The increased prevalence of metabolic syndrome in people with severe mental illness (SMI) is well documented. The International Diabetes Federation (IDF) criteria for metabolic syndrome are three or more of the following: waist circumference ( 80 cm (females), (94 cm (males) OR BMI (30, triglycerides >1.7 mmol/l or on treatment, raised blood pressure (systolic >130 mg Hg or diastolic >85 mm Hg, OR on treatment for hypertension), raised fasting blood glucose (.5.6 mmol/l) OR diagnosed type II diabetes) and reduced HDL cholesterol (< 1.03 mmol/l) OR on treatment.

The IMPACT RCT is a Department of Health funded trial of a health promotion intervention (HPI) delivered by care co-ordinators to people with SMI across South London, Kent and Sussex. The intervention is focussed on improving health by addressing modifiable lifestyle factors such as diet, physical activity, obesity, cigarette smoking, alcohol and substance use.

We investigated the prevalence of metabolic syndrome in a sample of 212 patients for whom we had relevant baseline measures.

Data (weight, BMI, waist circumference, blood pressure, fasting HDL cholesterol, triglycerides and glucose levels) were analysed on 212 patients.

45% of the sample met IDF criteria for metabolic syndrome. Mean BMI was 30.6, glucose 6.4 mmol/L, triglycerides 2.0 mmol/L, HDL 1.2 (mmol/L), waist circumference 105.8 cm, and BP 122/82 mm Hg.

Metabolic syndrome was highly prevalent in this sample, significantly increasing the risk of physical morbidity and potentially lowering life expectancy. There is an unmet need for health promotion interventions in order to lower morbidity and mortality risk in these populations.

The aim of this study was to evaluate theprevalence of night eating syndrome (NES) and its correlates in schizophrenicoutpatients.

The 14 items of self-reported night eatingquestionnaire (NEQ) was administered to 201 schizophrenic patients in psychiatricoutpatient clinic. We examined demographic and clinical characteristics, bodymass index (BMI), subjective measures of mood, sleep, binge eating, andweight-related quality of life using Beck's Depression Inventory (BDI),Pittsburgh Sleep Quality Index (PSQI), Binge Eating Scale (BES) and Koreanversion of Obesity-Related Quality of Life Scale (KOQoL), respectively.

The prevalence of night eaters in schizophrenicoutpatients was 10.4% (21 of 201). Comparisons between NES group and non-NES grouprevealed no significant differences in sociodemographic characteristics, clinical status and BMI. Compared to non-NES, patients with NES reportedsignificantly greater depressed mood and sleep disturbance, more binge eatingpattern, and decreased weight-related quality of life. While 'morning anorexia'and 'delayed morning meal' (2 of 5 NES core components in NEQ) were notdiffered between groups, 'nocturnal ingestions', 'evening hyperphagia', and'mood/sleep' were more impaired in NES group.

These findings are the first to describe theprevalence and its correlates of night eaters in schizophrenic outpatients. These results suggest that NES has negative mental health implications, although it was not associated with obesity. Further study to generalize theseresults is required.

Physical and mental health has been found to be affected by occupational factors that cause psychological strain. The aim of this cross-sectional study was to investigate the Prevalence of risk for mental disorders among paramedical students at the Fatemeh nursing &Midwifery college in Iran.

The studied population included 184 paramedical students from First year and fourth year of education. Self-administered questionnaires were used to solicit demographic information and Psychological ill health was measured using a standard instrument—the General Health Questionnaire (GHQ 28). In this study a cut-off point of 23 was used for prevalence estimations. By this scoring, if the total score was 23 or less (from84) then the person was regarded healthy. The higher the GHQ-28 scores indicated the subject might suffer from a psychiatric distress.

The majority of the respondents (68.5%) were between the ages of 20-24 years and 80.8 % were female.47.3 percent of paramedical students had GHQ scores of 24 and above, indicating an increased likelihood of psychological disorder. The average score was 25.93 +/-14.93.Depression has the lowest mean score (3.92+/-7.2), while social dysfunction has the highest mean score (8.12+/-3.97) among the subscales. GHQ scores between the dissatisfied and satisfied groups were statistically significant (P = 0.001).

This study suggests that paramedical students have high levels of stress, so counseling and other support services should be made available to them.

Mental patients are at more risk of being under polypharmacy in compare to other medical disorders. Elderly patients are more at risk of using polypharmacy.

