The aim of the study was level of anxiety, depression and alexithymia in patients with rheumatoid arthritis (RA).

Alexithymia is defined as the difficulty in verbal expression of feelings. Alexithymia is more common seen in patients with chronic and temporary health problems.

One hundred forty eight patients with rheumatoid arthritis and a hundred healthy subject were included into the study. The level of alexithymia was assessed with Toronto Alexithymia Scale- 20 (TAS-20). Depression and anxiety disorders severity and quality of life (QoL) were assessed Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Assessment- Brief (WHOQoL-BREF), respectively.

TAS-20 scores in patients group was higher than control group. The patients with rheumatoid arthritis had significantly poorer scores in all domains of WHOQoL-BREF (p<0.001). BDI and BAI scores were greater than control group. There was no significant difference between patients with or without alexithymia in terms of sociodemographic features, treatment and scales scores.

The results of this study suggest that alexithymia is more common in patients with RA. Treatment of alexithymia may improve QoL, depressive and anxiety symptoms.

We investigated whether the personality factors measured in individuals with irritable bowel syndrome (IBS) symptoms differ from healthy participants, taking into account the subgroups of IBS (IBS-diarrhea, IBS-constipation, IBS-mixed and IBS-undetermined).

A cross-sectional survey of 4763 participants was carried out in Isfahan University of medical sciences. They were asked to fill two questionnaires: A validated questionnaire which fulfilled Rome III criteria for IBS considering their sociodemographic and lifestyle data as well, and the NEO-FFI questionnaire. Data was processed and analyzed using SPSS, Student's t-test for quantitative variables and Chi-squared statistic test for qualitative variables. Prevalence of each IBS subgroups was also assessed according to predominant stool pattern.

There were significant differences between IBS and non-IBS group in all dimension except openness(p<0.01). The mean score of neuroticism was significantly lower in non-IBS group but they showed a significantly higher level of extraversion, agreeableness and conscientiousness. Mean score of all dimensions was reported to be higher in female patients except extraversion (p<0.01).

The results indicate that the personality dimensions in irritable bowel syndrome differ from non-IBS group.

Paraphilias are rarely diagnosed in the clinical setting, although the estimated highest possible lifetime prevalence is approximately 12% for males and 4% for females. There are various presentations, including transvestism and fetishism. In this regard we present a case report of a 41 year old patient with a clinical picture compatible with Transvestism and Fetishism, whose clinical diagnosis was clinched years later.

The objective of this paper is to describe a case report whose diagnosis is compatible with transvestism and fetishism.

Understanding the clinical features of this pathology, regarding a diagnostic and therapeutic improvement.

Case report and bibliographic research on Pubmed e Medscape

Travestism and Fetishism is often under-diagnosed and occurs almost exclusively in heterosexual men and can cause significant distress. Therefore, it is crucial to clinch an early diagnosis in order to start an appropriate treatment.

Neurosteroid dehydroepiandrosterone (DHEA) has been associated to various functions in the central nervous system, including modulation of memory and behavior. It has been suggested that the effects of DHEA are mediated through several neurotransmitter systems; however its mechanisms of action are not fully understood. This study aimed to investigate the behavioral profile of DHEA in the forced swim test (FST), and also its impact on locomotor activity.

FST was performed in a glass cylinder, 45 cm high, 20 cm diameter filled with water up to a height of 30 cm. On the first day, male Wistar rats were forced to swim for 15 min. Rats were re-exposed to the FST for a single 5 min session, after the acute and chronic challenge with saline or DHEA. The measurement of locomotor activity was performed in a clear Plexiglas box (40×25×35 cm) for 30 min without any habituation period. The data were analyzed by one-way ANOVA, followed by Dunnett's test.

In FST, ANOVA indicated statistically significant effects of DHEA. Dunnett's analysis showed that DHEA significantly decreased the duration of immobility at the dose of 10 mg/kg, exerting acute, but also chronic antidepressant-like effects. However, DHEA did not induce significant differences in time of struggling behavior. ANOVA did not show a significant effect of treatment on locomotor activity.

