Based on clinical impressions personality disorders (PDs) and psychiatric disorders characterized by body image disorder (BID) have been suggested to be relatively common in cosmetic surgery settings and closely associated with patient's post-operative dissatisfaction despite technically satisfactory surgical results, leading to problems for both patients and surgeons.

The study investigated the prevalence and the comorbidity between BID and PDs in patients seeking cosmetic surgery, as well as the impact of the following clinical variables on patient's post-operative dissatisfaction: number of pathological personality traits, severity of body uneasiness and worries about particular body parts and intensity of these concerns.

Two hundred fifty patients scheduled for profile, breast and body contouring cosmetic surgery from two Italian hospitals (90% F; Mage = 31.5 ± 4.0) completed the Body Uneasiness Test (BUT), the Personality Diagnostic Questionnaire-4+ (PDQ-4) before surgery and a measure of patient satisfaction 13 months after surgery.

18.9% of subjects, had at least 1 PD (cluster B and C's in particular). Using the BUT cut-off score as a marker of clinical significance, 48.8% of subjects had a BID, and all PD patients showed comorbidity with BID. The number of pathological personality traits, the severity of body uneasiness and the intensity of worries about body parts showed a predictive power on patients’ post-operative dissatisfaction.

PDs and BID are common in cosmetic surgery settings. Our data suggest also that a thorough pre-operative clinical assessment may allow the pre-operative identification of patients with low levels of post-operative satisfaction.

In the literature, service users and informal caregivers have been critical towards psychiatric inpatient care. However, little is known about their fears related to hospital care.

We describe service users’ and informal caregivers’ experiences of fear in psychiatric hospital settings.

The data were collected from seven mental health associations located in six Finnish cities. Focus group interviews (f=8) were conducted (2015–2016) with service users (n=20) and informal caregivers (n=15), and were guided to focus on violence and challenging situations in psychiatric care. In a secondary analysis, experiences of fear were extracted from the transcriptions and analyzed using inductive content analysis.

Both groups’ experiences of fear focused on themes related to staff, treatment and fellow patients. Additionally, service users had experiences of fear related to the hospital environment. Fears related to staff involved intimidating personnel using force or acting in threatening ways. Participants also described staff seemingly being afraid of patients and care givers. Three types of fears related to treatment were described: fear of not being admitted to hospital even if needed, fear of being admitted to hospital, and fear of coercive methods used in care. Fear of fellow patients involved being afraid of aggressive, unpredictable behaviors, which could cause, e.g., a lack of sleep at night for service users. Fears related to the environment itself were also discussed.

Being hospitalized can be a difficult experience for service users and informal caregivers. These results can help psychiatric healthcare staff acknowledge areas in care that may potentially cause feelings of fear.

No significant relationships.

olanzapine and carbamazepine are effectively used in treatment of schizoaffective disorder but they can have numerous side effects including skin eruptions that can be severe sometimes.

To study the relationship between toxidermia and treatment with Olanzapine and Carbamazepine.

We report the case of a patient who developed a psoriasiform skin rash following the intake of Olanzapine and Carbamazepine.

Mrs SL, 46 years old, with no prior medical or surgical history, has been diagnosed with schizophrenia since the age of 26. She was initially treated with Haloperidol and Risperidone with an irregular follow-up. Then, due to the emergence of mood disorder symptoms, the patient was put on 20 mg/day of Olanzapine and 400 mg/day of carbamazepine. One month later, the patient presented a generalized rash requiring the discontinuation of the current medications. She was treated with corticosteroids, and then she was referred to our department to make the appropriate adjustment of her psychiatric treatment.

In view of the persistence of a dry erythroderma with erosive lesions of scratching and palmoplantar keratoderma, a skin biopsy was performed showing a psoriasiform and eosinophilic dermatosis that could be consistent with a toxidermia. The pharmacovigilance investigation concluded the incrimination of Olanzapine and carbamazepine in this symptomatology and recommended to avoid their prescription for this patient.

