The present aimed to examine the mental health conditions of children, ages 7-11 years, living in conditions of war and conflict conditions in two districts of a Nagorno-Karabakh, Azerbaijan.

The study surveyed teachers of 617 primary school children (mean age 8.9, SD 1.24; 50.7% female) across nine schools in Agdam and Karabakh districts.

The children were evaluated with the previously validated Azerbaijani version of the Strengths and Difficulties Questionnaire (SDQ) Teacher Form. The total difficulty and five subscale scores (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior) were assessed.

About a third of children (32.7%) had abnormal total scores, and a fifth (21.4%) were in borderline range. The SDQ subscale scores included emotional problems (19.4%); conduct problems (20.3%), hyperactivity/inattention (12.2%), peer relationship problems (31.1%), and pro-social behavior difficulties (13.1%). Boys had higher level of difficulties than females (p<.01) with a negative correlation of children’s school performance with maternal education.

The findings of the study show that more than half of the children living in the war zone in Azerbaijan have significant mental health problems. The psychological effects of the war environments have a profund effect on child development and education and need to be revisited under the United Nations Sustainable Development Goals. These include the provision of implicit supports in terms of their emotional, behavioral, psychosocial development and education of children and protection of children from wars, conflicts, and persecution.

No significant relationships.

To explore in a community-based sample of persons aged 0–25 years:

– trends in antipsychotic prescribing;

– characteristics of the zone of residence associated with antipsychotic prescribing rates;

– the pattern of antipsychotic prescribing.

The study was performed using reimbursement data from the French Insurance Healthcare system. Prescribing trends were investigated over the period 2006–2013. An ecological design was used to assess the impact of the socio-economical and health resource characteristics of the zone of residence (n = 96 administrative subdivisions of French territory) on antipsychotic prescribing rates. The pattern of antipsychotic prescribing was explored in a cohort of youths newly treated with antipsychotics.

Over the period 2006–2013, antipsychotic dispensing rates were globally stable in persons aged 0–25 years (4.8 per 1000 in 2006 and 4.9 per 1000 in 2013). First-generation antipsychotic dispensing rates decreased from 3.1 to 2.6 per 1000 (OR = 0.96, 95% CI = 0.94–0.98), while second-generation antipsychotic dispensing rates increased from 2.7 to 3.4 per 1000 (OR = 1.03, 95% CI = 1.01–1.05). Antipsychotic prescribing rates were impacted by health resource characteristics of the zone of residence in children aged 10 years and under and by socio-economical characteristics in those aged 16–20 years. In all the age groups, antipsychotics were principally started by hospital practitioners (47%) and general practitioners (34%). The rates of psychostimulants concomitantly prescribed with antipsychotics were lower than 5%.

Rates of youths exposed to second-generation antipsychotics are still rising. The impact of environmental characteristics on antipsychotics prescribing and appropriateness of these prescriptions in youths should be further investigated.

Transcranial direct current stimulation (tDCS) is a promising neuromodulation method that has, for example, been used to treat depression. Nevertheless, the adverse effects of tDCS and the validity of the current standard tDCS sham protocols have received limited attention.

To evaluate the extent and types of tDCS adverse effects and to assess the reliability of sham stimulation as a control procedure for tDCS in a double-blind setting.

To compare adverse effects between tDCS and sham stimulation groups, and to determine how well the participants and the experimenter are able to distinguish tDCS from sham stimulation.

A sample of healthy volunteers received a 20-minute session of either tDCS (n = 41; 2 mA) or sham stimulation (n = 41; ramp up 15 s, ramp down 15 s; no current in between). The anode was placed over F3 and cathode over F4. Both the participants and the experimenter reported immediate adverse effects and the perceived likelihood for the participant to receive tDCS. Analyses were conducted using the Mann–Whitney U-test.

The tDCS group reported more erythema compared with the sham group (P = 0.016, Cohen's D = 0.444). No other significant differences in adverse effects were observed. In the tDCS group, both the participants (P = 0.034, Cohen's D = 0.612) and the experimenter (P = 0.006, Cohen's D = 0.674) reported a higher perceived likelihood of the participant receiving tDCS than in the sham group.

tDCS has only modest adverse effects. Nevertheless, the current standard sham protocol appears insufficient.

