The authors aim to identify the main comorbidities in people with schizophrenia and define strategies to prevent it.

Literature review on Medline database.

People with schizophrenia have higher risk to have hepatitis, cardiovascular diseases, diabetes, overweight, sexual dysfunction and obstetric complications. This high vulnerability is associated with higher rates of preventable risk factors, such as smoking, alcohol consumption, use of street drugs, poor dietary habits and lack of exercise. Moreover, some antipsychotic medications used to treat schizophrenia have been associated with higher incidence of physical disease. At last, there are risk factors attributable to patients and healthcare services. Psychiatrists are often not trained in detection and treatment of physical disease. Despite this, there are several attitudes that can reduce the associated morbidity and mortality in people with schizophrenia, such as improving access to healthcare services, integrated healthcare interventions to enable early diagnosis and promotion of healthy habits.

Diagnosis and management of morbidity in people with schizophrenia are more difficult because obstacles related to the patient, the illness, the medical attitudes and the structure of the healthcare services. Regardless these difficulties, the increased frequency of physical disease in people with schizophrenia must be valued due to improved detection and treatment of medical disease will have significant benefits for their psychosocial function and overall quality of life.

The authors have not supplied their declaration of competing interest.

The purpose of this study was investigating the effectiveness of rTMS (repetitive transcranial of magnetic stimulation) on increase social performance in patients with recurrent major depression.

It was used a quasi-experimental, pretest–posttest design with control group, a sample consisting of 32 patients who had depression on the basis of DSM-IV diagnostic criteria, SCID and BDI-II scales and were randomly assigned to two groups.

The experimental group underwent 20 sessions of rTMS as the independent factor and both groups (control & experimental) had 12-session psychotherapy and drugs treatment. Upon the intervention, both groups were tested with two tests (BDI-II & SASS). To determine the effect of the independent factor on the dependent factor of rTMS.

Data were analyzed by t-test.

The comparison between pre- & posttest of all the tests showed the reduction of signs & symptoms of depression, (a = 0/05) (Beck scale P ≤ 0/001 & F = 30) and increase social performance in participants (P ≤ 0/001 & F = 83).

The rTMS is effect in the reduction of signs & symptoms of depression and increase social functioning in recurrent major depression.

The authors have not supplied their declaration of competing interest.

Involuntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.

All patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.

Although psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.

The results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.

The authors have not supplied their declaration of competing interest.

The aim of this study is to assess the dependence between the obsessive-compulsive symptoms, the eating disorders symptoms and orthorexia in adolescents aged 15-19, due to define which of these areas orthorexia is closer to. The study controlled such variables as: age, sex, BMI, school type.

The study covered 1899 pupils of secondary schools. The OCD and ED symptoms assessment was carried out with the LOI-CV, EAT-26 and the ORTO-15 questionnaire (two threshold values: ON- 40 and ON -35). The research was financed by scientific grant of Nutricia Foundation.

Revealed correlations of risk factors of ON - OCD and ON - ED indicated the higher the probability of diagnosis of these disorders, the higher the probability of ON diagnosis, too. The compatibility of ON and OCD diagnoses was for ON-40 = 45.8% and ON-35, 76.5%. It was shown that the OCD increases the risk of ON at the threshold value ON = 35. In the case of ON and ED, the diagnostic compatibility was ON-40, 42.7% and ON-35, 84.4%. The analysis of various variables confirmed a significant dependency of ON from ED, which suggests that ON belongs to ED. The diagnostic accuracy in this case is better at the threshold value ON- 35.

The results of our study should be confirmed in further research.

Depression/anxiety disorders and smoking behavior often begin in adolescence as co-occurring phenomena. Epidemiologically, the relationship between them is bidirectional,

To examine both adolescent smoking as a predictor of depression/anxiety disorders, and the effect of these disorders on adolescent smoking.

