Lithium can induce renal and neurotoxic effects, particularly if it is combined with a neuroleptic or if there is an intercurrent condition. The neurological sequelae may be irreversible.

To show the renal and neurotoxic effects of lithium and the risk of its association with haloperidol.

A case of irreversible lithium neurotoxicity wih renal sequelae.

This case report is about a 57-year-old patient with a bipolar disorder type 1. She was well stabilized on lithium.On December 2020, the patient had an increased level of creatinine, therefore her medication was stopped. She developed a manic episode then she was switched on Haldol 25mg and lithium. After 4 days, she had a neuroleptic malignant syndrome with renal and neurological sequelae.. She was referred to us after her discharge from intensive care. The patient was agitated, anxious, sad with a superficial contact and a well-structured speech. She had delusional ideas of prejudice about her husband. On physical examination, she had a parkinsonian syndrome, moderate organic renal failure with a clearance of 45.93 ml/min. On the cerebral MRI, she had a diffuse cotico-subcortical atrophy with bilateral frontal predominance and vascular leukopathy. The most probable cause was the iatrogenic effects of the association of lithium and haloperidol. We decided to stop all medications and the patient got better.

Recognizing the neurotoxic effect of lithium and making an early diagnosis is a crucial determinant in the evolution of the disease and its irreversibility. Polypharmacy and comorbidities appear to be important precipitating factors for lithium toxicity.

No significant relationships.

The DSM-5 introduced severity indicies for the first time.

We conducted a systematic review and synthesis the frequency of each DSM-5 severity categories (i.e., mild, moderate, severe and extreme severe) for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorders (BED), and to evaluate studies that assess the clinical utility of these severity specifiers for all eating disorders (ED) subtypes.

Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO, and ProQuest) were used to identify for both academic and grey literature published from 2013 until July 8, 2020. Twenty-five studies were retrieved for the systematic review based on the inclusion and exclusion criteria, and up to six studies were qualified for meta-analysis

We found limited support for the current DSM-5 severity ratings for all ED indices, as the majority of ED severity groups were not significantly distinguishable in overall ED psychopathology (mean effect size ranged from .02 to .5). The value of the DSM-5 severity ratings was further devalued as 56.91% to 80.52% of individuals with AN, BN, and BED were categorized into mild and moderate groups. However, there was significant heterogeneity between the studies (p< .001), and some of these heterogeneities were explained by differences in study settings and measurement of eating disorder psychopathology.

Overall, the current study provided little support for the DSM-5 severity ratings for EDs, thus it is suggested that further exploration in alternative severity classification approach is needed.

No significant relationships.

Seasonal Affective Disorder (SAD) is a seasonal pattern of recurrent major depressive episodes that most commonly occur during autumn or winter and remit in spring. Second-generation antidepressants (SGAs) are established interventions to treat acute episodes of SAD. However, little is known about the efficacy and potential harms of these interventions for preventing SAD.

To assess the efficacy and safety of SGAs to prevent SAD and improve patient–centered outcomes in adults with a history of SAD.

We searched the Cochrane Depression, Anxiety and Neuorosis Review Group's specialised register, EMBASE, MEDLINE, PsycINFO and the Cochrane Central Register of Controlled Trials. In addition, we searched pharmaceutical industry trials registers via the Internet to identify unpublished trial data. We also conducted grey literature searches and handsearches of pertinent reference lists. Two authors reviewed the evidence, abstracted data, and assessed risk of bias. We pooled data for meta-analysis when participant groups were similar and the studies assessed the same treatments with the same comparator.

We did not find eligible studies for most comparisons. We included three RCTs comparing bupropion XL with placebo. Statistically significantly fewer patients treated with bupropion experienced the onset of a major depressive episode during winter months. The overall risk of adverse events was similar between treatment groups. However, bupropionn-treated patients had significantly higher risk for headache, insomnia, and nausea.

The evidence base on SGA treatment to prevent SAD is limited. Future studies are needed to provide a sufficient evidence base for clinical decisionmaking.

