Electroconvulsive therapy is currently used in the management of severe depression, long-term mania and catatonia. Regarding schizophrenia-related psychosis ECT is also an option, but the indication is restrictive to severe cases, drug intolerance or resistant ones. Lack of evidence of cost-effectiveness compared to clozapine, and side effects of ECT techniques before 2003, influenced NICE guidance to not recommend ECT in schizophrenia, but modern ECT machines and procedures are subsequent to 2003. ECT is often performed when clozapine fails to respond in monotherapy or if there is intolerance to antipsychotic side effects. ECT in combination with clozapine seems to have significant results allowing the patients to achieve rapid control of psychotic symptoms with fewer side effects, comparing with antipsychotics-association strategies.

To summarized the latest literature about this field and to present recent data from the Electrovulsivetherapy Unit, in Hospital de Magalhães Lemos, Portugal.

To explore and critically review the controversies of electroconvulsive therapy in the management of drug-resistant schizophrenia.

Retrospective data of an Electroconvulsive Therapy Unit during 2006–2015 was review.

198 ECT treatments in schizophrenic patients were performed in our unit, during 2006–2007, in a total of 647 ECT (30,6%). In 2014–2015, 945 schizophrenic patients received ECT treatment, in a total of 2149 performed ECT (43,9%).

Although guidelines are crucial for the uniform practice of medicine, sometimes is important to be critical about them. The use of ECT in schizophrenia is safe and effective and further research is needed to continue to support this treatment.

The authors have not supplied their declaration of competing interest.

Risk prediction for suicide in schizophrenia is known to be complex. Illness-related risk factors are important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions.

To analyze the impact of clinical features of schizophrenia on suicidal behaviour and analyze relationship between violence and suicidality.

We compared a group of 28 suicidal, 32 hetero-aggressive and 60 non-aggressive male patients with schizophrenia. The severity of the psychopathology was assessed using PANSS, hetero-aggressiveness using OAS and suicidality using C-SSRS and InterSePT scales.

Suicidality is in positive correlation with the presence of depression (r = 0.485, P < 0.001) and imperative hallucinations (r = 0.391, P < 0.001) but in negative correlation with total PANSS score (r = –0.297, P < 0.001), impulsiveness (r = –0,237, P < 0.001) and hetero-aggressive behaviour (r = –0.551, P < 0.001). Previous attempt was found in 53% suicidal patients (P = 0.047). Heteroaggressiveness is in positive correlation with total PANSS (r = 0.43, P < 0.001) and impulsive behaviour (r = 0.57, P < 0.001). This study supports the contention that high impulsivity in schizophrenia patients is significant in the etiology of violent but not suicidal behaviour.

In the order to diminish the level of suicide among patients with schizophrenia we must be aware of the importance of depressive symptoms, imperative hallucinations and previous attempts. This study supports the contention that high impulsivity in schizophrenia patients is significant in the etiology of violence but not suicidal behaviour.

The authors have not supplied their declaration of competing interest.

Poor physical health and shorter life expectancy often follows from mental illness. If the disorder starts in childhood/adolescence, the risk of this outcome is even higher. Second generation antipsychotics (SGAs) are suspected to increase cardiovascular risk factors through the development of the metabolic syndrome.

We investigated all the aspects of the metabolic syndrome in drug-naive youth, over a period of 12 months of treatment with SGAs.

This study examines drug-naive youth in their first year of treatment with SGAs, and the possible development of markers of the metabolic syndrome, in a naturalistic setting. We also look at aspects of the patient's disease and environment that may predict which patients are the most at risk for these metabolic derangements.

Thirty-five drug-naive adolescents were recruited after their contact with the Psychosis Team at Department of Child and Adolescent Psychiatry in Odense, Denmark. Measurements were taken at different times over the course of their first year of treatment. The markers included, among others: body mass index, waist circumference, blood pressure, fasting blood glucose, as well as high density, low density and total cholesterol. Factors of the patients’ lifestyle and development were recorded as well.

