Friedrich Schiller (1759-1805) was not only a famous German poet but also physician and one of the leading historians of his time at the university of Jena (Germany).

To show that Schiller was very early inclined for psychosomatic interactions.

Analysis of the secondary literature since the death of Schiller for the subjects ‘Friedrich Schiller” and ‘psychosomatics”

Already during his medical studies at the ‘Hohe Karlsschule’ in Stuttgart (Germany) Schiller studied very intensively psychosomatic issues on behalf of the disease of another student, Joseph Frédéric Grammont. After the tremendous success of his play ‘Die Räuber” he fled from his unhappy life as a military physician and lived as a poet, always threatened by diseases and poverty. Medical and psychological knowledge play an important role in the thought of Friedrich Schiller. His creativity seems to be of greatest importance for him to survive psychically and physically. The actuality of his plays is due to the description of the drama of life in every age group, beginning from early childhood. Critical turning points in his life very often caused psychosomatic reactions, especially pain. Towards the upcoming mesmerism he remained very sceptic and refused to be mesmerized by the physician Eberhard Gmelin.

Despite his own severe somatic illness he could cope with pain and emphasized in his writings the importance of the freedom of anxiety in difficult conditions. His descriptions of feelings, emotions and mental states are unique in their phenomenological precision and richness.

During the last decade there has been a resurgence of interest in the relationship between early adversity and the development of psychiatric symptoms later in life. There is accumulating evidence for a link between childhood trauma and the development of most psychiatric disorders, including mood and anxiety disorders, eating disorders, personality disorders and substance abuse.

Recently, a substantial number of studies have suggested that childhood trauma is also an important risk factor for psychosis. Indeed, a significant proportion of people with psychotic disorders report traumatic experiences during childhood and an increasing number of population-based studies have provided data that suggest that childhood trauma (and to a lesser extent adult abuse or experience of a traumatic event) is of aetiological importance in psychosis.

This work has as main goal, starting from a review of the literature on this subject, to reflect on the possible mechanisms that may mediate the relationship between maltreatment in childhood and greater predisposition for the development of psychotic symptoms in adolescence and adulthood.

There is increasing evidence that neurobiological mechanisms such as dysregulation of the hypothalamic-pituitary-adrenal axis and sensitization of the dopaminergic system may mediate the interaction between the experience of traumatic events at early stages of brain development and increased risk for psychotic symptoms later in life. Preliminary evidence also suggests that polymorphisms within the cathecol-O-methyltransferase and brain-derived neurotrophic factor genes may interact with psychosocial stress in the development of psychosis.

Insight is defined as the recognition that one has a mental disorder, the ability to identify its symptoms, and cognizance of the need for treatment. Lack of insight into having a mental disorder is found to be associated with a poorer clinical outcome, treatment noncompliance, and a more severe cognitive impairment.

Compare the insight and medication adherence in a population of schizophrenia and bipolar disorder patients.

We assessed and compared the insight and compliance of 60 patients with schizophrenia (n=30) and bipolar disorder (n=30) recruited in Psychiatry department Sfax, Tunisia.

Insight was assessed using the rating scale of consciousness disorder (Q8).

Adherence was assessed using the Drug Attitude Inventory [ICD-10].

Patients were mainly young adults, male (70%) and did not live in a couple (61.7%).

About half of them (43.3%) had no profession.

Insight was low in 15% of patients, intermediate in 53.3%, and good in 31.7% of cases. Bipolar disorder patients displayed better insight into having a mental disorder compared to schizophrenia patients (p=0.04)

Good adherence was observed in 64.4% of patients.

Factor influencing adherence in both populations was the type of treatment: patients treated with atypical antipsychotics have better compliance (p = 0.005).

A good insight was significantly correlated with good adherence (p = 0.000)

Our results showed that bipolar disorder patients have better insight compared to schizophrenia patients. So it is necessary; in schizophrenia; to work on awareness of the disorder and the need for treatment to improve adherence.

Impulsivity is recognized as a predisposing factor for addictive, suicidal and aggressive behavior.

The aims of our study were to evaluate the level of impulsivity in inpatients and identify risk factors associated.

Our study was conducted among 32 inpatients in the psychiatry ward ‘B’ in Sfax, Tunisia.

