The use of the hallucinogen ibogaine as an anti-addiction agent has been described in several case reports, dating back to the eighties. The anti-addiction properties of ibogaine have been confirmed in a large body of animal work. Ibogaine has been shown to be effective in reducing withdrawal severity and substance use for a variety of substances, including cocaine and opiates. Animal studies also show some potentially dangerous adverse reactions, including cerebellar toxicity and potential cardiac effects. While pharmacological treatment options for opiate and cocaine dependence are still limited, ibogaine assisted treatment might be a promising new option. Therefore more systematic studies on its toxicity and efficacy are warranted. In our studies we address these two research questions: is ibogaine treatment for opiate dependence safe and effective for treating opiate withdrawal and relapse prevention? A secondary objective is to explore the pharmacokinetic properties of ibogaine.

Animal work: first we performed a systematic review and meta-analysis of animal studies on ibogaine. Thirty studies were included in the systematic review, of which 27 could be analyzed in meta-analysis. Human studies: fifteen opiate dependent patients will be treated with ibogaine (10 mg/kg), on top of treatment as usual. Ibogaine toxicity will be assessed through close monitoring with electrocardiography, with QTc prolongation as main outcome measure, repeated assessments of ataxia using the (SARA) and observation of psychotic symptoms by using the Delirium Observations Scale (DOS). Ibogaine efficacy will be measured, using repeated evaluations of opiate withdrawal severity (Subjective Opiate Withdrawal Scale: SOWS; Objective Opiate Withdrawal Scale: OOWS), craving intensity (using a Visual Analogue Scale) and substance use, with a six-month follow-up. Clinical observations in ibogaine treated individuals will be compared with a cohort of opiate dependent patients treated with a rapid detoxification procedure. Both acute and long-term effects will be linked with serum ibogaine and noribogaine levels.

Animal work: overall, ibogaine reduced drug self-administration, particularly during the first 24 hours after administration. Ibogaine had no effect on drug-induced conditioned place preference. Ibogaine administration resulted in motor impairment in the first 24 hours after supplementation, and cerebral cell loss even weeks after administration. Data on ibogaines effect on cardiac rhythm as well as on its neuropharmacological working mechanisms are limited. Human studies: human data are still being collected. Treatment of the first patients confirmed strong effects of ibogaine on heart rhythm (QTc prolongation) and ataxia, while the opiate withdrawal symptoms were relatively mild. The first observations on the clinical effect of ibogaine on craving and substance use will also be shared.

Based on our meta-analysis of animal data, there is strong evidence that ibogaine is effective in reducing drug self-administration in animals. This warrants further studies into the clinical efficacy of ibogaine in substance dependent patients in reducing craving and substance use. Our first clinical experiences in a limited number of patients confirm that ibogaine treatment may be effective in reducing opiate withdrawal, but can potentially have transient cardiac and cerebellar toxicity.

The authors have not supplied his declaration of competing interest.

It has been assumed that a key difference between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive. This view has recently been challenged at a theoretical level and additional empirical investigation has been called for.

The aim of this study was to examine whether chronic occupational stress—the putative cause of burnout—discriminated burnout from depression. Following a scope-based approach to the burnout-depression distinction, chronic occupational stress should be primarily related to burnout and only to a lesser degree to depression. This hypothesis was tested.

A total of 2124 French teachers took part in this study (mean age: 41.36; 73% female) during the last trimester of the 2013-2014 school year. Burnout was assessed with the Maslach Burnout Inventory and depression with the 9-item depression module of the Patient Health Questionnaire. The Effort-Reward Imbalance Questionnaire short form (ERIQ) was used for assessing chronic occupational stress.

Burnout and depression were almost identically correlated to effort-reward imbalance at work. Interestingly, the job over-commitment component of the ERIQ was slightly more correlated to depression than to burnout. Multiple regression analyses showed that effort-reward imbalance at work and job over-commitment predicted depression as much as burnout, controlling for gender, age, and length of employment.

Chronic occupational stress was not found to discriminate burnout from depression. These results further question the relevance of a scope-based distinction between burnout and depression and supports the idea that burnout overlaps with depression.

Stigmatization of people with mental disorders often leads to impairment of quality of life (QoL) - lack of self-esteem and life opportunities, social isolation, decreased productivity, violation of human rights and inadequate health care. However, data comparing stigma and QoL between different psychiatric disorders is fairly limited.

