Although psychoactive substance use disorders (PSUD) belong to the domain of mental health, their management varies greatly among European countries. Furthermore, both the role of psychiatrists and trainees in the treatment of PSUD is not the same for each European country.

Among the context of the European Federation of Psychiatric Trainees (EFPT), the PSUD Working Group has developed a survey that has been spread out between the 15th of august 2015 and 15th of October 2016, at the aim of gathering information about the training in PSUD in Europe, both from Child and Adolescent, and General Adult Psychiatric (CAP and GAP) trainees.

The survey investigated, at European level, the organisation of the PSUD training, trainees satisfaction, attitudes towards people who use psychoactive substances, management of pharmacologic and involvement in common clinical situations.

A 70-items questionnaire regarding the aforementioned objectives was developed, and shared trough an online data-collecting system among European CAP and GAP trainees, with 40 trainees per country filling the survey in at least 25 countries. One national coordinator per country facilitated the delivering of the survey.

A total of 1250 surveys were filled from more than 25 European countries.

Data from the survey will be promptly analysed.

The survey will be the first to explore European psychiatric trainees attitudes and practices about PSUD. Findings from this independent survey may serve in understanding the needs of trainees in the field of substance misuse psychiatry.

The authors have not supplied their declaration of competing interest.

Comorbidity between mental and physical illnesses is very common and their possible interactions must always be taken into account. Hepatic disorders in particular, can affect the blood levels of antipsychotic drugs altering their effects on patients. Therefore, it is very important to assess in each case which treatment might be the most beneficial for the patient to avoid iatrogenic complications.

To review articles in Pub-Med and UpToDate about the possible iatrogenic complications that can arise using antipsychotic drugs in patients with hepatic disorders.

We describe the case of a 52-year-old male with Schizophrenia who was diagnosed of HCV infection ten years ago, for which he rejected any kind of treatment due to delirious ideation. In the past he was treated with oral Paliperidone with good tolerance, which he discontinued because of pour insight and stopped attending Psychiatric consultation. In April 2016 the patient was hospitalised suspecting a hepatocellular carcinoma.

During hospitalization he began treatment with long-acting injectable formulation of Paliperidone Palmitate that improved his insight. The patient agreed to perform the necessary tests to verify the suspected diagnosis, which was sadly confirmed. He achieved psychopathological stability, but unfortunately the patient died 6 months later because of his hepatocellular carcinoma.

Paliperidone is a good therapeutic option in patients with hepatic disorders because it is not metabolised by the liver. It also has a depot formulation that improves adherence in patients with low insight, reducing the danger of future psychotic decompensation and improving the long-term prognosis.

The authors have not supplied their declaration of competing interest.

To describe a rare case of Acromegaly presenting as psychotic disorder without neurological signs, in a 19 years old boy.

Single case report.

We describe the case of a 19 years old boy, that was taller than his peers and had started to grow his hands. He suddenly presented with an acute psychotic episode. He presented with persecutory delusions, perceptual abnormalities, disorganization and marked fluctuation in his behavior, he showed marked emotional liability, fluctuations in orientation and psychotic symptoms in the form of grandiosity, persecutory delusions and delusional misidentifications. At times, he was seen talking to himself, although he denied hearing any voices. There was no impairment of consciousness. His mood was irritable. An urgent CT and subsequent MRI scan revealed a pituitary macro adenoma, extending into the cavernous sinus. The initial diagnosis of prolactinoma was revised to acromegaly. His symptoms responded to combination of olanzapine and valproic acid, followed by trans sphenoid resection of the adenoma.

This case highlights the need for investigation, especially of neuroimaging, in atypical presentations of psychosis, which may be first manifestation of rare disorders like acromegaly. Despite a lack of information regarding the path physiology, this particular case emphasizes the importance of ruling out an organic cause for atypical presentation of psychosis.

The authors have not supplied their declaration of competing interest.

