This is a presentation of the FEP of a 23 y.o. patient. The patient had a Duration of Untreated Psychosis (DUP) of 6 months and Duration of Untreated Illness (DUI) of six years. The therapeutic response and the adverse effects of Paliperidone are being described.

To investigate the tolerance of Paliperidone in a patient with FEP.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments and investigations took place.

Upon admission the patient appeared guarded. She also presented with weight loss and dehydration. Initial PANSS score was 173, positive subscale 41. The patient was initially treated with monotherapy 6mg of Paliperidone. However, the heart rate was around 100 bpm culminating as high as 156 bpm. The ECG indicated sinus tachycardia. The patient presented with serious EPSs and diarrhea. Simpson-Angus Scale score 10. Metoprolol 25mg was prescribed twice a day. The clinical team proceeded in cross titration replacing Paliperidone with Olanzapine. A brain CT scan was also performed, unremarkable. After 10 days of therapy the PANSS score reduced to 102, positive subscale 21.

Initial sinus tachycardia is a common adverse effect of Paliperidone. However in this case the tachycardia was refractory in time even after the 7th day, making an alternative SGA trial necessary.

No significant relationships.

This study examines the occurrence and correlates of somatization in a sample of adult Ethiopian immigrants and refugees residing n Toronto, Canada.

A random sample of 342 adult (≥ 18 years of age) Ethiopian immigrants and refugees in Toronto completed structured face-to-face interviews. The Diagnostic Interview Schedule (DIS) Somatization Disorder Module was used to collect data on somatic symptoms. The Composite International Diagnostic Interview (CIDI) was used to assess major depression and generalized anxiety disorder.

Nearly two-thirds of the study participants reported having had at least one somatic symptom, and 5% reported experiencing medically unexplained symptoms in the 12 months preceding the interview. Individuals with major depression had significantly increased number of somatic symptoms compared to those without major depressive disorder. In a multivariate linear regression analysis, controlling for major depressive disorder, a higher level of somatization was associated with older age, pre-migration trauma, and post-migration stressful life events, and limited English proficiency.

The findings of the study suggest that somatic symptoms are prevalent among individuals in cross-cultural transition and symptom level was associated with pre-migration trauma, post-migration stressors and mental disorder, particularly depressive disorder. The data also indicate a need for primary care physicians to routinely screen immigrant minority clients who present with somatic complaints for common and treatable psychiatric conditions, such as depression. In minority immigrant communities, somatic symptoms may reflect psychiatric problems.

Schizophrenia and other serious mental illnesses (SMI) are most accurately conceptualized as chronic conditions, in which pattern of functioning rather than diagnosis is often most important in determining what services are needed at any given time. People with SMI have lost the ability to carry out daily tasks, live independently, work, have interpersonal relationships, and engage in leisure pursuits. Much of the focus of treatment is based on needs assessment in these areas rather than on the diagnostic category.

To demonstrate how WHO's International Classification of Functioning Disability and Health (ICF) can provide a framework for treatment planning, defining goals, assessing progress and outcomes, and allocating resources for people with SMI.

To analyze the ability of the ICF to reflect the functional problems, treatment goals and outcomes of major psychosocial rehabilitation approaches for people with schizophrenia and other forms of SMI.

Extended clinical examples will be provided to illustrate the potential application of the ICF in this context.

The goals and outcomes of psychosocial rehabilitation approaches including training related to social skills, independent living skills, occupational skills, and illness/wellness management and other approaches such as family-based treatment, neurocognitive therapy, and environmental engineering are a good fit with the conceptual structure, content and descriptive, individualized nature of the ICF.

The ICF provides an internationally recognized basis for the specification of treatment goals, evaluation parameters, and health care outcomes, including specific characteristics of mental disorders and broader functional issues likely to be treatment's most important goals.

The Mental Health Assessment Unit (MHAU) isa gateway between community services and in-patient services. It aims to provide an acute setting in which to assess patients within 72 hours, with the view to reducing in-patient hospital admissions. We aimed to ascertain the number of referrals made to the MHAU and admissions over a one month period. The presentation and length of stay was investigated and the diagnosis and follow up plans made were explored.

Data was collated from a one month period. Crisis and home treatment team (CRHT) notes were reviewed.

100 referrals were made to the MHAU; 48 patients were admitted. 25 patients had care coordinators. In the majority of cases the source of referral was through the Emergency Department. There was a range of presenting complaints.Diagnoses included a wide variety of nature and severity. Average length of stay was 2 nights. Patients deemed to require in-patient management had shorter length of stay with swift transfer to treatment units. Shorter stays were also associated with milder degrees of illness. Longer length of stay was associated with more complex illness.

