Schizophrenia is a chronic disease characterized by disturbances of thought, perception, volition, affectivity and cognition. An imbalance of the oxidant-antioxidant system is one of the proposed etiological factors. There are controversies regarding the effect of antipsychotics on the oxidant-antioxidant balance.

The aim of this research is to study the serum levels of the total antioxidant capacity (TAC) in paranoid schizophrenia patients treated with typical and/or atypical antipsychotics.

The sample is comprised by 38 patients admitted to the psychiatric ward of the University Hospital of the Canary Islands. All patients met DSM-IV criteria for paranoid schizophrenia. Some patients were treated only with atypical antipsychotics (N=21) while others were treated with a combination of atypical and typical antipsychotics (N=17).

The next table shows the comparison of serum TAC levels at admission (TAC-A) and discharge (TAC-D) at 12:00 and 00:00 h.

Patients treated with a combination of typical and atypical antipsychotics present at discharge (12:00 hours) significantly higher levels of TAC than patients treated only with typical antipsychotics. The remaining comparisons did not elicit significant results.

The results point out the fact that a combination of typical and atypical antipsychotics is more helpful in reducing the deficits of the antioxidant system than treatments based only on typical antipsychotics.

Depression is a common mental health problem among elderly persons, about 10–15% of elderly suffers depressive symptoms.

to find out the prevalence of depression among geriatrics living in geriatric homes versus those in clubs (living in home with their families), to detect the underlying risk factors of depression.

In Beni Suef city there are three geriatric homes where the elderly are completely living away from their families, besides one geriatric club where the elderly people enjoy their daytime (there are two other clubs were inactive and under establishment), all the elderly above 60 years: males and females in geriatric homes and those attending the geriatric club were included (145) during the period (December 2008 – October 2009). Those who can not communicate and answer the questionnaire were excluded. Data collection tools were a pretested questionnaire besides, Geriatric Depression Scale and Life Satisfaction Scale and Facing Daily Stressful Live Events Scale- Arabic version- Appropriate statistical analysis was applied.

Depression among elderly living in geriatric homes was higher (89.7%) in comparison to those in geriatric clubs (56.7%) i.e. living with their families (the difference was significant). Chronic medical conditions are not considered as a risk of depression among elderly, also there was no significant difference between males and females while depression is common with those who suffer from loneliness as single, widowed or divorced elderly. Other factors as educational level, sex difference or family history of depression has no effect on presence of depression (difference was insignificant). So it is recommended to strengthen social relationships and activities besides encouraging visiting geriatric homes either by related families or the civil societies and this is an important key in preventing depression. There must be a social and health programs about the importance of family support for the elderly in our community that will save a lot of medical and hospital care cost.

The aim of the present study was to (i) examine cognitive functions in kidney transplant recipients and a concurrently assessed group of dialysis patients on the waiting list for a kidney transplant; (ii) assessment of cognitive functions in transplant patients in relation to their estimated glomerular filtration rate (eGFR) by Modification of Diet in Renal Disease (MDRD).

The study included 60 transplanted patients of both sexes from Kasr Alaini king Fahd Unit. Their age ranged from 18-65 years old. Glomerular Filteration Rate (GFR) was calculated by the MDRD equation (Modification of Diet in Renal Disease). Then the transplanted patients were divided into two groups according to the estimated level of glomerular filtration rate (GFR). Another group included 30 patients of both sexes on hemodialysis with the same age range from Kasr Al-Aini King Fahd Unit. A 60 control healthy individual with age and sex matched were recruited in the study. All subjects in three groups were subjected to the following: Full clinical Kasr Alaini Psychiatric sheet and diagnosis if any was according to DSM IV TR criteria, Trail-Making Test, and Montreal Cognitive Assessment (MoCA).

Patients with chronic kidney disease and dialysis were significantly affected in trail making B, total attention, total visuospatial, delayed recall and total MoCA scores in comparison with the control healthy group. Transplant patients showed more significant affection in scores of trail making B test, total visuospatial, total attention, delayed memory recall and total MoCA scores than the control group. This study found that the level of estimated glomerular filtration rate (eGFR) by MDRD did not show significant difference in cognitive functions in transplant patients.

