Eating disorders often have serious medical complications, including the highest mortality rates of any psychiatric disorder. The search for an optimal therapeutic strategy during the last decades has been difficult and it has included antidepressants, antipsychotics, anticonvulsants, benzodiazepines and mood stabilisers.

To review the medical literature related to the treatment of eating disorders with atypical antipsychotics.

Medline search and ulterior review of the related literature. Keywords: “eating disorders”; “anorexia nervosa”; “bulimia nervosa”; “binge eating disorder”; “antypsychotic agents”.

To the date, most of the studies have been with olanzapine. Olanzapine has shown effects, not only on weight gain, but also on management of other psychological features such as obsessive-compulsive symptoms, depression, aggression, persistence and interpersonal distrust. However, most of these studies have been compared to placebo, and binge-eating behaviour has also been described when using olanzapine (not with aripiprazole or ziprasidone). Recently, Marzola et al, when comparing olanzapine + SSRIs versus aripiprazol + SSRIs, described that aripiprazole (compared to olanzapine) is significantly more effective in reducing purging episodes, eating preoccupations and rituals.

So far, aripiprazol and olanzapine have been proved to be the most effective atypical antypsichotics in eating disorders, especially in anorexia nervosa. However, most of studies were placebo-controlled and in quite small samples. Further investigation is needed.

The authors have not supplied their declaration of competing interest.

To present a clinical case that reflects the causal relationship between the administration of high-dose corticosteroids and the appearance of maniform-type psychopathology.

Descriptive study of a case report and literature review on the subject.

32-year-old woman with alcohol abuse detected, added Antabus 250 mg / day to her treatment.

After 2 months of treatment, she was admitted to the Digestive Service due to acute hepatitis. After a liver biopsy and autoimmunity study was diagnosed as Autoimmune Hepatitis. Treatment with Antabus was withdrawn, and Prednisone 60 mg/day was prescribed. Seven days after starting treatment with corticosteroids, she presented maniform symptoms (psychomotor restlessness, expansive mood, dysphoria, megalomanic delusions, alteration of biological rhythms with decreased need for sleep and risk behaviors), and she was admitted in a psychiatric hospitalization unit. After considering various differential diagnoses she is diagnosed with Substance-Induced (corticosteroids) Mood Disorder with manic features. Psychiatry agrees with the Digestive Service to start treatment with Paliperidone and progressively lower the dose of corticosteroids until suspending it and prescribe an immunosuppressant. Finally, the maniform symptoms that led to admission remitted completely and control and outpatient treatment were continued.

Its important to always keep in mind the great risk of the appearance of psychiatric disorders that treatment with high doses of corticosteroids entails, especially in susceptible patients or with a psychiatric history or genetic susceptibility. It is necessary to know the possible appearance of these neuropsychiatric adverse effects in order to prevent them, and if it appear, to assess, if possible, the suspension or reduction of corticosteroid treatment.

None Declared

Nurses in the Western world have given considerable attention to the concepts of vulnerability and self-autonomy in recent decades.

A qualitative study was conducted with nurses to analyze the problems found by health care professionals in their ethical practices when providing care to patients with terminal diseases, in particular concerning aspects of self-autonomy and vulnerability, in respect to those patients and health care providers.

Using bioethics approach, an analysis of the context was carried out to apply a rigorous methodology in this studied area and fundamental concepts in ethical practices that are intermix. We recruited a purposive sample of research participants from among nurses who worked at a hospital located in the middle part of Portugal.

The transcribed interviews of 8 nurses were analyzed. The results identify the types of difficulty with ethical nuances, found by health care providers, in which constitutes a challenge to ethical practices. The interviewed nurses emphasized the need to broaden the arguments about this subject with other health care professionals faced with these cultural changes and ethical paradigms.

The staff's ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork.

This is a retrospective descriptive study that evaluated the consultation liaison (CL) psychiatry services in Imam Khomeini hospital, during two recent years.

