The objective of this study was to assess the nonpsychotic psychiatric disorders of stoma patients in Iran.

The only study that evaluated stoma patients in Iran indicated that postoperative problems, especially psychosocial ones, have a rather high frequency in comparison with other reports, but since no standardized questionnaire was applied for the evaluation of psychosocial problems and their severity, further studies were needed.

In this cross-sectional study, patients referred to the Iranian Ostomy Association from 2005 to 2006 filled the 28-item General Health Questionnaire (GHQ) in Farsi as a screening instrument to identify cases of nonpsychotic psychiatric morbidity.

A total of 155 patients participated in the study, of whom 79 (51%) were female and 76 (49%) were male. Fifty-five percent of the patients (n=86) had psychiatric problems. The females’ mean GHQ score was significantly higher than that of males (P=.001). Psychiatric disorder was significantly more frequent among patients with the following specifications: educational level of high school or lower (P=.001), mucosal hemorrhage of the ostomy (P=.03), stomal stenosis (P=.012), and history of psychiatric drug consumption (P=.000). GHQ score decreased as stoma age increased (P=.032; r=−.177).

Similar to other complications, psychiatric problems are prevalent in Iranian stoma patients. Our findings highlight the need for special support.

To investigate the association between catechol-O-methyl transferase (COMT) gene polymorphism and Gilles de la Tourette’s syndrome (GTS).

Using Amplification Refractory Mutation System(ARMS) PCR genotyping assay method, a polymorphism (val158met) of COMT gene was genotyped in 112 of all GTS patients including 54 GTS-alone patients, 48 GTS+ADHD patients among of them and 71 healthy controls. The correlation between positive association of polymorphism (val158met) of COMT gene in GTS and the age of onset in patients with GTS was also analyzed.

When compared with healthy controls, genotype of val158met did not differ in total GTS patients or alone- GTS patients (x2=0.56, P = 0.756; x2= 1.05, P = 0.600 respectively). There is also no significant difference (P>0.05) in allele distribution of val158met in total GTS patients or alone- GTS patients when respectively compared with controls (x2= 0.18, P = 0.669; x2= 0.29, P = 0.593 respectively). However, Genotype distribution of val158met was significantly different between GTS+ADHD patients and controls (x2=6.35, P = 0.041). The frequency of the val allele of this locus was significantly higher in GTS+ADHD patients than those in controls (x2= 5.49, P = 0.019).The age of onset in children with GTS having the val/val genotype of COMT gene val158met polymorphism were significantly earlier than no val/val genotype (P = 0.016).

Polymorphism (val158met) of COMT gene may be associated with GTS children with comorbid ADHD, which may play an important role to make the age of onset in children with GTS become earlier.

Présenter le programme MindReading et l’intérêt de son utilisation chez les patients souffrant de schizophrénie ayant une longue durée d’évolution et/ou d’hospitalisation.

Utiliser et développer des programmes de remédiation en cognitions sociales validés chez des patients souffrant de troubles autistiques pourraient être pertinents pour des patients souffrant d’une certaine forme de schizophrénie avec altérations sévères des cognitions sociales en complément d’un programme de remédiation cognitive sur les cognitions froides.

To explore the relationship between resilience and social support, coping style of children in two middle schools for providing an evidence for improving childrens’resilience.

Six hundred childrens were surveyed with the Connor-Davidson resilience questionnaire(CD-RISC), perceived social support scale(PSSS)and coping style questionnaire (CSQ).

Resilience had significant difference between male and female children.

The resilience was positively correlated with social support and two factors of coping style: seeking help and solving problem, but negatively correlated with the other factors in coping style questionnaire.

Children with high score in Connor-Davidson resilience questionnaire are more tend to the positive coping style.

Social support is an important factor of resilience in children.

Epidemiological studies have convinced that prenatal stress (PS) might cause offspring depression.

Our pervious research work certified that PS can increases the glutamate level of hippocampus of rat offspring, which inspired us to explore the pathogenesis of depression by focusing on glutamatergic system.

