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Introduction The research field of disability and mental health is politically and socially relevant, because the psychological well-being of people with intellectual disabilities has often been trivialized in therapy and legislation. Since the pursuit of mental health is coming into focus due to removal of stigma and emerging awareness, people with disabilities must have equal opportunities to choose their place of residence and get suitable psychosocial support. Objectives Our aim is to investigate the influence of assisted outpatient treatment (AOT) on the quality of life and resilience of people with intellectual disabilities who are living self-determined. Methods A participatory mixed-methods design is chosen as it enables the greatest possible standardization and allows a high flexibility. The project will be divided into three parts: A systematic literature search to gain knowledge about the field and to estimate the sample size, a pre-post-comparison of the WHOQOL-BREF to evaluate AOT in terms of self-perceived quality of life and a focus-group of handicapped people to reflect the study results with attention on resilience. Results To foster the doctoral thesis, several questions can be discussed: 1) How is the relation of disability and mental health to be described? 2) What might be the pros and cons of self-determined living? 3) Which steps need to be taken to implement AOT more often? Conclusions The topic is relevant in the public health sector and the results could help to sensitize professionals and the general society regarding to participation in everyday life. The recommendations developed may serve to implement comparable forms of housing. Disclosure No significant relationships.

Introduction: Intellectual disability (ID) is a neurodevelopmental disorder of etiologically diverse conditions starting in childhood characterised by impairments in intellectual and adaptive functioning. Although life expectancy is still lower compared with the general population, the number of people with ID growing old is increasing. Consequently, age-related mental health (MH) disorders, such as dementia, are becoming a common comorbidity of ID. Objectives: Description of the challenges related to the provision of appropriate healthcare for elderly persons with ID and MH disorders. Method: Review of the recent literature based upon a comprehensive search of medical databases using the keywords: intellectual disability, mental health, dementia, Alzheimer's disease, Down's syndrome and age. Results: ID is associated with a higher prevalence of physical and MH disorders across all ages, while clinical diagnostics and management of dementia are made complicated by the comorbidity rate. Elderly people with ID, especially those with Down's syndrome (DS), more commonly develop dementia than their age-matched counterparts without ID. For peoplewithDS and Alzheimer's disease (AD) the survival time was related to the age at diagnosis of AD, severity of ID, anti-dementia medication, history of epilepsy and living status. Conclusion: Elderly people with ID have greater early-onset multimorbidity and a prevalence of dementia which is up to five times higher compared to the elderly non-ID population. Their care is more challenging, and their diagnostics requires a comprehensive approach, including ID-appropriate neuropsychological evaluation. Specialist services for elderly persons with ID and MH disorders are, however, sparsely available and should be established. [ABSTRACT FROM AUTHOR]

Introduction: There are few studies about how people with intellectual disability (ID) perceive their own quality of life (QoL), with research being focus, mainly, in the opinion of caregivers and/or family. Thinking about QoL, the World Health Organization developed an instrument that measures QoL, the WHOQOL. In Brazil, this instrument was adapted, validated and translated for people with ID and their caregivers. Objectives: The aim of this study was to increase knowledge and understanding of how people with ID perceive their own QoL. Methods: This study was approved by the Ethics and Research Committee. Sample of 51 individuals aged between 19 and 54 years (G1), with medical diagnosis of ID, who did not present physical/mental disabilities and/or mental disorders and 31 caregivers (G2). G1 answered the WHOQOL-DIS-ID questionnaire and G2 answered the WHOQOL-DISID Proxy questionnaire. The results were statistically analyzed considering p-value ≤ 0.05. Results: The individuals with ID presented higher score on the psychological and lower score in the discrimination domain. The caregivers presented higher scores on the physical and lower scores in the autonomy domain. Regard the comparison between self-perception and the perception of caregivers, on Table 1, it was possible to observe significant differences in Psychological, Social, Environmental and all domains for the Disabilities Module. Table 1. Correlation between Domains Domain Mean G1 Mean G2 SD G1 SD G2 Median G1 Median G2 P value Physical Capacity 72,3 68,8 17,1 19,1 78,5 71,4 0,32 Psychological 80,1 67,7 17,5 17,9 83,3 66,6 <0,01* Social Relationships 68,8 54,3 22,6 21,6 66,6 50 <0,01* Environment 73,9 63,3 14,5 18,4 75 68,7 <0,01* Discrimination 43,1 55,1 25,4 16,7 50 50 0,04* Autonomy 65,5 41,9 31,4 25,2 66,6 50 <0,01* Inclusion 77,0 58,9 16,1 20,1 75 54,1 <0,01* Conclusions: It is critical that people with ID participate in the creation and/or changes of inclusion policies and actions. Since the relationship between the perception of self-reported QoL and reported by caregivers are different and converge only in the physical domain. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Persons with intellectual disability (PwID) and/or and autism spectrum disorder with high support needs (ASD-HSN) have resulted to be among the most vulnerable populations to COVID-19 and distress factors associated to the measures for containing its spread. Many health, rehabilitation, and assistance needs were managed through the use of telemedicine, specifically teleassistance (TA) and telerehabilitation (TR), with regard to the prevention and treatment of the epidemic illness as well as the continuity of care required for the condition of developmental disability and co-occurring physical or mental disorders. TA and TR can function either directly or indirectly with the PwID/ASD; in the latter case, a family member, a regular caregiver, or a technician provides local mediation. This paper examines the most common TA and TR activities, along with their requirements, applications, and goals. All of these activities should be in line with the overarching goal of each customized therapy and rehabilitation plan, which is to enhance and support the quality of life for people with intellectual and developmental disabilities. Studies on TA and TR efficacy for PwID/ASD are limited, especially concerning adulthood. The scant research that is currently available demonstrates efficacy in maintaining or marginally enhancing cognitive, adaptive, and vocational skills. In addition to managing both routine and unusual activities as well as critical episodes, family members and other caregivers reported feeling more empowered about their educational and interpersonal abilities with the PwID/ASD. The primary benefits over traditional in-person services have been found to be greater accessibility and availability as well as a reduction in both physical and psychological distance. The primary limits include the absence of all elements of the therapeutic alliance pertaining to face-to-face communication, possible poor ability to use technology, accessibility of the technology itself, concerns regarding privacy, and variables that divert attention connected to the household setting. Even while telemedicine has proven to be feasible and beneficial thus far, it is doubtful that traditional techniques will be able to be replaced, at least not anytime soon. Telemedicine could, nonetheless, serve as a useful addition, integration, or short-term substitute. Future studies should provide light on the indications, contextual deployment, efficacy evaluation, and operational stability over time of certain TA and TR activities in addition to the use of artificial intelligence, machine learning, and interactive avatars. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

