To conduct a three-arm partial randomised controlled trail to evaluate the effectiveness of expedited regular supportive psychotherapy and assertive case management for patients presenting with suicidal ideation or self-harm to the emergency department (ED).

we expect expedited regular supportive psychotherapy plus assertive case management will reduce the suicidality and/or suicidal behaviour in patients by at least 20% at 4 weeks compared to patients receiving only assertive case management or routine care and these differences will be sustained at 6 months.

This will be a longitudinal, prospective, three-arm controlled single-rater-blinded partial randomized clinical trial with a recruitment period of 12 months and an observation period of 6 months for each participant. Patients in the intervention group will receive regular face-to-face or over the phone brief supportive psychotherapy during weekdays following presentation to the ED with suicidal ideation or self-harm until patients are actively enrolled in regular community mental health services with active case management by the therapist. Patients in the control and the assertive outreach arms will each receive the usual follow-up services offered routinely to regular patients and assertive outreach patients respectively who present to the ED with suicidal ideation or self-harm.

Recruitment will commence in February 2016 and we expect the results of the study to be available by September 2017.

If our hypothesis is proved correct, our intervention will be a new model for caring for patients with self-harm and suicidal ideation and is expected to reduce suicide rates.

The authors have not supplied their declaration of competing interest.

Parasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.

we report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack.after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.

in this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.

Parasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.

The authors have not supplied their declaration of competing interest.

Hyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia.in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.

we report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms.an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.

in this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.

Hyperthyroidism is very common in general population, being infradiagnosed most of times.in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder.in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.

The authors have not supplied their declaration of competing interest.

aggressive behavior in wards is associated to poor treatment compliance and low clinical insight. Most studies focused on the clinical and cognitive dimensions of insight, while the relationship between metacognitive dimension and aggressive behaviors was not investigated. Our aim was to understand what relationship occurs between dimensions of insight (metacognitive, cognitive, clinical), and specific aggressive behaviors in acute patients.

we recruited 75 acute schizophrenic patients using:aQ; MO aS; IS; P aNSS; BCIS.

a positive correlation between the IS score and the hostility, angry and physical aggression sub-scores of theaQ was highlighted, while no correlation between the score of IS and MO aS total score was found. No correlation between the score of the P aNSS G12 item and theaQ scores and MO aS was found, and no correlation between BCIS scores, MO aS andaQ scores was found.

in our patients, a higher level of metacognitive insight, but not clinical nor cognitive insight, was associated to higher levels of hostility. we suggest that a higher ability to monitor and appraise one's own altered processes of thought and related discomfort, feeling of destabilization and loss of control, could contribute to enhance resentment and suspiciousness. Findings help develop specific therapeutic strategies to enhance metacognitive and self-monitoring abilities, helping patient's understanding of the illness, improving compliance with treatment, and patient's quality of life. Our results support the multidimensional nature of insight in schizophrenia, confirming that clinical, cognitive and metacognitive dimensions are independent though related facets of the phenomenon of insight in schizophrenia.

The authors have not supplied their declaration of competing interest.

The DSM-5 defines psychomotor agitation as excessive motor activity associated with a feeling of inner tension. The activity is usually nonproductive and repetitious and consists of behaviors such as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still. This kind of behavoir occurs in up to 25% of psychiatrics patients who consult in emergency medical services.

The main objective was to determine the efficacy of loxapine inhalation powder in acute agitation.

Ten agitated psychiatric patients scored Positive and Negative Syndrome Scale – Excited Component (P aNSS-EC) baseline and ten minutes after the administration ofaD aSUVE®.

The efficacy of loxapine 10 mg in the acute treatment of agitation was established in a short-term (10 minutes).

Loxapine is the first and only orally inhaled medication for the acute treatment of agitation associated with psychiatrics disorders, which is a tool easy-to-use in emergency medical services.

The authors have not supplied their declaration of competing interest.

Emergency situations related to mental disorders represent a significant proportion of all medical emergencies. Over the last years we have been witness to an upturn in the incidence of psychiatry emergency service because to change of mood.

To determine the profile of the patient who requires psychiatric attention with changing of mood in our area in different seasons.

