Hyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia.in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.

we report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms.an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.

in this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.

Hyperthyroidism is very common in general population, being infradiagnosed most of times.in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder.in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.

The authors have not supplied their declaration of competing interest.

Mindfulness based programs during pregnancy (some including self-compassion components) increase self-compassion, mindfulness and maternal self-efficacy, and reduce anxiety, stress and psychological distress in pregnant women. According to our knowledge, there are no studies about the association between self-compassion and sleep outcomes in pregnancy.

To explore differences in self-compassion, between three sleep groups, in a sample of Portuguese pregnant women.

Four hundred and nineteen pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) completed the Self-Compassion Scale (SCS, Bento et al., 2015), presenting six dimensions (self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification) and the Insomnia Assessment Scale (Marques et al., 2015). Three sleep groups were formed: good sleepers (no insomnia symptoms; no associated daily impairment); insomnia symptoms groups (one/more insomnia symptoms; no associated daily impairment); insomniacs (one/more insomnia symptoms; daily associated impairment).

There were significant differences in the total SCS, self-judgment, isolation and over-identification scores, between sleep groups [respectively, F (2,396) = 7,926, P ≤ 0,001; F (2,409) = 19,155, P ≤ 0,001; F (2,410) = 13,016, P ≤ 0,001; F (2,412) = 11,258, P ≤ 0,001]. Self-judgement, isolation and over-identification scores of good sleepers and insomnia symptoms group were higher than of insomniacs. Total SCS score of good sleepers was higher than of insomniacs and the same score of symptoms of insomnia group was also higher than of insomniacs.

Results seem to show the importance of developing self-compassion to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).

The authors have not supplied their declaration of competing interest.

Antipsychotic drugs are the cornerstone of the pharmacological treatment of psychotic disorders; however, even with Second-generation antipsychotics (SGA), adverse effects continue to be extremely accentuated and the treatment effectiveness is compromised by low adherence of the patient.

Taking into consideration the importance of adverse effects for psychotic therapeutics, this study aims to analyze the adverse effect of the Neuroleptic Malignant Syndrome (NMS) reported in EudraVigilance Database, associated with 3 widely used SGA, Risperidone, Quetiapine, and Clozapine.

The EudraVigilance Database was analyzed from 09/01/2017 to 31/10/2020 about NMS, associated with Risperidone, Quetiapine, and Clozapine. NMS is the second most reported adverse effect inside the Nervous System Disorders SOC (System Organ Class). There were just considered NMS as suspected adverse effect.

It was observed a general tendency of reduction of NMS reports from 2017 to 2020 (most of them performed by healthcare professionals). Risperidone presented the highest level of reports during this period (more than 350), followed by Quetiapine and Clozapine. The NMS reports were predominantly referred to the male sex, from 18 to 64 years old. Risperidone presented the lowest number of fatal cases of NMS (1), in contrast with 3 reported with Quetiapine and Clozapine. A significant number of patients with Schizophrenia recovered from NMS.

It is important to do clinical monitoring of the NMS, because it is rare, although it has life-threatening consequences. Pharmacovigilance databases are important tools to evaluate the safety of drugs and it must be more widely and efficiently promoted for healthcare and patients use.

No significant relationships.

Adolescents’ well being is affected by their parenting situation and can influence their well being over time. We present an exploratory study with an Illumina 450 k array, comparing methylation in adolescents, based on perceived parenting at T0, and how methylation can interact with parenting in explaining depressive symptoms two years later (T2).

Identify differentially methylated regions (DMRs) associated with perceived parenting at T0 and investigate their association with depressive symptoms two years later.

An exploratory analysis evaluating the association between methylation and depressive symptoms longitudinally.

From two extreme parenting clusters: perceived supportive, and punishing neglecting, we randomly selected 44 adolescents (MAge = 14 at T0; 48%boys). The CES-D scale (Center for Epidemiologic Studies Depression Scale) assessed depressive symptoms. DMRs were identified based on the parenting clusters (DMRcate and comb-p) using llumina Infinium HumanMethylation 450 BeadChip data. Associations between the most significant CpG for each DMR and the depression score at T2, were calculated using linear regression analysis.

We identified 17 DMRs, but only cg13306335 in PEX10 was associated with depressive symptoms at T2 (P = 0.0014, Bonferroni (17 tests): P < 0.0029). Additionally, an interaction between parenting at T0 and PEX10 methylation (T0) in explaining depressive symptoms (T2) can be suggested (P = 0.014).

