Description of the most relevant data found in a Psychiatric Day Hospital opened ten months ago in the hospital complex of Ávila.

The goal is to evaluate clinical and management data in patients of the Psychiatric Day Hospital.

Retrospective cross-sectional descriptive study. A data collection form where each patient is classified into: sex, age, average stay, first admission or readmission, origin, reason for discharge, destination on discharge and diagnoses (classification ICD-10) was used.

From the opening of the Psychiatric Day Hospital ten months ago, 58 patients have been admitted: 70.7% women and 29.3% men. Readmissions: 1.7%. Their origin was: psychiatric hospitalization (53.5%), outpatient department (31%), emergency room (13.8%) and Centre for Psychosocial Rehabilitation (1.7%). 41 out of 58 patients have been discharged. Reasons for discharge: improvement (78%), referral to other units (7.4%), voluntary discharge (4.8%) and others (9.8%). The destination on discharge was: outpatient department (90.4%), Centre for Psychosocial Rehabilitation (4.8%), and Inpatient Rehabilitation Unit (4.8%). The most frequent diagnoses on discharge were: bipolar affective disorder, adaptation, emotionally unstable personality disorder, dysthymia, persistent delusional disorders, specific personality disorders and severe depressive episode with psychotic symptoms.

The Psychiatric Day Hospital is an intensive treatment unit with a partial hospitalization system, which is distinguished by the variety of patients it is able to admit, as well as the clinical and management benefits the dynamic of these units can provide.

The authors have not supplied their declaration of competing interest.

Patients with epilepsy seem particularly liable to certain major psychiatric disorders. Prevalence of schizophrenia within an epileptic population varies between 3% and 7% (1% in general population). The aetiology is possibly multifactorial (drugs and neurosurgery).

To study comorbidity between psychoses and epilepsy and management in the literature and in our patients.

To analyze factors that might influence the onset of psychoses within an epileptic population and how this potential association could influence our practice.

PubMed search was conducted with interest in psychoses of epilepsy, pharmacology, and comorbidity. Up to 10 variables related with factors influencing psychotic episodes that required hospital admission in three patients with epilepsy were studied.

Unlike published data, our patients did not have postictal psychoses. All cases had early onset temporal lobe epilepsy with no seizure activity since diagnosis (more than 20 years). No family history of either epilepsy or psychoses. Management included lamotrigine, oxcarbazepine, carbamazepine, zonisamide, and levetiracetam in conventional doses. The psychosis, which comprised affective, schizophrenic, and confusional elements, lasted longer and was more troublesome than psychosis in non-epileptic patients. Response to neuroleptics was poorer than in non-epileptic patients with psychoses. Consultation with Neurology Unit resulted in end of treatment with zonisamide and levetiracetam.

Less than perfect evidence suggests the association between psychosis and epilepsy. In our patients, no postictal cases were recorded. Management showed poorer effect of neuroleptics when compared with non-epileptics, and zonisamide and levetiracetam were changed for other drugs with presumably lower association with psychoses.

The authors have not supplied their declaration of competing interest.

Neurosyphilis has been called “the great imitator” because of its atypical clinical presentation ranging from motor dysfunctions to psychotic episodes to dementia. This, and the fact that it has become a rare disease, makes diagnosis challenging.

This work will present three early onset Major Neurocognitive Disorder cases for which neurosyphilis was considered as a possible cause.

In this presentation, we underline clinical characteristics that should raise the suspicion of neurosyphilis and the importance of an adequate diagnosis.

The three patients presented as case-reports were admitted to an acute psychiatric ward, presenting with psychomotor agitation and aggression. The initial clinical evaluation (including the patient's medical history) did not suggest the presence of syphilis. Subsequent blood-tests were performed, including RPR (Rapid Plasma Reagin) or VDRL (Venereal Disease Research Laboratory) which were positive in all three cases. Other tests were performed in order to confirm the presence of neurosyphilis.

All three patients had positive treponemal and nontreponemal test results. For only one of the three patients, imagistic abnormalities of the brain were present. For two of the patients, a positive diagnosis of Major Neurocognitive Disorder due to neurosyphilis was established.