This research was designed to observe the benefits of replacing polypharmacy with a single medication in elderly patients with chronic schizophrenia.

Antipsychotic polypharmacy in elderly results in higher rate of interactions, side effects and cost. Polypharmacy would escalate medical risks which ends to decrease patients' quality of life.

A survey was performed at the long stay public and academic Tehran Razi Mental Hospital. From the initial 157 conveniently access patients, 59 cases were selected based on inclusion and exclusion criteria. Before intervention, 7 patients did not participate in the study due to their newly occurred medical conditions. 52 cases entered and completed the 36 weeks of research time period. Systematically, the patients' multiple antipsychotics were switched to a single medication, Risperidone. Their clinical assessments applied weekly for 36 weeks. Evaluations achieved by using validated and reliable tools of Brief Psychotic Rating Scale (BPRS), Global Assessment of Functions (GAF) and Extra-Pyramidal Syndrome (EPS) tools.

Wilcoxon signed ranks test and Friedman test revealed a significant difference in post intervention for positive, negative and general schizophrenic symptoms. Functional improvements and lower incidence of EPS, showed a significant difference statistically.

Risperidone may be safety used instead of other multiple antipsychotics in elderly patients with typical chronic schizophrenia. This replacement possibly will result in more clinical benefits, obvious cost reduction and less side effects.

The purposes of this study were to explore elderly outpatients’ perceived reasons for, opinions of, and suggestions for elderly people considering suicide in Taiwan.

Elderly outpatients (N=83) were recruited in 2011-2012 by convenience sampling from three randomly selected medical centers in Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by content analysis.

Findings revealed that most participants had heard of elderly suicide, with television news as the main source for their information. Their opinions about elderly suicide reflected judgmental attitudes, negative emotional reactions, expectations of social welfare, and could happen after losing one's meaning in life. Their suggestions for elderly people considering suicide fell into four major themes: give up suicidal ideas, seek help, enhance social welfare, and attend religious activities.

Since television news was the main source for participants’ information about elderly suicide, this mass medium should be used in suicide prevention to disseminate suicide knowledge, increase access to help, and strengthen suicide-protective factors among the elderly. Furthermore, no participants mentioned depression as a reason for attempted or completed suicide among older people despite depression being a well-known suicide-risk factor. Future suicide-prevention programs should emphasize the role of depression in suicide among older people. Participants also did not suggest that older people considering suicide seek help from the health system. Thus, older people should be educated about the role of the health system in suicide prevention and trained as gatekeepers to recognize signs of suicide ideation and respond appropriately.

Second generation antipsychotic drugs (SGADs) including olanzapine trigger adverse metabolic alterations possibly by a direct action on adipocytes.

The system of the inflammatory 5-lipoxygenase (5-LOX) and its activating protein (FLAP) have been implicated in lipid dysfunction in obesity. We investigated whether this system could participate in the adipogenic action of olanzapine.

Experiments were performed in 3T3-L1 adipocytes in vitro. Cells were treated with olanzapine and a FLAP inhibitor MK-886. Their lipid content, 5-LOX and FLAP mRNA content, and FLAP protein content were measured.

Olanzapine treatment did not affect the cell content of 5-LOX mRNA; however, it decreased FLAP mRNA content at day five but not 24 hours after olanzapine addition. The inhibitory effect of olanzapine on FLAP expression was confirmed by quantitative Western blot assays. In the absence of a FLAP inhibitor, low concentrations of olanzapine (0.5 and 5 μM) increased lipid content only by about 13% (compared to about a 56% increase induced by 50 μM olanzapine) whereas in the presence of MK-886 these concentrations of olanzapine produced lipid increases comparable to the increase caused by 50 μM. In these experimental conditions, MK-886 alone did not alter the cell content of lipids.

5-LOX system may be involved in lipid dysfunction not only in conditions of obesity but possibly in SGAD-related metabolic alterations. The known polymorphism in the genes of the human 5-LOX system could play a role in setting a variable individual susceptibility to the metabolic side effects of SGADs.

Suicidal ideation and behavior are present among Kosovar youth. The suicide rate is lower compared to the suicide rate in other countries, however the data indicate it is an increasing inclination. This study tends to asses the interaction between anxiety, depression and hopelessness with suicidal and behavior among the young people.

