Despite mounting evidence that non-injury-related factors have an important role in recovery from injury; specific variables associated with surgery outcomes are poorly understood. This lack of knowledge complicates efforts to improve the care of work-related hand injury (WRHI) patients. However, substantial research and investigation have still not clarified these underlying relationships, which merit further attention.

The purpose of this study was to evaluate the Health-Related Quality of Life (HRQL) outcome for WRHI patients after the impact of event and to investigate the moderated mediation analysis associated with their decision trust and regret.

A cross sectional study design was used to investigate the impact of event and the associated HRQL in 53 WRHI patients following severe and major hand injury. All consenting patients completed the Impact of Event Scale Revised, the Symptom Checklist-90-Revised, Decisional Trust scale, Decisional Regret scale and Short Form-36.

In the result of mediation analysis, patients affected HRQL via decisional trust and decisional regret, respectively. In addition, our data suggest that certain decisional trust and decisional regret (partial) characteristics significantly moderate this association. These findings may aid in the development of clinical interventions to enhance HRQL for WRHI patients. Overall, it is important for clinicians to consider the notion that more decisional trust or less decisional regret may sometimes, but not always, be better.

The authors have not supplied their declaration of competing interest.

The prevalence of mental disorders is considerably higher among incarcerated individuals than in the general population, but this burden is not matched by a proportional use of mental health services. Studies have found that incarcerated males are reluctant to seek help for mental health problems. Gaining knowledge of factors that influence incarcerated individuals to access or avoid professional help for mental health problems is important for tailoring interventions to address the mental health needs of this population. Promoting mental health service utilization among people in prison has the potential to reduce prison suicide rates and increase institutional functioning, thereby providing safer conditions for peers and staff, promoting rehabilitation, and reducing recidivism upon release.

This study explores personal, interpersonal, and systemic aspects that motivate incarcerated individuals to approach or avoid seeking help for mental health problems. While prior studies have primarily focused on barriers to help-seeking, this study also sheds light on facilitators for seeking professional help for people in prison.

Individual in-depth interviews were conducted with sixteen incarcerated males from three prisons in Northern Norway. The data analysis was inspired by Grounded Theory.

The majority of participants shared positive personal perspectives related to professional help-seeking, whereas the barriers were predominantly perceived to be of an interpersonal and systemic nature. Aspects that encouraged help-seeking were: regarding mental health treatment as necessary for successful rehabilitation, sufficient knowledge of when and how to contact mental health services, support from peers, having a higher ranking in the prison hierarchy, health services that are out-reaching, and prior positive experiences with professional help. The barriers to professional help-seeking were: lack of information about when and how to access mental health services, challenges with the self-referral system, perceived unavailability of services, confidentiality issues, and a prison climate that favoured a tough appearance.

The participants appeared to be more positive to seeking professional help for mental health problems than reported in previous studies with incarcerated individuals. Interpersonal and systemic aspects were emphasized by the participants as barriers to accessing mental health services; some participants even perceived these services to be unavailable to them. The results are relevant for designing interventions to promote help-seeking for mental health problems among people in prison.

None Declared

Psychoform and somatoform dissociation in anorexia nervosa (AN) and bulimia nervosa (BN) is yet to be studied in Portugal.

Explore the severity of psychoform and somatoform dissociation in ED; explore the differences between ED and other psychiatric disorders (PD), and between AN and BN.

From two psychiatric clinics, 29 women with ED (AN = 16; BN = 13) and 35 women with different PD (posttraumatic stress = 9; panic = 4; major depression = 4; obsessive-compulsive = 8, social phobia = 10), matched sociodemographicaly (mean age = 26.69 ± 7.31), were voluntarily assessed with the Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ-20).

