Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. Persistent neurological signs and symptoms of lithium intoxication gained clinical attention in the 1980s and were named Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT).

To review the long-term neurological sequelae of lithium intoxication (SILENT) to highlight their clinical presentation, assessment, management and preventive measures.

Non-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms syndrome of irreversible lithium-effectuated neurotoxicity.

Neurological manifestations of lithium poisoning may persist, even after effective removal of the drug – SILENT. The most frequent sequelae are cerebellum and brain stem dysfunction, extrapyramidal symptoms and dementia. They may last for weeks, months or years. Infection, dehydration, deteriorating renal function or the addition of other drugs may precipitate acute toxicity. Irreversible damage is difficult to treat. Some cases show spontaneous recovery that may be total, but in others, sequelae persist. Helpful measures include the avoidance of acute intoxications with lithium, long-term and continuous dose adjustment and serum level monitoring, stricter exclusion criteria for starting lithium, and aggressive treatment of acute neurotoxicity. Once the long-term neurologic sequelae have set in, the patient should be managed according to the impediment (physical rehabilitation, speech, cognitive training).

It is important to raise the awareness of SILENT so that clinicians are able to avoid it. There should be a low threshold for suspecting the existence of toxicity.

No significant relationships.

The theory of gerotranscendence, a developmental theory of positive aging was proposed by Lars Tornstam in 1989. It was based on the empirical researches done by him in late 1970s and early 1980s and work of other theorists. Tornstam began to explore aging with a phenomenological qualitative approach. Tornstam’s earlier work on aging revealed that aging is a natural developmental process towards maturity and wisdom.

To understand the ageing phenomena in terms of growth through cosmic and transcendent means.

Try to present a purely positive prospect on aging to a certain group of people experiencing a change during aging and provide an explanation for the miserable experiences in later life.

We have searched case reports, case series, cohorts and prospective studies, cross sectional data, review articles and research articles from search engines like PubMed, Medline and Google scholar.

The theory of gerotranscendence found that transcendent signs in old provide an interpretative framework to accept these signs as part of normal aging. It helps in development of a positive attitude in approaching older people.

The theory of gerotranscendence presents a positive view on aging. Tornstam has supported his perspective with various qualitative and quantitative research studies. The theory has also been adopted by many scholars and applied in a number of contexts. However, there is a need to further explore this theory in old age people suffering from depression and identify ways to promote gerotranscendence in them.

Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries.

The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009–2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population.

The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00–3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06–2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08–2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86–2.94).

In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

To evaluate the relative efficacy of Cognitive Behavioral Therapy (CBT) and Specialist Supportive Clinical Management (SSCM) for adults with severe and enduring anorexia nervosa.

Randomised controlled trial.

Sixty-three participants aged 18 and over (range 20-62) with a DSM-IV diagnosis of anorexia nervosa with at least a seven year illness history.

Thirty outpatient visits over 8 months. Participants were assessed at baseline, end of treatment (EOT), and 6-month and 12-month post-treatment follow-up. At EOP and follow-up, both groups improved significantly on the majority of outcome measures. However, there were no differences between treatment groups at EOT. At 6- and 12-month follow-up, analyses indicate greater improvement for those in CBT compared to SSCM. At 6-month follow-up, CBT participants had higher scores on the social adjustment scale (p = .038), and at 12-month they reported lower eating disorder examination global score (p = .004), and higher readiness for recovery (p = .013) compared to SSCM.

Patients with severe and enduring anorexia nervosa can make significant and meaningful improvements with therapy. CBT shows significant advantage over SSCM in terms of social adjustment, core eating pathology, and readiness for change over time.

Evidence about the clinical course of bipolar disorder is inconsistent and limited. The aim of this study was to assess changes in morbidity in patients with bipolar disorder along a mean follow-up period of 80 months.

Based on a mirror-image design, the follow-up period of each patient was divided into two halves. Then, three measures of morbidity — number of affective episodes, time spent ill, and cycle length — were recorded and compared between each half of the follow-up period.

On average, there was a trend to a smaller amount of time spent with subclinical symptomatology during the second half of the follow-up period. In contrast, there were no differences in terms of number of episodes, time spent with clinical symptoms, or cycle length between the first and second half of the follow-up period. A subgroup analysis identified 21.9% of patients with consistent data of a worsening during follow-up.

