We aimed to review the distribution of diagnoses in children and adolescents evaluated by a child psychiatrist, in refugee camps in Diyarbakır, Cizre and Silopi province of Turkey.

Sociodemographic data, psychiatric complaints and distribution of psychiatric diagnoses of 38 children and adolescents living in refugee camps in Diyarbakır, Cizre and Silopi were evaluated. Psychiatric diagnoses were made according to DSM-5 criteria but some diagnoses as conversion disorder were also mentioned even tough they were not included in DSM-5.

The sample consisted of 22 female and 16 male children and adolescents. The mean age was 12.1 ± 4.5 and the range was 2–18 years. The mean duration of residency in the camp was 23.2 ± 3.9 days. The most common symptom was sleep problems. The most frequently seen psychiatric disorder was depressive disorder (36.8%) and at least two comorbidities were detected in 50% of children and adolescents. This diagnosis was followed by conversion disorder (28.9%), adjustment disorder (21.8%), acute stress disorder (18.4%), enuresis nocturna (18.4%), post-traumatic stress disorder (10.5%), separation anxiety disorder (10.5%), somatization disorder (7.8%), selective mutism (2.5%) and night terror (2.5%) respectively.

The study revealed that in refugee children and adolescents, starting from the early days of the migration period, various psychiatric symptoms and disorders might be seen. Therefore, it is essential to integrate psychosocial support units into the aid and support programs for refugees and quite important to observe and treat children in terms of psychiatric disorders, starting from the early days of the migration period.

The authors have not supplied their declaration of competing interest.

Despite existentialism positing that existential concerns are universal, research into the existential issues related to addiction remains scarce. An existential model of addiction is lacking.

This research aims to develop an existential model of addiction, conceptualising the development of addiction through to authenticity.

A scoping literature review was carried out using PUBMED, reference lists and internet websites.

Psychopathology, from an existential point of view, occurs as a result of the avoidance of the existential givens which are death, freedom, existential isolation and meaninglessness. In this model, addiction is positioned as a coping mechanism to deal with the existential or neurotic anxiety which arises from facing or avoiding the existential givens. Addiction is defined as being-with-drug; a state in which our inherent relation to others is replaced by a relation with a substance. This state is understood from the ontological, axiological, ethical and praxeological levels, shedding light on the phenomenological experience of addiction. The existential dilemmas around meaning, loneliness, death, freedom, guilt and control while living with addiction are discussed. Finally, existential crises, boundary situations and secondary suffering are seen as the main motivators to overcome addiction.

Phenomenological and existential research support the fact that existential issues are relevant to addiction. This model explains the relationships between existential concepts and addiction, while providing a framework for clinicians to explore and address these issues with patients.

The rapid spread of the SARS‐CoV‐2 pandemic among the world poses challenges to the management of both physical and mental health. This unexpected situation could predict an exacerbation of anxiety, depressions, obsessions, and even multiple cases of psychosis.

The aim of this literature review is to identify and analyze studies conducted in 2020 that investigate the incidence of psychotic disorders, related to COVID-19 pandemic and describe its symptoms.

A systematic search in the PubMed electronic database was performed using keywords “COVID-19”, “pandemics”, “psychotic symptoms”, and “ first episode of psychosis” Relevant literature was limited to articles describing studies conducted and published in 2020.

9 papers met the inclusion criteria. The selected studies reported 20 cases of psychosis in patients with no psychiatric history, directly triggered by stress derived from the COVID-19 pandemic and by social distancing and quarantine. All cases were characterized by sudden behavioral changes out of character, increased concern about coronavirus risk infection, anxiety, psychomotor agitation, and insomnia. In multiple cases, psychotic symptoms were characterized by thoughts of reference, persecution, and structured delusional. 5 patients were convinced that COVID-19 Pandemic was part of a conspiracy and that someone was trying to infect them by diffusing the COVID-19 or other pollutants. Half of the patients had the delusional conviction that they got infected and they were contagious.

COVID-19 pandemic appears to be the trigger for precipitating psychosis which has a high risk of suicidal behavior. During pandemics, mental health professionals should carry out more focused diagnostic and therapeutic strategies.

No significant relationships.

Major depressive disorder (MDD) is complex and multifactorial, posing a major challenge of tailoring the optimal medication for each patient. Current practice for MDD treatment mainly relies on trial-and-error, with estimated 42%-53% response rates for antidepressant use.

We sought to generate an accurate predictor of response to a panel of antidepressants and optimize treatment selection using a data-driven approach analyzing combinations of clinical and demographic factors.