The very brief presentation will describe the initial approach to the psychiatric assessment of the case presented including the issue of fitness to participate in court proceedings. The use of screening tools at court to identify people with intellectual disabilities will be highlighted along with what support can be provided for vulnerable offenders in attending court. The potential disposal options for the court such as prison or hospital or community will be outlined. Variation in practice across Eurpean countries needs further discussion to ensure the rights of defendants with intellectual disabilities are safeguarded during their participation in court proceedings Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Care and treatment of prisoners with intellectual disabilities I will describe what is the care, from different points of view when an offender with intelledtual disabilities entry in the penitentiary system. As a vulnerable population, people with intellectual disabilities have to be treated in a more specific manner, and both prison managers and clinciacal staff have to be aware of of that. This prisoners, sometimes, also belongs to another vulnerable population (illegal inmigration, fenmales, ehtnic groups ,etc) that make this cases as a complex ones.  The care have to be as a comprehensive, with thr higest standards of care a nd avoid neglicence en treating this cases. We have to emphasize about rehablitation and a goodl coordnation with the intellectual disability community services to avoid relapse and recidivism Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Objectives People with intellectual disabilities (ID) present with behaviours that challenge community services. Community models of care as alternatives to hospital care exist but are often vary in their function. Certain strategies have been developed to manage challenging behaviour in people with ID. Data from a three-year period on a community-based service for people with ID and challenging behaviour that uses an objective, multi-disciplinary approach is presented. Methods A case note survey of adults with ID under the care of the Assessment and Intervention Team (AIT), a challenging behaviour service in the London Borough of Haringey. Results Over the three-year period, 65 adults were managed by AIT. Forty-four were male and 21 were female. The age range was 21–64 years of age. The level of ID was mild ID 61%, moderate 39%. Diagnoses included psychotic disorder (25%); mood disorder (20%); developmental disorder (40%); dementia (10%); challenging behaviour (45%). Six people (11%) were admitted to hospital during their time with AIT. The length of care under AIT ranged from four to fourteen months. Conclusions AIT managed effectively people with ID living in the community who presented with complex problems putting their placement at risk. The rate of hospital admission was reduced in this period compared with the previous three years. The length of stay in in-patient services was reduced. The most common reasons for the behaviours included mental illness and ‘challenging behaviour’. People with developmental disorders were a large proportion. Community alternatives are effective with positive benefits to the person. [ABSTRACT FROM AUTHOR]

The majority of people with intellectual disabilities (ID) and psychiatric disorders access mainstream mental health services across Europe. However, only 56% of countries provide postgraduate psychiatric training in ID according to a survey across 42 European countries. We explore the challenges of ID training and make recommendations for education and health policymakers. [ABSTRACT FROM AUTHOR]

Introduction: Mental retardation (RM) is defined as by a deficient intellectual capacity as well as by alterations of the adaptive capacity that are externalized in two or more functional areas (Personal autonomy, Communication, Orientation in the environment, Work and Free time). Objectives: Present a patient with a severe behavioural disturbance with an associated intellectual deficit, who remained hospitalized for 2 months and after observing an oral alteration her symptoms improved. Methods: A descriptive study of a clinical case Results: 54-year-old woman, single. You have a moderate intellectual disability. In January 2019, she began mental health consultations with a diagnosis of adjustment disorder, on treatment with aripiprazole 5 mg/day, mirtazapine 15 mg/day, lorazepam 0.5 mg/day and dipotassium clorazepate 10 mg/day. Went to the emergency room with mutism, hyporesponsiveness and refuse to intake, having lost 25 kg in 6 months. Abdominal and thoracic CT and upper gastrointestinal endoscopy without significant findings. Consultation with otorhinolaryngology, dermatology, traumatology without significant findings. Odontostomatology consultation: Deep cavities are observed, so it is necessary to carry out extractions of the pieces in poor condition. After this intervention, the patient returns to accept oral intake. Conclusions: People with intellectual disabilities have a wide range of medical problems that in many cases are directly associated with the underlying disease or syndrome and, in others, with poor physical health due to problems in basic self-care skills or the ability to express verbally. Usually, the first manifestation of pain is an alteration in behaviour, which must be taken into account when making a differential diagnosis. [ABSTRACT FROM AUTHOR]

Purpose It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this work is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists. Design/methodology/approach The development of a structured clinical exam “station” designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process. Findings The station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists in the UK. Practical implications The use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles. Originality/value Few institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the UK Department of Health to involve service users in the training of healthcare professionals. [ABSTRACT FROM AUTHOR]

Objectives Attention Deficit Hyperactivity Disorder (ADHD) is more prevalent in people with intellectual disabilities (ID). Drug therapy is the primary treatment for ADHD targeting the core signs of inattention, impulsivity, and hyperactivity (NICE 2013). Knowledge on ADHD has been gleaned from studies in children and children with ID. People with ID have comorbid disorders for example, autism and epilepsy that can complicate the management of ADHD. Knowledge of the effects of treatment is essential in managing ADHD in people with ID. The current evidence on the application of drug therapy for ADHD in ID is described. Method A literature review of publications in English language was undertaken. Results Using medication to treat ADHD is effective in treating the signs of ADHD in people with ID. The response rates in ID to drug therapy for ADHD approximates to 55% that is lower than in the general population. People with ID experience more side effects from medication that can lead to withdrawal from treatment. Guidelines exist internationally on the appropriate prescribing of medication. Methylphenidate, a psycho-stimulant drug is the drug of first choice. Atomxetine, a non-stimulant drug, is effective in people with ID. Conclusions ADHD in people with ID is treatable but clinicians need to be knowledgeable and skilled in managing the disorder in people with ID. Newer drugs could offer more because of their different profile of more tolerable side effects. [ABSTRACT FROM AUTHOR]

Introduction: Like the general population, people with intellectual disabilities (ID) suffer from mental disorders and furthermore show challenging behaviour. Treatment is often limited to psychotropic medication (PM). Estimates on the prevalence of PM prescription in adults with ID vary tremendously dependent on the methods used. Altogether, this topic is still understudied in Germany. Objectives: To assess the prevalence of regular PM and psychotropic PRN medication in adults with mild to profound ID. Methods: Key carers of N = 197 randomly chosen adults with mild to profound ID were asked about the current PM prescription. Results: In total, 64.0% (n=126) had a prescrption of at least one psychotropic drug according to ATC (Anatomical Therapeutic Chemical Classification). Most prevalent was the prescription of antipsychotics (43.7%). Prevalence rates differed e.g. across severity of ID. Conclusions: A comparison of prevalence rates of PM between different studies is difficult. However, prevalence of PM in adults with ID in Saxony, Germany, can be considered as rather high. [ABSTRACT FROM AUTHOR]

Introduction: Definitions of health in different branches of medicine are one of the key paradigms in medical sciences. Nowadays, there are two distinct definitions of sexual health and mental health. The definition of sexual health, as well as sexual rights, was proposed by the World Health Organization (WHO, 2006), and the definition of mental health was published in World Psychiatry (Galderisi et al, 2015). Objectives: The analysis and comparison of these two definitions: mental health and sexual health are two main objectives of this study. Methods: The analysis was carried out in three areas: logic, philosophical aspects (values) and the impact of other disciplines. Results: The definition of sexual health reveals a eudaimonistic approach, whereas the definition of mental health is based on a holistic paradigm. Regarding the main principles in the definition of sexual heath, one can identify the following values: well-being, pleasure, safety, sexual rights - compared to harmony, empathy, coping skills, universal values in the definition of mental health. Sexual rights are a constitutive part of sexual health. There is no comparative element in the definition of mental health (e.g. the rights of mentally disabled persons). Conclusions: These two definitions can have different effects on the prophylaxis and therapy of patients. It all depends on the specific context of care (sexology or psychiatry). Sometimes universal values matter and sometimes not. This is contradictory. Consistency is needed between definitions and practices. [ABSTRACT FROM AUTHOR]

