Sjogren's syndrome (SS) is a common autoimmune disorder that is characterized by chronic inflammation of lachrymal and salivary glands. The well-known clinical manifestations of SS are dry eyes and dry mouth. However, the disease may first present itself with psychiatric symptoms, such as depressed mood, agitation or irritability.

Our objective is to highlight the importance of systemic examination, including detailed biochemical workup in psychiatric patients with somatic complaints like fatigue and those patients with partial response to treatment.

We present a 35-years-old woman who had depressed mood, obsessions and compulsions, chronic fatigue, generalized muscle and joint pain, balance problems, weight loss, dry mouth and dry eyes for the past few years. Her symptoms would worsen during spring. She was diagnosed with seasonal affective depressive disorder and chronic fatigue and was started on mirtazapine 30 mg/day and venlafaxine 75 mg/day. She was partially responsive to this treatment. The detailed biochemical workup came 1/320 positive for anti-nuclear antibodies (ANA). The oral biopsy showed Sjogren's disease. Gluten sensitivity was found as well.

The patient was started on hydroxychloroquine sulfate 400 mg/day in addition to her anti-depressant medication. She was put on a gluten-free diet. She was in full remission in a month and had no depressive attack in spring. Her ANA decreased to 1/80.

Psychiatric syndromes may arise from different pathologies of the central nervous system. In patients with recurrent psychiatric syndromes or patients who are partially responsive to conventional treatment approaches further systemic evaluation of the patient is needed.

The authors have not supplied their declaration of competing interest.

For most of the physical illnesses, behavioral, emotional, cognitive and inter-personal reactions develop. These psychiatric conditions and reactions are actually the adjustment process of the organism.

Study is conducted in order to identify the psychiatric signs as well as findings of the patients who receive treatment in the general services of hospitals.

The study was carried out with a total of 500 patients who receive treatment in the general service of a hospital of a ministry of health in Turkey between February and May in 2015 by descriptive cross-sectional method. For collecting the data; patient charts, SCL 90-Rand general health questionnaire as well as hospital anxiety and depression scale were utilized. Kolmogorov Smirnov Normality test was applied for the average SCL90R and general health. Questionnaire, as a result of the test, it was detected that both scales did not meet the assumption of normality Therefore, Kruskal Wallis test of non-parametric was used.

The study showed no significant difference among the lengths of stay in the hospital according to the average SCL90-R and general health questionnaire It was observed that the patients in the cardiology, neurology, and plastic surgery departments had a higher rate of signs of obsessive compulsive disorders; that the patients in the plastic surgery and internal diseases departments had a higher rate of depressive signs; that the patients in the neurology and plastic surgery departments had a higher rate of paranoid ideation; and that the patients in the neurology service had a higher rate of psychoticism.

Overall, it has been observed that the patients hospitalized in the neurology and plastic surgery services had more physiological signs compared to those receiving treatment in the other services.

The author has not supplied his declaration of competing interest.

Multicenter study showed that sleep disorders was diagnosed in approximately 40% of patients with chronic obstructive pulmonary disease. COPD is a condition that is most widely investigated regarding its relation with sleep.

Our study is a complementarily one that is carried out to determine how COPD affects the quality of sleep.

This study enrolled 300 patients with COPD, who receive treatment in an occupational diseases hospital of ministry of health, Turkey, and control group of 100 healthy volunteers. This definitive, cross-section study was conducted between 01.02.2016–31.04.2016. Socio-demographic details form, epworth sleepiness scale and Pittsburgh sleep quality index are used to gather the study data. Any disease that affects sleep structure (Obstructive sleep apnea syndrome, substance abuse, irritable leg syndrome, depression, anxiety disorder, peptic ulcer) and a treatment that can affect sleep patterns (antidepressant, anxiolytic, diuretic) and to work all patients who were planned to receive Hamilton depression and were assessed with anxiety scale and anxiety, depression those who have high points to think of the reins are not included in the study.

Score obtained from Pittsburgh sleep quality index–A subjective test - was significantly high in the COPD group. Actigraphic sleep parameters that include ‘actual wake time’, ‘actual wake %’, ‘total activation score’ and ‘fragmentation index’ were significantly high in the COPD group comparing to control group. Among actigraphic sleep parameters, ‘actual sleep time’, ‘actual sleep’ and ‘sleep efficiency’ were significantly lower in the COPD group comparing to control group.