We analyzed the response patterns of patients to five antidepressant medications in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS), and employed state-of-the-art machine learning (ML) tools to generate a predictive algorithm. To validate our results and confirm the algorithm’s external generalizability outside of its training groups, we assessed its capacity to predict individualized antidepressant responses on a separate validation and test sets consisting of 1,021 patients overall from both studies.

The algorithm’s ML prediction models achieved an average accuracy of 0.6416 (64.16%, SD 4.4) across the analyzed medications, and a cumulative accuracy of 0.6012 (60.12%), AUC of 0.601, sensitivity of 0.6034 (60.34%) and specificity of 0.599 (59.9%).

These findings support applying ML to accumulating data derived from large studies to achieve a much-needed improvement in the treatment of depression. By an immediate analysis of large amount of combinatorial data at the point of care, such prediction models may support doctors’ prescription decisions, potentially allowing them to tailor the right antidepressant medication sooner.

Dekel Taliaz is the founder and CEO of Taliaz and reports stock ownership in Taliaz. Amit Spinrad and Sne Darki-Morag serve as data scientists in Taliaz.

Vaccine hesitancy is a known phenomenon predating the COVID-19 pandemic. Vaccine hesitancy is a significant factor effecting the control and spread of the COVID-19 Virus. Hesitancy of parents choosing not to vaccinate their children is studied here. Also studied is the effect of a brief motivational interviewing intervention on the parent’s decision to vaccine their child, or not. What was found was a myriad of beliefs and values in the parents, and varied reactions and outcomes in response to the motivational interviewing.

The aim of our study is to determine whether motivational interviewing techniques can be used as an effective tool to educate patients and their families about the benefits of vaccination against COVID-19 and increase vaccinations rates. In our urban community hospital-based child and adolescent psychiatry outpatient clinic, we found a high level of vaccine hesitancy among our patient population. As motivational interviewing is an evidence-based approach to addressing ambivalence and behavior change, we sought to engage parents with this approach.

This is a quality improvement project where chart review of all pediatric patients currently enrolled in our clinic was performed to determine which patients are unvaccinated for COVID-19. Telephone contact was made to reach parents to obtain verbal consent and to deliver the intervention consisting of standardized motivational interview techniques followed by brief educational points about the vaccines. Follow up calls were made one week later to determine whether there was any change in readiness to consider vaccination on a scale from 1-10. We reached a total of 29 parents on initial outreach, and 11 parents during the follow up phase. Many were lost to follow up due to unavailability or refusal to participate further.

Parents (N = 11, 5- African American, 6- Hispanic) reported on their decision to have their child (mean age=12.2, 55% Female) receive the covid-19 vaccine. Preliminary findings show an increase in readiness on a scale from 1-10 to receive the vaccine following a one week interval post intervention (t(10)=2.096, p=.06), with the most common barriers that subjects endorsed being fear of side effects, skepticism regarding the speed at which the vaccines were developed, and wanting to allow their children to decide for themselves.

We found that there was an overall improvement in vaccine hesitancy following our intervention, though it did not cross the threshold of statistical significance. We also identified common reasons given for hesitancy within our community. Motivational interviewing is a promising intervention to address vaccine hesitancy. Further study is warranted as expanding the reach of such interventions could lead to more robust data as well as broader vaccine acceptance.

None Declared

Lifestyle interventions are important to improve the mental and physical health outcomes of people with mental illness. However, referring patients to lifestyle interventions is still not a common practice for mental healthcare professionals (MHCPs) and their own lifestyle habits may impact this. The aim of this study was to investigate MHCPs’ personal lifestyle habits, their lifestyle history and referral practices, and if these are associated with their lifestyle habits, gender, and profession.

In this cross-sectional study, an online questionnaire was distributed across relevant MHCP’s in The Netherlands. Ordinal regression analyses on lifestyle habits, gender, profession, and lifestyle history and referral practices were conducted.

A total of the 1,607 included MHCPs, 87.6% finds that lifestyle should be part of every psychiatric treatment, but depending on which lifestyle factor, 55.1–84.0% take a lifestyle history, 29.7–41.1% refer to interventions, and less than half (44.2%) of smoking patients are advised to quit. MHCPs who find their lifestyle important, who are physically more active, females, and MHCPs with a nursing background take more lifestyle histories and refer more often. Compared to current smokers, MHCPs who never or formerly smoked have higher odds (2.64 and 3.40, respectively, p < 0.001) to advice patients to quit smoking.

This study indicates that MHCPs’ personal lifestyle habits, gender, and profession affect their clinical lifestyle practices, and thereby the translation of compelling evidence on lifestyle psychiatry to improved healthcare for patients.

