

105 patients visited in one winter sunday with depressive patients in top is concluded.

Negative emotions such as anxiety and depression have been related to increased mortality in both healthy individuals and medical patients The method of treatment would be changed when the patients have psychological problem. In internal ward researcher observed many patients that them shown psychiatric disorder such as depression and anxiety. Therefore, this study has been done for evaluation of prevalence of anxiety and depression and comparison with a control group.

In this cross-sectional study, we checked 150 patients of internal medicine department and 150 patients, who have admitted to the A&E department as a control group. They have chosen by a Purposive accessible sampling method. A questionnaire form, namely “SCL-R-90” was filled by a group of nursing student. This is known as a standardized questionnaire in Iran. Data have been computed and analyzed by SPSS V.13 and we used t-student, Mann-Whitney tests and logistic regression methods. The results have been considered significant when the two tailed p-value was less than 0.05.

In internal ward 69.3% and A&E department 42% of patient have had depression (OR=3.5, 95%CI=1.9—6.5). Anxiety were observed in 50.7%of internal medicine patients and 12% of A&E's patients (OR=1.94, 95%CI=5.1 —23.7).

Prevalence of the depression and anxiety in internal ward patients was significantly higher in compare to A&E's patients. Therefore, it's necessary to consider these patients in order to diagnosing for the early treatment. Recommendation are made to further investigate by greater sample size and different setting in this field is warranted.