Studies with electroconvulsive therapy (ECT) in elderly focus mainly on the assessment of possible side effects on the cognitive functioning; there are few studies that evaluate the effectiveness.

Evaluate the effectiveness of this treatment in the population over 65 years.

Perform a preliminary study to evaluate the response to ECT of ≥ 65 years patients with depression.

We carry out a descriptive study based on patients treated in the last 10 years in the ECT Unit of Centro Hospitalar Psiquiátrico de Lisboa.

Our initial sample consisted of 457 patients. We select patients aged ≥ 65 years with depression, and with complete data, including electroconvulsive parameters, and initial and final Hamilton Rating Scale for Depression (HRSD) scores (n = 59). Of this, 81.36% (n = 48) had unipolar depression, and 18.64% (n = 11) had bipolar depression. In the first group, the mean variation between the initial and final scores in HRSD was 13.88 points, and 27.10% (n = 13) of the patients ended the treatment in the normal range of HRSD score. In the second group, the mean variation was 12.82, and 63.60% (n = 7) ended the treatment in the normal range of HRSD. Considering the initial and final HRSD scores, it appears that unipolar depression group presents higher values (severe depression) (P < 0.05). When we compare the mean variation between the initial and final HRSD scores, we didn’t observe a statistically significant difference between the two groups. There was a clinical improvement in both.

The acute treatment with ECT appears to improve depressive symptoms in bipolar and unipolar depression, when considering an elderly population.

The authors have not supplied their declaration of competing interest.

Repetitive transcranial magnetic stimulation (rTMS) is a new treatment, used for different psychotic disorders mainly depression.

Assessing knowledge and attitude toward rTMS among psychiatrists in Saudi Arabia, and determining factors affecting that.

To ensure that psychiatrists have sufficient knowledge regarding rTMS. A good knowledge will most likely have a positive impact on their attitude.

Cross-sectional study was conducted through an online survey. The study population is all psychiatrists in Saudi Arabia. A new valid and reliable questionnaire was developed.

Sample of 96 psychiatrists enrolled in the study, 81% were males. Participant's mean age was 37 years. Half of participants were consultants. The sample mainly consists of general psychiatrists (65%). The study showed that 80% of psychiatrists have an efficient knowledge about rTMS. Consultants have higher knowledge than residents do. Abroad training has no association with the level of knowledge or attitude. Seventy-nine percent of psychiatrists have a positive attitude toward rTMS. Only 53% of psychiatrists agreed to receive (rTMS) in case they were in a psychotic depressive condition. Minority (7%) of psychiatrists would not refer their patients for rTMS.

Most of psychiatrists have a good knowledge and a positive attitude toward rTMS. Those who have high level of training and experience show higher level of knowledge. Articles are found to be a better source for updating knowledge. Having an rTMS treated person in the family or relatives will positively affect the psychiatrist's attitude.

The authors have not supplied their declaration of competing interest.

Electroconvulsive therapy (ECT) is one of the most polarizing treatments in medicine. Although the treatment effect is well documented in clinical studies, there is a lack of data regarding patients treated in an ordinary clinical setting. In 2013, we established a regional register of neurostimulation treatment in Western Norway.

To describe the use of ECT at the Haukeland university hospital in Bergen.

Patients treated with ECT between June 2013 and June 2015 were included in the register.

One hundred and forty-seven patients received ECT during the 2 years period. The mean age was 58.4 years (22–91 years), 67% were female. Half of the patients (49.7%) had been treated with ECT previously. Indication for treatment was depression in 137 patients (93.2%), of which 29 (19.7%) were moderately, and 69 patients (46.9%) severely depressed, and additional 37 patients (25.2%) presented with severe depression with psychotic features. All but two patients were treated with right unilateral electrode placement, with a mean of 9.7 (3–22) treatments.

