Antidepressant-induced galactorrhea and increases in prolactin levels have been sporadically reported among SSRI-related side effects.

Current rapport presents a case of 39 y.o. female who developed several adverse effects on paroxetine - including galactorrhoea - which improved on discontinuation of the drug.

Case discussion of 39-year old woman who was treated with paroxetine for her panic disorder and developed galactorrhoea with hyperprolactinemia that resolved upon discontinuation of the drug. Additionally, authors performed the literature search using PubMed and Embase to review the similar cases and used PDSP Database to assess the latest pharmacodynamic (PD) properties of paroxetine and other SSRI’s.

Literature review (1966–2020) revealed 24 prior published case reports of SSRI-induced galactorrhea in users of paroxetine (n=4), escitalopram (n=4), sertraline (n=2), citalopram (n=2), fluoxetine (n=3), fluvoxamine (n=2) and other non-assessable reports (n=7). Elevated prolactin levels were mostly observed with paroxetine and escitalopram and rarely with fluoxetine, fluvoxamine and sertraline. PD-assessment showed the highest binding affinity of paroxetine and escitalopram to SERT (kPi = 0.07-0.2 and 0.8-1.1 nmol/L respectively) compared to other SSRI’s, in absence of other relevant PD-properties

Increasing body of evidence shows that galactorrhea does occur among paroxetine female users. Pharmacodynamic mechanism of action is poorly understood but given the modern insights in relationship in serotonin and dopamine circuits, we suggest that strong SERT inhibitory properties of paroxetine might lead to a tonic suppressive influence on dopamine neurotransmission. This physiological link may explain an increase in prolactin levels through dopamine depletion in the tuberoinfundibular pathway.

No significant relationships.

Dyskinesias are motor disorders that occur as a side effect to treatment with typical and less frequently with atypical antipsychotic drugs. They are more frequents in child population. Treatment usually consists of decrease the dose of drug or replace it with a better profile tolerability antipsychotic. Clozapine is an antipsychotic drug indicated as second-generation treatment of motor disorders that appear as side effects to treatment with neuroleptics.

Demonstrate the efficacy and tolerability of clozapine in the treatment of dyskinesias in childhood.

The patient 12 year-old boy, has episodes of psychomotor agitation once a month. This will alternate with quiet moments in which dyskinetic movements are observed in upper limbs, without being able to detect any type triggering environmental factor. Personal history: hydrocele, diagnosed at 8 years becomes neurodevelopmental disorder considered. Neurosurgery tracking for Subarachnoid cyst. Psychopathological examination: Child presents psychomotor restlessness, disruptive behavior, impairments in communication, movement disorder, stereotypies and dyskinetic movements in shoulder and neck.

In the patient suffering from an autistic disorder, stereotypies and other motor symptoms were observed, the predominant and most relevant being dyskinetic movements in the shoulder and neck, which appeared one month after starting treatment with risperidone and worsening psychomotor skills. Treatment of dyskinesia with clozapine improved the motor symptoms presented by the patient.

Clozapine should be the treatment of choice in the event of dyskinesias as a secondary effect to other antipsychotic treatments, proving effective in controlling them as well as well tolerated in both adults and children.

No significant relationships.

Sexual dysfunction is a quite common side effect of antidepressant treatment. Sexual side effects may affect the person’s adherence to treatment, quality of life, and relations. Premature ejaculation is rarely seen as an adverse effect of antidepressant drugs.

We aimed to present a clinical case of a 53-year-old man who developed painful ejaculation with the use of venlafaxine.

We made a narrative literature search in Pubmed and Google scholar with the terms of painful ejaculation induced by venlafaxine and antidepressant treatment.

A 53-year-old man was admitted to the psychiatric outpatient unit with symptoms of anhedonia, decreased sleep, decreased self-esteem for the last month. The patient was diagnosed with depression and he started to take 37,5 mg venlafaxine per day. After one month, when venlafaxine dose was increased to 75mg and the patient started to complain of painful ejaculation. The pain continued from the beginning to the end of the ejaculation. The pain increased more when the venlafaxine dose increased to 150mg per day. The patient was consulted at the urology clinic. The urological examination, laboratory tests (direct microscopic examination of the urethral discharge and urethral culture), and serum prostate-specific antigen levels were normal. No pathology was found in uroflowmetry and ultrasonography of the urinary system. The dose of venlafaxine decreased and the patient started to take 20 mg of fluoxetine per day. His symptoms disappeared after venlafaxine was discontinued.