Major traumatic natural disasters have occurred worldwide. Post-traumatic stress disorder (PTSD) has been the most common psychiatric disorder discussed by the studies addressing the psychological sequelae of adolescents after traumatic natural disasters. In this study we have studied the impacts of natural disaster yash cyclone that took place in West Bengal on the development of PTSD; factors related to the development of PTSD; predisposing, precipitating, and perpetuating factors related to the development of PTSD.

To assess the incidence and prevalence of ptsd amongst survivors of natural disaster yash cyclone in a rural hamlet of West Bengal.

In this study ,200 survivors from Yash cyclone who belonged to Child and Adolescent age group were randomly selected .PCL 5 Scale was used to collect data and assess the incidence and prevalence of PTSD , standardized Bengali versions of the questionnaire was used in our study.

There is statistical correlation between post traumatic stress disorder and subjects exposed to climate change events such as cyclone Yash.

Initial research suggests that a PCL-5 cut-off score between 31-33 is indicative of probable PTSD across samples.

In our study the mean pcl 5 value from the data assessment is 70.67 with standard deviation of 4.61.

Further assessment by linear regression analyses shows that female subjects are more prone to post traumatic stress disorder and higher income groups are more susceptible to ptsd.

As shown by higher values as per the pcl 5 scale.

Our study clearly demonstrates the impact of climate change and natural disasters on the mental health status of people living in disaster prone areas especially the child and adolescent population. Our study group was child and adolescent population between 10 to 15 years.

The psychologist and volunteers had to collect data in disaster affected zone , yet they collected data which gave a clear cut findings and a very clear statement on climate change and mental health. The values are very high and consistent in most subjects across all twenty domains.

It is our opinion that Mental health support should be provided for all victims of climate change and natural disaster calamities such as cyclone and earthquake.

None Declared

Desvenlafaxine is a prescription medication approved for the treatment of major depressive disorder in adults. Hyponatremia secondary to inappropriate secretion of antidiuretic hormone (SIADH) is a possible side effect in patients receiving serotonin-norepinephrine reuptake inhibitors (SNRIS)

To report a case of SIADH associated with desvenlafaxine.

We present a 80-year-old female patient who required hospitalization due to an episode of psychotic depression. During the hospitalization, the patient developed hyponatremia after commencing treatment with desvenlafaxine. The serum sodium at this time was 117 mmol/L, serum osmolality was 249 mosmol/kg, urine osmolality 395 mosmol/kg and urine sodium 160 mmol/L, consistent with a diagnosis of SIADH. Desvenlafaxine was ceased and fluid restriction implemented. The mental status improved, and electrolyte studies 6 days later revealed serum sodium and osmolality values of 135 mEq/L during treatment with duoxetine.

SIADH has been reported with a range of antidepressants in elderly patients. This case report suggests that desvenlafaxine might cause clinically significant hyponatremia. Close monitoring is recommended in patients starting therapy with antidepressant treatment to study and prevent possible adverse effects.

The authors have not supplied their declaration of competing interest.

As awareness of ADHD has increased worldwide, interest has grown beyond the constellation of ADHD symptoms, to include long-term impact on people's lives and society in general.

Examine the results of studies of long-term life consequences of ADHD.

To identify areas of life affected long-term by ADHD and differences in outcomes with and without ADHD treatment.

Following Cochrane guidelines, 12 databases were searched for studies published in English (1980–2010). Limiting criteria maximized study inclusion while maintaining high study rigor: (1) peer-reviewed, (2) primary study reports, (3) including a comparator condition, and (4) reporting long-term outcomes (mean 8 years, range 6 months-40 years from study start for prospective studies; subjects in adolescence or adulthood for retrospective or cross-sectional studies). The fully-defined electronic search yielded 4615 citations. Manual review based on titles and abstracts yielded 340 studies included in this analysis of outcomes.

The majority of studies (86%, 243 of 281; studies of untreated ADHD only) showed that untreated ADHD has substantial negative long-term outcomes, encompassing nine broad-ranging areas of life: non-medicinal drug use/addictive behaviour, antisocial behaviour, academic achievement, occupational achievement, public services use, self-esteem, social function, obesity, and driving outcomes. In contrast, most studies including ADHD pharmacotherapy and/or non-pharmacotherapy (94%, 46 of 49) showed that compared with baseline or untreated ADHD, long-term outcomes improved or stabilized with treatment of ADHD.

ADHD has notable negative long-term consequences, and this negative impact may be reduced with treatment of ADHD. Supported by Shire Development Inc.

Alcohol dependence is seen in approximately 15-20% of hospitalized patients. Delirium tremens is a serious manifestation of alcohol withdrawal. Understanding physicians' knowledge, attitudes and practices is vital to facilitate early recognition and timely management.