37 patients were discharged home, 11 were transferred to in-patient treatment units. Most patients discharged home were followed up by the CRHT.

5 patients were admitted to the MHAU more than once. This may represent a subgroup of more complex patients.

We recommend study into patients’ experiences with care coordinators at times of need. We also plan to re-audit for a longer time frame.

To examine the risk of depression and anxiety in MS patients in the post-diagnostic period by using clinical screening instruments and a diagnostic structured clinical interview.

A population of 134 MS patients was examined for the risk of depression and anxiety in the post-diagnostic period of MS using the clinical screening instruments Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Within six weeks of diagnosis, patients with cut-off > 12 for BDI and > 7 for HADS were offered a clinical structured interview using the Schedules for Clinical Assessment in Neuropsychiatry/SCAN Version 2.1.

The prevalence of depressive symptoms and depression in the post-diagnostic period of MS was 49.2% when using the screening instruments, but only 15.2% when using the SCAN interview. For anxiety, the prevalence was 3.4% for both the screening instruments and the SCAN interview in the post-diagnostic period of MS.

MS patients have a risk of depression and anxiety in the post-diagnostic period of MS, but it is crucial to consider which tools to use in a clinical setting to investigate depression and anxiety in MS patients.

The authors have not supplied their declaration of competing interest.

Survivors of suicide are generally supported by many kind of interventions focused on containing the pain and the grief of the loss at the most. The holding capacity of these approaches is essential but the experience taught us that survivors need more than just support. In many cases there is the possibility to work on the resources they have to go beyond and to resolve the dynamics that the loss had let emerge.

Aim of this paper is to present an experience of group psychotherapy with survivors of suicide.

The group was made of 6 survivors, weekly sessions, 12 in total, 1h 30m each, 2 psychotherapists with more than 5 years of clinical experience focused on suicide. The approach to the group was to understand and to resolve the dysfunctional dynamics that each of them had with the suicide and/or with the people around (family, parents, friends and so on) before and after his or her death.

The emerging and the comprehension of the dysfunctional dynamics helped the survivors to manage in a better way anguish and pain, resolving the grief and mostly to find the possibility of beginning again a life even with such a dramatic loss always present.

The approaches to help the survivors of suicide are not only supportive. The elaboration of the dynamics that the loss had enhanced can require a targeted psychotherapy as our model of group psychotherapy showed.

As various studies show, women after mastectomy are accompanied by many problems in the sexual sphere; it considerably lowers their quality of life. Goal of the study is to describe the relationship between the illness as well as the treatment of choice and the sexuality of Polish patients. Another goal is a comparison of the study results with results obtained in similar studies in Europe.

The target group of 300 women after mastectomy is in the process of assessment. The subjects are recruited among Polish patients diagnosed and treated at the Department of Clinical Oncology, Cracow University Hospital in Cracow, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw and its branches in Katowice and Cracow.

The following questionnaires are used: Changes in Sexual Functioning Questionnaire (CSFQ – F – C), Body Image Questionnaire (KOC-BR), Sexual Interaction Inventory (SII), Quality of Life Questionnaire QLQ – BR23. Questionnaires were supplemented by questions related to socialeconomic status and oncology treatment.

The type of treatment has a major impact on patients’ health, including sexual health. During chemotherapy, hormonal therapy, changes in mood and appearance of patients are present, which has an impact on both self-image of women after mastectomy, as well as the relationship with their partners. Mastectomy patients feel less attractive, less likely to engage in sexual activities. They have ambivalent feelings about their body image and sexual attractiveness.

The prevalence of Human Herpesvirus 8 (HHV8) has never been investigated in schizophrenic patients.

This study aimed to assess the prevalence of HHV8 serum antibodies in schizophrenic patients and in healthy controls.

During a 24 months period, we consecutively enrolled 108 patients meeting DSM-IV criteria of schizophrenia, in psychiatry department of Sousse Farhat Hached hospital (Tunisia). We also enrolled 108 controls among consenting blood donors. They were age and sex matched and free from any psychotic disorder as screened by MINI-Plus.

Psychopathology and severity were measured using PANSS, BPRS, SANS, SAPS and CGI. Sera samples were obtained from patients and controls and then analyzed for the presence of anti-HHV8 antibodies (anti-HHV8) using a sensitive indirect immunofluorescence assay to latent and lytic HHV8 antigens.

A significantly higher prevalence of anti-HHV8 in schizophrenic patients than in healthy controls was found (28.7% vs. 14.8%, p = 0.01). Marital status, educational level, professional activity, poverty, promiscuity, number of children, sexual behavior or presence of risk factors of blood transmission were not associated with HHV8 prevalence (p > 0.05). However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms (SAPS score) (p = 0.01) and the severity of illness (CGI score) (p = 0.02).