It seems that the family of heroin addicts carry certain characteristics which constitute the base for the indulgence in psychosocial deterioration . Objectives : To clarify the elements constituting family structure and family function in heroin addicts and to compare it with that of non addict group . Methodology : A sample of 80 heroin dependents diagnosed according to DSM IV TR was studied and compared to a control (non addict) group composed of 20 persons . Data were collected using a pre-designed questionnaire.

parental separation/divorce was higher in the group of addicts compared to control group. Comparing the main caring person among the two groups revealed the following : father (11.3% : 0%), mother (8.8% : 35%), both parents (33.8% : 60%), Addicts were moved to grandparents in 6.3% of cases (0% in non addicts), to other relatives in 11.3% of cases (0% in non addicts), and to others (non relatives) in 7.5% of cases (5% in non addicts), which reflects the unstability and change of caring persons for addict . Positive family history for substance abuse was higher in the group of addicts compared to non addicts. Negative feelings towards father and mother were more predominant in heroin addicts' group and also perception of negative attitude from parents.

The family of heroin addict involves a lot of deformities and dysfunctions which need to be considered and highlighted in all therapeutic programs designed for such patients .

It has been suggested that dysregulation of sex hormones is associated with schizophrenia. However, obesity and metabolic syndrome are very common between schizophrenic patients, and it can also dysregulate sex hormones so they could act as confounders.

To determine if estradiol and progesterone are abnormally elevated regardless of obesity or metabolic syndrome in men with SCZ.

We measured serum levels of progesterone and estradiol in 56 schizophrenic male patients at treatment with a depot antipsychotic. Subsequently, we studied the association or independence of our results with obesity or metabolic syndrome by a Chi Square Test.

66.07% of our patients elevated progesterone levels, 19.64% of our patients elevated estradiol levels, and 16.07% of our patients elevated both, progesterone and estradiol, simultaneously. We found no relationship between increased estradiol and / or progesterone with obesity and / or metabolic syndrome.

Estradiol and progesterone are abnormally elevated regardless of obesity and / or metabolic syndrome in male schizophrenic patients on depot treatment.

No significant relationships.

We evaluated the efficacy of eszopiclone (ESZ) and concurrent escitalopram oxalate (EO) in patients with insomnia and co-morbid GAD.

Patients meeting DSM-IV-TR criteria for GAD and insomnia received 10 weeks of EO 10mg and co-therapy with ESZ 3mg or placebo (PBO) for 8 weeks. For the last 2 weeks, ESZ was replaced with single-blind PBO to evaluate discontinuation effects. Sleep, daytime functioning and anxiety measures were captured during the study.

ESZ+EO improved sleep and daytime functioning at each week and the double-blind period average (p<0.05). At Week 8, significantly more ESZ+EO patients had no clinically meaningful insomnia based on ISI</=7. Significant improvements with ESZ+EO (relative to PBO+EO) were observed in HAM-A total scores each week, and Weeks 4-10 excluding the insomnia item. ESZ+EO was significantly better at every timepoint on CGI-I (p<0.02); CGI-S was not different between treatments after Week 1. Median time to anxiolytic response was reduced with ESZ+EO based on HAM-A and CGI-I. HAM-A response and remission rates at Week 8 were higher with ESZ+EO, and HAM-D17 scores were improved at all timepoints (p<0.004). After eszopiclone discontinuation, there was no evidence of rebound insomnia, and no treatment differences in sleep or daytime function. Significant treatment differences in anxiety and mood were maintained after discontinuation.

In this study, ESZ+EO was well tolerated and associated with improved sleep and daytime function without evidence of tolerance. Improvements in anxiety and mood were observed with ESZ+EO.

Support for this study provided by Sepracor Inc., Marlborough, MA.

The comorbidity between obsessive-compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD) has been discussed for a couple of decades. Reported co-occurrence rates are highly inconsistent in the literature.

To review phenomenological and theoretical issues concerning concomitant OCD-ADHD.

Phenomenological and theoretical issues regarding OCD-ADHD comorbidity are reviewed.

Although numerous studies suggest an OCD-ADHD comorbidity, thus far etiological (i.e., genetic) background has been provided only for a pediatric comorbidity. High rates of co-occurrence may be mediated by the existence of tic disorders, and evidence of impaired neuronal maturational processes in OCD pediatric population may lead to probably transitory phenotypical expressions that look like ADHD symptomatology. Thus, it is possible that ADHD-like symptoms resulting from OCD-specific symptomatology may be misdiagnosed as ADHD. This may explain the lower co-occurrence rates reported in adolescents and adults.

