The authors have not supplied their declaration of competing interest.

To explore the biochemical indicators of the persons at high risk of suicide.

To achieve early screening of the persons at high risk of suicide.

Suicide ideation of new recruits was generally investigated with self-rating idea of suicide scale (SIOSS). Twenty-five recruits whose scores were more than 12 were recognized as the suicide ideation group. Another 25 recruits without suicide ideation were randomly selected as the control group. Saliva samples of each group were collected for biochemical analysis after one month and three months. The SIOSS was used again for evaluation of suicide ideation.

After one month, the concentrations of Ca, Mg, Amy and SA in saliva were demonstrated to be statistically different between the two groups. After three months, the concentrations of Ca, Mg, Amy and SA in saliva between the two groups showed no significantly difference. According to SIOSS results, only 7 persons of the original suicidal ideation group were recognized as suicidal ideation group, the other 18 people's SIOSS scores were less than 12. And the SIOSS scores of the control group (without suicidal ideation group) were also less than 12. There was no statistical difference in the three groups for comparison of salivary Ca, Mg, Amy and SA.

The biochemical indicators l of saliva lack specificity for suicidal ideation screening.

The author has not supplied his declaration of competing interest.

Fibromyalgia is a chronic disease. This diagnosis has been controversial in scientific society. However, there is one fact: there are women who feel not only uncontrollable and non-specific body pain, but also psychological symptoms.

To compare the efficacy of online sessions versus in onsite sessions. To demonstrate that online mindfulness sessions could help to reduce pain in patients with a diagnosis of fibromialgya.

A website created to give education and advice to women with fibromyalgia related to the disease was used as a platform to offer online mindfulness sessions.

Two hundred and thirty-four patients with fibromyalgia asked to participate in the online sessions, but only 13 were included in the study. Nineteen other women received onsite mindfulness sessions. Patients were evaluated before and after intervention. Two analyses were undertaken: intragroup and intergroup.

No differences were found between online mindfulness session and onsite mindfulness session. In both cases, an improvement in the questionnaire scores was demonstrated. Mindfulness as a kind of psychotherapy helped patients to control pain and symptoms of anxiety.

The new ICTs offer a huge of possibilities in medicine and mental health. With respect to psychiatry, not only intervention, like psychotherapy, can be offered but also psychoeducation. However, there are factors such as age and educational level that make online intervention difficult.

In the near future, most people will interact with technology and it would be easier to supply online interventions and psychoeducation e-patients already exist, so e-doctors and e-psychiatrists should be online soon.

The authors have not supplied their declaration of competing interest.

A website was designed to offer psychoeducation and advice to women who demand more information about health after traditional visit to GPs. A total of 564 patients visited the website in three months. Women asked for information and interacted with different topics on the platform. Only the women who completed all the form (age, previous diseases, current treatment) were analyzed. A total of 226 e-patients were included.

The most demanded information was about: excess weight, fibromyalgia, depression, anxiety, bipolar disorder and the menopause although other topics related to medicine such as HTA, breast cancer, and pregnancy were part of the website contents.

Even when many topics about medicine were available on the website, women were more interested in, and showed the need for information about mental health.

Online psychoeducation could help the clinician to save time at the personal consultation and could be especially useful in following the patient for a long time.

However, there are technological barriers and at least one first face-to-face interview is required in complicated cases to determine a correct diagnosis.

A high demand for e-mental online health education does exist. It would be useful for professionals to be trained in information technology in order to cover that demand and avoid misinforming patients.

It would be interesting to undertake a meta-analysis with all the studies around the world and determine the profile of the patient that could be helped through online attention.

The authors have not supplied their declaration of competing interest.

In the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.

To develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:

– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;

– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.

The aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.

The study consists of both qualitative and quantitative components. The study will be run across three strands:

– qualitative work;

– test run and intervention refinement;

– feasibility trial.

Preliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.

Research in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.

The authors have not supplied their declaration of competing interest.

