Pica is an eating disorder characterized by eating of nonnutritive materials. It has been reported in different population, from certain ethnic groups, children, pregnant woman or organic disorders (eg. mineral deficiency) to psychiatric patients, including psychotic.

To describe a patient who ingest nonfood substances and its relationship with delusions.

X is a 26 year-old male with Paranoid Schizophrenia who came into the psychiatric emergency service because of an acute exacerbation of his mental illness, presenting auditory hallucinations and delusional mysticism. Draws our attention the presence of an aberrant eating behavior ingesting animals, lime, earth and leaves. The patient was hospitalized in the Impatient Psychiatric Unit for examination and treatment.

Several medical tests were performed and the only finding was an idiopathic eosinophilia, considered secondary to pica. He referred that the ingested items provided him from energy and better sight, as an explanation for his eating behavior. No suicidal ideation was objectified. Neuroleptic treatment was prescribed and behavioral and psychotic symptoms improved progressively.

The etiology of pica is unknown. Schizophrenic motivation for deliberate foreign body ingestion is a poorly understood phenomenon. In the case presented, the ingestions seems to be secondary to delusional beliefs that these objects contains properties that the patient lacks, not obeying to suicidal behavior and objectifying parallel remission of the pica and delusional activity. Further research is needed to clarify the etiology and mechanisms of this disorder, as it can lead to serious medical consequences (eg. metal poisoning, parasitosis, intestinal obstruction).

Transitions from child and adolescent mental health services to adult mental health services have been quite troublesome for young people in the UK. There is strong evidence throughout the literature that long waiting lists and rigid adult services criteria hamper dramatically transitions across services. Little knowledge exists about transitions from forensic adolescent services to adult services.

To interview health-care professionals and young offenders in transition of care from forensic child and adolescent mental health services in England.

This study aimed to bridge the current literature gap in regards to transitions across forensic services and the complexities resulting from disruptive care.

This study adopted a prospective design to identify young offenders referred to adult services over a six-month period. We utilized semi-structured interviews. Health-care professionals were interviewed about their transition views and perspectives. Young offenders were followed-up within a month of their transition and were interviewed.

The numbers of transitions within forensic settings are much lower compared to those of general transitions across mental health services in England. Transition delays were a repetitive theme across interviews due to lack of bed availability, especially in medium secure hospitals, and poor multi-agency communication. Commissioning determines age boundaries along with transfer destination for each service.

Ineffective liaison among different sectors might impact adversely young people and hallmark their long-stay in the system. Therefore, continuity of care within forensic services should be looked warily along with the role of policy shaped by commissioning. Multiple transitions can repeatedly traumatize young people moving across services.

Parental alienation is a form of psychological and emotional child abuse which generally is initiated after the divorce, when one parent (the guardian) starts to disqualify and demoralize the other parent (the alienated), trying to keep the child away from the last one and destroying basic emotional links between them.

On the 26th of August 2010, the Brazilian Parliament ratified a law (Law nº 12.318) against parental alienation, which defines and punishes this act.

To demonstrate that parental alienation is a major cause of distress for the child, independent of the evaluation of sexual abuse. Parental alienation can bring psychosomatic and psychiatric problems as well.

To prevent “alienation” cases which can cause harmful effects in the child's life.

Evalluation of a case report studied by Psychiatrists and Psychologists in Rio de Janeiro. A girl who was taken away from her father by her mother after the divorce, when she was 6 months old. the mother tried to avoid the father's contact with the child, alleging that he sexually abused the kid. Nowadays, the girl hates her father.

It was not possible to conclude if the child was sexually abused or not. But it was clear that the girl was a victim of emotional and psychological abuse.

A child's life can be devastated by parental alienation because of the “loss” of one parent and the negative effects in the development of emotional life. Severe penalties for the parents should be taken to prevent it.

In a recent study developed with a community sample, we have found that although PNT mediated the relationship between perfectionist cognitions and bulimic behavior, the effect of perfectionism on other disordered eating dimensions, such as diet, was independent of the PNT levels (Monteiro et al., 2015).

To investigate if PNT mediates the relationship between perfectionism and disordered eating behaviors in a clinical sample.

