To evaluate in adults the associations between persistent ADHD and comorbid psychiatric disorders and gender differences, among subjects from a population-based birth cohort.

Subjects were recruited from a birth cohort of all children born during 1976–1982 who remained in Rochester, MN after five years of age. Participating subjects with research-identified childhood ADHD (n = 232; mean age 27.0 years; 72% men) and non-ADHD controls (n = 335; mean age 28.6 years; 63% men) were administered a structured psychiatric interview (MINI-International Neuropsychiatric Interview) to assess current ADHD status and comorbid psychiatric disorders.

Among the 232 with research-identified childhood ADHD, 68 (49 men and 19 women) had persistent adult ADHD. Compared to subjects without childhood ADHD, adults with persistent ADHD were significantly more likely to have any (81% vs. 35%, P < 0.001) as well as each of the specific psychiatric comorbidities. The associations retained significance when stratified by gender and there were no significant gender by ADHD interactions on psychiatric disorders except for dysthymia with which ADHD was more strongly associated in women than men. Among subjects with persistent ADHD, externalizing psychiatric disorders were more common in men (73%) and internalizing disorders were more common in women (53%).

Persistent ADHD is associated with an increased risk of comorbid psychiatric disorders in both adult men and women. Clinicians treating adults with persistent ADHD need to be aware of comorbid psychiatric disorders, especially externalizing disorders for men and internalizing disorders for women.

The authors have not supplied their declaration of competing interest.

Major depression affects 1.5%-19% general population. High use of healthcare services and increase in morbidity and mortality are common consequences. Despite of appropriate pharmacological treatment, 30-40% of patients don't achieve significant improvement. TRD refers to no remission after two adequate trials of antidepressants: these patients qualify for ECT.

Our Mood Disorder Unit treats about 600 patients/year, 4% undergo ECT for TRD.

Ongoing, retrospective, observational study on 73 TRD patients treated with ECT 2/week, considering acute and late responsiveness 1 and 12 months later.

Sample of 52 (71.22%) patients with Recurrent Major Depression and 21 (28.78%) with Bipolar Disorder, collecting epidemiological and clinical data. Clinical course assessment through weekly Hamilton Rating Scale for Depression (HRSD); follow-up evaluation after 12 months, with telephone interviews.

73 inpatients, 26(35.62%) males, 47(64.38%) females with 4.31±3.43 previous episodes; mean age 59.42±11.60 years. Average duration of reference episode 52.71±39.42 weeks with HRSD initial score 30.16±4.76. Each patient was treated with 6.92±2.90 ECT applications. 64(87.67%) patients responded to treatment (50% reduction of HRSD initial score), 33(45.21%) achieved remission (HRSD≤8); 18(24.66%) patients maintained 12-months remission.

Our experience strengthens pivotal role of ECT in TRD. Each patient had long-lasting, severe episode under 1 year-long unsuccessful pharmacological therapy. ECT managed to quickly ameliorate their clinical course. We didn't record any adverse event. ECT showed similar relapse rates compared to conventional pharmacological treatment. This procedure requires further studies about long-term outcome.

At resent 3desaides management of chronic mental disorders at psychiatric health association tobe high attention.

Determining effect of psychodrama on depression among women with chronic mental disorder.

This study was a quasi-experimental study that done in RAZI comprehensive psychiatric center. Community of this research consists of chronic mental patients bedridden at RAZI comprehensive psychiatric center that among them 30 women with chronic mental disease possess entrains criterions selected and with randomized permuted blokes´ allocation to two control and intervention groups. Then them depression examined with beck depression inventory (BDI). Then 12sessions hours long of psychodrama, 2ice per week, 6 weeks for intervention group enactment but control group received routine treatments. When the program ended depression of ills reexamined whit study instrument and analyzed with independent T test, paired T test kolmogroph smernophand Leven and covariance analyzes tests.

Main of depression before and after intervention at control group was not significant but at Intervention group was significant (P=0.000).

At two groups after Intervention depression differences revolve significant (P=0.000). Comparison between main of depression after psychodrama even after modification of age and before intervention depression effect by covariance analyzes at two groups showed significant deferens.

Psychodrama leads to decrease of depression at intervention group.

To examine the long-term efficacy and safety of quetiapine in combination with lithium (Li) or divalproex (DVP) in the prevention of recurrent mood events (manic, mixed, or depressed).

