The objective of the study is to gain knowledge about the interaction process by nurse students and users in the field of District Psychiatry practice in Norway.

A qualitative study design was chosen. The data came from the students written day books and from focus-group interviews repeated two times in the two different eight weeks period of practice. 28 students were interviewed and 16 students delivered the day books.

Analyzing the data was done by using grounded theory as described by Strauss & Corbin (1997). The main process was called “To be in change”. The findings were insecurity in between users and students, security in between users and students. The interaction process between users and students was to Balance.

Based on this result, we need to focus on the students need for time for reflections over practice and the need for time to discuss their personal competence as well as their learning process in this field of practice.

To determine incidence of complicated grief in the families of enforced disappearance in the conflict torn Kashmir valley. Complicated GRIEF is a recently identified symptom complex marked by continued separation distress and bereavement related accompanying traumatic distress.

A total of 100 family members who were recruited from a workshop conducted by department of psychiatry and MEDICENS SAN FRONTIERS with family members of enforced disappearances were screened by psychiatrists.

COMPLICATED GREIF was very prevalent, 79% screened positive for complicated grief, PTSD was present in 30% of screened, 41% met criteria for major depressive disorder, 38% neither met criteria for major depressive disord: er nor PTSD, even though everybody who met criteria for PTSD had major depressive disorder as comorbidity.

COMPLICATED GRIEF is a important diagnosis in this subgroup of population and results into significant distress and dysfunction and hence warrants attention.

Significant physical co-morbidity is recognised as prevalent among patients with severe mental illness. UK guidelines for treatment of both schizophrenia (NICE 2009; Clinical guideline 82) and bipolar disorder (NICE 2006; Clinical guideline 38) provide recommendations for screening physical health problems. Despite the evidence base, physical health screening in this population is inconsistent. The Dundee Health Screen Clinic was set up to monitor cardiovascular and metabolic problems by providing health checks and offer exercise and dietary advice along with smoking cessation groups. This survey demonstrates the prevalence of metabolic syndrome in this sample, associated risk variables and prescribed antipsychotics.

Metabolic syndrome prevalence was assessed among 240 new patients attending the Dundee Health Screening clinic from Nov 2005-Aug 2008. The health screen designed included demographic details, clinical investigations, a lifestyle history and a record of prescribed medication.

Metabolic syndrome (defined by the International Diabetes Federation (IDF) criteria) prevalence was 39.7%, with a higher propensity among those prescribed atypical versus typical antipsychotics. Predictors of metabolic syndrome suggested that BMI, a 10-year risk of CHD and diabetes are significantly associated with metabolic syndrome. 135 patients had dyslipidaemia with only 5.9% receiving lipid-lowering agents. Only 13 out of 94 patients with hypertension had received antihypertensive treatment.

This study identifies significant unmet medical need in the health screening of the severely mentally ill. Health screening programmes are required for this high risk population with early intervention and appropriate medical follow up to minimise cardiovascular risk and its associated morbidity and mortality.

Acute Care Model introduced in 2006 in UK has revolutionised the way Adult inpatient services are provided. Here, we look at the impact of this model on detained patients, which might serve as a service evaluation tool.

Our objective is to study the effect of the acute care model on the application of the 1983 Mental Health Act (MHA) in Adult Psychiatry Wards at Clatterbridge Hospital, England.

Our aim is to measure any difference in the number and duration of detentions, use of tribunal hearings after the inception of this new model.

Data on Section 2 (for assessment) and Section 3 (for treatment) were collected retrospectively from the Register at the hospital MHA Office. As the Acute Care Model was implemented on 6th June 2007, the data were collected from 6th March 2006 to 5th Oct 2008. From these data, the number and duration of stay of detained patients were calculated.

The number of people who were detained in hospital before and after the introduction of acute care did not change (n=122). However, the average duration of detention under Section 3 reduced significantly from 81.44 days to 46.25 days (43.21% reduction). There had also been a 55% decrease in the utilisation of tribunal hearings after the new model (45 tribunals before vs 18 tribunals after).

