There is a high co-morbidity between chronic inflammatory disorders and depression1. Proinflammatory cytokines like TNFα seems to play a central role in the pathogenesis of these disorders and its neutralization provides a potent treatment for inflammatory disorders2. Trying et al (2006) showed that a TNF-α blocker -etanercept- caused at least a 50% improvement in depression scores in psoriasis patients.3 These observations together with the theoretical background led to the hypothesis that TNF-α blockers may reverse depressive symptoms associated with chronic inflammatory disorders.

To evaluate the effectiveness of TNF-α blockers on symptoms of ankylosing spondylitis (AS) and depression.

9 treatment resistant AS patients with no contraindications for TNFα blockers, who were not using any psychotropic or nonbiological drugs were enrolled for the study. TNF-α blockers were given at weeks 0, 2 and 6 and Hamilton Depression and Anxiety Scales (HAMD, HAMA), Hospital Depression and Anxiety Questionnaire (HAD), Quality of Life Scale (SF36), AS severity index (BASDAI) was applied to the patients at week 0, 2 and 6.

There was a significant reduction in HAMD (p = 0.00), HAMA (p = 0.00), HAD-anxiety scores (p = .004) and a significant improvement in SF36- physical role (p = 0.00), physical role limitations (p = 0.01), bodily pain (p = 0.01), general health perception (p = 0.00), vitality (p = 0.02) and emotional role limitations (p = 0.01) subscales and BASDAI scores (p = 0.00) from week 0 to weeks 2 and 6.

This study showed that TNFα blockers may have a potential antidepressant effect besides its antiinflammatory effect in AS patients in a small sample.

Subjective well-being(SWB) is the scientific name for how people evaluate their lives, and since Thalassemia is an inherited blood disorder that requires lifelong adherence to a complicated and burdensome medical regimen, SWB could be easily underevaluated.

To measure the impact of SWB in adult patients with thalassemia.

To explore possible demographic, physical, and psychosocial correlates in SWB.

117 patients(23-60 years old, Mean age=37.2±9.3; 73% females) took part in the study. Satisfaction with Life Scale(SWLS-Ed Diener) was used for SWB, along with SF12 for health related quality of life, Depression Anxiety Stress Scale (DASS), life orientation test(GrLOT-R) for dispositional optimism and a questionnaire about sociodemographic characteristics. Statistical analysis was performed with SPSS 21.

16.8% of patients were substantially to extremely dissatisfied with their lives(SWLS=5-14). 16.4% were slightly below average(SWLS=15-19), 19.8% had an average score (SWLS=20-24) and the rest had a high(29.8%-25-29) and very high score(17.2%-30-35) respectively. There was a significant difference between males(M=20±7) and females(M=22.8±7.2)(t=-1.906-p=0.05). Multivariate analysis revealed that optimism(beta=-.403), stress(beta=-.415), spouse existence(beta=.155), and gender(beta=.228), explained 56.4% of the variance in SWB(adjusted R2=.564-p=0.026). Age, SF12, depression, anxiety and education had a Non Significant effect in the model.

Given these findings, almost half of thalassemia patients have average to low life satisfaction, something which implies that they are sometimes not functioning well because their unhappiness serves as a distraction. Talking to a psychologist or psychiatrist can often help the patient get moving in the right direction, although positive change will be up the person

Attributional style (AS) indicates cognitive dispositions for explaining positive and negative events. People with pessimistic АS explain failure with stable and global causes. Previous studies and meta-analyses (Hu et al., 2015; Peterson et al., 1985; Zhang et al., 2014) showed that pessimistic AS for failures is a reliable predictor of depression and ill-being, but the possible mediators of such relations are understudied.

Our main objective was to analyse relations of pessimistic AS for success and failure with mental health. We hypothesized that pessimistic AS would be a predictor of low mental health mediated by self-esteem, dispositional optimism, and gratitude.

A cross-sectional study was conducted on a sample of 261 adults (MA=32.09, SD=12.53, 13% male) using a 24-item attributional style questionnaire (SFASQ, Gordeeva et al., 2009), mental well-being scale (Tennant et al., 2007), self-esteem scale (Rosenberg, 1965), gratitude questionnaire (McCullough et al., 2002), and LOT (Scheier, Carver, 1985).

