To examine the influence of gender on burden experience and depression among informal caregivers of frail older people.

The study was part of a large survey in private households in Germany headed by TNS Infratest Social Research. Based on a probability sample of the German population (n = 52,916), we contacted all people who were 60 years of age and older and who screened positively for at least one deficit in a range of activities of daily living as well as for cognitive impairment. Characteristics of the frail person and the care situation were assessed and - if an informal caregiver was available - burden measures and the CES-Depression Scale were applied.

The care of the frail old people (n = 306, attrition: 39%; mean age: 80.2 years; female: 68.6%) was provided mostly by family caregivers (n = 262; mean age: 61 years; female: 73%). Both the burden experience and the depressive symptoms were higher among the female than among the male caregivers. Multiple linear regression analyses confirmed that caregiver's gender was one of the strongest predictors of burden experience as well as of depression. Structural equation modeling suggested that burden mediates depression; it further proposed that there should be separate models for female and male caregivers.

The results provide a basis for the development of strategies to reduce or even prevent serious distress and psychiatric disorders among informal caregivers. Furthermore, they point to the need for gender-specific interventions in this field.

Psychological problems like anxiety in patients who are candidate for coronary artery bypass graft (CABGs) may increase mortality and morbidity. The effect of reassurance and preoperative information in decreasing anxiety is uncertain.

This study was designed to address the effect of preoperative information and reassurance in decreasing anxiety patients who are candidate for CABGs.

With experimental study and random sampling 85 (55male and 30 female) of 238 patients who were candidate for CABGs were included and completed spilberger anxiety test on the day of admission. Preoperative information and reassurance was done and test was completed again a day before the surgery. At last the Statistical analysis was done.

The Mean score of anxiety in patients with mild anxiety disorder (21 patients) was 34± 4.2 before and 39±5.8 after intervention. In patients with moderate anxiety disorder (39 patients) the score decreased from 52.61±3.8 to 50.76±56. Twenty five patients had severe anxiety disorder formerly with score of 63.88±2.8 which decreased to 53.88±7.6. All of differences were significant statistically.

In patients with mild anxiety intervention of preoperative information and reassurance resulted in increasing of anxiety but in patients with moderate or severe anxiety disorder such intervention decreased the level of anxiety significantly.

Domestic violence is a troubling problem, but it has acquired a new, previously unknown significance during the COVID 19 pandemic. According to WHO, the number of calls from victims of domestic violence to hotlines during quarantine in many countries has increased by an average of 5 times.

The purpose of this study was to find out the consequences of domestic violence against women and to identify psychological problems and mental disorders. Attention was paid to the mental health of victims of violence in self - isolation during COVID-19 pandemic.

We analyzed the psychological problems and mental disorders of women who applied to the newly created hotline for women at the Serbsky Center in Moscow during the COVID 19 pandemic.

The situation caused by restrictive quarantine measures related to the COVID-19 pandemic provokes aggressiveness and all forms of domestic violence.Clinical interview has revealed depression, anxiety, fear, low self-esteem, self-harm behavior, which formed the clinical picture of adaptation disorders, acute stress disorders, PTSR, psychosomatic disorders, substance abuse), sexual dysfunctions, eating disorders in the form of bulimia and anorexia.

The study requires taking into account social, economic and gender characteristics. In all types of emergencies, including epidemics, violence against women tends to increase. This is facilitated by a number of factors, such as the crowding of the stay,a decrease in prosperity, provocation of alcohol abuse, state of uncertainty.

Empirical studies on the clinical characteristics of older persons with medically unexplained symptoms are limited to uncontrolled pilot studies. Therefore, we aim to examine the psychiatric characteristics of older patients with medically unexplained symptoms (MUS) compared to older patients with medically explained symptoms (MES), also across healthcare settings.

A case–control study including 118 older patients with MUS and 154 older patients with MES. To include patients with various developmental and severity stages, patients with MUS were recruited in the community (n = 12), primary care (n = 77), and specialized healthcare (n = 29). Psychopathology was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria (Mini-International Neuropsychiatric Interview) and by dimensional measures (e.g., psychological distress, hypochondriasis, and depressive symptoms).

