The English health system has recently undergone significant change via the Health and Social Care Act 2012. The Royal College of Psychiatrists successfully lobbied for an amendment to this Act which explicitly recognised the importance of both physical and mental health. This became known as the ‘parity of esteem’ amendment.’

The College has since published an extensive report on how to achieve parity between mental and physical health in England. Many of the areas considered by this report (such as avoidable premature mortality, the stigma associated with mental illness and the low levels of treatment compared to incidence) are also significant problems in parts of Europe.

To inform delegates about the English experience regarding parity of esteem, in order to inform their own engagement with nation-specific issues as necessary.

The detailed aims of this session are to outline the English experience in (1) securing a legislative basis for parity of esteem, (2) defining parity of esteem as a concept and (3) identifying the England-specific issues which needed to be addressed in order to achieve parity. It is intended that delegates will be able to use the information provided as a template for action in their own country, as necessary.

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The longstanding lack of parity between mental and physical health remains inequitable and socially unjust. It is hoped that English experience will lead to improvements which can be exported to other European nations as necessary.

Alcohol dependence (AD) is a highly prevalent disorder that is associated with serious morbidity and mortality. The development of alcohol dependence is the result of an interaction between environmental and hereditary factors. Previous studies have implicated GABRA2 receptor genes with AD, alcohol use patterns, and levels of response to alcohol. The aims of this study were to analyze the effects of polymorphisms in the GABRA2 gene on the risk of alcoholism ; associations between genotypes and alleles were studied;

This study included a group of 161 Caucasian subjects, with no history of psychiatric disorders other than alcohol or nicotine dependence as classified by ICD-10. The control group comprised 150 unrelated individuals matched for ethnicity and gender, and excluded for mental disorders using the Primary Care Evaluation of Mental Disorders questionnaire. All subjects were recruited in the North West region of Poland. Alcohol use and family history of alcoholism were assessed by means of a structured interview, based on the Polish version of Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Genomic DNA was extracted from venous blood. Polymorphisms (rs 279826, rs 279871, rs279845) were detected using PCR real time method.

Significant associations for genotypes and alleles were observed in rs 279871 polymorphism (p=0,31). The advantage of this research is that the genetic analysis of GABRA2 gene rs 279871 polymorphism was conducted on quite large and, most importantly, homogenous subgroups of alcohol-dependent patients.

Supported by grant of Ministry of Science and Higher Education (MNiSW no.: NN 402466540).

Neuropsychological and neuroimaging studies of response inhibition in cannabis users have reported inconsistent results. The age of onset of cannabis use and individual genetic differences may play a critical role in the regulation of inhibition in cannabis users.

We examine the influence of COMT Val158Met functional polymorphism on the response inhibition brain network in a group of early-onset chronic cannabis users compared with healthy controls.

fMRI data was acquired from 27 chronic cannabis users who began use cannabis before 16 years of age, and 29 non-using control subjects matched in terms of age, educational level and intelligence quotient while undergoing the Multi-Source Interference Task (MSIT). Participants were male, Caucasians aged between 18 and 30 years. All were assessed by a structured psychiatric interview (PRISM) to exclude any lifetime Axis-I disorder (DSM-IV). COMT genotyping was performed and resonance imaging data was analysed by voxel-based morphometry (VBM).

Both groups did not differ on their behavioural performance and brain responses during the MSIT task. A significant group-by-genotype interaction was observed on task-related brain activation (and on MSIT reaction times), in which met carrier load was associated with increased activation in cannabis users and val carrier load with increased activation in controls. The interaction pattern included the medial frontal cortex, ACC, inferior frontal gyrus, ventral striatum, anterior mesencephalon, inferior parietal and superior temporal cortices and the PCC.

Chronic cannabis exposure interacts with the genetically driven dopamine function in the modulation of the neural mechanisms related to response inhibition.

Grants:PNSD/2011/050, PNSD2006/101, SGR2009/1435.

Less than half of depressed patients achieve remission. Identification of biological markers may help clinicians to predict remission and improve patient's treatment.

To identify brain regions whose activity during self-referential processing at baseline could predict long-term remission among patients with Major Depressive Disorder (MDD) and to investigate the brain effects of Agomelatine.

