Previous optimistic assumptions about the prognosis of BAD based on the control of mood symptoms is now challenged as majority of patients continue to have cognitive deficits during the euthymic phase.

To describe cognitive impairment in euthymic BAD and study the association with clinical characteristics.

Identify the prevalence and severity of cognitive impairment (CI); to correlate CI with the first episode, illness duration, number of episodes and predominant polarity.

Patients attending the psychiatry clinic of the National Hospital of Sri Lanka diagnosed with BAD in the remission phase were recruited. An interviewer-administered questionnaire and Montreal Cognitive Assessment test was used to ascertain clinical characteristics and cognitive functions respectively. Scores of 18–26 described as mild, 10–17 moderate and < 10 as severe cognitive impairment.

Total sample size was 58. Mean age = 48.84 (SD12.5). Fifty-five percent were females. Mean duration of illness was 179.7 months (SD128.5). A mean of 6 episodes were experienced during the course of illness (min = 1, max = 18); 58.6% had depression, 37.9% had manic and 3.4% had mixed as their first episode. The predominant polarity was depressive in 65.5%. No cognitive impairment – 8.6%, mild – 63.8%, moderate – 27.6% and none with severe. There was a significant association between the presence of cognitive impairment and the predominant polarity being depressive (r = 10.886, df = 4, P = 0.028). No significant association was found between illness duration, number of episodes or the type of first episode.

Patients with a predominant depressive polarity are more likely to experience cognitive impairment. Cognitive impairment had no association with illness duration, type of episode or number of episodes.

The authors have not supplied their declaration of competing interest.

Although there is considerable evidence on the impact of negative life events during childhood on the etiology of psychiatric disorders, little is known about the specific influence on the social anxiety disorder. The objective of the study was to examine this association.

In a cross-sectional survey in 571 university students we analysed the association between loss of someone close, emotional abuse, physical abuse, family violence and sexual abuse with social anxiety assessed by the Liebowitz Social Anxiety Scale.

Twenty percent of the sample had social anxiety and 50,6% had an early negative life events in childhood. After controlling for family psychiatric history and gender only family violence was associated with an increased risk of social anxiety (OR = 4.63; 95%CI = 1.13–18.9).

This study found childhood family violence associated with social phobia in university students.

Abnormal vasopressin (VP) and oxytocin (OT) signaling may contribute to the altered activity of the hypothalamo-pituitary-adrenal (HPA) axis in major depression; the underlying mechanisms remain uncertain.

This study characterized plasma levels and affinities of OT-and VP-reactive autoantibodies (autoAbs) with relation to disease severity and plasma cortisol response to physical exercise in patients with mild and moderate depression and healthy controls.

Physical exercise was used to elicit plasma cortisol response in 23 male depressive and 20 healthy subjects. All subjects were evaluated by the MADRS. Plasma levels VP-and OT-reactive IgG, IgA and IgM autoAbs were measured by ELISA, before and after the exercise, and affinity was measured by plasmon resonance.

Plasma levels of OT-and VP-reactive total IgG autoAbs were lower in patients with moderate depression vs. controls and patients with mild depression. Both OT- and VP- free IgG autoAbs levels were negatively correlated with MADRS scores. Affinity values displayed 100 fold variability in both groups. Patients with moderate depression displayed blunted response of cortisol secretion to physical exercise. Baseline levels of VP total IgG and IgM autoAbs correlated negatively and of VP free IgG autoAbs correlated positively with plasma cortisol after physical exercise.

These data show that changes of levels but not affinity of OT- and VP- reactive autoantibodies can be associated with the altered mood in subjects with moderate depression and that levels of VP-reactive autoAbs are associated with cortisol secretion.

According to our national data based on PREDATORR study, the point prevalence of diabetes mellitus in Romania was 11.6 % in adults between 20 and 79 years old. Unequivocally, type 2 diabetes mellitus is highly correlated with psychological and personality factors.

The objective of our research was to evaluate the frequency of type D personality in patients suffering from type 2 diabetes and its influence on angiopathic complications.

A cross-sectional study was conducted in 173 patients with type 2 diabetes who were self-assessed by using Beck Depression Inventory I, STAI-Y scale and DS 14 scale for detection of type D personality.

Both depression (p = 0.012) and state and trait anxiety (p = 0.019 and 0.023 respectively) scores were significantly higher in diabetic patients with type D personality compared with non-type D diabetic patients. Lower limb complications were more frequent in non-type D personality diabetics (p = 0.018) while diabetic retinopathy and diabetic polyneuropathy (p = 0.004 and p = 0.010 respectively).