We show that methylation at PEX10's most significant CpG is correlated with depressive symptoms at T2, these exploratory results also suggest a possible interaction between parenting and PEX10 methylation at T0 in association with depressive symptoms at T2. Validation in a larger sample is needed to support the role of methylation and its interactions in depression over time.

The authors have not supplied their declaration of competing interest.

Tuberculosis is one of India's major public health problems. According to WHO estimates, India has the world's largest tuberculosis epidemic. Many research studies have shown the effects and concerns revolving around TDR-TB especially in India, where social and economic positions are still in progression.

Seventeen questionnaires were administered to the consented participants regarding the demographic data and awareness, also Hospital Anxiety and Depression Scale (HADS) was recorded to analyse the level of depression. The average age was 32.3 years (STD = 12.7), and the age range was from 13 years to 71 years. The data collected was analysed with SPSS 19.

The patients who were in the intensive phase had a considerably higher depression rate (42%) than the patients who were in the continuous phase (22%). However, the variations were not enough for the statistical significance. The patients with TB only (35%) showed a higher depression rate than the patients with TB/HIV (28%).

According to this study, it can be found that the prevalence of depression was lower for patients who were old, female, college educated, married, and earned the highest, compared with their counterparts. Most of these findings might agree with a general perception that social and financial stabilities would provide a less likelihood of being depressed.

The author has not supplied his declaration of competing interest.

The Programme d’éducation à la vie affective, amoureuse et sexuelle (ÉVAAS), an affection, love and sex education program for people with moderate intellectual disabilities (Desaulniers, Boucher, Boutet, & Voyer, 2001), is widely used in Quebec and is applied in several locations in Belgium, France and Switzerland.

An implementation evaluation was recently completed as the first stage of a program evaluation.

The aim of the project was to establish the value of this program.

For the purpose, 73 ÉVAAS sessions at five different sites were observed and questionnaires and interviews with 10 group leaders and their supervisors were analyzed.

It was found above all that the program was normally implemented in accordance with its spirit and objectives. However, it was also noted that follow-up to interventions carried out during ÉVAAS sessions was much less structured and sustained, particularly as regards those intended for friends and family.

The research team formulated seven recommendations regarding the program's implementation framework and adjustments required to ensure the achievement of its objectives. The recommendations concern the authors of the program, the educators who use it, their supervisors, as well as service managers.

Cognitive deficits and anxiety are common symptoms in patients suffering from schizophrenia.

The aim of the research was to find a relationship between selected cognitive functions and intensity of anxiety as state and trait in people suffering from schizophrenia.

18 patients (9 women and 9 men) with a diagnose of paranoidal schizophrenia (according to ICD-10) were recruited to the study. The battery of cognitive neuropsychological tests used to assess cognitive functions included: trail making tests, part A and B, and Stroop test, part RCNb and NCWd. The intensity of anxiety as state and trait was assessed by means of the Spielberger State-Trait Anxiety Inventory (STAI).

In the examined group statistically significant relation was found between the results of trail making test, part A and B (measuring psychomotor speed and visual spatial working memory), as well as part RCNb of the Stroop test (measuring reading speed), and the intensity of anxiety as state measured with STAI. Another statistically significant correlation was found between results of trail making test, part A (measuring psychomotor speed) and anxiety as trait measured with STAI. No other significant correlations between results of the applied cognitive tests and anxiety as state and trait were found.

The above correlations between cognitive tests results and intensity of anxiety indicate that there must be a modulating impact of emotions on some of measured cognitive functions. The awareness of these correlations may be important in the process of constructing rehabilitation programmes for patients.

Tobacco use has been associated with more excitement and agitation symptoms, greater severity of global psychopathology as measured by the Clinical General Impression (CGI) Scale, and psychotic symptoms in patients with schizophrenia.

To assess the effects of nicotine abstinence versus nicotine maintenance on the clinical symptoms of a sample of outpatients smokers diagnosed with schizophrenia.

Sample: 81 outpatients with schizophrenia [72.8% males; mean age (SD) = 43.35 (8.82)] currently smoking tobacco [no. of cigarettes (SD) = 27.96 (12.29)]. Desing: non-randomized, open-label, 6-month follow-up and multi-center study conducted at 3 sites in Spain (Oviedo, Santiago de Compostela and Orense). Instruments: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression for Schizophrenia (CGI-SCH), Hamilton Depression Rating Scale (HDRS). Antropometric measures: Body mass index (BMI) and waist circumference. Vital sings: heart rate. Procedure: Patients were assigned to 2 conditions:

– control group = patients continuing their tobacco use;

– experimental group = patients participated in vareniclina or nicotine patches treatment for smoking cessation.

Patients were evaluated at baseline (all patients smoking) and after 3 and 6 months.

