bluuebunny/crossref_metadata_2025 huggingface dataset:
P02-06 - Decision Making Capacity in Patients Admitted to a Psychiatric Emergency Service: a Field Trial
Authors: De Fruyt J. , Axters M. , Haspeslagh M. , Demyttenaere K.
Published: June 2010

Introduction

Psychiatric emergency services (PES) are a main entry for patients with acute mental disorders. Most of them are voluntarily treated and a shared decision making model is implicitly used. Not much is known about decision making capacity (DMC) of patients and the utility of a shared decision making model in PES.

Objectives

To assess neuropsychological abilities of DMC in a convenience sample of patients admitted to a PES.

Methods

Patients were assessed when discharged from the PES. A DSM-IV-TR diagnosis was generated. Neuropsychological abilities were assessed by the Trail Making Test (TMT), Stroop Colour-Word Test (SCWT) and the Mini-Mental State Examination (MMSE). MMSE was used a general assessment of cognitive functioning, TMT and SCWT as a more specific assessment of executive functioning. Patients with marked agitation, no cooperation or withdrawal symptoms were excluded.

Results

47 patients were assessed. Most prevalent primary diagnoses were depressive disorder (11), adjustment disorder (8) and substance abuse/dependence (17). MMSE scores were normal in 87% of patients. SCWT and TMT differential scores were below the 20th percentile in 57% and 61% of patients respectively.

Conclusions

Cognitive functioning in patients, admitted to a PES, seems impaired when assessed by the TMT and SCWT. When replicated in further trials (larger study population, use of more extensive assessment of different components of DMC, careful consideration of ecological validity of these assessments), the implicit idea of a shared decision making model of care should be questioned.
P02-08 - Mental Health Crisis Resolution and Home Treatment Teams: a Qualitative Evaluation
Authors: Ferguson B. , Middleton H. , Shaw R. , Collier R. , Purser A. ,   Crisis Resolution and Home Treatment Study Group, East Midlands Mental Health Research Hub, UK
Published: June 2010

Objective

To understand those factors which facilitate or hinder resolution of Mental Health Crises in order to inform future development of Crisis Resolution and Home Treatment (CRHT) Teams.

Method & Design

Qualitative Interview study conducted by service users trained in research techniques. Home based interviews were conducted with 36 randomly selected patients who had used the services of one of nine CRHT teams across the East Midlands, United Kingdom, which serves a catchment population of 1.2 million people during a two week census period in October 2007.

Results

Participants reported different levels of satisfaction with the treatment and professional responses they received. We identified three themes leading to successful resolution of mental health crises: being enabled to feel safe, to feel accepted and to feel understood. Participants did not identify specific treatment interventions such as medication or formal psychotherapy as important contributors to recovery. Unhelpful experiences included professional responses which resulted in participants feeling misunderstood or ignored, unsafe, vulnerable or anxious, or that they were being judged.

Conclusion

The quality of relationship between the patient and members of the CRHT team is critical to any therapeutic effect. Therapeutic effect is optimum when it is based upon an adult to adult relationship which can provide a holding function allowing the service user to feel safe, accepted and understood while the crisis resolves. These findings have important implications for commissioning and managing such teams, and theoretical implications for medical practice morewidely.
P02-10 - An Assessment of the Crisis Resolution Home Treatment Teams in Two Neighbourhood Districts in Birmingham, United Kingdom
Authors: Hoseyni Moosa H. , Qureshi M. , Ukpong M. , Singh V.
Published: June 2010

Objectives

The Crisis Resolution Home Treatment team (CRHT) provides comprehensive care and support to individuals experiencing acute mental health difficulties in the community. It offers a same day assessment and provides an alternative to hospital admission by providing intensive intervention in the community. In case of hospitalisation, the CRHT can assist in minimising inpatient stay.

Handsworth and Ladywood are two major residential areas in Birmingham with high level deprivation and a population of approximately 9000. The study reviews the completeness and efficacy of CRHT intervention.

Methods

The study retrospectively examined 100 consecutive referred case notes during June and July 2008. That period was about four months prior to the start of the study which provided enough time for the completion of a home care episode. Data was gathered and assessed statistically.

Results

62% of referrals were assessed on the same day and 27% within one day of referrals. 11% of referrals were new to psychiatric services. Referrals were from Accident and Emergency (32%), Community Mental Health Teams (22%) and general practitioners (8%). There were three and two assessors in 60% and 100% of cases respectively. A doctor was always present for all the assessments. Eighty-three percent of the referrers were notified of the assessment outcome the same day and 14% the following day.

Conclusions

The CRHT provides an effective care to psychiatric patients with acute needs. The organised nature of this service reduces hospitalisation and ensures that needs of patients experiencing acute mental health difficulties are met in the community.
P02-11 - Psychiatric Emergencies in Children: Demographic and Clinical Care in a University Hospital
Authors: Jacintho A.C.d.Á. , Santos A. , Salán T.M. , Celeri E.H.R.V. , Banzato C.E.M. , Dalgalarrondo P. ,   Child and Adolescent Psychiatry Study Group
Published: June 2010

Objectives

To analyze, for all the pediatric consultations in 2008 in the emergency ward of the Pediatric Hospital of the University of Campinas, the clinical and demographic profile of the consultations in which there was a possible psychiatric diagnosis.