The results suggest that, on average, there is stability or slight improvement of clinical morbidity over the course of BD. Then, worsening of the clinical course may be a feature of a subgroup of patients rather than an inherent characteristic of the disorder. These subgroups or patient profiles could represent an opportunity for further studies to assess clinical, pathophysiologic, and therapeutic features associated with them.

Due to their frequency and negative impact on quality of life, eating disorders in schizophrenia need to be considered and highlighting.

To identify the risk of eating disorders (ED) and its correlates among mental patients.

It was a descriptive and analytic study. It included 53 inpatients with DSM-5 diagnoses of schizophrenia or schizoaffective disorder, followed in the department of Psychiatry at the Hedi Chaker University Hospital of Sfax in Tunisia, during the three months of August, September and October 2016. Data collections were conducted using questionnaire exploring sociodemographic and medical data. The SCOFF (sick, control, one, fat, food) Questionnaire was used to screen ED. A total score of ≥ 2 was used as a cutoff point to select persons at risk of ED.

The average age of our patients was 30.47 ± 9.5 years old. The majority of our patients was male (71.7%) and single (71%). The mean of extra Body mass was 27.9. The mean duration of disease was 9.9 ± 8.1 years and patients were mostly (54%) in atypical neuroleptics. According to the SCOFF Questionnaire, 35.8% had a risk of ED. Female gender and treatment with atypical neuroleptics were significantly associated to ED risk with respectively P = 0.02 and P = 0.038.

Eating disorders remain underestimated among patients suffering from schizophrenia. Yet, its screening prevention and management are crucial and must be multidisciplinary for optimal care.

The authors have not supplied their declaration of competing interest.

Elevated levels of C-reactive protein (CRP) have repeatedly been observed in schizophrenia (SZ) and related disorder but without clear description of the associated clinical variables. The objectives of this study were:

– to determine the prevalence of abnormal CRP levels in an observational sample of patients with SZ or schizoaffective disorders;

– to identify the clinical variables associated with elevated CRP levels as well as the effects of treatments.

Two hundred and nineteen stable patients with schizophrenia or schizoaffective disorder (mean age = 31.6 years, 75.3% male gender) were systematically included in the network of FondaMental Expert Center for schizophrenia and assessed with a dedicated electronic medical records including the Structured Clinical Interview for DSM-IV Axis I Disorders and validated scales for depressive and psychotic symptomatology. High sensitivity CRP (hs-CRP) was measured with an assay using nephelometry (Dade Behring). Abnormal CRP level was defined by levels > 3 mg/L. Metabolic syndrome was defined according to the International Diabetes Federation.

Overall, 63 patients (28.8%) were found to have abnormal CRP levels. In univariate analysis, abnormal CRP levels were found to be significantly associated with the DSM-IV-TR schizophrenia diagnosis compared to schizoaffective disorder (32.6% vs. 10.5%, P = 0.006). This association remained significant after adjustment for BMI (P = 0.007) and antidepressants (P = 0.043). Abnormal CRP levels were also found to be significantly associated with BMI (P < 0.0001), hypertriglyceridemia (P = 0.0015), high waist circumference (P < 0.0001), metabolic syndrome (P = 0.0011) and abdominal obesity (P < 0.0001), while current tobacco status, hypertension or high fasting glucose were not (all P > 0.05). All patients were treated by antipsychotics. Patients treated by antidepressant were found to have less abnormal CRP levels than others (P = 0.01), contrary to those treated by mood stabilizing agents (P > 0.05).

CRP may be considered as a biomarker of interest to differentiate schizophrenia from schizoaffective disorder, and as a marker of inflammation induced by perivisceral fat. Treatment with antidepressant appears as a protective anti-inflammatory agent.

In empirical literature, impulsivity is identified as a core feature of gambling addiction. Furthermore, pathological gamblers are prone to have a poor self-esteem. Previous researches studied the link between impulsivity and self-esteem bringing contrasting results. However, relationships between such constructs among pathological gamblers have not been investigated.

We sought to explore the associations among pathological gambling, self-esteem and different facets of impulsivity comparing a clinical sample of pathological gamblers with community participants.

To highlight patterns of associations between self-esteem and impulsiveness in pathological gambling.

A sample of pathological gamblers and a sample of healthy men, were administered the South Oaks Gambling Screen (SOGS), the UPPS Impulsive Behavior Scale (UPPS) and the Rosenberg Self-Esteem Scale (RSES).

