Huntington's disease (HD) is an autosomal dominant inherited neurodegenerative disorder, beginning in adulthood. HD represents the majority of patients who present the triad of motor, cognitive and psychiatric symptoms. The last two may be early manifestations, but the clinical diagnosis is based on motor symptoms and a positive genetic test for CAG repeat extension. The remaining patients that are negative for the HD genetic mutation may have HD phenocopies.

Illustrate the role of psychiatric assessment, discuss the psychiatric and behavioural manifestations, and management.

Illustrate the challenge of diagnosing HD in psychiatry.

A literature search was performed on PubMed database. The patient clinical record was reviewed.

We report a case of a 49-year-old male with a family history of HD (mother, uncle, cousin). He was diagnosed with a psychotic disorder fifteen years ago, hospitalised twice and thereafter treated as an outpatient with fluphenazine long-acting injection. He was a symptomatic for ten years. During the last year, he started showing dysphoria, marked irritability, stammering, inappropriate behaviour, poorly structured paranoid delusions, mild cognitive impairment and lack of insight. This was correlated with the beginning of functional impairment, both professionally and socially. Further assessment was performed: neurological evaluation, head CT scan and the genetic test was negative. He is clinically stable under haloperidol long-acting injection.

HD is a rare condition which is frequently under diagnosed, especially in early stages, due to lack of recognition of psychiatric symptoms. HD-like disorders should be considered if the clinical picture is obvious, but HD gene test result is negative.

The authors have not supplied their declaration of competing interest.

Frontal meningiomas are benign brain tumours known for their late onset. They may be presented by only psychiatric symptoms. Thus, the diagnosis at early stages can be missed or overlooked until the tumour causes neurological deficit.

We report the case of a 61-year-old man, receiving a treatment and a follow-up for bipolar disorder for 11 years. He has history of 3 major depressive episodes, 2 suicide attempts and a manic episode. The symptoms were initially well controlled by medication. Since 6 months, the patient started to experience atypical symptoms: he had presented disinhibited and aggressive behaviour, psychomotor instability, pyromania and self-neglect. The patient did not respond to treatment despite repeated adjustments. A frontal syndrome was suspected. Cerebral CT scan revealed an unexpected mass measuring 6.8 cm × 5.6 cm at the right frontal area, suggestive of a giant meningioma (Fig 1).

Generally, once diagnosed, psychiatric disorders are rarely revised. Consequently, “silent” tumours such as frontal meningiomas can be overlooked. Neuroimaging should be considered in case of new-onset psychiatric symptoms, atypical or change in clinical presentation.

The authors have not supplied their declaration of competing interest.

Care-giving practices by family members have inherent value and importance in the provision of care for patients with schizophrenia. There is dearth of assessment tools that focus on practices followed by caregivers’ while dealing with their relatives with schizophrenia, especially from India.

To develop a tool for the assessment of ‘care-giving practices’ followed by family members while caring for their patients with schizophrenia.

(a) To construct a reliable and valid tool on ‘care-giving practices’ followed by family members while caring for their patients with schizophrenia; (b) To determine the various ‘good’ and ‘bad’ practices within this tool.

Initial detailed literature (Pubmed, Goggle search with input by the caregivers generated a list of 24 commonly used practices; which was shortened to 17 statements whose face validity was tested by 14 mental health professionals. Hindi translation with ‘test-retest’ reliability was conducted. Finally, ‘Consensus based approach’ was adopted by the mental health professionals to arrive at objective (b) i.e. statements reflecting ‘good’ or ‘bad’ practice.

Final questionnaire comprised 15 statements with adequate face and content validity and high test-retest reliability (Cronbach's alpha = 0.747). 6 items reflected ‘good’ and 9 reflected ‘poor’ practice respectively with maximum score of 15; and categorization from ‘very poor’ to ‘very good’ practices.

This preliminary yet simple and easy to use tool will give better understanding about how family members provide ‘care-giving’ practices for patients with schizophrenia. However, this needs further validation, replicability, and possible modifications in a multi-cultural, multi-linguistic country like India.

The authors have not supplied their declaration of competing interest.

The aim of this study was the effectiveness of emotion regulation and distress tolerance skills on improving coping strategies and reduce perceived stress in prisoners in Foman city in Iran.

