In psychotherapeutic clinic, patients without visible marks of acne report this experience with great emotional charge, even when it occurred many years before.

This observation arose the interest in investigating the psychological impact of acne, which led us to find out what acneic subjects think of their disease, how they deal with it and, simultaneously, evaluate the beliefs of dermatologists on it. The present work is part of an investigation whose aim is to develop a program for the promotion of skills to deal with acne and its effects.

The inventory of beliefs, behaviours and treatment of acne – ICA – was developed through the content analysis of non-structured interviews to health care professionals and to patients with acne and/or who had it. This inventory was applied to a convenience sample (n = 367), to a university sample (n = 1666) and to a sample of 95 dermatologists – the 16 questions related to the beliefs on acne.

We found general agreement with some statements. Most respondents agree with a group of statements, though opinions are divided. Most respondents “disagree” or “disagree more than agree” with “…ingestion of chocolates or dairy products would cause acne”. Finally, there is no consensus about “…caused by the combination of psychological and hormonal factors”.

Further studies are needed, on the impact of acne in patient's quality of life. We also found great interest of promoting a close collaboration between dermatologists and psychology.

The authors have not supplied their declaration of competing interest.

The ability to solve problems and make decisions creatively has become paramount to new nursing graduates, as these skills assist them with recognizing and evaluating situations that require prompt attention. The purpose of this study was to determine and compare nursing student's perceived levels of own problem solving skills in various years of their 4-year program.

This is a cross-sectional study. Three hundred and twenty-two undergraduate nursing students in BSc nursing program participated in this study. The study setting was nursing School of Iran university of medical sciences. The Problem solving inventory (PSI) was used to data gathering. The scale was divided into three subscales including: problem-solving confidence (PSC), approaching avoidance style (AAS), and personal control (SC). Students involved in the study signed the study Informed consent.

Findings showed that the mean score of total problem solving skill was 89.52 ± 21.58. The mean score of the 4th year students in PSI was less than other year students (84.18 ± 27.47 vs 89.13 ± 18.71, 91.57 ± 21.87, and 91.52 ± 20.8). This study finding revealed that 4th year students in 3 factors of problem solving (PSC, AAS, PC) considered themselves more successful than others. Meanwhile, when the results are compared according, no significant differences occurred among the student in different years (F: 1.46, P ≤ 0.22).

Educating should help students to reach the desired levels of problem solving skills by allowing them to acquire and practice these abilities in the field. Nursing students with advanced problem solving skills will be essential for this changing society.

The authors have not supplied their declaration of competing interest.

Mental health stigma is a multidimensional concept that encompasses many different themes and definitions. Public stigma is defined as the degree to which the general public holds negative views and discriminates against a specific group.

To understand the context and correlates of stigma in multi-ethnic Singapore.

The current study aimed to (i) explore the factor structure of the Depression Stigma Scale and the Social Distance Scale using an exploratory structural equation modelling approach and (ii) examine the correlates of the identified dimensions of stigma in the general population of Singapore.

Data for the current study came from a larger nation-wide cross-sectional study of mental health literacy conducted in Singapore. All respondents were administered the Personal and Perceived scales of the Depression Stigma Scale and the Social Distance scale to measure personal stigma and social distance respectively.

The findings from the factor analysis revealed that personal stigma formed two distinct dimensions comprising “Weak-not-Sick” and “Dangerous/Unpredictable” components while social distance stigma items loaded strongly into a single factor. Those of Malay and Indian ethnicity, lower education, lower income status and those who were administered the depression and alcohol abuse vignette were significantly associated with higher weak-not-sick scores. Those of Indian ethnicity, 6 years of education and below, lower income status and those who were administered the alcohol abuse vignette were significantly associated with higher dangerous/unpredictable scores.

There is a need for well-planned and culturally relevant anti-stigma campaigns in this population.

The authors have not supplied their declaration of competing interest.