Introduction The problem of employment of people with intellectual disabilities is present in many countries. The literature on this topic draws attention to the fact that the improvement of the situation in this area is conditioned by changes in government policies, practices of employers and adequate preparation to undertake professional duties by persons with intellectual disabilities. Objective The objective of this review was to explore the changes in vocational rehabilitation forms in Poland. Methods The analysis of documents and accessible literature was done. Results As one of the ways to solve this problem since 1991 in Poland the so called Workshops of Vocational Therapy have been created. According to the regulations the Workshops were designed for adults with intellectual disabilities, aged over 16 years with a total incapacity of gaining an employment, for which occupational therapy was a form of social rehabilitation. The further step in this process was the establishment of Vocational Activation Centers, with which high hopes were associated. They were expected to be an intermediate link in the creation of career paths from rehabilitation forms ultimately to open labor market. In practice it turned out that the creation of these Centers in Poland has been too slow. Conclusions This raised the necessity to change the attitude from the concept of matching the participant to work and to the new environment, which frequently ends as a trauma, to the concept of matching jobs to people. New initiatives and new rehabilitation programs are developed based on this attitude. [ABSTRACT FROM AUTHOR]

The aging person with Intellectual Disability (DI) occurs early and uncharacteristically, accompanied by disability and increase the degree of dependence in everyday occupations. This aging still unknown in Brazil, is confirmed by the absence of theoretical models and lack of evidence to base clinical practice. The need for differentiated interventions highlights the importance of creating calls that address their needs and demands programs. Given this, created the program which Multidisciplinary Consulting aims to describe its actions on the model of the International Classification of Functioning, Disability and Health - ICF and working methodology of Therapeutic Project Single - PTS for family in the daily management of the person with DI in the aging process, focusing on maintenance and prevention of disability and quality of life. Experience Report. The sessions take place at home, 2 times per week and lasting 1h30min. Will be met by the professional staff people with DI, both genders, aged 30 years, with cognitive decline - functional and / or alteration of mood and behavior kept a period of at least 6 months, with or without hypothesis syndrome dementia. Interventions occur at three levels of care according to the degree of impairment of functionality: 1-Diagnosis Clinical-functional application Wide Geriatric Evaluation - AGA; 2-Cognitive Intervention and Rehabilitation / Functional; 3-Monitoring functionality and palliative care. This program will contribute to maintenance, prevention of disabilities and less need for assistance of another person to care. Should be reproduced in other professional and specialized services. [ABSTRACT FROM AUTHOR]

The introduction of the ICF scale in Poland started a few years ago. One of the institutions, which started trainings and implementation of the scale is the Polish Association for Persons with Intellectual Disability (PSONI). The use of the ICF scale turned out to be very important because the diagnosis itself still tells us little about the life and personality of a person. The disorder itself does not determine functioning in society. The application of this scale helps to capture the dynamics between concepts such as health, human body functions, ability to participate in different activities, environmental factors and personality. It allows, for example, to clearly define whether the problems are caused by the health of a given person or by external limitations, even of an architectural nature. It is expected to implement ICF in different centers run by the Association like e.g. Vocational Activity Centers or the Center forVocational Counseling and Support for People with Intellectual Disabilities (DZWONI). The scale is also being implemented in Health Care Services for Individuals with ID and Mental Health Problems in Poland because it remains an integrative model and not only medical and social one. [ABSTRACT FROM AUTHOR]

Elderly people with intellectual disabilities represent one of the fastest growing groups of the special needs populations. This is mainly the consequence of improved and adaptive care standards as well as better general medical treatments. Living longer also carries more mental health problems, including those related to cognitive dysfunction and dementia. Such patients are often treated with antipsychotics and mood stabilizers, with main reason to use of these drugs being „sedation". At least some of them may benefit form cholinesterase inhibitors and / or memantine, although evidence form clinical trials is scarce. Also antidepressants, particularly those blocking serotonin and / or norepinephrine transporters are probably underused. Importantly, understanding behavioral and psychological problem of these patients within the frame of the biopsychosocial paradigm might be useful, leading to potentially effective and harmless nonpharmacological interventions. Particularly, the concepts of attention to frustrated needs and reactions to environmental change may prove to be fruitful. [ABSTRACT FROM AUTHOR]

Introduction: Intellectual disability is a condition of cognitive impairment and deficit in adaptive skills. Mental illness is frequent in people with intellectual disability. As a result antipsychotics are often prescribed to treat not only mental illness but also problem behaviors. Objectives: Perform a literature search about intellectual disability and antipsychotics. Methods: A non-systematic literature review was performed on PubMed using the keywords "intellectual disability" and "antipsychotics". All papers published between 2015 and 2020 were evaluated. Results: A review of the literature reveals that antipsychotics are the most frequently prescribed psychotropic drugs in people with intellectual disability. However, results fromthe studies are ambiguous. Several studies showed that antipsychotics are effective in improving problem behaviours, nevertheless some recent studies showed no significant difference in the outcomes between antipsychotics and placebo Conclusions: Even though antipsychotics are prescribed in people with intellectual disability, evidence to support their use is lacking. In consequence, clinicians should consider the pharmacological approach as a part of an integrative treatment. Assessing adverse events, drug effects and the possibility of decreasing dose of antipsychotics is crucial. [ABSTRACT FROM AUTHOR]

Introduction: There is a lack of objective evaluation with validated tools in school children with intellectual disability (ID). Standardized and validated tools, allowing children evaluations and follow-up, exist but are poorly used. Our action-study wishes to develop evaluation practices to better adapt to the specific needs of children with ID. Objectives: We evaluated the multidimensional profiles (cognitive, adaptative and behavioral) of children with ID attending regular or adapted school system. Methods: School children, aged 5 to 13 years old, with mild to moderate ID were enrolled in this French cohort study. The multidimensional evaluation consisted of a school evaluation grid proposed by the French educational system, a scale of school needs (GEVA-sco), an intellectual assessment (WISC IV), a behavior adaptative scale (Vineland II) and a behavior rating scale (the French Nisonger Child Behavior Rating Form (Nisonger CBRF)). The results of this multidimensional assessment were analyzed. Results: Between November 2014 and June 2016, 121 children were enrolled, 3 children were lost to follow-up. Analysis was performed on 118 children. Seventy one (60.2 %) were male. Fifty-two (44.1%) were aged 6 to 9 years. Sixty-eight (57.6%) children were in regular schools and 50 (42.4%) in adapted schools. Children in regular schools had a higher mean IQ score (57.5) than children in adapted schools (43.5). The adaptative behavior profile of children in regular school is less severe than in children in adapted schools. Conclusions: Multidimensional evaluations allow optimizing and personalizing support. Evaluation of adaptative behavior is more informative than cognitive profile which does not differentiate between children skills. [ABSTRACT FROM AUTHOR]

Introduction: Remedial education of children with intellectual disabilities is a challenging problem of modern education. Underdevelopment of cognitive processes makes it difficult to assimilate the educational program, adaptation and interaction with the environment. Ways of learning form the basis of cognition. Objectives: To identify ways of teaching children with intellectual disabilities at the initial stage of school education. Methods: Material: The research sample consisted of primary school children: 127 children from 7 to 8 years old with intellectual disabilities. Methods: observation of the child; psychological and pedagogical examination [1]. Results: Three groups of children identified: group 1 (40%): children understanding the teacher's instruction. The teaching approach based on independent actions. In group 2 (52%) children partially understood the instruction, performed tasks after assistance. The approach based on demonstration and sample example. In group 3 (8%) children did not understand the instruction, performed tasks after additional explanation. The approach based on joint actions with the teacher. Conclusions: Different approaches to teaching were identified: independent actions, demonstration and sample example, joint actions. Teaching methods improve classroom work methods and help to adapt the educational content. Literature: 1. Strebeleva E.A., Zakrepina A.V. Methods of pedagogical examination of first-graders with mental retardation//Defectology, 2018 - №2. - p. 65-75. [Strebeleva Ye.A., Zakrepina A.V. Metodika pedagogicheskogo obsledovaniya pervoklassnikov s umstvennoy otstalost'yu//Defektologiya, 2018 -№2. - S. 65-75]. [ABSTRACT FROM AUTHOR]