No significant differences (P>.05) were found between groups at baseline evaluation. Likewise, there were no significant differences between smokers and non-smokers after treatment (3 and 6 months follow-up) in their clinical symptomatology (according to PANSS, HDRS and CGI-SCH), anthropometric measures and heart rate.

No significant differences were found in the clinical symptoms after a period of nicotine abstinence. Therefore, clinicians should motivate and help their patients to quit smoking (CIBERSAM - FIS PI11/01891).

The authors have not supplied their declaration of competing interest.

Lithium has been widely used as mood stabilizer in bipolar disease, despite its narrow therapeutic range and its side effects. Sodium levels and water consumption could affect lithium renal elimination.

Describe a lithium intoxication without risk factors and normal kidney function.

A 71-year-old female, diagnosed with bipolar disorder, current episode euthymic. On treatment with lithium 800 mg/day, 6 months ago she started with hematuria and urologist found a multifocal oncocytoma in left kidney. She was operated with double lumpectomy and partial nephrectomy without complications. Normal preoperative and postoperative renal function. Two months ago, she started with dysarthria, dystonia and coarse tremor, and T wave inversion on the electrocardiogram. In the blood test, lythemia was 1.67 mEQ/L. Creatinine was 0.65 mg/dL. She was admitted to Internal Medicine Unit. She was treated with rehydration by serum. All psychoactive drugs were removed. Twenty days later, lithemia was undetectable in the blood analysis.

Two weeks ago, the patient was transferred to the mental health unit due to worsening her mood. Lithium was reintroduced 3 days ago, at doses of 200 mg per day. Today, the patient starts again with symptoms of poisoning by lithium. Lithemia was 1.78.

On this occasion, partial nephrectomy due to oncocytoma is the most likely cause two consecutive lithium poisonings. Although creatinine and glomerular filtration are in normal range, patients after partial nephrectomy may have a reduced sodium reabsorption in proximal convoluted tubule, which may cause lithium compensatory resorption. This could cause rising in blood lithium levels.

The authors have not supplied their declaration of competing interest.

To asses the effect of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum on postmenopausal women's sexual satisfaction.

In this triple blind randomized control clinical trial, 80 healthy volunteer postmenopause women with age 50–60 years old in one of clinics of west of Tehran had been involved (year 2013–2014). Participants were randomly assigned to intervention and placebo group and received one month same shape capsules two times in a day. Tools of this study had two main parts of personal characteristics and sexual satisfaction. All ethical points were considered and approved by Ethics committee of Research Institute for Islamic & Complementary Medicine (RICM, IUMS).

After a month intervention, there is significant increase in the mean score of sexual satisfaction between two groups (P = 0.01), but when sexual satisfaction compared with pre-menopausal time in two groups, t-test results showed no significant difference (P = 0.16).

Use of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum two times a day for a month could improve sexual satisfaction in postmenopausal women. Referring to no significant change with comparing premenopause time, it sounds they have same satisfaction as premenopause time. There were no side effects during study and one month follow-up. It is suggested to do same research on sexual satisfaction and function with more month intervention.

The authors have not supplied their declaration of competing interest.

Psychiatric morbidity among Afghan refugees in Iran, especially those who are resettled in camps has been poorly studied. This study was done to determine the prevalence of mental health problems and the associated effective demographic factors.

Cross-sectional survey of 321 resettled Afghan refugees who were at least 15 years old. A version of the General Health Questionnaire (GHQ-28) in Persian was administered. Data were analyzed using univariate analysis and logistic regression.

Social dysfunction with 80.1% and depression with 22.1% had the highest and lowest prevalence. 48.9% had psychosomatic problem, and 39.3% of them had anxiety. Regarding each person that had at least one mental health disorder as unhealthy, 88.5% of the studied population had mental health problem. Being a man, living with more than eight persons in the same home, and being ten or under ten years at the migration time were statistically significantly associated with higher levels of social dysfunction. Having psychosomatic problem was associated with unemployment, being born in Iran, being ten or less than ten years at the migration time, and having no entertaining programs. Having 1-3 children, living with more than eight persons in the same home, and positive history of chronic disease were statistically significantly associated with higher levels of anxiety. Moreover, having no entertaining programs, and family members' death during migration were associated with higher levels of depression.

Mental health problems related to immigration and living in camps, were common among Afghan refugees resettled in Bushehr refugee camp.

The hardness of military service, the implementation of behavior of a person within the charter and the type of the personality are the important factors that led to the suicidal attempts during the adaptation period.

