Recent literature suggests that over 70% of cases of antibody-mediated encephalitis present to psychiatry services with features of psychosis predominantly.

To investigate the seroprevalence of N-Methyl-D-Aspartate receptor antibodies (NMDAr-Ab) in patients with first episode psychosis (FEP)

Following ethical approval, all cases meeting entry criteria were invited to participate. Participants were interviewed with SCID to obtain a DSM diagnosis. NMDAr-Ab were identified in serum by cell based assay using co-transfected Human Embryonic Kidney (HEK)cells. Positive cases were reviewed by clinical neurology. Decision to treat with immunotherapy was made on a case by case basis.

85/115 (72%) of patients with FEP entered the study. 49 (58%) participants were male, mean age (SD) 37 (15.7) years. 42 (52%) were outpatients at the time of assessment. Four cases (5%) were serum NMDAr-Ab positive. 3 of these cases were male, age 48 (16.3) years. All four were admitted as inpatients with normal brain MRI imaging. One case (female, 55) was confirmed as NMDAr-Ab encephalitis based on case presentation, EEG demonstrating bilateral cerebral dysfunction and NMDAr-Ab in CSF. Immunotherapy treatment lead to clinical improvement. In remaining cases, EEG was normal and CSF negative. All 3 of these cases showed clinical improvement following psychiatric treatment as usual.

Our findings support the current estimates as to NMDAr-Ab prevalence in FEP. Increased awareness has lead to rapid treatment of florid cases of NMDAr-Ab encephalitis in our service. Additional seropositive cases are being followed with neuro-cognitive testing for any evidence of decline.

The current study elucidates the relations between alexithymia and several biological components of the Metabolic Syndrome (MS). We hypothesized that various facets of the alexithymia construct are differentially related to single components characterizing the MS.

Investigated were N = 101 patients with MS. To establish the diagnosis of MS according to IDFC criteria, both laboratory (lipid profile, fasting plasma glucose, type 2 diabetes) and non-laboratory (blood pressure, waist circumference, BMI) tests were included. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20).

Based on alexithymia scores, patients were classified as low- (TAS-20 score ≤ 51; N = 31), moderate- (51 < TAS-20 score < 61; N = 33), or high-alexithymic (TAS-20 score ≥ 61; N = 37). The amount of moderate and high alexithymic patients proved highly significant amongst patients with MS with readily established diabetes type 2. The alexithymia score showed overall correlations with diabetes type 2 (r = 0.380, p < 0.001) and triglyceride levels (r = 0.214, p < 0.016). Correlations with non-laboratory measures were significant for high blood pressure levels (r = 0.233, p < 0.010). Linear regression models confirmed the existence of linear causal relationships for the observed correlations.

The present results suggest that the alexithymia trait is related to specific biological marker variables in the metabolic syndrome. Alexithymia may, according to our study, contribute to the aggravation of the MS.

Vitiligo, a dermatological problem, affects a person's emotional and psychological well being, having major consequences on patient's life. Most of the patients of vitiligo report embarrassment, helpless and low self esteem.

To study socio-demographic profile and psychiatric comorbidities and their correlation with site of lesion in vitiligo patients.

100 vitiligo patients and 100 subjects as control group who were well enough to complete the assessment were assessed with a semi-structured self designed Proforma, Hospital Anxiety Depression Scale (HADS) to obtain the relevant information. Data so obtained were tabulated, analyzed and conclusions were drawn using suitable statistics (i.e. Chi2).

79% of vitiligo patients were between age 13 to 45 years, 67% were males, 33% were females patients in study group. In comparison to healthy controls, the psychiatric morbidity was found to be significantly higher in the vitiligo group (62% v/s 25%). 37%, 18%, and 7% vitiligo patients suffered from Mixed anxiety and depressive disorder, Depressive disorder and Generalized anxiety disorder respectively. Incidence of psychiatric morbidity was higher in patients who had lesions more on exposed body areas.

Vitiligo affected marital, sex life and intimacy. This generates psychological distress and disrupts the social relationship and creates a vicious stress-vitiligo cycle. Among vitiligo cases, psychiatric morbidity was found more frequent in young participants and higher in patients having lesions on exposed body areas.

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

The European impact of the clinical high risk for psychosis (CHR-P) paradigm is constrained by the lack of critical mass (detection) to power prognostic and preventive interventions.

