Medical education in the UK has undergone dramatic change in recent years with both content and methodology being reviewed, assessed and updated in an iterative revolution. The aim has been to provide graduates with an educational experience more relevant to clinical practice.

To present the reflections and experiences of some students learning through these new educational approaches.

The effects of these changes are felt keenly by students. Here, in comparison with the views of senior collogues, two medical students nearing the end of their training reflect upon their own experiences.

They present a brief explaination of the structure of medical and psychiatric training in the UK followed by an exploration of one individual medical school's course.

The course structure will be detailed with reference to the guidance document “Tommorrow's Doctors” and to the school's own literature.

Medical students were consulted and an amalgamated “week in the life” based on their experiences produced.

The integration of psychiatric education throughout preclinical and clinical courses, coupled with individual attention and encouragement in gaining useful transferable skills, were seen as most useful.

Reforms have been successful and show that the delivery of both a basis in psychiatry and additional transferable skills (such as audit, research and publication) is best achieved by individual mentorship from an experienced clinican.

A continued reflection on how current practices may be modified to improve student experience is essential, but should also seek ways (such as more indivdualised attention) to improve recruitment and retention.

UPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.

Description of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.

Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.

Retrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.

47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.

19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.

Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.

10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.

Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.

Psychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.

Patients with psychotic or mood disorders often undergo electroconvulsive therapy (ECT) while receiving antipsychotic and/or other pharmacological agents. Paliperidone (PLP) -a benzisoxazole derivative and the principal active metabolite of risperidone- is a second-generation antipsychotic which has been developed in an osmotic controlled-release oral-delivery system. Thus the peak-through fluctuations of its concentration in plasma are minimized, with consequently decreased incidence of side-effects. To the best of our knowledge, there are, as yet, no reports on the safety of ECT-PLP co-administration.

Nine female inpatients suffering from affective disorders (N=7) or schizophrenia (N=2) underwent ECT while receiving PLP (3-12 mg/d). Patients’ regimen included other psychotropic medications as well (mainly antidepressants and/or antipsychotics). All patients were monitored closely for recovery time, post-ictal delirium, cardiological and EEG status for at least one hour after each ECT session. In addition to their clinical evaluation, patients’ cognitive -especially memory- functioning was regularly assessed by the Mini Mental State Examination. Overall, patients underwent 83 sessions of bilateral ECT.

ECT-PLP combination was well tolerated and even in cases where cognitive side-effects were of moderate severity (three cases; all were also receiving venlafaxine), they were transient.

Although anecdotal and thus in need of replication in well-designed large studies, our preliminary findings suggest that ECT and PLP can be safely combined whenever both indicated.

A questionnaire, which was sent to the 33 German University Hospitals, was evaluated. Furthermore, we have evaluated the demographic data and diagnosis of the patients that presented themself at the Specialists Service for adults with Autisms spectrum disorders at the RWTH Aachen University “Aachen Autism Clinic for Adults” (AACA) within the first 18 months after it has been established.

At the time of the evaluation, only 9 University Hospitals offered a Specialists clinic for diagnostics and/or treatment for adults with ASD in Germany. A total number of 73 patients were seen at the Aachen Autism Clinic within the first 18 month after establishing this service.

There is still great need of Specialists services at University Hospitals in Germany for adults with ASD.

Evidence is accumulating that mitochondrial dysfunction is involved in the pathophysiology of some psychiatric disorders such as Bipolar Disorder and Schizophrenia. In addition, among their other symptoms, people diagnosed with mitochondrial disease have high rates of psychiatric disorders. Leigh syndrome is a heterogeneous disorder, usually due to a defect in oxidative metabolism. The symptoms begin in the childhood by neurological troubles. Few reports mention psychiatric disorders. The objective of this work is to study relations between mitochondrial dysfunction and psychiatric disorders through a case of Leigh Syndrome.

It was a 20 year-old male patient, who had taken L-Dopa to treat severe extrapyramidal symptoms caused by Leigh syndrome. He developed, four months ago, acute psychotic symptoms such us audio-visual hallucinations, persecution and mystic delirium. The cerebral MRI had shown signal abnormalities in Basal Ganglia. This aspect was similar to those observed in the MRI having been practiced five years ago. The EEG recording was normal.The CSF and blood lactate levels were normal. The hypothesis that drug (L-Dopa) caused psychiatric disorders was possible. But, the digression of medicine was impossible due to the severity of extrapyramidal symptoms. The evolution under atypical antipsychotic was only partial.

