Several lines of evidence implicate dopamine is involved in the psychomotor retardation (PMR) in major depressive disorder (MDD). Besides, abnormal cerebral blood flow (CBF) of PMR was also found in the cortico-basal ganglia-thalamo-cortical (CBTC) circuitry. We hypothesize that the polymorphisms of the dopaminergic pathway should be associated the abnormal CBF in the CBTC circuitry.

To investigate the association of the polymorphisms throughout the dopaminergic pathway with the cerebral blood flow (CBF) of PMR in MDD.

The blood sample of 63 patients (23 PMR, 40 NPMR) were collected for genotyping the dopaminergic polymorphisms (92 SNPs from10 genes). After quality controlling, 15 SNPs in 8 candidate genes were entered into the mass univariate modeling analysis. For the statistical analysis, patients with unqualified fMRI image and unmatched demographic data were ruled out. Consequently 56 patients (23 PMR, 33 NPMR) were taken into the statistical analysis.

Genotype-by PMR associations with the CBF differences predominately distributed in bilateral prefrontal cortex (PFC), temporal cortex, and striatum, the left thalamus, the right primary motor cortex, insular cortex, fusiform gyri, and lingual gyri. There were significant negative correlation between the CBF of the PFC and the PMR severity. However, the CBF of the striatum and the thalamus were positively correlated with the PMR severity.

The polymorphisms of dopaminergic pathway are associated with not only CSTC circuitry, but also some other brain regions involving in cognition and emotion controlling. While the increased CBF of PFC might suppress PMR, the increased CBF of striatum and thalamus adversely aggravate PMR.

ADHD is one of the most common neuropsychiatric disorders in children. The worldwide prevalence is estimated to be between 2–18%. The exact cause of ADHD is still unknown, but some factors have been found to increase the risk of having ADHD like increase TV exposure time and video games.

To study the association between time spent on computer tablets (iPads or Android tablets) by children and ADHD.

This cross sectional study targeted children from 3 to 12 years old who use computer tablets. Two non-random sampling techniques were used to distribute self-administered questionnaires to one of the caregivers of 275 children, 36 of them installed an application in their children's computer tablets that measures the actual time spent by the children. The questionnaire contains demographics, validated Arabic ADHD rating scale and questions to assess the parental attitude. The SPSS package was used for statistical analysis.

The results showed that the overall prevalence of ADHD is 22.2% and it is higher in males. There is no statistically significant association between ADHD and all variables except for the time spent on computer tablets, which showed that children using computer tablets more than the average time have an increased chance of having ADHD with an odds ratio of 1.9 with 95% confidence interval from 1.08 to 3.40.

This study shows an association between time spent on computer tablets by children and ADHD. There is need for longitudinal studies to demonstrate the temporality and to confirm the association.

Shared decision-making (SDM) has shown to improve adherence, decrease hospitalization, and enhance knowledge of the illness and satisfaction with mental health services. Eliciting each patient's preferences for information allows tailoring the physician behavior according perspectives and expectations. Patients with depression (PWD) have frequently limited information regarding the availability and efficacy of psychiatric treatments.

Unveil information seeking attitudes of patients with depression and their a priori use of digital sources of information.

A convenience sample of PWD was submitted to a battery of self-report questionnaires. Standardized instruments were used to measure information seeking attitudes and the accessibility and usage of digital information resources.

Thirty-six patients were inquired, with a mean age of 39.8 (13.4) years. Information-seeking preferences were high, with an API-I score of 90.1 (13.8). Preferences for information-seeking behaviors were higher in severely depressed (P = 0.010) and less educated (P = 0.026) patients. Preferences were negatively correlated with length of psychiatric treatment (r = −0.514; P = 0.002). Sixty-one percent had a priori information regarding their psychiatric problem, and 68.8% considered it was influential in the decision-making behavior. Access and use of digital resources were correlated with education level (0.644; P = 0.000 and 0.554; P = 0.003), age (−0.357; P = 0.001 and −0.559; P = 0.007) and illness severity (−0.431; P = 0.04).