The results will be presented at the EPA March 2016 in Madrid.

This is, to our knowledge, the first study to include all of the aforementioned aspects in drug-naive adolescents over a 12-month period. Because of this, it may provide us with a unique insight into how, and in which patients, these metabolic changes develop.

The authors have not supplied their declaration of competing interest.

Depression is often observed in schizophrenia, in all phases of the disorder. Age of illness onset and sex have been found to correlate with depressive symptomatology in many but not all studies.

In the present work the relation between depressive symptoms and age of onset and sex was investigated, in a sample of patients with paranoid schizophrenia.

Eighty-eight (88) patients with paranoid schizophrenia according to DSM-IV-TR criteria were examined, 21 of which became ill at ≥35 years of age (late onset), whereas 60 had age of onset < 30 years (young onset). During the active phase the Calgary Depression Scale for Schizophrenia (CDSS) was applied. Comparisons were performed by using the two-tailed Wilcoxon rank-sum and Chi-squared tests.

The percentage of patients with depression (CDSS > 6) in the whole sample was 27.2%. There was a trend for higher scores in early awakening in late onset patients (P = 0.060). In men, there was a trend for heavier depression in late onset patients, and higher scores in early awakening (P = 0.082, 0.019, respectively). In young onset patients, there was a trend for heavier symptomatology in women compared with men, and heavier pathological guilt (P = 0.073, 0.007, respectively), whereas in late onset patients, there was a trend for heavier self depreciation in men (P = 0.072).

Although the frequency of depression does not seem to be influenced by age of onset or sex, more subtle differences are found in the severity of certain depressive symptoms, in relation to these factors, possibly warranting further investigation.

The authors have not supplied their declaration of competing interest.

Sarcosine - glycine transporter inhibitor - increases glycine concentration around NMDA (N-methyl-D-aspartate) receptors. Function of the glutamatergic system in the prefrontal cortex and hippocampus is impaired in schizophrenia, which may lead to negative and cognitive symptomatology.

We evaluated the influence of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) and left hippocampus in patients with stable schizophrenia.

Fifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned (25 patients in each group) to administration of sarcosine (2 g) or placebo for six months. 1H-NMR spectroscopy (1.5 T) in both localisations and clinical evaluation (PANSS) was performed before and after sarcosine addition.

Initially we noted no differences in metabolite concentrations between groups. In the left DLPFC, NAA/Cho, mI/Cr and mI/Cho ratios were significantly higher in the sarcosine than the placebo group after six months. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. In the left hippocampus Glx/Cr and Glx/Cho decreased in sarcosine group at the end of our study.

The addition of sarcosine to antipsychotic therapy for six months caused increase of neurons viability (NAA) and neurogilal activity (mI) markers in the left DLPFC and decrease of hyperglutamatergic overstimulation parameters in the left hippocampus with simultaneous improvement of clinical parameters including negative symptoms.

The authors have not supplied their declaration of competing interest.

Deficit of glutamatergic transmission and aberrant function of kynurenine pathway, with disturbed synthesis of glutamate receptors antagonist, kynurenic acid (KYNA) and neurotoxic metabolite of kynurenine, 3-hydroxykynurenine (3-OH-KYN) have been implicated in the pathogenesis of schizophrenia.

Demonstrated by others higher level of KYNA in the brain may cause relative deficiency of glutamate-mediate transmission with resulting behavioural and cognitive changes.

Search for predictors of satisfactory response to antipsychotic treatment based on the analysis of KYNA and 3-OH-KYN serum levels.

Fifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. Quantitative analyses of KYNA and 3-OH-KYN were performed using high-pressure liquid chromatography (HPLC) and electrochemical detection, respectively. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted at 3 time-points: during the active phase of disease, after 4 weeks of modified pharmacotherapy, and after reaching remission.