To literature, this is the second presentation of painful ejaculation observed during the use of venlafaxine.

No significant relationships.

To compare eGFR values of patients on long term lithium compared to controls matched for age, sex and confounding comorbidities

Patients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls matched (1:1) for age, gender and presence or absence of diabetes and hypertension. The eGFR was calculated according to the modification of diet in renal disease study formula. A meta-analysis was performed to compare our findings with similar studies in literature.

Forty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly low (p = 0.04) compared to controls and the mean decline in eGFR was -2.7 ml/min/1.73m2(SD ± 9.8) per year. The significant difference in eGFR persisted between the subgroup without comorbidities (diabetes and hypertension) and their controls but disappeared for subgroup with comorbidities and their controls. Nevertheless, lithium users had a lower eGFR in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference -10.3 ml/min (95% confidence interval: -15.13 to -5.55, p < 0.0001).

Lithium causes a subtle decline in glomerular filtration rate and renal functions need to be monitored in lithium using patients.

Borderline personality disorder (BPD) is defined as “a pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity” (DSM-IV-TR; APA, 2000). These very characteristics make it difficult to establish firm therapeutic relationships and keep patients in treatment. In recent decades, a number of new psychotherapeutic approaches have been developed in order to meet these specific challenges and demands. To date, there is evidence of efficacy for various treatments, as data of a recent systematic review and meta-analysis of our working group indicate.

To give an overview of all psychotherapeutic treatments investigated in randomised controlled trials so far and included in the above mentioned systematic review. To establish common and distinct treatment features of successful psychotherapeutic approaches for BPD treatment and investigate possible relations to treatment outcomes.

Essential treatment characteristics were extracted from primary studies and surveyed. Subgroup analyses were done where possible with regard to presence/absence of these characteristics in order to investigate possible impacts on treatment outcome.

BPD specific therapies share many similarities like use of explicit treatment frameworks, e.g., as delineated in explicit treatment contracts, and special attention to the therapeutic relationship. However, they differ with regard to treatment intensity and length, provision of complementary group sessions, availability of the therapist in case of crisis or importance of psychodynamic and experiential techniques.

Though stemming from different theoretical backgrounds or schools, various treatments seem both feasible as well as beneficial if applying BPD specific adaptations.

Nurses are the most important contributor of care during patients’ hospitalization and have become an important source in the delivery of mental health care. However, the attitudes and ability of many nurses in providing this care have been shown to be deprived, and this may have a negative effect on providing patients’ care. There is a little is known about the attitude of nurses toward people with mental illness in Saudi Arabia.

This study has a qualitative research design. The main aim of this study is to explore the attitude of nurses toward people with mental illness in Saudi Arabia.

Data were collected through semi-structured fact to face interviews with nurses. Thematic analysis was used for data analysis.

Data analysis identified three main themes that affect nurses’ attitude toward people with mental illness. The identified themes are: 1) personal factors, 2) social factors, and 3) factors related to the view of mental illness.

This study concluded that there are a number of factors that affect nurses’ attitude toward people with mental illness. Several recommendations were discussed related to nurses’ education, continuous mental health training courses, public education about mental health and mental health nursing, and mental health care and resources.

The author has not supplied his/her declaration of competing interest.

Pathological gambling is a behavioral addictive disorder that usually results in a severe financial and psychosocial disaster. A longer duration of the disorder is associated with more severe problems. Thus, early therapeutic interventions may reduce the burden of pathological gambling.

To explore factors associated with time to seeking help.

Data of all subjects who attended for their first time the largest treatment institution for pathological gamblers in Vienna, the 'Spielsuchthilfe” from the years 2002 to 2013, and who had never had treatment for pathological gambling before, were analyzed.

In total 2313 subjects (1941 men and 372 woman) with pathological gambling or problem gambling could be included in the analysis. The mean time from beginning of the problem to first treatment was 6.4 years (SD 6.8). In an analysis of variance of the years from 2002 to 2013 there was no significant difference in the time to first treatment. Women attended treatment significantly earlier than men (mean 4.9 vs. 6.7 years) and subjects with later onset of the disorder (> 26 years) (mean 5.0 vs. 8.0 years).

