The aim of this study was to examine (1) public knowledge and perceptions about attention-deficit hyperactivity disorder (ADHD) and (2) factors influencing the public's decisions to adhere to ADHD pharmacotherapy.

In this study, 396 participants responded to the Internet survey regarding their experiences, beliefs and treatment preferences about ADHD.

Two hundred and fifty-two respondents (63.6%) were reluctant to pharmacological treatment of ADHD. The respondents chose the functional impairment of the brain as the main cause of ADHD were favorable to pharmacological treatment and scored significantly high on the ADHD Knowledge Questionnaire. On the other hand, the respondents who regarded ADHD as an overly active personality rather than a disease were skeptical to pharmacotherapy and scored significantly low. The respondents who were acquainted with someone who had been diagnosed with ADHD perceived themselves relatively well informed about ADHD. However, the subjective perception of the degree of knowledge of ADHD was not correlated with the objective score of the ADHD Knowledge Questionnaire.

The Korean public is not well informed about ADHD and its treatments. Culturally appropriate psychoeducational strategies based on the media and the Internet are needed. Providing biomedical conceptualization of ADHD to the public may aid with treatment decisions and promote adherence to pharmacological treatment.

The authors have not supplied their declaration of competing interest.

Koro syndrome has traditionally been considered a culturally bound syndrome, characterized by the delusional belief that one's genitalia are retracting and the anxiety caused by the perception of imminent death. Although it is widely regarded as an epidemic in South-east Asia, there are some isolated cases in other cultures as well.

We present a Koro case study and a systematic review, focusing on the presentation and its treatment, in order to make visible this syndrome to Western culture and provide the tools to identify it.

To provide an overview of Koro's presentation, phenomenology and treatment. We also want to clarify the nosology classification of this syndrome and its influence in the reported cases.

We begin describing a new case of Koro syndrome: a Spanish male presented an acute psychosis, the patient had an intellectual disability and a family history of mental illness. A systematic review was done based on articles published in Pubmed following the PRISMA guidelines.

From 117 studies, only 29 met the inclusion criteria. Data were analyzed on several epidemiological and clinical characteristics. We found that Koro syndrome is more often presented as a result of intoxication or as a part of a previous known psychotic disorder. Cases involving patients sharing their delusion have been only reported in Asia.

No specific data could be obtained about epidemiology and pathogenesis, as our conclusion about Koro syndrome was based mainly on few case studies. Pharmacotherapy and social support may be effective in ameliorating the symptoms.

The authors have not supplied their declaration of competing interest.

There is a lack of cross-cultural comparison of patients and staff perceptions of quality of care in the psychiatric care. One reason is the absence of standardized instruments.

The international research programme “Quality in Psychiatric Care” aims at adapting the instrument QPC versions for patients and staff to different international settings.

The aims are to test the psychometric properties and equivalence of dimensionality of the different language versions of QPC and also to describe and compare the quality of inpatient, outpatient and forensic in-patient psychiatric care across different countries.

The QPC is a family of self-reported instruments from the patients’ perspective. In this programme, we used different languages versions in three areas for patient and staff; inpatient (QPC-IP/IPS), outpatient (QPC-OP/OPS) and forensic inpatient care (QPC-FIP/FIPS).

The Danish versions for QPC-FIP and QPC-FIPS show that the confirmatory factor analysis revealed that the factor structure was equivalent to the original Swedish version. Patients rated the quality of care generally lower than staff and lowest in the participation dimension. The Indonesian version of QPC-IP is under analysis. The first result show that patients rated the quality of care lower than Swedish inpatients and lowest in the discharge dimension. Several studies in Indonesia are still ongoing as well as in Brazil and Spain.

There are few standardized instruments for measuring quality of care in the psychiatric care. Therefore, QPC is expected to makes an important contribution to the development in this field.

The authors have not supplied their declaration of competing interest.

There is a notion that emotional expression is universal, yet it is subject to cultural variations. Research in this field has studied cultural extremes in European, American and East Asian cultures. However, very little is known about the differences in emotional expression in the Arab subcultures.

Exploring the differences between the emotional reactions among the nine Arab subcultures.

Aims (1) Examining the cultural differences in emotional reactions; (2) examining the differences between Muslim and non-Muslim individuals; (3) exploring the differences between Arabs and non-Arabs.

Several real life scenarios including 15 different stressful situations and 15 non-stressful situations were presented to 40 individuals from the nine Arab subcultures. The participants were aged between 18 to 40 years of age. The subjects were randomly classified into groups depending on whether they were Arabs or non-Arabs and according to whether they were Muslims or non-Muslims. The subjects’ emotional reactions were measured by means of Likert-like items.

