Due to its anticholinergic action, antipsychotic drugs, especially phenothiazines and atypical antipsychotics, have been described as a rare cause of drug-induced ischemic colitis. We present two cases of patients that were admitted to the gastroenterology unit of a general hospital and were diagnosed of quetiapine-induced ischemic colitis.

To describe an uncommon side effect of neuroleptic treatment.

Case report and literature review.

First patient, aged 73, with history of dysthymia, in treatment with desvenlafaxine, quetiapine, ketazolam, lorazepam, enalapril/hidroclorothiazide, omeprazole, simvastatin, tramadol/paracetamol, alendronate/colecalciferol and hidroferol, consulted in the emergency room for malaise, disorientation, haematuria, abdominal pain and changes in deposition rhythm; family members admitted frequent use of higher than prescribed doses of quetiapine and benzodiazepines. Second patient, aged 63, with history of histrionic personality disorder, in psychopharmacologic treatment with venlafaxine, quetiapine, diazepam, fentanyl, rupatadine, cinitapride, omeprazole, levosulpiride, simvastatin, fluticasone/salmeterol and celecoxib, consulted for abdominal pain and bloody diarrhoea. Colonoscopy findings in both of them were compatible with ischemic colitis. Quetiapine was withdrawn in both cases, as the main diagnostic hypothesis was quetiapine-induced ischemic colitis. The patients achieved full recovery.

Ischemic colitis is a rare but potentially fatal adverse effect of antipsychotic drugs, with clozapine being the most reported atypical antipsychotic thought to cause it. The risk associated with quetiapine is thought to be lower given its milder anticholinergic effect. Co-prescription with other drugs with anticholinergic actions increases the risk. Clinicians should be aware of this association and the onset of constipation should alert medical staff.

No significant relationships.

In this 15-week, randomized, double-blind, placebo-controlled, parallel study the impact and tolerability of 150 mg b.i.d. n-3 PS were investigated in 200 children (6-13-y) with ADHD. Efficacy was assessed by teachers’ Conners Rating Scale (CRS) and strength and difficulties questionnaires (SDQ) - school version and clinicians who filled Clinical Global Impression of Improvement. Additional measures included parental rating of behavior (CRS and SDQ - home version) and wellbeing (Child Health questionnaire - Parental Form 50), and continuous performance test (Test of Variables of Attention). Safety evaluation included adverse event reports, vital signs, and parents’ Barkley’ side effects rating scale.

The interim results of the first group of children that were randomly assigned in a 2:1 ratio to n-3 PS or placebo will be presented.

n-3 PS impact on ADHD symptoms at school and home as evaluated by teachers, clinicians, and parents will be discussed.

This work was sponsored by Enzymotec LTD.

Behavioral and psychological symptoms in dementia are known to increase caregiver stress and proceed admission to a nursing home. We studied caregiver stress due to the impact of sleep disturbances in different types of mild dementia.

A sample of 151 persons with mild dementia from the Norwegian DEMWEST- cohort and their caregivers. Sleep problems in dementia were studied with the Mayo Sleep Questionnaire and the Neuropsychiatric Inventory. Caregiver stress was studied with the Relative's Stress Scale.

Caring for a person with mild dementia with any sleep disturbance significantly increased caregiver stress as compared to caring for a person with mild dementia without any sleep disturbances. (18.2 vs. 13.0, p=0.017) Caregivers to patients diagnosed as having mild Dementia with Lewybodies with any sleep disturbance reported significantly more stress as compared to caregivers to person with mild Alzheimer's Disease with any sleep disturbance. (14.7 vs. 21.7 p=0.010).

Sleep disturbances in mild dementia significantly impact on caregiver stress, more so in DLB as compared to AD.

Emigration is the act of leaving one’s country of nationality or habitual residence to settle in another nation. In Tunisia, this phenomenon is increasing in particular for doctors.

Evaluating the intentionality of emigration among interns and medical residents in Tunisia while studying the factors related to it.

We conducted a cross-sectional, descriptive and analytical study of interns and medical residents who participated in our study through the social network ’Facebook’ by an anonymous self-questionnaire. The level of satisfaction with the different aspects of life were assessed by a 5-point Likert scale, from “not at all satisfied” to “very satisfied”.