Nineteen acutely depressed patients and fourteen healthy controls performed self-referential judgments on emotional pictures during two fMRI sessions: before treatment and after 6 to 7 weeks of Agomelatine in patients or one week of placebo in controls. Patients were treated during 6 months and remission was assessed (HAM-D≤7).

Activation in dorsomedial prefrontal cortex (dmPFC) and precuneus, during self-referential processing at baseline, was lower in future remitters than in non-remitters and remained stable after 6/7 weeks of treatment in both groups of patients. Pre-treatment activation of dmPFC and precuneus predicted clinical remission at 6 months with a sensitivity of 100% and a specificity of 71.6%. After 6–7 weeks of Agomelatine, the brain activation of MDD patients during self-referential processing was normalized i.e. decrease in the excessive activation of the dorsolateral prefrontal cortex and increase in the ventral anterior cingulate cortex activation.

Pre-treatment activation of precuneus and dmPFC during self-referential processing appears to be a valid predictor of clinical remission. Such results are consistent with the idea that cortical midline structures activity may play a major role in treatment outcome of MDD and may help developing biomarkers-based treatment of MDD.

The analysis of medication discontinuation may allow the comparison of the effectiveness of different medications and may help us understand treatment patterns in depression. Clinical guidelines recommend at least six months of antidepressant maintenance treatment for major depressive disorder (MDD).

To determine the duration of antidepressant treatment in Asian patients treated with antidepressants for a major depressive episode and to understand the reasons and factors associated with discontinuation.

Nine hundred and nine in- and out-patients from Asia, of which 569 started an antidepressant medication at the baseline visit, presenting with a new or first episode of MDD were enrolled in a 3-month prospective observational study. The Kaplan-Meier method and Cox models were used to estimate discontinuation rates and factors associated with discontinuation. Survival analysis with competing risks was used to analyze the influence of different reasons for discontinuation.

Of the 569 patients included in the study, 430 (75.6%) were evaluated at three months and analyzed. Of them, 242 (56%) discontinued the treatment during the three months follow-up and 188 maintained it. Of the overall sample, half of the patients discontinued the medication within 70 days. The most frequent reason for discontinuation was inadequate response (n=155, 64%), followed by adequate response (n=62, 26%). A relatively high proportion of patients with adequate response (30% at 130 days) discontinued the medication. Country and type of antidepressant were associated with medication discontinuation.

Medication discontinuation in Asian patients with depression is high, even for patients who respond adequately to treatment.

To evaluate the effect of Souvenaid (a multicomponent nutritional drink for early AD) on cognition, behavioral and psychological symptoms of dementia (BPSD), activity of daily living (ADL) and well-being of M.Alzheimer patients in a real-life prospective clinical setting.

Patients (and caregivers) with M.Alzheimer, using Souvenaid, were evaluated after 6 months on cognition, behavior, ADL and wellbeing, based on the KATZ Activity of Daily Living, Mini Mental State Examination (MMSE) and Neuro Psychiatric Inventory (NPI).

58 Alzheimer patients were included and 43/58 were evaluated after 6-months. 15/58 did not have a follow-up visit yet. 2/58 patients stopped using Souvenaid. 24/43 patients (58,1%) were better or stable on the 4 items mentioned above. 28/43 patients (65%) improved when only evaluating ADL-functions, BPSD and Cognition. Sub-group analyses (1. start Souvenaid and Alzheimer medication together, 2. start Souvenaid < 6 months after start Alzheimer medication, 3. Start Souvenaid > 6 months after start Alzheimer medication); a positive outcome on 4 items was observed in group 1 (57%, 4/7 patients), group 2 (53%, 8/15 patients) and group 3 (57%, 12/21 patients). Another sub-group analyses (MMSE < 20 vs ≥ 20) showed an improvement in 4 items of 28% (2/7 patients) vs 58,8% (20/34 patients).

Souvenaid is well tolerated in a real-life prospective clinical setting, also in conjunction with standard care Alzheimer medication. Souvenaid may be more beneficial in early stage AD patients and seems to improve quality of life.

Understanding the complex impact of epilepsy on a person's quality of life is increasingly significant since it is recognized as an important component of clinical care.