The results showed that there were no significant differences among the nine Arab subcultures in their emotional reactions to the non-stressful situations. However, there were significant differences among the Arab subcultures in the stressful situations. Moreover, both religion and ethics were strong predictors of the differences in the emotional reactions that varied between subjects in their cultural group. The Arab Muslims tended to express more anger but the Arab non-Muslims expressed more sadness.

Emotional expression is impacted by ones’ cultural background and is particularly influenced by religion and ethics. Although Arab countries share the same language, they express emotions differently.

The authors have not supplied their declaration of competing interest.

The extension project “UNIRIO is madness: the improvement of mental health competences and skills.” work since 2015 with “Ponto de Cultura Loucura Suburbana” on the promotion of mental health and culture style in Brazil. The project work on the development of psychosocial rehabilitation for psychiatric patients, their families and the community.

Participate on the production and execution on the artistic/therapeutic workshop that demystify the social stigmatizing vision about psychiatric patients.

The activities developed are: administrative actions; institutional strengthening for social inclusion initiative through work; and the Carnival Block organization.

This study work on constituting a social inclusion initiative through workshop that generate employment, e.g.: sale material production, financial management, material replacement. Although we do all the preparative to the Carnival Block–“Loucura Suburbana”.

The relationship with the psychiatric patients shows that social inclusion through carnival workshop practice is the primary means for the identity of people suffering from mental disorders and contribute to reduce community social stigma.

The authors have not supplied their declaration of competing interest.

DUP is the time from the emergence of first psychotic symptom to the commencement of adequate antipsychotic treatment. Psychopathological and sociocultural factors influence patient's treatment seeking behavior. Better understanding of DUP could help in development of improved therapeutic strategies and public health initiatives. Emphasis on early detection of psychosis and reduction of DUP has led to a huge interest in pathways to care.

To understand the differences in baseline demographics, presentation, care-pathways and DUP in ethnically diverse population of Lancashire, UK.

Our cross-sectional study involved a subset analysis of National EDEN data for Blackburn and Preston in Lancashire.

Of the 183 patients, 78% were Whites and rest belonged to BME population. Median DUP was 188 days. Whites were significantly younger at onset of both non-specific symptoms and psychosis and at acceptance into EIS. Whites were significantly less likely than non-whites to be married, more likely to be in paid work and to have used illicit drugs. There were no significant differences with respect to other demographics/delays in help seeking or DUP. Non-White group had shorter DUP of 95 days (but not statistically significant, P = 0.060).

Better understanding of mental illness and local services in White patients could have led to early help seeking. Having a supportive family may have promoted early help seeking and thus shorter DUP in BME group. Further studies are needed exploring socioenvironmental variables, substance misuse and knowledge of local psychiatric services amongst the BME population and the influence of these variables on DUP.

The authors have not supplied their declaration of competing interest.

In the rubber hand illusion (RHI) [1], sense of body ownership is changed by synchronous touches to the hidden participant's hand and a visible rubber hand. It was previously shown [2] that medically unexplained symptoms were associated with the weaker RHI (n = 40).

We used data from our previous research [3] and supplementary questionnaires to test the hypothesis that somatoform symptoms would be associated with the decreased response to RHI.

Subjects (n = 78) voluntarily undergo the following procedures: RHI experiment with measurement of proprioceptive drift and self-reports, Screening for Somatoform Disorders (SOMS-2) and Symptom Check List-90-Revised (the “somatization scale”).

Robust regression was used to evaluate predictors influence: Drift/Self-reports∼SOMS-2 + somatization. SOMS-2 was a significant predictor for proprioceptive drift with positive coefficient (P < 0.05, adjusted), both predictors were insignificant for self-reports.

Thus, the results of [2] were not reproduced. We demonstrated on the larger sample, that the higher somatoform symptoms (scores of SOMS-2) predicted the stronger RHI. Since our research and [2] had been conducted on non-clinical groups, it is necessary to conduct the critical experiment on the clinical population.

The reported study was funded by RFBR according to the research project No.16-36-00394.

The authors have not supplied their declaration of competing interest.

There is a limited amount of data regarding the relationship between epilepsy and psychiatric symptoms and quality of life (QoL) in children and adolescents.

The aim of this study was to determine the levels of depression, anxiety and attention-deficit hyperactivity disorder symptoms and health-related quality of life (HRQL) in children and adolescents with epilepsy.

