Valproic acid is an antiepileptic drug used in different fields of Psychiatry. It is known mostly for its use in managing patients with bipolar affective disorder. In psychiatry of addiction, there is still no approved indications for its usage, but it is widely prescribed in treating alcohol and cocaine abuse, due to the existence of studies in these addictions.

This review aims to clarify the relation between valproic acid and dependences, particularly cocaine.

Non-systematic literature review using a PubMed search, using the following key words: “valproate”; “cocaine use”.

Cocaine dependence can decrease GABA levels in humans. Valproic acid has multiple mechanisms that favour the synthesis of GABA, potentiating its release and postsynaptic GABAergic response. Because of this, valproic acid was found effective in promoting abstinence and in reducing the use of cocaine. There are studies that support the valproic acid’s use in alcohol and cocaine dependences. Valproic acid has been shown to be promising in relapse prevention. It has also showed efficacy in the management of impulsivity and irritability, what makes it useful in managing patients with borderline personality disorder – patients at higher risk for alcohol or substance use disorders.

Cocaine addiction involves different phenomena and may respond to distinct pharmacologic approaches. Although some studies need to be confirmed by larger clinical trials, valproic acid seems a promising agent as one of some potential treatments for cocaine dependence. Further studies are required in this field to come to more reliable conclusions.

No significant relationships.

No significant relationships.

No significant relationships.

Despite the huge effect eating disorders (Eds) have on the lives of sufferers and their families there has been little research on the effect an ED has on siblings even though their lives are repeatedly significantly affected by the situation. It is important to gain more insight into the experiences and needs of siblings as the nature and magnitude of the effect of patients EDs on non-affected siblings is mixed in the current research.

To conduct a systematic review allowing an extensive search of the current literature to identify where the current research is lacking. Also, to highlight the need for a greater focus on the effect of EDs on siblings both in research and clinical practice.

A systematic review is being conducted to gain an understanding of the gaps in the literature.

It is expected that the systematic review will reveal a lack of literature regarding siblings’ experiences of having a brother or sister with an ED. As well as showing the conflicting emotions felt by the siblings, both positive due to the love they feel for their sibling and negative due to the burden they feel.

By raising awareness of the needs of non-affected siblings this research should have a notable impact on their experiences by highlighting the need for specific interventions and support services as well as education about their siblings’ ED.

No significant relationships.

Aripiprazole (ARI) is an atypical antipsychotic drug with D2 partial agonist properties, usually prescribed to treat mood disorders (major depression or bipolar disorder) and schizophrenic disorder (schizophrenia or schizoaffective disorder). Dopamine receptor agonists, as is ARI, have been implicated in some cases of impulse-control problems, such as gambling disorder (GD), increased spending, hypersexuality and compulsive eating.

Currently, it is hypothesized that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We intend to do a non-systematic review of the scientific information regarding this subject.

The authors revised the published literature about this topic, selecting relevant articles, systematic reviews and case reports, with the topic words: “aripiprazol”, “gambling disorder” and “dopamine receptor” in scientific data base.

Overall, a few cases of ARI-induced pathological gambling as well as ARI-induced hypersexuality have been reported. In one study it was verified that comorbid psychiatric and substance use disorders were common among those who have experienced GD or worsened GD after beginning ARI treatment. In another study, it was verified that the group of patients who reported this alleged side-effect were mostly young (mean age, 33.6 years), mostly men (88.2%) and most lived alone.

Attributing to dopamine agonists the only factor that can explain the onset of GD is simplistic and dangerous. Many other potential risk factors, including individual vulnerability factors (temperament, genetics) as well as environmental factors, must be considered.

No significant relationships.

Postpartum depression (PPD) is an important cause of discomfort and dysfunction that impair the quality of life and the daily functionality not only of the patient but also of her child and her family, in its entirety. New treatment options have been made available for this pathology, but their use is restricted by methodological aspects, like the difficulty of administration, lack of enough data regarding their long-term efficacy, and costs.

