Valproic acid (VPA) is a commonly prescribed medication for epilepsy, migraine and especially bipolar disorder therapy. Although the common adverse effect associated with VPA are typically benign, less common adverse effects can occur; these include acute pancreatitis.

Describe the clinical and therapeutic characteristics of a case of acute pancreatitis induced by VPA with a review of the literature.

We report the case of a patient who presented an acute pancreatitis induced by VPA. The data was collected from the patient’s medical file. A review of the literature was performed by selecting articles from the PubMed search engine using ‘acute pancreatitis and valproic acid’ and ‘drug induced acute pancreatitis’ as key words.

This is a 51-year-old male patient with a history of type 2 diabetes, dyslipidaemia and psychiatric follow-up for bipolar disorder type I on lithium. He was admitted for a resistant depressive episode. We opted for the combination of two mood stabilizers (VPA and lithium). On the third day of treatment, the patient reported epigastric pain with incoercible vomiting. Laboratory tests showed increased levels of pancreatic enzymes and a biological inflammatory syndrome. The diagnosis of acute stage A pancreatitis was made.VPA was discontinued and the patient was put on symptomatic treatment with favourable outcome after one week. The etiological investigation ruled out other causes of acute pancreatitis. As a result, iatrogenic origin was retained.

This case supports the idea that acute pancreatitis may be induced by VPA, it has no predictable factors.

No significant relationships.

Wake therapy (sleep deprivation) is known to induce a rapid amelioration of depressive symptoms. Recently, techniques using bright light therapy and sleep time control have been developed to sustain the acute response of wake therapy.

The aim of this study was to establish the efficacy of these new methods and to control for the placebo response by incorporating an active control group.

Patients with an actual diagnosis of unipolar or bipolar major depression were randomized to either a wake group or an exercise group and followed for 9 weeks. All patient were treated with duloxetine 60 mg daily. After a one week medication run-in phase, all patient were admitted to an open ward for six days: The wake group had 3 wake nights during their stay in combination with daily bright light treatment and sleep time control and the exercise-group started their exercise program. Bright light and exercise were continued for the whole study period.

Patients in the wake group had a statistically significant larger improvement from immediately after wake therapy and maintained for the rest of the study period. At end of study the Wake group achieved a response / remission rate of 70.2 % and 45.6 %. The exercise group had a response/remission rate of 42.2 % and 23.1 %

The chronotherapeutic intervention induced a rapid and sustained response superior to the response seen in the exercise group.

The Driver and Vehicle Licensing Agency in UK have published guidelines on driving for mentally ill patients. An earlier audit done in 2008 showed that none of the 25 patients included in the audit received advice on driving.

A re-audit was done in terms of documentation of

1. 1) the driving status of patients,

2. 2) advice on driving at time of discharge.

Retrospective audit was done by retrieving 25 case notes and discharge summaries of patients admitted. Demographic details, driving status and driving advice given were collected using a pre-defined proforma.

25 patients admitted to adult wards were included (16 males, 9 females, and mean age 46). 15 patients were admitted as informal while 5 each were on section 2 and 3 of Mental Health Act (MHA). The following were the diagnoses; mental disorders due to alcohol (2), Schizophrenia (8), manic episode (1), bipolar affective disorder (5), depressive episode (8) and personality disorder (1). 16 patients (64%) were documented to have current driving licence and this information was not recorded in 9 cases (36%). 12 (48%) patients were current drivers and 4 of them were professional drivers. 13 (52%) patients were given documented advice regarding driving at the time of discharge.

52% of patients admitted to general adult mental health wards were given advice regarding driving at the time of discharge and compared to previous audit data, there has been a significant improvement. However this needs to be improved by increasing the awareness among healthcare professionals.

Autosomal recessive ataxia of Charlevoix-Saguenay (ARSACS) is characterized by early onset cerebellar ataxia, lower limb spasticity, and sensorimotor axonal polyneuropathy. Early atrophy of the superior cerebellar vermis is always present. Molecular linkage analysis found that the ARSACS gene is located on chromosome 13q12. Cloning of the gene, SACS, demonstrated that it encodes the protein sacsin.

Systematic evaluation of neurological, neuropsychiatric and neuropsychological features in two male siblings.

Investigation of the putative relationship between cerebellar dysfunction and affective symptoms.

Detailed neuropsychiatric and neuropsychological assessment.

