The authors have not supplied their declaration of competing interest.

The most common comorbid disorder in schizophrenic patients is social phobia. It is usually unrecognized problem that may be associated with a highdistortion in managing claims of life. The aim of our study was to determinethe extent to which comorbid social phobia affects the severity and course ofschizophrenia.

Thepublications were indentified in the database Medline and Web of Science usingthe key words 'schizophrenia comorbidity” in combination with the terms “social phobia” or “social anxiety disorder”. Otherrelevant sources of information were obtained from the cited works by importantarticles.

Thecurrent state of research shows that comorbidity with social phobia is morecommon in schizophrenia than in the general population. The incidence ofcomorbid social phobia in psychotic disease states in range from 11 % to 36 %. Social phobia in psychotic patients remains largely unrecognized. If it isundetected and untreated, this comorbidity is associated with more severepsychotic symptoms, worse quality of life and lower self-esteem. It is anotherobstacle for patients suffering from schizophrenia that deterioratesfunctioning in everyday life. It also increases the tendency to socialisolation and overall worsens social adaptation. Patients with comorbid socialphobia and schizophrenia have a higher amount of lifetime suicide attempts, ofwhich they select the ways of suicide with higher lethality and often abusealcohol or addictive substance.

Patients suffering from both schizophrenia and social phobia have a lowerquality of life, impaired functioning in life, a higher incidence of suicideattempts and increased risk of relapse of psychosis compared with those who donot suffer from comorbid social phobia. It is therefore necessary thatphysicians treating the patients with schizophrenia had in mind the possibilityof presence of comorbid social phobia and in case of its occurrence they alsotreat it.

A major concern in patients with BIPOLAR Disorder (BD) is the high frequency of suicidality. It is important to determine the subgroup of patients particularly exposed to this risk.

To explore sociodemographic and clinical characteristics of BD patients with a history of suicide attempts and compare them to those who never attempted suicide.

This is a retrospective, cross-sectional, descriptive and comparative study on 100 patients followed in our department and diagnosed with BD type I according to DSM 5. Demographic and clinical data was compared across the groups: suicide+ (S + ) and suicide–(S-).

Overall, 77 patients never attempted suicide (S−), whereas 23 had made at least one suicide attempt (S+). Females represented 61,9% of the S+ group. S+ patients had more relatives with psychiatric illness (82,6% vs. 57.1%) and affective illness (43.5% vs. 33,8%). The mean diagnostic delay was 6.61 years in the S+ group vs. 4.58 in the S− group, with 78,3% of S+ patients first receiving another diagnosis than BD. S+ patients had significantly more depressive episodes and manic episodes with mixed features. Quality of intervals was worse in S+ patients. Anxiety comorbidity was significantly higher in the S+ group (52.2% vs. 13%; P = 0,000). Hyperthymic temperament was significantly associated with the S− group.

Depressive polarity, anxiety comorbidity, as well as diagnostic delay seem to elevate the risk for suicidality in bipolar patients. Suicidality should be closely monitored in patients with these characteristics.

The author has not supplied his declaration of competing interest.

Since December 2007 all Western countries have fallen into a severe economic recession, that caused an increase in unemployment and a lowering of income. Main consequences on health reported from previous economic crises such as the ‘29 Great Depression, the Post-communist Depression in early 1990s or the East Asian financial crises in late 1990s were:

1. 1) Increase in overall mortality,

2. 2) Increase in day-time alcohol drinking,

3. 3) Increase in male suicides and

4. 4) decrease in traffic fatalities.

To review the consistency of Italian data regarding the effects on health of the current economic recession with reference to effects of previous crises.

PubMed was searched for literature. Data on mortality, alcohol abuse and self-harm behaviours were obtained from the website of the Italian National Institute of Statistics (ISTAT).

Overall mortality in Italy increased in years 2008 and 2009, this increase being more evident among women. Overall male suicides and attempted suicides increased in the same years as well. Male suicides potentially referred to economic reasons showed an alarming increase. Traffic fatalities decreased during the last decade. Contrary to the expectations, alcohol consumption diminished gradually after recession onset.

Italian data are consistent with expectations and previous findings. Other concomitant and not related events could be involved (such as decrease in traffic fatalities or steadiness in alcohol consumption, which might be related to the introduction of new laws), though it seems extremely suggestive that the socio-economic context has a deep impact on mental health of general population.

Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed antidepressants with generally fewer side effects than most other types of antidepressants. However, in frail elderly, the use of SSRIs was anecdotally reported as a potential cause of a delirium.