Methods

Review of all forms of consultations for children enrolled in the unit during 2008, selecting those with the possibility of a psychiatric diagnosis.

Results

Of 21,811 consultations in 2008, 95(0.43%) included psychiatric complaints - 60(63.2%) girls and 35(36.8%) boys, aged 1-13 years(9±0.4). 70(73.7%) were white, 18(18.9%) mixed and 7(7.4%) black. A psychiatric evaluation was called for in 39(41.0%) cases. In 35(36.8%) sexual abuse was suspected. Other forms of violence were reported in 8(8.4%) cases. There were 6(6.31%) suicide attempts, 10(10.5%) cases of extreme agitation, 14(14.7%) consultations for extreme anxiety/dissociative symptoms, 5(5.3%) for depressive symptoms and 4(4.2%) for a psychotic condition. Twenty(21.1%) children were already using psychotropic drugs at the time of evaluation and in 29(30.5%) evaluations there were subsequent psychiatric interventions, with drug prescriptions in 11(37.9%). Nine(9.5%) children had clinical/pediatric conditions.

Conclusions

Children may need psychiatric care in emergency situations for various conditions. Despite the small percentage among the total number of pediatric emergency consultations, psychiatric evaluation, when necessary, can be useful and have an impact on diagnostic and therapeutic procedures. The plight of these children can be intense, demanding prompt and effective action. A psychiatrist can provide assistance that may help the pediatrician in the management of severe pathological conditions that affect the mental lives of children.
P02-15 - Emergency Pshychiatric Treatment in an Emergency General Hospital
Authors: Pyrkov P.
Published: June 2010

Objectives

We have studied the treatment modes and therapies of patients with acute psychotic disorders, in a general hospital for 1600 beds.

Methods

Clinicopshycopathologic, clinicotherapeutic, and statistical.

Results

1982 patients, 18-92 years of age, 64% of them males, have been examined.

All the patients have been primary admitted with acute somatic disorders:

insult - 18%,

skull injury - 21%,

myocardial infarction - 23%,

exogenic poisoning - 31%,

parasuicides -4%,

operations on the thoracic organs - 3%.

The mental disorders diagnosed were following:

amnesic syndrome, organic - F04 - 29%,

depression - F43.20 - 5%,

organic hallucinosis - F06.0 - 12%,

organic delirium - F05 - 33%,

psychotic disorder - or drug induced - F1 - 21%.

Conclusion

After psychiatric examination by an attending psychiatrist, the patients have been moved to the resuscitation department where they have been treated up to their recovery.

None of the patients has been moved to the mental hospital.
P02-16 - E.R. Admissions of Immigrants Presenting with Psychiatric Symptoms: a Retrospective Study in Eastern Piedmont
Authors: Zeppegno P. , Lavatelli L. , Parafioriti A. , Probo M. , Ressico F. , Antona M. , Torre E.
Published: June 2010

Objectives

The immigrant population in Italy is currently increasing, particularly, foreigners in East Piedmont raised by 16,8 % last year. We aim to compare immigrant and Italian patients’ Emergency Room (ER) admissions due to psychiatric symptoms.

Results

Of the 658 admissions we observed, 13.1 % of ER contacts concerned immigrants mostly coming from Russia, Albania, Morocco and Romania, consistently with migration streams in East Piedmont. Compared to the Italians, immigrant patients were younger (35.70; SD = 10.56 versus 44.78; SD = 16.57) and more frequently admitted for alcohol and substance abuse/withdrawal. Italians had a higher probability of having a psychiatric history including previous hospitalizations and contacts with Mental Health Services (OR = 2.60; CI 95 %: 1.64-4.12). The presence of social/relational problems associated with admission was significantly lower among the Italians (OR = 0.55; CI 95 %: 0.35-0.88).

Conclusions

Preliminary data suggest that ER utilisation by immigrants may represent their main way to primary health care. Monitoring ER contacts may provide relevant information for the development of culturally sensitive Mental Health Services.

Methods

We considered Italian and immigrant patients with psychiatric symptoms who were admitted to the ER Department of Novara during a period of 13 months. We compared sociodemographic (gender, age, education, occupational history, marital status, living circumstances) clinical-anamnestic (history of psychiatric illness, presentation symptoms, previous contacts with Substance Abuse/Mental Health Services, social/relational problems) and admission (type of admission, intervention and discharge) characteristics of the two groups (Italians versus immigrants).
P02-21 - Physical Comorbidity in Hospitalized Patients in a University Affliated Mental Hospital in Bolu-Turkey
Authors: Arisoy O. , Kilic B. , Akyildiz K. , Boztas M.H. , Guney E. , Sercan M.
Published: June 2010

Objective

Severe mental disorders as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. Our aim was to estimate the prevalence of physical health problems in hospitalized patients and to determine the sociodemographic and clinical factors associated with physical comorbidity.