The mean MADRS before treatment was 34.2 (4–56) and after treatment 11.9 (0–39). One hundred and ten patients (74.8%) responded to treatment; of which 89 (60.5%) remitted (response defined as a 50% or greater decrease from MADRS baseline score, remission defined as MADRS ≤ 12). Twenty patients (13%) continued with continuation or maintenance ECT after the index series.

The authors have not supplied their declaration of competing interest.

Depression is the most common co-occurring syndrome in schizophrenia, which affects up to 60% of patients. Depression aggravates negative symptoms and cognitive deficit and can deteriorate social functioning, quality of life and outcome of the disease. Insufficient clinical response to adequate pharmacotherapy determines rising interest to brain stimulation techniques such as rTMS.

The primary goal was to evaluate safety and efficacy of rTMS in treatment-resistant schizophrenia patients with dominant depressive and negative symptoms in open non-controlled trial.

Thirty-one schizophrenia (ICD-10) patients with evident depression (CDSS ≥ 6) and negative symptoms and with stable low rate positive symptoms on combined adequate pharmacotherapy (antipsychotic + antidepressant), which have not been changed for at least 6 weeks, were included to the study.

All patients received 15-Hz rTMS on the left dorsolateral prefrontal cortex (100% intensity, 1800 pulses per session, 5 sessions per week, 15 sessions per course) with 8-shaped coil of Neuro-MS/D stimulator (Neurosoft). The primary efficacy measure was 50% CDSS score reduction after the 3rd week of treatment. The secondary measures were weekly reduction rates for CDSS and for PANSS negative syndrome scale.

Twenty (64,5%) patients respond to rTMS. Final mean CDSS score reduction was 55,2% (P = 0,000004), and mean PANSS negative scale score reduction was 21,3% (P = 0,000012). Two patients (6,5%) were excluded due to persistent headaches, no serious adverse events were observed.

rTMS is safe and effective strategy for the management of treatment-resistant depression in schizophrenia and can alleviate negative symptoms. Further sham-controlled studies are needed.

The authors have not supplied their declaration of competing interest.

We previously reported that deep brain stimulation (DBS) in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) is effective in reducing symptoms in severe treatment-resistant obsessive-compulsive disorder patients.

To examine the long-term evolution of obsessive compulsive disorder (OCD) symptoms in 24 patients treated with chronic electrical stimulation in IC/BST.

We aimed to examine the evolution of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and to determine if a number of predictors assessed before surgery are significantly related to this evolution.

We used a linear mixed model to investigate the evolution of the Y-BOCS in 24 patients. Data was collected in a naturalistic manner. Seven hundred measurements, taken during a total of 1836 follow-up months, are included in this analysis.

Our analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms stay relatively stable. In addition, results show a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Beside the ON/OFF effect of stimulation, the surgery itself has no additional effect on OCD symptoms. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time.

Electrical stimulation in the IC/BST has a fast and sustained effect on OCD symptoms.

The authors have not supplied their declaration of competing interest.

The alpha rhythm (EEG) in prefrontal regions has been related with the emotional equilibrium, predisposition for a positive mood (Urry et al., 2004) and the activation of the approximation system (Davidson and Irwin, 1999). Superficial neurostimulation application (SNSA) provokes an increase of such rhythm in prefrontal and temporal areas (Bardasano et al., 2010).

To demonstrate that the increase of alpha synchronization is a common factor in the satisfactory evolution of patients with different pathologies.

Thirty patients with different symptoms (hostility, anxiety, bruxism and obsessive symptoms) received 20 weekly sessions of 45 minutes long using the SNSA.

–SNSA topology system: it is a machine for superficial stimulation that uses electricity through superficial electrodes which are placed on feet and hands and an electrode over the 7th cervical vertebra;

–digital encephalogram;

–Faraday cage.

The alpha rhythm was incremented in 85% of the cases in anterior regions of the brain, related with the improvement of scale's punctuation.

