Background: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). Methods: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). Results: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. Conclusion: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

-Background and Objectives: Dual diagnosis is associated with increased emergency department service use. During recent years, increased emphasis has been given to monitor the decision to hospitalise the most sever patients. Many rating scales have developed based on patient-related factors. To assess the level of severity of dual diagnosis patients measured by the Severity Psychiatric Illness (SPI) Scale and to evaluate it as a tool for predicting discharge in emergency psychiatric practice.Methods: Data on 1,227 consecutive admissions visited in a psychiatric emergency room of a general teaching hospital during a period of six months were collected. A routine computerised protocol was completed which included socio-demographic, clinical and social factors and the SPI scale.Results: 206 admissions (17%) had dual diagnosis disorder, 106 (9%) had substance abuse disorder (SUD), and 906 (74%) had non-substance abuse disorder (NSUD). Differences among groups were found in clinical characteristics, discharge decision, readmissions, previous psychiatric history, reason for referral, DSM-IV diagnosis and illicit drug use. Dual diagnosed patients had the highest scores of severity. Logistic regression analyses revealed the independent contribution of different SPI'items. The model showed a good fit and indicated excellent calibration in the sample studied, predicting 87.6% of discharge decisions.

Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.

Our results showed that in the psychiatric emergency service borderline personality disorder was diagnosed less frequently in the immigrant group v. the indigenous group. Our results do not support the concept of migration as a risk factor for borderline personality disorder.

Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.