There are few published studies on the relationship between gender and psychiatric disorders. We assessed sex differences in a sample of first-admission psychiatric inpatients to identify possible risk factors and targets for sex-tailored treatment interventions.

A retrospective study of admissions to the psychiatry department, Coimbra hospital Universitary Centre, Portugal, in 2015 was accomplished (n = 924). The two groups were compared for demographic features, psychiatric diagnoses and medical comorbidities.

Male patients were significantly younger (age average = 47.7 vs. 53.3). Differences in employment, educational, and marital statuses were found between male and female psychiatric patients. Having a degree was a protective factor for males, whereas it was a risk factor for females. Being divorced and single were both risk factors for medical co-morbidity in females. A higher proportion of men among patients hospitalized for schizophrenia (14.9 vs. 5.5%) or substance use disorder (10.3 vs. 2.1%) and a higher proportion of women among those admitted for affective disorders (43.3 vs. 25.9%), including bipolar disorder (13.4 vs. 9.0%), were found. No significant differences in duration of hospitalization between the two groups (22.8 in male vs. 22.2 days in female)

The differences between the two groups of inpatients were very pronounced. A better understanding of these differences may help to establish more effective treatment strategies.

The authors have not supplied their declaration of competing interest.

A large number of foreign travellers and expatriates visits or lives in Tunisia.

To explore socio-demographic, clinical and therapeutic characteristics of European patients admitted to psychiatric care in Tunisia.

This is a retrospective, descriptive study on all European patients admitted to Razi psychiatric university hospital, which is situated at the outskirts of the capital Tunis, between 2000 and 2015.

A total of 44 Europeans was admitted. Most frequent nationalities were: French and Germans (19 and 16 patients). The stay in Tunisia was mainly due to pathologic travel (17 subjects) and tourism (13 subjects). In total, 25 patients travelled without being accompanied. Average age was 51.3 years with extremes from 16 to 78 years. A history of psychiatric disorder was found in 15 patients, of whom almost all had stopped treatment. A majority (19 patients) was diagnosed with bipolar I disorder, and 8 patients suffered from schizophrenia. Average duration of hospitalization was 19 days. A total of, 22 patients were repatriated for medical reasons. Major difficulties during hospitalization were the language barrier, difficulties to contact family members or former treating psychiatrists for further information on the patient and his medical history, and the lack of insurance covering repatriation for medical reasons.

Psycho-education and early action on the precipitating factors could help to prevent psychiatric illness or relapse in these patients. Furthermore, attention of public authorities should be drawn to incomplete insurance coverage in many psychiatric patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Lyme disease (LD) caused by the spirochete Borrelia burgdorferi (Bb) results from human contact with rural environments and is transmitted by infected ticks (Ixodes spp.)

To report a case with LD and to highlight the importance of differential diagnosis in a first psychotic episode.

Case report and systematic review of the literature.

We report a case of a 19-year-old man that was admitted because of strange behaviour with alienation, perplexity and persecutory delusions. He had one previous admission to an inpatient unit two years prior and was diagnosed with psychosis not otherwise specified. After being admitted to the psychiatric ward a medical work up was completed. The patient had had a long stay in a rural environment; so anti-body specific to Bb was ordered and came positive. LD was diagnosed based on cerebral magnetic resonance imaging (MRI) findings and the presence of Bb in the cerebrospinal fluid. During treatment with anti-psychotic and antibiotic there was a noticeable clinical amelioration correlated with improvement of MRI's perfusion patterns.

LD is relatively rare, but physicians need to be aware of typical neuropsychiatric symptoms, given that they may occur months to years after the initial infection. Prompt diagnosis and effective treatment are crucial to avoid the possibly irreversible mental illness. In the evaluation of a first psychotic episode LD should be considered and excluded, principally if there's an epidemiological context and no psychiatric family history. MRI may be another useful asset in the diagnostic evaluation of this condition.

The authors have not supplied their declaration of competing interest.

Paraphrenia is a chronic psychotic disorder with a better-preserved affect and minimal disturbances of emotion and volition and a much less cognitive deterioration and personality changes.

To report a case with probable Paraphrenia and to highlight the importance of the differential diagnosis in a first psychotic episode.

Case report and systematic review of the literature.

