Adherence to practice guidelines for diagnosing and treating attention-deficit/hyperactivity disorder (ADHD) by primary care providers (PCPs) is important for optimizing care for many children and youth. However, adherence is often low. To address this problem, we implemented an intensive intervention in 2009 aimed at improving diagnosis and management of ADHD among PCPs.

The study objective is to assess the sustainability of intervention-attributable outcomes.

The study aims are to assess the sustained effect of the intervention on PCP intentions to implement, attitudes toward, and obstacles to implement ADHD practice guidelines.

During November 2009, 48 PCPs from 31 clinical practices completed a 3-day training, 6 months of biweekly telephone peer group reinforcement, and baseline questionnaires; follow-up questionnaires were completed at 12 months. To assess sustainability, we tracked PCPs and administered the questionnaire in 2016.

Intentions to implement ADHD guidelines remained stable over seven years, with all mean values ranging from “probably will” to “definitely will” implement guidelines.

Generally, favorable self-reported intentions (see Exhibits 1 & 2), attitudes and obstacles to implementing ADHD guidelines were sustained seven years after the intensive training and follow-up intervention.

The authors have not supplied their declaration of competing interest.

To examine the role and scope of practice of community mental health workers (CMHWs) as well as the impact and challenges associated with of work of CMHWs within Ghana's mental health delivery system.

A cross sectional survey of 11 psychiatrists, 29 health policy directors and 164 CMHWs as well as key informant interviews with 3 CMHWs, 5 psychiatrists and 2 health policy directors and three focus group discussions with 21 CMHWs. Results of quantitative data were analysed with SPSS version 20 whilst the results from qualitative data were analysed manually through thematic analysis.

In addition to duties prescribed in their job descriptions, all the CMHWs identified several jobs that they routinely perform including jobs reserved for higher level cadres such as medication prescribing for which most of the CMHWs have no training. Some CMHWs reported they had considered leaving the mental health profession because of the stigma, risk, lack of opportunities for continuing professional development and career progression as well as poor remuneration. Almost all the stakeholders believed CMHWs in Ghana receive adequate training for the role they are expected to play although many identify some gaps in the training of these mental health workers for the expanded roles they actually play. All the stakeholders expressed concerns about the quality of the care provided by CMHWs.

The study highlights several important issues, which facilitate or hinder effective task-shifting arrangements from psychiatrists to CMHWs and impact on the quality of care provided by the latter.

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

The authors have not supplied their declaration of competing interest.

The fit note, introduced in England, Wales and Scotland in 2010, was designed to radically change the sickness certification process from advising on individuals’ inability to work to what they could do if adjustments were made available. Our review aimed to evaluate: (1) the percentage of fit notes utilizing the new “may be fit for work” option or advising on work adjustments, (2) the impact of the fit note on sickness absence and return to work, (3) demographic variation in fit note use.

We systematically searched in Embase, Cochrane CENTRAL, Pub Med, Worldcat, Ovid and PsychInfo from 1 Jan 2010–30 Nov 2016 for studies on working aged adults which included the search terms “fit note” or “fitnote”. Relevant abstracts were extracted and we assessed the quality of the papers and assessed bias using the modified Newcastle Ottawa Scale.

Nine papers met the inclusion criteria, four of which were based on the same cohort. Maybe fit notes made up just 6.6% of all fit notes. Work adjustments were most often recommended for patients who were less deprived, female and patients with physical health problems. Fit note advice for patients with physical health problems increased over time, but the opposite was seen for patients with mental health problems.

Further research needed to evaluate the use, impact and potential of the fit note, especially for patients with mental illness.

The authors have not supplied their declaration of competing interest.

The Mental Health Act (MHA) 2007 made some significant changes from the Mental Health Act 1983, including the fact that detention is now only allowed if an appropriate medical treatment is available to the patient at the time [1]. There was considerable concern at the time that the 2007 Act would lead to an increase in detentions.

The primary objective is to assess how the change in the English law with the MHA 2007 has affected the number of detentions under the MHA.

A retrospective, observational and noninterventional study used anonymised and routinely collected data regarding 11,509 people who were formally assessed under the Mental Health Act during the period of 2001–2011 in the county of Norfolk. This included 7885 assessments before the 2007 MHA and 3620 done after implementation.

The proportion of people detained following assessment decreased from 53.2% before the 2007 MHA to 42.9% after implementation (P = .000). The total proportion of patients admitted (whether informally or detained) also decreased from 63.3% before the 2007 MHA to 52.8% thereafter (P = .000).

These results show a significant decrease in the rate of detentions under the MHA since the 2007 Act became law.

