Psychiatric population is characterized by a higher prevalence of cardiovascular events compared to general population. This difference might be due, in part, to the metabolic adverse effects of psychotropic agents, and, in part, to common risk factors such as smoking, sedentary lifestyle and unhealthy diet. Another potential risk factor is represented by the presence of metabolic syndrome (MetS).

We aimed to evaluate the prevalence of MetS and to identify the baseline predictors for the longitudinal development of MetS in a sample of Italian psychiatric inpatients.

Medical records of 343 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.

Prevalence of MetS was 21.5%. MetS appeared directly associated with age and number of medication assumed. ROC curves showed HDL as the best predictor of metabolic syndrome in our sample.

Our results confirm previous data on the association between metabolic syndrome and exposure to complex polytherapy. Additionally, our findings support the notion of psychiatric patients as an at-risk group for metabolic abnormalities, which should be carefully monitored.

The authors have not supplied their declaration of competing interest.

Ischemic heart disease (IHD) is the leading cause of morbidity and mortality in the industrialized world. Recent research evidence suggests that psychosocial distress has been implicated as both a precursor to IHD and significant risk factor for death in those with established IHD. According to WHO, psychosocial distress will be the most harmful risk factors for the development of IHD in the near future. High IHD mortality in Russia and its profound fluctuation over the past decades have attracted considerable interest. Some experts have underlined the importance of the psychosocial distress of economic and political reforms as the main reason for the IHD mortality crisis in Russia in the 1990s.

The aim of the present study was to estimate the effect of psychosocial distress on IHD mortality rate in Russia.

Trends in age-adjusted, sex-specific suicide (as an integral indicator for psychosocial distress) and IHD mortality rate in Russia from 1965 to 2005 were analyzed employing a distributed lags analysis in order to asses bivariate relationship between the two time series.

Time series analysis indicates the presence of statistically significant association between the two time series both for males (r = 0.73; SE = 0.17) and females (r = 0.35; SE = 0.17).

These findings suggest that the Russian IHD mortality crisis is most likely to have been precipitated by the psychosocial distress imposed by rapid societal transformation. The experience of Russia should serve as an example of how societal-level change can influence the health of a population.

Sleep problems are a common presenting symptom of elderly patients to Primary care physicians and Psychiatrists. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation.

The aim of this article is to sumarize and explore the facts envolving sleep disorders, discusses approaches to treatment and highlights new research in the area of geriatric sleep disorders.

An online bibliographic search was carried out on PubMed and Medline using the keywords “Elderly”, “sleep” and “Psychiatry”.

Management of sleep disorders is complicated by the risk of side effects of pharmacologic treatment approaches, and thus nonpharmacologic strategies are preferred when possible. Additionally, many of the pharmacologic strategies used in treating younger adults have not been studied adequately in the geriatric population, and more specifically in patients with underlying cognitive disorders, making treatment choices difficult.

This review has provided insights into the biopsychosocial impact of sleep disorders in the elderly, as this group pose unique challenges for diagnosis and treatment. Sleep changes in the elderly may have a far broader impact on geriatric health than originally thought, with implications for AD and delirium, and further research is needed in these areas as well.

In our study, the magnitude of EEG power spectra of delta, theta, alpha and beta power was examined to address the relationship between EEG spectral changes after activation methods and alcohol dependence. Electroencephalography has shown that the brain activity of alcoholics and nonalcoholics differs in some characteristic ways. These differences are consistent with an imbalance between excitation and inhibition processes in the brains of alcoholics.

We examined eyes-closed resting EEG and EEG after activation procedures (eyes-open, hyperventilation). A group of 54 male chronic alcoholics were selected according to inclusion and exclusion criteria. We compared this group with 54 age- and gender-matched control subjects from the group of healthy volunteers. All subjects in both groups were Caucasians.

Our results in power spectra of activated EEG /after eyes-open period, hyperventilation) showed statistically significant differences in reactivity to activation methods between alcohol dependent patients and healthy volunteers. Our data manifested significant contrast in modulation of alpha activity after EEG activation using eyes-open test.