The early intervention service (EIS) approach is based on therapeutic interactions, which promote service user recovery from first episode psychosis. Collaborative therapeutic work between the service user and case manager depends on good communication. This can be a challenge for people with psychosis as the process of thought can be disrupted or stimulus misinterpreted leading to communication errors.

The objective is to develop an interactive tool that can assist service user's communication of distress, whilst employing a psychoeducational approach to the use of an informal therapeutic measurement scale; subjective units of distress (SUDs) and early warning signs (EWS). The ApTiC mobile intervention will include ten numerically graded emoticons from low to extreme distress. Each emoticon is associated with specific individualised service user descriptors and linked to an individually agreed action plan and level of response to be offered by a staff member.

The aim of the present study will be to examine the feasibility and acceptability of the ApTic mobile intervention in preparation for a larger randomised controlled trial.

Phase one: qualitative research to inform the development of the complimentary tool and mobile app (qualitative). Phase two: a 12-week rater-blinded randomized control trial of ApTiC compared to routine EIS case management (quantitative).

The qualitative data will be presented.

It is expected that once validated, the SUDs based ApTiC will enhance rapport and understanding thus improving the recovery approach to well-being and hopefully preventing relapse or the involvement of the crisis team or hospital admissions.

The authors have not supplied their declaration of competing interest.

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Telepsychiatry takes advantage of modern communication technologies and new forms of patient–doctor and doctor–patient contact.

This research focuses on the knowledge of telepsychiatry and the attitude to it among patients and psychiatrists in Poland.

An anonymous survey was conducted among 105 psychiatrists aged 26–74, including 74 women and 31 men and 102 patients aged 21–79, including 61 women and 41 men.

Research reveals that the majority of patients never met with the concept of “epsychiatry” and do not know what it means. However, more than 50% of respondents answered positively to every question considering the utility of telepsychiatry. Furthermore according to 18%, it is possible to replace an eye-to-eye conversation by videoconferencing. Only 15% of doctors claim to have an extensive knowledge on telepsychiatry, and 10% do not know what it means. The vast majority of physicians perceive positive aspects of this method of medical care, but 63% would not want any general insertion of telepsychiatry. Doctors are apprehensive of losing personal data and medical confidentiality, and of the necessity of legal changes.

The obtained results allow us to conclude that Polish patients and doctors, regardless of their knowledge, age, gender or disease, perceive advantages of telepsychiatry. In connection with this, implementing this method into the Polish medical market makes sense and is in accordance with both patients’ and doctors’ opinion. Based on our research, we confirmed that there is a necessity of wider popularisation of telepsychiatry among Polish therapists.

The authors have not supplied their declaration of competing interest.

Infertility is not only a medical condition and its impact in mental health is well established. Although most couples facing fertility problems and the demands of medical treatment are able to adjust, some of them may show psychological difficulties with clinical relevance, such as depression and anxiety. The Mindfulness Based Program for Infertility (MBPI) is a group intervention designed for infertile women and data from its efficacy study revealed impact in depressive symptoms reduction as well as in internal and external shame, entrapment and defeat. Based on the MBPI, a mindfulness app targeting infertile patients was developed – the MindfulSpot.

This study addresses the MindfulSpot development.

The MindfulSpot is a prototype mobile app, which seeks to offer the chance of practicing mindfulness in a comfortable and accessible way. This app covers informative audio and written texts. The audio contents correspond to mindfulness formal practices and suggestions for informal practice, making possible its use throughout different moments of the day. Beyond the practices mentioned above, users are invited to explore the informative menu, including information on the impact that infertility may have in several aspects of the patients’ lives.

The efficacy of the MindfulSpot is still under analysis and results are expected to be available soon.

The MindfulSpot was designed as a medium for training mindfulness skills and it includes useful information regarding specific aspects of the emotional impact of infertility. Additionally to its independent use, it may also be used as a support tool of the MBPI.

The authors have not supplied their declaration of competing interest.