The authors have not supplied their declaration of competing interest.

In Italy, considerable variations exist in the organisation of out- and in-patient mental health care. One main issue is whether to prioritise specialisation (distinct clinicians for inpatient and outpatient care) or personal continuity of care (same primary clinician for a given patient within the two settings).

To study the use of psychiatric in-patient units in the Veneto region (Italy) and to evaluate differences between personal continuity of care and specialization systems.

Study conducted in the context of the COFI, multisite naturalistic EU-funded research aiming to compare the two care approaches in 5 European countries. In Italy, baseline data collection was carried out in 14 in-patient units. Data on hospitalisation, diagnosis, severity of the illness (Clinical Global Impression Scale- CGI) and patients’ appraisal of inpatient care (Client Assessment of Treatment Scale- CAT) were collected.

Overall, 1118 patients were assessed. Most frequent diagnostic categories were mood (41.6%) and psychotic (38.3%) disorders, while anxiety disorders were less represented (11.9%). The majority of patients were at least at their second admission (69.4%) and had been voluntary admitted (91.5%). Length of stay and CGI scores were significantly higher for patients with mood and psychotic disorders. No difference in CGI score between the two systems was found. Patients in the continuity of care systems reported higher level of satisfaction with initial treatment and longer hospital stay (P < .001).

These preliminary findings suggest higher service satisfaction for personal continuity system, possibly reflecting a more individualised and comprehensive focus on the patient's needs, rather than on symptoms reduction only.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

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

We present the case report of a 21-year-old Chinese female, who was brought to the emergency department. We open the debate between the operative criteria stablished by DSM-5 of the clinical entity dissociative amnesia and Shenjing Shuairuo - the Chinese “culture-bound syndrome”.

To expose the relevance of the cultural formulation in the clinical evaluation of patients with a different non-Western culture in Psychiatry.

The Shenjing Shuairuo syndrome (“nervous system weakness”) was originally descripted in China, it has a gradual onset, usually after a stressful event. It involves a minimum 3 of 5 symptoms group: weakness, emotions, excitement, neurological pain and sleep. This complex group of symptoms overlap with dissociative syndrome such as dissociative amnesia.

The cultural formulation interview (CFI) was used for the diagnostic and subsequent treatment of dissociative amnesia with fugue in a different culture patient who met the clinical criteria of this two divergent clinic entities.

In our clinical practice, we will deal with different culture patients, who could present common clinical entities or with the so-called “culture-bound syndromes”. The cultural formulation of the clinical cases will help the clinicians to diagnose and have better treatment's options in clinical manifestations do not correspond to the conventional entities included in mostly Western-based nomenclatures.

The authors have not supplied their declaration of competing interest.

(1) Understand the predicament of refugees including risks to mental health, coping strategies and mental health consequences, (2) know the evidence for the emergence of mental illness in refugees and the effectiveness of multi-level interventions, (3) become familiar with published guidelines and gain a working knowledge of assessment and management of psychiatric conditions in refugee populations and cultural idioms of distress.

How will the participants receive feedback about their learning? Participants will have direct feedback through answers to questions. The authors welcome subsequent communication by email. Presenters can give attendants handouts on pertinent and concise information linked to the workshop.

The authors have not supplied their declaration of competing interest.

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

The burden of mental health impairment in medical students is an important research subjects. Evidence shows that medical students have a higher prevalence of symptoms of depression and anxiety than the general population. A number of studies regarding suicidal ideation among medical students have been carried out, but this topic has largely been ignored in regard to international medical students coming from Western European countries studying medicine in Eastern European countries. Suicidal ideation is the early symptom of suicidal actions. The students are the most vulnerable and easily influenced by cases of suicide, especially in a closed group with little connections with the general population like the international students.

Following 2 suicides in our university, we aim to measure the prevalence of suicidal ideations in international students.

Overall, 150 medical students from the French section studying at the University of Medicine and Pharmacy “Iuliu Hatieganu”, Romania, were evaluated for symptoms of depression using BDI and for suicide ideation using Beck HS.

Suicidal ideation was present in 28.57% of the French international medical students. Depression and the lack of social support had a significant relationship with suicidal ideation.

Suicide is a serious issue that has to be dealt with immediately. It is important to assist medical students who are considering the possibility of committing suicide, so that they overcome their difficulties. There is a need to identify the prevalence of suicidal ideation among medical students and for student counselling.

The authors have not supplied their declaration of competing interest.

In 2006, prior to the worldwide economic crisis which especially affected Western countries, Southern Spain was one of the illegal immigrant gateways from Africa into Europe. The aim of this study is to establish the rate of homeless immigrants in a cohort of 2006 and carry out a follow up until 2015 in order to explore the chronicity associated to the territory.