Neurosyphilis can be a cause for Major Neurocognitive Disorder. The diagnosis of this pathology is important because cognitive function can be improved by adequate treatment.

The authors have not supplied their declaration of competing interest.

Attention Deficit Hyperactivity Disorder (ADHD) prevalence in the general adult population is estimated to be between 2–4%. Despite the high prevalence, until recently there was only one validated semi-structured interview available for the accurate diagnostic assessment of ADHD within the adult population: the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID).

To examine the concurrent validity of the DIVA 2.0 interview comparing the diagnostic rate with the CAADID interview. To analyse the criterion validity of the DIVA 2.0 in the Spanish language in an adult sample.

The aim of this is to study was to evaluate criterion validity of the DIVA 2.0 in an adult sample comparing with the CAADID and other ADHD severity scales.

A transversal study was performed to check the criteria and concurrent validity of the DIVA 2.0 compared to the CAADID.

Forty patients were recruited in an adult ADHD program at a university hospital. The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview and goods correlations with three self-reported rating scales: the WURS, the ADHD Rating Scale and Sheehan's’ Dysfunction Inventory.

The DIVA 2.0 has good psychometric properties and is a reliable tool for the assessment of ADHD in adults.

The authors have not supplied their declaration of competing interest.

Autism spectrum disorders (ASD) are a group of neurodevelopmental syndromes characterized by deficits in communication, social interaction and imagination. These symptoms are present in the early developmental period, but may not be fully obvious until social demands exceed the child's limited capacities. In spite of its early presenting, this condition is not diagnosed until adult stage. In Japan, many patients with ASD were diagnosed after entering university, however, few treatment options are available. The aim of this study is to investigate the effectiveness of group therapy in university students with ASD.

A one-group, pre-intervention-post-intervention design was adapted for this study. All patients with ASD were recruited from Shizuoka University. The group therapy programs consisted of cognitive behavioral therapy and recreational activity. Outcome measures were Beck Depression Inventory-Second Edition, Quality of Life Inventory, State Trait Anxiety Inventory and Rosenberg Self-Esteem Scale.

There were 14 participants, 7 males and 7 females. Their ages were from 19-years-old to 23-years-old. All participants had over 80% of attendance in the six-month group therapy.

These preliminary results suggest that the group therapy can improve symptoms of depression and anxiety for some students with ASD. More research is needed to draw more sturdy conclusions, especially with respect to improvements in quality of life.

The authors have not supplied their declaration of competing interest.

Autistic disorder (AD) is a neuropsychiatric disorder that often presents significant disruptive symptoms such as irritability, aggression and self-injury in addition to impairment of social skills and communication. These symptoms interfere both individuals with AD and their families and social environment.

Show paliperidone effect in behavioural symptoms in AD.

Literature review about behavioural symptoms in AD and paliperidone effect in its treatment, followed by a case report of clinical improvement after treatment with paliperidone in a patient with autism. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores was compared prior and 4 weeks after paliperidone treatment, and clinical improvement was assessed with Clinical Global Impression-Improvement Scale (CGI-I).

Although risperidone has been one of the most studied atypical antipsychotic to treat this symptoms, its use should be limited in order to avoid extrapyramidal and metabolic symptoms. Paliperidone – the major metabolite of risperidone – has shown effectiveness in the treatment of behavioral symptoms in patients with autism, even in subjects with a prior ineffective trial of risperidone. Our patient, 21-years-old male with AD and significant disruptive symptoms was treated with paliperidone 9 mg/day. We observed a 20-points reduction in ABC-I scores 4 weeks later, with most significant improvement in items like auto-agression, heteroaggressivity, irritability and slams. CGI-I scores showed a much better improvement, and no significant adverse effects appeared.

Paliperidone is an effective and safe treatment in behavioral symptoms associated to AD, with reduction in ABC-I subscale scores. More studies are needed to confirm our data.

The authors have not supplied their declaration of competing interest.