The total number of participants was 56 of which 64.3% were medical residents. More than 50% of the participants expressed dissatisfaction with the distribution of tasks and organization of work (66.1%), safety at work (53.6%), comfort (57.2%), time allocated to personal life (53.6%) and salary (69.6%). The political, health and educational situation in the country was considered unsatisfactory by the majority of participants (90% to 95%). Among our participants, 44.6% regretted having chosen the profession of medicine and 53.6% had plans to immigrate to work abroad. The intentionality of immigration was significantly higher among men (p=0.02), those with siblings abroad (p=0.047) and those without dependent relatives (p=0.040).

Young physicians are strongly looking for emigration. This decision could emanate from professional, personal and political factors. Further studies seem to be necessary to explain this emigration phenomenon.

No significant relationships.

It's known that, patients with schizophrenia smoke more tobacco than general population, and that tobacco is a potent inducer of cythocrome P450 isoenzyme 1A2 (CYP 1A2). In addition, clozapine and quetiapine, drugs frequently used in the treatment of schizophrenia, are CYP1A2 substrates. So, tobacco smoking may reduce blood levels of clozapine and quetiapine.

To revisit the influence of changes in tobacco consumption in clozapine and quetiapine side effects.

Case report.

A 48-year-old male diagnosed of schizophrenia following DSM IV-TR criteria. He required five hospital admissions from 2008 to 2013 because of psychotic episodes. Since 2013, he was asymptomathic receiving clozapine, 600 mg/day, and quetiapine, 1200 mg/day. Recently, he came to the emergency service due to sudden extreme sedation, thinking impairment, sialorrhea, and walking disability. The patient denied treatment abuse and his family confirmed this statement. When asked about toxics he referred progressive tobacco reduction in the last 3 months (from 60 to 20 cigarettes/day). Bearing in mind the relationship between clozapine and quetiapine metabolism and tobacco, treatment was slowly reduced until the doses of clozapine 500 mg/day and quetiapine 400 mg/day. One week after admission, side effects disappeared, psychotic symptoms were not detected, and the patient was discharged.

Inquiring about changes in tobacco consumption may be useful when anti-psychotics side effects appear suddenly without an alternative explanation.

The authors have not supplied their declaration of competing interest.

Cerebellar cognitive affective syndrome (CCAS) is a condition that arises from cerebellar lesions. CCAS can easily be overlooked by medical teams; therefore a bibliographic review will facilitate the understanding of symptoms in order to effectively diagnose and provide a holistic early treatment approach.

A case report of a 72-year-old woman with bilateral cerebellar lesions with high pre-morbid function presented with classic symptoms of CCAS. Multidisciplinary workup included medical, psychiatric, neuropsychological assessment (R-BANS (Form 1), Digit Span, Verbal fluency tests, the Hayling Test, the Delis-Kaplan Executive Function System) as well as other investigations (neuroimaging and blood tests) were conducted on the patient to confirm CCAS and exclude other differential diagnoses.

The results from the medical assessments conducted showed symptoms of cerebellar dysfunction. A psychiatry and neuropsychological review revealed aggression, irritability, disinhibition, deterioration in cognitive function and personality changes. A multidisciplinary team was formed to rehabilitate the patient however patient was non-compliant with therapy. The patient was prescribed Seroquel 50 XR and she responded well to the medication.

This case review illustrates the challenges associated with engaging a CCAS patient in rehabilitation activities due to cognitive and mood disorders. The use of psychotropic medications can be an effective method in improving cognition and mood disorders in CCAS patients. Early psychiatry and psychological intervention can significantly improve the overall outcome of a patient diagnosed with CCAS.

Nil.

The author has not supplied his declaration of competing interest.

Worldwide, thalassemia poses a serious public health problem due to the high prevalence. Mothers usually take active roles in the care of their ill children. Several studies have found that parents of children with chronic diseases or disabilities have higher depression scores than control parents. The main aim of the present study was to investigate if mothers of children with thalassemia higher scores of depression compared with a group of control mothers.

In this study, 30 mothers were assessed using the Beck Depression Inventory (BDI), Symptom check list-90-revised (SCL-90-R), COPE and SF-36, also 30 mothers were enroled as control group who have healty children.

Mothers who have children with the diagnosis of thalasemia had higher scores of depression from the BDI and lower quality of life scores (p< 0.05).