This is a prevalence and prospective study in which the dependent variable is taken as change of mood and we also use three more independent variables that are age sex and seasonality. The seasonality (spring period and summer period) will be at the same time the form of divided the population in two groups to compare.

Out of all the consultations for changing of mood in the emergency service during the first period (113 patients), 34% were men and 66% were women. The age range of 36–50 years was more frequent for women and the age range of 51–65 years was more frequent for men.in the second period (with 162 patients), 137 women (86%) and 25 men (14%).in this case, the most common age range was 36–50 years, both for women and for men.

The epidemiological and clinical characteristics of patients with changing of mood assessed by the emergency service are described from a naturalistic approach.

Which Chi2 we will discover if the population who has been taken between woman and man is significant and with the median, we will also determine if the age ranges are enough significant to confirm our hypothesis.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Over the past 40 years, services for psychiatric patients have become increasingly deinstitutionalized, shifting away from inpatient facilities.as a result, patients seek other avenues for treatment, including outpatient facilities and community resources. Unfortunately, those resources have also become increasingly constrained by widespread budget cuts, leaving patients with the health care system's last remaining safety net—the emergency department (ED).

Because EDs are seeing increasing numbers of patients, hospital administrators have recognized the importance of improving throughput and the quality of care delivered in EDs.

The aim of this report is to investigate the gender difference among patient's profile in psychiatric emergency room, assessing the socio-demographic and clinical characteristics, reasons for attendance and practices.

Retrospective and observational study, conducted at Centro Hospitalar e Universitário de Coimbra, during a three month period. Statistical analysis of data with “SPSS 21”.

During the three months period, a total of 2309 patients were admitted in Psychiatric ED, 1485 female and 824 male.

Regarding clinical data, the authors are expecting to find different psychopathology among male and female, as well as psychiatric comorbidities, diagnoses after discharge, treatment conducts, social support and different rates of psychiatric comorbidities.

Factors such as patient's vulnerability, defined by socio-demographic elements, characteristic as the type and severity of their mental illness, social support, treatment adherence, with significant implications of prognosis, costs and care. The conducted study enabled us to outline a profile of male and female psychiatric patients in ED.

The authors have not supplied their declaration of competing interest.

New psychoactive substances (NPS) are drugs that have recently become available, are not worldwide regulated, and often intend to mimic the effect of controlled drugs. α-Pyrrolidinopentiophenone ( alpha-PVP) is a potent stimulant cathinone that is thought to act inhibiting dopamine and noradrenaline reuptake. It has been associated with hallucinations, psychosis and death.

To explore the presence ofalpha-PVP from the samples handled to, and analyzed by energy control.

To determine whether it is a new trend in recreational settings.

all samples presented to energy control were analyzed.

Samples in which alpha-PVP was detected using Gas Chromatography-Mass Spectrometry were selected for study.

a Google trend analysis was also performed to asses the media impact of alpha-PVP.

From a total of 20,062 samples, 33 contained alpha-PVP (0.16%). The samples containing alpha-PVP were mostly sold as such (40%) despite a significant proportion being sold as MDM a (15%). Google trend analysis showed an abrupt increase of alpha-PVP searches in 2015 reaching 50% of the MDM a-ones.

Our results suggest presence ofalpha-PVP in the drug market may be increasing, especially as adulterant of other drugs. Severe side effects might be even more serious considering that a significant proportion of users may ignore which substance they are actually using. However, the total amount of alpha-PVP analyzed remains small, and does not support the alarming reports published in media.

The authors have not supplied their declaration of competing interest.

Frequent attenders (F a) are patients who attend a health care facility repeatedly. The frequency of frequent attendance at emergencies department has been defined as 4 or more attendances/annum. F a are few in number but they produce a high number of attendances.

To determine prevalence of F a, mean attendances/year generated by F a and frequency of visits by months.

a retrospective study was performed on psychiatry's emergency department database from January until December 2013. F a was defined as those with ≥ 4 attendances at emergency services in a year.

Prevalence of F a, attendances’ prevalence, diagnosis’ prevalence, Mean attendances generated by F a and frequency of visits by months were analysed.

among 4824 attendances we found 181 F as (5.98%). Men represented 50.80% and women 49.20%. F a presented a mean of 6.33 attendances/year, while non-F a presented a mean of 1.29 attendances/year.

in accordance with frequency of visits by months, it was observed that number of attendances was increased inapril and May, in both F a and non-F a.

