Delirium occur frequently in hospitalized patients. High-potency antipsychotic drugs have been used for the treatment of delirium; however, there is a risk of acute side effects. Therefore, atypical antipsychotic drugs could be used to the treatment of delirium.

The present study aimed to provide comparison of intramuscular injection of olanzapine and intramuscular injection of haloperidol for patients with delirium was conducted with a randomized, open prospective study.

Sixty-two patients admitted at the Catholic University of Korea Kangnam St. Mary's hospital, Seoul, South Korea were enrolled in this study. They were diagnosed as delirium by two independent psychiatrists using DSM-IV-TR. the Delirium Rating Scale-revised-98(DRS-R-98) and clinical global impression-severity (CGI-S) were checked daily. the Simpson-Angus Rating Scale, the Barnes Akathisia Rating Scale and the Abnormal Involuntary Movement Scale were used for the assessment of side effects.

The DRS-R-98 and CGI-S scores were significantly decreased over time in both treatment groups without any significant group difference and time by the group interaction effect (F=28.35, P< 0.0001). Adverse events occurred lower in olanzapine group. both treatments were well tolerated and there were no serious adverse events occurred by intramuscular olanzapine or haloperidol.

This study showed that either intramuscular olanzapine or intramuscular haloperidol would be effective and tolerable for treating delirium, however, olanzapine showed lower side effects than haloperidol. Adequately powered studies will be mandatory to draw any definite conclusion.

Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to themselves and to patients, yet they are often reluctant to seek help. Focusing on psychiatry, it is known that psychiatrists as a professional group are prone to stress burnout and suicide. Thus, it seems relevant and current to address on the burnout in this professional group.

To analyze the burnout levels and the existence of psychopathology in a Portugal psychiatry department.

Anonymous self-completion questionnaire, prepared by the Suicide Prevention Consultation (also using MBI-Maslach Burnout Inventory and QIS-Suicide Ideation Questionnaire) and distributed by e-mail and online submitted for all psychiatrists in the department.

Forty-two percent of psychiatrists responded, mostly women. Although the percentages of responses related to fatigue/amount of work are significant, there were not high levels of emotional exhaustion and depersonalisation, but before satisfactory levels of personal fulfilment.

High levels of “burnout” are associated with high scores of emotional exhaustion and depersonalisation, but also with low scores of personal fulfilment. Despite the preliminary results of this study, it is important to remember important prevention strategies. Further studies directed to psychiatry trainees seem important, as this represents an important risk group, where an early intervention can make a difference.

The authors have not supplied their declaration of competing interest.

Methanol poisoning is uncommon but potentially lethal. The way of poisoning is usually oral. However, in a small number of cases, inhalated methanol poisoning was described. Most of these occurred among patients suffering a disorder by use of this substance. This type of poisoning has an insidious presentation, that complicates its diagnosis. This poisoning may be lethal. It may produce a chronic and severe affectation of the central nervous system in those who survive to the poisoning. After diagnosis, it is compulsory to act quickly, and it often requires advanced vital support and hemodialysis.

Educate the Mental Health professionals about a type of disorder by consumption increasingly more frequent in some cities across Europe. This is a high fatality related poisoning that emergency and general psychiatrists should know as it is increasingly common in Europe.

We present the case of a 20-year-old patient, treated at the emergency department of our hospital in context of metanol inhalation. The patient regularly attended to our Dual Pathology outpatient unit due to a severe inhalant use disorder. Several stays at the intensive care unit had been recorded and he already presented with severe optic nerve affectation.

In recent years there has been an increase in inhalant abuse in Europe, which is still underestimated by our poor knowledge about its potential toxicity.

Inhalated methanol poisoning occurs with a typical presentation, and may appear after suicide trial or overdose. Mental health professional should become aware of its potential lethality to approach properly to these patients.

The authors have not supplied their declaration of competing interest.

Painful physical symptoms (PPS) in major depressive disorder (MDD) can obscure the diagnosis and impair treatment outcome. Antidepressants inhibiting serotonin and norepinephrine reuptake (SNRI) can be effective in the treatment of both emotional and PPS in MDD. This study evaluated efficacy and safety of duloxetine, an SNRI, in the treatment of patients with moderate pain associated with depression.