Current analysis were 95 militaries, who surveyed and treated at psychiatric and surgery department of Central Clinic Hospital of Armed Forces, after “unlucky” attempts of suicide (analysis for the period 2001–2011). Aged between 18–21.

64.1% of the suicidal attempts of militaries during the adaptation period was observed in the first 6 months. 18.2% of them registered in the first month. In general, 77.7% of surveyed have secondary or incomplete secondary education. On time of days the greatest rating of suicides 37,8% fell at evening time. There were no complications in hereditary mental illnesses among the 93.9% of surveyed (complications only in 6.0% of them). Depending on the daytime and the season, 53.3% of suicidal attempts was observed at noon and 27.7% of suicidal attempts registered in autumn and winter. Only 24.8% of suicidal attempts made by military officers (85.1% by soldiers).

Main causes of suicide among the conscripts are: severities during military service adaption owing to weak preinduction training, low mental attitude and motivation of soldier caused with the omission in education, the current situation in the family, targeting and mockery from fellow servicemen; heavy moral climate in some military units, increased physical and mental stress associated with understaffing personnel of military units, and other negative factors in military sevice activities.

Valproate (VPA) is widely used for acute and maintenance therapy of bipolar disease and it is the most prescribed drug for epilepsy treatment worldwide. VPA-induced hyperammonemia is a serious and unusual advers effect of VPA treatment.

We aimed to describe the 20 year-old-woman bipolar case of VPA induced hyperammonemic encephalopaty with therapeutic VPA levels and normal liver functions.

The case will be discussed.

The patient complained of confusion, disorientation, somnolance, agitation and slurred speech at the end of the first week of VPA treatment. VPA blood level was 116.5 μg/mL (N:50-125) and ammonia level was 237 μmol/L (N:10-50). Other laboratory tests including serum transaminases (both ALT and AST) and coagulation profile (PT, PTT and INR) were normal. After discontinuation of VPA treatment and hydration, these symptoms have disappeared dramatically. After 24 hours, blood ammonia level was 80 μmol/L and patient returned the baseline mental status.

Hyperammonemia occurs due to inhibition of mitochondrial enzymes in the urea cycle by valproic acid. Hyperammonemia and encephalopathy can develop even at therapeutic concentrations without elevated liver function enzymes. Clinicians should be aware that VPA- induced hyperammonemia and encephalopathy is still one of the most feared side effects of VPA which may require emergent management.

Despite improvements in treatment for patients with severe mental disorders, such as bipolar disorder and schizophrenia, there is still a long delay from first symptoms to correct diagnosis and treatment. Since these illnesses usually manifest themselves within adolescence and young adulthood, this time lag impacts chances for an adequate individual development.

With rather unspecific symptomatology in early stages of the development of the disorders and the still existing stigmatisation, a broad and low-threshold strategy is needed. In November 2008 an early recognition and prevention centre for mental disorders was opened at the University Hospital in Dresden.

The aim of this service is to shorten the delay to correct diagnosis and treatment in severe mental disorders. In parallel, early detection instruments are developed and early intervention strategies studied in research projects.

In this specialized centre diagnostics, counselling and treatment are provided for subjects aged 12 to 40 by a multidisciplinary team in a low-threshold setting.

250 youth and young adults were offered diagnostics and, if appropriate, treatment. In about 2/3 of clients, mental disorders had already manifested themselves, in some cases an additional risk for even more severe developments was ascertained. Counselling and transfer to appropriate treatment is offered to all clients, all are followed up on a regular basis to validate the process and assess the prognostic value of our service.

A broad, low-threshold and multidisciplinary approach for early recognition and treatment of severe mental disorders holds the chance of earlier appropriate care.

Loneliness is a distressing feelings, described as an individual experience of lack of satisfying relationships. There are a number of causes of loneliness: a loss of significant persons in life, divorce; it may occurs after the birth of a child or after marriage. Loneliness is common experience, most in adolescence and older adults. Many studies shows that loneliness is a predicting factor of mental and health illnesses and as such is associated with elevated blood pressure, increased risk of cancer and stroke, impaired sleep, impaired immune function, alcoholism, depressive symptoms and suicide.

of this pilot study is to describe the relationship of loneliness in four groups of psychiatric disorders (depression, dementia, schizofrenia and anxiety disorders).

Loneliness is measured by UCLA Loneliness Scale - R (N=50 for each group).

The people with psychiatric disorders have higher level of loneliness (p< 0,01), especially with dementia and depression (p< 0,1), in comparison with the control group.

This pilot study, hand in hand with the relevant studies, demonstrates higher level of loneliness among people with specific psychiatric disorders. Therefore loneliness can be an important factor in etiology and therapy of mentall ilness.