To assess stigma and QoL of patients with affective disorders compared to patients with psychotic spectrum disorders and to assess the association of stigma to QoL.

A cross-sectional study. the patients from diagnostic groups F30–39 (n = 61) and F20–29, diagnosed according to ICD-10 criteria, in remission for at least six months at the time of testing, matched by age and gender were included in the study. A semi-structured socio-demographic questionnaire, Stigma Scale and World Health Organization Quality of Life Questionnaire (WHOQoL) - BREF were used in the study.

The QoL of patients from affective spectrum is significantly lower in some of its domains (overall perception of QoL, overall perception of health QoL, psychological domain) compared to the patients from psychotic spectrum. in addition, the affective spectrum patients scored higher on Stigma Scale, although not significantly. Furthermore, the scores on Stigma Scale showed strong, negative correlation with all domains of QoL.

The stigmatization strongly affects the QoL in psychiatric patients. Patients with affective disorders feel more stigmatized and perceive their own QoL as lower compared to the psychotic spectrum patients

We describe a case of a man of 39 years, treated with paliperidone palmitate after treatment failure with other antipsychotics, including those of (conventional and atypical) oral and injectable, and developed secudary hyperprolactinemia.

Evaluate the effectiveness of the method for management of hyperprolactinemia secondary to the use of second generation long-acting antipsychotic.

Follow-up during 18 months in outpatient mental health.

In the period the patient remained stable with the use of paliperidone palmitate. Serum prolactin levels were obtained at baseline, and every two months.

The patient had sexual dysfunction as the main complaint.

Initially adopted the gradual reduction in dosage of antipsychotic 150 mg / month to 75 mg / month, however, the patient had psychotic relapse.

So, we decided to keep the dose of paliperidone palmitate and associate the drug cabergoline at a dose of 0.5 mg per week, and serum prolactin levels were normalized.

There was a decrease in serum prolactin levels as well as the related sexual sphere, with the addition of cabergoline to treatment with paliperidone palmitate symptoms.

The long-acting antipsychotic paliperidone palmitate is a safe and effective medicine to control the symptoms of schizophrenia. Hyperprolactinemia is a rare side effect associated with this psychotropic drug, which can be handled without difficulty with antidotes. The cabergoline proved to be an effective and free from adverse side efects alternative to reduce the levels of hyperprolactinemia secondary to use of paliperidone palmitate effects, including sexual dysfunction relieving.

(Hypo)mania is a known consequence of antidepressants in type I, type II and type III bipolar disorder. This conceptualization often induces the generalized belief that only the introduction of the antidepressant induces the mood switch.

Report the occurence of an understudied therapeutic event with unknown mechanism and associations. Promote clinical attention and further investigation.

Case report of a patient who developed a hypomanic switch upon venlafaxine discontinuation; bibliographic search using PubMed/MedLine database with the following keywords: bipolar; mania; hypomania; venlafaxine; antidepressant; discontinuation.

We report and discuss the case of a 48-year-old woman with previous history of a recurrent depression. The patient was successfully treated with Venlafaxine (300mg/day), Pregabalin (300mg/day) and Clonazepam (0.5mg/day) completing the acute and continuation phases of the treatment. She was then discharged with the indication to maintain treatment for her maintenance phase. After a couple of months the patient initiated slow Venlafaxine discontinuation after which she developed a clinical picture characterized by talkativeness, persistently elevated mood, increased goal-directed activity and unreasonable expenses lasting for an unspecified number of weeks and subsequent severe depressive episode without psychotic symptoms. The patient was again referred to our consultation and medicated with Venlafaxine (300mg/day) and Valproic acid (1000mg/day) remaining depressed and treatment resistant to this day.

Studies show that antidepressant-withdrawal (hypo)mania is a known but rarely reported leading to its unawareness an consequent unknown true incidence. Two hypothetical models may explain this clinical entity: Withdrawal-induced cholinergic overdrive; and Noradrenergic hyperactivity.

Bruxism is the most common form of maxillofacial hyperkinesia. Behavioral disorders as well as affective psychological factors, depression and anxiety being one of the most prominent factors, can together with emotional stress, induce bruxism. There has been the correlation between medications and bruxism (for example SSRI's).