Assess knowledge, attitudes and practices of managing alcohol withdrawal in physicians in Tan Tock Seng Hospital, Singapore.

An anonymous self-administered survey assessing demographics, training experience, department of service, knowledge and attitudes was distributed between July to September 2014 to all registered medical practitioners in fifteen departments within the general hospital.

Six hundred and fourty surveys were distributed and 259 responses received with a response rate of 40.5%. Medical disciplines comprised of 55.1% of the responses and surgical 20.9%. Among the physicians surveyed, 61% were male, 39.8% were less than 30 years old, most were junior doctors/trainees (56%) and 71% saw 0-1 case of alcohol withdrawal/delirium tremens per month.

Overall, physicians felt they had been exposed to management of alcohol withdrawal, there was value in learning how to manage (71%) and learning how to manage should be part of core training (73.4%). Only 40.5% felt they were competent in managing and most felt it was not difficult to learn (43.7%). A majority (58.6%) felt they would be more comfortable if there was a protocol available and 36.6% hoped for more education in this area.

There are positive attitudes towards learning how to manage alcohol withdrawal and a protocol driven approach coupled with education as part of core training will be of value.

There is a huge need to search for new treatment options for depression but as well as its comorbidities. Particularly, depression and metabolic abnormalities often coexist, while a pathophysiological overlap, including microbiota changes, may play a role. Thus, the trials of microbiota interventions (e.g., probiotics) may establish a safe and easy-to-use treatment option as an adjunctive therapy in patients only partially responsive to pharmacological treatment.

The paper presents preliminary results of an RCT on the effect of probiotic supplementation on depression, anxiety and stress level, anthropometric, metabolic, and inflammatory parameters in adult patients with depressive disorders.

The trial was a two-arm, parallel-group, prospective, randomized, double-blind, controlled design that included 43 participants and lasted 60 days. The probiotic preparation contained Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175 in the amount of 3 × 109 colony forming units (CFU). We assessed depression level with Montgomery-Asberg Depression Rating Scale (MADRS), depressiveness, anxiety and stress level with 21-item version of Depression, Anxiety and Stress Scale (DASS-21), quality of life, blood pressure, body mass index and waist circumference, complete blood count, serum levels of C-reactive protein, high-density lipoprotein cholesterol, triglycerides, fasting glucose, selected secondary markers of inflammation and metabolic risk, as well as noninvasive biomarkers of liver fibrosis (APRI and FIB-4).

There were no differences in sociodemographic traits and psychometric questionnaires scores, as well as in anthropometric and basic laboratory findings between placebo and probiotic group at the start of the intervention period. Interestingly, there was a statistically significant improvement in MADRS score in both, placebo (p=0,010) and probiotic group (p=0,037) after intervention (see figure). The same finding was observed in total DASS-21 score as well as anxiety subscale of DASS-21. However, there were no differences in anthropometric, inflammation or metabolic laboratory parameters at the end of the study regardless of intervention.

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Whilst probiotics may benefit some individuals who do not fully respond to antidepressant medications, our study did not show the superiority of probiotics over placebo in managing depressive and anxiety symptoms. However, the target clinical sample, as well as the intervention period and dosage of preparation for this intervention is not fully recognized. Moreover, larger clinical sample may be needed to detect differences between placebo and probiotics.

None Declared

Aggression is a particular problem commonly observed in personality disorders, especially in antisocial personality disorder (APD). It is well known that APD is closely related to substance use disorder (SUD). Individuals with higher aggression levels have also been suggested to have higher rates of SUD. The aim of this study is to investigate aggression levels and substance use characteristics of APD subjects with and without violent criminal behavior.

A total of 124 male subjects with APD consecutively admitted to the Forensic Psychiatry Department of GATA Haydarpasa Training Hospital were involved in the study. All subjects were evaluated with an assessment battery using a semi-structured interview for socio-demographic, APD, and substance use characteristics, APD section of SCID-II, SCID-I, and Aggression Questionnaire. The sample was divided into 2 groups in terms of having a history of violent criminal behavior and compared correspondingly.

Of the APD subjects, 90.3% reported a lifetime history of substance abuse and 75% had a current co-diagnosis of SUD. APD subjects with violent criminal behavior were more likely to be diagnosed with SUD as compared to those without violent crimes. Moreover, APD subjects with SUD had higher aggression levels than those without SUD.

Our results indicate that substance use may mediate the association between APD and aggression. Therefore, the treatment of SUD in APD subjects is an important target particularly for prevention of violent criminal behaviors.