The authors have not supplied their declaration of competing interest.

The state regulation model postulates that ADHD performance difficulties result from failures to regulate activation states in response to changing environmental conditions – producing poor performance under sub-optimal conditions. Behavioral and electrophysiological studies involving the manipulation of event rate (ER) lend support to this idea.

In this preliminary study, we extended this investigation by comparing pupil dilation, an established marker of cognitive effort allocation, in individuals with ADHD, and controls, in response to varying ERs on a simple cognitive task.

Nineteen children with ADHD (age range: 8–14 years) and 21 controls (age range: 10–16 years) completed a target detection task under three different ERs (1300, 4000, and 8000 msec). Pupil dilation was monitored using an eye-tracker.

Our results show that for controls, pupil dilation to targets varied as a function of ER according to a “U” function – with fast and slow ERs inducing greater phasic dilation than the moderate ER. However, for children with ADHD the relationship was linear with dilation increasing as ER decreased.

The results provide the first pupillary evidence suggestive of effort allocation dysregulation in ADHD especially under fast event rate conditions. Future studies should explore interventions to overcome effort allocation problems.

The authors have not supplied their declaration of competing interest.

With about 12 million people, Roma constitute the largest ethnic minority group in the EU. Children from Roma communities are much more likely to be out of school than their peers from majority communities, with a strong impact in global mental health status.

This paper reports the findings of an integrative review conducted to analyze recent empirical and theoretical literature on the factors of school absenteeism in Roma Children.

A comprehensive multi-step search (published 2004–2014) using databases such as SciELOand search engine such as B-on and EBSCO-host was performed. A sample of 8 final research reports met the inclusion criteria and was included in the review. A systematic and interactive approach was used to extract and reduce the data to draw conclusions.

The integrative literature review shows that there are three major groups of factors related to school absenteeism in Roma children – factors related to the children, factors related 8 to the school organization and factors related to the Roma families. These factors exist at the individual, community and institutional levels and are largely consistent with conceptual and empirical framework on mental health vulnerabilities factor’s

Eight themes summarised factors perceived to be related to becoming homeless: Relationship breakdown, Behavioural rebelliousness, Childhood abuse, Foster care/Frequent childhood relocation, Substance use, Eviction, Job loss, Jail; 5 themes categorised factors that participants thought contributed to continued homeless: Adverse life events, Substance use, Avoidant coping, Criminal offense, Ill-health. Chi square analysis indicated that females and young adults reported that relationship breakdown was a triggering factor for becoming homelessness. Young homeless were likely to see adverse life events as a risk factor for continued homelessness whilst mature adults more often reported alcohol/drug abuse as a triggering factor.

This study found that different subgroups experienced that different risk factors had led to their becoming and staying homeless. There may be a role for psychologically informed services to explore self-reported traumatic/trauma-like experiences to increase the ability to successfully intervene in the vicious cycle of events that prolong homelessness for many.

Sleep plays a key role in the pathogenesis and clinic of mood disorders. However, few studies have investigated electroencephalographic sleep parameters during the manic phases of Bipolar Disorder (BD).

Sleep management is a priority objective in the treatment of the manic phases of BD and the polysomnographic investigation can be a valid tool both in the diagnostic phase and in monitoring clinical progress.

Twenty-one patients affected by BD, manic phase, were subjected to sleep monitoring via PSG in the acute phase (at the entrance to the ward) and in the resolution phase (near discharge). All participants were also clinically evaluated using Young Manic Rating Scale (YMRS) Pittsburgh Sleep Quality Index (PSQI), Morningness-eveningness Questionnaire (MEQ) at different timepoints.

Over the hospitalization time frame there was an increase in quantity (Total Sleep Time) and an improvement in the quality and effectiveness of sleep (Sleep Efficiency). In addition, from the point of view of the EEG structure, clinical improvement was accompanied by an increase in the percentage of REM sleep.

Sleep monitoring by PSG can be a valuable tool in the clinical setting both in the diagnostic phase, “objectively” ascertaining the amount of sleep, and in the prognostic phase, identifying electroencephalographic characteristics that can predict the patient’s progress and response to drug therapy. The improvement in effectiveness and continuity of sleep and the change in its structure that accompanies the resolution of manic symptoms also testifies how the regularization of the sleep-wake rhythm is to be considered a priority in treating manic phases.