To assess the quality of life of patients with epilepsy;

To identify the influence of anxiety and depression on the quality of life.

It was a cross-sectional study involving 50 subjects with epilepsy and followed in the outpatient psychiatry. The state-trait anxiety inventory was used to assess the level of anxiety, whereas the Beck depression inventory was used to measure the severity of depression. The quality of life of our patients was assessed using the quality of life in epilepsy inventory (QOLIE -31).

The average age of our patients was 44.66 years. They were benefiting from family counseling in 80% of cases and family financial support in 64% of cases. Thirty percent of them were suffering from stigmatization and 38% from relational difficulties.

A low level of anxiety was found in 46 % of patients, while a mild to moderate depression was found in 52% of cases. The average overall score of quality of life of our patients was 71.66. A high level of quality of life was significantly correlated with a minimum level of anxiety (p = 0.012), but not with the severity of depression.

Health education of patients with epilepsy would improve their knowledge about this chronic illness, reduce their anxiety and contribute to improve their quality of life.

Common mental disorders are a leading cause of long-term sickness absence and disability pensioning.

To evaluate the effectiveness of a 5–15 session work-focused CBT integrating individual job support for people struggling with work participation due to common mental disorders.

Compared to usual care, increases the intervention work participation 12–18 months post baseline, and does it improve mental health and health-related quality of life as secondary outcomes.

The study was a randomized controlled multicenter trial with six secondary care centers, but with possibility for self-referrals. A total of 1416 potential participants were considered for inclusion, 197 failed inclusion criteria, 26 did not consent, leaving 1193 participants (67% female) to be randomized. The participants included both people on sick leave, people at risk of going on sick leave, and people on long-term benefits (>12 months). Primary outcome data were registry based, eliminating loss to follow-up.

Compared to usual care, participants in the intervention group had higher work participation (44.2% vs 37.2%, diff: 6.9%, P=0.015) at 12 months follow-up. The difference remained significant after 18 months (diff: 7.8%, P=0.018), and was even stronger for those on long-term benefits (diff: 12.2%, P=0.007). The intervention group also reduced their depression (t=3.44, df=625, P=<0.001) and anxiety symptoms (t=2.06, df=625, P=0.040), and increased their health related quality of life (t=2.45, df=616, P=0.015), more than the control group.

A work-focused CBT and individual job support was more effective than usual care in increasing work participation for people with common mental disorders.

Sexual problems noticed in patients with schizophrenia and who are treated with neuroleptics, are known but their meaning and importance is marginalized.

60 women and 64 men were examined before working out the results. These are just the beginning of the research which will include the results of 200 patients. The research was conducted in the Department of Psychiatry and Psychotherapy Silesian Medical University in Katowice, Poland.

Some of the data and the initial diagnosis were taken from the illness history card. Mini International Neuropsychiatric Interview (MINI) was used as well in the course of the research to confirm the final diagnosis. The data input was also conducted using the questionnaires (Sexual Function of Man according to Kratochvil (SFM/K) and of Woman (SFK/K), and Questionnaire of History of Sexual Life (BSP)) which the patients could fill in discreetly. The patients were also asked to provide such information as: the type of the received medicament, its pharmacological group.

Within the female group the frequency of the dysfunctions was 56,6%. The female patients pointed the following order of those dysfunctions: orgasm dysfunction 46%, vaginal dryness 20% and feeling pain during sexual intercourse 20%. 70% of men doesn’t report any sexual dysfunctions and the most common anomaly for the others is erection dysfunction (17% of men)

That issue should be often mentioned during the therapy, which in result can prevent the patients from putting the neuroleptic drugs aside or changing them.

Previous research suggests a possible link between insomnia and mortality, but findings are mixed and well-controlled studies are lacking. The aim of the current study was to examine the effect of insomnia on all-cause mortality.

Using a cohort design with 14 years follow-up, official registry data on mortality were linked to health information obtained during 1997–99, as part of the community-based Hordaland Health Study (HUSK), in Western Norway. 6,236 participants aged 40–45 completed baseline information included self-reported information on insomnia (defined according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), sociodemographic factors, health behaviors, obstructive sleep apnea symptoms, sleep duration, sleep medication use, anxiety, depression, as well as a range of somatic diagnoses and symptoms. Height, weight and blood pressure were measured. Information on mortality was obtained from the Norwegian Cause of Death Registry.

