Comorbidity of schizophrenia and transsexualism is still controversial. Some authors exclude diagnosis of transsexualism in patients with psychosis others report this coexistence as very rare.

Delusions of sex change have been described by some authors in about 20-25% of schizophrenic patients. Patient's “pseudotranssexual” beliefs are usually bizarre and do not cause diagnostic doubts. In some cases complaints of gender dysphoria are predominant and psychotic symptoms can be underestimated or even unnoticed before sex reassignment procedure.

Presentation of various clinical manifestation of gender dysphoria in patients with schizophrenia.

Three clinical cases are described.

Two patients have developed “pseudotranssexual” beliefs during course of psychosis. The first of them is an example of gender identity disorders related to psychotic process. The second patient presented complex psychopathology of schizophrenia and somatic symptoms which can hinder the diagnosis. The third patient has been diagnosed as a transsexual woman after diagnosis of severe schizophrenia and has undergone sex reassignment. Next she was hospitalized several times because relapses of psychosis but also because of alcohol withdrawal. Currently this patient has symptoms of dementia and a few severe somatic diagnoses.

The experiences of practitioners indicate that coincidence of schizophrenia and gender identity disorder is possible. Nevertheless, the consequence of misdiagnosis and sex reassignment can be serious and unconvertible. That is why the diagnosis of transsexualism in patients with psychosis should not be made hastily. It needs time, careful observation, examination and cooperation of psychiatrist and sexologist.

Obesity is a major public health problem and some developed countries have declared it ‘the modern day epidemic’. One of the major eating disorders that leads to obesity is BED, which involves consuming large quantities of high carbohydrate food. Studying the factors that cause and contribute to BED can help tackle this major health hazard and alleviate a huge burden on the nationalized health service.

To determine the frequency of Binge Eating Disorder (BED) among obese adults, and to study its relationship to depression, anxiety, life stressors, personality and self esteem.

The sample was a randomised sample of clinically obese individuals, body mass index (BMI) of 30 and above. The sample was collected from two sites; Nutrition Clinic in Student’s Hospital, Cairo University and a Private Nutrition Centre. 250 cases were recruited over one year. All patients were subjected to a clinical interview derived from Kasr El Aini sheet , and measurement of Waist- Hip Ratio. Assessment of depression and anxiety was through Beck Depression Inventory , Hamilton Depression Rating Scale and Taylor Manifest Anxiety Scale(TMAS). Other tools used were the Eysenck’s Personality Inventory, Eating Disorder Inventory -2.

BED among obese adults was 48%; 83 % of them had drive for thinness, 25% were bulimics, 45 % had ineffectiveness feeling. Also 83 % had body dissatisfaction, 8% were perfectionism seeking, 43 % showed interpersonal distrust and 25% presented maturity fears. Impulsivity was scored high in 25% , 66.6%had social insecurity and 77% had severe Extraversion. All were statistically significant. On the other hand there were no statistical significant difference between obese adults with BED and those without on TMAS. Half percent of participants with BED and 34.6 percent of participant without BED had moderate level of anxiety. In addition , there were no significant difference between obese participants with BED and those without BED according to BDI. However, 83.3% of obese cases with BED while 60 % for those without BED had manifest depression ranging from mild to severe depression.

Obese adults with BED have more drive for thinness, body dissatisfaction, feeling of ineffectiveness, perfectionism seeking, interpersonal distrust, maturity fears and social insecurity than non BED. Extraversion and Neuroticism are also more among BED. There were no significance different between both group in relation to Anxiety and Depression.

None Declared

Novel psychoactive drugs (NPS) has rapidly increase in the last years in the drug market as a recreational use. Fenethylline is a theophylline, an amphetamine-like drug, having stimulant effects similar to those of other amphetamine-type derivatives. Fenethylline was used as medicament for hyperactivity disorders in children, narcolepsy and depression, but it has also been used as a drug of abuse under the common name of ‘captagon’. The purpose of this report is to review the clinical evidence for the potential of abuse of fenethylline. We propose a case report and literature review.

We conducted a systematic review of the literature with the principal database (PubMed, Enbase, PsychInfo) and we present a case report.

The effects of fenethylline is characterized by euphoria, derealization, autopsychic and somatopsychic depersonalization, hallucination, agitation and decrease of pain perception.

The primary drug market for fenethyline (as captagon) has traditionally been countries located on the Arabian Peninsula but also North Africa since 2013. To our knowledge, there is no report on the recreational use of fenethylline in literature. The clinical features of fenethylline intoxication were also similar to effects from other amphetamine-like drugs. In our case report, dissociative symptoms are the core of fenethylline intoxication. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed-up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered [1,2].