These data experimentally support the findings that under certain circumstances, DHEA might have triggered the antidepressantlike effects in rats. Furthermore, these effects were not confounded by change in motor function.

Schizoaffective disorder is a poorly understood disease. In order to better understand it, we have to look at its history. Kraeplin believed that most psychoses could be divided into Dementia praecox and manic-depressive insanity, however this dualistic division was strongly contested and several descriptions of atypical psychoses appeared. In 1933, Kasanin proposed for the first time the term schizoaffective psychosis as a variant of schizophrenia. Since then, and up until 1979, 23 definitions of schizoaffective disorder have been counted. Sometimes different disorders have been called by the same name and similar disorders have different nosological names.

To describe the concepts of schizoaffective disorder, focusing on its historical aspects and the evolution of its diagnostic criteria.

To understand schizoaffective disorder by projecting its nosological position in the future.

We conducted a literature review using textbooks and PubMed.

Schizoaffective disorder is one of the most confusing and controversial concepts of psychiatric nosological entities.

After more than 80 years since its first definition, the term schizoaffective remains poorly defined. Indeed, there are studies that do not support the theory that schizoaffective disorder is a separate and distinct mental illness. Thus, the description, characterization, and understanding of this nosological entity continue to be a challenge in the field of mental health.

to investigate FC in RSNs in TLE patients with ADS.

54 patients with TLE from 18-50 y.o.were included. ADS were assesed by psychiatric interview with use of scales:BDI, HADS, HAMA, MADRS. All subjects underwent 9-min resting-state fMRI session.

SPM8,’GIFT’ toolbox ICA for isolate RSNs; for comparison - one-way ANOVA and two-sample t-test.( p< 0.005,10-voxel clustersize)

In groups of patients with ADS (n=36) a moderate level of depressive and anxiety symptoms (HAMA=25,4±2,6; MADRS=20,1±2,6) was found. There are 8 RSNs were identified: visual, FC audial, sensomotor, frontotemporal dorsal and ventral, frontoparietal right and left, default mode(e.g.DMN) networks. The main interest was focused on FC in key nodes of DMN as they are involved in emotional processing and may play a significant role in the origin of affective symptoms. Significantly increased FC was identified in the left insula, superior parietal cortex, left frontal cortex, right precuneus, right parahippocampal gyrus, right frontal cortex in patients with ADS. Increased FC in these nodes of neuronal networks can be explained as by the presence of affective symptoms in this group so as an their association with epileptic processes.

significant advances in imaging represent an opportunity to investigate psychopathological features, where TLE can be considered as a good model for investiagion other mental disorders.

Buprénorphine haut dosage (Subutex) est le médicament le plus couramment utilisé dans le traitement de médicament de substitution. Mais cette molécule est également bien connu pour son usage détourné ou abusif. Depuis la révolution tunisienne, le trafic de plusieurs médicaments a été une montée très dangereux.

Pour étudier la prévalence de la dépendance à la buprénorphine haute dose en consultation psychiatrique en 2010 (avant la révolution tunisienne) et 2012 (après la révolution).

Comparer les caractéristiques cliniques du patient accro à la buprénorphine haut dosage avant et après la révolution tunisienne.

Une étude rétrospective, descriptive et comparative a été effectuée sur les fichiers de patients qui ont consulté le service de consultation externe de l’hôpital Razi à Tunis depuis deux ans: 2010 et 2012 dont diagnostic était la dépendance à la buprénorphine haut dosage.

34 patients dépendants à la buprénorphine haute dose ont été recrutés: six patients en 2010 et 28 patients en 2012. Tous étaient des hommes. L’âge moyen était de 31,83 années en 2010 et 32,13 années en 2012. 44,11% de l’ensemble de la population de l’étude a développé une symptomatologie dépressive: quatre patients en 2010 et 11 patients en 2012.

Les groupes d’âge, la période de chômage et le montant des benzodiazépines consommées ont été corrélés avec l’année de consommation.

