Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from 2 Phase III, randomized, double-blind (6-week), placebo-controlled trials of fixed-dose cariprazine (3mg/d and 6mg/d, NCT01104766) and flexible-dose cariprazine (3–6mg/d and 6–9mg/d, NCT01104779) in adults with acute exacerbation of schizophrenia.

Evaluate the efficacy, safety, and tolerability of cariprazine in schizophrenia.

Primary and secondary efficacy parameters were change from baseline to Week 6 in Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 617 (NCT01104766; 153 placebo, 155 cariprazine 3mg/d, 157 cariprazine 6mg/d, 152 aripiprazole) and 446 (NCT01104779; 147 placebo, 151 cariprazine 3–6mg/d, 148 cariprazine 6–9mg/d). Improvement from baseline to Week 6 on PANSS total scores was significantly greater with cariprazine vs placebo: least square mean difference (LSMD) was −6.0 (3mg/d, P=.0044), −6.8 (3–6mg/d, P=.0029), −8.8 (6mg/d, P<.0001), and −9.9 (6–9mg/d, P<.0001). Cariprazine was significantly superior to placebo on CGI-S: LSMD was −0.4 (3mg/d, P=.0044), −0.3 (3–6mg/d, P=.0115), −0.5 (6mg/d, P<.0001), and −0.5 (6–9mg/d, P=.0002). Aripiprazole (active control, NCT01104766) was superior to placebo on both measures (LSMD: PANSS=−7.0, P=.0008; CGI-S=−0.4, P=.0001). The only common cariprazine-related TEAE (≥5% and twice rate of placebo) that occurred in both studies was akathisia. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of schizophrenia.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

A psychosomatic disorder, Stendhal Syndrome, causes tachycardia, dizziness, sweating, disorientation, fainting, and confusion when someone is looking at artwork with which he or she connects deeply emotionally. In 1817, a French author named Marie-Henri Beyle, whose pseudonym was Stendhal, described his experience visiting the Basilica of Santa Croce in Florence and feeling overwhelmed by all the beauty and rich history surrounding him. Over a century later, visitors to Florence continued to suffer from similar symptoms. In 1979, Dr. Graziella Magherini, Chief of Psychiatry at the Hospital of Santa Maria Nuova in Florence, observed more than 100 tourists who were hospitalized after looking at art in Florence and coined the term Stendhal Syndrome.

To review literature on Stendhal syndrome, a bizarre travel-related syndrome.

PubMed and Google Scholar search using the keywords Stendhal syndrome, travel syndromes, culture shock

Victims are typically impressionable, single people between 26-40 years old, who are stressed by travel and may be struggling with jet lag. For art lovers, the thrill of arriving somewhere like Florence that gathers so much famous art is like meeting all your heroes at once. This strange aesthetic sickness is surely evidence of the special power of Renaissance art.

Stendhal Syndrome does not currently appear in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Psychiatrists have however, documented the syndrome in medical journals and advise that tourists pace themselves in art museums and get enough rest in between viewings of Italy’s breathtaking, powerful masterpieces.

Neuropsychological methods for diagnosing neglect syndrome (NS) are focused on identifying the inability of patients to respond to stimuli localized in contralesional space. There are a large number of methods capable of diagnosing spatial neglect, but at the same time having various limitations and restrictions in their use.

To devise and to test universal diagnostic techniques for visuospatial neglect detection.

1) A.R. Luria test battery; Trail Making Test (Part A); the Bells Test; 2) Authors’ methods: the Puzzles Test, the Red Shapes Test. A total of 47 patients after stroke with right hemisphere damage participated in the study and were divided into a target (18 patients with NS) and a control (29 patients without NS) groups. The Puzzles Test consists of three tasks: turning over cards, completing a sentence using cards with letters, completing a picture. The Red Shapes Test consisted in the search for a variable number of geometric shapes. Objective indicators of the study: total task completion time, the number of left omissions.

The sensitivity of the tests to NS was examined using the Mann-Whitney U-test. Differences in the number of omissions and task completion time between patients with and without spatial neglect were statistically significant regarding all tasks: turning over cards (p=0.01), completing a sentence (p<0.001), completing a picture (p<0.001), finding geometric shapes (p<0.01).

The Puzzles Test and Red Shapes Test along with the foreign tests (the Bells Test, Trail Making Test) are sufficiently effective methods for spatial neglect detection.

No significant relationships.

Lurasidone is an atypical antipsychotic agent with potential antidepressant effects through its antagonist activity at the 5-HT7 receptor. Although treatment-emergent affective switch (TEAS) induced by second-generation antipsychotics are not frequent, several cases have been reported. To our knowledge, there is no evidence of lurasidone-induced TEAS.

To describe a case of lurasidone-induced mania.

We describe a clinical case of a patient admitted to our psychiatric outpatient unit who developed a manic episode, presumably induced by the introduction of lurasidone. We also conduct a review of the literature on this subject.

