Suicide rates are elevated among people with Bipolar Disorder (BD), yet there is limited research on the nature of suicide in this population. Intentional overdose (OD) is a common method of suicide, and the objective of this study was to characterize the specifics of OD suicides in a BD cohort, and compare with non-BD suicides.

Coroner records for all cases of OD suicide in Toronto, Canada over a 10-year period (1998-2007) were examined. Data collected included demographics, psychiatric diagnosis and all substances present at lethal levels determined by the coroner to have caused death. Data analysis focused on comparisons between the BD cohort and non-BD suicides.

Suicide by overdose was recorded in 34 people with BD (61.8% female) and 343 people without BD (46.9% female). There were numerous differences between the BD and non-BD suicide cohorts. The BD suicide group was younger, more likely to have made a prior suicide attempt, less likely to have a comorbid medical condition, and more likely to overdose on mood stabilizers or antipsychotics. Carbamazepine was the most frequently identified lethal substance among BD suicides (20.6%), with next most common being diphenhydramine (14.7%) and codeine (14.7%). Lithium was found at lethal levels in only one BD suicide (2.9%) and 3 non-BD suicides (0.9%).

Key differences exist between BD and non-BD groups who suicide by OD, including the types of ingested medications. Improving our understanding of suicide in people with BD will ultimately aid in development of effective, targeted prevention strategies.

Premenstrual syndrome (PMS) is a common disorder with prevalence rate of approximately 30%; its concurrence with psychiatric symptoms will make it a disabling condition that resists usual treatment.This study was enrolled to assess the co-morbidity of PMS andpsychiatric disorders in a sample of girls with PMS compared to those without PMS.

This study was conducted through a cross sectional method with 362 participants (166 with PMS and 196 healthy girls) who were selected randomly and completed the demographic questionnaire, premenstrual syndrome symptom daily record scale and the symptom checklist 90-revised (SCL-90-R).

According to the result of the independent t test, the mean score of all the psychiatric symptoms in the PMS group was significantly higher than those in healthy group (P < 0.001). According to SCL-90-R measurement, most of the participants in the PMS group were categorized as extremely sick for somatization (44%), obsessive-compulsive (59%), depression (58.4%), anxiety (64.5%), hostility (47%) and psychoticism (69.3%); most of the participants were diagnosed as having borderline severity of disorders for interpersonal sensitivity (44.6%) and paranoid (42.8%) and most of the respondents with PMS (46.4%) were diagnosed as healthy only for phobic anxiety.

There is a considerable relationship between PMS and different psychiatric symptoms that can complicate the diagnosis of PMS and its treatment for the health care providers. Therefore, all health care providers who are in contact with women in their reproductive age should be sensitive to mental health status in women with PMS.

It is estimated that 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year. Patients admitted to Old Age Psychiatric units clearly posses numerous risk factors relating to developing VTE.

The aim was to study inpatients admitted to the old age psychiatric unit and see if NICE and Department Of Health guidelines are being followed in relation to VTE (Venous thromboembolism) risk assessment and prophylaxis.

A prospective opportunistic sample of all the inpatients in the old age psychiatric unit during a 2 week period was audited. Standards were based on the NICE and Department Of Health guidelines.

13% of patients developed a deep vein thrombosis during the admission period audited. No patients had a VTE risk assessment completed on admission. Every patient had at least one risk factor for developing DVT (deep vein thromboembolism) due to being over 65 years old.

93% had at least 2 risk factors and 63% had at least 3 risk factors. Despite this no patients were treated prophylactically with graded compression stockings or enoxaparin.

It was evident that VTE risk assessment and prophylaxis was not something that was being considered for patients admitted to the old age psychiatric inpatient unit. However due to the risk factors this group of patients possess it is something vitally important. As a consequence of presenting the audit across the trust a service change was recommended with a VTE risk assessment planned to be introduced across the trust.

There is limited understanding of the health and treatment-related experiences of adults with Attention Deficit Hyperactivity Disorder in England.

To explore the experiences of adults with ADHD regarding impairment, accessing diagnostic and treatment services, and to compare experiences between patients diagnosed during adulthood and childhood.