The sample consisted of 75 children with epilepsy and 50 healthy controls aged 8–18 years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients.

Patients had lower child-rated psychosocial and total area HRQL scores, and lower parent-rated psychosocial, physical and total area HRQL scores than the controls did. Inattention scores of the epilepsy group were significantly higher compared to controls. No significant differences were found between patients and controls in terms of anxiety and depression scores. Regarding determinants of HRQL, severity of depression and anxiety had a decreasing effect on child-rated HRQL total scores; and severity of anxiety had a decreasing effect on parent-rated HRQL total scores.

Epilepsy is associated with poor QoL in childhood and severity of depression and anxiety are among the determinants of QoL. Clinicians should be more aware of accompanying psychiatric symptoms in epileptic patients and take the necessary precautions in the early period of the illness in an effort to improve QoL.

The authors have not supplied their declaration of competing interest.

Lyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.

Identification of neuropsychiatric symptoms associated with Lyme disease.

Literature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.

Since the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.

According to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.

The authors have not supplied their declaration of competing interest.

The early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how bedside cognitive tests perform across the spectrum of delirium and motor subtypes.

The performance on a battery of bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neuro cognitive disorder and in motor subtypes.

One hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test whereas those with subsyndromal delirium were best identified using interlocking pentagons test and months backwards test. Those with subsyndromal delirium were significantly better in their ability to engage than those with full syndromal delirium.

Simple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.

The author haS not supplied his/her declaration of competing interest.

Morbid obesity (BMI ≥ 35) has been associated with mood and anxiety disorders. Regular use of antidepressants is common among patients who are candidate for bariatric surgery. The Roux-en-Y gastric bypass (RYGB) is one of the most common techniques used in bariatric surgery for reducing nutrient absorption. This type of surgery may however result in major changes in drug absorption.

To report and discuss the consequences of bariatric surgery on changes in antidepressant drug absorption.

We present all published in vitro and in vivo studies on antidepressant drug absorption after bariatric surgery.

In vitro studies showed that only bupropion had a significantly increased dissolution in a post-RYGB environment; venlafaxine and citalopram showed no alteration of dissolution; fluoxetine, paroxetine, sertraline, and amitryptiline had an significantly decreased dissolution in a post RYGB environment. Some in-vivo studies reported that only citalopram and escitalopram had an increased dissolution.

After bariatric surgery, special caution is required in patients using antidepressant medication because of the expected changes in drug absorption, nutritional status, and electrolyte balance.

The authors have not supplied their declaration of competing interest.

There is a large consensus concerning the important aetiological role of childhood trauma in chronic fatigue syndrome (CFS). In the current study, we examine the differential effect of childhood trauma subtypes on fatigue and physical functioning in patients with CFS.

One hundred and fifty-five participants receiving treatment at the outpatient clinic for CFS of the Antwerp University Hospital in Belgium were included in this study. Stepwise regression analyses were conducted with the outcomes of the total score of the Checklist Individual Strength (CIS) measuring fatigue and the physical functioning subscale of the medical outcomes short form-36 health status survey (SF-36) as the dependent variables, and the scores on the five Traumatic Experiences Checklist (TEC) subscales as the independent variables.

Fatigue and physical functioning scores in CFS patients were significantly predicted by sexual harassment only. A significant effect of emotional neglect, emotional abuse and bodily threat during childhood on elevated fatigue or reduced physical functioning levels could not be found.

There is a differential effect of childhood trauma subtypes on fatigue and physical functioning in CFS patients. Sexual harassment emerged as the most important predictor variable. Therefore, childhood (sexual) trauma has to be taken into account in assessment and treatment of chronic fatigue syndrome.

The authors have not supplied their declaration of competing interest.

Joint hypermobility syndrome/Ehlers Danlos III (JHS/EDS III) is a common, connective tissue condition. This group is over-represented in panic/anxiety disorders and exhibits autonomic abnormalities and heightened interoceptive sensibility. Previous neuroimaging in healthy volunteers with hypermobility has observed differences in key emotional brain regions, notably amygdala and insula.

Aims and objective To explore, in a clinical population, the structural brain correlates underpinning the association between JHS/EDS III and anxiety.

Seventy participants were divided into four experimental groups: (2 × 2 factor design: presence/absence of hypermobility; presence/absence of anxiety). Hypermobility was assessed using Brighton Criteria. All participants underwent brief tests of autonomic function and interoception. Structural images were obtained using a 1.5 T MRI scanner. Results are reported at whole brain uncorrected significance threshold of P < 0.001.

