The presence of multiple pathological conditions in the form of comorbidity is present much more as a rule than an exception in all of the population of psychiatric patients. Medical and psychiatric comorbidity in general is more common in women than in men.

The aim of this study is to assess the prevalence of somatic comorbidity in female patients with different major psychiatric disorders who were hospitalized at the Female ward of the University Psychiatric Hospital Vrapce in 2014.

The data was collected from hospital medical records. The sample consisted of 56 female, all inpatient, diagnoses established by the ICD-10 criteria by attending psychiatrist.

Somatic comorbidity was present in 70% of patients. The most prevalent somatic disorder in comorbidity with psychiatric disorder was group of cardiovascular disorder (46%), followed by group of endocrine disorders (25%).

The results of this research show that the incidence of disease such as endocrine disorders (diabetes mellitus, the metabolic syndrome, thyroid dysfunction) and coronary heart disease is significantly higher in schizophrenia patient, than in mood affective disorder. There was difference between the age groups. Comorbidity was not found in younger population (mean age 45), while it was present in older population (mean age 57.1).

Somatic comorbidity is prevalent in psychiatric population with significant impact on their quality of life. There is obvious need to provide prompt and appropriate intervention avoiding iatrogenic complications.

Le trouble dépressif majeur (TDM) est associé à des altérations de l’expression génique au niveau cérébral et en périphérie, dans les leucocytes sanguins. Chez les dépressifs, les études de neuroimagerie ont mis en évidence des anomalies structurales et fonctionnelles affectant deux régions clés du réseau frontocingulaire : le cortex préfrontal dorso-latéral (DLPFC) et le cortex cingulaire (CC). Actuellement, les mécanismes moléculaires permettant de faire le lien entre ces différents niveaux étiopathogéniques restent inconnus. Les mécanismes épigénétiques, situés à l’interface entre le génome et la réponse cellulaire, constituent des candidats potentiels.

Explorer le rôle de l’épigenèse dans le cadre du TDM en phase d’état.

Nous avons mesuré l’expression de différents gènes impliqués dans les mécanismes épigénétiques dans les leucocytes du sang périphérique, le DLPFC et le CC, chez des patients dépressifs et des sujets contrôles appariés. Les niveaux des différents transcrits ont été mesurés par PCR quantitative en temps réel.

Chez les patients dépressifs, nous avons mis en évidence une surexpression des gènes codant pour des enzymes intervenant dans la mise en place de marques chromatiniennes réprimant la transcription : HDACs 4-5-6-8 et DNMT3B dans le DLPFC, HDAC2 dans le CC et les leucocytes sanguins.

Nos résultats retrouvent une activation des mécanismes épigénétiques réprimant l’expression génique dans le DLPFC et le CC chez les patients dépressifs. Il s’agit de la première fois qu’une telle dérégulation est décrite dans ces deux régions. Ces modifications pourraient participer aux dysfonctionnements affectant le DLPFC et le CC et participer à la physiopathologie du TDM. De plus, nous retrouvons une surexpression de HDAC2 dans les leucocytes sanguins des patients dépressifs, ce qui renforce son statut de potentiel biomarqueur périphérique.

Bipolar disorder is a frequent condition in the general population with a high morbimortality, which consists in dysfunctional temporal fluctuations between different mood phases during which frequently there is a lack of insight. Besides the pharmacological treatment, psychoeducational programs have proved to be a cost-effective approach to help patients recognize early signs and symptoms in order to prevent full-blown episodes, although its broad implementation is still difficult and costly [1].

The main aim of this study is to develop and clinically validate a smartphone application to monitor symptoms and signs in stable bipolar patients along with customized embedded psycho-education contents and empower the self-management of their disorder to avoid relapses and hospitalizations.

The study will be carried out in three different but complementary phases in order to fully include patients and therapist's preferences: 1. Feasibility study using SIMPLe 1.0 app (subjective information only). 2. Feedback-based improvement process which will incorporate the objective information. 3. Randomized controlled trial with two arms of 74 patients each (SIMPLe 2.0+TAU vs. TAU).

After the collaborative development of clinical algorithms to ensure adequate sensibility and specificity to detect relapses and personalize psychoeducational messages, a technical pilot test of SIMPLE 1.0 app is underway and the first patients are being recruited to start the 1st phase of the study in Mid-October of 2014.

The possibility to deliver personalized psychoeducation contents based on monitoring signs and symptoms through a smartphone seems a promising cost-effective method, although a clinical validation is necessary.

To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose.

An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363).

271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3%) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036).

Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research.

