In many cultures, weather and season have been thought to influence our physical and mental health. However studies of the effect of meteorological factors on suicidal behavior have yielded inconclusive and often contradictory results. Furthermore, little attention has been paid to weather is associated with suicide in Asian countries as shown in Western countries, even though suicide rates in Korea have increased steadily.

To study the effect of weather condition on suicidal behavior in Daejon, Korea. in this study, suicidal attempters who had visited the Eulji Medical Center were included.

The aim of this study is to further explore the differential effect of certain climatic factors on suicidal attempt probabilities in Daejon, Korea between 2009 and 2011.

Three-year data of suicidal attempts within Daejon, Korea were analysed in relation to meteorological data, which were measured at the Daejon Meteorological Administration. Data on suicidal attempt and weather were matched.

Our study indicates that temperature and duration of sunshine are significant associated with the suicidal attempts (p < 0.05). These correlation were independent of age and sex.

Within the interaction of biological and environmental influences in the development of suicidal ideation and behavior, some weather conditions may additionally contribute to the risk of suicidal attempt.

The practice of early interventions in psychiatry has became one of the most prevalent paradigms in modern psychiatry. in the routine care the dissemination remains frustratingly slow. However, little is known about the characteristics of training curricula.

To describe:

1. 1) characteristics of training on prevention and early intervention in psychiatry;

2. 2) organizational and clinical differences of early intervention services in the different countries;

3. 3) trainees’ satisfaction and management of patients with mental disorders.

Sixty early career psychiatrists have been invited to participate in the survey, recruited from the early career psychiatrists’ network of the World Psychiatric Association (WPA). Respondents were asked to provide the collective input of their trainees’ associations, and not the individual feedback of any officer of the association.

36 out of 60 invited countries compiled the questionnaire. University training programs in early intervention for mental disorders are provided in 21 out of 36 countries (58%). Half of early career psychiatrists feel completely or enough confident to provide specialistic interventions to patients during early stages or at the onset of the disorder. Fifty-three percent of respondents are not satisfied with training on preventive psychiatry. Early intervention services most frequently available are those for schizophrenia (76%). Informative campaigns on mental disorders are usually conducted in 33 countries (87%).

A huge variability exists as regards early intervention training and practice. Further efforts are needed in order to establish training programs according to the educational needs of trainees and early career psychiatrists.

The sample consisted of 123 war veterans who completed Suicide Behaviors Questionnaire (SBQ-R), Reasons for Living Inventory (RFL-48), General Health Questionnaire - subscale for suicidal behavior (GHQ), Hopkins Symptom Checklist Depression Scale (HSCL-25) and Harvard Trauma Questionnaire (HTQ).

Results indicated that suicidality is correlated with higher PTSD and depression scores, and negatively correlated with reported reasons for living. We discuss our results in terms of their use and applicability in everyday work with patients who are in suicidal risk.

The recent global crisis as well as the increasing crimes’ rates have been claimed to be a factor of mental distress and disturbance.

To describe the levels of insecurity and the fear of crime in a sample of patients with mental disorders with a sample of mental health professionals.

The study has been carried out in 24 Italian mental health centres. in each centre 20 patients and 20 mental health professionals have been recruited. Clinical status and social functioning have been evaluated with the Global Assessment of Functioning (GAF), the Hamilton Anxiety scale (HAM-A) and the Hamilton Depression scale (HAM-D). Fear of crime and insecurity have been assessed by Perceived Insecurity Questionnaire (PIQ).

The final sample consists of 426 patients. They are mostly female (70%), employed and married, with a diagnosis of mood disorder (52%). High levels of worries/insecurity at the PIQ are reported by 42% of patients. Perceived insecurity is associated with higher levels of HAM-A and HAM-D. Nearly all respondents report to have worries or fears about the future (93%), in particular as regards bereavement or loss (41%), economic difficulties (28%), mental or physical illness (26%). in multiple regression model, worries about the economic situation are more frequent in person who are male, young, married and with more than two children.

