This study examined the initial clinical presentation and monthly re-assessments of treatment outcome for a group of combat veterans and deployed peacekeepers with posttraumatic stress disorder (PTSD).

Participants were 102 Canadian combat and peacekeeping Veterans attending specialized PTSD treatment clinic (Operational Stress Injury Clinic).

Help seeking veterans with PTSD presented with significant comorbid major depressive disorder and results at 12 months demonstrated significant improvement in symptoms of PTSD, depression and anxiety. There was no significant predictor of PTSD symptoms decline. Initial depression significantly predicted anxiety symptom declines, and initial anxiety predicted depression symptom declines. There was also a demonstrable improvement in health-related quality of life as measured by the SF 36.

Rescue emergency personnel is at high risk to develop PTSD due to possible extreme and repetitive exposition to “cruel details of traumatic events”.

This study aimed to explore posttraumatic stress and subthreshold autism symptomatology and their impact on social and working functioning level among sub mariner of Italian Navy, who were employed in the Costa Concordia and Genova tower rescue operation.

Eighty-five subjects were enrolled and investigated by the following instruments: Trauma and Loss Spectrum Self-Report (TALS-SR), Adult Autism Subthreshold Spectrum (AdAS Spectrum) and Work and Social Adjustment Scale (WSAS).

The response rate was about 50%. Ninety-five percent of the subjects were employed in recovering corpses and 80% reported at least one rescue operation in the last three years. Full and partial DSM-5 PTSD rates were 8% and 27.5%, respectively. A strong correlation emerged between several TALS-SR and ADAS domain. Furthermore, TALS-SR domain scores were related to WSAS domain.

This data showed rescue personnel to be at risk for post-traumatic stress spectrum and related work and social impairment. Further studies are needed to better investigate possible risk and resilience factors associated to PTSD.

The authors have not supplied their declaration of competing interest.

Depression is the most frequent psychiatric disorder encountered in patients with Multiple Sclerosis (MS), with a life-time prevalence of approximately 50%. INF-beta (INF-β) shows beneficial effect on the course of MS. Although it has been suggested that interferons may be associated to depression, the validity and the nature of this relationship remain unclear regarding INF-β. The objective of this study is to review the scientific literature in order to elucidate the relationship between depression and INF-β therapy.

This systematic review was based on Medline, Embase and, PsycLIT literature searches (through January 2005), supplemented by bibliographical citations in identified papers.

The majority of studies ruled out a correlation between INF-β1a/1b and depression in MS patients. However, patients with a recent history of depression may be at higher risk for depression particularly in the early phase of treatment (first 6 months), even if they are not depressed at the initiation of medication. There is an association between depressive symptoms and discontinuation of INF therapy but INF-β does not seem to be associated with suicide attempts. Treating patient-reported depression increases adherence to treatment.

Clinicians should not refrain from including patients with MS in INF-β treatment programs, even those with depression in the past or at the present time. Screening, monitoring, and early antidepressant treatment is necessary to optimize IFN therapy for the majority of patients with MS.

The Beck Depression Inventory-II [BDI-II] (Beck et al., 1996) is the self-report instrument to depressive symptoms most widely used. A 2-factor structure is frequently obtained in clinical and nonclinical samples. Our group found an identical 2-factor solution in pregnant (3rd trimester) and postpartum women (3 months); the two factors were: Cognitive-Affective and Somatic-Anxiety (Bos et al., 2009).

To investigate the BDI-II factor structure in a sample of childbearing age women who were not pregnant or that did not have children in the last year and to compare the structure of depression symptoms experienced by women in the perinatal period versus outside the perinatal period.

120 non-perinatal women (students and employees at health and education institutions), aged 18-44 (M=29.42±7.159 years), currently or in the last year unpregnant, were asked to to fill in the BDI-II. A principal components analysis with Varimax rotation was performed.

The internal consistency coefficient Cronbach alpha (α) was of .82. Following the Kaiser and the Cattel's Scree Plot criteria, a two factors structure was selected, which explained 43.56% of the variance [EV]. Based on items content, Factor [F] 1 (EV=33.55%; a=.83) and F2 (EV=10.26%; a=.82) were respectively denominated’Somatic-Anxiety’ and’Cognitive-Affective’. The dimensions composition completely overlapped with the Bos et al. (2009) structure, obtained with perinatal women.

The BDI-II factorial structure in non-perinatal childbearing age women is robust and meaningful. Our results support the view that the structure of depressive symptoms does not differ between perinatal and non-perinatal women.

The objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk.

A systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials.

Of the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions.

We suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence.

Diagnosis of breast cancer is a devastating psychological experience for a woman. Also treatments such as radiation therapy may cause psychosocial distress in these patients and threaten their quality of life (QOL). Among several approaches, spirituality has been shown to be significantly associated with improving the quality of life.

The aim of this study was to assess the role of psycho-spiritual therapy intervention in improving the quality of life of patients with breast cancer undergoing radiation therapy.

