The association between somatic diseases and bipolar disorder (BD) have been described especially for auto-immune diseases.

Through a case study and a review of literature we are going to describe a comorbidity of BD and myasthenia.

Starting from a case report, we conducted a literature review on “PubMed”, using a key word “myasthenia and bipolar disorder”

The patient AJ, 57 years old, married, mother of 5 children; 4 sons and 1 daughter who also has BD. She is illiterate and a full-time mother. she has high blood pressure, a congestive gastropathy and hemorrhoids. She has been diagnosed with BD in 1987 (at 21 years old) and mainly had depressive episodes. She was put on Amitriptyline, carbamazepine, long-acting neuroleptics and benzodiazepines. Since 2006 the patient has been reporting persisting myasthenia even when she was euthymic. In 2009, she was hospitalized for persistent headaches, pain and a decrease in visual acuity in the right eye. An ophthalmoscopy, a cranial CT-scan and an MRI were performed with no anomalies. Then a fluctuant ptosis and an intense fatigability appeared. She then was hospitalized in a neurology ward where she was diagnosed with myasthenia. Changes in her treatment had to be made. Carbamazepine was switched to valproic acid, amitriptyline was switched to fluoxetine. And benzodiazepines were stopped.

It’s important to pay close attention to somatic diseases in our patients in order to insure appropriate medical care. Also, the association between somatic disorders and BD can be an interesting lead in elucidating the etiopathogeneses of BD.

No significant relationships.

Addictions are prominent among indigenous people in North America in relation to historical and contemporary trauma.

We describe the approach emerging in our services for the five indigenous tribes of Maine (the Wabanaki Confederacy) for culturally sensitive treatment of opiate use disorder.

In our auto-ethnographic approach, we introduce or re-introduce participants to cultural beliefs, values, and methods for treating addictions, inclusive of narrative methods (storytelling) which receive greater acceptance by indigenous and marginalized peoples. Indigenous philosophy states that we see the world using the stories that we have absorbed or constructed to explain our perceptions. Using substances is a story that is connected to poverty and adverse childhood events. We create new stories to develop a sense of agency, the sense that one’s actions can make a difference in one’s life.

We present the lessons learned and the results of our using this approach with a tribal population in Maine. Some key concepts include (1) reframing the person’s self-story about being addicted within a threat-power-meaning network, (2) working with stories about the spirit of the addiction and the consequences of ingesting spirit-laden substances without knowing their songs and protocols, (3) constructing future-self-narratives that explore right relationships and meaningful conduct, (4) constructing stories about the intergenerational transmission of addictions and exploring the question of “whom will be the recipient of your addiction?”

We come to understand that the client sets their goals and defines what recovery means for them, which is the heart of a harm reduction approach.

No significant relationships.

Lateralization is a complex process that evolves during the development of the child leading to the organization of the functional dominance with a body side. However, laterality is poorly examined.

The aim of this study was to explore the features of patients with a laterality disorder evidenced by a non-dominance affirmed of the handedness.

A retrospective review of 25 cases of patients (15 children of 8-9 years and 10 adults of 26-42 years old) presenting a laterality disorder. All patients were assessed with the standardized assessment of neuropsychomotor functions battery (NP-MOT).It enables physical assessment of muscular tone of limbs and axial tone (trunk), laterality (tonic, spontaneous gestural, psychosocial handedness, and usual with objects for hand, foot, and eye), body spatial integration (in relation to self, imitation, objects and map), auditory attention, and others motor functions.

The study findings revealed poor level of the dominant laterality for all the patients (< 2DS) regarding the proximal tonic laterality (elbows) and the psychosocial subtests of mimed gestures (tending to ambidexterity). In addition, it was found a hypotonic trunk and difficulties in body spatial integration and in asymmetrical bimanual tasks with slowness and failures, similar dexterity performance right/left.Strong correlations between all these features and the personal history match the difficulties to focus a long time an attention holding posture without to move, and associated to a fatigability.

A deep standardized examination of the laterality and tone may explain some components of the behavior in relation with hemispheric dominance impairment.

No significant relationships.

Neurocognitive deficits amongst patients with schizophrenia are considered one of schizophrenia’s central features. These deficits appear to be present from the first episode of psychosis (FEP) and certain cognitive impairments could be components of a genetic vulnerability to schizophrenia. Regarding research on cannabis and cognition in schizophrenia, different studies have assessed neurocognitive functions: memory, attention/vigilance, processing speed, verbal learning, executive functions, and verbal fluency.