The Acute Care Model in Adult Psychiatry seems to have had a significant positive impact on detained patients in reducing their in-patient stay and the need for tribunal hearings.

There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.

The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.

Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.

Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.

EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.

To understand how healthy siblings visualize and represent health and disease as conditions affecting them and others in their family. Furthermore, to evaluate the emotional settings following health and disease for healthy siblings, the reasons lead to illness and what could be done to avoid that path. Additionally, this study aims to investigate the parameters that interfere with the physical and emotional living of healthy siblings and finally to access their subjective knowledge on disease and in particular, cancer.

Fourteen healthy children, aged between 7 and 14, siblings to children diagnosed and receiving treatment for leukemia (acute lymphoblastic & myelogenous leukemia), nephroblastoma (Wilms’ tumor), lymphoma, rhabdomyosarcoma, where evaluated according to the Hatira's Projective Technique.

Analyzing the interviews lead to different kind of responses; some positive but mainly negative ones. The negative reactions addressed emotional instability, rejection, separation, siblings’ rivalry, the medical treatment itself and the fear of death, while positive reactions concerned self-awareness, sensitization, earlier maturing and increased family coherence after the crisis.

The physical relationship between siblings is a special kind of human relationship that can outrun time and crises, even outgrowing in some cases the relationship between parents and their children. On the other hand, it is simultaneously a very fragile and vulnerable relationship, since traumatic experiences such as those arising from childhood cancer interfere with the mental and emotional growing of the healthy brother or sister, causing confusion to the body, mind and soul.

An exploratory study was conducted with the aim of discovering and describing experiences of nursing students during clinical placement in a psychiatric unit in an Iranian hospital.

This hermeneutic phenomenological study was carried out in a psychiatric unit of an educational hospital in Iran. Data were produced with 13 participants using in-depth interviews to detain their full experiences in psychiatric unit. Analysis rooted in the Diekelmann manner facilitated data interpretation and clarification of frequent themes.

Four correlated themes - Anxiety, Maturation, Routine learning and Enthusiasm were recognized in the data.

These results present exclusive insight for scheduling and applying fitting clinical Education in Iran, especially in psychiatric units. The exploration and description of experiences of the nursing students will help nurse educators plan clinical learning opportunities in such a way that they are less stressful, thus ensuring that nursing students are equipped to utilize themselves as therapeutic instruments.

The World Health Organization (WHO) (1998) has proclaimed that the definition of health includes four Domains of well-being: physical, mental, social and spiritual. It is therefore suggested that nurses should prepare themselves to assist individuals and families, not only to cope with spiritual distress of illness and suffering but also to explore the meaning in these experiences. The purpose of this investigation is to explore the antecedents of spiritual distress experienced by Iranian Muslim patients in the context of Islam.

qualitative descriptive research was conducted using unstructured interviews with twenty-one patients and three relatives. The data analyzed using content analysis method.

three main categories were found: failure in communication, non-holistic care and inability to worship

The results showed that the patient's spiritual well-being could be enhanced by communication, listening and giving information. Finally, it is clear that staff members have a great deal of responsibility for the patient's well-being, facilitating the relatives’ involvement based on their wishes and limiting the stress and difficulties experienced by the family.

1. 1. Understand the concept and benefits of a collaborative care model through a case based presentation

2. 2. Become familiar with best practices for the successful implementation and ongoing service delivery of collaborative mental health care

TUHA's aim is to improve access to mental health services and strengthen each Community Health Centres’ capacity to meet the mental health needs of its clients through a “shared care model”.

This case based presentation will illustrate the benefits and promising practices of implementing such a model

A shared care model is generally utilized within a particular organization to foster collaborative work among multidisciplinary teams. The unique feature of TUHA is the partnership between six different community health centres and mental health specialists using a common set of principles and objectives to sustain and enhance the quality of service being offered in the community.

