It is known that antipsychotic drugs can increase prolactinaemia, we report a case in which the use of aripiprazole after treatment with paliperidone helped regaining normality levels.

During treatment with PALiperidone12 mg/day the patient, a 27-year-old female diagnosed with borderline personality disorder, developed hyperprolactinaemia with galactorrhea and menstrual disorders. During hospitalization, aripiprazole is introduced while paliperidone is progressively decreased. Antipsychotic were prescribed because delusions of reference and auditory pseudo-hallucinations arose suddenly in a woman without history of previous psychotic breaks. Before treatment with aripiprazole, prolactinaemia was 156,96 ng/mL (pregnancy test was negative) and after stopping, paliperidone was 23,60 ng/mL.

If hyperprolactinaemia symptoms appeared (galactorrhea…), aripiprazole is a good option if antipsychotic treatment is required. In this case, paliperidone was decreased slowly, while aripiprazole was increased, until minimum effective dose was reached.

Hyperprolactinaemia is a common side effect in antipsychotic treatments and if symptoms appeared aripiprazole is a good option.

The authors have not supplied their declaration of competing interest.

Is to examine possible environmental risk factors in children with autism spectrum disorder versus controls. Also, to assess the levels of trace elements and heavy metals in hair and urine in both autistic and control groups.

The participants were 25 Autistic Spectrum Disorder (ASD) Saudi children (3–9 years) according to DSM IV criteria.

A control group of 25 children was age and sex-matched. All autistic children were subjected to a parental semi-structured psychiatricl interview. the severity of autistic symptomatology was measured by the Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). Both groups were subjected to the Questionnaire on Exposure to Heavy Metals, Physical Symptoms, and Child Development. Hair and baseline urine samples were taken from both groups and sent to the Micro Trace Minerals Gmbh, Germany.

By comparing the ASD Group to the Control Group, we found a statistically significant difference in the mean hair levels of arsenic, cadmium, barium, cerium, lead, magnesium and zinc.

There were also statistically significant differences in the mean urine levels of Aluminum, Barium, Cerium, Mercury, and Lead, Copper and Germanium.

An agreement was found in both specimen (hair and urine) for barium and lead.

Taking care of a child with Autism has been shown to place a significant burden on the caregiver's, especially mothers (Khodabakhshi Kooalee, 2008).

Propose of this study is to identify mental health distress in mothers with Autism children.

50 mothers who had a child with Autism (APA, 2002) and 50 mothers who had not a child with Autism (control healthy group) selected in present study. A total 100 mothers were answered General Health Questionnaire (GHQ) Persian version. The mean of age of children was 10.50 years old.

The results indicated health -related distress (GHQ) was markedly increased in comparison to healthy controls. Mothers with Autism children reported high level of depression and Anxiety disorder than healthy group. Also, 66% of mothers reports very low level social function.

According to the results, mothers with Autistic Children experiences high level of stress and mental health problems. It is noteworthy to noted, the psycho-educational family, social network and supportive psychotherapy are offer to these mothers and other member of family.

The author has not supplied his declaration of competing interest.

According to the literature, cognition may be more preserved in late-onset schizophrenia (LOS) compared to early-onset schizophrenia (EOS), but data are limited.

To compare performance on cognitive tests in LOS and EOS.

LOS patients (n=14, mean age 58.1±8.2, 13 females, illness duration 1.07±1.5 years) and age-comparable controls (n=17, mean age 55.3±7.8, 12 females), EOS patients (n=25, mean age 20.7±3.9, 25 males, illness duration 0.75±0.62 years) and age-comparable controls (n=15, mean age 22.9±2.3, 15 males) underwent the Brief Assessment of Cognition in Schizophrenia (BACS) comprised of six subtests: Verbal Memory, Digit Sequencing, Verbal Fluency, Token Motor Task, Symbol Coding, and Tower of London. The Mann-Whitney U test with Bonferroni correction for multiple comparisons was applied (p <.05/8, i.e. p <.006).

Compared to LOS, EOS patients had lower score on Verbal Fluency (VF): U=78, p=.004; mean T-scores are 43.5±9.5 and 33.6±12.6 for LOS and EOS, respectively. Additionally, we compared VF performance in each clinical group with age-comparable controls and revealed significantly lower performance in both LOS (U=37.5, p=.001) and EOS (U=56.5, p=.000).