To conduct a literature review in order to find the most evidence-based pharmacological interventions for PPD.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “postpartum depression” AND “treatment” OR “pharmacological agents”. All papers published between January 2000 and August 2021 were included.

Among the most evidence-based agents for PPD treatment are serotonin selective reuptake inhibitors (SSRIs). As individual agents, sertraline seems to be the most supported antidepressant by evidence from clinical trials, followed by escitalopram/citalopram, and fluoxetine. Other antidepressants supported by clinical data were venlafaxine, desvenlafaxine, nortriptyline, and bupropion. A 6-12 months maintenance treatment is considered optimal after remission, in women with a low risk of recurrence. Brexanolone, zuranolone, and ganaxolone are members of a new class of drugs studied for postpartum depression, but currently, only the first agent is FDA-approved for this indication.

SSRIs are the most supported by evidence treatments for PPD, and brexanolone is a drug with a new mechanism, dedicated to this pathology that provides new hope for recovery.

No significant relationships.

Many studies have searched for an association between violence and psychiatric diagnoses, without providing a confirmative result.

We have sought to deepen this topic, analysing different aspects of aggressivity, focusing on a specific diagnosis and its particular phases of illness, and looking for a correlation between psychiatric co-diagnoses and outpatients’ visits adherence.

We studied 151 bipolar type I inpatients presenting complaint, past medical and family history; we collected information about lifetime hetero/self-aggressive behaviours, irritability, agitation, suicide attempts, alcohol, or substance abuse.

The overall aggressivity in our sample resulted in 11.92% of cases, while the number of aggressive episodes during euthymia decreased to 2.64%, close to the population without psychiatric disorders. Personality disorders and alcohol abuse appeared to be the main risk factors for irritability [Fig. 1]; substance abuse for both irritability and hetero-aggressive behaviour [Fig. 2]. We observed that subjects who displayed better compliance to follow-up visits exhibited a significant lower aggressive behaviour than less adherent subjects. Moreover, our data disconfirm the common conception that correlates the presence of psychotic features to violence.

Studying aggressive in a bipolar population, we observed that the rare episodes of aggressiveness were condensed in active phases of illness and mainly related to alcohol or substance abuse, while violent acts during long periods of wellbeing appear in line with those of the general population. We are confident our data might be helpful in deconstructing the stigma that a psychiatric diagnosis equals to violent behaviour.

No significant relationships.

Pregnancy is a time of profound physical and emotional change as well as an increased risk of mental health problems. Providing social support is vital to reduce such risk.

This systematic review and meta-analysis aimed at examining the relationship between social support and depression, anxiety and self-harm during pregnancy.

We searched observational studies from PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL databases. The Newcastle-Ottawa Scale tool was used for quality appraisal. The Q and the I² statistics were used to evaluate heterogeneity. A random-effects model was used to pool estimates. Publication bias was assessed using a funnel plot and Egger’s regression test and adjusted using trim and Fill analysis. All the analysis was conducted using STATA.

Sixty-seven studies with 64,449 pregnant women were part of the current review. Of the total 67 studies, 22 and 45 studies were included in the narrative analysis and meta-analysis, respectively. From the studies included in the narrative analysis, 20(91%) of them reported a significant association between social support and the risk of mental health problems (i.e. depression, anxiety, and self-harm). After adjusting for publication bias, the results of the random-effect model revealed low social support was significantly associated with antenatal depression (AOR: 1.18, 95% CI: 1.01, 1.41) and antenatal anxiety (AOR: 1.97, 95% CI: 1.34, 2.92).

Low social support was significantly associated with depression, anxiety, and self-harm during pregnancy. Policy-makers and those working on maternity care should consider the development of targeted social support programs to help reduce mental health problems amongst pregnant women.

No significant relationships.

Adolescence, when physical body image changes occur, is highly vulnerable to the development of eating disorders. At this age, there is an acute task of accepting oneself as another - an adult who has changed.