No significant relationships.

Purine metabolism may be affected in major depressive disorder (MDD). Increased enzymatic activity of the purine cycle has been observed in MDD. In MDD patients, purine metabolite levels also react to sertraline treatment.

To compare serum purine metabolites between: 1) MDD patients and non-depressed controls; and 2) remitted and non-remitted MDD patients.

To clarify the role of purine metabolism in MDD during active illness and recovery.

The sample comprised 99 MDD patients (DSM-IV, SCID interview) and 318 non-depressed controls (Beck Depression Inventory scores < 10) aged 20–71 years. Altogether, 78 patients returned for the follow-up; 33 were remitted and 45 non-remitted. Nine purine cycle metabolites were analysed using ultra performance liquid chromatography. Serum metabolite differences between the study groups were examined using logistic regression adjusted for age, gender, smoking, alcohol use, physical exercise and B-HbAC1. The follow-up analyses were adjusted for age, gender and physical exercise.

The participants’ likelihood of belonging to the MDD group increased 1.1-fold for each 1-unit decrease in serum inosine, 3.2-fold for each 1-unit decrease in guanosine levels and 2.2-fold for each 1-unit increase in xanthine levels. The remitted and non-remitted groups displayed no significant metabolite differences, but the remitted group showed a non-significant shift of values towards the values of the non-depressed group.

Increased degradation of purines and accumulation of xanthine may characterise MDD. Alterations in purine metabolism appear to only partially change during recovery. Nevertheless, recovery-related changes require further investigation in larger samples.

Frontal lobe dysfunction has been considered as a core feature in schizophrenia. To the evaluation of this impairment, time-consuming neuropsychological batteries are needed. Recently, Dubois et al (2000) reported a short battery for assessing frontal lobe function in patients with neurological disorders. To evaluate the clinical efficacy of this frontal assessment battery (FAB) in patients with schizophrenia, we performed both FAB and Stroop Color Word Test (SCWT), which is suggested to be a representative task of executive function.

24 schizophrenic patients and 30 sex and age-matched controls were included. FAB, SCWT and Mini Mental State Examination (MMSE) were performed in both groups. The FAB scores were compared with the performance in SCWT and correlated with education level, age and duration of disease. No difference in the MMSE scores between two groups was found.

The FAB global score was significantly lower in the schizophrenia group compared to controls. In the patients group, the conceptualization and the inhibitory control subscores were negatively correlated with mistakes in color-naming task. The FAB total score, the mental flexibility and the programming subscores were negatively correlated with latencies in color-naming, color-reading and in color-word interference task of SCWT. Negative correlation between the FAB scores and the age and duration of disease was also evident.

The FAB is likely to be a useful and brief battery for assessing frontal lobe function in schizophrenia, as it results from the comparison with SCWT.

Epilepsy is a public health problem that often affects personal and social patients’ life. Self-esteem, an important factor contributing to psychosocial well-being, is generally disrupted in epilepsy.

The aim of our study was to assess self-esteem and factors associated in patients suffering from epilepsy.

We conducted a cross-sectional, descriptive and analytic study, including 20 patients followed for epilepsy at neurology outpatient department, Habib Bourguiba hospital, Sfax, Tunisia. We collected socio-demographic and clinical characteristics, and used the Rosenberg Self-Esteem Scale (RSES).

The mean age was 35.9 ans. Sex-ratio (M/F) was 3. Hobby practice was noted in 45% of cases. The disease evolves since 19.9 years on average. A worsening of health in the last year was felt in 30% of cases. The stigma was reported in 30% of patients. Self-esteem was: very low 5%, low 40%, average 40%, and high 15%. It was better among married patients, living in family and those with disease evolving since more than 10 years, but without a significant correlation. The factors correlated with good self-esteem were: practicing a hobby (P = 0.006) and absence of stigma (P = 0.001). Poor self-esteem was significantly correlated with perceived health worsened during the last 12 months (P = 0.02). It was poor in unstable patients professionally, but without significant correlation.

