It is easy to find texts, in scientific literature, studying the adaptation of immigrants from developing countries in western countries. However, in these globalization times that we are living, few are the studies performed on members from developed countries emigrating to the third world.

To evaluate the factors predisposing to the onset of anxiety or depression symptoms in Spanish immigrants living in South Africa.

This is an exploratory study with a sample of 51 Spanish residents in South Africa between 24 and 57 years (44% male, 56% female), 44% of which were living there for more than two years. An online survey was administered, collecting data related to reasons and conditions for their moving to the country and traumatic events living during the stay. For the screening of depression and anxiety symptoms Hopkins Symptom Scale (HSCL-25) was used. Finally, we carried about several analysis using Chi2 test. For statistical analysis SPSS was utilized.

Thirty percent of the sample showed positive scores on anxiety symptoms scale, and 24% scored positive for depression. Job related items as being unemployed (P < 0.001) was associated to symptoms of depression. Insecurity/violence (P < 0.021) and race discrimination (P < 0.009) were the main factors related to anxiety symptoms.

Factor related to employment, security and discrimination, has been significantly associated to the onset of anxiety and depression symptoms. Other factors related to the moving to the country or social relationships have shown no relations. More studies are needed to provide information about adaptation and factors related to mental health in Occidental immigrants in developing countries.

The authors have not supplied their declaration of competing interest.

The aim of this paper is to study the profile of Moroccan users to contextualize interventions and to identify if specific requirements are observed.

A descriptive statistical analysis of sociodemographic and clinical variables are performed to acknowledge the differences between Moroccan users (n = 6) compared to the group of Spanish users (n = 12).

The following was found in the Moroccan users: the average age was 7 years higher. The percentage of Toxic abuse was slightly higher (83% vs 75%), although in comparison to the Spanish users the Moroccan users had double the percentage of patients treated in the Addictions center.

There were no significant differences in the duration of untreated psychosis (DUP) and in the duration of untreated illness (DUI). According to the referral, the Moroccan users were better detected in Primary care (50%/8%).

Regarding the PANSS negative symptoms predominated in Moroccan (45/20 percentile) and general psychopathology (65/35 percentile).

In the Social Functioning Scale (SFS), there are only differences in Autonomy Execution (T score = 104/T = 92).

The Family Questionnaire (FQ) shows that families reported greater frequency and discomfort of symptoms and the user as less capable of controlling themselves. Finally, the Global Assessment of Functioning (GAF) offers an average of nearly 15 points lower.

The training area stands out as a handicap in the rehabilitation process. Clinically negative symptoms and general discomfort are factors that limit the overall functioning. More specific interventions are also required for the families of these users.

The authors have not supplied their declaration of competing interest.

The Early Psychosis Intervention Programme (EPIP) in South Granada serves a population with a first psychotic episode. In 2014, 16 patients entered the program, 6 of whom were North Africans.

It is justified by clinical and health care needs to adapt and contextualize care plans and interventions to the specific necessities of this population: considering its suffering meaning and interpretation.

A descriptive study of the data obtained in this population with the Scale of Positive and Negative Syndrome of Schizophrenia (PANSS) arises.

In the positive scale, the 6 subjects score in the low range (between 6–25th percentile).

On the negative 2 score in the low range and 4 in the middle (between 26–74th percentile).

In the compound scale in 3 cases, the predominance of negative symptoms is in the low range scale, the rest is in the middle range.

Finally, in general psychopathology scale, 2 subjects scored in the low range, the same who scored in the same range in the negative scale. Two subjects scored in the midrange and 2 in the high.

According to data, positive symptoms do not stand out among this group of patients. As for negative symptoms, if the range is low, so is the measure of general psychopathology. If the range is average, general psychopathology is medium-high. Also, when the range is average in negative symptoms, means the compound profile reflects predominance of negative syndrome. This reveals the importance of emphasizing a negative symptoms approach and its relationship with general psychopathology.

The authors have not supplied their declaration of competing interest.

The brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.

To identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.

An online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.

Of 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.

Overall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.

The authors have not supplied their declaration of competing interest.

Recent studies point for an increased incidence of psychotic disorders among immigrants when compared to nom-immigrant population, with a substantial risk variation being observed among different ethnic minority groups and diverse host countries/societies.

This communication explores the relation between immigration and the onset of psychosis disease, namely the individual and socio-environmental factors implicated in this association.

Accessing the implications of immigration in the establishment of psychotic disorders.

The authors conducted a literary search on Medline and PsychInfo databases regarding the subject immigration and psychotic disorders, elaborating a bibliographic review of the topic.

A greater incidence of psychotic disorders in immigrants (in comparison to nom-immigrant population) has been established. In actuality a range of studies carried out in different socio demographic contexts and with different ethnic groups (of immigrants) identify ethnicity, neighbourhood characteristics (namely level ethnic density), discrimination and refugee status, as some of the probable factors that modulate the rate of psychotic disorder and influence its incidence in immigrants.