This presentation will focus on the importance of psychiatrists understanding that they operate at an interface between two very different disciplines; medicine and law. There will be consideration of what and why psychiatrists need to understand the law, the way it operates and the likely implications of their opinions. There will be consideration of an example from England and Wales to illustrate the way in which psychiatry and law might interpret the same information. The aim is that psychiatrists will be better equipped to face the challenges the law presents. [ABSTRACT FROM AUTHOR]

Introduction Schizophrenia is a psychiatric disorder is defined as the inability to understand reality. This disorder previously named as Praecox that these definitions show a lack of understanding of the schizophrenia in community. So by a qualitative study, social deprivation resulted from the labeling of the illness in the families of patients with schizophrenia were examined. Materials and Methods This study is a qualitative content analysis, using in-depth unstructured interviews to collect data from 20 family members of patients with schizophrenia. Gathered data were analyzed using conventional content analysis, the main themes of the interviews were classified as Level 3 codes. Results In this study, the researcher coded transcript interviews was merged into 7 main categories of discrimination and ridicule, shame, need support, isolationism, lack of knowledge, stress and low quality of life. Conclusions Based on the results, family members of patients with schizophrenia suffer of discrimination and ridicule, need support, shame, and need support, isolationism, and lack of knowledge, stress and low quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Intellectually disabled people are vulnerable to somatic and mental illnesses, often presenting behaviour changes. Moreover, difficulties in describing symptoms can limit their access to healthcare system and adequate treatment. Objectives: Through a case report, we aim to provide an overview on behaviour changes in people with intellectual disability (ID), emphasizing the screening for organic conditions. Methods: Description of a clinical case and a qualitative review about the assessment of behaviour changes in persons with ID, using PubMed database. Results: We present a clinical case of a 57-year-old man with history of ID, alcohol and tobacco abuse and Epilepsy. He had previous acute psychiatric admissions due to behaviour disorganization and irritability. In January he was admitted with disorganized behaviour and caregiver exhaustion, and stabilized with Olanzapine 20mg/day. On the 28th day of hospitalization, he fell of his of bed and suffered a mild traumatic brain injury. Cerebral CT scan revealed two metastatic lesions in the brain. Further investigations found out primary neoplastic lung lesion and multiple metastasis. Afterwards, his relatives mentioned a heavy familiar history of cancer and that he had postural instability signs that they did not value. Conclusions: Although psychiatric disorders are common in patients with ID, we must always remind that behaviour changes can mask the presentation of an organic disease. Despite a long follow-up in Psychiatry, organic conditions should be considered when patients with ID present behaviour changes. Further studies are needed in the assessment of this particular population to provide proper medical, psychological and social care. [ABSTRACT FROM AUTHOR]

Mental health workers play different roles in the District Mental Health Service, and they differs in professional education skills. Taking care of psychotic patients also include to administrate and observed the medication in practice, but there are different experiences in this area. Objectives: To gain knowledge about the practice in the District Mental Health Service according to medication trends. Aims: To gain knowledge and information about the daily practice. Methods: This pilot study was done in 2011. Focusgroup interviews where the informants was leaders and professional workers in two different municipalities in Nortern Norway in 2011. Literature rewievs was also done. Next step is quantitative methods based on the results in the pilot study. Results: The results show that the District Mental Health Service practice differed in organization of the service. The one who has the responsibility of medication for the patients in daily settings differed. The most educated persons in the mental health team took care of the treatment only in communication with the psychotic persons, while the lowest educated personal in the home care settings administrated to give patients medicine. Some of the workers in the home care settings had only a 10 hours medical course. They were afraid of the patients who could be aggressive and denied to take medication. Conclusions: The organization of the medication responsibility need to be focused more upon because of the need of good observation of the effects on the patients. [Copyright &y& Elsevier]

Introduction: Several studies suggest that people with serious mental illness represent a higher risk of violent acting out than the general population. Objective: To evaluate the prevalence of violent behavior in psychiatric patients and compare the group of patients who committed violent acts with nonviolent patients to identify risk factors for violence. Methodology: A retrospective-comparative study was conducted among 160 patients hospitalized in the psychiatric service D of the hospital Razi during the period between 1 July 2011 and 15 October 2011. Results: Among the patients in our sample 78.75% (N=126) had submitted an act of violence during the month before hospitalization. The male gender was correlated with violence (OR=2.7). History of violence and criminal history had significant correlations with violence with OR=2.5. Schizophrenia diagnosis was the most represented among the mentally ill violent. Monitoring irregular and poor adherence to treatment were important risk factors with OR=2.6. Addictive behavior was found among 49.2% of violent patients. Substance use was correlated with violence (OR=4.5). Conclusion: It is interesting to note that in recent years the interest of clinicians to the question of violence among the mentally ill has increased. There is also an evolution of psychiatric practice with dimensions of legal framework more rigorous. Clinicians and forensics must continue to work together in this area. [Copyright &y& Elsevier]

This session summarises the EPA Guidance on prevention of mental ill health and promotion of mental well being using the development of UK policy as structure and presented within the European and global context. The promotion of mental health and the prevention of mental illness are a significant component of any clinician's clinical work load. However, often this aspect is omitted from training and service delivery due to insufficient resources and the sheer volume of clinical load. Considerable evidence confirms that prevention can significantly reduce the onset of and subsequent related burdens to mental illness, and associated personal, social and economic costs. Acute mental illness usually prevents positive mental health or wellbeing, yet similarly someone without mental illness can have poor mental health and poor well being. Prevention of mental illness relates closely to and can result from promotion of mental health and associated resilience. Prevention can be categorised in many ways and most clinicians regularly utilise secondary and tertiary prevention. Primary prevention addresses wider determinants across whole populations. Selective prevention targets groups at higher risk of developing disorder. Secondary prevention involves early detection and intervention and corresponds to indicated prevention. [Copyright &y& Elsevier]

Migration is the process by which individuals change their place of residence to another largely for permanent or semipermanent periods. The reasons for migration are many and include economic, social, political, medical or recreational reasons. With increasing globalisation, unprecedented numbers of people are moving across various regions and this process causes stress not only for those who move but also for those who are left behind. With movement across different cultures the cultural identity of the individual and the actual process of acculturation play a role in enabling the individual to settle down in the new environment. Preparation in the pre-migration phase, the actual experience and process of migration, existing and new social support along with acceptance by the new culture may contribute to making the process manageable and less traumatic. The reasons for migration will affect experiences related to the trauma and ensuring stress. Clinicians must be aware of assessing special needs of the migrants. Guidance for clinicians on how to manage the clinical status of migrants will be discussed. [Copyright &y& Elsevier]

