National and International telepsychiatry service was established between Denmark and Sweden in order to increase access to cross-cultural expertise. Patient acceptability study was conducted to assess the patients’ attitudes toward the quality, advantages and disadvantages of telepsychiatry service.

Over a period January 2005-December 2007, 61 patients were treated via telepsychiatry by clinicians that speak patientsrespective mother tongues. Video-conferencing equipment connected the Little Prince Psychiatric Centre in Copenhagen with two hospitals, one asylum seekers’ centre and one social institution in Denmark. These stations were also connected to the Swedish department of the Centre. Number of languages spoken was 9 while the number of nationalities treated was 11. No interpreter assistance has been used.

After the end of the telepsychiatry contact all patients were asked to complete a satisfaction questionnaire.

Patients reported a high level of acceptance and satisfaction with telepsychiatry. They expressed a wish to use telepsychiatry via their mother tongue, rather than interpreter-assisted mental health care in the future.

The restricted physical contact and non-verbal communication of telepsychiatry was compensated by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references. The results of the survey may contribute to further development of, primarily, European Telepsychiatry Network. However, this model may be used for conducting of larger international telepsychiatry service capable to provide mental health care toward diversity of patient populations underserved on their mother tongue worldwide.

Due to our fear of extinction or annihilation, there is a great deal of preoccupation with the subject of death, through which we attempt to learn to feel more at ease with the concept, and allowing us to cope with our fear of death.

The study assumptions seek to emphasize the correlations between:

1. A. Demographic characteristics and anxiety of death and dying;

2. B. Inner - personality characteristics and death and dying anxiety variable; and

3. C. Intrapersonal characteristics and death and dying anxiety.

Findings indicate that the war increased the death and dying anxieties especially among those elderly women and those who live within nursing homes. In general elderly people with a high level of self-evaluation and sense of mastery will experience lower levels of death and dying anxieties.

In spite of age, experience and knowledge, war has a powerful influence on elderly people. The phenomena in which innocent citizens became more and more involved in politics violence must be in front of policy makers.

High work demands (i.e. a heavy workload, tight time pressures, conflicting work tasks) put individuals at high risk of depression. Our aim was to test whether the relationship between high work demands and depression is moderated by genetic vulnerability to depression and by work control.

Participants are members of the Dunedin Study, a 1972-73 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (96% response rate). This analysis included all participants who were employed at age 32. Depression was measured using the Diagnostic Interview Schedule. Work demands and work control were assessed in an interview. Genetic vulnerability to stress was ascertained by the serotonin transporter gene (5-HTT).

Among individuals exposed to high work demands, symptoms of depression were significantly higher among those who carried two short alleles of the 5-HTT gene (‘s/s’ group) than among ‘l’ carriers (interaction between 5-HTT gene and work demands: β=4.22, se=1.86, p=0.02). However, this gene-environment interaction was only present among those individuals who had low control over their work (interaction between 5-HTT gene and high work demands: β: 7.21, se: 2.73, p=0.009), not among those who had high work control (interaction between 5-HTT gene and high work demands: β: 1.32, se: 2.53, p=0.60).

Pending replication, the serotonin transporter gene appears to moderate the effects of high work demands on symptoms of depression. This gene-environment interaction is attenuated by high work control.

The authors have not supplied their declaration of competing interest.

The aim of this study was to compare testosterone level with clinical features of problem behavior in children with ASD.

The study sample consisted of 35 pre-pubertal boys with clinical diagnosis of ASD. In all children (ages 3-10) diagnosed as ASD, parents completed Nisonger Child Behavior Rating Form (NCBRF) (version for intellectual disabilities)-parent version. Rating scale assessed child´s behavior as observed in previous 1-2 months. Specific problem behavior was rated on subscales for conduct problems, anxiety, hyperactivity, self-injury/stereotypic behavior, self-isolated/ritualistic and overly sensitive. On this rating form parents also assessed social behavior: compliant behavior and adaptive social behavior. Total serum testosterone levels were determined after the parents completed rating forms, according to standardized procedure.

