Affective symptoms are a common feature of schizophrenia and define bipolar disorder. Alterations in dopamine neurotransmission and activity at D3-D2 receptors is associated with depressive symptoms providing the rationale for targeting D3-D2 receptors with partial agonists.

The aim of the analysis herein is to examine and compare the efficacy of cariprazine in treating affective symptoms in both schizophrenia and bipolar depression.

Data from 3 schizophrenia [NCT00694707, NCT01104766, NCT01104779] and 3 bipolar I depression studies [NCT013896447, NCT02670538, NCT0267055] were pooled for the analyses. To investigate efficacy across individual affective symptoms, the Marder anxiety/depression and negative symptom items of the Positive and Negative Syndrome Scale (PANSS) and single items of the Montgomery-Asberg Depression Rating Scale (MADRS) were analysed. Improvement across affective symptoms was examined primarily evaluating least square mean differences (LSMDs) in comparison to placebo in mean change from baseline.

The pooled ITT population was comprised of persons with schizophrenia (placebo=442, cariprazine=1024) and bipolar disorder (placebo=460, cariprazine=923). Cariprazine resulted in a significantly greater reduction when compared to placebo in three out of the four Marder anxiety/depression items; anxiety (p<0.01), tension (p<0.001) and depression (p<0.05). Similarly, cariprazine was significantly better than placebo in 9 out of the 10 MADRS individual items; apparent sadness (p<0.001), reported sadness (p<0.001), reduced sleep (p<0.05), reduced appetite (p<0.001), concentration difficulties (p<0.001), lassitude (p<0.001), inability to feel (p<0.001), pessimistic thoughts (p<0.01) and suicidal thoughts (p<0.05).

The results herein indicate that cariprazine treatment is significantly effective at treating affective symptoms in persons with both schizophrenia and bipolar I depression.

I am an employee of Gedeon Richter Plc.

Provision of holisitc, accessible and high quality mental health care to the patients requires sharing of responsibilities & resources, enhanced communication & collaboration at the interface (primary care systems and secondary care mental health services). An innovative model of single point of care for people with severe and enduring mental health problems hosted at a primary care (GP) setting has been developed and evaluated in Walsall, UK.

To develop and evaluate an integrated (multidisciplinary) approach of managing health & social care needs of people with severe mental health disorders.

People with severe & enduring mental health problems were reviewed in primary care (N=65). A comprehensive physical, mental and psychosocial assessments were undertaken by the clinicians that included GP, Psychiatrist and Care-Coordinator.The reviews included: 1) A review of physical health indicators based on the Lester toolkit by practice pharmacist/nurse, including lifestyle, body weight, BMI and blood pressure. 2) Individualised interventions included physical / psychiatric prescribing, social prescribing and advise on lifestyle changes. Stable patients were recommended for stepping down from the secondary care. Outcomes included Patient Satisfaction Questionnaire (PSQ).

Satisfaction on the PSQ was rated from very good to excellent. Results highlighted multiple benefits including trust generation, improved communication among professionals, physical health screening and prompt clinical decision making (e.g. referral / prescribing). Other benefits included patient access & satisfaction, time and cost efficiency by reducing the number of reviews.

The integtrated CPA reviews offers efficient, holisitc & cost effective model of care with high satisfaction levels for patients and is replicable.

No significant relationships.

Withdrawal symptoms are common upon discontinuation of many psychotropic drugs. Catatonia, a neuropsychiatric condition characterized by a number of motor, behavioral, emotional, and autonomic abnormalities, has been described as a withdrawal syndrome in a growing number of case reports, but it is not well recognized. Treatment of catatonia usually includes benzodiazepines and electroconvulsive therapy. Standard consensus states that the use of neuroleptics should be avoided, as they are thought to worsen catatonia.

With this case report, we attempt to contribute to the finding in literature that the withdrawal of clozapine may be associated with catatonia, and how reintroduction of clozapine could be indicated for its treatment.