Patients with bipolar I disorder (DSM-IV, most recent episode manic, mixed or depressed) received open-label quetiapine (400–800 mg/day; flexible, divided doses)+Li/DVP (target serum concentrations 0.5–1.2 mEq/L and 50–125 μg/mL) for up to 36 weeks to achieve ≥12 weeks of clinical stability. Patients were subsequently randomized to double-blind treatment with quetiapine (400–800 mg/day)+Li/DVP or placebo+Li/DVP for up to 104 weeks. Primary endpoint was time to recurrence of any mood event defined by medication initiation, hospitalization, YMRS or MADRS scores ≥20 at two consecutive assessments, or study discontinuation due to a mood event.

1953 patients entered the stabilization phase and 623 were randomized and received ≥1 dose of study medication. Rates of recurrence of a mood event were 20.3% (63/310) vs 52.1% (163/313) for quetiapine and placebo groups, respectively, a risk reduction of 68% (HR 0.32; P<0.0001). Risk reductions were similar for manic and depressed events (HRs 0.30 and 0.33, respectively; P<0.0001). Safety data were consistent with the recognized safety profile of quetiapine. However, a greater incidence of blood glucose ≥126 mg/dL was observed in the quetiapine treatment group.

Maintenance treatment with quetiapine+Li/DVP was significantly more effective than placebo+Li/DVP in increasing the time to recurrence of a mood event in stable patients with bipolar I disorder.

Supported by funding from AstraZeneca Pharmaceuticals LP.

Frontal meningiomas are benign brain tumours known for their late onset. They may be presented by only psychiatric symptoms. Thus, the diagnosis at early stages can be missed or overlooked until the tumour causes neurological deficit.

We report the case of a 61-year-old man, receiving a treatment and a follow-up for bipolar disorder for 11 years. He has history of 3 major depressive episodes, 2 suicide attempts and a manic episode. The symptoms were initially well controlled by medication. Since 6 months, the patient started to experience atypical symptoms: he had presented disinhibited and aggressive behaviour, psychomotor instability, pyromania and self-neglect. The patient did not respond to treatment despite repeated adjustments. A frontal syndrome was suspected. Cerebral CT scan revealed an unexpected mass measuring 6.8 cm × 5.6 cm at the right frontal area, suggestive of a giant meningioma (Fig 1).

Generally, once diagnosed, psychiatric disorders are rarely revised. Consequently, “silent” tumours such as frontal meningiomas can be overlooked. Neuroimaging should be considered in case of new-onset psychiatric symptoms, atypical or change in clinical presentation.

The authors have not supplied their declaration of competing interest.

After the first case of Covid-19 was emerged in Turkey on March 11, 2020, schools were closed distance education began. On March 21, curfew was declared for people who under the age of 20. Subsequently, the date of the nationwide university exam was changed twice.

This study has two aims. The first goal was to investigate the factors that affect the test anxiety of individuals who will enter the university exam during the Covid-19 outbreak. The second aim was to investigate whether the test anxiety levels of the participants vary according to the level of cognitive flexibility and self-regulation.

The study consists of 420 (284 women, 131 men and 5 others). The age range of the participants was between 18 and 21, with the mean of 18.33. Exam Anxiety Scale, Adolescent Self-Regulation Skills Scale and Cognitive Flexibility Scale were used to collect data.

The findings indicated that women’s level of test anxiety was higher than men. Those who do have concentration issues in distance education have high level of test anxiety. Test anxiety was higher for students whose household income decreased because of the pandemic. MANOVA results revealed that individuals with low test anxiety have higher ‘self-regulation successful’ scores and lower ‘self-regulation unsuccessful’ scores. Moreover, it was yielded that people with low test anxiety have higher level of cognitive flexibility.

Protective factors such as cognitive flexibility and self-regulation play an important role in individuals’ management of test anxiety.

No significant relationships.

Mood instability is an important problem but has received relatively little research attention. Natural language processing (NLP) is a novel method, which can used to automatically extract clinical data from electronic health records (EHRs).

To extract mood instability data from EHRs and investigate its impact on people with mental health disorders.

Data on mood instability were extracted using NLP from 27,704 adults receiving care from the South London and Maudsley NHS Foundation Trust (SLaM) for affective, personality or psychotic disorders. These data were used to investigate the association of mood instability with different mental disorders and with hospitalisation and treatment outcomes.

