Researches showed comorbidity of sleep disorders and mental disorders.

The current study aimed to evaluate depression and anxiety and their relationship with insomnia, nightmare and demographic variables in the medical students of Qazvin University of Medical Sciences in 2015.

The study population included 253 medical students with the age range of 18–35 years. Data were gathered using Beck depression inventory, Kettle anxiety, and insomnia and nightmare questionnaires and were analyzed by proper statistical methods.

Among the participants, 126 (49.6%) subjects had depression and 108 (42.5%) anxiety. The prevalence of depression and anxiety among the subjects with lower family income was significantly higher (Chi2 = 6.75, P = 0.03 for depression and Х2 = 27.99, P < 0.05 for anxiety). There was a close relationship between depression with sleep-onset difficulty, difficulty in awakening and daily sleep attacks, and also between anxiety with sleep-onset difficulty and daily tiredness (P < 0.05). In addition, there was a close relationship between depression and anxiety with nightmare; 16.2% of the subjects with depression and 26.5% of the ones with anxiety experienced nightmares.

Results showed a relationship between nightmare, insomnia and level of family income with increasing depression and anxiety in the medical students; hence, due to the importance of medicine in human life, it is necessary to evaluate the mental health of medical students, identify and solve the relative problems such as anxiety, depression and related symptoms such as insomnia and nightmare in them.

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

Most studies selected euthymic patients with bipolar disorder in inter-episodic phase according to clinical remission criteria at least between 1 and 6 months. However, possible differences can exist in the course of clinical symptoms in bipolar patients related to the duration of clinical remission.

The main aim of this study was to evaluate the clinical status of bipolar patients after 6 months of clinical remission.

We performed a cross-sectional study of bipolar outpatients in clinical remission for at least 6 months. Bipolar Depression Rating Scale (BDRS), Young Mania Rating scale, Pittsburgh Sleep Quality Index (PSQI) scale, Visual Analogic Scales (VAS) evaluated cognitive impairment were used to assess residual symptomatology of patients. Multivariate analysis (MANCOVA) was conducted for analysing possible differences between 3 groups of patients according to their duration of clinical remission (< 6 months–1 year, < 1 year–3 years, < 3 years–5 years).

A total of 525 patients were included into the study. The multivariate analysis indicated a significant effect of the duration of clinical remission on the different residual symptoms (Pillai's trace: F 4.48, P < 0.001). The duration of clinical remission was associated with the significant improvement of the BDRS total score (P = 0.013), the PSQI total score (P < 0.001) and the cognitive VAS total score (P < 0.001)

These results support a possible improvement of residual symptoms according to the duration of clinical remission in bipolar patients. Any definition of euthymia should specify the duration criteria.

The authors have not supplied their declaration of competing interest.

The use of cannabis is likely to increase as regulations on its consumption are diminishing throughout the world.

to identify the prevalence of anxiety and depression symptoms in a group of cannabis users in Tunisia.

this a transversal descriptive study about 137 participants in the University Hospital Of Mahdia during 2 months.

In our study population , the consumers were young adults aged between 18 and 35 years old ,of whom 40.8% were professionally active, 23.2% had psychiatric history. Moreover, the use of other substances was regular among users as follows: tobacco among 74.6% of users, alcohol among 72.5% of users, ecstasy among 41.3% of users, cocaine among 25.4% of users. The use of cannabis was considered as a means of exultation for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%. Overall, the effect of cannabis use on anxiety and depression on the HAD scale showed the following results: probable anxiety in 53% of cases, probable state of depression in 72% of time.

The correlation between cannabis use, anxiety and depression remains unclear. Equally concluded, the assumption of self-medication by cannabis stills a topic of discussion.

No significant relationships.

Psychotic disorders are frequently linked to a public perception of dangerousness and propensity to engage in violent acts. Despite efforts to demystify these disorders, the evidence on the relationship between violence and psychotic disorders is mixed. Together with media coverage of violent crime associating violence with the occurrence of a mental disorder, such a situation has contributed to the social stigmatisation of people with severe mental disorders and the consequent discrimination that this scenario entails. Despite efforts to demystify such disorders, the association between violent behaviour and psychosis remains unclear.

This study aims to explore the incidence and main clinical characteristics associated to violent offences recorded in a cohort of patients presenting a First-Episode Psychosis (FEP).

