The authors have not supplied their declaration of competing interest.

Drug safety surveillance strongly depends on the spontaneous and voluntary reporting of adverse drug reactions (ADR). A major limiting factor of spontaneous reporting systems is underreporting (UR) which describes incorrectly low reporting rates of ADR. Factors contributing to UR are numerous and feature country-dependent differences.

Understanding causes of UR is necessary to facilitate targeted interventions to improve ADR reporting and pharmacovigilance.

A cross-sectional questionnaire-based telephone survey was performed among physicians in outpatient care in a federal state of Germany.

From n = 316 eligible physicians n = 176 completed the questionnaire (response rate = 55.7%). Most of the physicians (n = 137/77.8%) stated that they report ADR, which they have observed to the competent authority rarely (n = 59/33.5%), very rarely (n = 59/33.5%) or never (n = 19/10.8%); the majority (n = 123/69.9%) had not reported any ADR in 2014. Frequent subjective reasons for ADR non-reporting were (specified response options): lack of time (n = 52/29.5%), the subjective evaluation that the required process of reporting is complicated (n = 47/26.7%) or requires too much time (n = 25/14.2%) or the assessment that reporting of an ADR is needless (n = 22/12.5%); within free answers the participants frequently stated that they do not report ADR that are already known (n = 72/40.9%) and they only report severe ADR (n = 46/26.1%).

Our results suggest a need of interventions to inform physicians about pharmacovigilance and to modify the required procedure of ADR reporting or to offer other reporting options.

The authors have not supplied their declaration of competing interest.

The aim of this study is to assess the dependence between the obsessive-compulsive symptoms, the eating disorders symptoms and orthorexia in adolescents aged 15-19, due to define which of these areas orthorexia is closer to. The study controlled such variables as: age, sex, BMI, school type.

The study covered 1899 pupils of secondary schools. The OCD and ED symptoms assessment was carried out with the LOI-CV, EAT-26 and the ORTO-15 questionnaire (two threshold values: ON- 40 and ON -35). The research was financed by scientific grant of Nutricia Foundation.

Revealed correlations of risk factors of ON - OCD and ON - ED indicated the higher the probability of diagnosis of these disorders, the higher the probability of ON diagnosis, too. The compatibility of ON and OCD diagnoses was for ON-40 = 45.8% and ON-35, 76.5%. It was shown that the OCD increases the risk of ON at the threshold value ON = 35. In the case of ON and ED, the diagnostic compatibility was ON-40, 42.7% and ON-35, 84.4%. The analysis of various variables confirmed a significant dependency of ON from ED, which suggests that ON belongs to ED. The diagnostic accuracy in this case is better at the threshold value ON- 35.

The results of our study should be confirmed in further research.

The assessment and management of psychomotor agitation may result in the use of coercive or sedative treatments. In the absence of conclusive evidence, the consensus of experts can guide clinical decisions.

To seek consensus recommendations on the assessment and management of psychomotor agitation.

An international expert task force in this field developed consensus using the Delphi method. Twenty-seven experts were invited to participate and 91% of them agreed. Initial survey items were gathered from the content of literature search (systematic review). This included open-ended questions inviting participants to add suggestions by e-mail correspondence. After this initial first round, the Delphi study was conducted online using Google Forms. Survey items were rated on a 5-point scale. Items rated by at least 80% of experts as essential or important were included. Items rated as essential or important by 65–79% of experts were included in the next survey for re-rating. Items with consensus below to 65% were rejected and excluded.

The initial survey included 52 items. The second web-based survey included 33 items. The briefer third survey consisted of 6 items that needed rerating. Twenty-two of the initial 33 items were endorsed and formed the clinical recommendations on the assessment and management of the psychomotor agitation. The endorsed items were categorized into 5 domains forming the clinical recommendations.

The panel expert generated 22 recommendations on the assessment and management of agitation. The Delphi method is a suitable formal iterative process for reaching consensus on relevant and controversial issues.

The authors have not supplied their declaration of competing interest.

Studies have shown that mental health risks related to military deployment depend on specific risk factors. Especially stressful experiences (SE) and lack of social support (SS) have been associated with deployment-related increases in mental disorders. Less is known about difficulties in emotion regulation (DER) in this context despite their well-known importance for the development and maintenance of mental disorders. To date, the number of prospective studies investigating the role of these potential risk factors for deployment-related psychopathology is limited.

