The revision of DSM-5 and the mental disorders chapter of ICD-11 are informed by concepts of mental disorders, which share some features, and some differences.

To review the similarities and differences in concepts of ICD-11 and DSM-5

By describing the classification of psychotic disorders, we exemplify the different conceptual approaches of both classification systems.

Review of the classification of psychotic disorders in DSM-5 and ICD-11 and the underlying concepts of mental disorders.

Both systems take an anosological approach and base the classification of mental disorders on psychopathology, which takes centerstage in the clinical evaluation for classification purposes. A major difference is the role of functional impairments, which are mandatory in DSM-5, but not ICD-11. Time course criteria were harmonized and dimensional assessments were introduced in both systems. Differences in duration criteria lead to different approaches regarding brief psychotic disorders. Attenuated psychotic symptoms did not receive full diagnostic status.

Neither DSM-5 nor ICD-11 have introduced neurobiological or genetic factors into the classification of psychotic disorders. Both systems take steps towards dimensional symptom assessments, with different practical operationalizations. Some differences prevail regarding time course criteria and the handling of brief psychotic disorders, which may indicate different concepts of chronicity underlying these decisions. An important aspect was the non-inclusion of attenuated psychotic symptoms syndrome among the mental disorders, indicating that the border towards normality is still uncharted terrain in both classification systems and open for discussions about concepts of subclinical or otherwise dimensional ratings of subdiagnostic symptoms in the general population.

Over the past years multi-source-feedback (MSF) is increasingly used in healthcare systems worldwide in assessing multiple components of professional performance. Despite the current widespread available research on MSF in industry, comparatively little research exists focusing on health services. Most of the effort to date, however, has focused on developing the instruments. Insufficient attention has gone into investigating its impact on physician's performance. This study is focused on psychiatrists and change in their performance following MSF.

43 Consultant psychiatrists who have participated in two MSFs were identified. Change in MSF ratings were used as a possible indicator of feedback impact on the performance. The study compared ratings over two administrations to identify: (1) changes in self, colleagues and patients’ ratings, (2) correlation between self and others’ ratings over time, (3) impacts of feedback on self-assessments.

Significant change in colleagues’ ratings over time noted, however the self and patients’ ratings did not revealed meaningful change. Self ratings were remained uncorrelated with others ratings even after receiving the feedback. However colleagues and patients’ ratings remained correlated. Self ratings at Time 1 were predictive factor of self ratings at Time 2.

Though we identified significant change in colleagues’ ratings over time, but self and patients’ ratings did not change. The remained question is to what extent colleagues and patients’ ratings could reflect an individual's work performance. A great deal of additional research looking at MSF and impact on performance is required prior to make any guidance for beneficial feedback system.

Self Disorders (SDs) are regarded as the subjective phenotype of Schizophrenia vulnerability. The EASE (Examination of Anomalous Self-Experiences) scale is the most detailed and widely used instrument to investigate SDs, but it requires long administration times and specific training. The IPASE (Inventory of Psychotic-like Anomalous Self-Experiences) scale might be a self-administered instrument of widespread use for an easier SDs investigation.

The present study was aimed at validating the Italian version of IPASE, testing its internal consistency and usability for a first level SDs survey. A secondary objective was to confirm the correlations between IPASE, EASE, main symptom dimensions, subjective bodily experiences, symptoms of schizophrenic autism as well as levels of global functioning.

Fifty patients with Schizophrenia were administered the IPASE scale in its Italian version, the Examination of Anomalous Self-Experiences scale (EASE), the Positive And Negative Symptoms Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS) to assess global functioning, the Autism Rating Scale (ARS) and the Abnormal Bodily Phenomena questionnaire (ABPq). The internal consistency of IPASE in its Italian version was investigated and the correlations between IPASE, EASE, ABP, ARS, PANSS and SOFAS were explored.

The internal consistency of the Italian version of IPASE was high (α 0.97). The IPASE and EASE total scores were positively correlated with each other, as were many of the conceptually related subdomains of both scales. The IPASE score was negatively correlated with global functioning (SOFAS) and positively correlated with total PANSS scores and with PANSS negative domain. Moreover, the IPASE total score was positively correlated with autism dimension (ARS), while anomalies in subjective experience of the lived body were coherently correlated with higher scores in IPASE “somatization” subdomain.

The IPASE may be an easy instrument with high internal consistency for an initial investigation of SDs. IPASE domains appear to be correlated with the SDs investigated through EASE and with the main symptomatologic dimensions of Schizophrenia, in particular with negative symptoms. IPASE might also be a useful instrument for a first level investigation of subjective experiences concerning intersubjectivity and bodily dimensions.

