Endovascular thrombectomy (EVT) is the gold standard treatment for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Multiple factors can influence EVT outcomes, including procedural and patient-related variables. This meta-analysis investigated the impact of periprocedural hemoglobin (Hb) levels on EVT outcomes.

We performed a comprehensive literature search across PubMed, Scopus, Web of Science and Cochrane CENTRAL. We analyzed the mean difference (MD) in Hb levels between good (modified Rankin Scale [mRS] 0–2) and poor (mRS 3–6) prognosis groups. We calculated pooled odds ratios (OR) for Hb levels as a predictor of prognosis and compared mortality and symptomatic intracranial hemorrhage (sICH) across different Hb levels.

The analysis included 921 patients from four studies. Patients in the good prognosis group had significantly higher Hb levels (MD: 0.48 g/dL, 95% CI: [0.2, 0.75], P = 0.0007). Each 1 g/dL increase in Hb was associated with a 22% increase in the odds of achieving a good three-month prognosis (OR: 1.22, 95% CI: [1.13, 1.33], P < 0.00001). Patients with Hb levels ≤13 g/dL in males and ≤12 g/dL in females were 1.69 times more likely to experience mortality (OR: 1.69, 95% CI: [1.1, 2.59], P = 0.02). No significant difference was observed in sICH occurrence between anemic and non-anemic patients.

Higher Hb levels may be associated with improved prognosis, and lower Hb levels might increase mortality risk in AIS-LVO patients undergoing EVT. Further research is needed to validate these findings.

Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.

To explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.

We performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.

The phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.

The kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.

None Declared

There is a current trend towards an increase in the number of elderly prisoners due to the increase in life expectancy and the change in the attitude of society and the judicial system. The cut-off for “older offender” is defined from the age of 50, due to the lifestyle previous to prision and premature ageing.

The authors intend to understand the challenges of aging in prison and forensic services, highlighting the psychiatric comorbidities of inmates and how these services can adapt to the needs of this population.

Non-systematic review of the literature.

Studies of elderly in prisons and elderly forensic psychiatric patients are limited. Prisoners have increased physical and psychiatric morbidity and early mortality as they are more exposed to risk factors and more likely to have at least one health problem compared to older adults in the community. Compared to older people in the community, older prisoners are at higher risk for most psychiatric disorders including depression, psychosis, bipolar disorder, cognitive impairment, personality disorder and anxiety. Suicide rates are also higher among elderly prisoners. The inadequacy of the prison system to respond to the unique needs of elderly prisoners has a detrimental impact on their overall experience of incarceration. The development of specific services for elderly prisoners or the adaptation of mixed units for the elderly population is proposed.

The elderly population in prisons is growing and has higher risk of psychiatric pathology compared to community elders. Prison services with difficulties in identifying and meeting these needs.

No significant relationships.

Delusional infestation (DI), also known as delusional parasitosis or Ekbom syndrome, is a rare disorder, characterised by fixed belief that the skin, body or immediate environment is infested by small pathogens, despite the lack of any medical evidence for it.

To describe and discuss two clinical cases of DI, in order to show two different ways of presenting in this entity.

Two case report and non-systematic review.

We present the case of a 76-year-old woman, without psychiatric history, with an DI with 5 years of evolution, referred to a psychiatric consultation by a dermatologist. The second case, is a 41-year-old woman with a history of multiple substance use disorder, with an DI with a month of evolution, who resorted to the emergency department. DI is not a single diagnostic entity. The classic form, as represented in the first case,is a primary form, which develops without any known cause or underlying disease, corresponding to a persistent delusional disorder. However, about 60% of patients have secondary forms of DI, in the context of substance misuse, some medications or in the course of physical or psychiatric diseases (e.g. stroke, delirium, dementia, depression, schizophrenia).

DI can occur as a primary delusional disorder or secondary to several other medical conditions. An in-depth clinical history is essential in order to make the correct diagnosis. A multidisciplinary approach is also important, to exclude any possible organic etiology, not forgetting that many patients may turn to other medical specialities first.

No significant relationships.

Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder, that typically manifests in adulthood, clinically characterized by progressive motor, cognitive and psychiatric/behavioural symptoms. Psychiatric symptoms are common in HD. The presentation of these symptoms is highly variable, and their course does not correlate with motor or cognitive disease progression. Psychiatric symptoms often precede motor onset by many years.

The authors intend to review the literature the most frequent psychiatric disorders in patients with HD.

Non-systematic review of the literature.

Psychiatric symptoms have been a core feature of HD. Pre-symptomatic HD patients exhibit a greater prevalence of psychiatric symptoms, particularly affective disorders. This symptoms are presenting symptoms of HD in up to half of all people. In symptomatic HD patients, it is estimated that up to 73–98% of patients will have a major psychiatric disorder or psychiatric symptoms. Psychiatric manifestations in HD include depression, irritability, apathy, anxiety, mania, perseverations, obsessions and psychosis. Cognitive changes include progressive deficits in attention, learning, executive and sensory functions, resulting in dementia. Depression, diagnosed in half of patients with HD, is the most common and earliest symptoms prior to the motor onset. There are likely multiple causes of the psychiatric symptoms, with underlying factors including a combination of neurobiological, cognitive, psychological, social and environmental factors.