Semi-structured face-to-face interviews were conducted with 30 adults with ADHD, recruited across England. Half of the participants were diagnosed during childhood and the remainder during adulthood. Data was analysed using Thematic Analysis and data saturation was achieved.

Getting a diagnosis and accessing ADHD services in adulthood was an ‘uphill struggle’, often due to negative and sceptical attitudes towards ADHD by healthcare professionals. Many patients struggled for years with misdiagnoses of depression and anxiety, and severe difficulties accessing care and treatment caused a downward spiral into functional impairment in some. Accumulated psychosocial burden was evident as living with undiagnosed ADHD had resulted in a chronic sense of failure and missed potential in many diagnosed from late adolescence onwards. Positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many deemed pharmacological treatment by itself as inadequate. Additional support, especially psychological therapies/psycho-education was strongly desired, yet few patients had access to non-pharmacological treatment.

This study suggests that the unmet needs of adults with ADHD are substantial, particularly in those diagnosed from late adolescence onwards. The findings suggest there is a wide gap between policy and practice in England.

There is a long tradition of reaction time studies in experimental psychopathology. Even though a diminishing interest in this paradigm has been seen over the last years, it is in line with more recent biological approaches to examine psychiatric disorders cross-diagnostically.

Patients (n = 95) with a positive subtype of schizophrenia (n = 22), a negative subtype of schizophrenia (n = 18), a full major depressive episode (n = 19), a full manic episode (n = 16), or a mood disorder in remission (n = 20) and subjects with no known psychiatric disorder (n = 30), respectively, participated in a computer-based reaction time test consisting of four trials with 55 short visual and auditory stimuli presented in a random sequence. Each participant’s median reaction time in milliseconds to light stimuli ipsimodal (light preceded by light) and cross-modal (light preceded by tone) and the difference between the two conditions (i.e. cross-modal retardation (CMR) to light) were recorded. Likewise, the median reaction time to tone stimuli ipsimodal and cross-modal and the difference between the two (CMR to tone) were recorded.

Patient groups performed worse than the control group, with the exception of the group of patients with mood disorders in remission in both CMRs. When comparing patient groups, the schizophrenia negative subtype performed worse than the remission group in both CMRs.

Our data support newer theories about underlying pathophysiological mechanisms and observable behavioural phenomena occurring across the different diagnostic categories, thereby supporting a dimensional approach in the diagnosis and clinical management.

Mood disturbances are often found in stroke patients and have a negative impact both on the recovery and the outcome of the stroke. Depression is the most common neuropsychiatric complication in the poststroke population, affecting nearly 30%–50% of patients within the first year. PSD implies a significant burden on both patients and their caregivers.

Using the search engines Pubmed and Scopus, 20 papers regarding the elderly dated from 2002–2010 were reviewed using the keywords depression, poststroke, recovery after stroke.

The core features of PSD include but are not limited to: persistent sadness, feelings of hopelessness, helplessness and worthlessness, guilt and sense of being a burden on the caregiver, lack of motivation, loss of interest, death wishes and suicidal ideation. Various cerebrovascular risk factors, including hypertension, atherosclerotic heart disease, hyperlipidemia and diabetes mellitus have been implicated as risks for depression in late life.

Other predisposing factors are: prior history of depression or anxiety disorder, certain personality traits, baseline dementia but also, social isolation, living alone, physical functional impairments or a history of other psychiatric disorder.

Depression may impede recovery from stroke and impair outcome by affecting social functioning, motor abilities, cognitive functions and quality of life, thus it is important to early diagnose and prevent PSD.

140 patients have been observed: basic group - 70 patients with depressive disorder with anxiety disorder; control group - 70 patients with depressive disorder alone. All patients were treated with SSRIs. We used in study 17-item HRS-D and CGI.

Baseline average score according to CGI has constituted 4,8±0,6 and 4,5±0,7. Comparative assessment of clinical picture of depression in groups has shown that in basic group more frequently (p< 0,05) dysphoric (31,4% and 12,9%) and conversion (21,4% and 11,4%) syndromes were noticed, while in the control group - adynamic (30% and 12,9%,). Statistical analysis of data of age at the onset of depressive disorder has revealed intergroup differences (p< 0,05), testifying to emerging depressive disorders in patients of basic group at younger age (39,6±12,1 years), as compared with patients of control group (43,9±12,9 years).

