The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

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

Aggression and violence are common phenomena, potentially experienced by everyone.

To demonstrate that coping patterns to face aggression and violence may exhibit differential group features.

To find differences in coping styles during moments of high aggression in psychiatric patients compared to non-affected controls.

We evaluated 34 outpatients from the section of psychiatry of university Federico II of Naples by two psychometric scales: AQ to evaluate aggression levels and Brief-COPE for coping patterns. Outcomes were compared with that of 34 non-affected controls, recruited from the university student population. Pearson's correlation was used to find relationships between aggression levels and coping skills in these two groups.

We found significant differences between groups in multiple scale items and in the correlation measures, e.g. the use of expression was completely reversed in this two samples according to aggression levels.

These results show that aggression is experienced differentially and with different coping styles by psychiatric patients compared to non-affected controls.

The authors have not supplied their declaration of competing interest.

Patients with psychosis often present with cognitive dysfunction during the course of their illness. Inflammatory markers such as cytokines and neurotrophins have been investigated, as they are relevant to the change in cognitive function.

To evaluate the cognitive function between patients with acute psychosis and those without. Moreover, this study also investigates cytokines and neurotrophins levels in acute psychosis and their relation with cognition, severity of psychosis and trajectory of their levels across time and under treatment.

Longitudinal, observational, pilot study, of psychiatric inpatients. Participants were assessed on the first day using brief psychiatric rating scale, CAGE, trail making test B and Wisconsin card sorting test. These assessments were repeated weekly until patients were discharged. Blood samples were also collected on the same day for cytokines and neurotrophins analysis. However, the result on cytokines and neurotrophins levels is still pending, therefore only clinical findings will be presented.

Thirty-one patients (mean age: 43.7, SD: 18.9, 14 females and 17 males) were recruited. Eleven were acutely psychotic. Generalized estimating equations modelling were used to compare these two groups based on cognitive and demographic variables. Patients with psychosis are more likely to have significantly lower scores for CAGE (Wald-x2 = 6.268, df = 1, P = 0.012), significantly more abnormal scores in Trail Making Test B (Wald–x2 = 7.338, df = 1, P = 0.007), failure to maintain set (Wald–x2 = 8.323, df = 1, P = 0.004) and perseveratives errors (Wald-x2 = 4.385, df = 1, P = 0.036) although they have more years of education than those without psychosis.

These data show individuals with acute psychosis have impaired cognitive function compared to others.

The authors have not supplied their declaration of competing interest.

Although, disturbances of sleep, as well as aggressiveness, have been described in patients with mood disorders, these patients may not be aware of them.

To access the personal perception of sleep, disturbances and aggressiveness in patients with mood disorders, admitted to an acute psychiatric ward.

Diagnostic data (ICD-10: F31–33), including mood evaluation, were prospectively collected for all patients admitted at the affective disorder ward at Centro Hospitalar Psiquiátrico de Lisboa (Portugal), during the third trimester of 2016. Then, 2 auto-questionnaires – Athens insomnia scale (AIS) and Buss and Perry aggression scale (both validated to the Portuguese population) – were applied to these patients. Statistical analysis was performed for possible correlations between patients’ mood and the questionnaires’ scores, using R software.

Thirty-eight patients admitted were enrolled in this study: 28 with bipolar disorder (19 manic, 4 depressive and 5 mixed episodes), and 10 with depressive disorder. Depressed patients presented statistically higher values in the AIS (average = 20), compared to manic (14) and mixed ones (17.2) (P = 0.031). However, there were no statistical differences found between depressed patients (bipolar versus non-bipolar). Even though manic patients presented an increased average score in the Buss and Perry questionnaire (both total–65; but also sub-scores), these values were not significantly different than depressed (60) or mixed patients’ scores (57.4).

Even though some symptoms (like sleep or aggressiveness) seem to be relevant to the clinics, patients with affective disorders do not seem to be aware these disturbances, and therefore are not able to acknowledge their relevance.

The authors have not supplied their declaration of competing interest.

Smoking causes many life-threatening diseases and is a major risk factor for several main causes of death. Damage by smoking is also caused to those called “passive smokers”. Passive smoking has been implicated in many adverse effects on health. Very few studies deal with empathy in smokers while smoking in the presence of non-smokers.

Estimation of empathy and psychological characteristics of Greek smokers.

For research purposes we used questionnaires Toronto empathy questionnaire (TEQ), symptom check list 90-R, experience of shame scale (EES) and other as Shamer scale – OAS.