The need for a mood stabilizer presented us with a challenge, particularly in view of the potential risk of cross-toxicity. We opted for the reintroduction of Risperidone with strict monitoring of the skin condition.

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon.

None Declared

Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.

To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.

Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.

All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.

Forty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).

Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).

At interview, participants (n = 12) particularly valued:

– the opportunity to ask questions of the psychiatrist e.g. about medication;

– improving self-care skills e.g. monitoring early warning signs of relapse;

– co-facilitation by a peer, which provided extra credibility and inspired hope;

– sharing experiences with peers.

The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.

The authors have not supplied their declaration of competing interest.

The researches show a rapid growth of mental disorders among adolescents and young adults that often co-occurs with risk behaviours, such as suicide, which is one of the leading cause of death among young ages 15–34. Therefore it's necessary to use some tools that can promote mental health getting to young lives such as Internet and media.

SUPREME (Suicide Prevention by Internet and Media Based Mental Health Promotion) is an European project for the prevention of risk behaviours and mental health promotion through the use of mass media and Internet, financed by DG SANCO EU Public Health and developed by a consortium of 7 European countries.

The main expected outcome of the project is to improve mental health among European adolescents and young adults.

The intervention will comprise of a highly interactive website targeted at adolescents and young adults in the age group 14–24 years, and a set of published guidelines, aimed at Media that targets young audiences, such as newspapers and magazines. In each participating country, a sample of 300 pupils in the age 14 – 24 years will be selected and randomized in one of the three different intervention arms. A baseline questionnaire will be administered to the pupils for require the data on lifestyles, values and attitudes, psychological well-being, familiar relationship and friendship.

Through the obtained data will be possible identify the best practices to promote mental health through the Internet and the media.

Pisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.

Regarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.

Description of a clinical case by consulting databases of current and scientifically relevant articles.

The clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.

Pisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.

No significant relationships.

Thyroid disease may contribute to mental illness, and thyroid dysfunction in psychiatric illness is common. However, the exact mechanism underlying the link between thyroid abnormalities and psychiatry illness is unclear, and the routine use of thyroid tests to assess psychiatric patients remains debatable. There are no specific guidelines about witch tests should be routinely done, however psychiatrists should be aware that thyroid test abnormalities do not always denote thyroid disease, because there are many factors that interfere with these tests at newly admitted psychiatric patients.

To review evidence about the clinical utility and cost-effectiveness of thyroid screening in psychiatric inpatients.

Searches were undertaken in PubMed and other relevant databases using keywords such as 'thyroid screening', 'psychiatric' and 'inpatients'.

Recent data suggests that clinical utility of thyroid testing in psychiatric patients is low, but in some subgroups of patients thyroid tests may be useful. In fact, there are few studies of cost-effectiveness of thyroid screening in psychiatric inpatients. Therefore clinicians have to pay attention to indications of request thyroid tests, to the moment of thyroid analyses and that transient nature of abnormal thyroid tests results may be a reflection of multitude of factors.

The diagnostic yield of thyroid testing in psychiatric patients is low, and recent studies do not fully support routine screening for thyroid dysfunction in psychiatry inpatients. However, the benefits of thyroid screening of newly admitted psychiatric patients should be evaluated in prospective studies.

Depression symptoms in bipolar disorder have debilitating effects on functioning and quality of life (QoL).

To assess effects of 8 weeks of quetiapine monotherapy on functioning and QoL in patients with bipolar depression (BPD).

To evaluate functioning and QoL using patient-reported outcomes.

Data from 4 trials (BOLDER I and II; EMBOLDEN I and II) of quetiapine (300 and 600 mg/day) in BPD were combined (n = 2593). The Sheehan Disability Scale (SDS) measured functioning (BOLDER II; EMBOLDEN I and II) and the QoL Enjoyment and Satisfaction Questionnaire (Q-LES-Q)-Short Form measured QoL (BOLDER I and II; EMBOLDEN II).