It was found positive correlation between total serum testosterone levels and conduct problem subscale (p=0.007, r=0.445) and as well as total serum testosterone levels and overly sensitive subscale (p=0.03, r=0.348) of NCBRF. In other subscalesof NCBRF(problem behavior or social behavior) were no significant correlations.

The results suggest that there might be some relationship between problem behavior (specifically conduct problems and overal sensitivity) and testosterone levels in boys with ASD. Testosterone levels had no significant correlation with other subscales of NCBRF. However further research is needed for investigation of complex androgen activity (free TST levels, SHBD levels) and potential roles of other hormones in complex etiology of conduct problems and overall sensitivity in children with ASD. This findings rise interest in further investigation of relationship between testosterone and conduct problems and overall sensitivity in children with ASD and indicate that therapeutic strategies targeting testosteronecould be useful in the treatment of problem behaviors in children with ASD.

This study was part of broader projects focused on ASD conducted in Autism Research Center for Autism (ARCA), Comenius University and was supported by grants APVV 02544-11 and VEGA1/0086/14.

Effectiveness of shared decision making in treatment planning at discharge of inpatient with schizophrenia: interim analysis.

Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Hamann et al. conducted a few years ago a randomized controlled trial with schizophrenic inpatients and found increased knowledge and perceived involvement in decisions about antipsychotic treatment at discharge by the experimental group, but not clear beneficial effects on long term outcomes. The present communication introduces the DECIDE study.

Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge in a simple of schizophrenics hospitalized after an acute episode of their disorder. Of the oral presentation: to present preliminary conclusions with more of the half of the sample.

Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.

At discharge, increased scale score COMRADE, both subscales (Satisfacción in communication and trust in the decision) statistically significant. At 3 months follow-up, intensification of these differences in effect size and statistical significance and shows trends in health outcomes. We will present results for 6 and 12 months.

The authors have not supplied their declaration of competing interest.

There is currently a resurgence of handwriting difficulties in school-age children. Researches in literature focus on kinematics temporal and spatial measures of letters in the writing process and on clinical performances such as the handwriting scale (BHK). This assessment doesn’t consider the organization and the maturation of the handwriting gesture.

We aim to study the developmental organization of the handwriting gesture to provide developmental standards of reference in order to complete performances measures allowing a better understanding of handwriting disabilities.

Healthy children of elementary school aged between 6 and 11 years old are eligible for inclusion. All children are assessed with neuropsychological and neuropsychomotor evaluations and with handwriting assessment (BHK). Two groups are established, the one with handwriting difficulties and the other one (control group) without writing disorder or learning disabilities. The children were matched for age, gender and school level. All children are filmed with a camera suspended over to observe with specific handwriting tasks, the upper limb gesture about segmental organization of fingers, hand, forearm, arm, shoulder and postural organization.

Preliminary findings show significant differences of the segmental organization of the writing gesture between the two groups. We will discuss the identified causes of the handwriting disorders with the analysis of neuropsychomotor and neurological assessments data in correlation with gesture segmental organization.

Developmental organization of the writing gesture is a possible underlying mechanism of handwriting disabilities. Practically, it appears important to improve news tools of evaluations with gestural writing consideration and to implement it in intervention process.

The authors have not supplied their declaration of competing interest.

Clozapine is licensed for treatment-resistant schizophrenia and when clozapine is not able to be used, less evidence based practices may be required. Full remission may require combinations or high doses of psychotropic medications having greater potential for interactions and side effects. If this is not successful, symptoms may persist and long-term disability may occur.

To explore safety and efficacy of a rechallenge of clozapine in a patient with treatment resistant schizoaffective disorder, who previously developed pericardial effusion. Collateral history reported best improvement with clozapine compared to other medications.

To improve level of functioning and reduce need for less evidence based choices of medication.