Insomnia was found to be a significant predictor of all-cause-mortality (hazard ratio [HR] = 2.86 [95% CI: 1.62–5.03]). Adjusting for several possible confounders did not attenuate the effect (HR=3.07 [95% CI: 1.53–6.15]). Stratifying on sex, the effect was significant in men (adjusted HR=3.93 [95% CI: 1.26–12.19]); but not in women (adjusted HR=2.11 [95% CI: 0.83–5.36]). The mortality risk among participants with both insomnia and short sleep duration (<6.5hours) was particularly high (adjusted HR=4.58 [95% CI: 1.22–17.19]).

Insomnia was associated with a four-fold risk of mortality in men during 14 years follow-up. The risk was especially high in combination with short sleep duration. Establishing prevention strategies and low-threshold interventions should consequently be a prioritized task for public health policy.

Driving is an essential activity of daily living for many patients. A diagnosis of dementia is likely to affect one's ability to continue driving safely due to cognitive decline. It is the role of the memory services team to inform the patient of the above, assess their risk and advise patients about their driving accordingly. Furthermore given that there are currently no gold standard assessment tools available, the method by which patient risk is assessed is often left of the discretion of the assessor. This literature review looks at assessment of driving to see if there is an effective method that could be adopted by memory service assessors.

To review literature with regards to assessing competency of driving in patients with dementia (pre and post disclosure).

To see if there are effective measures, tools or assessment criteria that can effectively determine if a patient is competent to continue driving.

PubMed and OvidSP search using ‘driving assessment’ and ‘dementia’ as search criteria for journal publications in English over the past five years.

The search gave 60 papers from pubmed and 14 from OvidSP. 12 papers met the criteria for selection.

There are many different tools that can be used to assess cognition, each with varying ability to identify those patients who are at risk when continuing to drive. The problem lies not only in detecting those at risk but there is also the issue over validation for the tests that are available

The aims of this study were to determine the presence of painful physical symptoms (PPS) and its impact on depression outcomes in different gender and age groups.

Three hundred in- and out-patients from China presenting with a new or first episode of major depressive disorder were enrolled in a 3- month prospective observational study from Asia (N=909). Hamilton Depression Scale (HAMD-17), Clinical Global Impression Severity (CGI-S), EuroQoL and the pain-related items of the Somatic Symptom Inventory were administered. Patients were classified into three age groups (<40, n=119; =40-<60, n=133; =60, n=48). Linear and logistic regression models were fitted to assess the relationship between PPS at baseline and outcomes.

Older patients had higher HAMD-17 severity at baseline. HAMD score was 25.9 (SD 6.1) in =60 vs. 22.5 (SD 5.0) in <40 and 24.8 (SD 5.2) in =40-<60. There were no statistically significant differences in the proportion of patients with PPS across gender and age groups. During follow-up, depression severity improved. There were no statistically significant differences in the degree of improvement by gender, but there were differences by age group. Mean change in HAMD was -16.4 (95%CI -17.7;-15.1) for those <40, -19.9 (95%CI -21.1;-18.7) in 40-60 and - 20.3 (95%CI -22.6;-17.9) in >60. PPS positive patients had worse clinical and quality of life outcomes across genders and age groups.

The presence of painful physical symptoms is associated with a lower improvement in depression outcomes and a lower quality of life in patients with major depression across different gender and age groups.

Medication non-compliance is common in the treatment of depression, particularly in Asia.

1) To describe the frequency and factors associated with medication non-compliance. 2) To study the influence of non-compliance on treatment outcomes.

Nine hundred and nine in- and out-patients from Asia presenting with a new or first episode of major depressive disorder were enrolled in a 3-month prospective observational study. Clinical severity and quality of life were assessed, using Hamilton Depression Scale (HAMD-17), Clinical Global Impression Severity (CGI-S), and EuroQoL measures (EQ-5D and EQ-VAS). Medication compliance was also assessed by the investigator and patient. Linear and logistic multiple regression models were used to analyze the consequences of non-compliance.