Comparison of grey matter volume revealed increased insular volume in anxious patients with JHS/EDS-III compared to anxious patients without (Fig. 1A, B), correlating with initial peak heart rate on standing. Additionally, amygdala volume correlated with hypermobility score in anxious patients, but not in non-anxious individuals (Fig. 1C, D). Amygdala volume correlated with interoceptive accuracy.

This data implicates amygdala and insula as likely neural substrates mediating clinical relationships between hypermobility syndrome and anxiety, demonstrating the relevance of autonomic and interoceptive influences on this relationship. Further work hopes to explore functional and structural connectivity between these regions in JHS/EDS-III.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Due to the aging population worldwide, chronic pain is becoming an important public health concern. Chronic pain is bidirectional associated with psychiatric disorders including depression and anxiety. Antidepressants are widely used as adjuvant therapy for the treatment of chronic pain for many disorders.

To review available literature on the efficacy and safety of antidepressants for the treatment of chronic pain, including neuropathic pain, fibromyalgia, low back pain, and chronic headache or migraine.

We performed a detailed literature review through PubMed, EMBASE and Cochrane's Library to assess the efficacy and safety of antidepressants in chronic pain conditions.

In neuropathic pain, fibromyalgia, low back pain, and chronic headaches/migraine, tricyclic antidepressants (TCAs) showed a significant analgesic effect. Selective serotonin reuptake inhibitors (SSRIs) are not effective for the treatment of low back pain and headaches or migraine. Venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI) showed significant improvement of fibromyalgia and neuropathic pain. Duloxetine (SNRI) also reduced the pain in fibromyalgia.

TCAs are the ‘gold standard’ antidepressant analgesics. However, an electrocardiogram and postural blood pressure should be implemented prior to TCA treatment and TCAs should be initiated at low dosages and subsequently increased to the maximum tolerated dose. One should pay attention to their cardiotoxic potential, especially in the older population. For the treatment of neuropathic pain, SNRIs are second-line agents. Although better tolerated, in most types of chronic pain conditions, the effectiveness of SSRIs is limited. To conclude: start low, go slow, and prescribe with caution.

The authors have not supplied their declaration of competing interest.

Short stature caused by growth hormone (GH) deficiency is one of the causes of the “Failure to Thrive” (FTT) condition. In absence of clear organic causes, several different psychosocial conditions may play a role in explaining the FTT phenotype. Advances in developmental psychology have highlighted the role of emotions and caregiving behaviors in the organization of child's personality and psychobiology, with the mother–son attachment bond being considered a fundamental developmental experience. The objective of the present preliminary study was to assess whether there are significant correlations between attachment styles and GH levels in a sample of subjects with non-organic FTT.

We enrolled 27 children (mean age: 9.49 ± 2.63) with non-organic FTT. Perceived attachment security was assessed through the Security Scale (SS) and its subscales focused on maternal and paternal security. Pearson partial correlation was used to test associations between GH levels and SS measures adjusting for confounding factors (i.e. age, gender and BMI).

Across all subjects, GH was significantly positively correlated with general security (r = 0.425; P = 0.038) and maternal security (SSM) (r = –0.451; P = 0.027) and not significantly correlated with paternal security (SSP) (r = 0.237; P = 0.264).

These findings preliminarily suggest that perceived attachment security may play a role in the etiopathogenesis of non-organic GH deficiencies and add to the accumulating evidence that attachment styles are associated with specific psychoendocrine underpinnings.

The authors have not supplied their declaration of competing interest.

To carry out comparative analysis of dynamics of mental and physical state in CHD pateints.

Two hundred and eighty (57.74 ± 5.59 years) CHD patients with grade II–III angina pectoris were examined. Psychopathological method, Center of Epidemiological Studies-Depression scale (CES-D) were used.

Ninety patients (32.1%) had depressive disorders within depressive episode, dysthymia, adjustment disorder. The level of depression according to CES-D varied from 19 to 28 points. Comparative analysis of two groups of patients showed that CHD patients with depression had more severe grade III angina (22.1% vs. 11.6%; P = 0.036) more frequently. Differences regarding frequency of arterial hypertension (AH) (91.1% vs. 63.2%; P = 0.0002), type 2 diabetes mellitus (DM) (26.8% vs. 17.5%; P = 0.038), obesity (30.7 ± 3.9 vs. 29.5 ± 4.5; P = 0.015), arrhythmias (34.4% vs. 25.2%; P = 0.015); cases of myocardial infarction (47.8% vs. 17.9%; P = 0.0001) were revealed. Among patients with depressive disorders persons with experience of surgical myocardial revascularization (P = 0.004), degree II–III of disability (23.3% vs. 11.6%; P = 0.0118) were present more frequently. Patients with depression were characterized by low economic status (64.4% vs. 23.7%; P = 0.0001); absence of social support (34.4% vs. 12.6%; P = 0.0001); frequent stress situations in personal history (71.1% vs. 32.6%; P = 0.0002).