The duration of hospitalization is related to many well-documented factors in literature. However, little is known about psychiatric patients and psychiatric service delivery in non-Western developing countries. It is supposed that major contributing factors in discharge are remission rates and functional levels. Therefore, this naturalistic preliminary study aimed at analyzing and describing the hospitalization duration and remission rates of a psychiatric population treated in the mental health inpatient facility.

A total of 88 male patients, who were hospitalized in a psychiatry clinic were included in the study. They were evaluated at admission and before discharge using the Brief Psychiatric Rating Scale (BPRS) and the Clinic Global Impression Scale (CGI). Other variables, including length of stay, number of previous admissions, demographic characteristics, and diagnosis were also assessed.

Mean of the total scores on BPRS were declined from 24.95 to 13, and the mean CGI scores were declined from 3.85 to 2.04 during hospitalization period. Mean length of hospitalization was 7.91 days.

Our study shows that patients are discharged from the hospital with approximately 50% decrease in symptom severity. Such research can contribute to understand better, the needs of psychiatric patients, and help to develop continuously improved service delivery and optimize therapeutic options.

The authors have not supplied their declaration of competing interest.

Given the emphasis on inclusion of well-being interventions in the treatment and rehabilitation of individuals with mental disorders, it is important to understand the level and determinants of positive mental health (PMH) among them.

To conduct a cross-sectional study among patients with schizophrenia, depression and anxiety spectrum disorders to estimate PMH.

(i) To estimate the level of PMH among patients with mental disorders and compare these with the established general population estimates; (ii) to identify socio-demographic and clinical determinants of PMH.

Following ethics approval, 353 patients aged 21-65 years, receiving treatment at a psychiatric hospital in Singapore for schizophrenia, depression or anxiety spectrum disorders were included. Patients provided socio-demographic information and completed the multidimensional PMH instrument that provides total and domain-specific scores ranging from 1 to 6; higher scores indicate better PMH. Functioning was assessed with the Global Assessment of Functioning (GAF) scale and clinical data were obtained from administrative databases.

Sample comprised 142, 139 and 72 patients with schizophrenia, depression and anxiety spectrum disorders respectively, with a mean age of 39.2 years. Mean total PMH scores among them were 4.2, 3.7 and 3.8 respectively which were significantly lower than the general population mean of 4.5 (P < 0.001). Patients of Chinese ethnicity, with lower education, depression or anxiety, and lower GAF scores were more likely to have lower PMH.

This study identified patient subgroups that are likely to have poorer PMH. Interventions facilitating PMH among these patient groups would be beneficial and are needed.

The authors have not supplied their declaration of competing interest.

To consider a phenomenon of destigmatization of mentally ill persons on the example of the analysis of screening-questioning in mental health service.

Randomized screening-questioning of participants of Open Doors Day in the clinics of Mental Health Research Institute (Tomsk, Russia) in connection with World Mental Health Day in October, 2015.

One hundred and forty-six residents of Tomsk and inhabitants of the Tomsk Region as well as other cities visited Mental Health Research Institute. 76,5% of them visited mental health service for the first time. More than a half of visitors (51%) was the most able-bodied age group – 20-50 years old; elderly people – 20%. According to many-year observation of authors of the work, there is a gradual destigmatization of people with mental health problems. Process of destigmatization will develop further, and mass media should also be engaged in it. One more moment should be emphasized – reduction of self-stigmatization. Though people do not still aim to seek for psychiatric help at the appropriate institutions (they prefer to visit the psychiatrist of the catchment area policlinic), they after all started recognizing presence of the problem, understanding the need of its overcoming, and possibility of its correction.

The attitude of society towards people with mental health problems and towards psychiatry reasonably changes, and this promotes further development in the field of help to patients and their relatives.

The authors have not supplied their declaration of competing interest.

We have developed a group of school-based universal prevention programs for children's health and adjustment. The programs are characterized by new theories such as the somatic-marker hypothesis and enjoyable methods that utilize animated stories and games. This study adopted one of the programs for the development of self-confidence.