The authors have not supplied their declaration of competing interest.

People on the autism spectrum are particularly vulnerable to various mental and somatic diseases. Admitting the health care system is, however, a prerequisite for appropriate diagnosis and treatment of these disorders. Substantial difficulties in accessing the heath care system are reported for all autistic people, independent from their intellectual ability.

The purpose of the work is first to assess various difficulties in accessing the health care system and second to provide strategies to overcome them.

Current barriers to the health care system and possible solutions were sampled from a collaboration of autistic self-advocates and professionals in Berlin, Germany. The findings were endorsed by a thorough Internet and literature research.

A comprehensive list of barriers to health care along with recommendations to facilitate access was compiled. Strategies considering the perceptual and communicative peculiarities of autism improved access to health care for autistic adults.

Providing access to the health care system may improve diagnosis and treatment of mental and somatic illnesses and hereby enhance quality of life in people on the autism spectrum. Recognition of the peculiarities and needs of adults with autism may serve as a model for other areas in society, such as education and employment. Data acquisition in this project is of special value because it results from collaboration of an autistic self-advocacy organization and professionals working in the field of intellectual disability, considering the experiences of autistic adults in the entire range of intellectual functioning.

Autism Spectrum Disorder and Social Anxiety Disorder are mental illnesses characterized by a dysfunction in social behavior (SB); a phenomenon largely mediated by the medial prefrontal cortex (mPFC). Clinical studies have demonstrated that lysergic acid diethylamide (LSD), a partial agonist of the 5-HT2A receptor, can promote SB. However, its mechanism of action on SB is unknown.

To assess the effects of repeated LSD administration on social behavior in mice and to identify which mPFC receptors mediate LSD’s behavioral effects.

Eight-week-old C57BL/6J male mice received vehicle or repeated LSD (30 μg/kg/day i.p. for 7 days) as well the selective 5-HT2A receptor antagonist MDL, or the AMPA receptor antagonist NBQX. Twenty-four hours following the last injection, mice underwent the Direct Social Interaction Test and the Three-Chamber Test (TCT) to assess sociability and preference for social novelty. in vivo electrophysiological recordings were performed in mice treated with vehicle or LSD using multi-barrelled electrodes for microiontophoretic ejections of the selective 5-HT2A receptor agonist DOI or the selective AMPA receptor agonist quisqualate on mPFC pyramidal neurons.

Repeated treatment with low doses of LSD increased the interaction time in the DSI as well as sociability and social novelty indices in the TCT. These pro-social effects were blocked by the intra-PFC administration of both 5-HT2A and AMPA antagonists. LSD also potentiated, in a current-dependent manner, the excitatory response of mPFC neurons to 5-HT2Aand AMPA agonists.

Repeated, low doses of LSD increases social behavior via a mechanism of action that is mediated by 5-HT2A and AMPA in the mPFC.

Violence in therapeutic centers, especially psychiatric wards is much higher than other units. In healthcare provider groups, nurses are at high risk of patient's aggression in the workplace.

The aim of this study is to evaluate the effect of violence on the health of nurses in Razi Hospital in Tehran, Iran.

In this cross-sectional study a total of 312 nurses working in psychiatric hospitals completed a GHQ28 questionnaire.

The results demonstrated that there is a statistical significant correlation between violence of patients (including physical violence and disrespect) to physical symptoms, anxiety and sleep disorder in nurses (P < 0.05). Also, increased frequency of disrespect by family of patient correlated to higher physical symptoms, anxiety, and sleep disorder in nurses. However, there was not any significant correlation between symptoms of depression, social function with aggressive patients.

Patients and their relative's violence affect the health of nurses. Therefore, it is necessary the therapeutic interventions for the prevention of physical and mental diseases in nurses and decreased desire to leave the organization.

The authors have not supplied their declaration of competing interest.

Postnatal depression as well as postnatal depressive symptoms may have detrimental effects in offspring.

The main objective of this study was to examine the nature of the video interaction guidance method Marte Meo offered new mothers experiencing depression or depressive symptoms.

The aim was to develop knowledge to be utilised in care in order to prevent sufferings for mothers, babies and their families.

Fifteen mothers were recruited from a health centre. They took part in Marte Meo guidance and in-depth interviews.

