Prior studies have suggested that patients suffering from schizophrenia and ADHD may process certain sound stimuli in the brainstem in an unusual manner. When these patient groups have been examined with the electrophysiological method of brainstem audiometry, some studies have found illness-specific aberrations. Such aberrations may also exist for patients suffering from bipolar disorder.

To explore the use of the method of brainstem audiometry as a diagnostic tool in psychiatry.

5 individuals with confirmed clinical diagnoses of schizophrenia, ADHD, and bipolar disorder, respectively, were examined with brainstem audiometry in a non-blind, comparative study. The data derived from the patient groups was compared to data from a control population according to a previously arranged data algorithm (SD-BERA).

There was a full match between clinical diagnosis and diagnosis by means of brain stem audiometry for 4 of the 5 patients suffering from schizophrenia (1 mismatch), 4 of the 5 patients suffering from bipolar disorder (1 patient was given a second audiometric diagnosis of schizophrenia), and 3 of the 5 patients suffering from ADHD (1 patient was given a second audiometric diagnosis of bipolar disorder and 1 patient was a mismatch).

Brainstem audiometry shows promise as a diagnostic tool, but blinded studies are needed to examine the diagnostic properties and validity of this method.

In this article, a case who was prescribed duloxetine (30 mg capsule) upon the fibromyalgia diagnosis by a physical therapist and had acute dystonia and dyskinesia after approximately 1.5 hours from duloxetine intake shall be presented.

It was learnt that a married female patient aged 38 consulted a physical therapist with the complaint of back pain and duloxetine (30 mg capsule) was prescribed. It was reported that, the patient applied to our hospital with the compliant of involuntary movements around the mouth, on the lips and neck, spasm, inability to open the mouth completely, spasm in jaw, gritting teeth, mumbling and aphasia after approximately 1.5 hours from her duloxetine intake. The patient was conscious. Her psychomotor activity was natural. As a result of cranial MR, EEG, BT examinations hemogram and the routine biochemistry examinations, any abnormality in zinc and iron levels was not detected. Complaints of the patient regressed after 1 hour from the discontinuance of duloxetine and the administration of biperiden 5 mg/mL ampoule 1000 cm3 in SF. After 72 hours, any symptoms were not found.

Dopamine neurotransmission can be inhibited through the increase in serotonin and norepinephrine. Additionally, dystonia may originate from the prevailing of noradrenaline as a result of the failure of dopaminergic–noradrenergic balance.

The author has not supplied his/her declaration of competing interest.

Recently the cognitive profile of restrictive anorexia nervosa patients, particularly visuospatial and constructive abilities, raised the interest of researchers as a maintenance factor of the disorder. This study focuses specifically on the impairment of these complex executive functions.

Only patients hospitalized in our department for restrictive anorexia nervosa restrictive type (AN-R) could participate in the study. They had to fulfill self-report questionnaires assessing anxiety and depression and had to achieve a battery of neuropsychological tests (the Rey Complex Figure (RCF), the Hayling Sentence Completion Test (HSCT) and the span test).

21 patients participated in the study. The average age was 20.62 years (σ = 5.39) and body mass index (BMI) was 14.67 (σ = 0.93). In this sample, the distribution of the copy of the RCF corresponds to the normal distribution for age 7 to 12 years. Visual memory (recall of the RCF) is impaired. The inhibition score of the HSCT is higher than normal. The mean score on the span task is at −0.68 standard derivation. Only the inhibition score of the HSCT is positively correlated with BMI (r = 0.46).

These results highlight a lack of visuospatial and visuoconstructive capacities and a lack of cognitive inhibition in patients with AN-R. These results can be integrated in an impairment of central coherence. Therapeutic perspectives that emerge would focus on the central coherence, i.e cognitive remediation. It is then necessary to improve knowledge on the cognitive profile.

Obsessive-compulsive disorder (OCD) typically begins early in life and has a chronic course. Despite the need for long-term treatment, the information about therapeutic effect on different clinical subtypes is limited.

