To identify possible change patterns or robustness in sources of meaning in family caregivers of pre-terminal patients after onset of support at home by an outreach palliative nursing team during a survey period of three months.

One hundred caregivers of terminally ill patients were included in a prospective observational trial. The Sources of Meaning and Meaning in Life Questionnaire (SoMe) was administered at four points of measurement: T0 (immediately before onset of palliative care); T1 (one week after T0); T2 (one month after T0); T3 (three months after T0). Descriptive statistics, random effects regression analyses; multivariate linear and quadratic regression models were performed for the full (n = 100) as well as for the reduced sample (n = 24).

Growth curve analyses reveal significant parabolic changes for the dimension “order” and for the subscales “social commitment”, “tradition”, “morality”, and “fun”. All other dimensions or subscales remained stable during the time of the study. Cross-sectional multivariate regression models (T0) showed negative associations of some dimensions with patients’ age and psychological burden of the family caregiver while psychological burden of patients was found to be positively associated with some dimensions. No significant effects of interaction variables with time (linear and quadratic).

With few exceptions, family carers seem to keep a stable sense of meaning in life during the final stage of their relatives’ terminal illness. Particular associations between sources of meaning and age of patients as well as psychological burden both of patients and carers have to be taken into consideration in support planning.

The authors have not supplied their declaration of competing interest.

Sleep disturbances are common among cancer patients. Especially during hospitalization, not only adverse medical conditions but also ward environments can affect sleep. We have developed a program of sleep-hygiene education and sleeping pill reduction for inpatients (the i-sleep program) and applied it to cancer patients. This study aimed to explore the effect of the program.

In a general hospital with 2,715 beds, we estimated the proportion of inpatients prescribed hypnotics at admission to and discharge from the department of oncology before (2014) and after (2015) the program. In addition, we estimated the proportion of inpatients prescribed hypnotics among all inpatients in the department of oncology on the first day of each month of 2014 and 2015.

A total of 12,382 patients (2014, before) and 12,313 patients (2015, after) were admitted to oncology department of Asan Medical Center. The proportion of inpatients prescribed hypnotics as discharge medication among inpatients who had been prescribed them at the time of admission decreased significantly, from 76.0% (2014) to 69.8% (2015), after the program (RR = 0.92, 95% CI: 0.87–0.98). The proportion of inpatients newly prescribed sleeping pills after admission to the hospital did not significantly decrease (4.03% to 3.98%; RR = 0.99, 95% CI: 0.87–1.12). The mean prescription rate of sleeping pills per day was 10.02% in 2014 and 7.99% in 2015 (P = 0.03).

Although the i-sleep program did not reduce the prescription rate of sleeping pills per day, it effectively reduced the proportion of cancer patients who continued to take sleeping pills from admission until discharge.

The authors have not supplied their declaration of competing interest.

Old people with diabetes are more likely to develop cognitive impairment, Alzheimer's disease and vascular dementia. However, the determinants of the association between diabetes and cognitive impairments are only partially known.

To evaluate cognitive disorders in elderly diabetic patients and to identify risk factors of cognitive impairment in this population.

It was a cross-sectional study. It involved outpatients aged 65 and older, who were followed for diabetes in the endocrinology department at the Hedi Chaker University Hospital in Sfax (Tunisia), from October 1 to December 31, 2015. For each patient, we collected sociodemographic, clinical and therapeutic data. We used the Montreal Cognitive Assessment (MoCA) to identify mild cognitive decline (score < 26/30).

We identified 70 patients, all with type 2 diabetes. The average age was 66.8 years. The sex ratio (M: F) was 0.7. The mean duration of diabetes was 14.76 years. The average MoCA score was 20.68 ± 6. Forty patients (57%) had cognitive decline. The cognitive impairment was statistically correlated with female sex (P = 0.02), low level of education (P = 0.00), high levels of glycated hemoglobin (Hb A1c ≥ 7%) (P = 0.00), presence of hypoglycemic episodes (P = 0.05) and presence of dyslipidemia (P = 0.00).