Patients presenting with an affective or non-affective first psychotic episode were recruited from the First Episode Psychosis Intervention Program (CRUPEP) cohort between 2009 and 2016. The main clinical variables were collected, including medical-forensic records of patients registered at the Basque Institute of Forensic Medicine (BIFM), to retrieve any violent acts in which patients with FEP were involved, either as victims or as offenders.

Overall, 79.5% (n=182) of CRUPEP patients had no violent record of crime or offence recorded in the BIFM. Annual crime rates for the 2009–2016 period show a decreasing trend in both the general population (IRR=0.981 (95%CI=0.978–0.983) p<0.001) and in patients with FEPs (IRR=0.019 (95%CI=0.012–0.028) p<0.001); this pattern is more pronounced the FEP group. Victimisation accounted for the vast majority of reported incidents; nevertheless, patients who have committed violent offences were mostly involved in intrafamily violence

Patients with FEP were not involved in a higher number of crime rates than the general population. The types of violent acts committed by FEP patients were heterogeneous, with extreme violence being particularly uncommon.

None Declared

Gray's theory of personality distinguishes two personality dimensions: Behavioral Activation System (BAS) and Behavioral Inhibition System (BIS). This construct has been widely used in the field of addictions and the study of impulsivity. BIS and BAS can be measured using the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). This questionnaire has been carried out in cross-sectional studies related to alcohol misuse, eating disorders, pathological gambling and cannabis misuse.

To study Sensitivity to Reward and Sensitivity to Punishment as factors that could predict the development of Alcohol Dependence.

380 subjects completed the SPSRQ at the beginning of the study and were followed-up for 4 years. At this point, participants completed a protocol that assessed drinking-related variables and drinking patterns. Statistic was performed using regression analysis.

Low scores obtained in the Reward Sensitivity Subscale was a significant predictor for developing an Alcohol Use Disorder (AUD). High scores obtained in the Punishment Sensitivity Subscale were not significantly related to the subsequent development of an AUD.

Low scores obtained in the Reward Sensitivity Subscale predict a higher risk for the development of Alcohol Dependence. This could be due to more difficulties that these individuals exhibit, despite the negative consequences, when they have to inhibit their seeking behavior and intake of alcohol.

Clozapine is a second-generation antipsychotic indicated in treatment-resistant schizophrenia. Patients taking clozapine are likely to experience an increase in salivation or sialorrhea. Clozapine‐induced sialorrhea (CIS) may lead to sleep disturbances or aspiration pneumonia. Treatment options include locally administered anticholinergic medication with atropine ophthalmic drops applied sublingually.

To review the current evidence for the effectiveness, safety, side effects and dosage of sublingual application of atropine in reducing or resolving of CIS.

Systematic review. Data were obtained from PubMed/Medline, EMBASE, PsycINFO, Cochrane Plus, Trip Database, Science Direct and Scopus searches of English-language articles, without restriction for date of publication and study design, reporting the sublingual use of atropine in the treatment of CIS. Large clinical studies with appropriate statistical methods and recruited adults were preferred.

12 selected articles (of 458 references) consisted entirely of case reports and case series. A total of 29 patients with CIS were reported, of whom 24 responded favorably to sublingually administered atropine drops 1% (1-2 drops a day). One limitation of its utilization is the dose-related dry mouth, which can be addressed by lowering the number of drops administered. CIS can occur at different clozapine doses, in various stages of treatment.

The reviewed articles suggest that the use of sublingual atropine is a promising local treatment for CIS. Oral anticholinergic and alpha-2 agonist medications have been used to treat CIS with variable efficacy, but can cause systemic anticholinergic side effects. Further experimental research is needed.

No significant relationships.

ASD is a heterogeneous group of pathological conditions.

Sensory Functions in Children with Autism

A brief review of scientific publications is presented, formed by the search result for the keywords: autism spectrum disorders, artificial intelligence, machine learning.

Patients with ASD respond to sensory information hyper-reactively and hypo-reactively. Patients, regardless of age and severity of ASD, have atypical information processing patterns in all sensory modalities. Atypical processing of stimuli correlates with social, cognitive and communication disorders.