The aim is to do a review of recent findings concerning the association of cannabis use with cognition in schizophrenia.

A literature review was conducted using the PubMed search database.

Patients with schizophrenia and concomitant cannabis use are associated with worse performance in immediate verbal learning, and in some studies with worse working memory performance. There is an improvement of verbal memory when they cease the cannabis’ consumption. Regarding attention capacity and memory types assessed, the results are controversial. In FEP, heavy cannabis use during the previous year correlates with slower processing speed. Also, FEP-patients with cannabis use but no family history of psychosis perform worse in executive functions, while those with a family history of psychosis perform better.

The studies of psychosis, cannabis and cognition differ in relevant aspects, which might be connected to the result variability. Therefore, before solid conclusions can be reached, it is important to carry out longitudinal studies to understand the changes in the cognitive variables, which can depend on the pattern of cannabis’ use (concurrent or prior to the FEP). Possible confounding variables that might be present should be acknowledged.

No significant relationships.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity. It is one of the most common disabilities in college populations and comorbidity with depression is frequently reported.

The aim of the study is to shed light on depression as comorbidity and other intrapersonal correlates of ADHD in young adults.

Participants were Hungarian university students (N=420; M=24.5, SD=5.0 years). Criteria of the ADHD group were based on the Adult ADHD Self Report Scale V1.1 (ASRS-V.1.1) screening tool. The participants filled in the Beck’s Depression Inventory, the Hyperfocus Scale, Flow State Scale, Academic Persistence Scale, Satisfaction With Life Scale, General Self-Efficacy Scale, and the Connor-Davidson Resilience Scale.

We found that in the group of students who had ADHD symptoms, depression score was significantly (p<.001) higher (M=18.38, SD=5.87) than the control group’s scores (M=14.56, SD=4.45). Frequency of severe depression was 13.4% (moderate: 33.5%) while in the control group: 1.6% and 17.6% respectively. Participants reporting ADHD symptoms (N=164, 39%) also reported lower levels of resilience (M=23.40, SD=6.96), relative to their non-ADHD peers (M=27.69, SD=6.48). Significant differences were found in the areas of self-efficacy, depression, flow and hyperfocus as well, and ADHD symptoms contributed to lower level of life satisfaction (β=-0.24, p<.001).

Our findings suggest that university students reporting symptoms of ADHD may be assisted with strategies that are focused on increasing protective factors (i.e., resilience, self-efficacy, flow) to prevent depression and improve their life satisfaction and quality of life.

No significant relationships.

Alexithymia, the lack of words to express emotions, is a common problem in multiple sclerosis (MS) patients.

To investigate the prevalence of alexithymia in patients with MS and to evaluate the factors related to it, including depression.

We conducted a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It involved MS outpatients in remission phase. Data collection was done using a form exploring sociodemographic, clinical and radiological characteristics. We used the Expanded Disability Status Scale (EDSS) to evaluate neurological impairments, the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

Our study included 93 patients. They were married in 57% of cases. The total number of relapses ranged from 1 to 30, with a median of 5. The EDSS score ranged from 0 to 8. A temporal lesion on brain imaging was found in 29% of cases. MS patients had alexithymia in 58.1% of cases and depression in 26.9% of cases. Alexithymia was more frequent in unmarried patients (p = 0.028). Among clinical and radiological factors, the number of relapses was higher (p = 0.035), and temporal lesion was more frequent in alexithymic patients (p = 0.045). In this study, alexithymic patients were more depressed (p < 10-3).

According to our results, depression and alexithymia were found to be significantly inter-related in MS. Future longitudinal studies might better clarify the nature of this relationship in MS patients.

No significant relationships.

The co-occurrence of mental illness and somatic comorbidities is a major cause of increased morbidity and mortality within psychiatric patients, compared to the general population. This may be caused by an unhealthy lifestyle, side effects of psychotropic drugs and systematic barriers in healthcare provision. The underlying mechanisms remain under-investigated.

We systematically investigated relevant barriers and risk factors to the utilization of primary care among severe mentally ill outpatients.

