Antenatal mental health problems are well recognised to impact negatively on a woman and her developing fetus, influencing both the pregnancy outcome and quality of life. There is limited information on prevalence and risk factors of antenatal depression in Singaporean women.

To examine the prevalence of depressive disorders in pregnant women attending Singapore's National University Hospital (NUH) and the association between these conditions and socio-demographic factors.

To improve our knowledge and understanding of the epidemiology of antenatal depressive disorders in Singapore.

Pregnant women attending NUH (2009 to 2010) were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale. Patients who screened positive (scores > 13) were clinically assessed by trained clinicians using DSM IV criteria for diagnosis. The cases were then discussed with a core group of 3 psychiatrists to reduce interrater variability.

From 530 screened women, the overall prevalence of antenatal depressive symptoms was 47.8% (EPDS > 13). 12.5% of patients were diagnosed with Major Depressive Disorder, 52.1% with Adjustment Disorder, 4.5% with Anxiety Spectrum illness (Panic Disorder, GAD, OCD, PTSD), 1.1% with Bipolar Disorder and 3.8% with Other diagnoses.

After adjustment with socio-demographic variables, depressive symptoms were significantly associated with single, divorced or separated pregnant women (OR = 4.09, 95% CI = 1.39−12.09, p < 0.05) and those with three or more social relationship problems (OR = 1.68, 95% CI = 1.00–2.84, p < 0.05).

Antenatal depressive symptoms are common in Singaporean women and they are associated with identifiable risk factors such as single status and limited social support.

The Internet addiction disorder(IAD) is conceptualized by an individuals inability to control his or her use of the internet which causes marked distress &/functional impairment.

It was a cross-sectional study with aimed to find out the proportion of IAD among adolescent students & association of age,sex, educational level with addiction as well as relation of Internet addiction(IA) to different internet related activities & to determine severity of addiction.

The study was conducted purposively from 5 schools & 7 colleges of Dhaka City of Bangladesh from January to June 2011.In total of 797 students(438 were male, 359 were female, mean age:16.47 ± 1.21 years) of grade IX,X & XII were recruited. A self-administered questionnaire & Young's Internet addiction scale were applied.

Among 797 students,161(20.20%) were found as IAD. Out of 797 respondents,40.15% were school (Grade IX & X) & 59.85% were college students(Grade XII).IA were identified more among elderly adolescent(16–18 years) students(22.6%) & male students were more addicted(24.4%) than female students(15%).There was no relation found between educational level & IA. Association between information seeking behavior(p < 0.05) & chatting(p < 0.01) with IA found but no relation with e-mail, face book & Instant message were established. Among 161 adolescent students who were identified as IAD,60(37.3%) were average user,96(59.6%) were occasional/frequent problematic & 5(3.1%) had significant problem.

This study demonstrated that IA presents among Bangladeshi urban adolescent students. It will create awareness among teachers, parents, policy maker & students about this addiction.

Organic disorders can mimic all kinds of psychiatric illnesses. Some neurological diseases including front location are misleading when psychiatric manifestations represent the beginning shape or dominate the clinical. It may be dementia, mental confusion, mood disorders and psychotic disorders.

the aim of this study was to point out through the study of a clinic observation, discuss the importance of the importance of organicity to psychiatric disorders and the resulting difficulties of diagnostic and therapeutic order.

We report the case of a 72 year old man without chronic disease identified, consulted in February 2013 emergency following a head injury with loss of initial knowledge . The brain scanner (TDM) was normal. In July 2013, the patient began to exhibit behavioral problems in such wandering, memory problems, slow ideation, delusions of persecution with audiovisual hallucinations. This table psychotic moved in a very insidious and fluctuating intensity. The patient was seen in psychiatry at the worsening of symptoms. Exploration has confirmed the diagnosis of chronic subdural hematoma (HSDC) without signs of compression. The surgery consisted of an enlarged trepanation and evolution was favorable.

It appears from this case and review of the literature that various psychiatric manifestations may reveal an HSDC and that, in the elderly, neuroimaging should be systematic, even for minor symptoms. The total resorption led to the disappearance of psychiatric symptoms in most patients, but this remains a topic of discussion for patients who retain residual symptoms, even after resorption of the mass.

To evaluate the subjective well-being of a group of patients who were hospitalized at the Institute of Psychiatry (Novara), compared to the severity of illness.

Patients are evaluated at admission and discharge through self-administration of the SWN (Subjective Well-being under Neuroleptics) scale, which contains five subscales (emotional regulation; self-control; mental functioning; social integration and physical functioning) assessing patients’ psychophysical and emotional well-being, calculating a value for each subscale and a total score. The clinician fills in the CGI (Clinical Global Impression) for each patient, which provides a global judgement in three areas: severity of illness, global improvement and therapeutic effectiveness.