OCD and ADHD are very different disorders in terms of pathophysiology, phenomenology, and treatment strategies. Several methodological concerns have been identified in our review. Future studies on OCD-ADHD comorbidity should try to mitigate these biases.

The authors have not supplied their declaration of competing interest.

Bariatric surgery is a relatively safe surgical procedure with high success rates. The improvement on patient’s self-esteem and overall quality of life are expected benefits that extend beyond physical health. Nonetheless, current literature describes a higher risk of developing alcohol use disorder (AUD) in patients undergoing bariatric surgery that is not better explained by differences in baseline characteristics such as socioeconomic factors. This reinforces the need to optimize mental health professionals’ intervention in these patients.

Report a clinical case and conduct a literature review on the etiology of the increased risk of alcohol use disorder in patients after bariatric surgery.

Description of a clinical case and a non-systematic review of literature on the PubMed database, selecting articles published in the last decade and their included reference lists, combining the following MESH terms: “bariatric surgery” and “abuse, alcohol”.

The clinical case presented is a 45 years old woman, with a college degree, that was diagnosed with AUD in 2020, 6 years after being submitted to bariatric surgery. She didn’t have any alcohol-related problems before the procedure but she describes the death of her mother in 2020 as the trigger for her current heavy drinking habits. Injuries induced by alcohol intoxication have since then caused multiple visits to the emergency room and she has now a reported cognitive impairment that severely compromises her ability for self-care. The association between AUD and bariatric surgery, as presented in the reported clinical case, is well established in current literature. The switch of patient’s coping mechanisms from eating to drinking, surgical-induced alcohol pharmacokinetics changes or adaptations of neuroendocrine mechanisms (such as ghrelin and it’s impact on the mesolimbic dopamine system) that contribute to the augmentation of brain reward signaling are all factors that could play a role in the increased reinforcing value of alcohol in these patients. Psychosocial factors were also identified as variables that could impact alcohol-misuse post-operatively. Furthermore, data suggests differences between surgical procedures: while both Roux-en-Y-Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) dramatically impact alcohol pharmacokinetics, Laparoscopic Adjustable Gastric Banding (LAGB) does not.

There is a strong possibility that the patient’s drinking habits started as a coping mechanism, but her surgery may have also contributed to her AUD. Our review found multiple biopsychosocial factors that could explain the link between bariatric surgery and AUD and some predictors for its development, but future research is needed to fully elucidate its complexities. Nonetheless, health professionals must be well informed for thetimely prevention, diagnosis and treatment of eventual AUD in these patients.

None Declared

No significant relationships.

Suicide is a major concern for those afflicted by schizophrenia. Identifying patients at the highest risk for future suicide attempts remains a complex problem for psychiatric intervention. Machine learning models allow for the integration of many risk factors in order to build an algorithm that predicts which patients are likely to attempt suicide. Currently, it is unclear how to integrate previously identified risk factors into a clinically relevant predictive tool to estimate the probability of a patient with schizophrenia for attempting suicide.

We conducted a cross-sectional assessment on a sample of 345 participants diagnosed with schizophrenia spectrum disorders. Suicide attempters and non-attempters were clearly identified using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Suicide Ideation Scale (BSS). We developed two classification algorithms using a regularized regression and random forest model with sociocultural and clinical variables as features to train the models.

Both classification models performed similarly in identifying suicide attempters and non-attempters. Our regularized logistic regression model demonstrated an accuracy of 66% and an area under the curve (AUC) of 0.71, while the random forest model demonstrated 65% accuracy and an AUC of 0.67.

Machine learning algorithms offer a relatively successful method for incorporating many clinical features to predict individuals at risk for future suicide attempts. Increased performance of these models using clinically relevant variables offers the potential to facilitate early treatment and intervention to prevent future suicide attempts.

The authors have not supplied their declaration of competing interest.