ED patients had higher scores on DES (M ± SD= 28.10 ±19.76, p < 0.05) and on SDQ-20 (M ± SD= 38.41 ±13.19, p < 0.05) than PD patients (DES: M ± SD= 19.27 ±12.84; SDQ: M ± SD= 38.41 ±13.19). Comparing with PD, BN had higher scores on DES (M ± SD= 31.13 ±21.25, p < 0.05), and on SDQ-20 (M ± SD= 42.45 ±17.36, p < 0.01). Finally, there were no differences between AN (DES: M ± SD= 25.65 ±18.80; SDQ-20: M ± SD= 35.63 ±8.98) and BN (p = 0.01).

Our findings point out to the need to of watchfully assessing ED for dissociative symptoms and, accordingly, include the treatment of dissociation.

Clinical practice in psychiatry is shifting toward personalized approach. In other words, clinicians aim to help patients based on their individual characteristics. It’s known that testosterone play a crucial role in the regulation of the emotions specially in men. The problems of hypogonadism and its possible role as an etiological factor in the development of depression in men are available in detail. But there is no solid date about the features of depression in men with testosteron defficency and theraputic approach including testosterone replacement therapy and antidepressants.

Аssessment of efficiency of different pharmacological approaches in the treatment of depression in men with testosterone deficiency

The main group included 37 men with a depressive episode that arose against the background of a decrease in testosterone levels (≤12.1 nmol / L). A depressive episode was diagnosed based on the ICD-10 criteria for a depressive episode (F32). Patients were randomized into 3 treatment groups, depending on the received treatment: 1) sertraline; 2) testosterone gel; 3) sertraline + testosterone gel. The control group consisted of men (n = 40) aged 18 to 65 years, suffering from depression in accordance with the ICD-10 criteria with normal testosterone levels

An insufficient effectiveness of antidepressant monotherapy in relation to sexual dysfunction was found in main group, while testosterone monotherapy did not give statistically significant improvements in depression indicators.

Combination therapy was most effective for the main symptoms and can be regarded as the most appropriate algorithm for the treatment of depression in men with low testosterone levels

No significant relationships.

Antipsychotics have been classically considered the treatment of choice for delusional disorder (DD) and antidepressant medications have been restricted to patients with comorbid depression.

Our aim is to describe the case of a patient with DD with delusions of parasitosis, who responded to paroxetine as monotherapy. We also aimed to review the recent literature on the potential use of antidepressants as the main treatment for somatic type DD.

After the case report, we present a narrative review on the use of antidepressants in DD, somatic type (DSM-criteria) by using PubMed database from inception until 2020.

Case: 74 year-old woman without previous psychiatric diagnosis who suffered from long-term cutaneous and vulvar pruritus. She was referred to psychiatry from dermatology to assess thought content and sensoperceptive disturbances. In the past, she had received unsuccessful treatment with antihistamines. The patient brought a collection of “the identified parasite” (matchbox sign) to our first appointment. On assessment, she was diagnosed with DD with delusions of parasitosis. Risperidone 1mg/day was poorly tolerated (excessive sedation). She refused further antipsychotic treatment, so we started paroxetine up to 20mg/day. The patient went into total remission of her pruritus and delusions of parasitosis. Review. In line with our case, 6 studies reported on the successful use of antidepressants as monotherapy for DD, somatic type. Most of studies report the successful use of an antipsychotic/antidepressant combination (case-series, case reports).

Although antipsychotics are the treatment of choice, antidepressant medications may be an effective alternative in somatic type DD when patients refuse antipsychotics.

Happiness has been associated with a number of individual and societal factors, but much of the individual-to-individual variation in happiness remains unexplained. The purpose of this paper is to examine a broad range of social and psychological correlates of self-rated happiness in Europe.

We used data from the European Social Survey to determine levels of happiness in individuals (n=30,816) from seventeen European countries and to identify associations between happiness and age, gender, family relationships, satisfaction with income, employment status, community trust, satisfaction with health, satisfaction with democracy, religious belief and country of residence.