Continuous out patients with OCD were evaluated for response to a 2months Fluoxetine therapy course by Yale-Brown Obsessive Compulsive Scale according to the clinical subtype of the disease.

Of 265 patients, Fluoxetine significantly decrease the symptoms in general. Yale-Brown Average score in washers and patients with obsessive thoughts significantly decreased after the intervention, while the decrease in Y-BOCS in checkers didn't reach the statistical significance.

Fluoxetine demonstrated sustained efficacy among patients with OCD and was generally well tolerated. Fluoxetine demonstrated greater efficacy in washers and on obsessive thoughts than checkers.

To assess the efficacy of Metacognitive Training (MCT) in symptoms and metacognitive variables in people with a recent onset of psychosis.

A multicenter, randomized and controlled clinical trial was performed. One hundred and twenty-six patients were randomized to MCT or a psycho-educational intervention. Patients with a recent onset of psychosis were recruited from 9 centers of Spain. The treatment consisted in 8 weekly sessions in both groups. Patients were assessed at baseline, post-treatment, and 6 months of follow-up. Symptoms were assessed by the PANSS. Metacognition was assessed by a battery of questionnaires of cognitive biases and social cognition: BCIS, IPSAQ, TCI, Hinting task and Emotional Recognition Test.

PANSS positive symptoms significant declined between baseline and post-treatment in psycho-educational (P = 0.04) and MCT group (P = 0.01), while general PANSS and total PANSS were significant between baseline and post-treatment in the MCT group only (P = 0.008; P = 0.005). Across time, the MCT group was superior to psycho-educational on the BCIS total and self-certainty subscale (P = 0.042). Regarding irrational beliefs, the intolerance to frustration subscale declined more strongly in the MCT in relation to psycho-educational group (P = 0.016). ToM, Personalizing Bias and JTC improved more strongly in the MCT group compared to psycho-educational group (P < 0.001–0.032). Most results remained significant at the follow-up.

MCT could be an effective psychological intervention for people with a recent onset of psychosis in order to improve symptoms, insight, tolerance to frustration and personalizing bias.

The authors have not supplied their declaration of competing interest.

Pharmacogenetic studies in obsessive-compulsive disorder (OCD) primarily focussing on serotonergic and dopaminergic polymorphisms, provided inconsistent findings. There is recent evidence for glutamatergic abnormalities in OCD.

Examine the association glutamatergic genes with serotonin reuptake inhibitor (SRI) response in OCD.

To study pharmacogenetic association between SLC1A1 and GRIN2B polymorphisms with SRI response in OCD.

DSM-IV OCD patients were recruited from a specialty OCD clinic and evaluated using the Yale-Brown obsessive compulsive scale (YBOCS), Mini International Neuropsychiatric Interview (MINI) plus, Clinical Global Impression scale (CGI). They were subsequently reassessed with YBOCS and CGI. To study extreme phenotypes, we included only full responders (> 35% YBOCS improvement and CGI-I score of 1 or 2) to any SRI (n = 191) and non-responders (< 25% YBOCS improvement and CGI-I score ≥ 4) to adequate trial of at least two SRIs (n = 84). Partial responders were excluded. Genotyping was performed using an ABI9700 PCR machine.

Genotype frequencies did not deviate significantly from the values predicted by the Hardy-Weinberg equation. Case-control association analyses revealed no significant association between genotype/allele frequencies with SRI response.

Our data does not show any association between polymorphisms in glutamatergic genes and SRI response in OCD though such associations have been found in other studies. More SNP's in the same gene could be responsible for the pharmacogenetic associations. More homogenous sample considering symptom dimensions and other phenotypic variables may be needed. It may be critical to go beyond “usual suspect” candidate gene research. In this regard, a novel approach to identify SRI response biomarkers is the use of cellular models.

The authors have not supplied their declaration of competing interest.

There is no report about the new theory of gene multiple hits. Which is identified through a MEDLINE search.