Technological innovation has been pervasive and has touched almost every aspect of modern life, including the delivery of behavioural and mental heath care. As telehealth expands, internet interventions are particularly interesting as a medium of delivering effective care. However, standards are required to help inform healthcare policy makers, providers, clinicians and patients.

Move towards outlining a gold standard for internet-delivered behavioural and mental health interventions.

Contribute and build upon existing standards and guidelines for the practice of telehealth, but to now extend these to include internet-delivered interventions.

Drawing from research, experience and practice, the authors propose a matrix for the evaluation of what might be considered a gold standard for internet-delivered behavioural and mental health interventions.

Seven elements are proposed and considered aspects of what would constitute a gold standard and they include, the use of evidence-based and empirically supported content, robust, engaging, secure and responsive technologies, shaped by behavioural health subject matter experts, employ user-centred design and development principles, have a focus on accountable care-achieving clinical outcomes, have research and evaluation that supports its effectiveness, and a well developed implementation science and support.

The paper proposes some characteristics that could compose a gold standard for internet-delivered interventions for behavioural and mental health care. The contribution is neither exhaustive nor conclusive, but offers an invitation to the discussion.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Tardive dyskinesia (TD) is a serious medical condition that affects a significant proportion of patients treated with antipsychotic agents.

To report a patient who developed tardive dyskinesia after initiation of antipsychotic and antidepressant treatment.

Miss H. is 24-year-old Tunisian woman who had been diagnosed with bipolar disorder 6 years ago. She received various drugs: olanzapine, haloperidol, amisulpride, sertraline, paroxetine, etc. On November 2013, she first complained of hand tremor and then developed severe dystonia of the trunk and chorea. A series of laboratory tests was performed after the onset of these involuntary movements. It included complete blood count, liver, renal, and thyroid function tests, blood prolactin level, blood glucose level, blood copper level and ceruloplasmin level. A brain MRI was also performed. These examinations showed no specific findings. The diagnosis of TD was presumed. The patient was first treated with amisulpride, lorazepam, avlocardyl and piracetam until May 2014. Then, amisulpride was substituted by olanzapine until August 2015. The luck of improvement led to her admission. We stopped antipsychotic treatments and prescribed her vitamin E (900 mg/day), clonazepam (6 mg/day) and vitamin B6. The follow-up led to the decline of the Abnormal Involuntary Movement Scale (AIMS) score of 7 points over 6 weeks.

TD remains a serious side effect that worsens the prognosis and affects the quality of life of patients. Cluster randomised trial should be done in order to develop practice recommendations for prevention and management of TD.

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder (SAD) is the second most frequent psychotic disorder after schizophrenia. There is a relative scarcity of specific studies looking into SAD treatment and evidence on drug treatment of SAD is patchy. We aimed to study naturalistically, interviewing psychiatrists systematically, what do they think is most useful in SAD treatment.

To know the actual management of SAD in real clinical practice and provided data for effective clinical studies.

We administered an online poll to 65 psychiatrists (52% male, 48% female), 75% of which described themselves as having a holistic background. The poll was completed using a Google doc's questionnaire. The three main questions made were:

– what is your first treatment choice for SAD;

– do you tend to use mono- vs. poly-therapy;

– provide a level of utility for each drug between 1 (little use) to 4 (maximum use).

Atypical antipsychotics were considered the most common first choice in the treatment of SAD according to 66.2% of psychiatrists. The second most selected first choice answer was combining drugs and psychotherapy, which was answered by 20% of the sample. Monotherapy was preferred (60%) to polytherapy (40%). Finally, the most useful drug for SAD according to the sample was aripiprazole followed by mood stabilizers, olanzapine and paliperidone.

Real practice in SAD treatment may differ grossly to what is advocated for in clinical guidelines and seem to also deviate from officially approved indications of some drugs.

The authors have not supplied their declaration of competing interest.

