Previous transcranial magnetic stimulation (TMS) studies indicate that exposing the subjects to an emotionally valent stimulus results in larger motor evoked potentials (MEP). Up to date, no TMS studies have been conducted in order to investigate the effect of personal memories with emotional value on corticospinal excitability.

To investigate changes in corticospinal excitability and sensorimotor integration induced by retrieval of negative or neutral autobiographical memories (AM).

To contribute to a further characterization of neural circuits involved during the evocation of negative AM.

In 12 healthy volunteers, we recorded motor evoked potentials (MEPs) elicited by TMS pulses during the retrieval of negative AM or neutral AM. Furthermore, we also tested Short-interval Intracortical Inhibition (SICI), Intracortical facilitation (ICF), Short and Long afferent Inhibition (SAI and LAI) in the two different experimental conditions.

Retrieval of negative AM induced a larger increase in MEP amplitude (35.01%) compared to neutral AM (F(1,22) = 7.04, P = 0.013). Furthermore we showed that retrieval of Negative AM increasedn ICF (F(1,22) = 5, P = 0.03) and decrease SAI (F(1,22) = 7.04, P = 0.039). The other TMS parameters were different between conditions.

Our results indicate that evocation of negative AM induce a complex modulation of excitatory and inhibitory sensorimotor networks. Further studies are needed to explore the link of these electrophysiological biomarkers with the strength, valence and specificity of negative AM.

The authors have not supplied their declaration of competing interest.

Humans learn how to behave both through rules and instructions as well as through environmental experiences. It has been shown that instructions can powerfully control people's choices, often leading to a confirmation bias.

To compare learning parameters in reinforcement learning task with and without instructions.

We recruited 52 healthy adult control subjects (21 males, 31 females, age 30 ± 6.5 years). Participants completed Repeatable Battery of Neuropsychological Status (RBANSS). Twenty-seven participants completed additionally Probabilistic Selection Task (PST) while twenty-five participants completed Instructional Probabilistic Selection Task (IPST). To analyze learning parameters, we used Q-learning model with 3 parameters: learning rate due to positive and negative reinforcements as well as exploration-exploitation parameter.

Both groups did not differ with respect to cognitive functioning measured with RBANSS (immediate and delayed memory, visuospatial abilities, language and attention); however, participants who completed PST had trend-level statistically faster learning rates due to positive (P = 0.099) and negative reinforcements (0.057) in comparison to participants who completed IPST. Both groups did not differ with respect to exploration-exploitation parameter (0.409).

In healthy adults, interference of confirmation bias can influence learning speed independent of cognitive functioning (immediate and delayed memory, visuospatial abilities, language and attention).

The authors have not supplied their declaration of competing interest.

Seizure disorders have been identified in patients suffering from different types of dementia. However, the risks associated with the subtypes of those seizures have not been characterized.

To compare the occurrence of seizure disorders (partial and generalized) between patients with and without a dementia diagnosis from the OPTUM database.

All ages, and patients with full eligibility between January of 2005 to December of 2014, were included. Data from OPTUM, a de-identified, HIPAA compliant database, made up of 40.7 million private insured patient individual electronic health records from the US, were utilized. Using ICD-9 diagnoses, the occurrence of generalized or partial seizure disorders was identified. A comparison between patients with and without dementia was performed.

A total of 150,516 patient records had a dementia diagnosis, and, 56.38% of them were females. Patients with dementia when compared to those without dementia had higher risk for seizure disorders [odds ratio (OR) = 6.5 95% CI = 4.4–9.5]; grand mal status (OR = 6.5, 95% CI = 5.7–7.3); partial seizures (OR = 6.0, 95% CI = 5.5–6.6); motor simple partial status (OR = 5.6, 95% CI = 3.5–9.0); epilepsy (OR = 5.0, 95% CI = 4.8–5.2); complex partial epileptic seizures (OR = 4.9, 95% CI = 4.6–5.2); generalized convulsive epilepsy (OR = 4.8, 95% CI = 4.5–5.0); localization-related epilepsy (OR = 4.5, 95% CI = 4.1–4.9); petit mal status (OR = 4.2, 95% CI = 2.9–6.1); fits convulsions (OR = 3.5, 95% CI = 3.4–3.6); and complex febrile seizure (OR = 2.5, 95% CI = 1.6–3.9).

