Schizophrenia is a disabling, chronic psychiatric disorder that has far-reaching consequences for both patients and their relatives. Management of schizophrenia involves family support and care. In this context, burden of care is a concept related to caregivers and family's members of patients assuming responsibility for these patients. This construct can be conceptualized as a syndrome of varying clustering affecting the general and mental health of caregivers.

This study aims to determine the frequency and clinical correlates of family burden in schizophrenia.

We performed a transversal study in department of psychiatry A at Razi hospital. Thirty principal caregivers of schizophrenia patients were interviewed. Caregiver's burden was assessed using the Zarit scale.

The mean age of caregivers was 48.7 ± 7.15 years. In our sample, 63.3% (n = 19) were parents, 23.33% (n = 7) were brothers or sisters and 13.33% (n = 4) were spouses. The mean score of Zarit was 58.75 ± 9.15. Caregivers had a severe burden in 56.66 of cases (n = 17). Levels of burden were significantly associated with history of aggressive acting out and poor treatment adherence.

Caregivers of schizophrenia patients experience enormous burden which is in part related to clinical features of disease. Further studies are necessary to establish the appropriate interventions in order to reduce and manage general and psychological impact of schizophrenic patients care giving.

The authors have not supplied their declaration of competing interest.

Resilience is a dynamic, context- and time-specific process that refers to positive adaptation or ability to maintain or regain mental health despite experiencing adversity. Pathways to resilience include biological, psychological, social and dispositional attributes. In mood disorders, resilience may influence frequency of relapse, severity of episodes and response to treatment.

To evaluate resilience as well as personality features, coping abilities, self-esteem and quality of life in a sample of mood disorder patients.

We recruited mood disorder patients at the Psychiatry institute AOU Maggiore della Carità, Novara. Socio-demographic data were gathered and patients filled in the following self-administered scales: Resilience Scale for Adult (RSA), Brief Cope, Rosenberg Self-Esteem Scale (RSES), Paykel list of stressful events, Temperamental and Character Inventory (TCI), Quality of life (SF-36).

We collected data from 61 patients. Statistical analysis was performed by calculating the Pearson Correlation Coefficient between the RSA and the other tests. We observed a positive correlation between RSA and coping “Emotion” and coping “Problem”. A negative correlation was found between RSA and coping “Avoidance”. Resilience was also positively related to self-esteem and physical, mental and general health. As far as personality traits are concerned, resilience was positively correlated with Reward dependence, persistence, self transcendence, self directedness and cooperativeness.

Since higher resilience levels are related with better physical and mental health, constructive coping and self-esteem, strategies aimed at enhancing resilience could improve treatment and quality of life in patients with mood disorders.

The authors have not supplied their declaration of competing interest.

Raised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences.

To compare exposure to antipsychotic medications in immigrant and native-born populations in Spain.

Descriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008.

1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant.

All immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.

Alterations of biological rhythms are well recognized to play a crucial role in the origin and maintenance of depression, but little is known about the profile of circadian rhythms at a premorbid age in adult depressed patients. The present study was aimed at investigating the association, if any, of depressive disorders with biological and behavioural rhythm modifications both at the time of observation and at an earlier age than the clinical onset of depression. The hypothesis was that such modifications could be an early biological index of vulnerability to the illness.

One hundred and seventy-eight patients affected by DSM-IV Major Depressive Disorder were examined/observed, compared to a group of 178 matched healthy subjects. All the included subjects were asked to fill in a retrospective questionnaire reporting time of awakening and falling asleep and time of subjective peaks of appetite, energy and cognitive function during “Adolescence” (12–15 years), “Youth” (16–20 years) and “Present condition” periods.

An advance of awakening time by about 20 minutes during “Adolescence” was reported in the depressed subjects as compared to the controls. Awakening is also reported as significantly (P < 0.001) advanced by about 36 minutes during “Youth” in depressed patients, while time of falling asleep at the same age in the patients group shows 19 minutes delay. Regarding “Present condition” an advance of awakening time (33 minutes) in depressed patients was reported, in association with a delay of the subjective peak of cognitive functioning (62 minutes).

Depressed patients show clear-cut differences in sleep pattern as compared to controls, consisting in a constant and significant advance of awakening time, while the time of sleep onset never reaches any statistical difference between the groups throughout ages.

The results are consistent with the hypothesis that early alterations of the general circadian profile can contribute to the onset of adult life Major Depressive Disorders.

Psychopathological disturbances are common in the aftermaths of a disaster. The consequences of these disorders can be long lasting. In August of 2007 an intense and destructive wildfire broke out in the Peloponnesus peninsula in Greece.

To investigate psychological and psychiatric morbidity in individuals who had experienced severe exposure to a wildfire disaster in a part of Greece and to indentify risk factors for the post disaster psychological problems.

To investigate a broader spectrum of mid-term psychological and psychiatric morbidity in victims, to evaluate the proportion of psychopathology that could be accredited to the disaster, to estimate the association of losses with different psychological symptoms, to indentify risk factors for psychopathology.

A Cross sectional case control study of adult population (18–65 years old). Data collected among others were demographic, Symptom Checklist 90-Revised for assessment of psychological difficulties, type and number of losses.