Our study confirmed the high rate of cognitive decline in older type 2 diabetes patients. The profile of subjects at risk was consistent with the literature: poorly controlled diabetes, severe recurrent hypoglycaemia and associated dyslipidemia. Acting on these risk factors would prevent cognitive decline and therefore progression to dementia.

The authors have not supplied their declaration of competing interest.

Fairness is a fundamental factor for prosocial behaviors and have a crucial role in social interaction. Examining fairness during maturation can shed light on different questions and hypothesis about the development of prosociality across life span.

The purpose of this study was to investigate the development of strategic planning in children and adolescents.

A total of 288 healthy students between ages 7 and 18 from four community schools participated in a one-shut run game which the participants were proposed and should set a package of offers concluded six suggestions.

Among 288 students, 128 (44.44%) participants were male and 160 (55.56%) participants were female. In first offer, 29.7% of boys suggested an unfair offer but girls with 23% were more generous. However, in last suggestion in comparison with girls (73% unfair), boys showed more generosity (64% unfair). Notably, girls in average, spent 135.78 seconds (SD = 86) to set their offers while boys needed less time to prepare their suggestions (117.16s, SD = 119.7)

According to the findings it seems that both genders start more generous offers and end up with less generous offers. In comparison with boys, girls need more time in economic decision-making and interestingly more fair options at the start of game.

The authors have not supplied their declaration of competing interest.

Neurocognitive disorders, previously not featured in the psychiatric nomenclature such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), have now been included in the latest, fifth edition of the DSM. There is a dearth of studies on neurocognitive disorders among non-western population.

The aim of this study is to compare neuropsychological functioning measured by tests of executive function and cognition among patients marked by apathy and impulsivity following a traumatic brain injury in a non-Western population, Oman.

Comparing the performance of various neurocognitive indices including negativistic features and disinhibition, which were identified using the symptom checklists Apathy Evaluation Scale and Disinhibited Evaluation Scale. Comparative neurocognitive measures included tapping verbal reasoning ability (Raven's Standard Progressive Matrices), working memory (Digit Span–Digit Forward–Digit Backward); Buschke Reminding Test, planning/goal-directed (Controlled Oral Word Association Test–verbal fluency, Tower of London(–planning time–number solved), (Wisconsin Card Sorting Test–perseverative errors, and–number of categories solved), and affective ranges (Hospital Anxiety and Depression Scale).

Analysis showed that those participants who scored highly at Apathy Evaluation Scale and Disinhibited Evaluation Scale did not differ on indices measuring working memory/attention and affective ranges except for one measure: Digit span-Digit Forward. In the measures operationalized here to tap planning/goal-directed behaviour, the two cohorts differ on all indices except for Tower of London-Number Solved.

This study lays ground for further scrutiny in delineating the different characteristics of what previously labelled as frontal dysexecutive phenotype. It indicates that apathetic and disinhibited temperaments marked with specific neuropsychological performance.

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

Flupirtine is used in many European countries for the treatment of different pain states because of its analgesic attributes. It is a centrally acting, non-opioid analgesic.

The aim of the study was to investigate an entire study the possibility of applying flupirtine (ktadolona) – selective neuronal potassium channel activators in the treatment of pharmacoresistant epilepsy and related non-psychotic depressive disorder in adults.

A total of 20 patients with the diagnosis of primary – generalized idiopathic epilepsy (IGE) and “non-psychotic depressive disorder due to epilepsy (F06.362)”. Before applying katadolon forte, patients received standard antiepileptic and antidepressant drugs (Depakine-Chrono 1000 mg/day, 150 mg lamotrigine/day, levitiratsetam 3000 mg/day of citalopram 20 mg/day). Assigning a first katadolon fote 14 days 200 mg 2 times a day, followed by 200 mg three in day inside.

Of the 20 patients, 10 had no seizures, 8 marked decrease in the frequency of seizures in 2 patients therapy was not effective.