Patients with depression want to be informed about their mental condition and treatment options. Few resources are used and decision mostly relies on health professional's opinion and guidance. Accessible resources seem scarce and future research shall address the acceptance and impact of decisional-aid instruments on this population.

Recently, cognitive behavior therapy has gone from being a promising new treatment to the most well established psychological treatment. In several hundreds of randomized controlled trials, it has shown effectiveness in treating obsessive-compulsive disorder. In addition, CBT is thus a highly promising treatment from a societal cost-effectiveness perspective.

Several forms of CBT have been developed using remote communication methods, the general idea is that CBT delivered through the Internet or using telephone communication reflects the content of conventional CBT, but is administered as a form of therapist-guided treatment protocol.

Estimation of applicability and efficacy of remote cognitive behavior therapy for treating patients suffering from obsessive-compulsive disorder in Egypt.

A group of patients suffering from obsessive-compulsive disorder was randomized into two groups; one received CBT as usual and the intervention group received CBT using telephone and/or the Internet. Both groups were assessed pre– and post treatment using the Yale Brown Scale for OCD symptom severity and Beck depression inventory for symptoms of associated depression. The quality of life scale was also applied to all patients participating in the study.

Pre– and post-study measures indicated a statistical and clinically relevant change in patients of two groups.

Delivering CBT for patients suffering from OCD in Egypt using remote communication methods appears to be effective in alleviating symptoms and improving the quality of life. Yet some adaptations to the standardized treatment protocol are mandated to render the protocol applicable through remote communication and enhancing cultural reception.

Providing mental health services by real-time videoconferencing has been increasingly adopted as a method of reaching hard-to-serve populations since the early 1990s. There is a growing body of evidence investigating the efficacy of delivering online mental health care. Though studies vary in quality, they generally demonstrate that online mental health care is effective across multiple age groups. Online is generally well accepted by patients and specialists and its implementation is feasible. It is also convenient and cost effective.

Due to the fact that almost 75% of Romanian population have internet access and that mental health services are still stigmatized we perceived the opportunity to develop an online platform where patients can easily find and interact with mental health specialists using secured videoconference.

During a timeframe of two years a multidisciplinary team managed to develop and test an online platform where patients can access psychotherapy sessions. Main design and development targets were usability and confidentiality/security. The platform has an appointment tool, a secure videoconference solution and an integrated online payment service.

The platform can be accessed at https://atlashelp.ro. It was launched in mid July 2016 and it already gathers more than 50 mental health specialists. The feedback was excellent from both specialists and patients.

The solution developed is complaint with most of international standards and offers easy to access and high quality psychotherapeutic services for Romanian patients.

Some techniques of psychotherapy are now widely evidence-based and very cost effective, especially cognitive and behavioral therapies. Most of the studies are indirectly based on patient reported outcomes or problematic behaviors evaluated before and after the psychotherapy. Unfortunately, studies struggle to control for what is actually happening during psychotherapy, especially the non-specific aspects, like the interaction between the patient and the therapist, that is a known predictor of psychotherapeutic efficacy. Consequently, it is difficult to make precise links between theory and practice, control its application and understand which of its ingredients are the most important.

Here, we suggest a research framework to extract automatically social signals from psychotherapy videos. We focused on the extraction of synchrony of the motor signal since it was considered to be a predictor of psychotherapeutic outcome in an earlier study and a relevant signal for the study of mother-child interactions.

We developed open source python and R scripts to compute this synchrony of motion history on a database of interaction between a parent and a child http://bit.ly/syncpsy

We confirmed that synchrony, was a relevant signal for studying social interactions since the scores are completely different from synchrony scores computed on shuffle motion history data. However, these scores alone are unable to distinguish the two periods of the videos (with and without disagreement).

Synchrony of motion history is a promising marker of social interactions.

