Worry is a repetitive cognitive process in which a person anticipates and elaborates on possible undesirable future events and their consequences. On the other hand, mindfulness is nonelaborative, nonjudgmental, present-centered awareness in which experiences that arise in the attentional field are acknowledged and accepted. In previous research, worry and mindfulness have been proposed, respectively, as risk and protective factors for psychopathology, including depression and anxiety. However, so far, the roles of worry and mindfulness were studied separately.

To estimate both specific and common contribution of worry and mindfulness to severity of anxiety and depressive symptoms in a sample of adults from the general population.

One-hundred fifty-six adults recruited from the community took part in the study. They completed self-report questionnaires measuring anxiety symptoms (State-Trait Anxiety Inventory), depressive symptoms (Beck Depression Inventory), worry (Penn State Worry Questionnaire) and mindfulness (Cognitive and Affective Mindfulness Scale Revised). A series of hierarchical stepwise regression analyses were performed on the collected data.

Mindfulness and worry were found to be related to severity of both depressive and anxiety symptoms, with worry being a risk factor and mindfulness being a protective factor. However, the relative contribution of worry and mindfulness was different for the two types of symptoms: worry was a stronger predictor of variance in anxiety symptoms than mindfulness, mindfulness was on the other hand a better predictor of variance in depressive symptoms.

Worry and mindfulness introduce both unique and common contribution to severity of anxiety and depressive symptoms.

Lithium has been used for the management of psychiatric illnesses over the years and it continues to be the first-line mood stabilizer used in treatment and prevention of bipolar disorder. Due to its narrow therapeutic index, other prescribed medications can increase lithium levels and potentiate its toxic effects. Among the most described drugs, non-steroid anti-inflammatory drugs and diuretics (mainly thiazides and loop diuretics) are the most commonly implicated. Risk factors for developing lithium toxicity include old age, polypharmacy, renal impairment, hyponatremic and hypovolemic conditions. Although there is interindividual susceptibility, older patients are at particularly higher risk.

To summarize the latest literature about this field and to present a case report as a basis for discussion.

A brief review of the latest literature was performed, using PubMed and the keywords “lithium” and “acute renal injury”. Also, a case report about a 73 year-old man who suffer from lithium intoxication due to lithium-furosemide interaction is presented.

In the presented case, Mr. F, 73 years old, independent for activities of daily living, was admitted to the Internal Medicine ward due to acute renal injury and lithium intoxication. Initially he was non-collaborative, sleepy, disoriented in all references and speechless. The creatinine was 1.28 mg/dL, urea 63 mg/dL, unspecific leucocitosis 17000/mm3, C-Reactive Protein 8 mg/dL, lithium 2.22 mEq/L. The psychiatrist was called to approach the psychiatric status, but as the patient awareness was impaired, the mental state examination was not possible. The patient’s daughter was interviewed. The patient had bipolar disorder (BD) type 1 and was diagnosed with mild cognitive impairment (MCI) a year ago. He had been stable for BD and MCI until the last month. He began to present nocturia, so he went to a urologist who prescribed him furosemide 40 mg daily for benign prostatic hyperplasia (BPH). Since that moment, he started being confused and progressively went to the state that was previously described at the admission of internment. Furosemide, quetiapine and lithium were stopped. He got better, to his previous state, and then started quetiapine 200 mg/day and tansulosine 0.4 mg/day.

Initiating diuretics in patients under lithium should be carefully considered and lithium blood levels must be monitored more regularly when new drugs are prescribed. Other medications must be regarded as alternatives but, if it is not possible, they should be used in the lowest dose and shortest duration as possible. With this case report, we highlight the importance of considering patients as a whole, taking both their physical and mental well-being into account. Healthcare professionals are invited to coordinate their efforts to deliver the best standard of care.

None Declared

Inflammatory Bowel Disease (IBD) is associated with co morbid depression and anxiety of up to 42%. Corticosteroids, used commonly in IBD, are known to cause psychiatric side-effects and could be an independent risk factor for affective illness. Recent studies show that depression is also associated with raised CRP and IL6.

This study aims to show which demographic, clinical, medication and immunological factors are predictors of anxiety and depression in IBD.