A clinical case is presented of a 37-year-old female with a history of schizophrenia, presenting with altered mental status and new onset of catatonic signs and symptoms in the setting of a 7-day emetic syndrome. The possibility that vomiting prevented proper absorption of clozapine is postulated, causing the patient to present clinical features compatible with malignant catatonia.

The patient required treatment with benzodiazepines, electroconvulsive therapy and clozapine re-initiation, leading to improvement of catatonic symptoms within a few days.

This case serves as a reminder to consider alternative diagnostic hypotheses in cases of catatonic syndrome unresponsive to standard treatments. When the clinical suspicion of drug withdrawal is high, restarting the discontinued medication, even an antipsychotic agent, may be indicated.

No significant relationships.

Traditional cultural healers -- their methods and their results -- are often invisible to conventional medical practitioners. When confronted with a result that does not make sense, we often ignore it.

We wanted to understand the process that happened between people and traditional cultural healers when these people experienced substantial improvement in mental health without psychiatric treatment.

We collected 56 case stories from people who consulted traditional cultural healers instead of conventional medical practitioners for serious mental health problems. We confirmed the stories with family members and interviewed the healers as well. We used constructivist grounded theory to explore commonalities in the stories from the clients’ points of view and from the healers’ perspectives. The context is indigenous people in North America.

Patients had a range of diagnoses, including psychotic disorders (12), bipolar disorder (28), and evere unipolar depression (16). Co-morbid anxiety disorders were common (22). Improvement in mental health was associated with participation in ceremonies within a community, building relationships with members of that community, engaging in prescribed daily practices endorsed by that community, with a resulting report of feeling increases in social and spiritual connectedness. The healers believed strongly that the embeddedness in community contributed to the results and that spirit beings played important roles in helping people feel better. The use of psychiatric medications was minimal.

Psychiatry can acknowledge that people can have substantial improvements in mental health when working with traditional cultural healers outside of conventional settings. Studying these settings and results can improve conventional practice.

No significant relationships.

The average concentration of copper in the air, e.g. in the USA it ranges from 5–20 ng/m3, in soil from 5–70 mg/kg, and the intake of copper from food is 1.0–1.3 mg/days for adults (0.014–0.019 mg/kg/day) (Barceloux, 1999). The effect of lipoic acid is reflected in the intensification of ATP synthesis, participates in the assimilation of lactic acid, activates the enzyme cycle of tricarboxylic acid, stimulates the growth of lactic acid bacteria by replacing acetate (acetate transfer factor), stimulates CoA synthesis (fatty acid utilization), prevents liver damage by various toxins, normalizes aldolase and transferase levels.

The aim of this study is to show the useful role of a supplement, lipoic acid, as an antioxidant in the prevention of oxidative stress.

All procedures were performed after anesthesia of albino rats with ketal in accordance with the principles of sacrifice in laboratories. After medial laparotomy albino rates Wistar soy, a 10% homogenate of brain tissue was made in an appropriate medium and an analysis of acid and alkaline DNase activity was performed (Kocić i sar., 2004).

DNases are thought to be the main executors of apoptosis, responsible for internucleosomal DNA fragmentation, which is the breakdown of chromosomal DNA into oligonucleosome-sized fragments. Administration of lipoic acid has been shown to protect against oxidative stress caused by copper.

Based on the results of this research, it can be concluded that lipoic acid is a powerful and powerful antioxidant.

No significant relationships.

Intriguingly, autism spectrum disorders (ASD) and symptomatic generalised joint hypermobility (S-GJH) (e.g. hypermobility spectrum disorders and Ehlers Danlos Syndrome) share several clinical manifestations including motor difficulties, sensory hypersensitivity and autonomic dysfunction. Moreover, many syndromic forms of ASD manifest a hypermobile phenotype. Despite the increased interest in the area, few systematic studies are available.

This large cross-sectional comparative study aimed to examine the association between S-GJH and ASD in adults.

We assessed GJH by physical examination using the Beighton Scoring System (BSS) and collected data on musculoskeletal symptoms and skin abnormalities amongst 156 adult patients with ASD and 413 adult community controls. A proxy for S-GJH was created by combining a positive BSS with at least one additional musculoskeletal symptom or skin abnormality.

