Traumatic experiences are a decisive factor for the manifestation of dissociative symptoms and, in turn, dissociative symptoms are often part of severe psychopathology.

Given the lack of research in Portugal examining dissociation and trauma in patients with Schizophrenia and Bipolar Disorders, we intended to determine if these patients dissociate and what kind of traumatic experiences they had, to analyze associations between dissociation and trauma, and check if there are differences by gender and formal education.

We assessed, through Dissociative Experiences Scale and Traumatic Experiences Checklist, 30 patients (M ± SD age = 42.6 ± 12.38; range 20-65 years) with Schizophrenia (n = 22) and Bipolar Disorder (n = 8) from a Residence for mentally ill (Mini International Neuropsychiatric Interview confirmed diagnoses).

Twelve patients (40%) revealed pathological dissociation (M ± SD = 33.52 ± 17.74), scoring highest in DES absorption factor, and had more traumatic experiences between 7-12 years of age. Dissociation correlated moderately with traumatic experiences (?? = 0.40). Significantly, women had more dissociation and traumatic experiences (M ± SD = 34.55 ± 18.60; 2.14 ± 2.53) than men (M ± SD = 27.55 ± 16.48; 1.51 ± 1.91). There were no significant differences by education.

Many schizophrenic and bipolar Portuguese patients dissociate and had traumatic experiences in childhood, which is supported by the literature, but is necessary to replicate with bigger samples, and compare the two disorders to draw more conclusive interpretations. Nevertheless, therapeutic interventions should consider these aspects.

Adolescence is a critical period for dissociation, until more effective coping strategies are developed. Dissociate in a chronic manner is likely to interfere with the construction of a cohesive sense of self, and may potentiate later psychopathology. Adolescent Dissociative Experiences Scale/A-DES is yet to be studied in Portugal.

Analyze the psychometric properties of the A-DES 11-item format; compare between nonclinical with psychological disturbed adolescents/PDA; and determine the variables that associate with A-DES.

A sample of nonclinical (n = 69) and PDA (n = 45) aged between 11 to 18 years, 55.3% boys and 44.7% girls, education mean years 8.96 (SD = 2.74), completed the A-DES and the Youth Self Report/YSR.

The A-DES had a very good internal consistency (α = 0.94), presenting significant large correlations with YSR (r = 0.67). Confirmatory factor analysis suggested a 1-factor structure.

The mean scores (2.78 ± 1.82) were equivalent to other countries, and significantly discriminated (t = 6.02; p < 0.001; Cohen's d = 1.12) between the nonclinical (M = 2.06 ± 1.41) and PDA (M = 3.89 ± 1.84).

There were no differences between the sexes, but the younger, less educated, and institutionalized had more dissociative experiences (r = 0.21 to 0.30). Hierarchical multiple regression revealed that only YSR was statistically significant in predicting levels of A-DES (Beta = 0.64; p < 0.001).

The Portuguese A-DES version seems a valid and reliable screening for dissociation amongst adolescents.

The liaison psychiatrist often attends Bipolar disorder (BD) patients when they are admitted to a general hospital. There is little research and literature about special needs of these patients. It is important a detail examination of characteristic of the consultations carried out by liaison psychiatrist.

Analyse the demand for mental health liaison consultation for people diagnosed of Bipolar Disorder (BD).

Evaluation of clinical data obtained from the consultations attended to patients diagnosed of BD by a liaison psychiatry service from 2010 to 2012 in a general hospital.

The number of consultations attended was 824. 34 of them (4,12%) were patients diagnosed of a BD. Their mean age was 61,26 (DE 12,93). All the patients attended had previous psychiatric history. The 65% of them were receiving outpatient psychiatric treatment at admission. The departments that most frequently requested consultation were internal medicine with 26, 47% of the total ; Neurology and Surgery both with 14,7%; Traumatology, Digestive, Cardiology and intensive care with 8,82% each of them. A pharmacological intervention was carried out in 44% of cases while only 5,88% of patients required both pharmacological and psychotherapeutic interventions. In 50% of the requests an evaluation was the intervention.

We found a low percentage of demand of attention in patients with BP. This data are similar to studies. We should consider the possibility of inappropriate consultations among data analyzed. This might be related to lack of information for the management of people with BD in other specialties.

For our investigation we observed 167 patients with paranoid schizophrenia according to the criteria of ICD 10.

