More recent definitions of stigma focus on the results of stigma – the prejudice, avoidance, rejection and discrimination directed at people believed to have an illness, disorder or other trait perceived to be undesirable.

During this study, we used Attitudes to Mental Illness Questionnaire (AMIQ), which helped us to understand the differences in the acceptance by the population for 3 different types of diseases: addiction, diabetes and schizophrenia.

(1) Alban has diabetes. (2) Besnik has schizophrenia.

(1) The patients with schizophrenia have higher levels of stigma compared diabetic patients or those alcoholics (Tables 1 and 2 and Fig. 1). (2) Statistical processing carried out concluded that have statistically significant differences between gender-stigma (P = 0.001), age-stigma (P = 0.0001) and education-stigma (P = 0.001) (Fig. 2). (3) Health care workers stigma is exactly the same as in general population (P = 0.01) (Fig. 2).

– Support recovery and social inclusion and reduce discrimination.

– Do not label or judge people with a mental illness, treat them with respect and dignity as you would anyone else.

– Do not discriminate when they come participation, housing and employment.

The authors have not supplied their declaration of competing interest.

The aim of the explorative study poster is to look into the phenomenon of psychotic disorder/manifestations collectively termed as Jerusalem syndrome – a psychotheological condition characterized by temporary psychosis like symptoms upon visiting Jerusalem.

The primary aim is to explore the theories pertaining to the possible causes and psychopathology involved in Jerusalem syndrome with a view to contextualize their credibility and weightage against the extant evidence in neurological science. It would also look at the possible treatments used.

A detailed literature search has been undertaken to identify variety of case reviews and publications about Jerusalem syndrome and case interviews of psychiatrists in Jerusalem: dealing with neurological, psychological explanations of the condition; have been proposed by psychiatrist or psychologist and neurologists as a possible psychopathological manifestation.

The results are synthesized and presented in a tabular form. The discussion expands on the various theories and their relevance with a view to establish the nosological validity of the condition and the viable treatment models available.

The author has not supplied his/her declaration of competing interest.

Previous studies have suggested that public beliefs and attitudes toward mental illness may be influenced by country-specific social and cultural factors.

This study aimed to carry out a national survey to assess people's beliefs and stigmatizing attitudes toward schizophrenia and major depression in Taiwan.

We randomly recruited participants aged 20–65 (n = 1600) in Taiwan, using a computer-assisted telephone interviewing. Participants were presented with a case vignette for major depression and schizophrenia. Questions were asked about causal attributions, emotional reactions, and social distance of individuals afflicted by psychosis or depression.

In respect of causal attributions, respondents were more concerned with the likelihood of biogenetic explanations for schizophrenia as compared with depression. The same applied to other explanations such as god's willingness and being possessed or haunted. In contrast, psychosocial factors were more likely to be endorsed as a cause of depression than as a cause of schizophrenia. For perceived dangerousness, significantly more respondents considered schizophrenia likely to be violent toward others and to be unpredictable. In terms of emotional reactions, respondents were significantly more likely to express anger or fear for schizophrenia vignette. A similar pattern was shown for the social distance, where respondents were also significantly less likely to express a willingness to contact people suffering from schizophrenia within different social relationships.

The findings from this study may enhance our knowledge of community beliefs and stigmatizing attitudes towards people with mental disorders in Taiwan and highlight the importance of understanding these issues in context.

The authors have not supplied their declaration of competing interest.

The interdiction of citizens is embodied in the Portuguese civil code and is untouched since 1966 regardless of the profound changes in our society. In 2006, Centro Hospitalar de São João (CHSJ) created protective measures for inpatients that are incapable; the procedure encompasses multidisciplinary evaluation of patients and the elaboration of a final report by liaison psychiatrists.

To describe the interdiction proceedings initiated at CHSJ in the last two years, establishing parallels with our socio-demographical and epidemiological reality.

Retrospective study of the internal requests for psychiatric consultation concerning interdiction proceedings made in the CHSJ from January 2015 to December 2016.

During the study period, the liaison psychiatry service received 37 requests for evaluation of patients’ decision-making capacity through the internal consultation system. The typology of the patient targeted in the interdiction process is male, more than 70 years old, hospitalized due to infectious intercurrences whose dependency of others enables him to return to his residence. More than a half (51%) of the requests were performed by internal medicine services. Twenty-one reports declaring the patient's inability to govern his person and property were made. The most common pathology underlying this cognitive impairment was dementia (57%).

Our results reflect the aging of Portuguese population and the increased prevalence of dementia. The evaluation of the capacity for self-governance will be increasingly required in our clinical practice and demands a holistic approach to the patient while taking into account the preservation of his autonomy, dignity and rights.

The authors have not supplied their declaration of competing interest.