The information has been obtained from reviews of medical profiles of patients who attended the hospital.

A total of 681 patients (365 patients were male) received CL services during the study period. The most prevalent diagnosis groups were mood disorder (37.91%), delirium (13.6%) and anxiety (12.64%). Our study revealed that cardiovascular unit, infectious disease unit and general surgery units frequently requested for consultations among all hospital wards. Pediatrics unit had the lowest request rate for psychiatric consultation.

CL is on the rise in general hospitals, specifically in internal medicine and surgery units which alarm us to pay more attention to preventive strategies focused on the most referred problems including mood disorders, delirium and anxiety disorders in patients who attended general hospitals.

The authors have not supplied their declaration of competing interest.

Because blind patients with schizophrenia are not so many, we don't have much information about their psychotic symptoms, neither about their treatment.

The hallucinations of blind schizophrenic patients could be different from unblind patients, due to impairment of their visual function.

Analysis of psychotic symptoms and antipsychotic treatment of blind schizophrenic patients could provide new information about their features and treatment.

We had two case studies, both diagnosed with schizophrenia, multiple episodes, currently in acute episode according to DSM V. Both patients were treated with olanzapine 10mg/day.

The psychotic symptoms of both patients had the same particularity, the presence of tactile hallucinations (both patients describe insects moving on and in the skin, with repeated attempts to remove them, producing secondary skin lesions). Both patients had a good response and remission of this symptoms after 14 days of treatment with olanzapine 10mg/day. The PANSS score had a reduction on hallucinatory behavior item from 5 to 1 for the first patient and from 6 to 2 for the second patient, for both after 14 days of treatment.

We presume that tactile hallucinations could be specific for these two cases. Treatment with olanzapine (an antipsychotic with a large receptoral spectrum) was a good choice in these cases.

To evaluate the prevalence of MCI and its subtypes in the Faenza Project, using the Mini-Mental State Examination (MMSE).

Subjects living in the municipality of Faenza were clinically assessed. The diagnosis of MCI was achieved according to international criteria using a double-step procedure: first, we excluded subjects with dementia, functional impairment and MMSE< 24, leaving 6,745 persons. Then, the performance in different cognitive domains was considered and scores less than 1.5 standard deviations below the age- and education-adjusted norms on MMSE were settled as cut-offs. Four subtypes were identified: amnestic MCI, single non-memory MCI, multidomains non-amnestic, multidomains amnestic MCI.

2,720 (40.3%) participants met MCI criteria. Prevalence were 4% (amnestic MCI), 26.5% (single non-memory MCI), 4.4% (multidomains amnestic MCI), and 5.4% (multidomains non-amnestic MCI).

MCI is common among Italian elderly. In our study prevalence are higher than reported in other population-based studies. The use of MMSE with different operational criteria, diverse sampling and assessment procedure might explain such discrepancy. The role of MMSE to identify persons with mild cognitive deficits deserves concerns. However, MMSE is largely used in both clinical practice and research and has been suggested as a useful screening tool for assessing the degree of cognitive impairment in the guidelines for the Report of the Quality Standards Subcommittee of the American Academy of Neurology.

Loss of a loved one is a distressing event that may result in grief characterized by emotional distress, longing of the dead, and dysfunctionality. Persistent complex bereavement disorder (PCBD) is differentiated by extended and damaging bereavement [1], which is being treated by some with EMDR [2]. In this study, the effects of an EMDR session on a patient with PCBD will be analyzed.

G.Ö. (45) is a married housewife who had been working, mother of a kid and a baby. She has lived with her family and her mother in a metropolitan city until her mother died a year ago, unexpectedly. Then, she quitted her job and they moved in a small city upon her husband's wish. The inpatient had complaints such as active suicidal thoughts, marital dissatisfaction and an ongoing deep sadness. EMDR therapy is applied on her grief and dysfunctional beliefs.

