Recent literature suggests that over 70% of cases of antibody-mediated encephalitis present to psychiatry services with features of psychosis predominantly.

To investigate the seroprevalence of N-Methyl-D-Aspartate receptor antibodies (NMDAr-Ab) in patients with first episode psychosis (FEP)

Following ethical approval, all cases meeting entry criteria were invited to participate. Participants were interviewed with SCID to obtain a DSM diagnosis. NMDAr-Ab were identified in serum by cell based assay using co-transfected Human Embryonic Kidney (HEK)cells. Positive cases were reviewed by clinical neurology. Decision to treat with immunotherapy was made on a case by case basis.

85/115 (72%) of patients with FEP entered the study. 49 (58%) participants were male, mean age (SD) 37 (15.7) years. 42 (52%) were outpatients at the time of assessment. Four cases (5%) were serum NMDAr-Ab positive. 3 of these cases were male, age 48 (16.3) years. All four were admitted as inpatients with normal brain MRI imaging. One case (female, 55) was confirmed as NMDAr-Ab encephalitis based on case presentation, EEG demonstrating bilateral cerebral dysfunction and NMDAr-Ab in CSF. Immunotherapy treatment lead to clinical improvement. In remaining cases, EEG was normal and CSF negative. All 3 of these cases showed clinical improvement following psychiatric treatment as usual.

Our findings support the current estimates as to NMDAr-Ab prevalence in FEP. Increased awareness has lead to rapid treatment of florid cases of NMDAr-Ab encephalitis in our service. Additional seropositive cases are being followed with neuro-cognitive testing for any evidence of decline.

To evaluate efficacy and safety of intramuscular (IM) aripiprazole and IM haloperidol in patients with acute agitation associated with schizophrenia.

Patients (n=232) were randomized to IM aripiprazole 1-mg (0.5 ml of a 2-mg/ml solution), 5.25-mg (0.7 ml of a 7.5-mg/ml solution to approximate 5-mg), 9.75-mg (1.3 ml of a 7.5-mg/ml solution to approximate 10-mg), or 15-mg (2.0 ml of a 7.5-mg/ml solution), IM haloperidol 7.5-mg (1.5 ml of a 5-mg/ml solution) or IM placebo. Over 24 hours, patients received up to three injections, administered ≥2 hours apart. Primary endpoint was mean change from baseline in Positive and Negative Syndrome Scale Excited Component (PEC) score at 2 hours. Secondary endpoints included CGI-I, CGI-S and ACES scores.

Mean PEC improvements at 2 hours were significantly greater with IM aripiprazole 5.25-, 9.75- and 15-mg, and IM haloperidol versus IM placebo (Table). Compared with IM placebo, mean improvements were significantly greater in CGI-S with IM aripiprazole 9.75- and 15-mg, and in ACES with IM aripiprazole 9.75-mg and IM haloperidol (Table). Mean CGI-I was significantly better with IM aripiprazole 5.25-, 9.75- and 15-mg, and IM haloperidol versus IM placebo (Table). Overall, IM aripiprazole was well tolerated, with fewer extrapyramidal side effects versus IM haloperidol.

IM aripiprazole 9.75-mg is effective and well-tolerated for acute agitation associated with schizophrenia.

The European impact of the clinical high risk for psychosis (CHR-P) paradigm is constrained by the lack of critical mass (detection) to power prognostic and preventive interventions.

An ITAlian partnership for psychosis prevention (ITAPP) was created across CHR-P centers, which were surveyed to describe: (a) service, catchment area, and outreach; (b) service users; and (c) interventions and outcomes. Descriptive statistics and Kaplan–Meier failure function complemented the analyses.

The ITAPP included five CHR-P clinical academic centers established from 2007 to 2018, serving about 13 million inhabitants, with a recruitment capacity of 277 CHR-P individuals (mean age: 18.7 years, SD: 4.8, range: 12–39 years; 53.1% females; 85.7% meeting attenuated psychotic symptoms; 85.8% without any substance abuse). All centers were multidisciplinary and included adolescents and young adults (transitional) primarily recruited through healthcare services. The comprehensive assessment of at-risk mental state was the most widely used instrument, while the duration of follow-up, type of outreach, and preventive interventions were heterogeneous. Across 205 CHR-P individuals with follow up (663.7 days ± 551.7), the cumulative risk of psychosis increased from 8.7% (95% CI 5.3–14.1) at 1 year to 15.9% (95% CI 10.6–23.3) at 2 years, 21.8% (95% CI 14.9–31.3) at 3 years, 34.8% (95% CI 24.5–47.9) at 4 years, and 51.9% (95% CI 36.3–69.6) at 5 years.

The ITAPP is one of the few CHR-P clinical research partnerships in Europe for fostering detection, prognosis, and preventive care, as well as for translating research innovations into practice.

We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years.

The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses.

When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis.

Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.

No significant relationships.

Technological innovation has been pervasive and has touched almost every aspect of modern life, including the delivery of behavioural and mental heath care. As telehealth expands, internet interventions are particularly interesting as a medium of delivering effective care. However, standards are required to help inform healthcare policy makers, providers, clinicians and patients.