The aim is to determine the prevalence and incidence of depression for an Azerbaijani female sample and explore the impact of cultural factors on depression.

To determine: the optimal cut-off point of ZDRS; the point prevalence and 3 month incidence of depression; risk factors for depression. To compare the depression prevalence in the two language groups of the Azerbaijani population (Azerbaijani-speaking and Russian-speaking) for determining possible impact of cultural factors on depression.

The first screening with ZDRS (Az) and ZDRS (Ru) were carried out with 1500 research participants, who filled out the questionnaires at their homes. All the screened subjects who score 40 and more on ZDRS were examined by MINI. True-positive and false-positive results were defined. Ten percent of the screened subjects, who score less than 40 on ZDRS were randomly chosen for clinical interviews to define true-negative and false-negative results. According to the analysis the optimal cut-off point of ZDRS in the Azerbaijani female population was found with the definition of its sensitivity, specificity, positive predictive value and negative predictive value. Based on the optimal cut-off point of ZDRS, point prevalence and incidence of depression was determined in Azerbaijan. The follow-up screening was conducted to determine the 3 month incidence of depression.

The determined prevalence and incidence of depression will be reported with the optimal cut-off point of ZDRS.

The results of the current study suggested that the ZDRS was a valid tool for use in screening patients with depression disorders but need a modification.

The authors have not supplied their declaration of competing interest.

The current practice in medical and surgical care of women with breast cancer in Azerbaijan is to hold back disclosure of cancer diagnosis unless the patient actively asserts full disclosure. This study aimed to serve as a pilot, to appraise the level of anxiety and depression in women diagnosed with breast cancer and explore ways to develop approaches to further elucidating the important issue of cancer information disclosure.

The subjects in the study were women recruited consecutively with confirmed oncological diagnosis of breast cancer (n = 23; mean age = 50 (SD ± 11; range 27–73 years) and who were scheduled for mastectomy. All the subjects consented to be directly interviewed. The interview comprised of a socio-demographic questionnaire and inquiry regarding the subjects’ understanding of the nature of their breast condition. All the subjects were also administered the Hospital Anxiety and Depression Scale (HADS) in Azerbaijani. The patients who knew their diagnosis of cancer were ascertained subsequently from the record (n = 11 [42.3%]).

There was a significant correlation between anxiety scores (P = 0.006) and anxiety/depression scores combined (P = 0.009) with the level of subjects’ awareness regarding diagnosis of cancer; the correlation was not significant for depression scores alone (P = 0.068).

The findings are consistent with studies from culturally similar regions and reflect the need for improvement on disclosure, patient participation, and family support in treatment of women with breast cancer.

The author has not supplied his/her declaration of competing interest.

To determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.

While post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.

We used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

We analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.

Our study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.

The authors have not supplied their declaration of competing interest.

Referrals to psychiatry from primary care has increased in recent years. This can be the result of the global economic situation and represents a problem for specialized care, because patients can’t usually be correctly attended to. On the other hand, patients who don’t come to visits make up other important issues that we must analyze.

To analyze the differences between patients who did not come for their first visit and those who did in order to try to describe variables that could be affecting them.

This is an epidemiological, analytic, prospective study of patients referred to our department. The following variables were collected: (1) referral protocol, (2) reason, (3) demographic data, (4) attendance to appointment, (5) diagnosis impression and (6) destination of referral. The SPSS 19.0 was used to analyze the data.

We studied a total of 1.048 patients for 15 months, of which 20.6% did not come to their first visit. A statistically significant relationship between attendance and gender, year of the appointment, adequate demand or not, previous follow-up and diagnosis was found (Chi2). However, if a logistic regression was carried out, only the adequacy of the demand was included in the model.

Coordination with general practitioners is essential to improve referrals and, most importantly, the attention to patients. If we can agree on the referral criteria, a better-personalized assistance can be offered to patients who have more difficulties in coming (because of characteristics of illness, place of residence, and other variables).

The authors have not supplied their declaration of competing interest.

The distribution of the demand from primary care in the mental health units could be a way of facilitating the coordination and improving the attention to patients. For this reason, in our unit we have made a repartition of the areas among the different psychiatrists.

To analyze if there was a correlation between the geographical origin of the patients or their primary care areas and the referrals, and between them and their attendance.

This is an epidemiological, analytic, prospective study of patients referred to our department. The following variables were collected: (1) referral protocol, (2) reason, (3) demographic data (origin, gender, age), (4) Primary Care area, (5) attendance to appointment, (6) diagnosis impression and (7) destination of referral. The SPSS 19.0 was used to analyze the data.

A total of 1048 patients were sampled. A statistically significant relationship hasn’t been found between place of residence, primary care area or areas of distribution in the Unit and attendance (Chi2). If we analyze the population of each distribution, we can describe similar percentages depending on the size of these.