The proportion of non-compliant patients as assessed by the investigator was 16%. Sociodemographic factors and clinical severity were not associated with compliance at baseline. Regression models showed that medication non-compliance was associated with worse depression severity (difference in HAMD-17 -3.98; 95% CI -5.10, -2.87) and overall clinical severity (CGI-S difference -0.46; 95%CI -0.68, -0.24) at three months. Medication non-compliance was also associated with lower quality of life at three months (EQ-VAS difference -7.47; 95%CI -11.13, - 3.82) and EQ-5D score difference -0.08; 95%CI -0.1, -0.04)). Compliant patients had higher odds of response (odds ratio (OR) 3.18; 95% CI 1.98, 5.10) and remission (OR 3.94; 95% CI 2.42, 6.43) compared with non-compliant patients.

Patients non-compliant with medication had worse 3-month outcomes in terms of depression severity, quality of life, and response and remission rates, compared with compliant patients.

False-positive drug screenings have been reported for several drugs and can affect the therapeutic relationship.

We wanted to find out, which medication can cause false-positive phencyclidine drug screenings.

We systematically looked at all psychiatric inpatients with phencyclidine positive urine drug screenings using a kinetic interaction of microparticles in a solution (KIMS) based system treated in our psychiatric department between 2008 and 2013.

39 of 40 positive phencyclidine urine drug screenings could plausibly be explained as false-positives by psychopharmacologic medication. The most frequent common medication in our case series was chlorprothixene, which has not been reported as a cause for any false-positive drug screenings so far. We also found trimipramine as a medication in three cases, being structurally similar to imipramine, which has been reported before to potentially cause cross-reactivity. Other false-positive results could be explained by venlafaxine, lamotrigine, imipramine and tramadol, which have been reported to have the capacity for cross-reactivity. Chlorprothixene and venlafaxine accounted for almost 75 % of the positive screenings.

Confirmation by a second method like gas chromatography/mass spectrometry should follow positive drug screenings for phencyclidine.

Tobacco use and dependence is a chronic relapsing disease, due to nicotine in tobacco.

To assess smoking cessation rates and compliance to a smoking cessation program in moderate tobacco consumers with low and moderate nicotine dependence score.

Analysis of demographic variables, smoking profile, nicotine dependence score, type of cigarettes smoked, past history of nicotine withdrawal syndrome and medical history was performed. Patients underwent either pharmacological therapy and counselling, either counselling alone for 3 months. 6 months follow up based on face to face or telephonic evaluation was done to assess smoking abstinence rates.

Study group was made of 124 moderate smokers (40 % men, age average 31.2) referred to a smoking cessation center in the Clinic of Pulmonary Diseases Iasi in 2007-2009. While 31.2 % had low nicotine dependence (Fagerstrom scores < 3) and 40% moderate dependence (score 4-7) psychiatric co-morbidities were met in 12 % and 40 % of subjects described nicotine withdrawal history. 38.8% started smoking under the age of 14 and 30 % prefered nonfiltered or menthol cigarettes. 71.2 % of the study group underwent pharmacological therapy. Abstinence rate was 30 % at 3 months end of treatment and 12.5 % at 6 months.

Even if low or moderate cigarette consumption and low - moderate nicotine dependence score, quitting smoking may be difficult due to specific smoking patterns in this category of smokers, resulting in unexpected low abstinence rates.

Aggressiveness is one of the most stigmatization symptoms of paranoid schizophrenia with its possible roots in personality and/or acute psychopathology of schizophrenia.

To explore general and personality differences among suicidal, homicidal and non-aggressive male subjects with paranoid schizophrenia.

We recruited all consecutive inpatients fulfilling the ICD-10 criteria of paranoid schizophrenia during 2009-2011. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale which measures the five major personality traits: emotional stability, extraversion, openness to experience, agreeableness and conscientiousness).

The study included 359 male subjects diagnosed with paranoid schizophrenia. Their mean age was 37,8 yrs (SD 11,9) and duration of illness 13,77 yrs (SD 12,1). Majority were single (N=271, 75,5%), with 8-12 yrs of education (N=266, 75%) and unemployed (N=193, 53,8%). In an attempt to assess their auto and heteroagressivness, subjects were divided into three groups: subjects with suicide ideation (N=66, 18.4%), subjects with suicide attempt (N=67, 18,7%) and subjects with homicidal behavior (N= 86, 24%). These groups were compared against the comparative group of subjects without suicidal ideation, suicide or homicide behavior (N=140, 39%). Subjects with homicide behavior were significantly older, with longer duration of illness, majority were diagnosed with comorbid alcohol addiction and these participants scored higher on the emotional stability subscale (ANOVA F=7.8, df= 3, P=0.001).

