There are above 170 PICUs identified in the UK. A modest body of research has emerged documenting characteristics of PICU populations. Comprehensive data describing patients admitted to PICUs remains incomplete. There is no data on Female only PICU population's characteristics.

To offer the first and the only project data country wide up to date on Female only PICU population. It describes socio-demographic characteristics, mental state and outcome of treatment for 49 patients admitted to the first Female PICU in NHS in UK in 2008

Prospective case note analysis

65% of patients were single, 73% were Caucasian and 26% had BME background. Most of patients were admitted from police stations and detained under S2 or S3 of the MHA. Most dominant diagnoses were Schizophrenia and Personality Disorder. 77% of admissions were due to physical aggression and severe self harm. Most patients had more than 5 previous admissions to Mental Health wards. Half of the patients received intramuscular Rapid Tranquilization during the admission and 22% were placed in Enhanced Care Area. Median length of stay did not exceed recommended 8 weeks but some patients with the diagnosis of Personality Disorder experienced an excessive length of PICU stay. Most patients were transferred to open acute wards.

Patients admitted to Female PICU were most likely to have major psychosis or personality disorder, admitted due to violence or self harming behavior, more likely to exceed recommended max length of stay if diagnosis of PD was given, BME group being represented.

A negative attitude towards the body supposed to lead to eating disorders and to increase the level of social anxiety.

The research aim is to study the characteristics of eating behavior and social anxiety in women who have negative attitude towards their body.

The following methods have been used: Multidimensional Body-Self Relations Questionnaire (MBSRQ); Eating Attitudes Test (EAT-26); Brief Fear of Negative Evaluation (BFNE); Iowa–Netherlands Comparison Orientation Measure (INCOM), Social avoidance and distress scale (SADS). The sample consists of 98 women in the age from 18 to 60 years belonged to three age groups: Group 1: N=41, mean age 21.0+3.1; Group 2: N=29, mean age 29,5+4,9; Group 3: N=28, mean age 47,5+12,5.

We have found out a statistically significant correlation between the negative attitude towards the body and the social anxiety. The more a woman dislike her appearance the higher is the level of social anxiety and the higher is the risk of eating disorders. It should be mentioned that all the negative tendencies are more prounouced in the youngest age group.

The research results can be implemented when designing prevention programs. Such programs are extremely important for young women in the age from 18 to 24 years as they have the highest risk of forming an eatind disorder as well as the social anxiety disorder.

Down syndrome was clinically described the first time in France by Esquirol (1838) followed by Down (England, 1866), to the identification of a chromosomal abnormality in 1959 (trisomy 21), which is the most common abnormality in neurodevelopmental disorders. Life expectancy increased from 9 years in 1929 to 55 currently. This is a common cause of mental retardation, and few tools are suitable for the care of these patients, including patients with Alzheimer's disease (prevalence of 55% between 50 and 59) or depression (prevalence 30%). No study evaluates the effectiveness of cognitive and behavioral therapy (CBT) in patients with Down syndrome but it is known to be effective in Alzheimer's patients. Some cases have been reported on the efficacy of CBT on phobias in patients with intellectual disability.

To evaluate the efficacy of CBT in the treatment of a specific phobia in a patient with Down syndrome and early Alzheimer's disease.

Literature review and clinical case of a 51-year-old patient, hospitalized under constraints for behavioral disorders (agitation, body treatments refusals).

By adapting CBT techniques to the problem of intellectual disability, treatment against the phobia was effective with clinical improvement, which allowed a return home.

The tools provided by CBT are suitable for the treatment of anxiety disorders in patients with intellectual disability, especially in patients with Down syndrome. Psychiatric disorders are under-diagnosed in these patients and under-treated. CBT is an aid to the treatment. It may allow the dismantling of symptoms and reduce behavioral problems.

The authors have not supplied their declaration of competing interest.

to examine the longitudinal effect of depression on glycemic control in a sample of patients with type 2 diabetes.

the patients were recruited from diabetes clinic in Saudi airlines medical center, in Jeddah, the base line study community consisted from 172 patients with type 2 diabetes. They were assessed for depression using BDI II, and diagnostic interview, and for diabetic control using HbA1c. We created a person-period data set for each patient to cover 6 months intervals up to 3 years. We used generalized estimation equation (GEE) for analysis of longitudinal data. HbA1C was the response variable while depression and time were the main covariates. Variables were included in GEE models based on clinical importance and preliminary analysis. Other variables included as covariates were gender, education, duration of diabetes, co-morbidity and LDL. All statistical analysis used α = 0.05 level of significance and were performed using SPSS software version 21.