Today telemedicine is a very popular and rapidly growing area, which allows the treatment, regardless of the distance between the patient and doctor. We present the latest research, conducted amongst polish doctors about the usefulness of telemedicine as a therapeutic tool in different medical specialties.

The aim of the study was to examine doctors’ attitude to telemedicine and usefulness of Platform ‘Moneo’ in the therapy of the areas other than psychiatry.

The first part was the polish telemedical project (grant no. POIG.01.04.00–04–219/12) conducted to assess medical Platform ‘Moneo’. It was based on a questionnaire filled by participants in scale 1 to 5. The second study based on authors’ anonymous questionnaires was distributed amongst 105 psychiatrists from Poland.

Everybody noticed advantages of medical platform. The Platform's functionalities, rated as the best by healthcare directors were: educational materials, appointment and therapy planning. Managers indicated parts, which could be improved in e-prescribing system, the process of collecting information about hospitalizations and operations. Functionalities indicated by doctors as desirable to increase the utility of the platform is e-prescribing system, reporting side effects, planning visits, educational materials. In study addressed to psychiatrists, only 15% of them claimed to have an extensive knowledge on telepsychiatry, but they had confirmed the potential of telemedicine in psychiatry.

Telemedicine is a useful method, which can improve quality of healthcare services and make an access to it possible for some people. However, lots of improvements in telemedical services are needed to make it an efficient medical tool.

The current development of new technologies dedicated to healthcare, such as smartphones, provides an interesting opportunity to improve both assessment and follow-up of different illnesses, particularly mental diseases.

To investigate, the contributions and risks of smartphone use among mental health patients.

We conducted a literature research of PubMed and Sciencedirect using the key words “smartphone”; “bipolar disorder”; “schizophrenia”; “anxiety disorders”; “addiction”; “dementia”.

Literature data provide several examples of the use of the smartphone's features for patient monitoring. One such example involved patients with Alzheimer disease. An attempt to deal with the risk of wandering was proposed with the use of the Android app iWander, which works by using the smartphone's GPS to track the patient at all times. As for bipolar disorder, several applications have been proposed both for diagnostic ic instruments…) and interventional purposes (applications that offer subjects psycho-education in the form of emotional self-awareness…). Several other applications can be used in the management of schizophrenia, social anxiety disorder and addictions. Along with its obvious benefits, however, the smartphone use has a dark side. Problematic smartphone use is one form of behavioral addiction recently identified. In addition, the access to Internet through the smartphone opens the door to Internet addiction and its sub-types (cybersexual addiction, cyber-relationship addiction…).

The use of smartphone for medical purposes must be cautious among mental health patients, because of a field of vulnerability that promotes the appearance of other mental diseases, especially addictions, which may darken their prognosis.

The authors have not supplied their declaration of competing interest.

Psychotherapy is one of the most widely investigated and practiced forms of treatment used in the treatment of different mental health problems. However, there are some barriers in delivering this treatment, including long waiting lists, therapist shortage and lack of access to therapists in remote areas. Therefore, using alternative methods to overcome these barriers seems necessary.

The division of psychiatry at Queen's university provides different psychotherapy groups for individuals suffering from different kinds of mental health problem. We gave the participants the opportunity to choose online psychotherapy through an online clinic or the live group sessions. All the patients were assessed by different questionnaires for evaluation of the efficacy of the treatment. The online clinic was designed to facilitate the communication between patients and clinicians and the material was delivered in PowerPoint format through the online platform. All user activities were logged for security purposes.

Statistical analysis showed that this method of delivering psychotherapy significantly reduced patients’ symptoms and also decreased the number of people on the waiting list and increased the amount of compliance in patient's taking part in psychotherapy and number of people who were able to receive psychotherapy.

Despite the proven short and long-term efficacy of psychotherapy, there are some barriers in delivering this treatment. It is an unequivocal public health needs to overcome these barriers through alternative methods of therapy. With Internet use ever rising, developing an online clinic could be a new way in delivering different kinds of psychotherapy.