From June 2009, 51 patients were evaluated at admission and discharge: 26 diagnosed with psychosis and 25 diagnosed with personality disorders. Preliminary data suggest a meaningful improvement of the physical functioning in the psychotic group, a tendency to improvement of the social integration area in the personality disorders group. Among the psychotic group, the schizophrenic patients (n°=14) have shown an improvement in the self-control subscale.

Literature suggests that a high SWN score is associated with a better compliance and an early improvement of subjective well-being is a major predictor of the chance of remission. This study will allow to compare the subjective well-being evaluated by SWN with the clinical judgment of the CGI and above all if this can represent a predictor index for the compliance and the chance of remission.

Lyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.

Identification of neuropsychiatric symptoms associated with Lyme disease.

Literature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.

Since the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.

According to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.

The authors have not supplied their declaration of competing interest.

The difficulties in the clinical antidepressant treatment lead to the pursuing of more effective methods such as transcranial magnetic stimulation (TMS). Mixed findings from DLPFC targeted TMS result in the exploration of optimal stimulation location. Disturbed function of obitofrontal cortex (OFC) has been indicated in depression, which is involving in the remission of depression. However, whether it could be a more specific treating target is not tested. Simultaneously, disturbed reward network (RN) has been confirmed in depression, however, whether this could be improved by TMS treatment remains unclear.

Fourteen patients with major depressive disorder (MDD) were allocated in a four-week course of OFC targeted TMS. Motivated by the literature, before and after the treatment, the function connectivity of RN with the seed of ventral striatum was conducted. The results were also compared with the data from 33 healthy controls.

The OFC targeted TMS improved the clinical depression significantly and enhanced the function connectivity within the RN effectively. Specifically, lower baseline dorsolateral striatum connectivity predicted strong therapeutic effect of TMS on depression, while lower baseline insula connectivity predicted weak therapeutic effect on depression.

The findings offer the first experimental evidence of the therapeutic effect of OFC targeted TMS on clinical depression, enhanced function connectivity within RN might be the potential neural mechanism (Fig. 1). Lower dorsolateral striatum connection might be a reliable neural biomarker of strong responding for TMS treatment, which helps to identify the patients who will be cured by TMS most effectively.

Kleefstra syndrome [OMIM: 610253] is caused by a 9q34.3 micro-deletion or an intragenic mutation in the EHMT1 gene. Its core phenotype comprises intellectual disability, childhood hypotonia and distinct dysmorphisms. The syndrome can be associated with congenital anomalies, epilepsy, cardiac arrhythmias and a typical sleep pattern. Starting from adult age, a regressive phenotype may develop.

Further delineation of the neuropsychiatric phenotype.

Formulating a comprehensive treatment approach.

Detailed examination of two patients with EHMT1 mutation.

Patient 1, male aged 34 years, showed recurrent behavioral problems with aggression and self-injuries as well as obstipation. Elsewhere, a diagnosis of autism was established. Aged 24, he suffered from some epileptic seizures. Recently, paroxysmal atrial fibrillation was diagnosed. Neither treatment with pipamperone and risperidone nor with valproate was effective for behavioral control. Array analysis and metabolic screening did not reveal abnormalities. Whole exome sequencing revealed an intragenic EHMT1 mutation. Patient 2, female aged 53 years, was known with childhood epilepsy and developed gradual decline of general functioning with motor slowing from her third decade. In her thirties, a mood/anxiety disorder was suspected for which several antidepressants were given without any effect. Array analysis was normal. A pathogenic nucleotide deletion was identified resulting in a frame-shift in exon 21 of the EHMT1 gene. In both patients marked apathy was observed (AES = 62 and 64, respectively).

Apathy syndrome in Kleefstra syndrome should be differentiated from depression and autism. Apart from treatment with selected psychotropics, individually targeted contextual measures should always be implemented.

The authors have not supplied their declaration of competing interest.

The outbreak of the SARS-CoV-2 epidemic forced a change in the functioning of health care systems across the globe, requiring rapid adaptation to new conditions for the safe provision of services within all medical fields. General disruption has also affected the traditional program of a postgraduate training, which has been so far fixed with temporary solutions, but not given a proper evaluation in the times of big expectations and pressures from both patients and healthcare workers.