A statistically significant difference has been observed in the TEQ to gender (2.436, 0.02), with women showing the highest value (3.4 ± 0.4), as well as in the mean in behavioral shame 2. Another statistically significant difference has been observed in behavioral shame between educational level (3.419, 0.026) and the price of characterological shame among those who reported smoking in the workplace and those who did not.

The sample consisted of 27 subjects with average age 24 years and standard deviation of 4 years. Smokers accounted for 48.1%, of whom 69.2% stated that smoke in their living space. Respectively, the percentage of smokers in the workplace was equivalent. The largest percentage of smokers, (13 people, 69.2%) think that non-smokers are very annoyed when surrounded by people smoking close to them. The proportion of those who said they are very much bothered when in places where smoking is prohibited but somebody smokes, is large (47.1%).

The authors have not supplied their declaration of competing interest.

Cotard syndrome (CS) is a rare neuropsychiatric condition characterized by nihilistic delusions, which may range from negation of existence of parts of the body to delusion of being dead or negation of self-existence, and it requires an urgent and appropriate therapy.

Our objective is to highlight the importance of CS, reinforcing that medical professionals should be aware of this pathology to prompt clinical description, diagnostic and treatment.

The aim of this presentation is to alert psychiatrists to this remaining syndrome.

Review of phenomenological and theoretical issues regarding SC.

CS can be found in numerous psychiatric or neurologic pathologies but it is most seen in patients with severe depression. It is typically divided in three subtypes: psychotic depression, Cotard type I, with nihilistic delusions without mood symptoms, and Cotard type II, with mood symptoms and auditory hallucinations. There are numerous etiological hypothesis mechanisms, including unusual perceptual experiences, which can similarly be involved in Capgras delusion, disconnection from emotional or limbic processes, an impaired belief evaluation or a tendency to excessive self-attribution. Frontotemporoparietal circuitry also seems to have an important role in its pathology. Treatment usually involves electroconvulsive therapy, antidepressants and anti-psychotics and the prognosis depends on the underlying disorders.

CS is a rare pathology with self-defeating risk and its clinical recognition and proper treatment are essential to improve the prognosis of these patients. Diagnostic criteria or clinical instruments for assessment of this syndrome should be encouraged, since its lack is a limitation for systematic studies and consequent management advances.

The authors have not supplied their declaration of competing interest.

Hoarding disorders (HD) have increasingly become a public health hazard. It usually emerges during two broad life periods: in early age-of-onset is usually associated with obsessive-compulsive disorder (OCD); in the elderly, it can be due to psychiatric and organic disorders, unrelated to OCD.

Our objective is to increase medical awareness and to highlight that both young and elderly people may suffer from this condition.

The aim of this presentation is to address HD and its different presentations.

Presentation of two clinical cases of HD and pathology revision.

A 30-year-old woman was hoarding litter, food and several items in a systematic way, become aggressive when her family tried to clean the house and was admitted several times in a psychiatric facility for cleanliness of her house. She had a history of depressive symptoms and severe OCD, with obsessive thoughts and several verification behaviors. A 78-year-old woman, with history of cerebral vascular disease, was self-neglected, living in a filthy home, with hoarding of litter and many worthless objects in a disorganized way, become aggressive after her relatives try to enter her house and refused to get help of any kind. Later on, she was admitted in a psychiatric facility and diagnosed with vascular dementia.

Timely diagnosis and proper management of these two variations of HD will allow more advanced studies in this matter and more effective pharmacological and psychotherapeutic treatments. These clinical cases reinforce the importance of practical guidelines for appropriate approach of these patients with complex and multidimensional needs.

The authors have not supplied their declaration of competing interest.

Individual's personality profile is one of the major determinants of one's behavior. Thus, poor personality disposition of fathers and the child's perception of father have been reported to be powerful predictors of subsequent delinquency and criminal offences. The externalizers resemble the dimensions of conduct disorder as prescribed in diagnostic statistical manual IV. The essential feature is their repetitive behavioral pattern wherein the basic right of others or major age appropriate societal norms are violated.

This study finds out the relationship between the fathers’ personality-disposition, having male children with conduct disorder (CDC, n = 30, experimental group), dysthymic disorder (DDC, n = 30, control group), and normal (NC, n = 30, control group), by applying the new five factor inventory, and children's perception of their fathers on the parent–child relationship scale.

The children were matched on age, sex, socio-economic status and other relevant variables. The CD and DD were selected on the DSM-IV criteria for the diagnosis of conduct disorder and dysthymic disorder. The fathers of each group of children were administered the aforesaid questionnaires.

The CDF showed only significantly poor agreeableness compared to the NF. The CDC's perceived their fathers most negatively compared to the DDC and NC. The CDF's conscientiousness was significantly correlated to a number of variables of the children's perception of them as observed on the PCRS.

