Psychiatric disorders in obese patients range from 20% to 60%, with a lifetime prevalence as high as 70%. Bariatric surgery (BS) is an effective therapy for long-term weight control and ameliorates comorbidities. After BS, psychiatric outcomes are still a matter of controversy. Moreover, while psychosocial pre-surgical evaluation is mandatory, post-operatively psychiatric follow-up programs are lacking. Aim of this prospective study was to examine changes in psychiatric symptoms and weight over 1 year of follow-up among a population of individuals submitted to BS.

One hundred forty eight participants were enrolled, 98 women and 50 men; mean age was 46 (SD = 10.7), and mean BMI was 46 (SD = 7.7). Clinical interview and self-report instruments were administered before and one year after BS. Depressive symptoms were measured using Beck Depression Inventory (BDI), Binge Eating Disorder was measured using Binge Eating Scale (BES).

One year after surgery 86% of patients achieved a percentage excess weight loss (%EWL) ≥40%. Rate of psychiatric comorbidities declined from 41% at pre-surgery to 12% at 1 year post-surgery, P = 0.01. BDI mean score declined from 12 to 8, P > 0.000. After BS, binge eating, depressive symptoms, and age were independent and significant predictors of %EWL (F6,523 = 79.599, P < 0.0001, adjR2 = 0.471).

We reported an improvement of psychiatric symptoms through 1 year after BS. Post surgical binge eating disorder and depression were associated with less weight loss after surgery, adding to the literature suggesting that psychiatric disorder after surgery, unlike pre-surgery, are related to suboptimal weight loss.

The authors have not supplied their declaration of competing interest.

Patients with co-existing substance use and mental disorder (dual diagnosis) have complex and challenging care needs. Acute psychiatric care settings play a vital role in providing services for patients with dual diagnosis as they often do not voluntarily seek treatment. This is significant in that recent data reveals that 57% of the psychiatric inpatients at an inner city hospital in Vancouver, Canada are characterized as dual diagnosis.

To develop an educational module which will equip nurses/practitioners with the skills and knowledge required to deliver evidence-based dual diagnosis care in acute psychiatric settings.

A survey of 74 nurses working in acute psychiatric settings was completed to identify their learning needs and challenges. This was followed by a comprehensive review of evidence from literature to identify competencies, knowledge and skills needed to deliver dual diagnosis care. Content for the educational module was then validated by a panel of leading international experts on dual diagnosis. Two focus groups of acute psychiatric nurses were then conducted to discuss content. An 8 hour educational session was then developed and piloted using the content that was reviewed and validated.

Thirteen content areas were identified and validated by experts. Evaluations from participants of the educational session suggest improved knowledge, skills and competencies in dual diagnosis care.

This project translates evidence into practice, contributes to the body of knowledge on dual diagnosis care and improves practitioners’ confidence and competency in delivering evidence-based care which also will improve patient care outcomes and experiences.

The author has not supplied his declaration of competing interest.

Several psychotropic medications (i.e. antipsychotics, antidepressant) have been recently associated with QTc prolongation. Despite literature data report only mild prolongation of QTc following the use of antidepressants or typical antipsychotics, post-marketing studies have clearly evidenced an increased risk of QTc prolongation and potentially lethal arrhythmias (i.e. torsade de pointes) in psychiatric patients.

We aimed to evaluate the prevalence of prolonged QTc and to identify potential predictors influencing QTc in a psychiatric inpatient population.

Medical records of 200 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.

Prevalence of prolonged QTc at admission was very low (0.1%). No significant differences in QTc interval were observed between patients taking or not antipsychotics (P = 0.66), mood stabilizers (P = 0.36), or antidepressants (P = 0.07). A statistically significant difference was observed between patients on depot formulation and patients who were taking oral antipsychotic (P = 0.02). However, the pharmaceutical class of the medications appeared not significant.

We observed a very low rate of QTc prolongation in psychiatric inpatients at admission. Surprisingly we did not find a significant effect of specific medications; however, in our sample intramuscular formulation was associated with lower QTc interval.

The authors have not supplied their declaration of competing interest.

Internet addiction is a serious problem especially for children and adolescents. It is described by an individual's inability to control the Internet, which causes distress and functional impairment. Internet addiction symptoms can be Internet surfing, computer gaming, chatting and gambling by using Internet. Previous studies regarding Internet addiction can interfere with some psychiatric disorders; such as bipolar disorder, depression, anxiety or attention deficiency disorder (ADHD). Some researchers emphasized that psychiatric disorders and Internet addiction can be seen together and excessive use of the Internet has been associated with attention deficit hyperactivity disorder.

