Evidence for management of ’therapeutic dose’ dependence is more extensive than for ’non-therapeutic’ users and transferring the principles is affected by differing clinical picture, need to avoid abuse and diversion. There is evidence that long term prescribing causes harm and doses greater than diazepam 30 mg is rarely necessary.

To know the proportion of patients on combined Benzodiazepines and Opiate substitute prescriptions and review benzodiazepine reductions plans.

Drug Misuse and Dependence: UK Guidelines on Clinical Management 2007 and British Association of Psychopharmacologists guidelines.

A Cross sectional study at Mid June 2013. List of patients were generated from database and the doses, duration, reduction plans and benzodiazepines commencement dates extracted. We evaluated methadone stabilisation and concomitant psychotropic prescription.

The point prevalence is 8.4% and diazepam’only’ is prescribed in all except 10% who are combined with temazepam. More than 75% were commenced on 30mg dose or lower. 40% have been on diazepam script for more than 24 months and ½ of this have diagnosed co-morbid psychiatry illness while high proportion of remaining ½ await community psychiatrists input. This group also constitutes majority of patients with failed reductions plan.

There is a high correlation between long term benzodiazepine prescription, unsuccessful reduction and co-morbid psychiatry diagnoses. There is a correlation between co-morbid psychiatry diagnoses and higher starting doses of diazepam. Patients commenced on diazepam within last 12 months of this study have reduction plans and high percentage commenced on a dose of 30mg or less.

We invited pregnant women to participate in an 8-week therapy group (either mindfulness-based (MB) or interpersonal therapy (IT)) facilitated by an experienced psychologist. We collected depression, worry, and sociodemographic data on admission to the group, at the end of the group, and again one month postpartum. We subsequently matched and compared the women to 60 women who had participated in a longitudinal study of perinatal depression (age, gestation, marital status, education, medications) from the same community. We wanted to know if: 1) participating in a therapy group decreases depression and worry over the course of pregnancy into the postpartum? and 2) there was a significant change in depression, stress, and worry symptoms for the treatment group compared to a control group?

Data were available on 39 women who had completed 6 groups (4 MB and 2 IT). Women who participated in either group showed significant decreases in depression (p<0.001) and worry scores (p<0.001) compared to control group. Women in the MB groups complained of less stress postpartum than the IT group, otherwise the groups were similar. Women who were unmarried had significantly higher depression scores (p<0.0001).

In summary, participating in relaxation therapy groups can significantly lessen depression and worry symptoms over pregnancy and into the postpartum.

We invited pregnant women to participate in an 8-week therapy group (either mindfulness-based (MB) or interpersonal therapy (IT)) facilitated by an experienced psychologist. We collected depression, worry, and sociodemographic data on admission to the group, at the end of the group, and again one month postpartum. We subsequently matched and compared the women to 60 women who had participated in a longitudinal study of perinatal depression (age, gestation, marital status, education, medications) from the same community. We wanted to know if: 1) participating in a therapy group decreases depression and worry over the course of pregnancy into the postpartum? and 2) there was a significant change in depression, stress, and worry symptoms for the treatment group compared to a control group?

Data were available on 39 women who had completed 6 groups (4 MB and 2 IT). Women who participated in either group showed significant decreases in depression (p<0.001) and worry scores (p<0.001) compared to control group. Women in the MB groups complained of less stress postpartum than the IT group, otherwise the groups were similar. Women who were unmarried had significantly higher depression scores (p<0.0001).

In summary, participating in relaxation therapy groups can significantly lessen depression and worry symptoms over pregnancy and into the postpartum.

UK is one of the ethnically and culturally diverse countries in Europe with high rate of immigration and asylum applications. Significant proportion of this population do not speak English as their first language and have their mental health assessments carried out using an interpreter. However the structure, logistics in the Interpreter Mediated Reviews (IMR) vary without any standard consensus-guidance. Liverpool has ethnically diverse population and has the second largest Asylum Tribunal of the Home Office.

