The role of religious switching as an aetiological factor in dissociative trance disorder (DTD) is not well understood. We present a case of DTD diagnosed in a 57-year old Chinese lady who presented with a 3-week history of episodic passivity experiences and behavioural changes involving uncharacteristic hostility towards Christians after converting from Taoism to Christianity.

• To briefly review existing literature on DTD.

• To discuss a case in which religious switching in the context of unique cultural factors triggered a DTD.

To discuss the aetiological role of culturally-mediated psychological stress associated with religious switching in DTD.

We searched for existing literature on DTD on 'PubMed' using the keywords 'dissociative trance disorder'. Relevant information was synthesised into a brief review on DTD. The impact of religious and cultural nuances on the case formulation is discussed in the case presentation.

The patient's dissociative trances were assessed to be triggered by ambivalence about an upcoming baptism ceremony after converting from Taoism to Christianity. She and her family were psychoeducated about the identified intra-psychic conflict stemming from her religious switching. Psychotherapy was initiated. A low dose of antipsychotic was used for symptomatic relief. A subsequent reduction in frequency of dissociative trances was observed.

Identifying psychological stress associated with religious switching is imperative in differentiating dissociative trance from other mental disorders. Addressing underlying intra-psychic conflict is the mainstay of treatment. Adjunctive use of medications aids symptomatic relief. Recognising cultural nuances also has broader relevance in formulating psychiatric presentations.

Hikikomori: Japanese term which means 'being confined, pulled inward”, translated as 'social withdrawal” in Western cultures. Cultural, social, familiar and educational features predispose to it. Diagnostic criteria include home-centred lifestyle, refusal to attend school or work, symptoms persistence for at least six months, exclusion of schizophrenia, mental retardation or other mental disorders and lack of personal relationships.

We searched 'hikikomori” keyword on Pubmed and Scopus, and selected papers written in English, Italian or Spanish. We found 54 results:14 articles were excluded for being written in Japanese or French, and one paper for being unrelated to the topic. We also searched Google Scholar and PsychInfo, founding one additional relevant study.

Generally, hikikomori is an Asiatic, and specifically Japanese, phenomenon. Nevertheless, social withdrawal cases similar to hikikomori have been recently described in Western Countries (United States, Australia, Spain, Italy)

Typically, the hikikomori subject is male, described as apathetic, nihilistic, disillusioned, estranged from school and society, the young adult eldest son of a family with a good socioeconomic background. The low rate of suicidality among hikikomoris needs to be emphasized.

Internet represents an “emergency exit” to the difficulties that adolescents and young adults face: therefore, they choose social withdrawal to preserve themselves from the risk of being ashamed by their own inadequacy.

Hikikomori is more than a medical and psychiatric disease. Scientific literature regarding both epidemiological and psychopathological issues is still lacking and more scientific researches are required.

Studies from Pakistan reveal a high prevalence of depression in women. Evidence based and effective treatments are available, yet there is a significant gap between the number of women in need of treatment for depression and those who receive the services. This qualitative study identifies the barriers in access to mental health services for women with depression in Karachi from key informants' perspectives.

19 key-informant interviews were conducted with psychiatrists, psychologists, general health practitioners, pharmaceutical representatives, a government health department official and NGO workers working on women health issues.

Key-informants reported lack of awareness, misconceptions, self-medication, being young and unmarried and financial status as barriers for women in accessing mental health services. In addition, provider's lack of medical education about depression, mismanagement of cases by GPs, opposing mental health care and lack of referral system are also considered barriers to mental health services. Larger societal issues are stigma, gender bias, as well as poor resource allocation and management.

Key-informants considered women's education, mental health literacy and referrals as facilitators for women.

The study highlights the need for multipronged and multi-sector approach for increasing the access to mental health services for women in an urban context of developing country where mental health services are present but not accessed by women.

Study of clinical and social-psychological aspects of mental disorders associated with somatic diseases with distinguishing the basic pathogenetic factors and development of stepwise therapeutic programs.

Analyzed material – persons seeking for psychiatric help at primary care units on eastern frontier territories of Kazakhstan and Russia. Factorial analysis has identified the most significant factors (somatic-vegetative, psychopathological syndromes, somatic pathology, age peculiarities) in formation of combined mental and somatic diseases. With account for specifics of the contingent of patients, age structure, therapeutic-diagnostic complex of general primary care units, stepwise rehabilitative programs have been developed.

Basic stages of therapy have been distinguished: initial, basic and maintenance. Rehabilitative programs have been developed and introduced: for patients with neurotic disorders, organic mental disorders, personality disorders, affective disorders, alcohol dependence, and separately for persons of younger and elder age. Basic principles of rendering of medical assistance have been structured: complexity, sufficiency, individual-differentiated approach, continuity, cooperativeness.

Use of base of general somatic primary care units, integrative approach during rendering of specialized psychiatric assistance to patients with mental disorders appeared to be most effective and lesser economically expensive as compared with institutional assistance at a profile institution.