In schizophrenia group, lower levels of KYNA (P = 0.002) and non-altered levels of 3-OH-KYN (p = 0.195), as compared to control, were detected during active phase of disease. Despite clinical improvement, no significant changes in the level of studied metabolites were observed later on. The initial level of 3-OH-KYN correlated negatively (r = –0.368; Spearman's rank) with clinical improvement (negative symptoms) (P < 0.05).

1. The peripheral dysregulation of kynurenine pathway metabolites in chronic schizophrenia manifests as relative increase in the ratio between neurotoxic 3-OH-KYN and neuroprotective KYNA. 2. The higher serum level of 3-OH-KYN during relapse of schizophrenia seems to predict poor response to antipsychotic treatment.

The authors have not supplied their declaration of competing interest.

The relationship between olfactory and emotional processing is an area of increasing interest in schizophrenia research.

Olfactory identification deficits are well described in schizophrenia while the results for pleasantness ratings remain unclear.

Evaluation of odor identification and hedonic judgment related to severity of negative symptoms and β-endorphin concentration.

Fifty outpatients with schizophrenia were included in the study: 25 with negative symptoms (PN) and 25 without predominant negative symptoms (P). They were compared with 23 healthy individuals. In all study groups University of Pennsylvania Smell Identification Test (UPSIT) and odor hedonic evaluation were performed. Clinical symptoms severity was evaluated using PANSS. Plasma concentrations of β-endorphin were assayed in all participants.

PN made more odor identification errors than controls (P = 0.000) and P sample (P = 0.001). Hedonic judgments of unpleasant odors were significantly more pleasant in PN sample than in P (P = 0.03) and controls (P = 0.041). PN had significantly higher concentration of β-endorphin than P sample (P = 0.014) and controls (P = 0.009). No relationship between β-endorphin concentration and odors identification and odor hedonic judgment was found in both patient samples and controls.

Increased level of β-endorphin is related to predominance of negative symptoms but probably it is not involved in olfactory identification performance and hedonic judgment in schizophrenia. Patients with predominant negative symptoms revealed different pattern of pleasantness rating – they experience unpleasant odors as more pleasant. Alterations in smell identification and hedonic judgment could be differentially expressed in some subtypes of schizophrenia.

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

Negative symptoms have long been recognized as a central feature of schizophrenia, which limit recovery, having a strong negative impact on real-life functioning. External validators of the negative symptoms domains might help refining hypotheses on their pathophysiological basis.

The objective of this study was to evaluate, in the context of the multicenter study of the Italian Network for Research on Psychoses, the relationships between auditory event-related potentials (ERPs) components and negative symptom domains in patients with schizophrenia (SCZ).

We examined ERPs recorded during an auditory odd-ball task in 115 chronic stabilized SCZ (78% on second-generation antipsychotics) and 62 matched healthy controls (HC). Negative symptoms were assessed using the Brief Negative Symptom Scale.

Our main findings included significant N100 and P3b amplitude reductions in SCZ compared to HC. P3b amplitude did not correlate with any negative symptom domain, while N100 amplitude correlated with both anhedonia and avolition domains.

Avolition and anhedonia, often clustering in the same factor, are related to abnormalities of early components of the ERPs correlated with perceptual and automatic attention processes. None of the negative symptom domains is associated with abnormalities of the later stages indexed by P3 amplitude.

The authors have not supplied their declaration of competing interest.

Adherence to treatment of mental disorders is one of the key factors influencing its success and, secondarily, the patients’ quality of life and social adaptation.

The cross-sectional study of 90 outpatients diagnosed with psychotic disorders aimed at determining if there was a relationship between discontinuation of medication in the past, current adherence to treatment and self-stigma.

The assessment was made with the objective and subjective Clinical Global Impression – Severity scale, Drug Attitude Inventory, Internalized Stigma of Mental Illness (ISMI) scale and demographic data.

