In a previous meta-analysis investigating pharmacological treatment options in obsessive-compulsive disorder (OCD) we determined a significant efficacy for the augmentation of serotonin reuptake inhibitors (SRIs) with antipsychotic drugs. Because new relevant double-blind, randomized, placebo-controlled trials (DB-RCTs) evaluating new antipsychotics were conducted, we updated our meta-analysis.

We included all DB-RCTs that compared augmentation of SRIs with antipsychotics to placebo augmentation in SRI-resistant OCD. Meta-analytic outcomes were treatment response defined by 35% reduction in Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) total score and mean changes in Y-BOCS total score. Effect sizes were standardized mean differences (SMD) and risk ratios (RR).

Fourteen DB-RCTs (n=467) investigating quetiapine (N=5, n=178), risperidone (N=3, n=72), aripiprazole (N=2, n=79),olanzapine (N=2, n=70), haloperidol (N=1, n=34), and paliperidone (N=1, n=34) were incorporated. The pooled antipsychotic augmentation group was significantly superior to the placebo group in terms of response rates (N=14,n=467; RR=1.98, 95% CI: 1.23 to 3.19;p=0.005) and mean change in Y-BOCS total score (N=14, n=465, SMD=-0.6, 95% CI: -0.97 to -0.23; p=0.002). Concerning the individual antipsychotics, aripiprazole and risperidone significantly outperformed placebo in terms of both responder rates and mean Y-BOCS change. Olanzapine, paliperidone, and quetiapine were not significantly different from the control group. There was no significant heterogeneity and no evidence for publication bias.

Aripiprazole and risperidone augmentation of SRIs canbe regarded as evidence-based treatment options in treatment-resistant OCD and showed superiority over olanzapine, paliperidone, and quetiapine. About one third of all SRI-resistant OCD subjects responded to augmentation with antipsychotic drugs.

Patient 10-year-old pediatrics sent from service due to history of frequent admissions for recurrent abdominal pain. In the bypass request indicate that this is a patient of perfectionistic traits; detect dysfunctional family dynamics highlighting the rivalry in the phratry, and with an equal difficulty in the field. From 2010 to 2016, he has made more than 30 visits to hospital emergency combined intervention of psychiatry and psychology and multidisciplinary service available with a pediatric surgery and pediatrics is performed.

From 2011 to 2016, it has made 44 blood tests, sonograms 9 full abdomen, abdominal renal scintigraphy without significant findings.

F45.5 pain disorder.

Symptoms due to a medical condition. Other symptoms substance-induced mental disorders: non-specific conversion disorder, pain disorder, hypochondriasis, body dysmorphic disorder, somatization disorder, simulation, factitious disorder, medical symptoms…

Psychosomatic disorders are one of the most common clinical forms of mental disorders in childhood and adolescence expression. Knowing the stages of development and operating characteristics. In clinical practice, mainly in primary care, tend to find an organic cause somatic complaints in children, so prevalence data and/or referral to specialized services vary depending on mental consulted sources is critical to understand the pathogenesis of these disorders.

The authors have not supplied their declaration of competing interest.

To report a clinical case of SS in a 62-yr-old woman with postmastectomy pain syndrome, resulting from the addition of duloxetine to a medication regimen of sertraline and fentanyl. The review of the literature serves as an overview of the epidemiology, pathophysiology, clinical features, differential diagnosis and prevention of SS.

Literature review and clinical case description.

To our knowledge, few case-reports have been published including duloxetine as a precipitant agent of SS. Clinicians should be alert to this potential iatrogenic adverse interaction of serotoninergic antidepressants with commonly prescribed opioid analgesics in chronic pain patients.

Views on the causes and psychosocial consequences of schizophrenia of the Italian population, patients’ relatives and mental health professionals can influence detection and outcome of these disorders.

To investigate the opinions on schizophrenia in a sample of 614 lay respondents, 465 mental health professionals and 709 key-relatives.

The survey was conducted in 30 randomly selected geographical areas with the Questionnaire about Opinions on mental illness (QO).