In a cross-sectional analysis, the psychiatric as well as somatic diagnoses of inpatients of a German psychiatric community hospital were identified. Furthermore, somatic and psychiatric medication, blood values (HBA1C) and sociodemographic data of the patients were analyzed. The frequencies of the somatic diagnoses were presented according to psychiatric diagnoses. By a Chi-Square goodness-of-Fit Test the distribution of somatic diagnoses and drug classes were verified according to the total cohort as well as for each psychiatric diagnosis and in respect to sex.

Our results provide an overview of common comorbidities with regard to the psychiatric diagnosis. The medication, in relation to the recorded somatic comorbidities, as well as the blood values, allow a conclusion to be drawn about the extent and success of the treatment.

For the first time, real-life data on the somatic diagnoses and treatment of patients with a severe mental illness in a German hospital is presented. Our results will be used to create low-threshold interventions for the most relevant somatic comorbidities and to improve primary care of psychiatric patients through linking the care systems.

No significant relationships.

Premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), affects 3-5% of the women of childbearing age. According to scientific literature, the prevalence of PMDD increases with age and among the psychiatric patient population as well, e.g. in women suffering depressive disorder (DD) or panic disorder (PD).

To estimate the prevalence of PMDD in women without psychiatric comorbidities and those with concomitant DD or PD.

A cross-sectional non-interventional study that enrolled 159 women, divided in 3 groups: 1) 98 women (mean age 31.04 ± 6.31) with PMS and no psychiatric comorbidities; 2) 31 women with PMS and DD (mean age 39.4±7.21); 3) 30 women with PMS and PD (mean age 31.2±7.89). PMS was assessed by the PSST (Premenstrual Symptoms Screening Tool). DD and PD were diagnosed by MINI and a psychiatric evaluation. Descriptive and frequency statistics were performed.

Within the group without comorbidities mild PMS was present in 48% (N=47) of the cases, moderate - in 41,8% (N=41), and in 10,2% (N=10) of the cases PMDD was diagnosed. Within the group with comorbid DD 25,8% (N=8) had mild PMS, 58,1% (N=18) had moderate and 16,1% (N=5) had PMDD. Among the women with comorbid PD 56,7% (N=17) suffered moderate PMS, 43,3% (N=13) - PMDD and no mild cases were documented.

The results demonstrate that comorbid DD or PD increases the prevalence of PMDD. It is considerably more common in patients with PD than those with DD.

No significant relationships.

Psychiatric conditions can be both a symptom and a consequence of physical disease. Although understanding of this is important for health care delivery, coverage of the relationship between physical and psychiatric illness in undergraduate medical education is sparse. This relationship is particularly pertinent in neurological disorders, where psychiatric symptomatology is commonplace. As part of a student project, the author was tasked with developing accessible teaching materials to increase interest and understanding among medical students, using podcasts.

The aim was to develop podcasts which explored the relationship between psychiatric and neurological illness, for use in undergraduate psychiatric training.

Literature reviews were performed on podcasting in medical education to identify the optimal methods of production to maximise educational value, and on topics covered in podcasts to inform the interview questions. Experts in the relevant areas were contacted for recorded interviews, later used to create podcasts.

Four interviews were conducted between the author and consultant neurologists specialising in the specific neurological condition. A podcast was produced for each of the following topics: depression in multiple sclerosis, frontotemporal dementia in motor neurone disease, Lewy body dementia, and dissociative seizures.

Psychiatric and physical illness are often intertwined. As the prevalence of psychiatric illness rises, it is becoming increasingly important that this connection is recognised, in order to improve patient experiences and outcomes. Novel teaching modalities, such as podcasts, can provide additional ways to support medical education on this important topic.

No significant relationships.

The term comorbidity or dual diagnosis in this case refers to phsychiatric disorder and one or more medical diseases. The purpose of this study is to emphasize the importance of identifying medical diseases in psychiatry.

Medical diseases that develop most in comorbity with psychiatric disorders Identification of gravity of comorbidity symptoms Clinical progression Treatment efficacy/ Interaction of psychotropic medications with other medications.

Methodology: A regular clinical study strategy has been adopted, with adults aged 19-75 females and males diagnosed with mental disorders and one or more medical pathologies, including neurological diseases during a 10-year period (2010-2020) in ”Ali Mihali” Psychiatric Hospital, Vlora.