All patients received atypical antipsychotics. Patients were randomized into 3 groups. Patients of 1st group (n=52) received sertindole monotherapy 16–20 mg per day, patients of 2nd group (n=67) received paliperidone 9–12 mg per day and fluvoxamine in combination with zuclopenthixole depot 150–200 mg per day. Fluvoxamine was chosen because of its potential impact on sigma receptors.

the results of the study indicate the significance of differences of dynamics of neurocognitive deficit in schizophrenia and the importance of choice of biological therapy for correction of neurocognitive deficit in patients with schizophrenia. Also the study showed the possibility of correction of components of neurocognitive deficit in schizophrenia patients which was confirmed by objective psychological tests. The use of modern atypical antipsychotics and drugs which can influence on sigma-receptors can restore the social functioning in young patients with schizophrenia.

Chronically depressed patients show considerably impaired interpersonal features, which could be explained by a reduced Theory of Mind (ToM) ability.

The aim of this study was to examine whether chronically depressed patients are impaired in their ToM performance compared to a healthy control group in three different components of ToM: the social cognitive and social perceptual component as well as the ability to take someone else's visual perspective.

32 chronically depressed patients (DSM-IV) were compared to 32 matched healthy controls. ToM abilities were assessed by a cartoon picture story test (CT), the ‘Perspective task’ (PT) and the ‘Reading the mind in the Eyes’ test (RMET). In addition, information about depression severity, childhood trauma and executive functioning (working and logical memory) was assessed for both groups.

Patients mentalized significantly less frequently than healthy controls in the CT (Mann-Whitney-U=340,50, p<0,05). Furthermore, the CT was significantly correlated with the RMET (patients: r=0,46, p<0,05; controls: r=0,57, p<0,01). We didn’t find any significant difference between both groups in the RMET (p>0,05). In the PT, patients showed significantly lower scores than controls (t(35,68)=2,10, p<0,05). There wasn’t any significant correlation between the three ToM tests and severity of depression, duration of illness or childhood trauma (p>0,05).

Our results suggest that chronically depressed patients show deficits in their social cognitive ToM ability compared to controls, whereas their social perceptual ToM ability seems to be unimpaired. As to the capacity to take someone else's perspective, our results suggest that chronically depressed patients present significant deficits.

An early symptomatic response has been related with an early improvement in functionality, quality of life and subjective well-being.

The short version of the Social Functioning Scale (SFS) has been validated to get round the difficulty of lack of time in our clinical practice.

Evaluate functionality with SFS in a sample of schizophrenic outpatients treated with long-acting injectable antipsychotics.

20 outpatients with schizophrenia according to ICD-10 criteria. These patients were in treatment with long-term antipsychotic monotherapy during the past three months. Two treatment groups were established: paliperidone palmitate treatment group and another with the other long-acting injectable antipsychotics marketed in our country (constant release risperidone, olanzapine pamoate, zuclopenthixol, fluphenazine decanoate).

The severity of the disease was assesed by the CGI-S and function was assessed using the SFS. Antipsychotic medication was computed in equivalent mg of chlorpromazine (CPZe). Socio-demographic data were also collected.

Mean scores of SFS were: 25.91(SD 5.66) in paliperidone palmitate group and 27 (SD 6.78) in the other antipsycotics group. Mean score of CGIS were: 3.91 (SD 0.94) in paliperidone palmitate group and 3.33 (SD 1.41) in the other antipsycotics group. Mean score of CPZe was: 427.1 (SD 102,54) in paliperidone palmitate group and 580,59 (SD 332,54) in the other antipsycotics group.

We don’t find significant differences between the two groups. It should be noted observational design prevent us from make relevant inferences. It is likely that with a larger sample size these data can be modified.

Nicotine dependence is significantly more prevalent in patients with mental illness, e.g. 60% in affective and 60%–90% in schizophrenia spectrum disorders, than in the general population (about 30%). Smoking not only causes physical diseases and increases mortality, but also negatively affects psychiatric disorders.

To evaluate the acceptance, practicability and efficacy of a programme to help psychiatric patients quit or reduce smoking and to characterise smoking psychiatric inpatients.

‘The smokers’ group’ is a voluntary, manualised, behaviour therapy group programme adapted to the special needs of psychiatric inpatients. It consists of six 75-minute open-group sessions. We recorded the smoking status of all psychiatric patients and evaluated the programme with standardised questionnaires.

In July 2012, 49.2% (116/236) of inpatients were active smokers (55% of men, 45% of women). From July 2012 to December 2013, 113 patients (56% women, 44% men; mean age 46 years) participated in ≥1 programme sessions. Median duration of smoking was 21 years and mean physical dependence was severe (5 on the FTND). Of those who completed ≥3 sessions, 23% (n = 26) roughly halved their cigarette consumption (from 22 to 10 cigarettes/d). Thirty-six (31%) stopped smoking, 30 with nicotine replacement. Eleven patients were abstinent after the programme, as verified by expired carbon monoxide.