The use of new technologies is beginning to be embraced by volunteers and professionals, from crisis lines, suicide prevention centers, mental health centers, researchers and politicians.

New technologies have entered the field of suicide prevention with high expectations for the future, despite a relatively slow start. Internet, smartphones, apps, social networks and self-help computer programs have a strong potential to achieve, sustain and help people at risk of suicide, their families, teachers, health professionals and for the survivors.

To provide comprehensive overview on the role of new technologies in suicide prevention.

Given the relatively early and underdeveloped state of this area of inquiry, the author viewed his task as gathering and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.

New cheaper services will soon be available to effectively reach and assist the most vulnerable people and prevent suicides. The potential to help vulnerable people who do not use conventional mental health services and people in regions with inadequate psychiatric facilities represents an attractive target with favourable perspectives for suicide prevention Smartphone, apps, websites, avatar coach, and virtual suicidal subjects are important for both delivering help as well as to educate mental health professionals as in the case of role playing.

Shadows and lights are emerging through the use of new technologies. If more people can be reached there are however concern for improper use of social network and pro-suicide websites.

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

Subclinical symptoms of depression or mania, present prior to clinical manic or depressive episodes in individuals with bipolar disease. Mobile applications that measure habitual behavioral patterns such as mobility, physical activity level and social engagement present an opportunity to identify state transitions preceding relapse. This could lead to earlier intervention and improved treatment outcome.

To identify associations between changes in habitual behavioral patterns measured with smartphone usage and psychiatric emergency room visits or admissions for bipolar patients.

In a case-crossover study, around 70 patients at a specialized outpatient clinic for bipolar disorder will be offered to install MoodMapper®, an application that registers text message and calls (but not communication content or recipients), mobility (but not location), number of steps taken, screen-time, and battery level. A baseline level for each individual will be established. Deviations from baseline habitual behavioral patterns in the time preceding a psychiatric emergency room visits or admissions will be analyzed in order to establish predictor variables. The patients will be followed up to 18 months.

Preliminary results will be presented.

Smartphone-collected behavioral data can be used to predict worsening or improvement of a patient's condition. As smartphone ownership becomes more commonplace, mobile apps present a unique opportunity to detect digital real-time signatures of mental illness in a way that is minimally invasive to individual's daily life and privacy.

Discussing the threat of aggression is not always at the forefront in ambulatory care providers. A structured risk analysis model for ambulatory emergency psychiatry is currently not available, while aggression does occur regularly.

The aim of this study is to evaluate the added value of a risk analysis model and implement the best available model in emergency outpatient practice.

The study design is a mixed method model. Semi-structured questionnaires were administered by nurses and psychiatrists. A benchmark study took place at an outpatient emergency service in South Netherlands. A literature search was performed using PubMed and CINAHL for the period 2000–2014.

From this research, we found a discrepancy between the perception and the actual occurred aggression. Care workers often do not discuss aggression related issues, however, case studies show that aggression does occur frequently. In literature studies we have found several risk assessment models, most of which are used within the inpatient psychiatry.

To avert aggression incidents and prevent recurrence, it is important to maintain a solid risk analysis model. Introducing a checklist risk crisis service (CRC) can promote a critical reflection on the threat of aggression and bring awareness on the theme of aggression. Implementation of a CRC in daily practice can be of great value.

GHB abuse and dependence are common in the Western region of Northern Brabant, a rural region in the south of the Netherlands.

The main goal is to look at the incidence and management of GHB abuse and dependence seen by the CRT in a rural area.

This is a retrospective data analysis based on patient files of all assessments of the Western Northern Brabant crisis resolution team (CRT) from 2013 till 2015. Inclusion criterion was current or recent (<24 hours) use of GHB with or without alcohol and other drugs. Several parameters were studied: frequency, duration and dose of GHB use, reason for referral and treatment/policy, which is used (admission, prescribed medication).

