Schizophrenia is a severe and complex disease clinically characterized by disturbed thought processes, delusions, hallucinations and reduced social skills. Gene coding for neregulin 1 (NRG 1) located in 8 p21chromosomeand single nucleotide polymorphism (SNPs) have been identified strongly supporting NRG1 gene as a susceptibility gene for schizophrenia.

The present preliminary study, determines the relationship between polymorphism nucleotide sites (SNPs2) of NRG1 gene and schizophrenia.

Identifying rare allele T of neregulin 1 genein schizophrenic patients.

We analyzed the polymorphism (SNPs2) of NRG1 gene in 20 patients recruited from Psychiatry Department of Emergency Clinical Hospital of Arad diagnosed with schizophrenia according to DSM-5-TM and ICD-10 criteria and 10 healthy controls. From all subjects, we obtained 2 mL of peripheral blood samples. Genomic DNA was extracted using the phenol-chloroform method. Genotyping was performed byPCR-based RFLP analysis for all subjects. The obtained PCR product mixture was completely digested with restriction enzyme, separated on SNP1 and SNP2 agarose gel. We present the case of a 31 years old, male, schizophrenic patient with the SNPs2 polymorphism and rare allele T 126.

In both groups, common allele G 127 and 60 base pairs was identified but only 2 schizophrenic patients presented rare allele T 126 and 30,32 base pairs.

The polymorphism SNPs2 of NRG1 gene with rare allele T 126 and 30,32 base pairs, may play a role in predisposing an individual to schizophrenia. Further and extended replicating studies with multiple sequencing of NRG1 gene are necessary.

The authors have not supplied their declaration of competing interest.

Treatment-resistant schizophrenia (TRS) is a severe form of schizophrenia. From one fifth to one third of all patients with schizophrenia are resistant to treatment.

To determine the knowledge on TRS and to find out the extent and the quality of research on TRS.

To conduct a systematic review of the current literature on TRS.

Original studies and reviews on TRS were systematically collected from PubMed and Scopus databases. The following search strategy was used as a title search; (“ultra-resistant” OR “treatment-refractory” OR “treatment-resistant”) AND (schizophrenia). The search was restricted to English language articles.

The literature search identified 403 studies. After abstract and title review, 324 studies were included. The included studies considered medication (n 213), electroconvulsive therapy and repetitive transcranial magnetic stimulation (15), prognosis (15), genetics (15), studies on neurobiology (15), definitions (14), psychotherapy (12), brain structures and functioning (10), cognition (7) and other miscellaneous studies (6) on TRS. Definitions of TRS varied notably and in most of the non-pharmacological studies, the samples were fairly small. Regarding treatments, clozapine, ECT, and cognitive-behavioral therapy have shown effectiveness, though the quality of research on interventions is limited. Very little is known about risk factors and predictors of outcome in TRS.

Our findings suggest TRS is poorly studied and understood condition contrasted to its high prevalence, clinical importance and poor prognosis. There is a lack of studies on epidemiology, for example risk factors of TRS, as well as on outcomes and longitudinal course. Most of the studies considered medication.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a psychiatric disorder with multiple causes, including genetic, immune, environmental causes of various kinds, which all increase the vulnerability and predisposition to the disorder. Among them stand out prenatal infections, thus being a preventable risk potential factor in our daily clinical practice.

To analyze the relation between prenatal infections and schizophrenia.

Review of the subject and recent articles on schizophrenia in psychiatric guides and magazines.

After analyzing several studies, it have shown that prenatal infections, where the nervous system is not yet fully developed, may be a risk factor for the development of schizophrenia in adults, in relation with genetically predisposed individuals. Infections such as influenza, especially during the first quarter of gestation; rubella, toxoplasma and herpes simplex virus-type 2 are related to potentially increase risk of suffer schizophrenia.

Prenatal infections, especially in the first quarter and the periconceptional period, constitute a risk factor in individuals with vulnerability to develop schizophrenia. Awareness and prevention is important in the pregnant population of the influence of these infections on the possible origin of psychotic episodes.

The authors have not supplied their declaration of competing interest.

Compliance is a major issue in the treatment of schizophrenia. Many studies have attempted to identify factors that influence it.

To assess treatment adherence in patients with schizophrenia. To identify factors correlated with poor adherence.