Individual abilities to perceive internal and external sensations are defined respectively as interoception and exteroception: the dysregulation of these functions can explain many psychotic symptoms. (Ardizzi et al. 2016)

We evaluated the differences in the interoceptive and exteroceptive perception between 39 patients with psychosis and 250 healthy controls using self-administered questionnaires. The association between interoception and exteroception in the two groups was also tested.

The tests we used are AASP (Adolescent / Adult Sensory Profile) and MAIA (Multidimensional Assessment of Interoceptive Awareness). Differences were measured with t-tests, associations with spearman’s correlation.

Significant differences emerged between the two samples in the AASP total score and in its Low registration (LR) and Sensory Avoiding (SA) sub-scales and in the MAIA total score and in all its sub-scales except “Not Worrying” (Fig.1). Different patterns of associations between AASP and MAIA were observed: psychotic patients showed negative correlations between MAIA and AASP in the LR and Sensation Seeking (SS) sub-scales and in the auditory (AU) and tactile (TO) sensory channels. Healthy controls, positive correlations emerged between MAIA and AASP in the Sensation Seeking (SK) sub-scale and in the “perception of movement” (MO) sub-score (Fig.2)(Fig.3).

Higher scores of psychotic patients in AASP and MAIA reveal both a disregulated sensory related behavior and a hightened awareness towards internal stimuli. The negative correlation between the two scales in psychotic subjects highlights the importance of the interaction between internal and external perception in determining the global subjective experience.

This longitudinal, community based cohort study assessed the mother-offspring transmission of BPD and examined whether maternal parenting styles and offspring temperament are associated risk factors.

At baseline 315 mothers and 414 offspring of the general population were investigated. Five years later the offspring were followed up and diagnostic interviews were carried out. BPD risk in children of BPD-mothers was compared to the BPD risk in children of healthy mothers. The contribution of an anxious-impulsive temperament in offspring and invalidating maternal parenting style to the prediction of BPD features was analyzed.

Offspring of mothers with BPD were 8.5 times more likely to exhibit the diagnosis of BPD than offspring of healthy mothers. Prediction analyses suggest that mother-offspring transmission of BPD may be partially mediated by reciprocal transactions between a vulnerable temperament and an overprotective maternal parenting style.

Given that offspring of mothers with BPD are not only at heightened familial risk of BPD but also other mental disorders, specificity of factors that are shared between mothers and their offspring is questioned. Early prevention needs to be provided to this high-risk group, especially if there are additional risk factors, as the transaction between vulnerable temperament and maladaptive parenting.

Dysregulation in the neuroendocrine stress system has been attributed repeatedly to the stressful and anxiogenic state observed during alcohol withdrawal. Activity of the atrial natriuretic peptide (ANP) has been shown to inhibit the release of corticotrophin releasing hormone (CRH) and corticotrophin (ACTH) and opioid neurotransmission also plays a role in counteracting effects of sustained stress by facilitating the termination of the hypothalamo-pituitary-adrenocortical (HPA) axis stress response. Thus ANP and ß-endorphin may be involved in modulating the HPA axis activity in alcohol withdrawal. Aim of the study was to evaluate the anxiolytic activity of ANP and ß-endorphin during alcohol withdrawal in mice habitated to chronic alcohol intake.

24 male mice (C57/Bl6J) were studied following 21 days of free-choice and forced alcohol intake. Anxiety related behavior (elevated plus maze, open field) was tested during acute ethanol withdrawal (12 hours after last ethanol consumption). 30 minutes before testing, randomized groups of mice were given i.p. injections of ANP (60 μg/kg), ß-endorphin (2 μg/kg) or saline.

Acute alcohol withdrawal in alcohol habituated mice was associated with increased anxiety related behavior. Application of both, ß-endorphin and ANP, was significantly associated with reduced anxiety related behavior.

Taking into consideration data from studies in humans, where decreased levels of ß-endorphin and ANP were associated with anxiety during acute and protracted alcohol withdrawal, our results suggest a causal relationship between ANP, ß-endorphin and withdrawal-induced anxiety in alcohol related disorders.

While the links between cyclothymia and creativity are well documented, the experts have tried to determine whether temperament would influence the major choices of life such as career.