A total of 69/118 (58.5%) patients with MUS met the criteria for a somatoform disorder according to DSM-IV-TR criteria, with the highest proportion among patients recruited in specialized healthcare settings (p = 0.008). Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4 vs. 24.8%, p = 0.008), this difference disappeared when adjusted for age, sex, and level of education (odds ratio = 1.7 [95% confidence interval: 1.0–3.0], p = 0.070).

Although psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Therefore, treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in.

Stigma on psychiatric patients is frequent not only among common people but also in healthcare professionals. Cinema might be useful tool for medical educational purposes and might help reduce negative attitudes towards mental illness.

In the first place, to develop a pilot project of cinemeducation aimed at enhancing awareness and thinking over about psychiatry and stigma in medical students; secondly, to investigate students’ stigmatizing attitudes, empathy, personality and self-esteem and the impact of the cinemeducation intervention on some of these variables.

From October 2012 to January 2013, students will attend six cinemeducation lectures focused on helping relationships. Sociodemographic data will be collected at baseline only, and so will the Temperament and Character Inventory. In order to investigate attitudes towards psychiatry, self-esteem, alexithtymia and empathy, students will be asked to fill in some self-administered scales, both at baseline and at the end of the six lectures. These scales will include: Attitudes Towards Psychiatry Scale, Social Distance Scale, Dangerousness Scale, Mental Illness: Clinicians’ Attitudes Scale, Interpersonal Reactivity Index, Rosenberg Self-Esteem Scale, Toronto Alexithymia Scale.

The correlation among the variables assessed will be investigated in order to understand whether certain personality traits, self-esteem and empathic attitude influence students’ beliefs about psychiatry. The impact of the cinemeducation lectures on stigmatizing attitudes will be investigated as well.

Loin pain hematuria syndrome (LPHS) is a rare kidney disease with a prevalence of −0.012%. Its clinical features include periods of severe uni-or bilateral lion pain, accompanied by (microscopic) hematuria. It is often misdiagnosed as a psychiatric condition, particularly under the heading of a somatization disorder.

We describe the case of a patient who developed depressive symptoms after decades of suffering from severe intermittent bilateral loin pain.

To report a case-study, describing LPHS as a cause of severe chronic pain and persistent depressive symptoms.

A case-study is presented and discussed, followed by a literature review.

A 55-year-female was referred to a psychiatrist for her depressive symptoms and persistent periods of severe unilateral or bilateral lion pain and intermittent hematuria for over 25 years. There she was diagnosed with a depression and somatization disorder. She received amitriptyline for many years, without any effect. Finally, the patient opted for a second opinion in an academic hospital in Belgium where it was quickly discovered. After surgery, including renal denervation and kidney autotransplantation, her somatic problems and depressive mood disappeared.

The awareness of LPHS is still very limited in medicine. This may lead to incorrect diagnoses, including psychiatric disorders such as somatization disorder. More awareness could lead to earlier diagnosis and prevent the consequences of severe debilitating pain.

The authors have not supplied their declaration of competing interest.

To investigate the quality of life of schizophrenic patients, the influence of gender on their social adjustment and to compare male and female attitude to the quality of life.

Clinical and statistical, instruments for assessing Quality of Life (QOL). 200 patients (150 women and 50 men) were evaluated. We have compared clinical picture, socio-demographic factors, parameters of social adaptation and subjective attitude to the QOL in male and female schizophrenic patients.

The research has indicated sex related differences in the compared parameters. Male patients more frequently revealed personality disorders-like symptoms, they had poor social functioning and even social desadaptation, they were prone to aggression, substance abuse. Nevertherless they displayed subjective satisfaction with their QOL. Female patients more often revealed hypochondriacal symptoms but positive variant of social adaptation. at the same time women subjectively were not satisfied with their QOL.