The alpha rhythm has been showed to be presented in all individuals that improved their symptoms after the application of SNSA (Fig. 1).

The authors have not supplied their declaration of competing interest.

The four-step integrative model of psychotherapy is concerned with individual's needs, wants, rights and decisions in that order. It may carry a promise for deep and changing vision for patients with borderline personality disorder (BPD).

The study of the illuminating and changing effect of dealing with BPD patients in view of their needs, wants, rights and decisions.

To evaluate the effect of group work through the hierarchy of the four-step integrative model with BPD patients and to help them explore false and true elements of their femininity.

Forty-three female patients (age range: 19-37) diagnosed according to DSM-IV diagnostic criteria for BPD were enrolled in a dynamic psychotherapy group. Their progress was evaluated using Borderline evaluation of severity over time (BEST) and they wrote down detailed comments about their experience quarterly.

Results of regular attendants for 2 years were included (35 = 81.4%). The results of BEST showed a significant reduction of BPD severity at the end of 1 and 2 years. During psychotherapy sessions and within their quarterly comments, patients expressed their change in terms of moving from a state of cunning, manipulation, aggression, arrogance, envy and rejection (as stemming from their false femininity) into wisdom, confrontation, patience, pride, healthy competition and containment respectively (as stemming from their true femininity).

Patients with BPD may gain a better insight and genuine change as they realize what is false and what is true about their femininity in the context of attending four-step integrative model group psychotherapy.

The authors have not supplied their declaration of competing interest.

Solution-focused brief therapy (SFBT) is a strength-based and a social constructivist approach that assumes that individuals have the ability to develop creative solutions that enhance their lives to develop a new self, modify worldviews, and implement behaviour changes.

To develop a quantitative research to determine which clinical variables and process variables are measured using the technique of judges and determine its statistical association with the outcome at termination of therapy and follow-up, using the videos of SFBT psychotherapy sessions, and a follow-up call.

To identify variables associated with outcome at termination and follow-up and to evaluate the success applying SFBT.

Sample was composed by 74 cases.

A telephone number available to make the follow follow-up call and at least 6 months since termination (6 months to 39 months, mean 15.6 months). Three questionnaire were used, The First-Session Rating Questionnaire, The Last-Session Ration Questionnaire and The Follow-up Questionnaire.

Goals were reached 88% of the cases, patients said that complaint was totally resolved were 17% and 26% when the dropouts were excluded, and that complaint was partially resolved were 76% and 65% when the dropouts were excluded. According to the judges, the successful at termination was the 86%, and the successful at follow-up was 67% according to the Follow-Up Questionnaire. No variables were statistically associated to the successful at termination or the follow-up.

SFBT reaches the “minimum efficacy permitted” according to the general consensus of experts. Clinical of process variables was not associated to success.

The authors have not supplied their declaration of competing interest.

Cognitive Analytic Therapy (CAT) has emerged as an integrative new approach with promising results in the treatment of personality-disordered patients, particularly in borderline personality disorder. Although this approach has already demonstrated its effectiveness in adults, increasingly studies try to validate it in young population, which has meant a turning point in research.

The goal of this study is to know the whole production about CAT in a double way:

–articles that describes the main theoretical concepts underlying CAT theory;

–articles with evidence supporting its effectiveness in different mental disorders.

A bibliometric review of 397 scientific articles extracted from research databases including Dialnet, EBSCO, PUBMED, Unika and Scholar Google was conducted.

The results indicate an exponential growth in published studies on CAT, from first publications in the late 1960s, particularly strong in the last two decades and reaching its peak in 2008. Total research includes 247 literature reviews, 109 clinical studies, 47 case studies, 17 letters and comments from authors, 4 studies on diagnostic tests and 1 meta-analysis. Most research has focused on borderline personality disorder or other personality disorders (35% and 12% respectively) and eating disorders (11%). Studies have been conducted with adults (49%) the same as children and adolescents (46%) whereas only the 4% has been developed for elderly population.