The aim was to examine the effectiveness of the program. In addition to the direct purposes of the program, children's adjustments at school and homeroom class were evaluated as extended effects.

Participants were third grade children in six public elementary schools in Japan. The final sample included 442 children (219 boys and 223 girls). The program was implemented weekly in one regular 45-minute class over 8 weeks. Participants completed a battery of three questionnaires three times, 1 month before the start of the program (T1), 1 week before the start of the program (T2), and during 1 week after the last class of the program (T3).

Results showed that all of the main endpoints of the program significantly improved in the intervention condition (i.e., changes from T2 to T3), compared to the control condition (i.e., changes from T1 to T2). Moreover, children's adjustment at school and homeroom class increased in the intervention condition, compared to the control condition. However, implicit affect was unchanged.

This study suggests that the program is effective for enhancing self-confidence, along with adjustments at school and in class. Future research that examines the sustainability of the effectiveness of the program is planned.

The authors have not supplied their declaration of competing interest.

Anti N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an autoimmune disorder with a presentation that includes acute behavioral changes, psychosis, cognitive impairment and autonomic instability. In some cases, there are isolated psychiatric symptoms without neurological involvement.

To raise awareness of the disorder among psychiatrists, considering it a differential diagnosis in a first psychotic episode since a prompt diagnosis and treatment can dramatically affect the outcome.

To summarize the latest literature about this field and to present a case report.

A brief review of the latest literature was performed on PubMed using the keywords “anti N-methyl-D-aspartate receptor encephalitis”, “anti-NMDA encephalitis”, “psychiatric symptoms”.

A 20-year-old male was admitted to our inpatient unit with bizarre delusions of grandious and religious content, somatic hallucinations, sleep cycle inversion and strange behaviour. These symptoms had been present for 1 week and remitted after 10 days of treatment with risperidone. On follow-up, he developed anhedonia, apathy and blunt affect. Brain MRI showed multiple hyperintense changes in T2 and T2-FLAIR, highly suggestive of demyelinating lesions. The cerebrospinal fluid showed mild lymphocytic pleocytosis, mildly increased proteins, oligoclonal bands and anti-NMDAR antibodies of intrathecal production. He was treated with corticoids and the antipsychotic was discontinued. No neurologic symptoms were ever present.

This is an atypical case of anti-NMDAR encephalitis because of its isolated psychiatric presentation. Most patients develop neurological symptoms 2 to 3 weeks after onset of psychiatric symptoms. Monosymptomatic syndromes arise in less than 5% of patients.

The authors have not supplied their declaration of competing interest.

Being a caregiver of chronically ill children is a source of chronic-psychological stress affecting general physical and mental health. However, there is tremendous variance among caregivers: some may develop stress-related depression, whereas others are more “resilient”. The objective of the study was to phenotypically differentiate on psychobiology caregivers who developed depressive symptoms (“vulnerable”) vs. those who did not (“resilient”) from each other and from age-matched controls.

Forty-five mothers of chronically-ill children and 18 controls have been examined. Caregivers were divided via a median split of Center for Epidemiological Studies Depression Scale scores in “resilient” (RCs) and “vulnerable” (VCs). We assessed cognitive, affective, metabolic, neuroendocrine and oxidative markers at rest and in response to a laboratory social stressor. ANCOVAs and Bonferroni post-hoc tests were used to examine between-group differences.

Although RCs compared to VCs had similar levels of objective parenting-related burden (P = 0.51), they had lower subjective distress (P < 0.01) and higher levels of positive affect (P = 0.04). Although RCs compared to controls had higher levels of objective parenting-related burden (P = 0.04), they had greater cortisol suppression post-dexamethasone (P = 0.05), lower F2-isoprostanes/vitamin E ratio (P < 0.01) and lower fasting insulin levels (P = 0.06).