The results show significant differences among the three groups as regards opinions about patients’ civil rights and social competence of patients with schizophrenia. In particular, the belief that patients’ behaviors are unpredictable is maintained by 18% of mental health workers and by 35% of family members and the general public. As regards causes, 68% of relatives, 20% of mental health workers and 34% of general public believe that schizophrenia is caused by psychosocial factors only. Forty-eight percent of the relatives affirmed that they are fully convinced of the usefulness of pharmacological treatment compared to 28% of professionals and 25% of the Italian population. With respect to civil rights, about half of the relatives is fully convinced that patients with schizophrenia should not have children compared to 17% of mental health workers and to 19% of the general public.

These results underline the need to conduct sensitization campaigns about schizophrenia focused on specific aspects of the disease, such as unpredictability, civil rights and opportunities to recovery of patients, taking into account the target population to which they are addressed.

Self-stigmatization in patients with bipolar disorder could lead to shame, self-judgement, impaired quality of life, and could negatively affect self-esteem imeding recovery.

The aim of this study was to assess self-stigma in remitted patients with bipolar disorder and to evaluate its impact on self-esteem.

We conducted a cross-sectional, descriptive, and analytical study of 61 patients with bipolar disorder. Euthymia was verified using the Hamilton scale for depression and the Young scale for mania. We used the Internalized Stigma of Mental Illness (ISMI) to evaluate self-stigma, and the Rosenberg scale to assess self-esteem.

The mean age of patients was 43.4 years. The sex ratio was 2.4. The mean score on the ISMI was 2.36. More than half of our patients (59%) were self-stigmatized. With regard to self-esteem, the mean score obtained on the Rosenberg scale was 27.72. Low or very low self-esteem was found in 54% of patients. The most self-stigmatized patients had significantly lower self-esteem (p<10-3).

Internalized stigmatization negatively affects self-esteem of patients with bipolar disorder. Psychoeducation and cognitive behavioral therapy would improve self-esteem and enhance psychosocial treatment adherence and move people with bipolar disorder toward a culture of recovery based on hope and self-determination.

No significant relationships.

To investigate the diagnostic accuracy of the overlapping infinity loops, wire cube, clock drawing tests (CDT) and the combined score in the detection of mild cognitive impairment (MCI) and dementia.

The participants were 60 normal controls (NC), 35 patients with MCI, and 47 patients with dementia. For the overlapping infinity loops and wire cube tests, the participants were told to copy the figures from the examples. For the CDT, the participants were asked to draw a clock face with numbers on it with the hands at ten past five.

The results illustrate that infinity loops, cube, or CDT alone, or combined score, were not able to discriminate between NC and MCI groups. In dementia detection, the CDT had the highest diagnostic accuracy (sensitivity 76.6% and specificity 87.4%) followed by infinity loops (sensitivity 83.7% and specificity 78.9%) and cube (sensitivity 93.6% and specificity 46.3%). Additionally, when the three tests were combined, better diagnostic accuracy was demonstrated with a sensitivity of 87.2% and specificity 86.3%.

This study demonstrates that the three drawing tests are sensitive detectors of dementia but not MCI. The combination of these three drawing tests is a brief tool of good diagnostic accuracy for dementia screening.

The author has not supplied his declaration of competing interest.

Comorbidity is common among adults with ADHD, including substance abuse. To our knowledge relation between ADHD and SUD has not been studied in Arab countries.

Assessment of scope of comorbidity between ADHD and SUD in Egyptian patients.

Estimating prevalence rate of adult ADHD among substance use inpatients and to compare substance use inpatients with and without adult ADHD regarding onset, and severity of SUD.

This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One Hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis.

36 patients were diagnosed as having adult ADHD (35.3%) according to DSM-IV TR criteria. Presence of adult ADHD was associated with an earlier mean age of onset of SUD (15.58 vs. 13.22 years) and larger number of hospital admissions, (6.83 vs. 3.39 times). ADHD subjects achieved a shorter mean period of abstinence (124.53 vs. 209.82 days). Data were fed to the computer using the Predictive Analytics Software (PASW Statistics 18). Significance of the obtained results was judged at the 5% level.

The results of this study confirm the high rates of adult ADHD among substance use patients mentioned in other studies. Presence of adult ADHD was associated with a more complicated course of SUD.

To characterize connectivity patterns of brain default mode network (DMN) in lsTLE patients with and without anxiety and depressive disorders.

