Effective teamwork is vital for quality of care. The exchange of information, ideas and support, helps with patient safety, patient positive experience, and avoiding the detrimental effects of staff burnout. The aim of this study was to assess the development needs of a 44-member multidisciplinary acute inpatient mental health team and to improve team effectiveness.

A wide range of questionnaires and activities developed by the NHS Leadership Academy, U.K., was used to focus on seven essential aspects of effective team working: Team Identity, Team Objectives, Role Clarity, Team Decision Making, Team Communication, Constructive Debate, and Inter-Team Working. Team reflection and positive challenging were used to promote critical thinking.

The team's purpose and operating principles were defined and team objectives were agreed. Questionnaires identified Communication and Inter-Team Working as areas for development. On a scale of 1 (strongly disagree) to 5 (strongly agree), in areas showing need for improvement, scores were as follows: 3.2 (there is enough information to make decisions about work), 3.2 (effective communication between team members), 2.8 (well-managed time in meetings), 3.3 (planned outcomes achieved in meetings), 3.3 (decisions and actions clearly summarised in meetings), 3.3 (efficient working to resolve conflict with colleagues), and 2.9 (effective processes to quickly resolve difficulties amongst teams). Meeting processes were changed and time dedicated to care increased.

Teams can improve by focussing on specific factors contributing to their development and effectiveness. Communication and inter-team relationships might be particularly challenging areas that may improve by changing team processes.

This paper aims

1. a) to explore the difficulties in differential diagnosis between epileptic crises and psychogenic non epileptic seizures (pseudoseizures),

2. b) to suggest therapeutic guidelines for psychogenic non epileptic seizures. Our purpose is to present a literature review on this subject and to discuss the problems involved.

Typical systematic review of recent articles regarding this topic at the internet search engines of PubMed and Scopus. We used the following keywords: psychogenic seizures, psychogenic non epileptic seizures (PNES), pseudoseizures, conversion disorder, dissociative disorder.

A large percentage of the seizures are found to be psychogenic non epileptic. Most of the patients are firstly treated by neurologists and only a percentage of close to 1/3 of these are referred to psychiatrists for further therapy. The differential diagnosis is difficult because most of the patients actually suffer from both epileptic and non epileptic seizures and usually come to the emergency clinics with either. Video EEG and therapeutic hypnosis are considered to be helpful techniques.

In order to treat patients suffering from psychogenic non epileptic seizures there must be a close collaboration between the neurologists, the psychiatrists and the emergency physicians considering both the medication prescribed and the therapeutic guidelines followed.

Schizophrenia and psychotic disorders represent psychiatric disease patterns characterized by great impairment due to disease severity with a great effect in patient's health related quality of life, which still remain a challenge in everyday clinical practice.

To investigate group differences in health related quality of life(HRQoL) in patients with psychosis during in hospital treatment.

174 inpatients in a psychiatric ward in Athens-Greece participated in the study. 120(69%) were males and 54(31%) females. Of them, 0(11.5%) had bipolar disorder(BD), 126(72.4%) psychosis and depression(PD) and 28(16.1%) comorbit alcohol addiction(PAA). Patients filled a battery with tests of HrQoL, psychotic symptoms, negative motions, optimism, self-esteem, happiness and life-satisfaction. Stepwise regression models were used to determine the best predictors of compliance with SPSS.

There were a statistical significant difference in compliance between BD and PAA(good compliance 100%) and PD(good compliance 66.7%)(x2=21.09p=.001). Multivariate analysis revealed that good reaction to treatment(beta=−.736), atypical antipsychotics(beta=− .312), antidepressants(beta=−.270), days of hospitalization(beta=.203), bipolar disorder(beta=.199), sleeping pills(beta=.169) and stabilizers(beta=−.188) explained 74.5% of the variance in compliance(adjusted R2=.745 p<0.001). In a second model with the inclusion of personality and emotional characteristics in the model, stress(beta=−.381) negative emotions (DASS)(beta=.290) and subjective happiness(beta=.120) explained an additional 3% in compliance with therapy(adjusted R2=.775 p<0.001).