To normalize sensory deviations, it is necessary to build corrective and prognostic models of the child’s connection with the environment. Machine learning models, Data Mining methods to make medical management decisions and develop personalized therapeutic strategies.

None Declared

Aggression is a particular problem commonly observed in personality disorders, especially in antisocial personality disorder (APD). It is well known that APD is closely related to substance use disorder (SUD). Individuals with higher aggression levels have also been suggested to have higher rates of SUD. The aim of this study is to investigate aggression levels and substance use characteristics of APD subjects with and without violent criminal behavior.

A total of 124 male subjects with APD consecutively admitted to the Forensic Psychiatry Department of GATA Haydarpasa Training Hospital were involved in the study. All subjects were evaluated with an assessment battery using a semi-structured interview for socio-demographic, APD, and substance use characteristics, APD section of SCID-II, SCID-I, and Aggression Questionnaire. The sample was divided into 2 groups in terms of having a history of violent criminal behavior and compared correspondingly.

Of the APD subjects, 90.3% reported a lifetime history of substance abuse and 75% had a current co-diagnosis of SUD. APD subjects with violent criminal behavior were more likely to be diagnosed with SUD as compared to those without violent crimes. Moreover, APD subjects with SUD had higher aggression levels than those without SUD.

Our results indicate that substance use may mediate the association between APD and aggression. Therefore, the treatment of SUD in APD subjects is an important target particularly for prevention of violent criminal behaviors.

To compare socio-demographic and clinical profiles of patricide and matricide patients.

To compare modus operandi in matricide and patricide patients.

A retrospective, descriptive and comparative study was conducted, based on medical charts’ consult. Were included patients suffering from psychotic disorders (DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015, after not being held for insanity according to article 38 of Tunisian Criminal Code. Only patients who committed patricide or matricide were included.

Our sample included 26 patients (13 patricides; 13 matricides). There was non-significant differences between two groups concerning: instructional level (P = 0.277), professional status (P = 0.387) and marital status (P = 0.790). Committers of patricide and matricide did not differ in terms of psychiatric diagnosis (P = 0.242) and substance abuse (P = 0.550). A significant difference was found between the two groups in terms of schizophrenia subtypes, patricide patients suffered from a disorganized schizophrenia whereas matricide patients suffered from paranoid subtype (P = 0.05). Patricide was more frequently associated to a conflictual relationship between son and father (P = 0.05). We did not record a significant difference in the crime weapon or its motivations.

Our results helps draw a profile for parricide patients in order to help identify the ones at risk.

The authors have not supplied their declaration of competing interest.

A number of authors have hypothesized that psychotic patients who consume cannabis constitute a differentiated subgroup of patients that have better cognitive and social skills, necessary to engage in illegal drug consumption, than non-using patients.

Given that the prevalence, and patterns, of cannabis use are culturally driven, we wanted to study first-episode psychosis (FEP) cannabis-using and non-using patients coming from different European countries as part of the EUGEI-STUDY.

We tested the hypothesis of better premorbid social adjustment in cannabis-using FEP patients, by comparing them to FEP non cannabis users and to their respective healthy controls.

A total of 1745 people (746 cases; 999 controls) completed the assessment for premorbid adjustment [Premorbid Adjustment Scale (PAS)] and cannabis use (CEQ-Revised). We first extracted the Premorbid Social Adjustment Factor (PSA) from PAS and then performedlinear mixed models with PSA as dependent variable and cannabis lifetime (Yes/No) and subject status (Cases/Controls) as independent variables. We then considered “Country” as random intercept.

Across all countries, PSA scores were better in patients who had smoked cannabis in their lifetime than patients who had not (P = 0.009). The difference in PSA score between cannabis users and non-users was significantly greater in cases than controls (P = 0.038). The relationship between PSA, cannabis lifetime (Yes/No) and subject status among nations (random intercept) is shown on Fig. 1.

Cannabis-using psychotic patients show better premorbid social adjustment than non-using patients, across 5 European countries.

The authors have not supplied their declaration of competing interest.

Cyberchondria is a pathological behaviour linked to excessive online searching of health information.It is frequently associated with health anxiety. It may be regarded as an compulsive behaviour secondary to obsessions about a real or an imagined illness. The coronavirus pandemic of 2019 has brought about a fear of getting infected. In the absence of a definitive cure, the focus largely lies on stringent preventive measures and early diagnosis. Known to present with diverse symptoms, fear of coronaviral infection makes affected individuals search for symptoms on internet for reassurance. Added misinformation further increases stress,anxiety and confusion.