It seems that depressive people experience specific events before depression. Several studies have indicated that presence of a patient or disabled child in the family can cause stress and depression in parents.The results of this study can contribute to the development of a screening program for decreasing depression burden and promoting quality of life for mothers of children with thalassemia. It is an ongoing study.

Modern communication facilitates telepsychiatry in native language everywhere in the world. Using social networks (facebook), many pages promote mental health and provide advices for mental health problems. Unfortunately, many were inappropriate, so we decided to give confidential cost-free advice to those who asked for counselling.

Present one-year experience in counselling using facebook page administered by a psychiatrist in Serbian/Croatian/Bosnian language.

Present number of page likes, counselled people and most frequent problems.

Review page statistics and inbox.

The facebook page provides mental health educational content, confidential counselling with a psychiatrist, sharing opinion with other members and group discussion. There are 10.573 members (88% women, 12 % men). Up to 50.000 people are reached weekly. Majority of the members is age 18 to 44 (77%), coming from: ex Yugoslavia countries 8008 (75,7%), EU 1912 (18,1%), Switzerland 1,1%, USA, Canada, Australia 1,2% . There were 95 persons looking for help via inbox. The most frequent problems were: depression 24,2%, marriage/relationship problems 24,2%, emotional reactions after flooding in Bosnia 13,7%, anxiety disorders13,6%, low self-confidence 6,3%, emotional or physical abuse 6,3%, suicidal 6,3%, psychosis 3,1%, OCD 2,1% and 25,2% asked how to help others. Tele-psychiatric service with GP commenced during the flooding. Supervision has been provided by a psychiatrist. There were 52 reviews with the rates: excellent 92,3%, very good 7,7.

Social networks are useful for mental health promotion, education and counselling people around the world. Problems are acute psychiatric conditions and legal issues (suicidal and abused persons).

Besides affective instability and identity diffusion, disturbances in social interactions are a core symptom of borderline personality disorder (BPD). Interpersonal problems in BPD have been suggested to be associated with oxytocin dysregulation. To directly address this hypothesis, we investigated oxytocin plasma levels during a social exclusion (ostracism) paradigm in female BPD patients.

Twenty-two female BPD patients (diagnosed according to DSM-IV) and twenty-one healthy controls matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball paradigm, a virtual balltossing game that evokes a social exclusion situation. Emotional reactions were assessed and oxytocin and cortisol levels measured at baseline and 5, 15, and 40 min after Cyberball.

After social exclusion, oxytocin plasma levels were lower in BPD patients than in healthy controls, whereas cortisol levels did not differ between groups. BPD patients showed distinct differences in emotion regulation compared to healthy participants and reacted to social exclusion with an increase of other-focused negative emotions, particularly anger and contempt.

Our pilot study suggests that the oxytocin system shows a differential response to social exclusion in BPD patients compared to healthy controls. This difference may be related to the high rejection sensitivity of BPD patients and their difficulties in resolving social conflict.

Bioinformatic investigations indicate that has-mir-206 (microRNA-206, miRNA-206) could regulate BDNF protein synthesis by interfering with BDNF mRNA translation, which is disrupted in bipolar disorder (BPD).

This study is to investigate whether miRNA-206 gene variants were associated with BPD susceptibility in a Han Chinese population.

342 patients who met DSM-IV criteria for bipolar disorder type I (BPD-I) or type II (BPD-II) and 386 matched health controls were enrolled into this study. the miRNA-206 gene and +/-500bp were selected for gene sequencing. for the case-control genetic comparisons, differences in the genotype and allele distributions between patients and controls were examined using Pearson's χ2 test.

Gene sequencing showed that there are two polymorphisms rs16882131(C/T) and rs62408583 (A/C) located at the upstream of miRNA-206 gene, which are complete linkage disequilibrium. the association analysis showed that there was no significant difference for genotype frequencies (χ2 = 2.075, df = 2, P = 0.354) or for allele frequencies (χ2 = 0.041, df = 1, P = 0.839) between BPD patients and controls. Similarly, no significant difference was found between BPD-I patients and controls (genotype χ2 = 1.411, df = 2, P = 0.494; allele χ2 = 0.380, df = 1, P = 0.538). However, there was significant difference between BPD-II patients and controls (genotype χ2 = 7.933, df = 2, P = 0.019; allele χ2 = 5.403, df = 1, P = 0.020).