It seems that depression comorbidity is an effective factor affecting therapy compliance in psychosis, with days staying in hospital for treatment. Also if the patient is prior to the therapy happy with his life complies better with the pharmacological approach that was used during the days of treatment.

Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings.

To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among a general Chinese patient population.

Self-report data were collected from 484 patients at five randomly selected hospitals.

The prevalence of hazardous alcohol-drinking problems was 19.2%. Logistic regression analysis revealed that risk factors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29.1% of participants were assessed for drinking problems in the past year. Only 38.7% of participants with drinking problems had received a drinking intervention in the past year.

Alcohol problems in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups and integrating psychiatric healthcare teams in general hospitals are important to prevent patients’ drinking problems.

Secure forensic mental health services treat patient with high rates of treatment resistant psychoses, typically schizophrenia. These groups have high rates of obesity and medical co-morbidities. Population based studies have identified high risk groups in the event of SARS-CoV-2 infection, including those with long term medical conditions.

The aim of this study was to compare the vulnerability to serious adverse outcome in the event of COVID-19 infection in a forensic psychiatric patient population.

All patients of a complete National Forensic Mental Health Service (n=141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-AGE tool and the COVID-Risk tool.

Eighty-two patients (58.2%) met criteria for obesity, 32 had type II diabetes and 28 were hypertensive. Mean chronological age was 45.5 years (SD 11.4, median 44.1), while mean COVID-AGE was 59.1 years (SD 19.4, median 58.0), mean difference 13.6 years (SD 15.6) paired t=10.9, df=140, p=0.000. Three patients (2.1%) were chronologically over 70 years compared to 40 (28.4%) with a COVID-AGE over 70 (X2=6.99, df=1, p=0.008, Fishers exact test p=0.027).

These risk assessments may identify the extent of increased risk among a uniquely medically vulnerable patient group. Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population based cocooning and self-isolating guidance based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

Previous research has found that candidates for bariatric surgery usually present anxiety, depression, personality disorders and/or a tendency to binge eating. The situation related with the pandemic and the lockdowns during the 2020 are possible aggravating factors for these characteristics.

To study the more important psychological characteristics presented by candidates for bariatric surgery.

40 people between 29 and 65 years old (M=46.4, SD=9.1; 37.5% male, 62.5% female) were evaluated between July and December of 2020. The assessment consisted in an interview carried out by a clinical psychologist, and a pool of questionnaires to evaluate depression and anxiety symptoms (Beck Depression Inventory, BDI; and the Goldberg Anxiety and Depression Scale, GADS) the existence of a binge eating pattern (the Binge Eating Scale; BES) and personality traits (the Salamanca Screening Test).

The 25% of the sample had previous mental health antecedents. Eight people disclosed to feel stress in relation with the COVID-19, and 18 presented an emotional regulation strategy using food during the lockdown. 62.5% scored above the cut-off point on the BDI (mild=27.5%, moderate=20%, severe=15%) and a 40% and a 47.5% did it for the anxiety and the depression (respectively) GADS subscales. 20% presented a binge eating pattern according with the BES. Most common personality traits were histrionic (50%), emotionally unstable impulsive type (45%), and anxious (42.5%).

These findings support the previous scientific literature. Psychological intervention programs may be considered to guarantee the surgery’s success, especially when adverse contextual circumstances are presented.

No significant relationships.

Personality disorder (PD) with an associated diagnostic of major depressive disorder (MDD) is a common occurrence, being considered a factor of treatment resistant depression. In this study, we compare two groups of patients’ one group having Major Depressive Episode (MDD) and the other with MDD and PD as comorbidity.

This is an observational study of all patients admitted with diagnosis of MDD during one month period in an acute psychiatric hospital. Data collection is made using patients files. During one month period a total number of 105 MDD cases were recorded (group A-75 cases with MDD and group B-30 patients with PD and MDD). The diagnosis was recorded in files by a specialist psychiatrist. Data is analyzed using SPSS v.20.