Our results suggest that caregivers with higher resiliency demonstrate more salutary stress-related functioning in comparison with less resilient caregivers and, more surprisingly, non-caregiver controls. These findings might be interpreted in the spirit of Nietzsche's quote “What does not kill me, makes me stronger” and of the idea that successfully overcoming adversity may be more psychobiologically beneficial than not having been exposed to any adversity.

The authors have not supplied their declaration of competing interest.

Every more often, there is evidence that shows a relationship between psychiatric symptoms and autoimmune disorders. Such is the case of anti-NMDAR encephalitis, in which it has been recently described the development of psychotic symptoms. Anti-NMDAR encephalitis is an autoimmune disorder that involves IgG autoantibodies against the NMDA receptor subunit GluN1. This last fact could support the relationship with the glutamatergic model of schizophrenia.

To conduct a current review to deepen the detection and management of anti-NMDAR encephalitis, due to the frequent existence of psychiatric symptoms at onset, which have contributed to the difficulty of diagnose.

Systematic review of the literature in English (PubMed), with the following keywords: “Autoimmune encephalitis”, “psychosis”, and “NMDA receptor”.

Autoimmune encephalitis appears more frequently in children and young adults and it is characterized by a prodromal period, in which there usually are non-specific symptoms of headaches or fever. Next, it could progress to cognitive deficits, seizures, catatonic symptoms and psychosis. However, sometimes in the rarest clinical presentations, there is nothing but psychiatric symptoms at the onset of encephalitis, which leads to misdiagnose and lack of proper treatment. This fact has stimulated the curiosity of the psychiatry scientific community, since the anti-NMDAR encephalitis may mimic the glutamatergic model of schizophrenia.

To make an accurate and detailed diagnostic formulation in people with psychiatric symptoms as onset of any disorder is essential to determine whether it is a primary psychiatric disorder or symptoms associated to another disease.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Anti-NMDA receptor (NMDAR) encephalitis, formally recognized in 2007 by Dalmau et al, is an autoimmune disorder with a complex presentation that includes psychiatric symptoms, memory deficits, and autonomic instability. The exact incidence is unknown but age, gender, and ethnicity may all play a role. Presence of antibodies against the GluN1 subunit of the NMDAR in the CSF and serum confirm the diagnosis of NMDAR encephalitis.

We report the case of a previously healthy, 19-year-old woman, 6 weeks pregnant. She had a generalized tonic-clonic seizure followed by psychiatric symptoms, including insomnia, emotional lability, delusions, and disorganized behavior. During the course of the disease, she demonstrated speech impairments and catatonic features associated with abnormal movements.

She was provided lorazepam 1 mg twice a day to treat her catatonic symptoms, her insomnia and her speech improved. Olanzapine was introduced, reaching a dose of 20 mg/day for managing psychosis and agitation.

NMDA-R encephalitis is a novel disorder with prominent psychiatric manifestations that is widely underdiagnosed. Neuroleptics may be helpful for managing psychosis and agitation, but may exacerbate movement abnormalities. Benzodiazepines are helpful for agitation, insomnia and catatonia associated with this condition.

Earlier recognition of this illness is crucial as prompt diagnosis and multidisciplinary treatment, can potentially improve prognosis. There is an increasing need for psychiatrists to become aware of the disorder and consider it in their differential diagnosis, specially in patients with new onset psychosis, history of encephalitis or subtle neurological symptoms. Careful selection of psychopharmacological interventions may reduce suffering.

The authors have not supplied their declaration of competing interest.

HIV-infection is a very stigmatized, chronic disease with increased rates of psychiatric disorders, being major depression the most common.

To review the recent research related to depression in HIV-infected patients.

Literature review based on PubMed/Medline, using the keywords “HIV” and “depression”.