Index of cyclicity of disease in patients with RDD was calculated as ratio of disease duration in years to cycles of disease. Average value of the corresponding index in basic and control groups differed reliably (p< 0,05) and has constituted 3,2±1,1 and 7,6±1,6. I.e., in the basic group exacerbation of depressive symptoms in recurrent depressive disorder was noticed more frequently as compared with control group.

Thus, comorbidity of depressive and anxiety disorders results in complicating symptoms, change of its syndromal validation, more adverse course (acceleration of depressive phases in recurrent depressive disorder).

Psychiatric disorders in epilepsy have a multifactorial etiology, being pharmacotherapy only one of many risk factors, which can be both biological and psychosocial. The adverse effects of antiepileptics (AEDs) embrace all categories of psychiatric symptomatology, including disturbances of consciousness, psychotic state, neurotic state, behaviour and character disorder. In fact, Psychotropic effects of AEDs require further research because many relevant parameters related to pathological mechanisms, frequency, psychopathology, and prognosis are not well understood.

The authors aim to present a case of an adolescent with epilepsy who has developed secondary psychiatric symptoms.

To understand and deal with the most common Psychiatric side effects of AEDs.

A non-systematic review of English scientific literature was conducted using keywords “Epilepsy” and “antiepileptic side effects”.

A 14-year-old female adolescent with history of seven years of Epilepsy (usual medication: carabamazepine 45 mg/kg/day, Lamotrigine 8 mg/kg/day; pregabaline 8 mg/kg/day) was admitted in the paediatric ward due to behaviour disorder characterized by agitation, anxiety and seizures-like symptoms. A therapeutic adjust was made (Fenetoíne and Levetiracetam). After this medication change, the adolescent presented psychotic symptoms namely auditory and tactile hallucinations. A complete clinical investigation was performed and the hypothesis of drugs side effects was considered. After AEDs reduction, a total remission of the symptoms was obtained.

Psychiatric disorders in epilepsy have a multifactorial etiology and are not yet well understood. Behavioural side-effect profiles of AEDs (both negative and positive effects) should be considered in the choice of the optimal drug for each patient.

The authors have not supplied their declaration of competing interest.

The INTERMED method was created to identify patients with multiple care risks, needs and negative health outcomes, in order to assess their biopsychosocial complexity as a first step towards integrated care. Until now, it was based on a face-to-face interview (IM-CAG). Several studies in the last decades have confirmed its face-validity and reliability. A self-assessment version was derived (IM-SA) providing a complementary tool for clinical and research applications.

Preliminary evaluation of IM-SA's predictive validity, in comparison to IM-CAG's.

29 outpatients with liver disorders referred to the consultation-liaison psychiatry service of the Modena University Hospital underwent the protocol of evaluation, including: IM-SA, IM-CAG, CIRS, HADS, SF-36, EuroQol. Clinical and socio-demographic data were also collected for all patients.

Both INTERMED instruments, IM-CAG and IM-SA, were able to identify complex patients (with a total score higher than 21/60) and showed similar correlations to the other measurements (with a mean difference between correlations of 24%). Discrepancies were also suggested by preliminary data, particularly related to the prognostic assessment (“vulnerability”).

Preliminary results suggest that IM-SA is able to predict complexity of health care needs. the IM-SA Study, an European multicentric project supported by the INTERMED Foundation and including different clinical populations, will provide stronger evidence about generalizability of data.

The author has not supplied his/her declaration of competing interest.

The impairment of facial emotion recognition (FER) among patients with schizophrenia (SCZ) is a significant feature of the illness. Childhood trauma (CT) is reported with a high prevalence in SCZ and is considered one of its risk factors.

To investigate the relationship between FER and CT in SCZ.

Fifty-eight outpatients with stable SCZ completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed a newly developed and validated FER task constructed from photographs of the face of a famous Tunisian actress and evaluating the ability to correctly identify Ekman's six basic facial emotions (happiness, sadness, anger, disgust, fear and surprise).

