Neuroleptic malignant syndrome (NMS) takes place in patients in treatment with neuroleptics and it is potentially lethal, being important an early diagnostic and therapeutic approach.

To analyze from a clinical case the clinical and epidemiological features, and therapeutical approach to NMS.

Review of some articles in Mental Health journals and analysis of the following clinical case: 68-year-old woman with bipolar disorder, hospitalized in manic phase. Usual treatment: lithium, trazodone, quetiapine and asenapine. During the admission to hospital, the patient started presenting hyperthermia, sweating, electrolyte disturbances, limb rigidity, and elevation of CPK levels. The suspicion was NMS, so neuroleptics were stopped and fluids and dantrolene were initiated, with favorable evolution.

The discharge diagnosis was NMS. Neuroleptics were gradually reintroduced under vigilance. The patient is stable and has not had new complications. NMS is an uncommon (0.02% to 3% among patients taking neuroleptic agents), but life-threatening condition. Its symptoms are hyperthermia, autonomic nervous system dysfunction, limb rigidity, altered consciousness… The attendant infections, consume of lithium, dehydration, iron deficiency and sharp changes in neuroleptic treatment are predisposing factors. The withdrawal of neuroleptics is the key of the treatment. Benzodiazepines can improve the prognosis, and electroconvulsive therapy can be necessary if there is no response to previous measures.

Neuroleptic malignant syndrome is a life-threatening medical complication we should try to avoid by a correct and careful use of neuroleptics. Additionally, it is important the early treatment, taking withdrawal of neuroleptics as the key starting point.

The authors have not supplied their declaration of competing interest.

Erotomania is a rare delusional disorder. De Clerambault, a French psychiatrist, was the first who advanced the concept of pure erotomania, one of the “passionate psychosis”, as a distinct disorder. However, some authors tend to consider this syndrome as related to other psychiatric disorders.

To describe the case of a female patient with erotomanic delusion with no remission under an antipsychotic and to review the links between erotomania and other psychiatric disorders.

Literature review and a case report.

We report the case of a 32 year-old epileptic woman, hospitalized for a delusional erotomanic disorder. Initially, the patient was treated with an antipsychotic, with partial effectiveness. In fact, it appeared that the conviction of being loved began while she was depressed. After one month of combined antipsychotic and antidepressive medication, she became euthymic and her erotomanic delusions disappeared. Major depressive disorder with psychotic symptoms was diagnosed. After reviewing the literature we found that erotomanic symptoms frequently appear secondarily in other psychiatric disorders. Several publications indicate a frequent association between erotomania and mood disorder, especially bipolar affective disorder and major depression, and describe the efficacy of antidepressant and mood stabilizers. Numerous theories may explain the link between erotomania and mood disorder: from narcissistic needs, to the capacity of empathy and emotional processing. Further studies are needed to clarify the nature of this link.

In clinical practice, a mood disorder must systematically be searched for and treated in a patient with erotomanic delusions.

The authors have not supplied their declaration of competing interest.

The teaching of behavioral sciences was in form of lectures to the medical students in the 2nd year of the college, because the lecture is the least beneficial method of teaching. As I have noticed also that students were more interested to practice behavioral skills. So I suggested to the authority of the faculty to teach part of the behavioral sciences in a practical way and proposal of that was introduced and accepted to teach in that way and to give 20% of marks to this practical part, this in addition to the same theoretical lectures.

The students were divided into groups of 30, every group present one day only through their 2nd year. This day divided into two parts each is 2 hours and in between have an hour break. The 1st part includes group discussion about communication, group dynamics, group leading and scientific way of problem solving. The 2nd part is dividing students into small groups of 10 students, to practice the previous skills in group interaction to solve one problem in a scientific way. All groups collected again to see what they have done.

The results revealed more interest and more enthusiasm to learn in that way and make it easy to practice in their daily life.

We have to change into more practice in our teaching of medical students especially skills of human communication, group leading group dynamics as well as problem solving.

The author has not supplied his/her declaration of competing interest.

Maternal psychopathology can have a server effect on the ability of mothers to attach to their children.

To ascertain the level of attachment of adults between the ages of 18–25 years of age who were raised by mothers who suffer from schizophrenic disorders and depressive spectrum disorders, then compared to adults who were raised by mothers with no formal clinical diagnosis.