Reflections on a multi-site partnership in the delivery of a collaborative model within a large urban centre creates a platform to determine the possibility of replicating a similar model in other communities.

Mental disorders are associated with many harmful health behaviors such as smoking, abuse of alcohol or drugs, physical inactivity and overweight. Abdominal obesity has been positively associated with depressive symptoms independent of general obesity (BMI). Adult obesity has been associated with depression, especially in women. Recent evidence implies that causal link goes from depression to obesity. This study set out to investigate the relationship between depression, sleepiness, health behavior, BMI and inflammation.

The study based on a cardiovascular risk sample drawn from the participants of a population survey, (aged 45-70) which was carried out in in southwestern Finland. The subjects filled in several internationally known questionnaires: STAI-S (state-anxiety), BDI (depression), EQH5 and RAND-36 (health-related quality of life), Berlin, ESS and PSQI (sleep disorders), smoking and generic measures on health behavior (e.g. physical exercise, time spent watching TV and using PC, intake of calories and fat). Blood samples were drawn from the subjects to measure among other things hsCRP (n=1318).

We found a statistically highly significant correlation between BMI and hCRP (r=0.22, p< 0.001). Total daily minutes watching TV correlated with hsCRP (0.12, p< 0.001). Partial correlation between total minutes spent watching television and hsCRP while adjusting for depression or BMI did not render it the correlation insignificant not diminish its size.

High level of TV use was associated with silent inflammation despite BMI. Heavy use of TV may be an indicator of harmfully increased stress levels.

Study aims in describing a case of insomnia associated with Behcet's disease and responding to treatment with melatonin.

Case concerns a 59-year-old female arriving at our outpatient ward complaining of insomnia. Her sleep pattern was disturbed in a way that she has been sleeping for about an hour daily for the last two years. The problem had started five years ago, her sleep progressively deteriorating with time. She also mentioned a feeling of exhaustion being present every day during the last year and lasting all day long, difficulty in concentrating in the performance of everyday activities and also a feeling of hopelessness affecting her daily mood. All of the above were progressing as insomnia was persisting. Her medical history was significant for Behcet's disease diagnosed about 20 years before and being treated with corticosteroids.

Initially patient was prescribed lorazepam at a dose of 2.5 mg and melatonin 5mg, both once daily before bedtime. After 10 days, patient has started responding, sleep having increased from 1 to 2.5 hours daily. At that time, dose of lorazepam was halved. After altogether 25 days, patient was sleeping for about 5 hours daily, lorazepam was stopped and melatonin was increased at 10mg before bedtime. By the end of the 3rd month and whilst making no further adjustments in medication, patient was sleeping for 6 to 6.5 hours per night.

Melatonin seemed effective in treating insomnia associated with Behcet's disease, arising either from disease itself or corticosteroid treatment.

We measured oxyHb and totalHb in the prefrontal cortex during the performance of original version TMT by multichannel NIRS using sensitive for detecting changes of oxyHb and totalHb.

Sixteen healthy student volunteers performed four different screens of TMT-A, and then two different screens of TMT-B.

OxyHb increased while in the prefrontal cortex during the performance of TMT-A and TMT-B. The changes were prominent during the TMT performed at first. OxyHb significantly increased in the right lateral prefrontal cortex during TMT-A while it significantly increased in the bilateral prefrontal cortices during TMT-B.

The results suggest that blood flow increases in the prefrontal cortex during the performance of TMT, and that the bilateral prefrontal cortices are involved in the performance of the original version TMT.

We showed an increase of oxyHb during the performance of TMT in the prefrontal cortex. The increase of oxyHb was more prominent in TMT-B than in TMT-A.

The present study suggests that the simultaneous use of the paper version TMT and multichannel NIRS may provide evidence to disclose neuronal mechanisms related to cognitive functions.

The Community Mental Health Team (CMHT) in Singapore provides home-based psychosocial rehabilitation services for people with severe mental illness (SMI). Besides the direct clinical intervention to the patients and their caregivers, the multidisciplinary team also collaborates with social and non-governmental organizations in the community. It provides training, consultation and support to these agencies so as to strenghten their capability in the understanding and management of people with SMI.