It was a cross-sectional, descriptive and analytical study, involving 37 outpatients with DSM-IV diagnosis of schizophrenia, followed in the psychiatry department at the Hédi Chaker University Hospital of Sfax (Tunisia). The questionnaire included socio-demographic, clinical and therapeutic data. We also used the Medication Adherence Rating Scale “MARS”, the Insight Scale “IS” and the Stigma Scale (9 items).

The average age was 36.4 years. The majority of patients was male (68.8%), did not exceed the level of secondary education (89.2%) and had a low socioeconomic level (84.4%).

Paranoid schizophrenia was the most frequent type of schizophrenia (54.1%). Atypical antipsychotic were prescribed in 40.5% of cases.

Patients were non-adherent to treatment in 56.8% of cases. The factors correlated with poor adherence were: psychoactive substance use (P = 0.036), sexual dysfunction (P = 0.036), complexity of treatment (P = 0.036), poor insight according to the subscale “awareness of the need for treatment” of the IS (P = 0.047) and high score on the subscale “discrimination” of the Stigma Scale (P = 0.008).

Tunisian schizophrenic patients have a poor adherence to treatment. Acting on risk factors (such as substance use, sexual side effects, poor insight and discrimination perception) would improve patient compliance and management of schizophrenia.

The authors have not supplied their declaration of competing interest.

Relapse rate among patients with schizophrenia can determinate outcome of illness. Up to 40% of patients with first psychosis responds well to treatment. Despite this fact relapse rate is still high, in particular if treatment is discontinuated. Frequent use of first generation antipsychotics (FGA) in underdeveloped countries can be one of possible reasons for treatment discontinuation and consequent relapse.

To analyse rehospitalisation rate in patients with first and multiple episodes of schizophrenia, and compare it with medication choice.

Retrospective analysis of medical records of patients with schizophrenia hospitalised in Psychiatry Clinic of University Clinical Center Tuzla in period from year 2011 to 2013.

During the two-year period, 37 patients with first episode of schizophrenia were hospitalised. Second generation antipsychotics (SGA) were used in 40.5%, and first generation in 13.5%, long acting injectibles - first generation (LAI) were used in 8.1%, and combination of FGA's and SGA's in 5.4% of cases. In the same period, 121 patients with multiple episodes of schizophrenia were hospitalised. SGA were used in 21.4%, FGA in 33%, LAI's in 47.1%, and combination FGA's and SGA's in 35.5% of cases. Relapse rate in the first year after discharge was 16.2% in group with first psychotic episode, and 33% in the group with multiple episodes of schizophrenia.

High relapse rate in group with multiple episodes can be explained with nonadherence regarding the side effects of too frequent use of FGA's.

The authors have not supplied their declaration of competing interest.

There are high rates of substance use disorders (SUD) amongst first episode psychosis (FEP). SUD have been linked to better premorbid adjustment, more severe positive and negative symptoms at presentation and poorer symptomatic and functional outcome [1]. Moreover, shorter duration of untreated psychosis (DUP) has been described as an important predictor of outcome in FEP [2].

With this study, we want to know which baseline characteristics and clinical outcomes differ between FEP patients with and without substance use.

One hundred and seventy-five FEP were consecutively admitted to Hospital del Mar since January 2008 to September 2014 and entered the FEP programme of the institution. The included evaluation was socio-demographic and clinical data at baseline and 1 year follow-up. We studied differences in age, gender, DUP, GAF scores at baseline and 1 year follow-up and PANSS subscale scores at base and 1 year follow-up between substance users and non-users.

Cannabis: we found that users were significative younger (P < 0.01), had a higher proportion of males (P < 0.01) and a significative shorter DUP in users (P = 0.008).

Alcohol: we found that users were significative younger (P < 0.009), had a higher proportion of males (P < 0.003) and a significative lower PANNS negative scores at baseline (P = 0.01) and 1 year follow-up (P = 0.03).

In our sample of first episode psychosis, cannabis and alcohol use is linked with a younger age and a high proportion of males. Moreover, it seems that cannabis use could be associated with a shorter DUP.

References not available.

The authors have not supplied their declaration of competing interest.

The evolution of a first episode psychosis is a fundamental question, despite its unpredictability. It affects the type of management and drug treatment. In this context, schizophrenia, a disabling psychiatric disease, remains the most formidable evolution.

Assess the frequency and factors associated with schizophrenic evolution after a first episode psychosis.