Unadjusted HbA1c means were significantly higher in depressed vs. non-depressed subjects at all time points. The adjusted HbA1c means in final GEE model were significantly higher in depressed vs. non-depressed subjects. In all adjusted models depression was a predictor of glycemic control weather it was BDI score (estimate = .049, P = .002), diagnoses of MDD (estimate = 2.038, P = .000), or other depressive diagnosis (estimate = 1.245, P = .000).

This study on clinical sample of type 2 diabetic patients demonstrates that there is a significant longitudinal relationship between depression and glycemic control and that depression is associated with persistently higher HbA1c over time.

The authors have not supplied their declaration of competing interest.

Cognitive impairment in patients with depressive disorder is a subject of intensive research.

This study deals with the cognitive impairment in patients with severe depressive episode with psychotic symptoms and patients with major depressive disorder during the acute state of illness.

The aim was to define domains and the level of cognitive impairment in both groups of patients.

The next aim was to compare profiles of cognitive impairment in both groups of patients.

The last aim was to find out a relationship between cognitive performance and severity of depressive episode during the acute state of illness.

We have used neuropsychological test battery (Auditory–Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Logical Memory, Digit span test, Trail making test, Verbal Fluency Test, Block Design and Benton Visual Retention Test) for the evaluation of the cognitive functions in patients with severe depressive episode with psychotic symptoms (n = 5) and patients with major depressive disorder (n = 8).

We found cognitive impairment in all examined domains in both groups of patients.

More profound cognitive impairment was found in patients with severe depressive episode with psychotic symptoms, particularly in visual memory, visuo-constructive abilities, speed of cognitive processing and executive functions. We found no correlation between cognitive performance and severity of depressive episodes.

Our findings suggest a strong correlation between psychotic symptoms in depression and cognitive performance.

College students seem to be a population group that is increasingly recognized to be at risk of having sleep difficulties. Some studies revealed that medical students, in particular, are believed to be more stressed and sleep deprived than their non-medical peers.

The present work aimed at investigating the quality of sleep among medical students at the University College of Medicine in Sfax, Tunisia.

The study consisted of an anonymous, voluntary survey for a sample of 74 students. A two-part questionnaire was used, including demographic criteria and the Pittsburgh Sleep Quality Index (PSQI), a self-rated instrument that measures sleep habits for a month (a total score of 5 or greater is indicative of poor sleep quality).

The average age was 24 years (range 19–33) with a sex ratio almost equal to 1. In 47.3% of cases, students were married. These latter had at least one child in 34.2% of cases. A total of 39.4% of the students reported being smokers, while 25.6% of them admitted having regular alcohol consumption.

Poor sleep quality was reported by 63.5% of students with a PSQI average score of 9.32 ± 3.64.

The most correlated factors with poor sleep quality were parenthood (P = 0.031), alcohol consumption (P = 0.004) and stressful studies (P = 0.02).

Poor sleep quality was pervasive among surveyed medical students and this seemed to be in relationship with some factors. This study points to the need for further evaluation of medical students’ sleep problems in order to improve their performance and their quality of life as well.

The authors have not supplied their declaration of competing interest.

No significant relationships.

Cardiovascular disease (CVD) and major depressive disorders (MDD) are frequent diseases worldwide with a high comorbidity rate. Omega-3 fatty acids have been suggested as disease modulators for both CVD and MDD.

Therefore, we studied whether polyunsaturated fatty acids and the Omega-3 Index may represent markers for assessment of the cardiovascular risk in physically healthy patients suffering from MDD.

Case-control study in 166 adults (86 MDD patients without CVD, 80 matched healthy controls). Baseline examinations included depression ratings, conventional cardiovascular risk factors, fatty acid, and interleukin-6 determinations.

Several conventional risk factors were more prevalent in MDD patients. The Omega-3 Index and individual omega-3 fatty acids were significantly lower in MDD patients. An Omega-3 Index < 4% was associated with high concentrations of the proinflammatory cytokine IL-6.