All mothers experienced Marte Meo in a positive manner, the main point being that they viewed their babies and/or themselves in the videos “from the outside looking in”. This seemed to be the key to facilitating reflection, a renewed sense of vitality and increased capacity for mentalisation. This viewing thus had an overall positive influence on increasing sensitive mother-child interaction and decreasing maternal depressive symptoms as well as facilitating a mentalisation process in the participating mothers, increasing their ability to reflect on their own and others state of mind and in turn recognise their babies as subjects. The results are applied in both community and specialist health services.

Marte Meo may be a helpful method and can also be administrated on a community-based level where the threshold for seeking help is a low one.

Resilience enables people to develop and regain mental health in the face of adversity, and is related to recovery. There are no current measures of resilience for Bipolar Disorder (BD).

To develop and validate a BD specific resilience measure, and examine relationships between resilience and recovery-related variables.

(1) Describe the development and psychometric evaluation of the Spanish 23-item Resilience to Bipolar Disorder (RBD) questionnaire. (2) Test relationships between RBD scores and recovery-related variables in BD.

The 41-item RBD questionnaire (developed based on prior qualitative research) was completed by 113 participants with BD, along with measures related to quality of life, functioning and recovery. Exploratory Factor Analysis (EFA) using Principal Axis Factoring with promax rotation was conducted to identify redundant items and underlying factors. Reliability and Confirmatory Factor Analysis (CFA) for the resulting factorial structure were assessed.

EFA identified 23RBD items suitable for retention, structured within five factors. Cronbach αs were all satisfactory (all αs ≥ .76) at both subscale and total score level. Convergent validity was supported through positive correlations between RBDand the Resilience Scale-25. Additionally, the RBD correlated significantlywith quality of life, well-being, personal recovery, functional impairment and symptoms. CFA fit indexes supported the five factor structure of the RBD scale.

TheRBD is a reliable and valid measure of resilience in BD, being associated with measures related to quality of life, functioning and recovery, which is consistent with previous research in resilience and mental health in other psychiatric populations.

Concomitant antipsychotic prescription is common in clinical psychiatry, although it is not an evidence-based practice. The aim of the study was to describe the prescription of antipsychotics in inpatients with schizophrenia and identify which are the factors associated with this tendency.

We reviewed retrospectively the psychotropic drugs prescribed at the time of discharge of 177 inpatients who met criteria for schizophrenia [DSM-IV-TR] on an acute psychiatry unit from 2007 to 2008.

One hundred and two patients (57.6%) were male. Mean age (SD) was 38.1 (14.6) years. The percentage of patients discharged on treatment with two or more antipsychotics was 43.5%. Although in the strict sense we should not consider it as polipharmacy, the most frequent combination was long acting injectable risperidone with oral risperidone (21.5%), followed by long acting injectable typical antipsychotic with oral risperidone (3.4%). There was a significant association between the number of prescribed antipsychotics and the total number of previous hospitalizations and the number of hospitalizations during the previous year (ANOVA p=0.001 and p< 0.001 respectively). No correlation was found between polypharmacy and age. There was a significant association between the number of antipsychotics prescribed and the use of anticholinergic treatment (t-test p=0.005).

Our polypharmacy rates are comparable with prior European data (30-76%). Despite of the clinical guidelines, antipsychotic polipharmacy is an extended therapeutic strategy not necessarily related with resistant schizophrenia. Most of the antipsychotic associations identified are not evidenced-based practice. More clinical trials are needed to determine the efficacy of different combinations.

The traditional diathesis-stress model states that cognitive vulnerabilities in interaction with stressors predict the increase of depression. However, the relationships between these variables can be much more complex, with each variable influencing each other.

The present study is based on the transactional cognitive vulnerability to stress model (Hankin & Abramson, 2001) and assesses the bidirectional relationships between cognitions, depression and stressors over time.

To understand the dynamics between stress, depression, and cognitions.

1350 adolescents (47% girls & 53% boys; Age Mean = 15.86) were assessed at the beginning of the school year and at follow-up 6 months later. They completed measures of three cognitive vulnerabilities (maladaptive schemas, negative inferential style, and rumination), negative life events and depressive symptoms. A fully cross-lagged design panel was carried out.

Stressors and all cognitive vulnerabilities but rumination predicted the increase in depression at T2. Both initial levels of depression and cognitive vulnerabilities predicted the increase in dependent stressors. Initial levels of stressors predicted an increase in rumination, hopelessness inferences, and maladaptive schemas over time. Finally, initial level of depression predicted the increase in hopelessness inferences and maladaptive schemas. the bidirectional relationships between variables were very similar for boys and girls.