Move towards outlining a gold standard for internet-delivered behavioural and mental health interventions.

Contribute and build upon existing standards and guidelines for the practice of telehealth, but to now extend these to include internet-delivered interventions.

Drawing from research, experience and practice, the authors propose a matrix for the evaluation of what might be considered a gold standard for internet-delivered behavioural and mental health interventions.

Seven elements are proposed and considered aspects of what would constitute a gold standard and they include, the use of evidence-based and empirically supported content, robust, engaging, secure and responsive technologies, shaped by behavioural health subject matter experts, employ user-centred design and development principles, have a focus on accountable care-achieving clinical outcomes, have research and evaluation that supports its effectiveness, and a well developed implementation science and support.

The paper proposes some characteristics that could compose a gold standard for internet-delivered interventions for behavioural and mental health care. The contribution is neither exhaustive nor conclusive, but offers an invitation to the discussion.

The authors have not supplied their declaration of competing interest.

The current study elucidates the relations between alexithymia and several biological components of the Metabolic Syndrome (MS). We hypothesized that various facets of the alexithymia construct are differentially related to single components characterizing the MS.

Investigated were N = 101 patients with MS. To establish the diagnosis of MS according to IDFC criteria, both laboratory (lipid profile, fasting plasma glucose, type 2 diabetes) and non-laboratory (blood pressure, waist circumference, BMI) tests were included. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20).

Based on alexithymia scores, patients were classified as low- (TAS-20 score ≤ 51; N = 31), moderate- (51 < TAS-20 score < 61; N = 33), or high-alexithymic (TAS-20 score ≥ 61; N = 37). The amount of moderate and high alexithymic patients proved highly significant amongst patients with MS with readily established diabetes type 2. The alexithymia score showed overall correlations with diabetes type 2 (r = 0.380, p < 0.001) and triglyceride levels (r = 0.214, p < 0.016). Correlations with non-laboratory measures were significant for high blood pressure levels (r = 0.233, p < 0.010). Linear regression models confirmed the existence of linear causal relationships for the observed correlations.

The present results suggest that the alexithymia trait is related to specific biological marker variables in the metabolic syndrome. Alexithymia may, according to our study, contribute to the aggravation of the MS.

The clinical diagnosis of personality disorder in adolescence tends to be conservative and unspecific.

To examine the prevalence of personality disorder, and the involvement of stigma effect in adolescents with Axis I psychiatric disorders.

A sample of 100 patients with psychiatric disorders (M = 15.8, SD = 0.9 years, range 15-17, 70% women), were assessed and diagnosed for personality disorders in a mental health public centre.

The prevalence of PD identified by clinicians (12%), differs from the prevalence identified by the semi-structured interview (34–37%) showing a greater number (p < .001) of people affected. In the present sample most of the cases identified by clinicians are related to personality disorders (PD) not otherwise specified, while with the implementation of semi-structured interviews, most of the sample met criteria for Cluster B PDs. Additionally, 11% of the sample has dimensional pathological features (probable PD) without complying categorically the criteria for a full PD.

In clinical settings, a considerable proportion of adolescents with psychopathology meet features for PD, although few of them have a confirmed clinical diagnosis. Considerations about impact of the stigma are discussed.

Vitiligo, a dermatological problem, affects a person's emotional and psychological well being, having major consequences on patient's life. Most of the patients of vitiligo report embarrassment, helpless and low self esteem.

To study socio-demographic profile and psychiatric comorbidities and their correlation with site of lesion in vitiligo patients.

100 vitiligo patients and 100 subjects as control group who were well enough to complete the assessment were assessed with a semi-structured self designed Proforma, Hospital Anxiety Depression Scale (HADS) to obtain the relevant information. Data so obtained were tabulated, analyzed and conclusions were drawn using suitable statistics (i.e. Chi2).

79% of vitiligo patients were between age 13 to 45 years, 67% were males, 33% were females patients in study group. In comparison to healthy controls, the psychiatric morbidity was found to be significantly higher in the vitiligo group (62% v/s 25%). 37%, 18%, and 7% vitiligo patients suffered from Mixed anxiety and depressive disorder, Depressive disorder and Generalized anxiety disorder respectively. Incidence of psychiatric morbidity was higher in patients who had lesions more on exposed body areas.

Vitiligo affected marital, sex life and intimacy. This generates psychological distress and disrupts the social relationship and creates a vicious stress-vitiligo cycle. Among vitiligo cases, psychiatric morbidity was found more frequent in young participants and higher in patients having lesions on exposed body areas.

The author has not supplied his/her declaration of competing interest.

Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU).

At level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery–Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life.

Intention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21–1.15 for PHQ-9 and d = 0.51, 95% CI 0.04–0.99 for MÅDRS).

In the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms.

Suicide is a major public health issue.

Mentalization is a form of imaginative mental activity about others or oneself that may shed light on the phenomenology of suicide.