The study demonstrates that chronic obstructive pulmonary disease poses negative influence on the quality of sleep and leads to sleep disorders.

The author has not supplied his declaration of competing interest.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality chronic obstructive pulmonary disease can cause intense psychological distress due to the caused problems that individuals experience in their lives. COPD is among a number of medical disorders associated with a high rate of depression and other psychological problems.

In this study, it is aimed to evaluate the prevalence of psychological symptoms and disability in patients with chronic obstructive pulmonary disease.

The study includes 100 volunteers as a control group and 200 patients diagnosed with COPD who are being treated in a hospital for occupational diseases of the Turkish ministry of health. It is performed as definitive-cross-sectional between 12.03.2016–30.04.2016. In gathering the data; socio-demographic Information form, brief disability questionnaire and Beck depression scale and SCL 90 R scale are applied. The mean age of the COPD group is 49.2 ± 3.4 (25–78) and the control group is 45.1 ± 2.4 (27–60).

In our study, depression was detected in 56% of cases with chronic obstructive pulmonary disease. Mean brief disability questionnaire score was found 7.28. Mild disability was found in 21%, moderate disability in 38% and severe disability in 29%. Moreover, It was also found that obsessive-compulsive and depressive symptoms were higher in COPD cases in comparison with the healthy group.

The author has not supplied his declaration of competing interest.

While revealing the presence of Huntington Disease (HD) within the family setting has received considerable research interest, the sources of information and the detail of which aspects of the illness are discussed remains unexplored. This study's primary aim was to identify HD information sources, both professional and family, and to describe the types of information received by members of affected families, with the hypothesis that some aspects of the disorder would be more fully addressed than others.

Clients drawn from a specialist genetic unit looking after families with HD (n = 46) were engaged in structured interviews and completed standardized questionnaires, including: the psychological adjustment to genetic information scale (PAGIS); and a current psychological distress measure (K10). Participants obtained HD related information from a mean of 4.76 sources (49.3% professional).

As expected, genetic and neurological symptoms were more frequently described (97.7% and 86.4% respectively) than cognitive and psychological/psychiatric (63.6%; 52.3%). Regression analyses were used to identify potential predictors of current distress, adjustment, and information satisfaction. Rated satisfaction with information received was higher among participants with a gene positive family member. Across the PAGIS sub-scales, there were differential associations with the predictors examined.

Given that HD is a multi-faceted condition affecting the entire family, needs would be better addressed if information provided went beyond discussion of genetic and movement disorders, and extended to the cognitive, psychological and behavioral aspects which are strongly associated with quality of life.

The authors have not supplied their declaration of competing interest.

Mental disorders (MD), especially depressive, have high rates in rheumatic disorders (RD)–Behçet's Disease (BD) and Rheumatoid Arthritis (RA). Depressive and cognitive disorders have close pathogenesis interrelations with RD.

To compare the variants of MD in BD and RA-patients.

Two hundred and twenty-five (100 BD and 125 RA) inpatients were enrolled in the study. In BD patients prevailed men (70%) in RA–women (77%). MD were diagnosed in accordance with the ICD-10 in semi-structured interview. For evaluation of severity and the variants of cognitive disorders psychology and neuropsychological methods were used.

MD were diagnosed in the majority of patients (86%), significantly more often (P < 0001) in RA (94%) versus (vs) BD (79%) patients. The depressive disorders dominated (BD–100%, RA–93%). The chronic and recurrent depressive disorders prevailed in both groups : in RA more often than in BD patients (58.4% vs 39.2%, P = 0.003). Cognitive disorders of different severity were diagnosed in most patients with BD and RA (73% vs 66.4%, n/s). The mechanical memory (63%) and attention deficit (72%) in BD and impairment of associative memory (90%) and logical thinking (71%) in RA were the most frequent manifestations of cognitive disorders.

The results have shown high rates of MD, especially chronic depression and cognitive disorders in BD and RA patients. The necessity of interdisciplinary strategy implementation for the improvement of individualized treatment approaches in RD has been confirmed.

The authors have not supplied their declaration of competing interest.

