Young people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those related to the caregiver’s profile.

We interviewed 1,400 Brazilian primary caregivers of young people (aged 10–19), participants of a high-risk cohort. Caregivers reported on young people’s formal/informal mental health care utilization, and associated barriers and facilitators to care. Data were also collected on youth mental health and its impact on everyday life; and caregiver characteristics—education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization.

Persistence and greater impact of youth mental health conditions were associated with a higher likelihood of care, more clearly for formal care. Caregiver characteristics, however, also played a key role in whether young people received any care: lower parental stigma was associated with greater formal service use, and lower socioeconomic class showed higher odds of informal care (mainly from religious leaders).

This study highlights the key role of the caregivers as gatekeepers to child treatment access, particularly parental stigma influencing whether young people received any mental health care, even in a low resource setting. These results help to map barriers for treatment access and delivery for young people, aiming to improve intervention efforts and mental health support.

The Bulgarian Ministry of Health invited the European Psychiatric Association (EPA) to evaluate Bulgarian mental health care service provision in 2018. Bulgarian mental health services face very significant challenges including a legacy of historic underfunding, internal conflicts, poor planning, and the emigration of very high numbers of younger skilled staff that had followed accession to the European Union. There were significant disputes between stakeholders regarding the way forward and had been at least two unsuccessful previous external agency interventions that had attempted to find solutions.

This EPA position paper describes in detail the EPA mission to Bulgaria including methodology, findings, recommendations, and finally the positive actions and changes that are now underway as a result of the EPA report and intervention aimed at contributing towards improving Bulgarian mental health services.

After meetings with multiple stakeholders in the Bulgarian mental health system and analysis of data on service delivery, workforce, funding and configuration the EPA Panel agreed a list of twenty recommendations for change.

The EPA mission, with the collaboration of multiple stakeholders in Bulgaria, was successful in stimulating high level government action to improve mental health services. Despite longstanding differences, it was possible to involve the stakeholders in constructive dialogue. The importance of “speaking with one voice” was a key lesson learned.

Adolescents’ Internet gaming disorders might influence on their social and psychological developmental tasks and physical health negatively. Depression is the commonly co-existed conditions with addictive Internet gaming, but not much research has been reported whether depressive symptoms would precede the addictive Internet gaming in this population.

This prospective observation study was performed to make clear whether adolescents’ depressive symptoms precede their addictive Internet gaming.

Adolescents’ 1-year incidence of the addictive Internet gaming was calculated, and test their depressive symptoms increase the incidence.

In Korea, whole students of the 1st grade in three middle schools were participated in this study. Baseline assessment of 508 students was performed via standardized self-reported questionnaire on May–June, 2015. Internet game use-elicited symptom screen (IGUESS) was used to addictive Internet gaming conditions. IGUESS is the 9-itemed DSM-5 diagnostic criteria-based instrument to screen high risk of Internet gaming disorders. Depressive symptoms was measured by Child Depression Inventory (CDI) group. One year after the baseline assessment, follow-up assessment was performed. Four hundred and forty-eight students have been participated in the 1-year check up without addictive Internet gaming at baseline.

In total, 4.7% of subjects had depressive symptoms at baseline, and incidence of addictive Internet gaming was 9.2%. After adjusted by sex, Internet game use per week, and self-control status, depressive symptoms of baseline increased the 1-year incidence of addictive Internet gaming significantly (OR = 3.5, P = 0.034).

Depressive adolescents have higher possibility they could experience the addictive Internet gaming.

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.

Attention Deficit Hyperactivity Disorder (ADHD) prevalence in the general adult population is estimated to be between 2–4%. Despite the high prevalence, until recently there was only one validated semi-structured interview available for the accurate diagnostic assessment of ADHD within the adult population: the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID).

To examine the concurrent validity of the DIVA 2.0 interview comparing the diagnostic rate with the CAADID interview. To analyse the criterion validity of the DIVA 2.0 in the Spanish language in an adult sample.

The aim of this is to study was to evaluate criterion validity of the DIVA 2.0 in an adult sample comparing with the CAADID and other ADHD severity scales.

A transversal study was performed to check the criteria and concurrent validity of the DIVA 2.0 compared to the CAADID.

Forty patients were recruited in an adult ADHD program at a university hospital. The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview and goods correlations with three self-reported rating scales: the WURS, the ADHD Rating Scale and Sheehan's’ Dysfunction Inventory.

The DIVA 2.0 has good psychometric properties and is a reliable tool for the assessment of ADHD in adults.

The authors have not supplied their declaration of competing interest.