Performance on VF is deteriorated in clinical groups, but may be more intact in LOS compared to EOS. This result is of particular interest because low performance on VF is considered as a cognitive endophenotype of schizophrenia. Performance on VF requires preserved executive functions, language, and processing speed. Our results are in line with the idea that LOS and EOS may be different subtypes of schizophrenia. Limitation of this study is that the clinical groups are not sex-matched.

Schizophrenia is a serious disorder that influences all life aspects of the patients. The most important goals in schizophrenia are remission, recovery, improving psychosocial functioning and quality of life, which can be influenced by different factors, especially insight.

To evaluate the awareness of illness in Romanian patients diagnosed with schizophrenia and to determine the predictive role of insight.

This study wants to highlight the importance of the evaluation of insight in psychotic patients, taking into account that awareness leads to compliance with treatment, decreased rate of relapses and rehospitalization and a better prognosis.

Overall, 80 patients (44 males and 36 females) recruited from first and second psychiatric clinic Cluj-Napoca, diagnosed according to ICD-10 and DSM-V criteria with schizophrenia and acute psychotic disorder participated in this study. A semi-structured interview collected demographical data. Psychotic symptoms were evaluated using PANSS, severity of the disease using CGI and insight using SUMD.

Our results showed that the most important predictive factors for the evolution were: level of insight (r = −0.41 P < 0.01), presence of family history (r = 0.24 P < 0.05) and belonging to urban areas (r = 0.23 P < 0.05). The level of insight explained 16% of variance of improving psychotic symptoms during hospitalization.

The awareness of illness is one of the predictive factors for long-term schizophrenia and the best predictive model of disease progression is composed of variables SUMD total and PANSS total on admission.

The authors have not supplied their declaration of competing interest.

Patients with bipolar disorder (BD) frequently experience residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life (QOL).

* To evaluate the QOL of euthymic patients with BD compared to healthy controls (HC). * To identify factors associated with its deterioration.

This is a comparative and analytical study, conducted over 3 months, involving 30 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 34 HC. General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

The mean ages of BD patients and HC were 44.17 years and 40.1 years, respectively. Compared with HC, patients with BD had decreased overall SF-36 scores (53.73 vs 73.78; p=0.000) and decreased physical and psychological subdomain scores (p=0.001; p=0.000). The study of the relationship between the dimensional average scores and different variables revealed correlations between; physical health problems and somatic disease (p=0.021) and unemployment (p=0.001), impaired general health and somatic disease (p=0.02) and psychotropic association (p=0.021), emotional health problems and psychiatric family history (p=0.023), pain and psychotropic association (p=0.031), and impaired global QOL and psychiatric family history (p=0.05).

Our results confirm the impairment of the QOL of patients with BD even in euthymic periods. Many factors have been associated, including demographic and clinical variables. The improvement of QOL is to consider these factors in the management of these patients.

Poorer metacognitive abilities are recognized as strong predictors of social functioning deficits in individuals with schizophrenia.

The aim of the current study is to examine metacognitive functioning in people with schizophrenia and to explore correlations between metacognition, symptoms and general functioning.

It was a cross-sectional study involving outpatients diagnosed with schizophrenia and followed in the psychiatry “C” department at Hedi Chaker university Hospital, in Sfax -Tunisia, between may and december 2018. Sociodemographic, clinical and therapeutic data were measured using self-reported questionnaires, and metacognition was assessed with the Metacognition Assessment Scale – Abbreviated version (MAS-A). The general functioning was measured with The Global Assessment of Functioning (GAF).

A total of 74 participants participated in the study. The average age was 34.1 ± 11.8 years and the sex-ratio was 1.6. The average score of global assessment of functioning was 49.39±10. Means and standard deviations on MAS scores were as follows: self-reflectivity 4.18 (1.46), understanding of others’ minds 3.20 (1.06), decentration 2.5 (1.8), mastery 2.54 (1.85), and the MAS total scores 12.42 (6.17). The results indicate that poor social functioning is associated with metacognitive difficulties (r=0.27, p<10-3). Greater metacognition was significantly correlated with fewer negative symptoms (r= -0.62, p<10-3), but metacognition was not significantly correlated with positive psychotic symptoms, cognitive disorganisation, excitement or emotional distress

These findings underscore the importance of interventions designed to enhance the patients’ metacognitive capacities, that is, the more proximal capacities linked to poorer social functioning.