The presence of type D personality has a supplementary negative impact on type 2 diabetic patients’ affectivity and emotions. On the one hand, the more frequent microangiopathic complications in type D personality diabetic patients confirm that diabetes, at least in part, is an endovascular disease. On the other hand, some factors such as pro-inflammatory biomarkers may be more expressed in type 2 diabetic patients with concomitantly type D personality than those without this type of personality, leading to premature microangiopathic complications.

"Hikikomori” is known since the 80s and was described by Saito in 1998 as a different clinical picture from any current diagnostic category, being social withdrawal the most important aspect. Young hikikomoris, more than a million in Japan (Teo2010), withdraw in their room for at least six months, interrupting communication with the outside world. This picture was described by many international scholars (Watts 2002; Zielenzinger 2008; Teo 2010; Piotti et al.2014). Part of international literature, after DSMIV-TR, defined hikikomori as a culture-bound syndrome (Agugliaetal.,2010). However, recently similar cases were described in different contexts, both in Asia and Western world (Kato et al.,2012), highlighting peculiar clinical signs influenced by the context, although maintaining a common matrix referred to Saito framework.

This literature review aims to gather descriptions of hikikomori in different cultures, to identify cross-cultural variables on which the phenomenon is based and to analyse any differences in clinical manifestations.

Eighty-two articles which contained ‘hikikomori” in the title or abstract were reviewed and searched using online databases (PsycINFO, PubMed, googleschoolar)

The scientific literature was divided by year of publication and by three phases:

1. The articles are mostly Japanese

2. Western articles, referring to Japanese contexts

3. The Hikikomoriconcept isclosely related tosocial withdrawal (sources from many countries).

The literature shows a tendency to consider hikikomori a phenomenon which exceeds cultural context (although influenced by it), rather than a culturally characterized syndrome.

Indomethacin, a non-steroidal anti-inflammatory treatment used in various inflammatory diseases, is one of the drugs that has been related to the appearance of psychotic symptoms as a side effect.

Point out the importance of knowing the possible psychiatric symptoms that some drugs can cause as a side effect.

Description of a clinical case and bibliography review.

We present the case of a 71-year-old woman, with no previous mental health history, who is referred by her primary care physician due to the presence of auditory hallucinations and self-referential ideas. As a somatic history, the patient presented Rheumatoid Arthritis under control by rheumatology and acoustic neuroma, under control by neurosurgery. Treatment with Risperidone was started, up to 2 mg, which helped control her symptoms. After an exhaustive study of her situation, the possibility that her symptoms were a side effect of her usual treatment was raised. It was evidenced that the patient had taken a higher dose of Indomethacin than prescribed by the rheumatologist, reason why its daily intake was suspended, and subsequently an improvement and even suppression of symptoms was seen. Later, due to a misunderstanding, the drug was reintroduced, and symptoms appeared again.

The appearance of psychotic symptoms has been related to the intake of various drugs, including Indomethacin. It is essential to carry out a differential diagnosis if psychotic symptoms appear in the subject.

No significant relationships.

In Western Europe male die much more often by means of suicide than do females, although females attempt suicide more often. This pattern has been found in Belarus with some peculiarities.

Men and women under 18, who committed a suicide or made a suicide attempt.

To investigate peculiarities of suicides and parasuicides among men and women in Belarus in order to reveal target group for suicide prevention.

We used the Suicide database of the Ministry of Health for epidemiological analyze.

The study is still being carried out. The male to female suicide ratio is 5:1 in 2008 year. Prevalence of suicides hasn’t changed a lot in women during last 20 years. It rapidly grew among men in the beginning of 90ies with the peak in 2000 year. Then it started to decrease slowly with the rate of 48,5 in 2008 year. Prevalence of suicides is 2.5 time higher in countryside in comparing with cities. Men have higher suicide rate in age from 40 to 60 and after 70 years old, women -after 70 years old. Data on parasuicides have been collecting centrally since 2007. Prevalence of parasuicides was 80 per 100 000 of population and male: female ratio was 1:1 in 2009.

Men show a big influence of socio-economical state on suicidal behavior. Risk factors have different power in cities and in countryside. Main group for suicide prevention is 40–60 years old men in countryside with alcohol dependence.

The purpose of the present study was to examine the relationship between anxiety and hostility among teacher.

Participants were 531 teachers of education organization of Golestan province in Iran. The mean age of the participants was 37.49 years (SD = 5.58) and ages ranged from 21 to 50 years old. There were 215 men and 316 women.

All participants completed a questionnaire booklet containing one self- report measures: The Symptom Checklist-90-R (SCL-90-R).

The results of the present study demonstrate that: 1) Correlation between anxiety and student's hostility is meaningful and positive (r = 0.733, p<0.001).

The present study revealed that a more anxiety is associated with a high level of self-reported hostility.

