Caring for a child with autism is a stressful experience for parents. The daily stress of this handicap has a major impact and triggers in the parents a series of adverse psychological reactions.

To reveal sociodemographic characteristics of parents of autistic children and to estimate the prevalence of anxiety and depressive symptoms among these parents.

A cross-sectional study conducted among parents of autistic children supported by four of autistic children rehabilitation centers under the Tunisian Association for the Promotion of Mental Health. Data were collected through a questionnaire to explore the sociodemographic data of parents of autistic children. Depressive symptoms were assessed by the Beck scale and anxiety symptoms by the Hamilton scale.

Fifty-two parents were collected. The middle age was 35.73 years. They lived in an urban area in 96% of cases. The majority had an average socioeconomic level (88.4%). The respective rates of depressed or anxious parents as Beck scales and Hamilton were 48% and 23%. The association between depressive and anxious symptoms was found in 19%. In addition, depression was more common in mothers (P < 10−4) and anxiety was also more evident among mothers (P = 0.01).

The presence of an autistic child causes profound changes in families and can be a source of tension and stress. The anxious and depressive impact on parents is important and frequent. The intervention that designs the psychiatrist to help children with autism should necessarily include an action for parents.

The authors have not supplied their declaration of competing interest.

S100B is a 21 kDa protein expressed primarily in astrocytes and has been related with brain dysfunction. There is evidence for increased S100B in schizophrenia, including first-episode psychosis (FEP), and in epilepsy specially after seizures. Pico and nanomolar levels of S100B are neurotrophic and micromolar levels are toxic and apoptotic.

To assess serum levels of S100B at admission and at discharge in a patient with FEP who had comorbid juvenile myoclonic epilepsy (JME).

A 23 year-old male was admitted for injury delusions, suspicion and auditory hallucinations that had started in the last three months. In the last year the patient presented progressive social isolation and stopped attending classes. He was diagnosed JME at age 14 and was treated with 1300 mg valproic acid per day. The last seizure was two years ago. Risperidone was started up to 8 mg per day and valproic acid was continued. He had a progressive clinical improvement and in two weeks was discharged. Serum levels of S100B were determined at admission (3528.23 pg/ml) and discharge (3553.78 pg/ml).

This patient had high levels of serum S100B both at admission and discharge. These levels were ten times higher than previous studies in epilepsy (without psychosis), hundred times higher than previous in psychosis and thousands times higher than in healthy subjects. We interpret these results as an intense activation of astrocytes by a double brain insult. Monitoring this patient during more time will show the evolution of S100B with antipsychotic treatment.

A case report of a 55 year old male, previously diagnosed with Parkinson's Disease(PD), presenting cognitive deficit and psychotic features on admission, is presented. Aripiprazole, despite not being first choice for this indication, was the only antipsychtoic drug to improve psychotic symtoms without worsening motor movement and improving cognitive functioning. A literature review on treatment options in PD psychosis is presented.

Describe the triad Parkinson's Disease/Cognitive Decline/Psychosis and review treatment options.

To explain the unique activity of aripirazole in PD Psychosis on the grounds of existing reasearch evidence and neurotransmitter activity.

A case report is described and literature reviewed.

Due to its unique receptor binding profile, specifically on 5HTA1 receptors, M1 receptors and its affinity for D2 receptors, aripiprazole seems a promising drug in the treatment of PD psychosis when cognitive decline is equally present. Future prospective studies are needed to test this hypothesis.

There is a significant disagreement in the literature concerning the validity of psychiatric instruments in different cultures.

The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Greeks in Greece and all over the world.

Forward and back translation was used for the greek version of the instrument. The sample was divided into three groups:

i) general population(69,4%);

ii) people in non-psychiatric treatment(12,9%);

iii) people in psychiatric treatment (11,7%).

They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include SRQ-F culturally specific items and physicians also completed an encounter form about the presence of mental health symptoms in participants.

The study sample was composed of 631 Greek speaking adults, 502 females and 129 males, aged 18—67 (M = 30, SD = 11,5). Internal consistency for the overall score was very high (α = ,930). Item total correlations were between, 443 and, 692. Factor analysis revealed four factors accounting for the 54,22 of the total score variance. The factors were anxiety symptoms, depressed mood, somatic symptoms and psychotic symptoms. Content, construct, and criterion validity of each question led to 25 items. Independent t test revealed significant differences between psychiatric patients and control group in the total score (t = -17,795 p = ,0001), psychosis subscale (t = -12,622 p = ,0001) and somatic distress subscale (t = -17,712 p = ,0001).