Method

The medical records of all inpatients followed up between September 2007 and September 2009 were reviewed retrospectively.

Results

144 patients were evaluted of which 59 (%41) had schizophrenia, 31(%21.5) had bipolar disorder and 54 (%37.5) had other disorders. 43 (%29.9) patients had at least one medical illness, hypertension being the most common (%30) followed by thyroid disorders (%16) and diabetes mellitus (%11). Diabetes Mellitus was detected only in bipolar patients (p=0.005). Females were affected more than males regarding physical comorbidity (p=0.009). Patients with physical comorbidity were older (42.9 vs 35.54 yrs) and had a longer duration of illness (16.2 vs 10.0 yrs). Their hemoglobin levels were lower, blood glucose, urea, thyroid stimulating hormone levels were higher than the patients with no physical illness and the differences were all statistically significant (p=0.05). There was no difference regarding length of hospital stay, drug compliance, previous neuroleptic use, family history for medical and mental illness.

Conclusions: Although it is generally accepted that many physical conditions have been associated with serious mental disorders, the exact nature of the relationship between them is still unclear. Further research is required to identify medical comorbidity risk factors in order to improve the physical health of these patients.
P02-22 - Territorial Peculiarities of Prevalence of Addictions in Siberia
Authors: Artemyev I.
Published: June 2010

Prevalence of mental and behavioral disorders associated with alcohol and drugs in regions of Siberia and Far East varies widely. In north-eastern territories level of alcoholism and alcoholic psychosis per 100 thousand of population ranges from 2790 to 5563, vice versa, in West, covering much of West and East Siberia, figure ranges from 789 to 1583. Prevalence of drug use in regions of Russia has also large fluctuations, reaching 30-fold magnitude. Ranking of areas in terms of prevalence of drug use showed that Russia's total at 252 per 100 thousand of population of 55 territories of European part of Russia only in two territories indicated value exceeds 0.4% of population, accounting for 774 and 488, respectively. Similar figures for population of Siberia and Far East are taking place in 6 subjects from 22; here are high mortality rates due to drug intoxication. Thus, prevalence of drug abuse in 1/3 of territories of Siberia and Far East exceeded that of prevailing in European part of Russia. Proportion of registered drug users per 100 thousand people in general structure of therapy of addictive disorders ranges from 7% to 58%. However, in Far East, including north-eastern regions, proportion of drug addiction is not more than 22%, while in West Siberia - 35-60%. Thus, in structure of addictive disorders, substance abuse agencies reported, there is a definite territorial focus: drug abuse is prevalent in western territories, and alcoholic disorders - in East, i.e. in structure of drug addiction, disorders have the opposite territorial orientation.
P02-23 - Ratings of Therapeutic Boundary Excursions Differ with Culture: an Application of Rasch Analysis in Psychiatry
Authors: Bener A. , Ghuloum S.
Published: June 2010

Background

Boundary violations and boundary crossings have been constantly ignored in clinical settings due to its sensitive nature. Recent studies have identified several number of boundaries identified through quantitative and qualitative research. Large instruments have been developed for detecing boundary excursions in clinical settings. Rasch modeling offers a ground-breaking method for validating such large instruments.

Aim

The aim of this study is to introduce Rasch analysis features that enable to study large instruments like clinical boundary excursion questionnaire in a psychiatry setting.

Methods

An 88 item boundary excursion questionnaire was administered among 50 subjects during the period Jan-May 2008. Eligibility criteria for subjects included physicians, nurses and healthcare staff working in Psychiatry department at Rumeilah Hospital. Data was analysed using the Winsteps software.

Results

The boundary excursion questionnaire showed high reliability. The instrument also showed high unidimensional construct according to rasch analysis with only few items violating the criterion for unidimensionality.

Conclusion

Rasch analysis provides signigicant amount of information to researchers regarding the presence of invariance and mesearurement of separation of items which are otherwise not detected in traditional analysis. The advantages of the using rasch map given large number of items are further discussed.
P02-25 - The Epidemiology of Depression and Suicidal Behaviour - Pilot's Study
Authors: Breznoscakova D. , Dragasek J.
Published: June 2010

Introduction

Depression seems to be an important clinical risk factor for the prediction of suicide attempts, similar to risk factors such as substance use disorders and borderline personality disorder. All of these factors share the same diathesis for increased impulsivity and suicidal ideation, which could explain comorbidity and suicidal behaviour (Pezawas L et al., 2002). Insufficient treatment of depression is one of the most important causes of suicide (Althaus D et al., 2007).