A significant difference is found when comparing age groups, mean age for group A being 60 years and for group B 35 years (P = 0.05). Regarding suicide attempts a higher prevalence is found in Group B (Group A 6.7%, Group B 20%) although with statistical relevance (P = 0.04). Study limitation: small sample size of group B does not allow analysis on different type of personality disorders, length of hospitalisation could be biased by the requirements of assurance company.

The risk of admission is higher at younger age in patients with MDD associated with PD then in MDD alone. The risk of suicide attempts is significantly higher in group of MDD associated with PD.

The authors have not supplied their declaration of competing interest.

Acute Polymorphic Psychotic Disorder is a psychotic disorder with an acute onset, presenting thought and perception disorders variable into hours. Often, an emotional fluctuation is present and it may have a sudden onset and a rapid remission.

The review’s objective is to manifest acute polymorhic psychotic disorders and possible effective medical interventions.

The current case concerns a 52-year old mother of 4 children with the manifestation of acute polymorphic psychotic disorder with a background of a stressful factor. The patient was involuntarily hospitalized in the Psychiatric Hospital of Thessaloniki from 04/01/ 2019 -21/ 01/2019 due to disorganization and acute confusing condition within the last 9 days. Delusional ideas of religious content were first observed, which alternated with ideas of greatness and then persecution, association and self-denial. She also presented auditory hallucinations while there was a fluctuation of emotion from excessive euphoria to depression. The patient had no previous hospitalization in a psychiatric clinic, however, 7 months ago she experienced another acute psychotic epeisode, while at the age of 17 and under the influence of intense stress, she described mood disorders.

The current symptoms subsided after one week from the day of admission. During her hospitalization, a brain CT was performed without presence of pathological findings. Initially, her medication included i.m. haloperidol 15mg / ml daily, followed by a change to per os paliperidone 9mg daily.

Her mental status was improved, with no disturbances of consciousness noted and she was discharged on paliperidone as home medication.

No significant relationships.

The four-step integrative model of psychotherapy is concerned with individual's needs, wants, rights and decisions in that order. It may carry a promise for deep and changing vision for patients with borderline personality disorder (BPD).

The study of the illuminating and changing effect of dealing with BPD patients in view of their needs, wants, rights and decisions.

To evaluate the effect of group work through the hierarchy of the four-step integrative model with BPD patients and to help them explore false and true elements of their femininity.

Forty-three female patients (age range: 19-37) diagnosed according to DSM-IV diagnostic criteria for BPD were enrolled in a dynamic psychotherapy group. Their progress was evaluated using Borderline evaluation of severity over time (BEST) and they wrote down detailed comments about their experience quarterly.

Results of regular attendants for 2 years were included (35 = 81.4%). The results of BEST showed a significant reduction of BPD severity at the end of 1 and 2 years. During psychotherapy sessions and within their quarterly comments, patients expressed their change in terms of moving from a state of cunning, manipulation, aggression, arrogance, envy and rejection (as stemming from their false femininity) into wisdom, confrontation, patience, pride, healthy competition and containment respectively (as stemming from their true femininity).

Patients with BPD may gain a better insight and genuine change as they realize what is false and what is true about their femininity in the context of attending four-step integrative model group psychotherapy.

The authors have not supplied their declaration of competing interest.

Feelings and emotions are influenced by cultural factors. there are no specific words to refer to the emotional states of individuals in some cultures and sub-cultures around the world.Somatic metaphors and complains are the main outlets for emotional discharge in these cultures.

Analysis of presenting symptoms of the patients suffering from depression referred to the psychiatric clinic of Shiraz university of Medical Sciences.

Better understanding of distribution of the patient's chief complaints among people with different sex, marital status, place of residency and education.

300 patients with major depressive disorders referred to our clinic were selected by simple sampling. Diagnosis of the disorder was made based on the DSM-IV-TR criteria after a psychiatric interview. These patients had no history of any substance abuse or dependence. Also, their symptoms could not be explained by a general medical condition or other psychiatric conditions. Through psychiatric interview, we assessed the chief complaints and other presenting symptoms of these patients and then compared them according to such variables as sex, age, marital status, place of residency and education.