To present a case of citalopram-induced delirium in an older adult diagnosed with late-life depression.

To review available literature on SSRI-induced delirium.

A case report is presented and discussed, followed by a literature review.

Seven published cases of SSRI-induced delirium in older adults (> 60 years) were found while searching through Pubmed and Embase. Our case of a 75-year-old female is also included in this report. This patient was ambulatory treated with citalopram 20 mg per os against depressive symptoms and she developed a delirium four days after the initiation of the therapy. Blood tests were normal and CT scan showed no significant findings. No other medical evidence was found that could explain her delirium. Her symptoms finally resolved after discontinuation of citalopram.

The on- and off-treatment side-effect correlation by a segregate oral use of citalopram strongly suggests that SSRIs may have the potential to cause a delirium, especially in frail elderly. Further research on this topic is needed.

The authors have not supplied their declaration of competing interest.

Although there are studies showing that empathic concern and perspective taking is well correlated with a better outcome of therapy, little is known about the “natural history” of empathy in health care professionals. Within a transversal design, this study attempted to estimate the evolution of empathy components in nurses.

Using Davis's “organizational model”, we administered the Interpersonal Reactivity Index to 127 nursing students and nurses of both genders, working in various medical fields. Spearman's correlation coefficient was calculated for the 4 scores and variables such as age, years of experience, and the medians of the scores were compared for gender, marital status, number of children, number of brothers and sisters.

significant negative correlations were found between fantasy and personal distress scales, and age and years of experience. Women had higher scores of all 4 components. Significant correlations between scores were found as well.

apparently, nurses have different patterns of empathy than doctors (who have shown an increased personal distress over time in previous studies). Women are more empathic and e.

Depression is common in Alzheimer's disease (AD) with important clinical implications, but the etiology is not known.

30 subjects (15 with depression and 15 non-depressed matched for age, gender and cognitive impairment) with mild probable AD, defined as Mini-Mental State Examination score of 20 or above, diagnosed according to NINCDS-ADRDA criteria were included in the study. Data were collected at geriatric medicine and psychiatry outpatient clinics at three hospitals in Western Norway and all subjects underwent comprehensive clinical assessment. Montgomery-Asberg Depression Rating Scale with a cut-off point of 6/7 was used to evaluate depression. Automatic preprocessing using Freesurfer included steps for white and grey matter surface reconstruction. The resulting cortical thickness measurement was used in the subsequent GLM-based analysis. Correction for multiple comparisons was carried out cluster-wise by method of Monte Carlo.

We found 3 clusters of significantly reduced cortical thickness in the depressed group. The first cluster (p = 0,0014) contained Left Frontal Pole and Lateral Orbitofrontal cortex. The second cluster (p = 0,0131) included Left Anterior Temporal Area; Right Medial Prefrontal, Anterior Cingulate, Subgenual Cingulate and Medial Orbitofrontal cortex were included in the third cluster (p = 0,0032).

Depression in AD is associated with reduced cortical thickness in prefrontal and anterior temporal cortices. These areas have been found to be associated with depression in other age-related disorders as well as in major depression. This convergence of morphological profiles suggests a possible unity of depression brain mechanisms across disorders.

The treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.

To know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.

We retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.

A total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.

Second-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.

The authors have not supplied their declaration of competing interest.

Alexithymia, that is the inability to recognize and describe one’s own emotions, is a transdiagnostic feature across eating disorders (EDs) and it has been associated to a prolonged stress exposure.

Therefore, we evaluated whether alexithymia affects the hypothalamus-pituitary-adrenal (HPA) axis functioning in patients with anorexia nervosa (AN) or bulimia nervosa (BN).

Twenty-six women with AN and 26 with BN participated in the study. Alexithymia was evaluated by the Toronto Alexithymia Scale–20 and eating-related psychopathology was measured by the Eating Disorder Inventory-2. The activity of the HPA axis was assessed by the salivary cortisol awakening response (CAR). Group differences in saliva CAR were tested by repeated measures 3-way ANOVA with diagnosis and alexithymia as between-subject factors.

The prevalence of alexithymia did not differ significantly between the two diagnostic groups (c2=1.24, p=0.26). Alexithymia was associated with more severe eating-related psychopathology in AN women but not in BN women. A significant reduction in the magnitude of CAR occurred in alexithymic patients with BN compared to non-alexithymic patients with BN (t = 3.39, p = 0.008), but not in alexithymic women with AN (t = 0.67, p = 0.54).

These results confirm the presence of a more severe eating-related psychopathology in alexithymic individuals with AN and show, for the first time, an association between alexithymia and a dampened basal activity of the HPA axis in BN.