Le Metacognitions Questionnaire-30 (MCQ-30), développé par Wells et Cartwright-Hatton (2004) [1], est une échelle de mesure multidimensionnelle de facteurs métacognitifs impliqués dans le développement et la persistance de troubles psychiques. La théorie définitoire inhérente à cette échelle est résumée par Wells et Matthews [2] dans le modèle Self-Regulatory Executive Function (S-REF). Dans la dépression, une rumination pathogène serait induite par des pensées (croyances métacognitives évaluées par le MCQ-30) et des stratégies de contrôle qui perpétuent une cognition et des stratégies de coping inadaptées. Le but de notre étude est d’adapter et de valider une version française du MCQ-30 en évaluant ses propriétés psychométriques dans un échantillon de patients qui ont un diagnostic de dépression.

L’adaptation française de l’instrument a été réalisée après une traduction back-forward permettant une bonne validité de face. Elle est en cours de passation dans un échantillon de patients hospitalisés ayant un diagnostic de dépression établi selon les critères du DSM 4 TR. Le nombre de sujets nécessaires est estimé à 150 [3]. Une analyse factorielle confirmatoire permettra de vérifier la structure dimensionnelle à 5 facteurs retrouvée dans l’étude de validation de la version originale. Pour l’évaluation de la validité convergente, nous étudierons la corrélation des différents facteurs du MCQ-30 avec une mesure de l’anxiété d’état (Penn State Worry Questionnaire), de la rumination (Rumination on Sadness Scale), et de la dépression (Beck Depression Inventory). Hypothèses sur le comportement de l’échelle : en accord avec les validations étrangères, nous supposerons une corrélation positive et significative de la MCQ-30 avec les échelles sus-citées.

Des résultats partiels seront présentés et discutés à la lumière de la taille de l’échantillon.

The present study evaluated the association between the WHO (Ten) Well-being index and major depression assessed by the Major Depression Inventory (MDI) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN). The main aim was to examine how well the WHO (Ten) Well-being index worked as a screening instrument for depression in a population-based sample.

A questionnaire including the WHO (Ten) Well-being index and the MDI was sent out to a randomly selected adult Swedish population and 10 441 persons participated. Psychiatrists using SCAN interviewed a selected sample. Sensitivity, specificity, Receiver Operating Characteristics (ROC) and Area Under the Curve (AUC) were calculated.

When a cut-off score ≤ 8 for the Well-being scale was used and depression according to SCAN was the index of validity the sensitivity was 0.81 and the specificity 0.81. When depression according to the algorithm of the MDI was used the sensitivity was 0.89 and the specificity was 0.86 at a cut-off score of ≤ 12. There were no age or gender differences between true positive persons versus false negative persons. The AUC was good (0.86) when using SCAN and when using the DSM-IV algorithm of the MDI excellent (0.93).

The WHO (Ten) Well-being scale can be used as s simple screening instrument for depression in population-based studies. However, the scale needs to be further evaluated in order to examine if the recommended cut-off score in the present study could be replicated in other surveys.

Proper recognition of facial expressions of emotion is crucial for human social relationships. Impairments in the capacity to process facial information may play an important role in the etiology and maintenance of certain mental disorders, especially music performance anxiety (MPA).

To assess the recognition of facial expressions of emotion in musicians compared to a group of subjects from the general population, considering also the presence/absence of MPA.

Hundred and fifty amateur and/or professional musicians who regularly take part in public performances (GM) and 150 subjects from the general population (GP) completed a task of facial emotion recognition and were assessed in terms of accuracy and reaction time. The group of musicians was subdivided between subjects with and without MPA indicators. Data were analyzed using Student's t test (P < 0.05) within the statistical package for the social sciences.

GM were less accurate and had a longer reaction time in the recognition of facial happiness (P < 0.001, effect size: 0.25–0.44) compared to GP. Musicians with MPA had a still lower accuracy in the recognition of happiness, as well as longer reaction times for emotions as a whole (P < 0.04; effect size: 0.32–0.40) compared to musicians without MPA.

The poorer performance of musicians in the recognition of happiness suggests difficulties to recognize indicators of social approval, which may negatively affect performance through increased anxiety and negative thoughts that can favor the onset of MPA.

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.

Autism spectrum disorders (ASD) are complex neurodevelopmental conditions characterized by impairments in social cognition and repetitive behaviors with onset in early infancy. Deficits in emotion recognition, social perception, and communication have been identified as core symptoms of ASD.

Comorbid disorders are frequent, namely psychiatric illness, epilepsy, sleep disruption, and hyperactivity.

Immune profile changes during early life may contribute to pathogenesis of ASD. Other risk factors include advanced parental age, fetal environment, fertility treatments, medications, and nutritional and toxic factors.

Several brain regions are involved in the pathophysiology of ASD but the cerebellum is the structure most consistently found altered. An increased risk of ASD is associated with cerebellar damage.

To highlight the importance of understanding the key processes of cerebellar development and how altered cerebellar function leads to social and cognitive impairments, and consequently ASD.

