In 2001, the World Health Organization (WHO) created the International Classification of Functioning, Disability and Health (ICF) to offer a comprehensive and universally accepted framework to describe functioning, disability and health. The ICF Core Sets (ICF-CS) are a selection of categories that serve as a minimal standard for the assessment of functioning and disability in a specific health condition. The ICF-CS for schizophrenia was created in 2015 based on four preliminary studies that intend to capture different perspectives.

The aim of this study is to describe the similarities (i.e. overlap) and discrepancies (i.e. unique contribution) between the clinical, patient and expert perspectives on the most relevant problems in functioning of individuals with schizophrenia, being focused on the European WHO region.

Forty-four experts from 14 European countries participated in an expert survey, patients with schizophrenia were involved in four focus groups, and health professionals assessed 127 patients in relation to daily life functioning. Information gathered from these three preliminary studies was linked to the ICF.

Data showed that although a considerable number of second-level ICF categories agreed on the three preparatory studies (n = 54, 27.7%), each perspective provided a unique set of ICF categories. Specifically, experts reported 65 unique ICF categories, patients 23 and health professionals 11.

Even though there were similarities between perspectives, each one underlined different areas of functioning, showing the importance of including different perspectives in order to get a complete view of functioning and disability in individuals with schizophrenia.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Psychological interventions for psychogenic non-epileptic seizures (PNES) show promising results. The aim of this meta-analysis is to evaluate and synthesize the available evidence from the previous 20 years regarding the utility of psychological interventions in the management of PNES.

Studies were retrieved from MEDLINE via OvidSP and PsychINFO. Selection criteria included controlled and before-after non-controlled studies including case series, using seizure frequency as an outcome measurement. Studies were required to assess one or more types of psychological intervention for the treatment of PNES in adults. Data from 13 eligible studies was pooled to examine the effectiveness of psychological interventions in treating PNES on two primary outcomes: seizure reduction of ≥ 50% and seizure freedom. A meta-analysis was conducted with data extracted from 228 participants with PNES.

Interventions reviewed in the analysis included CBT, psychodynamic therapy, paradoxical intention therapy, mindfulness, psychoeducation and eclectic interventions. Meta-analysis synthesized data from 13 studies with a total of 228 participants with PNES, of varied gender and age. Results showed 82% of people with PNES who complete psychotherapy experience a reduction in seizures of ≥50%. Additional meta-analysis synthesized data from 10 studies with a total of 137 participants with PNES. This analysis found 47% of people with PNES are seizure free upon completion of a psychological intervention.

The studies identified were diverse in nature and quality. Findings highlight the potential for psychological interventions as a favorable alternative to the current lack of treatment options offered to people with PNES.

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

Anxiety disorders (AD) are associated with significant morbidity and often are chronic and resistant to the treatment. A fascinating aspect of AD is the interplay of genetic and experiential factors. It is stablished that abnormal genes predispose to pathological anxiety states; however evidence clearly indicates that traumatic life events and stress are also etiologically relevant. The behavioral theories of anxiety postulates that anxiety is a conditioned response to a specific environmental stimulus. There may be two ways to neutralize fear conditioning either by facilitating a process called extinction or by blocking a process called reconsolidation.

Review novel approaches to the treatment of AD.

To update on treatment for AD.

A literature search was performed on PubMed database.

Cognitive behavioral therapies use exposure techniques, in which the patient has to confront the fear-inducing stimuli in a safe environment in order to facilitate the fear extinction. The therapy is often context-specific, so one way of strengthen extinction learning is by boosting NMDA receptor activation, either with direct acting agonists (D-cycloserine) or with indirect glycine enhancing agents (selective glycine reuptake inhibitors). Memory reconsolidation is based on the notion that memories are dynamic rather than stable. Reactivation of a memory can return it to a labile state from which it must be reconsolidated. Blocking reconsolidation is a therapeutic opportunity of update and alter the memory, weakening traumatic memories. Beta-blockers and opioids may disrupt this process.

Psychotherapy and psychopharmacology may have a synergistic role in AD treatment.

The authors have not supplied their declaration of competing interest.

Over 50% of adult disability claimants fail some form of SVT. While some over report psychological, affective symptoms, others may report incredible cognitive symptoms. We examined effects of different types of response bias on free recall and self-reported depression.

Participants and methods This is a single site cross-sectional study using a convenience sample (n = 224) of disability claimants in the Netherlands. The Green Word Memory Test (GWMT) was administered to all subjects. The Amsterdam Short Term Memory Test (AKTG), the Structured Inventory of Malingered. Symptomatology (SIMS), and the beck depression inventory (BDI-II) were administered in subsamples. Participant classification according to GWMT and SIMS outcomes resulted in four groups, G+/S+, G+/S−, G−/S+ and G−/S−.

Average age of the participants was 46.3 years (SD 9.9), 41.5% were female, and 43% were higher educated. GWMT was positive in 48.2% of all subjects, and 27.6% scored positive on both GWMT and SIMS. Analysis of variance of GWMT Free recall and Beck depression scores showed significant group differences [F(3, 123) = 33.21, P = .000] and [F(3, 106) = 25.17, P = .000] respectively.