Since the inception of CMHT in April 2007, it has networked with family service centres, non-governmental mental health service providers, police, religious groups and other community partners. CMHT provides 2 types of mental health training programmes - basic and skill-based mental health training. The former programme introduces the participants to common mental disorders and the clinical services of CMHT. The latter programme is customized for the community partners and would entail the management of violent, aggressive and suicidal behaviours encountered in the settings of the community partners.

Effectiveness of the training is assessed by a pre- and post survey of the participants. Satisfaction score were also obtained from the participants.

Pre-knowledge of the participants were assessed to be of the range of 22.5% to 29.8%. This improves to 95.6 to 97.8 % after the training. At least 81 % of the participants were satisfied with the training.

It is important to train and engage social agencies and community partners so that people with SMI can experience a coordinated and seamless care in the community.

The objective of this study was to differentiate ordinary dreams from traumatic and PTSD-related dreams, by using The Sang Bok Lee Neurocognitive Dream Orientation Scales assessing the narrative dream contents.

1248 dreams were collected from 416 Korean college students, Yongin, South Korea - 198 males (M age=20.46 years, SD=1.32) and 218 females (M age=20.17, SD=1.26). The collected dreams were evaluated to find traumatic and PTSD-related dreams by using The Sang Bok Lee Neurocognitive Dream Orientation Scales, designed by Sang Bok Lee. These scales particularly asked about the dreamers a series of cognitive orientations that cover location, person, event, the dreamer's perception and coping action in the dream narratives. The PTSD-related dreams were hypothesized as having (1) frequently recurrent, (2) unfamiliar, (3) unexpected and accidental, (4) emotionally dreadful or fearful, and (5) not actively coped by the dreamer.

392 dreams (31%) of 1248 collected dreams were found as traumatic or very/extremely anxious dreams according to The Lee Anxiety Dream Scales (Mean=4.56). 36 dreams (0.9%) of 392 traumatic dreams were frequently recurrent and evaluated as PTSD-related. Strong positive correlation was found between 392 traumatic dreams and independent variables (unfamiliar: r=.85, p=0.0001; accidental: r=.82, p=0.0001; dreadful or fearful: r=.95, p=0.0001; not coped by the dreamer: r=.87, p=0.0001).

In this study, the traumatic and PTSD-related dreams were associated with unfamiliar, accidental, emotionally dreadful or fearful, not coped by the dreamer, and recurrent events.

The aim of the present study was to examine if patients’ expectancy after bariatric surgery was related to improvement of body appearance, health, physical fitness, or ability to work. Further, the relationship between psychiatric comorbid disorders and outcome expectancies after surgery was investigated.

The study population consisted of 94 patients (F/M:74/20) age 22 to 62 years (mean 41.1, SD=10.2), with BMI from 33.4 to 64.7 kg/m2 (mean 44.9 kg/m2, SD=5.5). Psychiatric assessment was done prior to bariatric surgery, and included structured psychiatric interviews (M.I.N.I. International Neuropsychiatric Interview and Structured Clinical Interview for DSM IV Axis II disorders). The patients were asked to identify their most important expectancies after surgery.

The overall prevalence of current psychiatric disorders was 47%, with Social Phobia (18%, n=17), Dysthymic Disorder (14%, n=13), and Avoidant Personality Disorder (17%, n=16) as the most common ones. Thirty-six percent (n=34) rated improvement of health, 34% (n=32) physical fitness, 22% (n=21) improvement of body appearance, and 7% (n=7) ability to work as their most important expectancy after surgery. Patients with psychiatric comorbidity rated significantly more frequent improvement in body appearance as their most preferred outcome than patients without psychiatric comorbidity (34%/ 12%, p= .01, chi-square test).

