Forensic-psychiatric services are costly and very restrictive for patients. Clinical experience and the limited research available indicate that some patients stay for too long in these settings. A proportion of patients may, however, require long-term, potentially life-long, secure forensic-psychiatric care but their needs may not be met by existing service provision designed for faster throughput. Here we report the initial findings of a three year study on long-stay patients in forensic care conducted in England.

The overall objective of this project is to improve the quality and cost-efficiency of the care and management of patients who stay for prolonged periods in secure forensic-psychiatric settings.

1. 1. Estimate the number of long-stay patients in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care)

2. 2. Describe their characteristics, needs, care pathways and reasons for prolonged stay

3. 3. Identify patients’ perceptions of their treatment pathways, long-term needs, service provisions and quality of life

4. 4. Develop recommendations following the exploration of international models for this patient group

This project uses a mixed-methods approach including analysis of administrative data, case file reviews, patient interviews, interviews with clinicians and commissioners and a Delphi survey.

Initial findings indicate that up to 25% of the forensic population fulfill criteria for long-stay, a much greater number than originally estimated.

The high number of long-stay patients in high and medium secure services calls for specific service provision for this patient group, which we will explore further.

The PANSS is utilized in clinical trials for assessment of psychopathology. In order to determine the status of a patient, comparisons within a general population are necessary. If several groups of patients are to be compared, gender, age, co-morbid diagnoses, and other factors affecting clinical status are not identically distributed.

1) Phase 1: To establish the initial psychometric properties of the PANSS-Ru. 2) Phase 2: To establish normed-reference data for the PANSS-Ru.

Phase 1: 40 patients with schizophrenia and other psychotic disorders. Phase 2: 375 individuals (n = 250 patients; n = 125 controls). Responses were assessed for internal consistency, stability, reliability, discriminative validity, and construct validity. Fifth percentile norms are presented as step functions. Data were compared to US norms.

40 subjects enrolled for Phase 1. Alpha coefficient of 0.88 verified good internal consistency. Test-retest comparisons verified time stability (r = 0.67 to 0.92). Correlation between subscale and the total scores ranged from 0.76 to 0.86, compared to > 0.83 for US norm studies. Internal consistencies were α > 0.745. Mean subscale/ total score were equivalent to US population norms within 13%. However, there was a difference of > 5 norm-based points for mean general psychopathology subscale. Norms had a sensitivity of 85% and specificity of 89%.

Preliminary results show that different dimensions of symptom presentations in the Russian population may help to improve symptom-specific treatments, and will also provide comparison data for a Russian population. Further normative studies are warranted in other populations.

Developing empirically sound measures for social cognition is a key step in improving the factors that contribute to deficits in social functioning in schizophrenia. Investigating the psychometric properties and acceptability of social cognitive instruments may contribute to identification of a reliable and valid instrument for schizophrenia patients.

To investigate the psychometric properties and acceptability of a dynamic social cognition scale (DSCB) compared to three common social cognition instruments in schizophrenia.

41 patients with schizophrenia were evaluated to assess acceptability, internal consistency and validity of five social cognition measures: DSCB, Emotion Recognition-40 (ER-40), Facial Emotion Identification Task (FEIT), Tone Matching Task and MSCEIT. Multiple linear regressions were conducted to identify variables which perform well as social cognition determinants.

The DSCB and FEIT showed good acceptability, evidenced by shorter administration time, completion and patient preference for the DSCB. Good levels of internal consistency were found for the DSCB (α = 0.851), ER-40 (α = 0.803), and FEIT (α = 0.782). Confirmatory Factor Analysis indicated sufficient to good model fit. The DSCB and the ER-40 demonstrated a good model fit. The correlations for the DSCB were significant for the ER-40 (r = 0.512) and FEIT (r = 0.500).

Findings suggest that DSCB is the preferred instrument to evaluate social cognition, due to its dynamic nature and short administration time. Further research is needed to develop and improve these measurements. Additionally, the DSCB, FEIT and ER-40 show adequate to good reliability and validity.

Though Focus of mental health care is negative emotional state, positive psychology appeals to masses. Because troubled person not only wants relief but also wants a life of meaning & purpose (National Mental health plan 2003-2004, Australian Govt.). and purposeful life without mentally healthy family is difficult. So family's transformation's imperative (Welsh Assembly Govt. 2005 a).

To strengthen Family members to transform Dysfunctional family.

1. 1) Preserve family mental health & Prevent mental illness among family-members of mentally ill patient.

2. 2) Prevent deterioration of mentally ill patient.

Discussion -for therapeutic alliance.

Therapeutic Transformation of dysfunctional family -

1. (a) Family Therapy: Why? Because family therapy focuses on well-being which is over & above the absence of depression-anxiety etc. Family therapy addresses problem and not individual unlike other therapies (NIMH, EFTA).

2. (b) Psycho-education: To build positive emotions which facilitate skills & resources needed for recovery (Fredrickson). It includes (i) Transactional-analysis (ii) Proactive behavior (iii) Social maturity (Robert Kegan).