The most frequent complaints of the patients was headache and pain in other areas of body. Also this study showed a significant relationship between the chief complaint (physical vs. mental) and sex, marital status and place of residency.

Pain and other somatic complaints are important presenting problem among depressive patients.Paying proper attention to somatic complaints in some cultures, can lead to better understanding of patients and prevent unnecessary expensive interventions.

Studies of the cognitive and behavioral factors of perpetuation and quality of life in patients with somatoform disorders are important for identifying targets for psychological interventions and risk groups (Piontek et al., 2018, Dehoust et al., 2017, Schaefer et al., 2012, Flasinski et al., 2020).

To reveal beliefs and behavior in patients with somatoform disorders associated severity of somatic complaints and poorer subjective well-being.

125 patients with somatoform disorders 17-68 years old filled Screening for Somatoform Symptoms (Rief, Hiller, 2003), Cognitions About Body And Health Questionnaire (Rief et al., 1998), Scale for the Assessment of Illness Behaviour (Rief, Ihle, Pigler, 2003), and Quality of Life Enjoyment and Satisfaction Questionnairie-18 (Ritsner et al., 2005).

Severity of somatoform symptoms is higher in patients with catastrophization of bodily sensations, autonomic sensations, belief in their bodily weakness, somatosensory amplification, scanning for bodily symptoms, and disturbances in daily activities due to illness (r=.18-.38, p<.05). Adjusting for the severity of somatoform symptoms, subjective well-being was lower in patients with higher belief in their bodily weakness and somatosensory amplification, autonomic sensations, expression of symptoms, and changes in daily activities due to illness (r=.21-.40, p<.05).

The results suggests that regardless of symptoms severity poorer quality of life in patients with somatoform disorders is associated with beliefs about body and body perception that could be addressed in psychotherapy.

Day Treatment Programs are on the uprise in Germany. The Pfalzinstitut's Day Treatment Program in the south-western part of Germany was established in 2006 and provides multi-professional, non-residential psychiatric and psychotherapeutic treatment to mentally disturbed children and adolescents aged 6 to 18 years. This program addresses patients with moderate to severe mental health disorders thereby offering access to patients who were referred to in-patients departments in earlier years. Work with adolescents will be outlined as most day treatment units in Germany focus on work with children aged 6 – 13 years. The treatment approach includes psychiatric and psychotherapeutic consultation (Individual and group), psycho-educational groups, pharmacotherapy, occupational and recreational therapy and school.

Data despription of a five years' clinical population. Variables include demographics, length of stay, diagnoses using multiaxial classification, problem severity and clinical outcome. The spetrum of diagnoses is compared to Pfalzinstitut's in-patient department data from the same period.

Non-residential day treatment can replace in-patient admission in a broad spectrum of psychiatric diagnoses in children and adolescents. The number of personal contact between parents and the therapeutic team is higher than in the in-patient variant of treatment. However, certain disorders such as psychosis, severe eating disorder, severe self injury and suicidal behaviour must be excluded from day treatment programs. Step-down treatment from former in-patient to day treatment is often less tolerated by adolescent patients.

Day treatment appears to be effective and equally efficient as in-patient treatment in a large spectrum of psychiatric diagnoses.

The work is supported by the project of Russian Foundation of Basic Research No 14-04-01157a.

Although controversial in many countries, in The Netherlands euthanasia or physician assisted death has increased in patients with early stages of dementia, psychiatric illness and in conditions described as ‘being tired of life’ in the oldest old. There is a strong debate about this practice in the community and among professionals often with exclamation marks ranging from medical murder to providing ultimate care.

To provide figures, describe current practice and debate in The Netherlands with regard to capacity evaluation in older psychiatric patients and end of life questions.

Review of literature, case reports and own experience in the past decade.