After one session of EMDR, her mood improved, her ruminations declined, she sought job, and became hopeful for the future. In our case, even one session of EMDR let remarkable improvements on PCBD. Indeed, as for other trauma-related issues, EMDR therapy can be utilized on PCBD.

The authors have not supplied their declaration of competing interest.

Study of the relationship between bupropion and the onset of psychotic symptoms.

Review of the literature about this subject and review of the patient's history.

Mr D. was a 20 years old patient attended in our psychiatric unit for psychosis due to drug abuse that was exacerbated after the beginning of the treatment with Bupropion.

He showed a depressive episode at the age of 17, being diagnosed of Personality disorder (Cluster B), and he had history of substance abuse including cannabis (habit described as occasional), cocaine (only once in the past) and MDMA (only the 31 December 2008).

The patient recognized an intake of MDMA on the 31 December 2008, after which he showed visual hallucinations and insomnia in the following 48 hours. From the 3TH to 7TH OF January no symptom was observed although he had cannabis in unspecified amounts, appearing abnormal behaviour around January 8TH. On the 11th, his GP prescribed Bupropion at doses up to 150mg/day for smoking cessation, appearing two days later psychotic symptoms that included hallucinations, soliloquies, unmotivated laughter and an exacerbation of behavioral disturbances.

The symptoms disappeared after a week of treatment with antipsychotics.

Bupropion causes inhibition of dopamine reuptake, which would have created, an excess of this neurotransmitter that could explain the appearance of the psychotic symptoms.

We consider it appropriate to include in the contraindications section of this product, the use of bupropion among patients with history of psychotic symptoms in the context of consumption of toxic substances.

Sociocultural factors profoundly influence and determine every aspect of psychiatric disorder. The term culture bound syndrome refers to psychopathological entities that are not mere variants of well recognized psychiatric disorder, have a geographically defined prevalence, and are largely determined, at least in their symptoms by the beliefs and assumptions prevalent in the native culture. Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome are some of the frequently reported culture bound syndromes from Indian subcontinent.

To assess the prevalence rates and psychiatric co morbidities in patients affected by Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome.

50 subjects of either sex affected by at least one of the following culture bound syndromes - Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome were recruited on consecutive basis from the patients attending psychiatry outpatients department of a tertiary care hospital in Delhi, India. The selected subjects were assessed for respective prevalence rates and co morbidity profile in patients affected with above listed culture bound syndromes.

Of 50 cases of culture bound syndromes seen in psychiatry OPD, Dhat syndrome was most common (80%), followed by Possession syndrome (14%), Ascetic syndrome (2%), Gilhari syndrome (2%), Koro (2%). Depression was the most common associated psychiatric disorder.

Culture bound syndromes exhibit significant psychiatric co morbidity, this study calls for careful evaluation of these patients psychologically to detect and treat the associated psychiatric co morbidity appropriately.

The kynurenine pathway of tryptophan catabolism has come into the spotlight of schizophrenia research since its catabolites exert neuroactive effects. A strong body of evidence suggests that kynurenic acid, a catabolite of kynurenine pathway, acts as the only endogenous NMDA receptor antagonist leading to the weakening of circuits in layer III of dorsolateral prefrontal cortex of schizophrenia patients. Studies exploring the levels of kynurenic acid and other metabolites of tryptophan in peripheral blood did not yield any definite conclusions.

Primary objective of this study was to assess differences in concentrations of key constituents of kynurenic pathway in blood plasma – tryptophan (TRP), kynurenine (KYN) and kynurenic acid (KYNA) between schizophrenia patients (SCZ) and healthy controls (HC). Secondary objective was to explore correlations between these concentrations and clinical characteristics.

In our two-centre prospective case-control study we measured plasma concentrations of TRP, KYN and KYNA in 36 healthy controls (HC) and 38 schizophrenia (SCZ) patients during acute exacerbation and remission and explored the correlations with clinical parameters using PANSS scale. The patients were matched with HC by age, sex and body mass index and exclusion criteria included obesity class 2 or higher, any concomitant organic mental or neurological disorder, acute or chronic inflammatory disease, and use of immunomodulatory drugs or psychoactive substances.