The result of new discovery: explanation of the gene multiple hits theory

We have known that cancer development is caused by the long time carcinogens' effects. The carcinogens include psychological, social, behavioral, emotional and spiritual issues factors and hereditary factors, et al. After all, the author may say in this way that before the cancer development, there are many different proto-oncogenes and tumor suppressive genes suffer from many different carcinogens' hits and damages, that is gene multiple hits. And finally, after the genes are hit many times by the environmental or chemical factors; biological factors; physical factors and hereditary factors, et al., the cancer are developed.

The major previous theory for cancer development mechanism is the gene two hits theory. It is clear that this old theory can not fully explain all the findings for cancer development mechanism. Only can the gene multiple hits theory explain fully all the scientific findings for the cancer development mechanism. Therefore, the new theory is very scientific.

The significances of the gene multiple hits theory.

The new theory not only fully explain the research findings for cancer development mechanism. But also summarizes the huge lots of different scientific research findings and using the single new theory represents the whole related scientific research findings.

Clinical decision support systems (CDSS) are computer systems that deal with scientific knowledge and patient data in order to offer clinical guidance. The utility of CDSS in mental health can be viewed in terms of enhancing both the diagnosis and treatment processes.

Our purpose is to design AI-CARE as a CDSS that relies primarily on the evidence-based clinical guidelines and individual patient data, with the aim to elaborate on this information and offer regimen choices to clinicians for better mental health care.

We aim to develop an interactive tool that can be used for effective decision making by psychiatrists and other health professionals. The longitudinal course of Bipolar I Disorder (BDI) is the subject of our implementation.

We developed AI-CARE based on the medical knowledge of the domain expert and clinical guidelines for BDI. The ontology developed describes the domain concepts as well as the time evolution of BDI symptoms. The clinical guidelines are encoded in the form of Rules. Patient data constitutes the input of our system initializing the Ontology on which the developed rules are applied.

The approach of AI-CARE allows individualized diagnosis and treatment decisions as output of the examined case based on the applied rules. AI-CARE provides recommendations about the best therapeutic treatment, notifications and alerts.

We present the AI-CARE as a CDSS for BDI. AI-CARE platform enables clinicians to monitor the subject’s actual state and retrieve recommendations on the best treatment, while providing notifications for critical mood shifts of the patient.

Medical professionals are exposed to numerous high intensity stressors. This may lead to increased occurrence of signs of burnout syndrome and depression. This phenomenon is further connected to higher probability of serious medical errors, lower attention to patients and other medically serious issues.

We have conducted a national study to assess the level occurrence of burnout syndrome and depression using standardized questionnaires. We have collected data from n=7428 medical doctors cross all specialties and types of medical institutions.

The results of the study confirmed high occurrence of burnout syndrome and depression symptoms among Czech medical doctors. The study also brought information about specific risk factors as the type of specialty, age, marital status or educational level which influence the levels of burnout and depression syndromes at statistically significant levels (p<0,001).

The study supports the hypothesis that medical doctors are highly endangered by development of burnout and depression symptoms and thus should get appropriate care.

The study was supported by the Czech Medical Chamber.

Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization and low personal accomplishment. It concerns all professions especially healthcare staff.

A cross-sectional study conducted among medical residents working in hospitals located in Tunis. Three instruments are used: an anonymous self administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment.

A total of 149 résidents participated in the survey. 17,4% of participants had a severe Burnout. 42,26% reported a severely high score for emotional exhaustion, 46,92% reported a severely high score for depersonalization and 26,14% had a severely low score of personal accomplishment. Among stress factors significantly correlated to burnout: Lack of hobbies (p<0,001), bad job conditions (p=0,031), poor conditions of the workplace (p=0,046), relationship problems in workplace (p=0, 01), relationship problems with patient’s families (p=0,016), work-family conflicts (p<0,001) and far distance between home and hospital (p=0,026). Consequences of occupational stress associated with burnout: Antecedents of specialty change (p=0,017) and desire to specialty change (p<0,001).

Medical residents in all specialties are at risk of burnout. Nevertheless, it is shown that some specialties are more exhausting, which is consistent with the results reported in the literature. This syndrome deserves to be studied further in junior doctors to develop appropriate means of preventions.

application of the comprehensive approach to psychotherapy distinguished by a combination of individual and familial activities at the early regenerative stage for post-stroke patients allows reducing the rehabilitation period and extending opportunities for patients' adequate functioning in the social environment in general and in family, in particular.