In previous studies researchers compared eyes-closed resting EEG spectra in alcohol dependent study participants and age- and gender-matched control subjects. The present study reported statistically significant differences in reactivity to activation methods in both groups. Hence, the EEG spectra after activation methods in children of alcoholic, especially before alcohol exposure, need to be examined to consider these differences in reactivity to activation methods as an endophenotype marker of chronic alcoholism.

The Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.

To examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.

To propose amendments to the legislation, based on the experiences elicited.

This cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.

317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.

Nursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.

Counterfactual thoughts (CFT) are mental representations of alternatives to past events, actions or states. For example, “If only I had studied, I would have passed the exam”).

CFT in healthy subjects is associated with learning, behavioral regulation and planning.

Damage to the prefrontal brain regions has been related to decreased generation and use of CFT. Due to the fact that frontal deficits are documented in patients with schizophrenia, it is expected that these patients could also present impairments in CFT.

The aim of our study was to examine the role of the generation of CFT in schizophrenia patients.

Forty subjects who met DSM-IV criteria for schizophrenia and 40 healthy control participants were recruited. The two groups were matched in age, education, and handedness.

To investigate the generation of CTF we used an adaptation of the task made by Wells, Taylor & Turtle (1987). In this task, we presented to the subjects one history with 4 different scenarios. After the presentation of the history, we asked to the subjects that list alternatives to solve the problem presented in the history.

The schizophrenic patients generated less responses of CTF that controls. The patients obtained a mean of responses of 1.48 (1 SD). The mean for the controls was 2.08 (.971 SD). The control subjects generated significantly more counterfactual responses than schizophrenic patients ([t (78) = −2.670, p = .269]).

Our findings indicate that patients with schizophrenia have impoverished the generation of CFT compared to normal control participants.

Religious and spiritual beliefs are widely recognized as important components of human wellness, of health care outcomes and of holistic medical and nursing care. There are controversial data suggesting a correlation between religiosity and mental health disorders among young adults and students. Aim of the study was to determine the association between self-esteem, depression and religious and spiritual beliefs among nursing students in Thessaloniki, Greece.

A total of 122 students agreed to participate in the study. Data was collected using the Greek versions of three self-administered, structured, pre-tested questionnaires: I) The Royal Free Interview for Religious and Spiritual Beliefs II) Beck Depression Inventory (BDI-II) and III) Rosenberg self-esteem scale.

Self-esteem was found normal in 89,3% of the students, low in 10,7%, but it is important to notice that nobody reported high self-esteem levels. The vast majority of the students (61,5%) reported both religious and spiritual beliefs. 27% reported only religious beliefs and 9% only spiritual beliefs. 31,9% of the students perceived depressive symptoms, most of them in mild levels (19,5%). Praying, religious reading and religious attendance were associated with normal self-esteem and low depressive symptoms. However, a consistent negative correlation was found between intrinsic religiosity and depression.

These findings indicate that religious and spiritual variables influence the psychological well-being of students. Religiosity may have a protective role against depression; however, our study sample is relative small and further studies are required in order to evaluate the effect of religious beliefs on the mental health of students.

Emigration is the act of leaving one’s country of nationality or habitual residence to settle in another nation. In Tunisia, this phenomenon is increasing in particular for doctors.

Evaluating the intentionality of emigration among interns and medical residents in Tunisia while studying the factors related to it.

We conducted a cross-sectional, descriptive and analytical study of interns and medical residents who participated in our study through the social network ’Facebook’ by an anonymous self-questionnaire. The level of satisfaction with the different aspects of life were assessed by a 5-point Likert scale, from “not at all satisfied” to “very satisfied”.

The total number of participants was 56 of which 64.3% were medical residents. More than 50% of the participants expressed dissatisfaction with the distribution of tasks and organization of work (66.1%), safety at work (53.6%), comfort (57.2%), time allocated to personal life (53.6%) and salary (69.6%). The political, health and educational situation in the country was considered unsatisfactory by the majority of participants (90% to 95%). Among our participants, 44.6% regretted having chosen the profession of medicine and 53.6% had plans to immigrate to work abroad. The intentionality of immigration was significantly higher among men (p=0.02), those with siblings abroad (p=0.047) and those without dependent relatives (p=0.040).