Pregnant rats were randomly assigned to control group (CON), mid prenatal stress group (MPS) and late prenatal stress group (LPS). The pregnant rats of MPS and LPS were exposed to restraint stress on days 7–13, 14–20 of pregnancy three times for 45 min respectively. Tail suspension test (TST) was performed to examine the depression like behavior and Western-blot were used to test phosphorylated GluR1(pGluR1) of AMPAR expression in the hippocampus, striatum and frontal cortex of one month rat offspring.

For both male and female offspring, the time of immobility of TST in LPS (156±11, 155±12) and MPS (173±15, 155±12) was significantly longer (P< 0.05) than CON(118±8,113±12), the latency in MPS (18±3, 24±3) was significantly shorter (P< 0.05) than CON (30±5, 58±11). The pGluR1 expression in hippocampus and frontal cortex in LPS (1.77±0.45, 1.00±0.09) and MPS (1.65±0.51, 1.05±0.18) were significantly lower (P< 0.05) than CON (3.72±0.86, 2.05±0.34) in male rat offspring.

It is suggested that the PS may induce depression like behavior in rat offspring, and glutamate receptors subunit pGluR1 might be involved in the etiology of depression.

(The research is supported by National Natural Science Foundation of China, No: 30970952, 18110059).

Research has shown that Mirtazapine has been effective in stimulating appetite in the elderly. We present a case series of three patients with Moderate Intellectual Disability, each presenting with intractable refusal to eat over several months. They did not have overt symptoms of depression according to carers and family. Two patients were being considered for Percutaneous Endoscopic Gastrostomy (PEG) feeding in view of their significant weight loss and deteriorating physical health.

Mirtazapine was introduced as an appetite stimulant, despite the apparent lack of depressive symptoms. All three patients experienced an improvement in their appetite within days of initiation of Mirtazapine, increasing their calorie and fluid intake and obviating the need for PEG feeding. During the following 3 months, the patients also developed an increased interest in activities, improved sleeping pattern and improved concentration.

These patients had very limited communication skills and there was little suggestion of depression at the time of assessment. The families and carers also did not feel that their relative was significantly depressed. Despite this, Mirtazapine had the two fold benefit of early appetite stimulation and, over the subsequent weeks, treating what in hindsight had been an underlying depressive episode. A lesson to be learnt is that primary refusal to eat, even in the absence of overt depressive symptoms may indicate an occult depressive episode in this patient group. We have shown that Mirtazapine can be an effective treatment in such cases and can prevent distressing medical intervention from having to be used.

La métacognition se définit comme la surveillance et le contrôle de ses propres processus cognitifs [1,3] au cours de la tâche cognitive, « on line ».

Évaluation de l’impact de la mesure de la métacognition « on line » sur les performances cognitives auprès d’une population non clinique.

Les participants ont été recrutés parmi les donneurs de plaquettes de l’Établissement français du sang de Bordeaux, France. Les critères d’exclusion étaient les antécédents de trouble psychiatrique sévère évalués par le Mini International Neuropsychiatric Interview, l’abus d’alcool ou de substance et la prise régulière de psychotropes. Un premier groupe (n = 20) a passé la version standard de tests évaluant les fonctions exécutives (Modified Card Sorting Test), la mémoire épisodique (Rappel Libre Rappel Indicé 16 ou RLRI16), la mémoire de travail (Mémoire des chiffres Weschler Adult Intelligence Scale III), la cognition sociale (Facial Test). Un deuxième groupe (n = 50) a passé la version métacognitive de ces mêmes tests, consistant en l’ajout après chaque item du test neuropsychologique d’une question de confiance en sa réponse et d’une question de validation de sa réponse [2,4]. Les caractéristiques démographiques et les performances neuropsychologiques des deux groupes ont été comparées.

Aucune différence significative n’a été retrouvée entre les deux groupes concernant les caractéristiques démographiques. Le groupe ayant passé la version métacognitive présentait de meilleurs résultats que le groupe standard au test de mémoire des chiffres (t = 2,12, ddl = 68, p = 0,04), mais des résultats moindres au RLRI16 (2e rappel libre t = −2,50, ddl = 68, p = 0,01 ; 3e rappel libre t = −3,52, ddl = 68, p = 0,0008).