The results suggest an association between perceived insecurity with anxiety and depression. Further studies are needed to better understand this association and to develop educational programs on stress and mental disorders.

There are several studies evaluating the functioning in patients with schizophrenia. Nowadays, there are new tools and therapeutic alternatives to be considered.

Our hypothesis is administration of Depot antipsychotic improve patient adherence to treatment which reflect better social and personal performance, higher satisfaction with medication and less severity of the mental illness.

Sample of 68 patients with schizophrenia: 32 with Depot and 36 with oral antipsychotic.Scales: PSP assesses global function in terms of four functional domains: work/study, personal/social relationship, self care and disturbing/aggressive behavior. Other scales applied: CGI and MSQ.

PSP: Self care (t (67)=6.092,Pa=0.01),Personal Relationships (t(67)=3.368,Pa=0.05), Social Relationship(t(67)=5.0167,Pa=0.01) and disturbing behavior(t(67)=1.263,Pa>0.05).

Better response to the four areas studied in patients treated with Depot vs. patients treated with oral medication.The Global score of PSP in oral medication group was 68 which means barriers indentified by anyone but do not interfere with the role of the subject. and in the group of Depot the global score was 78 that mean mild difficulties indentified by relatives or close people to patient.

Very few cases have been reported in connection with excessive consumption of tianeptine. Tianeptine use can be a risk in terms of high doses especially for addicted patients.

A 28 year-old man administered after 5-years of medical prescription of the recommended dosage of 12.5 mg 2 times daily of oral tianeptine for an anxiety disorder. The patient spontaneously increased the dosage which after two months reached 120 tablets per day. No severe toxic effects were observed. As adverse effects, the patient, in the beginning of this high treatment period suffered from nausea, vomiting, abdominal pain, anorexia with weight loss, constipation. These side effects progressively disappeared. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seek a psychostimulant effect for five-years but after his family realized that he was using 2 boxes of drug every day he was hospitalized for treatment.

Tianeptine is an antidepressant agent like the selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. The anxiolytic efficacy of tianeptine is similar to that of tricyclic and tetracyclic antidepressants. But in contrast to SSRIs and tricyclic agents, systemic administration of tianeptine modestly enhanced the mesolimbic release of dopamine (DA). It is told that abuse or dependence of tianeptine is an important issue in patients who have histories of alcohol or substance abuse. However, as in our case, the use of tianeptine in patients without a history of substance abuse might be also a risk for addiction.

Gynecomastia is a medical condition that affects men. Physical symptom is an abnormal enlargement of the mammary glands. Men who have this condition often end up feeling too embarrassed to be seen and it can greatly interfere with their personal life and social skills. This study attempts to evaluate the hypothesis that surgical approaches to correct simply the view are not enough to improve the quality of patients’ lives.

30 patients who were admitted to general surgery outpatient clinic with complaints of large breast and diagnosed with gynecomastia were enrolled in this study. Social Skills Rating Scale (SSRS), Body Image Scale (BIS), Coopersmith Self-Esteem Inventory (SEI) were applied preoperatively to patients with grade 1 and 2 gynecomastia. Scales were repeated postoperatively on the third month.

Preoperative and postoperative scores of BIS were significantly different. in a similar vein, preoperative and postoperative scores of Coopersmith SEI were significantly different, too. Coopersmith SEI and BIS scores were low in the preoperative period and higher in the postoperative period. However, in terms of SSRS there was not a statistically significant difference between preoperative and postoperative period.

Results indicate that presence of gynecomastia even at the level of grade-1 and 2 is effective on self-esteem, body image and social skills. The results also show that for the treatment of individuals diagnosed with gynecomastia surgical interventions alone can be inadequate. in these patients, after the surgical treatments, the addition of individual training programs to improve social skills may be useful.

