There is limited data on psychological burden following spinal cord injury (SCI) in Singapore.

(1) To describe the prevalence of depression and anxiety at admission for inpatient rehabilitation and (2) describe the baseline characteristics that predict the development of anxiety or depression in patients following SCI.

We retrospectively reviewed medical records of SCI patients at admission from 01-06-2013 to 31-12-2015. The Hospital Anxiety and Depression Scale (HADS), ASIA score and demographics were collated.

A total of 157 subjects were included, 62.4% (n = 98) were male with a mean age of 56.7 years. 43.4% (n = 68) had a traumatic SCI with 73.9% (n = 116) having had spinal surgery. The average length of stay was 46.6 days with most discharged to their own homes. Ten subjects screened positive for anxiety (6.4%) and 16 for depression (10.2%). 13.4% (n = 21) screened positive for anxiety and/or depression. Two third (n = 95) had injuries at the cervical level and 14% (n = 22) scored ASIA A/B. 45.9% (n = 72) was referred to the psychologist. A significantly higher proportion of subjects (P < 0.05) who screened positive had a past psychiatric history, were prescribed antidepressants at admission and during rehabilitation. Significant differences were noted in primary caregiver (nursing home vs. others) following discharge when comparing those that screened positive vs. negative however there were no significant differences between baseline demographics, neurological level and ASIA score.

Psychological burden following SCI is significant. Standardized screening and psychological support is warranted with special attention to those with a past psychiatric history.

The authors have not supplied their declaration of competing interest.

Delirium is an acute clinical syndrome with diverse and multi-factorial etiologies. It has high prevalence in hospitalized patients and it is associated with serious adverse outcomes, increasing morbidity and mortality. Delirium requires a differential diagnosis with a wide range of mental disorders.

To evaluate cases referred to liaison psychiatry in Hospital José Joaquim Fernandes, in regard to the frequency, cause and misdiagnoses of delirium.

A retrospective analysis of liaison psychiatric referral from January to August 2016.

The overall referral consisted of a total of 111 cases. Delirium was the second most frequent referral (21.6%), after depression. Half of patients had an advanced age (71–90 years). A total of 44.8% of patients with delirium were misdiagnosed and the referral causes were “depression”, “dementia”, “aggressive behavior”, “agitation” and “schizophrenic psychosis”. The majority of patients were referred by internal medicine. The most frequent underlying conditions were: postoperative (27.6%), respiratory diseases (24.1%) and sepsis (17.2%).

Delirium is one of the most frequent diagnoses in liaison psychiatry. This study supports the statement that delirium is often not recognized and that is misdiagnosed as a primary psychiatric illness, mainly, dementia or mood disorder. Although delirium is classified in ICD-10 as a psychiatric diagnosis and clinically manifests with a wide range of neuropsychiatric abnormalities, it is secondary to a medical/surgical disorder that requires urgent approach by the respective specialty.

The authors have not supplied their declaration of competing interest.

Patients with epilepsy have 6–12 times higher risk of suffering from psychosis, with a prevalence of about 7–8%, and the coexistence of these two conditions is associated with increased morbidity and mortality. The psychosis of epilepsy is generally split into two groups: interictal psychoses and postictal psychosis (PIP), and the latter has been estimated to represent 25% of all types. However, many of these episodes remain under-recognized and/or are often misdiagnosed.

To provide an overview of PIP.

Literature review based on PubMed/Medline, using the keywords “epilepsy” and “psychosis”.

PIP has been recognized since the 19th century, when Esquirol described postictal “fury”. Although its etiology and pathogenesis remain poorly understood, several risk factors and etiopathogenic mechanisms have been suggested and analysed. An essential step in PIP management is its accurate and early diagnosis. Generally, before the onset of PIP there is a lucid period of one to six days after the seizure(s). PIP frequently has a polymorphic presentation, tends to be affect-laden and symptoms often fluctuate. It is of limited duration and frequently responds very rapidly to low doses of benzodiazepines and antipsychotics. However, the propensity of the antipsychotics to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptics are important considerations. Recurrence rates range 25% to 50%.