SDs are confirmed to be a core feature of the schizophrenia psychopathology, with a adverse impact on global functioning.

None Declared

Eating Disorders are a frequent pathology, particularly among teenagers, a group characterized by its vulnerability and body dissatisfaction. Social networks (SN) can be a gateway to ED, mainly with Pro-Ana and Pro-Mia resources. Despite the aforementioned, SN can also be helpful for professionals, either as a tool of approach to vulnerable groups or as a way of interaction in patients already diagnosed.

To study the relationship between ED and SN, using the open access evidence available in Pubmed over the last 5 years.

A single-phase computerised search was carried out in Pubmed. The search terms were: (“Anorexia Nervosa”[Mesh] OR “Bulimia Nervosa”[Mesh] OR “Feeding and Eating Disorders”[Mesh] OR “Eating Disorders”[Tiab] OR “Eating Disorder”[Tiab] OR “Disorder, Eating”[Tiab] OR “Disorders, Eating”[Tiab] OR “Anorexia”[Tiab] OR “Bulimia”[Tiab]) AND (“blogging”[Mesh] OR “social media”[Mesh]). The filters applied were: “free Full Text” and publications for the last 5 years.

36.84% studied SN as a positive tool for ED. 47.37% revealed negative influence, only 44.44% focused on Pro-Ana and Pro-Mia. 15.79% provided both positive and negative arguments. The most studied SN were Twitter and Facebook.

Despite the known negative effect that SN can have on ED, they can also be used as a supportive recovery framework. They can be used to identify dangerous behaviours and intervene or as a prevention tool.

No significant relationships.

The change in symptoms necessary to be clinically relevant in obsessive-compulsive disorder (OCD) is currently unknown. In this study, we aimed to create an empirically validated threshold for clinical significance or minimal important difference (MID).

We analyzed individual participant data from short-term, double-blind, placebo-controlled registration trials of selective serotonin reuptake inhibitors in adult OCD patients. Data were collected from baseline to week 12. We used equipercentile linking to equate changes in the Clinical Global Impression (CGI) scale to changes in the Yale-Brown Obsessive-Compulsive Scale (YBOCS). We defined the MID as the YBOCS change linked to a CGI improvement of 3 (defined as “minimal improvement”).

We included 7 trials with a total of 1216 patients. The CGI-scores and YBOCS were moderately to highly correlated. The MID corresponded to 4.9 YBOCS points (95% CI 4.4–5.4) for the full sample, or a 24% YBOCS-decrease compared to baseline. The MID varied with baseline severity, being lower in the group with mild symptoms and higher in the group with severe symptoms.

By linking the YBOCS to the CGI-I, this is the first study to propose an MID in OCD trials. Having a clearly defined MID can guide future clinical research and help interpretation of efficacy of existing interventions. Our results are clinician-based; however, there is further need for patient-reported outcomes as anchor to the YBOCS.

Hearing-impaired adults with hearing aids or cochlear implants have been proved to suffer from social isolation and that the under-use of these devices is possibly related to its impact on one's body image. The aim of the research was to evaluate the presence of social phobia and body image preoccupation, handicap perception, social functioning and psychopathological distress in patients with hearing aids or cochlear implant.

A clinical group of 70 hearing aid and/or cochlear implant wearers was compared with a control group of 75 healthy adults (age: 18-65) referred to the ENT Clinic of Modena University from 01/01/09 to 01/ 09/09. Both groups were administered the following psychometric instruments: Social Functioning Questionnaire, Brief Symptom Inventory, Liebowitz Social Phobia Scale, Body Uneasiness Test. Hearing-impaired subjects were also assessed by means of the following tests: International Outcome Inventory for Hearing Aids, Attitude towards Hearing Loss Questionnaire, Hearing Handicap Inventory for Adults.

the case group statistically differed from the control group as to lower level of social functioning (p< .05), higher level of somatization (p< .01), obsessive compulsive behaviour (p< .01), interpersonal sensitivity (p< .01), depression (p< .01), anxiety (p< .05), phobic anxiety (p< .01), paranoid ideation (p< .01), psychoticism (p< .01), social phobia (p< .001) and body image preoccupation (p< .05).

Social phobia and body image preoccupation are critical aspects in determining the psychosocial well-being and the compliance, the benefit and the personal satisfaction of hearing-impaired subjects in using the hearing aid and/or cochlear implant.

The authors have not supplied their declaration of competing interest.

This paper examines the historical development of mental health services in the UAE including formation of federal laws associated with mental health and ministerial decrees. It also discusses cultural considerations in mental health practice in a society that is highly pluralistic and populated mainly by foreigners. The sharia aspects of mental health are also addressed.