The hypothalamus-pituitary-adrenal axis (HPAA) plays a pivotal role in response to a range of external and internal factors often described as “stress”. Growing evidence in a literature, suggest various dysregulations of HPAA, in course of numerous mental disorders. Patients with schizophrenia and bipolar disorder seem to have elevated basal cortisol secretion, what might be caused by the diminution of glucocorticoid receptors’ amount. It was of the interest if the cortisol concentration in patients, with diagnosed schizophrenia, differs from healthy individuals.

Two groups of participants were included into the study. First group (study) consisted of 10 patients with diagnosed schizophrenia and control group which included 38 healthy individuals. Study was divided into two stages, first one (pilot) included only control group, and utilized cortisol concentrations measurement from saliva, blood and 24 h urine sample. Second part (main study) involved both groups although focused on a salivary cortisol concentrations.

A mean salivary cortisol concentration in patients with schizophrenia who underwent treatment was significantly lower in comparison with healthy individuals.

Obtained results indicate that patients who underwent a treatment, and does not present notable clinical signs of schizophrenia, may have moderately lowered levels of salivary cortisol. This may be a reflection of relenting psychotic symptoms as well as a direct effect of atypical antipsychotic drugs on a HPA axis activity.

The authors have not supplied their declaration of competing interest.

Elevation of prolactin level is a known adverse effect of antipsychotics. Long-standing hyperprolactinaemia may inhibit reproductive function by impairing gonadal steroidogenesis and is associated with a number of adverse effects such as galactorrhoea, amenorrhoea, gynecomastia, impotence and decreased bone mineral density. Lurasidone is a recently approved atypical antipsychotic agent for the treatment of schizophrenia.

To compare the incidence of treatment-emergent adverse events (TEAEs) related to hyperprolactinaemia in patients treated with lurasidone or active comparators.

Pooled data from two 52-week studies that evaluated the long-term safety and efficacy of lurasidone compared with quetiapine XR or risperidone in patients with schizophrenia were reviewed post-hoc for prolactin levels and TEAEs considered to be related to hyperprolactinaemia.

Prolactin levels decreased marginally in the lurasidone group (median -8.00 pmol/L, N=624) and quetiapine XR group (median -17.39 pmol/L, N=85), and increased in the risperidone group (median 385.00 pmol/L, N=199) (LOCF). The incidence of markedly abnormally high prolactin values (≥5× upper limit of normal) was 2.0%, 1.4% and 4.0% in the three groups, respectively. The hyperprolactinaemia-related TEAEs breast mass, gynecomastia, breast enlargement, breast tenderness, hypogonadism, infertility, pituitary tumors and mammary gland tumors were absent from all groups. Low rates (≤2.5%) of galactorrhoea, amenorrhoea and erectile dysfunction were seen in the lurasidone and risperidone groups, while no TEAEs were recorded in the quetiapine XR group.

This post-hoc review shows that long-term treatment with lurasidone was not associated with a clinically significant increase in prolactin levels and the incidence of associated TEAEs was low.

Cardiovascular disease is the most common cause of death in patients with severe mental illness (SMI). Patients are more likely to be overweight and to have hypertension, dyslipidemia, hyperglycemia and diabetes mellitus. Antipsychotic medication can induce or worsen these cardiovascular risk factors.

Accessibility to healthcare and adequate somatic treatment is limited in patients with SMI.

Prevalence of inadequate treatment for metabolic cardiovascular risk factors in patients treated with antipsychotic medication.

A health monitor was introduced as a screening instrument in a schizophrenia treatment and recovery program (so called F-ACT) at the outpatient departments. Assesment included physical and laboratory examination, demographics, DSM-IV diagnoses, remission-criteria, social functioning, use of medication and drugs.

Over a period of 18 months (2009–2010), 520 of the 600 patients included in the F-ACT were evaluated. Preliminary analysis shows that 452 patients met DSM-IV criteria of schizophrenia and other psychotic disorders. All patients were treated with at least one antipsychotic agent. Metabolic syndrome according to ATP-III was present in 50% of patients (60% abdominal obesity, 58% hypertension, 24% hyperglycemia, 52% high triglycerides, 49% low HDL-cholesterol). Rates of non-treatment ranged from 78% for hypertension, 85% for dyslipidemia and 48% for diabetes mellitus. Rates of inadequate treatment ranged from 69% for hypertension and 83% for dyslipidemia.

1. 1. Metabolic cardiovascular risk factors are highly prevalent in patients treated with antipsychotics

2. 2. Inadequate treatment of metabolic cardiovascular risk factors is common

3. 3. There is a need to improve the cooperation between psychiatrists and general practitioners

The main aim of this study was to analyze the association between a set of neurobiological/clinical factors and impulsivity in patients suffering from bulimia nervosa, as well as the capability of this factors to predict the severity of impulsivity.