Non-systematic review of the literature using Pubmed database. Papers were selected according to their relevance.

From imaging studies, we can understand that cerebellum is not just about motor function. Different tasks like adding working memory, emotional and social processing, and language seem to be part of core functions of the cerebellar circuit.

Adults with lesions in the cerebellum can develop cerebellar cognitive affective syndrome (CCAS), with core symptoms of impaired executive function, difficulties in spatial cognition, blunted affect, or inappropriate behavior. Some children who have tumor resection surgery for medulloblastomas also exhibit symptoms of CCAS, and some experience posterior fossa syndrome (PFS).

The linguistic, cognitive, and behavioral deficits in CCAS and PFS may contribute to explaining how cerebellar alterations are related to ASD, which is a neurodevelopmental disorder characterized by an earlier onset and broader spectrum of these symptoms.

The literature has suggested an important role for cerebellar dysfunction in etiology of ASD, under certain premises: (a) cerebellar expansion temporarily coincides with onset of ASD; (b) cerebellum is prone to lesions during this period; (3) cerebellar lesions contribute to dysfunctional social and language abilities.

Disturbances in cerebellar development lead to alterations in higher cognitive functions, due to changes in Purkinje cells. These dysfunctional neurons, once integrated into a brain circuit that controls complex tasks, lead to these functions becoming aberrant.

It is therefore fair to say that cerebellum is important for development of the so-called “cognitive and social brain” since it is itself part of this network. So, the cerebellum certainly plays a relevant role in pathophysiology of ASD.

None Declared

The effects of long-term antipsychotic medication on cognition in schizophrenia are unclear (Husa A.P. et al., Schizophr. Res. 2014).

Understanding how long-term antipsychotic treatment affects cognition is crucial for the development of safe, evidence-based treatment of schizophrenia.

To analyse the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia at age 43 years in a general population sample.

Sixty (33 males) schizophrenia spectrum subjects from the Northern Finland Birth Cohort 1966 were assessed at age 43 years by California Verbal Learning Test, Visual Object Learning Test, Abstraction Inhibition and Working Memory task, Verbal fluency, Visual series, Vocabulary, Digit Span and Matrix reasoning. Cumulative lifetime antipsychotic dose-years were collected from treatment records and interviews. A factor analysis based on the cognitive tests resulted in one cognitive factor. The association between this cognitive composite score and antipsychotic dose-years was analysed by linear regression.

Higher lifetime antipsychotic dose-years were statistically significantly associated with poorer cognitive composite score at age 43 years (B=-0.32, p>0.001), also when adjusted for gender, onset age, remission and number of hospital treatment days (B=-0.42, p=0.008).

To our knowledge, this is the first report of an association between cumulative lifetime antipsychotic dose and cognition in midlife in schizophrenia. Based on this data, the use of high antipsychotic doses may relate to poorer cognitive functioning in schizophrenia after twenty years of illness. These results do not support the view that antipsychotics prevent cognitive decline or promote cognitive recovery in schizophrenia.

The authors have not supplied their declaration of competing interest.

Koro syndrome has traditionally been considered a culturally bound syndrome, characterized by the delusional belief that one's genitalia are retracting and the anxiety caused by the perception of imminent death. Although it is widely regarded as an epidemic in South-east Asia, there are some isolated cases in other cultures as well.

We present a Koro case study and a systematic review, focusing on the presentation and its treatment, in order to make visible this syndrome to Western culture and provide the tools to identify it.

To provide an overview of Koro's presentation, phenomenology and treatment. We also want to clarify the nosology classification of this syndrome and its influence in the reported cases.

We begin describing a new case of Koro syndrome: a Spanish male presented an acute psychosis, the patient had an intellectual disability and a family history of mental illness. A systematic review was done based on articles published in Pubmed following the PRISMA guidelines.

From 117 studies, only 29 met the inclusion criteria. Data were analyzed on several epidemiological and clinical characteristics. We found that Koro syndrome is more often presented as a result of intoxication or as a part of a previous known psychotic disorder. Cases involving patients sharing their delusion have been only reported in Asia.

No specific data could be obtained about epidemiology and pathogenesis, as our conclusion about Koro syndrome was based mainly on few case studies. Pharmacotherapy and social support may be effective in ameliorating the symptoms.

The authors have not supplied their declaration of competing interest.

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.

Domestic violence is a troubling problem, but it has acquired a new, previously unknown significance during the COVID 19 pandemic. According to WHO, the number of calls from victims of domestic violence to hotlines during quarantine in many countries has increased by an average of 5 times.

The purpose of this study was to find out the consequences of domestic violence against women and to identify psychological problems and mental disorders. Attention was paid to the mental health of victims of violence in self - isolation during COVID-19 pandemic.

We analyzed the psychological problems and mental disorders of women who applied to the newly created hotline for women at the Serbsky Center in Moscow during the COVID 19 pandemic.