The term boxer's fracture refers fifth metacarpal neck fracture. These people have problem with anger management and may be incapable of problem solving. in this study, it was aimed to determine their coping behavior and psychological symptoms and their relations with coping behaviors in patients with boxer's fracture.

36 male patients with diagnosis of fifth metacarpal neck fracture and 36 healthy male control subjects were included in study. Groups were evaluated with “Coping Orientation for Problem Experiences” (COPE) scale and Symptom Check List- 90 (SCL-90).

“Emotion-focused” coping strategies like “denial”, “substance abuse”, “use of emotional social support” and “avoidance” were seen to be used more often by patient group. in SCL-90 symptom check-list “obsessive-compulsive symptoms,” “interpersonal sensitivity”, “anxiety”, “anger-hostility” sub-groups were significantly different in patient group than control group.

Coping strategies are divided in two categories as problem-focused and emotion-focused. The first targets main source of the problem. and latter targets the emotional impact caused by the main source. This may be only realistic option when the source of stress is outside the person's control. Sense of control directly reduces psychological disturbance. Feeling like you have control over smaller aspects of life could lead to a greater sense of overall control. in these patients, it can be predicted that to punch the wall can increase “sense of control”. It is evaluated that the higher scores of “obsessivecompulsive symptoms” subscale of SCL-90 symptom check-list in patient group when compared with control group is consistent with this result.

Research on suicide method substitution between last attempted and completed suicide is scarce (five studies).

The results are conflicting (three studies report persistence and two studies report switch).

To investigate this topic studying a sample of suicide victims from Greece.

We studied all recorded cases of completed suicide of the period November 2007-October 2009 in Athens Department of Forensic Medicine. We performed phone interviews with relatives of the deceased focusing, among other topics, on the characteristics of prior attempts.

335 individuals were recorded as suicide victims: 250 men (74.7%) & 85 women (35.3%). Interviews were conducted with the relatives of 246 victims: 24% had history of prior attempts (59 cases), 39 men (66.1%) & 20 women (33.9%). Most frequent last attempted suicide methods were: self-poisoning (57.6%), jumping from a height (20.3%), wrist-cutting (15.3%) & hanging (6.8%). 74.6% of the attempters became completers using a different method (p=0.016). Individuals with previous attempt by self-poisoning or wrist-cutting died by hanging or jumping while attempters by hanging or jumping became completers primarily by the same methods.

Most of the suicide completers had never been attempters in the past. Those who had attempted with low lethality methods- committed suicide choosing a different, more lethal method. Restrictions in the availability of lethal means may result in more surviving attempters while some suicides could also be prevented because a particularly lethal method is not in hand.

Cocaine abuse continues to be epidemic, and yet there are no FDA approved medications for the treatment of cocaine use disorders within the United States.

This 12-week, prospective, double-blind, randomized, placebo-controlled study examined the effectiveness of quetiapine (Seroquel XRTM) versus matched placebo for the treatment of cocaine dependence in non-psychotic individuals. Sixty Individuals with a diagnosis of cocaine dependence were randomized in this study. Those who were randomized to quetiapine (N=29) were titrated up to a target dose of 400 mg/day of quetiapine, while those in the placebo arm (N=31) were given a matched placebo. All subjects had weekly clinic visits and a cognitive-behavioral therapy group session. Outcome measures included questionnaires of cocaine use, money spent on cocaine, and urine drug screens (UDS).

The drop-out rate was substantial at 68%, however there were no group differences between the two arms of the study. Using a repeat measures ANCOVA, as a whole, the subjects in this study improved by reducing their self-reported use of cocaine (p=.018) and self reported money spent on cocaine (p=.041) over the course of the study. However, the quetiapine group was not significantly different from the placebo group. in addition, cox regression analyses yielded non-significant differences (p = .65) between groups in predicting sobriety, as defined as three weeks negative UDS.

This study did not find group differences between the quetiapine and placebo arms, indicating that quetiapine does not appear to be beneficial in the treatment of cocaine dependence.

