Women with triple X syndrome (TXS) have an extra X chromosome. TXS appeared to be associated with psychiatric disorders in biased or underpowered studies.

This study aims to describe the prevalence of psychiatric disorders in adults with TXS in a relatively large and less biased group of participants.

In this cross-sectional study, data were collected from 34 women with TXS (mean age = 32.9; s.d. = 13.1) and 31 controls (mean age = 34.9; s.d. = 13.7). Psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview (MINI) and the adult behavior checklist (ABCL). Trait and state anxiety were assessed using the State–Trait Anxiety Inventory.

In the TXS group, MINI results showed a higher prevalence of major depressive episodes (43.3%), psychotic disorders (29.4%), and suicidality (23.5%). Only 50% of the TXS group earned a normal score for the total syndrome score using the ABCL. In addition, levels of trait anxiety were higher in the TXS group. Only three women in each group received psychotropic medication. Impaired social functioning appeared to represent a major risk factor in TXS as regards psychotic, affective disorders, trait anxiety, and low self-esteem.

Women with TXS are vulnerable to developing psychiatric disorders, and women with both TXS and impaired social functioning are even more vulnerable.

Individuals with anorexia nervosa (AN) are often thought to show heightened self-control and increased ability to inhibit desires. In addition to inhibitory self-control, antecedent-focused strategies (e.g., cognitive reconstrual—the re-evaluation of tempting situations) might contribute to disorder maintenance and enable disorder-typical, maladaptive behaviors.

Over a period of 14 days, 40 acutely underweight young female patients with anorexia nervosa (AN) and 40 healthy control (HC) participants reported their affect and behavior in self-control situations via ecological momentary assessment during inpatient treatment (AN) and everyday life (HC). Data were analyzed via hierarchical analyses (linear and logistic modeling).

Conflict strength had a significantly lower impact on self-control success in AN compared to HC. While AN and HC did not generally differ in the number or strength of self-control conflicts or in the percentage of self-control success, AN reported self-controlled behavior to be less dependent on conflict strength.

While patients with AN were not generally more successful at self-control, they appeared to resolve self-control conflicts more effectively. These findings suggest that the magnitude of self-control conflicts has comparatively little impact on individuals with AN, possibly due to the use of antecedent-focused strategies. If confirmed, cognitive-behavioral therapy might focus on and help patients to exploit these alternative self-control strategies in the battle against their illness.

The presence of mixed features in bipolar disorder (BD) has been associated with a worse clinical course and high rates of comorbidities including anxiety, personality, alcohol and substance use disorders and head trauma or other neurological problems [1]. A recent study reports the connection of neurosyphilis and mania [2]. The aim of our study is to evaluate an inpatient with a psychotic mixed state due to a medical condition (neurosyphilis).

An inpatient with psychotic mixed state in BD was assessed with: SCID-P, HRSD, YMRS, and a complete internistical examination, blood test exams, urinanalysis, electrocardiogram and ecocardiogram, as well as a first level brain imagin (CT and/or MRI). We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “bipolar disorder”, “neurosyphilis” AND “mixed state”.

A comprehensive diagnostic and laboratory screening was unremarkable except for a positive venereal disease research laboratory (VDRL). Treatment for syphilis was started and we used olanzapine to control the psychiatric symptoms.

The estimated annual incidence of non-HIV STIs (sexually transmitted infections) has increased by nearly 50% during the period 1995–2008 [3]. Our case report underly, like Barbosa et al., the need to evaluate neurosyphilis as a potential cause of behavioural and psychiatric symptoms that simulate a psychotic mixed state of bipolar disorder. Olanzapine control and improve the psychiatric symptomatology in neurosyphilis. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

In the dawn of increasing interest in climate changes, including extreme weather events, e.g. the Foehn winds, and their influence on public health, it is of great importance to understand their role in suicide.

The association between suicides in the Tatra Mountains, Poland from 1999 to 2014 and the Foehn wind (called Halny in this region) was examined. The belief that suicides are affected by Halny seems to be firmly rooted in local language and culture.