Initial consultation with clozapine monitoring service over prospects of rechallenge. Full medication history and review. Consultation with a cardiologist regarding validity of local monitoring strategy. Obtain consent from the patient and his family. Titrate clozapine slowly. Once clozapine initiated, measure temperature, blood pressure, pulse rate and monitoring of symptoms of pericarditis including chest pain, cough and dyspnoea daily. ECG and echocardiography at baseline and 2 and 4 weeks after initiation of the rechallenge. ECGs monthly thereafter, with a further echocardiogram at 3 months. Weekly troponin and CRP for three months to monitor developing myocarditis and pericarditis.

Successful rechallenge of clozapine with significant reduction in psychopathology, improvement in functioning and no adverse events reported. Reduction of risk enabled transfer to open ward conditions.

There is increasing evidence of successful rechallenges of clozapine however, further research is necessary to aid such clinical decisions.

The authors have not supplied their declaration of competing interest.

The problem of cognitive dysfunction in eating disorders remains controversial and the research results are not univocal. Because of that, research was undertaken on a homogenous group of young patients suffering from eating disorders, hospitalized in the adolescent unit.

The cognitive functions were assessed by Wisconsin Card Sorting Test (WCST) and Digit Span Test in the group of 60 adolescent girls (30 anorectic, 30 bulimic) of the same age and compared with the control group of 39 healthy adolescent girls. Also the relation of cognitive disorders with some clinical features of the illness such as the degree of weight loss, BMI at the admission and discharge and the results of EDI test were assessed.

Research results did not show statistically significant differences in the performance in the WCST between anorectic and bulimic patients and the control group. However, the group of anorectic patients show the tendency to perform worse in some parameters of WCST (TA, TE, PE, %PE, %CLR) than the control group, althought the results do not reach statistical significance. The results of the bulimic patients were better (p=0.04) than the control group in the Digit Span Test.

No correlation was found between clinical data and results in WCST in eating disorder groups of patients while the correlation was found between results of Digit Span Test and BMI at admission in both clinical groups.

The research does not fully confirms that patients suffering from eating disorders show deficits in cognitive functions.

Recent developments in psychiatric diagnosis risk downgrading psychological and social aspects of personal recovery and marginalise the individual needs and aspirations of people, considered in their local context. The publication of the fifth edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-5) by the American Psychiatric Association (APA) prompted MHE to establish the Beyond the Biomedical Paradigm Task Force (BBPtf) to investigate, debate and report on these issues.

Mental Health Europe (MHE) – along with others both within and outside mainstream psychiatry – has noted with concern the increasing dominance of a biological approach to mental health problems. We see a risk of diagnoses being misused when they become part of a complex managerial health system responding mainly to the economic and issues of safety or social control. This kind of misuse could breach the principles of the UN CRPD. MHE welcomes the role of the WHO in coordinating internationally appropriate classification systems. However, we want to ensure that systems based on biomedical, economic and managerial issues are balanced with systems based on knowledge of personal experiences, life stories and direct relationships, which have proven outcomes and which respect human rights and dignity.

This workshop will explore the complex philosophical issues associated with psychiatric diagnosis and, in particular, the ICD-10 revision process.

I am President of the British Psychological Society and a member of both Mental Health Europe's “Beyond the Bio-Medical Paradigm Task Force” and the Council for Evidence Based Psychiatry. I am currently in receipt of funding from the National Institute for Health Research (NIHR) and the Economic and Social Research Council (ESRC), and I have previously received funding from a variety of sources.

The others authors have not supplied their declaration of competing interest.

Pain management is connected to use of Opioids and analgesics at the emergency care units and interfere with ability of emergency care provider to manage patient if patient identified as drug seeking. Pain has been reported as the main reason for seeking emergency care; therefore, emergency care providers have great difficulty defining or accurately predicting those patients who present with factitious complaints to obtain pain medications, and fear of additions and abuse.

Was to investigate meaning and knowledge level of emergency nurses in Jordan in relation to drug seeking behaviors at the emergency units in Jordan.

A descriptive-correlational study used to collect data related to drug seeking from 305 emergency nurses using self-report questionnaires.