In this double-blind, placebo-controlled, European, 8-week study, outpatients ≥18 years of age, presenting with major depression (Montgomery-Asberg Depression Rating Scale [MADRS] ≥20 and Clinical Global Impression-Severity [CGI-S] ≥4) and moderate pain (brief pain inventory [BPI] average pain score ≥3) not attributable to a diagnosed pain syndrome were randomized to either placebo (N=165) or duloxetine 60mg (N=162) once daily. Primary outcome measure was the BPI average pain score at endpoint. Secondary measures were MADRS total score, CGI-S, PGI-I, SCL-90 R, response and remission in MDD, safety, and tolerability.

Duloxetine compared with placebo significantly (P <.001) improved the mean change of both BPI average pain (-2.57 vs. -1.64) and MADRS total scores (-16.69 vs. -11.31) with significant separation after 1 or 2 weeks. Remission in MDD (53% vs. 29%) and response rates in pain and MDD were significantly higher in duloxetine-treated patients. Duloxetine separated on most secondary outcome measures from placebo. Treatment-emergent adverse events (≥10%) observed in duloxetine- treated patients were nausea, hyperhydrosis, and dry mouth.

These results support duloxetine's efficacy and tolerability in the treatment of PPS and emotional symptoms in patients with moderate pain associated with depression.

Significant physical co-morbidity is recognised as prevalent among patients with severe mental illness. UK guidelines for treatment of both schizophrenia (NICE 2009; Clinical guideline 82) and bipolar disorder (NICE 2006; Clinical guideline 38) provide recommendations for screening physical health problems. Despite the evidence base, physical health screening in this population is inconsistent. The Dundee Health Screen Clinic was set up to monitor cardiovascular and metabolic problems by providing health checks and offer exercise and dietary advice along with smoking cessation groups. This survey demonstrates the prevalence of metabolic syndrome in this sample, associated risk variables and prescribed antipsychotics.

Metabolic syndrome prevalence was assessed among 240 new patients attending the Dundee Health Screening clinic from Nov 2005-Aug 2008. The health screen designed included demographic details, clinical investigations, a lifestyle history and a record of prescribed medication.

Metabolic syndrome (defined by the International Diabetes Federation (IDF) criteria) prevalence was 39.7%, with a higher propensity among those prescribed atypical versus typical antipsychotics. Predictors of metabolic syndrome suggested that BMI, a 10-year risk of CHD and diabetes are significantly associated with metabolic syndrome. 135 patients had dyslipidaemia with only 5.9% receiving lipid-lowering agents. Only 13 out of 94 patients with hypertension had received antihypertensive treatment.

This study identifies significant unmet medical need in the health screening of the severely mentally ill. Health screening programmes are required for this high risk population with early intervention and appropriate medical follow up to minimise cardiovascular risk and its associated morbidity and mortality.

Neurological Soft Signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. They are divided into four categories: sensory integration, motor coordination, sequencing motor complex acts and primitive reflexes.

We sought to determine whether NSS were specifically related to schizophrenia.

1. 1) To compare NSS scores between patients with schizophrenia, bipolar disorder and controls.

2. 2) to assess the relationship of NSS scores with psychopathological measures and treatment (olanzapine equivalents).

We assessed neurological functioning by the Neurological Evaluation Scale (NES) in 67 patients diagnosed with schizophrenia (SCZ), 69 diagnosed with bipolar disorder (BD) and 50 healthy controls. Psychopathological dimension were assessed through the Positive and Negative Syndrome Scale (PANSS). Furthermore, we studied the correlation between NSS scores and psychopathological measures.Independent samples Student's t-tests and Post Hoc Tests were used to compute group differences. The correlations between NSS, treatment and PANSS scores were calculated using Pearson correlation coefficients.

Total NES and subscale scores were significantly higher in patients than in controls. SCZ patients performed worse than BD patients (p < 0,001). PANSS total scores were significantly related to NES scores (r = 0.63; p < 0,001). Antipsychotic treatment showed a significant correlation with PANSS total scores (p < 0,05), while no correlations was found with NES scores.

