This was a descriptive study of the prescription trend of anti-psychotics for elderly patients in a general hospital in Singapore.

Elderly patients aged >65 who received at least 1 prescription of anti-psychotics during 2005, 2007, 2009, 2011 and 2013 in Tan Tock Seng Hospital, Singapore, were selected. Data was obtained from the hospital computerized prescription records.

The total number of elderly patients who received anti-psychotics increased from 865 in 2005 to 1990 in 2013. Following the official warning issued by the health sciences authority in 2004 regarding the increased risks of cerebrovascular events in elderly patients taking olanzapine and risperidone, prescriptions for risperidone reduced between 2005 to 2013 (20.74% vs. 11.79%, 95% CI: 0.07–0.10, P < 0.0001). However, the percentage of prescriptions of other atypical anti-psychotics such as quetiapine increased from 27.47% to 58.48% (95% CI: 0.29–0.33, P < 0.0001), in 2005 and 2013 respectively, and prescriptions for olanzapine remained relatively stable at 6.65% in 2005 and 8.94% in 2013 (P > 0.05). With the black box warnings extended to typical anti-psychotics 3 years later, the percentage of prescriptions of typical anti-psychotics decreased between 2005 to 2013, e.g. haloperidol (33.19% vs. 13.39%, 95% CI: 0.17–0.22; P < 0.0001), sulpiride (6.58% vs. 2.83%, 95% CI: 0.03–0.05, P < 0.0001) and chlorpromazine (3.85% vs. 1.85%, 95% CI: 0.01–0.03, P < 0.0001).

After the first safety warning the percentage of prescriptions for risperidone dropped significantly, and there was a significant increase for quetiapine. The percentage of haloperidol, sulpiride and chlorpromazine prescriptions declined after both warnings. Anti-psychotics use in the elderly continues to be prevalent.

The authors have not supplied their declaration of competing interest.

Psychotic depression is a well-known entity, with recent data confirming the use of antidepressant and anti-psychotic co-treatment. Psychotic symptoms can be mood incongruent and present further difficulties for treatment.

A 51-year-old female presented to our hospital, with symptoms of genital cramping, paresthesiae, feelings of unease in the vulva and depressive mood. In December 2014, the patient was diagnosed with genital polyps, which were successfully removed by curettage. The patient continued feeling various genital symptoms, which she associated with social and family stressors. After short initial outpatient treatment, the patient was admitted to our ward for complete assessment. Psychological assessment revealed psychotic elements, high anxiety and a passive aggressive personality. Abdominal ultrasound, lumbal spine radiography, physiatrist exam and computerized tomography of the brain showed no abnormalities. The patient was diagnosed with psychotic depression and referred to further outpatient treatment. Her drug regimen consisted of venlafaxine, risperidone, clonazepam and carbamazepine, which led to slight initial improvement. However, the patient still referred persistent symptoms as well as sedation as an adverse effect, so risperidone was switched to aripiprazole, and carbamazepine to pregabaline. The initiation of this treatment has led to complete withdrawal of symptoms and the patient has since maintained stable remission.

Aripiprazole is well suited to the female population because of its lack of hyperprolactinemia, and its combination with pregabaline may be an option for augmenting treatment in psychotic depression with cenestopathy.

The authors have not supplied their declaration of competing interest.

Hyperprolactinemia is a frequent side effect observed in patients treated with anti-psychotic drugs. The frequency of clinical signs usually correlates with elevated serum prolactin levels.

To estimate the prevalence of hyperprolactinemia among patients treated with a single anti-psychotic and specify the risk factors for its occurrence.

Cross-sectional study performed in a period of 6 months in the psychiatric department of Mahdia's hospital, for all patients seen in the consultation and treated with a single anti-psychotic for 12 weeks, with a stable dose, and meeting the inclusion and exclusion criteria of the study. Prolactin blood tests have been performed and confirmed by a second one in case of abnormality objectified in the first lab test results. A magnetic resonance imaging (MRI) was intended for patients with prolactin levels greater than 150 ng/mL.

Ninety-two patients were gathered. Prevalence of hyperprolactinemia was 34.8% of which 7.6% had prolactin levels greater than 150 ng/mL. Two macroadenomas’ cases were detected. The analytical study found 7 factors significantly correlated with hyperprolactinemia, which are: female sex, substance use, the presence of side effects, prescription of atypical anti-psychotics, the anti-psychotic treatment prescribed: haloperidol/amisulpride, doses of anti-psychotic greater than 1000 mg equivalent to chlorpromazine and the combination of psychotropic drugs.