The purpose of the study was to assess the Halny wind as a suicide risk factor.

Data concerning all suicides in the region were included. Meteorological data were derived every three hours during the period of the study. Halny was defined as a complex of interacting meteorological conditions. The two days preceding and following the wind were recognized as the period of the Foehn influence (FI). The probability of suicide in the presence of Halny and during the FI period was calculated.

From 1st January 1999 to 31 December 2014 (5844 days), 210 consecutive suicides were registered. The number of suicides in men was markedly higher than in women. Halny did not change the overall probability of suicide. However, the presence of Halny modified the suicide risk according to the season (P = 0.00095, two-way ANOVA test). The FI periods appeared to increase suicide risk in summer and autumn.

Halny may contribute to the increased suicide risk in summer and autumn. It should be taken into account in suicide preventive interventions in this region.

The authors have not supplied their declaration of competing interest.

In this study we aimed to explore the role of inflammation in subjects with mild Alzheimer dementia (AD), mild cognitive impairment (MCI) and subjective cognitive decline (SCD) via new potential inflammation markers of Neutrophil-lymphocyte ratio (NLR) and Platelet-lymphocyte ratio (PLR). NLR and PLR are useful and cost-effective biomarkers, showing peripheral systemic inflammation, were previously shown in neuropsychiatric disorders [1].

In screening phase the patients were assessed with mini-mental state examination, clinical dementia rating scale (CDR), geriatric depression scale (GDS) and Hachinski Ischemic Scale (HIS) after unstructured psychiatric interview according to diagnostic and statistical manual of mental disorder, Text Revised (DSM-IV, TR). Spectrum of cognitive decline includes 31 patients with mild Alzheimer's disease, 30 subjects with mild cognitive impairment, 31 individuals with subjective cognitive decline. Thirty-one healthy controls enrolled to the study.

NLR value of patients with AD was 2.38 ± 0.81, subjects with MCI was 2.48 ± 1.19, SCD group was 2.24 ± 1.11 and control group was 1.85 ± 0.80. NLR was significantly higher in AD and MCI groups when compared with control group (P = 0.006, P = 0.03, respectively). Platelet-lymphocyte ratio was not correlated with cognitive impairment. Neutrophil counts were indifferent when comparing either of groups. Lymphocyte levels were significantly lower in each of cognitive decline groups when compared to healthy controls.

The present findings suggest that systemic inflammation may have a role in developing Alzheimer's Disease.

The authors have not supplied their declaration of competing interest.

Empathy is the human ability to understand and share other people's feelings through knowledge, observation and memory. Lower levels of empathy lead to poor social functioning, like in Major Depressive Disorder (MDD), Schizophrenia and Autism. Until today, very few studies have focused on empathic deficits in depressed patients.

Our aim was to evaluate whether MDD causes variations in empathy levels.

We wanted to assess cognitive and affective components of Empathy in a sample of women with MDD, and relate them to clinical issues. We compared these results to a control sample.

Our sample included 20 female patients with MDD and a control group, homogeneous for age and gender. We used the Hamilton scale for depression (HAM- D) to evaluate depression severity, the Interpersonal Reactivity Index (IRI) to evaluate cognitive and affective empathy, the Faux pas test to assess cognitive empathy; Pearson and Mann tests for statistic analysis.

In general, patients showed mild depression levels (HAM- D: 14, 41± 6, 07). Severity of symptoms and empathy levels were inversely related with Faux Pas and IRI results (R: −0, 5805; R: −0, 5145), with patients being worse than the control group. Patients showed deficits in personal distress and perspective taking IRI subscales.

Our study shows that in depressed patients both components of Empathy are modified; in particular, personal distress increases, while perspective taking decreases. Additional studies and higher numbers of patients will be necessary to further investigate whether empathic deficits are trait- or state-depending MDD characteristics.