We conducted a retrospective, descriptive and analytic study including 55 patients hospitalized in psychiatry department, Hédi Chaker Hospital, Sfax, Tunisia, during 7 years (from 2007 to 2013), then managed in the outpatient department. We collected socio-demographic, clinical and evolutive data from clinical observations.

The mean age was 26.5 years. Sex ratio (M/F) was 2.9. Among our patients, 74.5% were single and 49.1% had no profession. A trigger factor of this episode was noted in 43.6% and a break with the previous functioning in 63.6% of cases. A schizoid personality was reported in 74.5% of the population. All patients presented positive symptoms, 96.4% had negative symptoms and 61.8% presented mood symptoms.

Schizophrenic evolution was reported in 38.2% of patients. Factors associated with this evolution were: masculine gender (P = 0.004), social isolation (P = 0.009); absence of mood symptoms (P < 0.001) and mental automatism (P = 0.043).

Our study shows some factors associated with schizophrenic evolution after a first episode psychosis. The identification of these factors, as well as other factors reported in the literature is essential to allow early and adequate support, and ensure a better social integration.

The authors have not supplied their declaration of competing interest.

The development of treatment-resistant schizophrenia in a 16-year-old Maltese girl was analyzed in terms of its biopsychosocial model of disease.

To highlight the presentation of treatment-resistant schizophrenia.

To investigate the etiology of treatment-resistant schizophrenia.

To utilize the biopsychosocial model of disease in order to investigate the aetiology of treatment-resistant schizophrenia.

To highlight the treatment modalities utilized in this case of treatment-resistant schizophrenia.

Interviewing the patient.

Analyzing all investigations and documentation made during her admission in an acute psychiatric hospital.

Evaluating the response to various treatment modalities.

Carrying out literature reviews.

Image attached.

Although the aetiology of treatment-resistant schizophrenia remains somewhat unclear even after many years of study, the biopsychosocial model is nevertheless useful in understanding the development of this condition. The treatment modalities to which the patient was resistant were also identified.

Figure not available.

The authors have not supplied their declaration of competing interest.

Psychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.

To review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.

PubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.

Throughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.

A progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

It is only in the last decade that trans people have been accorded rights and give protection in law from discrimination. A survey of 10,000 people undertaken by the Equality and Human Right Commission showed that 1% of the population was gender-variant to some extent. Gender-variant people continue to suffer restricted opportunities, discrimination and harassment at work despite the existence of anti-discrimination and equalities legislation. It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help.

Review of UK policies, guidelines, legislation and research on challenges faced by gender-variant people and ways to improve their care and lives.

To improve gender-variant people access to care and ways to fight inequalities.

MEDLINE, PsycINFO databases were searched for articles published between 2005–2015 containing the keywords “gender dysphoria”, “gender-variant people” and “transgender people”. Relevant policies, guidelines and legislations were also reviewed.

Transgender people still face major health inequalities and discrimination. National statistics show that 80% have experienced harassment, 62% suffered discrimination at work or home and 54% reported being denied access to NHS care due to lack of cultural competency from staff. Guidelines, research, policies and equality legislation have begun to be implemented to protect transgender people from discrimination and accord rights.

Many areas need attention and improvement including not only healthcare but also employment, education, housing and media perception. Promotion of equality in the general population with the aim of achieving cultural change and improvement of cultural competency of health professionals is needed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Sex abuse within the military has long been an open-secret afflicting both male and female veterans whose etiology is often attributed to character deficits (personality disorders or paraphilic disorders). Few studies look at the sex-stress phenomenon as a feature of military life itself and the role this plays in sex abuse within the military milieu. While much attention is focused on US forces, this problem in endemic within military cultures per se. The recent sex abuse scandal involving the French military in the Central African Republic illustrates the pervasiveness of the problem.

To explore the psycho-cultural mechanisms of stress and its sexual expression and how certain scenarios within the military milieu exacerbates this impulse-control reaction. To address the relationship of the availability of sex-release options – without and/or without the military population (and how increased enlistment of women has changed the nature of the target population in today's military).

Look at the problem historically (from WWII – present) with particular illustrations. Evaluate common (often failed) approaches to addressing the problem, including the fallacy that superior officer know best how to handle these cases. Explain the psycho/physiology of the sex-stress phenomenon – mechanism of the hypothalamic-pituitary-adrenal-gonad axis. Look at the relationship between sex-trauma and suicides among veterans.