The comorbidity between obsessive-compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD) has been discussed for a couple of decades. Reported co-occurrence rates are highly inconsistent in the literature.

To review phenomenological and theoretical issues concerning concomitant OCD-ADHD.

Phenomenological and theoretical issues regarding OCD-ADHD comorbidity are reviewed.

Although numerous studies suggest an OCD-ADHD comorbidity, thus far etiological (i.e., genetic) background has been provided only for a pediatric comorbidity. High rates of co-occurrence may be mediated by the existence of tic disorders, and evidence of impaired neuronal maturational processes in OCD pediatric population may lead to probably transitory phenotypical expressions that look like ADHD symptomatology. Thus, it is possible that ADHD-like symptoms resulting from OCD-specific symptomatology may be misdiagnosed as ADHD. This may explain the lower co-occurrence rates reported in adolescents and adults.

OCD and ADHD are very different disorders in terms of pathophysiology, phenomenology, and treatment strategies. Several methodological concerns have been identified in our review. Future studies on OCD-ADHD comorbidity should try to mitigate these biases.

The authors have not supplied their declaration of competing interest.

Alcohol dependence belongs to one of the major risk factors to health worldwide. Alcohol consumption is a significant factor for mortality in the world: 6.3% in men and 1.1% in women. The alcohol use disorder is also very common: 5.4% in men, 1.5% in women. Despite its high frequency and severity of this disorder, only 8% of all alcohol dependents are treated once.

An interesting treatment option is geared toward reducing alcohol intake. Some patients in treatment for alcohol use disorder prefer an initial target of reducing consumption. Nalmefene, an antagonist naltrexone associated with opioid receptors, has been authorized in the European Union to help alcohol-dependent patients reduce their consumption. Antagonists’ opiate receptors are associated with reduced reward in relation to alcohol consumption, thus helping patients in reducing energy consumption.

A man of 39 years old, with a diagnosis of alcohol use disorder and depressive disorder and poor outcome despite different types of treatment (as aversive agents) was treated with nalmefene.

After a few months, nalmefene had a beneficial effect on the patient, with a significant reduction in the number of days of excessive alcohol consumption and total consumption in the sixth month. In addition, treatment was well tolerated, with no observed secondary effects.

Nalmefene appears to be effective and safe in reducing heavy drinking. Drugs such as nalmefene have demonstrated efficacy in association with a biopsychosocial approach to help patients achieve their personal objectives for this disorder.

The authors have not supplied their declaration of competing interest.

Modern psychiatry includes within its purposes to reintegrate patients into society. Our work's goal is to evaluate in terms of outcome, the current status of patients that underwent the rehabilitation program in a clinic in Centro Hospitalar Psiquiátrio de lisboa, in Lisbon.

The methods consisted of retrospective evaluation of the sample of patients that successfully completed the rehabilitation program between 2012 and 2015. Gender, age, provenience, previous and current socio-economic situations were taken into account.

Twelve patients concluded the program in the timeframe studied: 64 % males and 36 % between the ages of 36 and 40 and more than half were in homelessness situations. They progressed in increasing levels of autonomy and by the program's end, ten were dismissed and two were still waiting for housing. Ten of the patients are now living with their families or have been integrated in social housing program. Two await conditions to leave the hospital.

The program had a positive impact on the life of all patients that have engaged in it. Only two remain waiting social housing responses. Although the results are satisfactory, the number of patients admitted must improve in coming years.

The authors have not supplied their declaration of competing interest.

With this clinical case we want to show an example of diagnosis and treatment of a frequent psychiatric comorbidity in alcohol dependence: delusional jealousy.

We analyzed a clinical case of a 52-year-old man who has a voluntary drug intake promoted by a delusional jealousy to his wife in a context of chronic alcohol consumption. A bibliographic search is made about the comorbidity of delusional jealousy in alcoholism.