HIV-infected patients have a chance 2-7 times higher of developing major depression, around the time of diagnosis or during the course of their illness. However, only fewer than 50% of the cases are recognized clinically. Several factors contribute to its under-recognition and under-treatment, such as the overlap between the neurovegetative symptoms of depression, the somatic symptoms of HIV disease, and the effects of comorbid diseases; the mistaken belief that depressive symptoms are expected in this group; the neuropsychiatric side effects associated with some antiretrovirals. Besides, major depression presents important diagnostic challenges due to biological, psychological, and social components associated with the infection. The authors will analyze the clinical presentation.

Depression has been associated with a negative impact on quality of life, poorer HAART adherence, faster HIV disease progression and increased mortality risk. Importantly, however, appropriate psychiatric intervention can do it over. In fact, studies suggest that patients receiving SSRI treatments for depression have rates of adherence and CD4+ T-cell counts similar to non-depressed patients receiving HAART.

The high prevalence of major depression in HIV-positive individuals and its serious consequences if untreated, increase even further the importance of its effective identification and subsequent treatment in this group of patients.

The authors have not supplied their declaration of competing interest.

HIV infection is a chronic disease characterized by a great deal of uncertainty and unpredictability, being anxiety disorders a frequent psychiatric problem.

To provide an overview of anxiety in HIV-infected patients.

Literature review based on PubMed/Medline, using the keywords “HIV” and “anxiety disorders”.

HIV-infected individuals can experience symptoms of anxiety across the spectrum of anxiety disorders. Adjustment disorder with anxious mood is the most common diagnosis, followed by generalized anxiety disorder and panic disorder. Some patients present with these disorders prior to notification, others develop them during the course of their illness, mainly at key moments. In HIV-infected patients, anxiety can be a manifestation of side effects of medication; a symptom of an illness associated with HIV disease; or, most commonly, the psychological response to the stressors of the illness. In fact, many issues are responsible for the anxiety experienced by people living with HIV. The authors will analyze them. Besides the distress of anxiety disorders, these lead to a decrease in adherence to antiretroviral treatments, resulting in adverse progression of HIV disease and increased risk of mortality. Importantly, however, appropriate psychiatric intervention can do it over.

Careful diagnosis and treatment of anxiety disorders in the context of HIV disease is even important, given the serious effects if untreated. Thus, anxiety should never be seen simply as a natural reaction to a life-threatening illness.

The authors have not supplied their declaration of competing interest.

Mania occurs in higher rates among individuals with HIV/AIDS, especially with the progression of HIV infection, and constitutes an additional risk factor for facilitate the HIV spread.

To provide an overview of secondary mania in HIV-infected patients.

Literature review based on PubMed/Medline, using the keywords “HIV”, “AIDS” and “mania”.

Secondary mania or AIDS mania may be due to illicit or prescribed drugs, CNS infection with HIV, medical illness, including opportunistic infections. Of these, HIV neurotoxicity has been proposed to be the most important factor in its pathogenesis. Mania AIDS differs from primary mania with regard to clinical presentation, course, management and prognosis. The authors will analyze them. Besides decrease to treatment adherence, maniac symptoms also predispose to HIV risk behaviors, which may lead to further HIV transmission. Importantly, the occurrence of HIV mania may announce the transition from HIV infection to AIDS perhaps before other clinical signs are evident. Early recognition and treatment of manic symptoms with mood stabilisers, antipsychotics and HAART improve quality of life, protect from further cognitive deterioration and decrease mortality. In these patients, medication side-effects toxicity, drug interactions, and adherence require special attention.

Mania has been associated with HIV/AIDS and in many instances acts as a barrier to achieving best treatment outcomes. Thus, psychiatrists need to be aware of the complexities involved in the emergence of manic episodes in HIV-infected patients in order to deal with them in the most appropriate and effective manner.

The authors have not supplied their declaration of competing interest.

