Migratory mourning has specific features and migration is itself a risk factor for mental health. Basic grieving relate to seven areas: family and friends, language, culture, land, social status, contact with the national group and physical risks, as well as general mourning the failure of the migration project.

We intend to trace the process of acculturation seeking to distinguish its symptoms from those of most common psychiatric disorders.

We conducted a literature review using the National Library of Medicine and PubMed search system.

Adaptation process traces a U-shaped curve. In the second stage called crisis stage may appear rejection or isolation, sadness, crying, sleeplessness, irritability, distrust, recurrent and intrusive thoughts, psychosomatic symptoms (headaches, fatigue, musculoskeletal pain), dissociative and somatoform symptoms. Stress reactions can occur with cognitive fatigue, role and personal shocks.

Ulysses syndrome has features in common with acute stress disorder or adjustment disorder. Differential aspects regarding DSM-IV are: multiple identifiable stressors of high intensity, long duration, cultural interpretations and association of dissociative and somatoform symptoms.

Main observed pathologies are: PTSD, schizophrenia and paranoia, somatization and affective disorders, whose clinical expression is primarily determined by cultural factors.

Professionals should know the different manifestations of mental illness in immigrant population to distinguish them from experiential reactions and to avoid upset psychiatrization and therapeutic nihilism. Ulysses syndrome seems closer to preventive health and psychosocial support areas.

To evaluate the extent of hypomanic symptoms in patients presenting with a current major depressive episode (MDE) and to identify characteristics differentiating patients with hypomanic symptoms from those with pure unipolar depression, using the HCL-32 self-assessment tool.

This cross-sectional diagnostic study was performed in eighteen countries. Community- and hospital- based psychiatrists included consecutively all consulting adult patients with a diagnosis of MDE and completed a questionnaire on sociodemographic variables, diagnosis, medical history, treatment and comorbid psychiatric disorders. Each patient completed the Hypomania Self-Rating Scale (HCL-32 R2), and those scoring ≥14 were assigned a diagnosis of bipolar disorder. The frequency of study variables in the bipolar disorder (BD) and unipolar depression subgroups were compared.

A total of 5635 patients were included. Overall, 1645(39%) had received a diagnosis of BD, 703(16%) fulfilled DSM-IV-TR criteria for BD and 2942(54%) scored ≥14 on the HCL-32. Patients scoring ≥14 on the HCL-32 were significantly more likely to have experienced a mood switch in response to antidepressants (OR:3.4), a family history of bipolarity (OR:2.4), comorbid substance abuse (OR:2.1) or borderline personality disorder (OR:1.7) and current mixed-state symptoms (OR:1.5).

In patients with DSM-IV MDE self-assessed, hypomanic symptoms were present in 54% of patients, whereas only 16% fulfilled DSM-IV criteria for bipolar disorder. However, these patients presented features recognised to be associated with bipolar disorder. The presence of bipolarity in patients presenting with a major depressive disorder may be frequent and use of this questionnaire would contribute to improve awareness and prompt better diagnosis.

Previously, a number of observational studies have found no association between contact with services and improved outcomes in children with psychopathology, despite the existence of effective interventions. The British Child and Adolescent Mental Health Survey (BCAMHS) 2004 is a study of 5,325 children aged 5-16, with data on parent-reported mental health-related public sector service contacts and psychopathology over three years, allowing exploration of the association in a large community-based dataset.

• Describe the trajectories of children in contact and not in contact with services over three years from 2004-2007

• Explore the association between mental health-related service contact over the study period and outcomes in terms of parent-rated psychopathology

This study is a secondary analysis of children's trajectories by service contact status (no contact, contact 2004 only, contact 2007 only, contact 2004 & 2007). The main measure of psychopathology over time was the well-validated Strengths and Difficulties Questionnaire. Multivariable linear regression was used to examine the association between contact and outcomes in children with a psychiatric disorder at baseline in 2004.

Children in contact with services demonstrated the highest levels of psychopathology over time, and the 2007-only contact group displayed a trajectory of increasing difficulties. Overall, contact with services was not associated with improvement in outcomes, following adjustment for measured confounders.

The effectiveness of contact alone with services was not demonstrated in our findings. Despite methodological limitations, this underlines the need for continuing development and consistent implementation of effective interventions, alongside initiatives evaluating outcomes within services.