The aim of study

-

The occur of suicidal behaviour (thoughts or attempts) - with focus on type of depressive disorder, age, gender, treatment and changes in the frequency of suicidal behaviour compared to a baseline

-

The number of suicidal behaviour (thoughts or attempts) during depression

Patients and methods

-

Outpatient's files with depression from all Slovakia regions during 3 months in comparison with past

-

Depressive disorder, n = 2570 (female 1800, male = 770) (DSM-IV), average age = 49 years

-

3090 questionnaires from 200 psychiatrists

Results

-

Every third patient with depression - suicidal thoughts and every tenth patient

-

suicidal attempt (male more as female, NF)

-

We observed the most frequent suicidal behaviour in patients with depression: 41 - 60 years (21 - 20 years)

-

It was interesting: decreasing of consumption of hypnotics - decreasing of suicidal behaviour (SF), increasing of consumption of antidepressants - decreasing of suicidal behaviour (NF)
P02-29 - Outpatient Utilization of Benzodiazepines in Serbia
Authors: Divac N. , Dunjic Kostic B. , Prostran M.
Published: June 2010

The increasing benzodiazepines utilization in Serbia has been described at the close of the XX century.

Benzodiazepines have addictive potential and are often a subject of abuse and misuse. Therefore, their use must be followed very closely in every society.

The aim of this study is to analyse the utilization of benzodiazepines in Serbia after the year of 2000.

This is a retrospective study (2000-2007) in which defined daily dose methodology is used. Drug use is expressed as number of defined daily doses/1000 inhabitants/day (DID). Tha data are obtained from the reports of the Medicines and Medical Devices Agency of Serbia. Statistics was performed using Pearson's linear correlation.

Total utilization of benzodiazepines significantly increased during the period of the study.

Benzodiazepine20002001200220032004200520062007|r;pDiazepam33.5026.7031.9029.6049.6242.9342.0644 13r=0-729; |p<0.05*Lorazepam2.403.504.608.6011.8211.6414.8322.60r=0.960; p<001**Bromazepam2.704.606.508.2033.4627.8220.1428.05r=0.815; p<0.05*Alprazolam1.902.103.804.2010.257.4213.2611.97r=0,926; p<0,01Midazolam15.4011.1011.107.902.322.492.733.78r=-0,900; p<0.01**Others0.000.001.101.358.642.155.236.64not availableTotal55.9048.0059.0059.85109.4294.4598.15117.17r=0.875; p<0.01**

[Utilization of benzodiazepines in Serbia 2000-2007] The most prominent wass the increase of the use of lorazepam, bromazepam and diazepam.

There is a trend toward increasing benzodiazepines utilization in Serbia, which is in collision with the worldwide trends. Guidelines must be developed and implemented on all health care levels to promote more rational presribing of benzodiazepines.
P02-33 - General Psychiatry Consultation: an Experience
Authors: Ferreira P. , Martins A. , Silva A.
Published: June 2010

The outpatient consultation assumes a role of extreme importance in any Department of Psychiatry and Mental Health. The activities developed in the consultation are based on the promotion of patient's empowerment and the maintenance of balance and integration individual/environment.

The authors propose to analyze and characterize a sample of patients treated in a General Psychiatry Consultation at Hospital de São João, Oporto, Portugal, in order to improve the quality of the provided service.

It was selected a sample of 168 patients consulted between October 2008 and September 2009, having the authors proceeded to the correlation of variables as gender, age, diagnosis, follow-up in consultation, affluence to the Psychiatry's Emergency Service and number of hospitalizations at the Psychiatry's Department in the last three years.

The selected sample is majorly composed by women above the 30 years old. Compared to the patients with neurotic, anxious, affective and personality disorders, the ones with psychotic disturbances require a more regular follow-up in consultation and a superior need of hospitalizations. Curiously, the patients with personality disturbances are the ones who occur to the Psychiatry's Emergency Service more frequently.
P02-34 - Statistical Issues of the Psychiatric Care in Ukraine
Authors: Mikhaylov B.
Published: June 2010

Since independence, Ukraine still has inefficient public health care system, with its unbalanced structure of services, especially in mental health care. In 2007 parameters of mental illness and disturbances of behavior was 242,3 per 100 thousand population and in comparison with 1990 decreased per 2,5%. Maximal parameters of mental illness and disturbances of behavior in 1995 consisted 263,1 per 100 thousand population. In structure of parameters of mental illness and disturbances of behavior, in 2007 (72,7% or 176,1 per 100 thousand population) prevailed nonpsychotic. The same data was in 2008. At the same time, features of diagnostics separate nosologic and syndrome groups cause significant statistical errors. In particular, in Ukraine the diagnosis “Vegetative-vascular dystonia” which is ciphered G 90.8, according to ICD-10 instead of “Somatoform disoders” F40.0-F48 is used. It leads unreasonable treatment significant contingents of neurotic patients in neurological departments. In 2003 and in 2004 deseaseness of somatoform disoders was 243 per 100 thousand population, in 2005 - 241. Prevalenses of somatoform disoders in 2003 was 2472 per 100 thousaund population, in 2004 it was equal 2481 and 2005 has reached to 2497. Deseaseness of vegetative-vascular dystonia in 2003 has made 732 per 100 thousaund population, and already in 2005 was equal to 719. Prevalenses of vegetative-vascular dystonia in 2003 has made 2741 per 100 thousaund population, and in 2005 - 2750. This is predisposition to urgent change of the diagnostic doctrine and strengthening of psychotherapeutic service in Ukraine.
P02-37 - Factors Related to a Higher Risk of Readmission in Psychotic Patients. A Retrospective Study
Authors: Reyes-Nadal M.E. , Escobar-Fernandez J.L.
Published: June 2010

Introduction

In 1984 the Psychiatric Andalusian Reform began, with the objective of replacing the institutionalization manicomial system with an alternative model of integrated network of services, based on the community. This carried a dramatic reduction of inpatient beds and subsequent increase in pressure on available beds in hospitalisation units, as well as the appearance of a higher risk of readmission.