Our data should be considered preliminary, because small sample of patients and duration of follow-up (18 months). The next phase of work will be carried out on a large sample of patients and a longer observation, placebo – controlled, double blind study.

The authors have not supplied their declaration of competing interest.

Understanding violence as a public health problem brings as required its inclusion in the curricula of undergraduate courses in health.

To describe the approach to the topic of violence and the teaching strategies used by teachers of undergraduate courses in nursing of two public higher education institutions of the State of São Paulo, Brazil.

Knowing the approach to the topic of violence in two nursing under graduation courses.

Descriptive, exploratory qualitative study. For data collection, semi-structured interview was used; were subject of the study, 15 teachers of the institutions studied that ministered courses whose programs contained the word “violence” or related. The data were subjected to analysis of the “collective subject discourse”.

The results referred to speeches about the importance of addressing violence in theory and practical course, the experience of violence in the everyday practice and pedagogical strategies in the theoretical and practical learning. Teachers recognize the importance of violence be crafted at graduation, describing that, although not always appear in the formal curriculum, the subject appears in an informal way in academic training. Recognize, however, that there is a fragmentation in the approach of the theme, because teachers are divided between theoretical and practical classes and not all of them study the subject.

It is essential that there should be more discussions on violence among teachers as well as be designed strategies to better approach the theme at graduation.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The roots of social phobia, lay in the social nature of human beings who fulfil their basic needs in social relations. By the definition, it is the fear of witnessing the negative judgement and the criticism of other people, which is so intense that, is followed by reactions of avoidance of phobic situations and doings, followed by intense vegetative symptoms.

Introduce social phobia as an important social and medical problem with common co-morbidity and exceptional risk of suicide. At the same time it gives special accent to the diagnostic procedures and differential diagnosis.

Analysis of the information from literature and practice and coming to conclusions with the inductive method.

Social phobia is a chronicle illness, equally present in both sexes. The central position is taken by all-the-time present intense irrational fear. Alcoholism, misuse of sedatives, depression, and panic with agoraphobia, OCD are common followers of social phobia. Differential diagnosis witch eliminates panic with agoraphobia, or just the lack of social skills allows the right therapeutic approach.

Social phobia, alone or combined with other disorders, has a huge medical and social value. Coming back to regular life tracks depends on the right diagnosis and the right time to go into the healing process.

The authors have not supplied their declaration of competing interest.

Since the presentation of the symptoms of postnatal depression (PND) can vary; healthcare professionals must receive the appropriate level of training to develop the knowledge required for the effective assessment and referral of women. Yet, healthcare professionals may have limited knowledge in perinatal mental health and students may lack practice opportunities to develop the knowledge and clinical skills. For these reasons, the use of alternative learning resources within perinatal mental health education is vital.

To explore the use of visual media in perinatal mental health education.

Against the background of increasing concerns about the ability of professionals to assess women with PND, this paper will consider how using dramatisation as a teaching approach can enable students to develop their knowledge and guide clinical skill development.

Three separate groups of senior student midwives and health visitors were asked to evaluate a dramatisation developed from women's lived experience of PND. Pre and post verbal evaluation of the drama were undertaken with the use of focus groups guided by semi-structured questions. Ethical approval was granted by the university.

Following thematic analysis three issues were identified:

–the role of the healthcare professional;

–improvements needed in care;

–issues of education and training.

Against the background of limited placement experience and opportunity for assessment of PND, the use of visual media can improve student healthcare professionals’ learning; with the use of structured facilitation, there is a great potential for multidisciplinary learning.

The authors have not supplied their declaration of competing interest.

Since the advent of online streaming television, a new behavioural phenomenon have emerged among millennial, named “binge watching” that is viewing more than two episodes of a TV show in the same sitting. Whether or not this behaviour reflects emotional difficulties has been poorly studied.

Describe the phenomenon and search a possible link with depression and anxiety.

Fifty medical students were recruited. A questionnaire exploring the circumstances, the purpose and the outcome of the binge viewing was fulfilled. The Beck depressive inventory and the state-trait anxiety inventory were passed for the assessment of depression and anxiety.