Conventional cardiovascular risk factors, the Omega-3 Index and IL-6 indicated an elevated cardiovascular risk profile in MDD patients currently free of CVD. Our results support the employment of strategies to reduce the cardiovascular risk in yet cardiovascularly healthy MDD patients by targeting conventional risk factors and the Omega-3 Index.

Differences in eating habits/behaviours and eating disorders (ED) symptoms in adolescents from rural and urban schools has not been very considered, particularly in Portugal.

explore differences between students who attend rural and urban schools in eating habits/behaviors and ED symptoms; verify if there are differences regarding Body Mass Index (BMI) by school area.

282 adolescents students (mean age = 14,5; SD = 1,69; variation = 12-18 years old; urban subsample = 126, 44,7%), studying in two schools, one from an urban area and another from a rural area answered sociodemographic questions, eating habits/behaviours items and EAT-25 (Eating Attitudes Test-25).

Most of the adolescents from both schools have breakfast and drink milk daily. Moreover, they eat vegetables and fruits daily or weekly and only rarely fast-food. Adolescents that practice a sport eat more fruits/vegetables. Adolescents attending a rural school ingest more vegetables and less fast-food. ED symptoms (EAT-25) present a lower prevalence, comparing to a young adults sample. There were no significant differences in all the EAT-25 dimensions, EAT total score and BMI by school area.

Eating habits/behaviours seem to be positive in both schools (e.g. most adolescents have breakfast daily). There were only some small differences between the two schools in particular eating habits but adolescents from the two areas do not seem to differ in ED symptoms and BMI, which is not in accordance with the literature that tends to signal urban areas as a “risk factor” for dysfunctional eating behaviors.

Some study suggest that unipolar mania could be a separate subtype, while there is no unipolar mania listing in DSM. We compared sociodemographic and clinical data of unipolar and bipolar mania.

In an analytical-observation study,through 850 patients with bipolar I disorder, in 10 years of illness duration, 240 patients were included. We evaluated demographic and clinical information and interview with patients and their families consistent with DSM, then we assessment the comorbidities and other clinical conditions and analysed our data by using the mann-witney test, chi-squar test and fisher exact test.

22.4% of 219 patients presented a course of illness characterized by unipolar manic episodes without history of major or mild depression. When this group was compared with 170 manic patients with a previous history of depressive episodes, we found significant similarities in most demographic, familial, and clinical characteristics. Just positive family history for MDD was higher in bipolar mania significantly (P< 0.005). Unipolar mania group reported more congruent psychotic symptoms (Pv= 0.005). Lastly in unipolar group total number of episodes is less than and manic episodes is more than bipolar. (Pv= 0.005).

There is no prominent differences between two groups and inform clinical and psychopathological have common characteristics in unipolar and bipolar mania. So, biologic, physiologic and anatomical bases of unipolar and bipolar mania could be similar. Literature on this topic is still insufficient, and it is necessary to ongoing unipolar manic studies in future.

Adherence to treatment of mental disorders is one of the key factors influencing its success and, secondarily, the patients’ quality of life and social adaptation.

The cross-sectional study of 90 outpatients diagnosed with psychotic disorders aimed at determining if there was a relationship between discontinuation of medication in the past, current adherence to treatment and self-stigma.

The assessment was made with the objective and subjective Clinical Global Impression – Severity scale, Drug Attitude Inventory, Internalized Stigma of Mental Illness (ISMI) scale and demographic data.

The questionnaires were filled out by 79 patients, of whom 5 handed in incomplete questionnaires. Complete sets of data were obtained from 74 patients. The data analysis showed that the levels of self-stigma as assessed by the total ISMI scores was not statistically significantly correlated with most of the demographic factors (age, age of illness onset, gender, education, marital status, employment, duration of the illness, number of hospitalizations and antipsychotic dosage). However, there was a significant negative correlation with current adherence to treatment.

Adherence to treatment is one of the most important prerequisites for successful therapy. Adherence may be enhanced through better motivation and education of patients on the necessity of adhering to treatment recommendations and the consequences of non-adherent behavior. Important factors in adherence also seem to be patients’ stigmatization and self-stigma. Adherence may be increased by promising self-stigma-reducing strategies performed by systematic psychoeducation of patients or as a part of psychotherapeutic counseling.

The authors have not supplied their declaration of competing interest.