A representative sample of Catalan adolescents (N = 3008) participating in (PFI) a longitudinal study were interviewed about smoking behavior at baseline (T1) and at two follow-up assessments (T2 and T3). In interviews at baseline (T1) and at T4, the parents were asked whether their daughters/sons had a diagnosis of depression or anxiety. Smoking behavior was defined as smoking at least once a week. Age, sex and household income were included.

Depression/anxiety at T1 increases the risk of smoking behavior at T3 [odds ratio (OR), 1.97, 95% confidence interval (CI) 1.24-3.14] compared with undiagnosed adolescents. After adjusting for age and sex, the risk remains, but after adjusting for sex, age and income, the risk of smoking behavior decreases as household income increases [OR 1.6, 95% CI 0.9-2.85]. Alternatively, smoking behavior at T3 increases the risk of depression/anxiety at T4 [OR 1.7, 95% CI 1.1-2.5] compared with non-smokers. After adjusting for age and sex, the risk remains, but after adjusting for sex, age and income, the risk of depression/anxiety decreases as household income increases [OR 1.48, 95% CI 0.93-2.36].

Our findings provide the first evidence of a two-way relationship between adolescent smoking and depression/anxiety disorders in a community sample in Spain.

To extensively review the European Court of Human Rights (ECHR) case law concerning psychiatric commitment, and to estimate the role of this supranational jurisprudence in the practice of contemporary psychiatry.

Using keywords to search the ECHR computerized database “HUDOC”, we reviewed all cases concerning psychiatric commitment registered between September 1953 and December 31, 2004. Four groups were identified: applications declared inadmissible; applications accepted but not judged by the Court; pending cases; and cases judged by the Court.

Of the almost 118,000 decisions taken by the ECHR in this time frame, we found 108 situations concerning psychiatric commitment. Forty-one of these applications were considered by the Court to be inadmissible. Twenty-four other cases were considered admissible but not judged by the ECHR. Three admissible cases were still pending at the end of 2004. The ECHR judged 40 cases, and found in 35 of them that one or several rights as guaranteed by the Convention had been violated.

The ECHR protects the human rights of persons subjected to involuntary psychiatric commitment by creating supranational law in the following areas: definition of “unsoundness of mind”; conditions of lawfulness of detention; right to a review of detention by a Court; right to information; right to respect for private and family life; and conditions of confinement, which address inhuman and degrading treatment. The respective number of applications submitted to the ECHR did not depend on when the Convention had entered into force in that country.

The possibility of an individual to access the ECHR depends on the degree of democracy in his country and on the access to legal assistance through non-governmental organizations or individual intervening parties.

Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.

Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.

Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p = .023), but not that of MDD (p = .721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.

Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.

Schizophrenia is a complex and heterogeneous syndrome with high clinical and biological stratification. Identifying distinctive subtypes can improve diagnostic accuracy and help precise therapy. A key challenge for schizophrenia subtyping is understanding the subtype-specific biological underpinnings of clinical heterogeneity. This study aimed to investigate if the machine learning (ML)-based neuroanatomical and symptomatic subtypes of schizophrenia are associated.

A total of 314 schizophrenia patients and 257 healthy controls from four sites were recruited. Gray matter volume (GMV) and Positive and Negative Syndrome Scale (PANSS) scores were employed to recognize schizophrenia neuroanatomical and symptomatic subtypes using K-means and hierarchical methods, respectively.

Patients with ML-based neuroanatomical subtype-1 had focally increased GMV, and subtype-2 had widespread reduced GMV than the healthy controls based on either K-means or Hierarchical methods. In contrast, patients with symptomatic subtype-1 had severe PANSS scores than subtype-2. No differences in PANSS scores were shown between the two neuroanatomical subtypes; similarly, no GMV differences were found between the two symptomatic subtypes. Cohen’s Kappa test further demonstrated an apparent dissociation between the ML-based neuroanatomical and symptomatic subtypes (P > 0.05). The dissociation patterns were validated in four independent sites with diverse disease progressions (chronic vs. first episodes) and ancestors (Chinese vs. Western).