The cognitive deficits are a prevalent and costly burden to chronic kidney disease patients. Longitudinal researches are needed to clarify the prevalence and sequelae of neurocognitive deficits among patients with chronic Kidney disease treated with dialysis or kidney transplantation.

To evaluate personality profile, anxiety, patient satisfaction in patients with erectile dysfunction treated with penile prosthesis as compared to those on Intracorporeal Injection (ICI) home therapy.

A total of 40 male patients complaining of erectile dysfunction were classified into two equal groups according to the line of treatment: Intracorporeal Injection (ICI) and penile prosthesis. Patients were subjected to the following questionnaires: Beck Anxiety Scale, Eysenck Personality Questionnaire, sexual Satisfaction Scale and International Index of Erectile Function Questionnaire (IIEF-5).

Results for Beck Anxiety Scale showed statistically significant difference between both groups (P = 0.000), while for Eysenck Personality Questionnaire, no significant difference was found in Psychoticism (P = 0.056), Neuroticism (P = 0.169), in Extraversion (P = 0.225), Lie scale (P = 0.159), and in Criminality (P = 0.378). Statistically significant difference between both groups was found in the results of sexual Satisfaction Scale, (P = 0.013) and for the results of International Index of Erectile Function Questionnaire (IIEF-5), (P = 0.000).

Patients who underwent penile prosthesis implantation showed lower level of anxiety, better sexual satisfaction and erectile function, while no significant difference was found when comparing personality profile five dimensions Psychoticism, Neuroticism, Extraversion, Lie scale and Criminality.

most obsessive-compulsive disorder (OCD) patients meet psychiatrists 5 to 10 years after onset of OCD. Its relatively high prevalence ratio and the delay in seeking help suggest that patients with OCD may seek help at nonpsychiatric clinics. the present study was undertaken to provide some epidemiological data on the prevalence and severity of OCD in dermatological patients.

The participants included 265 consecutive patients with primary dermatologic chief complaint. They were visited by a dermatologist and diagnosis of dermatological lesion was done according to ICD-10. All patients were visited by a psychiatry resident and were screened for OCD using the structured clinical interview for DSM-IV-TR (SCID-I). If the diagnosis of OCD has been made, the Yale-Brown obsessive compulsive scale(Y-BOCS) was used to evaluate the severity of OCD. To analyze the data student t-test for quantitative variables and X2 tests for categorical variables.

From the total of 265 patients, 24(9.1%) met the DSM-IV-TR criteria for OCD and 9(37.5%) with OCD had previously been diagnosed with OCD, however, only three were treated pharmacologically. The most symptoms were pathological doubt (29.1%), fear of contamination(29.1%)and washing (54.16%). Severity of OCD according to Y-BOCS was evaluated among patients with OCD. Six (25%) were found with subclinical OCD, 11(45.8%) had mild OCD, six(25%) had moderate OCD, and one (4.2%) was detected with sever OCD.

prevalence of OCD in dermatology clinic was higher compared with general population.

Prevalence of discharge against medical advice in psychiatric populations ranges from 3 to 51 percent which has increased over the past 50 years. We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics.

This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who were willing to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables.

The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and previous hospitalizations and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge.

The 34.4% rate of premature discharge observed in our study is higher than average reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.

Evidence for management of ’therapeutic dose’ dependence is more extensive than for ’non-therapeutic’ users and transferring the principles is affected by differing clinical picture, need to avoid abuse and diversion. There is evidence that long term prescribing causes harm and doses greater than diazepam 30 mg is rarely necessary.

To know the proportion of patients on combined Benzodiazepines and Opiate substitute prescriptions and review benzodiazepine reductions plans.

Drug Misuse and Dependence: UK Guidelines on Clinical Management 2007 and British Association of Psychopharmacologists guidelines.

