Coercion in psychiatric wards may improve the safety of patients and surroundings, on the other hand, its use affects compliance and satisfaction with treatment. In Poland the coercive measures are strictly regulated by The Mental Health Act (1994). Most of published studies refers to the coercion only during hospitalisation.

Assessment of the extent of coercive measures in psychiatric emergency room and evaluation of the relationships between the use of direct coercion and selected demographic-clinical factors.

This study was conducted at the Bielanski Hospital in Warsaw on all the patients admitted to the psychiatric ward over one year. The extent of coercion in the psychiatric emergency room, demographic and clinical data were collected. Patients were assessed in Brief Psychiatric Rating Scale (BPRS) prior to admission. Patients’ sociodemographic and clinical factors were tested in a multivariate logistic regression model.

In the study 318 patients were included. Coercion of some form in the psychiatric emergency room was used in 29% of cases: admission without consent in 22% of cases and direct coercion (holding, forced medication, mechanical restraint) in 7%. Use of direct coercion in the psychiatric emergency room was associated with BPRS scoring: positively with severity of disorientation symptoms and negatively with severity of depression symptoms. Suicide attempts in the past were discovered to reduce the risk of being a subject of coercive measures. We found no demographic data associated in any way with coercion use.

Coercion in psychiatric emergency room was related to patients’ mental state and their past medical history. There is no evidence of coercive measures misuse towards any demographic group.

None Declared

Mothers after childbearing are vulnerable to many stress related disorders.

to emphasize the role of the past obstetric complications, as so present infant pathology as risk factors for the mother's post partum stress related disorders.

The case analysis.

The thirty-year-old, women left the maternity ward with her baby unnoticed on the fourth day after giving birth. She was referred to psychiatry ward, after finding her by the police. In the past history the patient had spontaneous miscarriage in the first pregnancy. She has waited with her husband 6 years long for the next baby. The second pregnancy was at risk, the labor was premature and the infant has palatoschisis. The mother had difficulties with feeding. She feared about baby's life, and had feeling of being neglected by the staff. In psychiatry ward she did not reveal any symptoms of mental illness. She was interested in her child, however the period of the flight was covered with memory gap. The predominance of immature defense mechanisms, as so mild cognitive dysfunctions were revealed in psychological testing. The dissociative fugue was diagnosed. The patient was discharged without any medication to ambulatory psychotherapy.

The interaction of past and present traumatic experiences in the patient with cognitive dysfunctions and immature defense mechanisms could impair ability of post-partum coping with fear about the child and consequently led to the loss of conscious control over the memory. Early diagnosing and supporting problematic patients of the maternity ward is needed.

Codependency is a dysfunctional style of close relation with alcoholic, as so risk factor of stress related mental disturbances.

Assessment of general health, as so the occurrence and correlation of the codependency features, traumatic experiences and the symptom of posttraumatic stress disorder -PTSD in the women from alcoholic families.

39 women from alcoholic families and 18 controls were screened with the General Health Questionnaire GHQ-28. In the group of women from alcoholic families the occurrence and correlation of: the features of codependency, traumatic experiences and PTSD symptoms, were compared in 12 psychiatrically hospitalized and 27 non hospitalized women from alcoholics families.

The average total GHQ-28 scores were significantly higher in the both groups of hospitalized (9,58) and non hospitalized (6,46) women from alcoholics families comparing with the controls (1,72). The percentages of: women with codependency features, women reporting traumatic experiences as so women reffering symptoms of PTSD did not differ significantly in hospitalized and non hospitalized groups. There was correlation between the number and intensity of traumatic experiences, PTSD symptoms and features of codependency in women from alcoholic families.

Codependency in the women in alcoholic families is frequently co-occurring with increased number of traumatic experiences, and PTSD symptoms. In the cases of mentally ill women living in alcoholic families the appropriate psychotherapy is needed besides the pharmacological reduction of the psychopathological symptoms. Usefulness of the GHQ-12. in screening mental disturbances in the persons from alcoholic families was confirmed.