The analysis showed that emergency nurses in Jordan have wide variation and moderate level of agreement on meaning of drug seeking. Emergency nurses also lack the knowledge and ability to detect drug seeking patients, and lack the effective interventions required to manage drug seeking if identified. Although nurse had low level of knowledge and low level of management skills, the analysis also showed that there was a positive association between level of knowledge and management skills. Also nurses ‘knowledge had negative association with nurses’ age, number of years of experience in nursing, and number of years of experience in emergency units.

The study provoke attention to quality of pain management and interventions provided at the emergency units

The Social Distance Scale (SDS) is an established tool in the measurement of discriminatory attitudes towards those with mental illness.

To send an electronic questionnaire incorporating the SDS to both healthcare and nonhealthcare undergraduates.

To compare attitudes using the SDS of both student groups towards vignettes describing active and medically resolved cases of mental illness.

567 first year healthcare and 501 non-healthcare (law and english) university students were sent a questionnaire randomly containing one of six possible vignettes (describing either active or medically resolved depression, schizophrenia or asthma). The SDS as used by Nordt (2006), was then completed, indicating what level of social closeness would be accepted with the person described.

180 responses were received for the healthcare group (31.7% response rate) and 125 for the non-healthcare group (25% response rate). Very good reliability of the Social Distance Scale (Cronbach's a=0.91) was observed in the sample. Statistical analysis was performed using SPSS. A linear regression model was applied which explained 20% of the variance. A significant difference was observed in attitudes between healthcare and non-healthcare students towards both the active and resolved schizophrenia, with the Non-healthcare group expressing higher social distance towards these vignettes (+0.31; P=0.043) compared to the healthcare group. The two groups did not differ significantly in social distance towards the depression and asthma vignettes.

The non-healthcare students were significantly more socially distant towards both active and resolved schizophrenia vignettes. The findings for the remaining vignettes were similar between the two groups.

Long-term functional outcome of dose-reduction/discontinuation strategies in first-episode psychosis (FEP) has not been studied before. The present study compared 7-year outcome of an early antipsychotic dose-reduction/discontinuation (DR) strategy with maintenance treatment (MT). Primary outcome was (symptomatic and functional) recovery; relapse rates, functional and symptomatic remission were secondary outcomes.

FEP patients (n = 128) symptomatically remitted for 6 m during their first treatment year who completed an 18 months trial comparing MT and DR were followed-up at 7 years. Symptomatic remission criteria were adopted from Andreasen et al., functional remission criteria were based on a functioning scale. Recovery was defined as meeting both criteria sets. MT or DR strategy, and baseline parameters were entered in a logistic regression analysis with symptom and functional remission and recovery at 7-years follow-up as dependent variables.

One hundred and three patients consented to participate. DR-patients showed twice the recovery-rate of MT-patients (40% against 18%), odds ratio 3.5 (P = .014). Symptomatic remission-rates were equal (69% and 67%). Better DR recovery-rates were attributable to higher functional remission-rates (46% vs. 20%) in DR. Predictors of recovery were DR, baseline living together and less severe negative symptoms. During the last 2 years of follow-up the mean daily dose in haloperidol equivalents was 2.20 mg in DR vs. 3.60 mg in MT (P = .031).

Relapse rates were initially higher in DR but leveled at 3 years; 61.5% relapsed in DR and 68.6% in MT in 7 years.

DR of antipsychotics during early stages of remitted FEP significantly improved 7-years outcome in terms of recovery and functional remission compared to maintenance treatment. Though initially relapse rates in GD were higher, these equalled those in MT from 3 years to the end of the study. While the necessity of immediate antipsychotic treatment in FEP and positive symptoms relapse is robustly demonstrated in a great number of studies, this study suggests that we are faced with a dilemma concerning the drawbacks of long-term maintenance antipsychotic treatment on functional capacity. Though antipsychotic discontinuation appears only feasible without relapse in a substantial minority of patients, guided dose-reduction as far as positive symptoms remain subsided and allow it, appears a feasible strategy in view of functional recovery, doing justice to both sides of the dilemma.

The authors have not supplied their declaration of competing interest.