We reported a case of a 47-year-old female patient who has been psychiatrically treated for depression since 1988 (F 32.1 by ICD 10). In 2005, she was hospitalised for the second time, this time for depression with psychotic traits (F 33.3 by ICD 10) due to which she was also hospitalised in 2006 and 2007. During 2005 and 2006 she was taking mirtazapine, paroxetine as well as olanzapine and since 2007 she has been taking sertraline and olanzapine.

There was an excessive wear of tooth surfaces and edges due to bruxism on seven-year-old bridge, which she noticed herself two years ago. She was awake during the diurnal bruxism and nocturnal bruxist activity was confirmed by her husband. Michigan splint was fabricated, thus alleviating the destructive impact of masticatory forces on the teeth and their supportive tissues.

Bruxism, associated with medications or mental disorders and very detrimental to teeth, the periodontium and oral health in psychiatric patients should be also treated as a general health problem and oral health problem. The prognosis for stopping bruxist activity is bad because a complete prosthodontic treatment was extremely limited due to the patient's psychiatric condition.

Shared decision-making (SDM) has shown to improve adherence, decrease hospitalization, and enhance knowledge of the illness and satisfaction with mental health services. Eliciting each patient's preferences for information allows tailoring the physician behavior according perspectives and expectations. Patients with depression (PWD) have frequently limited information regarding the availability and efficacy of psychiatric treatments.

Unveil information seeking attitudes of patients with depression and their a priori use of digital sources of information.

A convenience sample of PWD was submitted to a battery of self-report questionnaires. Standardized instruments were used to measure information seeking attitudes and the accessibility and usage of digital information resources.

Thirty-six patients were inquired, with a mean age of 39.8 (13.4) years. Information-seeking preferences were high, with an API-I score of 90.1 (13.8). Preferences for information-seeking behaviors were higher in severely depressed (P = 0.010) and less educated (P = 0.026) patients. Preferences were negatively correlated with length of psychiatric treatment (r = −0.514; P = 0.002). Sixty-one percent had a priori information regarding their psychiatric problem, and 68.8% considered it was influential in the decision-making behavior. Access and use of digital resources were correlated with education level (0.644; P = 0.000 and 0.554; P = 0.003), age (−0.357; P = 0.001 and −0.559; P = 0.007) and illness severity (−0.431; P = 0.04).

Patients with depression want to be informed about their mental condition and treatment options. Few resources are used and decision mostly relies on health professional's opinion and guidance. Accessible resources seem scarce and future research shall address the acceptance and impact of decisional-aid instruments on this population.

Depression is recognized as more frequent psychiatric disorder in epilepsy patients with significant impact on their health-related quality of life.

To analyze the occurrence and clinical particularities of different types of interictal depression in epilepsy patients.

One hundred and fourteen epilepsy patients with interictal depression were assessed with a clinical interview and Hamilton depression and anxiety rating scales. Diagnostic criteria of ICD-10 and of the International League Against Epilepsy (ILAE) were used.

A total of 45.6% of patients met ILAE criteria of inerictal dysforic disorder (IDD) with predominance of depressive mood, irritability, fear and atypical pain. All patients had chronic epilepsy with specific epileptic personality changes. Comorbid adjustment disorders (depressive and anxious-depressive reactions) were diagnosed in 27.2% of patients. The most frequent trigger situations were: family problems, serious illness, unemployment, financial difficulties. In more than half of patients were registered specific personality changes whose severity was in inverse ratio with trauma severity. A total of 18.4% of patients met criteria of comorbid affective disorder (depressive and bipolar) with some specific clinical traits due to personality changes. In 8.8% of patients, anticonvulsant-induced depression was observed; it was clinically simple, resolved after offending medication withdrawal.

Observed depressive disorders were heterogeneous: comorbid or attributed to epilepsy or its treatment. The most frequent condition was IDD. Specific personality changes may contribute to higher susceptibility and development of psychogenic depression. We emphasize the importance of treatment history (possibility of anticonvulsant-induced depression).

The authors have not supplied their declaration of competing interest.

There is a growing concern about the potential risk that the use of certain antipsychotics may have on the QTc prolongation, electrocardiographic parameter key to assess the potential risk of developing a potentially lethal ventricular tachyarrhythmia:“Torsade de Pointes”. Previous studies highlights the existence of low levels of potassium in severely agitated patients versus moderately agitated ones (1). So if we take into account that seriously agitated patients tend to receive higher antipsychotic doses, and mainly antipsychotic with a more sedative profile, we face a hotbed for causing a potentially lethal tachyarrhythmia.