Improving quality require the capability to evaluate clinical and operational processes and improve patients outcomes. Just in the view of evidence-based practise (EBP) it's used HONOS rating Scale, adopted since May 2012, by Mental Health Center of Villorba (Treviso-Italy) There are 3 package treatments: rehabilitative, territorial and clinical.

To identify which variables are positively correlated to HONOS improvement in patients group who frequented Mental Health Centre along 36 months. All patients present severe mental illness.

Evaluate the effectiveness of interventions and correlate to treatment package and individual feature. Analyze treatment process for quality improvement.

A psychiatric team (4 nurses, 1 psychiatrist) administered Honos Rating Scale along 3 years: on starting point and 6, 12 and 36 months later: T 0,1,2,3,4. Patients are also described by diagnosis, mental, social and autonomy skill, time, utilization of MHC and anagraphic information.

All 15 groups’ patients realize lower scoring, after 36 months’ treatment. Seven have got reliable improvement (i.e. = > 8-point lowering T3–T4) and positively correlate with: (1) 36 months’ treatment, at 12 months in rehabilitative Package; (2) days in residential/semi-residential community from 82 to 311 days. Related tables are included in paper.

HONOS score correlates directly with clinical and riabilitation improvement, i.e. mental, social capacity, and personal autonomy. It needs more investigation to clear which other factors are involved with improvement.

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

Neuroleptic malignant syndrome (NMS) takes place in patients in treatment with neuroleptics and it is potentially lethal, being important an early diagnostic and therapeutic approach.

To analyze from a clinical case the clinical and epidemiological features, and therapeutical approach to NMS.

Review of some articles in Mental Health journals and analysis of the following clinical case: 68-year-old woman with bipolar disorder, hospitalized in manic phase. Usual treatment: lithium, trazodone, quetiapine and asenapine. During the admission to hospital, the patient started presenting hyperthermia, sweating, electrolyte disturbances, limb rigidity, and elevation of CPK levels. The suspicion was NMS, so neuroleptics were stopped and fluids and dantrolene were initiated, with favorable evolution.

The discharge diagnosis was NMS. Neuroleptics were gradually reintroduced under vigilance. The patient is stable and has not had new complications. NMS is an uncommon (0.02% to 3% among patients taking neuroleptic agents), but life-threatening condition. Its symptoms are hyperthermia, autonomic nervous system dysfunction, limb rigidity, altered consciousness… The attendant infections, consume of lithium, dehydration, iron deficiency and sharp changes in neuroleptic treatment are predisposing factors. The withdrawal of neuroleptics is the key of the treatment. Benzodiazepines can improve the prognosis, and electroconvulsive therapy can be necessary if there is no response to previous measures.

Neuroleptic malignant syndrome is a life-threatening medical complication we should try to avoid by a correct and careful use of neuroleptics. Additionally, it is important the early treatment, taking withdrawal of neuroleptics as the key starting point.

The authors have not supplied their declaration of competing interest.

Erotomania is a rare delusional disorder. De Clerambault, a French psychiatrist, was the first who advanced the concept of pure erotomania, one of the “passionate psychosis”, as a distinct disorder. However, some authors tend to consider this syndrome as related to other psychiatric disorders.

To describe the case of a female patient with erotomanic delusion with no remission under an antipsychotic and to review the links between erotomania and other psychiatric disorders.

Literature review and a case report.

We report the case of a 32 year-old epileptic woman, hospitalized for a delusional erotomanic disorder. Initially, the patient was treated with an antipsychotic, with partial effectiveness. In fact, it appeared that the conviction of being loved began while she was depressed. After one month of combined antipsychotic and antidepressive medication, she became euthymic and her erotomanic delusions disappeared. Major depressive disorder with psychotic symptoms was diagnosed. After reviewing the literature we found that erotomanic symptoms frequently appear secondarily in other psychiatric disorders. Several publications indicate a frequent association between erotomania and mood disorder, especially bipolar affective disorder and major depression, and describe the efficacy of antidepressant and mood stabilizers. Numerous theories may explain the link between erotomania and mood disorder: from narcissistic needs, to the capacity of empathy and emotional processing. Further studies are needed to clarify the nature of this link.