Psychiatric assessment and care of people with Intellectual Disability (ID) is complex due to their cognitive and communication impairments. Demand for further training in this area by trainees in psychiatry has been well documented. The main of aims of this study were to explore the attitudes and perceptions of psychiatry residents and non-residents (non-trainees) with regards to care of patients with ID as well as their knowledge and training in this area.

The study was conducted as an anonymous survey at the Institute of Mental Health, Singapore. A survey questionnaire developed by the study team was sent to residents and non-residents in psychiatry.

Forty-eight out of the 76 questionnaires were returned with a response rate of 63.16%. Twenty-eight participants described themselves as non-residents and the rest were residents. All participants responded that postgraduate training was required in the area of ID and mental health and majority reported that available training was inadequate. Ninety percent of respondents believed that people with ID were vulnerable to exploitation by other patients in the inpatient unit and 94% of respondents believed that people with ID should be managed by a specialist team.

Currently residents and non-residents in psychiatry see that training in ID and mental health as well as services for people with ID as inadequate. Efforts should be made to include specialist training in psychiatry of ID in the Singapore psychiatry curriculum to enhance the confidence and expertise of psychiatrists in this field.

Sleep problems are commonly seen among the elderly people and these problems affect the quality of sleep and the quality of life.

The current research was conducted in order to determine the quality of sleep and the quality of life of the elderly people.

The research was conducted with 187 elderly people. Personal information form, Pittsburgh Sleep Quality Index and Turkish Version of WHOQOL-Bref-Quality of Life Scale were used for the data collection.

The ages of the participant individuals ranged from 65 to 83 and mean age was 72.5 ± 5.24. It was determined that all of the elderly people had a bad quality of sleep. There was a significant negative correlation between areas of the quality of life and the quality of sleep. It was found out that scores of all of the areas of the quality of life were low among the elderly who were illiterate and had a chronic physical disease and that their quality of sleep was worse. The widowed and women had lower scores in physical, psychological and social areas of the quality of life scale and their quality of sleep was worse.

The quality of sleep and the quality of life are closely interrelated among the elderly people. A decrease in the quality of sleep causes a decrease in the quality of life. The quality of sleep should be continued by ensuring sleep hygiene among the elderly people and thus the quality of life should be increased.

Individuals with serious mental illness (SMI) are at considerably higher risk for morbidity and mortality than those in the general population. In these diagnoses – a refinement of intervention is required, the user perspective overall is still underrepresented.

In mental health Services there is an international trend toward recovery-orientated interventions, like Peer-support (PS) in formal mental health services. There is a raising but still insufficient evidence for it's benefits

In Germany this is the first try to implement and research peer support services area-wide in psychiatric facilities to provide a low-threshold service that aims individual recovery. This project forms a part of 'psychenet ', a project supported by the Federal Ministry of Education and Research of Germany during 2011 – 2014 and investigates the effect of peer support on psychosocial factors, functioning and hospital admissions.

In a controlled multi-centre-trial involving 10 hospital facilities in Hamburg − 216 in- and outpatients suffering from affective disorders, psychoses or personality disorders get randomized to either receive additional Peer-Support at most half a year aligned to individual requirements or treatment as usual. A mixed method repeated measurement analysis is conducted.

Subjects refill questionnaires and get rated by clinicians at three points of measurement: Entry of the half year of intervention, after the intervention and in a six month follow up. Psychosocial Outcomes, global functioning, and in and outpatient days were assessed. There is a significant positive Effect for the PS of the primary outcome. Results will be presented

Atypical antipsychotics (AAPs) are known to increase the risk of metabolic syndrome (MetS), a predictor for cardiovascular disease and diabetes. This risk differs according to the AAPs.

The objective of this analysis was to examine the incidence of MetS in schizophrenia patients treated with asenapine or olanzapine.

The aim was to estimate the incidence of MetS among schizophrenia patients (DSM-IV criteria) after 52 weeks of exposure to asenapine or olanzapine.

Pooled data from patients completing 52-week extension of randomized trials (041512, 041513, 25544 and A7501014) were included. Patients were treated with asenapine or olanzapine.

The National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) definition of MetS was used, defined as 3 or more of the 5 following risk determinants: waist circumference > 102 cm for male and > 88 cm for female, triglycerides = 150 mg/dL, HDL cholesterol < 40 mg/dL for male and < 50 mg/dL for female, sitting blood pressure ≥ 130/85 mm Hg, or fasting glucose ≥ 110 mg/dL.

Incidence (i.e. new metabolic cases in patients without MetS at baseline) was calculated at week 52.