The IBD, Steroids and Affective Disorder (ISA) study is a cross-sectional study of IBD patients in Edinburgh, UK. Out patients underwent assessment including Hospital Anxiety Depression Scale (HADS) past psychiatric history, steroid medication history, inflammatory markers, the Medication Adherence Rating Scale (MARS) and Altman Self Rated Mania Scale (ARSM).

326 patients with Crohns and 256 with Colitis (72% of clinic attendees) were recruited. 251 (43%) patients scored 12 or above on the HADS questionnaire. 45% of patients had previously suffered from affective illness. Patients on Prednisolone and Budesonide scored significantly higher on HADS Depression (p = 0.03 and p = 0.002) as did those who had been on Prednisolone for more than 8 weeks (p = 0.041). Being on prednisolone was not associated with increased Colitis and Crohns activity indices (p = 0.2). HADS scores were measured against other disease and demographic variables.

Affective illness is common in the IBD population and the prescription and duration of systemic corticosteroids are associated with depression. Biological and disease variables may play an important role in co morbid affective illness in IBD

To compare neuropsychological functions of individuals at risk (IR) for psychosis and patients with a first episode of psychosis (FE) with healthy control subjects (HC). And to determine cognitive factors which have the potential to discriminate IR with (IRtrans) and without (IRnon-trans) transition to psychosis.

N = 60 prodromal IR and N = 51 healthy control subjects were assessed with a comprehensive neuropsychological test battery. Besides general intelligence the test battery covered two functional domains (executive and attentional functions) and working memory. Within a follow up period of at least 30 month N = 19 IR transited to psychosis and N = 30 IR still have been followed up.

For each patient group (FE and IR), cognitive profiles were constructed by means of z-values adjusted for demographic and medication influence. The HC mean performance level was used as baseline of each group profile. A further profile was constructed by differential values considering IRtrans versus IRnon-trans. Comparisons were carried out by MANOVA and post- hoc t-tests.

In all functional domains FE and IR performed below HC except for specific sustained attention measures. There were no significant differences between FE and IR.

Executive functions and working memory measures were more compromised in IRtrans as compared to IRnon-trans.

Neuropsychological deficiencies precede psychotic breakdown. This indicates that neuropsychological assessments of affected domains may support early detection of psychosis.

Routine Outcome Monitoring (ROM) is a new phenomenon in the mental healthcare system. Its introduction into daily clinical practice has not been straightforward. This study examines practical examples of the embedding of this innovation and its effective acceptance in clinical practice.

A case history illustrates how ROM was implemented in a large mental health hospital in The Netherlands. During implementation a number of weak points in the implementation process emerged. An intense analysis of the organization of the care process, in the context of care pathways and operations management, offered explanations of what went wrong in this case. Future improvements are suggested from an operations management viewpoint.

For the improved implementation of ROM in the mental healthcare sector implementation must be widely participatory, the process must be continuously monitored, and a leading, well-informed clinician must be appointed as process manager to guide the implementation process.

To describe principles and characteristics of mental health care in London.

Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.

London experiences high levels of need and use of mental health services compared to England as a whole. Inpatient andcompulsory admissions are considerably higher than the national average. Despite having more psychiatric beds and mental health staff, London has higher bed occupancy rates and staffing shortages. At the same time there is a trend away from institutionalised care to care in the community.

Mental health services in the UK are undergoing considerable reform. These changes will not remove the greater need formental health services in the capital, but national policy and funding lends support to cross-agency and pan-London work to tackle some of the problems characteristic of mental health in London. Whilst various issues of mental health care in London overlap with those in other European capitals, there also are some specific problems and features.

To study the dyadic adjustment in couples with a schizophrenic offspring.

140 married couples, 67 with a children with schizophrenia, and two control groups: 41 couples without pathology and 32 couples with pathology, were assessed with the Dyadic Adjustment Scale, the Beck Depression Inventory and the Self-Rating Anxiety Scale.

The couples with a schizophrenic offspring evidenced significantly worse dyadic adjustment than did the normal controls, especially low consensus and cohesion in husbands, and low cohesion and satisfaction in wives. Anxiety and depression in mothers of schizophrenics is significantly higher than in mothers of controls.

These findings suggest that the poor dyadic adjustment of the parents with a schizophrenic offspring could be an effect of the burden.

The treatment on the schizophrenia should be supplemented by interventions aimed at parents’ dyadic adjustment, and mothers’ anxiety and depression, so that they can be in better conditions to help their child.