Quetiapine improved overall functioning (mean change [SE] in SDS total score: -7.23 [0.49], -7.49 [0.49], with quetiapine 300 mg/day and quetiapine 600 mg/day, respectively vs placebo (-5.91 [0.54]); P < 0.01 for both). Both doses improved functioning in SDS domains of work/school, social life, and family life/home responsibilities vs placebo (P < 0.05). Quetiapine 600 mg/day reduced days missed from work/school and productivity losses vs placebo (P < 0.01). QoL was improved with both quetiapine doses vs placebo (P < 0.001; least squares mean changes (SE) in Q-LES-Q total score from baseline to Day 57: 9.69 (0.51), 9.95 (0.50), and 6.81 (0.54) with quetiapine 300 mg/day, quetiapine 600 mg/day, and placebo, respectively). Tolerability was consistent with the known safety profile of quetiapine.

Quetiapine treatment (300 and 600 mg/day) for 8 weeks significantly improved functioning and QoL vs placebo in patients with BPD.

Supported by funding from AstraZeneca Pharmaceuticals LP.

The authors have not supplied their declaration of competing interest.

Goal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.

The sample consisted of inpatients who met the ICD-10 criteria for the Depressive disorder, Panic disorder, GAD, Mixed anxiety-depressive disorder, Agoraphobia, Social phobia, OCD, PTSD, Adjustment disorders, dissociative/conversion disorders, Somatoform disorder or other anxiety/neurotic spectrum disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of clinical global impression-severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program.

The total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment in outpatients basis and were referred for hospitalization for the six-week complex therapeutic program, were enrolled in this study. Six hundred and six of them were statistically analyzed. The patients’ mean ratings on all measurements were significantly reduced during the treatment. The patients without comorbid personality disorder improved significantly more than patients with comorbid personality disorder in the reduction of depressive symptoms. However, there were no significant differences in change of anxiety levels and severity of the disorder between the patients with and without personality disorders. The higher degree of dissociation at the beginning of the treatment predicted minor improvement. The higher therapeutic change was connected to the greater reduction of the dissociation level.

Dissociation presents an important factor influencing treatment effectiveness in the treatment-resistant patients with anxiety/depression with or without personality disorders.

The authors have not supplied their declaration of competing interest.

Body image disturbance and eating disorders among the young population are increasing.

The aim of our study was to investigate the perception of body image and its relationship with eating disorders among tunisian medical students.

METHODS :

A total of 100 Tunisian medical students were interviewed using :

• - a self-administered questionnaire which explores clinical data,

• - a scale of screening of eating disorders : Eating Attitudes Test (EAT-26).

• - the Stunkard’s figure rating scale (FRS) which consists of 9 silhouette figures. The difference between ideal body and perceived body can be interpreted as a measure of body image satisfaction.

The mean age of the sample was 24.12 years, 71% were female and 29% male.

The average body mass index (BMI) was 22.72 kg/m2.

Students have normal weight (BMI 18.5–24.9) in 62 % of cases.

Sixty six percent of students who were ‘‘normal weight’’ were not satisfied of their body image and thirty eight percent of them showed a desire for thinness.

Seventy-three of students had a body image dissatisfaction. A BMI outside normal parameters influenced significantly the perception of body image (p=0.048).

Nineteen percent of students had eating disorders. These students had an abnormal BMI (p=0.047) and a body image dissatisfaction (p=0.018).

CONCLUSION :

Our study shows that the physical aspect of the students has a significant effect on their feeding behavior, it is thus essential to sensitize their circle of acquaintances to favor a healthy perception of body image.

The aim ofthis study was to assess the prevalence, size and burden of commonestpsychiatric disorders at Primary Health Care (PHC) Centres using the WHO Composite International DiagnosticInterview (WHO-CIDI) and co-morbidity.

A total of2,000 Qatari subjects aged 18 to 65 years were approached at PHC and 1,475 (73.3%) gaveconsent. Prevalence and severityof ICD-10 disorders were assessed with the WHO Composite InternationalDiagnostic Interview (CIDI, Version 3.0).