The questionnaires were filled out by 79 patients, of whom 5 handed in incomplete questionnaires. Complete sets of data were obtained from 74 patients. The data analysis showed that the levels of self-stigma as assessed by the total ISMI scores was not statistically significantly correlated with most of the demographic factors (age, age of illness onset, gender, education, marital status, employment, duration of the illness, number of hospitalizations and antipsychotic dosage). However, there was a significant negative correlation with current adherence to treatment.

Adherence to treatment is one of the most important prerequisites for successful therapy. Adherence may be enhanced through better motivation and education of patients on the necessity of adhering to treatment recommendations and the consequences of non-adherent behavior. Important factors in adherence also seem to be patients’ stigmatization and self-stigma. Adherence may be increased by promising self-stigma-reducing strategies performed by systematic psychoeducation of patients or as a part of psychotherapeutic counseling.

The authors have not supplied their declaration of competing interest.

PSY-3011 was a randomized, multicenter, double-blind, non-inferiority study of paliperidone palmitate 3-month injection (PP3M) vs. paliperidone palmitate 1-month injection (PP1M). Adults with schizophrenia were stabilized on PP1M in an open-label (OL) 17-week transition phase. Qualifying subjects at the end of the OL phase were then randomized to PP3M or PP1M in the 48-week double-blind (DB) phase. Healthcare resource utilization (HCRU) between PP3M and PP1M was compared using the HCRU questionnaire during the double-blind (DB) phase.

HCRU was measured at the start of the OL and DB phases, and every 12 weeks during DB until end of study/early withdrawal. Information included hospitalizations, ER visits, day or night clinic stays, outpatient treatment, daily living conditions, and occupational status. Logistic regressions modeled the probability of hospitalization vs. no hospitalization for psychiatric and social reasons, as well as hospitalizations for psychiatric reasons only, during the DB phase. The models controlled for OL baseline hospitalizations, OL phase hospitalizations, and time in study.

The analysis set included 483 subjects randomized to PP3M and 512 subjects to PP1M during the DB phase. The odds of hospitalization for psychiatric/social reasons during 1 year for PP1M subjects were 1.16 times the odds of hospitalization for PP3M subjects (95% CI: 0.70, 1.93, P = 0.56). For psychiatric reasons only, the odds of hospitalization during 1 year for PP1 M subjects were 1.63 times the odds of hospitalization for PP3M subjects (95% CI: 0.88, 3.02, P = 0.12).

PP3M and PP1M demonstrated similar trends in hospitalizations throughout the course of the study.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a severe disease which affects different aspects of behavior, including cognitive functions. The most important fields of cognitive disorders in schizophrenia are working memory, vigilance/attention, learning by oral and visual memory, argument and resolving, analysis rate and social knowledge.

This study was designed to assess the effects of fluvoxamine on cognitive functions of schizophrenic patients.

Thirty-six patients with schizophrenia, all male, were treated with 100 mg fluvoxamine and a second generation anti-psychotic for 4 weeks and before and after treatment, their cognitive functions were assessed by Wechsler-3 memory scale (WMS-revised) and negative symptoms by scale for the assessment of negative symptoms (SANS).

In our study, the average patients’ scores increased in Wechsler-3 memory scale (WMS-revised) before and after receiving fluvoxamine (P < 0.001). This study couldn’t show a statistically significant difference between the patients’ scores in negative symptoms (SANS test) before and after the treatment course (P = 0.59) There was a negative statistically significant correlation found between WMS score before and after the intervention and the level of education, living area and cigarette smoking. Increasing scores in the test was statistically correlated with lower education, cigarette smoking and living in rural area.

Augmented treatment with fluvoxamine, probably has effects on some parts of cognitive abilities of male schizophrenic patients which are assessable by Wechsler-3 memory scale. Therefore further studies on evaluation of fluvoxamine effects in other fields of cognitive abilities like concentration and attention in schizophrenic patients are still required.