The study has revealed that gender related mechanisms of social adaptation in women were presented by high compliance. Comparative analysis of males and females of the study exposed that gender related mechanisms of social adaptation with the inclusion of attitudes and behavioural patterns connected with regard of health and compliance are universal irrespective of clinical and social factors.

There are considerable gender differences in the subjective perception of QOL among patients with schizophrenia. the study indicate better social adaptation of females based on specific gender mechanisms. Results will contribute to improve treatment and rehabilitation.

To identify factors associated with delayed access of FEP to psychiatric care and possible measures that could help facilitate access and shorten duration of untreated psychosis (DUP)

FEP studies show that average time between onset of symptoms & first effective treatment is often one year or more1. Long DUP is undesirable as early treatment can reduce suffering and helps minimise risk of serious consequences due to changes in mental state & behaviour2,3,4. Early results suggested that early intervention in psychosis (EIP) service is more cost effective than generic services5.

Most FEP studies have been conducted in developed countries. This study aims to address the question of FEP delayed access to care in a rural Egyptian setting.

FEP cases who presented to Psychiatric Department at Mansoura General Hospital over a period of 6 months, were interviewed, together with relevant others either at first contact or after recovering from acute stage using a semistructured interview.

Main results:

1. 1. Total cases 40: Schizophrenia 14, Affective disorders: 15, Postpartum disorders: 5 and others: 6.

2. 2. On average FEP have first contact with Psychiatric service about 7 months from onset: Schizophrenia: 11 months and Affective within 3 months. No significant gender difference.

3. 3. Main factors associated with delayed access to Psychiatric care:

   1. • Cultural factors (36%): Jinn “Spirit” (16%), preference to traditional healers (10%), female gender (10%).

   2. • Lack of knowledge about Mental Illness and about service (28%).

   3. • Stigma (14%)

   4. • Financial factors (14%)

   5. • Effect of Mental Illness (7.4)

   6. • Unsuitable service (0.6%)

Study results indicate that cultural factors, lack of knowledge about mental illness & service, stigma and financial factors may play a significant role in delayed access of FEP to care in rural areas of Egypt. Programs to improve public awareness of mental illness & available service and address stigma are likely to help.

Infertile males experience considerable psychological distress, with feelings of inadequacy, marginalization, guilt and loss ofself-esteem.

Our study aims to investigate the impact of male infertility on men’s self-esteem and to study risk factorsfor low self-esteem.

We conducted a cross sectional, descriptive and analytical study, including 108 infertile men who presented to the laboratory of reproductive biology and the unit of assisted medical procreation of Military Hospital of Tunis between June and September 2019. For each patient, we collected sociodemographic and clinical data. We used Rosenberg scale to assess self-esteem.

The average age of participants was 36.8 years. Eleven patients had a history of varicocele (10.18%) and six of them sufferedfrom associated erectile dysfunction (5.55%). Infertility was primary in most of patients (77.8%) with an average duration of 3.32 years. 25% of patients had at least one previous failed assisted reproductive attempt. Spermogram abnormalities were found in 78.7% of patients. The mean score of Rosenberg scale was 30.68±4.35. Low self-esteem was associated with older age (p=0.006), lower educational level (p=0.019) and longer duration of infertility (p=0.022). Men who had children had better self-esteem (p=0.022). No associations were found between self-esteem and erectile dysfunction or previous failed assisted reproductive technique attempt.

Our results show that infertility reduces men’s self-esteem, especially of patients with lower educational level and longer duration of infertility. Physician dealing with infertility should be aware of these psychosocial aspects and offer help when needed.

The authors have not supplied their declaration of competing interest.

Cannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.

To describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.

To present an alternative treatment for CHS which can offer benefits over haloperidol.

We present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.

All three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.

Olanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.