The first patient, aged 55, the disease started in early infancy and a severe progressive cerebellar syndrome with spasticity of the legs and axonal polyneuropathy developed. In his brother, aged 50, the debut of neurological symptoms was in preadolescence with a less severe deterioration over time. Cognitive functioning was only marginally impaired in the latter patient, whereas behavioural aberrations were present in the first patient only. Both patients showed a reduced cognitive and emotional responsivity to environmental events leading to impairments in several areas of daily life, such as lack of effort and strategic planning, as well as impulsivity and impoverished social interaction with emotional indifference. This symptom profile typically points towards the presence of an apathy syndrome.

In ARSACS, in addition to the motor impairments, it may be postulated that the cerebellar cognitive affective syndrome is present. Thus, this hereditary form of ataxia may be accompanied by a series of non-motor symptoms of which motivational and affective signs dominate. \

Medical students have higher levels of depressive symptoms than the general population. Additionally, depressed students are more likely to commit suicide. Recent studies find up to 10% of medical students experiment depression and suicidal ideation, which is meaningfully higher than general population of similar age (5–8%). However, little is known about depression and suicidal ideation in medical students in Spain.

This study aims to create a self-administered questionnaire to investigate the prevalence and factors involved in depression and suicidal behaviour in medical students from a Spanish University.

We evaluated the main risk factors leaning to suicide in students. In addition, we selected an appropriate scale to assess depression among the existing ones. The evaluated items included demographic reports, academic information (academic course, unfinished subjects and accomplishment) and sanitary data (psychiatric family history, psychiatric personal history, psychotropic drug consumption, distress emotional events in the last twelve months and drugs consumption). Furthermore, we selected the 9-item Patient Health Questionnaire (PHQ-9) because of its rapidly implementation and proven efficacy.

Rates of depression and suicidal ideation are high in medical students. Currently, there is no program to detect and prevent depression neither suicide in students. For that reason, we consider that creating a new instrument to evaluate mental health in student is useful in order to offer early detection and treatment at medical school.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Anxiety symptoms are frequent during pregnancy, and they adversely affect pregnancy outcomes and offspring development. The underlying biological mechanisms are not known, but may in part be explained by alterations in certain maternal metabolic pathways. No metabolomic studies have investigated possible metabolic alterations in anxious pregnant women.

This pilot study compared the metabolic profiles of anxious and non-anxious pregnant women using a mass spectrometry-based quantitative metabolomics system.

Cases were 20 participants of the Kuopio birth cohort study (www.kubico.fi) with first and third trimester symptoms of anxiety (Edinburgh postnatal depression scale, anxiety subscale – EPDS-3A ≥ 4), but no depression (EPDS ≤ 12). Controls were 20 participants with low anxiety (EPDS–3A ≤ 3) and depression (total EPDS ≤ 9) in both the first and third trimester. Maternal metabolic profiles were analyzed from serum samples drawn when the mothers arrived at the delivery hospital.

Metabolic pathway analyses revealed significant enrichment in the glycine, serine and threonine metabolism (P = 0.046), as well as in the betaine (P = 0.048) metabolism pathways. Homocysteine was the only metabolite to significantly differentiate between cases and controls (VIP score 3.3), with lower concentrations in cases (P = 0.003) even when excluding non-users of folic acid supplementation (n = 5; P = 0.002), C-sections (n = 5; P = 0.013), or samples taken immediately postpartum (n = 2; P = 0.004). No other metabolites significantly differed between the groups.

Physiological adaptation induced by pregnancy, which may have homogenized the study populations, could explain the only minor metabolic differences between the two groups. Further research in larger samples, comparing metabolic alterations in umbilical cord blood and maternal blood is warranted.

The authors have not supplied their declaration of competing interest.

The relationship between health beliefs regarding formal mental health services, practical variables (time, affordability, transportation), stigma, and use of internet support groups in lieu of formal treatment has received little empirical attention.

The study examines the relationship between health beliefs, practical variables, stigma, and engagement in internet support groups among adults.

The study addresses whether beliefs regarding formal mental health services, having the time, finances, and transportation to use them, and the social consequences of being identified as having a mental health problem influence the use of internet support groups.

Data were analyzed from 2,532 respondents who endorsed perceiving the need for but not receiving formal mental health treatment in the National Survey on Drug Use and Health (2008). Binary logistic regression was used to examine the relationships between health beliefs, practical variables, stigma, and the use of internet support groups.