Young physicians are strongly looking for emigration. This decision could emanate from professional, personal and political factors. Further studies seem to be necessary to explain this emigration phenomenon.

No significant relationships.

There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease C-reactive protein (CRP). Ondansetron is a serotonin (5-HT3) receptor antagonist widely used to prevent nausea and vomiting in patients receiving chemotherapy for cancer. Small studies have suggested that adjunctive Ondansetron is efficacious against schizophrenia symptoms. We carried out a feasibility study in schizophrenia patients (within 5 years of first diagnosis) to explore the adjunctive use of simvastatin and ondansetron on positive, negative and general psychopathology.

This was a 12 week rater blind placebo controlled study. All to gather 36 patients with DSM-IV diagnosis of schizophrenia were recruited, 12 in each arm. Patients were assessed at baseline and at 12 weeks using PANSS, CGI, GAF and AIMS.

Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual (TAU) on PANSS total score, although, this was not statistically significant. In the secondary analyses, no significant differences were seen on CGI, GAF and AIMS.

Anti-inflammatory treatments have shown to have some beneficial effects in schizophrenia. Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual. This study has led to a larger SMRI-funded, double blind, randomized control trial.

Paraneoplastic cerebellar degeneration (PCD) is a rare disorder, presenting with severe cerebellar dysfunction. In addition to motor deficits, cognitive and behavioural changes can be associated with cerebellar damage. The cerebellar cognitive affective syndrome (CCAS) describes affective disturbances and impairments in executive function, spatial cognition and language.

We describe, using a timeline, a patient who developed a psychiatric disorder following PCD.

A 19-year-old female presented with subacute ataxia, dysarthria and nystagmus. She was diagnosed with Hodgkin's lymphoma and achieved complete remission following chemotherapy. Over the next seven years she experienced recurrent episodes of altered mood. Her depressive symptoms included low mood, crying spells, irritability, apathy, lack of energy and early waking. There were periods when she felt “high”, harboured unrealistic optimism, had reduced attention, increased her alcohol intake and was described as being “reckless” by her family. She was diagnosed with bipolar affective disorder and eventually stabilised on imipramine and lithium.

This presentation appears to describe a case of CCAS, in which the affective component is bipolar affective disorder, type II. The psychiatric findings are a direct result of the neuropathology, emphasizing the role of the cerebellum in affective illness. While depression, mood instability and psychosis are the possible psychiatric consequences of CCAS, bipolar disorder appears to be a more unusual variant.

This presentation adds to the existing literature suggesting a cerebellar role in the modulation of emotion, and emphasizes the importance of addressing psychiatric sequelae in the treatment and rehabilitation of patients with paraneoplastic cerebellar degeneration.

Studies have indicated antidepressant effects of anti-inflammatory treatment; however, results have been conflicting and side effects may contraindicate anti-inflammatory treatment.

To systematically review the antidepressant and possible side effects of anti-inflammatory interventions.

To include trials published prior to December, 31st 2013, and evaluate depression scores after treatment and side effects.

We identified randomized, placebo-controlled trials assessing efficacy and side effects of pharmacological anti-inflammatory treatment in adults with depressive symptoms including adults fulfilling depression-criteria. We calculated standard mean difference (SMD) and Odds ratios (OR).

10 publications covering 14 trials (n=6,262) were included: 10 on non-steroidal anti-inflammatory drugs (NSAIDs) (n=4,258) and four on cytokine-inhibitors (n=2,004). Anti-inflammatory treatment reduced depression (SMD=−0.54; 95%-CI:-1.08 to −0.01; I2=68%) and depressive symptoms (SMD=−0.27; 95%-CI:−0.53 to −0.01; I2=93%). Sub-analyses particularly emphasized antidepressant properties for the selective cyclooxygenase-2 inhibitor celecoxib in general (SMD=−0.29; 95%-CI: −0.49 to −0.08; I2=73%), on remission (OR=7.89; 95%-CI: 2.94 to 21.17; I2=0%) and response (OR=6.59; 95%-CI: 2.24 to 19.42; I2=0%). Among 6 studies (n=2,523), we found no evidence of an increased number of gastrointestinalor cardiovascular events after 6 weeks nor infections after 12 weeks of anti-inflammatory treatment. All trials were associated with high risk of bias.