Our findings do not support that BPD susceptibility was associated with miRNA-206 gene polymorphisms in the studied Han Chinese population. the association between miRNA-206 gene polymorphisms and bipolar disorder type II is needed to be carefully interpreted. Further studies are necessary to elucidate the involvement miRNA-206 in the pathophysiology of BPD.

Background: Existing evidence poses low self-esteem as a risk factor for both suicidal ideation (SI) and suicide attempts (SAs) in the general population.

The present study assesses the relationship between self-esteem level and SI/SA, considering across the lifespan. Two separate meta-analyses, one for SI and the other for SA are herein reported since they substantially overlap in terms of eligibility procedures and search strategies.

Eligible studies documented at least one suicidal, and a non-suicidal group. Data were analyzed using the Cochrane Collaboration Review Manager Software (RevMan, version 5.4.1) under the random-effects models. Values were standardized owing to the anticipated heterogeneity of self-esteem rating tools. Sensitivity analyses were performed to control for heterogeneity.

Out of 3,310 initial hits, 24 studies were deemed eligible for inclusion. The meta-analyses showed that individuals with lower levels of self-esteem, compared to those with higher levels, were more likely to endorse both SI and SA. SI reached a standardized mean difference of -0.43 (CI: -0.81, -0.05), while SA reduced by -0.89 (CI: -1.02, -0.76), overall. Limitations: The herein presented results rely on standardized mean differences rather than odds of either SI or SA since the original studies failed to systematically fetch rates of the events.

Lower levels of self-esteem represent a risk factor for both SI and SA across the lifespan. Forthcoming studies should systematically account for multiple moderators to allow meta-analytic synthesis including sub-group and meta-regression analyses assuming high-heterogeneity would still be concerned.

No significant relationships.

The authors have not supplied their declaration of competing interest.

In psychiatric practice, the assessment of change from pre- to post-treatment is a key approach for monitoring treatment effects and for the prediction of treatment outcomes. The Health of the Nation Outcome Scales (HoNOS) as a clinician-rated measure and the Brief Symptom Inventory (BSI) as a self-report measure are tools (that are) often incorporated in outcome monitoring. Their usefulness, however, has been questioned by two important issues: their psychometric properties and their lack of concordance.

The aim of the study is to evaluate the responsiveness of HoNOS and BSI as well as their interactions to predict clinical meaningful change according to the Global Clinical Impression (CGI) as quasi-gold standard for treatment outcome.

A consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders was assessed with Brief Symptom Inventory (BSI) at admission and discharge. The HoNOS and the CGI were rated by the responsible clinicians at admission and discharge. Ordinal logistic regressions will be conducted using the CGI categories as ordered categorical outcome. HoNOS and BSI scores as well as their interaction terms will be used as independent variables.

Complete data of admission and discharge is available from approximately 600 cases. Graphical presentations will illustrate the resulting associations.

The authors have not supplied their declaration of competing interest.

To assess the prescription of benzodiazepines (BZD) in elderly patients, and to explore any gender differences.

Six hundred and fifty-four patients (≥ 65) admitted in an emergency service of a general hospital due to a fall. BZD use information was collected (dose, half-life profile).

BZD are significantly more prescribed to women (47.6%) than men (36.1%) (X2 = 8.097, P = 0.004). We conducted a logistic regression analysis using as dependent variable taking or not BZD and sex as the independent one, covariating the model by age. We noted that sex remains significant despite enter the age variable in the model (OR = 1.5, P = 0.013). A total of 21.6% of patients consumed intermediate or long half-life BZDs, appearing a greater tendency to prescribe such BZD to women (X2 = 3.606, P = 0.058). In the 58.0% of prescriptions, prescribed dose was higher than the recommended for the elderly. The percentage is significantly higher for men (70.0%) than women (53.1%). Furthermore, a total of 54 prescriptions (15.8%) were even higher than the recommended adult dose, with no significant differences between men and women.

We found evidence of a higher prescription of BZD in women independently of age. Despite not being recommended, prescription of intermediate or long half-life BZD continues, in a slightly higher manner in women. BZD are prescribed above the recommended dose for elderly in a large number of patients, especially in men. A considerable proportion of elderly patients (15.8%) consume BZD doses even higher than the recommended for adults.