The study population was consisted of 200 prisoners of Foman Penitentiary in 2016. Then, 30 prisoners were selected randomly in two groups (15 persons each group) were replaced. Emotion regulation and distress tolerance training was given to the experimental group for 12 sessions and the control group were in waiting list. Both groups at baseline and end of intervention phase filled coping responses inventory Bellinger and mouse and Cohen perceived stress questionnaire – version 14 questions (PSS-14). Data were analysed by using the software spss22.

Emotion regulation and distress tolerance skills have been effective on Improving problem-focused coping strategies and reduce perceived stress in prisoners (P < 0/001).

emotion regulation and distress tolerance skills can improve problem-focused coping strategies and reduce the use of emotion-focused coping strategies and perceived stress in prisoners.

The authors have not supplied their declaration of competing interest.

The aim of this study was to compare early maladaptive schemas, emotion regulation and general health in offender prisoner men and normal group men.

The study method was causal – comparative (ex post facto). Participants included two groups: (1) all of offender prisoner men (n = 47) in Fooman jail and (2) normal group men (n = 47) in Fooman. Both groups were matched for age, occupation and education. All of the participants completed Young maladaptive schema questionnaire (Y MSQ), cognitive emotion regulation questionnaire (CERQ-P) and general health questionnaire (GHQ-12) individually. Data were analysed using independent t-test and multivariate analysis of variance (MANOVA).

There was significant difference between two groups in total score of early maladaptive schema questionnaire and also in its subscales included abandonment, impaired autonomy/performance, impaired limits, other – directedness, over vigilance/inhibition, emotional inhibition (P < 0/01). The general health was different between groups, too. In addition, while groups showed significant difference in total score of emotion regulation and one of the subscales (rumination), no significant difference was explored between groups in self-blame, acceptance, positive refocusing, planning refocusing, positive re-evaluation, perspective taking, catastrophizing and others blame.

Significant differences between the two groups in terms of general health, schema dimensions and emotional regulation dimensions suggest that dysfunctional schemas, maladaptive emotional strategies and low general health could be involved in criminal behaviour.

The authors have not supplied their declaration of competing interest.

CADASIL (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), the most common form of hereditary stroke disorder, is characterized by headaches, transient ischemic attacks and psychiatric symptoms which include mood changes, behaviour disorders and variable levels of dementia.

To emphasize the necessity of discarding somatic and neurological processes before a psychiatric diagnosis is reached.

We present a case initially followed in psychiatry and derived to neurology, and compare it with articles no older than ten years, found in a bibliographic search in Medline (PubMed), fitting the next keywords: CADASIL, autosomal dominant encephalopathy, psychiatric symptoms.

The most frequent manifestation of CADASIL is the early age onset of cerebrovascular ischemic attacks, nonetheless, a fair percentage of patients debut with insidious psychiatric symptoms, especially mood changes, behavioural disorders and even mutism. Independently of the age of onset, these symptoms are present at some point of the illness in most cases.

Psychiatric symptoms can be found in a vast number of somatic and neurological disorders, even being the first manifestation of such processes. This challenges diagnosis, and given than the line between brain and mind is blurred and not always clear, cooperation among different specialities is of utmost importance in order to correctly treat the illness as a whole, and not just the sum of the parts.

The authors have not supplied their declaration of competing interest.

Doctors have many constraints in their professional practice, which influence negatively the quality of their performance. This causes a psychological distress.

To compare job satisfaction (JS), burnout (BT), anxiety, depression and coping strategies among doctors of medical (DMS) and surgical specialities (DSS).

Comparative and cross-sectional study conducted among 33 DMS and 63 DSS with different grades, in the university hospital Farhat Hached Sousse, Tunisia. We used job satisfaction scale (JSS) to determine the degree of JS, hospital anxiety and depression scale (HADS) to evaluate anxiety and depression, the Maslach burnout inventory to assess the BT and the brief cope to determine coping strategies.