Prevalence of F a was 5.98%, F a generated a 23.74% of attendances. Most prevalent F a’ diagnoses were: anxiety disorder, personality disorder non-specified and schizophrenia.

F a at emergency department contributes to overcrowd them.for this reason, it is important to take into account these results to develop new strategies to improve F a’ attention and prevent its occurrence.

The authors have not supplied their declaration of competing interest.

This is a two years retrospective study conducted on a total of 1000 patients (56.9 females, 43.1 males) randomly selected, admitted in acute psychiatric hospital. From these on 100 patients restraining techniques were applied.

Out of the restrained patients male, younger usually suffering of personality disorder were more frequent restrained. Statistical analysis of restrained group characteristics comparing with larger group of the total patients admitted showed no significant differences between these two groups. Regressive analysis on different clusters found a higher risk to be restrained for patients with agitation and recurrent depressive disorder, male, from urban area. This study draws attention to the importance of a good study design and proper methodology.

The factors which influence the risk of being restrained in acute psychiatric setting are more related with behavior characteristics than diagnosis or demographical items.

The authors have not supplied their declaration of competing interest.

The intention of this study is to show the frequency of the burnout syndrome among the population seen at psychiatric ER for the most severe complication of the burnout, the suicide attempt.

(a) To demonstrate the frequency of burnout among the population examined at psychiatric ER for suicide attempt.

(b) To establish a correlation between the frequency of burnout and:

– the socio-demographic characteristics;

– the psychiatric follow-up;

– the type of personality found.

Descriptive study on a sample of 92 patients examined at psychiatric ER between 01/02/2014 and 01/06/2014 after a suicide attempt, seen by a single doctor. The patients received the Maslach Burnoutinventory (MBI).

The frequency of burnout among the population consulted for suicide attempts is 8.7%. The limitations of this study were: the use of MBI questionnaire only by one doctor and a collection of data carried on a certain period of time.

I managed to characterize the population seen after the suicide attempt induced by the burnout: 88% women; 25% foreign population working in a context with many responsibilities; the predominance of obsessive personality – 50%, followed by anxious personality type – 25%; the suicide attempt was done by a population without psychiatric history and without psychiatric follow-up – 75%; the studied population is divided between patients working in a high responsibility environment – 36% and patients working in the social or the public environment – 63%.

Eighty-eight percent of patients were brought in after their first suicide attempt.

Despite the fact that until now a unanimous definition has not been formulated on the CIM-10, the burnout syndrome is one of the most popular disorders.

The problematic is real, considering that this syndrome, which starts with a psychological distress, can escalade to a self-aggressive behaviour.

The authors have not supplied their declaration of competing interest.

autointoxication with nutmeg in an emergency setting is a rare, but potentially a life-threatening event. Despite the low incidence of ‘tentamen suicidii’ (TS) with nutmeg, this substance is cheap and readily available. Early recognition of a suicide attempt with nutmeg poisoning can be extremely difficult, especially when nobody witnessed the nutmeg intake. Worldwide there are only a few cases reporting TS with nutmeg.

To present a case of TS with nutmeg committed by a suicide attempter.

To review available literature on TS with nutmeg.

a case report is presented and discussed, followed by a literature review.

Five published cases of suicide attempts with nutmeg were found while searching through PUBMED and Embase. Our case describes a 57-year-old female, diagnosed with borderline personality disorder, who has been admitted to the emergency department in a state of agitation, diminished cognition, respiratory difficulties and hemodynamic instability. Electrocardiography showed a fast sinus arrhythmia with no uschemic or hypertropic changes. Blood sampling, serum and urine toxicology did not reveal any abnormalities.in view of the complexity of her condition, she admitted to have taken a large dose of nutmeg. The patient was kept for observation, offered reassurance, and rehydratation.

The presentation of inexplicable clinical state accomplished by disturbances of central nervous, respiratory and hemodynamic systems in the population of patients with attempting suicide should alert the physician to the rare but probably underreported possibility of nutmeg autointoxication.