No significant relationships.

Fear conditioning (FC) has been proposed as crucial factor in the etiology and maintenance of panic disorder (PD). This study compared the acquisition of discriminative fear learning between PD patients and healthy subjects (CTR). The main purpose was to test the hypothesis that abnormalities in this process may exist in this population, particularly referred to conditioned responses (CRs) and discriminative fear learning acquisition.

Aversive discriminative conditioning paradigm was administered to 45 patients with a DSM-IV diagnosis of PD with agoraphobia and to 43 healthy subjects. The visual-auditory conditioning paradigm is composed by four visual stimuli as conditioned stimulus (CSs) and a startlingly loud sound as the unconditioned stimulus (US). Only one stimulus (CS+) was followed by the US, instead remainder stimuli were never paired with the US (CS-). The protocol consisted of 3 phases: habituation (HAB), acquisition (ACQ) and extinction (EXT). Skin conductance response (SCR) was used as dependent variable.

During HAB phase no differences were found in response to all stimuli. During ACQ phase, the two groups did not differ in response to CS+; instead patients showed significantly greater reactivity to CS- than controls.

Results suggest equal level of fear acquisition and impaired discriminative fear learning in PD population; moreover discriminative deficit is driven by enhanced safety learning rather than any abnormality in excitatory danger learning. Enhanced responding to CS- among PD may also be interpreted as over-generalization of conditioned fear. Our result have important clinical implication, particularly for behaviour cognitive therapy in Panic Disorder.

Depression is associated with various inflammatory-related physical conditions, such cardiovascular and neurodegenerative diseases. Yet, little is known about the association between depression and autoimmune diseases.

To examine the association between depression and risk of autoimmune disease, investigating the temporal and dose-response nature of these relationships.

A prospective study including approximately 1.1 million people is conducted using linked Danish registries. We have identified 145,217 participants with depression between 1995 and 2012. Survival analyses are used to estimate the relative risk of autoimmune disease among those with, compared to without, depression. Analyses are adjusted for covariates.

Preliminary analyses indicate an association between depression and an increased risk of several autoimmune diseases, with a potential dose-response correlation. Final results are still in progress.

Depression seems to be associated with increased risk of the onset of a range of autoimmune diseases. As such, depression may play a role in the etiology of certain autoimmune conditions.

We recently demonstrated that weight gain could be prevented in young people experiencing a first-episode of psychosis commencing treatment with antipsychotics. A 12-week, intensive lifestyle and life skills intervention – the Keeping the Body in Mind program, – was delivered by dedicated nursing, dietetic and exercise physiology clinicians, for new referrals with < one month of antipsychotic exposure. (Curtis et al., Early intervention in psychiatry, in press). At the conclusion of the intervention the 16 young people participating in the program experienced a mean weight gain of 1.8 kilograms, and a mean increase in waist circumference of 0.1 centimeters. The participants were followed up for two years after initial referral.

During the two-year follow-up, participants had continuing access to an in house gym and weekly cooking groups, but without the same intensity of follow-up. Two year follow-up data were obtained from 11 participants form the original cohort.

Mean weight gain at two-year follow-up was 0.90 (SD 8.7) kilograms, and this difference was not statistically significant [t (10) = 0.3, NS]. Waist circumference decreased by 0.7 (SD 7.7) centimeters, which was not t statistically significant [t (10) = 0.3, NS]. Nine of the participants (82%) did not experience clinically significant weight gain two years after initiation of antipsychotic medication.

This two-year follow-up data demonstrated that it is feasible to prevent weight gain in youth with first-episode psychosis over the first two years of treatment.

The authors have not supplied their declaration of competing interest.

Antidepressant-related sexual dysfunction (ADr-SD) is the most frequent and long-lasting adverse event, often underestimated and rarely spontaneously communicated. Strategies to manage it haven’t been explored to date.

To explore ADr-SD clinical management in regular practice.

1. 1. To stablish the prevalence of SD in patients following antidepressant treatment.

2. 2. To describe the therapeutic interventions used when SD is detected.

Cross-sectional, multicentric and naturalistic study. Patients taking antidepressant for at least two months without previous SD were included. SD was evaluated with the specific questionnaire PR-Sex-DQ (SALSEX, Montejo et al 2001).