DMS were older than the DSS (P = 0.005). The MSC had more unsettled family life (P = 0.04) and more monthly guard (5.87 vs. 4.96, P = 0.03). DMS had more days of outpatient (P = 0.00), were more satisfied with the work schedule (P = 0.00), conditions of the guards (P = 0.02). Relationships with colleagues were more satisfactory among DMS (P = 0.001). DMS were less confronted to violent events (P = 0.03). The average score of JSS was higher among DMS (P = 0.014). The BT was more reported in the DSS (P = 0.049). An average sub-score HADS-D (depression) was higher in the DSS (P = 0.00). An avoidance-focused coping was more adopted by the DSS (P = 0.02).

DSS were generally less satisfied in their work than DMS with obvious psychological repercussions. This incites to intervene in factors that interfere with job satisfaction to improve the quality of physicians’ performance.

The authors have not supplied their declaration of competing interest.

Several professional and personal factors determine the degree of job satisfaction (JS) which is a necessary condition to ensure good quality work, especially for physicians working in university hospitals (UH).

To determine the degree of JS in a population of physicians working in UH and to determine the factors associated with the JS.

Cross-sectional, descriptive and analytical study involving 96 physicians with different grades in Farhat Hached University Hospital, Sousse, Tunisia. We used Job Satisfaction Scale (JSS) to assess the degree of JS, Hospital Anxiety And Depression Scale to assess anxiety and depression, Maslach Burnout Inventory to determine burnout (BT).

The average age was 28.15 ± 4.10 years. Doctors with medical specialty were the majority (65.6%). Most doctors were dissatisfied with their work (67.7%). The socio-demographic factor associated with ST was the young age (P = 0.00). Occupational factors associated with JS were: shorter time worked in the department (P = 0.02), lack of outpatient day (P = 0.01), a lower number of outpatient day (P = 0.02), dissatisfaction with the work schedule (P = 0.004), lack of safety (P = 0.00), salary (P = 0.00), non-operating skills (P = 0.00), the distribution of tasks (P = 0.00), the conditions of the guards (P = 0.00), ignorance of the laws governing the department (P = 0.00), BT (P = 0.01) and depression (P = 0.00).

The majority of our subjects were dissatisfied with their work. Several factors, especially the professional ones contribute to this state. It is necessary to take steps on these factors to improve the performance of doctors working in university hospitals to provide better care for patients.

The authors have not supplied their declaration of competing interest.

Oxytocin has been related to traumas and sociability.

To do a systematic review on the relationship between oxytocin and early (ET), current trauma (CT) and PTSD.

The Pubmed, Psycinfo, Web of Science, Lilacs and Scielo database were researched until to April 2016, using the keywords: oxytocin, early trauma, childhood maltreatment, emotional trauma, emotional stress, neglect, adversity, sexual abuse, emotional abuse, physical abuse and PTSD, and Boolean operators. We used a priori protocol based on PRISMA to select observational and quasi/experimental studies in both gender subjects, who suffer ET, CT, or PSTD. A full review was done, and meta-analysis was carried out when possible to estimate the strength of the association. Strobe, trend and consort statements were used for qualitative assessment.

Twenty-eight studies where included:15 observational, 3 quasi/experimental and 10 RCT. Quality assessment was 60–70%. Due heterogeneity between studies we analysed them in four groups. Meta/analysis of studies of oxytocin endogenous concentration showed a negative correlation with ET (r = -0.35; 95%CI = -0.46/–0.22). Association studies of genetic polymorphism of oxytocin gene receptor (rs53576) showed that subjects with ET, CT and GG genotype had higher vulnerability to develop later psychopathology (P < 0.05). Quasi/experimental studies measuring pre/post oxytocin concentration after a stress reactivity test in subject with ET, CT or PTSD showed any significant results. Finally, RCT studies showed that acute administration of oxytocin increased the levels of anxiety and flashback in subjects with CT; and decreased in PTSD or ET. These results were in parallel with brain and connectivity activation.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Psychogenic or primary polydipsia characterized by excessive thirst and compulsive water drinking is a common problem among psychiatric populations, affecting 6% to 20% of patients. It is frequent in chronic psychiatric diseases, particularly schizophrenia. We report a patient with excessive thirst and diagnosed as PIP syndrome.

