Quality of life (QoL) is increasingly considered an important outcome in health research. We wished to explore the determinants of change in QoL in patients with schizophrenia over the course of a one-year RCT.

Predictors of change in observer-rated QoL (Quality of Life Scale: QLS) were assessed in 363 patients with schizophrenia during the CUtLASS clinical trial.

Change in QLS score over the course of a year correlated with change in psychotic and depressive symptoms and treatment adherence. Linear regression showed that improvement in QoL was predicted by reduction in negative and depressive symptoms and improvement in adherence rating. These three change scores together explained 38% of the variance in QLS change. Exploration of the direction of any possible causal effect, using TETRAD, indicated that improved adherence leads to improved QoL, and that change in depression also leads to QoL change. The relationship between QoL and negative symptoms suggests that greater social activity (reflected as better QoL scores) improves negative symptoms. Such a direct relationship between treatment adherence and QoL has not been reported before.

Improving adherence to medication would appear to be a key approach to improving measured quality of life in people with schizophrenia.

Angioedema is a rare but potentially life-threatening adverse effect of antipsychotics. The late-onset angioedema is a rare clinical condition which occurs months or years after.

To describe the case of a female patient who developed late-onset angioedema following treatment with clozapine after 5 years and redevelopment of angioedema with introduction of olanzapine which resolved on discontinuation of both drugs.

A case report

27-year-old woman was diagnosed with psychotic disorder and mental retardation five years ago. Her clinical condition was going well with clozapine 150 mg/day. At one of her follow-up visits, the physical examination revealed swelling over the face and eruption on perioral region. A diagnosis of ‘acute angioedema’ was established. After discontinuation of clozapine, skin symptoms were resolved within one week and olanzapine was started. Few days after introduction of olanzapine, the same skin symptoms emerged over the face and repeated laboratory tests were unremarkable. Skin scratch test revealed hypersensitivity with the medications of clozapine, olanzapine and sulpiride. Olanzapine discontinued and quetiapine 900 mg/day was started. She remained well under quetiapine therapy without any recurrence of psychiatric symptoms or angioedema.

To our knowledge, this is the first reported case of late-onset angioedema due to clozapine monotherapy. This case report indicates the need for clinicians to be aware of late-onset adverse events in patients treated with antipsychotics.

Hyperbradykininemia was reported in case of angioedema and dry cough as an adverse effect of angiotensin-convertingenzyme (ACE) inhibitors. There is a possibility that the choking sensation, shortness of breath, or smothering sensation in anxiety nurosis could be induced by bradykinin (BK). We sought to examine plasma-BK concentration of Generalized Anxiety Disorder (GAD) and postulated a new concept of anxiety disorders.

We identified 11 GAD patients. All subjects had signed written informed consent. We measured inflammatory markers (WBC, ESR, CRP), C1-inhibitor activity and circulating BK (normal values : < 10.0 pg/ml). Anxiety was measured using the Hamilton Anxiety Rating Scale (HAM-A).

No abnormalities were found in WBC, ESR, CRP and C1-inhibitor activity. There were substantial rises in BK in GAD with a mean plasma-BK concentration of 100.1 pg/ml (SD=44.6). There was a significant correlation between HAM-A and plasma-BK concentration in the 11 GAD patients, expressed by the regression: BK=5.10(HAM-A)-51.5, r=0.62, p<0.05.

11GAD patients did not have any focal infection but presented hyperbradykininemia and free-floating anxiety. The symptoms of free-floating anxiety could be explained by the nature of BK which acts to produce pain, vasodilation, increased vascular permeability, and synthesis of prostaglandins. Therefore, GAD may be termed a diffuse nociceptive state, or an incomplete inflammatory state uncoupling from other inflammatory markers.

We would like to consider a single model which posits that hyperfunction of suffocation receptors in the lung could be the cause of Panic Disorder (PD).

The pulmonary neuroepithelial bodies (NEBs), which are situated at the bifurcation point of small bronchi, act as O2 sensors responding to a number of airway stimuli, including hypoxia, hypercapnia, and smoking, and release 5-hydroxytriptamine (5-HT) from their secretory granules. If we suppose that PD might represent an inflammation of the NEBs, bradykinin (BK) which augments the airway hyperresponse to diverse inducers might cause these cells to release 5-HT along with peptides and panneuroendcrine markers from their secretary granules.

Since it was revealed that BK with 5-HT could cross the blood-brain barrier (BBB), when 5-HT released from NEBs along with BK cross the BBB, the serotonergic neurons will be inhibited by the 5-HT1A autoreceptors. It is easy to suppress the periaqueductal gray (PAG), which inhibits flight reactions to impending danger, pain or asphyxia. In short, the hyperfunction of inflammatory NEBs might bring about panic reactions.

PD could be a lung desease that affects the brain directly and reversibly through the effects of 5-HT with BK. Future therapies for PD might be inhalants that can stabilize inflammatory NEBs, inhibit 5-HT release and BK receptors.

Dyslexia is a reduced reading comprehension despite normal IQ. This may affect sufferers’ ability to be competitive in high end degrees. We investigated the prevalence of dyslexics in 4 degree disciplines.

4 cohorts were analysed consisting of Engineering, Medical, Law, and Dentistry students. These were all students drawn from UK universities. They were polled, voluntarily through an online resource. Qualitative and Quantitative data was collected and analysed. Due to data collection being by way of a poll, ethical approval was not required

18 Engineering, 46 Medical, 22 Law and 11 Dentistry students responded. Of these 5/18 (28%) Engineering students classified themselves as dyslexic in comparison to 7/46 (15%) Medical students, 1/22 (5%) Law students and 1/11 (9%) of Dentistry students. Qualitative analysis showed the importance of teachers in the pre university years. Students felt they benefited from extra time in exams and that this ‘leveled the playing field’.