With regard to the relationship between immigration and the development of psychosis, much is still to be understood. Future studies with focuses on different individual, social, cultural and demographic aspects need to be developed in order to better understand and addressed this phenomenon.

The authors have not supplied their declaration of competing interest.

Emigration and remigration are one of the greatest modern problems and considered as a factor provoking manifestation and exacerbation of mental disorders as well as pathocharacterological personality changes. In emigrants and re-emigrants peculiarities of course of depressive disorders with different genesis are not investigated, that impedes a development of adequate therapeutic methods.

To study clinical-psychopathological peculiarities of depressive disorders in emigrants and re-emigrants patients with psychogenic (F43.21, F43.22) (69 non-emigrants, 68 emigrants, 67 re-emigrants), endogenous (F31.3, F31.4, F32.1, F32.2, F33.1, F33.2) (65, 66 and 63 patients, respectively) and organic depressive disorders (F06.3) (64, 62 and 61 patients, respectively) were examined.

A clinical-psychopathological investigation, Standardized Personality Examination Method, Lusher's Method of Color Choices, HDRS, HARS, MADRS, and SCL-90-R.

The highest level of severity of depressive disorders in re-emigrants and the lowest level in non-emigrants were registered. Re-emigrants had predominantly depressive, asthenic-depressive and apathic-depressive forms, whereas emigrants had mainly anxious-depressive ones. According to SCL-90-R data, emigrants had higher indexes of somatization, obsessive-compulsive disorders, anxiety, whereas re-emigrants had higher indexes of depression and interpersonal sensitivity as well as an index of distress expression. In patients examined it was determined a predomination of dysthymic personality traits manifested in the frameworks of the leading depressive of anxious-depressive syndromes. An influence of emigration and remigration factors was the greatest in psychogenic depressions and the lowest in organic depressive disorders.

The abovementioned regularities should be taken into account in pharmacotherapy and a social-psychological support for such patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The interest in experiencing training abroad has grown and its benefits have been progressively recognized. For these reasons, several psychiatric trainees seek to extend their competencies, skills and knowledge through these exchange opportunities, such as the European Federation of Psychiatric Trainees (EFPT) Exchange Programme.

With this work we intend to describe these international experiences of being acquainted with a different health system and psychiatry training programme.

Reflect on the impact of these experiences, considering on how these can be used to benefit the patient care provided across countries, further to the professional and personal individual benefits that colleagues gain.

Presenting the testimonials of junior doctors from abroad that have had the opportunity to observe and collaborate in the current system of the United Kingdom.

The EFPT Exchange Programme is an excellent opportunity for psychiatry trainees to share experiences, knowledge and good practices. The cultural and social framework of psychiatry certainly has an impact on the approach to mental health problems, and being knowledgeable of these differences can provide benefits not only to the junior doctors who complete these exchanges abroad, but also to their colleagues working at their hosting institutions that become acquainted with different realities through their presence and feedback.

The benefits of these exchange mobility experiences are unequivocal. Therefore, it is fundamental to share these experiences and promote these opportunities.

The authors have not supplied their declaration of competing interest.

The brain drain of psychiatrists is considered as a mental health care damaging phenomenon in low- and middle-income countries. Albania currently has one of the world's highest emigration rates, relative to its population and a total emigrant population of more than 1.25 millions in 2014. More than 50% of the lecturers and researchers in Albania left the country during 1991–2005. Nevertheless, the data on healthcare workers migration is very limited.

Assessing the migration profile and migratory trends of psychiatry trainees in Albania as part of EFPT Brain Drain study in Europe.

Data collection was accomplished by an anonymous online survey and hard-copy questionnaire in University Hospital Center “Mother Teresa”, to all psychiatric residents in Psychiatric Clinic in Tirana, during May–October 2013.

More than 2/3 respondents are very dissatisfied with their income but the main reasons for leaving the country are personal and family composition. A minority did have a short term or long term experience abroad respectively 8,3% and 16.7% during which 50% of them considered to have the same opportunities as the locals. A total of 66% of residents consider leaving the country after the residency training.

Losing large numbers of skilled psychiatrists contributes to decreasing of quality of mental health services. Since it can be considered “brain waste” in terms of a loss of investment into human resource development, Albania needs to establish policies to promote returnees.

The authors have not supplied their declaration of competing interest.

Recent studies have shown that it is important to understand the brain mechanism specifically by focusing on the common and unique functional connectivity in each disorder including depression.

To specify the biomarker of major depressive disorder (MDD), we applied the sparse machine learning algorithm to classify several types of affective disorders using the resting state fMRI data collected in multiple sites, and this study shows the results of depression as a part of those results.