Patients with higher scores of CT performed significantly worse in FER task. Our results suggest that the presence of sexual abuse is specifically correlated to a poor identification of anger (P = 0.02) and disgust (P = 0.03) while the presence of emotional abuse and physical neglect are correlated to a poor identification of happiness and sadness.

CT may represent one of the causes of the FER deficits in schizophrenia. Further studies are necessary to confirm the link between specific kinds of childhood trauma and deficits in the recognition of discrete emotions.

The authors have not supplied their declaration of competing interest.

The aim of study was to estimate the relationships among smoking/quitting behavior, having a smoke-free home and a number of social variables, including perceived family pressure to quit, the presence of adult non-smokers and children in the household, and belief in the harmfulness of secondhand smoke.

The study analyses data from Lithuanian adult population health behavior surveys, performed in period of 1994- 2008. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering smoking habits, sociodemographic characteristics.

65% of current smokers reported living in a home with a total smoking ban, 35% reported having no restrictions on smoking in the home. Report of a recent quit attempt and intention to quit were associated with family preference that the smoker not smoke. Smoke-free homes appear to prolong time to relapse following cessation. Male smokers were more likely than females to report smoke-free homes, and such reports decreased with age. Smokers were nearly 5 times more likely to report smoke-free homes if they lived with a non-smoking adult and child compared to when there was no child or adult nonsmoker in the household, and over 4 times more likely to report a smoke-free home if they believed in the harmfulness of secondhand smoke.

Social influences, especially at the family level, motivate smokers to modify smokers’ behavior in ways that would help them quit and stay quit.

A wealth of research supports the relevance of neuro-, social cognition and negative symptoms as treatment targets in schizophrenia. However, little is known about their interdependent relationships, their relative contribution to adequate functioning and quality of life as well as their associations with subjective, process oriented variables.

Data were collected in the context of an international RCT evaluating the Integrated Neurocognitive Therapy (INT) in comparison to treatment as usual (TAU). 169 outpatients with a diagnosis of schizophrenia according to ICD-10 or DSM-IV-TR participated in the study. We chose a longitudinal design.

First, by the means of structural equation modeling (SEM) we tested social cognition and negative symptoms as mediators between neurocognition and functional outcome. Additionally, the relationships of these variables with subjective parameters (hope, psychological strain, helplessness, initiative, knowledge about the disorder, insight, self-efficacy) were assessed. Second, we analyzed the same mediators and subjective variables but used quality of life instead of the traditional functional outcome measures.

1. 1. Social cognition and negative symptoms both served as mediators between neurocognition and functional outcome. Some subjective variables (e.g. hope) were associated with negative symptoms and functional outcome.

2. 2. Cognitive functions had no significant predictive or mediating influence on quality of life. Instead subjective variables (hope, psychological strain, self-efficacy) and negative symptoms functioned as significant predictors and were strongly related to each other.

The results of the study provide further evidence for integrated treatments. Including relevant subjective variables seems promising to generalize therapy effects to quality of life.

Although the harmful effects of alcohol have long been observed, organized social measures for the prevention of excessive consumption of alcoholic beverages were taken relatively late.

To present an historical overview of development of social, cultural aspects of alcoholism prevention in northeast Bosnia.

The authors provide a historical overview of societal and professional institutions that fight against alcoholism in the area of northeast Bosnia and Herzegovina (BH) following the definition of the World Health Organization, that alcoholism is illness and alcoholic is a patient.

Teetotaler societies in BH began with the establishment and work at the late 19th and early twentieth century. Through the period before World War II, between the two world wars, the national liberation struggle period from 1941 to 1945, and the post-war socialist enthusiasm to the last war from 1992 to 1995 there were different levels of organizing struggle against alcoholism with different impact on the development of mental health protection of alcoholics and their families. During the 1992–95 war, due to high trauma of veteran and civilian population, a number of posttraumatic effects appeared, which lead to people seeking release in self-medication by alcohol abuse, worsening the issues of alcoholism and its aftermaths.

After the tragic war 1992–95, many of the socio-political relations and the issue of functional organization of health is redefined, this resulted in search for new formulas of successful dealing with very serious drinking problem in the postwar situation in the region of Tuzla Canton (northeast Bosnia).