Aims

The purpose of this retrospective study is to identify clinical and demographic variables that correlated with readmission in our Psychiatry Unit, over a two year period (from January 2006 to December 2008).

Methods

Data were abstracted from medical records for retrospective analysis. Repeat users were defined as those individuals receiving two or more inpatient admissions to our Psychiatry Unit during the study period. Statistical comparisons were made between repeat and single admission groups to identify variables predictive of rehospitalization, such as age, gender, diagnosis, comorbidity of mood and personality disorders, alcohol dependence / abuse, number of previous admissions, number of compulsory admissions, length of admission and treatment among others.

Results

Most important predictors for readmissions included age, previous psychiatric admission, alcohol and illegal substance dependence / abuse, comorbidity of personality disorder and early drop-out of treatment.

Conclusions

Our results indicated that there are several factors involved in a higher risk of readmission in our Psychiatry Unit. By identifying predictors of readmission and intervening appropriately, unnecessary readmission may be prevented.
P02-39 - Admissions of Roma People in Psychiatric Hospital in Gornja Toponica
Authors: Stevanovic Z.
Published: June 2010

The Roma people are an ethnic group with origins in South Asia (India). When the Roma people arrived in Europe, curiosity was soon followed by hostility and xenophobia. They were subject to ethnic cleansing, forced labor, assimilation schemes and restrictions of cultural freedom. Many Roma faced discrimination and prejudice from both private groups and national Governments. In this poster socio epidemiological characteristics of patients admitted in Special Psychiatric Hospital in Gornja Toponica in the period between 1995. and 2008. have been observed. Patients with serious psychiatric conditions from southern and eastern Serbia (approximately 2,5 million people) are admitted in this hospital. Percentage of Roma people in this area is about 1,96% (by the census from 2002.). Majority of the population are Serbs, but there are other national minorities (Albanians, Bulgarians, Romanians, Bosnians.). Between 1995. and 2008. 19961 patients have been admitted to the hospital. From these 19961, 578 were Roma, which make 2,89% of admissions. Most of the Roma are admitted with diagnose of Schizophrenia and other similar disorders (F20- F29)- 42,01%, while in the second place come disorders caused by the usage of psychoactive substances (F10- F19)- 33,7%. Like with other nationalities admissions of men (68,51%) are more common then admissions of women (31,49%). Percentage of unemployed Roma people, and Roma without any income is much higher (74,55%) than of other nationalities (25,29%). There are also differences in marriage status. Most of the treated Roma were married (47,41%) while most of the other patients were not married (44,41%).
P02-41 - Mental Health Consequences of Industrial Crisis in East-west Region of Slovenia
Authors: Švab V. , Novak M. , Oravez J.
Published: June 2010

Introduction

Mental health consequences of social decline due to unemployment, poverty and social exclusion should be adressed with locally and culturally responsive mental health services.

Objectives

to influence development of mental health services in accordance with population needs.

Aim

to assess mental health needs of the local population.

Method

Data on frequency of visits to psychiatric outpatient clinic, hospitalization and rehospitalization rates, benzodiazepine and antidepressant prescriptions as well as social status and social services´ use because od mental health disorders in the east north region of Slovenia are to be presented.

Results

This is the region with one of the highest use of alcohol and BZD, with lowest income and high unemployment rate, rising in last years due to closing some large factories in the time of transition and economic crisis. The region also presents one of the highest sucide rates and high alcohol addiction problems.

Conclusions

Public mental health action regarding these problems is needed. Proposals for mental health needs assessment are to be suggested in this poster presentation.
P02-43 - Associations Between DSM-IV Diagnosis, Psychiatric Symptoms and Morning Cortisol Levels in a Community Sample of Adolescents
Authors: Young R.
Published: June 2010

Introduction

The hypothalamic-pituitary-adrenocortical axis (HPA-axis) is involved in the regulation of the stress response. Dysfunction of this system is implicated in a variety of psychiatric and emotional disorders.

Objectives/aims

To explore the association between HPA-axis functioning, as measured by morning cortisol, and common psychiatric disorders and symptoms among a community sample of adolescents.

Method

Data from a cross-sectional school-based survey of 501 school pupils, aged 15, were used to establish the strength of association between morning salivary cortisol and both diagnosis of psychiatric disorders and number of psychiatric symptoms. Analysis, conducted separately by gender, used multiple regression, adjusting for relevant confounders.