In clinical practice, a mood disorder must systematically be searched for and treated in a patient with erotomanic delusions.

The authors have not supplied their declaration of competing interest.

The teaching of behavioral sciences was in form of lectures to the medical students in the 2nd year of the college, because the lecture is the least beneficial method of teaching. As I have noticed also that students were more interested to practice behavioral skills. So I suggested to the authority of the faculty to teach part of the behavioral sciences in a practical way and proposal of that was introduced and accepted to teach in that way and to give 20% of marks to this practical part, this in addition to the same theoretical lectures.

The students were divided into groups of 30, every group present one day only through their 2nd year. This day divided into two parts each is 2 hours and in between have an hour break. The 1st part includes group discussion about communication, group dynamics, group leading and scientific way of problem solving. The 2nd part is dividing students into small groups of 10 students, to practice the previous skills in group interaction to solve one problem in a scientific way. All groups collected again to see what they have done.

The results revealed more interest and more enthusiasm to learn in that way and make it easy to practice in their daily life.

We have to change into more practice in our teaching of medical students especially skills of human communication, group leading group dynamics as well as problem solving.

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

Maternal psychopathology can have a server effect on the ability of mothers to attach to their children.

To ascertain the level of attachment of adults between the ages of 18–25 years of age who were raised by mothers who suffer from schizophrenic disorders and depressive spectrum disorders, then compared to adults who were raised by mothers with no formal clinical diagnosis.

This study used the Adult Attachment Questioner (AAQ), by Simpson Rholes Philips (1996) to ascertain the level of attachment of adults between the ages of 18–25 years of age who were raised by mothers who suffer from schizophrenic disorders (n = 30) and depressive spectrum disorders (n = 30). The findings of these two groups were then compared to adults who were raised by mothers with no formal clinical diagnosis (n = 30).

The findings indicated that there is a significant difference between adults who were raised by mothers with the aforementioned mental disorders (schizophrenic and depression), as compared to those who were raised by mentally healthy mothers.

The style of attachment in adults who were raised by mothers with the aforementioned clinical diagnosis (schizophrenic and depression) have insecure attachments, while the children who were raised by mentally healthy mothers have almost secure attachment style.

The authors have not supplied their declaration of competing interest.

Irritable bowel syndrome is one of the most commonly diagnosed functional gastrointestinal disorders. Irritable bowel syndrome (IBS) and its association with stress have not been researched in regards to foreign medical students in Cluj-Napoca, Romania.

To establish the prevalence of IBS in foreign medical school students and the relationship with stress.

This observational case-controlled study was carried out in “Iuliu Hatieganu” University of Medicine and Pharmacy in Cluj-Napoca, Romania. The sample size was 102, and the data was collected using an online self-report questionnaire. The ‘Rome 3 criteria’ was used to diagnose IBS and ‘Stressful Life Events Check-list’ was used to measure levels of stress.

The prevalence of IBS was 24.5%, with females having higher rates (34%) compared to males (16.4%). The types of IBS were IBS-M (mixed form) 8.8%, IBS-D (diarrhoea dominant) 6.9%, IBS-C (constipation dominant) 5.9% and IBS-U (undefined) 2.9%. Students with IBS reported higher social stress compared to students without IBS.

More efforts should be made to combat stress that medical students experience in order to reduce the number of IBS cases. This may involve an increased role of the medical school to develop initiatives and support, with the aim of helping medical school students better cope with stress and stressful events.

The authors have not supplied their declaration of competing interest.

The work describes the well-succeeded experience of the Non-Smoking Program developed in a psychiatric clinic in Rio de Janeiro city, Rio de Janeiro, Brazil.

To treat the tobacco dependence in patients with disorders for the use of substances and other psychiatric disorders. To transform the clinic therapeutic space in a free tobacco environment.

To promote the restoring of the patients’ health integrally, considering the use of tobacco is responsible for a large number of avoidable deaths, in addition to much harm to health.