We report a case of a 41-year-old man without a past psychiatry history that was led to the psychiatry emergency department (PED), by officers, because of strange behaviour and aggressiveness towards his family. In the PED the patient said that his real father was his father-in-law and that his ex-wife was his sister. His mental exam revealed disinhibition, disorganized speech with slightly mood elation, persecutory, mystic and influential delusions with various delusional interpretations. After being admitted to the psychiatric ward, in compulsatory care, he began treatment and a medical work up was completed. According to the family the patient had begun this strange behaviour four years prior. During the hospitalization it became clear that the patient was experiencing imaginative-confabulatoric multi-thematic delusions, sometimes interviewer guided, without showing cognitive deterioration and retaining his personality.

The diagnosis of atypical psychosis or psychosis not otherwise specified is not satisfactory since it agglutinates different conditions together. Paraphrenia is a well-established concept and should be used in order to define a group of psychotic patients who exhibited characteristic symptoms of schizophrenia, minus personality impairment and slower cognitive decline.

The authors have not supplied their declaration of competing interest.

Ganser syndrome was first described by a German psychiatrist Ganser in 1898, in a patient who showed a peculiar twilight state. Ganser syndrome is defined as the presence of approximate answers, somatic conversion symptoms, clouding of consciousness, and pseudo-hallucinations. The etiology of this disease remains a subject of debate. While the DSM-IV-TR classifies Ganser syndrome under the heading of dissociative disorder, it is not listed as a diagnosis in the DSM-V.

The purpose of this paper is to review available literature on Ganser syndrome, published in Dutch, English, German, and French for examining the etiological debate, in order to gain insight into the etiology of this disorder.

The study design was a retrospective case series of all published cases since 1898. For this purpose we used the electronic databases PubMed and Embase.

Over a period of 118 years, we found 79 papers, describing 117 case reports on Ganser syndrome. It generally occurs in patients who are exposed to somatic disorders or to psychological stress, however, often in absence of a psychiatric disorder.

Ganser syndrome remains a controversial disorder in terms of its etiology. Ganser syndrome has been associated with organic disorders, as well as with stressful and intolerable life events. Based on this report, it is noteworthy that this syndrome predominantly occurs in the absence of co-morbid psychiatric disorders and is often associated with stress factors and underlying somatic diseases.

The authors have not supplied their declaration of competing interest.

Serotonin syndrome is a potential adverse reaction to drugs increasing serotoninergic activity in the nervous system, some of them being frequently prescribed, such as antidepressant drugs. The association of myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, in-coordination, fever and diaphoresis, when patients are treated with serotoninergic agents, could constitute a “serotonin syndrome”. The purpose of this report is to review the clinical evidence of serotonin syndrome with SSRIs augmentation of amisulpride. We propose two case report and literature review.

We conducted a systematic review of the literature with the principal database (PubMed, Enbase, PsychInfo) and we present two case report [1,2].

We describe two different case report with SSRIs augmentation of amisulpride.

To our knowledge this is no report about the emergence of serotonin syndrome due to the use of SSRIs augmentation of amisulpride. Serotonin syndrome symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, fever, dilated pupils, and diarrhea. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The aim of this project was to improve the physical health monitoring for patients with mental health illness. The patients group was under the care of south Barnet primary care mental health pilot (SB PCMH Pilot). SB PCMH pilot is a multidisciplinary team that includes: consultant psychiatrist mental health nurse and psychologist.

Between November to December 2014, 60 patients were discharged from SB PCMHT and the electronic case notes of 38 of them who had an assessment/intervention by the service were reviewed. Results showed that 82% of the records verified that discussion and screening of physical health, smoking, drugs and alcohol had been completed. The data was discussed in team meetings with all team members. After thorough team discussions and brainstorming; the team agreed that an improvement in the process of monitoring was needed to work towards ensuring these matters are discussed with 100% patients and that this is accurately recorded. It was agreed to re-audit in 3 months.

A re-audit completed between January to April 2015 confirmed an improvement as 98% of patients seen for an assessment by SB PCMH pilot have had their annual health checks and appropriate health screenings discussed and recorded routinely.

The authors have not supplied their declaration of competing interest.

Personality traits and social cognition are important predictors for the future performance, success, adjustment and mental health of medical students.

The purpose of the study was to assess and compare personality traits and emotion recognition abilities of two medical student samples: general medicine (GM) and general nursing (GN) students.