The authors have not supplied their declaration of competing interest.

Being a homosexual may be burdened by several psychological problems. This is due to the minority stress that results from feeling excluded and it is characteristic of social minorities. Negative beliefs about their psychosexual orientation and sense of exclusion may be the cause of both depressive disorders and internalized homophobia. These factors can affect the quality of sexual life.

The aim of the study is to analyze the relationship between internalized homophobia, social pain and the severity of depressive symptoms and quality of sexual life.

The study included 103 young adults remaining in permanent homosexual relationships. The study was cross-sectional. The study used Beck Depression Inventory, Social Pain Thermometer, Internalized Homophobia Scale and Quality of Sexual Life Questionnaire.

It observed the significant correlations between the level of internalized homophobia and a sense of social pain and the severity of depressive symptoms. Both internalized homophobia, and severe social pain and depressive symptoms proved to be significant predictors of reduced quality of sexual life of homosexuals.

During the treatment of depressive symptoms and discomfort associated with the sexual life of homosexuals, it is important to take into account the phenomenon of internalized homophobia.

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

To evaluate prevalence, pattern and risk factors of sleep problems in epileptic children.

Eighty-two epileptic children and 40 healthy controlled children were evaluated using children's sleep habits questionnaire – Arabic form and night polysomnography (2 consecutive nights).

Prevalence of sleep problem in epileptic children was 45% and 17% of normal control children with significant difference in sleep latency, total sleep time and number of awaking per night with significant prevalence with partial epilepsy, poly therapy and poor controlled epilepsy.

Sleep problems are common in epileptic children with close relation to partial epilepsy, number of anti epileptic and poor controlled epilepsy. This is important to deal with it in order to better control of sleep problems in such patient.

The authors have not supplied their declaration of competing interest.

Sleep disturbance is one of the most common health complaints among late adolescents and young adults. Women report more sleep-related complaints than men (Krishnan and Collop, 2006) and more anxiety or depressive symptoms (Voderholzer et al., 2003). Higher levels of repetitive negative thinking appear to be causally involved in the initiation/maintenance of emotional problems (Ehring and Watkins, 2008).

To analyze the sleep difficulties differences by gender and its associations with stress, cognitive emotion regulation, perseverative thinking and negative affect.

Five hundred and forty-nine students (80.1% females) from two Universities filled in the PSS-10 (Cohen et al., 1983; Amaral et al., 2014), CERQ (Garnefski et al., 2001; Castro et al., 2013), PTQ (Ehring et al., 2011; Chaves et al., 2013) and POMS-58 (McNair et al., 1971; Azevedo et al., 1991; Amaral et al., 2013). Three questions were used to access difficulties of initiating sleep (DIS), maintaining sleep (DMS) and early morning wakening (EMA).

Females reported more sleep difficulties (excluding DIS), stress, perseverative thinking than males. Males reported higher levels in self-blame and blaming-others dimensions. In female sample we found significant correlations between all sleep difficulties and stress, perseverative thinking, emotional regulation (rumination, self-blame, catastrophizing) and negative affect. In male sample only the difficulties of initiating sleep are correlated with stress, perseverative thinking, self-blame and negative affect.

There are no gender differences in frequency and most of correlates of DIS. DMS and EMA were higher in females and were related to perseverative thinking and emotional regulation mechanisms in this sample.

The authors have not supplied their declaration of competing interest.

Nigerian adolescents report various sleep disorders metaphorically based on the local/native description of such disorders. Hence, it is sometimes difficult for clinicians without a good grasp of the nuance in their description to understand their presentation.

To develop a culturally relevant (Nigerian) instrument for assessing sleep disorders.

One thousand two hundred and twenty-seven Nigerian Secondary School adolescents (634 males and 593 females) between 12–19 years with mean age of 15.20 (SD = 1.5) were administered a 44 item instrument developed following the DSM (V), American Association of Sleep Medicine's International Classification of Sleep Disorders (ICSD, 2005) criteria, and case reports of sleep disorders. The data was subjected to a Principal Component Analysis using Varimax rotation.