Although there was an increasing amount of information on the media on gambling in the last years this did not promote help seeking behavior to the same extent. The results suggest that subjects with a later onset of the disorder and probably more stable personality attend treatment in an earlier stage of the disorder . Thus, prevention programs should focus more on the needs of younger subjects.

Antipsychotic-induced hyperprolactinemia (> 29 ng/ml in women) is associated with relevant side-effects.

We describe the case of two women aged 50 and 54 years, respectively, diagnosed with schizophrenia who were receiving outpatient treatment with paliperidone depot 100 mg/month and risperidone depot 50 mg/2 weeks, respectively and complained of oligoamenorrhoea and amenorrhoea for at least 6 months.

Routine blood tests showed hyperprolactinemia of 203.5 ng/ml and 306.2 ng/ml, respectively. The patients were evaluated by the Endocrinology unit and an MRI was performed discarding the presence of any primary brain condition. Both patients were switched to LAI aripiprazole due to its partial agonism of D2-brain receptors. At the time of switching both patients were stable in terms of psychopathology.

Changes in prolactin levels 3 months after switching are shown in the Fig. 1. Two months after switching, both patients regained cyclic menstrual function. After 6 months, they still showed psycopathological stability.

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In these two cases, the normalization of prolactin levels and the resolution of oligoamenorrhoea/amenorrhoea were observed as soon as 2–3 months after switching to LAI aripiprazole. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia.

The authors have not supplied their declaration of competing interest.

Gender dysphoria is a new diagnostic class in DSM-5 that reflects a new conceptualization of the disorder emphasizing the phenomenon of 'gender incongruence”. It refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Hormone and/or surgery are treatment options available. There is some clinical evidence that patients under gonadotropin-releasing hormone (GnRH) agonists may develop symptoms consistent with various psychiatric disorders with and without psychotic features.

To review new DSM-5 conceptualization of gender dysphoria and psychiatric side-effects of ovocyte stimulation drugs. Also to report one selected clinical case of psychosis after FSH and LH stimulation in a patient under female to male sex reassignment process.

The authors have conducted an online search on PubMed on psychosis after ovocytes stimulation and gender dysphoria and systematically reviewed a case report.

There is little evidence of psychiatric side-effects of GnRH agonist. Case report: 22 years old male with diagnosis of gender dysphoria under female to male sex reassignment process with FSH and LH stimulation to ovocyte preservation that acutely developed psychiatry symptoms of bizarre behaviour, irritability, flight of ideas, soliloquies and erotomaniac delusions that remit on antipsychotic drugs.

Gender dysphoria is a new diagnostic class in DSM-5. There are multiple hormone and/or surgery treatments options. There is little evidence hormone treatments are associated with psychiatric side-effects, namely psychosis. To conduct a well-designed clinical trial on psychiatric symptoms related with hormone treatment in gender dysphoria patients is needed.

Anecdotal evidence suggests that the general public including patients with mental health problems are largely unaware of the potential risks of codeine abuse and dependence. Despite this, little research has been done in establishing the public’s level of awareness on this issue.

To assess the extent of use of codeine-containing preparations, as well as the level of knowledge regarding the dependency potential of codeine, in patients admitted to an acute psychiatric hospital.

150 patients admitted consecutively to an acute psychiatric hospital over a 2 month period were asked to fill out an anonymous 18-item semi-structured questionnaire. The results were compiled and analysed using descriptive statistics with SPSS version 17.

116 questionnaires were returned giving a response rate of 77% (54% female, mean age 46.7 years, SD = 15 years). 90% of respondents reported that they had ever used codeine-containing medications, 80% have bought them over the counter, 65% always used them without prescription, and 7% reported daily use of such medicines. 14% reported using them for the euphoriant effect, 5% to curb cravings, and the remaining mainly for migraines or aches and pains. 11% of all patients had used a codeine-containing medication as recently as 24 hours prior to their admission and 66% of patients indicated that they were aware of the dependence potential of codeine.

Awareness among psychiatric patients regarding the dependence potential of codeine is high. Additionally, a considerable proportion of patients indicated use of codeine for euphoriant effects or to curb cravings

There is no doubt that cannabis abuse contributes to the development of schizophrenia. However, the influence of cannabis on schizophrenia psychopathology remains unclear.

This study aimed at investigating the association between life time diagnosis of cannabis abuse (LTCA) and psychopathological manifestation of first-episode schizophrenia (FES).