As expected, levels of impulsivity were significantly higher in the clinical sample while levels of self-esteem were significantly lower. A significant and negative correlation between impulsivity and self-esteem was found among pathological gamblers. Different patterns of associations were found between self-esteem and dimensions of impulsivity.

Coherently with others results, our study confirmed that pathological gamblers showed high impulsivity and low self-esteem. The peculiars patterns of associations between impulsivity and self-esteem could be informative to tailor treatment programs for pathological gamblers.

The authors have not supplied their declaration of competing interest.

Recreational use of nitrous oxide (N20) or ‘laughing gas’ inhalation is a common phenomenon in countries like UK and US where it is associated with music festivals and parties. However, as far as we know, recreational N20 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N20 use and addiction in a young Singaporean male who was introduced to it by a friend from a Western country where its use is prevalent.

A 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N20 inhalation that escalated from infrequent low dose use to the current daily high-dose use which he was unable to control. He exhibited symptoms of dependence — including preoccupation, tolerance, withdrawal and difficulty in cutting down. No major adverse medical complications were noted so far.

The patient was assessed to have Nitrous Oxide Dependence; and is currently undergoing regular counselling sessions in an attempt to motivate him to cut down or stop his N20 use.

This case is unique for 2 reasons:

– extant literature suggests that only anectodal evidence exists for psychological dependence of N20 in Singapore; yet our patient clearly demonstrates psychological dependence;

– this is the first reported case of N20 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private.

The authors have not supplied their declaration of competing interest.

It is assumed that dysfunctional meta-cognitive beliefs about one's thoughts increase problematic appraisals and coping behaviors, which further contribute to the development of mental disorders (Wells and Matthews, 1994; Wells, 2000). Although this research interest originated around generalized anxiety disorder (GAD), recent studies have begun to examine similar meta-cognitive processes in other disorders. The majority of studies using Meta-cognitions Questionnaire (MCQ; Cartwright-Hatton & Wells, 1997) and its variants to assess meta-cognitive beliefs.

We conducted a meta-analysis to integrate empirical findings on group differences in meta-cognitive beliefs between healthy individuals and patients with various psychiatric disorders.

We followed the PRISMA guideline (Liberati et al., 2009). A systematic literature search was conducted. We included studies that involved a diagnosed psychiatric group and healthy controls (aged 18 or above), reported group comparisons of metacognition, and were published during the period of 1990–27 August 2015. Effect sizes were computed.

A final set of 43 studies was included. Large combined effect sizes were found on each subdomain of the MCQ, indicating increased levels of dysfunctional meta-cognitive beliefs in patients. Subgroup analyses were carried out based on psychiatric diagnosis (i.e. psychosis, n = 10; GAD, n = 7; obsessive-compulsive disorder, OCD, n = 15; anorexia nervosa, n = 5). All patient groups were more dysfunctional on each subtype of meta-cognitive beliefs than controls. Effect size of U/D was particularly large for GAD, and that of CSC was particularly large for OCD.

Dysfunctional meta-cognitive beliefs are evident across several psychiatric disorders, with specific types of beliefs being more marked in certain diagnoses.

The authors have not supplied their declaration of competing interest.

To investigate the prevalence of pathological Internet use (PIU) among adolescents in eleven European countries in relation to demographic and health-related risk factors and Internet accessibility using homogenous methodology.

Cross-sectional analysis.

The 7th Framework European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), is a Randomized Controlled Trial (RCT) evaluating preventive interventions for risk-behaviors among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain with Sweden as the coordinating site.

11,956 adolescents (F/M: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the eleven study sites.

Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on the Young Diagnostic Questionnaire for Internet Addiction (YDQ).

The overall prevalence of PIU was 4.4%. the rate was higher among males than females (5.2% vs. 3.8%). Students not living with a biological parent or relative had the highest risk for both maladaptive and pathological Internet use. Low-parental involvement and parental unemployment showed high relative risk for both maladaptive and pathological Internet use. PIU significantly correlated with the average number of hours spent online. No correlation was found between national levels of Internet accessibility and pathological Internet use.

Prevalence of PIU varied by gender. Youth in households without a biological parent and/or low level of parental involvement had the most significant health-related factors associated with PIU. National levels of Internet accessibility were not a risk factor for either maladaptive or pathological Internet use.