The aim of this study is to understand some specific pattern of functional connectivity in MDD, which would support diagnosis of depression and development of focused and personalized treatments in the future.

The neuroimaging data from patients with major depressive disorder (MDD, n = 100) and healthy control adults (HC: n = 100) from multiple sites were used for the training dataset. A completely separate dataset (n = 16) was kept aside for testing. After all preprocessing of fMRI data, based on one hundred and forty anatomical region of interests (ROIs), 9730 functional connectivities during resting states were prepared as the input of the sparse machine-learning algorithm.

As results, 20 functional connectivities were selected with the classification performance of Accuracy: 83.0% (Sensitivity: 81.0%, Specificity: 85.0%). The test data, which was completely separate from the training data, showed the performance accuracy of 83.3%.

The selected functional connectivities based on the sparse machine learning algorithm included the brain regions which have been associated with depression.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).

A 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.

Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.

Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.

This case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.

The authors have not supplied their declaration of competing interest.

Body Dysmophic Disorder (BDD) is relatively common disorder. Patients with delusional beliefs seem to show greater morbidity (more suicidal attempts and drug abuse or dependence) and less likelihood of receiving treatment.

In this study, we intended to report a case of BDD followed in psychiatric consultation from 2 years ago, and to make a review of the literature, namely presentation, treatment and prognosis of BDD.

We conducted a description of a BDD case and a research using “Body Dysmorphic Disorder” keywords on Pubmed.

J.F., 45 years old, unemployed, living with his father, referred to the Psychiatric consultation by his GP. The disorder started in the adolescence with an excessive preoccupation with hair loss and nose length, but in early adulthood these concerns became more important. Around 30 years old he was followed in Psychiatry but abandoned. Years later he underwent nose plastic surgery. He tried underwent other nose surgeries, but was refused. He was advised to look for psychiatric care. From the initial observation I highlight the appearance (thin, with a wig, adhesive tape connecting the tip of the nose to the forehead pulling up the nose), delusional ideas regarding the appearance of the nose, overvalued hypochondriac ideas, and no insight for the disease. The patient was reluctant in taking psychotropic drugs. He was referred to day hospital, which he attended with great irregularity.

BDD is a disorder with poor prognosis, especially when delusional variant is present, probably in relation to the lack of insight.

The authors have not supplied their declaration of competing interest.

The prevalence of obsessive symptoms in bipolar patients is currently under discussion. Last years, different cases of antidepressant-induced mania and hypomania in patients with OCD have been described.

Several authors have reported that patients with OCD and bipolar disorder have more depressive episodes than patients with only OCD.

To know the relationship between OCD and other bipolar spectrum disorders.

Bibliographical review on comorbidity between obsessive symptoms and bipolarity.

Some longitudinal analysis have shown that patients firstly diagnosed with OCD have an increased risk for subsequent diagnosis of all other conditions, especially for bipolar and schizoaffective disorder, for those whose risk is of up to 13 times higher. The handling of a patient with bipolar disorder and OCD implies some difficulty, because of the main treatment of anxiety disorders, the antidepressants, alters the course of manic-depressive illness, accelerating cycles.

OCD is etiologically related to bipolar spectrum disorders and schizophrenia. Therefore, it is necessary to continue the investigation of possible involved genes and approaches for clinical practice.

The authors have not supplied their declaration of competing interest.

Obsessive-compulsive disorder (OCD) is a frequently reported comorbid disorder (20–30%) in patients with anorexia nervosa (AN). Increasing evidence suggests that repetitive transcranial magnetic stimulation (r-TMS) may be effective in the treatment of refractory OCD and to a lesser extent in AN. Hereby, different target areas: supplemental motor area (SMA) and orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex in AN. We report two patients with enduring AN and comorbid treatment resistant OCD treated with r-TMS.

Both female patients (34 and 26 years respectively) were hospitalized at the Eating Disorder Unit at the Ghent University Hospital. Treatment responses were evaluated with Yale Brown Obsessive Compulsive Scale (Y-BOCS) and weight gain. Inhibitory continuous thetaburst stimulation (cTBS) of the SMA followed by cTBS of the OFC was conducted during 20 sessions, 5 sessions a week, during 4 weeks. Stimulation intensity was respectively 100% and 80% of the motor treshold.

After cTBS treatment Y-BOCS score of both patients decreased (31 to 24 and 31 to 23 respectively). Only one patient showed a 10% increase of weight. The treatment was well tolerated. No significant side effects were reported.

Treatment resistant comorbid OCD in patients with AN may be succesfully treated with cTBS.

The authors have not supplied their declaration of competing interest.

Compulsive skin picking and trichotillomania are both impulse control disorders, characterized by the need or urge to touch, scratch, scrub, friction, rub, bite, press or dig in the skin; it is often an answer to minimum skin defects or to mild acne. The resulting tissue damage can be moderate to severe.