Prolactin blood test should be a systematical analysis for all patients treated with anti-psychotics, to prevent the short and long term side effects.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Adult patients with ADHD may go unrecognized. This can result in psychosocial and functional decline.

To investigate the use of objective testing, with an eye-tracker device in the diagnosis of adult patients with ADHD.

Case control study. Inclusion criteria were aged 18–65, minimum 5 years of education and literate in English. Exclusion criteria were visual impairment, amnesia and learning difficulties. ADHD was diagnosed with Conners’ adult ADHD diagnostic interview (group A, n = 15) and were matched for gender and age against normal controls (group B, n = 33). Participants completed four computer-based tasks while their eye movements were recorded. The tests included (i) Stroop effect test, (ii) Stroop effect test with visual aid, (iii) perceptual selectivity test and (iv) Saccadic interference. accuracy (%) and response time (msec) for tests (i–iii) measured while for test (iv), saccade count, average saccade amplitude and average fixation duration.

Stroop test accuracy showed a statistically significant difference between group A and group B (P = 0.004). Stroop response time also showed a statistically significant difference between the two groups (t = 3.228, df: 46, P = 0.001). For test (ii), there was a significant difference for response time (t = 2.326, df: 46, P = 0.024) but not for accuracy. For test (iii), the results were statistically significant for accuracy; (t = 2.682, df: 46, P = 0.010) and for response time (t = 4.028, df: 46, P = 0.001). There were no significant differences in the saccadic interference test.

Adults with ADHD have a longer response time and perform less accurately than controls. Thus, these data demonstrate that there is a use for objective tests (tests i–iii) in the diagnosis of adult ADHD.

The authors have not supplied their declaration of competing interest.

Defense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD).

We recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences.

Participants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery provided also support of the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD.

The authors have not supplied their declaration of competing interest.

Eye movements are used in several studies as a biomarker in order to evaluate cortical alterations in psychiatric disorders. Pursuit eye movements’ deficits were found both in schizophrenia and in affective disorder patients. Nevertheless, these findings are still controversial.

Set up a system to record and evaluate the eye movements in psychiatric patients.

To verify the applicability of a smooth pursuit task in a sample of psychiatric inpatients and to prove its efficiency in discriminating patient and control group performance.

A sample of psychiatric inpatients was tested at psychiatric service of diagnosis and care of AUSL Romagna-Cesena. Eye movement measures were collected at a sampling rate of 60 Hz using the eye tribe tracker, a bar plugged into a PC, placed below the screen and containing both webcam and infrared illumination. Subjects underwent to a smooth pursuit eye movement task. They had to visually follow a white dot target moving horizontally on a black background with a sinusoidal velocity. At the end of the task, a chart of the eye movements done is shown on the screen. Data are off-line analyzed to calculate several eye movement parameters: gain, eye movement delay with respect to the movement of the target, maximum speed and number of saccades exhibited during pursuit.

Patients compared to controls showed higher delay and lower gain values.

Findings confirm the adequacy of this method in order to detect eye movement differences between psychiatric patients and controls in a smooth pursuit task.

The authors have not supplied their declaration of competing interest.

Published research regarding the relationship between lipid levels in affective disorders has been contradictory. Additionally, most studies correlating psychosis to lipid serum concentrations only concern schizophrenic patients.

To access the relationship between serum lipid levels with the diagnosis and pathophysiology of affective disorders.

Diagnostic data (ICD–10: F31–32), including mood and psychotic features, were prospectively collected for all patients admitted at the affective disorder ward at Centro Hospitalar Psiquiátrico de Lisboa (Portugal), during the third trimester of 2016. Serum concentrations of triglycerides and total/HDL/LDL cholesterol were evaluated using standard laboratory tests. Statistical analysis was performed for possible correlations between serum lipid levels and:

– different stages of bipolar disorder (BD);

– elevated versus depressive mood (unipolar and bipolar);

– depressive mood (BD versus non-BD);

– psychotic features.