The Greek SRQ was found to be a valid instrument which can be used in primary care to help general practitioners in the early recognition of mental illness.

Mobile health (m-health) technology has been growing rapidly in the last decades. The use of this technology represents an advantage, especially for reaching patients who otherwise would have no access to healthcare. However, many ethical issues arise from the use of m-health. Health equity, privacy policies, adequate informed consent and a competent, safe and high quality healthcare need to be guaranteed; professional standards and quality of doctor-patient relationship in the digital setting should not be lower than those set for in-person practice.

To assess advantages and threats that may arise from the wide use of m-health technologies, in order to guarantee the application of the best medical practices, resulting in the highest quality healthcare.

A literature search has been conducted to highlight the most pressing ethical issues emerging from the spreading of m-health technologies.

Few ethical guidelines on the appropriate use of m-health have been developed to help clinicians adopt a professional conduct within digital settings. They focus on the need for professional associations to define ethical guidelines and for physicians to take care of their education and online behavior when using m-health technologies.

The rapid spreading of m-health technologies urges us to evaluate all ethical issues related to its use. It would be advisable to produce an ethical code for the use of these new technologies, to guarantee health equity, privacy protection, high quality doctor-patient relationships and to ensure that m-health is not chosen over traditional care for merely economic purposes.

SG received honoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other authors have declared.

Synthetic cathinones, the active component in “bath salts”, have surfaced as a popular alternative to other illicit drugs of abuse, such as cocaine, MDMA (ecstasy), and methamphetamine, due to their potent psychostimulant and empathogenic effects.

To describe the presence of Ethylone in samples delivered to energy control from 2014 to 2015 in Spain.

The total number of samples analyzed from 2014 to 2015 was 8324. Only those samples containing ethylone were studied. They were analyzed by energy control, a Spanish harm reduction NGO that offers the possibility of analysing the substances that users report. Analysis was done by gas chromatography-mass spectrometry.

From June 2014 to December 2015, 8324 samples were delivered to EC. From this samples 28 (0.336%) contained ethylone. Twelve (0.144%) were delivered as MDMA, representing a 0.783% of the samples delivered as such, and only one sample (0.012%) delivered as MDMA presented ethylene as an adulterant along with MDMA. Other 6 samples (0.072%) were delivered as ethylone and 10 samples (0.120%) were delivered as unknown pills.

Ethylone consumption is found to be an emerging issue according to the results of our samples, an increase of such is found during 2015. This might be traduced as an increase of ethylone in the drug market, but a sample selection bias should be considered as samples were voluntary delivered by consumers. An alarming phenomenon is that in some occasions ethylone is sold as MDMA, but effects take longer to occur and last longer, which may lead to an overdose if used as MDMA.

The authors have not supplied their declaration of competing interest.

Pathogenesis of metabolic syndrome (MS) and depression (MDD) is complex and insufficiently explored. In addition to chronic stress, psychotrauma, hypercortisolemia and immunological factors, some personality features may have an impact. Type D personality, most influential personality type in psychosomatic medicine, consists of two dimensions: negative affect (NA) and social inhibition (SI). Individuals with type D personality are more anxious, irritable and depressed and they do not share these emotions with others because of their fear of rejection. Type D personality was proven to be a risk factor for some MS components, as well as for the occurrence of depressive symptoms in cardiac patients.

To investigate the association of type D personality with MS and its components in MDD patients.

Cross-sectional study was conducted on the sample of 80 patients with depression and 40 healthy subjects as the control group. Mini International Neuropsychiatric Interview (MINI questionnaire) and Hamilton Rating Scale for Depression (HDRS-17) were used for the diagnosis of depression. Type D personality was determined by DS14 questionnaire. The MS diagnosis was made according to ATP III criteria.

The presence of type D personality did not significantly contribute to the probability of developing MS in patients with depression. NA was associated with abdominal obesity, low HDL-cholesterol and hypertension.

Negative affect was proven to be an independent risk factor in the pathogenesis of obesity, hypertension, and reduced level of HDL-cholesterol, while type D personality in general did not have predictive value for the MS development.

The authors have not supplied their declaration of competing interest.

Cognitive test anxiety is acknowledged as intense anxiety that prevents the effective use of the previously learned knowledge during the exam and leads to a decrease in success. Mindfulness is indicated as the ability to bring one’s attention to experiences in the present moment in a non-judgmental way. Despite promising outcomes of mindfulness techniques in regulating stress levels, much uncertainty still exists about the specific associations between cognitive test anxiety and mindfulness subcategories.

