Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis commonly begins with a prodromal phase characterized by flu-like symptoms, subsequently the patients experience a rapid deterioration with psychiatric symptoms that may include anxiety, irritability, insomnia, paranoia, aggression, auditory or visual hallucinations, sexual disinhibition, mania, cognitive disorder, and psychosis; seizures; motor and autonomic dysfunction. The triggers of the disorder comprise viral infections, tumors, and other unknown factors. Taking in count the prominence of psychiatric symptoms, it is relevant to rise the question whether patients with anti-NMDA receptor encephalitis are being misdiagnosed with psychiatric disorders.

Non-systematic literature review of the relationship between anti-NMDA receptor encephalitis and psychiatric disorders.

From the review performed, 2 studies stand out: In one study, 459 serum samples for NMDA receptor antibodies were evaluated. The analysis compared samples from patients diagnosed with schizophrenia, major depressive disorder, and borderline personality disorder with nonpsychiatric controls. In another study, serum was obtained prospectively from a cohort (n = 46) of patients at first presentation of psychosis and NMDA receptor antibodies were measured.

In the first study, the authors found that 9.9%, 2.8%, and 0% of patients with schizophrenia, major depressive disorder, and borderline personality disorder, respectively, were antibody positive. In the second study, it was found that 7% of the patients were serum NMDA receptor antibody positive.

It is unclear yet if patients with primary psychotic disorders have higher rates of pathogenic NMDA receptor antibodies. More evidence is needed to study this relationship.

No significant relationships.

Psychiatry is not immune to the effects of trends and fads, which are ideas that elicit short-lived enthusiasm, are quickly adopted, and abandoned when they fail to live up to expectations. Trends meet a deeply felt need to explain, or at least name, what would alternatively be unexplainable human suffering.

The authors aim to explore the trends and fads that have occurred in psychiatric diagnostic and treatment throughout history and assess if any modern trends can be identified as well as assessing the effects or consequences of these.

The authors conducted a non-systematized literature review with focus on those articles most pertinent to the topic in question.

The literature demonstrates that fads and trends not only plague fashion and diet, but also psychiatry. Trends in psychotherapeutic options can be observed by the swing from psychoanalysis to psychopharmacological focus. Overdiagnosis is one of the consequences of these trends, and can be seen from hysteria, schizophrenia, multiple personality disorder, attention-deficit and hyperactivity disorder to gender identity disorder. These trends impact the way diagnosis are made and the treatments implemented.

Fads in psychiatry have occurred not only on the edge, but in the very mainstream of theory and practice. A balance is called for, with caution needed in order not to fall into the temptation of the fad, however, an open mind should also be maintained when cutting-edge treatments and theories emerge. The sensible antidote to falling for fads and trends in psychiatry is commitment to evidence-based medicine.

No significant relationships.

The aim of this study is to investigate mobbing in the Hospitals of Etoloakarnania, Greece. Additionally, this research aims to find out which coping strategies are used by health care professionals who have suffered mobbing and how their quality of life has been affected.

This research aims to depict mobbing phenomenon’s extent and investigate the coping strategies and quality of life of working staff, victims of mobbing.

The research methodology was based on two questionnaires: LIPT scale and the scale of assessing bullying management strategies, as well as demographic data, which were answered by 130 people. A sufficient sample for the needs of this study to produce comparable results with the existing literature.

Mobbing is observed to a large extent of 83.8% , which, however, seems to be at lower levels in relation to corresponding researches abroad. In addition, the majority of respondents who appear to have been harassed at work are mostly women (78.5%), which seems to be in line with global studies. Τhe consultants and the supervisors take advantage of their position of power and impose or change duties on other staff (45.3%), in order to punish their subordinates, exacerbating the phenomenon of mobbing, also. Finally, the participants recognize the phenomenon and look for the majority of positive ways of action (65%), while they do not resort to non-constructive ways of solving the problem.

Mobbing is a serious phenomenon that affects working staff’s mental health and quality of life. Policies should address effectively this deleterious aggressive behaviour.

No significant relationships.