This study is limited by self-reporting of dyslexia, and the potential for respondent empathy to the subject.

This study highlights a larger than previously reported prevalence of dyslexia in high performing disciplines, markedly Engineering. Other studies have focused on dyslexics IQ-reading gap, and our results support this, with Law – a literature intensive subject, actually having the lowest prevalence. Engineering focusses on mathematic methods, and the increased dyslexic prevalence suggests they are more comfortable with subjects not focused on reading.

To investigate psychiatric implications of aesthetic surgery on adolescents.

Aesthetic surgery is carried out on adolescents for many reasons, often with a central aim being to aid their social inclusion and interaction. However there is anecdotal evidence that suggests stigma associated with this causes psychiatric repercussions for the children alter in life

4 patients who had undergone aesthetic surgery due to trauma in their adolescent years were interviewed. Their responses were then qualitatively analysed. This was approved by Meducation ethics committee.

3 of the patients felt that the surgery had benefitted them and that they had adequate psychiatric support to deal with the impact of the surgery, 1 didn’t. All patients feel they have current impaired mental health as a result of having the surgery. All 4 feel this is not as bad as if they had not had the surgery. We also investigated the way they spoke about their surgery, and found the 1 patient who had not received psychiatric support was more outspoken regarding the surgery, in comparison to the other 3 patients more composed responses.

Long term psychiatric outcomes of adolescent patients undergoing aesthetic surgery for trauma injuries are improved with postoperative psychiatric support.

‘Werther effect’ is a term synonymous with suicide clusters, following a trend for suicide instigated by a historic book. Depending on cluster size, they can be named’point’ or’mass’ clusters. These phenomena, typically affecting adolescents, can have substantial emotional consequences for a community. There is a paucity of comprehensive literature in this area, hence our aim was to investigate cluster triggers and demographics.

A comprehensive review using a PubMed search was undertaken. Search terms were’suicide cluster’,’recent suicide’ and’suicide outbreaks’. As this was a review paper ethical approval was waived.

Saman et al (1992) describe two ‘high risk’ spatial clusters which translated to a 38% increase in relative suicide risk. They also describe how suicide method is remarkably consistent within a cluster supported by Exeter and Boyle (2006). Qi et al (2006), in comparison to Saman et al, demonstrated how clusters may have variable risk groups, with differing correlations between age of females and suicide rates. All studies highlighted the central part media played in commencement of suicide clusters.

With globally increasing levels of mental health issues, the recession and other demands of 21st century living, rates of suicide could increase and knowledge in this area is therefore vital at the level of government resource allocation and for the health care professionals delivering care on a daily basis. We found a strong correlation with media exposure and subsequent suicide clusters.

A sound working knowledge of the neurosciences is essential for a functional psychiatrist. It is, however, a subject renowned for being difficult for students to understand. This study investigated the benefits of peer to peer teaching in psychiatry, as either an adjunct or replacement to areas of the current curriculum.

Medical students from throughout UK were invited to respond to an online poll provided through a free to use educational interface for medical students. Questions were designed to give both quantitative and qualitative results. Ethics approval granted by Me ducation.

Data collection took part over 2 days, during which time total visitors to the site were 624. Of these 378/624 clicked the link to the external questionnaire, and 192/624 (31%) filled out the questionnaire.

Quantitative data suggested students no benefit in direct peer to peer teaching 145/192 (76%), but felt exchanging of resources is of benefit 178/192 (93%). Further analysis demonstrates a lack of centrality for such resources.

Qualitative data goes on to prove Psychiatry is a subject considered by students to be ‘hard gain’. This relates to students having to study longer to achieve a similar mark for a subject considered ‘middle or low gain’.

It is important for students to feel supported in subject areas they feel less confident. This could UK wide student resource sharing. Student produced neurology teaching resources should be made available on a UK wide level on an open access website to support student development in the psychiatry.

the objective of the present study was to examine the clinical correlations of unawareness of mental disorder in psychotic patients.

The clinical symptoms using the Positive and Negative Symptoms Scale (PANSS), demographic data and unawareness of mental disorder (SUMD) for the 120 psychotic patients was evaluated.

the psychotic patients were significantly different in insight quality. Data analysis revealed that unawareness of mental disorder has significant correlations with positive symptoms and thought disturbance. There was no significant correlation between depression and unawareness of mental disorder. Investigation of dimensions of unawareness of mental disorder with all clinical variables in psychotic patients separately, show different results.

the results show that quality of unawareness of mental disorder is different in psychotic patients. Subcomponents of unawareness of mental disorder are influenced by different factors (such as positive and negative symptoms) emphasizing the need to consider insight as multidimensional.

Juvenile Idiopathic Arthritis (JIA) describes arthritis occurring under the age of 16. Pain has long been acknowledged to be associated with psychiatric morbidity. There is a paucity of psychiatric research into the long term outcomes and management benefits for this cohort. Hence we aimed to review what was currently known, to enable a thorough research study to take place.

PubMed search was carried out using search terms’JIA and psychiatry’,’Arthritis and psychology’,’long term effects of JIA’,’JIA psychiatric management’. The papers sourced were ranked in accordance with ICJME guidelines and reviewed. Ethics was waived as this is a review.

The findings highlight a high prevalence of depression in amongst JIA sufferers, with 50% experiencing depression into adult life. Somatoform disorders are also more common in JIA sufferers. Currently there is no uniform management strategy integrated into the JIA package, although it is considered more than we hypothesised.

This review thus emphasises the necessity of ensuring paediatric psychiatric management is within the care package offered to JIA patients, particularly as our paper discusses how 50% of patients continue to have symptoms in their adult life, thus impacting on their long term psychiatric status.