The balance of involvement between staff and service user in clinical decision making can be conceptualized as a continuum from paternalistic or passive through shared to informed or active. There is some evidence suggesting that shared decisionmaking contributes to better treatment outcomes. People with mental illness want a say in their care and it has been shown that sharing medical decisions is possible, even with people with severe and acute mental illness. However, despite shared decision making being increasingly recommended in treatment guidelines, paternalistic decision-making remains common. Especially psychiatrists seem to be skeptical and hesitant to integrate principles of shared decision making in their daily practice. Research so far has mainly focused on how to help patients make decisions, or on how to understand the degree of involvement in decision making desired by the patient, but not on vital aspects of decision-making in routine care. This presentation will give a practice-oriented overview of research on decision making in mental health care including a discussion of the reasons for the lack of adoption of shared decision making in daily practice. [Copyright &y& Elsevier]

Introduction: The authors would like to report on the case of an individual who developed psychosis, following pulse therapy of Itraconazole. We discuss his clinical presentation, history and similar reports in literature on Itraconazole. Methods: Case-report, Literature review, Discussion. Results: Mr.X was a 36 year old male who developed an acute psychotic episode after starting his second course of pulse treatment of Itraconazole. Subsequently he had three inpatient admissions for his psychosis, in which he was treated informally [-] initially with Olanzapine and Quetiapine, and following the third admission with Clozapine. Discussion: In the back ground of a negative history of any previous psychotic episode, no family history of psychosis or any mental illness, no concordant illicit substance abuse, and the emergence of clear cut psychotic symptoms at the age of 36 following treatment with a course of oral Itraconazole, our opinion is that Itraconazole has possibly contributed to the development of psychosis in a potentially vulnerable individual. Our literature review revealed only very few case reports of Itraconazole associated psychotic disorder. Conclusion: This case highlights, although rare, the potential risk of idiosyncratic reactions and psychiatric manifestations associated with the antifungal agent Itraconazole. We recommend increased awareness amongst clinicians about the potential idiosyncratic reaction and risk of psychosis associated with Itraconazole and also the importance in highlighting such cases for the awareness of the public as well as clinicians. [Copyright &y& Elsevier]

Introduction: Affective temperament is a phenotype underpinned by a constitutional substrate. It represents signs related to certain mood stability and attitudes to react to environmental stimuli. Temperament has been related to predisposition to bipolar disorder. Bipolar disorder is highly related to Substance Abuse Disorders but it is less clear which affective temperaments are more involved in this relation and if they can influence substance abuse patterns. Objective: The aim of this study was to investigate temperamental traits, according to the Akiskal and Mallya formulation, in patients with bipolar I disorder associated with comorbid substance abuse disorders. Methods: Data from 120 patients with Bipolar Disorders and Comorbid substance abuse disorders, were assessed in inpatient unit. The brief TEMPS- M self-questionnaire was used to assess the temperamental distribution. The temperamental scores on various outcomes were investigated using Sperman rank (Rho), Principal Component Analysis (PCA), Cluster Ananlysis (CA). Results: Chyclothymia was positively correlated to Opiate Addiction (ρ 0.18 p< 0.001). Irritability was positive correlated with Alchol Abuse and Cannabis Abuse (ρ 0.26 and 0.27 p< 0.001). The PCA and CA did not show statistically significant results although showed a trend to link irritability with alchool abuse. Conclusion: Our results suggest that bipolar patients with comorbid substance abuse disorders exhibit a prevalent temperament of irritable and cyclothymic related to alcohol and cannabis abuse and opiate dependence respectively. Further studies are needed to explore this relationship. [Copyright &y& Elsevier]

Introduction: Cognitive deficits belong to the most common symptoms of schizophrenia as well as of disorders related to substance abuse. It is then important to cope with those deficits effectively during the treatment of rehabilitation process of patients with dual diagnosis. Objectives: To analyze cognitive changes in patients with dual diagnosis participating in a cognitive rehabilitation program. Methods: 120 patients suffering from schizophrenia with a comorbid drug addiction were recruited to the study. All of them participated in a treatment program in a modified therapeutic community (TC) for patients with dual diagnosis. During their treatment they also took part in a program of rehabilitation of cognitive functions with a use of a computerized training battery. The cognitive functions were assessed twice: first time at the beginning of the treatment and second time after six weeks of cognitive rehabilitation. The applied neuropsychological tests were TMT, part A and B, Stroop Test and Verbal Fluency Test. The intensity of schizophrenic symptoms were measured by the PANSS scale. All participants of the study were treated with second generation antipsychotics. Results: After six weeks of cognitive rehabilitation all patient improved significantly in all applied neuropsychological tests. There were no significant changes in the PANSS scale results. Conclusions: The above results confirm the necessity of introducing cognitive rehabilitation in therapeutic programs for patients with dual diagnosis. The above results may also be an effect of other therapeutic interventions used in the TC rehabilitation model, antipsychotic treatment or other factors, which need further investigation. [Copyright &y& Elsevier]

Introduction: In Lithuania psychiatrist's service are easily accessible due to a wide network of Mental Health Centers; however, specialists recognize the existence of information gap, myths and attitudes that discourage well-timed appeal. Method, results: The project has guaranteed access for anybody to anonymous, free consultation on any problem from a psychologist, the possibility being introduced on the website of Republican Vilnius Psychiatric Hospital. The ways of communication are via e-mail or online/Skype (specialists are available at given hours). During two years approximately 1000 people has appealed concerning a variety of problems (from problems in interpersonal relations to complicated situations that urgently required interventions from mental health specialist). During our work we have discovered that about 25% required direct help from a psychiatrist, we were trying to keep emphatic contact and rapport with them, to give well-timed emotional support, to encourage and motivate to see a specialist eye-to-eye, to help to overcome fear of the first appeal, to dispel myths and attitudes towards psychiatrists, which are still present in our society. About 10% were appealing due to dangerous, troublesome behavior of their closest relatives, friends. They were also extensively informed about possibilities and ways of getting help. Conclusion: The Internet, simple to use, easy accessible for anonymous services that require low material resources, opens up new possibilities to inform/educate people, to help them overcoming fear of the first help appeal from a specialist, to encourage and motivate search for direct help, to provide with adequate, extensive and well-timed information. [Copyright &y& Elsevier]

Background: Internally displaced persons (IDPs) reach almost 6% of Georgia's total population. They were uprooted by the military conflicts in Abkhazia and South Ossetia in the 1990s and the brief but intensive war with Russia in 2008. Aim: To examine the patterns of mental disorders and functional disability among conflict-affected populations in Georgia. Methods: The study used a cross-sectional household survey design with multi-stage random sampling IDPs and “returnees” (IDPs who have returned to their original villages). Disorders of PTSD, depression, anxiety, and their co-morbidity, were measured, along with functional disability. A range of questions on exposure to violent and traumatic events and demographic and socio-economic characteristics were included. Descriptive and multivariate regression analyses were used. Results: Of 3600 respondents, 24% were recorded with PTSD, 14% with depression, 11% with anxiety. 30% of all respondents had ≥1 condition and 6% had all 3. Factors significantly associated with the mental disorders and their comorbidity included greater frequency of exposure to traumatic events, female gender, older age, displacement status, low levels of neighbourhood support, poor community conditions, and a bad economic situation. PTSD mediated the influence of traumatic events on outcomes of depression and anxiety. All 3 disorders significant influenced functional disability. Conclusions: The study provides the most comprehensive data on mental health problems among conflict-affected populations in Georgia. It highlights the persisting burden of poor mental health and the associated characteristics, and the significant impact of mental disorders on functional disability. It calls for greater access to needs-driven mental health services. [Copyright &y& Elsevier]