Ces résultats confirment l’impact de la révolution tunisienne sur la prévalence et le profil de dépendance à la buprénorphine haute dose dans notre pays. D’où la nécessité de mesures générales de gestion de ces toxicomanes est imposée.

Light-to-moderate alcohol consumption is associated with a reduced risk of overall dementia; however, moderate-to-heavy alcohol consumption is a risk factor for the development of dementia prior to age 65. Here we describe a case report of a 51-year-old man whose clinical presentation is consistent with dementia related to alcohol consumption.

To describe the clinical case of a patient with a probable diagnosis of dementia related to alcohol consumption.

This report aims to understand the role of alcohol consumption as a risk factor for dementia.

This report contains a case report and a literature review that was performed using Pubmed and Medscape.

Although a gradual improvement in cognitive ability with prolonged abstinence can occur, some cognitive impairments appeared to persist despite prolonged periods of abstinence. Thus, the avoidance of excessive alcohol consumption is crucial for the prevention of this disease.

Recently there is growing interest with regards to personality and character traits that may have an effect on the incidence and severity of climacteric symptoms. Neuroticism emerges as one important factor according to the Big-Five and Eysenck's models, but little is known about the possible relationship of menopausal symptoms and Cloninger's model of personality.

The present study aimed to explore the relationship between Cloninger's model of personality and the severity of climacteric symptoms. Specifically, this study investigated whether certain temperament and personality traits associate with either psychological, somatic or vasomotor distress symptoms in menopause.

One-hundred-seventy menopausal women from a Greek University menopause clinic completed Cloninger's Temperament and Character Inventory (TCI-140) which measures four dimensions of temperament: Harm Avoidance (HA), Novelty Seeking, Reward Dependence and Persistence, as well as three dimensions of character: Self-directedness (SD), Cooperativeness, and Self-Transcendence. Menopausal somatic, vasomotor and psychological symptoms were assessed using the Greene Climacteric Scale.

Higher HA emerged as the most significant temperament trait influencing anxiety and depressive symptoms. Lower SD resulted in more depressive climacteric symptoms. A multivariate regression model further showed that higher HA and lower SD independently associated with more depressive symptoms, whereas years since menopause, body mass index and waist-to-hip ratio influenced somatic and vasomotor symptoms only.

Our findings indicate that high HA and low SD associate to psychological climacteric distress symptoms, while somatic and vasomotor symptoms are independent of character or temperament traits and mainly influenced by menopausal age and body mass index.

The corticobasal degeneration (CBD) is a rare and severe neurodegenerative condition associated with a heterogeneous clinical syndrome of behavioral, motor, sensory and cognitive symptoms. Epilepsy is often associated with ictal, post-ictal and inter-ictal behavior changes, and it‘s a rare manifestation in DCB.

Literature review on topic Corticobasal Degeneration, with presentation of a clinical case.

Research conducted in Pubmed with the words:’corticobasal degeneration’,’neuropsychiatric symptoms’. The clinical information was collected from patient and family.

The authors report a case of a 55 years-old women with a history of anorexia nervosa, an affective disorder with features of Major Depression of 7 years of evolution and Epilepsy. Was admitted toInpatient Psychiatry Unit by rapidly progressive neurodegenerative clinical status of 6 months period, with temporo-spatial disorientation, incoherent speech, personality regression identifying substantial changes in behavioral pattern (apathy, depressed mood, anxiety), committing almost completely their autonomy. Neurological examination reported mnesic deficits, difficulty in memory recall, lack of ability to calculate and abstraction, ideational and ideomotor apraxia,’alien limb’ phenomenon, parkinsonism with global bradykinesia, gait in small steps and left hemibody stiffness. Emphasize the complementary diagnostic exams, the electroencephalographic study with bilateral paroxystic activity of central predominance and brain-MRI revealing leukoencephalopathy, Globus pallidus mineralization and cortico-subcortical atrophy.