Ten factors instead of the original eleven factors suggested by the authors emerged in the analysis and on closer examination and in juxtaposition with cultural nuances, it was found the ten factors were in line with what is generally reported by adolescents. Sleep walking disorders and sleep related movement disorders loaded in one factor labelled sleep movement disorders, while items representing non restorative sleep experiences, sleep talking, sleep paralysis, sleep apnea, circadian rhythm sleep disorder, narcolepsy, insomnia, sleep terror disorder and nightmare disorder loaded on their individual factors. The SDINQ showed a Cronbach Alpha of .916 and a good correlation with subscales of the School Sleep Habits Survey (SSHS).

The SDINQ has been found to be a valid and reliable instrument for assessing the presence of sleep disorders among adolescents in Nigeria.

The authors have not supplied their declaration of competing interest.

Restless legs syndrome (RLS) is a sleep disorder affecting a significant part of general population. Clinically RLS is characterized by abnormal sensations of irresistible urge to move legs, becoming worse at night, and frequently causing insomnia. Consequences of RLS include daytime dysfunction, depressed mood, anxiety and decreased quality of life.

Determine prevalence of RLS in professional cyclists.

The aim of this study was to examine the prevalence of RLS in professional cyclists. According to our knowledge this is the first research of RLS in professional cyclists.

A total of 43 professional cyclists were asked to complete 4-item questionnaire based on IRLSSG Diagnostic Criteria for RLS. Data from questionnaire was compared to antropometric measurements, epidemiologic data, age of starting trainings and total years of professional performance.

The results indicated that prevalence of RLS in professional cyclists is 14% and is higher than expected in this age group. We found statistically significant relationship between RLS and age (P < 0,001) and years of experience as a professional cyclist (P < 0,001). Results revealed no significant differences between genders (Table 1).

Table 1

RLS seems to be a common problem in professional cyclists. It can affect sport performance. Future efforts to estimate the influence of RLS on professional sport performance should be considered.

The authors have not supplied their declaration of competing interest.

To our knowledge there are no research about the influence of self-criticism and self-compassion in the occurrence of insomnia.

To study the association between self-criticism, self-compassion and insomnia on university students; to explore differences in these associations on two moments of student's lives–examination and no examination period.

We anticipate that the stress and pressure of the examination period have an impact on student's sleep and there are, also, differences by age and gender.

Self-Criticism and Self-Reassurance Scale, Self-Compassion Scale, Pre-Activation Sleep Scale, Insomnia Assessment Scale and Anxiety and Depression and Stress Scales were answered by 160 college students (M = 26.45, SD = 7.98; range = 19–54 years) during an examination period and by 108 college students during a no examination period (M = 26.34; SD = 0.43; range = 19–54 years).

In both periods (examination and no examination period) older students (30–54 years) tended to be more self-compassionate and tolerant, such as less self-critical and punitive. During the examination period, younger students (19–29 years) showed higher levels of self-criticism, cognitive, and somatic activation before falling asleep. There was also a higher proportion of younger students in the insomniac and insomnia symptomatic groups. Moreover, significant correlations were found between cognitive and somatic activation and depression, anxiety, and stress in both moments.

In the examination period, the youngest students are more critical and less compassionate, what might lead to greater cognitive and somatic activation before sleep and, consequently, to insomnia symptoms and insomnia itself.

The authors have not supplied their declaration of competing interest.

Mindfulness based programs during pregnancy (some including self-compassion components) increase self-compassion, mindfulness and maternal self-efficacy, and reduce anxiety, stress and psychological distress in pregnant women. According to our knowledge, there are no studies about the association between self-compassion and sleep outcomes in pregnancy.

To explore differences in self-compassion, between three sleep groups, in a sample of Portuguese pregnant women.