19 years old male patient discussed in this paper who was admitted to our psychiatric service for the first time in his life, complaining about uncontrollable use of internet. He spent time more than 10 hours/day. His family finally opposed and took his computer from him, just before he got depressive symptoms. We diagnosed him ADHD by using psychometric tests and psychiatric evaluations. After medical therapy and psychotherapy, we discussed changes his psychiatric situations and symptoms.

This case emphasized possible relationship between Internet addiction and symptoms of ADHD.

The authors have not supplied their declaration of competing interest.

The relationship between cancer and schizophrenia requires re-examination. We investigated the cancer risk among young and middle-aged patients with schizophrenia.

Records of newly admitted patients with schizophrenia (n = 32.731) from January 2000 through December 2008 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan, and the first psychiatric admission of each patient during the same period was defined as the baseline. Five hundred and fourteen incident cancer cases were identified and standardized incidence ratios (SIRs) were calculated to compare the risk of cancer between those with schizophrenia and the general population. Stratified analyses of cancer incidences were performed by gender, site of cancers, and duration since baseline.

The incidence of cancer for all sites was slightly higher than that of the general population for the period (SIR = 1.15 [95% CI 1.06–1.26], P = 001). Men had a significantly higher incidence of colorectal cancer (SIR = 1.48 [95% CI 1.06–2.06], P = 0.019). Women had a higher incidence of breast cancer (SIR = 1.47 [95% CI 1.22–1.78], P < .001). Intriguingly, the risk for colorectal cancer was more pronounced 5 years after the first psychiatric admission rather than earlier (SIR = 1.94 [1.36–2.75], P < .001), and so was the risk for breast cancer (SIR = 1.85 [1.38–2.48], P < .001). The cancer incidence was higher in schizophrenic patients contradicting the belief that schizophrenia was protective of cancers.

Men and women with schizophrenia were more vulnerable to certain types of cancers, which indicate the need for gender-specific cancer screening programs.

The author has not supplied his declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Craniocervical junction (CCJ) malformations are common pathologies in Northeast of Brazil, predominating Basilar Invagination (BI) and Chiari Malformation (CM), sometimes associated to syringomielia (SM).

Analyse the headache pattern in cases with CCJ malformation operated.

Retrospective study of 65 cases with CCJ malformation, operated between 1994 and 2015, with analysis of headache pattern.

Of 65 cases operated, 29 patients (44.6%) had BI and CM, 26 (40%) had BI, CM and SM, 2, only CM and 1, CM and SM. Of all patients, 39 (49.2%) presented headache and 43 (66.1%), nuchal pain. Among those who presented BI and CM, 12 (41.4%) presented headache and nuchal pain association. Of 26 with BI, CM and SM associated, 11 (42.3%) presented headache and nuchal pain association. We notice yet the presence of brachycephaly in 44 cases (67,7%) and brevis collis in 42 (64.6%). Headache, nuchal pain, brachycephaly and brevis collis were all present in 9 patients (31%) of BI and MC group, and in 8 (30.8%) of IB, CM and SM group.

Several denominations referred to psychogenic headache: muscle contraction headache, stress headache and, finally, tension headache, well defined in the classification of International Headache Society (IHS) with clear diagnosis criteria. Bilateral location, predominantly occipital, is an important differential diagnosis with holocranial headache or occipital secondary to craniocervical malformations, and when associated to brachycephaly and brevis colis, should be carefully investigated. Diagnostic failure in symptomatic or neurological deficit’ patients can sequelae due to chronic compression of structures adjacent to CCJ.

The authors have not supplied their declaration of competing interest.

Disorders of endocrine function are among the most common etiology of psychiatric illness.

The link between psychosis and hyperthyroidism is still poorly understood. We report an unusual presentation of hyperthyroidism as a psychotic state. Careful history, physical examination, and laboratory investigation, including thyroid function tests, should be part of the assessment of patients with any unexplained acute psychosis to detect this potentially curable disease. In this way, this article analyzes the psychiatric, physical and laboratory findings associated with hyperthyroidism and treatment.

To report a case of psychosis in a patient with endocrine disease.

Clinical records. Research on PubMed and Medscape using the Mesh Terms “hyperthyroidism”, “psychosis” and “thyroid and psychiatric manifestations”.

We present the case of a male patient, previously followed on our ambulatory psychiatric service for drug-induced psychosis. He was hospitalized due to psychotic symptoms, without substance abuse. Inpatient evaluation diagnosed hyperthyroidism. The patient did not present any somatic changes, except for psychosis. The patient was effectively treated with antipsychotics. He was referred to further evaluation and started antithyroid therapy.