The appearance of psychotic and affective symptoms in the patients treated with steroids has been described in the literature; however, there are limited data on factors affecting development of these disturbances.

38 year-old female with past medical history of depression, long-standing hypothyroidism and adrenal insufficiency on both thyroid and adrenal hormone replacement therapies (RT), was admitted to psychiatric ward due to psychomotor agitation, tangentiality of though and labile affect. the manic episode was diagnosed. the significant hyponatremia was found and corrected. After the reduction of the doses of hormone replacement therapy, and the treatment with valproic acid and haloperidol the manic symptoms were eliminated.

Steroid RT may have a significant effect on the development of psychiatric symptoms in that patients; however, presence of hyponatremia and simultaneous thyroid RT could be important contributing factors. Severity of the symptoms requiring antipsychotic medication did not allow verifying the hypothesis that reduction in the dose of steroids might be only necessary treatment in steroids-induced psychiatric disturbances. However as the only one depressive episode in the past history was connected with the significant adrenal insufficiency with hypothyroidism, the current episode in that patient was diagnosed as mania related to hormonal replacement therapy rather than to bipolar affective disorder. This case points out an increased risk of psychotic disturbances in the course of the treatment with steroids and a need to identify additional risk factors in the past history, somatic state and metabolic abnormalities.

Neuroleptic Malignant Syndrome (NMS) is life-threatening complication of antipsychotic treatment. The risk of NMS is greater by the classical antipsychotics, however there are reports on induction of NMS with the new antipsychotics NAP.

56 years old male with the schizoaffective disorder currently manic episode, hospitalized and treated with: valproic acid, lithium and olanzapine; developed depression and metabolic syndrome. Twelve days after the olanzapine was changed to amisulpride (400 mg/day) elevation of mood and drive followed by confusion, dysarthria, muscular rigidity and tremor emerged within hours. The lithium intoxication (blood level 1,22 mmol/l) or MNS were suspected. Lithium and amisulpride were discontinued. The occurrence of fever (38 C), insomnia, delirium, rigidity, elevated blood creatine phosphokinase CK (1346j) and myoglobin (144 n/ml) confirmed the NMS. After 20 days treatment with Diazepam and bromocriptine all the symptoms of NMS have disappeared, but the patient started to have depressive symptoms. The quetiapine (100 mg/d) for 3 weeks improved mood and activity, but the treatment was discontinued due to recurrent increase in blood CK and myoglobin (with no clinical symptoms of NMS).

The presented case reveals the risk of NMS connected with NAP. It is to notice that after withdrawal of the clinical NMS symptoms noticeable over-reactivity of receptors to other antispychotics (quetiapine) was persisting. The investigation of the role of other factors (co morbid somatic illness, interaction with lithium etc) in the induction of NMS is needed.

It has been shown that new antipsychotics (NAP) olanzapine or aripiprazole in combination with valproic acid or lithium are safe and improving the efficacy of the treatment of manic episode, and the mood stabilizing therapy in bipolar disorder (BD). NAP have less potent antidopaminergic action, and lover risk of Neuroleptic Malignant Syndrome (NMS) than typical antipsychotics.

59 years old male, with recent history of cognitive impairment, and long history of BD treated with combination of valproic acid, lithium and olanzapine was admitted to the hospital with acute manic episode. Because of ineffectiveness of the recent treatment there was added aripiprazole (15 mg/d) followed by slow reduction of olanzapine. After following 3 weeks the clinical symptoms of lithium intoxication, and the raising blood level of lithium (1,47 mmol/l) were observed, although the oral dose of lithium was not changed. The symptoms of intoxication disappeared during 10 days after lithium discontinuation. However, after the next 8 days of the treatment with aripiprazole combined with valproic acid - the NMS symptoms rapidly emerged and were lasting for 12 days

We have found in the literature description of NMS in the patient on aripiprazole combined with lithium, and in the patient with mental retardation treated with aripiprazole added to olanzapine. Our presentation reveals increased risk of toxic interactions between lithium and the new antipsychotic Aripiprazole, as so the possible role of neurobiological deficits as risk factors of NMS.