A 52 year-old man is brought to the hospital after to have a voluntary drug intake. He has not got medical history of mental health. As personal antecedents, the harmful alcohol consumption of the last 6 years in which he is unemployed is highlighted. After the clinical interview with the patient and with direct relatives (woman and daughter), we have the suspicion that it is a case of cellotipia induced by alcohol, in which the patient has made an autolytic attempt fomented by a delusion of jealousy. In this moment treatment is started. After a few weeks in which the patient starts treatment and leaves alcohol consumption, delusional clinic of jealousy refers progressively.

The alcoholic etiology of cellotipia has not been specifically confirmed. However, clinical experience shows this association is extremely frequent. It's a chronic delusional disorder with content of jealousy, providing interpretations and suspicions unfounded. Is added hostility to his partner, with potential risk of heteroagresivity. The most important thing is to assess the emotional and behavioral resonance of delirium. The treatment consists of indicating abstinence from alcohol and administration of neuroleptics.

The authors have not supplied their declaration of competing interest.

Symptoms of premenstrual dysphoric disorder (PMDD) recur during the premenstrual phase of the cycle and disappear to the beginning or after last menstruation. The main symptoms are emotional liability, dysphoria and anxiety.

To review PMDD for helping in the differential diagnosis between this disease and classical anxiety disorders.

It was made a clinical review about differential diagnosis and comorbilities on PMDD in specialized literature and Pub-Med.

PMDD causes significant distress and impairment in social or occupational functioning the first week following menstruation. In relation with differential diagnosis on PMDD, on the one hand, several organic diseases could produce the same symptoms than PMDD: for example gynecological pathology as dysmenorrhea or menopausal transition, endocrinological diseases as hypothyroidism and hyperthyroidism and some hormonal treatment including hormonal contraceptives. In addition, a variety of medical disorders are concomitant pathologies that could be associated with PMDD (eg, migraine; epilepsy, asthma, allergies, systemic exertion intolerance disease, chronic fatigue syndrome; irritable bowel syndrome). These pathologies are exacerbated just before or during menstruation. On the other hand, several psychiatric disorders as bipolar disorder, major depression, dystimia, and anxiety disorders could get worse on the premenstrual phase.

In relation with the diagnosis of PMDD, it seems necessary to consider various differential diagnosis such as psychiatric, gynecological and endocrine disorders because of all of them share like symptoms. For this purpose it is very important to make both a good clinical history and a comprehensive physical examination to offer the most accurate diagnosis and treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Patients with mental illness have an increased risk of morbidity and mortality from somatic complications, with a reduction in life expectancy of 15 to 30 years. During hospitalization in a psychiatric setting multiple risk factors can combine and contribute to a severe deterioration in the general condition of patients who may require reanimation.

Describe the profile of patients admitted to Razi who required transfer to an intensive care setting during hospitalization to more precisely determine the predictors of severe somatic decompensation.

A descriptive retrospective study of patients transferred from the Razi hospital to the emergency medical assistance center (CAMU) during the period between 1 January 2014 and 31 December 2015.

The average age of patients was 39.5 years; 64.2% of the patients were men, 60% had a low socio-economic level, 34.7% had a comorbid disease. Forty-one percent (41%) of the patients transferred had been diagnosed with schizophrenia, and 27% had bipolar disorder. Antipsychotics were the most prescribed psychotropic drugs. High doses were used with therapeutic combinations in 85% of the cases. A toxic cause was identified in 58% of cases, including neuroleptic malignant syndrome in 18%. Dehydration and ionic disorders are among the most frequent causes in 27% of cases. Conclusion; Identifying risk factors for deaths in psychiatric hospitals highlights needed changes in psychiatric management strategies taking into account the patient's characteristics as well as the drugs’ safety profile.

The authors have not supplied their declaration of competing interest.

It has been well documented that generalized anxiety disorder (GAD) can co-occur with mood disorders and other anxious disorders, particularly panic disorder (PD). These comorbidities can complicate therapeutic management and burden the prognosis.