Patients with psychiatric disorders rated improvement in body appearance as their most preferred outcome after surgery more often than patients without psychiatric comorbidity. Future studies should examine whether patient expectations predict outcomes and satisfaction after surgery.

To analyze psychiatric symptoms in relation to a case of Hallervorden-Spatz disease (neurodegeneration with brain iron accumulation (NBIA) or pantothenate kinase-associated neurodegeneration - familial brain degeneration with iron deposition in brain).

Pubmed revision on behaviour alteration and its relation to brain iron accumulation. Review of patient medical records, including image studies.

A 52-year-old female with diagnosis of mental retardation and psychosis was treated and followed since 1999. Severe behaviour alteration motivated hospital admission in 2009. Over the last two years, the patient had developed progressive dementia, choreoathetosis, mutism, ideomotor apraxia, urinary and fecal incontinence, and corticospinal signs.

A brain MRI (2008) revealed iron deposits in basal ganglia, hypointensity with an area of central hyperintensity (“eye-of-the-tiger”-sign) in both globus pallidi on T2. Based on clinical and MRI findings a diagnosis of Hallervorden Spatz Disease was made.

Classic form of the disease is characterized by early onset and rapid progression, culminating in early death. Atypical disease, as in our case report, has a later onset and more slowly progressive course.

Systemic chelating agents have not proved beneficial. Treatment remains symptomatic. Our patient has experienced a favourable response to low-dose trazodone and quetiapine.

At times, behavioral changes may predate neurologic manifestations, whereas at other times disturbances in mental status and physical functioning may coexist. Among patients with NBIA, those with atypical disease are much more likely to have psychiatric symptoms with cognitive decline. These features present in our case report usually make a difficult and late diagnosis and treatment.

Jealousy and attachment share some characteristics: both can be interpreted as dynamics aimed at maintaining the subjects/partners together, appear to be triggered by the separation from the attachment figure/partner, involve the same basic emotions, such as fear, anger, sadness, and, finally, both they elicit a sense of safety when the other is close and responsive, or the opposite when he or she is distant. Some studies showed that differences in attachment styles seem to influence both the frequency and the patterns of jealousy expression. However, jealousy is a quite heterogeneous phenomenon, even within the normality domain, and it would be more valuable to ascertain the impact of attachment styles on specific jealousy features. The present study explored the possible relationships between romantic attachment and jealousy in 100 healthy subjects.

The romantic attachment and jealousy were evaluated by means of, respectively, the “Experiences in Close Relationships” questionnaire (ECR), and the “Questionario della Gelosia” (QUEGE).

The ECR anxiety scale was related to all QUEGE dimensions, while the ECR avoidance scale to the self-esteem, fear of loss and suspiciousness dimensions. Individuals with the preoccupied, fearful-avoidant or dismissing attachment styles showed higher scores than secure subjects at all QUEGE dimensions, while dismissing individuals had lower scores at all dimensions.

Taken together, these findings suggest that the two phenomena, attachment and jealousy, are intertwined.

Concern has been expressed about the number of medical students who are not choosing psychiatry as a career.

We describe the methods used by one teacher to teach medical students psychiatry in a medical school in England.

The teacher describes methods which he has found worthwhile in teaching psychiatry.

An important method is one to one working with a student and a patient during clinic. The student takes the patient's history and the teacher sits with him, intervening when necessary, thus making the environment ‘safe’.

Socratic questioning is frequently used in order to enable the student to think for himself.

Students are encouraged to take the opportunity of the attachment to carry out an audit or a piece of research or an in depth case report of their choice using literature searches or the database of patients and conditions held by the teacher's team. If successful, the student is helped by the teacher to publish the work in a pubmed journal or as a poster in a major conference.

Most important is debriefing students after seeing patients. Opportunity is taken to teach about Michael Balint's understanding of communication skills, and the value of the student's own personality in the doctor-patient relationship and the importance of this in aiding patients to recover from illness.

Experience is that these methods are appreciated by students. Students are likely to be influenced in their career choices by meeting doctors who can demonstrate that they value the student's own worth.