Drinking has been shown to be a protective factor against the risk of rheumatoid arthritis (RA). On the other hand, high prevalence of depressive symptoms has been observed among RA patients.

To evaluate the association between depressive symptoms and somatic factors as well as drinking habits in RA patients.

Drinking habits and physical symptoms in 182 female RA outpatients in Ivanovo, Russia (average [standard deviation] of age, 62.0 [11.7] years), were investigated. Drinking status was classified as current drinkers (alcohol consumption within the previous 12 months) and others. Depressive symptoms were evaluated with MINI, HADS and CES-D questionnaires. Outcomes were (a) presence or history of major depressive disorder, presence of melancholic major depressive disorder, presence of dysthymia, or 1 point or greater of suicidal risk score in MINI, (b) 8 points or greater in HADS-depression, (c) 8 points or greater in HADS-anxiety, and (d) 16 points or greater in CES-D. Stepwise logistic regression was used to evaluate somatic factors associated with depressive symptoms, with age and drinking status included.

Drinking was rather protective against depression, but did not reach statistical significance. Symptomatic parts in the extremities associated with the outcomes were shoulders for MINI, elbows and knees for HADS-depression, shoulders for HADS-anxiety, and hands, elbows and shoulders for CES-D. In the stepwise selection, some symptoms in the extremities were positively associated with the outcomes.

Symptoms chiefly in large joints contributed to depressive symptoms.

The authors have not supplied their declaration of competing interest.

Repeated self-harm is difficult to predict particularly in the long-term. Scales that help identify risk of repetition are widely used, and the most popular is the modified SAD PERSONS scale (mSPS). We aimed to clarify the accuracy of the mSPS in first time and non-first time patients presenting with self-harm with an extended follow-up period of observation.

We conducted the UK's first long-term prospective risk prediction study of patients to an Accident and Emergency (A&E) department. We followed up 774 patients for a mean period of 7.4 years. At the time of study 429 patients presented with their first episode of self-harm and 345 had a hospital record of past history of self-harm.

During 7.4 years of follow-up 54.7% of those who initially presented with self-harm represented with a repeat self-harm episode. Four hundred and twenty-one patients had a mSPS score less than 6 (low risk), 260 had a score between 6 and 8 (moderate risk) and 94 scored 9 or higher usually notated as high risk. The clinical utility of the mSPS was “poor” for predicting future self-harm but at cut-offs ≥7 it was “fair” for predicting non-repetition. Of the individual questions in the mSPS, a positive answer to “stated future wishes” was a true positive in 74.0%.

We found the mSPS was a relatively poor indicator of future self-harm risk in a long term follow-up of patients who self-harmed regardless of hospital record of previous self-harm history. However, mSPS did have modest value in predicting non-repetition.

The authors have not supplied their declaration of competing interest.

To assess and compare the subjective rating of quality of life (QOL) in psychiatric patients who attended two psychiatric outpatient clinics in Baghdad city [Al-Rashad psychiatric teaching hospital and Baghdad teaching hospital]. In addition, it also aims at studying the effect of socio-demographic and clinical characteristics on the patients’ life qualities.

A sample of one hundred patients divided equally into two groups (fifty patient) from each hospital were interviewed and diagnosed in accordance with the DSM-IV diagnostic criteria, for the period (from the 1st of March to the 1st of September 2011). The Arabic modified version of WHOQOL-BREF questionnaire (modified by WHO) was applied on each patient.

Data gathered from completed hundred forms showed that 50% of patients from Baghdad teaching hospital responded and scored (fair, acceptable) to describe their satisfaction in overall QOL, while (38%) of patients from Al-Rashad teaching mental hospital scored (bad) and (16%) scored (very bad). There was no significant difference in the four domains of QOL between the two studied groups. The findings were discussed accordingly.

This study showed that although the overall satisfaction of the patients’ life quality was higher in patients from Baghdad teaching hospital than those of Al-Rashad teaching mental hospital, a non-significant difference in the four domains between the two hospitals was found. The socio-demographic and clinical characteristics were not significantly correlated to the QOL domains except for the educational level, which was significantly correlated, with the physical health domain in patients from Al-Rashad teaching mental hospital.

The author has not supplied his declaration of competing interest.