These findings support the hypothesis that neurological deficits measured through NSS could be a common endophenotype in schizophrenia and bipolar disorder, related to symptoms and independent from pharmacological treatment.

To identify the frequency and clinical features of DM and mania with delirium.

We reviewed all admissions to our acute inpatient unit with mania, hypomania or mixed affective state, in 2006 and 2007. Cases with delirious features and cases with a working diagnosis of DM, were reviewed in detail. The three groups (no delirium, delirious features and DM) were compared for general demographic and clinical variables, as well as features specifically associated with DM (e.g., catatonia; nakedness; inappropriate toileting; unexplained fever, etc).

We found 100 patients with mania, hippomania or mixed affective state. 14 had medically unexplained delirium, 4 of them with a final diagnosis of DM. DM cases (but not non-DM mania cases with delirious features) had extremely long durations of stay, acute onset, hypertermia, catatonia, autonomic instability, anarchic sleep, shouting/coprolalia, delirium persisting for over a week, and were more likely to receive ECT. Moreover, in three of them DM occurred in most manic/mixed affective episodes.

DM is a rare occurrence in bipolar disorder. It has typical clinical features and may be recurrent.

Primary or secondary delusional parasitosis is a phenomenon that often has a clear and memorable presentation. Stimulants and cocaine in particular, have a long history of producing psychotic episodes. A famous example of these is the 'cocaine bugs”. It has been noted that this is part-delusion and part-hallucination. There have been reports of delusions of parasitic infestation occurring in psychotic disorders as well. We are reporting a case of one patient with delusions of parasitic infestation who self inflicted a trauma to his ear by attempting to remove “a bug”.

1. 1. Obtain a thorough substance, psychiatric and medical history.

2. 2. A close collaboration between dermatologist, medical team and psychiatrist involved in the case is recommended.

3. 3. Antipsychotic and substance use treatment when stimulant use disorder is identified is identified.

1. 1 Identify the etiology of delusional parasitosis.

2. 2 Prompt diagnosis.

3. 3 Implement adequate treatment.

We are reporting a case of a patient with delusions of parasitic infestation and the review of relevant literature.

On admission patient’s urine drug screen was positive for amphetamines and cocaine. He had a questionable history of Schizoaffective disorder. Parasitic infestation was rulled out by the medical team. Pt achieved symptoms resolution during psychiatric hospitalization and treatment with antipsychotics.

Patients with delusions of parasitic infestation can at times present significant danger to self during the attempts to remove 'a parasite”,

therefore a prompt diagnosis and adequate treatment are of great value.

Dysfunction in the basal ganglia has been related to impaired reward processing and anhedonia, a core symptom of Major Depressive Disorder (MDD). In particular, the ventral striatum including the nucleus accumbens is increasingly implicated in the pathophysiology of MDD, but evidence for a specific role during episodes of full remission is lacking so far.

To investigate functional connectivity patterns of resting-state activity in patients in the remitted phase of MDD (rMDD).

To determine whether rMDD is related to disruptions of functional coupling between the ventral striatum and cortical regions.

Forty-three remitted depressed patients and thirty-five healthy controls were recruited at Medical University of Vienna, Vienna, Austria, and performed a six minute resting-state fMRI scan. Seed time series were extracted from the preprocessed data using individual masks for ventral striatum and correlated with all nodes in a surface based analysis using FreeSurfer, AFNI and SUMA. The resulting correlation coefficients were then Fishertransformed, group results were determined by comparing group mean smoothed z-scores with a two-sample ttest.

Increased resting-state functional connectivity was revealed between ventral striatum (seed region) and anterior cingulate cortex as well as orbitofrontal cortex in the rMDD group compared to healthy controls.

Our preliminary data is in accordance with the idea that increased functional coupling between the ventral striatum and two major emotion processing regions, the anterior cingulate cortex and the orbitofrontal cortex, may represent a neural mechanism contributing to the maintenance of full remission of MDD.

Cognitive dysfunctions have been well established in patients with schizophrenia (SZ). Recent studies also showed persistent cognitive impairments in patients with bipolar disorder (BD) in all phases of the disorder including the remission phase. Specific cognitive domains have been considered as candidate endophenotypes in SZ and BD. The aim of this study was to investigate the diagnostic specificity of neurocognitive deficits BD and SZ patients during a stable phase of the illness.