Omega-3 polyunsaturated fatty acids (n3-PUFA) are major constituents of the neural membranes. N-3 PUFA take part in several neuronal mechanisms, including modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression. Deficiency in n-3 PUFA has been postulated in the etiology of schizophrenia. Intervention trials supplementing n-3 PUFA were conducted to assess the efficacy of n-3 PUFA in reducing symptom severity in exacerbations of chronic schizophrenia and acute phase of first-episode schizophrenia. The results were n-3 PUFA were found to prevent conversion to psychosis in clinical high risk populations.

To assess the efficacy n-3 PUFA as add-on treatment in relapse prevention in first-episode schizophrenia patients.

We conducted a randomized, double-blind, placebo-controlled, parallel-group single-center 6 months augmentation trial of either 2,2 g per day of n-3 PUFA or placebo added on to an adjustable dose of antipsychotic medication in first-episode schizophrenia patients. Intervention was composed of either 1320 mg/day of eicosapentaenoic acid plus 880 mg/day of docosahexaenoic acid or placebo olive oil. The relapse rate was observed during a follow up period of 12 months.

71 patients completed the study (41% female). Relapse was observed in 4 patients (11.4%) enrolled in n-3 PUFA group and 12 patients (33.3%) in placebo group over a period of 12 months. The difference was statistically significant (log rank test, p=0.0225).

The results indicate, that n-3 PUFA add-on therapy can effectively prevent relapses in first-episode schizophrenia patients.

Psychological interventions for psychogenic non-epileptic seizures (PNES) show promising results. The aim of this meta-analysis is to evaluate and synthesize the available evidence from the previous 20 years regarding the utility of psychological interventions in the management of PNES.

Studies were retrieved from MEDLINE via OvidSP and PsychINFO. Selection criteria included controlled and before-after non-controlled studies including case series, using seizure frequency as an outcome measurement. Studies were required to assess one or more types of psychological intervention for the treatment of PNES in adults. Data from 13 eligible studies was pooled to examine the effectiveness of psychological interventions in treating PNES on two primary outcomes: seizure reduction of ≥ 50% and seizure freedom. A meta-analysis was conducted with data extracted from 228 participants with PNES.

Interventions reviewed in the analysis included CBT, psychodynamic therapy, paradoxical intention therapy, mindfulness, psychoeducation and eclectic interventions. Meta-analysis synthesized data from 13 studies with a total of 228 participants with PNES, of varied gender and age. Results showed 82% of people with PNES who complete psychotherapy experience a reduction in seizures of ≥50%. Additional meta-analysis synthesized data from 10 studies with a total of 137 participants with PNES. This analysis found 47% of people with PNES are seizure free upon completion of a psychological intervention.

The studies identified were diverse in nature and quality. Findings highlight the potential for psychological interventions as a favorable alternative to the current lack of treatment options offered to people with PNES.

The author has not supplied his/her declaration of competing interest.

Experience has shown that by the acquisition of a healthy and successful identity, the likelihood of violent and immature behavior in different situations will be reduced and appropriate solutions will be used to face problems. In this study, the identity style of each criminal will be examined in relation to her commitment.

The study is a cross–sectional type. 200 female prisoners of financial crimes, licentiousness, murder and participation in murder, robbery and drug addiction and drug transfer (each n=40) were selected by sampling quotas–randomized and Berzunsky identity style questionnaire.

The identity style of murderers and participants in the murder was normative. Identity style of immoral criminals was Informational, while the identity style of the other groups was confused. Commitment of both normative and informational identity styles was significantly correlated.

In general it can be suggested that the level of commitment, decision-making and problem-solving styles of the prisoners are correlated with their identity styles. Therefore, it can be suggested that the obtained results of this study can be used in the educational and reform programs of the prisons as well as during the interrogation prosess.

Identity style, female Prisoners, Crime, Commitment