To investigate risk factors for deployment-related increases in symptoms of common mental disorders.

To investigate associations between SE, SS and DER, and deployment-related increases in PTSD, major depression (MD) and alcohol use disorder (AUD) symptoms.

358 male soldiers were assessed before and 12 months following deployment using standardized diagnostic interviews (CIDI) and embedded questionnaires. Outcome measures were the number of PTSD, MD and AUD symptoms reported for the preceding 12 months at follow-up. Analyses were adjusted for baseline symptoms.

SE (incidence risk ratio (IRR)):1.06, p>0.001), SS (IRR:0.98, p=0.034) and DER (IRR:1.04, p=0.009) independently predicted increases in PTSD symptoms. SE (IRR:1.04, p=0.004) and SS (IRR:0.98, p=0.022) also predicted increases in MD symptoms. Increase in AUD symptoms was not predicted by SE, SS or DER, but by increase in PTSD symptoms (IRR:1.02, p=0.029).

Findings support the role of SE, SS and DER as risk factors for deployment-related disorders, particularly for PTSD symptoms. This knowledge might help to identify high-risk individuals and to develop targeted interventions.

Psychopathy is characterized by superficial charm, untruthfulness, lack of remorse, antisocial behavior, egocentricity as well as poverty in major affective reactions. This clinical profile has been empirically conceptualized and validated. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. However, no reliable pattern of altered neural activity has been disclosed so far.

To identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology.

First, we used activation likelihood estimation to meta-analyze brain activation changes in psychopaths across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 analyses (P < 0.05, corrected). Second, we functionally characterized the ensuing regions employing meta-data of a large-scale neuroimaging database (P < 0.05, corrected).

Psychopathy was consistently associated with decreased brain activity in the right amygdala, the dorsomedial prefrontal cortex (DMPFC), and bilaterally in the lateral prefrontal cortex (LPFC). Consistently increased activity was observed bilaterally in the fronto-insular cortex (FIC) (Fig. 1). Moreover, we found that the physiological functional role of the candidate regions related to social cognition (DMFPC), cognitive speech and semantic processing (left FIC/LPFC), emotional and cognitive reward processing (right amygdala/FIC) as well as somesthesis and executive functions (RLPFC).

Psychopathy is characterized by abnormal brain activity of bilateral prefrontal cortices and the right amygdala, which mediate psychological functions known to be impaired in psychopaths. Hence, aberrant neural activity can account for pertinent psychopathology in psychopathy.

The authors have not supplied their declaration of competing interest.

To evaluate the relative efficacy of Cognitive Behavioral Therapy (CBT) and Specialist Supportive Clinical Management (SSCM) for adults with severe and enduring anorexia nervosa.

Randomised controlled trial.

Sixty-three participants aged 18 and over (range 20-62) with a DSM-IV diagnosis of anorexia nervosa with at least a seven year illness history.

Thirty outpatient visits over 8 months. Participants were assessed at baseline, end of treatment (EOT), and 6-month and 12-month post-treatment follow-up. At EOP and follow-up, both groups improved significantly on the majority of outcome measures. However, there were no differences between treatment groups at EOT. At 6- and 12-month follow-up, analyses indicate greater improvement for those in CBT compared to SSCM. At 6-month follow-up, CBT participants had higher scores on the social adjustment scale (p = .038), and at 12-month they reported lower eating disorder examination global score (p = .004), and higher readiness for recovery (p = .013) compared to SSCM.

Patients with severe and enduring anorexia nervosa can make significant and meaningful improvements with therapy. CBT shows significant advantage over SSCM in terms of social adjustment, core eating pathology, and readiness for change over time.

High prevalence of impaired sexual function in patients with schizophrenia has been reported by several studies. Various factors were incriminated including the disease itself, the low level of social competence and treatmentside effects.

To compare sexual function in drug free schizophrenic patients and six months after initializing antipsychotic treatment.

A consecutive sample of 109 patients meeting DSM-IV criteria of schizophrenia was constituted in psychiatry department of Farhat Hached hospital (Sousse, Tunisia), during a twenty four months period. They were drug naïve or drug free for at least three months. Assessment was performed at two time points:

T0: During an acute phase of the disease as defined by a BPRS global score ≥ 40 T1: six months after antipsychotic treatment.

