The authors have not supplied their declaration of competing interest.

Lithium is a well-known substance used in treatment of mood disorders. It has a narrow therapeutic index with recognised adverse effects on renal and thyroid function. Clinical guidelines published by the national institute for health and clinical excellence in the United Kingdom (NICE) recommend renal and thyroid function checks before lithium is prescribed, as well as ongoing monitoring of renal function, thyroid function and serum lithium levels. Lithium-induced drug toxicity is frequently seen in clinical practice. While the ongoing monitoring serves to monitor reversible side effects of Lithium provided its discontinued, rarely patients develop a persistent neurological side effect known as a syndrome of irreversible lithium-effectuated neurotoxicity (SILENT).

This is a case report on a patient where the patient developed SILENT syndrome after being treated with Lithium, long term for bipolar disorder.

This case supports the biological mechanism of SILENT syndrome. It also caused a huge implication in the patient's care.

As clinicians, we are well aware of following treatment guidelines for Lithium. This case report was written to raise awareness regarding a “SILENT” albeit significantly debilitating syndrome of Lithium use.

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

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

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

A 38-year-old gentleman was admitted to an inpatient psychiatric unit with a first episode of fluctuating affective psychosis. He initially presented as manic although subsequently evolved a severe depressive episode, with prominent bizarre, affect-incongruent delusions throughout this period. Upon admission, anisocoria was evident, although this was attributed to a past head injury. Over the course of his admission he developed emergent Parkinsonism, initially ascribed to prescription of aripiprazole. Given his anisocoria and worsening Parkinsonism, further investigation was undertaken. While his MRI brain scan was unremarkable, his serum and CSF specimens tested positive for Treponema pallidum serology, and he was diagnosed with neurosyphilis. He was treated with a single dose of intramuscular penicillin, but experienced marked deterioration of neurological symptoms (paraparesis and truncal ataxia) and was transferred to the general hospital for an extended 14 day course of intravenous penicillin. Following this extended course of antibiotic therapy, resolution of neurological symptoms was seen, but no sustained improvement in residual psychotic symptoms has been seen.

This case demonstrates the potential neuropsychiatric consequences of neurosyphilis, and serves as a reminder of its potential to imitate other psychiatric presentations. This gentleman, and many like him, continue to experience severe and enduring psychopathology despite penicillin treatment when cases are detected late. Given the potential consequences of this, we would advocate assertive screening for syphilis in patients admitted to psychiatric units.

The authors have not supplied their declaration of competing interest.

The interface of the Liaison Psychiatry with Infectiology is fundamental for the continuous and specialized support of these patients. Prevalent psychiatric records are known in the HIV infection, such as anxiety, depression and abuse and/or addiction to substances. There are also different neuropsychiatric situations associated with this infection owing, namely, to the HIV direct action on the central nervous system, to the adverse effect of the antiretroviral therapy and to the resurgence of existing prior pathology.

The author intends to characterize the population evaluated in the Liaison psychiatry in the Coimbra university hospital with respect to inpatients of the Infectiology Service in a central hospital in order to optimize resources and better adjust interventions made.

The quantitative retrospective study was carried out between May 2015 and May 2016, with a duration of one year, in the infectiology service of the Coimbra university hospital.

Observation and evaluation of the inpatient of the infectiology service having in view the sample characterization in relation to demographic data, nature of the request, antiretroviral therapy, psychiatric diagnosis, type of intervention and follow-up. The quantitative data were subject to statistical analysis.

The prevalence of the psychiatric disorders associated with HIV infection is high and with great emotional impact and implications in the personal, sexual, occupational and social life of the individual. The diagnosis and treatment of the psychiatric comorbidity is determinant in the patients’ evolution, both in reducing suffering associated with experience of HIV infection and in its implications.

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

Chronic diseases, such as heart disease, stroke, chronic respiratory diseases and diabetes, are by far the leading causes of mortality in the world, representing 60% of all deaths. However, chronic disease rarely exists in isolation. Nevertheless, study of chronic disease rarely takes into account comorbidity and virtually none examine their occurrence in populations.

and aims To review the association between psychiatric disorders and other medical comorbidities.