Mood instability was documented in 12.1% of people included in the study. It was most frequently documented in people with bipolar disorder (22.6%), but was also common in personality disorder (17.8%) and schizophrenia (15.5%). It was associated with a greater number of days spent in hospital (B coefficient 18.5, 95% CI 12.1–24.8), greater frequency of hospitalisation (incidence rate ratio 1.95, 1.75–2.17), and an increased likelihood of prescription of antipsychotics (2.03, 1.75–2.35).

Using NLP, it was possible to identify mood instability in a large number of people, which would otherwise not have been possible by manually reading clinical records. Mood instability occurs in a wide range of mental disorders. It is generally associated with poor clinical outcomes. These findings suggest that clinicians should screen for mood instability across all common mental health disorders. The data also highlight the utility of NLP for clinical research.

The authors have not supplied their declaration of competing interest.

Morbid Hunger or persistent Hyperphagia are rare conditions after TBI and can pose life threatening health risks to the patient, risks of aggression towards professional and family carers managing this behaviour, and the ability to function in social settings.

1. 1. Systematic search of Medline, Embase, PsychInfo, CINAHL, DARE, Cochrane Database of Systematic Reviews, and Cochrane Clinical Trials Register, using terms Eating Disorders, Organic Eating Disorders, Binge Eating, Anorexia Nervosa, Hyperphagia, Morbid Hunger, Satiety, Hypothalamus, Pituitary Glands, Traumatic Brain Injury, and Acquired Brain Injury.

2. 2. Diagnostic review of currently admitted hospital patients at a tertiary care brain injury rehabilitation centre in order to establish point prevalence.

3. 3. Review of Dietetic records to establish clinical presentation and management principles.

1. Systematic review identified case reports and case series of these disorders, providing description of three distinct traumatic presentations:

   • a. Persistent Hyperphagia after head injury.

   • b. Serious food seeking behaviour and overeating after surgery for neoplasm resulting in pituitary/ hypothalamic injury.

   • c. Head Injury variant of Kleine Levine Syndrome presenting with Hyperphagia, Hypersomnolence, and Hypersexuality.

2. Diagnostic review of 88 admitted patients identified 2 (3%) patients presenting with this condition.

3. Review of dietetic records confirmed the persistent and serious nature of this presentation and identified a high need for environmental and cue exposure control in management of this condition.

Organic eating disorders are rare but potentially life threatening conditions, requiring formal cataloguing and recognition in diagnostic classifications to facilitate systematic study of pathophysiology and relevant management strategies.

Experiences of depression and anxiety are common among patients with persecutory delusions. It has been theorized that emotional disturbances affect the formation and appraisal of persecutory delusions directly and possibly via increasing the sense of aberrant salience.

Using a time-lagged analysis of experience sampling data, this study modelled the role of momentary levels of negative emotions and aberrant salience in maintaining persecutory delusions in patients with active delusions.

Clinically acute participants with at least a mild level of persecutory delusions were assessed using experience sampling method (ESM; 7 entries per day for 14 days) and clinical rating scales. ESM data of participants who completed at least 30 ESM entries were analysed by using multilevel regression modelling.

The final sample consisted of 14 participants, with a total of 1161 momentary observations. Time-lagged analysis revealed that both negative emotions (B = 0.125, P = .009) and aberrant salience (B = 0.267, P< .001) predicted an increase in persecutory delusions in the next moment. Conversely, persecutory delusions did not predict change in negative emotions or change in aberrant salience in the next moment (ps> .05). Negative emotions also predicted an increase in aberrant salience in the next moment (B = 0.087, P = .009).

Our results supported the hypothesis that both negative emotions and aberrant salience exacerbate persecutory delusions, rather than being merely the sequelae of the symptoms. Our results suggested both direct and indirect (via aberrant salience) pathways from negative emotions to persecutory delusions.

The authors have not supplied their declaration of competing interest.

To describe principles and characteristics of mental health care in Prague.

Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.

Mental health care in Prague has a special position in the Czech Republic. Prague has the longest tradition of psychiatrictreatment including the German Psychiatric Department of the Charles University. The density of services is higher, there are more extrainstitutional facilities and acute beds are located in general hospitals.