The study was conducted between 2015–2016 on 173 Romanian medical undergraduates from the Timisoara “Victor Babes” university of medicine and pharmacy: sixth-year GM students (n = 96) and fourth-year GN students (n = 83). Personality traits were evaluated with the 60-item NEO five-factor inventory (NEO-FFI). Emotion recognition abilities were assessed with the revised version of the “reading the mind in the eyes” test.

The GM sample consisted of 31 (32.3%) males and 65 (67.7%) females, with a mean age of 24.65 years (SD = 1.81). The GN sample was comprised of 13 (15.7%) males and 70 (84.3%) females, with a mean age of 23.84 years (SD = 2.12). Overall, compared with female students, males gave considerably less correct answers in the “eyes test” (P = 0.002) and had lower mean scores in “agreeableness” (P = 0.005). GM students scored significantly higher than GN students in “neuroticism” (P = 0.01), obtained lower mean scores in “agreeableness” (P = 0.015) and had poorer emotion recognition abilities (P = 0.03) than their GN colleagues.

GN students appear to be more emotionally stable and with better emotion recognition abilities than GM students. Results of the present study represent a starting point for other studies that may use larger and diverse student samples.

The authors have not supplied their declaration of competing interest.

Empathy is of most importance in the medical field. The ability to comprehend and connect with the emotional state of another person is essential for establishing a successful interaction between patients and health care professionals.

The aim of this study was to assess empathic response in general nursing (GN) students.

The study was conducted between 2015–2016 on 75, sixth-year Romanian GN undergraduates from the Timisoara “Victor Babes” university of medicine and pharmacy. To evaluate the level of empathy, we used the empathy quotient (EQ), a 60-item self-report inventory with 40 questions empathy-related and 20 filler questions.

We included in this study 12 (16%) males and 63 (84%) females, with a mean age of 23.48 years (SD = 2.17). Female GN students had significantly higher EQ mean scores than the general female population. Compared to female students, males obtained significantly lower EQ mean scores. There were no significant differences between male and female students regarding age distribution.

Female GN students showed greater empathy than their male colleagues, as well as than the general female population. These results support the theory on women's understanding of others mental states, vital to the provision of a worthy nursing care.

The authors have not supplied their declaration of competing interest.

During medical school, students experience significant amounts of stress. Since certain emotion regulatory strategies are known to be maladaptive, the way in which students are capable to regulate their emotions becomes very important, because it can affect their physical and mental welfare.

The purpose of this study was to assess cognitive emotion regulation strategies in Romanian general medicine (GM) students.

The study was conducted between 2015–2016 on 86 sixth-year Romanian GM undergraduates from the Timisoara “Victor Babes” university of medicine and pharmacy. In order to identify the cognitive emotion regulation strategies (or cognitive coping strategies) that students use after experiencing negative situations or life events we used the Romanian version of the cognitive emotion regulation questionnaire (CERQ).

The sample consisted of 30 (34.9%) males and 56 (65.1%) females, with ages ranging between 24 and 31 years (mean age = 24.97 years, SD = 1.74). Compared to female students, males obtained significantly lower mean scores in “umination” (t = -2.84, P = 0.005, 95% CI = -1.64; -0.29), “positive refocusing” (t = -2.09, P = 0.037, 95% CI = -1.42; -0.04) and “catastrophizing” (t = -3.17, P = 0.002, 95% CI = -1.31; -0.3). Both male and female GM students had significantly higher mean scores in “blaming others” than their respectively gender-related general population.

Results of this study suggest that GM students, when facing stressful or negative events, are more inclined in using “blaming others” as a coping strategy. Female students seem to be more inclined than males to use “rumination”, “catastrophizing” and “positive refocusing” as cognitive coping mechanisms.

The authors have not supplied their declaration of competing interest.

As antipsychotic agents are increasingly used, many patients are at risk for antipsychotic-induced hyperprolactinemia.

Estimate the prevalence of hyperprolactinemia in patients treated by a single antipsychotic and identify the risk factors for its occurrence.

This is a prospective study carried out at the psychiatric department of psychiatry of university hospital of Mahdia during 24 months. We have included all patients with a follow up and treated by single antipsychotic for at least 12 weeks. A pituitary MRI has been requested for patients with a prolactin level higher than 100 ng/ml.