To explore measures in electrocardiograms (ECG) influenced by autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent first antipsychotic pharmacotherapy discontinuation and five-year remission status.

Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.

Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy and with non-remission five years later.

In this longitudinal cohort study, simple ECG measures influenced by autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. As this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.

To evaluate the impact of the perception of body image on sexual activity of obese patients compared to a sample from the general population.

A cross-sectional case-control study. It involved 40 obese married patients (BMI ≥ 30 kg/m2) and 40 normal weight subjects of the general population. A questionnaire was presented with sociodemographic data, somatic and psychiatric personal histories and data on obesity. Besides, there were seven items assessing perception of body image and five items assessing the impact on sexuality.

The sex-ratio (men/women) of obese patients was 0.53. Obese women were less frequently satisfied with their body image than men (p = 0.002). Obese subjects were statistically more dissatisfied with their bodies than controls (p = 0.039). In Obese patients, avoidance of sexual intercourse was significantly related to dissatisfaction with body image (p = 0.025) and to the perception of unattractive body (p = 0.026). Sexual satisfaction was statistically correlated with the perception of a positive attracting body (p = 0.015). Sexual desire was statistically correlated to the satisfaction of body image (p = 0.019), positive perception of an attractive body (p = 0.017) and positive perception of a youthful body (p = 0.041). Sexual pleasure was correlated with the perception of an attractive body (p = 0.016).

The stigmatization of obese subjects leads to a weakening of the healthy perception of body and might be an obstacle to sexual fulfillment.

Maternal psychological stress during pregnancy has been associated with the risk for mood disorders in offspring, although there is no consensus about the influence of the timing of the stress on outcomes. We examined the relationship of prenatal stress at specific times in pregnancy to the incidence of mood disorders in offspring using data from a large birth cohort.

We linked data on 90,079 offspring born in Jerusalem in 1964–76 to Israel's psychiatric registry. We used proportional hazards models to evaluate the link between discharge diagnoses and gestational age during the Arab-Israeli war of June, 1967.

Those in their first trimester of fetal development during the war were significantly more likely to be admitted to hospitals for any mood disorders (RR = 3.01, 1.68–5.39, p = .0002), and the subgroups of bipolar disorder (2.44; 1.0–5.99; p = .054) and “other” mood disorders (3.61; 1.68–7.80; p = .001). Mood disorders were substantially increased in offspring whose mothers had been in the third month of pregnancy in June, 1967 (5.54, 2.73–11.24, p < .0001).

These findings suggest that acute maternal stress in early pregnancy may contribute to the etiology of mood disorders in offspring. They point to the third month of fetal development as a moment of special vulnerability.

Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms. PPD occurs without concomitant change in positive or negative symptoms.

We try to evaluate efficacy of Fluvoxamine, versus efficacy of mirtazapine and venlafaxine in PPD.

25 patients (17 men, 8 female), aged 18-45 years, diagnosed with schizophrenia and PPD by DSM IV criteria. All patients received a second generation of antipsychotic (SGA) .We divided in 3 groups - A (9 patients) treated with SGA + Fluvoxamine (100 mg/day), group B (8 patients) treated with SGA + mirtazapine (30-45mg/day) and group C (8 patients) treated with SGA + venlafaxine (150- 225mg/day). We use BPRS, HAMD, and CGI for severity. Period of study 2 month, with visit at every week. We evaluate efficacy in group A versus efficacy in group B and C.

in group A: 2 drop-out, 6 responders, 1 non-responders; in group B: 1 drop- out, 6 responders, 1 non- responders, in group C: 1 drop- out, 7 responders. The response was faster in group C. The treatment was well tolerated.

The results were similar in all groups, but the most responders were found in patients with family support, in first 3 years of evolution of schizophrenia, with family history of affective disorders, absence of negative symptoms. The response was better at patients who don't have traumatic stress in there children or adolescent period.