To highlight the relationship between GAD and panic and depressive disorders.

We conducted a cross-sectional study, among 250 subjects consulting in 6 primary care units in Sfax, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. The diagnosis of GAD and PD were assessed by the “Mini International Neuropsychiatric Interview” of the DSM-IV. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).

The average age was 39 years. The sex ratio M/F was 1/2.

The GAD was diagnosed in 10.8% of participants. The mean IDB score was 3.8. According to this scale, a mild depression was noted in 23.6%, moderate 12% and severe in 2.8% of cases. The GAD was statistically associated with psychiatric histories (P = 0.009), particularly depression disorder (P = 0.004) and the history of suicide attempt (P < 0.001).

The IDB score was significantly higher in participants with GAD (P < 0.001). Among them, 74% presented moderate to severe depression.

GAD co-occurs with PD in 22.2% of cases. This association was statistically significant (P < 0.001). Participants presenting GAD- PD comorbidity are at higher risk of developing depression (P = 0.003).

One must always think to screen comorbidities in the presence of either diagnosis, in order to ensure a better management.

The authors have not supplied their declaration of competing interest.

Patients with mental health problems (MHP) are known to have more physical comorbidities compared to the general population.

In Malta, Mount Carmel hospital (MCH) which is the main psychiatric hospital (consisting of both acute and chronic wards), is separate from Mater Dei hospital (MDH) which is the general hospital at which medical and surgical care is provided.

Such a division in healthcare may result in inadequate focus on physical health amongst patients of high demand in this regard. This subsequently puts an increased strain on the general hospital through repeated referrals.

The purpose of this study is to show that inpatients with MHP have a significant number of comorbidities and require multiple referrals to a general hospital for medical and surgical attention.

Three hundred and ninety-three inpatients at acute and chronic wards of MCH (during the first week of December 2016) were enrolled in the study.

Treatment charts and iSOFT (healthcare IT software used in Malta) were used to determine patient's diagnosed comorbidities, number and type of referrals to MDH outpatient clinics (OPC), casualty and admissions at MDH over 1 year.

Results of the audit indicate that a significant number of inpatients at MCH have medical comorbidities and the majority have been referred to MDH for OPC and casualty over the past year.

Having medical and surgical liaison teams in psychiatric hospitals may enhance patient care and reduce the pressure exerted on general hospitals.

The authors have not supplied their declaration of competing interest.

Research shows that the prevalence of obesity is greater in individuals with mental disorders than in general population. According to literature, obesity is correlated with intensity of symptoms and suicidality.

The aim of this study was to determine whether there is a correlation between BMI and severity of symptoms, as well as suicidality and gender. The aim was also to determine whether there is a difference in the severity of symptoms and suicidality among individuals with different diagnoses.

Participants in this study were 37 men and 73 women with diagnosis of psychosis, personality disorder, bipolar affective disorder, unipolar depression and anxiety disorder treated in Psychiatric hospital “Sveti Ivan”, Zagreb, Croatia. Sociodemographic data were collected and BMI was calculated. All participants fulfilled the DASS 21 (Depression, Anxiety and Stress Scale by Fernando Gomez) and Suicide Severity Rating Scale (Columbia–Suicide Severity Rating Scale (Center for Suicide Risk Assessment).

There is no significant correlation between BMI and severity of symptoms, as well as between BMI and suicidality. But there are significant differences in the severity of stress (P = 0.005) and suicidality (P = 0.004) in individuals with different diagnoses.

The results identify that a significant part of individuals with mental disorders are either obese or overweight, but there were no significant differences in relation to suicide and intensity of symptoms depending on the BMI.

The authors have not supplied their declaration of competing interest.