To study the features of the image of an adult in young people with eating disorders.

The study involved 58 girls (from 17 to 22 years old). The main group included 31 people with a high risk of eating disorders, the control group - 27 people with an average and low risk. Respondents filled in: Taylor Manifest Anxiety Scale, Eating behavior rating scale, projective drawing of an adult and child, association test about words «adult» and «child»

1. A high level of personal anxiety was revealed in the main group; 2. The visualized image of an adult in the main group has more distortions and fewer signs of gender identification than in the normal group; 3. Semantic ideas about adulthood in the main group are negatively emotionally colored and include categories related to eating behavior; 4. Semantic ideas about childhood in the main group are more negatively emotionally colored, and ideas about the present are more connected with appearance than in the control group. Semantic ideas about the future in this group are often negatively colored.

Figurative and semantic ideas about childhood, adulthood and about oneself in the present and in the future in girls with eating disorders have qualitative characteristics in comparison with the control group.

No significant relationships.

Metabolic syndrome (MetS) is common in chronic psychosis but also exists in the early stages. HOMA-IR is an independent predictor of cardiovascular diseases and has already been described in first episode of psychosis.

To determine whether HOMA levels differ according to MetS at each time assessment over 2 years.

MetS and HOMA levels are determined at baseline and at 6, 12, 18 and 24 months in a sample of 50 patients participating in the PEPsNa Early Intervention Programme during two years of follow-up. Adult Treatment Panel III (ATP III) criteria are used to define MetS. Insulin resistance measured with the Homeostatic Model Assessment (HOMA-IR) is computed with the formula fasting plasma glucose (mg/dL) times fasting insulin (mIU/mL) divided by 405. Mann-Whitney U Test are used to compare HOMA variable according to presence of metabolic syndrome.

The results showed that HOMA levels differed statistically significantly between patients who met MetS criteria and those who did not at 12 (p<0.046) and 24 (p<0.004) months of treatment.

Given the small sample size the results of our study indicate that there is a sustained relationship over time between HOMA levels and Metabolic Syndrome (MetS) and that the HOMA IR may be useful in identifying those patients with an increased metabolic and cardiovascular risk.

No significant relationships.

Exposure to severe childhood trauma has been associated with the onset and the severity of bipolar disorder in adults.

The aim of this study was to examine the relationship between childhood trauma and functioning of patients suffering from bipolar disorder.

We conducted a cross-sectional, descriptive, and analytical study, including sixty-one remitted patients with BD. We used the Childhood Trauma Questionnaire (CTQ-SF) to measure history of traumatic childhood experiences and the Functioning Assessment Short Test (FAST) to assess functioning.

The mean age of patients was 43.4. The sex ratio was 2.4. Almost two-thirds of patients (64%) had experienced at least one type of childhood trauma. An overall functional impairment was found in 70.5% of participants. The CTQ total score was significantly associated with low educational level (p=0.001), low socio-economic status (P=0.034), a family history of psychosis (P=0.022), the number of mood episodes (P=0.001), the number of hospitalizations (P=0.04), the number of relapses with psychotic features (p=0.002) and that of depressive relapses (P<0.001), rapid cycling (P=0.012), higher rates of suicide attempts (P=0.04) and poor functioning (P<0.001).The logistic regression analyses showed a significant association of childhood trauma with low educational level (p=0.001), high number of depressive episodes (p=0.013) and poor functioning (p<0.001).

Our findings demonstrate that childhood abuse and neglect are risk factors associated with worsening clinical course of bipolar disorder and higher functional impairment. These findings press the urgency for preventive practices and early intervention strategies to diminish the prevalence of childhood trauma and minimize their impact.

No significant relationships.