A Cross sectional study at Mid June 2013. List of patients were generated from database and the doses, duration, reduction plans and benzodiazepines commencement dates extracted. We evaluated methadone stabilisation and concomitant psychotropic prescription.

The point prevalence is 8.4% and diazepam’only’ is prescribed in all except 10% who are combined with temazepam. More than 75% were commenced on 30mg dose or lower. 40% have been on diazepam script for more than 24 months and ½ of this have diagnosed co-morbid psychiatry illness while high proportion of remaining ½ await community psychiatrists input. This group also constitutes majority of patients with failed reductions plan.

There is a high correlation between long term benzodiazepine prescription, unsuccessful reduction and co-morbid psychiatry diagnoses. There is a correlation between co-morbid psychiatry diagnoses and higher starting doses of diazepam. Patients commenced on diazepam within last 12 months of this study have reduction plans and high percentage commenced on a dose of 30mg or less.

We invited pregnant women to participate in an 8-week therapy group (either mindfulness-based (MB) or interpersonal therapy (IT)) facilitated by an experienced psychologist. We collected depression, worry, and sociodemographic data on admission to the group, at the end of the group, and again one month postpartum. We subsequently matched and compared the women to 60 women who had participated in a longitudinal study of perinatal depression (age, gestation, marital status, education, medications) from the same community. We wanted to know if: 1) participating in a therapy group decreases depression and worry over the course of pregnancy into the postpartum? and 2) there was a significant change in depression, stress, and worry symptoms for the treatment group compared to a control group?

Data were available on 39 women who had completed 6 groups (4 MB and 2 IT). Women who participated in either group showed significant decreases in depression (p<0.001) and worry scores (p<0.001) compared to control group. Women in the MB groups complained of less stress postpartum than the IT group, otherwise the groups were similar. Women who were unmarried had significantly higher depression scores (p<0.0001).

In summary, participating in relaxation therapy groups can significantly lessen depression and worry symptoms over pregnancy and into the postpartum.

We invited pregnant women to participate in an 8-week therapy group (either mindfulness-based (MB) or interpersonal therapy (IT)) facilitated by an experienced psychologist. We collected depression, worry, and sociodemographic data on admission to the group, at the end of the group, and again one month postpartum. We subsequently matched and compared the women to 60 women who had participated in a longitudinal study of perinatal depression (age, gestation, marital status, education, medications) from the same community. We wanted to know if: 1) participating in a therapy group decreases depression and worry over the course of pregnancy into the postpartum? and 2) there was a significant change in depression, stress, and worry symptoms for the treatment group compared to a control group?

Data were available on 39 women who had completed 6 groups (4 MB and 2 IT). Women who participated in either group showed significant decreases in depression (p<0.001) and worry scores (p<0.001) compared to control group. Women in the MB groups complained of less stress postpartum than the IT group, otherwise the groups were similar. Women who were unmarried had significantly higher depression scores (p<0.0001).

In summary, participating in relaxation therapy groups can significantly lessen depression and worry symptoms over pregnancy and into the postpartum.

UK is one of the ethnically and culturally diverse countries in Europe with high rate of immigration and asylum applications. Significant proportion of this population do not speak English as their first language and have their mental health assessments carried out using an interpreter. However the structure, logistics in the Interpreter Mediated Reviews (IMR) vary without any standard consensus-guidance. Liverpool has ethnically diverse population and has the second largest Asylum Tribunal of the Home Office.

To Check: Awareness of good practice guidelines for IMRs amongst clinicians involved in Merseyside area. Positive & negative impact on clinical engagement of IMRs Clinical challenges faced by staff in these assessments Training needs for professionals;

Comprehensive literature search was conducted to identify various available practice guidances. The literature was peer reviewed & a questionnaire was devised. It covered procedure for arranging interpreters, experiences of clinicians in interpretations, using adhoc interpreters, room-arrangements, utilizing post-interview debriefing and training involved. It was disseminated via surveymonkey to clinicians in the Merseyside; results were collated & analyzed for trends.