Fifty-two patients with eating disorders/ED (mean age = 22.54 ± 7.637; mean BMI = 20.07 ± 4.192; 14.5% Anorexia Nervosa cases; 7.8% Bulimia Nervosa and 9.0% EDNOS) were assessed with the ED section of the Diagnostic Interview for Genetic Studies and fill in the Portuguese validated versions of Eating Attitudes Test/EAT-25 (to evaluate Bulimic behaviors/BB, Diet and Social pressure to eat), Multidimensional Perfectionism Scales (to evaluate perfectionism composite dimensions Evaluative Concerns/EC and Perfectionistic Strivings/PS) and Perseverative Thinking Questionnaire/PTQ-15 (to evaluate Repetitive Thought/RT, Cognitive interference and unproductiveness/CIU). Only variables significantly correlated with the outcomes (EAT-25_Total and its dimensions) were entered in the regression models. Mediation analyses using Preacher and Hayes bootstrapping methodology were performed.

EC, PS, CIU and RT were significant predictors of EAT_Total. PA, CIU and PR were significant predictors of BB. EC and PS were significant predictors of Diet. CIU partially mediated the relationship between EC and EAT_Total (95% CI = 0.0025–0.3296) and between EC and BB (95% CI = 0.0037–0.1877).

Also in a clinical sample, CII, the most pernicious dimension of PNT, mediates the relationship between perfectionism and disordered eating behavior, particularly bulimic behavior; diet is predicted by perfectionism independently of PNT.

The authors have not supplied their declaration of competing interest.

The provision of mental health care should be promoted at the community level, in order to facilitate their recovery process. Thus, the people who care for these individuals go through a situational transition, as they have to play the role of Family Caregivers (FC).

a) to characterize the FC burden of the person with Mental Illness; and b) to correlate FC overload with the variables age, gender, cohabitation, degree of kinship and level of education.

A cross-sectional correlational study was conducted. The sample consisted of FC who went to consultations and to the inpatient psychiatric unit of a portuguese hospital. Data were collected through a questionnaire which included sociodemographic data, the Lawton-Brody Index and the Zarit Burden Interview (ZBI).

Of the 119 FC, 66.4% were female, with an average age of 53.8 years. 73.1% of FC cohabited with the person they care for, in which the majority was cared for by their child or spouse, 45.2% and 36.1%, respectively. It should also be noted that 71.4% felt the need for more support from health professionals. As for autonomy, 52% of the individuals cared for by FC were moderately dependent. It was verified that about 45% of the FC had an intense overload. Female gender has greater overload and that there are no significant differences between the level of education and cohabitation.

Considering the results, it is understood the importance of valuing FC, as a target and care partners, in order to reduce the burden, they feel when caring for people with MI.

Despite efforts to unify psychiatric education among European member countries, there are still considerable variations between national training programmes. To ensure equivalence of training standards the current tendency of recommended guidelines and reports is steering psychiatric training towards becoming more competency focused.

The research group of the European Federation of Psychiatric Trainees (EFPT) conducted a multi-national study on postgraduate psychiatry training. The aims are to assess the psychiatric trainees’ experiences and opinions on their national training and assessment methods in respect to the Union européenne des médecins spécialistes (UEMS) 2009 competencies framework.

This study surveyed 745 psychiatric trainees from 10 EFPT member countries using a questionnaire designed specifically for assessing this issue.

In this sample, the majority are aware of having a competency based training programme but 86.5% are poorly acquainted with the UEMS competencies framework. All key competencies were rated as being important but not all as being relevant in the assessment process. One's level of preparedness and the degree of education one's receives during their training differs from one competency to another. Trainees who aren’t satisfied with their national training would be in favour of taking an end of training Pan-European exam which differs from the one's that are satisfied and wouldn’t be interested in undergoing this assessment method.

This sample isn’t fully acquainted with the competency-based concept for postgraduate training. The ones satisfied with their postgraduate psychiatric education seem to be less inclined to take an end of training Pan European exam.

The authors have not supplied their declaration of competing interest.

Evidence from meta-analyses of randomised clinical trials shows interventions for young people at ultra-high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England.

A self-report online survey was completed by clinical leaders of Early Intervention in Psychosis (EIP) teams (n = 50) within the NHS across the UK.

Of the 50 EIP teams responding (from 30 NHS Trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14–5 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by CAARMS, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression.

Despite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia.

The authors have not supplied their declaration of competing interest.

Body image dissatisfaction is a risk factor for depression. Research has focused on female adolescents; yet little is known about sex and age differences.

The aim of our study was to evaluate the association of body weight dissatisfaction, a component of body image, with depression overall, and for different sex and age-groups independent of body weight.

We analyzed data of 15,975 individuals from the cross-sectional 2012 Swiss Health Survey. Participants were asked about their weight satisfaction. Patient Health Questionnaire (PHQ-9) was used to ascertain depression. Age was stratified in three groups (≥ 18-29; ≥ 30-59; ≥ 60 years). Body mass index (BMI) was self-reported and categorized into normal weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25.0-29.9 kg/m2), and obesity (BMI: ≥ 30 kg/m2). The association between weight dissatisfaction and depression was assessed with logistic regression analyses and adjusted for known confounders (including BMI).