The strongest positive predictors of internet support group use were fear of being hospitalized/taking medications (AOR = 8.252, CI = 8.170–8.334), lack of transportation (AOR = 2.313, CI = 2.271–2.357), and insufficient insurance coverage (AOR = 2.640, CI = 2.610–2.670). The strongest negative predictors of internet support group use were lack of belief in the efficacy of formal treatment (AOR = .629, CI = .618–.641), fearing that others would find out (AOR = .660, CI = .645–.675), and not thinking formal treatment was needed at the time (AOR = .681, CI = .665–.696).

Using the internet for relief from mental health symptoms has proliferated, yet has received little empirical attention. Research is needed to examine the implications of using internet technology rather than formal mental health treatment.

To find out how the use of ECT in psychiatry is perceived by the public in the Czech Republic.

The questionnaire (8 questions monitoring awareness, knowledge of ECT and its use in modern psychiatry) created for the purpose of this study was shared through internet and also distributed in paper version to public.

The sample consists of 365 respondents – age average 28.9 years, 62% of females, 53% of university graduates, 44% with secondary education, 3% other education, 27% of healthcare professionals outside the field of psychiatry, 20% of medical students before the start of the traineeship at psychiatry, 53% of the public. Among the respondents, 98% have heard about ECT, 7% of them think that ECT is no longer used. Among the respondents, 62% learned about ECT from the media (film, print). Among the respondents, 22% do not believe in the effectiveness of ECT, 30% think that ECT is abused by psychiatrists, 86% believe that ECT has side effects (personality changes, permanent memory disorders, brain damage, epilepsy). Among the respondents, 77% would agree with ECT, if it should be applied to their relative.

ECT is an effective method in treating of severe mental disorders. But until now the public view is influenced by media. Due to the negative stereotype of the method many people are afraid of this treatment. The interesting fact is that also health professionals and medical students are influenced by public stigma of ECT.

The authors have not supplied their declaration of competing interest.

Dialectical Behaviour Therapy (DBT), an innovative method of treatment developed to treat severe emotion deregulation, shows benefit for individuals with borderline personality disorder. The purpose of this pilot study was to evaluate the efficacy of DBT in reducing Eating Disorders (ED) symptoms.

Twenty-eight individuals with DSM- IV diagnoses of eating disorders and other concurrent disorders were randomly assigned to a DBT treatment modified to address eating disorders or treatment as usual (both one year duration). They were administered a series of eating disorders and mental health measures prior to and after treatment.

Data suggested that individuals in the DBT condition had decreased bulimic behaviour, weight and shape concerns and increased interoceptive awareness, treatment retention and overall health.

DBT can provide improvement of some eating disorders’ symptoms. Specific adaptations of DBT for individuals with eating disorders, ways to overcome challenges, and recommendations will be discussed.

Social interactions have an important effect on the subjective well-being of individuals. However, in periods of financial crisis these interactions are reduced, affecting thus the mental health of the individuals as well.

To investigate the effect of the reduction in social interactions, as a result of the economic crisis, on the subjective well-being of non-insurance health care seekers in Greece.

Two hundred and sixty-six individuals participated in this study, 90 (35.6%) males and 163 (64.4%) females, with a mean age of 47. Analysis of data was conducted with Anova, using the SPSS software.

The findings showed that reductions in social interactions, caused by the financial crisis, led to significant reductions in the subjective well-being of individuals as well (F(1.259) = 13.276, P < 0.001 for social activities and F(1,258) = 14.531, P < 0.001 for peer socialization). More specifically, individuals whose social interactions were greatly affected by the financial crisis reported significantly lower subjective well-being than individuals who reported a medium effect (M = −2.952, SD = .764, P < 0.001). Furthermore, individuals who reported that the economic crisis had a great effect on their peer socialization reported significantly lower subjective well-being compared to both those who reported a medium (M = −1.868, SD = .658, P < 0.015) or low (M = −2.77, SD = .809, P < 0.001) effect of the crisis.

The results of this research showed that the financial crisis reduced the well-being of affected individuals through reductions in their social interactions. Further research is needed to investigate appropriate interventions to reduce the negative impact that the financial crisis has on the well-being of affected individuals.

The authors have not supplied their declaration of competing interest.