The differential diagnosis of prion encephalopathy and limbic encephalitis were excluded, having performed therapeutic trial with methylprednisolone without improvements. It is discussed in this clinical case of DCB, the long pre-symptomatic period of pathological behavior and epilepsy, relative to rapidly progressive neurological deterioration.

Acute psychotic disorders include a heterogeneous group of disorders characterized by the acute onset of psychotic symptoms. Medico legal acts can be observed during these episodes.

To study different evolutionary terms of patients hospitalized in department of forensic psychiatry at Hospital Razi, Tunisia following a withdrawal of case by reason of insanity according to section 38 of the Penal Code and having been diagnosed as an acute psychotic d

A retrospective descriptive study was carried out on files of patients hospitalized in department of forensic psychiatry at Hospital Razi during the period of January 1991 to December 2011 and whose final diagnosis according to DSM VI was a brief psychotic disorder or schizophreniform disorder.

Our sample consisted of 30 patients. The average age was 28.6 years. Criminal acts were varied: they were dominated by homicide in 5 cases, attempted homicide in 5 cases, 4 cases in theft. On admission, the diagnosis of brief psychotic disorder was selected in 12 patients, whereas the diagnosis of schizophreniform disorder was labeled in 18 cases. Two cases of complete remission were objectified. The outcome was chronic in 17 case: it was paranoid schizophrenia in 5 patients, disorganized schizophrenia in 4 patients, schizoaffective disorder in 4 patients and a disorganized schizophrenia in 2 patients. 6 patients developed bipolar disorder later.

Acute psychotic episodes constitute a risk period of acting out. Screening for chronic psychiatric disorders occurs by the early identification of patients at risk from the prodromal phase.

Movement disorders are a frequent finding in psychiatric practice, even in emergency. Studies on acute movement disorders in psychiatric emergency are rare.

To determine characteristic features of patients presenting with movement disorders in psychiatric emergency.

We conducted a retrospective study over one year period including all patients presenting in psychiatric emergency of Razi Hospital for movement disorders (from October2012 to September2013). Clinical, etiological and therapeutic features were analyzed.

We included 335patients consulting in emergency for movement disorders (3.36% of all consultations in psychiatric emergency; sex-ratio: 3.53; mean age of 37.8 years). Main movement disorders (unique or in association) were acute and tardive dyskinesia(40%), Parkinsonian syndrome(34%), tremor(28%), acute dystonia(16.2%) (Mainly torticolis(22%), orofacial dystonia(17%)), akathisia(5.7%), oculogyric crisis(2.4%). Only one patient presented with neuroleptic malignant syndrome. Etiologies were mostly iatrogenic causes (drug abuse, weaning, errors, incomplinace). Most of patients had chronic psychosis (38.5%); 6.8% had simulated mevement disorders and 3.9% hysterical conversions. Anticholinergics (Trihexyphenidyle chlorhydrate in 64.5%) and benzodiazepines(14.3%) were the most used drugs in emergency. Only 3.9% of patients were admitted in hospitalization in emergency.

Our series shows the relative frequency (>3%) of movement disorders as a chief complaint in psychiatric emergency. The predominance of young male adults may be explained by the higher prevalence of dyskinesias in our series, for which younger age and masculine sex are risk factors. It is necessary to distinguish authentic movement disorders from psychogenic ones and simulations to avoid abusive prescriptions of anticholinergics, often explicitly claimed by simulators.

Brain connectivity changes have been recently demonstrated in victims of psychological traumas treated with the eye movement desensitization and reprocessing (EMDR).

Forty victims of psychological traumas were investigated at the first EMDR session (t0) and at the last one performed after processing the index trauma (t1).

To investigate differences in EEG functional source connectivity during bilateral ocular stimulation (BS) during EMDR therapy at t0 and t1.

Brain electrical activity during whole EMDR sessions was record with a 37-channel EEG. EEG functional connectivity analysis was based on the lagged phase synchronization (LPS), derived by a two-step eLoreta procedure: dimensionality reduction of inverse matrix from 6239 voxels to 28 regions of interest (ROIs); LPS index computation, for each spectrum band, in all possible ROI pairs.