An ITAlian partnership for psychosis prevention (ITAPP) was created across CHR-P centers, which were surveyed to describe: (a) service, catchment area, and outreach; (b) service users; and (c) interventions and outcomes. Descriptive statistics and Kaplan–Meier failure function complemented the analyses.

The ITAPP included five CHR-P clinical academic centers established from 2007 to 2018, serving about 13 million inhabitants, with a recruitment capacity of 277 CHR-P individuals (mean age: 18.7 years, SD: 4.8, range: 12–39 years; 53.1% females; 85.7% meeting attenuated psychotic symptoms; 85.8% without any substance abuse). All centers were multidisciplinary and included adolescents and young adults (transitional) primarily recruited through healthcare services. The comprehensive assessment of at-risk mental state was the most widely used instrument, while the duration of follow-up, type of outreach, and preventive interventions were heterogeneous. Across 205 CHR-P individuals with follow up (663.7 days ± 551.7), the cumulative risk of psychosis increased from 8.7% (95% CI 5.3–14.1) at 1 year to 15.9% (95% CI 10.6–23.3) at 2 years, 21.8% (95% CI 14.9–31.3) at 3 years, 34.8% (95% CI 24.5–47.9) at 4 years, and 51.9% (95% CI 36.3–69.6) at 5 years.

The ITAPP is one of the few CHR-P clinical research partnerships in Europe for fostering detection, prognosis, and preventive care, as well as for translating research innovations into practice.

The clinical diagnosis of personality disorder in adolescence tends to be conservative and unspecific.

To examine the prevalence of personality disorder, and the involvement of stigma effect in adolescents with Axis I psychiatric disorders.

A sample of 100 patients with psychiatric disorders (M = 15.8, SD = 0.9 years, range 15-17, 70% women), were assessed and diagnosed for personality disorders in a mental health public centre.

The prevalence of PD identified by clinicians (12%), differs from the prevalence identified by the semi-structured interview (34–37%) showing a greater number (p < .001) of people affected. In the present sample most of the cases identified by clinicians are related to personality disorders (PD) not otherwise specified, while with the implementation of semi-structured interviews, most of the sample met criteria for Cluster B PDs. Additionally, 11% of the sample has dimensional pathological features (probable PD) without complying categorically the criteria for a full PD.

In clinical settings, a considerable proportion of adolescents with psychopathology meet features for PD, although few of them have a confirmed clinical diagnosis. Considerations about impact of the stigma are discussed.

Technological innovation has been pervasive and has touched almost every aspect of modern life, including the delivery of behavioural and mental heath care. As telehealth expands, internet interventions are particularly interesting as a medium of delivering effective care. However, standards are required to help inform healthcare policy makers, providers, clinicians and patients.

Move towards outlining a gold standard for internet-delivered behavioural and mental health interventions.

Contribute and build upon existing standards and guidelines for the practice of telehealth, but to now extend these to include internet-delivered interventions.

Drawing from research, experience and practice, the authors propose a matrix for the evaluation of what might be considered a gold standard for internet-delivered behavioural and mental health interventions.

Seven elements are proposed and considered aspects of what would constitute a gold standard and they include, the use of evidence-based and empirically supported content, robust, engaging, secure and responsive technologies, shaped by behavioural health subject matter experts, employ user-centred design and development principles, have a focus on accountable care-achieving clinical outcomes, have research and evaluation that supports its effectiveness, and a well developed implementation science and support.

The paper proposes some characteristics that could compose a gold standard for internet-delivered interventions for behavioural and mental health care. The contribution is neither exhaustive nor conclusive, but offers an invitation to the discussion.

The authors have not supplied their declaration of competing interest.

Generalized anxiety disorder (GAD) is a common psychiatric disorder which may cause significant distress and disability. This study was done to estimate the effect of stressful life events on GAD in Erbil city.

A cross sectional descriptive study, was done on patients consulted a private psychiatric clinic from March 2012 to March 2014. A convenient sample of 123 patients, 86 females & 37 males, having GAD were taken after giving their informed verbal consent. The diagnoses were done clinically, and then checked according to DSM-5.

Mean age of patients was 31.2 years. Female to male ratio was 2.3/1. Mean age at onset was 26.9 years. Mean duration of illness was 4.4 years.