Nowadays, numerous definitions of placebo and the placebo effect have been proposed. Mechanisms of action have been intensely studied and interesting theories have emerged. It is well-known that the effects of the drugs are influenced by the clinical setting. The complexity of human mind and the social context make the patient highly suggestible to (auto)suggestion.

To assess factors influencing placebo effect in Romanian patients with mental disorders.

We present 5 clinical cases from our medical practice and compare them to cases from medical literature: 68 years old woman, psychiatric inpatient complaining of insomnia, with medically treated hypertension; 65 years old woman, neurological inpatient complaining of severe back pains that were neurologically uncommon, but impaired her walking and caused sleep disturbances and were not alleviated by a complex and combined analgesic pharmacotherapy; 70 years old woman, known for doctor shopping, came at the Neurology Emergency Department at 1:30 am for headache, foot burns, and abnormal gait; 48 years old man, psychiatric inpatient complaining of ‘paralyzed bowels”, ‘pain in the legs”, and ‘paralyzed muscles” after undergoing a surgical intervention for an abdominal hernia; 50 years old woman, inpatient suffering from schizophrenia at a Chronic Psychiatric Disorders Department, often complaining of headaches. Patients received different forms of placebo therapy.

All patients were placebo-responders. We noticed decrease of placebo effect in some patients in chronic use, and spectacular amelioration of symptoms when there was a high rate of allegiance.

Allegiance is an important factor for placebo effect.

The relationship between mental illness and travel can take many aspects. Travel may be underpinned by a psychiatric disorder out, reveal it or precipitate its decompensation.

The target of our study is to describe the sociodemographic and clinical characteristics of patients hospitalized in the psychiatric department E of the razi hospital during a cross-border travel and clarify the relationship between mental illness and travel.

We have conducted a retrospective study including all patients hospitalized in the psychiatric department E of the razi hospital from January 2004 to September 2014, during a cross-border trip.

Data was collected through a predetermined form, exploring the socio-demographic and anamnestic patient parameters, trip characteristics, and finally clinical and evolutionary data of the disorder.

Our population consists of 12 patients, 83% are male. The average age of patients is 41 years.

In our study, the majority of patients were followed by a psychiatrist. The admission mode of our patients was 80% without their consent. 72, 2% of patients were smokers, 63, 6% drinks alcohol regularly, and 9% used cannabis.

In our study, the beginning of troubles came before the trip in 5 cases. This is assuming the existence of a pathological travel in these cases.

Our patients had essentially psychotic disorders, mood disorders and related substance use disorders. These disturbances were precipitated by the travel in 7 cases out of 12. Thus, anticipating changes and preparing the necessary adjustments could help to reduce the risk of decompensation.

The relationship between basic educational skills andpsychological characteristics in Roma is not fully explored.

This study examined the potential association amongbasic skills of reading and writing and psychopathology, shame, hostility andanxiety as trait in Romani community members.

To test the link between basic school skills and psychologicalcharacteristics in Roma citizenships in Greece.

In this study 361 Roma residents in region of Greece were participated. The sample consisted of 125 men and 236women with mean age 34 years (SD = 13, ranged 18-73)The participants completed:a) question for the recording of social-demographic characteristics a) The Symptom Checklist-90-Revised, b) The Other as Shamer Scale, c) The Experience of Shame Scale, d) The Hostility and Direction of Hostility Questionnaire, and e) The State-Trait Anxiety Inventory.

One hundred thirty two out of361 Roma have the skill of reading while 131 out of those have the ability towriting. There were no statistical significant differences between the twosexes (reading p=.094 and writing p=.127) We did not found any significantassociations among the skill of reading and the psychological characteristicsthat investigated in the present study, by using general linear models (MANCOVA). Regardingskills of writing statistical significant associations were found in terms ofdepression (p=?<?.05) and trait anxiety (p?<?.05).

The analysis of Roma education related to theirpsychological profile is important, as it tries to reveal the ambivalence ofthe psychological situation in which the Gypsies may exist.

Paranormal believes are prevalent in general population, and it may interfere with compliance medication.

Level of Paranormal believes and medication adherence in patient with depression.

To know the level of paranormal belive, and its relationship with sociodemographic & clinical variables and medication adherence in patient with depression.

Fifty seven patients with depression in remission were recruited as perselection criteria and assessed with sociodemographic proforma, Revised Paranormal Belief Scale (BPBS) and Morisky Medication Adherence Scale (MMAS).

Statistically significant correlation was observered for traditional religious belief with marital status (P<.01), knowledge about illness (P<.001), family history of mental illness(p<.05) and knowledgeof treatment option(p<.001). Psi had a similar correlation with a family history of mental illness (p<.001), while witchcraft with family history of mental illness (p<. 05) and knowledge of treatment option (p<.001). Spiritualism subscale also had a correlation with religion (p<.001) and family history of mental illness (p<.05), while precognition found to have correlation with marital status (p<.05), family history of mental illness (p<.05) and method of treatment sought before (p<.05). Total score of MMAS had a significant correlation with subscale spirituality (p<.05) and Psi (p<.05) of BPBS.