To study the association between psychiatric diseases and medical comorbidities on a population-scale.

To reconsider our approach to medical comorbidities.

Using an informatics approach, a dataset containing physician billing data for 764 731 (46% male) individuals spanning sixteen fiscal years (1994–2009) in Calgary, Alberta, Canada was compiled permitting examination of the relationship between Physical Disorders and Mental Disorders, based on the International Classification of Diseases (ICD).

All major classes of ICD physical disorders had odd ratios with confidence intervals above the value of 1.0. Ranging from 1.47 (Injury poisoning) to Circulatory systems (3.82). More precisely, when a psychiatric disorder is present, the likelihood to develop one of the four preventable diseases is significantly increased: Stroke (4.27), Hypertension (3.34), Diabetes (2.66) and COPD (2.43).

We postulate that psychiatric disorder should be included in the classification of preventable chronic diseases that have a profound impact on society. Developing a consistent and standardized approach to describe these features of disease has the potential to dramatically shift the format of both clinical practice and medical education.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The work of Bion, developing the psychoanalytic theories of Freud and Klein on the origins of anxiety in childhood, includes the hypothesis of a protomental system as a matrix in the human organism in which physical and mental are at first undifferentiated. He defends that the continuing experience by the infant of parental containment of its anxieties, through a process of projection and introjection, develops its capacity for thinking about frustration rather than evading it. This conception was extended to psychosomatic illness, by the hypothesis that, without this experience, frustration may lead to basic assumption mentality and psychosomatic illness rather than emotions and thought.

This work aims to describe an experimental technique of group psychotherapy, inspired in Bion's principles combined with relaxation techniques, in the context of psychosomatic diseases.

The authors pretend to identify improvement in clinical symptomatology, quality of life, identification and expression of emotions, in the group submitted to this method, compared to controls.

It was performed a weekly group psychotherapeutic session and a weekly relaxation session (using Jacobson's method), along two months. The patients were randomly selected and submitted to psychological evaluation with scales and questionnaires, in the beginning and at the end of the study.

At the time of submission of this work, the results of the intervention were in analysis.

This paper describes an experimental method of psychotherapeutic intervention in the field of psychosomatic disease, using a transdisciplinary perspective.

The authors have not supplied their declaration of competing interest.

The early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how nine bedside cognitive tests perform across the spectrum of delirium and motor subtypes.

The performance on a battery of nine bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neurocognitive disorder and in different motor subtypes of patients with delirium.

One hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test. The ability to engage with testing was higher for those in the no subtype group.

Simple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.

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

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, impulsivity, intense and unstable or disturbed interpersonal relationships and self-image, and often self-destructive behaviour. BPD seems to be more common in patients suffering from migraine. However, typical migraine characteristics in this population remain partly unknown.

To present the specific clinical characteristics of migraine patients with BPD and to assess their response to migraine treatment.

We examined 10 patients with migraine and previously diagnosed with BPD (group 1), 10 patients with migraine and no history of BPD (group 2), and 10 patients with migraine and no history of BPD matched to group 1 for age, gender, and frequency of headache. Migraine was treated in group 1 and 3 and pharmacological treatment outcome was assessed after 6 months.

The group of migraine patients with coexisting PBD was associated with female gender, increased prevalence of medication overuse headache, higher rates of self-reported depression, increased migraine-related disability, and a decreased response to pharmacological migraine treatment.

Patients with migraine and previously diagnosed BPD can be regarded as a distinct population. They are more suffering from depressive symptoms, more disabled by their migraine, are more resistant to pharmacological treatment.

The authors have not supplied their declaration of competing interest.

Loin pain hematuria syndrome (LPHS) is a rare kidney disease with a prevalence of −0.012%. Its clinical features include periods of severe uni-or bilateral lion pain, accompanied by (microscopic) hematuria. It is often misdiagnosed as a psychiatric condition, particularly under the heading of a somatization disorder.