A path model of effects of pessimistic AS in positive and negative situations on mental ill-being was developed. The model with three mediators fits the data very well: CFI=0.990; RMSEA=0.048. The pessimistic attributional style for positive events was a significant predictor of mental ill-being mediated by self-esteem, dispositional optimism, and gratitude while the indirect effect of pessimistic AS for failures on mental ill-being (controlling for age) was not significant.

Only the pessimistic AS for successes but not for failures was a significant predictor of mental ill-being which underline the importance of stable and global attributions of positive life events for mental health.

Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.

Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.

To describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.

To study the relationship between CFS and ADHD.

The initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.

38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).

ADHD is frequent in CFS patients and it is associated with more severe clinical profile.

Emotional intelligence (EI) is a fundamental requirement to maintaining social activity. Patients with psoriasis and atopic dermatitis have difficulties in emotional awareness.

The objective of this study is to assess EI in patients with atopic dermatitis and psoriasis.

Patients with psoriasis n=67, atopic dermatitis n=59 and control group n=65 were included in cross-sectional study. EI and its main components (experiential: perceiving emotions and using emotions to facilitate thought; strategic: understanding emotions and managing emotions to promote personal growth and social relations) were assessed using The Mayer–Salovey–Caruso Emotional Intelligence Test 2.0. Statistical analyses were performed using One-Way ANOVA and One-Way ANOVA (Kruskal-Wallis test). The level of statistical significance was set at p<0.05.Data are presented as the Me (±SD).

Our results show that there is statistically significant lower “strategic” component of EI for psoriasis Me=0.367 (±0.0455) and atopic dermatitis Me=0.369 (±0.0353) than for the control group Me= 0.381(±0.0361), (χ2 =7.15; p= 0.028). “Managing emotions to promote personal growth and social relations” is presented with statistically significant lower for psoriasis Me= 0,293 (±0.0374) and atopic dermatitis Me= 0.301 (±0.0351) than for the control group Me= 0.312 (±0.0272), (F=0.05; p=0.007). There is no statistically significant difference between other components of EI and the EI scores in three groups.

Patients with psoriasis and atopic dermatitis have emotional difficulties when it comes to making effective decisions.

No significant relationships.

Obsessive-compulsive (OC) symptoms are common in both children and adults with Prader-Willi Syndrome (PWS), to the degree that they are considered central to the syndrome's behavioral phenotype and constitute diagnostic criteria for the disorder. Although efficacious behavioral treatments (e.g., exposure and response prevention) exist for OC symptoms in typically developing youth, these treatments are not tailored to meet the specific needs of youth with PWS and their families. The purpose of the current study is to report on a modified CBT protocol that addresses obsessive-compulsive symptoms in youth with PWS.

Three children received a modified version of cognitive-behavioral therapy targeting obsessive-compulsive symptoms in PWS. Measures were administered at screening, baseline, and post-treatment and included the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS), Family Accommodation Scale, Clinical Global Impression - Severity (CGI-S), Clinical Global Improvement (CGI), and measures of impairment and adaptive functioning. Treatment consisted for 12 family-based CBT sessions that included exposure and response prevention; cognitive restructuring; and other operant treatment elements.

Participants experienced reduced CYBOCS scores at baseline to post-treatment, 25 to 15.3. All three youth were considered treatment responders on the CGI-Improvement scale. Similar reductions on secondary variables such as OCD impairment were reported.

Although these results are preliminary, initial results suggest that behavioral treatment of OC symptoms may be effective in the PWS population. This treatment holds promise for being a safe and tolerable method for reducing compulsive symptoms in youth with PWS.

Acute dystonia, an adverse effect of neuroleptics, is linked to D2 neuronal receptor hypersensitivity or neurotoxicity due to oxidative stress mechanisms. Pisa syndrome (PS) or Pleurothotonus, a relatively uncommon condition, manifests as dystonia of the trunk and is potentially reversible with early intervention.

To describe PS following haloperidol decanoate injection in a treatment-resistant schizophrenia (TRS) patient, identify associated risk factors, and present therapeutic options.

We provide a comprehensive case description and perform a PubMed database search using the following keywords: “Pisa syndrome,” “dystonia,” “schizophrenia,” and “antipsychotic”.