The prevalence of S-GJH was significantly higher amongst patients with ASD than amongst controls (16.7% vs 4.8%, p< .001). A logistic regression model, adjusting for candidate covariates of GJH (age, sex, race), revealed a significant influence of ASD on S-GJH with adjusted odds ratio of 5.4 (95% CI 2.8-10.5, p< .001).

ASD and S-GJH are associated in adults. If recognised, musculoskeletal complications related to S-GJH can be relieved by physiotherapy. Clinicians should be familiar with that symptoms frequently occurring in GJH such as pain, fatigue and orthostatic intolerance may mimic or aggravate psychiatric symptoms (e.g. depression, anxiety). Knowledge about comorbidities may provide clues to underlying aethiopathological factors. Future research to clarify the mechanisms behind this association and to evaluate how comorbid S-GJH affects ASD outcome is warranted.

No significant relationships.

Restrictions related to COVID-19 may affect aggressive behaviour. Increased incidence of gender-based, domestic, and intimate-partner violence was expected during the pandemic, however, retrospective analyses yielded contradicting results.

Examine changes in frequency of assaults caused by pandemic restrictions, including separate analysis for male and female assault victims, for residential and non-residential location of assaults and for assaults related to domestic violence.

Weekly number of ambulance departures to injuries secondary to assaults in the Pilsen region, Czechia, during the COVID lockdown was compared to records from the three previous years using ANOVA and post hoc t-tests. Further, multilinear regression was used to model weekly number of ambulance departures between 1st January 2017 and 30th April 2021 based on presence of pandemic national emergency state, time, and seasonality.

During pandemic lockdown, ambulance departures to assaults dropped by 43% compared to equivalent periods of the three previous years. The decrease was notable specifically among departures to male victims and to assaults in non-residential areas, with only small decrease observed for female victims and assaults related to domestic violence and no change found in frequency of assaults happening at home.

Lockdowns and restrictions of public life were associated with a decreased incidence of violent assaults. While the incidence decreased especially in males and in those assaulted outside of their homes, we found no support for an increase in domestic or gender related violence. Pandemic restrictions may serve as a protective rather than a risk factor for assaults.

No significant relationships.

Depression during pregnancy leads to deterioration of the mothers’ and the fetus’ health.

To explore women’s perception and attitude towards using antidepressants during pregnancy and identify the factors that influence decision making regarding antidepressants use.

A cross-sectional survey of 991 subjects using convenient sampling. All study subjects (PNU affiliates; staff and students) were invited to fill out an electronic questionnaire, KAAUH staff and PNU female associates who were less than 18 years old were excluded. Answers were reported using 5- point Likert scale. The responses were summed up to give a total score for each respondent. The cutoff point is 75%. Respondents who scored above or equal 75% of the total score was considered as positive perception or favorable attitude.

The majority of women had negative perception and favorable attitude towards using antidepressants during pregnancy reaching 64%. While, women with positive perception and favorable attitude represented about 20% of the study subjects. The main factors influencing decision making were, education specialty (health, none-health) and subject history of diagnosis with any psychological disorder. Social stigma, religious believes and fear of addiction were reported by surveyors to be the reason influencing their perception and attitude about antidepressants use (P value <0.005).

This study reveals that although Saudi women reflect a negative perception towards using antidepressants during pregnancy, yet they have a favorable attitude once depression during pregnancy becomes an issue.

No significant relationships.

From clinical experience, majority of patients in adult forensic services who have childhood diagnosis of ADHD self-report onset of substance misuse around the age of 12.

Aim of the study was to explore if routine screening of childhood substance use is considered by ADHD diagnostic services.

PsycINFO and Embase databases were searched with the keywords: Attention Deficit Hyperactivity Disorder, ADHD, primary care/general practice, family physicians ,paediatrics, and children/adolescents, child and adolescent psychiatry, diagnostic assessments, substance / drug use, prescription drugs and drug screening.