Sixty-eight patients followed for hepatitis C were recruited. The treatment was based on the combination of pegylated IFNa or standard IFNa and ribavirin for 6 to 12 months. The evaluation was done by a questionnaire containing demographic information, medical and psychiatric history, substance use. Sleep assessment was made by Pittsburgh Sleep Quality Index, and measuring the quality of life by SF36. The assessment before starting treatment and at 1 month and 4 months. Statistical analysis by SPSS 21 software read.

Fifty-six patients were able to complete the monitoring. 36 women to 20 men. The average age is 59.1years old (standard deviation 9.88). A quarter of patients still gainfully employed. 64.3% of participants live in couple. Seventy-six point eight percent of patients live in the city. Seven percen consume tobacco and single patient use cannabis occasionally. Sleep disorders increased from 37.5% before the start of the treatment to 55.4% after its start. While 44.5% have kept a sleep disturbed to 4 months. At first, the quality of life had more impaired scores on psychological than physical scores. The overall score declined significantly way after initiation of treatment (0.04). A larger decline on the psychological component (0.000) while the physical score did not significantly decrease.

The authors have not supplied their declaration of competing interest.

This is a retrospective descriptive study that evaluated the consultation liaison (CL) psychiatry services in Imam Khomeini hospital, during two recent years.

The information has been obtained from reviews of medical profiles of patients who attended the hospital.

A total of 681 patients (365 patients were male) received CL services during the study period. The most prevalent diagnosis groups were mood disorder (37.91%), delirium (13.6%) and anxiety (12.64%). Our study revealed that cardiovascular unit, infectious disease unit and general surgery units frequently requested for consultations among all hospital wards. Pediatrics unit had the lowest request rate for psychiatric consultation.

CL is on the rise in general hospitals, specifically in internal medicine and surgery units which alarm us to pay more attention to preventive strategies focused on the most referred problems including mood disorders, delirium and anxiety disorders in patients who attended general hospitals.

The authors have not supplied their declaration of competing interest.

The liaison psychiatry (LP) is a feature used by the psychiatrist in order to improve the management of patients with mental suffering and/or mental disorder admitted to general hospital.

To characterize the epidemiological profile of hospitalized patients at the university hospital of the federal university of Sergipe (HU-UFS) submitted to LP.

retrospective and observational study, through analysis of medical records of patients admitted in the wards of clinical medicine and surgery from the HU-UFS, in the period from January to December 2015, submitted to LP. The information collected fed a specific questionnaire developed by the authors, intended for research of socio-demographic data and clinical profile.

the frequency of request for IP was of 3.5%, with the majority of applications was performed by clinical medicine (71.2%), while the surgical clinic was responsible for 28.8%. The main reason for the request of LP was the presence of depressive symptoms (49.1%). There was a predominance of females (52.5%) and the mean age was 45.9 ± 14.6 years.

The frequency of request for LP was very low, suggesting a difficulty in the early detection of mental disorders by physicians. This finding points to an underreporting of cases, since the prevalence of depressive symptoms in hospitalized patients is over 50% in this institution.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Lithium is a well-known substance used in treatment of mood disorders. It has a narrow therapeutic index with recognised adverse effects on renal and thyroid function. Clinical guidelines published by the national institute for health and clinical excellence in the United Kingdom (NICE) recommend renal and thyroid function checks before lithium is prescribed, as well as ongoing monitoring of renal function, thyroid function and serum lithium levels. Lithium-induced drug toxicity is frequently seen in clinical practice. While the ongoing monitoring serves to monitor reversible side effects of Lithium provided its discontinued, rarely patients develop a persistent neurological side effect known as a syndrome of irreversible lithium-effectuated neurotoxicity (SILENT).

This is a case report on a patient where the patient developed SILENT syndrome after being treated with Lithium, long term for bipolar disorder.

This case supports the biological mechanism of SILENT syndrome. It also caused a huge implication in the patient's care.

As clinicians, we are well aware of following treatment guidelines for Lithium. This case report was written to raise awareness regarding a “SILENT” albeit significantly debilitating syndrome of Lithium use.

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

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

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