In a clinic of hospitalization for diverse mental disorders treatment, especially disorders for the use of substances, in the city of Rio de Janeiro, Rio de Janeiro, Brazil, was simultaneously established a non-smoking treatment program. It was used the pharmacological therapy, associated with cognitive-behavioral therapy, occupational therapy and moderate physical activity. The average time of permanence in the non-smoking program was on average 90 days.

There was significant acceptance to the proposed program. In the long-term monitoring, over 12 months, it was evidenced that most patients found themselves in tobacco abstinence.

The project achieved its objectives, promoting the tobacco abstinence in patients with comorbidities in hospital treatment. The study proved that it is possible to remove tobacco in patients dependent on this substance during a psychiatric hospitalization.

The authors have not supplied their declaration of competing interest.

The use of coercion raises ethical dilemmas, as it deprives patients of their autonomy. In Denmark, the subject has gained political attention, and decreases in the use of coercion are demanded. In the attempt of reducing the use of coercion, it is of interest to obtain more knowledge about the circumstances bound to it.

The aim of this study was to investigate a possible correlation between the incidence of mechanical restraint (MR), and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts.

A naturalistic descriptive method was used to study cases of mechanical restraint in patients admitted to a psychiatric ward. In the study period of one year, 114 cases of MR were carried out. In 66% of cases, the patient was diagnosed with borderline personality disorder. Each case of MR was obtained from Statens Serum Institut's Electronic Reporting System. The care workers from each shift were identified using duty rosters. The statistical package SPSS version 20 was used for data processing, including a logistic regression analysis.

A significant association was found between the use of MR and the presence of male care workers on the ward, OR = 1.639, 95% CI: 1.163–2.311, P = 0.005. The risk of MR is increased during evening shifts, compared to day and night shifts, OR = 1.868, 95% CI: 1.165–2.995, P = 0.009. No significant associations were found between MR and staffing level, age, education, or experience of care workers.

The authors have not supplied their declaration of competing interest.

It has been universally regarded that Leonardo da Vinci was one of the all time geniuses in terms of his contribution to art and sciences. A number of theories have been proposed to explain his genius that range from neurological, psychological uniqueness, and enhanced functional intelligence.

The primary aim is to explore these theories in detail and register their pros and cons alongside contextualizing their credibility and weightage against the extant evidence in science.

A detailed literature search has been undertaken to identify variety of models and theories either:

• – dealing with neurological, psychological or neuro-philosophical explanations;

• – have been proposed by psychiatrist or psychologist and neurologists pertaining to Leonardo's brain or mind;

• – theories around occult and religion have been excluded.

The results are synthesized and presented in a tabular form. The discussion expands on the various theories and the relevance of Leonardo da Vinci to the merging unified field of neurology, psychology, technology and philosophy (consciousness studies)

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

Population aging is an issue increasingly gaining more prominence, as evidenced by the number of inquiries regarding the “problems” that this entails for society. This leads to a need to understand the role of caregiver for the elderly as the central figure of support in old age.

The purpose of this study was to describe formal caregivers’ perceptions of working conditions, difficulties and factors associated with quality of care in a Portuguese home-based care for elderly.

The participants were 8 formal caregivers whose profession falls under the categories of Direct Action Helper and Auxiliary Workers. The data were collected through individual face-to-face interviews and analysed using a content analysis following Bardin's method.

The results show that the sample is female, aged from 32 to 53 years, with a professional exercise time between 8 and 16 years. Regarding the main conclusions of our research, we can say that our group of participants has a strong sense of team work which contributes to avoid situations of physical and emotional exhaustion; mostly caregivers can separate their personal and professional lives; there are some difficulties in communication between the caregivers and the elderly, however the most difficult situations are usually overcome due to the caregiver's understanding of the characteristics of institutionalized elderly; the matter of death is frequently seen as the most difficult situation to face.

The caregivers should have an awareness of the importance of kindness and respect, supporting positive thoughts and help the older people to retain control over their lives.