A 54-year-old, married, female patient had normal vital signs. She has excessive water intake (10–12 L/day). She did not have edema, signs of dehydration or fever. The neurological examination, CT, MRI, and EEG was normal. The laboratory tests were normal. She had started using sertraline 100 mg, 7 months ago due to anxiety disorder. There is not any disease except the anxiety disorder, which is in remission due to the treatment. A total of, 2 μg desmopressin I.M. is applied in fluid restriction test. The urine density is determined as 1.008 mg/dL initially, 1.011 mg/dL one hour later, and 1.013 mg/dL two hours later in the urinary test. The diagnosis is psychogenic polydipsia (primary) according to patient history, the clinical examination, and the test results. The patient is recommended to continue the sertraline 100 mg treatment, and also assigned with fluid restriction behaviour.

Since excess water intake periods are correlated with psychotic exacerbations; psychosis and polydipsia might have similar physiopathologic mechanisms. Polydipsia might be due to anti-cholinergic side effect of some psychiatric drugs. The physiopathology of the polydipsia and polyuria is not totally enlightened in the psychiatric disorders. In some cases, the fluid intake occurs completely voluntary. Therefore, we decided to present this case.

The authors have not supplied their declaration of competing interest.

Educational advice for coping with loss and resolution of grief: VIVER®, proposes new method of research and action in the field of thanatology and grief psychology through systematic meetings, group in which the intervention takes place under the simultaneous care professionals of thanatology and psychology.

To present the principles that underlie the research typology and grief subject, its implications in the grieving process and the service to the mourning proposed by VIVER® assistance.

Thanatological hermeneutics and literature review were used to develop this work.

The educational assistance VIVER® offers a useful tool in the care of the mourning by the method, created by Färber and Färber, composed of two pillars: the presentation of educational content about loss and grief, and artistic, playful and expressive experiences.

The work on operational groups listening and intervention assists the development of losses and reinterpretation of the history of the participants.

The authors have not supplied their declaration of competing interest.

The purpose of this research is to present multidisciplinary and relevance of Thanatology in coping of addictions and other mental disorders.

The aim of this paper is to analyse the scientific connections that thanatology establishes with other knowledge. With this postulate we present the thanatology and its relations with other disciplines, especially psychiatry, considering that addictions and mental disorders often have as triggering events of loss, death and mourning.

To develop this research we use the systematic literature review, following the process of research, cataloging, careful evaluation and synthesis of the documentation.

Thanatology is multidisciplinary shares and receives information from other sciences or sectors of knowledge without these modified or enriched. It is interdisciplinary because it originated disciplinary specialty of a mother discipline: Anthropology; and it is transdisciplinary, thence its relevance in research on the realities that revolve around mental disorders and addictions (Fig. 1).

It is important to research on thanatology position in the scientific panorama, given the emergence of this reflection and the relevance of research for its interrelationship with other disciplines.

The authors have not supplied their declaration of competing interest.

Violence in therapeutic centers, especially psychiatric wards is much higher than other units. In healthcare provider groups, nurses are at high risk of patient's aggression in the workplace.

The aim of this study is to evaluate the effect of violence on the health of nurses in Razi Hospital in Tehran, Iran.

In this cross-sectional study a total of 312 nurses working in psychiatric hospitals completed a GHQ28 questionnaire.

The results demonstrated that there is a statistical significant correlation between violence of patients (including physical violence and disrespect) to physical symptoms, anxiety and sleep disorder in nurses (P < 0.05). Also, increased frequency of disrespect by family of patient correlated to higher physical symptoms, anxiety, and sleep disorder in nurses. However, there was not any significant correlation between symptoms of depression, social function with aggressive patients.

Patients and their relative's violence affect the health of nurses. Therefore, it is necessary the therapeutic interventions for the prevention of physical and mental diseases in nurses and decreased desire to leave the organization.

The authors have not supplied their declaration of competing interest.

Evaluate the different kinds of DPR described in the literature and propose an abduction-based model of the Servant DPR, in which patients are protagonists in their treatment.

Pubmed literature review of the last forty years with the keyword ‘physician-patient relations’.

While nursing care advanced in its professional efficacy through Watson's human care and through the leader servant model, the DPR models demonstrated that the doctors are lost in their posture, even feeling as abused heroes. Models that include the patient in decision-making and that value the patient as a person (PCC) promise a revolution in the medical realm. Nevertheless, the PCC model is not enough to heal the DPR itself, because the role of the doctor must be changed to adapt to the relationship, otherwise, the PCC by itself can increase the burden upon the doctor. Doctors with a role of remunerated servant (not slave), like any other professional who delivers a service with excellence, focusing in the main actor, the patient, can heal the DPR.