Based on this finding it may be concluded that paranormal belief vary with demographic and clinical variable, while medication adherence may vary with levelof sipirituality and Psi.

The shift to the online world supported by parents who actively encourage children to remain in the home; and typically justify the purchase of new technologies because of the danger of outside spaces as well as the educational role they are expected to play. The prevalence of social networking sites has certain implications for identity .

Determining the dominance of social networking sites (which largely of course means Facebook and Twitter at present) in the lives of the majority of teenagers which involve them dealing with three key public elements – profiles, friends and comments – which all have implications for the performance of identity.

Explaining the ways to reduce the effects of social networks on the identity crisis of youths.

The study was carried out on 150 boys and 100 girls from 11 to 15 years of age studying in schools, in Hamedan. In the 4 months of October to January,2013, the students were asked to write the summary of subjects they communicate online and the time they spent averagely online.

70% of boys exchanged songs and videoclips and photos related to sports and cinema actors of which 40% were abnormal. 40% of girls exchanged fashion and songs. Only 20% of both sexes talked about their school subjects online.

Social phobia has driven children to have a hidden identity to let them enter virtual world which can destroy their natural and real identity. It is necessary to construct special chatrooms for students to get involved in scientific and social affairs freely.

Exhaustive literature is available in the portrayal of mental illness in the English language films. However no major studies are available around the portrayal of mental health in Bollywood movies which in fact is consumed by nearly 25-30% of the world population.

in the era of unprecedented growth in visual medium, we wish to study the portrayal of mental illness in Bollywood cinema and how effective this medium is to create awareness around mental health and stigma.

Literature search with a specific purpose to identify any available literature on mental illness in South Asian cinema was undertaken. to create a synthesis of portrayal of mental illness, its impact on cultural consumption with its advantages and deficiencies. This was followed by a listing a cluster reviews of Bollywood films that have characters with mental health problems to identify how these illustrate both the condition and reactions to them.

These findings were compared with the literature surrounding mental health and the Indian culture to show if the perceptions correlate. The information was collated to see any patterns and 6 such patterns were identified.

Results

Recognising these motifs are crucial for public and clinician alike in contact with the population open to the influence of these films to not only understand the phenomenology of mental illness in this populace but also some of unique cultural factors, medication, stigma and charting out appropriate management plan. (On-going)

The details of the synthetic factors will be presented in the results and discussion.

The success of treatment of depression in rural Sri Lanka is under-assessed. Given the limited facilities, social stigma associated with mental illness and cultural beliefs, clinic attendance and treatment compliance was expected to be poor

To ascertain the default rates of patients treated for depression

This study was conducted at the psychiatry unit of the Provincial General Hospital, Ratnapura, Sri Lanka. All newly diagnosed patients with depression (with ICD 10 criteria) over a 4 month period were enrolled in to the study and were followed up for further 6 months. Each patient had their socio-demographic details recorded at the beginning. They were followed up at monthly intervals for 6 months and treatment response was assessed. At the end, statistical correlations between socio-demographic factors and defaulting were assessed.

Fifty patients (n-50) diagnosed with depression were recruited and the overall default rate was 70% (33). Of those who were lost to follow up, 19 (57.6%) only came for the initial visit and the rest did not come beyond a maximum of three monthly visits. On assessing correlations to defaulting; gender, monthly income, relationship status, being employed, severity of depression and living closer to hospital (less than 30 km) did not show a significant association with defaulting (chi square test, p>0.05).

Cultural beliefs and social stigma were not assessed in this study and may contribute significantly to high default rates. Identification of contributory factors to high default rates is urgently needed to improve treatment success in depression.

Psychopathological and biological markers that predict response to antidepressant drugs that selectively increase serotonin and/or chatecholaminergic neurotransmission will considerably increase the effects of currently available treatment options.

Comparison of tryptophan depletion (TD) and catecholamine depletion (CD) regarding the pathogenesis of depressive symptoms.

To elucidate the differential symptomatology and neurocircuitry in response to reductions in serotonergic and catecholaminergic neurotransmission in subjects at high risk of depression.

Using identical neuroimaging procedures with [18F] fluorodeoxyglucose positron emission tomography after TD and CD, subjects with remitted depression were compared to healthy controls in a double-blind, randomized, crossover design.

While TD induced significantly more depressed mood, sadness and hopelessness than CD, CD induced more inactivity, concentration difficulties, lassitude and somatic anxiety than TD.CD specifically increased glucose metabolism in the bilateral ventral striatum and decreased glucose metabolism in the bilateral orbitofrontal cortex, whereas TD led to a specific increase in glucose metabolism in the right prefrontal cortex and in the PCC. While we found direct associations between changes in brain metabolism and induced depressive symptoms following CD, the relationship between neural activity and symptoms was less clear after TD.

This study showed that serotonin and catecholamines play common and differential roles in the pathophysiology of depression. Thus, the development of psychopathological and neuronal markers predicting response to selective monoamine inhibition is feasible, and current efforts to develop antidepressants with dual and triple reuptake inhibition (serotonin, norepinephrine, dopamine) are supported by this study.