Assessment of sexual function used the Arizona Sexual Experience Scale (ASEX).

Sexual function was impaired under antipsychotic treatment. In fact, we noticed lower global score of asex (p = 0.03) and lower subscores of drive (p = 0.015), arousal (p = 0.006), erection or vaginal lubrication (p= 0.010), orgasm (p= 0.001) and satisfaction (p= 0.005).

Sexual function was impaired in patients under antipsychotic drugs, according to global score and to diffrent sexual dimensions subscores. This results seem to, prospectively, confirm the implication of treatment in sexual dysfunction occurence among schizophrenic patients.

Germany is one of the European countries that receive the highest number of refugees for the last years, with around 468 thousand asylum seekers in the first half of 2016. However, the increase in the speed of short-term procedures regarding refugees may at the same time overlook the risks regarding specific populations. Moreover, women and children constitute the most vulnerable groups during war and conflicts and the worst effects, in terms of physical, mental and social consequences, develop on these groups.

To understand deeply the psychosocial situation of female refugees that have arrived in Federal German Republic, to assess their challenges and resources before, during and after the displacement and to propose recommendations for policy changes.

The study consists of two modules, taking place in five states in Federal German Republic, including Berlin, Mecklenburg-Vorpommern, Bayern, Hessen und Mainz. In the first step, a representative stratified sample of female refugees from Syria, Iraq, Iran, Afghanistan, Somali and Eritrea are recruited. The quantitative study instrument include a socio-demographic question form and HSCL-Hopkins checklist, Harvard Trauma questionnaire, Beck depressions inventory, EUROHIS–QOL and SCL-14. In the second step, a qualitative in-depth analysis of focus group meetings is conducted.

There is an urgent need to take action for the mental health problems of refugees. This study constitutes one of the most extensive researches, especially on a subpopulation of refugees that requires specific attention. Challenges faced throughout the protocol and detailed results will be shared as presentation.

The authors have not supplied their declaration of competing interest.

At the present time, adolescents are in particular vulnerable to feelings of loneliness. They are gradually emancipating from their family and establish relationships with peers. Among the important predictors of loneliness belong genetic and personal variables and factors of social environment.

To examine predictors of adolescents’ loneliness which are located in family environment. To find out how empathy, emotional relationship and control by both of parents contribute to loneliness of adolescent boys and girls.

We examined 206 adolescents in the age from 10 to 18 years through Basic Empathy Scale, Parenting Style Scale and UCLA Loneliness Scale. Stepwise multiple linear regression analysis was used for data analysis.

The significant predictors of boys’ loneliness in family environment are emotional relationship of mother and affective empathy of father. The significant predictors of girls’ loneliness include emotional relationship and cognitive empathy of father. Parental control is not a significant predictor of adolescents’ loneliness.

Adolescents’ loneliness is largely influenced by factors of family environment. Our study highlights the role of emotional relationship provided by the opposite sex parent. Cold behavior of the opposite sex parent could reduce self-esteem and self-confidence of adolescents. Both could help them establish relationships with peers and people outside family, thus protecting them against loneliness. A significant predictor of boys’ and girls’ loneliness is also empathy of father. We recommend to make use of our findings in clinical practice with adolescents, in family therapy as well as in context of attachment.

The authors have not supplied their declaration of competing interest.

The aim was to investigate the dietary status of adults with ADHD. Furthermore, we compared the group with a representative sample of a healthy adult Danish population.

Data were collected from the ADHD database operated by the ADHD outpatient clinic at Aarhus university hospital. We used data from newly referred patients in a seven months period from April 2014 through October 2014. The collected data include weight, height, blood pressure, somatic or psychiatric co-morbidity, blood sample, physical activity scale. Concerning the diagnosis of ADHD: DIVA, ASRS, BRIEF-V. Inter99 was used to assess the dietary status. The representative sample was obtained as a part of a public health survey from 2010 called “how are you” conducted in the same region of Denmark as the location of the psychiatric hospital. Preliminary results, one hundred and forty-three patients were included in the study, 52% males. The mean age was 30.9 years. A larger proportion of ADHD patients fall in the category “unhealthy dietary pattern” compared to the representative sample population (26% vs. 12%), while the proportion in the “healthy dietary pattern” category is markedly lower (14% vs. 24%). The differences seem to be explained by lower than recommended intakes of fruits and vegetables.