This study used the Adult Attachment Questioner (AAQ), by Simpson Rholes Philips (1996) to ascertain the level of attachment of adults between the ages of 18–25 years of age who were raised by mothers who suffer from schizophrenic disorders (n = 30) and depressive spectrum disorders (n = 30). The findings of these two groups were then compared to adults who were raised by mothers with no formal clinical diagnosis (n = 30).

The findings indicated that there is a significant difference between adults who were raised by mothers with the aforementioned mental disorders (schizophrenic and depression), as compared to those who were raised by mentally healthy mothers.

The style of attachment in adults who were raised by mothers with the aforementioned clinical diagnosis (schizophrenic and depression) have insecure attachments, while the children who were raised by mentally healthy mothers have almost secure attachment style.

The authors have not supplied their declaration of competing interest.

Irritable bowel syndrome is one of the most commonly diagnosed functional gastrointestinal disorders. Irritable bowel syndrome (IBS) and its association with stress have not been researched in regards to foreign medical students in Cluj-Napoca, Romania.

To establish the prevalence of IBS in foreign medical school students and the relationship with stress.

This observational case-controlled study was carried out in “Iuliu Hatieganu” University of Medicine and Pharmacy in Cluj-Napoca, Romania. The sample size was 102, and the data was collected using an online self-report questionnaire. The ‘Rome 3 criteria’ was used to diagnose IBS and ‘Stressful Life Events Check-list’ was used to measure levels of stress.

The prevalence of IBS was 24.5%, with females having higher rates (34%) compared to males (16.4%). The types of IBS were IBS-M (mixed form) 8.8%, IBS-D (diarrhoea dominant) 6.9%, IBS-C (constipation dominant) 5.9% and IBS-U (undefined) 2.9%. Students with IBS reported higher social stress compared to students without IBS.

More efforts should be made to combat stress that medical students experience in order to reduce the number of IBS cases. This may involve an increased role of the medical school to develop initiatives and support, with the aim of helping medical school students better cope with stress and stressful events.

The authors have not supplied their declaration of competing interest.

The work describes the well-succeeded experience of the Non-Smoking Program developed in a psychiatric clinic in Rio de Janeiro city, Rio de Janeiro, Brazil.

To treat the tobacco dependence in patients with disorders for the use of substances and other psychiatric disorders. To transform the clinic therapeutic space in a free tobacco environment.

To promote the restoring of the patients’ health integrally, considering the use of tobacco is responsible for a large number of avoidable deaths, in addition to much harm to health.

In a clinic of hospitalization for diverse mental disorders treatment, especially disorders for the use of substances, in the city of Rio de Janeiro, Rio de Janeiro, Brazil, was simultaneously established a non-smoking treatment program. It was used the pharmacological therapy, associated with cognitive-behavioral therapy, occupational therapy and moderate physical activity. The average time of permanence in the non-smoking program was on average 90 days.

There was significant acceptance to the proposed program. In the long-term monitoring, over 12 months, it was evidenced that most patients found themselves in tobacco abstinence.

The project achieved its objectives, promoting the tobacco abstinence in patients with comorbidities in hospital treatment. The study proved that it is possible to remove tobacco in patients dependent on this substance during a psychiatric hospitalization.

The authors have not supplied their declaration of competing interest.

The use of coercion raises ethical dilemmas, as it deprives patients of their autonomy. In Denmark, the subject has gained political attention, and decreases in the use of coercion are demanded. In the attempt of reducing the use of coercion, it is of interest to obtain more knowledge about the circumstances bound to it.

The aim of this study was to investigate a possible correlation between the incidence of mechanical restraint (MR), and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts.

A naturalistic descriptive method was used to study cases of mechanical restraint in patients admitted to a psychiatric ward. In the study period of one year, 114 cases of MR were carried out. In 66% of cases, the patient was diagnosed with borderline personality disorder. Each case of MR was obtained from Statens Serum Institut's Electronic Reporting System. The care workers from each shift were identified using duty rosters. The statistical package SPSS version 20 was used for data processing, including a logistic regression analysis.

A significant association was found between the use of MR and the presence of male care workers on the ward, OR = 1.639, 95% CI: 1.163–2.311, P = 0.005. The risk of MR is increased during evening shifts, compared to day and night shifts, OR = 1.868, 95% CI: 1.165–2.995, P = 0.009. No significant associations were found between MR and staffing level, age, education, or experience of care workers.