3. (c) Positive Psychotherapy (PPT): Recovery rate was 85% (30%-single therapy) when psychotherapy was clubbed with pharmacotherapy. Positive emotions promote psychological resilience & positive emotional granularity. PPT focuses on pleasant, engaged & meaningful life (Seligman 2002).

4. (d) Spiritual Psychotherapy: Inevitable to future Psychiatry, because meditation alters levels of Melatonin, Serotonin, boosts immune response. Contents: (i) Meditation – changes brain (Dr Zedel, 2010) (ii) Spiritually-augmented CBT (SACBT), (iii) IBMT (Tang Y Y)/Yog-Nigra.

Family mental health is achieved.

Thus attained family mental health will facilitate family's transformation.

To determine whether hypersexual behavior can appropriately be characterized as an addiction, or rather, a symptom or manifestation of a coexisting Axis I or Axis II Disorder.

A literature review is being conducted to explore these opposing viewpoints. Articles published from the year 2000 to present relating to the topic of sex addiction/ hypersexuality/ sexual compulsivity/ impulsivity are reviewed.

The concept of sexual addiction was introduced in the 1970's. Two schools of thought have. Proponents of sex ’addiction’ argue that the neurochemical changes associated with hypersexual behavior are quite similar to that of drug addiction. They argued that sex ’addicts’ can experience a psychological withdrawal as experienced by those addicted to drugs of abuse. Some proponents of sex addiction even advise a 12-step treatment program. Critics of sex addiction argue that increased sexual activity is a way of alleviating affective symptoms, or is reflective of the impulsivity, associated with concomitant Axis I or Axis II pathology. They postulate that treating the underlying psychiatric disorder would ameliorate hypersexual behavior.

Despite standard, and even increasing use of the term ’sex addiction’ in media and popular culture, mental health professionals remain divided in regards to this subject. The proposed inclusion and subsequent rejection of hypersexual disorder in DSM-V highlights this existing debate. The notion of hypersexual behavior as an addiction warrants further exploration, especially since how it is defined may dictate treatment modality.

This study surveys patients with schizophrenia or schizoaffective disorder, to understand the relationship between sexual function and treatment with antipsychotic medication. The study compares patients on single versus multiple antipsychotics as well differences between first and second generation agents.

Patients diagnosed with schizophrenia or schizoaffective disorder at Beth Israel Medical Center are eligible. Once patients are evaluated to ensure they meet enrollment criteria and are consented, they are administered the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and either the International Index of Erectile Function for men, or the Female Sexual Function Index for women. Inclusion criteria include age 18-65, able to participate in a structured interview, fulfill DSM-IV criteria for Schizophrenia or Schizoaffective disorder, and on stable doses of one or more antipsychotic medications for at least six weeks. Exclusion Criteria include patients taking Selective Serotonin Reuptake Inhibitors (SSRIs), and inability to provide informed consent.

Presently, data suggests sexual function is impaired secondary to antipsychotic use. Further extrapolation of data is pending further enrollment.

Preliminary results point to better sexual function with certain second generation antipsychotics. It also appears that patients on single antipsychotic may have better sexual function than patients on multiple agents.

Les hallucinations figurent parmi les symptômes les plus invalidants de la schizophrénie. Même si ces expériences peuvent survenir à la fois dans la modalité auditive (HA) et visuelle (HV), l’impact de la présence d’une ou de deux modalités hallucinatoires (HA + V) reste peu exploré dans la schizophrénie. Cette étude vise donc à préciser les variations de connectivité fonctionnelle et structurale observables en fonction de la complexité hallucinatoire. Ces analyses seront complétées par des mesures structurales destinées à étudier l’impact de la plasticité et de facteurs neurodéveloppementaux sur la complexité hallucinatoire.

Deux groupes de sujets avec diagnostic de schizophrénie et souffrant tous d’HA ont été inclus et appariés sur l’âge, le genre, les scores de PANSS et les doses d’antipsychotique. Le groupe HA (n = 16) n’a jamais présenté d’hallucination visuelle, alors que le groupe HA + V (n = 17) présente des HV supplémentaires. Pour l’ensemble des analyses (connectivité fonctionnelle de repos ciblée sur l’hippocampe ou le nucleus accumbens, connectivité structurale par tract-based spatial statistics, analyse de forme et index de gyrification), une comparaison de groupe a été réalisée selon un modèle d’Ancova avec l’âge comme co-variable (qFDR < 0,05).

Des différences de connectivité ont été mises en évidence sur la voie mésolimbique et entre aires visuelles et complexe hippocampique. Ces différences sont liées à la présence d’HV complémentaires et ne peut être attribuée aux facteurs schizophrénie ou HA, contrôlés par le design expérimental. La présence d’HV chez les patients souffrant de schizophrénie avec HA est également associée à des modifications plastiques de la forme de l’hippocampe et à une vulnérabilité développementale précoce (baisse de gyrification). Les futures études portant sur les hallucinations devront non seulement s’intéresser à la sévérité de ces symptômes mais aussi à leur complexité sensorielle.