Aims: This presentation describes and analyses patient characteristics and service usage over one year of a cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity- of-care. Methods: Data were collected from primary care patient notes (n=1150) by trained nurses from 64 practices in England, covering all service contacts from 1st April 2008 to 31st March 2009. Results: The estimated national rate of patients seen only in primary care was 31.1% and rates of schizophrenia and bipolar disorder were 56.8% and 37.9%. Patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total). Of those seen in secondary care, 61% had at most two secondary care contacts recorded in primary care notes. Median consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index =< 0.5), and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome. Conclusions: Primary care is centrally involved in the care of people with serious mental illness, but primary care and cross- boundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface [Copyright &y& Elsevier]

Introduction: Stress and reward processing are two of the principal mechanisms involved in the modulation of homeostasis in the body. According to neurobiological research, these two mechanisms overlap in the cortico-striatal-limbic circuit, which can be disrupted due to chronic stress and substance abuse. Stress is primarily modulated by the hypothalamic-pituitary-adrenal (HPA) axis, from which cortisol is an end-product. Objectives: The aim of the study was to investigate the effects of chronic stimulant abuse on the cortico-striatal limbic circuit. This was examined by relating cortisol levels with grey matter volume in brain structures associated with addiction and stress. Aims: We hypothesised that stimulant-dependent individuals show increased cortisol levels and abnormalities in the corticostriatal- limbic circuit. We further hypothesised relationships between altered grey matter volume and increased cortisol levels in the patients. Methods: Twenty-two stimulant-dependent individuals and 21 healthy volunteers (matched for age and gender) underwent an assessment session and structural MRI brain scan. Cortisol was assessed in saliva and blood plasma. Mood, impulsivity and compulsivity were measured by clinical instruments. Results: Stimulant-dependent individuals showed higher levels of cortisol in both saliva and blood, which were associated with distinct alterations in grey matter volume in fronto-limbic structures. Plasma cortisol was positively correlated with the duration of cocaine use. No relationships were found with current mood, trait-impulsivity and drug-related compulsivity. Conclusions: The relationships observed between cortisol and fronto-limbic structures may, in part, be explained by HPA axis dysfunction and its downstream effects on brain structures involved in stress modulation in stimulant-dependent individuals. [Copyright &y& Elsevier]

Introduction: Alcohol abuse is the cause of many somatic diseases, more severe illness manifestation, and the premature patient deaths. Aims: The aim of this study was to determine the prevalence and severity of alcohol abuse and dependence among patients with a c somatic diseases hospitalized in emergency multidisciplinary hospital. Methods: Within five days, 807 patients were examined with the help of clinical and psychometric tools: specially designed patient study card, Alcohol Use Disorders Identification Test (AUDIT) and Hospital Anxiety and Depression Scale (HADS). In addition, all patients were tested for AST, ALT, GGT, and blood ethanol. In 1.5 months treatment outcomes were analyzed. Results: The study revealed a high percentage of patients with substance abuse disorders (about a quarter). The vast majority of them (80%) had a problems with alcohol. About the same number of patients admitted to hospital in varying degrees of alcohol intoxication. Among patients admitted to somatic hospitals, “hidden” contingent of people who have problems with alcohol is much greater than the “left out” (who consulted in the specialized addiction outpatient clinic). The majority of this hidden contingent did not seek any specialized treatment. Alcohol was found as a significant risk factor for urgent hospitalization, more severe disease manifestation and outcome. Alcohol problem were often observed in toxicology patients, patients with head injury, burns, diseases of the central and peripheral nervous system and diabetes. Conclusions: A program for qualified treatment intervention in somatic patients with alcohol problems is needed. [Copyright &y& Elsevier]

This study investigates the therapeutic orientations of substance abuse social workers and the relationship between these orientations and burnout. Ninety-two social workers who provided outpatient treatment to people suffering from substance abuse disorders in Israel participated in the study. The results obtained demonstrated that among substance abuse social workers the psychodynamic and ecosystems therapeutic orientations were more prominent than the cognitive-behavior orientation. A greater adherence to the cognitive-behavior orientation was associated with a higher sense of professional efficacy; a greater adherence to the psychodynamic orientation was associated with a higher level of exhaustion; and greater adherence to the ecosystems orientation was associated with lower levels of exhaustion and cynicism. Females reported lower levels of exhaustion and cynicism. The cognitive-behavioral orientation mediated the connection between the social workers' experience in the field of substance abuse and two dimensions of burnout - exhaustion and professional efficacy. Significance of the findings for improving the well-being of substance abuse social workers and for the advancement of psychosocial services is discussed. [Copyright &y& Elsevier]

Introduction: Aripiprazole has been shown to be effective in children and adolescents with Schizophrenia spectrum disorders and few adverse effects have been reported. However, little is known about the effectiveness of aripiprazole in the treatment of pediatric patients with Intellectual Disabilities (ID) and Schizophrenia. Aims and objectives: To expand our knowledge on the use of aripiprazole in treating adolescents with ID for Schizophrenia. Methods: Using a retrospective review, one female and one male adolescent inpatient (11.5 and 14 years old; Wechsler Scale of Intelligence full intelligence quotient equal to 61 and 38, respectively) with a diagnosis of Schizophrenia received aripiprazole 15mg/day and were monitored for six weeks. The primary outcome was the Positive and Negative Symptom Scale (PANSS) from baseline to endpoint. Results: There was a significant reduction in the overall PANSS score in both adolescents with a marked decrease in negative symptoms (blunted affect, emotional withdrawal, poor rapport, passive/ apathetic social withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation, and stereotyped thinking). Among symptoms of general psychopathology, guilt feelings, motor retardation and poor attention were mostly improved. In both cases, positive and negative subscales showed significant reductions after week four. Female inpatient''s weight increased from 49.5Kg to 50kg, while male inpatient''s weight remained stable (75kg) during monitoring. No other side effect (e.g. Q-T-corrected interval alterations, hyperprolactinemia, extrapyramidal symptoms) was developed. Conclusions: Aripiprazole could be considered as a potential therapeutic agent for adolescents with ID and Schizophrenia, especially when negative symptoms are of major concern. [Copyright &y& Elsevier]

Negative symptoms in schizophrenia are basis for forming a defect and the degree of its expressiveness defines possibilities for rehabilitation. Necessity of a more detailed study of schizophrenic defect in patients with old schizophrenia arose in connection with a worldwide tendency to aging of population. Apatho-abulitical type of defect on our supervision and according to the literature is the most widespread at patients of late schizophrenia. The aim of research was to establishment clinico-psychopathological and social characteristics in patients with a late onset of schizophrenia with apatho-abulitical defect of the person. Are surveyed 36 sick by schizophrenia with a debut at late age (the basic group) and 16 patients with the early beginning of schizophrenic process (control group). Are used clinico-psychopathological, clinico-anamnestic, clinico-dynamic, pathopsychological and statistical methods of research. It is established, that the given type of defect is formed at continuous current of disease, duration of its current from 5 till 10 years with significant progress of process, with rather uniform defeat of all spheres of mental activity. For patients with the given type of defect the moderate and expressed degree of frustration, their slow increase was characteristic. All patients had the second group of physical inability, for formation of defect 2-3 attacks were necessary. Obtained data promote deeper understanding of structure apatho-abulitical defect at patients with a late schizophrenia and optimization of psychosocial actions to this contingent of patients. [Copyright &y& Elsevier]