Sixty-three patients admitted were enrolled in this study: 47 presented with BD (32 manic, 10 depressives and 5 mixed episodes) and 16 presented depressive disorders. Statistical analysis (R software) revealed that depressed bipolar patients had significantly higher triglyceride (P = 0.026), total and LDL cholesterol (P = 0.525) levels than other states; mixed episodes presented higher HDL levels (P = 0.542). Although not significant, manic patients’ HDL levels were consistently elevated compared to depressive ones, whom presented with lower values overall. Finally, when adjusted for age, psychotic patients showed lower levels of total (P = 0.031) and LDL cholesterol (P = 0.052) compared to non-psychotic patients.

There is a potential link between serum lipid levels and diagnosis/psychopathology of affective disorders. Further research is needed to characterize its pathophysiologic relevance.

The authors have not supplied their declaration of competing interest.

According indicators from the OECD in 2015, cardiovascular diseases remain the main cause of mortality in most OECD countries. But main risk factor, as smoking, obesity, hypertension or physical activity do not explain that Slovak republic was the worst from OECD countries with number 404 age-standardized rates per 100,000 population.

Determine which psychological, psycho-physiological and anthropometrics factors are at risk of cardiovascular diseases:

The aim is to determine, which risk psychological, psycho-physiological and anthropometrics markers are remarkable in time, when individual subjectively perceives himself as health. Based on the analysis of these correlates will be identified predictors, mediators and moderators of the cardiovascular diseases from the area of psychological variables, which accentuates the clinical picture of a patient with cardiovascular disease. Another aim is to identify specific risk factors for target advice on a lifestyle modification and creation of an interdisciplinary methodology for the prevention of cardiovascular diseases.

Project is aimed to clarify the relation between psychological factors (measuring by personal inventories as temperament predispositions, maladaptive schemes, coping, personality characteristics), balance of autonomic nervous system (by measuring HRV, skin conductance, muscle tension, respiration, and surface temperature), anthropometrics characteristics (BMI, weight, height) with potential symptoms of cardiovascular diseases confirmed in cardiac evaluation (12-lead ECG), blood pressure, examination of pulse wave, and data of arteriographic examination.

The results of the study can help to the better understanding of the interface between psychological factors and cardiovascular problems, which help to find new diagnostic, preventive and treatment approaches.

The authors have not supplied their declaration of competing interest.

An integration between psychiatry, neurochemistry and differential psychology gives an evidence-based framework for the diagnosis of mental illness rooted both in modern neurophysiology and clinical observations.

To investigate whether, a neurochemical model of temperament might (FET) provide a better discrimination between major depression (MD), anxiety (GAD), co-morbid depression and anxiety and delusional disorders than existing emotionality-based temperament models.

Three studies compared the profiles on temperament and personality disorder inventories in patients who were diagnosed and treated for named disorders across four adult age groups (17–24, 25–45, 46–65, 66–84).

The FET distinguished between MD and GAD in line with the DSM descriptors and showed significant differences for the traits of motor endurance and motor tempo (much lower values in MD), and neuroticism (much higher value in GAD). The results showed benefits of differentiation between physical and social types of fatigue as a symptom of MD and that high impulsivity and low plasticity can be also considered symptoms differentiating between mental disorders. Moreover, high sociability appeared as a symptom associated with high dominance–mania tendencies. The FET framework appeared to be sensitive to age and sex differences: higher anxiety and anti-social symptoms appeared to be more prominent in the younger age (unlike depression symptoms), and declined with age.

This study suggest the utility of using a functional approach to both taxonomy of temperament and classification of mental disorders and the benefits of systemic differentiating between 12 functional aspects of behavior, with special attention to non-emotionality-related aspects of behavior.

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

The authors have not supplied their declaration of competing interest.

Theory of Mind (ToM) deficit is investigated by psychological and neurobiological methods using a range of social cognitive tests, including the verbal test Hinting Task. However, it remains unclear whether there is a connection between ToM results and the physiological characteristics in norm and in pathology.

We performed the comparison of Hinting Task performance in patients with schizophrenia and healthy subjects; analysis of correlations between Hinting Task performance with physiological parameters; discriminant analysis in order to classify subject groups according to predictors, including psychological and physiological parameters.

We measured Hinting Task, spectral power of the EEG mu-rhythm (SP) and heart rate (HR) at rest and during a motion imagery task in 114 right-handed subjects, 1st episode patients with schizophrenia (SCH1) n = 29, chronically ill patients with schizophrenia, duration of illness more than 5 years, (SCH2) n = 23, and healthy subjects (НС) n = 62.