Depression is a serious illness that affects health, family and professional life of many people of all sectors of society. It also affects medical students, regardless of their geographical location. The stress of studying and the great responsibility awaiting students immediately after graduation may predispose the occurrence of depression.

To compare the level of depression among medical students from different countries.

Medical students from different parts of the world were asked to fill in an electronic form containing the Beck Depression Inventory(BDI). The form was created separately for each country, using official translation of the BDI, approved by the competent psychiatry association. The control group were students of the University of Technology. Google Drive and Statisticav10 were used for statistical analysis.

The form was filled in by 752 medical students from 7 countries: Poland-218, Taiwan-227, Germany-64, Portugal -102, Mexico- 65, Indonesia-45, Spain-31. The control group consisted of 195 students. The average score of the BDI of Polish medical students was 14.0+/- 10.0 points. The score of the BDI of the control group was: 9.5+/-8.2 points. The score of the BDI of the other countries: Taiwan-10,02+/-7,48, Germany- 7,57+/-5,92, Portugal-7,01+/-7,41, Mexico-9,85+/-8,05, Indonesia-11,33+/-8,96, Spain-7,24+/-6,92. There was statistically significant differences(p<0.05) between groups in terms of the mean score of the BDI.

Depression is a serious problem among medical students regardless the part of the world they are studying. A proper monitoring of depression is required, as well as rapid and appropriate help for those who suffer from it.

Little is known about the predictive association between victimization among children and adolescents with depression and suicidal ideation in adults. The aim of our study was to examine whether victimization in childhood and early adolescence increases the likelihood of self-harming in adults.

The sample consisted of 82 patients, 65 females and 17 males, aged 38.02 ± 11.05 years on average, hospitalized in Daily hospital. The juvenile victimization questionnaire (JVQ), defense style questionnaire (DSQ) and Beck depression inventory were applied in 48 patients following suicide attempt and in 34 patients who were on psychotherapeutic treatment due to various life crises not resulting in suicide attempt. According to indication, we excluded patients with psychosis, substances abuse and dementia. The examinees of both groups were matched by age, education, professional and marital status. Comparison of the patient groups was done by t-test.

The suicide attempters were depressed (Beck depression inventory 19.13 ± 10.20), using immature defense mechanisms (P < 0.005). The JVQ established statistically differences in two general areas: Peer and Sibling Victimization (P < 0.001) and sexual victimization (P < 0.05).

Even after controlling for lifetime factors known to increase the risk of suicidal behavior, adults who reported peer and sibling and sexual victimization in childhood were still more likely than other adults to attempt suicide later in life. Psychotherapists must understand that history of childhood victimization is important to put suicide attempt in a psychodynamic context which can help them in their work with patients’ psychotherapeutic crisis intervention following suicide attempt.

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

Limbic encephalitis is an inflammatory disorder, commonly characterized by psychiatric features and cognitive impairment. It used to be considered a rare disease, usually paraneoplastic, with poor prognosis. Recent findings of membrane-surface directed antibodies, including anti-VGKC (Voltage-Gated Potassium Channels) antibodies, showed a substantial proportion of cases with no association with any malignancy and better prognosis.

A 56-year-old woman was admitted to the psychiatric ward in Nov/2007, with an acute onset of psychomotor retardation and agitation periods, apathy and nihilistic symptoms. She improved very slowly with lorazepam, clomipramine and quetiapine.

In Jun/2014, she was admitted again to the psychiatric ward with acute onset of intense headache, confusion, insomnia, agitation and prejudice ideas. There was a clinical deterioration with mnesic deficits, catatonic stupor, autonomic dysfunction and seizures. Complementary exams revealed: ESR>120mm; hyponatraemia; acelular CSF with slightly elevated protein; EEG with slow base activity; Brain MRI with diffuse cortical atrophy and multiples subcortical hyperintensities of frontoparietal regions on FLAIR and T2 sequences; and positive anti-VGKC antibodies. Initially there was a poor transitory improvement with high-dose steroids and intravenous immunoglobulins. After 5 months, she did plasmapheresis with relevant clinical improvement.

About 80% of anti-VGKC encephalitis patients have clinical improvement following prompt treatment. In this case, there was not as good improvement as initially expected probably because of the prolonged duration of disease prior to effective treatment. Given the good prognostic outcome with prompt initiation of immunotherapy, early recognition and diagnosis of this rare neuropsychiatric syndrome is crucial.