This was a randomized controlled trial study undertaken in a radiotherapy clinic, Isfahan, Iran. Between October 2010 and February 2011, 68 patients under radiation therapy were randomized to either spiritual therapy intervention group or control group who received routine management and educational programs. Before and after 6 weeks of spiritual therapy sessions, the quality of life was evaluated using Cancer quality-of-life questionnaire (QLQ)-C30 and breast cancer specific questionnaire (BR-23). MANCOVA, T-test and Paired T-test were used for analysis using Predictive Analytic Soft Ware (PASW, version 18) for windows.

In all sixty five patients actually completed the 6 week intervention and were evaluated for the outcome. The mean Global health status score/QOL reached from 44.37(SD = 13.03) to 68.63(SD = 10.86), (p = 0.00). There was a statistically significant difference in all functional scales of QLQ-C30 after intervention. (p < 0.05)

The results of this trial showed that the psycho-spiritual therapy program can improve the overall QOL of women with breast cancer; therefore it could be adopted in comprehensive care programs for women with breast cancer.

Pica is the consumption of non-nutritive substances, which is inappropriate to the individual's cultural practices or developmental level. It is frequently associated with mental retardation, and occasionally observed in pregnant women and children.

We describe a case of long-standing pica in a woman with no co-morbid psychiatric condition.

Madam NA is a 27-year old married Malay housewife, with 4 sons and 4 miscarriages. Her mother had addiction problems. She sought help from the Eating Disorders Clinic, Singapore General Hospital, for uncontrollably eating uncooked rice. This started at age 8, when she was left alone at home with no food. Since then, she had been eating up to 10 cups of raw rice daily. She was unable to leave the house without carrying a bag of raw rice; if she forgot, she would feel intense discomfort and would need to return to get the rice. She persisted in eating raw rice despite it causing friction in her marriage. When she tried to stop, she would get irritable and crave it. This behavior only ceased during her pregnancies but would restart soon after delivery. There was no other psychiatric history. Blood investigations showed anemia, with iron and zinc deficiency, as well as newly diagnosed Grave's disease. After iron and zinc supplementation, her raw rice intake decreased substantially.

We report an unusual case of long-standing pica with compulsive features in a young woman with no psychiatric co-morbidity, which improved during pregnancy and with iron and zinc supplementation.

The authors have not supplied their declaration of competing interest.

Delay discounting (DD) procedure has been used to probe the extent to which behaviour is insensitive to its long-term consequences. During the DD task, participants are offered a choice between a small reward, which is delivered immediately, and a larger reward, which can be obtained only after a delay. Several studies has been reported that drug addicts are insensitive to future outcomes in DD. Previous studies indicated that Methadone Maintenance Treatment (MMT) decreases risky behaviors such as illegal drug use, needle sharing and risky sexual behaviors. But, there is a serious question that could it change underlying cognitive processing of risky behavior or not?

In this study, we evaluated 266 opioid dependents (age: 31±9 years, education: 10±3 years) before MMT entry on DD. 78 patients (30%) has been completed at least three month MMT and re evaluated on DD. The Mazour model was fitted to data (V=A/(1+kD)) (K: delay discounting coefficient, D: delay) and least square parameter estimation was used to estimate delay discounting coefficient.

K was significantly reduced after 3 month successful MMT (0.12±.6 vs. 3.9±12.6) (P values=0.016). Successful patients in MMT had lower K in baseline but not significantly.

MMT could improve future time horizons in underlying cognitive processing of decision making. Based on this study, We could accept more favorably MMT as a real effective addiction therapy not just a substitution between street drugs and state drugs.

Adolescents with emotional dysregulation are at risk for self-injury. Antipsychotics are often used to manage these symptoms.

The aim of the present case is to show the use of cariprazine as an effective drug for emotional dysregulation and impulsivity in a 17-year-old adolescent girl

Case report

The patient was a 17-year-old female admitted to in patient psychiatric unit for a self-harm attempt due to sertraline overdose. She was being followed up for self-injury, anxiety and eating disorder symptoms. Her treatment was sertraline 200 mg, diazepam 20 mg per day and olanzapine 15 mg per day. With this medication she had gained up to 7 kgs in 4 months. A progressive change was made with cariprazine up to 3 mg and olanzapine was reduced to 2.5 mg at night. With this adjustment the patient did not present worsening in anxiety levels, with adequate impulse control and being able to perform emotional regulation strategies.

Although it has no indication in patients under 18 years of age, it shows a case of good tolerance and efficacy for the management of impulsivity by improving emotional regulation. Cariprazine is an atypical antipsychotic that works through partial agonism on dopaminergic receptors, serotonin 5-HT1A receptors and an antagonist at the 5-HT2B receptors, with moderate affinity for adrenergic, histaminergic, and cholinergic receptors reducing the likelihood of side effects

None Declared

A 38-year-old gentleman was admitted to an inpatient psychiatric unit with a first episode of fluctuating affective psychosis. He initially presented as manic although subsequently evolved a severe depressive episode, with prominent bizarre, affect-incongruent delusions throughout this period. Upon admission, anisocoria was evident, although this was attributed to a past head injury. Over the course of his admission he developed emergent Parkinsonism, initially ascribed to prescription of aripiprazole. Given his anisocoria and worsening Parkinsonism, further investigation was undertaken. While his MRI brain scan was unremarkable, his serum and CSF specimens tested positive for Treponema pallidum serology, and he was diagnosed with neurosyphilis. He was treated with a single dose of intramuscular penicillin, but experienced marked deterioration of neurological symptoms (paraparesis and truncal ataxia) and was transferred to the general hospital for an extended 14 day course of intravenous penicillin. Following this extended course of antibiotic therapy, resolution of neurological symptoms was seen, but no sustained improvement in residual psychotic symptoms has been seen.