Domestic violence against women has increasingly been recognized nationally and internationally as a serious problem. Violence against women is a troubling phenomenon in Russia. Meanwhile domestic abuse against women often results in long-term mental health problems.

The main aim of the study was to find out the psychological and psychiatric consequences of violence against women and to determine the origins of crimes committed by abused females.

A cohort of 18 females was examined by forensic psychiatrists. All women had committed crimes of violence (murders, attempted murders). Details of background, psychiatric and offending history were extracted. Each item was assessed with the help of descriptive statistics.

A research has been carried out on the basis of psychiatric and forensic psychiatric assessment of two groups of women who had a long history of violence by their husbands or partners. Clinical assessment has revealed depression, anxiety, low self-esteem, post-traumatic stress disorder, drug abuse. All women underwent forensic psychiatric assessment as they had committed serious crimes of violence. The research has revealed two types of homicides. Women of the first subgroup displayed pathological altruistic motivation of their children. Women of the second subgroup had committed homicides of their husbands and partners whose violence towards women escalated in severity.

The research shows the necessity of domestic violence prevention by legal provisions and multidisciplinary research with participation of psychiatrists, psychologists, sociologists, human rights advocates and feminist societies.

The authors have not supplied their declaration of competing interest.

Gender identity disorder is an emergent and important disorder which may lead to devastating consequences and comorbidities if proper treatment approaches are not used.

We planned showing the improvements in patients’ life in multilple domains after sex reassignment surgery (SRS).

In our research we focused on changes experienced by people who gained new gender identity with sex reassignment surgery.

We interviewed at least one year after the operation with 20 sex reassigned transsexuals (SR-T) who were once on SRS programme of Istanbul University Psychiatry Department Psychoneurosis and Psychotherapy Unit and who had confirmative rapports for surgery and we also interviewed with 50 non-sex reassigned transsexuals (NSR-T) who applied to the same unit for SRS programme.

Worries about gender discrimination and gender victimization were lower, but worries of being uncovered about transgender identity were higher in SR-T group. SR-T group scored lower on Family Assessment Device, 4th and 5th items of Arizona Sexual Life Scale and total points excluding the 3rd item (item for penile erection and vaginal lubrication), but scored higher on Multi Dimensional Scale for Perceived Social Support, Coopersmith Self Esteem Scale and psychological subscale of World Health Organization Quality of Life Scale-Brief Form.

The SRS used in the treatment of transsexuality releases the conflict and makes the transformation on official gender and is associated with improvements in quality of life, self esteem, family support, sexual life satisfaction and interpersonal reliationships and reduction in worries about gender discrimination and gender victimization.

Teachers are confronted with increasing difficulties and demands that make them vulnerable to burnout.

To evaluate burnout among a population of Tunisian teachers and to identify factors that may be involved.

It was a cross-sectional, descriptive and analytic study, involving 165 teachers working in 10 primary schools and 7 high schools in Sfax, Tunisia. The participants completed a self-questionnaire containing their socio-demographic and professional characteristics. They were explored by the scale of the burnout: Le Maslach Burnout Inventory General Survey (MBI-GS).

The mean age of teachers was 39.96 years. The sex ratio (M:F) was 1.32. The majority (75.2%) was married. The burnout syndrome was found in 49.7% of teachers. Moderate burnout was found in 43% of cases and severe burnout in 6.7%. The causes of burnout reported by our population were bad working conditions (71.50%), quality of working relationships (65.5%) and overload work (30.3%). Bad working conditions were associated with a high level of emotional exhaustion (P < 0.005) and a low level of professional efficacy (P < 0.001), while poor quality of work relationships and overload work were associated to a high score on cynicism (P < 0.001) and a low score on professional efficacy (P < 0.001).

According to our study, poor working conditions, overload work and bad quality of relationships seem to be risk factors of burnout in teachers. Preventive measures should be instituted against those factors to reduce the constraints of work and improve the professional quality of life of these individuals, essential thing to optimize the educational level in our country.

The authors have not supplied their declaration of competing interest.

To examine the effect of cariprazine, a dopamine D3/D2 receptor partial agonist with preferential binding to D3 receptors, on predominant negative symptoms of schizophrenia.