History of childhood separation from one or both parents was 15.3%. Regarding the stressful life events in last year prior to onset; in males, the changes in financial status was the most frequent (34%), followed by occupational problems (26%). In females, parenting stress was the most frequent 35%, followed by interpersonal problems (27%). As a whole, parenting stress formed the highest percent (31.1%), followed by changes in financial status (24.6%). Patients who faced two stressful life events formed 37%, while 25.2% of patients faced three, & only 2.4% of patients did not face any stressful life events in the last year prior to onset.

History of childhood separation from one or both parents & stressful life events in the last year prior to onset were an important factors in the development of GAD.

Anandamide (AEA) and 2-arachidonoylglycerol (2-AG) play a pivotal role in stimulating motivational behavior toward food and energy metabolism. Aberrant functioning of the endocannabinoid system has been observed in extreme weight conditions (EWCs), suggesting it may influence pathophysiology. Then, we aimed to analyze fasting AEA and 2-AG plasma concentrations among individuals with EWC (i.e., anorexia nervosa [AN] and obesity with and without eating disorders [EDs]) compared with healthy controls (HCs), and its association with clinical variables and body mass index (BMI).

The sample included 113 adult women. Fifty-seven belonged to the obesity group, 37 without EDs (OB-ED) and 20 with ED (OB+ED classified within the binge spectrum disorders), 27 individuals from the AN group, and 29 from the HC group. Peripheral blood samples, several clinical variables, and BMI were evaluated.

Unlike 2-AG, AEA concentrations showed significant differences between groups (p < 0.001). Increased AEA was observed in the OB-ED and OB+ED compared with both HC and AN group, respectively. Likewise, AEA was differentially associated with emotional dysregulation, general psychopathology, food addiction, and BMI in all clinical groups.

These results support the interaction between biological and clinical factors contributing to delineating vulnerability pathways in EWC that could help fit personalized therapeutic approaches.

Hikikomori, a form of severe social isolation, once characterized as a Japanese cultural-bond behavior with social and economic consequences, it is now being described in other countries. Its presentation mimics some clinical features of various classified mental diseases, such as prodromal phase of schizophrenia, personality disorders, Internet dependence, social phobia or depression, without fulfilling their defining criteria.

This work aimed to do a brief review of this subject, describing one case that is probably the first ever reported in Portugal, comparing it with similar cases around the world.

The patient was a 22-year-old male, taken to psychiatry evaluation after 4 years of social withdrawal, avoiding or blocking any contact even with family members, which resulted in work and school impairment. He spent most of his days locked at his room, investing his time in particular interests and Internet use, only leaving to eat or do his basic hygiene. At that time, he presented no affective or psychotic symptoms and perceived his behavior as egosintonic. After six appointments with psychotherapeutic approach, he was able to get a job and improved his communication with the others, especially with family.

This case fits most of the reports found on literature, in its presentation and clinical management. Hikikomori is not considered yet a disorder and further documentation of these cases is still needed to define its place in psychiatric nosology.

The authors have not supplied their declaration of competing interest.

This research aims at examining the relationship between anxiety, depression, and hopelessness among nonclinical Kuwaiti sample using Beck Anxiety Inventory, Beck Depression, and hopelessness inventories.

highlighting the relationship between anxiety, depression, and hopelessness among nonclinical sample of females and males and the common factor/s.

The participants were 616 (308 females & 308 males), Kuwait University students. The two genders were matched in age (18.15 ± 0.36 & 18.18 ± 0.38, t = 0.94, P > .05) and BMI (24.12 ± 3.27 & 23.50 ± 4.85, t = 0.54, P > 0.5). The Arabic versions of the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and demographic surveys were administered to participants during classes. All participants read and signed a consent form before participating. The correlation matrices, exploratory factor analysis, and reliability analysis are used in this study.

Internal consistency of scores were satisfactory for the BAI, BDI-II, & BHS inventories respectively (Cronbach's alpha (M) = 0.88, 0.75, 0.74 & (F) = 0.89, 0.84, 0.88). A correlation of (r = 0.53) between the BAI and BDI-II and (r = 0.43) with BHS. Meanwhile a correlation of (r = 0.58) between BDI-II & BHS. A principal-axis factor analysis with oblique rotation suggested one factor accounting for 67.73% of the common variance.

The results indicate that there is a strong relationship between anxiety, depression and hopelessness. This highlights the important of examining common factors between anxiety, depression and hopelessness among nonclinical sample.

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