Perceived and anticipated stigma is relevant issues in patients with schizophrenia. Stigma has negative consequences both in quality of life and in the course of illness.

To analyze the degree of perceived and anticipated stigma and discrimination in patients with schizophrenia and their relationship with clinical and socio-demographic variables.

A cross-sectional study was carried out in a sample of 100 patients with diagnosis of schizophrenia, 18 or more years old, clinically stabilized, without axis I DSM-IV comorbidity. Patients received treatment in the outpatient services of a catchment area in Madrid. Perceived and anticipated discrimination was evaluated trough the DISC-12 (Discrimination and Stigma scale). Other study variables were: socio-demographic characteristics, symptoms of depression (Calgary Scale) and functionality degree measured by Global Assessment of Function (GAF).

The presence of symptoms of depression evaluated by the Calgary Scale and low degree of functionality measured by GAF are associated with greater feelings of discrimination and stigma, especially in the sub-scales of experienced and anticipated discrimination of the DISC 12. Anticipated stigma is higher in men than in women while the rest sub scales of the DISC-12 do not correlate with gender or other sociodemographic variables.

Preventive strategies to avoid the stigma in schizophrenia should consider some characteristics associated with disease, especially the degree of functionality and presence of depressive symptoms.

The authors have not supplied their declaration of competing interest.

Ankylosing spondylitis (AS) is a chronic inflammatory disease, associated with significant pain, functional impairment, and diminished quality of life. However, there is significant uncertainty regarding the prevalence of depression in AS and its associations.

We performed a meta-analysis to examine the prevalence of depression in AS and its associated correlates.

The study protocol was prospectively registered with PROSPERO (CRD42015019676). EMBASE, Medline, PsycINFO and Web of Science were systematically searched for cross-sectional studies with ≥ 50 adult AS patients, which reported depression prevalence using diagnostic criteria or a validated screening tool. Depression prevalence, tool and threshold used, age, gender, disease duration, as well as measures of disease activity, functional impairment, pain and innate inflammation, were abstracted. OpenMeta was used to calculate pooled prevalence estimates and to conduct meta-regression.

Eight hundred and seventy-seven texts were identified and 17 studies satisfied inclusion criteria, totalling 3187 participants (75.2% male). Six diagnostic tools and 10 different thresholds were reported, with depression prevalence estimates ranging from 4.9–55.5%. In studies using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), 37.1% of participants satisfied criteria for mild (≥ 8) and 8.2% met criteria for moderate depression (≥ 11). Multivariate meta-regression demonstrated significant positive correlations between depression and, respectively, disease activity (P < 0.001) and C-reactive protein (P < 0.001).

The prevalence of depression in AS is comparable with that of other rheumatic and degenerative diseases. Moreover, depression demonstrates significant associations with age, inflammation and disease activity, which require further investigation in prospective studies.

The authors have not supplied their declaration of competing interest.

Burn out mainly occurs among healthcare employees. This professional category is exposed to a large load of emotional disturbance.

The aim of this work was to study the levels of burnout syndrome in caregivers who were victims to occupational accident.

This cross-sectional study was conducted during 2014-2015 in the occupational medicine department. The target population consisted of the healthcare employees who reported their exposure to occupational accident. A semi-structured self-reported questionnaire including the Maslach questionnaire was used to collect information. Data were analyzed using SPSS-20.

One hundred and sixty health professionals returned the questionnaire (58% women, mean age 31.9 years old). Occupational accidents occurred mostly in the morning (62.5%). Among the healthcare providers, 112 health professionals (70%) had had sharp injuries. Burn out was found among 23.1% of the studied population. It was defined by its three domains: a high emotional exhaustion (46.9%), high depersonalization with low personal accomplishment (36.3%) and high depersonalization without low personal accomplishment (34.4%). Professionals with less years in the function (P = 0.031) and technicians (P = 0.028) were more affected by Burnout. A significant relationship was found between traumatic accidents (P = 0.012), needle stick injuries (P = 0.009) and burnout.

The prevalence of burnout is high among health professionals which can increase the risk of occupational accidents and its subsequent risks. It seems that holding workshops and increasing healthcare givers’ awareness and skills to face these risks can be effective in mitigating them.

The authors have not supplied their declaration of competing interest.