The present study confirms that patients with dementia have higher risks for either generalized or partial seizures disorders when compared with patients without dementia.

The authors have not supplied their declaration of competing interest.

The neuropathological features of Alzheimer's disease (AD) are deposition of amyloid plaques, neurofibrillary tangles and neuro-inflammation. Among these, neuro-inflammation is a common pathological substrate of neurodegenerative disease, such as AD, and Parkinson disease.

Herein, we tested whether the inhibition of bromodomain and extra-terminal domain (BET) protein, a critical regulators of transcription in neurons, could attenuate the neuronal cell death and amyloid beta aggregation using rat primary cortical neurons. We also investigated whether a BET inhibitor could prevent the inflammatory processes and cognitive decline in an animal model of AD.

The effects of BET inhibition on neuronal cell death were assessed in the followings:

– cell viability and reactive oxygen species generation;

– enzyme activity of tPA/PAI-1 measured by casein zymography;

– the signal pathways including BDNF/CREB and MAPKs using western blotting;

– the effects on inflammatory responses in an animal model of AD using immunohistochemistry.

JQ1, an inhibitor of Brd2/4 protein, significantly decreased the neuronal cell death in mixed cortical neurons in concentration-dependent manner but not in pure neurons. JQ1 increased the enzyme activity of tPA, which decreased the expression of Brd2 protein. JQ1 also decreased the ROS generation and decreased cleaved caspase-3 expression. Moreover, Brd2 inhibition by transfection of Brd2 siRNA reduced amyloid beta aggregation.

Our results suggested that BET inhibition might have therapeutic potential for AD. That is, Brd2 inhibition by JQ1 can prevent the neuronal cell death and neuroinflammation as well as amyloid beta aggregation through regulation of tPA/PAI-1 system.

The authors have not supplied their declaration of competing interest.

Fluency tasks, e.g. verbal, design fluency test, etc. are often used in the evaluation of cognitive function in patients with schizophrenia. In the standard approach, the test result is the sum of stimuli generated in a given time period. However, this approach does not allow to determinate of what strategies are used by subjects to regulate the cognitive engagement during task execution.

To investigate the specific dynamic profile of fluency tests performance comparing with healthy controls.

Thirty patients diagnosed with schizophrenia and 30 demographically matched healthy controls took part in the study. Participants performed two tests: COWAT (3 trials) and Ruff Figural Fluency Test in accordance with the original instructions. During the generation of these stimuli, the investigator wrote down their quantity in 15-second intervals, which enables the assessment of cognitive engagement variability in different parts of the whole time (1 minute).

Comparison of cognitive engagement variation in both fluency tests showed statistically significant differences. The differences in repeated measures ANOVA with group as an independent variables reached P < 0.0001. Factor differentiating the profiles in verbal and figural fluency was first 15 seconds after the tasks started.

The beginning of task was the most difficult part for patients with schizophrenia, which may indicate that the overall worse performance of fluency tests is associated with significant difficulties in mobilizing the cognitive activity.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The term Pseudodementia, as presented by Kiloh, is being used to describe the clinical image characterized by depression combined with impairment in cognitive functions which reacts positively in treatment with antidepressants.

To explore the aspects that make this condition unique, so that mental health professional will be able to use the proper psychometric tools when they face patients with confusing symptoms.

Hundred and thirty-one participants were recruited from the B’ Psychiatric Clinic of G.H.N.P “Agios Panteleimon” and Day Center of Alzheimer's Disease in Amarousion, with 56 (42.7%) males and 75 (57.3%) females. All participants were administered the MoCA and the DASS21 questionnaires. Statistical analysis was performed with SPSS21.

The findings reported a significant difference in the scores of MoCA done by patients with dementia (M = 13.9, SD = 5.4) and patients with depression (M = 20.5, SD = 4.9) while both groups scored below the accepted scores indicating cognitive impairment [CI]. However, analysis showed that in the following sectors of MoCA, depressive patients scored significantly higher than demented ones: visuospatial (MD = 0.651), clock (MD = 1.288), orientation (MD = 1.212) and delayed recall (MD = 1.329).

Findings shows a significant pattern in the difference between depressed and patients with cognitive impairment. These findings suggest that mental health professionals should use neuropsychological measurements like MoCA when evaluating such cases in order to be able to diagnose effectively cases of pseudodementia.

The authors have not supplied their declaration of competing interest.