Those damnified from the disaster scored significantly higher (p < 0.05) in the symptoms of somatisation, depression, anxiety, hostility, phobic anxiety, paranoia, and had significantly more symptoms (PST) and were more distressed by them (GSI) compared to controls. In addition risk factors for someone to be a psychiatric case were to be a victim from the fire, to have finished primary school, to be windowed and to have damages to his property.

Wildfires can cause considerable psychological symptoms in victims and there are reasons for public health policy makers to create services in order to help and improve the mental health of those affected.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder, bipolar type (SAD) and bipolar disorder I (BD) present a large clinical overlap. In a 1-year follow-up, we aimed to evaluate days to hospitalization (DTH) and predictors of relapse in a SAD-BD cohort of patients.

A 1–year, prospective, naturalistic cohort study considering DTH as primary outcome and incidence of direct and indirect measures of psychopathological compensation as secondary outcomes. Kaplan-Meyer survival analysis with Log-rank Mantel-Cox test compared BD/SAD subgroups as to DTH. After bivariate analyses, Cox regression was performed to assess covariates possibly associated with DTH in diagnostic subgroups.

Of 836 screened patients, 437 were finally included (SAD = 105; BD = 332). Relapse rates in the SAD sample was n = 26 (24.8%) vs. n = 41 (12.3%) in the BD sample (p = 0.002). Mean ± SD DTH were 312.16 ± 10.6 (SAD) vs. 337.62 ± 4.4 (BD) days (p = 0.002). Patients with relapses showed more frequent suicide acts, violent behaviors, and changes in pharmacological treatments (all p < 0.0005) in comparison to patients without relapse. Patients without relapses had significantly higher mean number of treatments at T0 (p = 0.010). Cox regression model relating the association between diagnosis and DTH revealed that BD had higher rates of suicide attempts (HR = 13.0, 95%CI = 4.0–42.0, p < 0.0005), whereas SAD had higher rates of violent behavior during psychotic episodes (HR = 12.0, 95%CI =.3.3-43.5, p > 0.0005).

SAD patients relapse earlier with higher hospitalization rates and violent behavior during psychotic episodes whereas bipolar patients have more suicide attempts. Psychiatric/psychological follow-up visits may delay hospitalizations by closely monitoring symptoms of self- and hetero-aggression.

Catatonia is a neuropsychiatric syndrome described in a variety of medical and psychiatric conditions. Its association with frontotemporal dementia (FTD) has been sparsely described.

We reported two patients with FTD that present a catatonic state.

Case reports

Literature review through Pubmed and report of a clinical cases.

Case 1: Frontotemporal dementia, behavioral variant.

65 year old female who was hospitalized after losing weight due to his active refusal to eat and subsequently was undergone a gastrostomy. Once stabilized physically was derived to psychogeriatric ward where the patient was stuporous, mute, with mannerisms and rigidity. Continued with refusal to take food. On examination she had staring, posturing, echophenomena, automatic obedience, Gegenhalten, ambitendency and perseveration. It featured 12 of 23 symptoms of Bush and Francis Catatonia Rating Scale (BFCRS), scoring 32. She improved completely her catatonic state within one week with lorazepam 2.5 mg /day and zolpidem 10mg/day. Perseverative behavior and mannerisms was maintained.

Case 2: Frontotemporal dementia, primary progressive aphasia

67 years old male who was admitted to psychogeriatric ward because had aggressivity and negativism. On examination immobility, mutism, staring, echolalia, rigidity, negativism, withdrawal, perseveration, Gegenhalten, impulsiveness and combativeness were observed. It featured 11 of 23 symptoms of BFCRS, scoring 22. He was treated with lorazepam 10mg/day and valproic acid 900 mg/day. Catatonic symptoms disappeared a month later. Negativism and impulsiveness persisted slightly.

The catatonic syndrome may occur in patients with FTD. In both conditions symptoms overlap. The response to GABAergic drugs was optimal.

Characterized by compulsive rituals and Obsessive thoughts, OCD is a chronic and disabling disorder. Despite converging evidence pointing towards the involvement of dysfunctional cortico-striato-thalamo-cortical circuit in OCD, the neurophysiological pathology of OCD is still not well characterized. Indeed, 40%-60% of patients do not respond adequately to standard treatments.

TMS is a noninvasive therapeutic technique, recently applied to treat and investigate OCD. However, lacking the ability to target the CSTC circuit directly, standard TMS treatment protocols for OCD showed diversified results. The use of special deep TMS (dTMS) coils allows direct stimulation of deeper neuronal pathways relative to those affected by standard TMS coils. Here we evaluated whether dTMS targeting the medial prefrontal and the anterior cingulate cortices may influence symptom severity.

40 patients were treated with either dTMS or a sham coil for five weeks in a double-blind controlled study. The patients were divided into groups receiving either high (20Hz) or low (1Hz) stimulation frequencies, and were simultaneously administrated with symptom provocation. EEG measurements were taken at baseline and at the end of treatment.

The active 20Hz dTMS group improved significantly in YBOCS score compared to the 1Hz and placebo groups (28% vs. 6% reduction), {t (93) = -2.29 (p=0.0243)}. Moreover, follow-up assessments revealed 3 months stability in improvements as measured by YBOCS scores. EEG evoked responses measured over the ACC correlated with clinical response.

High frequency dTMS treatment, targeting the medial prefrontal and the anterior cingulate cortices is a promising therapeutic intervention in OCD.