We collected socio-demographic and clinical data and we measured impulsivity using the Barratt Impulsiveness Scale (BIS-11), insight using insight Q8 scale and medication adherence rating scale (MARS).

The mean age of the sample was 36.72 years.

Patients had a low socioeconomic status in 50% of cases.

They had a criminal record in 25% of cases, a history of suicide in 34.4% of cases and addictive behaviors in 59.4% of cases.

Ninety-four percent of patients had a violent behavior.

Patients were diagnosed with schizophrenia in 59.4% of cases, suffering from mood disorders in 28.1% of cases, and had manifested personality disorder in 18.8% cases.

The percentage of patients with a high degree of impulsivity was 59.4.

Patients had poor insight in 75 % of cases and were not adherents to treatment in 65.6 % of cases.

Impulsive patients were smokers (p=0.046), had a familial history of violent behavior (p=0.01), had poor insight (p=0.02) and were not adherent to treatment (0.04).

Impulsive behavior is associated with several factors, including addictive behavior, poor insight and lack of adherence to treatment. It is imperative to detect and treat them in time to avoid serious consequences.

Autism Spectrum Disorders (ASD) are neurodevelopmental disorders that affect people across their lifespan. Among those without an intelectual disability, the disorder may not become apparent until adulthood, when it usually presents with comorbidities.

As ASD symptoms are poorly recognized and assessed in adulthood, and the diagnosis is made easier by the application of appropriate evaluation scales, we intend to identify and describe all tools available for screening or diagnosing ASD in adults without intellectual disabilities, and report their psychometric properties.

Pubmed, PsycINFO and Embase database search up until September/2014, using 'high-functioning autism” or 'Asperger” and 'adult”, combined with 'questionnaire”, 'assessment”, 'instrument” or 'scale” as search terms.

We identified 14 instruments, including observational scales, interviews and self-report questionnaires, among which seven are specifically designed for adults. Time to administer and training required vary widely. Psychometric properties are generally good, although validation is scarce. Six instruments are designed for screening purposes: ASQ and its shorter version (ASQ-10), RAADS-14, ASDASQ, KADI and ASSERT. The remainder are intended to be diagnostic: ADI-R (with adaptations – deleted items), ADOS-G Module 4, AMSE, GADS, ASDI, RAADS, AAA and SRS-A.

Besides the time-consuming gold-standard instruments (ADI-R and ADOS-G), there are many instruments available for assessing ASD in adults. Nevertheless, lack of enough validation and comparison between these scales prevents making safe recommendations regarding their use.

Depression and anxiety are frequently reported by MS patients. Studies examining the association between depression, anxiety and personality in MS patients is very limited.

Our objective is to compare temperament and character, depression and anxiety in Relapsing Remitting Multiple Sclerosis (RRMS) patients with healthy controls and inquire into the association between these entities.

The aim of this study is to investigate the possible presence of spesific temperament and character profiles in RRMS patients.

Seventy one RRMS patients and 50 age and gender matched healthy controls were enrolled in the study. Diagnostic neurological examination, sociodemographic and clinical data including the type of MS, duration of the disease, number of relapses, current treatment and the duration of treatment were recorded. SCID-I, Standardized Minimental State Examination, Temperament and Character Inventory, Beck Depression Inventory and Beck Anxiety Inventory were administered.

Patients scored significantly higher in Harm Avoidance and lower in Novelty Seeking, Persistence and Self-directedness than the healthy controls. Depression, anxiety, temperament and character scores were not correlated with disability and the number of relapses.

Temperament and character, depression and anxiety seems to be independent of the disability and the number of relapses in RRMS patients.

In Portugal, after the integration, in 1992, of the Mental Health Services in General Hospitals and, later, with the publication of the Mental Health Act in 1998, there was a clear choice, in terms of health policy, for the deinstitutionalization of the mentally ill and for promoting the integration into their communities. In 1977, at the time called Mental Health Center of Viseu, inspired by the avant-garde currents of French sector psychiatry, pioneered through the creation of their Community Service, immediately reducing its capacity from 120 inpatients to 44.

To conduct a descriptive analysis of the patient population monitored by the team of the Community Service of Centro Hospitalar Tondela-Viseu.