There have been reports of myopathic dysfunction with creatinine kinase (CK) elevation associated with neuroleptics, particularly, in clozapine-treated patients. The patients in these reports did not have any other clinical symptoms or signs indicative of neuropleptic malignant syndrome. Myopathic dysfunction was supported by the presence of CK elevations and either proximal limb weakness or fatigue, characteristic electrophysiologic abnormalities, or both. It has also been reported that CK elevation is neither dose nor treatment-duration dependent. The underlying mechanism is still unknown although it has been postulated that it is associated with cytochrome P450 interactions and/or calmodulin antagonism.

To report a case of elevation of CK during treatment with clozapine.

The authors report a case of elevation of CK during treatment with clozapine. A non-systematic review was conducted by searching the PubMed database, using the terms “clozapine”, “myotoxicity”.

A 36-year-old man was admitted after abandoning treatment with clozapine. During the titration of the medication, he developed complaints of muscle fatigue in conjunction with an elevation of CK. CK levels normalized after intravenous hydration and with dose reduction. Furthermore, CK levels would increase with clozapine re-titration.

Clozapine has numerous side effects. Myopathic dysfunction with CK elevation is a possible side effect which could have serious consequences such as renal impairment. In such cases, appropriate treatment should be implemented. Therefore, clinicians should be aware of this potential side effect.

No significant relationships.

Psychosis in Alzheimer’s disease has an incidence of ˜ 10% per year. Recent work has focused on the presence of psychosis in people with mild cognitive impairment, as a risk factor for the development of Alzheimer’s disease.

To Study a case of Alzheimer’s disease presenting psychotic symptoms

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology.

A 40-year-old goes to the emergency room due to hetero-aggression at home. He says that his father steals his money and prostitues have been hired in his house. The patient is oriented, partially collaborative and approachable. Psychomotor restlessness is observed. He has self-referral delusions, auditory hallucinations and insomnia. Provisional diagnosis of acute psychotic episode made and low dose risperidone was prescribed. During his stay on the hospital Ward, sedation, recent memory alterations, spatio-temporal disorientation lack of initiative and disorganized behaviors appear. Risperidone is withdrawn and complementary test are performed. Imaging tests show temporal and frontal atrophy. Increased TAU protein and low levels of amyloid in CSF are found. Brain biopsy is +. His mother died of Alzheimer’s disease with 36 years-old and another affected brother with 42 yeras-old. The definitive diagnosis is Alzheimer’s disease and genetic studies are currently being carried out.

Alzheimer’s disease can debut with psychosis. It is important to investigate family history of patients who begin with memory loss in the context of psychosis

No significant relationships.

Esketamine is a novel antidepressant approved by the FDA in 2019 in the form of an intranasal spray, recommended for Treatment-Resistant Depression (TRD). The intranasal spray system appears to be more manageable than intravenous ketamine infusion. It contains ketamine’s S- isomer which is four-fold more potent for the NMDA receptor.

The aim of this case series is to describe our clinical experience in the use of Esketamine.

6 TRD patients (3 men; 3 women) were recruited in San Raffaele Turro Hospital from March 2021. All patients (2 bipolar and 4 unipolar) were diagnosed with a Major Depressive Episode according to DSM-5 criteria, resistant to at least two antidepressants. Initially, Esketamine was administrated twice weekly for one month; afterward, it was administrated once weekly for a month; finally, it was administrated once weekly or every two weeks for a month. Clinical scales (HAM-D, YMRS, SSI, HAM-A, MADRS, CADSS) were administrated to assess symptoms and sides effects before and after each administration on a weekly basis.

Three patients out of six showed an improvement in depressive symptoms: two patients had remission (final HAM-D score < 8); one patient had a clinical response (final HAM-D score < 50 % respect baseline value). Three patients withdrew the treatment: two for perceived inefficacy, after 16 and 19 administrations, one for personal reasons.

The use of Esketamine in our TRD patients showed good effectiveness and tolerability but randomized controlled clinical trials are needed to confirm our findings.

No significant relationships.

Mental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.

This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.

MHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.

A total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).

This study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.

No significant relationships.

Chronic hand eczema (CHE) , inflammatory dermatitis, can lead to physical and psychosocial disability altering the quality of life of these patients.

The objective of this study was to examine the quality of life in patients with chronic hand eczema

Descriptive study collating patients who consulted for CHE, at the Dermatology Department of the CHU Hédi Chaker Sfax, during 3 years (2018-2020). A socio-demographic, clinic , and the Quality of life Questionnaire (DLQI) were administered in this study.