Anti-inflammatory treatment, in particular celecoxib, decreased depressive symptoms without increased risks of side effects. However, a high risk of bias and high heterogeneity made the mean estimate uncertain. This study supports a proof-of-concept concerning use of anti-inflammatory treatment in depression. Identification of subgroups that could benefit hereof might be warranted.

We investigated the relationship between tyrosine hydroxylase (TH) polymorphisms rs11042978, rs2070762 and rs6356 and early-onset schizophrenia in the Chinese Han population.

The tag single nucleotide polymorphisms (tag SNPs) rs11042978, rs2070762 and rs6356 in the TH gene were genotyped in 315 early-onset schizophrenics (188 male patients,127 female patients)and 391 controls subjects (219 males,172 females). Single nucleotide polymorphism association and haplotype analysis were performed.

There were significant differences in allele and genotype frequencies between patients and normal control subjects for rs11042978 allele (χ2 = 4.47, df = 1, P = 0.034) and genotype (χ2 = 6.35, df = 2, P = 0.042). No statistically significant differences were found in allele or genotype between patients and normal control subjects for rs2070762 and rs6356. The haplotype analysis revealed that there were significant differences between patients and normal control subjects for haplotypes GAC (χ2 = 6.35, P = 0.012).

Our study indicates that the TH gene may play major roles in the susceptibility to early-onset schizophrenia in the Chinese population.

The authors have not supplied their declaration of competing interest.

To identify correlates that might constitute risk factors for problematic video game use (PVU) among urban Tunisian secondary school students.

This multivariate cross-sectional study was carried out on 587 secondary school students, aged 14 to 20 years. They were randomly selected from seven secondary schools in the urban area of Sfax. The self-administered Fisher's nine-item questionnaire was used in this survey. To identify an associated problematic internet use video game addiction, Young's eight-item questionnaire was used. A self-administered, anonymous questionnaire covered socio-demographic, individual and family data.

The prevalence of PVU was 14.01%. In multivariate logistic regression analysis, we found that the individual risk factors for problematic video game use were anxiety symptoms (P = 0.034) and an associated problematic Internet use (P < 0.001). Playing sport was a protective factor (P = 0.011). The poor relationships within the family (P = 0.001), the lack of parental supervision of time spent on playing video game (P < 0.001) and mother profession as mid-to upper level manager (P = 0.002), predicted PVU.

The identification of risk factors can help to determine individuals at high risk, and alert mental health providers to be careful to screen these patients for PVU. Total avoidance of the Internet is unrealistic and inadvisable; but a sensibilisation outreach for youth, their families and health professionals may help to limit the onset of PVU among young people.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Kleptomania is characterized by recurrent failure to resist the impulse to steal items of little value despite the ego-dystonic impulse and awareness of the wrongfulness of the act. Its prevalence is considered to be 0.6–0.8% in the general population and it is mostly comorbid with other psychiatric disorders. Kleptomania is a disabling disorder since patients suffer from emotional distress and impaired functioning.

Although there is no cure, treatment may help prevent Kleptomania worsening and its negative consequences. We propose a review of the therapeutic approach to this disease.

Non-systematic literature review.

No effective treatment is available for Kleptomania. Better efficacy can be achieved by combining psychotherapy with pharmacotherapy. Different treatment interventions can be selected based on clinical similarities to other disorders, co-occurring conditions or behavioral core features. Patients with significant mood symptoms may benefit from mood stabilizers or antidepressants. For patients with shoplift cravings and/or family history of substance use disorders, Naltrexone may reduce symptoms. Stimulants may be useful for Kleptomania bassociated with Attention Deficit Hyperactivity Disorder impulsivity. Benzodiazepines are effective in tension relief when used as adjuvants, at the beginning of treatment. Electroconvulsive therapy should be reserved for patients with treatment-resistant symptoms and comorbid depression. Cognitive-behavioral therapy has replaced Psychoanalytic and Psychodynamic psychotherapies.

Treatment helps decrease disruption to the person’s life, preventing the intense shame, legal, social, family, and occupational repercussions of Kleptomania. Although pharmaceutical and psychosocial interventions are available, we still lack specific treatments for Kleptomania.

No significant relationships.