On a total of 4093 cases 50 persons were included. It shows that the percentage over the years has remained about the same (resp. 1.13%, 1.54% and 1.02%). Of all cases 41.5% used GHB only, 39.6% also used other drugs, and 9.4% GHB with alcohol and other drugs. During the assessment in the emergency department 37.7% was treated with a benzodiazepine, while 43.4% received no psychotropic medication.

GHB abuse and dependence are not commonly seen in the CRT, but the withdrawal symptoms can be challenging and GHB withdrawal is often accompanied by aggressive outbursts. Therefore, it is very important to make a decision whether outpatient or inpatient treatment is necessary and if psychotropic medication is needed.

We report the case of a 45-year-old male diagnosed with mixed personality disorder brought the hospital for strange behavior. He is being treated with fluoxetine, lorazepam and topiramate; and visited his psychiatrist 72 hours ago.

He has an adequate level of consciousness and describes retrograde amnesia of the last 72 hours. We found blocks of thought and abnormal behaviors such as dressing and undressing or sorting his belongings repetitively. Urine was only positive for benzodiazepines. In arterial blood gas analysis it performed highlights compensated metabolic acidosis. After ruling out neurological diseases and administrating fluids i.v. the symptoms remitted, persisting only the amnesia, establishing the diagnosis of suicide attempt with topiramate.

The use out-of-guidelines of topiramate in personality and eating disorders is an increasingly common habit in daily clinical practice, as well as suicide attempts with this drug. In therapeutic doses, over 40% of patients taking topiramate, have asymptomatic metabolic acidosis, which in stressful situations may have clinical relevance. In case of acute poisoning, metabolic acidosis is more frequent and severe, manifesting itself by hyperventilation, hypertension and varying degrees of impaired consciousness and cognitive functions. There is also a paradoxical increase in the frequency of seizures. Treatment is supportive and there is no antidote, being lethal cases exceptional. Gastric lavage and administration of activated charcoal have limited use. The determination of plasma concentrations of topiramate is not available for most centers and is not useful in acute poisoning.

The legal criteria for involuntary admission in Norway are that the patient has a serious psychiatric disorder (i.e. psychosis) and is in need of admission to secure needed treatment or that there is a risk of danger. While there have been some studies focusing on coercion in hospitals, less is known about the processes leading up to involuntary admission and the reasoning of referring doctors. In Norway, it is primarily general practitioners (GPs) that refer patients.

To study which factors that GPs who had recently referred patients to involuntary admission thought might have made their latest referral unnecessary.

Seventy-four GPs were interviewed by phone. They had all recently referred patients involuntarily to a major Norwegian university psychiatric hospital. One central question concerned how their latest involuntary referral might have been avoided.

These are the main factors that the GPs thought could have been of importance in avoiding involuntary referral of their patients:

– that the patient took the prescribed medication (28%);

– that they personally had the opportunity to closely follow up the patient in the following days (22%);

– that other health care staff could follow up the patient closely in the patient's own home (i.e. home care nursing, etc.) (19%);

– that a family member of the patient could help the patient (8%).

The GPs suggested that an increased availability of resources and more assistance from other parts of the health service were some of the factors that could be of importance in reducing involuntary admissions.

Increasingly, psychiatric patients are presenting to the emergency department (ED) with agitation. ED staff rarely, if ever, use scale to assess agitation or use any self-assessment tools to determine a patient's level of agitation.

To evaluate the relationship between a patient's self-reported level of agitation and other validated agitation assessment tools.

This is a prospective study using a convenience sample of patients presenting to the ED with a psychiatric complaint. This study was conducted in an urban, inner-city trauma level 1 center with 55,000 ED visits a year. After obtaining consent, a research fellow administered observational tools, PANSS-EC and ACES and BAM and Likert scale self assessment tools on arrival to the ED. SPSS version 24 was used. The study was IRB approved.