The aim of this study was to investigate the relationship between cognitive test anxiety and subcategories of mindfulness among university students which may help improving current mindfulness interventions that show promising results to tackle cognitive test anxiety.

One hundred-eighty-two university students were recruited for the study via online forms. Mindfulness was measured with Five Facet Mindfulness (FFMQ-S) and the cognitive test anxiety was assessed with Cognitive Test Anxiety Scale-Revised (CTAR).

Total scores of CTAR-R has an association between subscales of FFMQ; act-aware and non-judge in a positive direction, whereas; observe and describe in a negative direction. In addition, according to our regression model, FFMQ subscales of describing to indicated lower levels of CTAR scores, whereas act aware and non-judge indicated higher levels of CTAR scores.

The findings of the study partially corroborated the previous results by offering inferences about the subcategories of mindfulness. Additionally, these findings suggest that current interventions may target specific subcategories of mindfulness to maximize the positive outcomes of the treatment.

No significant relationships.

Recruitment of medical students and junior doctors in to psychiatry is a long-standing concern in many countries, with low proportions of medical graduates choosing it as a specialty and ongoing stigma from within the medical profession. In some countries the reverse problem is the case, with too many doctors wishing to enter psychiatry, and insufficient training places available.

To understand the current situation within Europe with regards to recruitment in to psychiatry and to identify existing recruitment initiatives.

The European Federation of Psychiatric Trainees conducts an annual survey of all member organisations. A delegate of each national association of psychiatric trainees is asked to identify if their country has a problem with recruitment and if so, whether there were too many or too few applicants for training places. Delegates from countries with recruitment initiatives were contacted to provide further details.

In 2014, a total of 31 countries completed the survey, with 17 stating that too few medical practitioners choose psychiatry. In total 8 countries with recruitment problems reported that initiatives exist to encourage doctors to enter psychiatric training. Of these, 7 responded to describe the initiatives, which included national recruitment strategies, financial incentives, careers fairs, mentoring schemes and a whole host of other projects.

Recruitment in to psychiatry remains a serious problem in a significant proportion of European countries, but a wide range of initiatives exist which aim to combat this shortfall. It will be important over the coming years to establish which initiatives are most effective at increasing recruitment.

The authors have not supplied their declaration of competing interest.

According to studies done in recent years regarding the treatment of patients with melancholy in major depressive disorder, a shift of interest from studies evaluating the effectiveness of therapy to the study of remission is seen. Despite significant progress in the development of pharmacotherapy of depressive disorders, difficulty in achieving rapid reduction in depressive symptoms and stable remission in patients with melancholic depression necessitated the search for new approaches to the treatment of this pathology.

Evaluating the effectiveness of art therapy in treatment in patients with melancholy in major depressive disorder on the quality of remission.

The study involved 135 patients – 60 male and 75 female patients aged from 18 to 30 years old. The main group of patients apart the combined treatment also participated in group art therapy with the use of drawing techniques, while the control group – statutory standard therapy.

The results of the use of art therapy in complex treatment in patients with major depressive disorder is detected primarily in reducing of the level of anxiety at the early stages of treatment (60% of patients have noticed decreasing of melancholic state), as well as improving the quality of life in remission period.

These results support the use of art therapy in treatment in patients with melancholy in major depressive disorder during period of active treatment, and after achieving clinical remission contributes to achieving and maintaining high-quality and stable remission with full restoration of quality of life and social functioning.

The authors have not supplied their declaration of competing interest.

Proper documentation and relevant updating of patients’ health status has become a cumbersome task with the inception of electronic medical records.Inpatient, ED, and ambulatory patient evaluation generate billions of records each year.It brings about a burden on the workload of the providers regarding registering and completing patients’ records.Incomplete medical records set up complications in patient management and subsequent administrative operations.Specifically, denials for reimbursement because of incomplete medical records emerge as a critical concern.Effective measures, consisting of both technical and administrative enforcements are required to reduce number of open charts.

To understand the reasons,consequences and solutions for Incomplete/Delinquent medical records.

We searched Google scholar and Pubmed database using keywords “Incomplete medical records”, “Imapacts” and “Solutions”.Articles popped up.We selected 4 based on internal and external validity.

Incomplete/Delinquent medical records are nowadays imposing a critical challenge upon financial, administrative and legal affairs in practicing Medicine.Our review shows that CMS recovery audit with hospital denials went high from 7-10% in recent years because of open/incomplete medical records.Provider’s documentation time increases as well with implementation of EHR.Appropriate measures could be taken to resolve this issue, broadly we can try two ways- training and administrative courses.