40 patients with schizophrenia (20 female, 30.4 ±8,1 years) were compared with 40 bipolar patients (27 female, 34.7±10.4 years) and 43 healthy volunteers (24 female, 34.7 ± 8.7 years). Executive functions (WCST), attention (CPT), immediate and delayed verbal memory (VLMT) and verbal fluency (RWT) were assessed. Differences in neurocognitive functions between diagnostic groups were analysed for each domain by analyses of covariance (ANCOVA analysis with age, education, IQ, gender and medication as covariates).

SZ and BD patients performed worse than control subjects in the WCST (p<0.001), VLMT (p<0.01) and in the CPT (p<0.03). There was no significant difference in the WCST and VLMT between SZ and BD patients. However, in the CPT, SZ patients showed a significantly greater impairment than BD patients (p<0.001). In BP patients deficits in the CPT were associated with the number of illness episodes.

The findings are comparable to previous results suggesting that the specific profile of the deficits seems to differ between the diagnosis, while the same underlying domains describe neurocognitive functioning in both groups.

Rehabilitation should help the mentally ill persons to strength their potentials and reduce the deficits in order to live successfully in community. First Croatian Outpatient Rehabilitation Center is organized in Psychiatric Hospital Vrapce. Its goal is to improve the quality of life in patients with psychotic disorders through a holistic rehabilitation program. The Rehabilitation Centre offers program provided by Multi-disciplinary team. Team evaluates each patient on individual bases and develops a realistic treatment/rehabilitation plan. The key of treatment is combination of case management and group treatment. Rehabilitation program includes a supportive individual therapy, provided by the coordinator and different group therapy (psychoeducation, anti-stigma program, family education, healthy life styles, social skill training, stress cooping and vocational training) and creative groups.

40 patients were evaluated in program in our Center according to frequency of visits and rehospitalisation. Also we followed up the family involvement, the number and types of groups which patients attend and contacts with case manager. The obtained data will be compared with BPRS score and the Satisfactory scale results.

It was evident that patients, who regularly contact their case managers, attend to more than one group and have family support, have the treatment better results on Satisfactory scale and BPRS score.

Community Rehabilitation Center offers highly individualized program which combines case management and group therapy in order to help patients with psychotic disorders to recover and live with higher quality standards in community and its long lasting benefits are expected in future.

For a long time it was a problem of treatment research in schizophrenia that uniformly accepted definitions of response, remission and recovery were not available. The presentation will summarize recent reports on these issues and will come up with a number of suggestions.

Review of recent publications.

Response can be defined as a clinically meaningful improvement of the patient's psychopathology irrespective of whether he is still symptomatic at the end or not. When the BPRS or the PANSS are used for definitions of response, a cutoff of at least 50% reduction of the baseline score should be used for acutely ill, non-refractory patients and a cutoff of at least 25% reduction for refractory patients. A table presenting responder rates in 25% steps covering the whole range up to 100% has been suggested.

Remission is a state in which the patient is free of clinically significant symptoms. A definition based on 8 PANSS items rated mild or better for a duration of at least 6 months has recently been presented. The advantage of these remission criteria is that in contrast to the response cutoffs they show how many patients are still symptomatic at the end of a study or not. Their disadvantage is that they do not reflect the amount of change.

Both remission and responder rates could be indicated in future studies. The next challenges are the development of universally accepted definitions of recovery and relapse of schizophrenia.

Missed nursing care is inescapable and can result from several factors, subsequently affecting the healthcare system, nurses, and patients. Maintaining and improving nursing care quality and patient safety is a major challenge for nursing managers.

The main goal of this study was exploring factors affecting missed nursing care from the perspective of nursing managers.

The participants in this qualitative study were 10 nursing managers. The data were collected at a university hospital in Portugal through individual face-to-face interviews using an interview guide and focus group discussions. The data were analysed using a content analysis following Bardin’s method.