Subjects with schizophrenia and PANSS factor score for negative symptoms (PANSS-FSNS) ≥ 24 and no pseudospecific factors (e.g. extrapyramidal symptoms, depression) were randomized to cariprazine 4.5 mg/d (dose range: 3-6 mg/d) or risperidone 4 mg/d (dose range: 3-6 mg/d) for 6 months.

Four hundred and sixty-one patients were randomized 1:1 to double-blind risperidone (n = 231) or cariprazine (n = 230) treatment. Change from Baseline (CfB) at week 26 in the primary parameter, PANSS-FSNS, was larger in the cariprazine group than in the risperidone group (LSMD = −1.47; 95% CI: [−2.39, −0.53]; P = 0.002) significant from week 14 onwards. CfB at week 26 in the functional parameter, Personal and Social Performance (PSP) total score, showed similarly greater improvement with cariprazine than risperidone (LSMD = 4.63; 95% CI: [2.71, 6.56]; P < 0.001) significant from week 10 onward. Statistically significant differences in favor of cariprazine at week 26 were shown in the PSP areas of self-care, socially useful activities and personal and social relationships. Most patients tolerated the study treatment well, as reflected by low discontinuation rates due to adverse events (AEs). Adverse event profiles of cariprazine and risperidone were similar. The most common AEs during study treatment were insomnia (10.0%), and headache (10.4%), both in the risperidone group.

26-week cariprazine treatment, given as antipsychotic monotherapy, was significantly more effective on negative symptoms and on functioning than risperidone in patients with predominant negative symptoms of schizophrenia.

The authors have not supplied their declaration of competing interest.

Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England.

We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis.

Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, −786;31) to £599 (−1,321;−156) (in 2020–2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [−0.03;0.05] to 0.01 QALY, [−0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving.

Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.

N-acetylcystein (NAC), a precursor to the amino acid cysteine, has been emerging as an interesting add-on treatment in several psychiatric conditions and especially in Obsessive Compulsive Disorder (OCD). These results may be linked to its metabolic profile: antioxidant properties through glutathione production; anti-inflammatory properties; and modulation of the glutamatergic and dopaminergic systems of neurotransmission.

Review the potential therapeutic effects of NAC in psychiatry, with main focus on syndromes of the obsessive-impulsive spectrum with report of a clinical case.

Case report of a patient with OCD and Hoarding disorder, with complete clinical remission after treatment with NAC; bibliographic search using PubMed/MedLine database with the following keywords: n-acetylcysteine; OCD; hoarding.

We report and discuss the case of a 44-year-old man with a diagnosis of Obsessive Compulsive Disorder with orderliness and contamination themes, coupled with Hoarding disorder. The patient experienced gradual though slight improvement with Paroxetine (60 mg/day) to which was subsequently added Risperidone (2 mg/day) with further slight improvement. In combination with the previously given pharmacological agents, NAC (1800 mg/day) was introduced with subsequent complete remission of all symptoms.

Studies suggest that NAC may be useful in the treatment of several psychiatric conditions. Our case report suggests direct relation between treatment with NAC and remission of obsessive and hoarding symptoms. Although encouraging, additional controlled research will be required to ascertain NAC clinical usefulness.

Pregabalin is an analogue of gamma-aminobutyric acid (GABA). Recent reports suggest illicit pregabalin use may be increasing among youth, however its addictive potential has not been well established (1).

Drug seeking behavior and chronic drug use are associated with defcits in glutamate clearance and activation of postsynaptic glutamatergic receptors (2). Based upon multiple studies, we compare here the addiction and misuse risks of pregabalin with those of traditional psychoactive substances (3).

Users of pregabalin were identified from 1st January 2019 to 31 December 2019 in Oran Addictology service, at west Algeria. The aim of the study was to establish the addictive potential of pregabalin and to compare the addiction risks of pregabalin with traditional psychoactive substances in west Algerian population. Clinical diagnosis was established according DSM-5 diagnosis criteria.

A total of 92 cases of pregabalin abuse or dependence were identified. The principal population at risk consists of patients with other current or past substance use disorders, for the most part opioid and multi-drug users, the age group were between 17-38 years old, mostly single men. The mean daily dose of pregabalin was 1200 mg. Almost all patients experienced withdrawal symptoms when pregabalin was discontinued.

The misuse of pregabalin often leads to abuse and dependence, mostly in the context of multiple drug addiction, especially in youth population.