Although a different distribution and a relationship is thought between some areas and the attendance or the number of referrals, we didn’t find out them in our sample.

The authors have not supplied their declaration of competing interest.

Depression is a common disorder among the unemployed, but research on identification of their depression in health care (HC) is scarce.

The present study aimed to find out if the duration of unemployment correlates to the risk for unidentified major depressive disorder (MDD) in HC.

Sample of the study consisted of long-term unemployed who were in screening project diagnosed as having MDD (n = 243). The diagnosis was found in the records of HC in 101 (42%) and not found in 142 (58%) individuals. Binary logistic regression models were used to explore the effect of the duration of unemployment to the identification of MDD in HC.

The odds ratio (OR) for non-identified MDD in HC was 1.060 (95%CI 1.011–1.111, P = 0.016) per unemployment year and when unemployment had continued, for example, five years the OR for unidentified MDD was 1.336. The association remained significant throughout adjustments for the set of background factors (gender, age, occupational status, marital status, homelessness, self-reported criminal records, suicide attempts, number of HC-visits).

This study among depressed long-term unemployed indicates that the longer the unemployment period has lasted, the greater the risk for non-identification of MDD is. HC services should be developed with respect to sensitivity to detect signs of depression among long-term unemployed.

The authors have not supplied their declaration of competing interest.

Early intervention services (EIS) can significantly reduce the rate of relapse, risk of suicide and number of hospital admissions for people with first episode of psychosis (FEP). However, care pathways in FEP can be complex, thus extending the period before patients commence appropriate treatment. Recently in the UK, guidelines have set a limit of two-weeks before patients with a FEP receive treatment at EIS.

We explored the impact of this new policy on referrals to an EIS in the area City and Hackney, London, which has one of the highest incidence of psychosis in the UK.

Referrals from 6 months of 2015 have been compared with the data from the same period of 2016, once the waiting standard had been implemented.

We observed more than a two-fold increase in the monthly number of referrals (9.4 in 2015; 20 in 2016) and this wasn’t due to a rise of inappropriate referrals (2.23% in 2015; 1.53% in 2016). Moreover the number of referrals doubled further when, in addition, the City & Hackney EIS went from a 18–35-year-service to an “ageless” adult service.

The recent focus on FEP in the UK might have increased awareness and reduced stigma, leading to the increment in referrals. Also, shortening the waiting time made the service more accessible for those that would have gave up in front of a longer waiting list. Interestingly enough a peak in the number of referrals has been observed from September 2016 when another standard was implemented.

The authors have not supplied their declaration of competing interest.

Mental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.

To evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)

This is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)

We included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.

Our results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.

The authors have not supplied their declaration of competing interest.

Teachers serve as models for young people and significantly influence their health behavior.

We were interested in conducting the first epidemiological survey about tobacco smoking among Greek teachers.

A total of 1032 teachers of the two biggest cities of Greece participated in the study. A questionnaire was created to include questions regarding tobacco smoking, history of tobacco use, nicotine dependence as well as health attitudes. Frequencies and relative frequencies were determined for all the questions. Pearson's Chi2 and Chi2 adjusted tests were used to examine the potential association of current smoking status with gender, age and school level in a statistical significance level of 0.05.

Prevalence of current smokers in the sample was 25.6%. Cigarette emerged as the tobacco product of choice reported by 88,3% of the respondents, followed by e-cigarette (5.2%), cigar (2.4%), hookah (2.4%) and pipe (1.7%). The highest prevalence of current smoking was found in the age group of 40–49 years old (46.1%). Current smoking proportion was higher among female (26.0%) than male teachers (24.9%). Intention to quit smoking was reported by 18.1% of the sample.

As compared to other countries, teachers in Greece have a moderate percentage regarding tobacco smoking. A concerted effort must be made towards smoking cessation in this population with gender specific interventions. It is of great importance for teachers to act as public health promoters, as performers of tobacco prevention curricula and as leaders in the implementation of school tobacco control policies.

The authors have not supplied their declaration of competing interest.

British psychiatry was in its embryonic stage in the late nineteenth century. Early psychiatrists employed radical treatments with little success and not much is documented about public attitudes. Using fictional depictions of madness and physicians allows us to explore cultural attitudes to psychiatry at the time.

First, to analyze the portrayal of madness and physicians in the island of Dr. Moreau and Dr. Jekyll and Mr. Hyde; second, to use this to provide insight into the public opinion of psychiatry and third, to evaluate the development of attitudes using twentieth century media.

To provide an insight into the social perspective of mental illness in the late nineteenth century and consider its evolution over the last one hundred years.