Hinting Task rate: HC > SCH2 (P < 0.01), HC ≥ SCH1 (P = 0.07), SCH1 = SCH2 (P = 0.3). Only SCH1 Hinting Task score was associated with a complex of physiological parameters in the resting state [Multiple R = 0.78, F (3.25) = 13.31, P < 0.0001]. Discriminant function analysis of HC and the combined SCH group [F (7.106) = 7.078, P < 0.0000]. The samples were classified at 89% and 71%, respectively, including HR (P < 0.000001), SP in the resting state in C4 (P < 0.001), C3 (P < 0.01), SP changes in C3 (P < 0.05) and Hinting Task (P = 0.2).

Hinting Task Hinting Task is a part of classification model of norm and schizophrenia. Patients with first episode and chronically ill patients with schizophrenia do not differ in the studied parameters.

The authors have not supplied their declaration of competing interest.

Walter Jackson Freeman II was born the grandchild of William Williams Keen, one of world's most renowned surgeons from Philadelphia and the son of an otorhinolaryngist, which may have been contributed to his interest in medicine. Freeman started his medical career in a psychiatric hospital and over the years, he operated thousands of patients. He was a protagonist in American psychosurgery and therefore, he often has been referred as the “lobotomist”.

To present the scientific papers of Walter Jackson Freeman on psychosurgery.

To review available literature and to show evidence that Freeman made a significant though controversial contribution to the development of psychosurgery.

A biography is presented and discussed followed by a literature review.

In this whole career, “the lobotomist” operated more than 3500 patients and performed mainly operations on the frontal areas. However, he operated human brains without due regard for his patient's mental abilities and emotional well-being after their lobotomy. Despite his work was praised, there was also a lot of criticism on his methods.

Despite the dubious reputation, Freeman can be remembered as an ambitious doctor who made a significant contribution to the development of psychosurgery. However, unfortunately he crossed medical and legal boundaries.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To study the place of electroconvulsive therapy (ECT) in the treatment of major depressive disorder in France and compare it with international recommendations and algorithms.

Multicenter, retrospective study in 12 French university hospitals. Diagnosis, delay between the onset of the episode and the first day of ECT, previous treatments have been identified. Only patients treated for major depressive disorder between 1 January 2009 and 1 January 2014 were included.

A total of 754 patients were included (middle age 61.07 years, sex ratio 0.53). The diagnoses listed were: first major depressive episode (14.95%), bipolar depression (38.85%) and unipolar recurrent depression (46.19%). The delay before ECT, was 11.01 months (13,98), and was significantly longer for first episodes (16.45 months, P < 0.001) and shorter in case of psychotic symptoms (8.76 months, P < 0.03) and catatonic symptoms (6.70, P < 0.01).

The delay before ECT appears on average, four times longer than recommended by treatment algorithms for the management of major depressive disorder. This long delay could be explained by a very heterogeneous access to this treatment in French territory.

The authors have not supplied their declaration of competing interest.

José Manuel Rodriguez Delgado (1915–2011), a Spanish physiologist, was among the first scientist to perform electric brain stimulation in both animals and humans. His work on brain-stimulation research during the 1960s and 1970s was innovative but also controversial.

To present the scientific papers of Jose Delgado on psychosurgery.

To review available literature and to show evidence that Jose Delgado made a significant contribution to the development of psychosurgery.

A biography and private papers are presented and discussed followed by a literature review.

Delgado showed that with electrical brain stimulation one could evoke well-organized complex behavior in primates. A rhesus monkey was stimulated with an electrode implanted inside the red nucleus, followed by a complex sequence of events. After stimulation of an area three millimeters from the red nucleus, the rhesus monkey just yawned. Delgado also investigated the mechanisms of aggressive behavior in other animals. Stimulation of the caudate nucleus by remote control in a fighting bully resulted in sudden paralysis. In some human patients suffering from depression, euphoria was induced after stimulation of the septum.

Delgado pioneered the brain electrode implantation in order to electrically stimulate specific brain areas for treatment epilepsy and of different types of mental illness. He was severely criticized. His studies, however, paved the way for new modulation techniques such as the development of deep brain stimulation.

The authors have not supplied their declaration of competing interest.