Patients with HD have high psychiatric comorbidity, that causes significant functional impairment and affect quality of life. Thus, they require a multidisciplinary approach in the recognition and treatment of psychiatric symptoms.

We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations.

Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986–2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression.

We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33–1.62) to 1.05 (95% CI: 1.01–1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05).

Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.

75 children (55 male) fulfilled the criteria for ADHD: 35 of inattentive type, 28 of combined type and 12 hyperactive/impulsive. In addition, 33 (44%) of the children had comorbities. Children with higher scores for hyperactivity and impulsivity showed low performance in these working memory measures than those with other types. In the Conners’ Continuous Performance Test (CPT), a higher rate of omissions was found in the inattentive group. Children with comorbidity of oppositional desafiant disorder presented lower ISI and Hit RT scores in addition to higher rates of omission.

This study suggests that neuropsychological profile in children with ADHD is associated to specific differences in working memory performance and also in specific measures of the CPT. In addition, better defined tests, involving not only attention and motor planning may determine different neuropsychological profiles and, consequently, different approaches in cognitive rehabilitation.

Despite the relative lack of controlled data, psychostimulant drugs are frequently used as augmenting therapy for refractory depression. Modafinil is a nonamphetamine stimulant approved for narcolepsy often prescribed for off-label indications. While its mechanism of action is not yet fully understood it is known to be a well tolerated drug with high selectivity for the central nervous system. It also appears to have a lower abuse potential than other stimulants.

It will be presented a case report of a refractory depression that achieved symptom remission following augmentation with modafinil.

Review of clinical record and interview with the patient.

A 60 year old patient suffering from Major Depression has been highly resistant to several first-line pharmacological treatment as well as several conventional augmentation strategies and psychotherapy. The clinical picture was characterized mainly by anergy, excessive sleepiness and fatigue. Along the course of the disease the patient has been admitted to the psychiatric ward several times. During the last admission 50 mg/day of modafinil were added to the antidepressive treatment. The patient improved throughout the followup and full remission was achieved, currently being asymptomatic with modafinil monotherapy.

Modafinil proved to be an useful pharmacological option for augmentation of antidepressive therapy specially regarding symptoms of sleepiness and and fatigue. Its prescription has been increasing mostly due to off-label indications. As concerns have been raised about hypersensitivity reactions and neuropsychiatric adverse effects, further studies are needed to increase the safety of its use in this specific group of patients.

Poor adherence remains a problem in schizophrenic patients. Treatment guidelines for schizophrenia recommend depot medications for patients who are no adherent to oral regimens. This study aims to evaluate subjective experiences, adverse effects and adherence of depot medicated patients.

Was applied a questionnaire composed by the “Drug Attitude Inventory” (subjectively assesses the attitude and experiences of patients towards their depot medication) and by questions about adverse effects with medications. We took into account four different depot formulations: risperidone, haloperidol, fluphenazine and zuclopenthixol.

Participated 44 schizophrenic patients. The majority is male (77%). Clinically, the mean age of diagnosis is 28 years. About 50% of patients do the long acting risperidone, 31,8% the haloperidol decanoate and 9,1% the fluphenazine or zuclopenthixol. About 52,3% say they do not know the reason they take depot medication and 16% report previous therapeutic abandonment. There are not differences between mean results in “Drug attitude inventory” and all depot medications average in the positive range. Most frequent adverse affects are weight gain (29,5%) and sedation (15,9%). In rating discomfort of adverse affects 54,5% patients score zero (no discomfort) and 2,3% score ten (very uncomfortable) without significant differences between formulations.

Despite reporting adverse effects, patients attribute a low score in terms of discomfort. Although some of them report ignore the reason they are taking depot, patients have positive subjective experiences and attitudes with these medications. This fact may be predictive of good compliance.

To analyse publication and citations trends of case reports within otolaryngology – head and neck surgery literature, with specific attention to the most-cited reports.

Database query.

Web of Science was searched for article type ‘case reports’ published in the leading otolaryngology – head and neck surgery journals since 1945. Variables including publication dates, citation dates and numbers, author, author number, and others were recorded and analysed for trends. The reports with the most citations (classics) were further studied.

Of nearly 67 000 published articles in leading otolaryngology – head and neck surgery journals, the overall number of case reports as a percentage of the total has substantially decreased over time. A total of 110 case report classics were identified for which citations have increased.

Although the case report may not be worthy of its tarnished record, declining trends in publication suggest a limited future for this valuable research and educational resource.