The authors have not supplied their declaration of competing interest.

Studies confirm that caregivers play host to a high level of compassion fatigue. Day in, day out, nurses struggle to function in care giving environments that constantly present heart wrenching, emotional challenges.

This concept analysis will aim to capture the current meaning of fatigue compassion in the context of healthcare and explore how it may be recognised and measured in education and clinical practice.

Using the same search terms, findings from a literature search in 2000 and from a follow-up search in 2014 were used to conduct the concept analysis. The Walker and Avant theorethical framework was used to develop a model case of fatigue compassion in nursing care. The attributes, antecedents, consequences and references were delineated.

Four attributes of fatigue compassion were delineated. (1) Perceptual incongruence and appraising defines how an individual perceives role demand in relation to capabilities or resources. (2) Multidimensionality consists of physiological and psychological effects on a person. (3) Interactional feedback is the experienced acknowledgement/validation communicated by others during compassive stressful situations at a workplace. (4) Response pattern describes the coping mechanisms used by an individual experiencing fatigue compassion.

The concept analysis of fatigue compassion among nurses at the workplace recognized the vulnerability of the nursing discipline towards distress in general. There needs to be greater research within the field of role stress and nursing, specifically in the development of scales or tools to assist in the identification of fatigue compassion amongst nurses.

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

Directed by Edward Zwick “Pawn Sacrifice” is a biographical film released on September 2015. The film stars Tobey Maguire as Bobby Fischer, the American World Chess Champion, considered one of greatest player of all time. His career's peak was in 1972 when he captured the World Chess Championship from Boris Spassky of the USSR.

We tried to dig a little in the biography of Bobby Fischer who many described as mentally ill. We tried to figure out what is reality and what is just legend about Fischer. Our goal is promote chess, and also honour the great Fischer. Moreover, we wanted to explore the scientific literature published about the benefits of playing chess, especially in childhood.

We made an exhaustive review of the author's life, and also testimonies of people who knew him. Moreover, we found some articles that review the relationship between chess and IQ trying to confirm or debunk some myths about this legendary game.

It was incomprehensible to everyone that the top of the career of Bobby Fischer at the same time meant an abrupt and complete fall. One possible explanation for this attitude would be a mentally unbalance not specified disorder throughout his lifespan.

Not all geniuses are crazy, neither all crazy are geniuses. A genius is a person with extraordinary capabilities, that focused on a topic, has the ability to enlight new ways to explain this complex world, whether it is to create a symphony, paint masterpiece or the next move on the chessboard.

The authors have not supplied their declaration of competing interest.

Mindfulness is a form of meditation that cultivates present moment awareness in a non-judging way. It has a Buddhist origin but has been practiced in the last 40 years without relation to any religious belief. It has been proposed as a treatment for a variety of ailments.

To carry out an overview of systematic reviews of the evidence on mindfulness as a therapeutic tool.

To summarize the existing evidence on the efficacy of mindfulness.

We searched for systematic reviews in the Cochrane Database of Systematic Reviews (Cochrane Library).

We found nine Cochrane reviews (for fibromyalgia, aggressiveness in intellectually disabled people, mechanical neck disorders, reducing sedentariness at work, anxiety, somatoform disorders, and post-stroke fatigue), two Cochrane review protocols (stress reduction of patients with breast cancer, and substance use disorders), 50 non-Cochrane reviews (29 provisional abstracts and 21 structured abstracts from the Centre for Reviews and Dissemination) on the efficacy of mindfulness. The Cochrane reviews showed a lack of conclusive evidence for fibromyalgia, aggressiveness in intellectually disabled people, anxiety disorders, somatoform disorders and post-stroke fatigue. Mindfulness training induced a non-significant reduction in workplace sitting time. For chronic neck pain, mindfulness exercises minimally improved function but no global effect was perceived at short term.

According to the existing Cochrane reviews, there is a general lack of evidence mindfulness as an effective treatment. For chronic neck pain, mindfulness exercises minimally improved function. We have detected important areas where high quality clinical trials are needed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.