Sample: 949 persons experiencing homelessness in Girona, according to official records. Procedure: prospective longitudinal study of the total population of homeless people in Girona. In 2006, a list was made of all the homeless people detected by both specialised and nonspecialised teams, which have been followed until the present day. Instruments: data bases of different official teams. Statistical analysis: measures of central tendency and dispersion and contingency tables were used for the comparison of qualitative variables.

Overall, 64.8% of the population of Girona are immigrants (n = 614), principally from the Maghreb, (χ2 = 36.9, df = 4, P < .001) and 333 (36.3%) are autochthonous. The percentage of homeless immigrants in relation to the total immigrant population was 4.4%. Comparing the homeless autochthonous population with the total of the autochthonous population, homelessness among autochthonous population was 0.4%.

The results suggest that homelessness was more incidental in the immigrant group than in the autochthonous group. The percentage of immigrants who still live in homeless conditions suggests that immigration is a risk factor in the chronicity of the problem.

The authors have not supplied their declaration of competing interest.

In recent years, there has been an increase in migration in Europe. Particularly, Italy has been one of the most important landing place. Currently, migrants in the province of Avellino, South Italy city, amount to about 1400, housed in 40 facilities in 23 municipalities. Psychological interest on migration and its impact on lifestyle patterns has increased in recent years.

There are few studies that evaluated the frequent psychosomatic symptoms in these populations. Despite the trauma experienced, they are not able to give a name to the suffered and somatized pain.

Assessment of somatic symptoms reported by the immigrant cohort after a three-month observation period.

We included 50 migrants (21.3 mean years) hosted in emergency centre in Avellino, Italy. All guests have conducted psychological clinical interviews. At baseline, were administered following scales: the patient health questionnaire (PHQ-9); Illness Behaviour Inventory (IBI); Symptoms checklist-90-Revised (SCL-90-R) scale. Same data was collected after three months.

The migrant group was a heterogeneous group. Overall data on IBI and PHQ-9 scale indicate a statistically significant variation baseline vs deadline Data of IBI scale is statistically significant [T-Score: 3,921; P: 003]; also with PHQ-9 [T0 vs. T1: T-Score: 3,986; P: .003]. Similar results have been found with SCL-90-R.

In their vocabulary, terms such as anxiety, sadness, fear exist hardly. They tend to minimize the psychological pain, not because I do not feel, but because move it on the body. They have difficulty to talk about emotions, not just a matter of culture and language, but also because they are ashamed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Over one percent of the world's population are currently uprooted. Over half of the world's displaced population are children.

There is considerable evidence that refugee children are at significant risk of developing psychological disturbance as they are subject to a number of risk factors.

Consistent research findings show that as the number of risk factors accumulates for children, the likelihood that they will develop psychological disturbance dramatically increases.

Traumatic events can have an effect on a child's emotional, cognitive and moral development because they influence the child's self-perceptions and expectations of others. The multidimensional effects of trauma on children and their families are compounded by forced uprooting, multiple losses and the myriad changes brought about by migration. Mental health services can be key to restoring basic psychological functioning and to supporting resilience and positive coping strategies for children, adolescents and adults.

Refugee children are a silent group that are easily overlooked. Our attitude toward young refugees and their families will determine the burden of trauma, not only on their adult future but also on our community.

An empathic and mentalizing attitude, secure sheltering, addressing health and educational needs will create a sense of stability and confidence. This is the very first step to favour, for these future adults.

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

Children's abuse and neglect is widely studied as a major risk factor for emotional and behavioural disorders, various somatic and psychiatric problems during adulthood.

Mental health is fundamental to health. Mental illnesses are real, disabling conditions affecting all populations regardless of race or ethnicity but disparities in mental health services exist for racial and ethnic minorities, and thus, mental illnesses exact a greater toll on their overall health and productivity.

The most important aim when working with ethnic minorities is to better understand the roles of culture, race and ethnicity, and overcome obstacles that would keep anyone with mental health problems from seeking or receiving effective treatment.

The Day Centre “The House of the Child” is a community unit which provides customized clinical mental health services for therapeutic treatment and psychosocial rehabilitation of children victims of abuse, neglect or domestic violence. The Day Centre was founded by the non-profit voluntary organization “THE SMILE OF THE CHILD”. The services are based on the bio-psycho-social model approach and treatment, which aim at early detection, and treatment of possible mental disorders and the overall psychosocial rehabilitation of victims of abuse/neglect and the support of their carers.