28 lsTLE patients, divided into two groups: patients with (“affective” group) and without anxiety- depressive symptoms. Beck Depression Inventory (BDI), Hospital Anxiety Depressive Scale (HADS), Hamilton Anxiety Scale (HAM-A) and Montgomery-Asberg Depressive Rating Scale (MADRS) were used to assess affective symptoms. All subjects underwent 9-min resting-state fMRI scanning session. Independent component analysis (ICA) was used to isolate DMN. The resulted maps were compared in groups using two-sample t-test. The results were considered as statistically significant according to threshold of p < 0.005 with a 10-voxel extent that has recently been shown to produce an optimal balance between Types I and II error rates in fMRI studies (Lieberman, 2009). The data were processed and analyzed using SPM8 and “GIFT” toolbox for ICA “GIFT”.

Mild depression and moderate-severe anxiety levels were observed in the "affective" group. Significantly increased functional connectivity was found in “affective” group in the right cerebellum (culmen), right gyrus fusiformis, dorsolateral prefrontal and midcingulate area, and in the left insula.

We found that brain DMN is altered by affective disorders associated with lsTLE. The observed regional pattern of difference can reflect the impaired levels of self-control often present in lsTLE patients with affective symptoms

Oxytocin has received much attention as a pro-social and anxiolytic neuropeptide. In human studies, the G-allele of a common variant (rs53576) in the oxytocin receptor gene (OXTR) has been associated with protective properties such as reduced stress response and higher receptiveness for social support. In contrast, recent studies suggest a detrimental role of the rs53576 G-allele in the context of childhood maltreatment. To further elucidate the role of OXTR, gene by maltreatment (GxE) interactions on brain structure and function were investigated.

n = 309 healthy participants genotyped for OXTR rs53576 underwent structural as well as functional MRI during a common emotional face-matching task. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ). Gray matter volumes were investigated by means of voxel-based morphometry (VBM) across the entire brain.

Structural MRI data revealed a strong interaction of rs53576 genotype and CTQ-scores, mapping specifically to the bilateral ventral striatum. GG homozygotes but not A-allele carriers showed strong gray matter reduction with increasing CTQ-scores. In turn, lower ventral striatum gray matter volumes were associated with lower reward dependence, a pro-social trait. Furthermore, the G-allele was associated with increased amygdala responsiveness to emotional facial expressions.

The findings suggest that the G-allele constitutes a vulnerability factor for specific alterations of limbic brain structure in individuals with adverse childhood experiences, complemented by increased limbic responsiveness to emotional interpersonal stimuli. While oxytocinergic signalling facilitates attachment and bonding in supportive social environments, this attunement for social cues may turn disadvantageous under early adverse conditions.

The author has not supplied his declaration of competing interest.

Associations between childhood trauma (CT), social support (SS), brain functions and major depressive disorder (MDD) is unknown.

This study aimed to investigate whether brain functions mediated associations between CT, SS, and MDD.

164 MDD and 98 healthy controls (HC) were recruited and measured by HAMD-24 and HAMA. Some completed CT questionnaire (CTQ) and social support rating scale (SSRS). We examined amplitude of low-frequency fluctuation (ALFF) between the two groups and correlations between HAMD-24, HAMA and ALFF in MDD. Then, the peak voxels of the ALFF changed regions were used as seeds to analyze whole-brain functional connectivity (FC). Next, correlations between FC and clinical variables of MDD were performed. Last, mediation analysis was used to further determine whether ALFF or FC could mediate the associations between CT, SS, and different clinical variables in MDD patients.

Compared to HC, MDD showed decreased ALFF in right posterior cingulate (PCC_R), left postcentral gyrus, right precentral gyrus, and left thalamus (THA_L), but increased ALFF in right medial frontal gyrus, left subgenual anterior cingulate, and left middle occipital gyrus as well as decreased FC in bilateral PCC and THA_R. HAMD-24 had negative correlation with ALFF of THA_L, while positive with sexual abuse (SA) score in MDD. Mediation analysis revealed that FC of PCC_R mediated association between SA and baseline HAMD-24, and itself or together with SS mediated association between CT and onset age of MDD.

CT may influence the depression severity and onset age of MDD by moderating FC of PCC_R only or together with SS.

Internet addiction is an emerging disorder, considered as a form of behavioral addiction.