L’évaluation de la métacognition « on line » améliore les performances en mémoire de travail en forçant la concentration sur la tâche. Elle altère les performances en mémoire épisodique, en agissant comme un distracteur. Il paraît essentiel de prendre en compte ces effets dans les programmes de remédiation cognitive.

La thérapie cognitive et comportementale (TCC) est un traitement efficace pour soigner le trouble obsessionnel compulsif (TOC). Elle est connue pour induire des changements dans le métabolisme cérébral, mais la dynamique de ces changements et leur relation avec l’évolution clinique restent encore largement inconnues. Leur caractérisation représente une étape cruciale vers l’identification de biomarqueurs individualisés de réponse au traitement.

Nous avons procédé à l’évaluation clinique et à l’examen en IRMf de 35 patients atteints de TOC avant une TCC, à mi-thérapie (1,5 mois), à la fin (3 mois), ainsi que 6 mois après la fin de la thérapie. Pendant les examens en IRMf, nous avons utilisé une tâche originale d’exposition aux symptômes en utilisant trois types d’images : des images neutres, des images génériques induisant des obsessions et des images personnalisées induisant des obsessions.

La TCC a entraîné une amélioration significative des symptômes obsessionnels compulsifs. La réponse à mi-thérapie s’est avérée être prédictive de l’amélioration finale (r2 = 0,67, p < 0,001). Initialement, les patients étaient plus sensibles aux images personnalisées qu’aux images génériques et neutres, ce en proportion avec de plus fortes activations dans le cortex cingulaire antérieur, le cortex orbitofrontal et pariétal. Dans le groupe de patients hauts-répondeurs (ΔYBOCS > 45 %), la sensibilité a été réduite à l’issue de la thérapie pour les images génériques et encore plus pour les images personnalisées. L’amélioration clinique a été associée avec une baisse de l’activité dans le cortex cingulaire antérieur et dans le cortex orbitofrontal gauche.

L’utilisation d’une tâche d’exposition novatrice et hautement sensible en IRMf montre que les symptômes et les marqueurs métaboliques ont des évolutions parallèles au cours de la TCC. Nos résultats, qui suggèrent que les premières séances de TCC sont cruciales, nous incitent à étudier les modifications anatomofonctionnelles qui sous-tendent les premières étapes de la thérapie.

Quality and clarity of correspondence with other professionals and especially GPs have been always important. Nowadays when patients would receive a copy of our letters automatically, this has become even more sensitive and paramount.

A guideline and template were designed based on the best recommendations taken from available NHS policies, review of literature and interviewing six experienced psychiatry consultants in Oxford deanery.

• – Decide about sending a copy of your letter to each patient individually. It is a clinical decision. Do not send a copy if this would mean compromising the information you need to give to GP. Situations like third party information, safeguarding issue, risk to therapeutic relationship and lastly, patient’s refusal to have a copy of letter

• – Send a separate letter to the patient if your are directly asked in one of situations outlined above. This letter should be short and simple containing clear treatment plan.

• – Letter to GP should be short (200-300 words) with simple language.

• – Use a standard template for writing to GP. Template should have headings for “Reason for referral”, “Impression/diagnosis”, “Summary of findings”, “Prognosis”, “Risks”, “Information given to the patient”, “Detailed treatment plan”, “Name of care coordinator” and finally “Follow up details”.

Writing short, simple and clear letters would facilitate communication between psychiatrist and GP. This eventually will improve the quality of patient care. Using of a standard template, attending report writing courses and thoughtful deciding about sending a copy to each patient are greatly recommended.

Body image disturbances are core symptoms of Anorexia Nervosa (AN). This study investigated self-face recognition in cases of AN, and the influence of others factors associated with AN, such as massive weight loss.