Results revealed variation in practice due to lack of agreed guidance. Both clinicians and interpreters had very minimal training in undertaking IMRs. The reviews were complicated by cultural intricacies between interpreters and patients leading to poor or prolonged assessments. Staff and interpreters did not have a standard practice about room arrangement or debriefing process.

It was clear that consensus guidance on IMRs to be developed. Further, training the staff in undertaking an efficient IMR was recommended.

In the UK, Deaneries have specific protocol for handover between doctors during on-call duties. However, there is no formal protocol for handover between trainees during changeover of their posts in February/August rotations. This has significant impact on service provision and training as outlined in the good practice guidelines of the GMC. Further, end of post handover is important in psychiatry as trainees have their own clinic caseload.

To evaluate the handover practice extant amongst trainees in Mersey deanery at the changeover of posts.

Literature search was conducted to identify handover protocol recommended by any deaneries in UK during changeover of posts. A questionnaire was synthesized based on the recommended good practice guidance. It was disseminated to trainee psychiatrists and results were analyzed.

The questionnaire covered how long prior to their rotation trainees were intimated of their placements, whether trainees and their trainer met prior to the commencement of the post; whether they discussed the job role and leave arrangements, handover practice etc.

Results showed there was no formal arrangements for handover at the end between trainees. In many cases, the trainees had not arranged to meet with their trainers before commencing their post. There was very minimal interaction between outgoing and incoming trainees about clinical caseload.

Handover at the end of the post has significant impact on service provision and trainee confidence during rotation, especially in psychiatry. It is recommended that protocols be developed for handover between trainees prior to commencement of the post.

Asylum seekers and refugees experience psychological distress at various phases, such as during pre-migration, migration and post-migration. In the post-migration phase, the period of asylum process has many risk factors for severe mental health implications.

The aim of this study was to identify research evidence that suggest asylum process as a cause of psychological distress among the forced migrants in the United Kingdom (UK).

The study was carried out by searching the NHS database for the relevant information and interviewing asylum seekers and refugees.

The literature search identified several relevant studies in this area. However, only one study was found as the most relevant for my study focus. The study was ‘Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland’ by Ryan et al. The qualitative data gathered from the interviews of forced migrants showed a strong link between the asylum process and mental distress.

This research strongly suggests that the asylum process does contain many risk factors causing psychological distress among the asylum seekers. In particular, the restrictions from freedom to work or study, and the constant fear of deportation are the key stressors identified. Increasing the mental health awareness of all personal who come into contact with forced migrants could prevent severe psychological consequences. These points should be taken into consideration for improving the asylum policy and training medical and non-medical staff who may encounter forced migrants.

Schizophrenia is a major psychotic disorder with significant comorbidity and mortality.

Consequently, we investigated whether physical comorbidity and its relevance on general hospital mortality (GHM) differed between patients with- and without schizophrenia in a 12-year follow-up in general hospital admissions.

During 1 January 2000 and 31 June 2012, 1,418 schizophrenics were admitted to three General Manchester NHS hospitals. All comorbidities with a prevalence ≥ 1% were compared with those of 14,180 age- and gender matched hospital controls. Risk factors i.e. comorbidities that were predictors for GHM were identified using multivariate logistic regression analyses.

Compared with hospital controls schizophrenics had a higher burden of physical comorbidity that was associated with a worse outcome. In deceased schizophrenics, T2DM was the most frequently recorded comorbidity, contributing to 31.4% of hospital deaths. Further predictors of GHM in schizophrenia were found to be alcoholic liver disease, Parkinsonism, T1DM, nonspecific renal failure, ischemic stroke, pneumonia, iron deficiency anaemia, COPD, and bronchitis. There were no significant differences in their impact on GHM compared to controls with the same diseases except Parkinsonism which was associated with higher mortality in the schizophrenia population.

Optimal management of acute T2DM and COPD with its infectious respiratory complications, as well as the accurate detection and management of iron deficiency anaemia, of diabetic related long-term micro- and macrovascular complications, of alcoholic liver disease, and of extrapyramidal symptoms are of utmost relevance in schizophrenia.