Whilst various issues of mental health care in Prague overlap with those in other European capitals, there also are some specific problems and features. After substantial political changes in early 90s, the prevailing institutional model of psychiatric care has started to be changed according to the Concept of Psychiatric Care prepared by the Czech Psychiatric Association and approved by the Ministry of Health. However, stigma connected with mental disturbances is still present and there are not enough financial resources and will to put these plans rapidly into the practice.

Depressive disorder is common psychiatric morbidity among the elderly outpatients. It is also evident that cognitive disorders, ranging from mild cognitive impairment to severe dementia, are widely prevalent in the elderly coexistence of the above is quite common. Treatment for both conditions is quite challenging, aiming at symptomatic relief and improvement in functional status.

To investigate the coexistence of depression and cognitive impairment in aged depressive outpatients, 65 years or older. Correlation of cognitive level and depressive symptomatology was measured.

We used hamilton depression scale (HAM-D) and MMSE in 35 (mean age 68.2 years) depressed outpatients over 65-year-old. We excluded depressed schizophrenics and bipolar patient.

On a preliminary basis, a correlation between low MMSe and HAM-D (P < 0.05) was found. An interesting finding, though not measured primarily, was that low MMSE was accompanied with a low compliance with medication.

The mental deterioration that accompanies cognitive impairment is being widely studied and it is real complex. In our ongoing study previous findings are confirmed and can be interpreted both ways, i.e. depression is a risk factor for dementia and also the fact that existing dementia is positively correlated with a low HAM-D.

Compliance to medication is affected, among other variables, by the patients’ mental state.

The authors have not supplied their declaration of competing interest.

Delusion and hallucinations occur in a variety of psychiatric disorders. In the last years they have been considered multidimensional phenomena, since emotional, cognitive and action-oriented aspects were recognized. According to the cognitive model of the development of positive symptoms, emotional processes play an important role for the relationship between delusion and hallucinations. Although delusion and hallucinations often coexist, there are few empirical studies, which explore this relationship.

Aim of the study is to elucidate the relationship between delusion and hallucinations taking into consideration their multidimensionality.

Eighty-two patients with delusion and hallucinations with a schizophrenia spectrum disorder were examined. Several instruments to the exploration of delusion and hallucinations were used as the Psychotic Symptoms Rating Scales (PSYRATS), MacArthur-Maudsley Delusions Asessment Scchedule (MMDAS), Dimensions of Delusional Experience (DDE), Positive and Negative Syndrom Scale (PANSS), Brown Assessment of Beliefs Scale (BABS), Clinical Delusion Rating Scale (CDRS) and the Heidelberger Delusion Profile (HDP). The correlations between formal hallucination and delusion criteria, as well as formal hallucination criteria and delusion content were calculated. The causal relationship between delusion and hallucinations was tested through a structural equation modelling.

Correlations between delusion and hallucinations dimensions could be found, at item, subscale and scale levels. Emotional and cognitive delusion dimensions correlated significantly with hallucinations magnitude. The delusion content showed a significant influence on the occurrence and emotional dimension of hallucinations. Delusion secondary to hallucinations could only be partially confirmed.

The results confirm the complex structure of the relationship between delusion and hallucinations.

Subjects with psychoses have significantly increased rates of physical illnesses, but the nature of the relationship remains largely unknown.

The present study is part of the European Prediction of Psychosis Study (EPOS). Data were collected from 245 help-seeking individuals from six European centers (age 16–35) who met criteria for ultra-high risk of psychosis criteria. This paper seeks to investigate self-reported physical ill health and its associations with psychiatric symptoms and disorders, risk factors, and onset of psychosis during 48 months of follow-up.

In multivariate analysis, lifetime panic disorder (OR = 2.43, 95%CI: 1.03–5.73), known complications during pregnancy and delivery (OR = 2.81, 95%CI: 1.10–7.15), female gender (OR = 2.88, 95%CI: 1.16–7.17), family history of psychosis (OR = 3.08, 95%CI: 1.18–8.07), and having a relationship (OR = 3.44, 95%CI: 1.33–8.94) were significantly associated with self-reported physician-diagnosed illness. In the Cox proportional hazard model we found no significant differences between those who had undergone a transition to psychosis and those who had not.

The physical health of patients defined to be at ultra-high risk of psychosis seems to be commonly impaired and associated with female gender, marital status, complications during pregnancy and birth, lifetime panic disorder, and genetic risk of psychosis.