Our study confirms the decline of self-esteem in patients with epilepsy. A better education of these patients to accept their illness, as well as raising public awareness on this affection could facilitate social insertion and improve self-esteem.

The authors have not supplied their declaration of competing interest.

Violation of the functional activity of the nervous and immune systems is an essential link in the pathogenesis of chronic alcohol dependence. The search for new psychopharmacological agents whose action is directed to correction of neuroimmune interaction opens new perspectives for the treatment of alcohol dependence.

(CBAxC57Bl/6) F1 mice with active and passive behavioral types in a state of chronic alcohol dependence owing to 6 month 10% ethanol exposure were undergoing intragastric administration of original anticonvulsant meta-chloro-benzhydryl-urea. Animal's behavioral and immune parameters, brain cytokines synthesis before and after anticonvulsant receiving were estimated.

In the formation of experimental alcohol dependence in animals the most pronounced changes in motor and exploratory activities in open field test, brain cytokines synthesis and suppression of immune response were registered in mice with passive type of behavior. Daily consumption of ethanol solution in mice with chronic alcohol dependence decreased sharply starting from 2 days of anticonvulsant administration and led to the cessation of ethanol consumption by the 5 day. After anticonvulsant administration for 10 days behavioral parameters in mice were comparable with those in the control group of healthy animals. It also restored brain cytokines synthesis and significant stimulated humoral immune response, estimated by the relative number of antibody-forming spleen cells.

Behavior and immune changes following chronic ethanol exposure depended on the behavior status of animals; administration of the original anticonvulsant meta-chloro-benzhydryl-urea may correct both immune and behavior disorders in mice with chronic alcohol dependence, so it has promise in the treatment of alcoholism.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Quincke-edema has been specifically associated with using certain drugs including chlorpromazine as detailed through two clinical cases.

Illustration of two clinical cases about angioedema induced by Chlorpromazine.

We reviewed clinical data from two patients who committed a suicide attempt and then transferred to the psychiatry department after their somatic stabilization: the first was 27-year-old followed in psychiatry since childhood for intellectual deficiency and admitted to the emergency department for the suicide attempt by taking 14 tablets of chlorpromazine 100 mg and the second was a 20-year-old patient, admitted to the emergency department for suicide attempt by Raticid.

The first patient presented a delusional persecution-themed syndrome with auditory hallucinations. Therefore, he was initially put on injectable treatment with Haloperidol 15mg and Diazepam 30mg then oral relay after 48h by Risperidone 4 mg and Chlorpromazine 200 mg. On the fourthday of his hospitalization, he presented a Quincke edema without laryngeal impairment. We stopped chlorpromazine and eliminated the other causes of this edema, resulting in a gradual regression of symptomatology. The second patient was put on chlorpromazine. On the second day, the patient presented a Quincke edema without laryngeal impairment. Somatic examination and biological exploration did not reveal any abnormalities. We stopped chlorpromazine and put the patient on Dexamethasone 3 days in a row resulting in a good outcome.

These two cases identified a Quincke-edema reaction associated with the use of Chlorpromazine, this complication can lead to life-threatening manifestations and warrants greater awareness of the potential for recurrence.

Being a student in higher education can be a factor in development of psychosocial distress among university students. Numerous studies have raised a lot of concerns related to the stressors consequences. Different types of stressors can lead to impairment in social and academic performance.

to study the prevalence of psychological, social, and academic stress among medical students.

• To explore types & patterns of various stressors affecting medical students.

• To determine the impact of these stressors on the students’ academic achievements.

• To discuss interventional programs that could help in reducing the levels of stress experienced by students and how to cope with it.

We emailed about 1500 medical students in college of medicine, King Saud University with simple four exploratory questions. The survey evaluated the students’ opinions that addressed their psychological, social and academic difficulties and the need for help. Stage two will be a cross sectional survey which includes various validated scales. It will estimate the prevalence of psychological, social and, academic stressors. It will help us to choose the suitable intervention programs accordingly. Stage three will be designing intervention packages and measure their effects.

A total of 164 medical students completed the survey (61.5% were female). Percentage of respondents who reported they had experienced stress since college enrollment is 95%. The main factors that causing stress among medical students are displayed in Figure 1. The majority of respondents emphasized on the immense need for well-being programs.