1988 out of 2000 patients recruited resulted eligible for the analysis. According to PRSexDQ scores SD was present in 87.5% ot the sample. Only 44.2% communicated it spontaneusly. 66.2% reported regular to poor tolerance of SD and 19.6% had thought about discontinuing treatment due to it. Regarding the therapeutic interventions used for managing ADr-SD, waiting for its spontaneus remission was the most frequent strategy reported (36.8%), followed by changing the antidepressant (32.5%) and reducing the dosage (18.5%); 5% chosed “weekend holidays”, 4% discontinued the antidepressant, 2.5% associated another antidepressant and 1.3% added a 5-phosphodiesterase inhibitor. Bupropion and mirtazapine were the antidepressants most frequently selected for the switching and association strategies.

These results study highlight the high rates of SD related to antidepressants and its potential association with non-adherence to treatment. Despite this unfortunatelly clinicians do prefer to wait rather than performing any active strategy to manage this adverse event.

It is well known that medical students are subjected to different levels of stressors during various stages of their study. Exposure to severe and prolonged stressors may cause serious psychological distress that may hinder students’ academic performance and may affect their mental and physical health as well. Therefore, this study aimed to determine the prevalence of psychological distress among medical undergraduate students throughout the different stages of their study.

A sample of 551 undergraduate medical students from Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia participated in this study (First year 141, Second 119, Third 109, Fourth 101, Fifth 81), the psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12), which is the short version developed by David Goldberg and Paul Williams. A binary scoring method was used to evaluate responses (i.e. 0-0-1-1). The rate was compared between different stages of the academic programme.

The overall prevalence of psychological distress among medical students was found to be 31.2% and the rate was higher during clinical than preclinical phases (33.7% and 28.5% respectively). Gender wise, it was found that the rate of psychological distress was significantly higher among female (35.5%) than male students (24.3%).

Psychological distress is common among medical students, it is higher among female than male students, and the rate is higher during clinical phase than preclinical phase.

Medication non-adherence presents a considerable problem in patients with schizophrenia. Cognitive and executive functions can affect adherence. The association between medication non-adherence and cognitive impairment in schizophrenia is under investigated with limited and conflicting research data.

To prospectively assess the rate of drug adherence among a sample of patients with schizophrenia and to compare the cognitive and executive functions between adherent and non-adherent patients.

One hundred and nine patients with schizophrenia diagnosed according to the DSM-IV classification were initially assessed by the Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale-Revised (WMS-R) and Wisconsin Card Sorting Test (WCST) and six months later by the Brief Adherence Rating Scale (BARS).

Among the patients, 68.8% were non-adherent to their antipsychotic medication. Adherent patients (31.2%) had significantly higher mean scores for the total, verbal and performance IQ. Moreover, they had significantly higher mean scores in most of WMS subtests (orientation, information, verbal paired association, digit span, visual memory span), and higher mean scores for; total correct, conceptual level response, percentage and categories completed on the WSCT subscales (P < 0.0001). Whereas the non-adherent group had higher mean scores in; trials administered, total errors, perseverative responses, and perseverative errors (P < 0.0001). In a step regression analysis, digit span, conceptualization, total and percentage of errors were putative predictors of non-adherence to antipsychotic medications.

Cognitive deficits, especially verbal memory and executive functions were the strongest patients’ related factors associated with non-adherence to medication. Psychiatrists should consider possible cognitive factors influencing adherence to enable offering proper interventions.

The author has not supplied his declaration of competing interest.

Suicide is a serious public health problem, being the second leading cause of death among 15–29-year-olds. Many risk factors have been associated with suicidal behavior, such as psychiatric disorders, family history of suicide, loss of a close friend/relative, physical/sexual abuse, lack of support network, or sleep disturbances where nightmares and insomnia have been consistently reported to increase the risk of suicidal behaviors.

To conduct a systematic review to examine the association between short sleep duration and suicidal behaviour (suicide ideation/attempt/suicide).

This is a systematic review of published research articles in the electronic database PubMed in the last 10 years. The query “sleep” or “sleep disorders” and “suicide” was used. Studies that assessed the relation between sleep duration and suicidal behaviour, with a well-defined index for sleep disorders and with an outcome measure of suicidal behavior were included.

Of the 522 references founded, 33 articles met the inclusion criteria (1 review, 1 qualitative and 31 quantitative studies). An association between short sleep duration and suicidal behaviour was found in most of the studies with children/adolescents and adult samples. However, this relation was not verified in the research into the elderly.

The results point to a significant association between short sleep time and the presence of suicidal behaviours, for both adults and children/adolescents. The effect of short sleep duration seems to be more consistent with suicidal ideation, but not for attempts, needing further studies to highlight the importance of this link between sleep duration and suicide.

The authors have not supplied their declaration of competing interest.