The Servant DPR gives a positive counter transference, increasing the doctor's motivation and giving him back the sense of purpose in medicine, increasing the health system's effectiveness.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Medical record, general examination, laboratory findings, neuropsychological interview and multidisciplinary consideration are essential to establish differencial diagnosis and correct approach in amnesic episodes.

To describe differences between organic and psychogenic anterograde amnesia.

Single case report and literature review.

A 51-year-old man with only diagnosis of DM I, single, a good relationship with his family, without any personal or familiar psychiatric or neurological history, came to the hospital emergency department brought by his sisters referring disorientation, acute memory loss and mood changes, prevailing indifference to the situation for the last three days. After general exploration, including psychopatological examination and higher brain functions study, we arrived to the conclusion that the patient suffered from anterograde short-term severe amnesia as the only symptom, with evident conservation of autobiographic memory. The family referred as a possible stressor factor his mother's recent transfer to a different city, which had caused constant repeated questions about her location. Given the questionable presentation and trigger we shared the case with the neurologist, who ordered an array of tests to rule out any organic cause (LP, CT, MRI…), obtaining as a final result a diagnosis of limbic encephalitis, treated and effectively solved in two weeks with high-dose glucocorticoids.

Certain features of the symptoms exploration in amnesic episodes such as reiterative questioning about a specific topic, a non-modified autobiography or the absence of a clear traumatic precipitant factor, are essential for a correct approach and may lead the clinic to an organic evaluation.

The authors have not supplied their declaration of competing interest.

Non-Suicidal Self-Injury (NSSI) is considered a dysfunctional way of dealing with problem situations.

This study aimed to investigate the problem solving capacity in adults with NSSI compared to controls.

Thirty-three patients who sought treatment for NSSI (NSSI group) were compared with 33 individuals without psychiatric disorder (control group). We also investigated Axis I disorders, executive functions and problem solving capacity.

In both groups, the majority were women (77.25%) with a mean age of 30 years, and the beginning of NSSI behavior of 16 years. The most common NSSI behaviour was skin cutting, and the most common reason given for engaging in that behaviour was “to stop negative feelings”. The most common psychiatric comorbidities were major depressive disorder (60.6%). Compared to controls, the group with NSSI showed lower results in relation to problem solving capacity (P = 0.000) and mental flexibility (P = 0.007). Deficits in problem solving capacity may be a reflection of low mental flexibility of adults with NSSI. This may be a risk factor for the beginning of NSSI and the persistence of it in adulthood.

Early identification and treatment focused on problem solving capacity during the adolescence may prevent the chronicity of NSSI.

The authors have not supplied their declaration of competing interest.

Patients with severe mental illness (SMI) suffer from two to three times higher rates of obesity, and this has translated into much higher rates of obesity-related morbidity and premature mortality in this population.

Measuring the frequency of obesity and its associations with gender, and others socio-demographics factors among 115 adults psychiatric outpatients.

A cross-sectional study, was conducted to assess frequency of obesity among 115 adults attending public mental health department in the regional hospital of Gabes (south of Tunisia). For the diagnosis of mental disorders, we used the diagnostic and statistical manual of mental disorders (DSM-V). Obesity was estimated by body mass index (BMI). This index is defined as the ratio of weight (kg) to squared size (m2). Overweight is defined as a BMI between 25 and 29.9 kg/m2 and obesity by a BMI ≥30 kg/m2. BMI was measured directly and other information was gathered by interview.

The mean BMI was 25. In our patients, 40.9% were overweight, 49.6% (n = 57) were obese including 8.7% (n = 10) who were morbidly obese. Obesity was significantly more frequent in women (63.8% vs 39.7%, P = 0.009), living in a couple (60.9% vs 42%, P = 0.03) and having a medium or high socioeconomic level (53.3% vs 30.4%, P = 0.03). There were no differences between obese and non-obese regarding age, level of education and professional status.

The high prevalence of obesity among women suggests that targeted approaches are needed to promote optimal physical health in this population.

The authors have not supplied their declaration of competing interest.