24 articles were retrieved for age groups 12 to 17 years. Studies identified substance misuse as highly comorbid with ADHD but more so in conduct disorder. Studies identified diversion risk in adolescents.

Both ADHD and amphetamine misuse disorders are Axis 1 disorders (Baldwin 2009). Literature links substance misuse in ADHD to conduct disorder. There needs to be research into the diagnostic overlap between conduct disorder and ADHD and how this fits into the trauma model of adult offender treatment pathways. Treatment pathways for ADHD or conduct disorder and childhood onset substance misuse disorder are not clear both in primary or secondary care. Literature appears to put emphasis on early diagnosis and prescription stimulant treatment outside the social and psychological context and cites outcomes of the short term studies as reason for continued prescriptions in adolescence and beyond. There is need for studies exploring perspectives and trajectories of amphetamine use in adults who were diagnosed with ADHD in childhood, adolescence and as adults.

No significant relationships.

The Altai Republic (AR) is the national subject of the Russian Federation where suicidal situation is unfavorable as the death rate from suicide exceeds the national rates by three times. The high level of suicide among adolescents and young people is especially alarming.

To analyze the dynamics of mortality from suicide among adolescents and young people in the AR for the period from 1990 to 2019.

Data on mortality of the population were obtained from the Russian databases of demographic indicators and analyzed in terms standardized per 100,000 population.

The highest mortality rates from suicide are recorded in the 20-24 age group. The suicide rate, compared to 1990, decreased slightly from 82.5 (in 1990) to 79.7 per 100 thousand (in 2019). The dynamics of mortality from suicide among adolescents aged 15-19 is also unstable. When comparing the indicators in 1990 and in 2019, one can verify the negative dynamics in the form of a 4-fold increase in the suicide rate – from 14.4 (in 1990) to 58 (in 2019). An analysis of the ethnicity of young people who committed complete suicide showed that the majority of suicides (90%) were indigenous Altaians.

In adolescents and young people of the AR, the death rate from suicide exceeds the all-Russian indicators from 7.9 to 9.3 times. Effective preventive measures are needed to improve the situation.

No significant relationships.

Qatar established its Forensic Community Mental Health Team (FCMHT) in 2019 as part of the region’s first comprehensive forensic psychiatry service. We present here the data on clinical and offending outcomes since its establishment and compare this with data from before the service was established

To compare clinical and offending outcomes in mental health patients with criminal offending histories in Qatar before and after the establishment of Forensic Community Mental Health Team (FCMHT).

This is a retrospective study comparing the socio-demographical characteristics, clinical outcome and recidivism measures of forensic patients, under the FCMHT for the last two years with data from a similar period before the services were in place.

Data for 170 patients in total was analyzed. 85 patients currently under the active care of forensic community team were matched with a comparable group before the establishment of the services. The re-admission and reoffending rates after the establishment of the service over 1 year of follow up was 15% and 20% respectively compared with 60% and 85% of the group before the service.

Since its inception, the FCMHT has made significant positive impact on quality of life, mental well-being and safety of patients under its care. Close working relationships with criminal justice system, families and carers has helped fight stigma and promote safer community.

No significant relationships.

Trichotillomania (TTM), also known as hair pulling disorder, is an obsessive- compulsive disorder characterized by the recurrent, overwhelming urge to repeatedly pull out one’s hair. Hair pulling can occur anywhere on the body but is most common on the scalp, eyebrows, and eyelashes and subsequently results in bald patches. While TTM is a very prevalent, debilitating disorder, there is still no FDA approved treatment that exists.

The main objective of this study is to explore the various forms of available psychotherapy available for the treatment of trichotillomania.

Two independent reviewers conducted title, abstract, full-text searching and data extraction among the PubMed, PsycINFO, and ResearchGate data bases. Of the 79 articles screened, five were included in this review

Habit reversal therapy (HRT) is a form of cognitive behavioral therapy that is considered the first line treatment for management of TTM. Other psychotherapeutic techniques include acceptance and commitment therapy, progressive muscle relaxation, and mindfulness therapy.

