Intramuscular (IM) medication may be considered as part of an appropriate plan to treat safely patients who are at immediate risk of violence. We aimed to assess the characteristics and monitoring of IM medication use in an inpatient population, in the context of the Sheffield Rapid Tranquillisation (RT) protocol, based on the National Institute for Clinical Excellence (NICE) guidelines.

The population studied included 639 discharges from four acute inpatient wards in Sheffield, U.K., from April 2011 to April 2012. Thirty patients who had been administered IM RT were identified. Demographics, Mental Health Act (MHA) status, diagnosis, non-pharmacological interventions and monitoring procedures were recorded.

Patients were female on 20(66.7%), White British on 14(46.7%), and under the MHA on 29(96.7%) occasions respectively. Diagnoses most frequently recorded were Schizophrenia 7(23.3%), Bipolar Disorder-Mania 7(23.3%) and Acute and Transient Psychosis 5(16.7%). Verbal de-escalation was used on 8(26.7%), oral medication was repetitively offered on 23(76.7%), a doctor was contacted on 14(46.7%), and the patient was restrained on 22(73.3%) and secluded on 13(43.3%) occasions respectively. Physical observations (blood pressure, pulse, temperature, oxygen saturation, level of consciousness and respiratory rate) were monitored and recorded on 13(43.3%) cases only, and only 3(10%) and 6(20%) had a pre-treatment and post-treatment ECG respectively.

IM RT was used on a small percentage of general adult inpatients, almost all detained, mainly with Schizophrenia, Bipolar Disorder-Mania and Acute & Transient Psychosis. Better implementation of the monitoring protocol is needed to improve the quality of care of acutely disturbed patients.

1. to assess the subjective perception of HRQoL in medical students’ sample; and

2. to ascertain predictors of better perception of HRQoL in medical students.

We have assessed and compared scores of Short Form Health Survey (SF-36), used for the assessment of HRQoL in sample of 561 medical students and 332 control participants. Also, we have used linear regression to identify predictors of better perception of HRQoL in the sample of medical students.

The results indicate that medical students had statistically significantly higher total score of SF-36. The statistically significant predictors of better perception of HRQoL in medical students were: male gender, younger age and higher grade year of studies and non-medical students was male gender. The other sociodemographic and academic variables did not emerge as possible predictors of better perception of HRQoL.

Medical students perceive their health much better than other university students do but female, older and second year medical students have worse perception of their HRQoL. In non-medical university students females had worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better quality of life of medical students and life of nonmedical students.

Individuals with posttraumatic stress disorder (PTSD) often have symptoms of re-experiencing traumatic life events, recurring nightmares, hyper arousal and insomnia. Evidence is increasing that stress-related hyperglutamatergic states may contribute to dissociative symptoms and neurodegeneration in temporo-parietal cortical areas. Cognitive performance is also be effected in some of the traumatized patients. We are going to present a PTSD case who demonstrates significant memory impairment.

38 years-old, male patient. He had experienced combat related traumatic life events June in 2009 and diagnosed with PTSD according to DSM-IV criteria. Disturbance in short time memory, perception, attention, concentration deficiency was observed in the clinical interview. As a result of cognitive assessment, calculating and remembering subtests were lower than the others so it could be associated with cognitive impairment. To evaluate the organic brain pathology CT was applied and it was within normal limits. After than PET was conducted to reveal the metabolic abnormalities. Left parietal cortical global hypo-metabolic activity, global hypometabolism in temporal cortex and regional hypometabolism in medial parietal cortical regions was demonstrated. He has been treated and fallowed up for two years and provided significant improvement in PTSD symptoms but cognitive impairment was still showed constancy.

It is well known that left parietal and temporal cortical region would be associated with impaired memory performance. The areas that we have found at PET are known to be involved in episodic memory consolidation and retrieval. Comorbid PTSD and hypometabolism in lateral cortical region has not been well documented in the literature.

Researches indicate that traumatized people besides development of mental and physical disorders can experience positive changes.

Investigate relationships between war trauma, social support, psychological distress and posttraumatic growth.

Determine the predictors of posttraumatic growth in war displaced persons in Bosnia and Herzegovina.

The test sample was composed of 71 refugees, who were due to war-related events been forced to leave the original residence, and their new residence is on the territory of Bosnia and Herzegovina. Subjects were recruited by snowballing method, and the starting point of inclusion in the study were acquaintances of the medical staff at the Clinical Hospital Mostar. The study used General Demographic Questionnaire, the Harvard Trauma Questionnaire-version for BiH (HTQ), Brief Symptom Inventory (BSI), Social Support Appraisals Scale (SS-A) and Posttraumatic Growth Inventory.