The authors have not supplied their declaration of competing interest.

It has been universally regarded that Leonardo da Vinci was one of the all time geniuses in terms of his contribution to art and sciences. A number of theories have been proposed to explain his genius that range from neurological, psychological uniqueness, and enhanced functional intelligence.

The primary aim is to explore these theories in detail and register their pros and cons alongside contextualizing their credibility and weightage against the extant evidence in science.

A detailed literature search has been undertaken to identify variety of models and theories either:

• – dealing with neurological, psychological or neuro-philosophical explanations;

• – have been proposed by psychiatrist or psychologist and neurologists pertaining to Leonardo's brain or mind;

• – theories around occult and religion have been excluded.

The results are synthesized and presented in a tabular form. The discussion expands on the various theories and the relevance of Leonardo da Vinci to the merging unified field of neurology, psychology, technology and philosophy (consciousness studies)

The author has not supplied his/her declaration of competing interest.

Population aging is an issue increasingly gaining more prominence, as evidenced by the number of inquiries regarding the “problems” that this entails for society. This leads to a need to understand the role of caregiver for the elderly as the central figure of support in old age.

The purpose of this study was to describe formal caregivers’ perceptions of working conditions, difficulties and factors associated with quality of care in a Portuguese home-based care for elderly.

The participants were 8 formal caregivers whose profession falls under the categories of Direct Action Helper and Auxiliary Workers. The data were collected through individual face-to-face interviews and analysed using a content analysis following Bardin's method.

The results show that the sample is female, aged from 32 to 53 years, with a professional exercise time between 8 and 16 years. Regarding the main conclusions of our research, we can say that our group of participants has a strong sense of team work which contributes to avoid situations of physical and emotional exhaustion; mostly caregivers can separate their personal and professional lives; there are some difficulties in communication between the caregivers and the elderly, however the most difficult situations are usually overcome due to the caregiver's understanding of the characteristics of institutionalized elderly; the matter of death is frequently seen as the most difficult situation to face.

The caregivers should have an awareness of the importance of kindness and respect, supporting positive thoughts and help the older people to retain control over their lives.

The authors have not supplied their declaration of competing interest.

Studies confirm that caregivers play host to a high level of compassion fatigue. Day in, day out, nurses struggle to function in care giving environments that constantly present heart wrenching, emotional challenges.

This concept analysis will aim to capture the current meaning of fatigue compassion in the context of healthcare and explore how it may be recognised and measured in education and clinical practice.

Using the same search terms, findings from a literature search in 2000 and from a follow-up search in 2014 were used to conduct the concept analysis. The Walker and Avant theorethical framework was used to develop a model case of fatigue compassion in nursing care. The attributes, antecedents, consequences and references were delineated.

Four attributes of fatigue compassion were delineated. (1) Perceptual incongruence and appraising defines how an individual perceives role demand in relation to capabilities or resources. (2) Multidimensionality consists of physiological and psychological effects on a person. (3) Interactional feedback is the experienced acknowledgement/validation communicated by others during compassive stressful situations at a workplace. (4) Response pattern describes the coping mechanisms used by an individual experiencing fatigue compassion.

The concept analysis of fatigue compassion among nurses at the workplace recognized the vulnerability of the nursing discipline towards distress in general. There needs to be greater research within the field of role stress and nursing, specifically in the development of scales or tools to assist in the identification of fatigue compassion amongst nurses.

The author has not supplied his/her declaration of competing interest.

Directed by Edward Zwick “Pawn Sacrifice” is a biographical film released on September 2015. The film stars Tobey Maguire as Bobby Fischer, the American World Chess Champion, considered one of greatest player of all time. His career's peak was in 1972 when he captured the World Chess Championship from Boris Spassky of the USSR.

We tried to dig a little in the biography of Bobby Fischer who many described as mentally ill. We tried to figure out what is reality and what is just legend about Fischer. Our goal is promote chess, and also honour the great Fischer. Moreover, we wanted to explore the scientific literature published about the benefits of playing chess, especially in childhood.