Our study included 12 patients (8 men and 4 women). The mean age was 46.8±11.6 years. The patients were in professional activity in 86.8% of the cases. No patient was in early retirement or disability status. The average duration of the disease was 4.5 years (1- 9 years). All patients were in remission. The intensity of pruritus at the last attack was mild (25.77%), moderate (72.23%), and severe (2%). The impact of pruritus on sleep was noted in 100%. The mean total quality of life score (DLQI) was 6.8±5.5 which means a moderate impairment of quality of life

This work highlights the importance of the impact of this dermatitis on the quality of life of these patients. Therefore, multidisciplinary dermatological and psychiatric management is considered necessary

No significant relationships.

The 5-HT2A agonist classic psychedelic, psilocybin (O-phosphoryl-4-hydroxy-N,N-dimethyltryptamine) is a tryptophan, indole-based alkaloid present in up to 2% of certain hallucinogenic “magic” mushroom species; typically Psilocybe azurescens, semilanceata, and cyanescens,. In addition, mushrooms may contain psilocin (4-hydroxy-N,N-dimethyltryptamine). Both are indolylalkylamines (tryptamines); other naturally occurring tryptamine compounds include norbaeocystin, baeocystin, norpsilocin, and aeruginascin. A putative synergistic contribution of these compounds has been referred to as the “entourage” effect. Aeruginascin (N,N,N-trimethyl-4-phosphoryloxytryptamine) is found naturally in Inocybe aeruginascens and Pholiotina cyanopus mushroom species and ingestion reportedly invokes elevation in mood without accompanying hallucinogenic effects:

To review the pharmacology of aeruginascin and putative entourage effect.

The extant literature on aeruginascin was reviewed and discussed.

Methylation of aeruginascin results in an active metabolite, 4-hydroxy-N,N,N-trimethyltryptamine (4-HO-TMT) which has been shown to bind at 5-HT1A, 5-HT2A, and 5-HT2B receptors with Inhibition Constants (Ki) of 4400, 670, and 120 nM respectively; compared with psilocybin’s binding of 567.4, 107.2 and 4.6 nM respectively. Further, 4-HO-TMT does not bind at the 5-HT3 receptor, and as a quaternary trimethylammonium compound it is less likely to be able to cross the blood-brain-barrier (BBB).

There are very limited data with respect to the pharmacology of aeruginascin. Its activity at serotonin receptors is less by several orders of magnitude than psilocybin and it has potentially less brain penetrance. Given that it is found in different mushrooms species the data would suggest that its direct contribution to any entourage effect is limited. Further research in needed into other naturally occurring tryptamine compounds.

PC is a member of the Scientific Advisory Board of Zylorion. AA, EB, JC, CE have no disclosures to report.

Cadmium is defined as one of the leading toxic industrial pollutants (Valko i sar., 2005). Although some products containing cadmium can be recycled, much of the pollution with this metal is the result of inadequate disposal and uncontrolled incineration of cadmium-containing waste (Jarup, 2003). Copper particles are released into the atmosphere from copper smelters and ore processing facilities, as well as from anthropogenic sources (use of pesticides, herbicides and fungicides). Oxidative stress occurs due to increased production of reactive oxygen species (Parkinson’s and Alzheimer’s disease) or reduced ability of cells to neutralize it through their internal antioxidants (eg mutation of the superoxide dismutase gene in amyotrophic lateral sclerosis).

The aim of this research was to examine the protective role of supplement, GSH, S-donor ligand, and in conditions of acute and chronic intoxication with sublethal doses of cadmium-II-chloride and copper II sulfate.

After medial laparotomy albino rates Wistar soy, a 10% homogenate of brain tissue was made in an appropriate medium and an analysis of acid and alkaline DNase activity was performed (Kocić i sar., 2004; Kocić i sar., 1998).

This experiment demonstrated the beneficial role of GSH supplement that exhibit antioxidant character in preventing and reducing the adverse effects of acute and chronic cadmium and copper intoxication.

Antioxidants prevent the formation of oxidative stress in the cell by reducing and stopping DNA damage and degradation, and thus represent potential scavengers of free radicals.

No significant relationships.