The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990–2013

The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of total disease burden in EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years. The highest proportion of DALYs occurred in the 25–49 age group. The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Depressive disorders accounted for most DALYs, followed by anxiety disorders. Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to global level. Our findings call for EMR health ministries to increase provision of mental health services and to address stigma of mental illness. Our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability.

Introduction Recently, new patient-oriented outcome measures have emerged in mental health research and practice. Among these, generic quality of life (GQoL) has gained a central place and has come to represent a valid endpoint in most settings, from basic care programs to clinical trials, especially for the field of intellectual disability (ID). However, most studies still refer to health-related QoL, and the tools for the assessment of GQoL present many issues related to the structure complexity and administration time. Aim The purposes is to evaluate psychometric properties of a new rapid tool for the GQoL assessment named QuIQ (quick instrument for quality of life), originally constructed for use for people with ID. Methods Two hundred and ten persons with ID were consecutively administered with the QuIQ. A part of them were also assessed with the BASIQ, the Italian adaptation of the quality of life instrument package. QuIQ has the same conceptual framework and refers to the same areas of the BASIQ, but include a low number of dimensions (only attribution of importance and perception of satisfaction) and a factor way of score attribution such as visual analogue scale and graphic geometrical mean calculation. Results QuIQ showed good internal coherence (Cronbach's = 0.92), inter-rater reliability (Cohen's K > 0.93), and concurrent validity (> 0.8) with BASIQ. Conclusion These findings seem to display for the QuIQ good psychometric characteristics. They also suggest that it could be possible to apply rapid QoL assessment to all the range of people with ID. This could have very important implications for future massive use in different settings.

Predictors of the use of psychosocial interventions in Portugal: Results from the SMAILE project
Introduction The treatment of psychiatric disorders depends on a combination of different types of care, such as psychiatric treatment and psychosocial interventions. However, there is little research on the factors that determine access to care, particularly to psychosocial interventions.

Objectives
To characterize the use of psychosocial interventions (psychotherapy, day hospital, and psychosocial rehabilitation) in users of outpatient psychiatric services in Portugal.

Aims
This retrospective study analyses all outpatient psychiatric visits in four Portuguese departments of psychiatry in the metropolitan areas of Lisbon and Porto, and aims to evaluate the socio-demographic and clinical determinants of psychosocial interventions.

Methods
Socio-demographic and clinical variables were obtained from clinical charts of outpatients ' visits in 2002, 2007 and 2012 (n = 2621). All patients were characterized regarding the use of any psychosocial intervention beyond psychiatric consultations. Logistic regression analysis was performed to evaluate the predictors of psychosocial interventions use.

Results
Being followed in 2012, being single, having no professional activity, and having a diagnosis of psychosis or common mental disorder were significantly associated (P < 0.05) with higher odds of accessing psychosocial interventions. On the other hand, a lower level of education was associated with less use of this type of care. Conclusions Socio-demographic and clinical characteristics of psychiatric services, outpatients are determinants of the use of psychosocial interventions. Evidence suggests that social inequalities may influence the access to psychosocial interventions in Portugal. The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S106-S169 S157 assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs Objectives Although, emotional cues like facial emotion expressions seem to be important in social interaction, there is limited specific training about emotional cues for psychology professions.
Aims Here, we aimed to evaluate psychologist', psychological counselors' and psychiatrists' ability of facial emotion recognition and compare these groups.
Methods One hundred and forty-one master degree students of clinical psychology and 105 psychiatrists who identified themselves as psychopharmacologists were asked to perform facial emotion recognition test after filling out socio-demographic questionnaire. The facial emotion recognition test was constructed by using a set of photographs (happy, sad, fearful, angry, surprised, disgusted, and neutral faces) from Ekman and Friesen's. Results Psychologists were significantly better in recognizing sad facial emotion than psychopharmacologists (6.23 ± 1.08 vs 5.80 ± 1.34 and P = 0.041). Psychological counselors were significantly better in recognizing sad facial emotion than psychopharmacologists (6.24 ± 1.01 vs 5.80 ± 1.34 and P = 0.054).
Conclusion We have revealed that the pyschologist and psychological counselors were more accurate in recognizing sad and angry facial emotions than psychopharmacologists. We considered that more accurate recognition of emotional cues may have important influences on patient doctor relationship. It would be valuable to investigate how these differences or training the ability of facial emotion recognition would affect the quality of patient-clinician interaction.

Family functioning, trauma exposure and PTSD in a middle-income community sample
Introduction Only a minority of trauma-exposed individuals go on to develop post traumatic stress disorder (PTSD). Previous studies in high-income countries suggest that maladaptive family functioning adversities (MFFA) in childhood may partially ex-plain individual variation in vulnerability to PTSD following trauma. We test in a lower middle income setting (Sri Lanka) whether: (1) MFFA moderates the association between exposure to trauma and later (a) PTSD (b) other psychiatric diagnoses; (2) any moderation by MFFA is explained by experiences of interpersonal violence, cumulative trauma exposure or other psychopathology.

Methods
We conducted a population study of 3995 twins and 2019 singletons residing in Colombo, Sri Lanka. Participants completed the composite international diagnostic interview, including nine traumatic exposures and a questionnaire on MFFA.

Results
In total, 23.4% of participants reported exposure to MFFA. We found that (1) MFFA moderates the association between trauma exposure and both (a) PTSD and (b) non-PTSD diagnosis. (2) This was not explained by interpersonal violence, cumulative trauma exposure or other psychopathology. Conclusions In our sample MFFA moderates the association between trauma and PTSD, and the association between trauma and non-PTSD psychopathology. Objective KBG syndrome is caused by a mutation in the ANKRD11 gene, characterized by short stature and specific dental, craniofacial and skeletal anomalies. Scarce literature on the phenotypical presentation mention delayed speech and motor development as well as mild to moderate intellectual disabilities. As to psychopathology, often, autism and ADHD are mentioned but not yet substantiated in terms of neurocognitive variables.

Disclosure of interest
Aim Aim of the current study was to investigate neurocognitive aspects of KBG syndrome. Participants and Methods Seventeen patients (aged 6-66 years; ten females) with a proven ANKRD11 mutation were compared with two different groups of patients with a genetic disorder and similar developmental ages (n = 14 and n = 10). Neuropsychological assessment was performed focusing on the level of intellectual