We recruited 45 FES patients. Schizophrenia was diagnosed based on DSM-IV and ICD-10 criteria, and confirmed using Operational Criteria for Psychotic Illness (OPCRIT). Additionally, all patients were assessed using Positive and Negative Syndrome Scale (PANSS). Patients with drug and/or alcohol abuse within one year of onset of psychotic symptoms were excluded.

Assessment with OPCRIT revealed that LTCA is associated with longer duration of excessive (p = 0.044) and reckless activity (p = 0.023), reduced need for sleep (p = 0.023), other primary delusions (p = 0.046), as well as thought withdrawal (p = 0.01) and thought broadcast (0.01). There was no significant difference in the total score of PANSS subscales (i.e. positive, negative and general). However, FES patients with LTCA experienced significantly more severe excitement (p = 0.031) and grandiosity (p = 0.018), as well as poorer impulse control (p = 0.008).

Our results indicate that LTCA has a differential influence on psychopathology of FES exacerbating delusions of thought broadcast and withdrawal, affective symptoms and behavioural manifestation of experienced psychotic symptoms.

One of the main challenges facing the fact that every society has always called divorce. Phenomenon in modern societies is growing at a rapid rate and adverse effects of economic, social and especially psychological, parents and children.

This study pays to determining the influence of game treatment on decreasing divorce children's’ stress.

The method of study is of testing in which statistical society of study includes all children (girl and boy) of divorced parents. From all statistical society, we have selected a sample about 26 persons by randomly sampling. The instrument for gathering information in this study includes children stress test (SCARED) in which has been studied sample after measuring its narration and stability.

The result of dependent t-test and covariance analysis showed game treatment has meaningful and positive influence on children stress.

The amount of its interference on decreasing divorce children stress is about 83%. It means 83% of the whole remained scores variance is related to game treatment interference.

The author has not supplied his declaration of competing interest.

Earlier researches have established that migrants with refugee background have increased risk for variety of mental health problems due to often traumatic reasons for leaving their home country, hazardous journey and post-migration adversity. The challenge is that mental health work with refugees is not systematically organized in Finland. PALOMA (developing National mental health policies for refugees 2016-2018) project was launched to answer these challenges. The project is carried out through the combined effort of National institute for health and welfare, The Finnish association for mental health, Helsinki and Kuopio university hospitals, and the municipality of Hämeenlinna. PALOMA Project is founded by the Asylum, migration and integration fund (AMIF).

PALOMA project focuses on exploring existing good practices and weaknesses in mental health services in use for refugees. The objectives of the project are to develop a national model for effective mental health services for refugees and implement it nationwide in Finland.

The aim of PALOMA Project is to develop a national model for effective mental health services for refugees in Finland.

PALOMA Project includes three phases: data collection (interviews, literature review, seminars), building the model in expert groups and implementing the model.

As a result of PALOMA Project, there will be guidelines for professionals working in different levels of administration with refugees in Finland.

Refugees’ mental health and wellbeing will be improved as a result of better prevention, recognition and appropriate care of mental health problems.

The authors have not supplied their declaration of competing interest.

Studies have shown that children with learning difficulties are likely to demonstrate a host of shared behavioral and emotional problems that affect their daily functioning.

The goal of this study was to examine profiles of behavioral and emotional problems in children at risk for Learning Disorders (LD) and Communication Disorders (COMM), without intellectual disabilities.

Data on the Child Behavior Checklist (CBCL) of 52 participants (4–12 years old) at-risk for LD and 52 age- and gender- matched participants at-risk for COMM were obtained from the archival records of a local outpatient child psychiatric clinic. For all CBCL scales, T scores ranging from 65 to 69 are in the borderline clinical range, whereas a T score of 70 and above are in the clinical range. T scores of below 65 are considered as non-clinical. For the purposes of this study, a T score of 65 and above for the CBCL syndromes indicated the problem to be of clinical concern.

A total of 51.9% of these children had at least one problem of clinical concern, with Attention Problems (LD: 36.5% vs. COMM: 17.3%), Social Problems (LD: 21.2% vs. COMM: 30.8%), and Withdrawn/Depressed (LD: 23.1% vs. COMM: 26.9%) syndromes being commonly reported. There were no significant differences between the 2 groups on the CBCL syndromes.

Findings from the study suggest that children with any form of learning difficulties demonstrate high prevalence of behavioral and emotional problems, suggesting possible comorbidities such as Attention Deficit Hyperactivity and Depression.