Among the 50 students questioned, 68% met the criteria of binge viewers and 64.7% of them adopted this behaviour at least once a week with an overall average of screen exposure of 3.8 hours in one sitting. Before the binge watching, 35.3% reported excitement and 29.4% boredom and have used it mostly to pass time (47.1%) and for fun (44.1%). Participants have felt more relaxed and happier after the viewing. Mild depression was found in 10 cases and moderate depression in 5 cases. Anxiety scores averaged 35.38 for state anxiety and 40.32 for trait anxiety. An inverse relationship was found between depression and anxiety scores and the frequency of the binge watching and its exposure duration. The correlation was hover non significant.

Could it be that the binge watching is a means of fighting against anxiety and depression rather than an evidence of emotional difficulties? Further studies are needed.

The authors have not supplied their declaration of competing interest.

Drawing tests provide good opportunity to research potential risks in emotional and personal development of a child with speech disorder, because drawing tests almost do not involve speech.

The research was aimed at detecting potential risks in emotional and personal development of children with speech disorders. The study involved 28 children (15 girls and 13 boys) with moderate speech disorders and 30 normally developing children. All the children attended kindergarten and were of age 5.5 years at the moment of the research.

The following methods were used: non-participant and participant observation, expert assessment, structured interview with educators, individually conducted family drawing test.

Most children (86%) expressed willingness to perform a task, in some cases (14%) children failed to perform a task because of emotional numbing. The children's perception of a specialist was marked by increased anxiety and stress, in some cases it was expressed in a drawing by filled areas (38%) or by barely visible figures (62%). Most children (87%) tried to demonstrate their abilities and were diligent, but their drawings were generally poorer than that of normally developing children. This phenomenon reflects deficit of skills, imagination deficit and low level of aspiration. Quality of drawings and their visible from differ from the drawings of normally developing children that indicates low self-esteem and feeling of personal incapacity formed by speech disorder.

Increased anxiety, constriction and imagination deficit characterize children with speech disorders. Their emotional attitude to speech behavior influences their graphical self-fulfilment.

The authors have not supplied their declaration of competing interest.

Homelessness is a phenomenon, which is hard to limit, as it contemplates different situations including roofless and squatters.

To determine the presence of these homeless categories in the city of Girona and examine the prevalence of diagnosed mental pathology and its principal socio-demographic characteristics.

Transversal, observational and analytic study of the population of roofless people and squatters. The registers of the outreach street work team, the local police and the public shelter were used in order to detect the cases and their basic socio-demographic characteristics. The clinical record of the mental health and addiction public network was accessed to determine their diagnosis.

During the 6 years of registers, 781 cases of people in situation of roofless and squatters were detected. In total, 83.2% (n = 630) of the cases were men and 16.8% (n = 131) women. The average age was 44.8 (ED = 11.2) and no differences were found regarding gender (Men = 45.3, ED = 11.0 vs. Women = 42.9, ED = 12.2; t = 1.7, df = 405, P = 09). However differences were found regarding origin (Immigrants = 42.2 years, ED = 10.3 vs. Natives = 46.8 years, ED = 11.4; t = -4.2, df = 402, P < .001). A total of, 52.9% of the cases (n = 412) displayed diagnosed mental pathology and 15.8 (n = 123), dual pathology.

Mental pathology is more prevalent among this typology of homeless people than in general population, as other studies prove.

The authors have not supplied their declaration of competing interest.

There exists a great number of empirical studies which refer as causes of homelessness not only individual factors such as mental disorders or addictions, but also structural factors such as poverty rates or unemployment.

To describe the evolution of the prevalence of homelessness in Girona from 2006 to 2015, and compare it with the evolution of unemployment in the same region.

The absolute number of homelessness is obtained from the official records in the city of Girona, which include the data of the open medium intervention team, the local police, and the specific municipal hostel. The rates are calculated on the annual totals of population. Correlations are used to compare quantitative variables.