The purpose of this study was to evaluate internet addiction among medical students, undergraduates.

Our study was cross-sectional and descriptive, interesting a sample of 60 students, undergraduate medical studies at the Faculty of Medicine of Sfax- Tunisia.

We performed self-award of:

1. - Questionnaire YIAT: Young's Internet Addiction Test (8 items). A score> = 5 was considered pathological

2. - And a predetermined questionnaire assessing the frequency and reasons for the use of the social network site Facebook.

Among the sample, 23.6% was diagnosed as Internet addicts. The prevalence of Internet addiction did not vary with gender. Consumption of tobacco or alcohol was found associated with 11% of students.

As for the use of the social network Facebook, 20% of students perceive their connection as excessive and 36.4% hold back hard not to see their facebook account. The use of facebook as a mean of entertainment and information on recent events were the most frequently reasons found in respectively 58.2% and 87.3% of cases.

A correlation was found between internet addiction and the perception of the student to have an excessive use of facebook (p =0.02).

Our results are consistent with the literature data on the prevalence of internet addiction. This relatively high rate leads to pay more attention to this particular type of addictive behavior, particularly that associated with other psychopathologic problems, especially social anxiety, which should be sought.

Smartphones are becoming widely popular and the number of users is significantly increasing, reaching over 65% in South Korea in 2013 and the children begin to use a smartphone at earlier age. Earlier and higher exposure of multimedia is known to have negative effects on children's physical and mental status.

The aim of the present study was to examine young children's exposure to smartphone and identify the effects of high exposure of smartphone on children's behaviors among Korean children from ages 3–5 years.

In 2014–2015, the parents of 400 children aged 3–5 years (207 boys and 193 girls) were surveyed using a questionnaire on the use of smartphone, children's behaviors, temperaments, social and language development at 3 community-based children's mental health centers.

Many children used televisions (95.5%), computers (37.3%) or tablet PC (36.2%), and smartphones (84.6%). Most (74.2%) started using mobile medias before age 2. Parents gave children devices like smartphones to keep them calm (60.8%), when being busy doing something (52.2%), and at playtime (34.3%). The children's age at first smartphone use and the frequency were not associated with children's behaviors and temperaments. Higher use group (> 2 h/d) show more somatic symptoms (OR 8.97, P < .001), more attention problem(OR 4.43, P < .001), more aggressive symptoms (OR 1.30, P < .001) and more withdrawal symptoms(OR 1.22, P < .001) than lower use group.

Young children in Korean urban communities had almost universal exposure to mobile devices, especially smartphone. Early and severe exposure of smartphone by young children aged 3–5 years is highly associated with children's behaviour problems like both internalising and externalising problems.

The authors have not supplied their declaration of competing interest.

The “Gharb” plain (area of our study) localized in the North-West of Morocco is one of the most important agricultural and industrial regions of the Kingdom. Unfortunately, it suffered from the increase of different polluting human activities which expose the population, especially children, to serious neurobehavioral problems.

Evaluation of the short term memory and working memory in urban, periurban and rural schooled children (aged 6 to 8 years) living in Gharb plain and studying the relationship between the performance in this test and the quality of environment.

Memory Sub-test of WISC III (Wechsler Intelligence Scale for Children) and questionnaire about some environmental conditions.

The obtained results had shown that 3,64% periurban children and 3,03% rural children suffer from short memory impairments and no impairments in urban children were registered. For working memory, 21,05%, 47,06% and 66,67% of impairments were found in urban, periurban and rural children respectively.Moreover, a significant correlations between the performances of short term memory and building materials (p < 0.05), source of pollution near the school (p < 0.05), and consumption of well water (p < 0.001) were registered.

The memory impairments recorded in these children appeared in connection with environmental factors, but a deeper investigation is needed for studying all these factors, in addition to others (psychological, socio-economical, and nutritional) ones.

No psychotropic drug has been approved by FDA for usage during pregnancy. Data on safety of the second generation antipsychotics in pregnancy and lactation are limited. Quetiapine is in FDA category C and limited human studies reported no abnormality during pregnancy, delivery and in the postnatal period after using quetiapine throughout the pregnancy. The foregoing is a case presentation of high dosage of quetiapine use during pregnancy.