741 patients were included in this analysis of 52-week studies (asenapine 397, olanzapine 344). After 52 weeks of treatment exposure, the incidence of MetS was significantly higher in olanzapine-treated patients than in asenapine-treated patients (19.44% versus 11.46%, p = 0.01).

These post-hoc analyses confirmed a higher risk of developing a MetS with olanzapine. The incidence of MetS after 52 weeks of treatment with asenapine was found to be significantly lower.

Excessive mind wandering is a common feature of ADHD in adulthood also referred to as mental restlessness and ceaseless mental overactivity. ADHD is a predisposing factor for many psychiatric symptoms, especially negative emotions such as depression and anxiety. Rumination is thought to be a mediator for depression in individuals with ADHD. The above-mentioned mental processes may reduce the ability of individuals with ADHD to be mindful.

This study investigates whether the mentation processes (excessive mind wandering, rumination, mindfulness) mediate the relationship between ADHD symptoms and anxiety, and depression in adults with ADHD.

Medication-free 175 individuals with ADHD who were referred to the Adult Neurodevelopmental Disorders Clinic, Department of Psychiatry, Selçuk University were invited to the study. After initial diagnostic examination including The Structured Clinical Interview for DSM-5 (SCID 5), all participants completed a test battery that included a sociodemographic form, the Adult ADHD Severity Rating Scale, the Hospital Anxiety Depression Scale, the Mind Excessively Wandering Scale, the Ruminative Response Scale, and the Freiburg Mindfulness Inventory. The data of 159 patients whose ADHD diagnosis was confirmed, who did not have any mood episodes and psychotic symptoms at the time of inclusion of the study, and who filled out the forms completely, were included in the analysis. The study was approved by the Selçuk University Local Ethics Committee.

Participants ages ranged from 18 to 39 (mean of 22.93 ± 4.36), and 57.2% (n = 91) were women. Also, their 48.6% (n = 77) reported that they alcohol use, and 21.1% (n = 34) had substance use history. According to SCID 5 interview, participants 64.2% had comorbid psychiatric conditions. Pearson correlation analysis revealed that ADHD symptoms, rumination, excessive mind wandering, anxiety, and depression scores were significantly positively correlated with each other, but all were negatively correlated with mindfulness. Linear regression analysis showed mindfulness association with rumination, excessive mind wandering, anxiety, and depression scores, but not with ADHD symptoms. Thereupon, a conducted mediation regression analysis showed that ADHD symptoms indirectly worsened depression and anxiety through increased rumination and excessive mind wandering, and decreased mindfulness ability (Figure 1).

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Adults with ADHD have distressing mentation patterns which worsened their anxiety and depression. Mindfulness-based cognitive behavioral therapy modalities may help improve excessive mind wandering and rumination in ADHD. Our findings should be warranted in future studies of functional brain connectivity patterns that may serve as a mentation endophenotypes in ADHD.

None Declared

The ageing process is characterized by a high level of complexity, due to theco-occurrence of multiple chronic diseases (comorbidity) that often resultsin the concomitant use of multiple drug therapies (polypharmacy) fortreatment and prophylaxis. Institutionalized elderly may be regarded as theparadigm of this complexity because of their multiple chronic diseases anddecreased functional and cognitive functions.

To explore and characterize the prevalence of comorbidity and polypharmacy ina sample of institutionalized elderly.

A cross-sectional study was conducted with an elderly sample recruited fromthree Portuguese nursing homes. Clinical information was obtained throughinterview and by review of residents’ medical records. The AnatomicalTherapeutic Chemical/ATC classification was used to indicate the main groupof medicines used, and polypharmacy was categorized into minor (2–4medicines) or major (≥ 5). Comorbidities were coded using theindividual body systems of Cumulative Illness Rating Scale forGeriatrics/CIRS-G.

The sample included 175 elderly with a mean age of 81 (sd = 10) years andinstitutionalized for an average of 7 (sd = 11) years. Residents presented amean of 9 (sd = 4) co-morbid medical conditions, mostly psychiatric (80.8%),vascular (76.7%) and endocrine/metabolic (70.3%). Major polypharmacy wasverified for 73.9% of residents. The mean number of medicines was 7 (sd =3), most commonly for cardiovascular (86.0%) and nervous system (79.1%) andfor blood and blood-forming organs (69.2%).