This case demonstrates the potential neuropsychiatric consequences of neurosyphilis, and serves as a reminder of its potential to imitate other psychiatric presentations. This gentleman, and many like him, continue to experience severe and enduring psychopathology despite penicillin treatment when cases are detected late. Given the potential consequences of this, we would advocate assertive screening for syphilis in patients admitted to psychiatric units.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Antipsychotic drugs (APDs) are the first-line pharmacological treatments for schizophrenia. Recent human studies have found that myelin integrity could be improved by APD treatment in schizophrenia patients. Previous studies indicated that regulation of oligodendrocyte development and function may be a novel target for APDs.

The aim of this current study was to examine the possible effects of the antipsychotic drugs (APDs) haloperidol (HAL), olanzapine (OLA), and quetiapine (QUE) on the development of oligodendroglial lineage cells.

CG4 cells, an oligodendrocyte progenitor cell line, were treated with various concentrations of HAL, OLA, or QUE for specific periods. The proliferation and differentiation of the CG4 cells were measured. The regulation of CG4 cell differentiation by oligodendrocyte lineage transcription factors 1 and 2 (Olig1 and Olig2) was examined.

The APDs used in this study had no effect on the proliferation of CG4 cells. The APDs elevated the expression of 2’,3’-cyclic nucleotide 3’-phosphodiesterase (CNP), a specific marker of oligodendrocytes, and promoted the CG4 cells to differentiate into CNP positive oligodendrocytes. QUE and OLA increased the expression of Olig1 and Olig2 whereas HAL only increased the expression of Olig2.

Our findings suggest that oligodendrocyte development is a target of HAL, OLA, and QUE and provide further evidence of the important role of oligodendrocytes in the pathophysiology and treatment of schizophrenia. They also indicate that the expression level of oligodendrocyte/myelinrelated genes could be profoundly affected by APDs.

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that is characterized by impaired social and communicative abilities as well as restricted, repetitive, stereotyped pattern of behaviors, interests, and activities. Significant difficulties in social interactions in autistics are manifested by impairment in eye-to-eye contact, social reciprocity, and response to emotional cues.

Highlighting the neurological basis of normal face processing and its abnormalities in ASD with percussions on the management plan of autistic children.

Human face processing that was proved to be compromised in autistic individuals is pivotal for proper social interactions. Such simple spontaneous perceptual task in normal children is carried out by face processing areas of the brain; fusiform gyrus, superior temporal sulcus, and amygdala. Behavioral, electrophysiological, and neuroimaging studies showed evidences of dysfunction of such areas in autistics who often focus on face periphery and cannot interpret that it tells something about a person's state of mind. Very early targeted intervention can stimulate face processing areas of the brain during the early developmental phases of social brain circuitry which in turn will help autistics to pay attention to faces and learn to understand emotional expressions.

Eventually, prevention or at least significant amelioration of severity and symptomatology spectrum of autism might be possible.

The author have not supplied his declaration of competing interest.

The usage of clozapine in patients with schizophrenia and epilepsy raises many challenges due to the epileptogenic effects of the drug. There is little data about using clozapine for treatment of treatment-resistant schizophrenia (TRS) accompanied by epilepsy.

To present a case report illustrating a patient diagnosed with epilepsy and TRS, successfully treated with clozapine.

A literature review on “PubMed” database was conducted, using the keywords: clozapine, antipsychotics, epilepsy, seizures, psychoses. Information regarding the clinical case was obtained by consulting the patient’s file.

We present a woman, 33 years old with mild intellectual disability and a 10-year history of schizophrenia. At the age of 24, the patient lost consciousness and experienced tonic – clonic seizure, but epilepsy was not diagnosed. The patient was hospitalized multiple times due to positive symptoms of schizophrenia and suicidal thoughts. Various combinations of neuroleptics and electroconvulsive therapy were used for treatment without therapeutic effect. At the age of 32, a diagnosis of TRS was established, leading to treatment with a moderate clozapine dose (400mg/day). At the fifth month of treatment with clozapine un episode of generalized seizures occurred, leading to a diagnosis of idiopathic generalized epilepsy. Since then, the patient was treated with levetiracetam and the dosage of clozapine was lowered to 275mg/d. The seizures did not re-occur and clinical response to the psychiatric treatment was positive.

This case report highlights how clozapine can be used safely and effectively for patients with TRS and epilepsy and how the epileptogenic effects can be moderated by using antiepileptics in the overall treatment scheme.

No significant relationships.