A 37-year-old man diagnosed with obsessive-compulsive disorder (OCD) and an alcohol use disorder was hospitalized due to OCD decompensation with depressive symptomatology and suicidal thoughts, and for alcohol detoxification process. Since he had a previous history of clomipramine-induced TEAS, he was started on lurasidone up to 111mg to avoid the use of antidepressants, showing a progressive improvement of depressive symptoms. Thus, the patient was discharged when alcohol detoxification process was completed. Eight days after discharge, the patient began to show manic symptoms, so he had to be readmitted. Lurasidone was discontinued and valproic acid up to 1000mg/day as mood stabilizer was added, presenting a positive remission of manic symptoms.

According to our experience, lurasidone may have induced an affective switch in this patient. Based on our findings, patients and psychiatrists should monitor possible lurasidone-induced mood switching. However, further research is needed in order to back-up this one case report findings.

No significant relationships.

This was a quasi experimental study which covered 34 Women with Multiple Sclerosis in Iran Multiple Sclerosis Society. The samples have been selected through purposive sampling and then Random assignment into intervention (16 Samples) and control group (18 Samples). Intervention was Yang style Tai Chi Chuan classes twice a week for 3 months (12 weeks). In this study demographic questionnaire, Berg Balance Scale (BBS) and Multiple Sclerosis quality of life questionnaire (MSQOL-54 scale) were used to collect data.

In the Tai Chi intervention group there was a significant improvement in mean comparison of balance score (P= 0.03) and global score of Quality of life (P = 0.00), also its subscales such as Pain (P = 0.03), Energy (P = 0.00), Overall quality of life (P = 0.01), Role limitation due to emotional problems (P = 0.04), Social Function (P= 0.03) and in Physical Health Composite Score (P = 0.03) after Tai Chi training intervention. (P< 0.05) In the control group, no statistically significant improvement was found in mean comparison of balance and Quality of life scores after 12 weeks. (P > 0.05)

The results suggested that Tai Chi Chuan could be an alternative exercise intervention to increase balance and quality of life in patient with Multiple Sclerosis.

Mental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.

To evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)

This is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)

We included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.

Our results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.

The authors have not supplied their declaration of competing interest.

Truancy is correlated to many aspects of adolescent daily life: physical, mental health, social and economical conditions. WE-STAY (Working in Europe to Stop Truancy Among Youth) is a prevention program designed to reduce truancy and to promote mental health among European adolescents.

To evaluate the effectiveness of the awareness program, in truancy prevention . The awareness intervention aims to increase knowledge about a number of factors, including psychological ones, associated to truancy and how to get help.

Gather information on truancy in European adolescents and perform three school-based health- promotion interventions for adolescents in the entire study and compare the results with a control intervention.

Six European countries are participating in the WE- STAY intervention. In each country, a sample of 1600 pupils ages 14–18 will be randomized into one of four different intervention arms. Baseline evaluation of students’ lifestyle, coping styles, at-risk truancy, self-harm behaviours and mental health issues will be collected using a structured questionnaire.

In the Molise region there are 58 schools, 15 vocational schools and 43 high schools, with a total of 15393 students. After the randomization, we were left with 32 schools, 6 vocational schools and 26 high schools, encompassing a total of 9.489 students, 4.166 males and 5.323 females.

Truancy is often related to mental health problems and at-risk behaviours. WE-STAY will make it possible to evaluate outcomes of different preventive programs and to recommend effective culturally adjusted models for preventing truancy and promoting mental health for adolescents.

Faced with the global health emergency, a product of Covid-19, the educational system was forced to change its dynamics, assuming new challenges and adapting to virtual environments (Sierra, López, Azar & Trevethan, 2020). In this sense, the teaching task from home supposes an increase in the hours dedicated to their work, since they have seen the need to be trained in digital platforms to be able to respond to the changes derived from confinement; which can quietly generate professional wear and tear.

Analyze the relationship between professional burnout and increased workload on teachers

A cross-sectional study of correlational scope was carried out in 60 (n = 60) teachers, working actively at a higher education institution. A sociodemographic scale was designed to identify the hours dedicated to work before and during confinement and to evaluate professional burnout, the adaptation of the MBI instrument for the Colombian population was used (Barbato, Córdoba, González, Martínez & Tamayo, 2011)

A 50% increase in the workload of teachers was observed during confinement, besides, a statistically significant correlation between professional burnout and the increase in hours dedicated to work (Table 1)

It was possible to conclude that the significant increase in the workload in teachers correlates positively with levels of emotional exhaustion and depersonalization; however, no correlations were observed between workload and personal achievement of higher education teachers.

Infertile males experience considerable psychological distress, with feelings of inadequacy, marginalization, guilt and loss ofself-esteem.

Our study aims to investigate the impact of male infertility on men’s self-esteem and to study risk factorsfor low self-esteem.

We conducted a cross sectional, descriptive and analytical study, including 108 infertile men who presented to the laboratory of reproductive biology and the unit of assisted medical procreation of Military Hospital of Tunis between June and September 2019. For each patient, we collected sociodemographic and clinical data. We used Rosenberg scale to assess self-esteem.