Ms. N, a 30-year-old gravida one-para one woman, who had been treated for a diagnosis of bipolar affective disorder since 1994, experienced her third manic episode at the 21th week of her pregnancy, 6 months after quitting her lithium (1500 mg/day) treatment. When she was hospitalized, her mental status examination was positive for grandiose delusions, psychomotor agitation and pressured speech. Quetiapine 400 mg/day had been given the patient and the dose increased to 1200 mg/day in 15 days and then haloperidole 15 mg added to the treatment. During her stay at hospital her obstetrical and perinathological examination had done by consultant obstetrician and had been followed after discharge. At the follow up detailed ultrasound examinations, fetal echocardiography and blood investigations showed no abnormality. This combination was continued for 4 weeks and then haloperidole had stopped. Quetiapine 1200 mg/day was reduced to 400 mg/day slowly in 4 weeks period and the patient had stopped taking medicine 10 days later. 4 weeks after that, she gave birth to a healthy boy at 39th week of her pregnancy with C/S.

In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.

Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.

Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).

The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.

European Commission/ERA NET Research Grant Ministry of Labour, Health and Social Policies of Research Grant North-Rhine-Westfalia, Germany Joint Federal Committee (GBA) Rese

In comparison with postnatal depressive symptoms, few studies considered antenatal depressive symptoms risk factors/correlates.

In a multidimensional work our aim was to explore the associations/predictive role of lifetime and current pregnancy variables for antenatal depressive symptoms.

Two hundred and thirty six women (M = 30.5; SD =4.02; variation = 19-41), at the third pregnancy trimester were interviewed with the DIGS/OPCRIT (to make lifetime/current depression diagnoses) and answered a booklet about sociodemographic variables, lifetime/current insomnia, current stress perception, perception of being an anxious person, gynecological variables, past health perception and pregnancy health problems, among others. They filled in the Profile of Mood States to assess anxious symptoms, Negative and Positive affect and the Postpartum Depression Screening Scale (PDSS) to assess antenatal depressive symptoms at pregnancy. Women with a depression diagnosis (DSM-IV/ICD-10, n =5) and on sleep medication at pregnancy were excluded from the analyses.

We found significant associations between antenatal depressive symptoms (PDSS total score), current job situation, perception of being an anxious person, lifetime history of depression (DSM-IV/ICD-10), past health perception, health problems at current pregnancy, stress perception at pregnancy, lifetime and current insomnia, anxious symptoms at pregnancy, Negative and Positive affect. In an hierarquical multiple regression past health perception, negative affect, positive affect and current insomnia were significant predictors of antenatal depressive symptoms.

Past health perception, negative affect (anxious and depressive symptoms) and insomnia at current pregnancy seem to be risk factors/correlates for the outcome. Positive affect seems to work as a protective correlate.

Despite a putative role for estrogen in depression, studies on the association between depression and estrogen receptor (ER) polymorphisms are surprisingly lacking.

To determine the association between ER polymorphisms and late-life depression in 6809 men and women and to investigate factors which could modify this association.

Community-dwelling elderly aged 65 years and older were recruited in France as part of the Three City Study. Depression was assessed using the Centre for Epidemiological Studies Depression Scale and the Mini-International Neuropsychiatric Interview, according to DSM-IV criteria. The association between five polymorphisms of the ER-α and ER-β with depression was determined using multi-adjusted logistic regression models.

Men with the AA genotype of the ER-β rs4986938 polymorphism had an increased risk of depression, while in women, carriers of the A allele for the ER-β rs1256049 had an increased risk. Subsequent analysis indicated that the increased risk in women occurred only in those not using hormone treatment. In women the CC and GG genotypes of the ER-α PvuII and XbaI, respectively were associated with a decreased risk of depression. A significant interaction between the ER-α PvuII and ER-β rs4986938 polymorphisms suggests they may act together to modify the depression risk.

Sex-specific associations between ER polymorphisms and depression have been identified, with HT appearing to be beneficial for genetically vulnerable women. These findings of distinct genetic susceptibility to late-life depression may be important for designing novel hormone-based therapies that would have optimal effectiveness in sub-groups of depressed women and men.

Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.

To describe and study a case of Psychosis produced by Levetirazetam

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.

A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found. Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations

Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.

No significant relationships.