Depressive disorders caused by psychosocial stress influence negatively CHD course that requires complex approach to therapy of comorbid pathology.

The authors have not supplied their declaration of competing interest.

Ulcerative colitis and Crohn's disease is characterized from a complicated therapeutic management, with bodily and psychological impact to the family.

This study examined the coping strategies among families with a child or adolescent with IBD.

The aim was to investigate possible sex differences with respect to coping strategies of the parents would correlated to overall coping strategies.

The participants were biological parents of patients diagnosed with IBD. The total sample included 61 parents with a mean age 46.2 (SD = 7.4). The parents completed:

– the Family Crisis Oriented Personal Scales;

– the Other As Shamer Scale;

– the Experiences of Shame Scale (ESS);

– questionnaire concerning socio-demographic information.

Mother reported higher levels of social support, accept help, passive appraisal, and overall strategies compared to fathers. The strongest difference was found in accept help (P < 0.001). The feelings of shame of the mothers and fathers of the IBD families were very similar, without statistically significant differences between the groups. The results of the MLR, after controlling for adolescents age, sex and illness duration, revealed that the older age, being a mother, being married and being employment had direct positive associations with the overall coping strategies, while ESS had direct negative associations with the overall coping strategies. The model with all seven predictors explained 68% of the total variance (R2 = 0.68, F = 6.409, P < 0.001).

Our findings provide more detailed information on the coping strategies of Greek families with a child or adolescence with IBD.

The authors have not supplied their declaration of competing interest.

To examine the risk of depression and anxiety in MS patients in the post-diagnostic period by using clinical screening instruments and a diagnostic structured clinical interview.

A population of 134 MS patients was examined for the risk of depression and anxiety in the post-diagnostic period of MS using the clinical screening instruments Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Within six weeks of diagnosis, patients with cut-off > 12 for BDI and > 7 for HADS were offered a clinical structured interview using the Schedules for Clinical Assessment in Neuropsychiatry/SCAN Version 2.1.

The prevalence of depressive symptoms and depression in the post-diagnostic period of MS was 49.2% when using the screening instruments, but only 15.2% when using the SCAN interview. For anxiety, the prevalence was 3.4% for both the screening instruments and the SCAN interview in the post-diagnostic period of MS.

MS patients have a risk of depression and anxiety in the post-diagnostic period of MS, but it is crucial to consider which tools to use in a clinical setting to investigate depression and anxiety in MS patients.

The authors have not supplied their declaration of competing interest.

Psychosis is an uncommon but serious complication of treatment with interferon-α, a cytokine frequently used to treat several infectious and malignant diseases.

To provide an overview of interferon-α-induced psychosis.

Literature review based on PubMed/MEDLINE, using the keywords “interferon-α” and “psychosis”.

Psychotic symptoms usually emerge between 6 to 46 weeks and on average 3 months after the start of interferon-α treatment, occurring most frequently in the form of persecutory, guilt or grandeur delusions and auditory hallucinations. Often they are accompanied by mood symptoms, anxiety, attention disturbances and insomnia. Many factors are known to increase the risk of psychiatric effects as a whole associated with interferon-α. Pathogenesis of interferon-induced psychosis remains unclear, however several theories have been discussed, namely the overlap influence of biological vulnerability and the cytokine's action on the brain. Dopaminergic, opioid, serotoninergic and glutaminergic pathways as well as hypothalamic-pituitary-adrenal axis hypersensitivity are some of the hypotheses raised about the underlying cause of that susceptibility. Psychosis management usually includes stopping interferon-α and introducing antipsychotics with minimal antidopaminergic effects and at the lowest possible dose, due to the increased risk of extrapyramidal reactions in these patients.

The decision to use interferon-based treatments in psychiatric patients should be highly individualized. Early recognition and adequate treatment of interferon-induced psychosis might prevent subsequent emergence of serious debilitating symptoms. Thus, it is very important that medical and psychiatric treatment teams work closely together and are familiar with this important subject.

The authors have not supplied their declaration of competing interest.