In the first predictive model (R2=0.053; F=4.889; P=0.030) that included BSI, HTQ and SS-A questionnaires, a linear regression analysis showed that a stronger social support leads to greater posttraumatic growth (standardized β coefficient=0.257; P=0.030), same as greater sensitivity in interpersonal relationships (standardized β coefficient=0.698; P=0.014), while growth in the number of positive psychological symptoms have a negative impact on posttraumatic growth (standardized β coefficient=-1.008; P=0.042). In the second predictive model (R2=0.043; F=1.226; P=0.299), of all demographic factors only the economic status was a significant predictor, where persons with stable economic status had greater posttraumatic growth (standardized β coefficient=0.337; P=0.040).

Social support is significant positive predictor of posttraumatic growth, which is also supported by sensitivity in interpersonal relationships.

Neonates born in the winter and those with hypovitaminosis D levels exhibit a higher propensity to develop schizophrenia. Several reports have suggested that adult schizophrenics have lower vitamin D levels.

This study was done to evaluate the presence of hypovitaminosis D in institutionalized schizophrenics.

To compare vitamin D levels in institutionalized patients with schizophrenia.

We retrospectively reviewed the vitamin D results on all schizophrenic patients seen in our office during a period of six months. Vitamin D was measured as 25-hydroxyvitamin D in the blood and reported as ng/ml. The levels were recorded and classified as follows: more than 30 ng/ml: normal; 21 to 30 ng/ml: mild deficiency; 11 to 20 ng/mL: moderate deficiency; 10 ng/ml or less: severe deficiency.

Total of 83 patients, 63 had vitamin D levels measured. 46 (73%) had low Vitamin D levels, while 17 (27%) had normal vitamin D levels. Of the 26 females, 20 (77%) had low vitamin d levels and of the 37 males, 26 (70%) had low vitamin D levels. 10 of the 63 had severe deficiency, 22 of the 63 had moderate deficiency while 14 of the 63 had mild deficiency. No difference was noted between the males and females.

It is estimated that as much as 60% of the adult US population suffers from vitamin D deficiency. Our population of institutionalized schizophrenia patients had a 73% incidence of hypovitaminosis D. It may contribute to the higher morbidity and mortality noted in this population.

Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. Thousands of research participants were administered hallucinogens in the context of basic clinical research or therapeutic clinical research, resulting in hundreds of publications. Results across studies were ultimately inconclusive due to such variations in methods and a lack of modern controls and experimental rigour. The growing controversy and sensationalism resulted in increasing restrictions on access to hallucinogens throughout the 1960s (ultimately resulting in the placement of the most popular hallucinogens into Schedule I of the 1970 Controlled Substances Act in the United States).

Renewed human administration research began in the 1990s. Recent clinical studies have administered hallucinogens to evaluate their safety and efficacy in the treatment of psychiatric disorders: specifically, anxiety related to advanced-stage cancer (Grob, 2005), obsessive-compulsive disorder (Moreno, et al., 2006), heroin dependence (Krupitsky, et al., 2007), personal meaning and spiritual significance (Griffiths, et al., 2008), and a meta-analysis of randomized controlled trials of LSD for alcoholism (Krebs,et al., 2012).

Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic drugs to enhance the normal mechanisms of psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline. This phenomenon was termed a “psychedelic afterglow”.

Fhurther research, blinded, randomized, placebo-controlled, methodology should explore the efficacy of hallucinogens.

PCOS is a syndrome of the heterogeneous nature, affecting multiple systems, particularly the endocrine system. We propose to investigate the possible relationships among hormonal changes, levels of anxiety, depression, and anger in patients with PCOS.

Fourty four female patients with PCOS and 44 BMI (Body Mass Index)-matched healthy women participated in this study. We measured the sociodemographic features, some serum hormonal levels (insulin, gonadotropins, prolactin, dehydroepiandrosterone sulfate (DHEAS), TSH, T3, T4, 17 OH-Progesterone, total and free testosterone) and some other biochemical parameters of the participants. Also, all participants completed Trait Anger-Anger Expression Scale (STAS), Beck Depression and Beck Anxiety Inventories.