A 54-year-old man with TRS, previously treated with 100 mg of haloperidol decanoate and 10 mg of olanzapine due to clozapine-induced myocarditis, exhibited hallucinatory delusional syndrome and behavioral disturbances. Neurological examination, lab tests, and brain imaging confirmed a psychotic relapse. Haloperidol decanoate dosage was increased to 150 mg. Four days later, the patient developed a trunk tilt that resolved after receiving anticholinergic treatment.Despite PS being more common in females and associated with brain conditions, this patient presented multiple risk factors, including prolonged typical antipsychotic treatment, advanced age, and an increase in antipsychotic doses. Discontinuing the causative antipsychotic or adding synthetic anticholinergics led to symptom reversibility.

PS is a rare occurrence. Understanding associated risk factors and frequently implicated medications is crucial for elucidating the phenomenon and managing the disorder

None Declared

Though eating disorder cases have been on the rise in Asia, little is known about them. Bulimia nervosa (BN) has been associated with poor treatment outcome and high mortality risk, and is the second most commonly diagnosed eating disorders in Singapore, after anorexia nervosa (AN), yet no report thus far has explored this condition.

The current study seeks to describe the clinical population diagnosed with BN in our hospital treatment program, as well as to compare their clinical characteristics with a previously published local study on patients with AN.

Retrospective medical records review was carried out for patients diagnosed with BN in our hospital's eating disorders treatment program. Patient records from 2003 to 2013 were retrieved and analyzed. We also further compared presenting characteristics across genders and with AN patients.

Between 2003 and 2013, 348 patients were diagnosed with BN by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). BN patients presented with high rate of self-harm behaviors (37.1%), previous suicide attempts (19.0%) and psychiatric comorbidities (67.5%), many of which require inpatient treatment. Significant differences were found between genders and in comparison with the AN patients.

Our results suggest that many patients with BN present with severe psychiatric comorbidities, in some aspects more severe than the AN population. The current study appeals for the development of more effective detection and treatment of vulnerable populations in Singapore. We further discuss about the potential roles of mental health literacy and stigmatization in influencing treatment-seeking behaviors.

The authors have not supplied their declaration of competing interest.

This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.

Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.

Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.

The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).

It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.

During their career and sometimes during their training psychiatrists have to deal with the suicide of patients and have also to help other colleagues and families to cope with the situation. Suicide postvention should be integrated in psychiatric training and better implemented in both psychiatric and community contexts.

To discuss the concept of suicide postvention in Psychiatry. To discuss the importance of addressing suicide postvention in psychiatric settings including during specialized training of Psychiatry residents.

MEDLINE and PubMed databases searches for peer-reviewed studies, published in the last ten years, using combinations of the key-words suicide postvention and psychiatry. Selection of the relevant studies according to the study aims.

The literature search retrieved a total of 44 papers. All the articles that didn´t refer to the studied topic were excluded. Relevant articles discussing suicide postvention were selected, comprising a total of 22 articles. The reviewed papers discuss different contexts and strategies of suicide postvention that will be explored and critically discussed.

Addressing the topic of suicide postvention and implementing support programs and training in this field is crucial to psychiatry trainees, psychiatrists and other mental health professionals that integrate multidisciplinary teams, patients and their families and also to the community as a whole. Future research in this field can help to improve suicide postvention across different settings.

No significant relationships.

Sodium oxybate, an effective treatment for narcolepsy-associated daytime sleepiness and cataplexy, has been extensively. Despite its therapeutic benefits, sodium oxybate is not without its risks, and adverse psychiatric effects have been documented. This case report highlights a rare manifestation of sodium oxybate-related secondary mania with psychotic symptoms in a patient with narcolepsy, emphasizing the importance of recognizing and managing such adverse events. Additionally, we provide a brief review of similar cases reported in the literature.

This report aims to describe the presentation, evaluation, and management of sodium oxybate-induced secondary mania with psychotic symptoms in a patient with narcolepsy. We also discuss the potential mechanisms underlying this adverse reaction and its clinical implications. Furthermore, we summarize findings from previous studies that have reported cases of secondary mania associated with sodium oxybate use.

We present the case of Mr. X, a 48-year-old male diagnosed with “Narcolepsy with cataplexy,” who had been receiving sodium oxybate treatment for 11 years. He was admitted to the hospital following a mild head injury and the emergence of a manic episode with psychotic features. Comprehensive clinical evaluation, including medical history, toxicology screening, and neuroimaging, was conducted.