According to schema theory people have categorical rules or templates that they use to interpret the world and guide their behavior. A. T. Beck et al. (1990) and Young (1994) defined maladaptive or dysfunctional schemas as enduring, unconditional, negative beliefs about oneself, others, and the environment which organize one's experiences and subsequent behaviors. Because the early maladaptive schemas have been shown to predict psychosocial functioning and psychopathology it is reasonable to suspect that they might also impact substance abuse and substance dependence.

Examining the 3 addict subgroups in terms of EMS factors and comparison of addict patients with control group.

To determine whether there are particular schemas that may be underlying the addictive behavior.

Participants were 34 opiate dependent, 18 methamphetamine addicts, 30 subjects with heroin dependence and 48 healthy subjects as control group. Addict group had completed at least 6 months of treatment, all were in early full remission. Participants were given the Young Schema Questionnaire-Long Form in order to identify EMSs.

The results suggest that there are significant differences between the addict and control groups on 8 of the 18 schemas. There was not found any significant difference between opioid and methamphetamine groups regarding mean scores of EMSs or schema domains.

People with schema domains of impaired performance and impaired limits may be more likely to engage in substance dependence and these findings may have implications for drug abuse prevention programs.

Compassion is the capacity to be sensitive to pain and suffering of ourselves and others, accompanied by the commitment to alleviate it. Self-compassion has a positive effect on mental health (stress reduction and preventing recurrence of depression) and increases with the practice of mindfulness. For the general population several loving-kindness and compassion training programmes have been studied with promising results. At our outpatient center for integrative psychiatry, a novel compassion-focused training was developed: Mindfulness Based Compassionate Living training (MBCL) for patients who already followed a mindfulness training. MBCL consists of explicit exercises in loving-kindness and compassion, so that patients can deepen their skills in mindfulness and particularly in self-compassion in a safe way.

To examine the effects of MBCL training in a heterogeneous psychiatric outpatient population on levels of depression, anxiety, mindfulness and compassion.

The training consists of nine 1,5-hour sessions. Patients completed four questionnaires before and after the training (Beck Depression Inventory-II, Generalized Anxiety Disorder Scale, Five Facet Mindfulness Questionnaire, Self Compassion Scale).

Thirty-three patients participated in this pilot study (mean age 47,6 years; 82% female). MBCL training reduced levels of depression and anxiety, although results for anxiety were not significant. Levels of mindfulness and self-compassion increased significantly.

The outcome of this pilot study was judged very encouraging and MBCL training was therefore included in the treatment program of our center, enabling us to further investigate its effects as well as the underlying working mechanisms.

Little is known about the excess mortality associated with use of some illicit substances. In particular, this concerns the risks associated with injection drug use and psychiatric disorders.

This study estimated mortality following substance abuse treatment among primary users of cannabis, cocaine, amphetamine, MDMA, and opioids. The risks associated with injection drug use and psychiatric comorbidity were assessed.

A register of individuals in treatment for illicit substance disorders was linked with registers on psychiatric treatment and mortality. The study population consisted of 20581 individuals who received treatment in Denmark between 1996 and 2006. There were 1441 deaths recorded over 111445 person-years of follow-up.

Standardized Mortality Ratios (SMRs) for primary users of specific substances were: Cannabis: 4.9, cocaine: 6.4, amphetamine: 6.0, heroin: 9.1, and other opioids 7.7. For MDMA the crude mortality rate was 1.75/1000 person-years, and the SMR was not significantly elevated. Sharing of syringes was associated with increased mortality in both primary users of opioids (hazard ratio (HR): 1.58 [95% CI 1.22–1.99], p < .001) and cocaine/amphetamine (HR: 9.52 (95% CI 3.94–23.02, p < .001). Overall, psychiatric comorbidity was associated with modestly increased mortality (HR: 1.15 [95% CI 1.03–1.29], p = .012) and in particular for primary users of cocaine/amphetamine (HR: 2.74 [95% CI 1.56–4.80], p < .001).

High SMRs were found among individuals who had received treatment for cannabis, cocaine, amphetamine, and opioid use disorders. Injection drug use was clearly associated with excess mortality, while the impact of psychiatric comorbidity was generally modest.