The mean ages of the patients with PCOS and control subjects were 27.3 ± 5.6 and 27.4 ± 6.1 years, respectively. The measures of BMI, insulin, LH, DHEAS, and total testosterone serum levels in the patient group were significantly higher than the control group (p < 0.05). There was statistically significant positive correlation between BAI scores and DHEAS levels. We found significant differences between two groups in terms of trait anger, anger control, anger outward and inward, anxiety level and depression scores (P < 0.05).

Anxiety symptoms indicate stronger relationship compared to the depression with the DHEAS serum levels via autonomic nervous system, considering GABA antagonistic effect of DHEAS. Obesity, hirsutism, and infertility may reduce selfconfidence, and create depressive symptoms in patients with PCOS. in addition, changes in the hormonal levels may lead to anxiety directly. Possibly, depressive symptoms are a secondary reflection of these changes.

Premenstrual dysphoric disorder is a premenstrual syndrome comprising physical and psychic symptoms. Bipolar disorders, particularly “soft” forms, share symptoms such as depressive mood, irritability or mood reactivity with premenstrual dysphoric disorder, posing challenges on differential diagnosis. In the present work a case of a woman suffering from cyclothymia is reported, with mood episodes confined in the luteal phase of the menstrual cycle.

Case Report.

A 42-year-old married Caucasian woman is presented, suffering from mood disorder episodes lasting for 10-12 days each, during the luteal phase of the menstrual cycle, and remitting after the beginning of her menses. The mood episodes occurred since the age of 20, in almost every menstrual cycle. The patient described hypomanic symptoms during the first 4-5 days of the luteal phase, reporting irritable mood, pressured speech, increased libido as well as vividness of her perceptions and excessive goal-directed activity. The hypomanic symptoms were followed by irritable and depressive mood, fatigue, hypersomnia, tearfulness, decreased self-esteem and pessimism, lasting for another 6-7 days. The patient also reported migraine and binge-eating episodes during each depressive phase. A full range of examinations, including blood and hormonal tests, yielded normal results. Lamotrigine was titrated at 200 mg/day, with subsequent amelioration of symptoms.

The exact relationship between premenstrual dysphoric disorder and other disturbances, which either coexist, or deteriorate premenstrually, or even synchronize with the menstrual cycle, has not been elucidated yet. Studies aiming at a better understanding of this relationship could aid at accurate diagnosis and treatment.

Schizophrenia is a chronic severe psychiatric disorder with multiple environmental and genetic determinants. Several reports indicate the possible role of immune system dysregulation in the pathogenesis of schizophrenia. An accumulating body of evidence indicates an association of schizophrenia and its psychopathology with altered cytokine production. The variation of the level of cytokines might be partly due to their functional gene polymorphism.

The study was carried out to investigate the association of schizophrenia with the following cytokine polymorphisms: IL-2 (-330T/G), IL-6 (-174G/C), IFN-gamma (+874 T/A), TGF-beta (+869 T/C and +915 G/C).

We included 130 patients diagnosed with schizophrenia and 184 controls in our study. The patients were evaluated for lifetime psychotic symptomatology using the Operational Criteria for Psychotic Illness (OPCRIT) checklist. The patients having history of traumatic brain injury, neurologic disorders, substance abuse or immune related diseases were excluded from the study by detailed medical examination.

The polymorphisms were in HWE both in the cases’ and controls’ groups. In single marker analysis, we did not find an association for the tested polymorphisms.

Our data do not support the role of IL-2, IL-6, IFN-gamma and TGF-beta gene polymorphisms in the predisposition to schizophrenia in the Polish population.

Patients with chronic kidney disease (CKD) have more cognitive impairments. However, the etiologies are not fully clear. Plasma homocysteine levels and vascular burden rise in CKD; meanwhile, high homocysteine levels and vascular factors are known risk factors of dementia in non-CKD patients. Thus, we aimed to investigate the association between homocysteine, vascular burden and cognitive impairment in CKD and to see if the effect of elevated homocysteine on cognitive impairment mediated by vascular factor.

146 patients with CKD and 69 normal comparisons were recruited. Cognitive function was evaluated by comprehensive neuropsychological tests assessing processing speed, executive function, language, visuospatial function, memory, and attention domains. Vascular burden was assessed by Framinghan cardiovascular risk scale (FCRS) which indicates risk of atherosclerotic diseases including stroke.