Fifteen anorexic female patients and 15 matched Healthy Controls (HC) performed a self-face recognition task. Participants viewed digital morphs between their own face and a gender-matched, unfamiliar other face presented in a random sequence (Fig. 1). For each stimulus, subjects were asked if they recognized their own face, and respond by selectively pressing a button on a computer. Participants’ self-face recognition failures, cognitive flexibility, body concerns and eating habits were assessed, respectively, with the Self-Face Recognition Questionnaire (SFRQ), the Trail Marking Task (TMT), the Body Shape Questionnaire (BSQ) and the Eating Disorder Inventory-2 (EDI-2).

Fig. 1

Examples of stimulus. For each subject, a photograph of an unfamiliar face was digitally morphed into a photograph of the subject's face in 10% increments.

Anorexic patients showed a significantly greater difficulty than healthy control in identifying their own face (P = 0.028, Fig. 2). No significant difference was observed between the two groups for TMT (all P > 0.1). However, analysis did not reveal significant correlations between behavioral data and the EDI-2 or BSQ (all P > 0.1). A correlation analysis revealed a significant, negative correlation with BMI (P < 0.001) and the SFRQ “self-face recognition” subscale (P = 0.015).

Fig. 2

Self response rates per stimulus ranked in increasing order of familiarity (other to self) in both groups.

We observed a decrease in self-face recognition, correlated with BMI, suggesting this disturbance could be linked to massive weight loss. It thus supports the theory of a lack of ability to update body image by the central nervous system, underlying self-images distortion in AN patients.

Elderly psychiatric patients are at constant risk of having a fall due to numerous reasons e.g. frailty, gait problem, vision problem, cognitive and judgment impairment, psychotropic medications.

Consequences of a fall for an elderly patient could be potentially life threatening, protracted, painful and detrimental. Also the cost of falls for NHS is enormous.

To improve the quality of fall reviews undertaken by junior doctors in Oxford Health Foundation Trust.

The quality of a random sample of 23 fall reviews by junior doctors was assessed against the national guideline (NICE guideline No.: CG21).

Proper actions taken to raise the awareness of junior doctors i.e. circulating an email and short talk about national standards.

The second cycle (Sample size: 17) in 6 months time showed substantial improvement in most areas but not all of them.

In the next stage a “Fall intervention proforma” designed for the wards. Also reminding posters were mounted in clinical rooms and junior doctors’ offices.

The third cycle (Sample size: 10) in 6 months time conducted to assess the sustainability of improvements in our compliance.

Our compliance improved from less than 50% in most essential components of a high quality fall review (Musculoskeletal examination, Neurological examination, History taking, Cardiovascular examination, Medication review) to around 100% in 3rd cycle.

• – routine use of “Fall intervention proforma” as standard check list on the wards

• – mounting of reminding posters in clinical rooms

• – a short talk about fall reviews in induction programme for new junior doctors

Despite the availability of an ever-expanding range of typical and atypical antipsychotics, a substantial proportion of patients with schizophrenia show a partial or total lack of response to antipsychotic mono therapy. This study was done to evaluate the effect of purslane on psychologic symptoms of schizophrenic patients.

This randomized clinical trial study was carried out on 60 chronic schizophrenic patients in Sina hospital Shahrekord, Iran during 2011-12. Subjects were randomly divided into intervention and control groups. The control group received Risperidone up to 6mg/day and Biperiden 4mg/day for 8 weeks. The Patients in interventional group received 1gr extract of purslane daily with the same regimen for 8 weeks. The scales for assessment of positive symptoms (SAPS) and assessment of negative symptoms (SANS) were recorded in prior and 8th weeks. In addition, CRP and MDA level of patients were assessed in two stage of study.

At the end of study, the mean score of positive symptoms were 47.93±18.56 and 57.1±14.83 in intervention and control groups, respectively (P< 0.05), and the mean score of negative symptoms were 40.83±11.03 and 46.13± 9.34 (P< 0.05).The CRP levels of patients in intervention and control groups were .53±.55 and 1.72±.73 at 8 week respectively (P< .05) and the MDA levels were 3.25±1.25 and 5.43± 1.76 respectively (P< .05).

According to findings of this study, the use of purslane as an adjunct to Respridone can improve psychological condition of chronic schizophrenic patients and decrease MDA and CRP levels of them.