Cognitive analytic therapy represents a well-documented psychotherapy with a proven efficacy in a wide range of clinical contexts.

The authors have not supplied their declaration of competing interest.

Acceptance and commitment therapy for the treatment of panic disorder and agoraphobia has been a big boost in last years, and there are preliminary studies about its efficacy. However, most studies have used individual interventions.

Evaluate the effect of an acceptance and commitment group therapy in patients with panic disorder and agoraphobia.

The sample consisted of 24 patients, aged between 18 and 55 years old, who were referred to groups by psychologists and psychiatrists of Mental Health Center. The intervention in each group consisted of 12 treatment sessions of 1 h 30 m duration, weekly. One pretest and posttest evaluation was conducted. The variables studied were: severity of panic disorder (Panic Disorder Severity Scale [PDSS]), fear of physical sensations (Body Sensations Questionnaire [BSQ]), frequency of catastrophic thoughts (Agoraphobic Cognitions Questionnaire [ACQ]) and level of experiential avoidance (Acceptance and Action Questionnaire-II [AAQ-II]).

The mean scores for all variables studied decreased in the post-evaluation. Means in post-evaluation were significantly lower (t Student, a = 0.10) in three of the four variables studied: severity of the condition (P = 0.001), frequency of catastrophic thoughts (P = 0.038) and level experiential avoidance (P = 0.073). In other words, patients had fewer panic attacks after treatment, and those who had were less intense, they had less catastrophic thoughts about consequences of anxiety, and they were better to accept their feelings and thoughts.

Although it is necessary to continue the study with a larger sample, these preliminary results support the use of ACT in group format in the treatment of panic disorder and agoraphobia.

The authors have not supplied their declaration of competing interest.

Most current psychotherapeutic approaches are self-focused in terms of focusing attention on how one thinks, feels, behaves or maintains, in one way or another, a pathological chain reactions. The aim of current is to challenge such focus by shifting the focus of attention to serving others rather than analyzing one's self.

Sixty patients were recruited after heroin detoxification, all have been subject to psycho-education about addictive behavior, craving process and risks of relapse. Half of them (group A; n = 30) were subject to weekly basis classical CBT group sessions while the other half (group B; n = 30) were subject to shifting focus approach where they were encouraged to serve on voluntary nonprofit basis at Alexandria university hospitals with weekly group support sessions to share experiences and encourage action. Patients in both arms were followed for 3 months and evaluated in terms of abstinence rate and quality of life.

Both groups were balanced in terms of age, marital status, age of onset of abuse, number of previous detoxification, criminal record and score of the Quality of Life Scale QLS at base line before psychotherapy. After 3 months, no difference as regards abstinence rate between both arms (X2 = 1.763; P = 0.288), also no difference between both groups as regards change in QLS score after 3 months (t = 0.039; P = 0.969).

Shifting focus approach shows no difference in terms of abstinence or quality of life improvement compared to classical CBT in non inferiority study.

The authors have not supplied their declaration of competing interest.

It is well known that students have several stressful situations to cope with and their coping strategies are of a wide range (Brougham et al., 2009, Zi et al., 2011, Pierceall and Cane, 2009).

The purpose of the study was to investigate how students coped with various stressful situations they faced.

One hundred participants, 60 men and 40 women, studying at TEI of Patras, Greece, were randomly selected and asked to describe their stressful situations and the ways they dealt with them.

The questionnaire used was based on “Échelle Toulousaine de Coping” (Tap et al., 1993) adjusted by Theodoratou et al. (2006).

Forty-five percent of the students could not control their feelings, while facing a difficult situation and might feel panic, but the majority of the students (63%) did not use medication to cope with a difficult situation. When facing a problem, the 45% of the students did not amuse themselves and 35% of the participants avoided communication with other people when they faced a problem. Moreover, 29% of the students chose to pray to face a difficult situation. Finally, 58% of the participants estimated that a counseling center in TEI of Western Greece would be necessary.