In controlled analysis, patients with CKD had lower scores in all cognitive domains, and had higher homocysteine levels (18.5±6.4 vs. 9.8±2.9, p< 0.0001) and FCRS(17.0±4.7 vs. 14.0±4.7, p< 0.0001). Among patients with CKD, higher homocysteine levels (p=0.026) were associated with lower score on digit symbol task which is related to processing speed and executive function with controlling for age, sex, education and stage of CKD. The association persisted (p=0.047) after controlling for vascular risks.

Patients with CKD had extensive cognitive impairments. Elevated homocysteine levels may be an risk factor, which is independent of vascular burden, of cognitive impairment on processing speed and executive function. Further studies to investigate if normalization of homocysteine can improve cognitive function will be suggested.

Over the last decades, acupuncture has been seen as an acceptable primary detoxification treatment for opiate dependence, and currently used to relieve the severity of opiate withdrawal symptoms among MMT patient.

To investigate the effectiveness of electroacupuncture treatment in reducing opiate withdrawal symptoms among MMT patient.

This was a pilot study with randomized, single-blinded, and parallel. Recruitment of 22 subjects, 11 in methadone treatment + acupuncture and 11 in methadone treatment without acupuncture. The severity of withdrawal reaction was assessed by Objective Opiate Withdrawal Scale (OOWS) and Subjective Opiate Withdrawal Scale (SOWS) at baseline, third, fifth, seventh, tenth and fourteenth day of treatment.

One way Analysis of Variance (ANOVA) comparing the mean scores of the OOWS between treatment and control group has shown at tenth day of treatment p value is 0.026 and at fourteenth day p value is 0.022. One way ANOVA comparing the mean scores of the SOWS between treatment and control groups has shown at tenth day of treatment, p value is 0.015 and at fourteenth day, p value is 0.009.

The study has shown the promising results, where electroacupuncture treatment had an effectiveness in relieving opiate withdrawal symptoms among MMT patient.

Gender differences in psychopathological symptoms have frequently been found in chronic schizophrenia and first-episode psychosis (FEP) patients. However, many of the existing studies suffer from methodological problems. Furthermore, very few studies have investigated gender differences in at-risk mental state (ARMS) individuals.

To investigate whether male and female ARMS and FEP patients differ in self- and observer-rated psychopathological symptoms when adjusted for potential confounders.

Psychopathological symptoms were assessed in 117 ARMS and 87 FEP patients by two observer-rated scales:the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and one self-report scale,the Frankfurt Complaint Questionnaire (FCQ). Gender differences were investigated by applying Analyses of Variance using the BPRS, SANS and FCQ subscales as dependent variables and, group and sex as between-subject factors. Furthermore, Analyses of Covariance were conducted by including age, antipsychotic, antidepressant and cannabis use as covariates.

No significant gender × patient group interactions were found, suggesting that gender effects did not differ between patient groups. Women showed higher scores in positive psychotic symptoms (BPRS Psychosis/Thought Disturbance) while men had higher scores in negative symptoms (BPRS negative symptoms, SANS total score, and subscales Affective Flattening, Avolition-Apathy and Asociality-Anhedonia). However, the differences did not withstand correction for multiple testing. Furthermore, these results did not change when corrected for potential confounders.

Our findings suggest that male and female ARMS and FEP patients do neither differ in self-report nor in observer-rated psychopathological symptoms when corrected for multiple testing and potential confounders.

Traumatic brain injuries (TBI) may lead to persistent depression symptoms. We conducted several pilot studies to examine the efficacy of mindfulness-based interventions to deal with this issue; all showed strong effect sizes. The logical next step was to conduct a randomized controlled trial (RCT).

We sought to determine the efficacy of mindfulness-based cognitive therapy for people with depression symptoms post-TBI (MBCT-TBI).

Using a multi-site RCT design, participants (mean age = 47) were randomized to intervention or control arms. Treatment participants received a group-based, 10-week intervention; control participants waited. Outcome measures, administered pre- and post-intervention, and after three months, included: Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-9 (PHQ-9), and Symptom Checklist-90-Revised (SCL-90-R). The Philadelphia Mindfulness Scale (PHLMS) captured present moment awareness and acceptance.

BDI-II scores decreased from 25.47 to 18.84 in treatment groups while they stayed relatively stable in control groups (respectively 27.13 to 25.00; p = .029). We did not find statistically significant differences on the PHQ-9 and SCL-90R post- treatment. However, after three months, all scores were statistically significantly lower than at baseline (ps < .01). Increases in mindfulness were associated with decreases in BDI-II scores (r[29] = -.401, p = .025).

