Although rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2].

We report two cases of antidepressant withdrawal induced mania.

Clinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation.

Case report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely.

Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic.

Psychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon.

The authors have not supplied their declaration of competing interest.

Suicidal behaviors are increasing in our country and they can be influenced by several factors such as social and cultural factors. It is important for physicians to better elucidate the risk factors in order to develop better strategies for prevention and management.

To determine socio-demographic and clinical features in Tunisian patients who committed suicide attempts.

Retrospective and descriptive study using medical files of patients referred to the outpatients clinic of Razi hospital. Included patients have made a suicide attempt in the period from january to september 2014. Socio-démographic and clinical features were collected.

Thirty-three patients were included (19 men and 14 women). The mean age was 30.6 years.

Most of these patients were single (n=20; 60.6%), unemployed (n=19; 57.6%), with a low education level (n=19; 57.6%) and a low financial income (n=18; 54.5%).

Nine of our patients went to jail (27.3%) and 8 had a personal history of suicide attempt (24.2%).

Eighteen patients had addictive behavior (54.5%) and 7 of them were addicted to many substances (21.2%).

Most prevalent psychiatric disorders in our population were adjustment disorder (57.6%) and depression (39.4%).

Personality disorders were found in 18 patients (54.5%).

57.6% of patients used drugs for their suicide attempts

Four patients were hospitalized and 82.2% of patients were lost afterward.

Suicidal attempts were associated with a disturbed and unsettled social and familial life leading to personality disorders. Furthermore, we noticed the high prevalence of addiction behaviors and bad treatment compliance.

Most children experience some degree of fear during their development. Excessive fears can create serious obstacles to children. The aim of this study was to identify the most common fears in a sample of children and adolescents and examine the socio-demographic correlates of fears.

This cross-sectional study was conducted during the period July 2010 to February 2012 at Public and Private Schools of the Ministry of Education and Higher Education, in Qatar. Out of 2188 students approached, 1703 students agreed to participate in this study, with a response rate of 77.8%. The questionnaire includes socio-demographic information, academic performance, behaviour at home and various fears.

More than half of the children experienced fears (56.7%). Most of them were in the intermediate level, 12–15 years old (46.1%). Overall, reported fears were significantly more frequent in girls (62.6%) than boys (37.4%) (P < 0.001). A significant difference was observed between girls and boys who experienced fears in their age group (P < 0.001), education of mother (P = 0.04), household income (P = 0.008) and academic performance (P < 0.001). The most frequent reported fears were fear of someone dying in the family (85.2%), parents getting divorced (84.5%), breaking religious law (82%), being kidnapped (78.2%), family members ill (78%) and dying (76.7%).

The study findings revealed that fears were highly prevalent in Arab children and adolescents in Qatar. Girls reported more fears than boys. There was a significant difference observed between girls and boys in their age group and academic performance for the reported fears.

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

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.

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.

The increased prevalence of metabolic syndrome in people with severe mental illness (SMI) is well documented. The International Diabetes Federation (IDF) criteria for metabolic syndrome are three or more of the following: waist circumference ( 80 cm (females), (94 cm (males) OR BMI (30, triglycerides >1.7 mmol/l or on treatment, raised blood pressure (systolic >130 mg Hg or diastolic >85 mm Hg, OR on treatment for hypertension), raised fasting blood glucose (.5.6 mmol/l) OR diagnosed type II diabetes) and reduced HDL cholesterol (< 1.03 mmol/l) OR on treatment.

The IMPACT RCT is a Department of Health funded trial of a health promotion intervention (HPI) delivered by care co-ordinators to people with SMI across South London, Kent and Sussex. The intervention is focussed on improving health by addressing modifiable lifestyle factors such as diet, physical activity, obesity, cigarette smoking, alcohol and substance use.

We investigated the prevalence of metabolic syndrome in a sample of 212 patients for whom we had relevant baseline measures.

Data (weight, BMI, waist circumference, blood pressure, fasting HDL cholesterol, triglycerides and glucose levels) were analysed on 212 patients.

45% of the sample met IDF criteria for metabolic syndrome. Mean BMI was 30.6, glucose 6.4 mmol/L, triglycerides 2.0 mmol/L, HDL 1.2 (mmol/L), waist circumference 105.8 cm, and BP 122/82 mm Hg.

Metabolic syndrome was highly prevalent in this sample, significantly increasing the risk of physical morbidity and potentially lowering life expectancy. There is an unmet need for health promotion interventions in order to lower morbidity and mortality risk in these populations.

Interferon combined with ribavirin is widely used to decrease the burden of Hepatitis C virus (HCV), but some serious side effects might limit its usefulness. There has been recently a growing awareness about neuropsychiatric complications of many drug treatments. Anecdotal case reports of HCV treatment induced psychosis were published but there seems to be no consensus about the causative relation and no systematic reviews were done to the date.

To describe a paradigmatic case that was managed as an iatrogenic psychotic episode following interferon associated with ribavirin.

Call attention to problems that interfere with the recognition, diagnosis and management of drugs induced psychosis.

Bibliographic research was conducted through the PubMed in the Medline library and clinical information was obtained through medical records and clinical interviews with the patient.

A 50-year-old Brazilian woman, with a previous episode of postpartum depression, presented with paranoid psychosis six months after initiating HCV antiviral therapy. Psychotic symptoms consisted of persecutory delusions and auditory hallucinations and developed together with agitation and aggressive behavior. Psychiatric hospitalization was required and psychosis resolved with discontinuation of therapy and initiation of risperidone. Laboratory tests and brain images were of no help in the etiologic investigation.

There are many drugs known to possibly cause neuropsychiatric symptoms. It is the job of every physician to be aware of this hypothesis especially in cases with acute onset and atypical presentations.