The study aims mainly to evaluate the temperaments of a sample of Tunisian students, and to look for the possible correlations between the temperament and the choice of studies.

The Tunisian version of the TEMPS-A which is a self-evaluation measure to assess affective temperaments was administered to 100 medical students and 100 humanities students.

Student populations differed in their socio-demographic and scholar variables such as age, sex ratio or socio-economic level, choice of studies and their religiosity. The temperamental prevalences were close between our two populations by considering the threshold score Mean +1standard deviation; they ranged between 13 and 18%. Hyperthymic and cyclothymic scores were significantly higher among humanities students (11.38 ± 4.385 versus 9.00 ± 4.192 and 11.96 ± 4.497 versus 9.63 ± 4.499 respectively) and irritable scores were higher in the latter, though not significant (6.45 ± 3.823 versus 5.39 ± 2.998). Depressive and anxious temperament scores were close in both groups. The study showed significant temperament differences within gender, socioeconomic status, high school marks, religiosity and political affiliation.

It is relevant and even necessary to include such studies in the selection of candidates who could adapt to a specific professional field on the basis of objective criteria such as conscientiousness, and privileging profile diversity.

To determine long term effects of intensive early intervention programme (OPUS)for first episode psychotic patients.

RCT of two years of intensive early-intervention programme versus standard treatment. Follow-up was two and five years.

547 first-episode psychotic patients were included and interviewed after two years (N=369) and five years (N=301). Registerbased information was available for all patients.

The intensive early intervention programme OPUS consisted of ACT with family involvement and social skills training.

At five-year follow-up, the positive effect of the OPUS treatment seen after two years had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1 to 4.8, P =0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15 to 88,12 P= 0.05) during the five-year period.

The OPUS treatment improved clinical outcome after two years, but the effects were not sustainable up to five years after. A difference on supported housing and use of bed days were found after five years in favour of the OPUS treatment.

This is the case of a girl, aged 13, starting on 2021 with a first psychotic episode. Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.

To describe an interesting case of early-onset psychosis.

We have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).

The first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient. 3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech. Also, she showed motor symptoms, consisting in oral and right-hand stereotypies. Then, she was hospitalized in a Pediatric unit, in order to rule out organicity. The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries. Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study. Besides, the blood count, the biochemistry, the gasometry and serology were also negative. No drugs were detected in the urinalysis. Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit. During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps. During the interviews she was desinhibited. She initiated a delusional speech, focused in sexual topics. She said that she’s had a baby in the future with his father, and talked a lot about things she had already made in the future. During this admission, we changed the treatment to Quetiapine and Valproate.

The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts. We switched from Quetiapine to Aripiprazole. After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men. After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though. So we finally changed to Clozapine, in combination with Gabapentin. Since she got clinical levels of clozapine, the delusions have been encapsulated.

The differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder. Obviously, the evolution of the sypmptoms in the following months and years will have the last word.

None Declared

P300 is an event-related potential (ERP) thought to reflect attention, working memory and context integration and has been shown to be consistently reduced in patients with Schizophrenia. Despite a possible relation between P300 components and cognitive deficits in Schizophrenia has been hypothesized, few studies addressed this hypothesis.

In the context of a multicenter study of the Italian Network for Research on Psychoses, our study focused on the investigation of auditory P300 component in relation to clinical and cognitive domains in patients with Schizophrenia.

ERPs were recorded in 64 chronic, stabilized patients with Schizophrenia during a standard oddball task. N1 and P3b latency and amplitude were assessed at Fz and Pz, respectively. State of art instruments was used for clinical assessment. Cognitive indices (from the seven cognitive domains of the Measurement and Treatment of Cognition in Schizophrenia, MATRICS) were expressed as Z-scores from an Italian normative sample.

Correlation analysis revealed associations of P3b latency with age, education, PANSS-DIS, processing speed, working memory, St. Hans parkinsonism subscale. In a multiple linear regression model, processing speed was an independent significant predictor of P3b latency.

For the first time, a strong relation between P3b latency and processing speed impairment was shown in Schizophrenia. Processing speed is considered a central factor in the relation between cognitive deficits and functional outcome in chronic schizophrenia. The association with P3b latency might shed lights in the neural basis of this complex construct.