We describe the case of a patient who developed depressive symptoms after decades of suffering from severe intermittent bilateral loin pain.

To report a case-study, describing LPHS as a cause of severe chronic pain and persistent depressive symptoms.

A case-study is presented and discussed, followed by a literature review.

A 55-year-female was referred to a psychiatrist for her depressive symptoms and persistent periods of severe unilateral or bilateral lion pain and intermittent hematuria for over 25 years. There she was diagnosed with a depression and somatization disorder. She received amitriptyline for many years, without any effect. Finally, the patient opted for a second opinion in an academic hospital in Belgium where it was quickly discovered. After surgery, including renal denervation and kidney autotransplantation, her somatic problems and depressive mood disappeared.

The awareness of LPHS is still very limited in medicine. This may lead to incorrect diagnoses, including psychiatric disorders such as somatization disorder. More awareness could lead to earlier diagnosis and prevent the consequences of severe debilitating pain.

The authors have not supplied their declaration of competing interest.

Bariatric surgery is globally increasingly being applied in patients with morbid obesity to achieve permanent weight reduction. More than fifty percent of these patients have a psychiatric disorder in their history and over thirty percent take psychotropic medication. The prevalence of bipolar disorder in patients who undergo bariatric surgery is around four percent, and most of them are treated with lithium.

To report and discuss the effect of bariatric surgery on changes in lithium absorption.

We present all published case studies and literature review on lithium toxicity after bariatric surgery.

To date; only two case-reports were published with dramatic changes in lithium level after vertical sleeve gastrectomy and Roux-en-Y bariatric surgery. Within a period of two to five weeks, the patients were presented to the emergency department with signs of dehydration and acute kidney failure.

Clinicians should be aware of dramatic and possibly even life-threatening pharmacokinetic changes in drug absorption that may occur after bariatric surgery. Careful monitoring and even reduction of lithium dosage before and after surgery could potentially prevent serious complications.

The authors have not supplied their declaration of competing interest.

Depression is the most common syndrome associated with Multiple Sclerosis (MS) with a high prevalence during a lifetime.

To assess the prevalence of depression in patients treated in neurology for MS.

We performed a retrospective study on 17 patients diagnosed with MS and confirmed with the criteria of Mac Donalds 2010 with a follow-up in the neurology department of the EPS Mahdia for a period of nine years (2006–2014), then addressed to a psychiatric consultation for depression.

In total 17 patients were hospitalised in the neurology department during the study. Ages ranged from 20 to 39 years with an average of 33 years. The average course of the disorder is 5 years. We objectified a female predominance with 82%, a professional activity was found in 76% of patients. The comorbidities found are mainly hypertension, diabetes and asthma, respectively in 11%, 5% and 5%. Depression was clinically confirmed in 9 patients, that to say, 52% of our sample addressed in the psychiatric consultation, whose 6 received an antidepressant (fluoxetine) and 3 received paroxetine. An anxiolytic was given to the half of these patients.

The association between MS and depression would, therefore, be neither fortuitous nor only related to non-specific factors of any chronic disease. Specifying the relative share of these explanatory factors is probably one of the challenges for future researches in this area.

The authors have not supplied their declaration of competing interest.

In 2015, the worldwide point prevalence for diabetes mellitus was 8.8%. Type D personality was found as being more prevalent in type 2 diabetes than in the general population.

We aimed to reveal the frequency of type D personality and to analyze the impact of type D personality on both quality of life and angiopathic complications, in patients with type 2 diabetes from our region.

A cross-sectional research was performed on 79 outpatients that were monitored for diabetes mellitus at Timisoara diabetes, nutrition and metabolic diseases clinic. Type D personality was assessed with the DS-14 scale. Quality of life was quantified by using the Q-LES-Q-SF scale (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form). The angiopathic complications were abstracted from medical records.