Given the negative impact of PIP in morbidity and mortality among these patients, it is crucial that neurologists and psychiatrists are able to adequately recognize and treat this clinical condition.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

According to international scientific literature, and as summarized in the guidelines of the International Society of Hypertension, lowering of blood pressure can prevent cardiovascular accidents. Some studies suggest that hypertension, anxiety, and depression might be inversely correlated.

To investigate whether blood pressure is associated with anxiety and depression.

Cross-sectional design. Male and female primary care patients were enrolled, aged 40–80. Criteria of exclusion adopted: use of antidepressants or antipsychotics; previous major cardiovascular event; psychosis or major depression; Type 1-DM; pregnancy and hereditary disease associated to obesity. Anxiety and depression symptoms were assessed using HADS. Waist circumference, hip circumference, blood pressure, HDL, triglycerides, blood sugar, hypertension, albumin concentrations and serum iron were also assessed.

Of the 210 subjects, 84 were men (40%), mean age was 60.88 (SD ± 10.88). Hypertension was found to correlate significantly to anxiety (OR = 0.38; 95% CI = 0.17–0.84), older age (OR = 3.96; 95% CI = 1.88–8.32), cigarette smoking (OR = 0.35; 95%CI = 0.13–0.94), high Body Mass Index (OR = 2.50; 95% CI = 1.24–5.01), Waist-hip ratio (OR = 0.09; 95% CI = 0.02–0.46) and the Index of comorbidity (OR = 16.93; 95% CI = 3.71–77.29).

An inverse association was found between anxiety and hypertension, suggesting the need to clinically manage these two dimensions in a coordinated way. Other findings are well known and already included in prevention campaigns. Further research is needed, also to better understand and explain the causative pathways of this correlation.

The authors have not supplied their declaration of competing interest.

Previous studies showed different classification systems lead to different case identification and rates of delirium. No one has previously investigated the influence of different classification systems on the outcomes of delirium.

To determine the influence of DSM-5 criteria vs. DSM-IV on delirium outcomes (mortality, length of stay, institutionalisation) including DSM-III and DSM-IIR criteria, using CAM and DRS-R98 as proxies.

Prospective, longitudinal, observational study of elderly patients 70+ admitted to acute medical wards in Sligo University Hospital. Participants were assessed within 3 days of admission using DSM-5, and DSM-IV criteria, DRS-R98, and CAM scales.

Two hundred patients [mean age 81.1 ± 6.5; 50% female]. Rates (prevalence and incidence) of delirium for each diagnostic method were: 20.5% (n = 41) for DSM-5; 22.5% (n = 45) for DSM-IV; 18.5% (n = 37) for DRS-R98 and 22.5%, (n = 45) for CAM. The odds ratio (OR) for mortality (each diagnostic method respectively) were: 3.37, 3.11, 2.42, 2.96. Breslow-Day test on homogeneity of OR was not significant x2= 0.43, df: 3, P = 0.93. Those identified with delirium using the DSM-IV, DRS-R98 and CAM had significantly longer hospital length of stay(los) compared to those without delirium but not with those identified by DSM-5 criteria. Re-institutionalisation, those identified with delirium using DSM-5, DSM-IV and CAM did not have significant differences in discharge destination compared to those without delirium, those identified with delirium using DRS-R98 were more likely discharged to an institution (z = 2.12, P = 0.03)

Assuming a direct association between delirium and examined outcomes (mortality, los and discharge destination) different classification systems for delirium identify populations with different outcomes.

The authors have not supplied their declaration of competing interest.

Diagnosis and treatment of patients with craniofacial anomalies such as cleft lip and palate and skeletal malocclusions present a challenge to public health. Dentofacial abnormalities may be associated with depressive and anxiety disorders and poor quality of life.

The aim of this screening study was to evaluate and to compare the rates of anxiety and depression in cleft patients and non-cleft patients with skeletal malocclusions.