The authors have not supplied their declaration of competing interest.

inhaled loxapine has shown efficiency in the treatment of the mild-moderate agitation syndrome of schyzophrenia and mania patients. Its rapid response and calming effect non-sedative allow to hypothesize reasonable efficiency and tolerability in borderline personality disorder diagnosed patients.

analyze the efficiency and tolerability of inhaled loxapine as a pharmacological approach in the treatment of agitation in borderline personality disorder (BPD) clinical diagnosed patients.

an application was administered for every agitation episode in BPD patients treated with inhaled loxapine in the emergency room or the psychiatric ward, which included B aRS and CGI-S scales for the evaluation of each episode and its severity, before and after its use. Other secondary measures of efficiency were taken into account, such as requirement of physical restrain.

in the majority of evaluated episodes inhaled loxapine decreased notably initial B aRS and CGI-S values and no serious clinical side effects attributable to this medication were observed.

in our sample, inhaled loxapine was efficiency and well tolerated pharmacological intervention for agitation in BPD patients.

The authors have not supplied their declaration of competing interest.

agitation is a frequent and complex emergency. Prehospital management of agitation requires appropriate measures to preserve patients’ safety, stabilize the patient and alleviate suffering, and transfer to the hospital psychiatric services, including involuntary admission if needed.

To describe the incidence and management of agitation by the emergency medical service of Castilla y León (S aCyL) in an area of Valladolid.

Retrospective study of all psychiatric emergencies attended by a prehospital emergency medical service in 2014.

one hundred and twenty-one emergencies were attended over a catchment area that covered 170,000 inhabitants (1.4/1000 inhab.). Overall, 55% were men, mean age was 45 years, 60% were considered psychiatric, 29% organic and 11% mixed. However, men had a higher frequency of organic (39%) compared to psychiatric (48%) agitation than women (16% and 75%, respectively), and most of them were related to alcohol or drug use.among patients with psychiatric or mixed agitation 81% had psychiatric history and the pharmacologic treatment most frequently used was intramuscular midazolam.

The incidence of acute agitation accounts for almost half of the total psychiatric emergencies in the prehospital setting. Since there are different healthcare providers in charge, specific protocols as well as treatment procedures are needed to provide the most adequate management, in order to ensure the best psychiatric emergency chain.

The authors have not supplied their declaration of competing interest.

Mechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. There are not clinical studies that compared if there are differences of the frequency of the specific indication for the mechanical restraint.

The aim of this study is to explore the differences of frequency of each indication of mechanical restraint on patients on the psychiatry acute and dual pathology units.

we reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of Neuropsychiatry andaddictionsinstitute of the Parc de Salut Mar de Barcelona, between January 2012 and January 2015. The episodes of mechanical restraint, the specific indications for them and the DSM-IV diagnostic were coded. Then, was calculated the frequency and proportion of mechanical retrains in the most common diagnostic groups.An ANOV a was performed:

– risk of self-aggressiveness;

– state of self-aggressiveness;

– risk of hetero- aggressiveness;

– state of aggressiveness;

– risk of psychomotor agitation;

– state of psychomotor agitation;

– acute confusional state;

– fall risk;

– risk reduction on therapeutic interventions;

– avoid pulling out of life support systems;

– facilitate administration of drug treatment;

– patient voluntarily requests it;

– high-risk of escape.

The number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint associated.

The authors have not supplied their declaration of competing interest.

Ciudad Real is an area of approximately 500,000 inhabitants, with a University Hospital and several district hospitals. Psychiatric services and emergencies are centralized in the University Hospital. we analysed the totality of area admissions during 2014, establishing different categories according to ICD 10 diagnosis.

we want to compare different categories of patients who are admitted to hospital (severe mental illness versus non-severe mental illness), morbidity in different areas and readmission rates according to diagnosis.

To establish a correspondence between attention and severity of psychiatric pathology, diagnostic criteria and how we manage both severe and non-severe mental illness and the repercussion in terms of assistance and pressure in psychiatric emergencies.

initially, we made a simple statistic analysis of all admission (400 approximately) in 2014 based on ICD-10 diagnosis, socio-demographic parameters, area, admission stay, number of admissions. we compare both groups: severe and non-severe mental illness according to international criteria. we apply a Pearson correlation searching for relation between severity and attendance to psychiatric emergencies.

around a 60% of admissions are not due to severe mental illness, these conditions have twice the readmission rate than severe mental illness. we did not find a correlation between attendance to psychiatric emergencies and severity of the condition. Other factors seem to have an important role in re-admissions.