Results

With one exception (a positive association between conduct disorder symptoms and cortisol among females) there was no association between cortisol and psychiatric diagnosis or symptoms. However, there was a significant two-way interaction between gender and conduct symptoms, with females showing a positive and males a negative association between cortisol and conduct problems. A three-way interaction showed that while the association between cortisol and conduct symptoms was negative among males with few mood disorder symptoms, among females with many mood symptoms it was positive.

Conclusions

Except in relation to conduct symptoms, dysregulation of morning cortisol levels seems unrelated to any psychiatric disorder or symptoms. However, the relationship between cortisol and conduct symptoms is moderated by both gender and mood symptoms. Our findings suggest research should concentrate on the moderated associations between cortisol, gender, and psychiatric symptoms.
P02-45 - Factitious Disorder: a Relational Ethics Perspective in Consultation Liaison-psychiatry
Authors: Barbosa A.
Published: June 2010

Factitious disorder confront the consultation liaison psychiatrist with (self)destructive behaviour and some lies from the patient trying to involve the physician in this behaviour. There is always a difficult balance between patient autonomy, open communication and the promotion of patient health, doctor integrity and maintenance of the constructive doctor/team-patient relationship.

Consultation liaison psychiatrists are more and more requested to accomplish a role of “clinical ethicists” and they are really well prepared to that propose because they usually cope by means of the biopsychosocial model with clinical, legal, social, economic, religious and institutional problems.

Common ethical principles (beneficence, autonomy, justice, vulnerability, dignity, responsibility) are referential tools on clinical decision making. However, in psychiatric ethics we feel the need to construct a more clinical model: relational ethics. Its main references come from a dialogical, hermeneutical and pragmatic ethics based on an intersubjectivity perspective of human development which can deal with the practical rationality in clinical psychiatry faced with complex but concrete situations. It recognizes interpersonal and intrapsychic conditions of authenticity, a process of mutual reciprocity in order to allow psychic growth.

We describe the way this theoretical and deliberative proposition can be easily applied to a particular case of a young man with factitious disorder admitted to the dermatological department of a Universitary Hospital.
P02-46 - Audit on Ward Review Meeting
Authors: Zafar S.
Published: June 2010

Introduction, literature & review

•

Ward rounds and clinical review meetings should reflect the recovery model for mental health and person centred planning. They play a pivotal role in hospital-based care. They should enhance the quality of patient care, improving communication and address service users’ concerns and problems.

•

They should involve users as fully as possible in the development and review of their treatment plan, allow proper planning and evaluation of treatment and facilitate multi-professional training and education.

•

This audit is designed to benchmark current practice against proposed standards outlined below.

Objective

To establish if the ward review practice in Prof. Benbow's team on Cedar Ward, Penn hospital is in line with the proposed standards and to consider whether the standards are appropriate.

Methodology

•

The sample population includes patients or the cares involved in their care. Data was gathered by means of questionnaires and retrospectively from psychiatric case records between the period 01/001/2008 and 31/12/2008.

•

The questionnaires were both respondent and researcher completed. Open and close ended questions were used.

Summary/recommendations

•

The findings showed satisfaction with the ward meeting process, but participants identified issues that could be improved upon.

•

Audit strength includes clearly defined standards and giving room for additional comments.

•

Limitations includes small sample size and poor response from patients and the carers.
P02-48 - The Clinic-social Characteristics of Involuntary Hospitalized Schizophrenic Patients in Bulgaria
Authors: Angelova-Barbolova N. , Berezantzev A. , Dechkova-Novakova T.
Published: June 2010

Introduction

The study of psychic disorders and violence occupies a central place in the general and forensic psychiatry. A lot of various studies focused on grave crimes against personality, done by mentally diseased people have been carried out. A part of the studies are dedicated to the aggressive behavior of the schizophrenics - the risk of exercing violence turned out to be 3-5 times higher than in the general population.

Aims

Comparing of the clinicpsychopathological and socialpsychological characteristics between schizophrenic patients hospitalized voluntarily and those hospitalized non- voluntarily; setting up of:

1.

the factors forming the dangerous behavior with those patients;

2.

preventive ambulatory measures of the dangerous behavior.

Methods

Patients have been examined in the Regional hospital of psychiatry - Russe: 180 non-voluntary hospitalized schizophrenic patients and 110 schizophrenic patients treated voluntarily in hospital. The diagnoses of the specialists of psychiatry match the requirements of ICD 10. The objective assessment of the social functioning is included in the individual card of the research (assessed in a year,s time too). Also been used: PANSS (with additional questions towards the profile of the aggressive risk); a short version of the questionnaire of the WHO for an assessment quality of life.

Results, conclusions

The following factors are important when forming the dangerous behaviour: breaking up of the therapy for 1-3 weeks before hospitalization; obvious psychotic symptoms, personal changes; alcochol abuse; social disadaptation lack of social support, family rows and conflicts, material insecurity. The leading role of the social factors has been determined.
P02-49 - Corrective Seclusion or Punitive Incarceration: an Overview of the State of the Nigerian Juvenile Justice System
Authors: Atilola O.
Published: June 2010

Objectives

To make a critical review of the history, structure,facilities and practices as well as the laws governing the Nigerian juvenile justice system with a view to determine how well it can currently serve its intended purpose.