Our findings suggest a general shift towards more unhealthy dietary patterns among patients with ADHD. This exposes them to higher risk of somatic diseases, notably diabetes mellitus and cardiovascular disease. Lifestyle interventions could be a necessary part of standard treatment for patients with ADHD.

The authors have not supplied their declaration of competing interest.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 1 year efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol dependent patients with high DRL from a randomised controlled trial [NCT00811941].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 187 patients: placebo N=42; nalmefene N=145 (mean age 46.2±11.9 years; 78% men; mean HDDs 19±6.3/month; mean TAC 101±45.0 g/day). Mean number of HDDs decreased to 7 days/month and mean TAC decreased to 33g/day at 1 year in the nalmefene group. At 1 year, there was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.6 [95% CI:-6.5;-0.7]; p=0.0164) and TAC -17.3 [-30.9;-3.8]; p=0.0129). Improvements in clinical status and in liver enzymes from baseline were larger in the nalmefene compared to the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. Persistent neurological signs and symptoms of lithium intoxication gained clinical attention in the 1980s and were named Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT).

To review the long-term neurological sequelae of lithium intoxication (SILENT) to highlight their clinical presentation, assessment, management and preventive measures.

Non-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms syndrome of irreversible lithium-effectuated neurotoxicity.

Neurological manifestations of lithium poisoning may persist, even after effective removal of the drug – SILENT. The most frequent sequelae are cerebellum and brain stem dysfunction, extrapyramidal symptoms and dementia. They may last for weeks, months or years. Infection, dehydration, deteriorating renal function or the addition of other drugs may precipitate acute toxicity. Irreversible damage is difficult to treat. Some cases show spontaneous recovery that may be total, but in others, sequelae persist. Helpful measures include the avoidance of acute intoxications with lithium, long-term and continuous dose adjustment and serum level monitoring, stricter exclusion criteria for starting lithium, and aggressive treatment of acute neurotoxicity. Once the long-term neurologic sequelae have set in, the patient should be managed according to the impediment (physical rehabilitation, speech, cognitive training).

It is important to raise the awareness of SILENT so that clinicians are able to avoid it. There should be a low threshold for suspecting the existence of toxicity.

No significant relationships.

Schizophrenia is a complex and heterogeneous syndrome with high clinical and biological stratification. Identifying distinctive subtypes can improve diagnostic accuracy and help precise therapy. A key challenge for schizophrenia subtyping is understanding the subtype-specific biological underpinnings of clinical heterogeneity. This study aimed to investigate if the machine learning (ML)-based neuroanatomical and symptomatic subtypes of schizophrenia are associated.

A total of 314 schizophrenia patients and 257 healthy controls from four sites were recruited. Gray matter volume (GMV) and Positive and Negative Syndrome Scale (PANSS) scores were employed to recognize schizophrenia neuroanatomical and symptomatic subtypes using K-means and hierarchical methods, respectively.

Patients with ML-based neuroanatomical subtype-1 had focally increased GMV, and subtype-2 had widespread reduced GMV than the healthy controls based on either K-means or Hierarchical methods. In contrast, patients with symptomatic subtype-1 had severe PANSS scores than subtype-2. No differences in PANSS scores were shown between the two neuroanatomical subtypes; similarly, no GMV differences were found between the two symptomatic subtypes. Cohen’s Kappa test further demonstrated an apparent dissociation between the ML-based neuroanatomical and symptomatic subtypes (P > 0.05). The dissociation patterns were validated in four independent sites with diverse disease progressions (chronic vs. first episodes) and ancestors (Chinese vs. Western).

These findings revealed a replicable dissociation between ML-based neuroanatomical and symptomatic subtypes of schizophrenia, which provides a new viewpoint toward understanding the heterogeneity of schizophrenia.

Some 25%–30% of patients with schizophrenia have auditory verbal hallucinations that are refractory to antipsychotic drugs. transcranial directcurrent stimulation (tDCS) is a novel somatic treatment proposed for hallucinations and negative symptoms (Brunelin et al. 2012).

We aimed to assess the efficacy of tDCS in reducing the severity of auditory verbal hallucinations as well as negative symptoms in patients with schizophrenia.