Non credible test performance was prevalent in this Dutch study of disability claimants. Insufficient effort and over reporting of psychological symptoms are associated with different score profiles on regular tests and self-rating scales.

The author receives funding for his work as a neuropsychologist in an expertise setting.

The authors have not supplied their declaration of competing interest.

Seventy percent of patients with panic disorder (PD) have sleep impairment. Cognitive behavior therapy (CBT) effectively treats PD, but the concomitant effect on sleep is understudied. Physical exercise (PE) improves sleep, but this has not been investigated in patients with PD.

To compare the effects of CBT or PE on sleep in PD-patients, and to determine potential mechanisms of action.

Thirty-six PD-patients were randomized to either group CBT for PD or regular PE. Sleep was assessed pre/post with the Pittsburgh sleep quality index. Effects were investigated with repeated measures ANOVA and t-tests. Expected mediators were added to the general linear model to assess mediation.

The effect of time was significant, F(1.33) = 10.11, P = 0.003, but not the interaction (Time × group), F(1.33) = .48, P = 0.49. Symptoms were significantly reduced from pre- to post-treatment: PE, t(16) = 3.03, P = .008, and CBT, t(17) = 2.18, P = 0.044. CBT-patients changed significantly (P < 0.05) on Sleep quality, t(17) = 2.47 and Sleep disturbance, t(17) = 2.38. PE-patients changed significantly on sleep duration, t(16) = 2.58 and sleep disturbance, t(16) = 2.58. A significant interaction with change in fear of bodily symptoms, F(1.16) = 5.53, P = .032, and with change in depression-level, F(1.16) = 12.13, P = 0.003 was only found for CBT. A significant interaction with change in physical fitness, F(1.15) = 5.01, P = .041, was only found for PE.

Both interventions improve sleep in PD-patients, but differently. The findings also suggest that these changes are related to different mechanisms for PE and CBT.

The authors have not supplied their declaration of competing interest.

The Beck anxiety inventory (BAI) is a widely used 21-item self-report inventory used to assess anxiety levels in adults and adolescents in both clinical and non-clinical populations. The values for each item are summed yielding an overall or total score for all 21 symptoms that can range between 0 and 63 points. A total score of 0–7 is interpreted as a “Minimal” level of anxiety; 8–15 as “Mild”; 16–25 as “Moderate”, and; 26–63 as “Severe”. There is no study until this date that examines the Explanatory and confirmatory factor structure factor structure of BAI in college student in Kuwaiti.

The current study investigated the original four-factor structure of the (BAI) in non-clinical sample of college students.

Sample one consisted of 540 males and females while sample two consisted of 600 males and females from Kuwait University undergraduates. The Arabic version of BAI was administered to participants. Explanatory factor analysis based on sample one and conformity factor analysis based on sample 2.

The results revealed four factor structures of BAI in the two samples of Kuwaiti students. Which included neurophysiological, subjective, autonomic, and panic factors.

The results of both confirmatory and exploratory factor analysis indicated that the original four-factor structures of the BAI do provide the best fit for the college sample.

The authors have not supplied their declaration of competing interest.

Video games become increasingly popular form of spending free time, therefore they are often a research subject. Researchers focus mainly on video games influence over children's psyche and their social interactions, although video games can also have an impact on adult's behaviour.

Incidence of social anxiety disorder and impulsiveness among video game players and non-players.

An anonymous online survey included 263 students of medical university of Silesia (112 M and 151 W). In study group, 142 people (54%) declared to be players. Questionnaire contained questions about playing time, Barratt Impulsiveness Scale and Liebowitz Social Anxiety Scale. Statistical analyses were performed using the statistical software package Statistica 12.

Using Liebowitz Scale in 168 (64.86%) all studied people lack of phobia was found, moderate social phobia 39 (15.06%), marked social phobia 26 (10.03%), severe social phobia 17(6.56%) and very severe social phobia 9(3.47%). There was no statistical significance between players and non-players (test Chi2P = 0.6521). Also in Barratt Scale statistical significance was not found in attentional impulsiveness (test U M-W P = 0.3267) and in Motor impulsiveness (test U M-W P = 0.3140). Statistical significance was observed in Non-planning impulsiveness (players: 23.68 V non-players: 22.02; test U M-W P = 0.0036).

The study did not show clear influence adult's video games playing over social phobia and impulsiveness occurrence.

The authors have not supplied their declaration of competing interest.

The greatest social and economic burden is divided between the three main anxiety disorders: social phobia (SF), generalized anxiety disorder (GAD) and panic disorder (PD).

To examine the pathways of patients with PD, SF and GAD since the beginning of the first anxiety symptoms and before the first course of a standardized treatment in a specialized mental health facility.

To evaluate the period of delay in seeking specialized care and to identify the main ways of seeking medical/non-medical care.