Evaluate the presence of hypokalemia in agitated psychiatric patients.

We chose a random sample of 31 agitated psychotic patients attending emergency room and we make a determination of potassium level at that time, compared to a sample of 33 others randomly as control who donate their blood in the hospital blood bank group. Final results, showed that agitated patients presented potassium figures significantly lower than the control group. (3.88 average in agitated versus 4.14 control group), (p = 0,048).

These data confirm our hypothesis of work and the relationship between hypokalemia and psychomotor agitation in psychotic patients attending the emergency ward, increasing notably the risk for “Torsade de Pointes”.

Clozapine is the drug of choice for patients with an unsatisfactory response to classic antipsychotic treatment. Little is known about the involvement of clozapine in the development of parotid disease.

Identify the clinical characteristics of Clozapine-induced parotitis through a case and literature review.

We report the case of a patient with a refractory schizoaffective disorder, bipolar type and who developed recurrent parotitis while taking clozapine. We conducted a literature review based on a PubMed search of articles published on this subject with the following keywords: ‘parotitis clozapine’.

Miss W., 34 years old, suffers from a severe schizoaffective disorder that has been diagnosed for several years. She has received various psychotropic medications. She suffered from frequent relapses that required recurrent hospital admissions. One year ago, a diagnosis of treatment-resistant schizoaffective disorder was made. The decision to introduce clozapine, associated with mood stabilizer treatment, was made on the basis of her treatment refractory symptoms. She experienced considerable sialorrhea after beginning clozapine treatment. Miss W. developed bilateral recurrent swelling over both temporal-mandibular areas after 6 months of treatment. It often appears after eating and lasts from 4 to 6 hours. There was no change in white blood cell count and she was afebrile. An otolaryngologist was consulted and a diagnosis of clozapine-induced parotitis was suggested. A spasmolytic and an anticholinergic treatment were prescribed and clozapine was continued.

This iatrogenic effect of clozapine must be recognized by clinicians in order to be better prevented.

Attention Deficit and Hiperactivity Disorder (ADHD) is a neurobiological disorder, affecting executive functions and defined by hyperactivity, attention deficit and/or impulsivity symptoms. This neurodevelopmental disorder affect up to 7% of children. It is observed as a chronic pathology appearing on childhood with other comorbid diseases. Often, remarkable symptoms use to change with the age, however a real improvement is also related with other -external- factors, as social environment.

-To highlight variability of ADHD symptoms and complexity of available treatments in childhood. -To analize influence of personal and familiar factors, which affect to evolution of ADHD and the response to treatment.

Comparative-study. Retrospective selection of 8 patients with treatment for ADHD and currently stable. A 12-months ADHD confirmed diagnosis in Child and Adolescent Mental Health Unit and follow-up after diagnosis. They are compared by aged-pairs (females and males) at the different development school-stages (preschool 3-6 years, primary school 7-12 years and adolescence 13-16 years). *Pairs of study: male-5 years/female-6 years; male-7 years/female-8 years; female-10 years/male-11 years; female-13 years/male-15 years

-Evolution of ADHD highlights the influence of age-factor about remarkable symptoms mainly (from hiperactivity to inattentiveness). -Comorbid disorders seems related with sex-factor (impulsivity-eating disorders on females and irritability-mood disorders on males). -Children social environment, specially family support, is an important external factor for all these patients (low self-steem or somatization disorders).

1. ADHD as a chronic disorder whose evolution depends on the age, sex and social factors 2. Genetic component or familiar support are also considered as influencers factors 3.Multidisciplinary approach to objectives: motivation, organization and maturity 4. Treatment is consider according to side effects and comorbidity

The epilepsy literature shows a high prevalence of psychological and social disorders which are considered more handicapping than seizures themselves.

1. - To assess the quality of life (QOL) of patients with epilepsy.

2. - Determine the relationship between QOL and level of anxiety, depression and coping strategies.

It was a cross-sectional study involving 50 subjects with epilepsy and followed in the outpatient psychiatry department. The state-trait anxiety inventory was used to assess the level of anxiety, whereas the Beck depression inventory was used to measure the severity of depression. The QOL was assessed using the quality of life in epilepsy inventory (QOLIE -31). The items of the Brief COPE were used to assess coping strategies.

Coping strategies most frequently used were: emotional support (mean score = 5.52), acceptance (mean score = 5.22) and the emotional expression (mean score = 4.18), but none used the strategies of problem avoidance and self-blame.