The aims of the paper are to familiarize readers in above areas and encourage further work in the area of mental health in UAE.

The research is based on literature review.

All federal laws and ministerial decrees are listed and local cultural considerations and sharia laws discussed, as they are unique to his country and region.

Although mental health is traditionally neglected in this country it is developing very fast and it is essential to keep track of and encourage such growth for the benefit of consumers and mental health professionals.

The authors have not supplied their declaration of competing interest.

The COVID-19 pandemic has brought additional worries and challenges to people’s lives, with potential implications for psychological well-being.

To understand which worries and life changes have affected most the Portuguese general population during the COVID-19 pandemic and to analyse which contents are associated with higher levels of repetitive negative thinking/RNT and psychological distress/PD.

In September-December 2020, 413 Portuguese adults (69.2% female; Mean age= 31.02±14.272) were asked one open questions, with reference to the COVID-19 pandemic period: “what was your biggest worry?”; the answers were independently categorized by two researchers. Participants also filled the validated Depression Anxiety and Stress Scale and the Perseverative Thinking Questionnaire.

The most prevalent worries were about: 1) fear of contamination (oneself and others-48.7%; 2) physical and mental health and well-being (self and others)-27.2%; 3) studies and profession-13.3%; 4) uncertainty about the future-7.7%; 5) economic-financial issues-6.5%; 6) miscellaneous-3.3%; 7) no worries-0.7%. Participants who had worries of the theme 4 had the highest RNT and PD mean scores, followed by themes 3 and 5, and then themes 2 and 1. These thematic groups significantly (p<.01) differ between each other (except 3-5) and from the other groups. RNT was a significant predictor of PD (R2=37.0%, β=.609, p<.001).

People who worry about the future uncertainties, occupational activities and finances should be systematically assessed with regard to their levels of anxiety, depression and stress and they can learn to deal with the RNT as a way to reduce their psychological suffering in times of pandemic.

No significant relationships.

There is significant overlap between the cortical network involved in fearful face perception and regional abnormalities identified in patients with bipolar disorder. The primary aim of this study was to measure effective connectivity arising from Dynamic Causal Modelling (DCM) to identify differences within this network in a group of patients with bipolar disorder and controls during an affective processing task.

Functional MRI was used to record brain activations from 52 euthymic patients with bipolar disorder and 44 healthy controls engaged in a fearful versus neutral facial affect recognition task. We used Bayesian model selection to identify the best model of effective connectivity, as well as a random-effects analysis. Additionally, the endogenous connections and modulatory influences were extracted and further analyzed.

Within the network subserving fearful facial affect recognition, patients with bipolar disorder demonstrated reduced connectivity from the inferior occipital gyrus to the fusiform gyrus compared to healthy controls. Furthermore this connection when modulated by fear showed a reduction in strength in patients with bipolar disorder.

Bipolar disorder was associated with deficits early in the processing of facial affect suggesting the possibility of perceptual abnormalities being associated with the disorder.

Dr Frangou was supported by a NARSAD Independent Investigator Award

In dementia, delusions are common with prevalence up to 75%. However, erotomanic delusions, or De Clerambault's syndrome, are a rarity in dementia. To date, only six case-reports have been described in vascular dementia, frontotemporal dementia, and Alzheimer's dementia.

To present a case of De Clerambault's syndrome in an older adult diagnosed with vascular dementia.

To review available literature on De Clerambault's syndrome in dementia.

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

We report a 72-year-old female with a history of right posterior cerebral artery infarction. The patient developed a sudden onset erotomanic delusion after she met a male patient of her age during her stay in a dementia day care center. She was agitated, disorientated, presented with confabulation, and showed a dysphoric mood. On MMSE she scored 14/30, the clock-drawing test revealed visuospatial deficits. On MRI, the right occipital lobe showed an encephalomalacia. The patient was treated with sertraline 50 mg/day and olanzapine 5 mg/day. Her erotomanic delusions improved after 3 months of treatment.

De Clerambault's syndrome is a rare and poorly understood disorder with generally a poor response to treatment. Some cases were successfully treated with atypical anti-psychotics. However, further research is needed to explore the course and treatment of this delusion.

The authors have not supplied their declaration of competing interest.

In pandemic conditions, obsessive rituals such as hygiene can be considered adaptive together with the extreme measures that must be followed to avoid contagion by Covid-19, we suggest that the stress the pandemic has caused may result in an increase in the percentage of OCD symptom and severity in the Chilean population at Santiago.