Theory of mind (ToM) has repeatedly been shown to be compromised in many patients with schizophrenia (SCZ). By contrast, the association between ToM deficits and neuro-cognitive functioning (NF) remains uncertain.

To investigate the association between ToM functioning and neuro-cognitive functioning in SCZ.

Fifty-eight outpatients with stable SCZ completed the intention-inferencing task (IIT), in which the ability to infer a character's intentions from 28 short comic strip stories is assessed. They also completed a neuro-cognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

The performance in the IIT significantly correlated with performance in some neuro-cognitive tests including efficiency in DBZ, number of uncorrected mistakes in ST, number of correct categories in MCST and the time needed to succeed the TMT-A. No correlations were found between performance in the ITT and in memory tasks (HVLT-R and DS).

ToM may rely on some neuro-cognitive functions (mainly attention and executive functioning). Elucidating the exact relationship between ToM and NF may be useful as both are targeted in specific psychotherapeutic interventions.

The authors have not supplied their declaration of competing interest.

It has been suggested that psychotic bipolar patients have more severe cognitive deficits and lower functioning that non-psychotic bipolar patients.

To evaluate neurocognitive and functional performance in stabilized psychotic bipolar patients (BP+), non-psychotic bipolar patients (BP−) and schizophrenia patients (SZ).

To examine whether BP+ might be defined as a more homogenous subtype of bipolar disorder with more severe cognitive deficit and more severe functional impairment.

Fifty TB+, 50 TB−, 50 SZ and 51 controls were evaluated with a comprehensive neurocognitive battery (WCST, FAS, TMT-A and B, Stroop Test, Digits span, letters and numbers – WMS-III−, CVLT, ROCFT, CPT-DS). Moreover, patients were evaluated with clinical scales (PANSS, MADRS, YMRS) and functionality scales (WHOs Disability Assessment Scales, QLS and GAF). IBM SPSS Statistics (version 19.0) was used to the data analysis.

No significant differences were found between three patients’ samples (P < 0.0001). No significant differences in neurocognitive measures were found between BP+ and BP−. Significant differences were found between both groups of bipolar patients and schizophrenia in working memory measures (P < 0.0001). BP+ and BP− showed significant higher functionality than SZ (P < 0.0001), without significant differences in functionality between BP+ and BP−.

The pattern of neurocognitive and functional deficit is similar in BP+ and BP−. The neurocognitive deficit is very similar in both groups of bipolar patients groups in comparison to SZ; functionality is better in both bipolar groups than in schizophrenia patients.

The authors have not supplied their declaration of competing interest.

Empathy, which refers to the ability to understand and share the thoughts and feelings of others, may be compromised in schizophrenia (SCZ). Yet the relationship between empathy and neurocognitive functioning remains unclear.

To explore whether cognitive and affective empathy are associated with the neurocognitive functioning in SCZ.

Fifty-eight outpatients with stable SCZ completed the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Better affective and cognitive empathy correlated with better performance in the ST (less hesitations and less errors). Patients with better cognitive empathy performed better in the MCST (more categories achieved; P = 0.029) and in the LDST (more substitutions per minute; P = 0.031).

Our results bolster support for the presence of an association between NF and the decreased cognitive and affective empathy in schizophrenia.

The authors have not supplied their declaration of competing interest.

The impairment of cognitive and affective empathy among patients with schizophrenia (SCZ) may represent a significant feature of the illness. However, the relationship between those impairment and dimensions of psychosis remains unclear.

To explore whether cognitive and affective empathy are associated with severety of different psychotic symptoms.

Cognitive and affective empathy were evaluated in 58 patients with stable schizophrenia with the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. Symptomatology evaluation comprised the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impressions Scale Improvement and severity (CGI).

Patients with better cognitive empathy had less total CDSS scores (P = 0.036, r = −0.449) and lower CGI-severity scale scores (P = 0.01, r = −0.536). Patients with better affective empathy had lower scores (which means a better improvement) at the CGI-improvement scale (P = 0.03, r = −0.461).

Our results suggest that empathy with its different component is not totally independent of the clinical state of the patient. Further studies are required to confirm whether empathy deficits are state or trait aspects of SCZ.

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.

Chronic hepatitis C virus (HCV) is one of world's most important chronic infections. HCV can be treated using interferon-alpha (IFNα) and ribavirin (RBV). HCV, IFNα and RBV are known to impair mental and physical life quality. Many HCV-infected individuals have life-prevalence of substance use disorder (SUD).