Four hundred and nineteen pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) completed the Self-Compassion Scale (SCS, Bento et al., 2015), presenting six dimensions (self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification) and the Insomnia Assessment Scale (Marques et al., 2015). Three sleep groups were formed: good sleepers (no insomnia symptoms; no associated daily impairment); insomnia symptoms groups (one/more insomnia symptoms; no associated daily impairment); insomniacs (one/more insomnia symptoms; daily associated impairment).

There were significant differences in the total SCS, self-judgment, isolation and over-identification scores, between sleep groups [respectively, F (2,396) = 7,926, P ≤ 0,001; F (2,409) = 19,155, P ≤ 0,001; F (2,410) = 13,016, P ≤ 0,001; F (2,412) = 11,258, P ≤ 0,001]. Self-judgement, isolation and over-identification scores of good sleepers and insomnia symptoms group were higher than of insomniacs. Total SCS score of good sleepers was higher than of insomniacs and the same score of symptoms of insomnia group was also higher than of insomniacs.

Results seem to show the importance of developing self-compassion to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).

The authors have not supplied their declaration of competing interest.

Sleep symptoms, depression and anxiety often coexist and tertiary students are a population group that are increasingly recognised to be at risk. However the rates of these conditions in the tunisian population are poorly understood.

The aim of this study was to evaluate sleep quality among medicine students during exam periods and identify correlations with anxiety and depression.

This is a descriptive and analytical cross-sectional study. It involved students of medicine University of Sfax during the period of exams. Each student filled out demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) to assess the quality of sleep and Hospital Anxiety and Depression scale (HAD) to screen for anxiety and depressive disorders.

The average age was 22.27 years. The sex ratio M/F was 0.66. The students were single in 96.7% of cases. The average score of PSQI was 6.67 ± 3.23. According to the PSQI, 53.3% of students had poor sleep quality. The anxiety score ranged from 0 to 7 with an average of 8.37. The depression score ranged from 0 to 16 with an average of 7.47. Anxiety and depressive symptoms were present in 26.7% of students. The PSQI score was significantly correlated with anxiety (p <0.01) and depression scores (P = 0.019).

Anxiety and depressive symptoms are common among students during exam periods. They are associated with poor quality sleep. The establishment of a helpline for students during exam time, with psychologists and psychiatrists, would help them better manage this difficult period.

The authors have not supplied their declaration of competing interest.

Pregnancy is characterized by important changes in sleep and some of them (as insomnia) predict negative outcomes, like depression, through all the perinatal period. There are few Portuguese adapted and validated instruments assessing insomnia in pregnancy.

To validate the Insomnia Assessment Scale in a sample of Portuguese pregnant women.

419 pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) answered the Insomnia Assessment Scale (IAS), constructed according to the DSM-V and the ICSD-3 criteria and presenting fourteen items: three evaluating insomnia symptoms (1 to 3); one assessing if sleep difficulties were present although there were adequate conditions to sleep (item 4); one assessing if sleep difficulties occurred three times/week (item 5); one evaluating if sleep was not restorative (item 6); three assessing daily impairment associated to insomnia symptoms (7 to 9); two assessing the use of prescribed and/or homemade medication (10 and 11); three excluding that sleep difficulties were not due to another sleep disorder, substance use, a physical condition or a mental disorder) (12 to 14).

The IAS Kuder-Richardson alpha was very good (α=0.85) and none of the items increased the alpha if removed. A principal component analysis revealed a three factors solution, explaining a variance/EV of 63,74%: F1/Insomnia symptoms (items 1 to 6) (EV 36.02%; α=0.81); F2/Daily impairment associated to insomnia symptoms (items 7 to 9) (EV 18.67%; α=0.79); F3/Differential diagnosis (items 12 to 14) (EV 8.38%; α=0.81).

The IAS adapted for Portuguese pregnant women presented good reliability and validity.

The authors have not supplied their declaration of competing interest.