Study OCD symptoms and their severity during a contamination pandemic such as COVID and quarentine, and compare them to national reports of OCD prevalence in Chile. We hypothesize that OCD symptoms would be higher in these stressfull situations.

An online voluntary and annonymous survey was carried out asking about sociodemographic variables and the Y-BOCKS scale, an OCD symptom severity scale version already validated in Chile.

497 completed the survey and Y-BOCKS scale. 241 people which is equivalent to 48% of the sample presented scores that classified them as having OCD.Off these 30% had mild, 12% moderate and 7% severe symptoms. 85% of them were inquarantine for more than 2 months.

These results are above the 2% of OCD reported at the national level. These percentages may be due to a smaller sample size, but even so, the high percentages of people with symptoms during COVID and those who were in quarentine or lockdown for 2 months or more, stand out. Future analysis and research needs to be made. We ask ourselves wether is Covid, quarentine, or both and of so, how much each pf these contribute to these high percentages of OCD symptoms observed.

The term “olfactory reference syndrome” (ORS), introduced by Pryse-Phillips in 1971, is a persistent false belief and preoccupation with body odor accompanied by significant distress and functional impairment. Nowadays, it is not a distinct syndrome and it is currently classified as a delusional or obsessive-compulsive disorder.

Review the history of ORSs classification and discuss why it should be considered as a separate diagnostic in the current health care classification systems.

Description of a clinical case of a 36-year-old man and review the published articles on ORS by using PubMed database with the keywords: “olfactory reference syndrome”, “chronic olfactory paranoid syndrome”, “hallucinations of smell”, “chronic olfactory paranoid syndrome”, “delusions of bromosis” and “taijin kyofusho”.

The published literature on ORS spans more than a century and provides consistent descriptions of its clinical features but nowadays is not explicitly mentioned in current classification systems as Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Statistical Classification of Diseases and Related Health Problems (ICD). ORS is overlap with different diagnostics such as delusional disorder, body dysmorphic disorder, obsessive-compulsive disorder, and hypochondriasis.

Right now, it is not clear how the ORSs should best be classified so we consider interesting to include it as a separate diagnosis in our set classifications, since we understand that an adjusted diagnosis is important in order to help patients and therapists to work on a treatment and to establish a more accurate prognosis.

The authors have not supplied their declaration of competing interest.

Religion plays an important role in symptoms phenomenology, attribution and management in the Arab culture. Mentally ill patients in the Arab countries tend to pass through different health care providing filters. Traditional healers form part of the informal and sometimes unofficial health care sector.

Explore the timing of local traditions contacts in regard to diagnosis and treatment, and identify types of local traditions contacts of Iraqi schizophrenic patients.

Hundred Iraqi acute schizophrenic patients, admitted to Ibn-Rushd psychiatric teaching hospital, Baghdad, Iraq, with informative informant were examined. Information list of 3 parts was prepared: 1st part asking about the contact timing with faith healers in regard to diagnosis and treatment; 2nd asking about the types of traditional faith healer contacts; 3rd was asking about the causes of illness.

22% have no any contact, 47% contact faith healer before and after, 7% before, 24% after the diagnosis and treatment. Types of traditional faith healer contacts were: Sayed 37%; visiting Emams 54%; jinn dealers 32%; Daraweesh 17%; witchcraft 3%; and reading Holly Quran 9%. Causes of illness were: life stresses 42%; patient himself 25%; poor faith and belief 14%; weak personality 11%; genetic causes 4%; witchcraft 5%; Jinn possession 11%; and wish of God 13%.

This study explores the importance of religious background in the course of diagnosis and treatment of acute schizophrenia. Psycho-education was needed to increase the awareness of publics about faith, beliefs, traditional healers, and mental illness.

Socioeconomic status (SES) are well known to be associated with mental health. Previous studies are often restricted by the use of individual SES indicators, while contextual measures aggregating multiple dimensions would present a better picture of SES in multivariate context.

The present study aims to construct the socioeconomic index (SEI) by integrating significant socioeconomic factors in predicting mental health of young adults in Hong Kong.

Data were drawn from the Hong Kong Youth Epidemiological Study of Mental Health (HKYES), a population-based psychiatric study of young people in Hong Kong. The present study exacted data of 1,164 participants who had completed baseline interviews between April 2019 to August 2020. Socioeconomic characteristics including age, gender, education years, income, expenditure, home ownership, housing type, household crowdedness and parental occupation were collected. Data were checked for the assumptions for normality, linearity and homoscedasticity before the standardized SEI were derived using Principal Component Analysis (PCA). Logistic regression analyses were performed to further examine the association between SEI and mental health outcomes.