The study used psychometric method-HADS and State Trait Anxiety Inventory were used. The first group consisted of cleft patients, the second group consisted of non-cleft patients with skeletal Class II, Class III and anterior open bite malocclusions; the third group was control.

Study sample consists of 42 patients (33 females; 24 ± 7.2 years). In the 1st group, anxiety symptoms were detected in 34.7%; depression symptoms - in 17.2% of patients, high rates of reactive anxiety were registered in 35.8%. In the 2nd group, anxiety symptoms were detected in 29.6% of patients; depression symptoms - in 13,1% of patients, high rates of reactive anxiety were registered in 34.2%. In the 3rd group anxiety (18.7%) and depression (8.3%) symptoms and high rates of reactive anxiety (17.7%) were registered significantly less often than in 1st and 2nd groups (P < 0.005, P < 0.001 and P < 0.001 respectively).

Our data suggest that cleft-patients and non-cleft patients with skeletal malocclusions have statistically significant higher rates of anxiety and depression than controls and require orthodontic-surgical treatment that should be organized with the assistance of psychiatrist.

The authors have not supplied their declaration of competing interest.

Though phenomenon of dysmorphic disorder has been studied extensively clinical dynamical characteristics of this disorder are still being investigated.

Aim of this study was to evaluate patterns of dynamics and risk factors of body dysmorphic disorder in patients of plastic surgeons and cosmetologists.

We included adult patients of Maxillofacial Surgery and Cosmetology departments of Moscow State University of Medicine and Dentistry (from January 2010 to May 2016) with unconfirmed “facial deformity” diagnosed with dysmorphic disorder (F45.2 and F22.88 according to ICD-10). The study used clinical psychopathological method with follow-up period 1–3 years. Data from clinical psychopathological assessment were processed using correlation analysis and non-lineal regression analysis by means of logistic regression method.

Study sample consisted of 103 patients (78.6% female; mean age 33.4 ± 4.7 years). Statistically significant chronobiological (age, hormone fluctuations, genesial cycle) and psychosocial (financial changes, forced separation, bereavement, loss of job, reduction of social activity, conflict situation, sexual dysfunction, violation of law, diagnosing of somatic disease) risk factors for dysmorphia in different life periods have been established. Strong correlations were found between dysmorphic disorder heterogenic clinical picture (overvalued–33%, affective–24.3%, hypochondric–23.3%, obsessive-compulsive–10.7%, delusional–8.7%) and patterns of dynamics (phasic–41.7%, recurrent–33%, chronic–25.3%). Our data suggest that dysmorphia manifests in any age group and in 74.7% cases is not continuous.

Our findings allow to conduct focused diagnostic search, prophylactic psychotherapeutic interventions and early psychopharmacological treatment in individuals with identified risk factors for dysmorphic disorder.

The authors have not supplied their declaration of competing interest.

Sturge-Weber syndrome or encephalotrigeminal angiomatosis is an uncommon neurocutaneous syndrome that manifests with vascular malformations involving the brain, eye and skin; Severe cases present with refractory seizures, sometimes requiring major surgery such as hemispherectomy. Most of the times, some degree of mental retardation and behavioral problems are associated, requiring use of psychotropic medication and other contention strategies. This report describes the case of a 19-year-old boy who was submitted to a left hemispherectomy by the age of one, and was still able to successfully complete basic education. He started presenting severe behavioral problems, with aggressive outbursts, by the beginning of adulthood, having been committed to psychiatry ward. By the age of 22, the patient finds himself calm and functional considering his limitations, with no need for hospital admission for 2 years.

To describe a clinical case whilst reviewing literature concerning this matter.

Case report with complete clinical history and medical data. Non-systematic review of PubMed database under the terms “Sturge-Weber disease”, “Hemisferectomy”, “behavioral disorder due to organic causes”, “post hemisferectomy out-comes”.

Although presenting with severe arteriovenous malformation, refractory epilepsy and left hemispherectomy, the patient was able to conclude basic instruction; He has lived with his family until the age of 19, when he started displaying disruptive behaviour; after 3 hospital admissions and perfecting psychotropic drugs treatment, the patient was admitted to an institution for rare diseases patients Since then he has experienced a calm and functional life, with trained professionals who can offer the non-pharmacological approaches he needs.