The situation caused by restrictive quarantine measures related to the COVID-19 pandemic provokes aggressiveness and all forms of domestic violence.Clinical interview has revealed depression, anxiety, fear, low self-esteem, self-harm behavior, which formed the clinical picture of adaptation disorders, acute stress disorders, PTSR, psychosomatic disorders, substance abuse), sexual dysfunctions, eating disorders in the form of bulimia and anorexia.

The study requires taking into account social, economic and gender characteristics. In all types of emergencies, including epidemics, violence against women tends to increase. This is facilitated by a number of factors, such as the crowding of the stay,a decrease in prosperity, provocation of alcohol abuse, state of uncertainty.

Autism Spectrum Disorder and Social Anxiety Disorder are mental illnesses characterized by a dysfunction in social behavior (SB); a phenomenon largely mediated by the medial prefrontal cortex (mPFC). Clinical studies have demonstrated that lysergic acid diethylamide (LSD), a partial agonist of the 5-HT2A receptor, can promote SB. However, its mechanism of action on SB is unknown.

To assess the effects of repeated LSD administration on social behavior in mice and to identify which mPFC receptors mediate LSD’s behavioral effects.

Eight-week-old C57BL/6J male mice received vehicle or repeated LSD (30 μg/kg/day i.p. for 7 days) as well the selective 5-HT2A receptor antagonist MDL, or the AMPA receptor antagonist NBQX. Twenty-four hours following the last injection, mice underwent the Direct Social Interaction Test and the Three-Chamber Test (TCT) to assess sociability and preference for social novelty. in vivo electrophysiological recordings were performed in mice treated with vehicle or LSD using multi-barrelled electrodes for microiontophoretic ejections of the selective 5-HT2A receptor agonist DOI or the selective AMPA receptor agonist quisqualate on mPFC pyramidal neurons.

Repeated treatment with low doses of LSD increased the interaction time in the DSI as well as sociability and social novelty indices in the TCT. These pro-social effects were blocked by the intra-PFC administration of both 5-HT2A and AMPA antagonists. LSD also potentiated, in a current-dependent manner, the excitatory response of mPFC neurons to 5-HT2Aand AMPA agonists.

Repeated, low doses of LSD increases social behavior via a mechanism of action that is mediated by 5-HT2A and AMPA in the mPFC.

Psychiatrists are particularly exposed to the risk of being victims of stalking (repeated persecution, unwanted communicating & contact causing fear) by patients.

To summarize the latest research findings on this topic. We conducted a literature review on Medline sources. Key words: Stalking by patients, psychiatrists, mental health professionals.

Up to 20% of psychiatrists have been victims of stalking, at least once. Stalkers are usually male, single & unemployed, and under the care of the clinician; 3/4 of them suffer from a psychotic and/or personality disorder(s), mainly cluster B personality disorder(s). Duration of stalking varies between several weeks and could reach 16 years. Methods of harassment include intrusive approaches, loitering near the victim, telephone calls, following the victim, spreading gossip, violating property, and sending unwanted material (letters, sexual material etc). Victims most commonly express fear, anger, helplessness or even PTSD symptoms. Stalked psychiatrists are usually male consultants but also at risk are inexperienced trainees. Most victims search assistance and counselling from colleagues, family, friends, police or lawyers.

Countermeasures include modifying professional style, taking more precautions at work, changing telephone number, increasing home security; in serious cases residence change is needed. Any attempt of the victim to contact the stalker gets things worse.

Whether the stalker's behaviour is motivated by anger, envy, delusion, or because of misunderstandings about the nature of the psychotherapeutic relationship (false sense of intimacy), psychiatrists should maintain high levels of attention. the threat of stalking should not be underestimated.

We investigated whether adults with attention-deficit/hyperactivity disorder (ADHD) show pseudoneglect—preferential allocation of attention to the left visual field (LVF) and a resulting slowing of mean reaction times (MRTs) in the right visual field (RVF), characteristic of neurotypical (NT) individuals —and whether lateralization of attention is modulated by presentation speed and incentives.

Fast Task, a four-choice reaction-time task where stimuli were presented in LVF or RVF, was used to investigate differences in MRT and reaction time variability (RTV) in adults with ADHD (n = 43) and NT adults (n = 46) between a slow/no-incentive and fast/incentive condition. In the lateralization analyses, pseudoneglect was assessed based on MRT, which was calculated separately for the LVF and RVF for each condition and each study participant.

Adults with ADHD had overall slower MRT and increased RTV relative to NT. MRT and RTV improved under the fast/incentive condition. Both groups showed RVF-slowing with no between-group or between-conditions differences in RVF-slowing.

Adults with ADHD exhibited pseudoneglect, a NT pattern of lateralization of attention, which was not attenuated by presentation speed and incentives.