L’accumulation de preuves avant une prise de décision, et la capacité d’attendre avant d’agir, respectivement nommées « impulsivité décisionnelle » et « impulsivité différée », sont des formes du contrôle du comportement, dysfonctionnel dans le trouble obsessionnel compulsif (TOC). Ce travail a exploré les effets de la stimulation cérébrale profonde (SCP) du noyau sous thalamique (NST) chez ces patients et sur ces deux types d’impulsivité.

Douze patients souffrant d’un TOC traités par SCP du NST ont été inclus dans une étude randomisée en double aveugle utilisant un design croisé au cours de laquelle chacun a réalisé une évaluation comportementale en condition de stimulation ON et OFF. Leurs performances ont été comparées à celles d’un groupe de 24 sujets témoins sains appariés (âge, sexe). « L’impulsivité différée » était évaluée par la tâche de « temps de réaction en série à quatre choix », requérant une réponse motrice après avoir détecté un stimulus cible, et « l’impulsivité décisionnelle » via le « test des perles » impliquant une décision après un cumul variable d’informations laissé à l’appréciation du sujet.

La tâche de « temps de réaction en série à quatre choix » a montré que les sujets sains avaient un nombre moindre de réponses prématurées que les patients en condition ON (p = 0,007), différence non retrouvée en condition OFF (p = 0,073), suggérant une augmentation de « l’impulsivité différée » en ON. Le test des perles a montré que les patients en condition OFF accumulaient davantage de preuves que les sujets sains avant une prise de décision (p = 0,021), et que cette différence disparaissait en condition ON (p = 0,017), témoignant d’une augmentation de « l’impulsivité décisionnelle » en ON.

L’augmentation retrouvée de ces deux types d’impulsivité pourrait être impliquée dans l’effet thérapeutique de la SCP du NST.

La dépression est une maladie hétérogène, au niveau clinique et physiopathologique. La recherche de biomarqueurs des troubles affectifs apporterait une meilleure compréhension des mécanismes sous-jacents et améliorerait la prise en charge. L’asymétrie de l’activité frontale de la bande de fréquence alpha (frontal alpha asymmetry [FAA]) basale est une mesure psychophysiologique issue de l’analyse spectrale de la bande de fréquence alpha à partir d’électroencéphalogrammes. Elle serait une mesure stable de la motivation (d’approche avec une hyperactivité frontale gauche relative et de retrait avec une hyperactivité droite frontale relative) et des émotions. Elle témoignerait aussi de dispositions individuelles émotionnelles et comportementales, et d’une vulnérabilité psychopathologique à la dépression . Une hyperactivité frontale droite (ou une hypoactivité gauche) relative basale serait associée à la dépression, particulièrement au site frontal médian F3/F4 , malgré une certaine inconsistance de la littérature.

Nous avons mesuré la FAA (calcul de la différence de puissance alpha entre 2 électrodes homologues) au site frontal médian F3/F4, dans un groupe de patients déprimés et un groupe contrôle. Nous attendions une différence significative entre ces 2 groupes, dans le sens d’une hypoactivité frontale gauche relative dans le groupe de patients.

Nous avons retrouvé une différence significative de FAA entre les 2 groupes, au site F3/F4 mais avec un pattern d’asymétrie opposé à celui attendu (hyperactivité corticale frontale gauche relative dans le groupe de patients).

Le pattern d’asymétrie retrouvé est en faveur d’une augmentation de la motivation d’approche. Il est similaire au pattern d’asymétrie de patients souffrant de troubles bipolaires . Le pattern qui était attendu dans le groupe de patients déprimés signait une diminution de la motivation d’approche, et donc une baisse de la sensibilité à la récompense dans la dépression (anhédonie) .

Children's beliefs regarding mental disorders depend on their age, but also on their education and contact with this field.

The study aims to explore children's knowledge and views on mental disorders, focusing on the definition and causes of mental illness and the way they perceive people with mental disorders.

A sample of 41 children aged 12-14 was analyzed. They completed a questionnaire designed by the authors including demographic data (age, gender), yes/no questions and open-ended questions about mental disorders. Data were analyzed quantitatively and qualitatively.

Most of the children described mental disorder in terms of thinking or behavioural disturbances, like 'not thinking clearly”, 'acting differently or abnormally” or 'a problem affecting the brain”. When asked to give examples of mental disorders, Alzheimer's Disease and Schizophrenia were the most frequently mentioned. The subjects believed that mental disorders can be caused by trauma, stress, environmental factors or family conflicts. Some of them thought that they are congenital or hereditary. 66% of the children do not know any person having a mental disorder. The ones who had contact with someone suffering from a mental illness were more informed about the subject. 69% of them thought that persons with mental disorders are dangerous and 7% that they are contagious.

Many children have little or no information about mental disorders, leading to false beliefs and stigma. Thus, education in this field and mental health promotion need to start at a young age.