The yearly homelessness rates increased progressively from 2006 to 2014, the year in which they began to decrease. Similarly, unemployment both in Spain and in the city of Girona in particular evolves in a similar way, with the burden of the worldwide economic crisis. There exists a positive correlation between the evolution of homelessness in Girona and unemployment both in Spain (r = 9.4, P < .001) and in Girona (r = 9.5, P < .001).

The effect of the economic crisis affects the people who are socially excluded in a direct way. These results prompt the investigation of the causes of homelessness, which in many cases are attributed to the responsibility of the individuals.

The authors have not supplied their declaration of competing interest.

Font de la Pólvora is a neighbourhood located on Catalonia, which has been one of the most important points of sale of heroin and cocaine in the country. The sale of drugs was also affected by the economic crisis, changing the behaviour pattern of patients with drug dependence.

To describe the changes in drug trafficking in this region and how these influence their consumption.

The investigation is carried out by the harm reduction outreach team, who selected, with a non-probabilistic method, a sample of 6 drug users. An in-depth semi-structured interview was conducted.

From 2006 to 2012, there existed up to 19 points of drug sale of heroin and cocaine. There are currently 2. The reasons behind the decrease are:

–the demand for cocaine decreases;

–the sporadic consumption of heroin decreases;

–with the decrease in demand, drugs lose quality.

With the housing bubble in Spain and the rise in foreclosures on behalf of banks, empty flats proliferated in the area, which were eventually occupied illegally. This fact prompts the production of cannabis.

Many of the strictly punitive actions in the control of narcotics lead to the dealers coming up with new ideas and new patterns of consumption which complicate the intervention of the teams working in the territory.

The authors have not supplied their declaration of competing interest.

Animal hoarding is considered an under-reported problem, which affects the welfare of both people and animals. Few reports on animal hoarding are available in scientific literature, particularly outside North America.

We designed a study to analyse cases of animal hoarding in Catalonia.

We wanted to expose the presence and consequences of this disorder in our area and to check for cross-cultural similarities with previous studies in other countries.

Data was obtained retrospectively from 23 case reports of animal hoarding in Catalonia collected by city councils and the Catalonian police from 1992 to 2015.

Thirty-three people (20 women and 13 men) and 1521 animals, mainly dogs and cats, were involved. Most cases (n = 13) involved a sole animal hoarder. Most cases (n = 14) were chronic (lasting longer than 5 years). Object hoarding co-morbidity was found in most cases (n = 17). All hoarders were over 40-years-old, with half of them aged over 65. Only in 4 cases was an intervention by the healthcare system reported. Most of the hoarders (9 out of 13) actively opposed animal removal. In more than 50% of cases, the hoarder's personal care, health and financial situation were precarious. No awareness of the impaired welfare of the animals was found in most cases.

To the author's knowledge, this is the first study on animal hoarding in Catalonia and one of the few available in Europe. Our results are aligned with previous research, adding evidence of cross-cultural common elements of animal hoarding.

The authors have not supplied their declaration of competing interest.

Huntington's disease (HD) is an autosomal dominant inherited neurodegenerative disorder, beginning in adulthood. HD represents the majority of patients who present the triad of motor, cognitive and psychiatric symptoms. The last two may be early manifestations, but the clinical diagnosis is based on motor symptoms and a positive genetic test for CAG repeat extension. The remaining patients that are negative for the HD genetic mutation may have HD phenocopies.

Illustrate the role of psychiatric assessment, discuss the psychiatric and behavioural manifestations, and management.

Illustrate the challenge of diagnosing HD in psychiatry.

A literature search was performed on PubMed database. The patient clinical record was reviewed.

We report a case of a 49-year-old male with a family history of HD (mother, uncle, cousin). He was diagnosed with a psychotic disorder fifteen years ago, hospitalised twice and thereafter treated as an outpatient with fluphenazine long-acting injection. He was a symptomatic for ten years. During the last year, he started showing dysphoria, marked irritability, stammering, inappropriate behaviour, poorly structured paranoid delusions, mild cognitive impairment and lack of insight. This was correlated with the beginning of functional impairment, both professionally and socially. Further assessment was performed: neurological evaluation, head CT scan and the genetic test was negative. He is clinically stable under haloperidol long-acting injection.