To Check: Awareness of good practice guidelines for IMRs amongst clinicians involved in Merseyside area. Positive & negative impact on clinical engagement of IMRs Clinical challenges faced by staff in these assessments Training needs for professionals;

Comprehensive literature search was conducted to identify various available practice guidances. The literature was peer reviewed & a questionnaire was devised. It covered procedure for arranging interpreters, experiences of clinicians in interpretations, using adhoc interpreters, room-arrangements, utilizing post-interview debriefing and training involved. It was disseminated via surveymonkey to clinicians in the Merseyside; results were collated & analyzed for trends.

Results revealed variation in practice due to lack of agreed guidance. Both clinicians and interpreters had very minimal training in undertaking IMRs. The reviews were complicated by cultural intricacies between interpreters and patients leading to poor or prolonged assessments. Staff and interpreters did not have a standard practice about room arrangement or debriefing process.

It was clear that consensus guidance on IMRs to be developed. Further, training the staff in undertaking an efficient IMR was recommended.

Bien qu’il soit classiquement admis que les patients schizophrènes seraient moins sensibles à la douleur cela reste controversé. L’objectif de cette étude était d’évaluer l’effet d’une récompense sur la sensibilité et la tolérance à une douleur expérimentale au froid chez des patients schizophrènes et des sujets sains [1].

La douleur expérimentale était réalisée en utilisant le Cold Pressor Task (CPT). Les sujets volontaires était divisés en 4 groupes : un groupe de 25 sujets sains récompensés (SSR), un groupe de 25 sujets sains non récompensés (SSNR), un groupe de 25 patients schizophrènes récompensés (PSR) et un groupe de 25 patients schizophrènes non récompensés (PSNR). La récompense était 70 euros.

Pour la détection de la douleur : Pas de différence entre les PSNR et les SSNR : 9,7 sec (9,4) versus 8,14 sec (6,15), p > 0,05. Pas de différence entre les PSR et les SSR 30,84 sec (30,45) versus 22, 17 (18,30), p > 0,05 tout en ayant de meilleurs scores que les PSNR et les SSNR. PSNR = SSNR < PSR = SSR. Pour la tolérance à la douleur : SSNR avaient une meilleure tolérance que les PSNR : 36,43 sec (49,35) versus 18,22 (21,40), p = 0,05. Pas de différence entre les PSR et les SSR 74,9 sec (61,17) versus 66,16 sec (56,14), p > 0,05) tout en ayant de meilleurs scores que les SSNR.

En l’absence de récompense les patients schizophrènes stabilisés avaient le même seuil de détection de la douleur que les sujets sains mais une moindre tolérance. En présence d’une récompense les patients schizophrènes et les sujets avaient le même profil de sensibilité à la douleur (détection et tolérance). Cette étude suggère que la sensibilité à la douleur serait influencée par le circuit de la récompense.

In the UK, Deaneries have specific protocol for handover between doctors during on-call duties. However, there is no formal protocol for handover between trainees during changeover of their posts in February/August rotations. This has significant impact on service provision and training as outlined in the good practice guidelines of the GMC. Further, end of post handover is important in psychiatry as trainees have their own clinic caseload.

To evaluate the handover practice extant amongst trainees in Mersey deanery at the changeover of posts.

Literature search was conducted to identify handover protocol recommended by any deaneries in UK during changeover of posts. A questionnaire was synthesized based on the recommended good practice guidance. It was disseminated to trainee psychiatrists and results were analyzed.

The questionnaire covered how long prior to their rotation trainees were intimated of their placements, whether trainees and their trainer met prior to the commencement of the post; whether they discussed the job role and leave arrangements, handover practice etc.

Results showed there was no formal arrangements for handover at the end between trainees. In many cases, the trainees had not arranged to meet with their trainers before commencing their post. There was very minimal interaction between outgoing and incoming trainees about clinical caseload.

Handover at the end of the post has significant impact on service provision and trainee confidence during rotation, especially in psychiatry. It is recommended that protocols be developed for handover between trainees prior to commencement of the post.

Asylum seekers and refugees experience psychological distress at various phases, such as during pre-migration, migration and post-migration. In the post-migration phase, the period of asylum process has many risk factors for severe mental health implications.