Weight dissatisfaction was associated with depression in the overall group (OR: 2.04, 95% CI: 1.66-2.50) and in men (1.85, 1.34-2.56) and women (2.25, 1.71-2.96) separately, independent of body weight (multivariable adjusted). Stratification by age groups revealed associations of weight dissatisfaction with depression in young (1.78, 1.16-2.74), middle-aged (2.1, 1.61-2.74) and old individuals (2.34, 1.30-4.23) independent of BMI. A sub-analysis in the overall group revealed statistically significant positive associations of weight dissatisfaction with depression in underweight, normal weight, overweight and obese individuals.

Body weight dissatisfaction is associated with depression in men, women, young, middle-aged and old individuals independent of BMI.

The authors have not supplied their declaration of competing interest.

Auditory and musical hallucinations have been reported in patients as an adverse effect of the use of opioids. Hearing loss, old age, and female gender are considered risk factors in the development of musical hallucinations. The aim of this report is to describe a case of a patient with auditory and musical hallucinations and to discuss the role of an opioid –tramadol- in the origin of those.

An 80 years old woman experiencing auditory hallucinations was referred to our hospital from an emergency room. The patient had bilateral mild hearing loss and was receiving tramadol 112.5 mg/daily during the last year for cervical pain. In the last ten months, she had been gradually noticing the voice of her dead husband coming from under her pillow, as well as intermittently hearing popular songs being played inside her head. The patient had good insight on both types of abnormal perceptions, which were reported as increasingly unpleasant through time.

Tramadol was discontinued and pimocide (range 1-4 mg/day) and loracepam (2.5 mg/day) were introduced, achieving the improvement of the hallucinations and the anxiety associated with them.

The outcome of this case supports the hypotheses that Opioids could induce musical hallucinations. Hearing impairment, old age, and gender could be underlying risk factors on the development of musical hallucinations.

In patients with MDD, empirical evidence supports the existence of moderate but significant neuropsychological deficits as compared to non-depressed controls. with respect to cognitive domains, impairment has been reported for executive functioning in particular, whereas less significant deficits have been found for psychomotor speed, attention and memory. Additionally, studies reported a substantial improvement in neuropsychological functioning during the course of an antidepressant treatment in patients with MDD. Nevertheless, the effect size of executive dysfunctions in unipolar, non-psychotic MDD as well as their relationship to antidepressant treatment is ambiguous.

Meta-analytic methods were used to assess the severity of executive dysfunctions in unipolar, non-psychotic MDD as compared to healthy controls and to investigate their course during antidepressant treatment.

15 studies comparing the executive functions of 375 patients with DSM-IV MDD and 481 healthy controls were analysed. Furthermore, in 3 studies including 122 MDD patients the Stroop test performance was examined before and after antidepressant treatment. MDD patients performed 0.439 up to 1.18 (p < 0.0001) standard mean differences worse than healthy controls. the Stroop performance improved during the course of treatment (p = 0.0001).

We revealed significant executive dysfunctions in unipolar, non-psychotic MDD patients compared to healthy controls and an improvement of the Stroop performance during the course of treatment. However, the results of our longitudinal analysis are not transferable to other components of executive functioning. Future studies with different test procedures are needed to further investigate the influence of antidepressant treatment on executive functions.

Budgets allocated for mental health make up a relatively small proportion of total health expenditures, although there is an increasing burden of mental disorders.

To review the mental health situation in Greece with regards to mental health policy through review of relevant literature.

To explore the basic implications of the economic crisis from a health policy perspective, reporting constraints and opportunities.

A narrative review in PubMed/Medline along with a hand search in selected Greek biomedical journals was undertaken, relevant to mental health policy.

Greece is among the OECD countries with high health expenditure as a percentage of Gross Domestic Product (9.7% of GDP in 2008) but it doesn’t have a specified budget for mental health and is mostly depended in out-of-pocket expenditure (48%). The system is plagued by problems, including geographical inequalities, overcentralization, bureaucratic management and poor incentives in the public sector. The lack of cost-effectiveness and the informal payments comprise a major source of inequity and inefficiency. Uneven regional distribution of psychiatrists exists and rural areas are mostly uncovered by mental health care facilities, as well as extramural mental health units and rehabilitation places, despite the current reorganization of the whole mental health care delivery system.

The core problem with mental health services in Greece is the shrinking budget with poor financial administration consistent with inadequate implementation of mental health policy. A clear authority with defined responsibility for overall mental health policy and budgetary matters is needed.