Depression represent an important and predictable complication in chronic haemodialysis.

The prevalence of depression, QoL indicators, correlations between number of years of hemodialysis, depression and quality of life.

To determine if higher depressive levels are correlated with years spent on haemodialysis.

We used Beck questionnaire two times, one at the beginning of the year, and one at the end for 102 patients, excluding diabetes, who were undergoing hemodialysis three times a week, for 4 hours and SF 36 questionnaire. We considered these values for depression: Normal: 0-10, Mild: 11-15, Moderate: 16-23, Severe: 24-63 according to Romanian Guidelines in Nephrology.

98 pacients answered to the Beck questionnaire. Years of haemodialysis: min=0.25, max=18, average=5.7, standard deviation= 4.37 (n=102). SF 36 has close values distributed between the intervals 80-100, 60-80, < 60%. The linear correlation between average depression and years of hemodialysis is very, very weak, square of the coefficient of regression is 0.00- (by the linear model we can explain < 0.1% of the dates) and also between SF36 total and years of hemodialysis:square of the coefficient of regression is 0.04- (by the linear model we can explain 4% of the dates). We followed other models (logaritmic, polinomial, exponential), for both correlations, but we couldn’t notice better results.

The study proved high levels of mild depression, lack of linear correlation between years of haemodialysis, depression and QoL indicators. Although this, there is an influence of time spent in haemodialysis and QoL.

Physicians have an increased risk of dying by suicide in comparison with the general population.

This difference has been studied in the literature.

To present the characteristics of this phenomenon.

Literature review using Medline and hand search of relevant articles.

The suicide risk is slightly higher for male and substantially higher for female physicians in comparison with the general population (relative risk 1.1-3.4 and 2.5-5.7 respectively). It also varies from 1.5-3.8 in males and 3.7-4.5 in females as compared with other professionals. Depression, drug & alcohol abuse problems, history of prior attempts, availability of method (drugs), physical illness, burn-out syndrome, interpersonal difficulties and loneliness constitute risk factors. Physicians rarely do “unsuccessful” attempts and most commonly die by drug poisoning. This may be due to the fact that they have easy access to drugs, knowing better their lethal doses. Anesthesiologists, Psychiatrists and General Practitioners have the highest risk. The increased risk in female physicians is concerning given the rising number of women in the medical profession. However, as poor status integration has been proposed as an explanation, their increasing proportion in the medical workforce could hopefully help reverse this trend.

Physicians -particularly female- present high risk of suicide. Adequate services of counseling, support and care that provide anonymity and confidentiality should be the cornerstones of preventive efforts. The last are complicated by the fact that restriction in the main suicide method (drugs) seems a hardly applicable preventive measure in this population.

When compared to the general population psychiatric patients smoke at higher rates. in Greek psychiatric wards smoking has been “quietly” allowed up until 2011 and up to date there is no provision of nicotine dependence interventions.

The opening of offered a unique opportunity to establish the first psychiatric ward with a clear no smoking policy.

To describe the effect of this intervention on the smoking behaviour of the inpatients.

For a 12month period we conducted a prospective study of smoking avoidance measures in the 2nd Department of Psychiatry of Attikon University Hospital in Athens. We monitored the smoking habits of 330 inpatients before admission, during their hospitalization and at discharge.

From 330 patients, 170 were smokers (51.5%). 101 of them (59.4%) had made at least one effort to quit smoking in the past. Regarding diagnosis, patients with schizophrenia were smokers significantly more than patients suffering from mood disorders (83/177 vs. 56/138, x2=4.8, p=0.03). Concerning the smoking habits during hospitalization, only 12 of the 170 smokers (7%) admitted or were seen to smoke in their rooms despite regulations. The mean difference (before admission/at discharge) was -21.8 cigarettes per day (p< 0.001).

Smoking avoidance measures are effective in a new psychiatric unit.