The CDF showed lower agreeableness than the NF. The CDC perceived their fathers most negatively, hence, setting the model for the child to observe and learn socially inappropriate behavior.

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

Influence of repetitive watching of films of fiction and horror genres on onset phenomenology in young adults.

Two case reports on onset of psychotic features and mixed anxiety depressive phenomenology were seen in two patients aged 16 and 20 years respectively and based on the fantastic imagination created by films. The 28-year-old female patient diagnosed with schizoaffective disorder had onset at 16 years of age and the course of phenomenology was influenced by the fiction movie ‘Jumanji’ with partial response to medications over 10 years. The depressive and anxiety symptoms of less than 6 months duration of a 20-year-old male patient was influenced by film ‘Hannibal’ and responded to antidepressant and cognitive behavior therapy.

Horror and fiction films can influence the thinking patterns and attribution styles of a young adult by stimulating fantasy thinking which if unrestrained can lead to phenomenology. Viewing films compulsively, obsessive ruminations on horror and fictional themes can lead to onset of psychopathology of both psychosis and neurotic spectrum. Further research on neurobiological, psychological correlates is needed. Parental guidance and restricted viewing of horror genre films with avoidance of repeated stimulatory viewing of same genre movies in children, adolescents, young adults and vulnerable individuals is required.

The authors have not supplied their declaration of competing interest.

Behavioral addictions are conceptually controversial and their relationship with mental health problems and psychopathology is poorly understood.

To review the relationships between personality traits, mental health issues and mental disorders on one hand and several behavioral addictions on the other. The latter include problematic Internet use, Internet gaming disorder, hypersexual disorder/compulsive sexual behavior disorder, compulsive buying and exercise addiction.

Literature review and conceptual synthesis.

Mental health issues, personality dimensions and mental disorders are commonly associated with behavioral addictions. Although some relatively specific associations were found (e.g., between Internet gaming disorder and attention deficit/hyperactivity disorder, between compulsive buying and pathological hoarding and between exercise addiction and eating disorders), the specificity of most associations was low. Most studies were cross-sectional and the direction of causality, if any, was uncertain. Therefore, it is unknown under what circumstances certain mental health issues predispose to the particular behavioral addiction or represent a primary problem and when they are a consequence of behavioral addictions. This review also underscores the importance of distinguishing between certain behavioral addictions and overlapping conditions, e.g., between compulsive buying and bipolar disorder (mania/hypomania).

These findings suggest that proper conceptualization of behavioral addictions as distinct conditions or a manifestation of an underlying psychopathology will have to await results of the prospective studies. In the meantime, there are implications for treatment in terms of the importance of identifying and addressing the underlying or associated mental health problems in individuals with behavioral addictions.

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

A recent cohort study in the Netherlands and Belgium showed that 38% of children experienced psychological violence, 11% physical violence, and 14% sexual violence in sport (Vertommen et al., 2016). This study aims to explore the long-term consequences on anxiety, depression and somatic complaints in adults who experienced psychological, physical or sexual violence in the specific context of organized youth sport.

A web survey in a representative sample of adults, prescreened on having participated in organized sport before the age of 18 (n = 4043) was conducted. In this sample, depression, anxiety and somatic problems were assessed using the brief symptom inventory. A generalized linear model was used to quantify the impact of experiencing severe interpersonal violence in sport on psychopathology.

All three types of severe interpersonal violence (psychological, physical and sexual) were significantly associated with the total score and the subscales of the brief symptom inventory. The effect remains significant after controlling for socio-demographics, as well as disability, sexual orientation, adverse childhood experiences outside sport, recent trauma and family history of psychological problems.

Experiencing interpersonal violence against in youth sport is associated with mental health problems in adulthood. This is an important finding to consider in child protection policy in sport.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

For over 20 years, bupropion has been used as an antidepressant by inhibiting the norepinephrine-dopamine reuptake. Hyponatremia is a relatively rare condition that has been associated with the use of antidepressants including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). However, a few case studies have reported that bupropion was associated with hyponatremia.

To review available literature on bupropion-induced hyponatremia and its possible underlying mechanisms.

Case studies are presented and discussed followed by a literature review.

Hyponatremia has been reported with the use of many antidepressants, however, studies on bupropion induced hyponatremia has been limited. In literature only four case reports have been presented. Typically, this condition is only seen in frail or elderly patients. Possible mechanism is that bupropion may cause hyponatremia by the noradrenergic stimulation of vasopressin release.

Clinicians should be aware of increased risk of hyponatremia associated with antidepressants, including bupropion. Especially in the elderly, clinical symptoms of hyponatremia can be misinterpreted and may lead to a life-threatening condition.