In this case, the CSF lactate levels mean that mitochondrial dysfunction is not an overall explanation for these psychiatric disorders but may at least play a partial role. Psychiatric disorders may be induced by drugs or may just be a simple comorbidity.

The aim of this prospective study was to determine the efficacy of DBS using several targets in a pharmacoresistant OCD population with heterogeneous symptoms.

Five patients (3 males) have been included in the study. Patients were classified according to their prominent features as follows: contamination/cleaning, symmetry/checking, exactness/counting and forbidden thoughts.

The entire surgical procedure was performed under general anaesthesia. Direct targeting based on stereotactic MRI without microelectrode recordings was done. A combination of two of the following targets was simultaneously implanted for all patients: subthalamic nucleus, accumbens nucleus and bed nucleus of stria terminalis, limbic globus pallidus internus.

Patients were assessed pre-and postoperatively using the Yale-Brown Obsessive Compulsive Scale.

Mean age at surgery was of 42.6±12.68 years. Mean follow-up with DBS was of 21±14.88 months.

Mean preoperative Y-BOCS scores was 31.6±2.70 and of 11±7.97 (p=0,057, Wilcoxon signed Rank test).

Subthalamic nucleus and accumbens nucleus targets seem to be comparable in alleviating several subtypes of compulsions (checking, cleaning, counting) as well as obsessions. Further investigations are required to assess the role of limbic globus pallidus in improving pharmacoresitant OCD. Implanted system was well accepted without triggering new obsessions.

Memory and concentration may be affected by hemodialysis in end-stage renal disease. In this study, changes in cognitive function parameters such as attention, impulsiveness, and reaction time were measured and evaluated in the Iranian hemodialysing patients.

In this analytic observational study, cognitive function of 38 hemodialysis patients was measured before and after hemodialysis sessions using Conners’ continuous performance test.

Mean age of patients was 37.97 ± 12.58 years. There wasn’t any significant difference between numbers of matches successfully recognized, number of Miss Faire and mean of reaction time of those matches successfully recognized before and after hemodialysis. There weren’t any differences between history of hemodialysis and number of matches successfully, matches missed and mean reaction time of matches. Educational level of patients was significant effect on number of Miss Faire during hemodialysis.

It has been concluded that hemodialysis did not have any significant impact on the cognitive function. However, this hypothesis needs to be checked and confirmed by careful selection of patients and other cognitive function tests.

ECT is an effective and unknown treatment in the psychiatric patients. The authors compared the clinical and cognitive effects of bifrontal electrode placement with standard bitemporal electrode placement in the treatment of patient with major depression disorder and bipolar mood disorder.

Twenty -five patients with major depression disorder and Twenty-one patients with bipolar mood disorder were treated with a cource of bifrontal or bitemporal ECT. The Beck Rating Scale for depression and the Yung test for bipolar and the standardized Mini-Mental State Examination were adminestered at baseline and repeated during the cource of treatment (After 6th ECT& 1mouth later).

Forty-six of the 47 patients who completed the course of treatment met remission criteria by the 6th treatment. There were no differences between the patient given bifrontal ECT and those given bitemporal ECT in the number of treatment required to reach remission criteria. The standardized Mini-Mental State score of the patient given bitemporal ECT was simillar to those of the patient given bifrontal ECT. The result of Yung test and Beck test was similar in two BT&BF groups.

Bifrontal electrode placement was as efficacious as bitemporal electrode placement and resulted the same cognitive impairment. A study of the two placements with more cognitine measures is indicated.

Who or what is responsible for sex caused differences in brain structure and functioning: our biological inheritance or is it simply the consequence and the result of learning, experience and socio cultural influence? Scientists with different approaches and different orientation agreed in one: responsibility for sex caused differences of cognitive capabilities share innate (genes and hormones) and acquired (experience and learning) factors.