The Impulsive Behaviors Scale (IBS), the Diagnostic Interview for Bordeline Patients - Revised (DIB-R), the Beck Depression Inventory (BDI), the Millon Multiaxial Clinical Inventory (MMCI-II) and the Family Environment Scale (FES) were applied to 70 female patients with DSM-IV BN (purging subtype). Twenty-four hour urinary excretion of norepinephrine (NE), 3-methoxy-4-hydroxyphenylglycol (MHPG), serotonin (5-HT), 5-hydroxi-indol-acetic acid (5-HIAA), dopamine (DA), homovallinic acid (HVA), and morning serum cortisol levels before and after the administration of 1 mg of dexamethasone were determined.

Impulsivity was associated to lower levels of urinary 5-HT and 5-HIAA, borderline features, and lower family expressed emotion.

The consideration of impulsivity as a core clinical feature in patients with bulimia nervosa could lead us to identify clinical subtypes of patients, with specific clinical profiles and specific treatment needs.

Obsessive compulsive disorder (OCD) with religious contents is more prevalent among religious populations. The aim of this study was to evaluate efficacy of religious cognitive-behavioral therapy (RCBT) on OCD with religious content and co-morbidities.

This is a randomized controlled clinical trial. Our intervention consists of 10 weekly RCBT 90 minutes sessions supervised by both clergyman and psychiatrist.

Randomly 50 patients with 17 and more Yale Brown scores and religious content obsessive symptoms were selected and divided into two intervention and control groups. Yale Brown, SCL-90, and Hamilton depression questionnaires were used in this study. Data were analyzed by ANOVA/ANCOVA repeated measure tests using SPSS ver. 13.

Mean age of patients was 32.9 ± 8.86 years. 94% (n = 47) were female. Yale Brown scores in three stages (before intervention, after fifth and tenth session) in both groups decreased specially in intervention group but showed no significant difference (p = 0.294). However there were significant difference between mean scores of two groups (p = 0.047). Comparison of obsession subscale and compulsion subscale of Yale Brown scale showed decrease in three stages of the study. Decreasing trend in obsession subscale is not statistically significant (f (2, 42) = 0.94, p-value = 0.398), but decreasing trend in compulsive subscale is statistically significant (f(2,43) = 36.008, p value < 0.001).

In obsessive compulsive disorder with religious contents, religious CBT not only could significantly increase clinical responses, especially in compulsive behavior but also improve co-morbid symptoms such as depression as well as global severity index and decrease symptoms.

ECT is an effective and safe treatment for severe psychiatric disorders including major depressive disorders, bipolar mania and depression and acute exacerbations of schizophrenia according to clinical guidelines. However, an overall decline in the use of ECT utilization has been reported worldwide and concerns have been raised that ECT is being underused in some countries.

To describe temporal trends in ECT utilization rates in european countries

A systematic review was conducted of studies which reported on ECT temporal trends in european countries in the last 25 years

Results

There had been a decrease in the useof ECT in recent years in Europe. However, recent publications suggest that its use may be stabilizing or even rebounding.

Data on clinical outcomes with long-acting antipsychotic treatment in young, newly diagnosed patients with schizophrenia is sparse.

To explore hospitalization, drug utilization and clinical outcomes from medical records of newly diagnosed schizophrenia patients during first 12 months of treatment with once-monthly paliperidone palmitate (PP).

International, multicenter, retrospective, observational study. Outcomes presented: baseline (BL) characteristics and demographics, clinically relevant improvements in disease severity (ie ≥ 20% decrease in PANSS or BPRS total score or CGI-S Change ≥ −2 or CGI-C ≥ 3, with no score showing worsening) and clinically relevant functional improvement (i.e. change in PSP total score ≥ +7 points or change in GAF total score ≥ +20 points, with no score showing worsening) from BL to last-observation-carried-forward endpoint (LOCF-EP) within 12-month documentation period, mean mode PP dose and adverse drug reactions.

Eighty-four patients analyzed: 69% male, mean age at initiation of PP was 24.1 (SD2.7) years, mean BL weight was 78.7 (SD16.0) kg and 80.0 (SD14.7) kg at LOCF-EP, with a mean change of 1.2 (SD3.9) kg; mean time from first psychotic episode to initiation of PP was 5.5 (SD3.3) months. At LOCF-EP 86.6% achieved a clinically relevant improvement (71/84, Kaplan-Meier median time from initiation of PP: 52.4 days). 63.4% achieved a clinically relevant functional improvement (52/84, Kaplan-Meier median time from initiation of PP: 53.1 days). PP mean mode maintenance dose was 96.4 (SD19.8) mg. ADRs reported in ≥ 5% of patients were weight increase 9.1% and hyperprolactinemia 5.7%.

Treatment with once-monthly PP was well tolerated and associated with clinically relevant improvements in disease severity and functioning in young, newly diagnosed schizophrenia patients.

The authors have not supplied their declaration of competing interest.