Fibromyalgia and major depressive disorder (MDD) frequently co-occur. Quetiapine XR has demonstrated efficacy in the treatment of MDD and has recently been shown effective in patients with fibromyalgia.

To evaluate the efficacy and safety of quetiapine XR in patients with MDD and comorbid fibromyalgia.

To report on the antidepressant and analgesic effects of quetiapine XR in a sample of dually diagnosed patients.

An 8-week double-blind, randomized controlled trial in 120 non-psychotic adult outpatients with a confirmed diagnosis of MDD and fibromyalgia. Quetiapine XR was administered once daily in the evening at a starting dose of 50 mg/d for 2 days then 150 mg/d for 2 weeks and up to 300 mg/d if needed. The primary efficacy endpoint was mean change from baseline to week 8 on the HAM-D17 total score. Secondary endpoints included other measures of depression, anxiety, pain, quality of life, global functioning and adverse events.

At week 8, mean change in HAM-D17 score from baseline was significantly greater in the quetiapine XR arm than placebo (-10.0 vs. -5.8, p=0.001). Improvements in the Fibromyalgia Impact Questionaire (FIQ total -11.1 vs. -3.9, p=0.022) and Brief Pain Inventory (BPI-Total -2.1 vs. -1.6, p=0.007) was significantly greater in the quetiapine XR arm versus placebo. Improvements in all secondary outcomes were significantly greater in the quetiapine XR with the exception of the Sheehan Disability Scale total score.

Quetiapine XR demonstrated significant antidepressive and analgesic effects in this population of patients with MDD and fibromyalgia.

The Insomnia Severity Index ISI is a Questionnaire to screen insomnia in clinics;so,it has been translated to many languages.

To determine the Reliability and validity of the Chinese Translation of Insomnia Severity Index(C-ISI) in patients with Insomnia and compare it with Chinese version of Pittsburgh Sleep Quality Index(C-PSQI).

To show the Reliability and validity of C-ISI for using it in chinese speakers.

English version ISI was translated into Chinese base on standard guidelines then Chinese version was filled in 83 patients with insomnia as a clinical group and 45 persons without sleep complain as the control group by themselves in Neuropsychiatery Department of DongzhiMen hospital. For finding Test-Retest reliability they refilled ISI questionnaire 2 weeks later.

Cronbach-α coefficient of C-ISI for the clinical group, control group and both of them was 0.72, 0.75 and 0.91 respectively. The C-ISI component and total scores in test were significantly correlated with their related components and total scores in re-test (P < 0.05). Mean Ranks for All C-ISI components, total score were significantly higher in clinical group than control group that presents low sleep quality in clinical group. There are Significant correlations between C-ISI component and total scores and C-PSQI components and Total scores in related Items.

C-ISI has acceptable reliability and good sensitivity for assessing insomnia patients ;besides,C-ISI can evaluate the insomnia patients similar to the PSQI-C so it can be used as a good scale to measure sleep quality in Chinese speakers.

Polypharmacy continues to be a major concern in psychiatry. Besides the risk of unintended and untoward pharmacological interactions, it carries the potential to cause prescriber liability and increased healthcare costs. Although polypharmacy has been commonly reported in forensic units, there have been no studies examining potentially serious pharmacological interactions in secure settings.

To identify the prevalence of potential pharmacological interactions through a cross-sectional study of prescribing patterns in a medium secure unit in the UK.

Medications prescribed for all 43 patients on 3 male medium secure wards in London in September 2012 were analyzed for potential pharmacological interactions using the Medscape Drug Database/Interaction checker.

A total of 233 regular and 113 ‘as required (p.r.n)’ medications were prescribed. 98 medications were psychotropic and 248 were physical health related. 284 potential pharmacological interactions were present with an average of 6.6 interactions per patient (1-28), involving 31 of the 43 patients(72.09%). These interactions were categorized into four groups: 1.Contraindicated (4.65% of patients;2 interactions) 2.Serious-Use Alternative(30.23% patients;20 interactions) 3.Significant- Monitor Closely(69.6% patients; 232 interactions) and 4.Minor(39.53% patients;30 interactions). Interestingly, 65% of contraindicated/serious interactions involved non-psychotropic medication.