Although smoking cessation is often difficult for psychiatric inpatients, they showed interest in the programme. about a third reduced or even stopped smoking. Adherence (high drop-out rate due to discharge and completely voluntary participation) and long-term followup require further attention.

World tendency towards overall age increase of the population leads to increase of elderly people among patients. Delirium (confusional state) is common in geriatric inpatients in general hospital. It is one of the most significant syndromes of cognitive dysfunction in people of senior age. The presence of delirium increases the duration of hospital stay, morbidity and mortality.

To evaluate the prevalence of delirium amongst inpatients of senior age in different departments of general hospital.

We have studied a total of 247 randomly selected inpatients. Of these, there were 113 patients in the Traumatology Department and 134 in the Neurology Department. Delirium was diagnosed based on the criteria of ICD-10. We used the Mini-mental state examination (MMSE) scale as a metric of the degree of the disorder of cognitive functions.

60 patients (24,3%) of the studied population were found to be delirious. There were 26,5% of delirious patients in the Traumatology Department and 22,4% in the Neurology Department. and the maximum prevalence of delirium was in the range of 81–85 years (39%).

We present statistically significant results showing unequal prevalence of delirium amongst elderly inpatients of the two biggest departments of the general hospital. The large amount of delirious patients forces of medical professionals to pay more attention on psychiatric condition of patients.

Subjective well-being (SW) has a strong direct relationship with quality of life. It has also been strongly associated with adherence, and with a lasting symptomatic remission. Several studies point to the SW one of the main predictors of a comprehensive response to treatment

Evaluate the subjective response to neuroleptics (both SW and attitudes towards medication) in patients with schizophrenia treated with longacting injectable antipsychotics.

20 outpatients with schizophrenia according to ICD-10 criteria. These patients were in treatment with long-term antipsychotic monotherapy during the past three months. Two treatment groups were established: paliperidone palmitate treatment group and another group with other long-acting injectable antipsychotics (constant release risperidone, olanzapine pamoate, zuclopentixol and fluphenazine decanoate).

SW was assesed by the Subjective Well-being under Neuroleptic Treatment Scale (SWN-K) The attitude towards medication was assessed by the Drug attitude inventory (DAI).

Mean scores of SWK-N were: 87.64 (16.22) in paliperidone palmitate group and 89.67 (17.19) in the other antipsychotics group. Mean score of DAI was 17.09 (SD 3.08) in paliperidone palmitate group and 18.78 (SD 1.09) in the other antipsycotics group.

We did not find significant differences between the two groups. It should be noted observational design prevent us from make relevant inferences. It is likely that with a larger sample size these data can be modified.

Pain is a frequent reason for psychiatric consultation. It is a symptom that is often associated with other mental disorders. It can have a significant impact on the quality of life of the patient. Yet pain is a complaint often underestimated by the clinician. It is considered inherent to mental illness and so poorly supported.

Studying the relationship between mental illness and pain and include means to support this co morbidity.

This is a cross-sectional and descriptive study on a population of 50 consultants who suffer from chronic pain. The evaluation consists of a questionnary on the characteristics of the pain, psychiatric illness and modality of care.

Among the patients studied, 80% were female. The mean age was 47.33 years. Predominant type of pain was headache in 78 % of cases, followed by stomach pains and diffuse arthralgia. The impact on daily life was average for most patients. Radiological exploration was performed in 35% (without abnormalities in 100% of cases). Depressive disorders were present in 60 % of cases. The most prescribed analgesics was Tier 1 (paracetamol) with a positive trend in 65 % of cases.

The pain, especially headaches are a common complaint in psychiatry. Their association with depression is classic. But it can also accompany other mental illnesses and worsen their prognosis. A better understanding of causality of pain and its management is essential to improve the quality of life of patients.

Sleep is a basic physiological need for the health and well being. Aging brings many changes in sleep holding the advance in age, multiple comorbidities and changes in lifestyle.

Describe the quantity and quality of sleep in the elderly.

Prospective and descriptive study involving 40 people aged over 65. The sleep evaluation was done over a period of four weeks with a sleep diary (daily self-assessment tool of sleep and wakefulness).

