The authors have not supplied their declaration of competing interest.

Several studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.

Despite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.

We present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.

Our limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.

Despite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.

A mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.

The authors have not supplied their declaration of competing interest.

Sickle cell and thalassemia (haemoglobinopathies) are autosomal recessive inherited conditions that affect haemoglobin and as chronic diseases, stress, anxiety and depression are comorbid conditions.

To examine possible biopsychosocial factors affecting stress, anxiety and depression symptoms in these patients.

To investigate whether different condition related markers, contribute to the psychological symptomatology.

A total of 97 patients participated in the study, 21 males (21.6%) and 76 females (78.4%), with a mean age of 44.35. Convenience sampling method was used and participants were recruited from the General Hospital of Nikaia, ‘Ag. Panteleimon’, in Athens, Greece. DASS and MFI scales were used to measure the dependent and independent variables. Data were analysed with the SPSS 21 software.

Multivariate analysis revealed that days between transfusions (beta = −0.454), reduced activity (beta = 0.350) and age (beta = −0.207) explained 30.1% of the variance in Stress [F(3.91) = 13.04 R2 = 0.301 P = 0.03]. Reduced activity (beta = 0.417) and days between transfusions (beta = 0.318) explained 30,3% of the variance in Anxiety [F(2.92) = 19.96 R2 = 0.301 P = 0.03]. Finally reduced activity (beta = 0.334), days between transfusions (beta = 0.364), and reduced motivation explained 41.3% of the variance in Depression [F(3.91) = 21.34 R2 = 0.413 P = 0.03]. Levels of ferritin, haemoglobin, age and present condition of health had a NS effect in the models.

Similar factors were found to affect stress, anxiety and depression in the sample, with days between transfusions and reduced activity being the major factors affecting the psychological symptoms in haemoglobinopathy patients. More research is needed in order for all the biopsychosocial factors to be revealed in this field.

The authors have not supplied their declaration of competing interest.

In Albania, at the current time, no research has been conducted to assess students’ risk for depression, anxiety and stress.

To explore which group of students are at risk for depression, anxiety and stress.

The aim of this study is to explore the symptoms of depression, anxiety and stress among students according to the 42-item Depression Anxiety and Stress Scale (DASS-42).

The DASS-42 was translated from English to Albanian, culturally verified, back-translated and administered to 570 students in university campus of Tirana district. Exploratory factor analyses (EFA) and Cronbach's alpha, were performed to identify the psychometric properties of the Depression, Anxiety, and Stress subscales and the overall scale.

EFA with equamax rotation indicated that the 42 items loaded on three factors accounting for 53.2% of the total variance, 19.9% for depression, 17.6% for anxiety and 16.7% for stress subscale. The internal consistency coefficients were high, ranging from 0.90 to 0.93 for subscales and 0.96 for the scale. The mean score of females for the overall scale M = 28.0 (± 36.3 SD) was significantly higher as compared to males, M = 22.9 (± 36.5 SD), (t = 2.6, P < 0.01). Females also had a significant higher score M = 11.5 (± 12.8 SD), for depression as compared to males M = 8.7 (± 12.6 SD), (t = 2.4, P = 0.02), whereas no difference was found with regard to anxiety (P = 0.2) and stress subscales (P = 0.07).

Female students, students from rural areas and married individuals have more total scores for depression, anxiety and stress symptoms.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Conversion disorder is a condition defined by the presence of symptoms of altered voluntary motor or sensory function, not intentionally produced or feigned, presumed to be the expression of a psychological conflict or stressor, but mimicking neurological diseases or other medical conditions, that must be excluded before this diagnosis is made. The suspicion of conversion disorder arises when clinical findings are incompatible with the suggested neurological or medical conditions and there is a temporal relation between the onset of the symptoms and a psychological stressor. However, when these hints are absent, diagnosis may not be clear and require wider workup.

To make a brief review on conversion disorder and present an illustrative clinical-vignette.

We collected information from medical records and interview with the patient and made a research on PubMed with the MeSH terms “conversion disorder”.

We present a 51-years-old female outpatient with episodes of paralysis of left upper and lower limbs. Some months before the onset of these symptoms, her daughter came to live with her. Their relationship became very conflictual. Electroencephalogram, laboratory and imaging studies were normal. She did not tolerate the antidepressants tried (SSRI, SNRI and trazodone), but reported to feel better with amisulpride and alprazolam.

Widely discussed in the past as “hysteria”, conversion disorder is still intriguing, because little is known about the link between body and mind, making the management of patients with this disorder challenging and highlighting the need for more studies on the topic.