This study supports the current data which states that HRT is the first line treatment and there is yet to be a pharmacological treatment of choice for TTM. It is also very important to note that TTM is still underdiagnosed and can be mistaken for a dermatological disorder like alopecia aerata. Furthermore, many people with trichilemmoma have underlying mental health disorders such as anxiety and depression that must first be addressed before treating the hair pulling itself.

No significant relationships.

In addition to physical problems, patients with COVID-19 suffer from considerable stress throughout the disease crisis and could present psychiatric consequences even after their remission.

To assess anxiety, depression and post-traumatic stress symptoms among patients who had recovered from the acute COVID-19 infection in Tunisia.

A cross-sectional design included 50Tunisian adults who survived COVID-19 virus infection.Participants have been screened with a telephone interview 1 to 3 months after a diagnosis of COVID-19. We used a questionnaire including socio-psychological variables,presence of close relatives being infected, bereavement due to COVID-19 and post infection physical discomforts.The Impact of Event Scale-Revised (IES-R) was used to investigate post-traumatic stress disorder (PTSD). Depression and anxiety were measured using The Hospital Anxiety and Depression Scales (HADS).

The age of the participants ranged from 19 to 86 years.38%were female. Twelve percent (12%) of patients required hospitalization during COVID-19 infection. After a mean of 86.60 days (SD = 23) following the diagnosis, 28 % of patients reported clinically significant PTSD. The rates of depression and anxiety disorders in our population are 20% and 30%, respectively. Seventy percent of patients (70%) reported one or more post infection physical discomforts that the most common symptoms included Difficulty breathing and anosmia. Patients with PTSD, depression or anxiety had a more frequent history of a relative diagnosed positive for corona virus, a longer duration of infection, and more frequently post-infection physical discomfort

Long-term psychological impact of COVID19 should not be ignored and mental health care could play an important role in rehabilitation.

No significant relationships.

Depression in the elderly is common and closely interrelated with the deterioration of the quality of life, especially in the institutionalized elderly.

In this work, we propose to determine the prevalence of depression in the elderly in institution, to assess their quality of life and to evaluate the correlations between depression and the quality of life.

Our study concerned 30 elderly subjects institutionalized at the retirement home(Sousse, Tunisia). Three validated Arabic version scales were used: The 30-item GDS (Geriatric Depression Scale), the MMSE (Mini Mental State Examination) and the SF36 (assessing the quality of life).

The mean age of our population was 75±7.3 years, the sex ratio was 1.73. The prevalence of depression was 37%. The elderly had a cognitive impairment in 16.7%. The mean global SF36 score were 11.2, attesting an altered quality of life in all our subjects: the mental component (9.43) were more altered than the physical one (13.03). No correlation between depression and quality of life was found. Depression was significantly correlated with the presence of a medical history (p=0.05). Depression had a negative and statistically significant correlation with the physical score of SF36 (r=-0.41, p=0.02) and tended towards significance for the “general health” dimension of SF36 (r=-0.32, p=0.08).

Our study shows a high frequency of depression in the institutionalized elderly as well as a deterioration in their quality of life. Depression is strongly linked to deterioration in physical condition.Our results underline the influence of somatic diseases as a major risk factor for depression in the elderly.

No significant relationships.

The sense of agency concerns the experience of controlling our actions, referring both to superior and lower levels of psychological functioning that are also related to the physical dimension of agency. Diverse clinical conditions affect the awareness of being a bodily and agentive self.

The aim of this systematic review was to provide a comprehensive evaluation of the relationship between individual sense of agency and body perception.

PsycINFO, Psycharticle, Medline, Web of Science and Scopus were systematically searched for articles published until 19/10/2020.

After removing duplicates, a total of 2.556 records was screened. Fifteen articles were selected based on the inclusion criteria fixed for the systematic review.

In the last decades, this line of research seems to attract a growing number of studies.

However, these studies are affected by a great heterogeneity in the investigation of both constructs.

Body perception and sense agency were operationalized across research in diverse ways, making the evaluation of the relationship between them very difficult. In addition, there is a paucity of studies investigating the relationship between body perception and agency among individuals suffering from specific psychopathology or physical diseases. According to literature review, the main objective for future research is to develop more robust approaches to estimate the variability of these constructs such as their relationship.