HD is a rare condition which is frequently under diagnosed, especially in early stages, due to lack of recognition of psychiatric symptoms. HD-like disorders should be considered if the clinical picture is obvious, but HD gene test result is negative.

The authors have not supplied their declaration of competing interest.

Frontal meningiomas are benign brain tumours known for their late onset. They may be presented by only psychiatric symptoms. Thus, the diagnosis at early stages can be missed or overlooked until the tumour causes neurological deficit.

We report the case of a 61-year-old man, receiving a treatment and a follow-up for bipolar disorder for 11 years. He has history of 3 major depressive episodes, 2 suicide attempts and a manic episode. The symptoms were initially well controlled by medication. Since 6 months, the patient started to experience atypical symptoms: he had presented disinhibited and aggressive behaviour, psychomotor instability, pyromania and self-neglect. The patient did not respond to treatment despite repeated adjustments. A frontal syndrome was suspected. Cerebral CT scan revealed an unexpected mass measuring 6.8 cm × 5.6 cm at the right frontal area, suggestive of a giant meningioma (Fig 1).

Generally, once diagnosed, psychiatric disorders are rarely revised. Consequently, “silent” tumours such as frontal meningiomas can be overlooked. Neuroimaging should be considered in case of new-onset psychiatric symptoms, atypical or change in clinical presentation.

The authors have not supplied their declaration of competing interest.

Care-giving practices by family members have inherent value and importance in the provision of care for patients with schizophrenia. There is dearth of assessment tools that focus on practices followed by caregivers’ while dealing with their relatives with schizophrenia, especially from India.

To develop a tool for the assessment of ‘care-giving practices’ followed by family members while caring for their patients with schizophrenia.

(a) To construct a reliable and valid tool on ‘care-giving practices’ followed by family members while caring for their patients with schizophrenia; (b) To determine the various ‘good’ and ‘bad’ practices within this tool.

Initial detailed literature (Pubmed, Goggle search with input by the caregivers generated a list of 24 commonly used practices; which was shortened to 17 statements whose face validity was tested by 14 mental health professionals. Hindi translation with ‘test-retest’ reliability was conducted. Finally, ‘Consensus based approach’ was adopted by the mental health professionals to arrive at objective (b) i.e. statements reflecting ‘good’ or ‘bad’ practice.

Final questionnaire comprised 15 statements with adequate face and content validity and high test-retest reliability (Cronbach's alpha = 0.747). 6 items reflected ‘good’ and 9 reflected ‘poor’ practice respectively with maximum score of 15; and categorization from ‘very poor’ to ‘very good’ practices.

This preliminary yet simple and easy to use tool will give better understanding about how family members provide ‘care-giving’ practices for patients with schizophrenia. However, this needs further validation, replicability, and possible modifications in a multi-cultural, multi-linguistic country like India.

The authors have not supplied their declaration of competing interest.

The aim of this study was the effectiveness of emotion regulation and distress tolerance skills on improving coping strategies and reduce perceived stress in prisoners in Foman city in Iran.

The study population was consisted of 200 prisoners of Foman Penitentiary in 2016. Then, 30 prisoners were selected randomly in two groups (15 persons each group) were replaced. Emotion regulation and distress tolerance training was given to the experimental group for 12 sessions and the control group were in waiting list. Both groups at baseline and end of intervention phase filled coping responses inventory Bellinger and mouse and Cohen perceived stress questionnaire – version 14 questions (PSS-14). Data were analysed by using the software spss22.

Emotion regulation and distress tolerance skills have been effective on Improving problem-focused coping strategies and reduce perceived stress in prisoners (P < 0/001).

emotion regulation and distress tolerance skills can improve problem-focused coping strategies and reduce the use of emotion-focused coping strategies and perceived stress in prisoners.

The authors have not supplied their declaration of competing interest.