The authors attempt to describe cyberchondria and highlight its increased prevalence during the coronavirus pandemic.

5 cases from different backgrounds were seen in the outpatient clinic during the months of April-July 2020.Consent was obtained from subjects before the study.They were clinically diagnosed with obsessive-compulsive disorder and exhibited cyberchondria in the background of the pandemic.

All of the described 5 cases had prominent fear of contracting or having contracted coronavirus disease-19.All of them were found to have significant scores rang on Yale-Brown Obsessive-Compulsive Severity Scale(ranging from 25-35) and improved after a trial of selective serotonin reuptake inhibitors.

The emergence of cyberchondria during the coronavirus -19 pandemic warrants further introspection.Changes in policy-making to prevent misinformation and present health information in a simple way to prevent confusion in the lay public is a necessity to tackle this problem in the near future.

Social dysfunction is a significant feature of schizophrenia leading to deminution of quality of life (QoL).

To explore the correlation between social functioning and quality of life in patients diagnosed with schizophrenia.

The study sample comprised 32 patients diagnosed with schizophrenia (24 males and 8 females) recruited from the Clinic for mental disorders “Dr Laza Lazarevic” in Belgrade, with a mean age of 41.28 years (min 24, max 62), assessed by the Social Functioning Scale (SFS) and the World Health Organization Quality of Life questionnaire (WHOQOL-BREF).

There were two significant quasi-canonical positive correlations between social functioning and QoL (1: f-test=16.4, p=.001; 2: f-test=23, p=0.0001.) The first structure is formed through the set of SFS subscales- Recreation, Independence-performance and Independence-competence and set of QoL subscales- Mental health, Physical health, Environment and General assessment of QoL. The second structure is formed through the set of SFS subscales- Interpersonal functioning and Social engagement/withdrawal and the set of QoL subscales- General assessment of QoL and Environment. Furthermore, the first canonical component indicates a greater overlap of the opposition set by social functioning (23%) which leads to the assumption that the direction of influence goes from social functioning to QoL. Due to the equality of redundancy in the second canonical component, the direction of influence can only be inferred on the basis of the first canonical component.

Social functioning and quality of life are related in patients diagnosed with schizophrenia, and this relationship is based on specific subfactors within those areas.

No significant relationships.

Stigma towards psychiatry and mental illness significantly worsens the quality of life of psychiatric patients. Negative prejudices in medical students make it difficult for future doctors to send patients to mental health services and promote an increased risk of premature death.

Our aim is to assess stigma towards mental illness and psychiatry in medical students, and to study the influence of real-world experiences, such as having visited a psychiatric ward, having personally met a psychiatric patient or having friends and/or family members who suffer from a mental illness.

One hundred and thirteen Italian medical students completed the following tests:

– Attitudes Towards Psychiatry (ATP-30);

– Community Attitudes Towards Mental Ill (CAMI);

– Perceived Discrimination Devaluation Scale (PDD);

– Baron-Cohen's Empathy Quotient (EQ).

Having visited a psychiatric ward correlates with a better attitude towards psychiatry (P = 0.008), rather than towards the mentally ill. Having personally known someone with mental disorders correlates with less stigmatizing scores in CAMI: total score (P = 0.002), authoritarianism (P < 0.001), benevolence (P = 0.047) and social restriction (P = 0.001). Similar results emerged in those who have close relationships with a psychiatric patient. There is no statistical significance as to empathy.

The students who have visited a psychiatric ward have a less stigmatizing vision of psychiatry, while having personally known psychiatric patients favors a less stigmatizing attitude towards them. Those who have not had this experience, have a more hostile and intolerant vision of mental illness, and consider psychiatric patients as inferior subjects that require coercive attitudes and that would be better to avoid because socially dangerous.

The authors have not supplied their declaration of competing interest.

Aberrant salience is the incorrect assignment of salience, significance or value to different innocuous stimuli. It seems closely related with dysregulation of the dopamine system that in turn relates with proneness to develop psychosis.