In our study, we found an average of hours of sleep in elderly subjects 8 to 9 hours per day. The sleep time was in 60% of cases before 10 pm and the wake-up time was in 52% cases at or before 6 am. The sleep latency did not exceed 30 min in 68% of cases. Sixty pourcent subjects have had nocturnal awakening for more than an hour. Sleep quality was considered poor by 55% of sujets and disturbance was attributed significantly to somatic diseases.

Sleep disorders in the elderly are common. The effective treatment must take account of psychological, psychosocial and somatic factors specific to age.

Film wields an extraordinary power and can both influence and be influenced by society. Given that 1/4 people suffer from a mental illness at some point in their lives, mental health issues play huge roles in our society and on our screens.

The medical film festival Medfest operates under the auspices of the RCPsych and the aim of the festival in 2012 was,’To stimulate debate of the social and political implications of portrayals of health and illness on our screens’.

Waltz with Bashir is a film that vividly depicts the 1982 Lebanon War through the lens of an Israeli veteran.

The former Prime Minister of Lebanon stated,’…that Lebanon would be the last Arab state to have peace with Israel…’

To demonstrate how the power and synergy of film can be utilised to deliver the peaceful message of co-existence.

The WPA announced that it would be holding the 2012 Cultural Psychiatry Conference in Tel Aviv. I submitted an abstract on Medfest and the portrayal of PTSD in Waltz with Bashir.

I received an invitation from the Scientific Committee to deliver a Keynote Lecture in Israel.

RCPsych initiatives like Medfest inspired me to challenge preconceptions and prejudices. Most importantly, however, whilst I have no misgivings that it will take more than a lecture to resolve the on-going Arab-Israeli conflict this experience has given me, a Lebanese early-trainee psychiatrist, and others that glimmer of hope that one day the two people may live in peaceful co-existence.

Adequate pathways to care are a prerequisite for early detection and intervention in First Episode Psychosis (FEP). Two systematic reviews examined the influence of ethnicity, social and clinical factors on psychosis care pathways. Accessibility to health services differs for under 18s, yet differences in care pathways between age groups and the impact of family factors have not been investigated.

To investigate the influence of family factors in help-seeking pathways for adolescents with FEP.

Naturalistic crossectional study of 1351 FEP (14-35 years) referred to Early Intervention Psychosis teams (London, UK; 2003-2009). Care pathways included accounts on who initiated help-seeking process, initial contact points (GP, emergency services, education, social services, police and court/prison), and family factors (social support, living arrangements and family load of mental illness).

For the majority of adolescents (n=118) and adults (n=1232), first and second contact points were GP (30% vs 42%) and emergency services (18% vs 23%). However, these two services accounted for less than half of the adolescents’ sample. Adolescents made higher use of education (p<0.001). Family factors, such as good social support (p=0.036), living with carers (p<0.001) and family load of mental illness (p=0.018), were associated with family taking a leading role in problem recognition.

Adolescents with psychosis differ from adults in their contact points when seeking help. Problem recognition is a complex process which involves identifying and legitimizing mental health concerns. Parental awareness and perception of problems revealed as a key step in seeking help for adolescents.

Gender Incongruence (GI) is a rare condition in adolescence characterized by a marked incongruence between one's experienced gender and the assigned sex. It presents as a combination of: a strong discomfort and/or intense rejection of the behavior/attributes of the born gender, a strong desire to live (and be treated) of the experienced gender, and/or a determination to follow the process of transition (i.e. hormonal therapy, sex reassignment surgery). Psychological functioning and treatment outcome has shown significant variation across transgender individuals.

This study aimed to investigate the diagnostic stability of GI in adolescents across ICD-10, DSM-IV-TR, DSM-5, and ICD-11.

Case series of four adolescents aged 16-17 (3 female-born and 1 male-born) with GI seen at Child and Adolescent Mental Health Services (London, UK) in 2012, who completed clinical assessments and questionnaires (Utrecht Gender Dysphoria Scale and Gender identity/GD questionnaire for adolescents and adults).

GI diagnostic criteria varied across diagnostic systems regarding: (1) number of indicators required, (2) symptoms duration, and (3) presence of clinical distress/impairment. In our case series, the latter led to diagnostic instability: two adolescents did not fulfill DMS-IV-TR and DSM-5 criteria. Nonetheless, the dimensional approach supported the GI diagnosis for the four adolescents.

Classification systems evolved in their conceptualization of GI over time evidenced by a shift in the condition name and diagnostic criteria. Diagnostic instability across classification systems may have an impact on their clinical utility. Evidenced-based investigations are required to further assess the clinical utility of the new classification systems.