To study life quality (SF-36) in HCV patients with SUD history during antiviral treatment.

SF-36 questionnaire was assessed in 384 HCV patients at baseline, and at 4, 12, 24, and 48 weeks of treatment. ANCOVA models were used to study the association of SF-36 scores and potential risk factors at baseline. Risk factors from baseline scores over time were studied through linear mixed models, adjusting for baseline scores.

At baseline, SUD men had worse mental (P = 0.03) and physical health (P = 0.022), and younger patients had worse social functioning (P = 0.011), and mental (P = 0.001) but better physical health (P < 0.001). Figs. 1 and 2 show the results of mental and physical life quality during treatment from baseline.

This study emphasizes the decrease in life quality in HCV patients with SUD before and during antiviral treatment.

Instituto de Carlos III-FIS: PSICOCIT-PI110/01827,EU “One way to make Europe”, Ministerio de Economia y Competitividad (MTM2012-38067-C02-01), and support of SGR/2014/1135.

The authors have not supplied their declaration of competing interest.

Psychiatry has seen significant progress in recent decades due to scientific advances. However, beyond genes, neurotransmitters and neurocircuits, there is a truly human dimension that escapes all the science. The choices each one makes, even if biologically mediated, and the consequences, even if mediated through individual vulnerabilities, dictate an outcome. That outcome may be a biopsychosocially ill individual. Health professionals trained and up-to-date on the latest research are confronted with challenges that far outweigh what they expected and know what to do with, defying the humanity of even the most humane.

To reflect upon a clinical case of human misery.

To promote growth at a professional and personal level through the process of treating challenging patients.

Presentation of a clinical case.

A homeless person with a history of and current drug use, prostitution, untreated HIV-AIDS, hepatitis B and C, untreated Mycobacterium lentiflavum pulmonary infection, bleeding rectal prolapse, prolonged psychotic manic episode and a very difficult personality has trouble finding and ultimately rejects help from medical professionals and ends up involuntarily admitted to a psychiatric inpatient unit.

Many unsolvable or only partially solvable puzzles end up under psychiatric care. The complexity of human nature escapes all scientific advances. We can put many pieces together but the whole often remains a challenge, a challenge of our values, our motivation, creativity and resilience.

The authors have not supplied their declaration of competing interest.

The consumption of toxic substances often causes agitation, which makes more difficult the pharmacological management of the symptoms.

About one case, a search was performed of the different therapeutic options in the agitation takes place in the context of intoxication.

Thirty-five-year-old male patient diagnosed of dual pathology under treatment since 2003 in our outpatient. The patient shows paranoid schizophrenia disorder due to alcohol, cannabis and cocaine use disorder, summing up different pharmacological treatments with no remission. Whilst the examination is taking place the patient is under alcohol and cannabis effects. His physical and verbal behaviour are aggressive showing psychotic instability. The therapeutic team administers loxapine to its patient.

The inhaled loxapine turned out to be a good alternative in the case given.

Handling agitation when toxics are involved is complex. The new formulation of inhaled loxapine helps to control agitation quickly and it might be a feasible option for this kind of patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The dual pathway model (DPM) attempts to explain the processes that are etiological to the development of Bulimia Nervosa (BN) symptomology by examining both individual and sociocultural risk factors of BN. The DPM, however, is yet to incorporate the sociocultural factor Facebook, which is important given the widespread use of the social media website Facebook. In addition, research has suggested that the personality trait sociotropy may increase vulnerability to developing BN symptoms, however, there is limited evidence examining this factor in the DPM.

To test a revised DPM with the inclusions of social comparisons made on Facebook and sociotropy both (a) cross-sectionally and (b) longitudinally.

Four hundred and seventy females participated at baseline (T1). Four weeks later, 274 females completed the follow-up assessment (T2), which assessed a subset of measures from the baseline assessment.

An acceptable fit for both DM models was obtained through Structural Equation Modeling (SEM) using MPlus (See Figs. 1 and 2).

Prevention and early intervention efforts for both depression and BN should focus on addressing appropriate Facebook and social media use and these interventions should be tailored to individuals scoring high on sociotropy.

The authors have not supplied their declaration of competing interest.

Despite the considerable number of studies that have assessed evidence for a longitudinal relationship between eating pathology and depression, there is no clear consensus regarding whether they are uni- or bi-directionally related.