Case report of a woman with Skin picking resistant to treatment.

Clinical observation.

43-year-old woman who was admitted in emergency in June 2014 because of her skin lesions. After observation by Dermatologist she was sent to the Psychiatric due to injuries caused by her. She referring compulsion to scratch, bite and tear the skin since she was 3 years old. After introduction of psychotropic drugs, the patient was referred to the Psychiatric consultations. After 1 year consultation there is some clinical improvement.

Despite clinical advances in psychiatry, the Skin Picking disease is still little known today, requiring more research and knowledgement in terms of phenomenology and of treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

An association has been observed between obsessive symptoms in Obsessive Compulsive Disorder (OCD) and psychotic symptoms in schizophrenia, being sometimes difficult to establish a clear limit between them. The term “schizo-obsessive disorder” was proposed to describe the resulting disorder of comorbidity of OCD and schizophrenia, although it has not been definitely settled.

To analyze the incidence of coexistence of OCD and schizophrenia symptoms and the way it modifies the treatment and prognosis of the illness.

Review of some articles published in Mental Health journals such as “Salud Mental” and “Actas Españolas de Psiquiatría”.

Some studies about psychotic patients have determined 15% as the average of comorbidity of OCD and schizophrenia. The probability of having OCD is six times bigger if there is psychotic pathology associated.

The fact that obsessive and psychotic symptoms get together in some patients shades the prognosis bringing more negative symptoms, more depressive humor, a larger cognitive impairment, more resistance to treatment and more relapses than we can observe in OCD and schizophrenia isolated.

The pharmacological treatment usually consists in neuroleptic plus anti-obsessive drugs, together with cognitive-behavioral therapy. Sometimes, when there is a very bad evolution, it is required to consider psychosurgery as one necessary option, even though its use in this context is not much widespread.

The simultaneous presence of OCD and schizophrenia is more common than we could expect only by chance and makes the prognosis worse, being difficult to find a truly effective treatment.

The authors have not supplied their declaration of competing interest.

OCD is one of the most frequently diagnosed disorders during childhood. A prevalence of 1% is estimated, but according to the literature is an underdiagnosed pathology.

To differentiate pathological rituals from those that children can have as normal behavior during their natural development. To perform a differential diagnosis and a current review of the literature.

Descriptive analysis of a patient's medical record diagnosed of OCD and Tourette syndrome.

Eight years old male diagnosed of Tourette syndrome (vocal and motor tics). Obsessive thoughts cancer related, self-examinations with compulsive pattern and anxiety with social and academic interference. Family history of tics in both parents during childhood. Currently, father with order rituals and mother with an Anxiety Disorder in treatment. Treatment with Sertraline 25 mg/day was tested with poor tolerance. Currently, the patient is being treated with Aripiprazole 1 mg/day with an important improvement of his symptoms and quality of life. OCD has comorbidity with affective and anxiety disorders, as well as Tourette syndrome. It's essential to differentiate pathology from certain behaviors considered normal during a child's development. For example, some children can have certain level of meticulousness, insecurity or a lucky object, but these behaviors shouldn’t be confused with OCD symptoms. The treatment of choice is a combination of CBT with pharmacological therapy.

An early diagnosis during childhood together with an appropriate comorbidity detection can reduce the tendency towards chronicity of this disorder leading to a better quality of life in these patients.

The authors have not supplied their declaration of competing interest.

Koro syndrome is a culturally related disorder characterized by intense anxiety that the penis (vulva or nipples in females) is shrinking or retracting and will recede into the body. Usually it occurs in epidemics in Southeastern Asia, being extremely rare in western countries. The condition is more common in males and is classified within Obsessive Compulsive and Related Disorders.

A 27-year-old single man was referred to the psychiatric department. By the age of 23, he began worrying that his penis was shrinking and retracting into the abdomen. He described these thoughts as intrusive, ridiculous and repetitive. During the first months the thoughts were not very disturbing but he progressively developed an urge to verify the length of his penis several times a day. To diminish the anxiety provoked by the obsessive doubts on penis length, he started to have repetitive thoughts and mental images about sexual acts, to consume pornography compulsively and to increase his masturbatory behaviors (from some times a week to several times a day). He described those thoughts and behaviors as unpleasant and uniquely driven to reduce anxiety provoked by obsessions.

He was prescribed fluvoxamine 200 mg/day and initiated cognitive behavioral therapy with good response. Y-BOCS score decreased from 30 at initial evaluation to 18 after 3 months of treatment.

Koro syndrome is a very rare condition in psychiatry in western countries, usually presenting secondarily to other psychiatric disorders. Awareness of this diagnosis and knowledge on its management are critical to provide optimal care to patients.

The authors have not supplied their declaration of competing interest.