These findings might contribute to discussion of the role of personality characteristics in paranoid schizophrenia.

There are four levels of human functioning: biological, ontogenetic and psychological, social-relational and cultural-spiritual. The social-relational level exerts its influence through specific individual groups that a person belongs to. Of all groups to which an individual belongs, the family group seems essential, from the ontogenetic-psychological perspective, in acquiring self-confidence, self-esteem and emotional stability.

To assess the possible impact of family group structure on suicidal behavior in suicide attempts.

All suicidal behaviour emergency cases that reached the ER at Bihor County Emergency Hospital (medical and surgical profile) as well as the Psychiatric ER were analyzed. A number of 292 cases were collected from 01.Jan.2012 to 31.Dec.2012. The structure of the family of origin and current family structure were analyzed.

Out of the monitored parameters present in the description of the cases, the existence of a psychiatric diagnosis, presence of somatic illness, marital status, presence of children had no statistical significance. In turn, the structure of family of origin analysis had an unexpected result. Out of all attempted suicide cases, 74.4% were only children. 14% of the cases had one sibling. Families with 3 or 4 children gave 5% of the studied cases, while 4 or more siblings had only 6.6% of the suicide attempters.

Being an only child represents a major risk for suicide attempts. The explanation can be complex and nonlinear. It is also a part of group psychology.

Metabolic syndrome (MS), which consists of several metabolic abnormalities, is highly prevalent in patients with schizophrenia. According to some studies, MS is characterized by a mild chronic inflammatory state, while for the elevated white blood cell (WBC) and neutrophil counts are considered to be positively associated with MS.

To determine the WBC and neutrophil counts and to establish their possible association with MS and its components in schizophrenic patients.

We conducted a cross-sectional study. The study group consisted of schizophrenic patients from the University Clinical Hospital Mostar (n=100), while the control group consisted of healthy subjects who came to the systematic medical examinations in the Health Center Mostar (n=100). The diagnosis of MS was made according to ATP III criteria, and on that basis the subjects from both groups were divided into two subgroups, one with and one without MS.

Schizophrenic subjects had significantly higher average WBC (p<0,001) and neutrophil (p<0,001) counts compared to the control group. Schizophrenic subjects with MS had significantly higher WBC and neutrophil counts compared to both control subgroups. WBC and neutrophil counts correlated positively with fasting blood glucose level and MS prevalence. There were no significant correlations between WBC or neutrophil counts with the number of MS components.

WBC and neutrophil counts are positively associated with MS prevalence and fasting glucose level. Routine monitoring of these inflamatory indicators might have an important role in predicting MS development in schizophrenic patients.

In Norway, it is mainly GPs that admit refer involuntarily to psychiatric hospitals. The process is regulated by legislation that requires that the patient suffers from a serious psychiatric disorder and is a danger to him/herself or that necessary treatment cannot be given otherwise. about 1/3 of patients are referred involuntarily in Norway. While legislators have tried to reduce the number of patients being referred involuntarily by changing the legislative requirements, the proportion of involuntarily referred patients has remained high. More knowledge is needed about why patients are referred involuntarily, and especially about GP's expectations.

To examine which expectations GPs have when referring patients involuntarily to a psychiatric hospital.

Semi-structured phone interviews were performed with 74 GPs that had referred patients involuntarily to a major Norwegian University Psychiatric Hospital. One topic that was discussed was GPs expectations. Each GP could give several expectations.

81% expected to solve an acute situation and make sure that the patient was cared for.

58% expected that appropriate medical treatment would be given.

38% expected a major change/improvement in the treatment or care of the patient.

22% expected that the patient's diagnosis would become clearer during the stay.

GPs may have different expectations when admitting patients involuntarily to psychiatric hospital. Solving an acute situation and making sure that the patient was cared for was the most important expectation given by the GPs.