Several scientific studies support the relation between pulmonary embolism and antipsychotic treatment (acute or chronic). We present a case of possible association of venous thromboembolism (VTE) and ziprasidone.

Man, 55-year-old, with mild hypertension. He has neither toxics habits nor allergies. He does exercise every day. He started with behavioral and perception disorders during 9 months before being diagnosed of paranoid schizophrenia in 2002. He began with risperidone 3 mg per day and amisulpride 25 mg per day as hypnotic. It allowed a good development and he keeps stable since then. The treatment produced sedation and weight increase, so it was changed to ziprasidone 60 mg per day and later 40 mg per day. A few months ago, he was hospitalized with breathelessness that started suddenly two days before. After all diagnostic tests, he was diagnosed with pulmonary embolism and right leg VTE. His medical development was very positive and he must begin with acenocumarol (doses–depend) and support stockings.

As we know, since last 10 years, antipsychotic exposure significantly increases the risk of pulmonary embolism. Due to the lack of risk related factor in this case, it would point that reason. The increase related is about 50% of developing VTE and this increased risk similarly applies to first and second generation antipsychotics drugs. Despite that, there are more cases in olanzapine, clozapine and haloperidol treatments due to antiaggregatory action and antithrombotic effects. We present this case probably closely related with ziprasidone.

The authors have not supplied their declaration of competing interest.

The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.

The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.

102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.

The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.

The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.

The authors have not supplied their declaration of competing interest.

OCD is a common disorder, affecting 1% of the population and usually responds to treatment with serotonin reuptake inhibitors (SRIs) or exposure and response prevention (ERP) and to augmentation with antipsychotics. However, some patients fail to respond. The national inpatient unit for obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) (i) is the only 24-hour staffed inpatient facility for OCD in the UK and treats patients with profound, treatment-refractory OCD. There is evidence of efficacy of aripiprazole in augmenting SRI sin severe OCD (ii).

To compare the efficacy of aripiprazole versus other antipsychotics as SRI augmentation.

One hundred and nine patients admitted to the unit between March 2006 and September 2011 and discharged on an antipsychotic and an SRI were included. The Yale-Brown obsessive compulsive scale (YBOCS) was administered at admission and at discharge. Data were analysed using SPSS version 23 using analysis of variance (ANOVA). Two groups were compared: those receiving SRI + aripiprazole versus those receiving SRI + another antipsychotic.

sixty-two patients received SRI with aripiprazole and 47 SRIs with another antipsychotic. Overall, patients showed improvement, with an average YBOCS reduction of 11.7 (33% reduction). Patients taking aripiprazole improved by an average of 13 (36% reduction, P < 0.05).

Patients of the national unit with severe, treatment refractory OCD treated with aripiprazole augmentation showed a greater improvement than those on other antipsychotics. Further research into aripiprazole in OCD is warranted.

The authors have not supplied their declaration of competing interest.

Depression is common among patients with schizophrenia and is associated with a wide range of poor outcomes, including psychotic relapse and suicide. The aim of the study is to evaluate the presence of depressive symptoms in patients with schizophrenia and to compare depression intensity in schizophrenic patients and patients with depressive disorder.

In this cross sectional study were included 40 patients from both genders. Patients were divided in 2 groups: (1) examined group: 20 schizophrenic patients who presented depressive symptomatology. Depressive symptoms-evaluated with the 17-item Hamilton Rating Scale for Depression. Inclusion criteria: schizophrenic disorder by ICD-10 (F20.0-F20.9), total score higher than 7 on the HRSD-17 and age between 25 and 65; (2) control group: 20 patients with depressive disorder. Inclusion criteria: recurrent depressive disorder by ICD-10 (F33.0-F33.9), total score higher than 7 on the HRSD-17 and age between 25 and 65. Psychiatric rating scales for clinical evaluation of prominence of symptomatology: 17-item Hamilton Rating Scale for Depression (HRSD-17) and PANSS (Positive And Negative Syndrome Scale).

The prevalence of patients with depressive symptoms among the schizophrenic patients was 45% i.e. out of 20 evaluated patients with schizophrenia, 9 showed depressive symptoms. The total score in the remaining 11 patients on the HRSD-17 was lower than 7 and they were excluded. Difference between the two groups for gender difference was not statistically significant.

The percentage of patients with depressive symptoms among the patients with schizophrenic disorder was 45%. Schizophrenic patients more frequently presented mild and moderate depression in comparison to the control group. In the majority of subjects with schizophrenia and depressive symptoms positive schizophrenic symptomatology was predominant.

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

In this article, a case who was prescribed duloxetine (30 mg capsule) upon the fibromyalgia diagnosis by a physical therapist and had acute dystonia and dyskinesia after approximately 1.5 hours from duloxetine intake shall be presented.