Erotomania (“Clérambault's syndrome”) is a rare syndrome characterized by a delusional belief of being loved by another person, usually of higher social status.

This case report aims to describe and discuss a case of erotomania, providing an updated review on this disorder.

Regular clinical interviews were performed during admission period to collect information about the clinical case and to promote an intervention approach to the patient. A literature review in Science Direct database, with the keyword “erotomania”, was also conducted.

A 51-year-old woman was admitted in Beatriz Ângelo Hospital psychiatric ward with delusional beliefs of being loved by the ex-boss. Positive misperceptions and persecutory delusions regarding her husband as the obstacle for the love were manifested. The lack of insight for the situation and the necessity of treatment created some difficulties. A clinical report and a bibliographic review were made to allow a better understanding about the case and to orient the case evidence based.

Despite the evidence about the good response of atypical antipsychotics (e.g. risperidone) in erotomania, in our case study, the partial remission was only achieved with high dose of the old typical antipsychotic, pimozide.

The authors have not supplied their declaration of competing interest.

Emotional dysregulation is one of the core problems of borderline personality disorder (BPD). Forty-one year-old married female diagnosed with BPD at the age of 21, was admitted to the partial hospitalization unit due to a depressive symptoms and emotional dysregulation and poor overall functioning.

Patient was previously treated with numerous psychotropic agents: antipsychotics (AP) – fluphenazine, levomepromazine, risperidone, clozapine; antidepressants (AD) sertraline, mirtazapine, maprotiline, amitriptyline; psychostabilizers – carbamazepine/valproate) without achieving the full therapeutic response. After switching to combination of clomipramine and aripiprazole, we have reached partial clinical response.

The aim of this treatment was to improve clinical response and achieve emotional stability by augmentation with neuromodulator pregabalin.

Augmentation strategy was realized by gradual titration and tapering of pregabalin (300 mg/d) over a two-week period. We started with pregabalin dose of 75 mg/d, followed by gradual increase to the dose of 300 mg/d. The Beck Depression Scale (BDS) and the Emotional Dysregulation Scale-short form (EDS) have been used for efficacy monitoring.

Mental state before augmentation therapy: the BDS (score 30-moderate depression) and the EDS-short form (score 127). Parameter status after augmentation with pregabalin: BDS score 16-mild mood disturbance, EDS score 87.

Augmentation strategy with pregabalin have improved emotional control, maintained affective and behavioral stability, with significant reduction of feelings of emptiness, as well as the achievement and maintaining of emotional attachment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

We discuss the different explanations for the results we got.

The authors have not supplied their declaration of competing interest.

Previous studies of prescribing in psychiatric services have identified the relatively frequent use of combined antipsychotics in schizophrenia.

– To analyze the proportion of patients treated with more than one antipsychotic;

– to study clinical as sociodemographic variables associated with types of prescription.

Retrospective descriptive study of treatment prescribed to psychiatric inpatients treated in an acute care unit of Psychiatry Service in a large teaching hospital during a period of 3 years. Consecutively admitted inpatients receiving concurrent antipsychotics were compared with those treated with a single antipsychotic. Prescription drug records at discharging were revised, n = 263.

From the total sample, 61% received more than one antipsychotic. The most common types of combinations were atypical plus a typical antipsychotic followed by two atypical antipsychotics, being less frequent combination of three or more antipsychotics. There were 19 different drug combinations. Concurrent antipsychotics were most frequently prescribed in schizophrenia and schizoaffective disorder. Patients with more previous episodes of illness received more frequently concurrent antipsychotics than patients with low number of previous episodes of illness (P < 0.03). Patients with longer time of hospitalization, and age between 30 and 50 years were treated more frequently with several antipsychotics. Analysis with other variables is presented in the study.

There is a significant difference in the strategies of treatment with antipsychotics depending on diagnosis and number of previous episodes of illness. The concurrent use of multiple antipsychotics in psychiatric inpatients appears to be a response to treatment resistance and is frequent in schizophrenic patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.