The average overall score of QOL of our patients was 71.66. It was significantly higher in patients with a minimum level of anxiety (p = 0.012) and those using active coping strategies (p << 0.005), acceptance (p << 0.005) and distraction (p = 0.015). There was no statistically significant relationship between the level of QOL and that of depression.

Our results emphasize the importance of reinforcing strategies of adjustment to illness and the role of the anxiety associated with the unpredictability of seizures; it seems to have an important impact on QOL of patients with epilepsy.

The previous studies reported that elevated serum cholesterol levels (≥ 200 mg/dl) were associated with poorer response to fluoxetine and nortiptyline treatment in patients with depression.

The aim of this study was to examine the relationship between pretreatment serum cholesterol levels and clinical response to treatment with different antidepresants among inpatients with depressive disorder.

One hundred and four inpatients with depressive disorder who did not respond to previous treatment were enrolled in a six-week open study. New treatment (different antidepressant monotherapies, combinations or augmentations) was chosen according to clinical judgment. Serum cholesterol levels were obtained before starting new treatment. Cholesterol levels were classified as either elevated (≥ 200 mg/dl) or nonelevated. Clinical response was defined as ≥ 50% decrease in the Montgomery Åsberg Depression Rating Scale (MADRS) score at endpoint compared to baseline.

Forty-six patient (44%) were classified as having elevated cholesterol levels at baseline. Patients with elevated cholesterol levels did not significantly differ in gender ratio, baseline MADRS score, duration of current episode and number of previous episodes but were significantly older than patients with nonelevated cholesterol levels. After adjusting for age, gender, and Body Mass Index (BMI), we did not find significant differences in response rate and as well as in the pretreatment-posttreatment change in MADRS between patients with elevated cholesterol and patients with nonelevated levels.

We did not demonstrate association between pretreatment cholesterol level and response to treatment in depressive disorder.

Study was supported by the grant NS10368 IGA MZ CR.

Parricide is defined as the killing of one's father, mother or any other lawful ascendant. Parricide is a rare event and statistics indicate that accounts for less than 4% of all resolved homicides.

To describe the most common psychiatric pathologies associated with parricide.

The authors performed a non systematic review of literature.

Parricide is a crime committed essentially by males, and the most frequent form is patricid committed by sons. Parricidal offenders diagnosed with psychiatric diseases usually suffer from severe and prolonged mental illness, with clinical symptoms evidenced for years before they commit the crime. As risk factors for parricide, literature refers suffering from paranoid schizophrenia or an alcohol or drug abuse, associated with family and personal history of violence and mental illness, possible cessation of psychotropic medication, and lack of acceptance of the mental illness. Also the presence of a sexual component of the crime was reported. Relating to the symptoms that motive parricide, studies showed that the majority were persecutory paranoid delusions, involving delusional beliefs about the parent and other family members and occurred mostly in individuals with schizophrenia.

The literature about parricide is sparse and the majority of studies performed in parricide have a small sample, which difficult generalization. A great proportion, but not all adult parricidal offenders suffer from a major psychiatric disorder. However, the majority of individuals with severe mental disorders do not kill a parent, so risk factors for parricide among mentally ill adults need to be identified in order to prevent them.

In Portugal, drastic changes in suicide rates have been claimed in the last 10-year period. Portugal is frequently presented as an example of masked suicides within the registered undetermined deaths. References on suicide and undetermined death rates and trends in Portugal are outdated.

To ascertain the actual numbers of suicide in Portugal providing the scientific community with an updated, methodologically correct, source of reference.

Raw data of suicide deaths was obtained per year, by age, sex, geographic region and lethal causes, and specific rates per 100,000 habitants and age-adjusted rates were calculated.

From 1980 to 2009, rates of suicide mortality have remained stable, but this trend does not occur in all age groups, decreasing with respect to young people and increasing in higher age group. Mortality is much higher in males than in females, and in the south. Hanging is the main method. Mortality from suicide and undetermined causes correlate inversely and undetermined death and suicide rates ratio are close to 1:1.

Suicide prevention should focus on males older than 55 years. A substantial proportion of deaths of undetermined causes seem to correspond to misclassified suicides. However, it is unlikely that not counting these masked suicides modifies the trends of suicide rates in the period under study. These are realistic trends for the Portuguese population.