Methods

Information on the history, structure and current practices and existing laws were obtained from review of relevant literature and on-site visits to a juvenile remand home in South-West Nigeria.

Results

The Nigerian juvenile system evolved during the British colonial era and was modeled after the British system. The few differences were mainly to accommodate local customs. However, over the years, the Nigerian juvenile justice system may have deviated beyond customary differences to include systematic ones. For instance record keeping is poor, and there are research evidence of widespread physical and emotional abuse of children while in custody. Also, a lot of young offenders are being processed in adult courts having being passed as adults by juvenile justice officers to avoid adhering to the legal requirements for their treatment. Furthermore, incarcerating forms of custodian care is the norm in Nigeria as non-incarcerating methods are not developed. The existing facilities are also in states of disrepair. Moreover The existing laws are obsolete and needs urgent review as some provisions runs contrary to children rights.Useful suggestions were offered.

Conclusion

The Nigerian juvenile system needs an urgent overhaul to be able to serve its intended purpose. The Government, Child mental health professionals and non-profit organizations all have a role to play.
P02-50 - Victimological Aspects of Forensic Psychiatric Assessment of Mental Disorders in Victims of Crimes
Authors: Berezantsev A. , Kachaeva M. , Filatov T.
Published: June 2010

The testimonies of victims of crimes are extremely important in criminal prosecution and court proceedings because often they are the only witnesses of the crime.

Aims

To find out clinical factors which determine victimological behavior in adult persons with mental disorders who become victims of crime and to work out criteria of their competence to stand trial.

Methods

Psychopathological, psychological, statistical.

Results

128 adult patients with different mental disorders were examined (organic brain disorders, mental retardation, schizophrenia, personality disorders). All were victims of crimes (rape, robbery, beating, fraud). According to Russian legislation persons who due to mental disorder can not understand the nature of the crime committed against them may not be put to trial. In such cases pretrial forensic psychiatric assessment must give a conclusion about capacity of a victim to give evidence. The study has revealed that the competence to stand trial is determined by severity of symptoms. The relation between psychopathologial symptoms and types of victimological behavior was revealed. Light symptoms determined psychological mechanism with provocative type of victim's behavior. In such cases victims could understand the nature of crime and give the evidence. Moderate and severe symptoms determined psychopathological mechanism and significant victimization of the patients with passive and aggressive types of behavior. Those victims could not understand the meaning of the crime and give evidence.

Conclusion

If the court decides that victim not competent to stand trial it can reduce revictimization of the patients avoiding traumatic experience of giving evidence in the court.
P02-52 - Efficacy of Forensic Statement Analysis in Distinguishing Between Truthful and Deceptive Eyewitnesses Accounts about Highly Stressful Events
Authors: Morgan C.
Published: June 2010

Forensic statement analysis (FSA) research has shown that statements provided by truthful persons may differ from those proffered by individuals who are lying. However, these data are from low stress laboratory study environments that do not compare to situations of stress experienced by people experiencing legal jeopardy or threatening events. As such, our current understanding about how well this may apply to real world situations is limited. This study tested whether speech content of genuine eyewitness accounts about exposure to a highly stressful, personally relevant event differed from deceptive accounts.

Military personnel were randomized to Genuine or Deceptive Eyewitnesses groups. Genuine eyewitness reported truthfully about their exposure to interrogation stress associated with military survival school training; Deceptive eyewitnesses studied transcripts of genuine eyewitnesses for 24 hours prior to being interviewed. Cognitive Interviews of all were recorded, transcribed and assessed by FSA raters blind to the status of participants. The accounts of genuine eyewitnesses contained more external and contextual referents, more unique words, a greater total word count and lower type-token ratio (TTR) than did deceptive accounts.

The classification accuracy when using FSA techniques on Cognitive Interview elicited eyewitness accounts was 82%; FSA methods may be effective in determining whether eye witness accounts about real world, high-stress events are genuine; these data have relevance to professionals working with asylum seekers, or professionals in law enforcement, security and in criminal justice.
P02-54 - Is Outpatient-based Substance Abuse Treatment a Predictor of Re-offending and Other Outcomes Among Swedish Offenders Subjected to Psychiatric Assessment?
Authors: Durbeej N. , Hellner Gumpert C. , Alm C. , Eriksson Å. , Hephzibah Berman A. , Kristiansson M. , Lindqvist P. , Palmstierna T.
Published: June 2010

Introduction

Substance abuse is associated with criminal recidivism. Substance abuse treatment has been found to correlate negatively with re-offending among treatment utilizers. However, for offenders with mental health problems and substance abuse, research on how substance abuse treatment affects re-offending is sparse.

Objectives

The study aimed to examine the relationship between self-reported outpatient-based substance abuse treatment and self-reported a) re-offending, b) substance use and c) psychiatric problems among offenders with mental health and substance use problems.