Thyroid disease should be considered in the differential diagnosis of a broad spectrum of psychiatric symptoms. Psychosis is a rare complication of hyperthyroidism, ranging between 1–20%. The typical psychosis is reported to simulate manic-depressive psychosis. This association reinforces the need of a careful clinical evaluation in patients presenting with psychosis. Such psychiatric symptoms remit successfully with concomitant administration of antipsychotics and normalization of thyroid levels.

The authors have not supplied their declaration of competing interest.

Alcohol use disorders and bipolar disorder commonly co-occur and both are associated with more pejorative outcomes, thus constituting a major public health problem. We undertook this synthetic review to provide an update on this issue in order to clarify the nature of the relationship between the two disorders, improve clinical outcomes, prevent complications and therefore optimize management of patients.

We conducted an electronic search by keywords in databases MEDLINE, EMBASE, PsychINFO, published in English and French from January1985 to December 2015.

The AUD prevalence is important among BD patients in whom the effects of alcohol are more severe. However, in terms of screening, it appears that the comorbidity is not systematically sought. The concept of co-occurrence finds its clinical interest in the development of specific screening and therapeutic strategies. To date, there are only few recommendations about the management of dual diagnosis and the majority of them support “integrated” approaches.

Recommendations should emphasize this strong co-occurrence and promote systematic screening and offered integrated cares.

The authors have not supplied their declaration of competing interest.

Epilepsy is a chronic disease defined as a brain disorder, characterized by a predisposition to present seizures, generating cognitive, psychological, and social consequences.

To determine the prevalence of psychiatric comorbid disorders in patients with epilepsy (PWEs) and its associated factors.

We conducted a cross-sectional study involving 30 PWEs who were treated in the neurology department of Habib Bourguiba Hospital in Sfax, Tunisia. We used the Mini International Neuropsychiatric Interview for the diagnosis of Axis I psychiatric disorders.

The half of patients had psychiatric comorbidities: 4 had major depressive disorder (MDD), 2 had MDD with generalized anxiety disorder, 4 had MDD with social phobia, 1 had bipolar disorder type I, 1 had panic disorder, 1 had agoraphobia and 2 had generalized anxiety disorder.

Twenty-five PWEs had seizure-onset below 30 years old and among them, 40% had psychiatric comorbidities. Among patients who had seizure-onset above 30 years old, none had psychiatric comorbidities. Psychiatric comorbidities were found in 71.5% of patients with seizure frequency >2 per year. Psychiatric comorbidities were more common in patients with generalized seizures compared to whom with partial seizures (53% versus 45%). It was also more common in patients treated with polytherapy compared to whom with monotherapy (64% versus 37.5%).

The prevalence of psychiatric comorbidities is relatively high among PWEs. The most frequent diagnoses found were mood and anxiety disorders. It is very important to identify them and treat them to enhance seizure control.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The relationship between brain tumours, temporal epilepsy and psychiatric symptoms are historically known.

To report a case of mania in a patient with previous diagnosis of bipolar disorder, temporal tumour and temporal epilepsy.

Clinical records. Research on PubMed, using “lateral temporal epilepsy” or “brain tumour” and “mania”.

A 52 years old man was conducted to the emergency department by the police. He was found with psychomotor agitation at the Sanctuary of Fátima. He was apparently hyperthimic with flight of ideas. He had a history of epilepsy and temporal tumour and two previous manic episodes. It was assumed as a maniac episode.

During inpatient evaluation, patient had memory for the occurrence. He described a sudden onset on the day before, after drinking wine. He described delirant atmosphere, persecutory and mystic delusional beliefs “this is the third secret of Fátima being revealed”, followed by ecstasy and psychomotor agitation. Remission was obtained in one week on psychotropics. MRI documented the lesion. Electroencephalography performed one month later revealed “slow waves.”

Organic causes should be excluded before consider a psychiatric disorder. The hypothesis of epilepsy-related psychosis or mania and other effects of a temporal tumour should be considered in etiology. However, co morbidity with bipolar disorder cannot be excluded.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Obesity and overweight are major public health issues. Obesity is a risk factor associated with many non-communicable diseases such as diabetes, certain types of cancers, musculoskeletal disorders and cardiovascular, dermatological or gastroenterological diseases. Patients with severe psychiatric disorders have a higher risk of developing overweight or obesity than the general population. The risk of obesity in schizophrenics patients can be multiplied by a factor ranging from 2.8 to 3.5. Patients suffering from mood disorder have sightly lower risk of obesity, however we still consider a factor ranging from 1.2 to 1.5. This significant weight gain can be partly explained by medication.