A total of 139 patients were enrolled. The most common ED diagnoses were depression, schizophrenia, or bipolar. Majority of patients were African-American (59%), falling in the 25–44 year old age range (56%) 52% male. Self-reported agitation was rated as moderate to high in 72.4% of these patients on the Likert scale and 76.3% on the BAM. There was a significant correlation between the self-reported score versus the BAM (F = 11.2, P = 0.00). However, the self-reported scores were significantly different from the scores assessed by observational tools (P < 0.05).

ED providers should assess a patient's self-reported level of agitation because a patient could be feeling markedly agitated without expressing outward signs detected by observational tools.

The authors have not supplied their declaration of competing interest.

Fratricide comprises approximately 2% of all intra-familial homicides. Analyses of national data on fratricide show that adult males are considerably more likely to be offenders and victims or fratricide. A previous study suggested there were two main categories of fratricide: related to alcohol intoxication or associated with mental disorder.

Present and discuss the results of an original study comprising 28 cases of fratricide.

To provide up-to-date scientific knowledge on fratricide.

This is a retrospective study of 28 cases of fratricides, extracted from a sample of over 1000 consecutive cases of coroners’ files of victims of domestic homicide occurring between 1990–2015.

Two victims out of three were males, most of adult age. There were only 2 female offenders in the whole sample. A majority of victims were Caucasians while 21% were aboriginals. Most victims were stabbed to death. The murders usually occurred at the residence of the victim. In total, 39% of offenders suffered from a major mental illness; 21% were acutely intoxicated at the time. In victims, 29% were under the influence of alcohol and 18% of offenders were free from mental problems.

Our data indicates that fratricides are most often impulsive and lack preparation. The most common method was the opportunistic use of a knife, suggestive of impulsive killing, and this is consistent with the rest of the information including the high rate of alcohol use and intoxication at the time. The study confirmed two main categories of fratricide: impulsive killing in the context of alcohol and dispute and killing associated with psychosis.

The authors have not supplied their declaration of competing interest.

Italian forensic mental hospitals closed on March 31st, 2014 and offenders sentenced to need a psychiatric care are restrained in facilities. Since 2002, the residential psychiatric facility “Tiziano” (Aulla, Massa-Carrara) hosts forensic patients, on appointment with national health system and compulsorily admitted by the justice system.

This descriptional and prospective study provides a thorough report on the main epidemiological, clinical, and criminological features of 60 mentally ill offenders hosted in the “Tiziano” facility between 2002 and June 2016.

Most forensic patients were male (90%, n = 54; average age: 33 years). Sixty percent of subjects (n = 36) had a clinical diagnosis of psychosis (19.4% affective psychosis, 72.2% non-affective psychosis, 8.4% organic psychosis), and about one third of them (31.6%, n = 19) had a personality disorder (63.1%, n = 12, antisocial personality disorder, 42.1%, n = 8, borderline personality disorder, 21.0%, n = 4 other personality disorders). Mental insufficiency was diagnosed in 11.6% (n = 7) of subjects, while substance use disorder affected 35.0% (n = 21) and alcohol use disorder 26.6% (n = 16). Forty-nine patients (81.7%) had committed serious crimes against people; 15% (n = 9) were murderers or attempted murderers, and 46.7% (n = 28) had committed more crimes. The average length of stay is 22 months.

To date, there are no data about long-term follow-up and clinical outcome of mentally ill offenders restrained in Italian psychiatric facilities. Additional studies are needed to assess psychopathology and differentiate treatment according to diagnosis, and to identify risk factors of relapse for criminal behavior relapse.

In response to the Winterbourne scandal, and the large number of people with intellectual disabilities (IDs) and offending behavior being treated in psychiatric hospitals, this study identified the domains that should be used to measure treatment outcomes of this group.

A systematic search of relevant databases was undertaken to identify domains. Sixty studies met the eligibility criteria, and findings were synthesized using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts.

The final framework encompassed three a priori super-ordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviors, reactive and restrictive interventions, quality of life and patient satisfaction.

To index recovery, services need to measure outcome using this framework.