We made an exhaustive review of the author's life, and also testimonies of people who knew him. Moreover, we found some articles that review the relationship between chess and IQ trying to confirm or debunk some myths about this legendary game.

It was incomprehensible to everyone that the top of the career of Bobby Fischer at the same time meant an abrupt and complete fall. One possible explanation for this attitude would be a mentally unbalance not specified disorder throughout his lifespan.

Not all geniuses are crazy, neither all crazy are geniuses. A genius is a person with extraordinary capabilities, that focused on a topic, has the ability to enlight new ways to explain this complex world, whether it is to create a symphony, paint masterpiece or the next move on the chessboard.

The authors have not supplied their declaration of competing interest.

Mindfulness is a form of meditation that cultivates present moment awareness in a non-judging way. It has a Buddhist origin but has been practiced in the last 40 years without relation to any religious belief. It has been proposed as a treatment for a variety of ailments.

To carry out an overview of systematic reviews of the evidence on mindfulness as a therapeutic tool.

To summarize the existing evidence on the efficacy of mindfulness.

We searched for systematic reviews in the Cochrane Database of Systematic Reviews (Cochrane Library).

We found nine Cochrane reviews (for fibromyalgia, aggressiveness in intellectually disabled people, mechanical neck disorders, reducing sedentariness at work, anxiety, somatoform disorders, and post-stroke fatigue), two Cochrane review protocols (stress reduction of patients with breast cancer, and substance use disorders), 50 non-Cochrane reviews (29 provisional abstracts and 21 structured abstracts from the Centre for Reviews and Dissemination) on the efficacy of mindfulness. The Cochrane reviews showed a lack of conclusive evidence for fibromyalgia, aggressiveness in intellectually disabled people, anxiety disorders, somatoform disorders and post-stroke fatigue. Mindfulness training induced a non-significant reduction in workplace sitting time. For chronic neck pain, mindfulness exercises minimally improved function but no global effect was perceived at short term.

According to the existing Cochrane reviews, there is a general lack of evidence mindfulness as an effective treatment. For chronic neck pain, mindfulness exercises minimally improved function. We have detected important areas where high quality clinical trials are 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.

In psychiatric clinical practice, we can face numerous organic diseases in the differential diagnosis between primary psychiatric disorders. As an example of this, we can see the autoimmune limbic encephalitis(LE), which in a significant percentage of cases begins with psychiatric symptoms. Currently, one of the theories of the origin of the LE is as a idiopathic autoimmune entity, leaving behind the idea of been generated only by a viral or paraneoplastic etiology.

To achieve a better knowledge about this underdiagnosed entity, presenting a case of an anti-LGI1 limbic encephalitis.

A 60-year-old Caucasian woman who starts with neuropsychiatric symptoms as: behavioral disorders, manic symptoms, memory impairment and attention deficit.

Finally, the diagnosis was confirmed when the patient had positive results in both serum and CSF samples for anti-LGI1 antibodies. Gastric neuroendocrino tumour type I was discovered. Neither paraneoplasic syndrome nor onconeuronal antibodies were shown. A thin hyperintense signal was identified in the left hippocampus using a brain MRI. Despite the patient had been treated with corticosteroids, immunosuppressants and immunoglobulins, she still showed positive antibodies in CSF samples with poor clinical results, especially psychiatric symptoms. The patient required one psychiatric hospitalization due to reference and persecutory delusions and manic symptoms.

Our patient had an unsatisfactory evolution with little response to immune treatment. Given the possible underdiagnosis of this condition, the importance of a differential diagnosis and an early treatment, we consider that there is an important need for a greater knowledge and scientific divulgation of this clinical entity.

The authors have not supplied their declaration of competing interest.

Teachers are confronted with increasing difficulties and demands that make them vulnerable to burnout.

To evaluate burnout among a population of Tunisian teachers and to identify factors that may be involved.

It was a cross-sectional, descriptive and analytic study, involving 165 teachers working in 10 primary schools and 7 high schools in Sfax, Tunisia. The participants completed a self-questionnaire containing their socio-demographic and professional characteristics. They were explored by the scale of the burnout: Le Maslach Burnout Inventory General Survey (MBI-GS).