Stigma toward mental illness is an international phenomena and it has negative consequences on the patients and their families. Studies on public attitudes toward people with mental illness (PWMI) in the Arab world initially reported less prevalence of stigma compared to other societies; however, follow up studies showed that stigma was influenced by specific socio-cultural factors.

This study aims to examine public attitudes toward people with mental illness in Oman and the impact of socio-demographic factors.

This is a cross-sectional survey conducted among the general public in Oman. The attitude was measured via the Attitude toward Mental Illness (AMI) questionnaire. Various demographic factors were examined including age, place of residence, occupation and previous encounter with PWMI. The data were collected using online research methods.

A total of 601 subjects participated in this study, (M: 41.4%, F: 58.6%). 48% of the participants were aged 15–30 years while 46% were aged 31–45 years. The majority of the participants were employed and 10% were students. After adjusting for all other variables, subjects aged (15–30years) had less positive attitude compared to those aged (46–60 years) (P = 0.06). Socio-demographic factors such as gender, occupation and previous contact were correlated with the endorsement of positive attitudes toward PWMI.

This study illustrated that public attitudes toward PWMI in Oman is generally sub-optimal. The observed attitudes were strongly influenced by age, gender, occupation and previous exposure to PWMI. Future studies with robust methodology are recommended to scrutinize the present findings.

The authors have not supplied their declaration of competing interest.

Shame, especially when enmeshed in cultural beliefs about mental illness and cultural roles, could be a detrimental factor in psychiatric illness in context of adherence to treatment and continuation of care. Shame is defined as a painful experience which embodies multiple components including: collapse of self esteem, feeling of humiliation, rupture of self continuity, sense of isolation, and feeling of being watched by critical others.

Understanding the psychodynamics of shame, in a particular cultural milieu and its components which could impact psychiatric treatment and care.

Here we present a case report of a 41-years-old Arab male patient from Yemen, with a history of paranoid schizophrenia who was admitted to inpatient psychiatric service for bizarre and aggressive behavior.

Initially the depth of patient's delusions and psychotic symptoms were not fully appreciated due to the cultural gap between the patient and the treatment team. He was then re-valuated through the implementation of the cultural formulation interview (CFI) by clinicians from same cultural background. This team was able to elucidate the deep feelings of shame and inadequacy in patient's presentation and provide a culturally tailored treatment plan.

Evaluation of psychiatric patients in a different cultural setting where western values do not apply might not be sufficient to assess the breadth of psychotic symptoms especially when an underlying feeling of shame contribute to presenting symptoms. Treatment of those patients with neuroleptics without assessing the cultural dynamics might result in poor adherence to medication and follow up.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Methodological basis of Vygotsky's scientific school implemented in the study provides possibility to detect risk variants in emotional and personal development of children from different social strata and to explore the mechanisms responsible for pathological development.

The study included two groups:(1) children from a middle-high social stratum (n = 31); (2) children from a middle-low social stratum (n = 36). All the children were between ages 5.5–7 years at the moment of research, lived in Moscow and attended extracurricular activities. Following methods were used: objective description of child's development in socio-cultural context; semi-structured interview; long-term overt and covert observations; diagnostics of intellectual, emotional and personal school readiness.

Children from the 1st group demonstrate higher level of intelligence; they are more successful in solving unusual tasks. Children from the 2nd group tend to follow instructions given by teacher. Children from the 1st group unlike those from the 2nd one are characterized by lower level of social competence; they encounter difficulties in establishing contacts and don’t perceive hierarchy in adult–child relationship. Mass protection typical for children from the 1st group and hyper-satisfaction of their needs determine decrease of frustration and don’t deepen their personal experience providing basis for pathological development. Children from the 2nd group are more inclined to demonstrate alarm reactions, but in general they possess higher level of emotional and personal maturity and social flexibility.

Socio-cultural environment has a direct say in potential risk zones of child development.

The authors have not supplied their declaration of competing interest.

The study explores subjective image attributed by parents to their child that was formed under the influence of different socio-cultural conditions and affects communication with a child. Methodological basis of Vygotsky's scientific school was used in the research.