Six patients (aged 41–66 year) with schizophrenia and medication-refractory auditory verbal hallucinations were enrolled. Positive and Negative Syndrome Scale (PANSS) and Cardiff Anomalous Perceptions Scale (CAPS) were administered as outcome measure, before (T0) and after tDCS (T1), to assess treatment response. tDCS delivered by a HDCstim (Newronika, Milano, Italy) (2mA, twenty minutes, twice a day for 5 consecutive days) with the anodal electrode over the left dorsolateral prefrontal cortex and cathodal electrode on the left temporo parietal cortex.

The patients tolerated well the procedure and there was no side effect. After tDCS auditory verbal hallucinations improved by 33% in frequency (T0 vs T1 p=0.03) and by 40% in distress (T0 vs T1 p=0.02), for up to one month. Negative symptoms as measured by the PANSS also decreased by 24% (T0 vs T1, p=0.02).

The results of this small, open tDCS trial prompt the further studies with controlled, double blind design in a larger sample size of schizophrenic patients. Nonetheless, our findings are in line with available data reporting a beneficial effects of tDCS in schizophrenia (Brunelin et al. 2012).

Although current standard treatment for migraine headache is medication, high levels of psychological comorbidity has led to migraine influencing by cognitive, emotional and environmental factors, as well as biological. Viewing migraine in a biopsychosocial framework introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy (CBT). The aim of this study was to evaluate the efficacy of CBT for chronic migraine.

Thirty-five participants diagnosed as chronic migraine were recruited from Headache Clinic. According to inclusion criteria 14 participants, underwent bi-weekly lasting 30 minutes CBT sessions for 6 months, were administered Hamilton Anxiety Scale, Hamilton Depression Scale, Visual Analog Scale (VAS) and the Migraine Disability Assessment Scale (MİDAS) before and after CBT.

Nine of the participants were female and 5 male. Mean age of group was 34.35 ± 8.17. Duration of illness was 13.07 ± 7.18 and 12 of participants had the history of a psychiatry illness whose diagnoses were depression (7), anxiety disorder (4) and post-traumatic stress disorder (1). Nine of the patients had prophylactic migraine treatment. There were statistically significant difference in Hamilton Depression scores between before CBT (29.07 ± 7.74) and after CBT (14.21 ± 7.7); in Hamilton Anxiety scores before CBT (26.8 ± 11.7) and after CBT (11.7 ± 2.6); in VAS scores before CBT (8.07± 0.91) and after CBT (3.71 ± 1.32); in frequency of migraine attacks between before CBT (10.85 ± 3.50 day) and after CBT (4.92 ± 2.70 day) and in MİDAS before CBT (55.5 ± 20.4) and after CBT (20.12 ± 16.6) (P < 0.05).

CBT might reduce the severity of symptoms in migraine patients especially with the comorbidity of psychiatric illness.

The authors have not supplied their declaration of competing interest.

There have been lots of psychological studies on the difference between the West and East; however, it was mainly focused on the cultural and social outlook rather than the personality perspective of the individuals. The difference in personality construct between the West and East needs to be examined with objective and validated instruments.

We used Temperament and Character Inventory (TCI) and NEO Personality Inventory (NEO-PI) along with Sasang Personality Questionnaire (SPQ). SPQ measures the psychological traits with three subscales of behavior (SPQ-B), cognition (SPQ-C) and emotionality (SPQ-E) based on the Yin-Yang and traditional Korean medicine. We analyzed the correlation between TCI, NEO-PI and SPQ with 104 college students in Korea (age, 28.8±4.8; male/female, 52/52).

The personality structure of SPQ showed distinctive features with emotionality (SPQ-E) which generally perceived as concurrent with behavior and cognition. SPQ-B/SPQ-C were correlated negatively with TCI Harm-Avoidance (r=-0.542 and -0.387) and NEO-PI Neuroticism (r=-0.285 and -0.340), however SPQ-E positively with Harm-Avoidance (r=0.283) and NEO-PI Neuroticism (r=0.398). In addition, SPQ-B/SPQ-C were correlated positively with TCI Novelty-Seeking (r=0.355 and 0.369) and NEO-PI Extraversion (r=0.67, 0.283), but SPQ-E not significant with them.

The disparities in personality construct might be originated from difference in the definition of emotionality; the West accentuates the emotional stability, however the East emphasizes the level of emotional activity. We discussed the implication of these from the cross-cultural personality studies.