Impulsive behaviours (impulse control deficit) and compulsive behaviours (over control) have been considered at the core of different disorders, but patients often present with mixed features of impulsive and compulsive behaviours (i.e. patients with OCD and borderline personality disorder). Therefore, a clinical spectrum from impulsivity to compulsivity could exist, in which obsessive compulsive disorder (OCD) and impulsive personality disorders (borderline personality disorder, antisocial personality disorder…) would be the endpoints.

Regarding treatment, SSRI have demonstrated high efficacy in the treatment of both impulsive and obsessive-compulsive symptoms. On the other hand, topiramate has been described as an effective agent in treating impulsive behavior.

The aim of this study is to test the hypothesis that coadjuvant treatment with SSRI and topiramate would improve the outcome of patients with comorbid OCD and impulsive behaviour disorders.

We will describe two clinical cases admitted to our Psychiatric Hospitalization Unit. Case 1 is a 39 years old female diagnosed with OCD, borderline personality disorder and alcohol dependence and case 2 is a 38 years old male with OCD, mixed personality disorder and cocaine abuse.

Treatment with topiramate (range dosage: 250-400 mg/daily) as well as SSRI (paroxetine 40 mg/daily- case 1; sertraline 200 mg/daily-case 2) improved affective instability and impulsive symptoms in both patients. Topiramate was well tolerated without important side effects.

Topiramate could be an interesting alternative in the coadjuvant treatment of OCD with impulsive features.

Considerable evidence shows that a patient who is involved in determining the treatment approach is most likely to comply with treatment.The aim of this study was to identify until point the clinicians talk about the neuroleptic medication(NM) and assess patients' beliefs about treatment.

In this cross sectional study we use a convenience sample of patients with schizophrenia attending in the mental health departments of three general hospitals in Lisbon great area. Data is being collected through individual interviews. We have applied clinical and socio-demographic questionnaire and additional measures to assess symptom severity, treatment adherence and attitudes towards medication.

Thirty eight subjects with schizophrenia met the inclusion criteria and were interviewed. Variables of interest focused on experience of communication between doctor and patient about medication side effects, therapeutic alliance, treatment adherence and beliefs about medicines.71% of patients reported that doctors did not talk about how to deal with side effects of medication and 65%think that neuroleptic drugs have more side effects compared to other drugs.55.3% of patients think that if the clinicians had more time with patients, prescribing fewer drugs.

The clinical-patient communication is one of most important factors in rehabilitation outcome. For this reason, it is important for the patient that the doctor clarifies all your doubts and beliefs about NM in order to promote recovery. The clinical-patient communication can help the patient to identify and manage any side effects and contribute to the development of effective strategies to prevent relapses. Results suggest that forming a strong clinical-patient communication may enhance rehabilitation among persons with schizophrenia.

Ablify Maintena (AM) is a long acting injection of aripiprazole that received marketing authorisation in the UK in January 2014. It is costly compared to first generation antipsychotics (FGAs) LAIs and there are no robust trials comparing AM with FGAs. We examined the effectiveness and use of AM in a mental health trust.

We identified all patients prescribed AM in North Staffordshire (population: 470,000) since launch and examined records for demography, diagnosis, bed and medication use. We examined the effectiveness of AM using a mirror image design.

Thirty patients received AM in a time frame allowing a 1-year follow-up. Sixty-nine percent were male and the mean age was 39 years. Over half were detained under the 1983 Mental Health Act and 30% were inpatients on a psychiatric intensive care unit when AM was started. Twenty-eight patients had a psychotic diagnosis. There was a significant reduction in bed occupancy (63 v 6 days, P = 0.0001) and admissions (1.6 v 0.5, P = 0.0001). The median dose was 400 mg. Lack of effectiveness/poor adherence with prior treatments were the main reason for starting AM in 84%. Eighty-six percent of patients clinically improved on AM. Blood parameters were in the normal range.

Within the limitations of the methodology, our results show a reduction in psychiatric bed use in the year following AM initiation on an intention to treat basis. The reduction in bed use equates to a minimum annual saving of £14,250 per patient. AM at the median study dose costs £2645 per year.

The authors have not supplied their declaration of competing interest.