TRP concentrations were significantly higher in HC than in SCZ patients in acute phase (p<0,001) and remission (p<0,001), while SCZ patients in acute phase had significantly higher TRP levels than in remission (p<0,01). Levels of KYNA and KYN were significantly lower in SCZ patients than in HC both in acute phase and remission, all with high statistical significance (p<0,001). There was no statistically significant difference between acute phase and remission neither for KYN (p>0,05), nor for KYNA (p>0,05). There was no correlation of plasma levels of TRP, KYN and KYNA with total PANSS score, PANSS positive scale score, PANSS negative scale score and PANSS general psychopathology scores, both in acute phase and remission (p>0,05). Also, there was no correlation between plasma levels of TRP, KYN and KYNA in SCZ patients in remission with improvements measured with PANSS scale (p>0,05).

Although there are concerns about the value of measurement of metabolites of kynurenine pathway in the peripheral blood, our data suggest that significantly decreased levels of KYN and KYNA could suggest that disrupted TRP degradation in SCZ patients may be reflected in the peripheral blood as well. Further studies of peripheral levels of kynurenine pathway metabolites on larger samples should also explore effects of antipsychotic therapy, but also their correlation with other clinical parameters such as neurocognition.

None Declared

It is well known about relation between skin and mind, not only due to their mutual origin, but also by their illness expression parallelism. We report a case to show that reciprocity.

Woman, 42-year-old, single. She only suffers from a skin disease; mild psoriasis guttata placed in both elbows and knees. She treated it with local treatment (cortisone cream) during seasonal prutius and the lesions did not grow or expand. She was hospitalized due to psychotic symptoms (paranoid delusions with her colleagues) and started antipsychotics treatment (risperidone 12 mg per day and olanzapine 10 mg per night). By the same time, she suffered a psoriasis crisis. Her psoriatic plaques increased their sizes and her chest and both thighs were affected too. She complained about grave pruritus. All her medical test results were normal. After that, the patient improved her psychotics’ symptoms, but she started with agoraphobic signs and seclusion at home. Psoriasis were even worse than before and she needed metrotexate to treat it. Being introduced to escitalopram 15 mg per day, anxiety and depression symptoms disappeared and her grave psoriasis became the mild one that she knew.

Schizophrenia was associated with a greater variety of autoimmune diseases than was anticipated. Studies found evidence for a shared genetic etiology between schizophrenia and psoriasis. Despite that, we think that the study of psychopathology can amplify our understanding about the etiopathogenesis of psoriasis and associated mental disorders.

The authors have not supplied their declaration of competing interest.

Role functioning is key to optimal health and inoculates against life-long inequality. Depression is a leading cause of functional disability. In most cases, improved symptomatology corresponds with improved functioning; however, functioning does not always return to “normal”, despite symptom remission. Furthermore, the relationship between symptom remission and the likelihood of being Not in Employment, Education or Training (NEET) is unknown.

To examine the temporal associations between depression course, functioning, and NEET status in young adults with mental health problems.

A prospective and multisite clinical cohort study of young people aged 15–25 years seeking help from a primary mental health service (n = 448). Participants completed a clinical interview (incl. QIDS-C16) and self-report battery (incl. WHODAS 2.0, employment, education) at baseline which was repeated at 12-month follow-up whilst continuing treatment as usual.

Remitted depression was significantly associated with improved functioning; however, 12 month functioning was still lower than the normative ranges for age-matched peers. Remittance of depression did not change the likelihood of being NEET. Only 10% of those who were NEET had received vocational support during the study.

Remittance of depression was associated with improved functioning but it did not reduce the likelihood of being NEET. This may be explained by economic influences or alternatively, a time lag may exist where improvements in functioning do not immediately correspond with reduced NEET rates. Lastly, there may be a scarring effect of depression such that change in NEET status requires an additional intervention to depression treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.