It was learnt that a married female patient aged 38 consulted a physical therapist with the complaint of back pain and duloxetine (30 mg capsule) was prescribed. It was reported that, the patient applied to our hospital with the compliant of involuntary movements around the mouth, on the lips and neck, spasm, inability to open the mouth completely, spasm in jaw, gritting teeth, mumbling and aphasia after approximately 1.5 hours from her duloxetine intake. The patient was conscious. Her psychomotor activity was natural. As a result of cranial MR, EEG, BT examinations hemogram and the routine biochemistry examinations, any abnormality in zinc and iron levels was not detected. Complaints of the patient regressed after 1 hour from the discontinuance of duloxetine and the administration of biperiden 5 mg/mL ampoule 1000 cm3 in SF. After 72 hours, any symptoms were not found.

Dopamine neurotransmission can be inhibited through the increase in serotonin and norepinephrine. Additionally, dystonia may originate from the prevailing of noradrenaline as a result of the failure of dopaminergic–noradrenergic balance.

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

Burn out is defined as a syndrome of physical and emotional fatigue, which leads to a negative self-perception and negative attitudes at work. It affects particularly caregivers, because they are in tune with the suffering, misery, misfortune, sickness and death.

The objective of our study was to assess the degree of burnout among medical interns.

This was a cross-sectional study, which studied a population of 40 interns engaged in Hedi Chaker Hospital in Sfax.

To assess burnout, we used a psychometric tool: the Maslach Burn-out Inventory (MBI).

With each intern we collected sociodemographic variables (sex, age, marital status, spouse's occupation, number of children), the parameters concerning the occupation (specialty, professional grade, number of hours per week, number of guards per month …), the causes of exhaustion, and if there were consequences.

The average age of interns was 28 years 4 months. They were married in 47.5% of cases and 52.5% in single cases.

The results of the MBI:

• A high level of emotional exhaustion was found in 37.5% of interns, 40% had moderate levels of emotional exhaustion and 22.5% had a low score of emotional exhaustion.

• The “dehumanization of the relationship,” was high in 25%, moderate in 20% of doctors, and 55% spared them.

• Personal achievement was high in 25% of doctors, moderate in 35% and poor in 40% of them.

Once recognized, the burnout syndrome among medical interns requires concrete actions focusing on their professional lives and their privacy ones.

Quality of life (QoL) is a complex concept that depends on many factors such as life style, past experiences, expectations, future plans and ambitions. It may be altered in patients suffering from chronic disease.

Assess QoL in patients with asthma as well as associated factors.

We conducted a cross-sectional, descriptive and analytic study, including 30 patients followed for asthma at pulmonary outpatient department, Hedi Chaker Hospital, Sfax, Tunisia. Asthma control level was evaluated by the Asthma Control Test (ACT). QoL was assessed using the 36-item Short Form Health Survey (SF-36), that contains 36 questions grouped into 8 domains (D1: Physical Functioning, D2: Role limitations due to physical problems, D3: Bodily Pain, D4: General Health, D5: Vitality, D6: Social Functioning, D7: Role limitations due to emotional problems and D8: Mental Health).

The mean age was 51 ans. The mean duration of disease was 11 years. The average ACT score was 16.8 points. Asthma was uncontrolled in 1/3 of patients. The mean of average overall scores SF-36 was 46.22. QoL was altered in 83.3% of patients. The most altered domains were D8 followed by D7then D4 and D2. The average overall score SF-36 was correlated to ACT score (P < 0.001), early age of onset of the disease (P = 0.049) and poor asthma control (P < 0.001). Altered QoL was associated to advanced age (P = 0.016), long duration of disease (P < 0.001) and low ACT score (P = 0.034).

Optimum asthma and associated comorbidities support would improve control and therefore the patient's quality of life.

The authors have not supplied their declaration of competing interest.

Quality of life is defined by the World Health Organization as “Individuals’ perceptions of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.” Schizophrenia is a severe, disabling, lifelong disorder, associated with severe social and occupational dysfunction. Aripiprazole Long Acting Injection (LAI) is indicated for maintenance schizophrenia treatment in adult patients stabilised with oral aripiprazole. It is the fourth second-generation antipsychotic depot formulation approved for treating schizophrenia.

Assessing quality of life in 4 patients treated with aripiprazole LAI.

In this paper, we evaluate of quality of life in 4 subjects with diagnosis of paranoid schizophrenia (less 10 years of diagnostic), male, age between 42 and 50 years, with poor adherence to oral treatment. These patients received aripirazol LAI 400 mg/month. We evaluate quality of life at baseline and after 3 months. We used the Quality of Life Scale (QOLS) and WHO-Quality of Life-Bref (WHOQOL-BREF).

Results demonstrated significant greater improvements in all QLS scores. No significant changes in the WHOQOL-BREF total, but improvement in subscale scores.

Quality of life in schizophrenia is adversely influenced by the presence of clinical symptoms, especially negative and depressive. Depot medications can improve treatment adherence, however, long-term antipsychotic use can lead to irreversible adverse effects (dyskinesias), which in some cases were reduced by using newer antipsychotics (risperidone, paliperidone, aripiprazole). Aripiprazole LAI can be useful to improve quality of life. Further methodologically robust studies are needed to generate evidence-based conclusions.

The authors have not supplied their declaration of competing interest.

To study the prevalence of anxiety and depression in a general hospital and to determine the ability of non-psychiatric residents to recognize the patients with clinically significant depression or anxiety.