The three most common disorders weremajor depression disorders (18.31%), any anxiety disorders (17.29%), any mooddisorders (16.95%), followed by separation anxiety disorders (15.25%),personality disorder (14.1%). Most of the respondentswere in the age group 35-49 years (37.8%), followed by 18-34 years (34%), then50-64 years (19.6%) and above aged 65 years old (8.5%). In the present study, prevalence in women was significantly higher thanmen for the most common psychiatric disorders, specifically generalised anxietydisorder, panic disorder, social phobia, specific phobias, obsessive compulsivedisorders, post traumatic disorder, somatisation, major depressive disorder, bipolar disorder, dysthymia, and oppositional defiant disorder. Of the total 20% had only one psychiatric diagnosisand 12% had two disorders, 9.7% respondents with three diagnoses, and finally4.3% of respondents had four or more diagnoses.

One-fifth of all adults who attended the PHC Centre 20% had at least one psychiatric diagnosis. The prevalence of thegeneralized anxiety disorders; socialphobia, specific phobia, major depression, and personality disorders werethe significantly higher in women than inmen.

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) are neurodevelopmental disorders that commonly persist into adulthood. ADHD in adults can resemble, and often co-occurs with, bipolar disorder (BD), which might lead to diagnostic errors, ineffective treatment and potentially serious adverse consequences.

To review on the overlaps and differences in the psychopathology of the two entities and particularities of the management when they occur comorbidely.

The Medline database through the Pubmed search engine was used with the following keywords: “adhd” and “bipolar disorder”.

ADHD has an estimated prevalence of 10-30% in adults with BD. Despite the symptomatic similarities, there are some important differences. In the ADHD/BD comorbidity, symptoms like attention-deficit, distractibility, irritability, impulsiveness and hyperactivity that may present in (hypo)manic and/or depressive episodes, tend to persist after clinical stabilization. While adult patients with ADHD typically experience ceaseless mental activity and wandering mind, BD patients may have racing thoughts and perceive them as making sense. ADHD patients may have poor socio-occupational achievement that may lead to low self-esteem, low self-confidence and depressed mood. Features like course of illness, psychiatric family history and treatment response may help differentiate the two entities. The treatment must start with mood stabilization and then proceed to the treatment of ADHD symptoms.

A complete clinical history, with particular focus in the neurodevelopmental history, is important but sometimes is not enough for an accurate diagnosis of this comorbidity. As so, clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide the best care for both disorders.

No significant relationships.

Jealousy is a complex emotional state and some degree is considered normal in mature love, but when does it become destructive in a relationship? There's a thin line between what is normal and what is pathologic. Pathological jealousy differs from normal by its intensity and irrationality. Obsessive and delusional jealousies are different types of pathological jealousy, difficult to distinguish, which is important, since they have different treatment. Despite the differences, both result in significant distress and carry the risk of homicide/suicide, so it's a matter deserving the psychiatrists’ attention.

Explore the psychopathological differences between obsessive and delusional jealousy and list the characteristics and difficulties in the approach to pathological jealousy.

The results were obtained searching literature included on the PubMed and Google Scholar platforms.

Delusional jealousy is characterized by strong and false beliefs that the partner is unfaithful. Individuals with obsessive jealousy suffer from unpleasant and irrational jealous ruminations that the partner could be unfaithful, accompanied by compulsive checking of partners’ behavior. This jealousy resembles obsessive-compulsive phenomenology and should be treated with SSRIs and cognitive-behavioral therapy. Delusional jealousy is a psychotic disorder and should be treated with antipsychotics.

The common issue in pathological jealousy is the problem of adherence to treatment and bad prognosis. In order to achieve better treatment outcomes, we should follow-up the patient regularly. One key factor is to explore the psychopathology and motivate the sufferer for the proper pharmacological and psychotherapeutic interventions, trying to reduce the suffering caused by ideas of unfaithfulness.

The authors have not supplied their declaration of competing interest.

Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.

To emphasize the importance of defining predictors of response to ECT in OCD.

The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.

Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.

Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.

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

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

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

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

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

None Declared