Offer a viable assessment/diagnostic of sexual problems within the military culture along with a treatment model that offers both psychotherapeutic (cognitive-behavioral protocols…) as well as identifying acute clinical symptoms that may respond to psychotropic medications.

The author has not supplied his declaration of competing interest.

Gender dysphoria is incoherence between the sex a person feels or expresses and the biological.

Revise the inclusion criteria for hormone therapy and sex reassignment surgery in gender dysphoria. Expose the multidisciplinary approach. Make differential diagnosis with other psychological disorders.

A 45 years old male patient (biological female), who was sent from Endocrinology Unit for a psychiatric evaluation before restart a hormonal treatment. Since his childhood, he has presented dissatisfaction with his sexual characteristics; he has had fantasies and dreams, in which he belonged to the other sex. He has always chosen male activities and male stereotypes companies. He has presented preference for cross-dressing from 9 years. Always felt the sexual attraction for women. He first consulted for this reason in 1995.

It reported favorably to start hormone treatment after completing the eligibility criteria: > 18 years old; knowledge of the effects of hormones; and more 3 months documented real-life experience. The hormone therapy caused the growth of microprolactinoma, which was treated with dopamine agonists until it disappeared and the cessation of galactorrhea. Testosterone treatment is restarted. Laboratory tests are done every 3 months during the first year and then, every 6 months.

Is the gender disphoria a pathology? The EU recommends a reclassification as no pathological disorders in ICD-11. The treatment of gender dysphoria is necessary, and there is no reason to postpone it. The main difficulty is the differential diagnosis; there may be comorbidity with others mental disorders which are not exclusive (psychotic disorder, OCD, personality disorders and other disorders of gender identity).

The authors have not supplied their declaration of competing interest.

Transsexualism suffers from several definitions that evolve across time. Therefore, some discrepancies appear progressively in regard of evidence-based medicine and psychological approaches as sexo-analysis.

In our present study, we test if “primary” or “secondary” transsexualism defines in accordance with sexo-analysis definitions will be reliable with the pathology course.

Clarify the definition of transsexualism to obtain a better understanding of this trouble and perhaps to change psychological approaches of gender disorders.

Nine transsexual male-to-female (MtF) aged between 25 to 65 were voluntary recruited. They were diagnosed by a psychiatrist. We adapted the GID scale to measure the lifetime process. Descriptive statistics were reported. Results are expressed as mean ± standard deviation.

Age of the group is 41 ± 12. All subjects were treated by hormone therapy. One of them was surgical reassigned. All subjects reported a persistent feeling to be a woman across their entire life. None showed a decreased female feeling during a part of their life or a brutal apparition of this trouble during the adult period.

In regards of our preliminary results, we concluded that secondary transsexualism should be redefined and was probably induced by sociocultural aspects. Our results are limited by amount of subjects and should be confirmed by a large population included MtF and FtM people.

The authors have not supplied their declaration of competing interest.

The side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.

To estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.

Transversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).

Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.

Twenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).

The high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.

Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The sexual compulsive behavior also known as sex addition is the repetitive and intense sexual behavior of the individual. Although the few studies carried out, the prevailing rates vary between the 2% and the 20%.

We present the case of a 46-year-old male with psychiatric treatment records since he was 17 and a personality disorder group B diagnosis and depressive reactions reactive to environmental frustrations. Several short-, medium- and long-term hospitalizations. Currently he is admitted after having expressed some autolytic ideas.

The patient started a treatment in the Unit of Addictive Behaviors. He says he started to frequent the brothels 10 years ago to satisfy his sexual needs, but gradually increased the frequency. Later, he started to have sex online, also in fee-paying web pages. This has had a negative influence in the different aspects of his life, leading him to economic stress and endless debts.

Borderline personality disorder. 301.83 (F60.3).

Other specified disruptive, impulse-control, and conduct disorder (sex). 312.89 (F91.8).

Pathological gambling. 312.31 (F63.0).

Persistent depressive disorder. 300.4 (F34.1).

It is clear that the compulsive sexual behavior is a disorder that includes repetitive, intrusive and distressing thoughts and leads to behaviors that affect negatively several aspects of the lives of people suffering such disorder, so that is why it is associated with other psychiatric disorders. Even though it has been described and discussed for years in literature, it is difficult to classify within psychiatric nosology and nowadays its categorization is still a challenge within the mental health.

The authors have not supplied their declaration of competing interest.