To our knowledge, this would be the first report of high HHV8 prevalence in schizophrenic patients, which support the role of this virus in the pathogenesis of schizophrenia. To go on further with this hypothesis, more investigations of HHV8 in schizophrenia are needed.

Reports in the medical literature describe several cases of acute onset psychosis as a result of hypothyroidism, and a small number related to radioactive iodine treatment (RAIT). The effectiveness of RAIT in the therapy of differentiated thyroid cancer depends on a sufficient TSH level elevation obtained by discontinuing thyroid hormone replacement therapy.

Describing a case of new-onset psychotic disorder in a 42-year-old woman following a RAIT session, one year after total thyroidectomy for papillary thyroid carcinoma developed on multinodular goiter.

Identifying a relation between the psychosis onset and the therapeutic protocol the patient underwent for the thyroid disease treatment.

We present the case of a patient with a medical history of thyroid disease, secondary posttraumatic epilepsy and minor thalassemia; the clinical and paraclinical evaluations; the psychiatric presentation, treatment and evolution.

The overt psychotic symptomatology developed in this case a few days after RAIT and led to an emergency psychiatric hospitalization, the laboratory findings showed a TSH value of 75 microunits/ml. The psychotic episode remitted after a month of antypsichotic medication and levothyroxinum replacement therapy. The patient has been receiving psychotropic medication for a year, during which she was readmitted for a depressive episode (6 months after first discharge).

The patient's psychotic disorder developed after a period of thyroid hormone replacement therapy discontinuation and consecutive to the RAIT session, which indicates that in susceptible individuals there is a risk for psychosis with this therapeutical strategy.

It is widely known comorbid Bulimia Nervosa (BN) with Borderline personality disorders (BPD). This is associated with worse prognosis and resistance to pharmacological and psychotherapeutic treatments. In integrated treatment, both disorders are addressed, not being frequent psychotherapy groups that address only the personality traits. Some studies have proposed the brain basis of psychodrama intervention in both pathologies.

To highlight the clinical effectiveness of adding a nonverbal orientation (psychodrama) to the treatment of BN patients; to specifically address personality traits, by presenting a clinical case. We rely on studies.

Clinical case: 42-year-old woman patient with BN (DSM-5) severe degree, BITE: Symptoms scale = 28; S. Severity = 13; and BPD (7 DSM-V); MCMI-III: BPD = 115 She is incorporated into a day hospital with integrated and multidisciplinary approach: psychotropic drugs, individual, group and family psychotherapy. This patient is added to an open psychodrama group; where he works exclusively personality pathology, during one year.

Improvement was observed in BN (she switched to intermediate grade); BITE: Symptom scale = 23, S. Severity = 8; also improves BPD criteria of DSM-V = 4 (minimum = 5) MCMI-III: BPD = 104.

(1) Psychodrama psychotherapy groups to treat Bulimia and BPD could provide an added clinical improvement in both pathologies.

(2) Insufficient RCTs compared to other models of psychotherapy (mentalizing, interpersonal, dialectical behavior) do not allow to speak even scientific evidence of psychodrama.

The authors have not supplied their declaration of competing interest.

Social interactions dysfunctions make up core symptoms of many mental disorders and have been extensively studied through cognitive paradigms gathered under the concept of social cognition. Nevertheless, a growing body of literature have demonstrated that motor coordination is an important feature of these human social interactions but has been little studied in the context of mental diseases.

In this study, we propose to compare the processes of inter-agent coordination in healthy and socially impaired clinical populations (e.g. schizophrenia and social phobia patients).

20 schizophrenia and 20 social phobia patients were compared to 20 healthy subjects using an hand-held pendulum paradigm in intentional and unintentional interpersonal motor coordination, with different leadership conditions. All participants had psychopathological and neuropsychological evaluations.

Our results demonstrated that each group of subject was characterised by specific signature concerning interpersonal motor coordination. More specifically, instability of the coordination and temporal delay between patient and controls revealed that schizophrenia impaired intentional coordination but not spontaneous non-intentional coordination whereas social phobia only affected leader conditions.

Taken altogether, these preliminary results give evidence that motor control through motor coordination behaviours is a fundamental part of social interactions deficits in schizophrenia and social phobia. These results lead us to examine if the evaluation of motor coordination during a social interactions could help to discriminate the deficits in social interactions and to propose specific therapy for their rehabilitation.

This research was supported by an Agence Nationale de la Recherche grant (Project SCAD # ANR-09- BLAN-0405-03).