Introduction Caring for individuals with intellectual disabilities is a passionate, but challenging profession. Whether working in residential homes or in occupational facilities, its staff deals with the ordinary issues of teamwork, but also with these clients behavioral comorbidities. It often includes self-harming and aggression towards others – namely towards the staff itself. This is particularly relevant since a high turnover of staff implies the loss of people who are familiar with the needs and specificities of those clients. The quality of care provided may also be affected. Objectives To investigate whether, or not, formal caregivers are at greater risk of occupational health issues, and what their main determinants are. Methods Research in Medline for intellectual disability caregivers. Only the relevant articles, published in English, were considered. Results Among formal caregivers of people with intellectual disabilities, job dissatisfaction and job strain were found to be especially relevant and were associated to the following variables: • Younger workers or those with less professional experience • Personality and individual maladaptive coping strategies • Poor organizational support • Conflicting, ambiguous, or overloaded professional roles • Unclear work tasks The incidence of Burnout Syndrome was also described as relevant among these workers and was associated not only to aggression towards the worker, but also to the fear of aggression. Conclusions Caring for people with intellectual disabilities, in a residential or in an occupational context, implies heavy emotional and physical demands and a high prevalence of job dissatisfaction, Job Strain and Burnout Syndrome. In addition to the high risks to the quality of life and health of caregivers, there are consequences for the quality of the care that is provided. For this reason, guaranteeing proper work conditions should be considered part of the Social Institutions main goals. Yet, we lack specific, controlled studies that properly evaluate what measures could indeed help institutions to prevent occupational (and mental) health distress among their staff. Disclosure of Interest None Declared

Background: There is little information on the dental health status and treatment needs of sub-population groups especially psychiatric in-patients in developing countries such as Iran. This study aimed to assess the oral and dental health status in hospitalized psychiatric patients. Methods and materials: The study was conducted in two psychiatric hospitals (Shahid Beheshti and Bahman) in the city of Kerman, Iran. The study population comprise of 193 psychiatric patients. According to the duration of the hospital stay, patients were categorized into two groups of acute and chronic. The oral and dental health of the patients were assessed using Decay, Missing, Filling Teeth (DMFT) index and Oral Assessment Guide for Psychiatric Care (OAG-PC). High score for these two scales indicated a worse oral and dental health. Results: The mean DMFT and OAG-PC scores of patients were 19.74±7.88 and 20.77, respectively. Univariate analysis showed that patients in chronic group had higher OAG-PC (P=0.014), but the difference of DMFT scores was not statistically significant between two groups (0.57). After controlling the effects of confounding variables the differences of the DMFT and OAG-PC scores were not statistically significant between two groups (p values = 0.88 and 0.64, respectively). Conclusion: The results of the present study showed that the oral and dental health in psychiatric patients were poor. Our findings indicate that it is vital to improve the oral and dental health status of psychiatric patients and thereby the quality of life of these patients. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the extent of mental stress between mentally retarded and normal children’s parents. Method: The study had a post-event survey design (causal- comparative one). The sample size including 120parents with mentally retarded children and 120 parents with normal kids was selected through clustering multi-stage sampling method. Questionnaire on Resources and Stress (QRS) developed by Friedrich et al was used to examine the degree of parental stress. Accordingly, by applying statistical t-tests for independent samp and Pearson correlation coefficient, the research data were analyzed. Findings: Results from this study showed that a significant difference was found at stress level between parents with mentally retarded children and those with healthy kids. In fact, the degree of mental stress amongst parents with mentally retarded children was turned out to be much more than that of in parents with normal children (P< 0.01).No significant difference was observed between mothers and fathers having children with mental retardation in terms of mental stress. That is, both fathers and mothers with mentally retarded kids suffered from the same degree of mental stress. Despite the fact that parents’ stress had nothing to do with child’s gender, it significantly increased with mentally retarded child’s age(P=0.01). On the other hand, the more the age of the mentally disabled child was, the more the stress of parents would be. Also, the relationship of parents’ literacy level with degree of stress was significantly different (P< 0.01). [Copyright &y& Elsevier]

Introduction: A recent systematic review found a high prevalence of violence and mental distress among women trafficked for sexual exploitation; no data were identified for trafficked men and children. Objectives: To describe the clinical characteristics of trafficked people in contact with a large inner city mental health service compared with a non-trafficked cohort. Aims: To investigate whether, compared with a non-trafficked cohort, trafficked people would be significantly more likely to have co-morbid disorders and have significantly smaller improvements in functioning at the end of an episode of care. Methods: Study population: mental health service users who had been trafficked for exploitation and a non-trafficked service user cohort matched for gender and age. Data source: The South London and Maudsley NHS Trust (SLaM) Biomedical Research Centre Case Register Interactive Search (CRIS) database of anonymised full patient records (2006–2012). Results: We identified case records of 135 people who had been trafficked. 104 (77%) were female; age at first SLaM contact ranged from 8 to 49 years (mean 23.6, SD 8.0). 38 (28%) of the trafficked service users received psychiatric care from an emergency department. Depression (28.1%, n=38), PTSD (19.3%, n=26), non-affective psychoses (12.6%, n=17) were the most frequently recorded diagnoses among trafficked service users. Further analysis is in progress and scheduled for completion by March 2013. Conclusions: Significant numbers of trafficked people were seen in an inner-city mental health service; services therefore need to understand their complex needs. [Copyright &y& Elsevier]

Introduction: The European Psychiatric Association (EPA) established the project “EPA Guidance” in order to improve the quality of mental healthcare in Europe by disseminating written information based on best evidence and expert consensus. Objectives: To provide information on good clinical practice to national societies, health authorities and clinicians. Aims: The development of guidance for selected mental healthcare topics in order to improve the practice of psychiatry in Europe. Methods: Systematic literature searches and consensus processes. Results: In order to improve the quality of mental healthcare and thereby reducing the burden of mental disorders, a first series of guidance documents on the quality of services structures, prevention and treatment of suicidal crises, prevention of mental disorders in general (illness prevention and health promotion), pharmacotherapy of depression, and how to deal with conflicts of interest in research and other professional activities, was published. The series of EPA guidance formulates recommendations and proposes strategies that may help to reduce the burden of mental disorders. The burden of mental disease is sought to be reduced by evidence-based, effective mental health prevention and promotion strategies as well as by optimizing the structures and processes of mental health services by the development of recommendations in the EPA guidance on the quality of mental health services. Conclusion: Many important clinical situations or problems beyond treatment that until now lacked proper guidance are addressed by the EPA guidance. [Copyright &y& Elsevier]