Upon evaluation, Mr. X exhibited hyperactivity, restlessnes, grandiose delusions, paranoid delusions related to hospital staff, and decreased need for sleep. Notably, he had been consuming sodium oxybate excessively. Sodium oxybate was discontinued, and low-dose olanzapine was initiated. Within 24 hours, his manic and psychotic symptoms resolved. He admitted to overusing his medication, and his family reported a recent increase in his activity level. A review of the literature revealed similar cases of sodium oxybate-induced secondary mania with psychotic symptoms.

This case underscores the importance of vigilance for psychiatric side effects of sodium oxybate, particularly in patients with a history of substance abuse or potential overuse. Secondary mania associated with medications is a rare but significant clinical entity. Prompt recognition and intervention are crucial for patient safety and well-being. Further research is needed to elucidate the mechanisms underlying such reactions and to establish guidelines for their prevention and management.

None Declared

To report the long-term remission results from the relapse prevention trial (ConstaTRE) in stable patients treated either with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.

Clinically stable adults with schizophrenia or schizoaffective disorder treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with RLAI or oral quetiapine. Dosing was according to package-insert recommendation. Efficacy and tolerability were recorded for up to 24 months of treatment. Remission was defined as achieving and maintaining mild or less symptoms of schizophrenia over a 6-month period as defined by Andreasen et al, (2005).

710 patients were randomized (n=355 per group) to either RLAI or quetiapine. Demographics were similar between treatment groups. Relapse occurred in 54 RLAI (16.5%) and 102 quetiapine (31.3%) patients (p< 0.001). Full remission was achieved by 51% RLAI and 39% of quetiapine-treated patients (p=0.003) and was maintained until the end of the trial by 44% of RLAI and 31% of quetiapine patients. Mean duration of full remission was 540.8±181.4 and 508.1±188.0 days for RLAI and quetiapine groups, respectively (p=0.1325). Tolerability was similar between treatment groups. Most adverse events (AEs) were transient. Six RLAI and 10 quetiapine patients discontinued study treatment due to AEs.

Among stable patients with schizophrenia or schizoaffective disorder, remission was more likely to occur in patients switching to RLAI when compared with quetiapine. both RLAI and quetiapine treatments were well tolerated.

To investigate the effect of Chinese herb Danshen-Dahuang on learning and memory ability in rats with Alzheimer disease (AD) induced by D-galactose and AlCl3 and its possible mechanisms.

The AD model was produced by injecting D-galactose and AlCl3 intraperitoneally for 90 days. Since the 20th day of D-galactose and AlCl3 intraperitoneal injection, the rats in Danshen-Dahuang group had been treated with Danshen-Dahuang extraction by intragastric administration for 70 days. Subsequently,learning and memory ability of the mice was evaluated by Morris water maze and hippocampal gene expression of APP, PS1 was tested by reverse transcription polymerase chain reaction (RT-PCR).

Rats intragastric administration with Danshen-Dahuang, mice had shorter latency (P< 0.05) and less error times (P< 0.05) in water maze test compared with those in AD model group. At the same time, Danshen-Dahuang down regulated the expression of APP, PS1 mRNA (P< 0.05) in hippocampus.

Danshen-Dahuang improves the learning and memory ability of AD rats, its mechanism may be related to the downregulated expression of APP, PS1 mRNA.

Perinatal depression is related to poorer outcomes for women and their children. Measurement indices that categorize perinatal depression as present or absent are commonly used in clinical practice and research efforts. Categorization minimizes the health effects of potentially different symptom clusters and may confound understanding of health outcomes.

The objective of this investigation is to explore the symptom clusters resulting from administering two commonly used depression screening instruments during pregnancy and postpartum.

(1) Identify the depressive symptom clusters for perinatal depression; (2) Test whether symptom clusters predict maternal and newborn outcomes, and if so, whether these differ from categorization analytics.

A secondary analysis was conducted on data from a longitudinal study of 139 women. They participated from their 3rd trimester of pregnancy through 8 months after birth and completed surveys at five times using the center for epidemiologic studies Depressed Mood Scale (CES-D) and the Edinburgh Postnatal Depression Survey (EPDS). Analysis procedures included cluster analysis and hierarchical regression.

Individual symptoms were reported by 2.9–31.7% of the sample. Separate clusters (CES-D = 4; EPDS = 2) were identified and, of these, two clusters were primary predictors of maternal and newborn outcomes. Results differed from that obtained with cut-score analytics.

Examination of depression symptom clusters as related to health outcomes during childbearing has significance for clinical practice and research, particularly for women who would not score as depressed on established screening instruments.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.