Patients with major depression who are otherwise medically healthy have activated inflammatory pathways. It has been described that depression is not only escorted by inflammation but also by induction of multiple oxidative/nitrosative stress pathways. Nevertheless, there are finely regulated mechanisms involved in preserving cells from damage, such as the nuclear factor Nrf2.

To explore in a depression-like model the Nrf2 pathway in the prefrontal cortex (PFC) and the hippocampus of rats and to analyze which classic antidepressants affect the antioxidant activity of the Nrf2 pathway.

Male Wistar rats were exposed to chronic mild stress (CMS) and some of them were treated with desipramine, escitalopram or duloxetine. We studied the expression in the PFC and hippocampus of upstream and downstream elements of the Nrf2 pathway and the oxidative damage induced by the CMS.

After exposure to a CMS protocol, in the PFC, there is an inhibition of upstream and downstream elements of the Nrf2 pathway. Moreover, antidepressant treatments, particularly desipramine and duloxetine, are able to recover some of these elements and to reduce the oxidative damage induced by the depression model. In the hippocampus however, Nrf2 pathways are not that affected and antidepressants do not have many actions.

Nrf2 pathway is differentially regulated by antidepressants in the PFC and hippocampus. The Nrf2 pathway is involved in the oxidative/nitrosative damage detected in the PFC after CMS exposure. However, it seems that Nrf2 is not very involved in the effects caused by the CMS in the hippocampus.

The authors have not supplied their declaration of competing interest.

According to some studies, deaf psychiatric inpatients have prevalence rates of psychotic disorders ranging from 20 to 54%. There are descriptions of the paradoxical finding that prelingually deaf patients with psychosis may hear voices.

To present a case report and conduct a database review in order to understand if deaf patients with psychosis can have auditory hallucinations.

The authors’ aim is to describe a case, highlight the clinical and scientific relevance of auditory hallucinations in deaf patients and the difficulties and limitations of this process.

A Pubmed database search using as keywords “auditory hallucinations”, “deaf” and “deafness” and retrieved papers were selected according to their relevance.

The authors report a case of a 47-year-old female patient apparently suffering from congenital deafness. The patient had no previous psychiatric history until 4 months prior to her admission at our institution, when she started having psychotic symptoms. The patient was admitted into a Neurology ward but because no neurological sign was found psychiatric liaison consultation was requested. Four months later, she had the same symptoms, describing a voice that said to “shut up” and was admitted to a psychiatric hospital. After medication, the symptoms relapsed and now she is followed in an outpatient setting.

The presence and nature of auditory hallucinations in deaf patients is not fully elucidated and there are methodological problems in the investigation of this subject.

Current evidence is still inconclusive and the fact that prelingually deaf patient hear voices needs further research.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is a plurality of differing opinions defining borders between mental disorders and spiritual experiences. This research proposes criteria for clarifying those boundaries.

Summarize practical criteria for clinicians to assess psychopathological symptoms with spiritual content and to attain a differential diagnosis from healthy spiritual experiences.

Merge different approaches from psychopathology, psychology of religion and religious studies to attain practical criteria.

Literature review using a phenomenological and critical approach.

1. Severe psychiatric symptoms with religious content: (1) are usually in the context of personal impoverishment; (2) appear odd in cultural environments and within a person's biography; (3) do not enhance action or, in the phenomenological tradition, (4) these symptoms come from a weakening of the “intentional arc”. 2. A guiding map is suggested to evaluate spiritual expressions and their relationships with mild or moderate mental disorders and with mental health and personal growth. This map is developed by combining different traditions from the psychology of religion. 3. Psychiatric and psychological judgment of religious/spiritual experiences should be self-limited. There is a judgment about its content and about its validity or truth, which is only possible within the different spiritual traditions.

Psychopathology establishes principles to discriminate some psychotic symptoms from healthy spiritual experiences. Psychology of religion offers some general rules to guide the psychological evaluation of spiritual beliefs and their influence on mental well-being and personal growth. This review opens fields for future research in relating psychopathology and the study of religious experience.

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