The sample consisted of data collected from 25September-30 November 2008 2001 to 2005. 2393 participants were high school students (grades 11–13) from 25 municipalities of Kosovo. Participants completed the Questionnaire on Suicide ideation and behavior (Q-SIB), Hamilton Anxiety Depressive scale (HADS), Brief Hopelessness Scale (BHS), and demographic survey. Data collected are analyzed with statistic program SPSS 12, and statistic parameters are used .

The analysis revealed that the anxiety, depression and hopelessness are related with suicide ideation and behavior (arithmetic mean M, standard deviation SD), p < .001, Also T-test was used.

These findings contribute to a theoretical framework, which has implications for educational and clinical intervention. The present findings will help guide further preventative research on examining sub-clinical anxiety and depression, also hopelessness.

Lithium occurs naturally in food and water. While low environmental concentrations in drinking water are associated with mental illnesses and behavioral offences, at therapeutic dosages it is used to treat psychiatric disorders, partly by facilitating serotonergic (5-HT) neurotransmission. However, as little is known about the physiological role of nutritional lithium for neurobiological functioning and emotional processing in the general population, endogenous lithium concentrations were hypothesized to be associated with measurable effects on emotional liability and the loudness dependence (LD) that is proposed one of the most valid indicators of 5-HT neurotransmission.

Auditory evoked potentials (AEP) of healthy volunteers with either high or low lithium serum concentrations were recorded using multi-channel EEG. Emotional liability was assessed using the Brief Symptom Inventory (BSI).

Serum lithium concentrations varied widely, low levels correlating with symptoms of Somatization. While there were no significant correlations between LD and lithium concentrations, LD correlated positively with Paranoid Ideation, and in the high-lithium group inversely with further aspects of emotional liability (Depression, Psychological Distress).

Effects of low levels of endogenous lithium are associated with an increase in emotional liability, and high levels with some protective effects. Findings on the mediating neural correlates point to the 5-HT system, but remain inconclusive regarding LD. Potential benefits of endogenous lithium as a neurobiological trace element on neurobehavioral functioning especially in high-risk individuals would have public health implications.

The review the successfulness of efforts to decrease suicides in Finland in the light of scientific studies.

The rate of suicide has decreased considerably and its association with the use of alcohol has weakened. Although the use of alcohol increased in the 1990's the rate continued to decrease. Two studies have linked the decrease in rate of suicide with the sale and use of antidepressants. This trend appears to be especially pronounced among men. Additionally, evidence shows that the replacement of hospitalbased services with outpatient care has had a positive impact on suicide mortality of patients, who have received care in psychiatric hospitals. The decrease in suicide rate is associated with intensive outpatient care.

In the long run, the national suicide prevention project has been successful, although other factors, such as increase of standard of living and general wellbeing among citizens of Finland, have been likely contributors.

Assess the incidence and time-course of somnolence in placebo- and active-controlled asenapine schizophrenia and bipolar I disorder (BD) trials.

Data were from schizophrenia (4 short-term [6wk]; 3 long-term [26-52wk]) and BD (2 short-term [3wk]; one 12-wk adjunct therapy to mood stabilizers) trials. Data were pooled across asenapine doses (5or10 mg BID); active controls were risperidone 3 mg BID, olanzapine 5-20 mg QD, and haloperidol 4 mg BID.

For schizophrenia, incidence of somnolence was higher with active treatment than placebo in short-term trials; (asenapine,13.1%; placebo, 6.9%; active controls, 5–20%); and comparable for asenapine and olanzapine in long-term trials; (asenapine,18.4–18.5%; olanzapine, 19.6–21.1%); severe somnolence was infrequent (0–8%). Somnolence onset (median [days]) occurred early in short-term (asenapine, 2.0; placebo, 7.0; active controls, 2–6) and long-term (asenapine, 9.0; olanzapine, 7.5–9.0) trials; median somnolence duration (days) was relatively brief in short-term (asenapine,15.0; placebo, 4.5; active controls; 3.0–22.5) and long-term (asenapine, 22.0–25.0; olanzapine, 21.0–25.0) trials. For BD, incidence of somnolence was higher with active treatment than placebo in short-term (asenapine, 23.8%; placebo, 6.4%; olanzapine, 26.4%) and adjunctive therapy (asenapine, 24.1%; placebo, 10.2%) trials; severe somnolence was infrequent (0–3%). Somnolence onset (median [days]) occurred early in short-term (asenapine, 1.0; placebo, 2.0; olanzapine, 1.0) and adjunctive therapy (asenapine,1.5; placebo,2.0) trials; median somnolence duration (days) was brief in short-term (asenapine, 7.0; placebo, 5.0; olanzapine, 8.5) and adjunctive therapy (asenapine,12.5; placebo, 7.0) trials.