The findings highlight the high prevalence of potential pharmacological interactions in the forensic population. The challenging presentations in forensic psychiatry often necessitate ‘p.r.n. prescribing’ and medication augmentation to treat partial response. However, this can lead to unpredictable and dangerous interactions. Clinicians should be mindful of the pharmacodynamic and pharmacokinetic implications prior to prescribing psychotropic and non-psychotropic drugs.

Diminished Responsibility has formed an important aspect of the law of homicide in England and Wales since 1957. It acts as a partial defence to murder and if successful, reduces the charge to manslaughter. Despite operating for over fifty years in England and Wales, it was subjected to regular criticism leading to the enactment of a revised plea.

This paper examines diminished responsibility, the elements of the revised plea and its legal/ clinical impact.

The core components of the old plea involved abnormality of mind substantially impairing mental responsibility. However, the obscure wording, the lack of psychiatrically recognized concepts and expert-jury role confusion led to a number of proposed reforms to the plea. The revised plea which came into force in 2010 consists of four limbs- abnormality of mental functioning, recognized medical condition, substantial impairment of mental ability and an explanation/causation requirement.

Although the new plea has intended to accommodate medical advances and modernize and clarify the law, its scope has been largely narrowed. Academics have criticized the explanation/causation requirement for being too complex to prove and so restrictive that satisfying an insanity plea might be easier. Concern has been expressed that more contested cases and murder convictions would result from this restriction in the plea's scope. Cases such as mercy-killing and battered spouses which previously could be dealt with ‘sympathetically’, might now be excluded. Interestingly, role confusion continues to be present with medical experts treading onto the jury's territory, opining on legal issues.

For 115 patients with TRS, we divided them into two groups; the one is those with a history of DSP and the other is without DSP, and treatment with RLAI was conducted for 12-month duration. This is an observational study which did not control concomitant medications or dosage of RLAI.

Clinical symptomatology and medications at baseline did not differ between the two groups. The results from the final analysis for remaining 95 patients revealed that the group with DSP showed greater improvements in the change of BPRS total score than the group without DSP.

These results suggested strongly that the dopamine supersensitivity state could be related partly with the etiology of TRS. An atypical agent with long half-life time such as RLAI, can provide beneficial effect for patients with DSP.

There is a high prevalence of cannabis use among patients with psychosis. Persistent cannabis use in firstepisode psychosis affects prognosis and recovery. Understanding the reasons of cannabis use may help improve psychosis outcome. Several studies suggest that cannabis is used to ameliorate symptoms related to the disorder (self-medication hypothesis). Comparing the reasons of cannabis use in first-episode patients with a control group, may help to acknowledge that question. So far few studies with a control group have been carried out.

Identify the reasons of cannabis use in first-episode psychotic cannabis users and compare them to non-psychotic cannabis users.

Thirty-two first-episode psychosis cannabis users and thirty-four non-psychotic cannabis users were included. They completed a self-reported reasons for use cannabis questionnaire, adapted from Dixon et al.

The amount and frequency of cannabis use was higher in patients with first-episode psychosis than controls (6.47+/- 8.2 patients vs 19.59+/- 27.7 controls; p=0.024). The two groups did not differ significantly in any of the reasons for cannabis use. The main factors attracting them to use cannabis were: relaxation, sleep better, getting high and pleasurable experiences.

Both first-episode psychosis and controls seem to use cannabis for the same reasons, which does not support the self-medication hypothesis. However additional research would be necessary to further investigate cannabis use correlation with symptoms to discard that hypothesis. Recognition of the actual reasons of use should help prevention strategists to develop appropriate programmes to general and specific audiences.