The hospital centre Le Vinatier, in France, has developed a therapeutic patient education program in helping patients to self-manage their preventable disease. In order to tackle the multifaceted nature of obesity, the program used the expertise of many different professionals: general practitioners, dieticians, dentists, physical adapted education teachers, pharmacists, nurses and so on. This programme is provided for patients suffering from obesity or an overweight complicated by diabetes, or/and metabolic syndrome, and/or history of cardiovascular diseases or/and a failure of a dietary monitoring. The program includes individual care and collective workshops in nutrition, oral heath, body image, adapted physical education, and roundtable.

A retrospective study has already shown that this therapeutic patient education program, like others before, presented better results than dietary consultations. A prospective study is currently being carried out to validate these results in the long term and to demonstrate the benefit associated to this program.

The authors have not supplied their declaration of competing interest.

Tuberculosis is one of India's major public health problems. According to WHO estimates, India has the world's largest tuberculosis epidemic. Many research studies have shown the effects and concerns revolving around TDR-TB especially in India, where social and economic positions are still in progression.

Seventeen questionnaires were administered to the consented participants regarding the demographic data and awareness, also Hospital Anxiety and Depression Scale (HADS) was recorded to analyse the level of depression. The average age was 32.3 years (STD = 12.7), and the age range was from 13 years to 71 years. The data collected was analysed with SPSS 19.

The patients who were in the intensive phase had a considerably higher depression rate (42%) than the patients who were in the continuous phase (22%). However, the variations were not enough for the statistical significance. The patients with TB only (35%) showed a higher depression rate than the patients with TB/HIV (28%).

According to this study, it can be found that the prevalence of depression was lower for patients who were old, female, college educated, married, and earned the highest, compared with their counterparts. Most of these findings might agree with a general perception that social and financial stabilities would provide a less likelihood of being depressed.

The author has not supplied his declaration of competing interest.

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.

Pathological gambling, as behavioural addiction, is always related with psychosocial important problems. In this case, everything is even more difficult due to grave mental disease associated, Paranoid Schizophrenia. Man, 26 years old, single. He was diagnosed of psychotic disease at the beginning due to his grave addiction to THC and others stimulant drugs. His outpatient treatment was complicated and he needed to be hospitalised once (being diagnosed of Schizophrenia). After that, he improved till he got a standardised job. He was able to have his medical treatment (Aripriprazol 15 mgs per day and Biperidene 4 mgs per day) although he kept his isolation. Then, the patient could talk about his pathological gambling. He suffered from slot machine addiction, and he also suffered from depression symptoms closely related to family and economic problems due to pathological gambling. This patient was in contemplation state and he accepted to start with antidepressant (Mirtazapine 15 mgs per day) and psychological treatment. We agreed to make a record of his gambling uses (with regular self-reports). His salary would be administered by his parents and he only could take a little money every week. The treatment was useful; it increased the capacity of economic self-management and the recovery of depression disease related.

In our opinion, he used gambling as filling a need for activity, and as a way of connecting with society/world. These findings suggest the need for improved prevention and treatment efforts related to problem/pathological gambling in individuals with psychotic disorders.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The factitious disorder is characterized by simulation or exaggeration by the subject of his/her physical or psychological symptoms to take a sick role. This disorder may be associated with a real disease, used to simulate other symptoms and receive treatment. Our case is represented by a 49-year-old man, affected by Arnold Chiari Malformation Type I (ACM-I), a structural defect in the cerebellum with extension of the cerebellar tonsils into the foramen magnum, without involving the brain stem. The patient had three surgical operations involving the complete resolution of the disease. However, the subject reported a worsening of all symptoms, with the outcome of a severe self-limitation, with admission to a residential care and taken over by the multidisciplinary equipe of the district. Symptoms, which mainly consisted in pain, motor functional impairment, headaches, slurred speech were not evaluated due to the ACM-I. This diagnosis was confirmed when there was the complete resolution of the symptoms in a date pointed by the patient.

To make an appropriate differential diagnosis, in addition to the neurological examination, the subject had psychiatric interviews and completed an MMPI evaluation.

Neurological examinations revealed no residual outcome of the ACM-I. At MMPI there were not significant peaks. Regarding to the attitude towards this test and its validity, it appears an obvious attempt to lie from the patient, which tries to present himself in a favourable unrealistically way.

This case shows that appropriate diagnosis can help health services in a better management of their resources in such situations.

The authors have not supplied their declaration of competing interest.