The authors have not supplied their declaration of competing interest.

University students represent a specific population with concerns, burdens and worries that differ from other age and occupation groups. Students’ experiences are often exciting and empowering, yet facing multiple stressors that may trigger various forms of psychopathology. Our psychiatry department created a specific liaison service for university students in order to provide an easy and quick access to this medical speciality, included at the Multidisciplinary University Medical Services.

To characterize a sample of college student users of our Psychiatry Liaison Unit regarding socio-demographic and clinic variables.

Socio-demographic and clinic characterization was undertaken in all students observed during sixteen months (1st April 2015–30th July 2016).

Fifty-three outpatients were observed: 35 females (66%) and 18 males (34%), aged between 18 and 39 years old (average: 23.94; median: 23). The majority was Portuguese and lived originally in urban areas. A total of75.3% were displaced and 60% lived with colleagues while 84.9% attended an undergraduate degree, and 38% studied at faculty of Science and Technology. Clinically, 79.2% were referenced by the University Medical Services, and adjustment disorders (ICD-10 F43.2) were the most frequent diagnosis. Relatively to suicidal behaviors and self-harm, 5.7% did self-cutting, 49.1% took an antidepressant combined with another psychotropic drugs, and 81.1% maintained cognitive-behavioral interventions.

The typical university students’ psychiatry outpatient was of female gender, in an undergraduate degree, displaced and living without their family. The most frequent diagnosis was adjustment disorder, and about a quarter were successfully discharged. Multidisciplinary University Medical Services located near to students can easily refer patients to Psychiatry Liaison Units, allowing diagnosis and intervention at early stages of mental disease.

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.

The aim of this study was to identify association between pneumo- or hemo-thorax and psychological distress using the Military Personality Inventory (MPI).

A retrospective cross-sectional study was conducted with 19-yr-old examinees who were admitted to the Military Manpower Administration in Korea from February 2009 to January 2010. A total number of 1955 young men were enrolled in this study. The normal volunteer group (n = 1561) comprise individuals who did not have pneumo- or hemo-thorax. The pneumo- or hemo-thorax group (n = 394) included individuals with pneumo- or hemo-thorax. This group was divided into two subgroups, group A (treated with conservative care or chest tube insertion, n = 341) and group B (treated with wedge resection, n = 53).

We compared each of three groups (Control group, Group A, Group B) using the analysis of covariant (ANCOVA). The somatization subscale score of the neurosis category was significantly higher for group A (P < 0.001) and showed higher tendency for Group B than the control group (P = 0.073). The other categories (validity scale; anxiety, depression, and personality disorder subscales for neurosis scale; and psychopath scale) showed no significant difference in the MPI among Group A, Group B and Control group.

Conservative care or chest tube insertion group had higher somatization symptoms than control group. Wedge resection group had higher somatization tendency than control group. Individuals with pneumo- or hemo-thorax history may be concerned about their body shape or their general condition. Therefore, supportive intervention and psychiatric education may be needed for them to relieve somatic distress.

The authors have not supplied their declaration of competing interest.

Although psychological distress is highly prevalent, palliative cancer patients are mostly too lethargic to undergo many sessions of the conventional psychotherapy.

The study aims to develop a brief, quick and easy to administer psychological intervention for rapid reduction of distress in palliative care patients.

In phase I, an expert panel of multidisciplinary team was formed. The theory of mindfulness-based intervention was simplified into a 5-minute mindful breathing technique that can be learnt and practiced by palliative care patients.

In phase II, the efficacy of 5-minute mindful breathing was investigated in a pilot test that comprised of nine palliative cancer patients and eleven care takers.

In Phase III, the efficacy of 5-minute mindful breathing was further examined in a non-blinded, randomized controlled trial (RCT) that included 60 cancer patients under palliative care. Apart from perceived distress, physiological measures were assessed.