The authors have not supplied their declaration of competing interest.

There is a lack of attention on generalized anxiety disorder (GAD) in the psychiatrists’ education programs in Russia. The consequence of this is difficult to estimate because of insufficiency of the GAD epidemiology in Russia.

Are estimation of the comparative prevalence of diagnosis of GAD among other anxiety and stress related disorders; psychiatrists’ knowledge about GAD and theirs therapeutic approaches.

The invitations to survey were sent by e-mail to members of the Russian Society of Psychiatrists; 888 psychiatrists took part in the survey. Twenty-six percent of them worked in inpatient departments, 43% – in outpatient departments, 15% – in somatic services, 17% – researchers and university professors.

A total of 83% of respondents have diagnosed GAD at least once during last year. Most often GAD was diagnosed by psychiatrists of somatic services. Mixed anxiety and depressive disorder was diagnosed in 2.5 times more often than GAD; adjustment disorders – in 2.1 times. Doctors have noted that among their patients with other mental disorders 26% have chronic anxiety, but most of doctors do not establish the comorbid diagnosis of GAD for these patients. Only a quarter of doctors consider that detachment of GAD from other anxiety disorders is based on the features of etiology and pathogenesis. In the treatment of GAD together with SSRIs, SNRIs, and pregabalin prescribing, doctors often prescribe benzodiazepines, atypical anxiolytics (hydroxyzine, buspirone) and low-potency antipsychotics (alimemazine, chlorprothixene).

Increasing attention to GAD in the psychiatrists’ education programs may improve diagnosis and treatment of this disorder in Russia.

The authors have not supplied their declaration of competing interest.

Deep brain stimulation (DBS) is a neurosurgical procedure under investigation for a range of psychiatric and neurological disorders. One of them is obsessive compulsive disorder (OCD), which is a neuropsychiatric illness that often develops in childhood, affects 2% of the general population and causes significant impairment across the lifespan. Some cases are refractory to pharmacotherapy and psychotherapy and that is why new treatments have been investigated over the last decades.

In this paper, we intent to do a review of the literature about the efficacy of DBS in the treatment of OCD.

We present a literature review of some scientific articles found on Pubmed search using “deep brain stimulation and obsessive compulsive disorder/DBS and OCD”.

Clinical outcome of DBS for OCD shows robust effects in many studies. It appears that most patients regain a normal quality of life after DBS, reporting changes in perception, feeling stronger and more confident, and doing things unreflectively. It seems that DBS is a valid alternative to lesional ablative neurosurgery for severe, therapy-refractory OCD patients, although with partially discrepant results probably related to differences in anatomical targeting and stimulation conditions.

DBS seems to be a promising modality for the treatment of some refractory psychiatric disorders such as OCD, but the search for the best target still continues. Randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions.

The authors have not supplied their declaration of competing interest.

Whether anxiety and depression are associated with hypertension and to what extent is not clear.

The aim of the present study was to assess any differences in the prevalence of anxiety and depression among different groups of hypertensive patients.

The study cohort comprised of 127 patients (75 male, mean age 54 ± 14) who underwent assessment of their blood pressure levels and were divided in four groups: group I (normotensives, n = 34), group II (stage 1 HTN, n = 33), group III (stage 2 HTN, n = 30) and group IV (stage 3 HTN, n = 30). The evaluation of anxiety disorder was made by means of Hospital Anxiety Depression Scale (HADS), while the evaluation of depression was made with the Beck Depression Inventory (BDI). Statistical analysis was done with SPSS for windows. P-value was set at 0.05 for differences to be considered significant.

Comparing the four groups of patients there was a significant difference both in BDI (8.6 ± 7.0 vs. 11.6 ± 10.4 vs. 27.1 ± 5.8 vs. 32.4 ± 3.9, P < 0.0001) and HADS (10.2 ± 7.2 vs. 9.7 ± 7.0 vs. 16 ± 4.7 vs. 27 ± 5.1, P < 0.0001). We proceeded to comparison among the 4 groups and there was a significant rise in the BDI and HADS in three of the four groups group II > group III > group IV, P < 0.0001.

These data suggest that there is a clear burden of anxiety and depression as the levels of BP increase. This finding is of important clinical significance as it could contribute to a different approach of hypertensive patients. A larger cohort study could enlightened the mechanisms involved.

The authors have not supplied their declaration of competing interest.