MBCT-TBI may alleviate depression symptoms up to three months post-intervention. Greater mindfulness may have contributed to the reduction in depression symptoms although the association does not confirm causality. More work is required to replicate these findings, identify subgroups that may better respond to the intervention, and refine the intervention to maximize its effectiveness.

The influential role of family in the outcome of chronic mental illness is well documented; however there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP).

To investigate possible differences in family environment between FEP and chronic patients with schizophrenia and bipolar disorder.

To compare family measures between relatives of FEP and chronic psychotic patients.

Family functioning (FACES-IV), expressed emotion (FQ), family burden (FBS) and psychological well being (GHQ- 28) were assessed in relatives of 30 FEP and 30 chronic patients.

Multivariable linear regression models adjusted for confounders revealed that relatives of chronic patients scored significantly lower in balanced cohesion (β coefficient -4.27, 95% CI: -08.03, -1.71) and balanced flexibility (β coefficient -4.01, 95% CI: -6.91, -1.10), as well as communication (β coefficient -6.61, 95% CI: -11.70, -1.50) and satisfaction scales (β coefficient -7.32, 95% CI: -13.23, -1.41). Relatives caring for a chronic patient had significantly higher scores in critical comments (β coefficient 7.81, 95% CI: 3.95, 11.68) and emotional overinvolvement (β coefficient 3.70, 95% CI: 0.24, 7.16). They, also, reported higher objective (β coefficient 12.23, 95% CI: 3.76, 20.71) and subjective (β coefficient 2.79, 95% CI: 0.45, 5.14) burden, as well as poorer psychological well being (β coefficient 12.23, 95% CI: 3.76, 20.71).

These findings suggest that chronicity adversely affects patients’ family. Early intervention strategies are needed to reduce family burden which in turn may adversely affect the course of the patient’s illness.

In psychiatric emergencies, there is a high premium on rapid assessment, acuity categorization and objectivity in decisions regarding the disposition of patients. The Crisis Triage Rating Scale (CTRS), a 3-item clinician-rated instrument, has demonstrated validity in determining the disposal of patients in psychiatric emergency settings. However, its utility has not been evaluated in Nigeria.

This study aimed to assess the validity of the CTRS in predicting the disposal (need for hospitalisation or out-patient treatment) of patients presenting to a psychiatric emergency unit in Nigeria.

The CTRS was administered to consecutively presenting patients (N=247) at the Emergency Unit of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos. Following a comprehensive psychiatric evaluation, clinicians blinded to the CTRS scores made appropriate decisions regarding the disposal of the patients. The ability of the CTRS to predict the need for hospitalisation at different threshold scores, compared with clinical judgement as criterion, was determined statistically.

The optimal threshold on the CTRS for detecting the need for hospitalisation is a cut-off score of 9 as it has the best trade-off with a sensitivity of 0.94 and specificity of 0.89. At this threshold, the overall misclassification rate is 0.09, while the area under the Receiver operating characteristics curve is 0.95. The positive predictive validity for the assessment of disposal at the optimum threshold is 0.91.

The CTRS is a useful tool in determining the disposition of patients presenting to psychiatric emergency service in Nigeria

Insulin-dependent diabetes, obesity and gestational diabetes are factors associated with macrosomia. Some psychiatric medications have well established side effects of weight changes in exposed pregnants. However, very few studies have investigated about the effects of lithium in fetal and neonatal anthropometry.

To investigate the effects of maternal use of lithium during pregnancy on fetal and neonatal growth.

A case-control study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA. Case group consisted of 18 pregnant women on maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=5) during pregnancy; control group involves 49 healthy women selected from an initial sample of 309. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, fetal and neonatal anthropometry.

Women did not diabetes or obesity criteria pre-pregnancy and during pregnancy. Mean maternal age (SD) in lithium exposed cases was 33.5 (3.8) and 32.5 (4.1) in non-exposed pregnant. No statistically significant differences were found regarding sociodemographic variables and pre-pregnancy BMI. Caesarean section was required in 91.8% of lithium exposed mothers, whereas 8.2% of non-exposed women did not need it (p= 0.000). Fetuses exposed to lithium had greater abdominal circumference (p= 0.018) and femur length (p= 0.010) compared to non-exposed group. There were no differences in umbilical cord/maternal plasma lithium ratio between women treated with lithium monotherapy or polytherapy (1.11vs.1.03).

The fetuses exposed to lithium had a greater abdominal circumference, greater femur length and more caesarean section in comparison to non-exposed group. Fetal growth surveillance is recommended in pregnant treated with lithium.