The presentation will focus on how psychosexual medicine and sexology education can be integrated into psychiatry residency training.

The Psychosexual Medicine Program currently being implemented at Beth Israel Medical Center, Department of Psychiatry and Behavioral Sciences in New York, NY will be described.

The positive impact on the training program and overwhelming support from faculty and residents of the program will be discussed.

An argument will be made why it is important to teach sexual medicine in psychiatry residency training and how psychiatrists are uniquely positioned to be good sexologists. It will be recommended that sexual medicine education become an integrated part of psychiatry residency training everywhere in the USA.

To pose a new hypothesis of schizophrenia that affirm and unifies conventional hypotheses.

Outside the brain, there are 5-HTP-containing argyrophil cells that contain tryptophan hydroxylase 1 without L-aromatic amino acid decarboxylase. Monoamine oxidase in the liver and lung metabolize 5-HT, rather than 5-HTP, and 5-HTP freely crosses the blood-brain barrier, converting to 5-HT in the brain. Therefore I postulate that hyperfunction of 5-HTP-containing argyrophil cells may be a cause of schizophrenia. I investigate the consistency of this hypothesis with other hypotheses using a deductive method.

Overactive 5-HTP-containing argyrophil cells produce excess amounts of 5-HTP. Abundant 5-HTP increases 5-HT within the brain (linking to the 5-HT hypothesis), and leads to negative feedback of 5-HT synthesis at the rate-limiting step catalyzed by tryptophan hydroxylase 2. Due to this negative feedback, brain tryptophan is further metabolized via the kynurenine pathway. Increased kynurenic acid contributes to deficiencies of glutamate function and dopamine activity, known causes of schizophrenia.

The 5-HTP hypothesis affirms conventional hypotheses, as the metabolic condition caused by acceleration of tryptophan hydroxylase 1 and suppression of tryptophan hydroxylase 2, activates both 5-HT and kynurenic acid. In order to empirically test the theory, it will be useful to monitor serum 5-HTP and match it to different phases of schizophrenia. This hypothesis may signal a new era with schizophrenia treated as a brain-gut interaction.

Although child mental health problems are prevalent, treatment gap is high. Low literacy level on child mental health problems in the general population and religious and cultural practices may be responsible but has not been extensively studied in Sri Lanka.

To elicit the parental beliefs about causes of child mental health problems and how such beliefs may influence help seeking behaviour.

A descriptive study. The sample comprised of all consecutive new referrals over a period of 3 months to make up a total of 52. Interviewer administered questionnaire was used. Frequency distribution and chi square test was used to analyze data.

Average age was 7.2 years (range 3–16). Main presenting problems were speech delay (n=15, 28.8%) and aggressive behaviour (n=9, 17.3%). Bad astrological period was given by parents as the as the cause in 46.1% of children. Bodhi-poojas and astrological interventions were performed in 61.5% and 44.2% respectively before a decision was made to seek medical help. In 61.6% of children, the delay in getting medical help was delayed as long as 2 years (mean delay 23.5 months). In 30.8%, the delay was the result of inappropriate reassurance given by doctors. There was no statistically significant association between parental educational level and delay in seeking help or use of cultural rituals (p>0.05).

The study highlights the delay in receiving attention for mental health needs and the financial burden on families, indicating the importance of improving mental health literacy of the general public and among medical practitioners.

Deliberate self-harm is non-fatal self-poisoning or self-injury. It occurs much more frequently than suicide. It is a common presentation among the patients referred to psychiatric unit, Teaching Hospital, Karapitiya, Sri Lanka from medical units.

To determine common methods used for deliberate self harm, to determine the medical and psychosocial factors associated and to assess psychopathology among persons presented with deliberate self harm

A descriptive cross sectional study. Sample was drawn from patients referred to psychiatric unit Teaching Hospital, Karapitiya following attempt of deliberate self harm. All Patients referred on every other day of the week for consecutive 2 months selected using systematic sampling. Interviewer administered questionnaire was used to asses.

Seventeen (53.1%) were females. Mean age was 29.3 years. Leading precipitant was acute conflict with a family member (n=15, 46.8%) followed by conflicts in relationships (n=5, 15.6%). Majority (n=18, 56.2%) had the intention to die seven (21.8%) had intention to change others behaviour. Majority (n=24, 75%) contemplated act for period less than 24 hours. Poisoning was used by majority (n=19, 59.3%) followed by overdosing of medication (n=10, 31.2%). Poison was available at home in 46.8% persons who used poison. Six (18.7%) had previous suicidal attempts. Six (18.7%) were previously diagnosed to have a psychiatric disorder. Nine (28.1%) each met the criteria for major depressive disorder and impulsive act.

The commonest method was poisoning. Leading precipitant was acute conflict with a family member. Majority had the intention of dying. Leading diagnosis was major depressive disorder.