Type D personality was present in 38 subjects with diabetes mellitus (48.10%). Compared to those without type D personality, patients with type D personality and diabetes had significant lower mean scores for the following domains of the Q-LES-Q-SF scale: social relationships (P < 0.001), daily life function (P = 0.027), sexual activity (P = 0.005), to get around physically (P < 0.001), work or hobbies (P = 0.008) and raw score (P = 0.003). Type D personality did not make any difference regarding micro and macroangiopathic complications of type 2 diabetes patients.

Type D personality, a highly frequent entity, did not make the difference with respect to diabetic complications; however, it may interfere significantly with several facets of the quality of life of these patients. These results should be taken into account for an interdisciplinary approach to these patients.

The authors have not supplied their declaration of competing interest.

Obstructive sleep apnea syndrome (OSAS) is a highly widespread sleep-related breathing disorder that leads to serious impairment in quality of life (QOL).

We aimed to assess QOL in patients with OSAS and to investigate its relationship with illness representations.

We performed an analytical cross-sectional study of 87 recently diagnosed OSAS patients. Apnea hypopnea index (AHI) was determined by an overnight polysomnography. Excessive daytime sleepiness (EDS) was assessed by the Epworth Sleepiness Scale (ESS). QOL was assessed by the 36-item short form health survey (SF-36). Illness representations were measured by the Brief Illness Perceptions Questionnaire (B-IPQ); High scores reveal a more threatening perception of the illness.

Mean age of the participants was 55.7 years (SD = 11.6). According to the AHI, 70,1% of the patients had severe OSAS, and 16.1% had moderate OSAS. The mean score of the SF-36 was 40.2 (SD = 18.7). Overall QOL was impaired in 87.7% of the patients. There was a considerable decrease in both mental and physical QOL. EDS was associated with impairment in mental QOL. Illness representations were negatively correlated with overall QOL (r = - 0.45; P < 0.01). No relationship was found between QOL and illness severity.

The present study provides evidence that OSAS has serious influence on QOL of patients, which could be mediated by negative illness perception. So it is extremely important to know how OSAS sufferers perceive their illness to better understand their coping behavior and to improve their adherence to treatment and their QOL.

The authors have not supplied their declaration of competing interest.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder, which leads to higher morbidity, and mortality and can result in various psychological problems, such as depression.

The purpose of this study was to assess the severity of depression and to examine its relationships with coping strategies in OSAS patients.

We performed an analytical cross-sectional study of 87 recently diagnosed OSAS patients. Apnea hypopnea index (AHI) was determined by an overnight polysomnography. Depressive symptoms were evaluated by the hospital anxiety and depression scale (HADS). Coping strategies were assessed by the brief cope.

Subjects included 38 men and 49 women averaging 55.7 years of age (SD = 11.6) with a mean body mass index (BMI) of 33.8 kg m−2. According to the AHI, 70.1% of the patients had severe OSAS, and 16.1% had moderate OSAS. Depressive symptoms were found in 44.8% of all patients. Emotional coping was used by 72.4%, while problem-focused coping was used by 28.7% of the patients. The score of depression on HADS (HADS-D) showed positive correlation with BMI (r = 0,48; P ≤ 0.001). No significant association was found between HADS-D and AHI. Depressive symptoms were associated with more emotional coping (P = 0.03) and with less problem-focused coping (P = 0.002).

Our findings suggest that depression is highly prevalent among patients with OSAS, and that coping style seems to have a significant influence on emotional status in these patients. Further research should explore the possibilities of intervening on this factor, aiming to lessen depressive symptoms in OSAS patients.

The authors have not supplied their declaration of competing interest.

Untreated patients for H.I.V can present various types of neuropsychiatric syndromes (NPS): subclinical cognitive symptoms, behavioral changes, agitation, personality changes, dementia complex associated with H.I.V and delirium, depressive disorder, bipolar affective disorder or manic episode. However, it is controversial whether antiretroviral induce NPS, or on the contrary, when there are patients will evolve into an AIDS stage for therapeutic resistance or noncompliance.