To evaluate aberrant salience processing in a clinical trans-diagnostic sample, its relationship with anamnestic psychotic symptoms and current psychopathology, and possible variations of aberrant salience after three months of clinical-based treatment.

Twenty inpatient subjects attending the Psychiatric Unit (Florence University) were recruited: 3 with Major Depression Disease, 6 with Schizophrenia, 3 with Bipolar Disorder, 4 with Obsessive-Compulsive Disorder, 4 with Eating Disorders. Patients were assessed by means of a clinical interview (SCID-I/P) and several questionnaires (AMDP, MADRS, HAM-A, MRS, PANSS and Aberrant Salience Inventory-ASI) at enrolment (T0) and after an individual and clinical-based treatment lasting 3 months (T1).

At T0 subjects with positive ASI (cut-off>14) reported more frequently past and lifetime psychotic symptoms (p<0.05) and constituted a distinct cluster from patients with ASI score < 14. A positive anamnesis of psychotic symptoms was significantly correlated with AMDP susbscales (delusions and perception disturbances), PANSS pos, PANSS neg, PANSS tot scores (p<0.05). A significant reduction of mean MADRS, PANSS tot and HAM scores between T0 and T1 was found (p<0.05). No differencesin ASI scores between T0 and T1 were observed.

Aberrant salience is significatively associated to lifetime psychotic symptoms. It represents a relevant psychopathologic dimension that, unlike other symptoms, seems not to significatively modify after pharmacological treatment and could represent a stable lifetime.

People who attempt suicide often display cognitive impairments, particularly poor cognitive control. Could poor cognitive control contribute to high suicide rates in old age? A component of cognitive control, cognitive inhibition – active suppression of task-irrelevant processing – is very sensitive to aging and has been linked to attempted suicide. We investigated cognitive inhibition in older high-lethality suicide attempters, closely resembling suicide victims, as well as low-lethality attempters, and control groups with and without depression and suicidal ideation.

102 participants aged 60+ (17 psychiatrically healthy control subjects, 38 depressed control subjects, 16 suicide ideators, 14 low-lethality suicide attempters, and 17 high-lethality suicide attempters) underwent comprehensive clinical and cognitive assessments. They completed the Delis–Kaplan Executive Function System Color-Word Interference Test, a validated modification of the Stroop test.

High-lethality suicide attempters demonstrated a distinct pattern of cognitive inhibition deficits. Compared to psychiatrically healthy control subjects and non-suicidal depressed patients, high-lethality attempters took longer to complete inhibition trials, even after accounting for potential confounding factors (age, education, MMSE score, information processing speed, and accuracy). Compared to non-suicidal depressed and healthy control subjects, low-lethality suicide attempters committed more uncorrected errors; however, this difference was not specific to the inhibition condition.

Older suicide attempters are a cognitively heterogeneous group. Poor cognitive control in high-lethality attempters may undermine their ability to solve real-life problems, precipitating a catastrophic accumulation of stressors. Meanwhile, low-lethality attempters’ poor performance may reflect a careless approach to the task or faulty monitoring.

Nurturing children with neurodevelopmental disorders such as ADHD is associated with psychological burden to the caregivers. Oman has a pyramidal population structure with the bulk of the population are in the pediatric age group. Previous studies have indicated that ADHD is common in Oman.

To measure level of burden of care among caregivers of children with ADHD and the relationship between the degree of burden, subtypes of ADHD and socio-demographic factors.

A cross sectional study conducted in a tertiary hospital in Oman. Arabic-version of the Zarit Burden Interview (ZBI) was used to evaluate the level of burden among the caregivers. The severity and subtypes of ADHD were quantified using Vanderbilt ADHD Parent/Teacher Rating Scale. Socio-demographic background and clinical data were gathered from medical records.

The study included caregivers of 100 children with ADHD. The mean ZBI score was significantly high for the parents of children with ADHD. As for the relationship with socio-demographic background, mothers of children with ADHD reported a higher mean ZBI score compared to fathers. Factors such as income, number of siblings, and severity/subtypes of ADHD played significant roles.

To our knowledge, this is the first study of Arab/Islamic population exploring the burden of care for children with ADHD. Some of the risk factors appear to have direct effects. If this study will withstand further scrutiny, concerted effort is needed in emerging economies such as Oman to address the issue of burden among the caregivers of children with ADHD.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.