Hepatic ones are some of the most described somatic complications in anorexia nervosa (AN) affected patients. They can be due to malnutrition, which is the more usual thing, or due to re-feeding. The first one can lead to more marked elevations of the hepatic enzymes, especially alanine-aminotransferase (ALT). It’s been also described the relation between a sharply decreased body mass index (BMI) and this kind of complications, but there are still to determine more predictors.

Identifying clinical predictors of hepatic complications in AN.

We analysed data from 71 AN affected patients hospitalized at Bellvitge Hospital from January 2016 to October 2021. We used IBM SPSS Statistics 22 to do all the statistics in this work.

The medium age of the sample was 27.66 years with 10.8 years of evolution of AN. The medium BMI was 13.88. 33.80% of them had some sort of hepatic enzymes elevation, two of them a several one. AST, ALT and ALP were significantly more elevated in those patients with lower BMI. GGT was significantly more elevated in patients with more years of disorder development. We didn’t identify correlation between any purgative method and hepatic alterations.

The elevation of ALT, AST and ALP seems to be related with the BMI of the patients, while the elevation of the GGT turns out to be related to the time of evolution of the eating disorder. Purgative methods don’t seem to be related to the development of hepatic alterations in AN.

No significant relationships.

Alexithymia, the lack of words to express emotions, is a common problem in multiple sclerosis (MS) patients.

To investigate the prevalence of alexithymia in patients with MS and to evaluate the factors related to it, including depression.

We conducted a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It involved MS outpatients in remission phase. Data collection was done using a form exploring sociodemographic, clinical and radiological characteristics. We used the Expanded Disability Status Scale (EDSS) to evaluate neurological impairments, the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

Our study included 93 patients. They were married in 57% of cases. The total number of relapses ranged from 1 to 30, with a median of 5. The EDSS score ranged from 0 to 8. A temporal lesion on brain imaging was found in 29% of cases. MS patients had alexithymia in 58.1% of cases and depression in 26.9% of cases. Alexithymia was more frequent in unmarried patients (p = 0.028). Among clinical and radiological factors, the number of relapses was higher (p = 0.035), and temporal lesion was more frequent in alexithymic patients (p = 0.045). In this study, alexithymic patients were more depressed (p < 10-3).

According to our results, depression and alexithymia were found to be significantly inter-related in MS. Future longitudinal studies might better clarify the nature of this relationship in MS patients.

No significant relationships.

Today, a number of researchers consider the problem of addictive behavior as one of the most global problems for Kazakhstan and Russia. Some scientists consider CBT to be the most effective way to work with addictions. In our country there are no scientific works devoted to the study of addictive beliefs, so we decided to conduct such a study.

The Objective of the study was to identify the characteristic addictive beliefs of drug addicts with different type of addiction: opioids and synthetic cathinones (designer drugs called “salts”, “bath salts”).

Questionnaire of addictive beliefs by A, Beck, questionnaire of beliefs about cravings by A. Beck and F. Wright, clinical interview. Descriptive statistics and chi-square test were used for data processing.

People with opioid addiction are more likely to believe that their lives will become more depressive if they stop using drugs (p= 0.0347); that drug use is the only way to cope with pain in their life (p= 0.0347) and that they cannot cope with anxiety without drugs (p=0.009). Respondents who use synthetic psychostimulants endorse to believe that addiction is not a problrm for them (p= 0.0358).

Having categorized these beliefs in accordance with A. Beck’s classification, we came to the conclusion that “relief-oriented beliefs” are more typical for people who use opiates. The motive for use is often the desire to alleviate a negative emotional or physical state. For people using psychostimulants “salt”, “anticipatory beliefs” are more characteristic - the desire to experience euphoria and pleasant experiences.

No significant relationships.

Type I bipolar disorder (BDI) is characterized by a chronic evolution, with recurrent mood episodes that severely disrupt the overall functionality and quality of patients’ life. An adequate maintenance treatment is necessary to prevent relapses and to improve the functional prognosis of these patients.