The effect of 5-minute mindful breathing in rapidly reducing distress among palliative care patients was confirmed in both the pilot test (Tan et al., 2015) and RCT (Ng et al., 2016). The finding was further supported by the significant physiological changes associated with distress reduction such as decreased breathing rate, blood pressure, pulse rate, galvanic skin and increased skin surface temperature (Ng et al., 2016) with the 5-minute mindful breathing.

The 5-minute mindful breathing is a quick and easy to administer intervention that is useful for reducing acute suffering or distress in palliative care patients.

The authors have not supplied their declaration of competing interest.

Non-epileptic seizures (NES) are a diverse group of disorders, whose paroxysmal events can be mistaken for epilepsy, although they are caused by a mental or psychogenic process rather than a neurological cause.

We present a case of a 45-year-old female patient with history of generalized seizures prior to Meningioma resection in August 2015, referred to the Liaison Psychiatry outpatient follow up clinic at the Royal London Hospital after has gone several times to emergency department complaining about flush and hot sensation that proceeded to corners of mouth turning down, teeth chattering, shaking of left arm and torso at first and then legs. During the episodes, she was awake with no consciousness loss. Her mood was low, with clinical evidence of depression and she had very high levels of health anxiety.

A diagnosis of non-epileptic attacks was made in the sequence of those episodes. A holistic and multidisciplinary approach was made, including pharmacotherapy, cognitive-behavioral therapy and domiciliary support. The clinical response was good regarding both mood, anxiety levels and NES.

Approximately 25% of patients who have a previous diagnosis of epilepsy and are not responding to drug therapy are found to be misdiagnosed and it is common that epileptic patients have both epileptic and non-epileptic seizures. Although distinguishing epileptic and non-epileptic seizures is not easy, there are some clinical clues that the physicians should look for, like age of onset, time of the day that episodes occur and presence or absence of postictal confusion.

The authors have not supplied their declaration of competing interest.

Depressive Symptoms (DS) generate a public and economic health problem, with decreasing productivity, labour market withdrawal and increased demand for health services. Studies show that in hospitalized patients, DS rates are higher than in the general population, in medical practice, however, they are under diagnosed or under-treated. Consultation Liaison Psychiatry (LP) can prevent aggravation of the psychic symptoms by early identification of them and by integration of psychiatry with the other medical specialties.

To estimate the prevalence of DS and associated factors in inpatients and the frequency of consultation LP.

A cross-sectional study was carried out in March 2016, with 87 patients hospitalized in the clinical and surgical wards at the University Hospital (Sergipe/BR), through two instruments: (1) Structured Questionnaire prepared by the authors, (2) Beck Depression Inventory (BDI). Data analysis through descriptive and analytical statistics with final step of logistic regression.

The prevalence of DS were 54%, of which 24% correspond to moderate and severe symptoms, and only 3.4% of the patients had a LP. In Logistic Regression, the only factor associated with DS was the reason for hospitalization. Clinical causes (87.2%) were 9.24 times more likely to develop DS than surgical causes.

Results suggest a high prevalence of inpatients with some psychic symptom. Physicians did not detect these symptoms and, therefore, LP request was low. These data reinforce the importance of LP for early identification of DS that should be stimulated during medical training.

The authors have not supplied their declaration of competing interest.

Although current standard treatment for migraine headache is medication, high levels of psychological comorbidity has led to migraine influencing by cognitive, emotional and environmental factors, as well as biological. Viewing migraine in a biopsychosocial framework introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy (CBT). The aim of this study was to evaluate the efficacy of CBT for chronic migraine.

Thirty-five participants diagnosed as chronic migraine were recruited from Headache Clinic. According to inclusion criteria 14 participants, underwent bi-weekly lasting 30 minutes CBT sessions for 6 months, were administered Hamilton Anxiety Scale, Hamilton Depression Scale, Visual Analog Scale (VAS) and the Migraine Disability Assessment Scale (MİDAS) before and after CBT.