In conclusion, many students were overwhelmed by a negative emotion and most of them chose social withdrawal. Thus, they might feel helpless and suggested that a counseling center in their College and university might help them to overcome difficulties during their studies.

The authors have not supplied their declaration of competing interest.

The number of psychiatrists continues to grow in Canada. Patient psychiatry utilization statistics, including reasons for termination of such services, are important factors that have the potential to impact future Canadian and international psychiatry service policies and practices. In addition, understanding the reasons for psychiatry service termination is necessary to improve service quality and effectiveness.

This study focused on utilization trends, perceived effectiveness of psychiatry services, and reasons for termination of psychiatry services in Canada.

Prevalence of psychiatry service use, perceived effectiveness, and reasons for termination of such services were investigated in a Canadian sample (n = 25,113). Prevalence rates were investigated by geography, sex, and age. Data were self-reported and collected through a national Canadian phone survey focused on mental and physical health.

Results highlight that a small percentage of participants reported utilizing psychiatry services. The majority of participants using such services perceived them as useful. Across geographical regions, reasons for discontinuing services were most often related to completing treatment, feeling better, or not seeing the treatment as helpful.

This study explored psychiatry utilization trends, perceived psychiatry effectiveness, and reasons for patient termination of such services. Results are explored through a geographical region breakdown, sex differences, and age stratification. Implications for policy, practice, and training are discussed from a Canadian and international perspective.

The authors have not supplied their declaration of competing interest.

Non-adherence to antipsychotic medication is commonly found in mental health disorders (MHD), thus forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates and also can influence the attitudes and beliefs of mental health professionals (MHP).

–assess the beliefs of MHP;

–assess perception of illness in patients with MHD.

Contribute to treatment adherence of patients with MHD, through developing adequate strategies to their needs.

In this cross-sectional study, we use a convenience sample of patients with MHD attending in the mental health departments of three general hospitals in Lisbon great area. Data is being collected through individual interviews. We have applied clinical and socio-demographic questionnaire and additional measures to assess symptom severity, treatment adherence and attitudes towards medication. For MHP, we used a optimism scale (ETOS), Difficulty Implementing Adherence Strategies (DIAS); Medication Alliance Beliefs Questionnaire (MABQ).

Two convenience samples were composed by 150 patients with MHD (mean age: 39.7; SD ± 9.8) and 65 MHP (mean age: 37.0; sd 8.3) working in a variety of settings is being collected. From the perspective of patients, the most important reason for adherence is to accept the illness (54,7%, n = 82). 50.8% (n = 33) of MHP believes that if patients are unmotivated for treatment, adherence strategies are unlikely to be effective. 43.1 (n = 28) of MHP agrees that if patients do not accept their illness, any adherence strategies that result.

With this study, we expect to gain further knowledge on the factors related patients and MHP that might influence compliance and, therefore, contribute to the development of effective strategies to promote treatment adherence in MHD.

The authors have not supplied their declaration of competing interest.

Elderly institutionalization involves an emotional adaptation and the research shows that the risk of depression increases.

Evaluate the impact of a neuropsychological group rehabilitation program (NGRP) on depressive symptomatology of institutionalized elderly.

NGRP influences the decrease of depressive symptoms.

Elderly were assessed pre- and post-intervention with the Geriatric Depression Scale (GDS) and divided into a Rehabilitated Group (RG), a Waiting List Group (WLG), and a Neutral Task Group (NTG).