Significant differences were detected between t0 and t1 in alpha band LPS indexes. A prevalent enhancement in right intrahemispheric functional connectivity was found in t1 respect to t0, particularly among ROI pairs of (a) frontal regions (anterior frontal, orbital frontal, lateral frontal cortices) and limbic structures (anterior cingulate cortex, ACC), (b) frontal regions and associative areas (insula cortex, parietal lobe), (c) ACC and primary visual cortex and (d) ACC and associative areas.

These findings suggest that EMDR efficacy is associated to electrical brain connectivity changes during BS. An enhancement in the right hemisphere alpha band functional connectivity of areas involved in cognitive control, emotional processing and visual associative functions may play a key role in the elaboration of psychological traumas.

The aim of this study was to detect longitudinal differences in white matter brain structures in adults with schizophrenia compared to healthy controls.

Twenty adult patients with multi-episode schizophrenia under stable antipsychotic medication and twenty-two age- and sex-matched healthy subjects were included in the study. Diffusion Tensor Imaging (DTI) was applied at baseline (t1), after 6weeks (t2) and after 3months (t3) and data processing was done with tract-based spatial statistics (p<0.05, corrected). Two subjects in the schizophrenic sample dropped out at t2 and one healthy subject at t3. Clinical and neuropsychological variables were measured and correlated with the most significant DTI findings.

Compared with healthy age- and sex-matched controls schizophrenic patients showed widespread decreases in mean fractional anisotropy values (p<0.05, corrected). The most obvious FA decrease in the long-term was found in the anterior part of the corpus callosum (p<0.005, corrected), the left temporal lobe (p<0.004, corr.) and the mid-cingulate gyrus bilateral (p<0.004, corr.). Correlations to demographic variables, clinical rating scales (PANSS, CGI and GAF), verbal learning and memory and working memory will be presented.

Magnetic resonance imaging was able to detect altered structural connectivity in patients with multi-episode schizophrenia in a longitudinal design.

The new version of DSM-5 provides nearly the same criteria as DSM-IV for delirium with an exception. The DSM-5 requires a disturbance in awareness while DSM-IV, a disturbance in consciousness.

Awareness is not the same as consciousness. In this study we examined the concordances between awareness and consciousness and the agreement between DSM-5 and DSM-IV.

All acute medical admissions 70 years and over. Exclusion criteria: terminal phase of illness, severe aphasia, intubated. Those included were assessed on Day 1, 3, 7, 10 of their admission. During the assessment each individual was tested with: MoCA, DRS-98R, CAM, RASS and the subscale of levels of consciousness and awareness of surroundings from RCDS; APACHE II, CAPE and BARTHEL index. Demographic data and a medication list were also recorded.

123 participants;

Mean age: 81.3 SD (6.7) range 70-100 years old

Females 60(48.9%)

Delirium according CAM 21 (17.1%)

Delirium 23 (18.7%)

Subsyndromal delirium 28 (22.8%)

No delirium 72 (58.5%)

Previous cognitive decline: 76 (61.8%)

RCDS (awareness and consciousness)

Mean awareness: 0.4, SD (0.8)

Mean consciousness 0.4 SD (0.8).

Correlation (agreement) between awareness and consciousness Kendal's Tau =260, p=0.026

Using the awareness definition of delirium 8 participants with full awareness of surroundings have been indentified as delirious according to DRS 98, while using the consciousness definition 12 participants where indentify as delirious.

DSM-IV and DSM-5 detect two slightly distinct populations with delirium. Awareness and consciousness are not the same. DSM-5 is more restrictive in indentifying delirium.

Cognitive impairment during acute illness in older patients is acknowledged, although factors that underpin this condition are less well studied.

To investigated the relationship between cognitive recovery and a range of clinical and biological variables.

Observational and longitudinal study. Participants were consecutive patients aged ≥70 years assessed within 3 days of their admission to elderly medical unit and re-assessed twice weekly with the DRS, CAM, MMSE, APACHE II, APS, Barthel index, frailty scale. Cytokines and APOE genotype were measured in a subsample.