The mean age of teachers was 39.96 years. The sex ratio (M:F) was 1.32. The majority (75.2%) was married. The burnout syndrome was found in 49.7% of teachers. Moderate burnout was found in 43% of cases and severe burnout in 6.7%. The causes of burnout reported by our population were bad working conditions (71.50%), quality of working relationships (65.5%) and overload work (30.3%). Bad working conditions were associated with a high level of emotional exhaustion (P < 0.005) and a low level of professional efficacy (P < 0.001), while poor quality of work relationships and overload work were associated to a high score on cynicism (P < 0.001) and a low score on professional efficacy (P < 0.001).

According to our study, poor working conditions, overload work and bad quality of relationships seem to be risk factors of burnout in teachers. Preventive measures should be instituted against those factors to reduce the constraints of work and improve the professional quality of life of these individuals, essential thing to optimize the educational level in our country.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Encountering a patient with Münchausen syndrome (MS) or with MS by proxy is more frequent than it is assumed. Treating this type of patient is indeed a challenge, thus, knowing to depict the signs is important for every doctor. A specific therapeutic approach is needed and sometimes, even law enforcement must be involved.

We plan to highlight the signs and consequences of Münchausen syndrome and Münchausen syndrome by proxy.

Clinical data were collected during admissions of patients in the psychiatric hospital. A literature review has been performed.

We report the case of a nurse diagnosed with MS, who had multiple admissions with different diagnostics, before the patient was exposed with the factious disorder diagnosis. We also report the case of a mother diagnosed with MS by proxy and the case of another mother where the obsessive-compulsive elements of her depressive disorder are combined with signs of MS by proxy, both of them inflicting consequences upon the child in care.

Patients suffering from Münchausen syndrome and Münchausen syndrome by proxy can be a burden for society and for themselves. The relationship with them is sabotaged from the start. The diagnostic is difficult to establish. Numerous expensive procedures are being taken and a considerable amount of funds is spent. Most importantly, the abuse of a child with a parent or guardian suffering from this disease is incommensurable and can even lead to death. It is vital to take action as soon as these syndromes are discovered.

The authors have not supplied their declaration of competing interest.

Apathy is commonly defined as lack of, or diminished, emotion, interest, concern, interest and motivation manifesting as poor engagement with others and loss of pleasure in usual interests. Occurs in various medical condition (stroke, HIV, dementia and Parkinson disease) and other psychiatric disorders. It has been related with thalamus stroke, and seen on clinical practice as a blunted emotional response and indifference.

We have tried to link cases of apathy associated with thalamic stroke and systematically review the literature for similar case reports.

We have searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database until October 2015. Published case reports of apathy in persons who had suffered a brain stroke were selected.

Support the evidence in the literature of the multidimensional nature of apathy and correlate the psychiatric manifestation with the neurological findings. We find similar case reports that could support the anatomical subtract of the apathy and it's also correlated with the previous data reports.

These findings are discussed and interpreted in the seeking of regarding the neurobiological substrate of apathy.

The authors have not supplied their declaration of competing interest.

A 56-year-old female admitted to psychiatry clinic due to complaints of forgetfulness, visual and auditory hallucinations, inability to go outside alone, washing hands in closet cabin, difficulty finding words for the last one year, progressing in last four months. Personal and family background was unremarkable. Vital signs and physical examination revealed no abnormalities. In neuropsychiatric examination, Glasgow Coma Scale score was 15 without any meningeal irritation signs or gait abnormalities. Cranial nerves, extrapyramidal, motor, cerebellar, and sensory systems were intact. All aspects of orientation (time, place and person) were impaired. She scored 12 points out of 30 in Mini Mental Test. Speech was non-fluent with looseness of associations. Impaired recall, abstract thinking, judgment, behaviour planning and attention were noted. Visiospatial disorientation and contructional dressing apraxia were revealed. MR Imaging reported a T2-weighted signal intensity change in nodular fashion suggesting a granulamatous lesion. Differential diagnoses included granulomatous diseases, neoplasms, infections and Behcet's disease. After necessary excluding evaluations were undergone, a diagnosis of NS was made due to increased angiotensin converting enzyme levels in cerebrospinal fluid. The clinical picture responded well to prednisone treatment and symptoms resolved within one month.

Increased awareness is essential to identify rare granulamotous diseases as a differential diagnosis in encountering psychotic symptoms accompanying demantial clinic presentation.

The authors have not supplied their declaration of competing interest.