This study was performed on a cohort admitted to Dr. Shariati Hospital in Tehran. Within 72 hours of admission, the patients were screened using the Hospital Anxiety and Depression Scale (HADS). Simultaneously, the residents who provided care for the patients were asked whether they believed the patients had significant levels of depression or anxiety. They were also asked to rate the degree of depression and anxiety of their patients in a 5 point Likert scale. Prescription of antidepressants and benzodiazepines during hospitalization was recorded by chart review. Assessments were completed for 401 patients.

According to HADS score, 136(34.25%) patients had probable depressive disorders(HADS-D score>7) and 157(39.75%) had probable anxiety disorders(HADS-A score>7). The residents only asked 26(6.4%) and 32(8.2%) patients about depression and anxiety respectively. Among the patients, only 10.2% with probable depressive disorders and10.8% with probable anxiety disorders were identified. No significant correlation was observed between HADS scores and the residents’ assessment of severity of depression and anxiety. Only 16.4% of the patients with probable depressive or anxiety disorders were given medication.

This study confirms the results of previous researches that had shown high levels of depressive and anxiety disorders among patients admitted to a general hospital. It also indicates that non-psychiatrist physicians overlook a marked proportion of depression and anxiety diagnoses identified by standardized instruments.

Though interest grows in improving patient activation in general medical health services, there is little evidence from randomised controlled trials in mental health settings of how to achieve this.

We aimed to evaluate the effects of a brief pre-treatment peer-co-led educational intervention added to mental health treatment. The intervention was developed and carried out in cooperation with user representatives, peer educators and health professionals, and aimed at activating and preparing patients to participate in own treatment.

To assess the 4 months and 12 months effects on patient activation measure-13 (PAM-13) and attendance.

Patients from two community mental health centres were randomised to a control group (CG, n = 26) receiving treatment as usual, or an intervention group (IG, n = 26), consisting of four-hour group pre-treatment educational seminar (peer-support and encouragement to adopt an active role) followed by treatment as usual.

At 4 months follow-up only the IG improved significant on PAM-13. Preliminary results at 12 months on PAM-13 and attendance will be presented.

Brief pre-treatment education improves patient activation at 4 months and could potentially have an effect on attendance at 12 months follow-up.

Pre-treatment education co-led in cooperation with user representatives, peer educators and health professionals is a rational and easy way to activate and engage outpatients in their own health care process.

Clinicaltrials.gov Identifier: NCT01601587

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The prevalence of eating disorders has been increasing in the Asian countries. Malays in Singapore are at the crossroads because they are largely traditional in practice and almost all are Muslim, but are exposed to western culture. Studies found that Malays at increased risk of eating disorders but yet those that present for treatment are very small, and this study aims to study Malays with eating disorders to unveil this contradiction.

All Malay patients presenting to Singapore General Hospital (SGH), which hosts the only specialized eating disorder programme in Singapore, between 2003 and 2014 were identified and medical records studied retrospectively.

Malays constitute only 42 out of 1340 patients treated in the same period. The mean age at presentation is 18.81 years (SD = 5.54) and the majority are students (78.6%). A total of 92.9% are single. There are more cases of bulimia nervosa than anorexia nervosa (45.2% vs. 26.2%). In total, 54.8% have psychiatric comorbidities, the most common is depression (31.0%), 38.1% have a history of deliberate self-harm and 21.4% attempted suicide. A total of 52.4% reported teasing as a trigger, while 16.7% were triggered by being overweight.

There is only a small number of Malays that presented. Fasting is commonly which may be confused with restriction. Other factors could be lack of awareness. The higher prevalence of bulimia nervosa suggests that purging is recognized as abnormal. High prevalence of comorbidities suggests that family members recognize comorbidities better. Outreach programs for Malay will help increase awareness.

The authors have not supplied their declaration of competing interest.

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

There are few published studies on the relationship between gender and psychiatric disorders. We assessed sex differences in a sample of first-admission psychiatric inpatients to identify possible risk factors and targets for sex-tailored treatment interventions.

A retrospective study of admissions to the psychiatry department, Coimbra hospital Universitary Centre, Portugal, in 2015 was accomplished (n = 924). The two groups were compared for demographic features, psychiatric diagnoses and medical comorbidities.

Male patients were significantly younger (age average = 47.7 vs. 53.3). Differences in employment, educational, and marital statuses were found between male and female psychiatric patients. Having a degree was a protective factor for males, whereas it was a risk factor for females. Being divorced and single were both risk factors for medical co-morbidity in females. A higher proportion of men among patients hospitalized for schizophrenia (14.9 vs. 5.5%) or substance use disorder (10.3 vs. 2.1%) and a higher proportion of women among those admitted for affective disorders (43.3 vs. 25.9%), including bipolar disorder (13.4 vs. 9.0%), were found. No significant differences in duration of hospitalization between the two groups (22.8 in male vs. 22.2 days in female)

The differences between the two groups of inpatients were very pronounced. A better understanding of these differences may help to establish more effective treatment strategies.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.