The authors have not supplied their declaration of competing interest.

nowadays drug abuse and addiction is one of the most important health,social and political problems in the world. substance use among university students is a mental health concern. people with depression have high rates of comorbidity with other mental disorders and substance use disorders. the purpose of this study was to determine the prevalence of depression, substance use and the relationship between depression and substance use among student of guilan university of medical sciences(GUMS).

this was a cross-sectional study carried out on a representative sample of 254 students(n=167girls;n=87boys) of GUMS. The samples were selected randomly by stratified sampling. data was collected using a confidential multiple choice questionnaire detecting the frequency of various substance use. the beck depression inventory(BDI)were used to determine depressive symptoms. Data were analyzed by chi-square and exact fisher test using SPSS ver 16software.

results showed that the prevalence rate of each substance in use was: Opium (1.2%), Morphine (0.4%), cannabis (1.2%), Cocaine (0.4%), codeine (7.5%), Ritalin (2%), tramadol (4.7%) cristal (0.4%), Amphetamines (0.8%),cigarette (8.3%), alcohol(7.1%). according to BDI,(29.9%)of students had depression.there were significant differences between the prevalence of substance use with gender(p=0/0001),parent marital status(p=0/01)and depression(p=0/01).

This study demonstrated that the substance use among students is considerably high and specific interventions seem to be necessary in preventing or reducing the rate of substance use in students. Reading the result of this study,it is suggested that parents and universities authorities have a better over solving students emotional and social problems.

The authors have not supplied their declaration of competing interest.

Autism spectrum disorders (ASD) are complex neurodevelopmental conditions characterized by impairments in social cognition and repetitive behaviors with onset in early infancy. Deficits in emotion recognition, social perception, and communication have been identified as core symptoms of ASD.

Comorbid disorders are frequent, namely psychiatric illness, epilepsy, sleep disruption, and hyperactivity.

Immune profile changes during early life may contribute to pathogenesis of ASD. Other risk factors include advanced parental age, fetal environment, fertility treatments, medications, and nutritional and toxic factors.

Several brain regions are involved in the pathophysiology of ASD but the cerebellum is the structure most consistently found altered. An increased risk of ASD is associated with cerebellar damage.

To highlight the importance of understanding the key processes of cerebellar development and how altered cerebellar function leads to social and cognitive impairments, and consequently ASD.

Non-systematic review of the literature using Pubmed database. Papers were selected according to their relevance.

From imaging studies, we can understand that cerebellum is not just about motor function. Different tasks like adding working memory, emotional and social processing, and language seem to be part of core functions of the cerebellar circuit.

Adults with lesions in the cerebellum can develop cerebellar cognitive affective syndrome (CCAS), with core symptoms of impaired executive function, difficulties in spatial cognition, blunted affect, or inappropriate behavior. Some children who have tumor resection surgery for medulloblastomas also exhibit symptoms of CCAS, and some experience posterior fossa syndrome (PFS).

The linguistic, cognitive, and behavioral deficits in CCAS and PFS may contribute to explaining how cerebellar alterations are related to ASD, which is a neurodevelopmental disorder characterized by an earlier onset and broader spectrum of these symptoms.

The literature has suggested an important role for cerebellar dysfunction in etiology of ASD, under certain premises: (a) cerebellar expansion temporarily coincides with onset of ASD; (b) cerebellum is prone to lesions during this period; (3) cerebellar lesions contribute to dysfunctional social and language abilities.

Disturbances in cerebellar development lead to alterations in higher cognitive functions, due to changes in Purkinje cells. These dysfunctional neurons, once integrated into a brain circuit that controls complex tasks, lead to these functions becoming aberrant.

It is therefore fair to say that cerebellum is important for development of the so-called “cognitive and social brain” since it is itself part of this network. So, the cerebellum certainly plays a relevant role in pathophysiology of ASD.

None Declared

An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including substance abuse, depressive disorders, and attempted suicide among adolescents and adults. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship as observed in population studies.

We have tested the association between early trauma and suicide attempts in a sample of suicide attempters from the Eureca International Project and a matched healthy control sample.