In this randomized study, before rehabilitation, 60 elderly people (RG; 80.31 ± 8.98 years of age; 74.2% women) had a mean GDS score of 13.33 (SD = 9.21). Five elderly included in the NTG (80.13 ± 10.84 years; 75.0% women) had a mean GDS score of 10.60 (SD = 4.72). Finally, 29 elderly in the WLG (81.32 ± 6.68 years; 69.0% women) had a mean GDS score of 14.93 (SD = 6.02). The groups were not different in GDS baseline scores (F = 0.74; P = 0.478). ANCOVA has shown significant differences (P < 0.05) in GDS scores between the three groups after 10 weeks. Sidak adjustment for multiple comparisons revealed that elderly in the WLG got worse scores in GDS, comparing with elderly in RG (P < 0.01), and with elderly in NTG (P < 0.05).

Elderly that are not involved in a task get worse in depressive symptomatology. Being involved in a structured group task means lower depressive symptoms and being in a NGRP means even greater results.

The authors have not supplied their declaration of competing interest.

Cognitive deficits are a core feature of the first psychotic episode patients and could be an obstacle to functional ability. Cognitive stimulation could be a promising method to surpass neuropsychological deficits.

–to implement an online training protocol to stable first psychotic episode outpatients;

–to assess adherence to the intervention;

–to measure neurocognitive, psychopathological and functional outcomes pre- and post-training.

To investigate the feasibility of an online-based resource for cognitive stimulation (COGWEB®) and explore possible benefits in different domains.

Fifteen patients were enrolled from the Early Psychosis Intervention Program (PROFIP) at the Department of Psychiatry of Santa Maria Hospital, Lisbon. The training consisted on 30-40-minute online sessions performed every weekday during 6 months at home. Assessments were performed at baseline and after program completion and included: psychopathological scores; personal and social functioning scores; Clinical Global Impression and a neuropsychological battery.

Every participant had some kind of impairment on baseline. Mean training time was 36 h. Six patients left the program before completion (half of them because they got employed). The program showed overall good feasibility and safety with no reported significant psychiatric occurrences or hospitalizations. Results regarding final neuropsychological, psychopathological and functioning showed a tendency for stability or improvement on an individual case analysis.

Our results show that cognitive training using an online-based stimulation software is a feasible intervention for first-episode psychosis patients with possible benefits for this population. However, results should be analyzed very carefully because of different participant trajectories and of study limitations.

The authors have not supplied their declaration of competing interest.

Obesity is an increasingly common chronic disease. Its biopsychosocial basis provides the rationale of multidisciplinary interventions, such as Therapeutic Patient Education (TPE, WHO 1998), which is effective for lifestyle change and awareness improvement, thus reducing the disease's prevalence and its health care-related financial burden. However, patients’ socio-demographic and psychopathological factors may influence TPE's effectiveness.

We aimed to assess the effectiveness of an 8-week TPE program in obese patients candidates for bariatric surgery and identify factors predicting its success.

We enrolled 159 patients with a BMI > 35 Kg/m2 and obesity-related comorbidities (females = 71.3%; age range = 18-35 years) at the C.A.S.C.O. (EASO COMs) of our University Hospital. They filled out the Binge Eating Scale (BES), the Symptom Checklist-90-R (SCL-90-R), and the Short Form-36 Health Survey (SF-36). We used Tukey's multiple comparison test to assess Quality of Life (QoL) improvement after TPE and multivariate logistic regression to estimate the size of the association between TPE and the aforementioned factors.

The SF-36 showed a significant improvement (P < 0.05) of physical and mental QoL post-TPE, especially in obese patients without binge eating disorder. The same applied to BES and SCL-90-R scores. The factors predicting TPE success were a short duration of obesity, a limited number of past diets, and low levels of anxiety/depression pre-TPE.

In obese patients candidates for bariatric surgery, TPE is useful to improve physical and mental QoL, eating behavior, and psychological status. Several factors are predictive of TPE success, allowing a personalization of the intervention to render it more effective.

The authors have not supplied their declaration of competing interest.

The Family Assessment Device (FAD) is a self-report questionnaire, developed to assess the six dimensions of the McMaster Model of family functioning. It has been translated to the Greek language but never validated.