The authors have not supplied their declaration of competing interest.

It has been previously reported that a substantial proportion of newly referred

neurology outpatients have symptoms that are unexplained by disease. There has however been controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, explains these symptoms. Our aim was to determine in a large sample of new neurology outpatients: (a) what proportion had symptoms unexplained by disease and their diagnoses; (b) how often a neurological disorder emerged which with hindsight explained the original symptoms.

The Scottish Neurological Symptom Study (SNSS) An 18 month prospective cohort study.

Secondary care NHS neurology clinics throughout Scotland UK

3781 primary care patients referred to neurology outpatient clinic (91% of those eligible).

1) The proportion assessed by the neurologists as having symptoms ‘not at all’ or only ‘somewhat explained’ by organic disease and the neurological diagnoses in these patients, 2) The frequency of an unexpected new diagnosis at 18 months which with hindsight, may have explained the original symptoms (according to the primary care physician, neurologist and consensus rating).

1144 patients (30%) were rated as having symptoms unexplained by organic disease.The most common categories of diagnosis in this group were: (a) organic neurological disease but with symptoms unexplained by it (26%); (b) headache disorders (26%) and (c) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow up, (mean 19 months), only 4/1030 patients (0.4%) had an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients’ original symptoms. Eight patients had died at follow up; five with initial diagnoses of non-epileptic attacks.

One third of new neurology outpatients have symptoms that are unexplained by organic disease. Such patients rarely develop a new organic disease that could explain their original symptoms.

Chronic hepatitis C virus (HCV) infection is a disease that afflicts more than 170 million people worldwide and is a major cause of liver disease, cirrhosis, and hepatocellular carcinoma. Standard pharmacologic treatment for HCV infection is the antiviral combination of pe-gylated interferon (IFN) and ribavirin (RBV). Several psychiatric side effects such as depression, anxiety and even psychosis and cognitive impairment were reported.

To review the neuropsychiatric side effects of interferon treatment of HCV infection though the study of a case report.

We present a case of a 45-years-old without personal or familiar psychiatric history, admitted in our inpatient unit with psychotic symptoms during the last 2 weeks, consisting of paranoid delusions and aggressive and bizarre behavior. The patient had history of HCV and HIV infection and had initiated treatment with pegylated IFN alpha e RBV in the prior 6 months. Neuroimaging and laboratory tests were done without significant alterations. He was treated with Olanzapine 15 mg od with improvement of the psychotic symptoms and without important side effects. At the time of hospital discharge, psychotic symptoms had almost disappeared and no behavioral disorder was observed.

IFN-associated psychiatric disorders appear to be much more common than previously thought. The increased in pro-inflammatory cytokines in certain psychiatric disorders was widely reported. We believe that the inflammatory setting may be considered as an important further piece in the puzzle in a genetic-environmental diathesis model of the psychiatric diseases.

The use of internet among children and adolescent has risen in the last decade. In addition, suicide is the second cause of death among adolescents. Previous research have indicated the relation between Problematic Internet Use (PIU) and different mental health problems. Nonetheless there is a lack of studies analyzing the relation between suicide behaviour and PIU

The main objective of the present work was to analyze the relation between Problematic Internet Use and suicide behaviour and depression in adolescents

A total of 1036 adolescents (450 males) were randomly selected. Mean age was 15,21 (SD = 1,23). The Adolescent Behavioural Suicide Scale SENTIA, The Reynolds Adolescent Depression Scale Short Form (RADS-SF), and The Compulsive Internet Use Scale (CIUS) were used. A Manova was performed with two groups (risk and non-risk to PIU) as independent variables and suicide and depression scores as dependent variables

The results revealed a statiscally signifficant association between PIU and both depression and suicide behaviour (λ = 0.245, F(2,81,000) = 15.549, P ≤ 0.001, η² = 0.116). In particular, adolescents at a higher risk for PIU obtained higher scores on suicide behaviours and depression.

Results found in the present study reveal that adolescents have moderate prevalence rates for PIU. Also adolescents at risk for PIU with a total of more than 3 hour sof internet use everyday were at a higher risk for suicide. Prevention strategies should be devote to intervene in internet use as it maybe a variable affecting suicide behaviour.

No significant relationships.