We have studied the prevalence of childhood stressful events compared with healthy controls in a multicentre sample of 791 suicide attempters (SA) and 630 healthy controls (C), we have measured childhood parental neglect, physical abuse, sexual abuse, and emotional abuse, using the Childhood Trauma Questionnaire (CTQ). Chi2 tests were performed using SPSS v15.0.

A significant increase in prevalence of childhood trauma was found in the suicide attempters sample for all types of trauma: childhood physical abuse: 25.3% (SA) vs. 11.1% (C) (Chi2 test: 120,108 P = 0.000); childhood sexual abuse: 18.2% (SA) vs. 2.4% (C) (Chi2 test: 88,212 P = 0.000); parental neglect 25.3% (SA) vs. 1.1% (C) (Chi2 test: 164,910 P = 0.000); childhood emotional abuse: 34.9% (SA) vs. 5.6% (C) (Chi2 test: 176,546 P = 0.000).

Suicide attempters were increasingly overrepresented compared with controls if experiencing more than 1 trauma: represented 77% of the sample who suffered 1 type of childhood trauma vs. more than 90% of the sample with 2 or more types of trauma.

A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide.

The authors have not supplied their declaration of competing interest.

To evaluate the effectiveness of extended release quetiapine fumarate (quetiapine XR) as once-daily monotherapy for manic symptoms in bipolar I disorder.

In this 3-week, randomized, parallel-group, double-blind study, adults with bipolar I disorder (most recent episode manic or mixed; with or without rapid cycling) were randomized to once-daily treatment with either quetiapine XR (n=149; Day 1, 300 mg; Day 2, 600 mg; Day 3 through Week 3, 400-800 mg flexibly dosed) or placebo (n=159). Primary outcome measure was change from baseline to Week 3 in Young Mania Rating Scale (YMRS) total score. Secondary outcome measures included YMRS response and remission and change in Clinical Global Impression-Bipolar (CGI-BP)-Severity of Illness and -Change scales. Change from baseline was compared between groups with analysis of covariance, using the last observation carried forward approach for missing data.

Once-daily quetiapine XR was associated with significant, sustained improvement in manic symptoms compared with placebo, beginning on Day 4 (P< 0.001) and continuing through Week 3 (mean change: -14.34 versus -10.52; P< 0.001). At Week 3, quetiapine XR-treated patients showed significantly greater response (P< 0.01) and remission (P< 0.01) rates and improvement in CGI-BP-associated scores than placebo-treated patients. Adverse events were mild to moderate in intensity, the most common being sedation, dry mouth, and somnolence for quetiapine XR.

Once-daily quetiapine XR monotherapy (400-800 mg) was efficacious (from Day 4 through Week 3) and generally well tolerated in the treatment of manic episodes associated with bipolar I disorder.

Supported by funding from AstraZeneca Pharmaceuticals LP.

The authors have not supplied their declaration of competing interest.

ADHD in adults is associated with a significant impairment in many life activities increasing the risk of chronic stress in everyday life. Previous studies reported normal cortisol awakening response (CAR) in children with ADHD without comorbidities, nevertheless there is a lack of studies in adults.

The aim of the present research is to examine CAR in adults with ADHD and to assess possible differences between the combine and inattentive subtypes.

Patients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample consisted of 50 adults, age between 18 and 51 years (mean 35.24 ± 9.21) fulfilling current diagnostic criteria for ADHD (DSM-IV criteria). All patients were naïve to stimulant medication. Psychiatric and organic comorbid disorders were excluded. To assess CAR, four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening.

The mean increase in CAR for the whole group of patients was 10.34±8.79 nmols/l. T-test comparisons showed no significant differences in the mean increase of CAR between the inattentive (mean: 9.47±9.04 nmols/l) and combine (mean: 11.25±8.67 nmols/l) subtypes (t=0.610; z=0.546).

Despite there were no significant differences in salivary CAR between ADHD subtypes in adults, the mean increase of CAR was higher in combine than in the inattentive subtype. Salivary CAR needs to be further explored as an index of vulnerability to stress in these patients.