The aim of this study was to identify research evidence that suggest asylum process as a cause of psychological distress among the forced migrants in the United Kingdom (UK).

The study was carried out by searching the NHS database for the relevant information and interviewing asylum seekers and refugees.

The literature search identified several relevant studies in this area. However, only one study was found as the most relevant for my study focus. The study was ‘Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland’ by Ryan et al. The qualitative data gathered from the interviews of forced migrants showed a strong link between the asylum process and mental distress.

This research strongly suggests that the asylum process does contain many risk factors causing psychological distress among the asylum seekers. In particular, the restrictions from freedom to work or study, and the constant fear of deportation are the key stressors identified. Increasing the mental health awareness of all personal who come into contact with forced migrants could prevent severe psychological consequences. These points should be taken into consideration for improving the asylum policy and training medical and non-medical staff who may encounter forced migrants.

Sport activities can be considered either in terms of sport consumption or sport dependence characterizing a behavioral addiction [1–3]. The objective of this study concerned the effects of exercise-induced sport dependence on soldiers stress resistance in the context of a six months deployment in Afghanistan.

In an anonymous prospective cohort study we assessed before during and six months after deployment Extra Regimental Sport consumption (ERS), exercise dependence (ED; 2,5), anxiety and depression diseases, perceived stress, and mood of Tension/Anxiety. Plasmatic Brain Derived Neurotrophic Factor (BDNF), considered as a good marker of central nervous system plasticity, was assessed before and after.

Among the 397 young soldiers evaluated before and during the deployment, 131 had been assessed six months after. Before deployment, 65% of soldiers have ERS consumption. 42% presented ED, which was not related with higher ERS consumption. Levels of perceived stress, anxiety and depression diseases were higher for ED subjects and were not influenced by ERS consumption. In soldiers without ED, perceived stress and mood of tension/anxiety were higher in subjects without ERS. Neither ERS consumption, nor ED altered BDNF concentration. During deployment, the percentage of ED was not modified, but the distribution in sport dependence group was modified: 64% of soldiers with ED were not identified as addicted before. After 3 months, soldiers presenting ED had a higher Mood of tension/anxiety level. After deployment, both a higher BDNF concentration and anxiety disease score were observed in soldiers developing ED refer to those who did not develop ED.

ED seems to present: (1) a relation with a high “anxiety”, (2) a liability in chronic stress environment. However, ED could be considered as an efficient strategy referred to the high level of BDNF after the mission. A follow-up is ongoing 18 months after the deployment to confirm this assumption.

Schizophrenia is a major psychotic disorder with significant comorbidity and mortality.

Consequently, we investigated whether physical comorbidity and its relevance on general hospital mortality (GHM) differed between patients with- and without schizophrenia in a 12-year follow-up in general hospital admissions.

During 1 January 2000 and 31 June 2012, 1,418 schizophrenics were admitted to three General Manchester NHS hospitals. All comorbidities with a prevalence ≥ 1% were compared with those of 14,180 age- and gender matched hospital controls. Risk factors i.e. comorbidities that were predictors for GHM were identified using multivariate logistic regression analyses.

Compared with hospital controls schizophrenics had a higher burden of physical comorbidity that was associated with a worse outcome. In deceased schizophrenics, T2DM was the most frequently recorded comorbidity, contributing to 31.4% of hospital deaths. Further predictors of GHM in schizophrenia were found to be alcoholic liver disease, Parkinsonism, T1DM, nonspecific renal failure, ischemic stroke, pneumonia, iron deficiency anaemia, COPD, and bronchitis. There were no significant differences in their impact on GHM compared to controls with the same diseases except Parkinsonism which was associated with higher mortality in the schizophrenia population.

Optimal management of acute T2DM and COPD with its infectious respiratory complications, as well as the accurate detection and management of iron deficiency anaemia, of diabetic related long-term micro- and macrovascular complications, of alcoholic liver disease, and of extrapyramidal symptoms are of utmost relevance in schizophrenia.