As in other studies in similar settings, polypharmacy was fairly common.These results convey an important message considering that polypharmacy hasbeen associated with negative clinical outcomes that could otherwise bepreventable by reducing the number of prescribed medicines.

The authors have not supplied their declaration of competing interest.

The people who maintain close relationships with relatives suffering from addiction to psychoactive substances may become more sensitive to develop a physical, mental and emotional state, similar to an emotional addiction.

The aim of this study is to give a cross-cultural perspective to codependence and reveal the profile of female relatives of addicted persons in Greece and Bulgaria.

Thirty-nine Greek mothers of addicted persons from Greece (Mage = 43.97, SDage = 18.34, all high school graduates), a similar group of forty Greek female participants (32 mothers of non-addicted persons, Mage = 40.97, SDage = 17.22, all high school graduates), and thirty Bulgarian women (all mothers of addicted persons, Mage = 53.55, SDage = 5.58, all high school graduates) were examined with the STAI-state questionnaire, the ZUNG Self Rating Depression Scale and the Questionnaire of Establishment of Codependency.

Results indicated that there are statistically significant differences between the Greek and the Bulgarian female relatives of addicted persons on the scores ofZUNG (MGreek = 51.64, SDGreek = 2.07, MBulgarian = 73.63, SDBulgarian = 4.04) and STAI (MGreek = 53.89, SDGreek = 2.68, MBulgarian = 74.16, SDBulgarian = 4.84), but not for the Questionnaire of Establishment of Codependency. Statistically significant differences in all three questionnaires were found for the groups of Greek mothers of dependent and non-dependent persons (P < .005).

This research suggests that although there is more anxiety and depression reported by the Bulgarian mothers of addicted persons, no cross-cultural difference was found for codependence in mothers of addicted persons.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is one of the sensory modulation disorders among others like autism, Asperger syndrome and Fragile X syndrome. Little is known about patients with ADHD and their sensory processing issues in Sri Lanka.

To investigate differences in sensory processing among children between (3–10) yrs with attention deficit hyperactivity disorder and those who are typically developing in Sri Lanka.

A descriptive cross sectional study of 75 children aged (3–10) yrs attending child guidance clinic at Lady Ridgeway Hospital (LRH) were compared with 75 age matched peers who were typically developing, using the Short Sensory Profile (SSP).

Out of the sample population of 150, there was a significant difference in sensory processing total score (P-0.001) (df-29) of children with ADHD when compared to the typically developing group. The greatest differences were reported on the tactile (P-0.013), taste (P-0.000), under responsiveness (P-0.002), auditory filtering (P-0.002) & low energy (P-0.017). Out of the raw items commonest sensory processing problems were difficulty standing in line, distractability if there is a lot of noise around, being unable to work with background noise & difficulty paying attention due to auditory deficits.

Majority of children in this sample were reported to have difficulties with processing and responding to sensory input on the SSP. Further studies are needed to assess sensory issues in children with ADHD, to carry out effective interventions.

The authors have not supplied their declaration of competing interest.

To evaluate the efficacy, safety, and tolerability of fixed-dose agomelatine 25 and 50 mg/d in the treatment of outpatients with obsesive-compulsive disorder (OCD) compared to placebo.

In this 8-week, multicenter, double-blind, parallel-group trial, patients with DSM-IV-defined OCD were randomly assigned (1:1:1) to receive a once-daily dose of agomelatine 25 mg, agomelatine 50 mg, or placebo. The primary efficacy measure was the change from baseline to week 8 in the clinician-rated 17-item Hamilton Depression Rating Scale (HDRS(17)); other efficacy measures were The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression scale. The study was conducted between December 2009 and January 2010.

Agomelatine 25 mg/d was more efficacious based on the HDRS(17) total score (P = .01) compared to placebo throughout the treatment period, whereas for agomelatine 50 mg/d, statistically significant reduction in HDRS(17) total score could be observed from weeks 2 to 6 but not at week 8 (P = .144). A higher proportion of patients receiving agomelatine 25 mg/d showed clinical response (P = .013), clinical remission (P = .07), and improvement according to the Clinical Global Impressions-Improvement scale (P = .065) compared to those receiving placebo. No statistically significant difference between patients receiving agomelatine 50 mg/d compared to placebo on clinical response. Both agomelatine doses were safe and well tolerated, although clinically notable aminotransferase elevations were observed transiently in the agomelatine 50 mg/d group.

Agomelatine 50 mg/d provided evidence for its antidepressant efficacy until week 6 and was also safe and well tolerated.