There are few studies on the important issue of capacity making in psychiatric patients. The research that was performed does not show that a high threshold of capacity is required for granting euthanasia. Research on physician-assisted death in early dementia is scarce. With regard to end of life questions the debate in The Netherlands is still ongoing.

The author has not supplied his declaration of competing interest.

Street working children are often poor, deprived of love and care, and lack supervision by responsible adults. The Kurdistan region of Iraq has experienced war conflicts for decades. Many families have been displaced and their children forced into the streets. However, little is known about mental health among the street working children in this region.

To explore mental health and trauma among street working boys in Duhok.

A cross sectional study was conducted on street working boys (n=100), eight to 16 years old in Duhok. A control group of age-matched school boys (n=100) were recruited. The Child Behaviour Checklist 6-18 was used for assessment of the children’s competences and behavioural problems. Mental disorders were assessed by using the Mini-International Neuropsychiatric Interview for Children and Adolescence. Experienced trauma was assessed by the Harvard-Uppsala Trauma Questionnaire for Children.

Sixty-one percent of the street working boys had at least one psychiatric disorder (57 % anxiety disorders). Street working boys reported more traumatic events than school boys, 96% vs 64% (X²= 32, p < 0.001), the largest effect size was found for torture (OR 28.4) and the smallest effect size for maltreatment or assault (OR 2.7). Also, they reported higher levels of internalising symptoms, T-score 59.4 (8.2). There was a significantly increased risk of more externalising symptoms with increasing working hours, OR 2.90 [95% CI 1.02; 8.29].

Internalizing symptoms, anxiety disorders and trauma were more common in street working boys compared to school boys. More working hours increased the risk for more externalising symptoms.

No significant relationships.

Research into the relationship between the subjective perception of clinical change and the objective evidence of the same is very limited. Less is known about the relationship between clinical judgments by mental health experts and the patient's perception of symptom change, in particular across different diagnostic groups.

This study aims to determine the level of concordance between the HONOS as a tool for clinical outcome monitoring and the self-reported change in psychopathology in a total sample of psychiatric patients as well as stratified by their primary diagnosis at admission.

A consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders, was assessed using the Brief Symptom Inventory (BSI) at admission and at discharge. The HoNOS were rated by the responsible clinicians. Complete data of admission and discharge were available from approximately 600 cases. Reliable change index (RCI) will be calculated to determine a clinically meaningful change based on the HoNOS scores. Concordance of RCI and change in BSI scores will be explored and compared between different diagnostic groups.

According to our preliminary results from this ongoing evaluation program, we hope to provide a step towards a deeper understanding of the interrelationship between clinical judgments and the course of subjectively experienced mental health problems.

The authors have not supplied their declaration of competing interest.

Smoking among adolescents is still a major public health problem and a global concern. Early onset and long-term smoking are associated with physical and psychological health problems.

To identify risk factors and comorbidities for occasional and daily smoking among European adolescents.

In the context of the Europe-wide 'Saving and Empowering Young Lives in Europe” (SEYLE) study we surveyed 12,328 youths at the age of 13 to 17 from 11 countries. We applied questions from the Global School-Based Student Health Survey to determine nicotine consumption as well as other risk behaviors. Psychiatric symptoms were assessed by the Strengths and Difficulties Questionnaire, the Becks Depression Inventory-II, the Zung Self-Rating Anxiety Scale,the Deliberate Self-Harm Inventory and the Paykel Suicide Scale.

On average 30.9% of adolescents reported daily smoking and the onset of smoking was reported by 35.3% between the age of 12 and 13 already. Multinomial logistic regression model showed significant correlations between adolescent smoking and migration background, living in single parent households, no physical activity, parental smoking and physical fights. Further it revealed significant associations of adolescent smoking with alcohol consumption, illegal drug use, anxiety, conduct problems, hyperactivity, suicidal ideation, self-injury and internet-dependence.

Our data show that adolescent smoking is associated with psychosocial factors, especially family setting and parental behaviors. Further, smoking and psychiatric problems are highly correlated. Therefore, early preventive measures are necessary and essential not only for adolescents but also for their parents.