Introduction: The science of implementation consider the steps that influence the translation of evidence-based treatments into routine use. The implementation of a new Portuguese National Mental Health Plan started in 2007. In order to improved the way that services are delivered, an implementation process of a case-management (CM) was initiated by the National Programme for Mental Health. Objectives: To assess the results of a implementation programme considering the following dimensions: [a)] mental health services main characteristics, [b)] leadership profile, [c)] main obstacles to implementation, [d)] implementation fidelity. Methods: 40 public and private mental health services were included for evaluation. Implementation activities included a CM training programme. Implementation degree and main obstacles to implementation were rated by: Barriers and Facilitators Assessment Instrument (Peters, 2001) and Illness Management Fidelity Scale (Mueser, 2009). Results: Assessment of services showed: liaison (50%), guidelines use (57%), single clinical records (50%), in service formal education plan (85%), research practice (21%). Regarding professionals profile, 70% used case management in practice, only 20% with formal training. Full implementation occurred in 36,3% of services, fair implementation in 45,4%, but still not enough implemented in 18,3%. Main barriers were lack of time (61%), lack of dedicated facilities (61%), low motivation (38%) and absence of financial incentives (38%). Conclusions: In spite the efforts to implement evidence based practices in Portuguese mental health services, there are still several obstacles that difficult full implementation. Structured implementation programmes may constitute coadjutants to ameliorate the delivery of effective practices. [Copyright &y& Elsevier]

Introduction: Although some improvements during the last decade, Portuguese mental health services still bear substantial shortages, in terms of accessibility, equity and quality of care. A new National Mental Health Plan with a community model has been launched in 2007. Objectives: To assess unmet needs at public mental health services in Portugal. Methods: Cross-sectional study, steering all the public mental health services throughout the country, both for adults (39 units) and children/adolescents (11 units). Evaluation was done by means of the WHO “Quality Assurance in Mental Health Care” tool, which includes dimensions such as physical environment, administrative arrangements, care process, interaction with families, outreach, discharge and follow-up. Results: The quality of services, according to the assessment made with the participation of professionals, did not reach the “Good level” (> 80% met needs). Level of unmet needs was worse in adult outpatient services (35%) than in inpatient units (27%, despite the relevance of the former. Most critical areas of unmet needs included human resources (only 44% met needs, concerning provision, distribution, interdisciplinary composition of the staff) and administrative arrangements (66% met needs). Regarding the child/adolescent units, the weighted level of quality of outpatient services (67% met needs) was similar to that of inpatient units (68%). Conclusions: The implementation of the mental health plan has to tackle some of the unmet needs present in mental health services in Portugal. Special attention should be given to the outpatient facilities, in order to undertake with the community philosophy of the National Mental Health Plan. [Copyright &y& Elsevier]

Background: Egypt has the highest prevalence of hepatitis C in the world (10–13%) yet understudied in terms of mental health services. Objectives: To shed light on depression among chronic hepatitis C patients in Egypt. Aim of the study: To assess the prevalence of depression and it's correlates in a group of Egyptian patients with chronic hepatitis C infection. Methods: 150 chronic HCV infection non cirrhotic Egyptian patients enrolled in the study. Patients are without past history of psychiatric disorder, having neither alcohol nor substance dependence disorders, did not receive interferon therapy. Psychiatric caseness, and depressive symptoms were assessed using General health questionnaire, and BDI-II questionnaire respectively. Results: The study included 82 Males patients (54.67%) and 68 female patients (45.33%). Seventy three Patients (48.67%) were found to have current psychiatric morbidity with higher affection rates in younger (p<0.001) and educated (p=0.019) patients. Among those, 64 patients (42.67%) suffered from symptoms of depression (55 patients (36.67%) of them had mild depression, 6 patients (4%) had moderate depression and 3 patients (2%) had severe depression) with higher affection rates in younger (p<0.001) and educated (p=0.019) patients. Gender showed statistically non-significant difference. Conclusion: There is strong evidence of an association between chronic hepatitis C and psychiatric morbidity in the form of depression in relation rates recorded in general population. Depression is strongly positively correlated with age and level of education. It warrants the attention for providing specialized mental health services in such neglected population. [Copyright &y& Elsevier]

Introduction: Assistance for mentally-ill patients can be performed in psychiatric units of general hospitals. At the Psychiatric Ward at Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil, the assistance offered follows the therapeutic ambient model. Group psychotherapy with clients is one of the approaches provided. The group meetings occur every day, are 1-hour long, and follow theoretical principles of group therapy with inpatients, emphasizing “here-and-now” interventions. They are coordinated by psychiatry residents and observed directly by a group therapist preceptor. Objective: To present a framework of group psychotherapy interventions with inpatients in a psychiatric unit of a university general hospital based on the analysis of one group meeting. Aims: To characterize a group psychotherapy intervention with inpatients in a psychiatric unit as a model for assistance and teaching. Method: Exploratory and descriptive qualitative research. It was performed a content analysis of an in loco transcription of a group meeting with 11 patients and 4 staff members. Results: The following themes were discussed: illness-, self- and other perceptions; respect and relationships within the unit; discharge. Patients had participated freely and interacted among themselves. The group’s coordinator guaranteed the meeting’s structure and facilitated discussion and exchanges among patients. Conclusion: Being concerned with the group’s structure in a therapeutic ambient model is essential for its development. However, it has been noticed that the coordinator’s flexibility tends to favor patients to transpose their experiences along group meetings and the therapeutic ambient to their lives outside the hospital. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is one of the leading causes of premature death among people with psychotic disorders. However, little is known about treating suicide in delusional disorder. Objectives: To investigate effectiveness of PPLAI in delusional disorder (DD) patients. Aims: To compare effectiveness of PPLAI vs,other atypical antipsychotics (OAA) in psychopathology and suicidality. Methods: Prospective observational study including 45 DD outpatients (DSM-IV-RT) attended at the Department of Psychiatry (Hospital Clinic- BCN) from 2008 to 2012 and followed up for 6 months. Demographic and clinical variables were recorded. Hamilton Rating Scale for Depression-17 (HRSD-17), PANSS for psychopathology, Personal and Social Performance Scale (PSP) and Columbia Suicide Severity Rating Scale (C-SSRS) were assessed at baseline and after 6 months. The sample was divided into four groups according to which treatment they received: oral risperidone, Risperidone Long Acting Injection (RLAI), OAA and PPLAI. For comparisons, Kruskal-Wallis and Chi-square tests were used. Results: Eighty-two per cent were women. Mean age (SD) at onset: 46.9(11.8) years. 6 patients received oral risperidone, 23 OAA, 7 RLAI and 9 were treated with PPLAI. No statistically significant differences were found regarding demographic features, motives leading for consultation, depressive comorbidity and antidepressant prescription. After 6 months, patients treated with PPLAI presented lower frequency of ideation (0% vs.11.1%;p=0.027) and suicidal behaviour (0% vs.2.2%;p=NS). The group receiving PPILD presented a significant increase in functionality (PSP) (p=0.046) and an improvement in PANSS negative subscale scores (p=0.017). Conclusions: Patients receiving PPLAI showed a decrease in suicidality, an improvement in psychotic symptoms and functionality. [Copyright &y& Elsevier]

Objective: The aim of this research was to verify if there is a difference in dissociation or other psychopathological symptoms between two groups of college students when questioned by two different examiners. Method: The Dissociative Experiences Scale, the Brief Symptom Inventory and the Marlowe-Crowne Social Desirability Scale were administered to 185 college students in Coimbra. In one group the examiner was of the same age and academic status, while in the other group the examiner was older and a professor. Results: The younger examiner’s group scored higher in the Dissociative Experiences Scale and in the Brief Symptom Inventory. There were no differences in the Marlowe-Crowne Social Desirability Scale. Conclusions: The examiner does have an influence in the evaluation of psychopathological symptoms amongst college students and this occurs not because of social desirability, but because of cultural and environmental proximity, age and empathy with the examiner. Implications: The results derived from mental health studies with college students should be interpreted cautiously, and who is the examiner should be pointed out. [Copyright &y& Elsevier]