The analyses show, on average, an early onset and a limited duration of treatment-emergent somnolence with asenapine, which may be clinically useful in certain clinical situations.

Mental distress has been suggested as an etiological factor of fertility problems. The aim of the study was to investigate the predictive value of common mental symptoms for fertility problems in a population sample.

The predictive value of anxiety and depression symptoms for incident fertility problems over an 11 year span was investigated in a N=5,873 female sub-sample from the Nord-Trøndelag Health Studies (HUNT 1 and HUNT 2). Only women who had not experienced fertility problems at the time of HUNT 1 were included. Fertility problems were reported retrospectively at HUNT 2. Sub-/infertility was defined as having tried to get pregnant for more than one year without success. Symptoms of anxiety and depression at HUNT 1 were measured by the one-dimensional 12-item Anxiety Depression Index (ADI).

Mean age at HUNT 2 was 42 years (S.D. 4.96, range 28-49). N=152 reported having tried to get pregnant for more than one year. No predictive value of anxiety and/or depression symptoms for sub-/infertility was found (crude OR=0.97 (95% CI=0.82; 1.15), p=0.736; analyses adjusted for age, level of education, civil status, somatic conditions, parity, and gynaecological surgery: OR=0.97 (95% CI=0.81; 1.15), p=0.687). Results were comparable in a sub-sample who had never been pregnant.

There is no prospective effect of common mental health symptoms on incident fertility problems in women. This zero-finding emerges from a large population-based data set with a long follow-up interval, and it provides evidence against the hypothesised causal relationship between mental distress and sub-/infertility.

Opioids modulate dopaminergic transmission in the pathophysiology of psychosis. Methadone, a pure agonist opioid synthetic contains a slightly higher potency, a longer lasting duration and reduced euphoric effect. Opiates may contain beneficial effects on psychosis. We report a case of psychosis after a complete opiate withdrawal.

To describe the possible antipsychotic effects of methadone on a patient who displays psychotic symptoms following the cessation of this treatment.

X is a 35 year old female ex-heroin addict who came into the psychiatry emergency because of a psychomotor agitation episode. The patient reported delusions and impaired sensory perception with a behavioural change coincided with the cessation of methadone treatment.

During admission, the patient’s condition consisted of injuries and erotomanic delusions partial structure. Furthermore, there were delusional interpretations of the environment and the presence of auditory and kinesthetich hallucinations. Behaviour was disorganised and affective blunting dominated. Neuroleptic treatment was prescribed and psychotic symptoms improved progressively.

Opiate use in patients with psychosis has been linked to a reduction of psychotic symptoms and worsening in periods of abstinence. The caring of these patients should take into account these potential side effects, noting caution in times of detoxification or dose reduction that may exacerbate psychotic symptoms. Although the efficacy of methadone for the treatment of opioid dependence has been demonstrated, there remains insufficient specific scientific evidence in patients with schizophrenia and dual diagnosis. Therefore, it’s recommended that further research into this field of study is both required and necessary.

With the growing epidemic of obesity many treatments are aimed at reducing weight like diets, exercise, pharmacotherapy and bariatric surgery. All of these can reduce weight at least for a period; however none of them adequately address the behavior of binge eating/eating disorder.

assessed the role of Cognitive Behavior therapy in reducing disordered eating behavior.

The subjects were enrolled in 12 weeks CBT. They were all obese and had a score of > 20 on the BES. They completed a BDI, MBSRQ, and BES before and after the groups. Their weight was recorded before and after the 12 weeks. 79 patients were enrolled in groups over a period of 3 years. Of those 56 patients completed the groups and questionnaires. Most groups consisted of 6–8 patients.

70% of patients had psychiatric symptoms psychotropic medications like antidepressants. More than 70% felt their eating habits were more in control and felt more informed about themselves since attending CBT groups. All of the patients who stayed and attended groups felt that the connection helped them sustain better eating habits. 67% of patients had lost 4–30 lbs during the 12 weeks of CBT, none had gained weight.

CBT helps the patient reduce disordered eating behaviors by understanding the cause of their self sabotage. CBT addresses the core of the problem i.e. disordered behavior as opposed to its consequences (viz. obesity and its multiple medical comorbidities); while affecting weight indirectly.