Outbreak of the COVID-19 put psychiatry trainees and Early Career Psychiatrists in an unprecedented position of responsibility for treatment of a variety of comorbidities they had no prior experience with due to closure of specialized hospital departments and limited access to regular diagnostic tools. In addition to changes in clinical practice and deployment to unfamiliar ground, rescheduling of different components of regular training, transferring most of the educational activities to distance learning, limiting professional growth by canceling most courses and conferences only strengthened the feeling of uncertainty caused by constant adjustments of the final examinations’ conditions.

The Speciality Training Section of the Polish Psychiatric Association decided to review changes forced by the COVID-19 outbreak in a traditional postgraduate training program in psychiatry.

Identified shortcomings pose questions about the necessity of a solid revision of the training in order to cope with more demanding working conditions.

Presented recommendations may be the starting point for a discussion on the programs’ evaluation across the entire region.

No significant relationships.

The authors have not supplied their declaration of competing interest.

Acromegaly is a rare, severe, life-threatening disease, with mortality twice at that normal. It is characterized by increased and disregulated growth hormone (GH) production, usually caused by a GH-secreting pituitary tumor (somatotropinoma). Pituitary lesions are supposed to alter mood and personality.

To assess point prevalence of mental disorders in patients with acromegaly.

This is a cross-sectional cohort study of 118 patients with acromegaly (aged 21-78 years) included into the Registry of acromegaly of the Moscow Region with total population of 7 million. All patients met international diagnostic criteria for acromegaly, including laboratory measurements and brain MRI. Mental disorders were diagnosed according to ICD-10 criteria; with additional use of MINI, Hypomania Checklist and cognitive battery.

In total mental disorders were found in 88/118 (74,6%) patients. 56% of all patients referred to cluster of organic mental disorders, including mild dementia, mood, anxiety, personality, asthenic and mild cognitive disorders. 4,2% had alcohol dependence, 5,1% - schizophrenia spectrum disorders. Affective disorders were diagnosed in 30%, including bipolar disorder II - 12,7%, cyclothymia - 5,1%. Neurotic, stress related and somatoform disorders were discovered in 12,7% of patients; personality disorder - in 1,7%. Mutual comorbidity among mental disorders reached 1,39.

Study performed with the large sample of patients with acromegaly shows a higher prevalence of psychopathology. This fact evidence that patients with acromegaly need special mental care.

The predominance of bipolar disorder with hypomania might be the result of stimulating effect of GH.

Psychotic morbidity significantly exceeds that in total population, which can be explained by dysfunction of dopaminergic pathways.

Alcohol misuse could be a treatable risk factor for suicidal behaviour, which is seldom approached in the emergency room.

This study aimed to evaluate the impact of alcohol misuse in an interventional follow up program of patients immediately after a suicidal attempt.

Transversal study based on a post hoc analyse of a controlled randomized study done. Epidemiological data and the impact of alcohol misuse were evaluated in relation to suicidal relapse, in compliance for the treatment and in the evolution of Beck’s scores of depression. The study took place in the Rouen University Hospital and lasted for 2 years.

A total of 228 patients, 50 (22.2%) men and 173 (78.8%) women were included. The group with alcohol misuse was composed of 31 (13.9%) patients, and the group without alcohol misuse was composed of 192 (86.9%) patients. The group with alcohol misuse had a lower employment level (n = 16, 51.6%) versus (n = 54, 28.1%) p = 0.009 and was older (mean age 41+/−12 years) than the group without alcohol misuse (mean age 31+/−13 years), p = 0.05. The group with alcohol misuse was composed of 15 (48.4%) of men, compared to 35 (18.2%) of men in the group without alcohol misuse, p = 0.0005. No statistical differences were found for evolution of the depression’s score obtained with the Beck’s scale, nor for the compliance, nor for the suicidal relapse.

Our conclusions are limited by age and sex difference among alcoholic and non alcoholic groups.

Erotomania, or De Clerambault's Syndrome, was first described in 1921. However, cases of Insane Love were long known before. Presently, this condition is classified as a delusional disorder typically affecting women. However, in forensic samples, most of these reports relate to men with violent behaviour, associated to harassing or stalking of a woman.

To present the case of a man, diagnosed with Erotomania and literature review of similar cases.

To bring awareness to the infrequent diagnosis of this condition in males and the legal implications this condition may have.

Consultation of the patient's clinical process and published articles focusing on Erotomania in men.

A 50-year-old man was referred from Court for persistently stalking a woman on the past few years. He revealed erotomanic and persecutory delusions, believing these accusations were all part of a scheme to restrain his alleged relationship.

There was a clinical improvement during hospitalization and treatment with antipsychotics. Due to the legal process in court, a forensic examination was also performed.