The study included two groups of families from different social strata: group 1 — middle-high stratum, group 2 — middle-low stratum (n1 = 31, n2 = 36), all the families live in Moscow; the children (5.5–7 years old) attend extracurricular activities. Following methods were used: analysis of social context of child's development; long-term overt and covert observations; analysis of complaints, ambitions and expectations — “a project of future development” of a child imagined by parents followed by reconstruction of their relations that appear to be the basis for the “project”; method of semi-structured interview.

First group demonstrates high level of irrelevance in subjective extra-positive image of a child. That poses risk for child's emotional and personal development. Families from different strata tend to demonstrate irrelevance between ambitions and real success of a child. First group tend to overstate, 2nd group — to understate. In some cases parents’ mindsets cause emotional peculiarities of the child: individuality and as a result inflated ego, demonstrative behavior accompanied by interest to external attributes. In 2nd group children are mostly anxious and encounter difficulties in demonstration their abilities, but they possess higher level of emotional and personal maturity and social flexibility.

Socio-cultural features of the stratum influence parental expectations that form potential risk zones in child development.

The authors have not supplied their declaration of competing interest.

Review the work of Jorge Amado in the thanatological hermeneutics makes it come to be apparent the role of art in shaping the popular imagination and its educational purpose, which art cannot do without.

The purpose of this research is to present that, Jorge Amado using various methods causes a semiotic and polysemic reading of life and a hermeneutics review of death, making his literary art an instrument of education for death.

Using the transversal method of bibliography review of the author's work.

We noted that in the anthropology of Jorge Amado, death might be the exercise of power, as those legitimated by a theology casuistry, in “Violent Land”. However, death can be an element of transformation of the state of life and overcoming the limits of the roles that society has agreed to be played by its subject, paradigm of this counterculture is Livia, widow of Guma in “Sea of Death”. In “The Double Death of Quincas Water-Bray” dead and death inset in starring roles, provoking a psychological reflection about death as a complex dimension, able to have their own intentions and itinerary and, assigning the dead freedom and responsibility for his death and die, the author will say: “Everyone take care of your own funeral.”

Death has the function of unveiling character and affections, and balance all forces presents in the society, and the art is the instrument to that reflection reach the community.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Transcultural psychiatry is a branch of psychiatry where cultural context for psychiatric symptoms is studied. It emerged as a consequence of migration of diverse ethnic groups and questions whether international diagnosis classifications fit in different cultures.

The aim of this review is to make professionals aware of the importance of cultural context for the way mental disorders present themselves depending on the patient's origin.

We report the detailed case of a 23-year-old Moroccan woman, attended for the first time by the mental health services when she was 8. Since that moment, she felt herself possessed by a strange being. Auditory hallucinations appeared. It was only when her father or her husband were at home that she felt the “being” was gone. Her husband, as formerly his father, represented a symbol of protection against that evil being and indeed against her mental disorder, which was directly related to her cultural beliefs.

Every country has a different culture and every migration brings with it a new environment. The way people adapt to it may result in mental illness. We want to discuss if symptoms fit international diagnosis classifications.

Psychiatrists should become aware of the limitations of the international classifications when used on different ethnic groups. We should have a cultural approach in order to treat the diverse populations from all around the world.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The concept of “highly sensitive person” is a cultural concept, which has become popular in western societies including Sweden. A highly sensitive person (HSP) is usually described as having hypersensitivity to external stimuli, different cognitive processing and high emotional reactivity. Although the concept lacks diagnostic validity, psychiatric patients may refer to this concept.

To examine the feasibility of the Cultural Formulation Interview (CFI) and the clinical relevance of cultural concepts of distress among patients with bipolar disorder that report being a HSP.

A case series of three patients with a diagnosis of bipolar disorder that report HSP. The CFI was conducted with all patients and the applicability of the DSM-5 cultural concepts of distress tested.

In all three cases, the CFI facilitated the clinical consultation as reported from the patients and in one of the cases also increased the treatment engagement. The HSP-concept could be conceptualized as a cultural syndrome, idiom of distress and as an explanatory model.

The CFI and the cultural concepts of distress proved to be useful for understanding the concept of HSP as also they increased the cultural validity of the diagnostic interview. The three cases illustrate the challenges when encountering patients with other cultural references than clinicians. This highlights the necessity to integrate anthropological thinking in our current diagnostic work in order to reduce the “category fallacy” and promote a more person-centered approach in psychiatry.

The authors have not supplied their declaration of competing interest.

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