Studies which consider cognitive abilities males and females are mostly done with heterosexual and homosexual individuals. The aim of this study was to asses some aspects of cognitive functioning of female-male transsexuals (FMT) and to compare it with the model of functioning of heterosexual female (HF) and male (HM) individuals.

Experimental group consisted of seven FMT and 14 individuals were in HS group (seven in each, HM and HF). FMT were in stage of preparation for operative treatment, and transsexualism was diagnosed and guided within this program. We used Thurstone Test of Verbal Fluency as a written test for word fluency.

The results showed that in the first part of the test (words starting with S) F-M transsexual group was the worst, and in the second part of the test (words with 4 letters starting with K) they had the score closer to homosexual females. Higher score in the last minutes in both parts of test had the group of F-M transsexuals and male heterosexuals. This could be interpreted as an outcome of better attention of individuals in these groups.

This presentation will describe a prospective study, due to commence in March 2010, to evaluate the use of Protected Engagement Time in adult acute inpatient wards in three mental health trusts in England.

Patients on acute psychiatric wards in the UK have recurrently reported that they are unhappy with the ward environment, that they are bored and have little to do, that wards are intimidating, and above all, that contact between staff and patients is often identified as too limited in both quantity and quality, and as lacking therapeutic content.

Protected Engagement Time (PET) has emerged as a promising initiative for improving quantity and usefulness of staff-patient contact. During fixed periods of the day, staff are asked to focus solely on patient contact, and are relieved of their administrative duties. However, we do not have any evidence about whether it works or how it should be implemented to achieve the best results.

This study aims to address this lack of evidence and will have three components:

1. a) A national survey investigating how widespread PET now is in England

2. b) Evaluation of the effects of PET on patients and staff by comparing 12 wards with PET and 12 wards without, by investigating staff-patient interactions, patient satisfaction, staff burnout and perceptions of the ward environment.

3. c) In-depth qualitative case studies on three wards with PET.

The objectives for each component and the measures used will be described in detail in the presentation, in addition to an update of study progress.

To determine female authorship of original articles, editorials and the geographical region of female first authors in selected British Psychiatric journals.

The gender of the first author of original articles and editorials published between January 1997 and December 2008 in British Journal of Psychiatry and Psychiatric Bulletin was determined. Editorials from Advances in Psychiatric Treatment and the geographical region of the female first authors of original articles were also included in the study.

The gender was determined for 99.2% of the 2324 first authors of original articles and 100% of the editorials. The percentage of original articles by female first authors fluctuated over the study period, ranging from 22.5% to 42.1% with an average of 33.6% in British Journal of Psychiatry and a range of 25.5% to 45% with an average of 37.6% in Psychiatric Bulletin. There was a gross under-representation of females as first authors of editorials. Female first authors of original articles from low- and middle income countries range from 0.3% to 3.4% in both British Psychiatric literatures.

There is an increasing trend in female first authorship of original articles. However, female remain under-represented especially in editorials, in the British psychiatric journals examined. Female first authors from low and middle income countries are disproportionately low.

Our project describes a methodology for creating personalized spatial elements within people's immediate surrounding environment that are able to ‘sense’ the hormonal and thus the emotional changes of a human organism and ‘respond’ in such a way so as to help the individual to either overcome ‘negative’ emotions and feel comfortable or to express ‘positive’ emotions and become more sociable.

The first path of the methodology examines the ways in which one can pinpoint the chemical imprint of feelings in terms of calculating the quantity of mood-affecting hormones in the blood. The second path employs micro sensponding (sense-and-respond) assemblies that monitor bio-indicators and control an exogenous spatial system that will respond accordingly to help the brain react. The third path examines the symbolisms of aesthetics and the social implications of this project.

The exogenous spatial system can either be portable and have direct contact with the body, like a piece of smart fabric formed in a type of suit or it can be placed within the immediate living environment, like a type of meditation room. In both ways, the spatial system has a plethora of reactions to work towards the emergence of desired emotional states, all resulting by affecting one or a combination of the human senses (sound therapy, color therapy, aromatherapy and so on).

Space is no longer conceived as a static protecting element but it is augmenting its use through technology to affect human emotions.