To evaluate the psychometric properties of the Greek version of FAD in a non-clinical sample.

In a sample of Greek families, FAD was administered together with the already validated Family Adaptability and Cohesion Evaluation Scale (FACES-III). In a subsample of 96 participants, the scales were administered again after 1 month.

A sample of 453 participants (194 children and 259 parents) had completed both questionnaires (151 families). Mean age of children was 23.62 (SD: 6.35), 68 (35%) were males. Mean age of parents was 51.4 (SD: 8.2), 117 (45.2%) males. All subscales of FAD had significant correlation (concurrent validity) with FACES-III (n = 453, P < 0.001). Test-retest reliability range from 0.58 to 0.82 (n = 96, P < 0.001). Internal consistency (Cronbach's alpha) range from 0.47 to 0.94. A model with the 6 factors had a good statistical fit but not all the items were loading in the same components as from the theory assumed.

The Greek FAD has good psychometric properties, although its factor structure might differ from the original version. Further evaluation of the Greek version of FAD in other settings and in different samples especially clinical remains a task for future research.

The authors have not supplied their declaration of competing interest.

The Bipolar Depression Rating Scale (BDRS) is a scale for assessment of the clinical characteristics of bipolar depression. The primary aims of this study were to describe the development of the Korean version of the BDRS (K-BDRS) and to establish more firmly its psychometric properties in terms of reliability and validity.

The study included 141 patients (62 male and 79 female) who had been diagnosed with bipolar disorder, were currently experiencing symptoms of depression, and were interviewed using the K-BDRS. Other measures included the Montgomery and Asberg Depression Scale (MADRS), the 17-item Hamilton Depression Scale (HAMD), and the Young Mania Rating Scale (YMRS). Additionally, the internal consistency, concurrent validity, inter-rater reliability, and test-retest reliability of the K-BDRS were evaluated.

The Cronbach's α-coefficient for the K-BDRS was 0.866, the K-BDRS exhibited strong correlations with the HAMD (r = 0.788) and MADRS (r = 0.877), and the mixed symptoms score of the K-BDRS was significantly correlated with the YMRS (r = 0.611). An exploratory factor analysis revealed three factors that corresponded to psychological depressive symptoms, somatic depressive symptoms, and mixed symptoms.

The present findings suggest that the K-BDRS has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in patients with bipolar disorder.

The authors have not supplied their declaration of competing interest.

Both genetic and environmental factors play a role in the extended psychosis phenotype which covers psychotic experiences, symptoms and disorders.

The respective contributions of genetic and environmental factors over time remain largely unknown.

To describe the objectives and design of a multistage study.

The TürkSch (Izmir mental health survey for gene-environment interaction in psychoses) is a prospective-longitudinal study consisted of several data collection stages to screen extended psychosis phenotype in a general population sample, and to assess individual, familial, genetic and neighbourhood level variables.

The study aimed to assess the prevalence of psychotic experiences and symptoms in Izmir-Turkey (stage I, cross-sectional; n: 4011), the socioeconomic deprivation and the social capital of neighbourhoods in a separate sample (stage II, cross-sectional; n: 5124) in 2008. A nested case-control study (stage III) recruited individuals with psychotic outcomes and healthy controls from stage I, and included blood sampling for gene-environment interaction and clinical reappraisal as well. After 6 years, follow-up study (stage IV) was set to assess the mental health outcomes with a focus on extended psychosis phenotype, environmental exposures of the eligiable sample (n: 2192) from the stage I, and to collect blood samples for further genetic analysis. On both stages, Composite International Diagnostic Interview was used by clinically trained interviewers, and was able to provide broad assessment of psychotic experiences, experience-related disabilities, help-seeking and health care utilization.

The TürkSch has a unique study design and yields data of high quality in the Turkish population, with a specific focus on psychosis.

The authors have not supplied their declaration of competing interest.