Physicians,residents and all respective providers should get training on a regular basis regarding EMR/EHR to complete medical records duly and effectively.The other way is administrative surveillance.If providers fail repeatedly to comply with HIM standard and complete delinquent medical records, warnings, suspensions or other regulatory actions can be executed strictly to keep them on track.

No significant relationships.

The author has not supplied his declaration of competing interest.

Poor adherence to antipsychotics is a major problem in long term treatment of schizophrenia, a relationship between poor adherence and relapse is well documented in the literature. One of the factors that may affect compliance is antipsychotic formulation. The primary objective of the study was to compare patient preference for olanzapine conventional tablet (OCT) with orodispersible tablet (ODT) as measured by a formulation preference question.

A 12-week open label, randomized, crossover, multinational study (Turkey, Romania, Israel, Brazil, Mexico) conducted to estimate the proportion of patients preferring OCT over ODT after 6 weeks of treatment with each formulation. Outpatients with stable schizophrenia (CGI-S<4) on OCT monotherapy for at least 1 month before study inclusion were randomized 1:1. Compliance, drug attitude were measured using DAI-10 and MAF scales; tolerability and safety by AMDP-5 questionnaire and adverse event summary.

From 265 randomized patients,207 were eligible for the analysis and 175 patients answered the preference question. 106(61%) patients preferred ODT, and 48(27%) preferred OCT (p<0.001 adjusted for treatment sequence); 21(12%) expressed no preference. 90% of patients were rated as almost always compliant on both formulations. The adverse event profiles of ODT and OCT were similar: most common (>1%) adverse events were weight increase, hypertriglyceridaemia, and somnolence.

Most of the patients who answered the preference question declared to prefer olanzapine orodispersible to conventional formulation. Given the importance of patient's preference as one of the factors for future compliance, olanzapine orodispersible tablet could be a good choice.

The purpose of this study is to examine the association between non-psychotic serious mental disorders and earnings in the general population of Belgium on both the individual- and society-level.

Data stem from a cross-sectional population study of the non-institutionalized adult (between 18 and 64) population from Belgium (N = 863). The third version of the Composite International Diagnostic Interview (CIDI-3.0) was administered to assess 12-month non-psychotic serious mental disorders and annual earnings. Multivariate approaches were used to estimate the observed and estimated annual earnings for persons with serious mental disorders, controlling for sociodemographic variables and alcohol disorders.

On the individual-level, 12-month serious mental disorders significantly predicted the probability of having any earnings (OR = 0.32; 95%CI = 0.14–0.74). Respondents with serious mental disorders had 12-month earnings of 5969€ less than expected in the absence of serious mental disorders. Taking into account the prevalence of serious mental disorders (i.e. 4.9%), the society-level effects of serious mental disorders in 2002 can be estimated at about 1797 million € per year for the Belgian general population.

Non-psychotic serious mental disorders had considerable impact on annual earnings.

This is the first study in Belgium that addresses the association between mental illness and earnings. Serious mental disorders are associated with individual- and societal-level impairments and loss of human capital.

Explore the prevalence of lifetime suicide attempts in women with bulimia nervosa (BN), and compare eating disorder symptoms, general psychopathology, impulsivity, personality, and genetic variants in four candidate genes of the serotonin pathway: the serotonin transporter (SLC6A4), serotonin receptors 1A (HTR1A) and 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) between individuals who had and had not attempted suicide. Determine the best predictors of suicide attempts.

566 consecutively admitted BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN). Patients completed a comprehensive assessment battery.

Lifetime prevalence of suicide attempts was 26.9% CI 95%: 23.2 to 30.5). BN subtype was not associated with lifetime suicide attempts (p=0.36). Compared to non-attempters, attempters exhibited higher unemployment, eating disorder symptomatology, general psychopathology, previous eating disorder treatment, impulsive behaviors, and lower educational level (p<0.004). In relation to personality traits, suicide attempters exhibited significantly (p<0.002) higher Harm Avoidance and lower Self-directedness, Reward Dependence and Cooperativeness. No significant differences in any of the genetic variants between attempters and non-attempters. The best predictors of suicide attempts were (p<0.006): lower education, minimum BMI, previous eating disorder treatment, family history of alcoholism and self-directedness.

Suicidality in BN patients appears to be within the range previously found. Our results support that internalizing personality traits combined with impulsivity may increase the probability of engaging in suicidal behaviors in these patients. Our data do not support the hypothesis that variants of SLC6A4, HTR1A, HTR2A or TPH1 are associated with suicide attempts in BN individuals.