Our results identified five significant socioeconomic factors (education years, personal income, home ownership, housing type and household crowdedness) which together explained 67.7% of the total variation. SEI was associated with depression (OR=0.671, p=.003) and anxiety (OR=0.667, p=.015) after adjusting for potential confounders.

The PCA-generated SEI took account of the multiple dimensions of SES in younger adults including education, income, expenditure and housing. The indices would provide meaningful contextual information of SES across geographical areas or different groups of interest.

No significant relationships.

The relationship of alexithymia with gambling addiction is not obvious, but it is present, as evidenced by the results of many studies. Alexithymia is likely to associate with gambling as a coping behavior to increase emotional arousal and avoid negative emotions, according to the affect dysregulation model. Alexithymic individuals experience the same spectrum of emotions as ordinary people, however, from the standpoint of psychology, psychiatry, unexpressed emotions are repressed into the subconscious, and their bodily manifestations accumulate.

We plan to conduct research to improve the medical and psychological support of patients with pathological gambling due to the presence of alexithymia.

A systematic search of the literature was run in the major reference databases including PubMed, Cochrane Database for Systematic Review, Web of Science, Scopus until 2019. All studies assessed alexithymia with the Toronto Alexithymia Scale while gambling problems were assessed mostly with the South Oaks Gambling Screen.

We assume that for pathological gamblers, specific psychotherapeutic techniques like body-centered psychotherapy could help them to differentiate feelings from bodily sensations.

The results highlight the importance of taking in the relationship between alexithymia and pathological gambling. Further studies are needed to widen the knowledge of this association.

Patients with severe mental disease have a considerably shorter lifespan than the general population. The majority of psychiatric drugs are metabolized by the liver. Cytochromes play a central role, interactions between drugs are expected. Neuroleptics are frequently associated with weight gain, steatosis development, elevation of liver enzymes and rare acute cytolytic hepatitis, particularly with clozapine and olanzapine. Mood stabilizers, like Valproate classically gives mitochondrial steatosis with potentially important damages, and also possible acute liver failure.

This case presents a 56-year-old patient, previously diagnosed of schizoaffective disorder, with chronic psychotic symptoms that showed high drug resistance. She had been treated in the past with most common antipsychotic drugs with no clinical response. While being in treatment with valproate and olanzapine, she was started on clozapine while olanzapine removed. Two weeks later she developed Acute Pharmacologic Hepatitis with mild liver failure.

Physical examination was normal. Mental exam revealed presence of delusion. Blood tests showed: hyperbilirubinemia and mil coagulopathy. Clozapine dose was reduced and valproate was suspended.

The patient showed a substantial improvement of hepatic damage. Delusions are active after 12 weeks of treatment with clozapine.

Psychiatric disorders and liver illnesses are entangled in multiple ways. Screening for liver diseases is essential in order to prevent liver complications in patients receiving psychotropic medications. Further investigation of combinations of agents such as mood stabilizers and atypical antipsychotics may yield valuable insights into the potential of combination therapies to enhance clinical outcomes in patients with Severe Mental Disease.

No significant relationships.

Dual diagnosis of schizophrenic disorders and drug abuse/dependence are increasing due to more frequent use of cannabis and cocaine. It is important to differentiate between primary schizophrenia with associate drug abuse/dependence and drug-induced psychosis. The objective is to detect neuropsychological differences between drug users and non-users in schizophrenia patients, which could be used as diagnostic tools.

We conduct one case-control study on 12 schizophrenia out-patients (10 male) with vital history of drug abuse/dependence (mainly cannabis and cocaine) and one control group of 18 schizophrenia out-patients (12 male) who never used illegal drugs (global age mean: 32.8 years; SD:7.2). It was applied one neuropsychological battery sensitive to the neuropsychological deficit frequent in schizophrenia: WAIS-III, BADS, WCST, Colour Trails, Trail Making A and B, BVRT, California Verbal Learning Test (spanish version: TAVEC). Variables was summarized determining Z values and principal components. It was constructed one Logistic Regression Model to determinate the better predicting model of drug use state.

The resultant model included two predictors: WAIS Perceptive Organization Index and Trails Component. The prediction formula for Ln Odd Ratio of drug abuse/dependence group is: -13.83 + 1.09 (Trails Z score) + 0.16 (WAIS Perceptive Organization Index). It explains for 63% of the variance (p = 0.001). The ROC curve for using in diagnose was constructed.

Neuropsychological diagnosis can contribute to the differential diagnosis of schizophrenia in dual pathology. The better functioning in visual-spatial tasks increases the probability of psychosis related with drugs use.