We compared the efficacy and safety of lamotrigine versus placebo for the treatment of acute alcohol hallucinosis comorbid depersonalization disorders.

10 days, randomized, double-blind, parallel study. A total of 40 patients with an ICD-10 diagnosis of acute alcohol hallucinosis comorbid depersonalization disorders were randomized to lamotrigine 300 mg/d (n = 40), or placebo (n = 40). The primary efficacy measure was the PANSS subscale for hallucinosis and Cambridge Depersonalization Scale (CDS).

Iamotrigine treated patients demonstrated a statistically significant greater improvement in PANSS subscale for hallucinosis and CDS than placebo-treated patients.

Lamotrigine demonstrated greater efficacy than placebo in treatment of acute hallucinosis comorbid depersonalization disorders and was generally well tolerated.

The application of scientific evidence in clinical practice management of Major Depressive Disorder (MDD) is complex. Generally, the usual dissemination process and implementation of Clinical Practice Guidelines (CPG) induce modest changes. A computerized version of a Clinical Practice Guideline for Major Depression (e-CPG-MD) has been integrated in Electronic Clinical Records of Primary Care in Catalonia (Spain). It offers an opportunity to improve clinical results. The design allows access to precise help in the visit itself, improving diagnosis, treatment and follow-up.

To evaluate the effects of a multifaceted implementation process of e-CPG-MD, analysing their use and changes in MDD diagnosis.

A cluster randomized clinical trial was performed in 10 primary care centers (PCC) in Barcelona. In five of ten centers, a multifaceted implementation process of the e-CPG-MD was developed during 6 month. The active process includes: interactive training program, regular feedback audit, educational outreach visits and periodic reminders.

The multifaceted implementation of e-CPG-MD was associated with a significant increase in use during the first 6 months (4.1% + 3.1% vs. 52.7% + 7.3%, P < 0.001). In the active centers, the MD diagnosis increased significantly (rate quotient = 1.56, P < 0.001) and the proportion of moderate and severe MD increased (13.6% vs 41.1%, P = 0.002).

A multifaceted implementation method of e-CPG-MD increased significantly its use in active centers at 6 months. Diagnosis of MDD and the proportion of moderate and severe cases also increased significantly.

The authors have not supplied their declaration of competing interest.

Benzodiazepines impair cognitive function, especially in the elderly. The current analysis sought preliminary data on the effect of pregabalin on cognition in elderly patients with GAD.

Patients aged ≥65 years who met DSM-IV criteria for GAD, with HAM-A≥20 and MMSE≥24, were randomized to 8 weeks of treatment with flexible-dosage pregabalin (150-600 mg/d) or placebo. A subgroup (N=89; 81% female; mean age=70.4 years; mean HAM-A=27.3) completed a cognitive battery including the Digit Symbol Substitution Test (DSST) and the Set Test at baseline and endpoint.

At baseline, scores for pregabalin and placebo on the DSST were 13.75±3.51 vs 13.39±3.89 and on the Set Test 37.88±3.25 vs 37.63±3.69. There was significant (P<.05) inverse Pearson correlation between HAM-A item-5 (intellectual) and DSST (-0.32) and Set Test (-0.30) scores. There were also moderate inverse correlations between the DSST and HAM-A total score (-0.35) and age (-0.25). Weaker correlations (with the same directionality) were observed between the Set Test and these variables. At 8-week LOCF-endpoint, scores were comparable on the DSST (13.82 vs 14.54) and the Set Test (38.24 vs 37.95). Endpoint improvement in the HAM-A was moderately correlated with improvement in the Set Test (-0.23, P<.05) but not with DSST. Univariate and multivariate analyses showed treatment with pregabalin had no effect on endpoint cognitive function.

Pregabalin significantly improved the symptoms of GAD in patients aged ≥65 years and caused no impairment of cognitive function. A more extensive cognitive battery is needed to confirm this preliminary finding.