Despite appropriate treatment, 30–40% of depressed patients, both unipolar and bipolar, do not achieve improvement, with high morbidity and mortality. For bipolar patients another risk is the switch into mania due to antidepressant treatment. The concern about the switch, suggests to administer antidepressants at lower doses, in combination with mood stabilizers and second generation anti-psychotics.

We performed an observational study on a sample of 23 bipolar patients treated with ECT for severe TRD in last 3 years, in order to evaluate the risk of switch.

Twenty-three bipolar inpatients, undergoing bitemporal ECT twice/week, with MECTA spectrum device. Main demographic and clinical data collected. Hamilton rating scale for depression (HAM-D). Clinical response defined as 50% reduction of HAM-D score at the endpoint from baseline; remission as HAM-D score at the endpoint < 8. Young Mania rating scale (YMRS) weekly in order to assess switch into mania.

Thirteen (56.5%) females, 10 (43.5%) males, mean age 60.1 ± 10.3 years. Mean age at onset 35.5 ± 13.6 years. Mean number of episodes: 7.1 ± 3.6. Mean duration of current episode: 33.4 ± 24.9 weeks. Mean HAM-D basal score: 30.0 ± 5. Each patient underwent a cycle of ECT (mean No. 6.7 ± 3.3). Pharmacological treatment was administered upon clinical need. Response rate 87%, remission rate 43.5%. Three out of 23 (13.04%) patients had transient hypomanic switch, spontaneous recovery within 7 days after the last ECT.

Our experience confirms that ECT is a powerful antidepressant, especially in patients with severe long-lasting depression, refractory to treatment. ECT is also a safe procedure: no adverse effects were reported. The manic switch rate is comparable with antidepressant drugs.

The authors have not supplied their declaration of competing interest.

In the early 20th century, shock therapies developed worldwide as the most effective means to treat severe mental illness. In 1927, Manfred Sakel introduced the newly discovered insulin as a means to treat opioid-addicted patients, by relieving withdrawal symptoms. After noticing that some psychotic patients notably recovered from their psychotic symptoms after accidental insulin comas, he extended this technique to schizophrenic patients, arguing that up to 70% of his patients improved with this therapy. Insulin shock therapy soon spread all-over the world and became one of the most important treatments for severe mental illness. Regardless of the high-rate complications, insulin shock therapy only declined after the introduction of anti-psychotic drugs.

Description of a clinical case.

Non-systematic review of literature and case report.

A 70-year-old female with type-1 bipolar disorder and type-2 diabetes was referred to a psychiatry emergency department (ED) for 2-week behavioral disorder, featuring restlessness, agitation, insomnia, verbiage and persecutory delusions. In the ED, she presented calm, cooperating, with a subtle humor elation and slight disinhibition. The speech was somewhat confusing, but with normal debit. Delusional thought or hallucinations were not evident. Severe hypoglycemia was first detected by capillary glucose measurement and confirmed by a blood test. After the blood glucose was corrected she became gradually more restless, talkative, disinhibited, with clear humor elation, compatible with a manic state.

We discuss if this case might be explained by the severe hypoglycemia and its correction, linking it to insulin shock therapy, reviewing this procedure's history, controversies and current developments.

The authors have not supplied their declaration of competing interest.

Depressive symptoms, with suicidal thoughts, anxiety, tremor and low food intake in the last month (due to choke phobia) with up to 10 kg of weight loss.

Major recurrent depressive syndrome resistant to treatment with Parkinson syndrome.

Lorazepam 10 mg/day levodopa 150/carbidopa 37.5 mg/day, LART Electroconvulsive therapy (Thymatron SYSTEM IV) was also carried out 3 times a week until 15 sessions were reached.

This case illustrates the successful response with LART ECT towards major recurrent depression syndrome associated with a pharmacological parkinsonism maintained over the long-term (one year with ECT). There are sufficient evidences showing that the ECT has an effect in the dopaminergic system at different levels: dopamine release, dopamine neurotransmission and linkage with its receptor, and these effects differ between an acute stimulation and when repeated stimulation is carried out. It must be taken into consideration the fact that concomitant existence of depression and parkinsonism could represent another indication for ECT, since the pharmacological management of these patients is highly complex and could even more if we bear in mind that one of the therapeutical options towards the antidepressant potentiation (atypical anti-psychotics) can worsen the symptomatology.

The authors have not supplied their declaration of competing interest.