Selective mutism is a psychiatric disorder characterized by consistent failure to speak in specific social situations despite speaking in other occasions.

To demonstrate different therapeutic approaches: Cognitive Behavioral Therapy (CBT)/ CBT besides medication.

The material used comes from the archives of the Child/Adolescent Clinic of the Community Mental Health Center (CMHC) of Katerini, Greece.

Two six-year-old children visited the Child/Adolescent Clinic of the CMHC of Katerini. They both presented reluctance to speak at school while interaction in other activities varied between them. Although they were both initially treated with CBT, the severity of symptoms in one case led to the administration of Fluoxetine in addition to CBT. Fluoxetine was initiated at 4 mg/day and gradually titrated to 20 mg/day. Two years later, both cases show clear improvement. The first one treated only with CBT has begun to speak at school, mainly when asked to do so, and appears more willing and comfortable among strangers. The second one shows signs of progress especially after the initiation of Fluoxetine. The patient interacts with strangers, speaks to children out of school and appears in better mood. Despite the progress, she still mutes at school.

In accordance with other international references, this presentation shows that cases of Selective Mutism respond to variant therapeutic approaches. Although CBT can be proved quite effective, Fluoxetine can be used to provide extra benefit.

Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.

Agomelatine may be a valid treatment of insomnia in schizophrenia.

To explore functioning in adult patients with recently diagnosed (< 5 years) and more chronic (> 5 years) schizophrenia treated with flexible doses of paliperidone ER.

International prospective open-label 6-month study. Endpoints were the Positive and Negative Syndrome Scale (PANSS), patient functioning (Personal and Social Performance Scale; PSP) and treatment-emergent adverse events (TEAEs).

Of 713 recently diagnosed patients, most were male (60.9%), mean age was 33.6 ± 11.2 years and mean time since diagnosis was 2.3 ± 1.7 years. Chronic patients (n = 1003) were predominantly male (59.2%) with a mean age of 43.8 ± 11.4 and mean time since diagnosis of 15.6 ± 9.2 years. Mean mode doses of paliperidone ER were similar between recently diagnosed and chronic patients (7.0 ± 2.9 mg/day and 7.2 ± 2.9 mg/day). At endpoint PANSS total scores were improved by 13.7 and 12.9 points, respectively, in recently diagnosed and chronic patients. The rate of patients with mild or less functional impairment increased from 17.7% to 39.8% in recently diagnosed and from 14.4% to 32.9% in chronic patients. Major functional improvements were observed for socially useful activities and personal and social relationships. TEAEs reported in >5% of recently diagnosed or chronic patients were insomnia (10.7% and 8.1%), anxiety (8.6% and 6.0%) and somnolence (5.8% and 3.4%), respectively.

These data suggest that both recently diagnosed and chronic patients previously unsuccessfully treated with other oral antipsychotics may benefit from paliperidone ER, with a tendency for recently diagnosed patients showing some higher treatment response in psychotic symptoms and patient functioning, particularly in socially useful activities and personal and social relationships.

Drugs which affect the level of dopamine have also an impact on the level of prolactine and hence influence the sexual conduct of patients. Hypersexuality is a well known side effect of the treatment of Parkinson's' disease, whereas hyposexuality is a side effect of the drug-treatment of schizophrenia by classical and some atypical antipsychotics. The novel antipsychotic drug Aripiprazole, however, has a partial dopaminergic effect, causes no hyperprolactinaemia and might alter the sexual conduct of some schizophrenic patients.

Three case reports of patients with iatrogenic forensic-psychiatric relevant hypersexuality.

Case 1: Comparatively young Parkinson-Patient with sexual desinhibition, frequent visits in brothels contracting debts and sexual harassment towards women after treatment with Ropinirol.

Case 2: Chronic hebephrenic patient with homoerotic paedophilia, who only started molesting boys after changing medication from Olanzapine to Aripiprazole.

Case 3: Chronic-paranoid young schizophrenic patient with no criminal record who seriously assaulted a foreign woman short time after changing from Amisulpiride to Aripiprazole.

Hypersexuality as side effect of the treatment of Parkinson's disease is well known, it might be more important an issue, if the patient is young. Hypersexuality as side effect of the treatment with partial dopaminergic drugs should be considered in the drug treatment of schizophrenic patients.