The average age of participants was 36.8 years. Eleven patients had a history of varicocele (10.18%) and six of them sufferedfrom associated erectile dysfunction (5.55%). Infertility was primary in most of patients (77.8%) with an average duration of 3.32 years. 25% of patients had at least one previous failed assisted reproductive attempt. Spermogram abnormalities were found in 78.7% of patients. The mean score of Rosenberg scale was 30.68±4.35. Low self-esteem was associated with older age (p=0.006), lower educational level (p=0.019) and longer duration of infertility (p=0.022). Men who had children had better self-esteem (p=0.022). No associations were found between self-esteem and erectile dysfunction or previous failed assisted reproductive technique attempt.

Our results show that infertility reduces men’s self-esteem, especially of patients with lower educational level and longer duration of infertility. Physician dealing with infertility should be aware of these psychosocial aspects and offer help when needed.

Social withdrawal is a potential signals of distress and mental illness such as psychosis, mood disorders, anxiety (Kirkcaldy & Siefen, 2012). The term 'hikikomori” defines a particular form of social withdrawal recognized in Japan at the end of the last century (Saito, 1998). At the moment in all the west world (United States, France, United Kingdom, Spain, Italy) there is an increasing frequency of adolescents and young people who show symptoms of hikikomori like a life style centered on the own home and refusal of the school.

Requests to take care of social withdrawal teenagers (hikikomori) are increasing. This work describes two cases in treatment of early adolescents.

Authors analyse the terapeutic steps of the clinical treatment of two very young teenegers arrived to the Public Health Service because their extreme social withdrawal. The work focusses the attention on the relationship with the patients, the families and the social context.

The two cases show that the treatment of hikikomori sindrome is complex. A single type of approach (e.g. individual psychoterapy or family therapy) is not sufficient. Combining different patterns it is possible to create a network of treatments able to promote the resources of subject and of his/her familiar and social context.

Results underline the necessity of increasing the clinical knowledges on the social withdrawal sindrome and creating new protocols useful for the treatment.

The Oxford Happiness Inventory (OHI) 29-Item, each involving the selection of four options that are different for each item. Although there is an Arabic version, it is not identical to the original version in terms of the number of items and response.

to evaluate the psychometric properties of the Arabic adaptation OHI and its factorial structure in undergraduate sample.

The participants were 720 first year undergraduate Kuwaitis: 360 males mean age = 20.38 ± 1.60 and 360 females; mean age = 19.71 ± 1.39 (t = 5.87, P < 0.001). The Arabic version of OHI (Argyle, Martin, & Crossland) was administered to participants. The internal consistency reliability, factor structure, and convergent validity of the OHI with Life Orientation Test (LOT-R, Adult Hope Scale (AHS), Satisfaction With Life Scale (SWLS) were assessed as well as divergent validity of the OHI with Beck Depression Inventory-II (BDI-II)

Internal consistency was satisfactory for the OHI (Cronbach's alpha = 0.87) for males and (Cronbach's alpha = 0.86) for females. The results revealed no significant gender differences on happiness (F = 1.77, P > 05). Principal component analyses (PCA) showed that a seven-component solution explains %50.50 of the total variance for males and 51.47% for females. The OHI positively correlates with the following variables: SWLS (r = .52), LOT-R (r = 0.56) AHS (r = .48) while the OHI correlates negatively with BDI-II (r = -54).

Findings confirm that the OHI provides satisfactory validation, and thus it can be recommended as a measure of happiness among Arab samples.

The authors have not supplied their declaration of competing interest.

The participant will get an insight in the challenges of the implementation of new systems in routine clinical practice. He will get an opportunity to learn about the positive impact of operations management in health care. He also will get an idea about the attitude of patients towards new systems.

Psychological problems like anxiety in patients who are candidate for coronary artery bypass graft (CABGs) may increase mortality and morbidity. The effect of reassurance and preoperative information in decreasing anxiety is uncertain.

This study was designed to address the effect of preoperative information and reassurance in decreasing anxiety patients who are candidate for CABGs.

With experimental study and random sampling 85 (55male and 30 female) of 238 patients who were candidate for CABGs were included and completed spilberger anxiety test on the day of admission. Preoperative information and reassurance was done and test was completed again a day before the surgery. At last the Statistical analysis was done.

The Mean score of anxiety in patients with mild anxiety disorder (21 patients) was 34± 4.2 before and 39±5.8 after intervention. In patients with moderate anxiety disorder (39 patients) the score decreased from 52.61±3.8 to 50.76±56. Twenty five patients had severe anxiety disorder formerly with score of 63.88±2.8 which decreased to 53.88±7.6. All of differences were significant statistically.

In patients with mild anxiety intervention of preoperative information and reassurance resulted in increasing of anxiety but in patients with moderate or severe anxiety disorder such intervention decreased the level of anxiety significantly.