We have collected 92 patients. Hyperprolactinemia was found in 34.8% of patients among which 7.6% have had prolactin level greater than 150 ng/ml. Pituitary MRI have revealed 2 cases of macro-adenoma. The decrease of the antipsychotic doses has significantly improved prolactin levels. The switch of antipsychotic with another less inducing hyperprolactnimea has significantly decreased prolactin levels. 7 factors were correlated significantly to hyperprolactinemia: sex (female), substance use, presence of side effects, combination of psychotropic drugs, atypical antipsychotics, type of antipsychotic: Haloperidol and amisulpride, antipsychotic dose greater than 1000 mg Chlorpromazine equivalent.

Hyperprolactinemia must be carefully identified, through a pre-therapeutic assessment and monitoring of patients.

The authors have not supplied their declaration of competing interest.

Hyperinsulinism is one of the most important causes of hypoglycemia. Rarely, drug toxicity can be a reason. In the context of Munchausen syndrome by proxy (MSBP), toxicity usually occurs in children due to drug administration by a parent or caregiver.

we report a case of a 2-year-old girl with hyperinsulinaemic hypoglycaemia due to insulin injections by her mother.

Mrs. W. is a 28-year-old mother of three children. In her medical history, she was diagnosed with gestational diabetes and treated briefly with insulin. She was hospitalized several times for hypoglycemia and she was diagnosed with factitious disorder. Lately, her youngest daughter aged 2 years old was hospitalized in the pediatric department for repeated unexplained loss of consciousness. The hospitalization lasted 2 months with recurrence of severe hypoglycemia. A full metabolic screen revealed no abnormalities. The mood of the mother appeared quite discordant with the situation. Strict monitoring of maternal behavior showed that the mother gives insulin injections to her daughter. She denied deliberately injecting insulin, and then she accused the health workers. She was referred to our psychiatric department and we diagnosed the MSBP.

MSBP should be considered particularly in patients who have been evaluated by more than one hospital and have discordant test results.

The authors have not supplied their declaration of competing interest.

The most frequently used anesthesiologic agents are methohexital, thiopental, etomidate, propofol, ketamine, and sevoflurane. The objective is to clarify the differences on recovery, cardiovascular variables, cognitive functions, and response to treatment showed by these drugs.

A review was conducted aiming to clarify the differences between anaesthetic agnets used in ECT. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.

– Propofol seems to have better hemodynamic effects in comparison with etomidate in patients with schizophrenia and depression;

– The seizure duration was significantly shorter with propofol, but this did not cause a difference regarding clinical improvement;

– The seizure duration was longer with etomidate in many studies. It did not decrease in a dose-dependent fashion with etomidate in a study comparing methohexital, etomidate, and propofol;

– The most frequently observed adverse effects were arrhythmias and nausea and they occurred more frequently in patients who were given thiopental. The pain at the injection site was more frequent in patients who were given propofol;

– Etomidate seems to have better clinical improvement than thiopental. Thiopental seems to have better results than propofol, which has an anticonvulsant feature effects.

In order to figure out which anaesthetic agent was the most indicated for undergoing ECT, we found that both EEG-based seizure duration and motor seizure duration showed the sequence etomidatemethohexical>thio- pental>propofol. These items are directly related with clinical improvement. When a drug is chosen, It is important to individualize the treatment according to the patients’ comobidity.

The authors have not supplied their declaration of competing interest.

Neuroacanthocytosis is an infrequent cause of both neurological and psychiatric manifestations, and acanthocytes, which are a special form of spiculated red blood cells. Clinically significant psychopathology, ranging from behavioural disturbance to frank psychiatric illness, has been reported to occur in up to 60% of ChAc patients.

A review was conducted aiming to clarify the physiopathology of this illness and its clinical features in order to distinguish neuroacanthocytosis from other neurological or psychiatric diseases. The literature search was conducted in PubMed data reviewing articles dating between 2010 and 2016.

– Neuroacanthocytosis autosomal recessive disorder associated with mutations or deletions in the VPS13A gene on chromosome 9q, which codes for the membrane protein chorein. Chorein is strongly expressed in the brain. Chorein loss particularly affects the basal ganglia, especially the caudate nucleus and putamen;

– Dysexecutive syndromes, OCD, depression and possibly psychosis, which may precede the frank motor and cognitive impairment;

– The most recently developed treatment for neuroacanthocytoses is the use of deep-brain stimulation (DBS), with stimulation of the globus pallidus internus.