To find data regarding the most evidence-based therapeutic strategies in the maintenance phase of BDI.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “type I bipolar disorder” AND “mood stabilizers” AND “antipsychotics” AND “anticonvulsants”. All papers published between January 2000 and August 2021 were included.

The main recommendation is to continue in the maintenance phase the same medication that has proven its efficacy and tolerability in the acute phase. In BDI the most evidence-supported pharmacological approaches for the maintenance phase were lithium, valproate, lamotrigine, and carbamazepine as anticonvulsants/mood stabilizers, as well as olanzapine, quetiapine, and aripiprazole as antipsychotics. Lithium and valproate have been associated with positive influence over neuroplasticity, while antipsychotics have considerably higher metabolic adverse events. Monotherapy is recommended, but drugs associations are frequently met in clinical practice. There are no consistent data about the superiority of one class over the other, but lithium has a proven effect of decreasing the suicide rate in this population.

Both anticonvulsants and antipsychotics are used in the maintenance phase of the BDI, without significant differences in the efficacy rates. However, benefits and risks should be weighted for each class and each individual agent recommended.

No significant relationships.

The transition into parenthood is associated with an increased psychopathological vulnerability. Most studies have focused on mothers, although recently, the role of fathers has grown more importance. Paternal perinatal depression (PPD) is an episode of major depressive disorder occurring in new or expectant fathers during the perinatal period. PPD is not widely acknowledged and research are rare.

The authors intend to review the literature about PPD, focusing on its prevalence, risk factors, clinical features, treatment and consequences.

Non-systematic review of the literature through PubMed.

A meta-analysis of PPD estimated a prevalence of 10.4%. Risk factors of PPD are multiple and complex. There are sociodemographic factors, such as marital status, monthly income and social support. Psychological factors, for instance history of depression, maternal prenatal anxiety and maternal depression. Some literature also suggests hormonal changes on men like increase estrogen and lower testosterone levels. PPD can present with symptoms of mood alterations, like irritability and restricted emotions, anxiety, fatigue, insomnia, loss of appetite. Also common are behavioural disturbances such as interpersonal conflicts, impulsivity, violence, avoidance behaviour, and substance abuse. There are no studies to specific treatments to PPD, so the treatment is the same for women, such as antidepressants and psychotherapy. If untreated, PPD can have an adverse influence on the health and wellbeing of the mother and child.

PPD is still underscreened, underdiagnosed and undertreated. It is fundamental identifying risk factors and the development of specific interventions. Further research on PPD is needed.

No significant relationships.

Bipolar disorder is a multifactorial disorder influenced by multiple genetic and environmental factors.There is limited understanding of how non-genetic factors may impact the age of onset of bipolar disorder

To study the age of onset of bipolar disease in Tunisia (where the average duration of sunshine is 8 hours/day) and compare it to the age of onset in countries with a lower duration of sunshine (Germany 0.17h/day; Norway 1.40h/day).

We conducted a retrospective study of 100 patients with bipolar disorder type I followed at the psychiatric department Aziza Othmana at Razi hospital.The data collection was done using a pre-established paper form exploring sociodemographic and clinical data.The duration of sunshine was estimated according to the average number of hours of sunshine per day in each country collected through meteorological sites.

Our population was predominantly male (60%) with a mean age of 48.7 years.The first episode was manic in 76% of cases. The mean age of onset in our sample was 25.86 years, with extremes ranging from 13 to 49 years.An early onset (threshold age=21 years) was found in 36% of the Tunisian population. The age of onset was earlier in patients with a family history of bipolar disorder: 22.76 years vs 28.23 years. A late onset (threshold age=37 years) was found in 13% of the Tunisian population.

The study confirmed that there is an inverse relationship between the degree of sunlight and the age of onset of the disease, especially in the presence of a family history of mood disorders

No significant relationships.

How do medical students, who have self-criticism of being procrastinators of their study obligations, deal psychologically with daily tasks? The experience of procrastination by those who are considered high-performance students involves resources of mental health to cope with guilt, exhaustion, or even self-sabotage. According to MeSH used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’.