Non-severe mental illness is consuming an important part of emergency psychiatric resources. Criteria of admission need to be reviewed or apply rationally.

The authors have not supplied their declaration of competing interest.

It is estimated that on average up to 50% of patients are non-compliant with their medication, resulting in 28% emergency room visits costing about $8.5 billion annually.

The purpose of this study was to examine, what, if any, differences there are between medical versus psychiatric non-compliant patients with regard to use of the emergency department (ED).

a random sample of patients who present to the ED for medical or psychiatric illnesses and who state that they were non-compliant with their medicine were given the National Healthaccess Survey. They were asked about sources of medical care, drug compliance and reason for non-compliance.

There were a total of 300 participants in the study. There was no significant difference in the reason both medical and psychiatric patients gave for being non-compliant with their medications that resulted in their ED visit. Each group cited cost as the number one reason for not taking their medication as prescribed. The psychiatric participants who were more likely to get admitted disposition (P = .00), not afford mental health care (P = .01), were not able to get care from other places and used the ED for their psychiatric care (P = .02).

There was no difference between the two populations with regards to their reasons for non-compliance that brought them to the ED. Non-compliance of the psychiatric patients compared to the medical patients lead to a higher admission rate.

The author has not supplied his declaration of competing interest.

The prevalence ofaDHD in adult population has been estimated at 2.5%. Higher rates (23.9%) have been reported among adult mental health service ( aMHS) users.

To estimate the prevalence ofaDHD among adult MH users in west county Ireland.

all consecutive patients attending any of 5 Sligo/LeitrimaMHS were invited to participate. Participants completed theadultaDHD Self-Report Scale ( aSRS) and the wender Utah Rating Scale (WURS). Clinical notes were reviewed to identify those with preexistingaDHD diagnosis. Exclusion criteria applied were: age: less 18 or above 65, illiterate, non-English speaking patients.

From 792 attending the clinics, n = 59 (47 aged above 65, 10 severe learning difficulties and 2 non-English speaking) were excluded. Ninety-three (11.7%) decline to participate, giving a total of n = 640 (87% eligible response rate). Mean age was 41.27 (SD: 12.8), and 336 (52.5%) were females. Three had diagnosis ofaDHD. Two hundred and thirteen (33.8%) met criteria on the WURS for childhood onsetaDHD and 238 (37.5%) participants met caseness on theaSRS.applying more stringent criteria of scoring on both scales, suggested 125 (19.5%) with unrecognisedaDHD.

While recall bias (WURS) and the possibility of overlapping symptoms with other major psychiatric disorders in adulthood need to be considered, the use of both screening reduces these confounders and suggests a very high rate ofaDHD. Given the low number previously identified, this becomes a clinical priority, both to offset the negative trajectories associated with untreatedaDHD, but also to effect optimal treatments in comorbid conditions.

The authors have not supplied their declaration of competing interest.

Social networks allow individuals to express themselves, and establish or maintain connections with others. Using social networks like Facebook may be associated with a sense of self-worth and may play an important role in psychological development of university students who are in emerging adulthood phase.

1. (1) Assess the psychological well-being of Saudi university students using social networks (Facebook).

2. (2) Explore whether the relationship between Facebook use and bridging social capital is different for individuals with varying degrees of self-esteem and satisfaction with life.

To study the psychological well-being of Saudi university students using social networks (Facebook).

An electronic survey was published in the community site for all students of King Saud University. in addition to the demographic information, the survey evaluates Facebook use intensity, bridging social capital and psychological well-being: self-esteem and satisfaction with life.

A total of 1005 students completed the survey, of which 50.5% were female. Majority of them were members in Facebook (92.1%).

Results showed no significant correlation between the use of Facebook and psychological well-being. It could be due to the fundamental difference between Arabs and other cultures or due to the use of other social networks. There was a positive relationship between bridging social capital and psychological well-being with being in preparatory year, which is most likely because advanced years has more workload preventing students from participating in King Saud University community. A longitudinal study over a series of years and addressing other popular social networks would be the next step.

The authors have not supplied their declaration of competing interest.