To undertake a meta-analysis to provide a quantitative synthesis of longitudinal studies that assessed the direction of effects between eating pathology and depression. A second aim was to use meta-regression to account for heterogeneity in terms of study-level effect modifiers.

Meta-analysis results on 30 eligible studies showed that eating pathology was a risk factor for depression (rm = 0.13, 95% CI: 0.09 to 0.17, P < 0.001), and that depression was a risk factor for eating pathology (rm = 0.16, 95% CI: 0.10 to 0.22, P < 0.001). Meta-regression analyses showed that these effects were significantly stronger for studies that operationalized eating pathology as an eating disorder diagnosis versus eating pathology symptoms (P < 0.05), and for studies that operationalized the respective outcome measure as a categorical variable (e.g., a diagnosis of a disorder or where symptoms were “present”/“absent”) versus a continuous measure (P < 0.01). Results also showed that in relation to eating pathology type, the effect of an eating disorder diagnosis (b = −0.06, t = −7.304, P ≤ 0.001) and bulimic symptoms (b = −0.006, t = −2.388, P < 0.05) on depression was significantly stronger for younger participants.

Eating pathology and depression are concurrent risk factors for each other, suggesting that future research would benefit from identifying factors that are etiological to the development of both constructs.

The authors have not supplied their declaration of competing interest.

The use of Performance and Image-Enhancing Drugs (PIEDs) is on the increase and appears to be associated with several psychopathological disorders, whose prevalence in unclear.

We aimed to evaluate the differences–if any–in the prevalence of body image disorders (BIDs) and eating disorders (EDs) in PIEDs users athletes vs. PIEDs nonusers ones.

We enrolled 84 consecutive professional and amateur athletes (35.8% females; age range = 18–50), training in several sports centers in Italy. They underwent structured interviews (SCID I/SCID II) and completed the Body Image Concern Inventory (BICI) and the Sick, Control, One, Fat, Food Eating Disorder Screening Test (SCOFF). Mann-Whitney U test and Fisher's exact test were used for comparisons.

Of the 84 athletes, 18 (21.4%) used PIEDs. The most common PIEDs were anabolic androgenic steroids, amphetamine-like substances, cathinones, ephedrine, and caffeine derivatives (e.g. guarana). The two groups did not differ in socio-demographic characteristics, but differed in anamnestic and psychopathological ones, with PIEDs users athletes being characterized by significantly (P-values < 0.05) higher physical activity levels, consuming more coffee, cigarettes, and psychotropic medications (e.g. benzodiazepines) per day, presenting more SCID diagnoses of psychiatric disorders, especially Substance Use Disorders, Eating Disorders, Body Dysmorphic Disorder (BDD), and General Anxiety Disorders, showing higher BICI scores, which indicate a higher risk of BDD, and higher SCOFF scores, which suggest a higher risk of BIDs and EDs.

In PIEDs users athletes body image and eating disorders, and more in general psychopathological disorders, are more common than in PIEDs nonusers athletes.

The authors have not supplied their declaration of competing interest.

Sensory deficits such as blindness and deafness are very common forms of disability, affecting over 300 million people worldwide according to World Health Organization estimates. These conditions can lead to misinterpretations of the environment, which may contribute to the development of a delusional disorder in predisposed people.

The objective of this study is to establish the prevalence of blindness and hearing loss across delusional disorder.

The aim is to provide useful information regarding this frequent, often disregarded, comorbidity.

Our results proceed from the Andalusian delusional disorder case-register (DelirAnda). We reviewed 1927 clinical histories of patients diagnosed of delusional disorder. Upon having verified the diagnosis following DSM-V criteria, we recollected data on the prevalence of blindness and hearing loss, which were defined based on clinical diagnosis.

One thousand four hundred and fifty-two patients matched DSM-5 delusional disorder criteria. Among them, 49.8% of our sample were women. The overall prevalence of sensory deficits was 7.4%, 3.5% of the patients with delusional disorder were blind, while 3.9% of them suffered from hearing loss.

Our results are consistent with previous studies, such as the Deliremp study, which found a 5.7% prevalence of sensory deficit among delusional disorder patients. These results show a higher prevalence of sensory deficit among delusional disorder patients compared with the general population. However, causality could not be established. Further study should be undertaken regarding the relationship between these two conditions.

The authors have not supplied their declaration of competing interest.