An observational, cross-sectional study.

Descriptive analysis. Data collected from the clinical files and the database built by this service team, analyzed in the program EXCEL ® 2010.

The Community Service currently integrates 562 patients, about half of which are aged between 30 and 49 years. Most patients are male and the main diagnosis is schizophrenic psychosis.

The Community Services have progressively assumed a more relevant importance in the monitoring of individuals with mental illness, allowing their deinstitutionalization to happen and contributing to a more harmonious reintegration of these patients in their community.

This work aims to review ADHD’s definition, epidemiology, frequent psychiatric comorbidities, differential diagnosis – highlighting it’s similarities with BPD –, treatment, and outcome.

A review of relevant literature was conducted alongside online database research (PubMed and Medscape).

ADHD is a neurodevelopmental disorder defined by persistent impairing levels of inattention, motor hyperactivity and impulsivity that exhibit a negative impact in functioning. It is estimated to affect 5% of children and 2.5% of adults. As the affected individual grows it is likely that the symptoms of hyperactivity will decrease, but the inattention, poor planning, and impulsivity tend to persist into adulthood, compromising social, academic, and occupational functioning.

It may be difficult to distinguish between ADHD and personality disorders, especially BPD. However, BPD has characteristic features like fear of abandonment, self-injury/suicidal behavior, extreme ambivalence, feelings of emptiness, and stress-related paranoia/severe dissociation, that are not present in ADHD.

Despite some similarities in clinical presentation in adolescents and young adults, PHDA and BPD differ substantially in their treatment, impairment in functioning, and outcome, making it crucial to establish a correct diagnosis which will enable proper treatment.

Assessment of posttraumatic cognitions after accidents, paired with active identification of suicide risk and reasons to stay alive, can generate more effective management strategies of traumatic events. Aim. To comparatively assess posttraumatic cognitions in survivors of accidents with and without suicide risk. Participants and method. Authors assessed a sample of persons exposed to motor vehicle accidents, work – related accidents or burns, treated in the Rehabilitation Hospital Cluj – Napoca. Suicidal risk after trauma and in the 2 weeks prior to assessment were evaluated through Paykel Suicide Scale. Posttraumatic Cognitions Inventory was employed in order to assess various types of catastrophic cognitions. Results. Most patients included in the study did not exhibit suicidal risk after the exposure to trauma. Nevertheless, specific differences between the samples with and without suicide risk were ascertained, regarding the types of posttraumatic cognitions mostly endorsed. Discussion. Excessive suppression and excessive expression may prove equally detrimental after exposure to specific types of trauma, generating increased suicide risk. Conclusions. Certain catastrophic cognitions can be considered risk factors for suicide after trauma and addressing them in therapy can be beneficial for individualized short- and long-term trauma management.

Stigma against people with mental illnesses is oppressive and alienating; it prevents many from seeking help, denying them access to the support networks and treatment they need to recover. Diagnostic overshadowing occurs when symptoms of physical illness are attributed to the service user’s mental illness. This increases the risks of treatment delay and the development of complications. The situation may arise due to stigmatisation of the mental condition and negative attitudes among healthcare practitioners.

To review the literature on 'diagnostic overshadowing” in mentally ill patients.

A literature review was made by searching for articles in PubMED.

'Diagnostic overshadowing' appears to be common in general health care settings. Studies have shown that people with mental illness die earlier compared to the general population. Suicide is a big factor, accounting for 30 to 40 percent of early deaths. But 60 percent die of preventable or treatable conditions. Studies showed that patients with both a mental illness and a cardiovascular condition received about half the number of follow-up interventions, like bypass surgery or cardiac catheterization, after having a heart attack than did the 'normal” cardiac patients.

Diagnostic overshadowing remains a hurdle in delivering high quality psychiatric and medical healthcare to our patients. It is believed that diagnostic overshadowing contributes to the excess medical morbidity and mortality seen in individuals with psychiatric disorders.

Until the second half of the nineteenth century the word paranoia was used to mean 'out of mind”. Kraeplin has been determinant to change the conceptual history of paranoia, leading, with the contribution of other authors, to the emergence of delusional disorder in current classifications.