The findings of this study present the concept of missed nursing care from nursing managers’ outlook and the outcomes of missed care, and indicate that factors affecting missed care are broadly determined by system structure, contextual factors, barriers to reporting missed care, and outcomes of missed care.

Efforts to foster a supportive work environment, improve the relationship between nurses and nursing managers, and create professional and organizational commitment are examples of important actions that could reduce the incidence of missed nursing care.

Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet.

Patients diagnosed with chronic prostatitis at a tertiary care ID clinic are evaluated for the presence of alexithymia, with the use of the Toronto Alexithymia Scale, as part of a prospective cohort. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category. Association of psychiatric symptoms with prostatitis category was performed.

Preliminary results are reported for 30 patients (median age 43 years old; IQR= 36-52). According to the NIH Prostatitis Classification System patients were categorized as type II : 48.2%, type IIIa: 6.9 %, type IIIb: 38%, type IV: 6.9%. Median CPSI score was 16 (IQR: 11-25). Abnormal TAS score was noted in 72% of the population. Specifically, 90% had high scores in external orientation of emotions, 25% in identification of emotions and 38% showed reduced expression of emotions. It is of notice, that mean TAS scores were significantly higher in type IIIa prostatitis cases (p=0.002, ANOVA).

High rates of alexithymia were noted in prostatitis subjects especially in type IIIa cases. These findings need further prospective evaluation.

Mental health literacy is an emergent research area in the fields of health promotion and mental illness prevention in communitarian environment, considered one relevant variable in the professional help-seeking behavior.

Evaluate the mental health literacy of Portuguese adolescents and youth concerning depression and schizophrenia; - Identify the contribute of the social demographic variables in mental health literacy.

Characterize the mental health literacy of adolescents and youth with the aim of create health promotion and mental illness prevention programs.

Descriptive-correlational study. Sample of 671 students, randomly selected of Portuguese schools. 294 of male gender and 323 of female gender, with an average age of 15,20 (sd = 1,84 years). The data were collected with the Mental Health Literacy Evaluate Questionnaire (Loureiro, Pedreiro and Correia, 2011). The data were analyzed using the IBM-SPSS 20.

Only 47,81% correctly identifies depression and 22,04% schizophrenia. Besides gender (p = 0,002), the familiarity with the mental illness and the socio demographic variables weren?t related to the recognition of the disorders.

The low levels of mental health literacy are a problem and a challenge, since they are associated with prejudiced and stigmatizing visions of the diseases and the ill with implications in the professional help-seeking behavior. The planning of programs should be alert since the adolescents and youth are the group with less interaction with the health system.

Wernicke's encephalopathy is an acute neuropsychiatric disorder which occurs as a direct result of a thiamine deficiency. Prevalence of Wernicke's encephalopathy is 1.4-2.2 % in the general population with an increased rate in known alcoholics of 12.5 %, and 35% in alcoholics with cerebellar damage. Wernicke's encephalopathy is missed on clinical examination in up to 75-80% of cases and only verified on autopsy. Thiamine deficiency can occur due to either alcoholic or nonalcoholic causes.

1. 1. Early and adequate intervention may prevent the development of Wernicke's encephalopathy.

2. 2. Early detection of Wernicke's encephalopathy is crucial in preventing the severe neuropsychiatric complications that may result.

3. 3. Aggressive treatment with high dose thiamine may reverse symptoms of Wernicke's encephalopathy and prevent the progression to Korsakoff's syndrome.

1. 1. Adequate and early prevention and treatment reduces morbidity and mortality associated with Wernicke's encephalopathy.

2. 2. Proper medical intervention significantly decreases the length of stay.

3. 3. By preventing progress of Wernicke's encephalopathy to Korsakoff syndrome, the cost of care can be significantly diminished.

We present a case series of patients with Wernicke's encephalopathy that were identified and treated by consultation-liaison psychiatrist and review of relevant literature.

Seven patients were diagnosed with Wernicke's encephalopathy. All patients were aggressively treated with high dose IV thiamine. All patients improved and were discharged in a stable condition. None of them progressed to Korsakoff.

The role of psychiatry in preventing, identifying, treating Wernicke's encephalopathy and educating the primary team had significant impact on improving patient's care and prognosis.