Self-rated happiness varies significantly between European countries, with individuals in Denmark reporting the highest levels of happiness and individuals in Bulgaria reporting the lowest levels. On multi-variable analysis, happiness is positively correlated with younger age, satisfaction with household income, being employed, high community trust and religious belief. Overall, these factors account for 22.5% of the individual-to-individual variation in happiness in Europe.

For the individual, this study highlights the strength of association between happiness and the individual's attitudes towards various aspects of their personal, household and societal circumstances. For social policy-makers, this study confirms the potential usefulness of civic measures to increase community trust and social capital. Further studies of the inter-relationships between individual and community-level variables would assist in further explaining the variance in happiness between individuals and countries.

Clozapine is an atypical antipsychotic medication which is mainly used in cases of treatment-resistant schizophrenia. Although it has several advantages over other typical and atypical antipsychotic medication, such as fewer relapses and lowering the risk of tardive dyskinesia and suicide it also has a range of adverse effects which makes compliance an issue for many patients.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis clinically characterized by painful pustules or nodules that rapidly evolve in ulcers with violaceous, undermined borders and raised periphery. The etiopathogenesis of the disease remains unclear, however PG is usually manifested in the setting of an underlying immune-mediated disease, more commonly inflammatory bowel disease, rheumatoid arthritis and haematological malignancies.

Nevertheless, in the literature there are scarce reports of drug-induced PG.

We present the case of a 56-year-old woman with a diagnosis of refractory schizophrenia on clozapine treatment for 4 months, who was admitted to the emergency department for a skin eruption localized on the trunk, genital area and extremities. The clinical examination revealed numerous, discrete erythematous macules, papules and plaques with central necrosis, and multiple, sharply marginated ulcers with undermined, red to purple border. Further physical examination disclosed no systemic findings and laboratory analyses and skin biopsy were performed.

On work-up, white blood cell count and C-reactive protein (CRP) were elevated, while blood and pustule cultures were negative. Histologic examination revealed dermal necrosis and inflammation, features consistent with the diagnosis of PG. The pathergy test was positive.

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Pyoderma gangrenosum is a rare autoinflammatory skin disorder of unknown etiology. The pathogenesis of the disease is not well understood, but drug-induced PG is considered to result from neutrophil dysfunction and dysregulation of the inflammatory response. Cases of drug-induced PG are rare and attributed to certain drugs. Clozapine is an antipsychotic medication for the treatment of refractory schizophrenia. It is suggested that clozapine alters plasma TNF-α levels and thus can modulate the inflammatory response. To date, a variety of adverse skin reactions (Stevens- Johnson syndrome, DRESS syndrome etc) have been previously described in the literature. However, to the best of our knowledge, this is the first case which strongly indicates the likely association between clozapine and drug-induced PG.

None Declared

With the popularity of high-tech devices and Internet use in recent years, playing online or offline games has become a popular activity, among young adults (YA). However, research suggests that excessive engagement may in extreme cases lead to symptoms commonly experienced by substance addicts.

Estimate the prevalence of problematic use of video and Internet games (PUVIG) among YA. Determine the factors associated with it.

A cross-sectional study was carried out during the first half of September 2016. A sample of 69 YA with a high education's level was randomly selected from the general population. Data were collected through a global questionnaire consisted of a sociodemographic part, the Young Internet Addiction Test, the Problem Video Game playing questionnaire, online network game scale and the Perceived Stress Scale.

The average age was 27.6 years. The majority (70%) reported using video or Internet games. The risk of dependency to online network games involved 10% of game players while the presence of video games use consequences concerning 16%. Gaming addiction was significantly more likely in boys (P = 0.001). The students had more PUVIG than employees (P = 0.036). A link was highlighted with a problematic Internet use (P = 0.008), a facebook addiction (P = 0.001) and high perceived stress level (0.014).

Playing video and Internet games is a widespread activity among YA. The factors potentially involved are inevitably multiple and complex. It supports the need to carefully explore these emerging practices among this vulnerable population and suggest the establishment of better prevention and better tracking of video gaming.

The authors have not supplied their declaration of competing interest.