Describe qualitatively and quantify the epidemiological point of the main subclinical and NPS symptoms in patients untreated and treated with antiretroviral drugs and their frequencies. Propose pharmacological treatments for each of the specified conditions.

Search in PubMed with the words “Neuropsychiatric and antiretroviral therapy” by applying the limits: full and free texts, past 10 years, Human, English language and adults; research liaison psychiatry textbooks.

Results yielded 381 articles with the criteria selecting 102, the most relevant for the purposes of work. They chose four most relevant chapters in the literature.

The most effective treatment of NPS in unmedicated patients is to start antiretroviral therapy; only if it does not improve them should be introduced psychiatric drugs as if they were functional. 50% of treated with efavirenz patients will develop NPS in the early days with gradual decrease. The dropout rate associated with these adverse events varies from 2.6–16%. Treatment of these NPS a challenge by the existence of numerous drug interactions, it is essential to know to deal with these entities to improve the quality of life of people with this chronic disease.

The authors have not supplied their declaration of competing interest.

Systemic lupus erythematosus is a chronic disease that can give neuropsychiatric episodes and systemic manifestations. About 57% of patients with SLE have neuropsychiatric manifestations in the course of their illness, however an initial presentation with neuropsychiatric clinic is rare.

Describe how patients receiving corticosteroids as part of their treatment can develop mental disorders but not only them.

It will raise grounds with a case: 20-year-old woman recently diagnosed with SLE because of arthritis in his ankle. Treatment was initiated with prednisone 10 mg and chloroquine 200 MG. After 20 days the patient comes to the emergency after episode of turmoil at home with major affective clinical maniform. Presenting fever. The presence of fever downloads the possibility of a psychosis chloroquine or corticosteroids to be a small dose. Treatment was initiated with high doses of prednisone and immunosuppressants. In addition to associating specific anticonvulsant and antipsychotic drugs at usual doses for a manic episode.

Treatment of psychosis in SLE is essentially empirical, and depends on the etiology. It usually responds to the use of high doses of corticosteroids combined with immunosuppressive drugs. Psychosis induced by corticosteroids requires lowering them. It is valid concomitant use of antipsychotics.

The presence of psychotic symptoms in a patient with systemic lupus erythematosus forces to distinguish between various etiological possibilities.

Corticosteroids may cause a variety of psychiatric symptoms. And yet, in patients with SLE these syndromes are not always attributable to the use of corticosteroids.

The authors have not supplied their declaration of competing interest.

Parkinson's disease is caused by decreased dopaminergic neurons of the substantia nigra. Psychosis occurs between 20 and 40% of patients with Parkinson's disease. Dopaminergic drugs act as aggravating or precipitating factor. Before the introduction of levodopa patients had described visual hallucinations but the frequency was below 5%.

Illustrated importance of treatment, reassessment after its introduction and refractoriness to answer; as well as the importance of a differential diagnosis at the onset of psychotic symptoms later in life.

Clinical case: female patient 75 years tracking Neurology by parkinsonism in relation to possible early Parkinson disease. She was prescribed rasagiline treatment. Begins to present visual and auditory hallucinations, delusional self-referential and injury. She had no previous psychiatric history. She went on several occasions to the emergency room, where the anti-Parkinson treatment is decreased to the withdrawal point and scheduled antipsychotics did not answer. Doses of antipsychotics are increased despite which symptoms persist and even increase psychotic symptoms. In this situation it is agreed to extend the study. Subsequently an NMR of the skull where the image is suggestive of a right occipital meningioma appears.

With the emergence of psychotic symptoms later in life it will be important to ask a broad differential diagnosis, since in a large number of cases will be secondary to somatic or to drug therapies.

Parkinsonism can be a symptom of occipital meningioma, presenting in the psychotic clinic. Refractoriness, on one hand to the suspension of treatment for Parkinson's disease, such as poor response to antipsychotics, did extend the study, which ultimately gave us the diagnosis.

The authors have not supplied their declaration of competing interest.