These findings revealed a replicable dissociation between ML-based neuroanatomical and symptomatic subtypes of schizophrenia, which provides a new viewpoint toward understanding the heterogeneity of schizophrenia.

To provide information on the mental health care system in Berlin, Germany.

Using available data we report on the spectrum of mental health care services provided in Berlin, the number of professionalsworking in these sectors, funding arrangements, pathways into care, and user/carer involvement.

The health care system in Berlin consists of a network of inpatient, outpatient, ancillary, and rehabilitative facilities, all of which are meant to work in a synergistic fashion. However, although the individual treatment options are generally well-planned, there is still a lack of co-ordination between them. Currently, the entire network is threatened by cuts in state funding for ancillary and rehabilitative services, by further reductions in the number of hospital beds, and by insurance company cuts in prescription drug budgets, such as those used for atypical antipsychotics in outpatient care.

Despite many similarities with the situation in other European capitals, the system of mental health care in Berlin suffersfrom a variety of problems related to co-ordination and costs that are unique to the German capital.

Infertility is described as a low-control stressor that may induce psychopathological symptoms. The Mindfulness Based Program for Infertility (MBPI) is a structured intervention targeting infertile women that aims to cultivate mindfulness and acceptance skills. The MBPI efficacy was tested in 55 infertile women who completed the program and 37 women in a control group. By the end of the MBPI, women who attended the program revealed a significant decrease in depressive symptoms, internal and external shame, entrapment and defeat. Inversely, they showed significant improvement in mindfulness skills and self-efficacy to deal with infertility.

Determine the MBPI feasibility and acceptability.

The MBPI includes 10 weekly sessions, in a group format, with the duration of about 2 hours each. Participants’ recruitment was supported by the Portuguese Fertility Association. Fifty-five female participants with an infertility diagnosis who were pursuing medical treatment for infertility completed a questionnaire specifically developed to address the acceptability and satisfaction with the MBPI at the end of the 10th session.

Participants scored as “very useful” most of the MBPI components (mindfulness practice, acceptance skills, values clarification, psychoeducation on stress and fertility-related lifestyle factors), except for the yoga component. The same pattern was found for the utility information, group support, small group exercises, contact with the therapist, progress notes and MBPI materials. The mean score for satisfaction with the therapist knowledge/competence was 9.55 (maximum: 10), the MBPI quality 8.91 and the MBPI global utility 8.95.

The MBPI showed to be feasible and well accepted by participants.

The authors have not supplied their declaration of competing interest.

High prevalence of impaired sexual function in patients with schizophrenia has been reported by several studies. Various factors were incriminated including the disease itself, the low level of social competence and treatmentside effects.

To compare sexual function in drug free schizophrenic patients and six months after initializing antipsychotic treatment.

A consecutive sample of 109 patients meeting DSM-IV criteria of schizophrenia was constituted in psychiatry department of Farhat Hached hospital (Sousse, Tunisia), during a twenty four months period. They were drug naïve or drug free for at least three months. Assessment was performed at two time points:

T0: During an acute phase of the disease as defined by a BPRS global score ≥ 40 T1: six months after antipsychotic treatment.

Assessment of sexual function used the Arizona Sexual Experience Scale (ASEX).

Sexual function was impaired under antipsychotic treatment. In fact, we noticed lower global score of asex (p = 0.03) and lower subscores of drive (p = 0.015), arousal (p = 0.006), erection or vaginal lubrication (p= 0.010), orgasm (p= 0.001) and satisfaction (p= 0.005).

Sexual function was impaired in patients under antipsychotic drugs, according to global score and to diffrent sexual dimensions subscores. This results seem to, prospectively, confirm the implication of treatment in sexual dysfunction occurence among schizophrenic patients.