Two famous, well-received novels of the time were chosen for analysis. Historical knowledge of the period was sought using JSTOR, NHS Scotland's The Knowledge Network and Google Scholar. Novels and media depictions were analysed in relation to the scientific understanding at the time.

The novels show two ways of control: surgical (Moreau) and chemical (Jekyll). Both are unsuccessful, as were physician's attempts in reality. The narrators’ concerns mirror the cultural anxiety at the time surrounding containment and treatment of mental illness. Media portrayal of cruel, unsuccessful treatment continues throughout the twentieth century.

Nineteenth century cultural attitudes to mental illness show a distinct anxiety and concern with barbaric treatments and their inefficacy. Despite psychiatric progress, the media have continued to portray mental illness and its treatment in a negative light, suggesting continued levels of societal concern.

The author has not supplied his/her declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Economic crises can contribute to a worsening of mental health problems and, consequently, to a possible increase of the use of psychotropic medication.

To assess the use of psychotropic medication in Portugal before and after the onset of the economic crisis, and to better understand the impact of the economic crisis in this highly hit country.

This 2015 follow-up epidemiological study re-interviewed a probability sub-sample of respondents to the 2008 national mental health survey, the first nationally representative study of psychiatric morbidity and treatment patterns in Portugal. Socio-demographic and clinical variables were assessed using a structured interview in 2008 (n = 2060) and 2015 (n = 911). All participants were questioned about the last 12 month use of psychotropic medication for mental health problems. Descriptive analysis was conducted to assess the use of psychotropic medication by group and gender in 2008 and 2015.

Between 2008 and 2015 there was an overall increase in the use of the main groups of psychotropic medication (22.5% to 28.6%), with a particularly relevant increase in the consumption of anti-depressants and anxiolytics. The use of psychotropic medication was higher among women in 2008 and 2015 (31.1% and 36.7%) compared to men. However, the increase in consumption was more relevant in men (13.3% to 20.0%), particularly in relation to anxiolytics (6.0% to 11.6%).

The economic crisis was associated with a substantial increase of psychotropic medication's use in Portugal, consistent with the increased prevalence of mental health problems that this study also found.

EEA Grants Programa Iniciativas em Saúde Pública.

The authors have not supplied their declaration of competing interest.

During economic crises additional mental health risks emerge and social inequalities in health can widen. In order to ensure universal coverage of mental health care and to reduce the impact of the crisis, it is crucial to assess the needs of the population to be able to reorganize mental health care accordingly.

To analyse the use of services for mental health problems in Portugal during the economic crisis.

In this follow-up epidemiological study, a probability sub-sample of respondents to the 2008 national mental health survey (n = 911) was re-interviewed in 2015. Socio-demographic variables and treatment patterns were assessed using a structured interview, and psychological distress was measured using the Kessler-10 Scale. Descriptive analysis was conducted to characterize the use of services for mental health problems.

In total, 27.9% of the respondents sought treatment for mental health problems in the previous 5 years, and GPs were the most contacted professionals. Only 57.7% (n = 119) of the respondents with moderate or severe psychological distress (n = 197) reported recognizing they needed treatment. Among people with moderate or severe psychological distress who recognized their need for treatment, most received treatment (80.5%, n = 105), which was minimally adequate for 74.4% (n = 81). Low perceived need and structural barriers were the main obstacles for access to care.

Under-treatment, low continuity of care and low adequacy of treatment are problems that the Portuguese health system must address in order to meet the mental health challenges of the economic crisis.

EEA Grants: Programa Iniciativas em Saúde Pública.

The authors have not supplied their declaration of competing interest.

The armed Colombian conflict is one of the bloodiest and most extensive in the contemporary history of Latin America, with multiple factors and causes implicated.

Determine the factors involved in the emergence of Colombian political violence from neurobiological, anthropological, social and psychoanalytic models.

We revised the report Basta Ya! of The National Center for Historical Memory, which approximates the casualties and victims of the armed conflict in Colombia. In addition, we conducted a rigorous review of current scientific and clinical literature on the neurobiology of violent behavior, social psychiatry and psychoanalytic papers about war, death, and survival instincts.

Violent behavior can be explained by the neurobiological model of aggressive response as an imbalance between the prefrontal cortex and the limbic system. There is evidence to support a geographically-based violence in Colombia with a fragmentation of the territory, the State, and the Colombian identity. Moreover, we found the psychological component raised by Freud and in psychoanalysis, about war, and life and death instinct, as antagonistic manifestations of life-present in acts of violence.

The violence from the armed Colombian conflict has been one of the longest in modern history, determining its causality has been complex. However, understanding violence multifactorially allows us to improve social psychiatry and our role as clinicians in this new post-agreement era, in order to better establish mental health policies for victims and perpetrators in future reparation.

The author has not supplied his/her declaration of competing interest.

The author has not supplied his/her declaration of competing interest.