Data for our study we used from computer database in our Hospital. We analyzed one-year period. Climatic data we used from Meteorological station in Nis: temperature, pressure, moisture, wind, cloudiness and precipitation (rain, snow). We compared climatic factors in days when patients died and climatic factors in days without deaths in our hospital.

There were 108 died psychiatric patients during the year, average 2 per week. In 11 days there were two or three deaths. 270 days were without deaths. Minimum deaths were in spring (April and May: 4 per month), and maximum were in winter (December and January: 12 per month). Average age of died patients were 70 years old. After analyzing of climatic factors we concluded that quickly changes of weather conditions have a large influence on mortality of psychiatric patients, and only value of climatic factors don't have influence on mortality.

There are some different ideas about family dynamics -particularly schizophrenic, major depressive and bipolar mood disorders- in psychiatric patient's family.

The aim of this study was to consider therapeutic purposes in Iranian patients.

90 randomly selected patients with schizophrenic, major depressive and bipolar mood disorders plus a member of their families - 90 people in 3 groups- who were referred to psychiatric hospitals were evaluated by Iranian version of Family Assessment Device (FAD). Statistical analysis was done at the end.

schizophrenic and bipolar patients who had more negative family functioning were compared with depressed patients. Family members of depressed patients had more negative family functioning compared with family members of schizophrenic and bipolar patients. Family members of schizophrenic and depressed patients had more impaired family functioning in comparison with patients.

More negative perception in schizophrenic patients may be related to the nature of illness and their suspiciousness. Due to negative believes in depressed patients they ascribe family problems to themselves. In general, members of these 3 groups of disorders had more pathologic and more negative functioning compared with patients. That could be the result of presence of ill member and tense interactions in these families.

Tuberculoma occurs in all age groups but are encountered most often during the first three decades of life. Recognized extra cranial infection or a history of exposure to tubercle bacilli are common but not constant feature.

Microscopically, the process of caseation culminates centerally as a core of amorphous eosinophilic substance but remains imperfect peripherally as a basophilic band of karyorrhectic debris. It is in this outer zone that tubercle bacilli are to be found in greatest abundance. The firm lamina that surrounds the caseous component consists of chronically inflamed fibrous tissue, scattered islands of lymphoid cells, granulomas & giant cells. Polymorphonuclear leukocytes predominate in some lesion. The paucity of granulomatous inflammation in rare lesions produces a similarity to the more common pyogenic abscess. Granulomatous forms of cerebritis also are seen in other mycobacterial & fungal infections, parasitic or spirochetal infection, and in idiopathic condition such as sarcoidosis, crohn disease, SLE. The only way to establish a definitive diagnosis is by biopsy.

Signs & symptoms as headache, seizures, papilledema, hemiplegia, and cerebellar dysfunction are expressions of the lesion's destructive & expansile nature. Fever may intimate its inflammatory character. In situ the Tuberculoma is remarkable for the contrast between its hard consistency & that of juxtaposed edematous brain.

Although, social & economic development lessen the incidence of brain tuberculomas, it might be a matter for the neurosurgeon which must be differentiated from abscess.

Social humans are embedded with a variety of relationships. Satisfactory social support is crucial for having physical and psychological well being.

The purpose of the present study was to find empirical support for the connections between perceived social support and loneliness with life satisfaction.

226 students of Golestan University of Medical Sciences participated in the study. They were assessed using demographic questions, Multidimensional scale of Perceived Social Support, Life Satisfaction Scale, and Loneliness Scale. Using SPSS (16) and Pearson correlation test, linear regression the data were analyzed.

122 male and 104 female students filled the questionnaires. 91 percents of the students were single and also 95 percents were residents of university dormitories. There was a significant relationship between life satisfaction with loneliness in the subjects (p< 0.05). The higher social support from the family and friends was also correlated with more life satisfaction and less loneliness (p< 0.05). Linear regression showed a significant correlation among social support, life satisfaction with loneliness.

Findings suggest, appropriate social support can reduce loneliness and increase life satisfaction. It is also one of the well being predictors. Therefore the universities should provide strategies to facilitate social support from family and the significant others. The empowerment of the students using teaching social communication skills may be helpful as well. The results were discussed within the context of findings from the studies conducted in eastern and western cultures.