We intend to characterize delusional disorder and its clinical utility.

We describe and analyse a case of a man with the diagnosis of delusional disorder – persecutory subtype and make a bibliographic review about this disorder.

The delusional disorder has a prevalence of 0,03%. The key feature is the existence of an encapsulated delusional system without impairment of other mental functions. As expected our patient has personality traits characterized by suspiciousness, rigidity, an inappropriate sense of personal rights and a tendency to misconstrue the actions of others as hostile. His defense mechanisms are mainly denial, projection and reaction formation. The beginning of the disease was between 35-45 years. First time he was observed by Psychiatry he was taken by family and recently it was by court order. The differential diagnoses were excluded (paranoid personality, schizophrenia, dementia, other medical conditions, disorders induced by substances).

The cause of delusional disorder is unknown. The importance of personality traits, life events and genetic factors seems to be uncertain and probably variable. The typical lack of insight conditions the therapeutic adhesion and establishing the necessary adequate therapeutic relationship remain a big challenge.

998 consecutive adult PC patients (678 (67,9%) women and 320 (32.1%) men) were evaluated for psychiatric disorders, using MINI International Neuropsychiatric Interview (MINI). Information on the clinical diagnoses and treatment was obtained from the patient's medical records.

Major depressive episode (MDE) was found in 15.2%, anxiety disorders were found in 26.3% (generalized anxiety disorder in 18.1%, suicidality in 6.1% and alcohol misuse in 34.8%) PC patients, according MINI. Of all respondents, 266 (26.7%) were diagnosed as having at least one current MD (or MDE, or one of four anxiety disorders): 60 (18.8%) of men and 206 (30.4%) of women (p<0.001). The anxiety disorders were stronger associated with psychiatric treatment in women (OR=2.94; 95 CI 2.0-4.33), particularly in the category of cardiovascular diseases (OR=2.32; 95% CI 1.09-4.94), but there was also a significant association with diabetes mellitus in men (OR=5.54; 95% CI 1.6-19.18). The most common reasons for patients to seek a PC doctor consultation were cardiovascular diseases (31.5%), administrative/'no complaints” cases (17.6%), acute respiratory tract disease (10.4%), muscle-skeletal/connective tissue disease (6.9%).

Our findings suggest that MD are highly prevalent and co-morbid with each other, and with general medical conditions in PC.MD are prevalent and co-morbid in administrative/ “no complaints” PC attendees.

Perfectionism is characterized by the relentless pursuit of unattainable high standards. Burn-out syndrome is characterized by professional exhaustion and it was defined by Freudenberge, in 1974.

The authors intend to carry out a review about the association between perfectionism and psychiatric disorders. Also one note about the possible association between perfectionism and burn-out.

Review about the concept of perfectionism and its implications, including in the development of psychiatric illness.

There are several works on the concept of perfectionism and its implications. particularly in obsessive-compulsive disorder, depression, anxiety and eating disorders. There are constraints on the development of this pathology, such as cognitive ability and adaptation to life-events.

The increasing pressure on labor activity may, in individuals with this characteristic, contribute to the development of burnout.

It is essential the research and the applicatin of strategies for prevention and intervention in patients with perfectionist traces, susceptible to develop mental illness.

This study was aimed to discover the correlation between those getting tattoos and their psychopathology relating to their delinquent behavior and emotional problems.

Date for this study was collected from 19-year-old men who were receiving a physical examination for conscription at the Korea Military Manpower Administration. 400 data sheets were collected among them. All of sjubjects were evaluated on the following measures: sociodemographic variants, Juvernile delinquency scale, State-trait anger expression inventory, Beck depression inventory, State-triat anxiety inventory, and Positive affect and negative affect schedule.

In comparison with those without tattooes, those with a tattoo scored higher in the scales that were related to delinquency, anger, depression, and negateive emotion. Furthermore, there were positive correlations between the number of tattoos and the scores for the Juvenile delinquent tendency and behavior scale as well as on the State-triat anxiety scale.

Those with tattoos had experienced anger, anxiety, and depression more strongly in comparison with those without tattoos. These reults recommended that tattooed males should be evaluated more on their regrading psychopathology compared to those without tattoos.