There has been an attempt to associate anxiety and depression with arterial stiffness. In the present study, we assessed differences in arterial stiffness among 3 groups of hypertensive patients compared to control normotensives as well as possible association with anxiety and depression scoring system.

The study cohort comprised of 127 patients (75 male, mean age 54 ± 14) who underwent assessment of their blood pressure levels and were divided in four groups: group I (normotensives, n = 34), group II (stage 1 HTN, n = 33), group III (stage 2 HTN, n = 30) and group IV (stage 3 HTN, n = 30). The evaluation of anxiety disorder was made by means of Hospital Anxiety Depression Scale (HADS), while the evaluation of depression was made with the Beck Depression Inventory (BDI). Arterial stiffness evaluation was done with Cardio-Ankle Vascular Index (CAVI). Statistical analysis was done with SPSS for windows. P-value was set at 0.05 for differences to be considered significant.

Both CAVI R and CAVI L indices were significantly higher as the severity of hypertension progressed (P < 0.001). BDI score was significantly correlated with CAVIR (Pearson r = 0.53, P < 0.0001) and CAVI L (Pearson r = 0.39, P < 0.0001). HADS score was also significantly correlated with both CAVIR (Pearson r = 0.53, P < 0.0001) and CAVIL (Pearson r = 0.43, P < 0.0001).

There is a burden in the arterial stiffness of this population with the increase of the levels of BP which is not surprising. However, the new finding is that there is a strong correlation with arterial stiffness indices and both anxiety and depression scoring system.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Up to 50% of patients with OCD have failed to respond in SSRI trials, so looking for pharmacological alternatives in treatment of obsessive compulsive disorder (OCD) seems necessary.

Surveying duloxetine augmentation in treatment of resistant OCD.

Study the effects of serotonin-norepinephrine enhancers for treatment of OCD.

This augmentation trial was designed as an 8-week randomized controlled, double blind study. Forty-six patients suffering from OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure.

Forty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement over the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 and P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS.

Our double blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in resistant OCD patients. However, it needs to be noted that our study is preliminary and larger double blind placebo controlled studies are necessary to confirm the results.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Increased statistics of prostitution and reduced age of prostitutes at the world and as a result, prevalence of diseases such as AIDS and other diseases has gained attention of scholars to the problem of prostitution and relevant problems. Hence, the main objective of this study is to analyze the correlation between object relations and attachment style in prostitutes in Iran.

Applied method in this study is correlation. Statistical population in this study consists of prostitutes of Tehran, Mashhad, Kerman, Tabriz and Mazandaran and statistical sample consists of 317 women selected using simple random sampling method in 2015. For purpose of data collection, Bell Object Relations and Reality Testing Inventory (BORRTI) and Hazan and Shaver attachment styles questionnaire are used. The data were analyzed using multivariate regression and Pearson correlation in SPSS-22.

The results showed that there is significant correlation between object relations and attachment styles in prostitutes (P < 0.01).

Object relations scales (incompetence, self-centeredness and alienation) are correlated to insecure attachment styles in prostitutes.

The authors have not supplied their declaration of competing interest.

To determine gender differences in prevalence of anxiety traits in general population and to evaluate its impact on the risk of hypertension in men and women aged 25–64 years in the open population in Russia/Siberia.

Under the third screening of WHO program “MONICA-psychosocial” a random representative sample of the population aged 25–64 were surveyed in Novosibirsk in 1994 (n = 657 men, n = 870 women). Anxiety levels were measured by means Spielberger test. Over the 16-year period were identified 229 cases of AH in women and 46 for men. Cox-proportional regression model was used for an estimation of hazard ratio (HR).

In general population aged 25–64 years at 99.5% of women and 97.5% of men had moderate and high levels of anxiety traits. In univariate Cox regression analysis model the risk incidence of arterial hypertension in women and men with high level of anxiety was 2.383-fold and 5.18-fold higher, respectively, over 5 years of follow-up. It was 1.853-fold and 5.75-fold higher over 10 years and 1.45 and 3.82 times higher over 16 years after baseline. In the multivariate Cox regression model HR of hypertension was 1648 in women with high level of anxiety; and it was 4.568-fold higher in men.

Despite the higher prevalence of HLA in women, the risk of developing hypertension is much higher in males.

The authors have not supplied their declaration of competing interest.