Among 160 million population in Bangladesh most of them are living in the rural area and about 50% of them are female. In our society most of the female psychiatric patients don't come to the hospital or any private consultation centre of a psychiatrist for their treatment. They mostly depend on treatments practiced by the traditional healers.

To assess the pattern of psychiatric illness among the women visited to a private psychiatric consultation service in rural area of Bangladesh.

This descriptive cross sectional study was done among the women attending the authors private psychiatric consultation centre in Tangail district from January 2013 to June 2014. All the new patients were included in the study. Socio-demographic data were collected through a semi-structured questionnaire and psychiatric diagnosis were made by using DSM-IV-TR diagnostic criteria.

Total 1173 female patients were included in the study. Most of them were (68%) belonged to 20 years to 40 years of age group. Among the respondents most of them were housewife (62%) of lower class family. Most common psychiatric diagnosis were found major depressive disorder (19%). pain disorder (16%), somatization disorder (12%), schizophrenia (8%), obsessive compulsive disorder (8%), bipolar mood disorder (6%), conversion disorder (4%), adjustment disorder (4%), post partum psychosis (3%). Rest were diagnosed as phobic disorder, substance related disorder, generalized anxiety disorder, epilepsy and dementia,

The result of the study indicate that further expansion of psychiatric services in the rural area with special emphasis on early diagnosis and management of psychiatric patients. Policy makers and planners should give attention in this regard.

Chronic pain is one of the most underestimated and undertreated health care problems worldwide. It has major consequences either on the quality of life of the sufferer or on the health care system. Consequently, social burden is very high. The main reasons for this rely on inadequate evaluation and understanding of pain as well as lack of knowledge about the psychiatric disorders that may occur in many pain conditions.

The authors aim to define the role of psychiatrists in chronic pain management.

Literature review in PubMed and Cochrane databases using the following words: 'chronic pain', 'psychiatric disorders', 'comorbidities' and 'pain treatment'.

There is a clearly established link between chronic pain syndromes and psychopathology. The influence of chronic pain is especially prevalent in depression, anxiety, personality disorders, substance abuse and posttraumatic stress disorder. There are several reasons for including the psychiatrist in the management of chronic pain syndromes: 1) the high prevalence of psychopathology: 2) psychiatrists are more skilled to understand and evaluate the role of the cognitive and affective dimensions of pain as well as to identify susceptibility traits to the patient's experience, such as sexual abuse and neglect that predispose individuals to pain, substances use and concurrent mental health disorders.

Treatment of the patient with chronic pain is often ineffective. Chronic pain management requires a comprehensive workup and thoughtful treatment plan which balances comfort with function and rehabilitation. For this, it is necessary an interdisciplinary approach, in which psychiatry can play an important role.

To report a clinical case of SS in a 62-yr-old woman with postmastectomy pain syndrome, resulting from the addition of duloxetine to a medication regimen of sertraline and fentanyl. The review of the literature serves as an overview of the epidemiology, pathophysiology, clinical features, differential diagnosis and prevention of SS.

Literature review and clinical case description.

To our knowledge, few case-reports have been published including duloxetine as a precipitant agent of SS. Clinicians should be alert to this potential iatrogenic adverse interaction of serotoninergic antidepressants with commonly prescribed opioid analgesics in chronic pain patients.

Decreasing the hyper excitability of neurons through opening of voltage-gated potassium (Kv7, also termed as KCNQ) channels has been suggested as one of the protective mechanisms in the effective management of neuropathic pain. Reactive oxygen/nitrogen species and inflammatory pathways are well implicated in the pathophysiology of neuropathic pain. Further, M current generated by opening of KCNQ channels has been modulated by reactive oxygen/nitrogen species.

The present study has been designed to elucidate the nitric oxide modulatory mechanism in the protective effect of retigabine against spinal nerve ligation induced neuropathic pain in rats.

Ligation of L5 and L6 spinal nerves resulted alterations in various behavioral (as evident from marked increase in thermal and mechanical hyperalgesia and allodynia), biochemical (raised lipid peroxidation, nitrite, & depletion of GSH, SOD, catalase) and inflammatory parameters (raised TNF-alpha) as compared to naive treatment.

Administration of retigabine (10 mg/kg) for 28 days attenuated these behavioral, biochemical and inflammatory cascades as compared to control. Further, L-arginine (100 mg/kg) pretreatment with retigabine (5 mg/kg) significantly reversed the protective effect of retigabine in spinal nerve ligated rats. However, L-NAME (10 mg/kg) pretreatment with retigabine (5 mg/kg) significantly potentiated their protective effects which were significant as compared to their effect per se respectively.

Present study highlights the involvement of nitric oxide mechanism in the protective effect of retigabine against L5/L6 spinal nerve ligation induced behavioral and biochemical alterations in rats.