Hypothyroidism is rarely associated with psychosis. This association has been reported since 1880 and described for the first time by Asher in 1949.

Case report: We report the case of a 60-year-old woman who presented at the age of 36 years a hyperthyroidism treated by benzylthiouracile, propranolol, and radioactive iodine. At the age of 49, she presented a hypothyroidism handled by a supplementation of thyroid hormones. The same year, she was admitted in psychiatric care for behavioral disorders, anorexia and insomnia. The diagnosis of hysteria was initially retained and the patient was lost sight of during 4 years. She was then re-hospitalized for psychomotor instability, delusions, insomnia, auditory and visual hallucinations, after she had stopped the treatment. Skin excoriations, caused by suspect cenesthetic hallucinations, were found in the examination. The diagnosis was chronic paranoid schizophrenia and the patient was treated with a long-acting antipsychotic associated to a supplementation of thyroid hormones. She was then lost from sight until 2014, when she was admitted for physical aggression, soliloquy, delusions of persecution auditory and visual hallucinations, and insomnia. The examination found significant dermal infiltration, a xerosis complicated with excoriations, a flushed face, macroglossia, hoarseness, difficulty in breathing and bradycardia . The biology revealed a rate of TSH=45.76uui/ml and FT4 <1pmol/l . Thyroid hormones have then been gradually introduced. The evolution was favorable with the disappearance of psychotic and somatic symptoms.

Though hypothyroidism is usually associated to a depressive symptomatology, it may, as shown by this case, be associated to psychotic symptoms.

Watkins and Moulds (2005) adapted the Positive Beliefs aboutRumination Scale (PBRS; Papageorgiou and Wells, 2001) to reduce confounds with mood states. The items keep the meaningthat recurrent thinking about feelings would be helpful, but direct mentions ofrumination, depression and negative mood or events were omitted.

To investigate thepsychometric properties of the PBRS-Adapted Portuguese version.

Acommunity sample of 552 university students (425 girls; 80.3%; mean age=19.72±1.147) answered the Portuguesepreliminary version of the PBRS-A, and the validated Portuguese versions ofother self-reported questionnaires: Perseverative ThinkingQuestionnaire/PTQ-15; Repetitive Thinking Questionnaire/RNT-10; The Metacognitions Questionnaire-30/MCQ-30;Profile of Mood States/POMS. To study the temporal stability, 242 (207girls; 85.5%) respondents answered the MCQ-30 again after approximately six weeks.

The PBRS-A Cronbach alpha was 'very good” (a=.80). All the itemscontribute to the internal consistency. The test-retest correlation coefficientwas high, positive and significant (.64; p< .001); there was not significantdifference between test and re-test scores [25.89±5.384 vs. 24.64±5.444, t (218)=4.014,p=.114]. Following Kaiser and Cattel Scree Plot criteria, only one factor wasextracted, meaning that the scale is unidimensional.

PBRS-Asignificantly, positively and moderately correlated with RNT-10, PTQ-15, MCQ-30and all their dimensions (all r>.35;p<.01) as well as with all the negative mood states from POMS (all [email protected]; p<.01).

The Portuguese version of PBRS-Ahas good reliability and validity. As a transdiagnostic measure, it could be veryuseful to assess individuals with several emotional disorders, both in clinicaland research contexts.

The aim of our case report is to highlight the possible association of NF1 and psychotic symptoms, to underline the usefulness of a complete somatic examination when confronting with epileptic or mentally retarded teens experiencing an hallucinatory syndrome.

We report the case of a 17-years-old boy, with consanguineous parents and history of mental retardation and generalized epilepsy since the age of three, consulting for auditive and visual hallucinations and an heteroagressiveness since two months. Skin examination found signs of NF1.

Electroencephalography (EEG) showed no epileptic abnormalities and brain MRI showed no abnormalities than could explain the psychotic symptoms that are usually parts of the organic brain syndrome. A medication by 2 mg per day of Risperidone has completely eliminate the psychotic symptoms within two months and is continued for one year at least.

Neurological and psychiatric disorders are often intricate. Psychiatrists should have a better knowledge of both psychiatric and somatic manifestations of NF1 to not pass through the right diagnosis and to ensure to these patients better intellectual, academic and social skills.