The Depression, Anxiety and Stress Scales are widely used in clinical and non-clinical populations, both in research and clinical settings. The need for briefer but valid and reliable instruments has motivated the reduction of the original 42-item scale to a short 21-version. On Portuguese samples, Pais-Ribeiro et al. (2004) found that the original 3-factor solution (stress, anxiety and depression) explained 50.35% of the variance and in an exploratory analysis; Xavier et al. (2015) presented a two factor solution and a modified three-factor solution with a sample of pregnant women, both with adequate factors’ reliability (< 0.70) and explaining above 50% of the variance.

Based on the previous results of factor analysis with Portuguese samples, the present study aimed to perform confirmatory factor analyses (using Mplus software) to evaluate which dimensional structure best fitted the data.

The sample comprised 234 students (78.2% female), between 18–26 years old (M = 20.55; SD = 1.66). Eighty-five percent of the participants were on their first three years of college education. Participants filled the Portuguese version of the DASS-21.

Our results showed that the original 3-factor structure had the best model fit [χ2(186) = 475.465, P < 0.05; RMSEA = 0.082, 90% CI = 0.073–0.091; CFI = 0.918; TLI = 0.908; SRMR = 0.05]. Good reliability was found for all subscales (0.92 for stress, 0.87 for anxiety and 0.91 for depression subscale).

The DASS-21 is a reliable instrument that, with student populations, seems to have better performance when used with a 3-factor structure. Further research is needed to confirm this structure in Portuguese clinical samples.

The authors have not supplied their declaration of competing interest.

Psychogenic nonepileptic seizures (PNES) are defined as a somatoform conversion disorder manifesting as paroxysmal events not associated with electroencephalographic (EEG) epileptiform correlates. This entity is poorly understood and often misdiagnosed as epilepsy. It is important to recognize that misdiagnosis leads to inappropriate use of antiepileptic drugs, which may worsen the course of the disease.

Recent studies have suggested that the frequency of psychogenic nonepileptic seizures ranges from 10 to 23% of referrals to a pediatric epilepsy center, as well as 60% of children with PNES achieve symptom improvement and event freedom of symptoms following appropriate treatment.

The aim of this study is to conduct a literature review of studies which the purpose was better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting.

A early identification of the risk factors for comorbid psychopathology, diagnosis and appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.

The authors have not supplied their declaration of competing interest.

Case presentation of a young woman Ms. A.M., referred by her GP with an eating disorder, who was thereafter diagnosed with an uncommon type of phobia (emetophobia – a specific phobia of vomiting) and treated accordingly.

To highlight the diagnostic dilemma with such uncommon cases, who are often misdiagnosed as having anorexia nervosa or bulimia nervosa or suffering from other anxiety disorders (like OCD or GAD).

A comprehensive mental state examination was conducted including a diagnostic clarification interview. She was followed up by the mental health team on a regular basis with support and also providing appropriate psychotherapy.

Ms. A.M. refused medications and only agreed to non-pharmacological treatment. She was therefore commenced on once weekly psychotherapy (CBT), which she undertook for a period of 4 months. She showed good response to the psychotherapy with significant attenuation of her core symptoms, although she still continued to exhibit some avoidance behaviors.

This particular patient showcases a relatively uncommon and often misdiagnosed specific phobia (emetophobia) and highlights the positive response seen in this case with psychotherapy.

The author has not supplied his declaration of competing interest.

In adolescence, social anxiety (SA) and anti-vital and suicidal behavior (AB and SB) constitute a single syndrome.

The aim is to define the role of SA and its components in shaping adolescent AB, with a subsequent risk of SB.

A total of 981 adolescents participated in the survey. The authors’ proprietary Anti-vitality and Resilience Questionnaire and Social Anxiety and Social Phobia Questionnaire; statistic methods: ANOVA, Correlation analysis.

Twenty-four percent from the sample have high SA levels, and 21.8% have clinical SA levels connected with high risk of AB and SB. Adolescents find themselves in unstable conditions of the psychological field reorganization (crisis), and they are in need of actualization of means to satisfy their social motives. It makes them vulnerable to mental disorganization under evaluation conditions, and the situation is aggravated with the absence of internalized mental regulation tools. AB, SB is higher, the higher the SA in adolescents is. SA as a subjective perception of insufficient means to influence the surroundings in order to satisfy social needs can play one of the key roles in the accumulation of negative affect in the system of mental activity, and lead ultimately to its failure.

Inability to satisfy their actual motives, lack of strategy for self-realization and dealing with failures, and inability to keep the targeted priority in evaluation situations lead to feeling loss of life purpose and negative evaluation of the future and shape AB, SB.

The research was supported by Russian Science Foundation (Altai State University).