The study supports not only the role of some cognitive styles as vulnerabilities for depression, but also the stress generation and the scar hypothesis. the findings support a transactional model with reciprocal relationships between stress, depression and cognitive vulnerabilities.

Undoubtedly any health care system could not meeting all of needs of people. so prioritizing of the needs is necessary. Needs assessment does not mean one need is superior to another perfectly. It is determing the most important needs, determing common needs and importance of each need in health care planning. the aim of this study is to assess psycho- Emotional needs of female adolescents.

In this cross-sectional study 2010 middle and high school female adolescents were recruited from randomly selected schools in Mazandaran province-Iran. Psycho- Emotional needs of participants were assessed by completing a self-administrated culturally-sensitive Iranian Female Adolescents Health Needs Questionnaire (IFAHNQ). Data were analyzed using Pearson Correlation Coefficient, Independent T-Test, One-Way Anova and Multivariate regression.

There was a meaningful relationship between psycho- Emotional needs' score of adolescents with their age and their mothers' education. Mean score of needs of urban adolescents was significantly higher than rural.

Ignoring adolescnts' psycho- Emotional needs and not to attempting for meeting them could lead to irrecoverable serious problems in the future of adolescent mental health.

Familial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression.

The familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses.

Some individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed.

Due to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.

Obsessive Compulsive Personality Disorder (OCPD) is a common, highly co-morbid disorder. Subjected to comparatively little research, OCPD shares aspects of phenomenology and neuropsychology with obsessive-compulsive spectrum disorders and neurodevelopmental disorders such as autism spectrum disorder (ASD). A greater understanding of this interrelationship would provide new insights into its diagnostic classification and generate new research and treatment heuristics.

To investigate the distribution of OCPD traits within a cohort of OCD patients. To evaluate the clinical overlap between traits of OCPD, OCD and ASD, as well as level of insight and treatment resistance.

We interviewed 73 consenting patients from a treatment seeking OCD Specialist Service. We evaluated the severity of OCPD traits (Compulsive Personality Assessment Scale; CPAS), OCD symptoms (Yale–Brown Obsessive Compulsive Scale; Y-BOCS), ASD traits (Adult Autism Spectrum Quotient; AQ) and insight (Brown Assessment of Beliefs Scale; BABS).

Out of 67 patients, 24 (36%) met DSM-IV criteria for OCPD, defined using the CPAS. Using Pearson's test, CPAS scores significantly (P < 0.01) correlated with total AQ and selected AQ domains but not with BABS. Borderline significant correlation was observed with Y-BOCS (P = 0.07). OCPD was not over-represented in a highly resistant OCD subgroup.

Disabling OCPD traits are common in the OCD clinic. They strongly associate with ASD traits, less strongly with OCD severity and do not appear related to poor insight or highly treatment-resistant OCD. The impact of OCPD on OCD treatment outcomes requires further research.

This work did not receive funding from external sources. Over the past few years, Dr. Fineberg has received financial support in various forms from the following: Shire, Otsuka, Lundbeck, Glaxo-SmithKline, Servier, Cephalon, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, Novartis, Medical Research Council (UK), National Institute for Health Research (UK), Wellcome Foundation, European College of Neuropsychopharmacology, UK College of Mental Health Pharmacists, British Association for Psychopharmacology, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioural Addiction, World Health Organization, Royal College of Psychiatrists.

Impaired cardiac autonomic regulation is likely important contributor to a potential cardiac complications in major depression. The knowledge regarding the depression effect on cardiac regulation in adolescent age is limited. Aim was to study short-term heart rate variability (HRV) as an index of cardiac autonomic control in never-treated major depressive disorder (MDD) adolescent patients using linear and nonlinear methods related to depressive symptoms severity.

We have examined 20 MDD girls and 20 healthy age-matched girls at the age from 15 to 18 years. The ECG was recorded in three positions: supine - orthostasis - supine. The HRV was analyzed using linear (time and frequency analysis) and novel nonlinear (symbolic dynamics, time assymetry) methods. The severity of depressive symptoms was evaluated using the scales Montgomery-Asberg Depression Rating Scale (MADRS) and Children’s Depression Inventory (CDI).

Several HRV linear and nonlinear parameters were significantly reduced in MDD group compared to controls in supine rest and during orthostasis. The HRV nonlinear analysis indices significantly correlated with depressive symptoms severity.

Linear and nonlinear analyses revealed reduced magnitude and complexity of the HRV indicating impaired neurocardiac regulation in adolescent major depression. In addition, new approach of HRV analysis using nonlinear methods provided important information about depressive symptoms severity and cardiac autonomic regulation relations.