Methods

Data were gathered from a naturalistic follow-up study with 208 participants, subjected to a court-ordered psychiatric assessment. This analysis covers 91 individuals who were followed-up after an average study period of 17 months. Among these, 68% had been sentenced to institutional imprisonment or forensic psychiatric care.

Results

Offences, substance use and psychiatric problems declined between baseline and follow-up. However, the reduction was not associated with self-reported treatment utilization. Among participants who were sentenced to non-institutional corrections, more individuals had utilized outpatient-based treatment compared to individuals who were sentenced to imprisonment or forensic psychiatric care.

Conclusions

A definitive conclusion about the effect of treatment is difficult to draw. For instance, self-reported data may not reflect actual treatment consumption. However, one interpretation is that participants naturally recovered over time. Institutional correction might also have resulted in positive outcomes equivalent to outpatient-based treatment.
P02-57 - The Forensic-psychiatric Assessment of Surviving Perpetrators of Homicide-suicide
Authors: Frei A. , Graf M.
Published: June 2010

Background

Murder-Suicide may be defined as extreme pattern of domestic violence. Research is hampered by the fact that with the death of the perpetrator the files are usually closed and an analysis of the cases is hardly possible. Knowledge about the circumstances of murder-suicide, however, is of special interest for the forensic-psychiatric expert when the perpetrator survives and the need for forensic assessment arises. Since forensic-psychiatric assessment is always based on comparison with similar cases we compared the files of surviving perpetrators of murder-suicide with those of lethal domestic violence.

Methods

All forensic-psychiatric expertises about surviving perpetrators of homicide-suicide which occurred in the region of Basle, Switzerland, between 1987 and 2006 (n = 6) were compared with those of perpetrators of homicide in a domestic environment (n = 20) in the same period.

Results

There were comparatively more women but less foreigners among the perpetrators of homicide -suicide, their socioeconomic level was much higher and there were more children among the victims. The most frequent psychiatric diagnosis in both groups was personality disorder, but the range in the domestic murder group, however, went from no diagnosis at all to psychosis, i. e. assumed full criminal responsibility to assumed not guilty by reason of insanity. There was no case of not guilty by reason of insanity among the homicide-suicide group.

Conclusions

The disparities of these two patterns of domestic violence are much greater than we expected, which underpins the need for specific forensic assessment as well as preventive actions.
P02-59 - Motivational Aggression and Personality Disorders
Authors: Gorinov V.
Published: June 2010

Forensic Psychiatry comes across the need to assess subjects with paranoid or schizoid types of personality disorders, whose criminal aggression can be characterized as motivational or conscious.

Motivational aggression is rooted in the person's scale. In isolated cases, the criminal act is committed along the lines of a delirious manifestation. This refers to patients with paranoiac dysfunction, whose actual state of mind can be qualified as the “paranoia of struggle”. They have poor social skills, are unsure of themselves, vulnerable, quick to take offence. Their inner conflicts are always exaggerated, the world around them is filled with animosity, interpersonal communication is a problem. Aggression for them is a mode of self-realization, a way of releasing anger and tension; it is their revenge to society for their own imperfections, vulnerability, uselessness and rejection.

Individuals committing crimes on these motives, tend to create their own theories based on their inner, subjective criteria. They perceive information through their preconceived notions and postulates. For such individuals, committing illegal actions is a mode of self-realization.

In reference to such subjects of examination, an expert conclusion can point out their lowered ability or inability to embrace, in a judicially meaningful situation, the real character and societal danger of their criminal actions, and to control these actions. In other words, in such cases, application of Article 22 of the Criminal Code of the Russian Federation (the so-called partial sanity) or Article 21 of the Criminal Code of the Russian Federation (insanity) can be recommended.
P02-60 - Evaluation of Structured Professional Judgment for Risk Assessment in its Proper Clinical Use
Authors: Graf M. , Dittmann V.
Published: June 2010

Structured professional judgement is the gold standard for forensic risk assessment proven by several studies. None of these studies however investigated the real strength of such a method, which lies in its function to guide clinical judgment by integrating the several evidence based risk factors in a professional process beyond arithmetical addition.

In our semi-prospective study (retrospective data-collection from 379 risk assessments from a forensic-psychiatric sample between 1989 and 2000 and a prospective follow-up with complete criminal records until 2007) we found the method of structured professional judgement by means of a catalogue of criteria being prospectively valid: With a median time at risk of 8.4 years the risk management (the process of risk assessment, court decision and sentencing respectively court ordered treatment) reduced both general as violent recidivism significantly.

37% of the subjects recidivated median 2.1 years after risk assessment. Recidivism rates (adjusted for time at risk ≥ 24 months) for homicide were 2.1%, 15.7% for all violent offenses, 7.1% for sexual offenses and 2.1% for child abuse.

None of the 56 subjects given a negative prediction (“no recidivism”) recidivated with serious offenses.

We will also present data about construct validity, CHAID-analysis for recidivism and comparison with PCL and HCR-20 scores.