The authors have not supplied their declaration of competing interest.

Quetiapine, a short-acting atypical anti-psychotic drug for the treatment of bipolar I disorder and schizophrenia, is increasingly used off-label for the treatment of sleep disturbances or insomnia. However, data supporting this off-label prescription of quetiapine are limited.

To report and discuss the effects of “off-label” use of quetiapine for the treatment of sleep disturbances.

An English-language literature search was conducted using Pubmed, EMBASE and Cochrane library (December 1980–December 2015) using the search terms quetiapine, insomnia, sleep disorders, sleep disturbances, and sleeplessness.

During the last decade, there is an enormous increase in prescribing quetiapine. This anti-psychotic drug is among the best selling drugs worldwide. For the approved indications, the usual therapeutic dose range is 400–800 mg/day. However, off-label use of quetiapine was most evident for the 25 mg/day to 100 mg/day. In some countries, off-label uses are promoted to non-psychiatrists for the treatment of insomnia, dementia, agitation, and aggression. Inappropriate anti-psychotic use may lead to serious health problems, including metabolic effects, increased sudden cardiac death, and age-related side effects with increased risk for orthostatic hypotension, fractures, pneumonia, cognitive impairment, and stroke.

There is growing concern regarding the potential harm from off-label prescription of anti-psychotics, particularly quetiapine. There is little evidence supporting the enormous off-label uses of quetiapine. In addition, prescribing quetiapine for indications that are not evidence based has ethical, financial, and safety implications, especially in the older population.

The authors have not supplied their declaration of competing interest.

In 2011, the FDA issued an alert recommending not to prescribe citalopram high doses, due to QT prolongation risk. We explored the clinical background of QT interval prolongation related to serotonin selective reuptake inhibitors (SSRI) use and the clinical implications of safety issues.

A review was conducted to clarify the mechanisms associated with the occurrence of TdP when using SSRI and investigating therapeutic measures to avoid/minimize these effects. The literature search was conducted in PubMed data reviewing articles between 2001 and 2016.

(1) Related to risk factors/intraclass differences: risk factors are increase in QTc interval ≥60 ms from the pretreatment value, advanced age, female sex, acute myocardial infarction and electrolytic abnormalities among others. Citalopram appears more likely than others to induce this phenomenon but its importance is under current debate. (2) Related to dose: drug-induced QTc interval prolongation and TdP was associated to citalopram in doses > 40 mg/day. However, psychotropic drug-induced sudden cardiac death may be an outlier in the absence of identified risk factors for QTc interval prolongation and TdP. (3) Related to poly-pharmacy/management: there is an additive effect when using SSRI and antipsychotics (EKG control is recommended in those cases). Cross-sectional studies showed that SSRI use was not associated with QT interval prolongation. This could be explained by the EKG intra-intersubject variability.

There is little evidence that drug-associated QTc interval prolongation by itself is sufficient to predict TdP. Future research needs to improve its precision to better understand the factors that facilitate/attenuate that progression. Clarifying this may lead to a safer SSRI use.

The authors have not supplied their declaration of competing interest.

The literature concerning possible cardio-toxic effects of lithium therapy in man is reviewed.

A review was conducted to clarify the mechanisms associated with the occurrence of conducting abnormalities when using lithium and investigating (if so) whether these alterations depend on the dose. The literature search was conducted in PubMed data reviewing articles between 1982 and 2015.

(1) Related to pathopsychiology/risk factors: reports indicate T wave morphology changes with lithium therapy. Of particular concern are cases of sinus mode dysfunction or sinoatrial block and the appearance or aggravation of ventricular irritability. The incidence of cardiac complications, in general terms, may increase with age. Recent findings (a retrospective study of bipolar patients) of lithium-associated hypocalcaemia showed that hypocalcaemia resulting from medical diseases and bipolar patients with lithium-associated hypocalcaemia had significantly higher frequencies of conduction defects. (2) Related/unrelated to dose: therapeutic and toxic levels of lithium have infrequently been associated with serious cardiac dysfunction. Several case reports demonstrate two important points about Brugada syndrome unmasking: electrocardiograph abnormality severity may correspond to lithium levels and unmasking may occur in the therapeutic range of lithium. Other report shows a case of lithium induced sinus-node dysfunction in a patient with serum lithium levels in therapeutic range.

Lithium abnormalities are rare and mostly not related to dose. Conducting heart anomalies may occur, especially when several factors are present (such as age or co-morbid illnesses that affect calcium serum levels).

The authors have not supplied their declaration of competing interest.