142 patients were analysed [mean age 84.8±6.4; 47 (33%) male; 64, (45% with comorbid dementia]. 55 (39%) experienced cognitive improvement, of which 30 (54.5%) had delirium while 25 had non-delirious acute cognitive disorder. Using bivariate statistics, subjects with more severe acute illness, lower IGF-I levels and more severe delirium were more likely to experience ≥ 20% improvement in MMSE scores. When the criterion of cognitive improvement was a 3 point improvement in MMSE, those with more severe delirium, females and greater age were more likely to improve. Longitudinal analysis using any criterion of improvement indicated that improvement was significantly (p<0.05) predicted by higher levels of IGF-I, lower levels of IL-1 (alpha and beta), lack of APOE epsilon 4 allele, female gender and the interactions of APOE genotype with IGF-I, and dementia with IGF-I.

Cognitive recovery during admission is not exclusively linked to delirium status, but reflects a range of factors. The character and relevance of non-delirious acute cognitive disorder warrants further study

In schizophrenia about 40% of patients have an additional diagnosis of metabolic syndrome (MetS). In this present study the effect of MetS on cognition in a relatively young group of patients with schizophrenia was examined.

290 schizophrenia patients (age/sd = 30/6.37 years old) were included in the study. Patients were divided into two groups, those with and those without MetS (MetS+/MetS-). Neuropsychological performance was assessed with the Wechsler Adult Intelligence Scale-III, the Continuous Performance Test-HQ, the Word Learning Task and the Response Shifting Task.

124 (42%) patients with schizophrenia met the criteria for MetS. MetS+ and MetS- groups did not differ on amount of cigarettes, alcohol, drug use, severity of illness, socioeconomic status and antipsychotic medication. MetS+ had a significantly lower estimated IQ (sd) 94.9 (17.4) compared to MetS- 100.1(16.3) (t=2,54; p=0.012). MetS+ performed significantly worse on immediate (t=3,12; p=0.002) and delayed recall (t=2,92; p=0.004) and processing speed (t=-2,80; p=0.006) as compared to MetS-. Linear regression analyses revealed that WAIS IQ scores (p=0.026) and immediate memory (p=0.003) were associated with waist circumference.

Patients with schizophrenia and an additional diagnosis of MetS had lower IQ, performed worse on immediate and delayed recall and processing speed as compared to patients without MetS. This suggests that, even at a relatively young age, metabolic abnormalities are related to poor cognition in schizophrenia. Future studies are needed to examine whether treatment of MetS will also have a beneficial effect on cognitive performance in schizophrenia.

The attention deficit is the main symptom of the Attention Deficit Hyperactivity Disorder (ADHD) in adults. This diagnosis is difficult in adults and comorbidity with substance abuse (SA) is high. As ADHD influences negatively the prognosis of the patients with SA, it is important to treat the ADHD in individuals with DS. Furthermore, it is common the use of substances to relieve ADHD and its comorbidities's symptoms.

It is known the paradoxical effect of amphetamines in individuals with ADHD and it was also described with cocaine. This characteristic is an important clinical clue to the diagnosis of ADHD and it is a predictor of a positive response to the therapeutics.

It is intended to approach the issues related to the psycopathology, differential diagnosis, prognostic and therapeutic implications when there is comorbidity between ADHD and SA in the adult.

Therapeutic implications of the comorbidity between ADHD and SA.

Analyses of a clinical case and a non-systematic review of the literature was made.

A 23-year-old woman, lawyer, has the diagnosis of ADHD since childhood. She regularly used cocaine for the last 2 years, without doing any medication, as she felt quiet, relax and focused, being more productive at work. The treatment with prolonged-release methylphenidate allowed to stop the use of cocaine without a recurrence of cognitive symptoms.

The ADHA is an independent risk factor to the SA; The early detection and treatment of ADHD helps to prevent the substance abuse;