To explore the psychological meanings that medical students attribute to procrastination phenomena to better understand how they handle the usual curriculum overload.

Clinical-qualitative design. Sample of 13 participants closed by information saturation with 2nd, 3rd, 4th-year students. Semi-directed interviews with open-ended questions in-depth. Clinical-qualitative content analysis, free-floating readings with psychodynamic concepts. Results were validated by peers at the Laboratory of Clinical-Qualitative Research.

Emergent categories: 1) between procrastination and despair: the process of stress in procrastination; 2) a proving mechanism: procrastination as an emotional defense; 3) a very delicate rumination: between procrastination and mere delay, an emotional dilemma; 4) this conflict is painful: the confrontation between the desire to comply with tasks with excellence and the enjoyment of life.

Procrastination is reported by students as a source of great tension generated by opposing forces and desires, in which exhaustion is eventually reached. There are emotional contradictions related to guilt for leaving tasks to the last moment and the need to live other things besides doing academic tasks. Procrastination is a message-metaphor. It is important that institutions listen to students to understand what procrastination is saying about them.

No significant relationships.

Recent studies suggest that online repetitive transcranial magnetic stimulation (rTMS) can induce local entrainment of ongoing endogenous oscillatory activity that impacts cognitive performance, and the effect may depend on the function of the oscillation. However, little is known about the effects of task-specific frequencies, especially when using an online rTMS paradigm. Our previous electroencephalogram (EEG) study showed that the frontal theta rhythm is associated with the cognitive giving-up processes during problem-solving tasks.

In this study, we combined online rTMS and EEG to examine the frequency-dependent stimulation effects of rTMS on the performance of problem-solving tasks and ongoing oscillations. We hypothesized that rTMS at the theta frequency would induce ongoing theta activity and accelerate the giving-up behaviour.

rTMS was applied during problem-solving tasks with the following conditions: individual theta (4-6Hz)- and alpha (9-13Hz)-TMS, no-TMS, and sham-TMS; the order of conditions was counterbalanced across participants.

Our results showed that theta-frequency rTMS application induced an increase in theta amplitudes and shortened the giving-up response, while a control alpha-frequency rTMS application induced an increase in alpha amplitudes, but did not change giving-up responses.

This study demonstrated the effectiveness of using specific task-relevant stimulation frequency and target location for the modulation of cognitive and behavioral performance. Furthermore, considering the close resemblance between giving-up behaviour and rumination in depression, neuromodulation of cognitive giving-up processes may lead to a new intervention to treat depression by rTMS.

No significant relationships.

The noun “maieutics” derives from maia (mother, midwife) and the related verbs “maieusis” and “maieonuai” mean “giving birth” and “easing childbirth”. Socrates’ maieutics aspires to give birth to the truth in the youth. Since homeric times psychotherapy has been part of medical act. Initially, the physician’s word had a magical character. Plato rationalized this in many of his dialogues, specially in “Charmides”.

The search of the essential characteristics of this therapeutic method described by Plato, as well as its ethical implications

Hermeneutic method

The consequences for doctor-patient relationship in general and psychotherapy in particular are: 1. Remedy and “epodé” (charm) must be applied in every doctor-patient relationship. 2. The body can only be healed if the soul is cured first by a charm. 3. The openness of the patient’s soul to the physician and the physician’s beautiful speech to the patient will enable the latter to reach the state of “sophrosyne” (temperance), condition of possibility of true health.

In the discussion of the meaning of “sophrosyne”, Socrates questions disciples’ propositions and concludes that the only thing one can be sure of is that “sophrosyne” is a way of searching virtue (arete). Later, in Theaetetus, Plato adds another element: temperance is a “homoiosis theó”, that is, the assimilations of patient to God. With this Plato seals the ethical character of psychotherapy for ever.

No significant relationships.