They showed that medical diseases, such as: hypertension, diabetes mellitus, urinary infections, gastrointestinal disorders, acute and chronic bronchitis, severe brain injury often develop in comorbidity with mental disorders. Mental disorders that develop most in comorbity are: schizophrenia, schizoaffective disorder, delusional disorder, mood disorder. Treatment of these disorders is difficult due to the gravity of symptoms, interaction of medications, and side effects they have.

Mental disorders in comorbidity with medical diseases are usually hard to treat. For this reason, it is imperative to diagnose them the soonest possible. When mental and medical disorders are comorbid, their coexistence has grave symptoms, chronic progression, which affects functioning, quality of life, and increases health care costs.

No significant relationships.

Cardiac surgery patients (CSP) are cardiovascular patients who undergo surgery to treat their disease. Are their psychological characteristics different from those of other cardiac patients?

The goal is to establish peculiarities of the clinical-and-psychological status of CSPs in different clinical groups.

According to clinical parameters, 152 CSPs were divided into three groups. The first group comprised patients with CHD indicated to an open-heart coronary artery bypass grafting, the second one included patients with heart failure who were to undergo aortic valve surgery, and the third group included CHD patients and those with heart rhythm abnormalities indicated to minimally invasive surgery.

CSPs had a number of cardiologic complaints, mental disturbance manifestations and concomitant somatic diseases. They showed difference in the duration of the disease, previous occurrence of heart surgery or myocardial infarction, and in the degree of heart failure manifestations. Self-assessment of pre-surgery CSPs corresponded to the severity of their clinical condition, while indications of hope for recovery were at the maximum level. The second group showed a moderate level of depression, while the third one – slight depression. All the groups revealed a disharmonic profile of time perspective. Group 1 CSPs showed some manifestations of hostility. We saw different manifestations of CSPs’ personal adaptation resources. While hardiness had insufficient showings at the level of most components, social support was excessive in all groups.

CSPs as other cardiac patients revealed depressive disorders and hostility. At the same time, they have more social support, which testifies availability of good interpersonal resources.

No significant relationships.

In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two conditions, since that they are commonly comorbid.

We aimed to investigate the impact of BPD on course of illness in patients with BP.

We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity.

The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001).

Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD.

No significant relationships.

In a significant proportion of people diagnosed with Borderline Personality Disorder (BPD) and adult Attention Deficit Hyperactivity Disorder (aADHD) comorbid mental disorders, such as mood, anxiety, personality and substance use disorders can be detected. BPD and aADHD present with a partial overlap in the clinical symptoms, including increased impulsivity levels and difficulty in emotional regulation. Higher impulsivity and emotional dysregulation (ED) can result in impaired global functioning or damaged social relationships.

The aim of this study was to assess the comorbid psychiatric diagnoses of the two patient groups, and explore the possible role of ED and impulsivity in the background of the different comorbid disorders.

Data about BPD (N=49) and aADHD (N=60) patients were analyzed based on the M.I.N.I. Plus 5.0 and SCID-5-PD structured clinical interviews. Participants were further investigated with online questionnaires: e.g. Barratt Impulsiveness Scale (BIS-11) Difficulties in Emotion Regulation Scale (DERS). For measuring the influence of impulsivity and ED in the development of comorbid disorders binary logistic regression was used.

Our results showed comorbidity rates similar to previous findings in BPD patients, but lower rates were observed in aADHD. Elevated levels of ED increases the risk of suicidal ideation, mood, anxiety and eating disorders. Based on our data increased impulsivity can reduce the chance of comorbid anxiety disorders.

The results provide insight into the pattern of comorbid disorders, role of ED and impulsivity in people diagnosed with aADHD and BPD in Hungary. Understanding their underlying mechanisms helps to establish an accurate diagnosis, which affects treatment effectiveness.

No significant relationships.

Anxiety and depression are among the most common psychiatric comorbidities in multiple sclerosis (MS) patients. These disorders could lead to significant emotional disturbances.

To study the different dimensions of alexithymia in patients with MS and determine their relationship with anxiety and depression.

Our study, descriptive and analytical, focused on patients followed for MS at the neurology department in Sfax (Tunisia). In addition to collecting sociodemographic data, we used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depressive symptoms and the Toronto Alexithymia Scale (TAS-20) to assess alexithymia and its three dimensions: difficulty identifying emotions (DIE), difficulty differentiating emotions (DDE), and externally oriented thinking (EOT).