While conducting a neurological exam, secondary causes of psychosis have to be included in the differential diagnosis. It is important to notice the possible confusion between tardive dyskinesia and a primary movement disorder. It should be necessary to investigate all de novo movement disorders in psychotic patients in order to eliminate etiologies other than iatrogenic ones.

The authors have not supplied their declaration of competing interest.

The concept of obsessive-compulsive disorder (OCD) as a disorder that affects the basal ganglia arising to the phenomenological similarities found between idiopathic OCD and other conditions associated with basal ganglia disease such as Huntington's disease (HD) and Sydenham's chorea. Huntintong's disease is characterized by cognitive, motor and neuropsychiatric symptoms.

A review of articles published from 1989 to 2016 in Pub-Med and UpToDate about relationship between HD and obsessive-compulsive symptoms.

Case report of a 56-year-old male who was admitted at the acute unit of psychiatry with obsessive-compulsive symptoms marked by hypochondriac obsessive thoughts. He also had cleaning rituals in relation with meals and we observed an important functional impairment and depressive mood. No previous history except family chorea without cognitive impairment in study by neurology department.

Affective disorders are the most common psychiatric disorders in HD. Less frequently it can be found other psychiatric symptoms as obsessive-compulsive behaviour with prevalences between 10% to 52%. Psychiatric symptoms do not correlate with duration of disease or presence of dementia or motor symptoms.

It is necessary to complete the study of the patient to provide a more appropriate therapeutic option. The neurological signs of basal ganglia disorder should be evaluated when considering OCD diagnosis, especially in atypical presentation ages. Longitudinal studies are needed to determine the pathogenesis, disease progression and future therapeutic options.

The authors have not supplied their declaration of competing interest.

The interdisciplinary group of studies on violence (GREIVI), created in 2006, develops teaching, research and community extension activities related to violence and its impact on individuals’ mental health (victims or perpetrators).

To describe the subjects studied, the participants and the activities developed in the GREIVI in the period of 8 years.

Knowing the GREIVI's activities.

Qualitative exploratory documentary study. Analysed 90 group monitoring reports from 2009 to 2016. The records were subjected to content analysis.

Production: completed 11 research projects of undergraduate and postgraduate students; 7 in progress; presented 9 works in international scientific events; published 9 articles; 1 extension project in elementary school (2009 to 2016). Established partnership with international research and education institution to articulate and implement new projects. Topics discussed: definition, types and nature of violence; ecological model of violence; violence against women; and school violence. Activities: directed reading; discussions and exchange of experiences between the participants; presentation, discussion and advice on research and community extension projects; production and dissemination of scientific papers; technical visits and activities’ structuring and planning. Participants: professionals and undergraduate and graduate students from different areas (nursing, psychiatry, psychology, social work, education, biology and political advisor who works with the theme of violence).

The GREIVI have provided interdisciplinary space for discussion of different aspects of violence and the construction of research and extension projects to the community.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

In a bargaining process, there are factors impacting the outcome (i.e. gain versus loss). Of the important factors is the informational asymmetries between bargainers which could provide a more powerful position for whom has information that the other partner has not as well as magnitude of resource.

Thus, in a modified two-round, 4 trials (different magnitudes) bargaining paradigm, we investigated deception in children when there is no chance of deception revelation (first round) and when there is a chance of deception revelation (second round).

One hundred and forty one healthy schoolchildren (90 boys and 51 girls) between age of 7 and 12 participated in the current study. We designed a modified version of the bargaining paradigm based on the experimental design by members of the junior faculty workshop in the conflict management division at the 1995 academy of management meetings in Vancouver, BC. Variables included earning amount, deception frequency, real generosity and pretend generosity.

Using paired-samples T-test we showed that there were significant differences between two rounds in earning amount, deception frequency and real generosity. We administered separate one-way ANOVA with repeated measure on 4 different conditions (bank amounts. We found that, the main effect of condition was significant for real generosity (in both round), for pretend generosity (in first round) and for deception amount (in both round).

We found that revelation (reputation concerns) decreases deception and increases generosity. Moreover, lesser magnitudes increase generosity and decrease deception and vice versa.

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