Long-acting injectable antipsychotics have undergone a great development in recent years, becoming useful tools to facilitate therapeutic adherence. Once-monthly risperidone ISM is a new way of treatment which has been commercialized in Spain since September 2022.

In this study we will analyze our clinical experience with this treatment, especially in terms of tolerance and efficacy, during its first year of widespread use.

Longitudinal retrospective study of monhtly risperidone users in a mental health center in the Autonomous Community of Madrid (Spain), between September 2022 and September 2023.

A sample of 13 patients was selected, collecting both sociodemographic (age, gender) and clinical variables (diagnosis, dose, time elapsed, number of hospital readmissions, adverse effects and monotherapy or combined use). A descriptive analysis of the collected data was then carried out.

Monthly risperidone was used in 13 patients: 15% (n=2) were women, and 85% (n=11) were male. The mean age of the patients was 43.6 years. The most frequent diganosis of these patients was “psychotic disorders” (84,6%, n= 11), with other diagnoses such as schizoaffective disorder (7,7%, n=1) and obsessive compulsive disorder (7,7%, n=1).

The doses used of risperidone were 100mg every month in 61,5% of patients (n=8) and 75mg in 38,5% of patients (n=5). The mean time since the first administration was 4.35 months.

Concerning monotherapy, 84,6% (n=11) of patients on monthly risperidone were on antipsychotic monotherapy, while 15,4% (n=2) required more than one antipsychotic. Among the switches made to monthly risperidone, 69,2% (n=9) were previously treated with oral risperidone, 15,4% (n=2) were treated with once-biweekly risperidone long-acting injectable, 7,9% (n=1) with oral paliperidone and 7,9% with aripiprazole monthly injectable.

During the study period, hospital readmissions for psychiatric descompensations occurred in one patient (7,9%, n=1), while the rest of the patients (92,1%, n=12) did not present decompensations that required psychiatric admission.

Moderate or severe effects occurred in one patient (7,9%, n=1), in the form of acute dystonia, which led to the interruption of injectable treatment. The rest of the patients (92,1%, n=12)) did not present severe adverse effects. Minor adverse effects appeared in 3 patients (25%); these adverse effects were already present in the previous treatment with oral risperidone and did not condition the suspension of the treatment.

In the sample analyzed, once-monthly Risperidone ISM had reasonable tolerance levels. Also, it´s shown to be effective in preventing psychotic decompensations and hospital admissions.

Therefore, this new injectable of monthly risperidone represents a therapeutic alternative to consider in order to guarantee therapeutic adherence and improve the quality of life of patients with psychotic symptoms.

None Declared

The stigma of mental illness is still a major challenge for psychiatry. For patients, stigma experiences and self-stigma are associated with reduced quality of life and increased vulnerability to a more chronicle illness course. Nevertheless, there is a scarcity of validated therapeutic approaches addressing strategies for coping with stigma.

A manualized psycho-educational group therapy for stigma coping and empowerment (STEM) should be tested for efficacy in patients with depression and schizophrenia. The study was funded by a research grant of the Federal Ministry of Education and Research.

A cluster-randomized RCT with two arms including 30 mental health care services (psychiatric inpatient services, day-units, and outpatient services, as well as inpatient psychiatric rehabilitation services) was conducted. The intervention consisted of 8 sessions regular psycho-education group therapy and 3 sessions addressing stigma coping and empowerment. Controls received 11 sessions regular psycho-education. Primary outcome variable was quality of life (WHO-QOL). Assessments were conducted directly before and after the intervention, and at 3, 6 and 12 months follow-ups.

A total of 469 patients participated and more than 300 participants (approx. 65%) completed the 12-month follow-up. First results of the analysis will be presented at the conference.

Since the statistical analysis is currently in progress, no conclusions concerning the efficacy of the tested therapeutic approach can be done by now. Nevertheless there is a strong need for supporting patients in developing positive stigma coping strategies. STEM is the first therapeutic approach to our knowledge tested for efficacy in a RCT.

The author has not supplied his declaration of competing interest.