By identifying the many barriers to quality care faced by racial and ethnic minorities, the Day Center provides mental health services also to children who come from minority populations.

Different case studies highlight challenges and various levels of difficulties in this specific scheme of cooperation aiming to open an interesting dialogue on the topic.

The authors have not supplied their declaration of competing interest.

The needs of refugees are of pivotal concern internationally. Relational trauma, in particular, is an area that is under-emphasised and under-researched. The strength to strength program (STS) was a rare, innovative relationship and family counselling service for recently-arrived refugees in Sydney, Australia during 2006–2014. The service model built on post-Milan systemic family therapy principles to include innovative cultural and trauma-informed aspects of care.

We were interested in the experiences of staff who delivered the program, and the ways in which more traditional, Western-informed modes of family therapy were transformed by the needs of refugee clients.

To identify and describe transformations to the delivery of relationship and family counselling with refugees that enabled care, from the perspective of staff.

A thematic analysis, guided by interpretive description, of individual interviews and focus groups with STS service staff (n = 20), including family therapists, bicultural workers and managers.

Key themes pertaining to innovative aspects of the relationship and family counselling service provided by STS staff will be outlined and lessons for future service provision in this space considered.

STS is an example of staff-driven innovation to the therapeutic care of refugee families resettling in Western countries, taking into account the unique and complex set of cultural, practical and psychological needs. Important and timely lessons for future service delivery can be drawn from qualitative inquiry into the experiences of staff who deliver such programs, with refugee numbers continuing to increase internationally.

The authors have not supplied their declaration of competing interest.

Over 1,5 million of them are Ukrainians who were forced to leave their home after Crimea annexation and military conflict in the East of Ukraine.

By 2015, the University Clinic asked 156 people displaced from Lugansk and Donetsk regions. Reasons treatment: all patients were somatic complaints. In screening: using the scale hospital, all patients were found higher rates of anxiety and depression. Overall, 48% of patients abandoned psychiatric examination, even 24% of psychological counseling.

Screening of IDPs’ mental health who sought medical help in somatic clinic (University clinic KhNMU) and estimation of efficiency of interdisciplinary treatment and complex rehabilitation.

Psychodiagnostical, clinical-psychological, clinical-psychopathological.

Clinical examination during the period of acute stress reactions was observed, dominated by anxiety disorders, prolonged depressive reaction. Anxiety disorders were found in 56.5%, prolonged depressive reaction in 32.0%, post-traumatic stress disorder in 10.5% of patients. The treatment of the underlying disease, complex psychological and physical rehabilitation. Psychological rehabilitation included CBT, relaxation, art therapy. Physical rehabilitation includes kinesiotherapy and TRE. A set of measures of physical rehabilitation led to reduction of anxiety to physiological levels in all mentally healthy patients, reduce the severity of psychosomatic symptoms in the structure of the underlying disease, increased satisfaction with the results of treatment by 28.5%.

Analysis of mental health study of IDPs and evaluation of comprehensive rehabilitation in terms of the University Clinic show the need for screening mental state when applying for medical assistance and the desirability of psychological and physical rehabilitation of patients during hospital stay somatic profile.

The authors have not supplied their declaration of competing interest.

Differences between the most frequently reported diagnoses of Greek people and immigrants in Greece are expected due to the different underlying factors which are associated with mental health issues.

Examine differences in diagnoses between Greek people and immigrants.

To investigate whether Greek people and immigrants had significant differences with regard to reported diagnoses in a Greek hospital.

The patients who participated in this study are 5551, among them 2760 (49.7%) were males and 2791 (50.3%) were females. The mean age of the sample was 45.54. The sample consisted of 455 (8.3%) immigrants and 5,042 (91.7%) Greek people. Convenience sampling method was used and the sample was collected at the General Hospital of Nikaia, “Ag. Panteleimon” in Athens, Greece, between 01/01/2012 and 31/12/2015.

There were significant differences between Greek people and immigrant with regard to diagnosis as χ2 (20): 136.875, P < 0.001. More specifically, among Greek people, the most frequently reported diagnosis was psychotic disorder (26.2%), followed by depression (24.7%), general anxiety disorder (9.9%) and substance abuse (8.4%). Among immigrants, the most frequently reported diagnosis was psychotic disorder (22.9%), followed by substance abuse (21.3%), depression (17.4%) and general anxiety disorder (12.1%).

The differences between Greek people and immigrants with regard to diagnoses showcase the different needs between the two populations with regard to mental health. Especially, the higher prevalence of anxiety disorders and substance abuse problems among immigrants highlight the need for protective measures to improve their well-being and reduce their risk of mental health issues.

The authors have not supplied their declaration of competing interest.