To assess the role of a number of variables in suicide risk.

Participants were 156 (73 men and 83 women) adult psychiatric inpatients (age range = 18/74 year). Most of the patients had a major mood disorder (26.3% BD-I, 3.2% BD-II, and 11.5 MDD), psychosis (16.7%), or a schizoaffective disorder (20.5%). All the patients were administered the Mini International Neuropsychiatric Interview (MINI) for assessing diagnosis and suicide risk, and the Impact of event scale, Mentalization Questionnaire, Childhood Trauma Questionnaire. Some patients (18.6%) were admitted for a recent suicide attempt and 34.6% had attempted suicide in the past.

At the MINI, 44.9% of the patients resulted at a moderate to high risk of suicide, and 55.1% at no or low risk of suicide with no difference for sociodemographic variables (sex and age) and diagnosis, but they differed for mentalization and symptoms of intrusions and avoidance caused by a traumatic event. Groups also did not differ for self-reported childhood trauma. Only mentalization was independently associated with higher suicide risk, and patients with moderate to severe risk of suicide were 1.7 times more likely to report more mentalization deficits than those with no or low risk of suicide.

Our study supports the notion that the investigation of mentalization among patients may help in proper assessment of suicide risk.

The authors have not supplied their declaration of competing interest.

This research aims at examining the relationship between anxiety, depression, and hopelessness among nonclinical Kuwaiti sample using Beck Anxiety Inventory, Beck Depression, and hopelessness inventories.

highlighting the relationship between anxiety, depression, and hopelessness among nonclinical sample of females and males and the common factor/s.

The participants were 616 (308 females & 308 males), Kuwait University students. The two genders were matched in age (18.15 ± 0.36 & 18.18 ± 0.38, t = 0.94, P > .05) and BMI (24.12 ± 3.27 & 23.50 ± 4.85, t = 0.54, P > 0.5). The Arabic versions of the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and demographic surveys were administered to participants during classes. All participants read and signed a consent form before participating. The correlation matrices, exploratory factor analysis, and reliability analysis are used in this study.

Internal consistency of scores were satisfactory for the BAI, BDI-II, & BHS inventories respectively (Cronbach's alpha (M) = 0.88, 0.75, 0.74 & (F) = 0.89, 0.84, 0.88). A correlation of (r = 0.53) between the BAI and BDI-II and (r = 0.43) with BHS. Meanwhile a correlation of (r = 0.58) between BDI-II & BHS. A principal-axis factor analysis with oblique rotation suggested one factor accounting for 67.73% of the common variance.

The results indicate that there is a strong relationship between anxiety, depression and hopelessness. This highlights the important of examining common factors between anxiety, depression and hopelessness among nonclinical sample.

The author has not supplied his/her declaration of competing interest.

Penn State Worry Questionnaire (PSWQ) is an appropriate instrument for assessing of worry. Worry is the cognitive component of anxiety. It has a positive correlation with severity of the anxiety disorders. Preparing PWSQ and its psychometric index was necessary for Iranian students.

The aim of this study was to assess factorial structures, validity and reliability of Pennsylvania State Worry Questionnaire.

The English version of the questionnaire was translated into Persian with the standard procedures done for translating Psychological tests. 272 second grade high school students were selected by cluster sampling from different educational regions of City of Tehran. They completed PSWQ and principal components procedure by the Varimax rotation used for data analysis.

Exploratory factor analysis showed that PSWQ is a one-dimensional instrument for worry. Validity according to internal consistency coefficients was 0.83. Correlation with metacognition 30 question questionnaire was 0.63 indicating convergence reliability. Correlation with the Spiel Berger Anxiety scale was 0.67, with trait anxiety scale 0.70, with state anxiety scale 0.58. This finding shows that the predictive reliability of the Questionnaire is acceptable.

According to the findings of this study PSWQ have good Psychometrics properties in Iranian population and can be used as a valid measurement in Psychological research.

Hikikomori, a form of severe social isolation, once characterized as a Japanese cultural-bond behavior with social and economic consequences, it is now being described in other countries. Its presentation mimics some clinical features of various classified mental diseases, such as prodromal phase of schizophrenia, personality disorders, Internet dependence, social phobia or depression, without fulfilling their defining criteria.

This work aimed to do a brief review of this subject, describing one case that is probably the first ever reported in Portugal, comparing it with similar cases around the world.

The patient was a 22-year-old male, taken to psychiatry evaluation after 4 years of social withdrawal, avoiding or blocking any contact even with family members, which resulted in work and school impairment. He spent most of his days locked at his room, investing his time in particular interests and Internet use, only leaving to eat or do his basic hygiene. At that time, he presented no affective or psychotic symptoms and perceived his behavior as egosintonic. After six appointments with psychotherapeutic approach, he was able to get a job and improved his communication with the others, especially with family.

This case fits most of the reports found on literature, in its presentation and clinical management. Hikikomori is not considered yet a disorder and further documentation of these cases is still needed to define its place in psychiatric nosology.

The authors have not supplied their declaration of competing interest.