On the follow-up, the patient remained stabilized. He would not verbalize any delusional content, and calmly deny any inadequate behaviour. However, some of his stalking attitude remains. As many of these patients, we believe his delusion is still present, although his behaviour is more controlled with treatment. Recognizing the characteristics and course of this disorder in our patients, grants a better chance of intervention and attentiveness towards the legal implications that may arise.

The authors have not supplied their declaration of competing interest.

Lithium is a mood stabilizer used in the treatment of bipolar disorder. Lithium has recently been associated to permanent neurological damage namely persistent cerebelar dysfunction as well as peripheral and central neuropathies.

To present a clinical case of a probable Syndrome of Irreversible Lithium-effectuated Neurotoxicity (SILENT) and a review of the literature concerning this rare syndrome.

Increase awareness and knowledge of SILENT.

Psychiatric and psychological evaluation of a probable clinical case of SILENT and review of the literature using the key words “lithium neurotoxicity” and “Syndrome of Irreversible Lithium-effectuated Neurotoxicity”.

A 54-year-old female patient was admitted in our hospital due to involuntary lithium intoxication, with acute renal and cardiovascular failure, neurological, metabolic and electrolytic dysfunction in an acute confusional state and in need of dialysis. The patient clinical picture rapidly improved although, when she achieved normal lithium seric levels, it was observed a worsening of the preexisting confusional state followed by two consecutive generalized tonic-clonic convulsions and a partial convulsion. A short time after, it was recognized the development of a persistent catatonic state. It was detected urinary incontinence and repetitive, monosyllabic, incoherent, short phrased speech featuring echolalia, together with emotional lability and incongruous affect. The patient slightly improved with the introduction of anti-Parkinson's pharmacotherapy.

This clinical case raises several differential diagnoses due to its psychiatric and neurologic characteristics. We conclude that the most probable diagnosis is SILENT.

The authors have not supplied their declaration of competing interest.

Despite the four factor model of PTSD proposed in the DSM-5 (APA, 2013) has received a better empirical support than three factor model of DSM-IV (APA, 1994), some alternative models proposed can provide a better representation of PTSD's latent structure.

The current study tested the fit of seven models, including the 3-factor DSM-IV model (APA, 1994), the 4-factor DSM-5 model (APA, 2000), the 4-factor dysphoria model (Simms, Watson & Doebbeling, 2002), the 5-factor dysphoric arousal model (Elhai et al., 2012), the 6-factor anhedonia model (Liu et al., 2014), the 6-factor externalizing behaviors model (Tsai et al., 2014) and the 7-factor hybrid model (Armour et al., 2015) that combines key features of the anhedonia and externalizing behaviors models.

It expected that the 7-factor hybrid model (Armour et al., 2015) would be the best fitting model.

PTSD symptoms were assessed using the Global Assessment of Posttraumatic Stress Disorder (EGEP-5; Crespo, Gómez & Soberón, 2016) in a sample of 165 victims of different traumatic events. Confirmatory Factor Analysis (CFAs) were conducted on each of the seven models using Maximum Likelihood (ML) estimation method.

All the models tested (except for DSM-IV model) yielded an adequate fit to the data. However, 7-factor hybrid model (Armour et al., 2015) provided a better fit than other competing models.

The current findings suggest that the dimensional structure of DSM-5 PTSD symptoms may be best represented by the 7 factors proposed in the hybrid model instead of 4 factors of DSM-5.

References not available.

The authors have not supplied their declaration of competing interest.

Previous research has confirmed that various types oftrauma, related to both wartime and peacetime, can negatively affectpsychological development and promote the occurrence of mental disorders inyouth and adults. Results of previous studies in the field of post-conflictmental health suggest that certain psychological consequences can persist foryears after traumatic events.

For this reason we have decided to investigate thepresence of anxiety and depression in young people who were exposed towar-related trauma during childhood. Special emphasis is given to clinicallysignificant forms of these emotions.

The aim of the study was todetermine the differences in intensity and frequency of clinically relevantanxiety and depression in students exposed to warfare during childhood.

The study comprised 324students from Serbia and Kosovo, aged 18-25, exposed to war-related events(WREs) during childhood. We used the Generalquestionnaire, the Beck Depression Inventory I (BDI-I), and the BeckAnxiety Inventory (BAI).

Approximately 2/3 of all of the examinees had clinicallysignificant anxiety, while 1/3 had clinically significant depression. Thefemales had higher intensity of anxiety (16.22 vs. 11.6; p<0.001) anddepression (9.57 vs. 7.05; p=0.004) than males. The examinees who reported WREsfrom two or three types of events had more intense anxiety (p=0.013) anddepression (p=0.013) than a group with one or no WREs.

There is an association between WREs duringchildhood and anxiety as well as depression in adolescence, more prominent infemales.