Nine of the participants were female and 5 male. Mean age of group was 34.35 ± 8.17. Duration of illness was 13.07 ± 7.18 and 12 of participants had the history of a psychiatry illness whose diagnoses were depression (7), anxiety disorder (4) and post-traumatic stress disorder (1). Nine of the patients had prophylactic migraine treatment. There were statistically significant difference in Hamilton Depression scores between before CBT (29.07 ± 7.74) and after CBT (14.21 ± 7.7); in Hamilton Anxiety scores before CBT (26.8 ± 11.7) and after CBT (11.7 ± 2.6); in VAS scores before CBT (8.07± 0.91) and after CBT (3.71 ± 1.32); in frequency of migraine attacks between before CBT (10.85 ± 3.50 day) and after CBT (4.92 ± 2.70 day) and in MİDAS before CBT (55.5 ± 20.4) and after CBT (20.12 ± 16.6) (P < 0.05).

CBT might reduce the severity of symptoms in migraine patients especially with the comorbidity of psychiatric illness.

The authors have not supplied their declaration of competing interest.

We present the case of an 18-year-old woman attending the emergency room due to behavioral disorders that appeared 24 hours ago. The clinic was of restlessness, uninhibited behavior, stereotyped movements, global insomnia, semimutism and negativism. Initially she was diagnosed with catatonia, and was admitted to the Mental Health Hospitalization Unit. There were no previous psychopathological antecedents, although relatives reported that she had several stressors. During admission, she had a partial response to benzodiazepine treatment, and a loss of strength in the left upper limb was evidenced, and venous sinus thrombosis was diagnosed. With the anticoagulant treatment, the psychiatric symptomatology presented was markedly improved.

Normal vital signs, afebrile. Absence of focal neurological signs. Stereotyped movements, oral-buccal dyskinesia. Negativism, disinhibition and oppositional behaviour. Supplementary tests with results within the normal range. Cranial MRI: Upper, transverse and sigmoid right sagittal sinus thrombosis.

Numerous cases of thrombosis have been documented as a result of a catatonic state, mainly due to the immobilization and the risk involved. However, in this case, sudden onset of psychiatric symptoms, absence of psychiatric antecedents, and excellent response to anticoagulant therapy, leads us to conclude that catatonic symptoms could be considered as a consequence of cerebral edema caused by thrombosis. The presentation of catatonia as the sole cause of a somatic disorder is not common, but would be stimulated by certain factors, such as excessive stress and personality disorders, documented as vulnerability factors for such symptoms.

The authors have not supplied their declaration of competing interest.

COPD (chronic obstructive pulmonary disease) is a chronic illness associated with psychological distress. Self-esteem and the associated comorbidities, like depression and anxiety, can influence its evolution.

To analyze how predominant coping styles associated with different levels of self-esteem and mental status in patients with COPD.

To demonstrate that different types of coping-styles have an impact on self-esteem, depression and anxiety.

To a lot consisting of 28 subjects with COPD, was applied the COPE scale to assess the style of coping, to rate anxiety and depression The Hospital Anxiety and Depression Scale (HADS) and for self-esteem the Rosenberg Self-Esteem Scale. According to their higher coping sub-scale score, they were classified to one dominant coping type as follows: patients with problem-focused coping type (n = 9), emotion-focused coping (n = 10), social support-focused coping (n = 6), respectively avoiding coping type (n = 3).

Patients with dominant problem-focused coping had the most elevated self-esteem compared to patients with social-focused coping (22.0 vs. 16.2; P = 0.039), the depression score was the highest in patients with dominant avoidance-type coping and the lowest in patients with dominant problem-focused coping (11.0 vs. 5.6; P = 0.042) respectively anxiety, was the highest in patients with dominant social-focused coping and the lowest in patients with dominant emotion-focused coping (11.6 vs. 5.0; P = 0.006).

In patients with COPD, problem-focused and emotion-focused copings are adaptive, while avoidance and emotion-focused copings are maladaptive on self-esteem and mental status. Such as, the coping represents a psychological dimension with an impact on the evolution of the disease, and the patients with COPD should be assessed and addressed multidisciplinary.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.