This study included 93 patients followed for MS. Our results showed a prevalence of 58.1% for alexithymia, 38.7% for anxiety and 26.9% for depression. The median score of the dimension DIE was 22. The median score of the dimension DDE was 17. The mean score for the dimension EOT was 26.96 ± 4.18. Alexithymic patients were more anxious and depressed (p = 0,002 and p < 10-3, respectively). Both dimensions DIE and DDE were associated with anxiety (p = 0.001 and p = 0.022, respectively) and depression (p < 10-3 and p < 10-3, respectively). Non-depressed patients had a higher score on the EOT dimension (p = 0.003).

Our results showed a relationship between depression, anxiety and alexithymia, hence the importance of looking for alexithymia in MS patients with anxiety or depressive symptoms.

No significant relationships.

Hypokalemia is often detected on standard biological assessments of patients hospitalized for psychiatric disorders. Many explanations are advanced by clinicians like insufficient food intake or drug effects. But what if there was a relationship between this ionic disorder and psychotic relapses?

To assess the frequency of hypokalemia in patients hospitalized for a psychotic relapse and to study its relationship with certain clinical characteristics.

This is a cross-sectional study conducted over a 3-month period (july-september 2021), including 37 male patients diagnosed with schizophrenia and hospitalized in a psychiatric unit for a psychotic relapse. Patients had blood collection before medication that was sent for a complete blood count and blood chemistry testing.

Blood potassium level ranged from 2.92 to 4.87 mmol/L with an average of 3.74 mmol/l. Half patients ( 54.1% , N=20 ) had hypokalemia. Among them, two had electric signs on their ECG and two had physical symptoms. In patients with hypokalemia, the cause of hospitalization was the agitation in 80% of cases versus 58.8% in patients with normal potassium levels. The correlation was not significant between hypokalemia and the use of a restraint (p=0.160) or the somatic history (p=0.495).

hypokalemia is an ionic disorder that should be detected in patients with schizophrenia. It exposes the patient to the risk of a sudden death, especially with use of antipsychotics that are at a high risk for torsade de pointes.

No significant relationships.

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). It can be defined as a subjective lack of physical and mental energy.

To study the prevalence of fatigue in patients with MS and to determine the factors related to it, including depression.

This was a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It focused on patients with MS in remission phase. We used the Expanded Disability Status Scale (EDSS) to determine the degree of disability caused by MS, the Chalder Fatigue Scale to evaluate the fatigue, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

The 93 patients included in the study had a mean age of 36.59 ± 10.69 years. The socio-economic level was low to medium in 52.7% of cases. The EDSS score ranged from 0 to 8 (median = 3.5). The total number of relapses ranged from 1 to 30 (median = 3.5). MS patients had fatigue in 72.4% of cases and depression in 26.9% of cases. Patients with a low to medium socio-economic level were more fatigued (p=0.027). High number of MS relapses, severity of disability on the EDSS, and presence of depression were associated with fatigue (p=0.014, p<10-3 and p=0.001, respectively).

In MS patients, fatigue is a common symptom. Patients with reduced physical activity and greater MS-related disability have more severe fatigue, which negatively affects psychosocial functioning, increasing the risk of depression.

No significant relationships.

Marfan syndrome is an autosomal dominant systemic disorder with connective tissue defects in multiple organ systems. Cardinal manifestations of this syndrome involve the cardiovascular, the skeletal and the ocular system. Interestingly, many cases of patients with Marfan syndrome and schizophrenia have been reported.

Discuss the etiological link between Marfan syndrome and schizophrenia

Presentation of a clinical case illustrating the comorbidity between schizophrenia and marfan syndrome. A search was conducted in PubMed database using the terms : schizophrenia AND Marfan syndrome.

Ms JW a 36-year- old single women, she had schizophrenia since the age of 20 years, she was hospitalized in our service for psychotic relapse in a context of treatment discontinuation. She had a personal history of persistence of the ductus arteriosus for which she had been operated during her childhood, a scoliosis operated and multiple pathological fractures. On mental status examination, she was distressed and hallucinated, She had disorganized thought processes and a paranoid delirium. On physical examination, she had features suggestive of Marfan syndrome such as crowded teeth, a high arched palate, arachnodactyly , hyperlaxity and a high myopia. We don’t dispose genetic evaluation for marfan syndrom because of the nonavaibility of facilities to perform genetic analysis. Several studies have indicated that psychiatric symptoms might be part of the clinical profiles of marfan syndrom. However, their relationship and underlying pathogenesis are not easily clarified.