No significant relationships.

No significant relationships.

The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students’ wellbeing.

To compare medicine/dentistry students’ depression/anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress.

Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1; n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2; n=650) the COVID-19 pandemic. Mean age (21.12±3.75), personality traits scores, and gender proportions (»75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues).

SAMPLE2 presented significantly higher mean scores of depression (3.89±3.55vs.3.33±3.34), anxiety (3.27±4.08vs.2.86±3.29), stress (7.07±5.72vs.6.18±4.59) and total DASS (12.28±10.55vs.13.65±11.13) than SAMPLE1 (all p<.05). Fear of COVID-19 was a significant predictor of DASS score (adjusted R2=2.9%, p<.001). COVID-19-related stressors continued explaining significant increments of DASS variance after controlling for each of the ISSDME dimensions: Course demands (R2 Change=1.8%), Human demands (2.5%), Lifestyle (2.3%), Academic competition (5.5%), and Academic adjustment (5.2%) (all p<.001).

This study adds to the evidence of the negative impact of COVID-19 on students and emphasizes its pernicious role on medical students’ psychological distress, which is already higher due to the individual and academic stressors to which they are more exposed.

No significant relationships.

No significant relationships.

Tunisia is viewed as an advanced country in terms of women’s rights in the Arab world. However, women are more exposed than men to many specific risk factors which greatly contribute to threaten their mental health.

The main objective of this study was to find out the sociodemographic and clinical profiles of women admitted in Razi psychiatric hospital and their access to mental health services.

A cross sectional and descriptive survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 40 female inpatients.

The majority of patients had low (37.1%) to moderate (61.9%) socio economic status, with primary education (40%), secondary education (20%) and higher education (28.6%). The majority was unemployed (68.8%). A significant difference was observed between adherence to treatment and family support (p=0.04). It was mainly the father or the husband who was taking care of the patient in 50% of cases. The first psychiatric consultation was 2.68 years after having symptoms. Hospitalization was about 4.94 years later. Twenty five percent of them have seen a tradipractioner before consulting. About 46.87% of patients had conflicts with a member of her family and 15.62% of them were victims of either domestic or family violence. The main diagnoses were mood disorders (31.4%) and schizophrenia (42.9%) Time between symptoms onset and hospitalisation was significantly associated with socioeconomic status (p=0.047) and cultural beliefs (p=0.026).

The protection of women’s mental health is not only a medical challenge but also a cultural and political one.

No significant relationships.

Amisulpride is an atypical antipsychotic. Rabbit syndrome(RS) may be seen after antipsychotics use a few days or long‐term application. RS occurs after more frequent typical antipsychotics and also in rare cases atypical antipsychotics.Its characterized by the involuntary rhythmic movements of the lips however involves no tongue movements.

Case report and reflection on its etiology

Case report and literature review

A 28-year-old female with a diagnosis of schizophrenia applied with the complaints and symptoms of withdrawal, do not want to leave the house, physical anergy and avolition that started after stopped taking her medications. She was admitted to the psychiatry service and amisulpride treatment was started and was gradually increased to 800 mg/day. After 30 days of hospitalization, the patient was discharged with mild recovery. 14 days after the discharge, because of the abnormal involuntary movements in mouth, the patient applied. In clinical examination without tounge involvement, rhythmic motions were observed in the lips and jaw.Neurological examination, labrotory tests and cranial screening were all normal. She was evaluated by a private psychiatrist and was diagnosed with RS. Amisulpride treatment changed to olanzapine treatment with 15 mg/day. After two months, RS spontaneously regressed.

The resolution of the involuntary movements following discontinuation of amisulpride in our case, supported the diagnosis of RS. Although the mechanism by which RS emerges as a side‐effect of amisulpride is not fully understood, the drug’s high affinity for and selective binding to dopaminergic D2 and D3 receptors are thought to be responsible for this involuntary motion disorder.

No significant relationships.