The authors have not supplied their declaration of competing interest.

Violence is a social and relational problem of humanity. When coming across a feminine jail population, the violence problem can take diverse proportions. Beyond being perpetrators of some sort of violence, these women can also be victims throughout their lives and even during their period of imprisonment.

Describe the social representations that imprisoned women have concerning daily experiences in prison.

Knowing the meaning of daily experience in prison to women.

Qualitative exploratory-descriptive field study, carried through with 15 prisoners of the feminine prison of Ribeirão Preto (SP-Brazil). A semi-structuralized interview was used. Results submitted to the content analysis technique.

“Daily experiences with violence in prison”: they revealed feelings of abandonment and indifference to their health; they denounced suffering physical and psychological violence from employees and other female prisoners; the relation between them is marked by conflicts and aggressions. “Consequences of the arrest in the women's lives”: complained about the loss of contact with their familiars; there were relieves about lack of support and system's indifference for the readjustment in society.

This study contributed as stimulus and reference for the implementation of other researches with populations of prisons, amongst them the ones that aim to establish strategies for the reintegration of these women in society and the shift of paradigms related to them. Moreover, with the intention of supplementing researches with incarcerated women, we suggest studies that also have familiars and professionals (or visitors) as subjects.

The authors have not supplied their declaration of competing interest.

This study examined the effect of Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on brain activation during a motor inhibition task.

Functional magnetic resonance imaging and behavioural measures were recorded while 15 healthy volunteers performed a Go/No-Go task following administration of either THC or CBD or placebo in a double-blind, pseudo-randomized, placebo-controlled repeated measures within-subject design.

Relative to placebo, THC attenuated activation in the right inferior frontal and the anterior cingulate gyrus. In contrast, CBD deactivated the left temporal cortex and insula. These effects were not related to changes in anxiety, intoxication, sedation, and psychotic symptoms.

These data suggest that THC attenuates the engagement of brain regions that mediate response inhibition. CBD modulated function in regions not usually implicated in response inhibition.

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.

Xenomelia or Body Integrity Identity Disorder (BIID) is the oppressive feeling that one or more limbs of one’s body do not belong to one’s self. Some studies report absent comorbid psychiatric conditions, others point to abnormal psychological characteristics in BIID individuals.

We carried out a study in order to shed light on theseinconsistent results. Unlike many previous investigations we examined each person individually in the frame of an extensive personal interview.

We examined 15 men with BIID and 15 pair-matched control subjects. Psychiatric and psychological assessment was performed using the SCID-Interview and various self-rating scales.

The structured clinical interview did not produce any evidence for a psychotic disorder, but four BIID-participants werediagnosed with depressive disorder. The results of the self-rating scales did not reveal differences between participants with xenomelia and control participants with respect to body dysmorphic, obsessive-compulsive, schizotypal, depressive and anxiety symptoms. However, participants with xenomeliatended to be more impulsive (P = 0.07), and scored higher on borderline symptoms (P = 0.07) and dissociative symptoms (P = 0.08).

BIID is a rare, but dramatic and severe psychiatric condition. Individuals suffering from this disorder do not show major psychological or psychiatric problems and comorbidities. Suffering and depressive symptoms might be the result of the unfulfilled wish for an amputation and raise important ethical and medico-legal issues about the amputation of healthy limbs.

The study was undertaken to estimate an effectivenessof art therapy and psychoeducational programs in an integrated system of the rehabilitation ofpatients with schizophrenia.

It was conductedcomprehensive examination of 142 women with an established diagnosis ofschizophrenia in the period of stabilization.

According to the leading psychopathological syndrome allthe patients were divided into 4 clinical groups: apathy abulia syndrome, paranoid hallucinatory syndrome, depressiveparanoid, and paranoid syndrome.

Anintegrated system of the rehabilitation including the methods of art therapy and psychoeducational programconcluding various information modules, cognitive behavioral therapy techniques, training interactions, problem-oriented discussions.

The present study demonstrated the rapid reduction of psychiatricsymptoms, normalization of emotional state, stabilization of the behavior ofpatients, improvement of cognitive results, improvement of psychophysicalactivity, expanding of contacts, restoration of usual driving mode on thebackground of art therapy and psychoeducational approaches.

The criteria were used to estimate the effectiveness:stability of remission, rates of hospitalization, quality of life, level ofanxiety, improvement of the mental state.

The sensitivity and specificity of a Chinese version of Montreal Cognitive Assessment (MoCA-CV) for Screening mild cognitive impairment (MCI) were examined.

MoCA-CV and MMSE together with a battery of neuropsychological tests were administered to 1056 elders who were recruited from three regions of Beijing (i.e. new town, old town, rural areas).

Twenty-six participants were diagnosed with dementia, 118 were MCI by psychiatrists and neurologists, and 875 were considered to be cognitively normal based on independent neuropsychological tested. Using the recommended cut-off score of 26, the MoCA-CV had an excellent sensitivity of 90.4% to detect MCI from controls, while the specificity was relatively poor (32.0%). Using a lower cut-off score of 22, the MoCA-CV exhibited the optimal balanced sensitivity of 68.7% and specificity of 65.2%. Among all the seven cognitive sub-domains, delayed recall performed the best differentiation of MCI from normal controls. Item analysis showed the internal consistency was relatively low in both naming and sentence repetition tasks which related with the characteristics of Chinese language and culture. Region differences were not significant when such confounding demographic variables as age, gender and education were controlled.

The MoCA-CV is a brief and effective screening tool for detecting MCI. However, presumably due to linguistic and culture issues and the lower education level of Chinese elders, the MoCA-CV did not show better screening capability than MMSE as expected. Some items may need further adaptation to accommodate the language, culture and education characteristics of Chinese participants.

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