Co-occurrence of marfan syndrom and schizophrenia might be explained by some shared etiological pathways between both disorders.

No significant relationships.

Noonan-like syndrome with loose anagen hair (NSLH MIM 607721) is associated to mutations in PTPN11, RAF1, BRAF and SHOC2 genes.

Here, we report behavioral phenotype of a child suspected to have NSLH.

A 2-years-old Tunisian child harboring severe pulmonic valvular stenosis was referred to our genetic counselling for genetic assessment. Medical dysmorphology, cytogenetic analysis as well as genetic exploration of RAS-MAPK pathway genes were conducted.

The child had short stature and ectodermal features including ichthyotic skin and thin-soft nails. He has specific hair appearance associated to NS features. In fact, he had a small nasal tip, thick lips and sticking-out rotated ears. He harbored typical nasal voice and loose anagen hair with ungrowing thin hair, sparse and pale scalp hair and eyebrows. He showed cognitive deficits with mental retardation and hyperactive behavior. Considered as having NSLH, cytogenetic analysis revealed a 46,XY formula, but molecular screening of PTPN11, RAF1, BRAF, RIT1 and SHOC2 genes was negative.

Mutations within the RAS‐MAPK signaling pathway affect neurophysiologic activity in brain regions underlying attention and executive functions. Children with rasopathies demonstrated higher rates of attention deficit-hyperactivity (ADHD) and autism spectrum disorders. However, no studies have examined specifically the aspects of behavioral attention in the various types of Rasopathies. A recent study demonstrated that ADHD seems to be higher in children with NSLH and SHOC2 mutation, which is the case of our patient. We suggest that assessment of inattentive and hyperactivity symptoms in children should consider Rasopathies with specific molecular screening.

No significant relationships.

We present the case of a 36-year-old male with depressive states, impulsive traits and fits of anger (including episodes of self and heteroagressiveness) since early childhood, in the context of traumatic family history and the beginning of an epileptic disease. These symptoms have been maintained over the years, in addition to other variable and recurrent symptoms, such as severe anxiety, somatizations or serious depressive symptoms.

To highlight the possible influence of epilepsy in the course of mental illnesses, especially depression, as well as the increased difficulty in management.

We collected the complete medical history of a patient with an important history of mental health in addition to epileptic disease since childhood and we carried out a review of the comorbidity between these diseases and their treatment.

The epileptic disease of our patient may have influenced the behavioural alterations and the depressive symptoms since childhood, as well as the personality traits with aggressiveness and impulsiveness. There is an added difficulty in treating this case given the possible interactions between antiepileptic and antidepressant medications.

This case highlights the importance of taking into account the influence of this comorbidity on the prognosis of patients. Knowing the interactions and side effects of drugs is essential for good clinical management.

No significant relationships.

Depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease. The prevalence of depression is rising and it often co-occurs with other physical diseases.

The research aims to determine the comorbidity of depression and anxiety disorders with chronic physical diseases among employees of the „Brown coal mine Banovici“.

We conducted a retrospective study that included 117 employees from the disease registry who are being under the treatment of depression and anxiety disorder. We collected data from medical records of patients about sex, age, marital status, smoking status, physical diseases, types of antidepressants, and the other drugs they use.

The study showed that there are 117 employees of the „Brown coal mine Banovici“ who are under treatment of depression and anxiety-depressive disorder. 22 (18,8%) of them are females and 95 (81,2%) males in an average life span of 48,3 years. The most commonly used antidepressant is Escitalopram. 62 (53%) out of 117 patients with depression have comorbidity with diseases of the circulatory system, 24 (20,51%) have comorbidity with diseases of the musculoskeletal system and connective tissue, 16 (13,68%) have comorbidity with endocrine, nutritional and metabolic diseases. 25 (21,37%) patients are not suffering from any other chronic physical disease. The most commonly used drugs besides antidepressants are antihypertensives.

The comorbidity rate of depression and anxiety disorders with cardiovascular diseases among employees of the „Brown coal mine Banovici“ is higher than with all other chronic physical diseases.

No significant relationships.