Retrospective study (n = 80). Structured interview were based on WHO instruments: WHO WMH CIDI and WHO Pathways to care encounter form.

Average age was 38 years, more females (72.5%). The delay period was 7 years (GAD = 8.7; SF = 8.2, PD = 5.9), during which at least 2 episodes of the disease. The most popular specialists were: neurologists (19%), psychiatrists (17%) (one-time visits to which were not accompanied by the appointment of a standardized course of treatment for an adequate period of time) and therapists (15%). Non-medical care was 10% of all studied (psychologists–5%, healers–3%, priests–2%). SF–psychiatrists (43%), therapists (14%), psychologists (14%); GAD–psychiatrists (22%), neurologists (19%), psychotherapists (11%), ambulance doctor (11%); PD–therapists (22%), neurologists (22%), ambulance doctor (17%), cardiologists (9%).

The findings suggest that patients with anxiety disorders have a long period of delay in receiving specialized care that causes the value of the social and economic burden of anxiety disorders in the community.

The authors have not supplied their declaration of competing interest.

Generalized anxiety in young adults during college career is a serious public-health problem that untreated has a chronic course. Research has shown that the self-report questionnaire generalized anxiety disorder-7 (GAD-7) is a reliable and valid measure to assess generalized anxiety symptoms severity in heterogeneous psychiatric samples. However, GAD-7 is not available for non-clinical populations and their factor structure has not been re-examined.

Our objective was to examine factor structure and measurement invariance of the GAD-7 among college students testing two alternatives models.

The original model fit of single-factor was compared to two-factor model that considered in comprehensive approach of generalized anxiety the assessment of cognitive-emotional nature and somatic symptoms.

In this cross-sectional study the GAD-7 was administrated to college students (n = 1031) recruited in the six schools which compose the Polytechnic Institute of Coimbra, Portugal. Confirmatory factor analysis was used testing two models.

Among college students, 32.8% reported significant generalized anxiety symptoms. The original unidimensional structure of GAD-7 was confirmed but the two-factor model comprising cognitive–emotional and somatic factors presented better fit to the data (χ2(1) = 21.01, P < 0001). This latent factor were positively associated (r = 0.51, P < 0.001) and presented a good internal consistency (α = 0.85 and α = 0.86 for cognitive-emotional and somatic items, respectively). The invariance factor of two-factor model across gender was also confirmed.

Results indicate that within college communities the GAD-7 integrates two stable generalized anxiety factors related but independent structure. The GAD-7 can be an adequate measure to detected generalized anxiety symptoms in this population.

The authors have not supplied their declaration of competing interest.

It is widely known that childhood traumatic life situations are associated with most of the adult life psychiatric disorders such as disassociative disorders, mood disorders, anxiety disorders and so on.

The purpose of this study to examine the relationship between childhood traumatic experiences and panic disorder development.

The sample of this study consists of 59 outpatients who applied to the department of psychiatry in addition to 61 healthy individuals serving as the control group. These 59 individuals, located within the range of 18 to 65 years, were selected from outpatients who had been diagnosed with panic disorder based on DSM-V diagnosis criteria who did not have any other mental disorder. The 61 healthy individuals in the control group were selected from hospital attendants who had not received any psychiatric diagnosis. The participants were administered the childhood trauma questionnaire (CTQ) and a socio-demographic form.

The participants in the panic disorder group were found to have significantly high scores in comparison to the control group with respect to CTQ subscales (i.e., the emotional neglect and the emotional abuse subscale) and the total CTQ score. Hence, there exists a strong relationship between childhood traumatic experiences and panic disorder development.

The results revealed that childhood traumatic experiences play an active role in the development of panic disorder. Moreover, it was found that the type and quality of trauma experienced during the childhood period is one of the predictors for the psychiatric disease that can occur in the future years.

The authors have not supplied their declaration of competing interest.

Proper recognition of facial expressions of emotion is crucial for human social relationships. Impairments in the capacity to process facial information may play an important role in the etiology and maintenance of certain mental disorders, especially music performance anxiety (MPA).

To assess the recognition of facial expressions of emotion in musicians compared to a group of subjects from the general population, considering also the presence/absence of MPA.

Hundred and fifty amateur and/or professional musicians who regularly take part in public performances (GM) and 150 subjects from the general population (GP) completed a task of facial emotion recognition and were assessed in terms of accuracy and reaction time. The group of musicians was subdivided between subjects with and without MPA indicators. Data were analyzed using Student's t test (P < 0.05) within the statistical package for the social sciences.

GM were less accurate and had a longer reaction time in the recognition of facial happiness (P < 0.001, effect size: 0.25–0.44) compared to GP. Musicians with MPA had a still lower accuracy in the recognition of happiness, as well as longer reaction times for emotions as a whole (P < 0.04; effect size: 0.32–0.40) compared to musicians without MPA.

The poorer performance of musicians in the recognition of happiness suggests difficulties to recognize indicators of social approval, which may negatively affect performance through increased anxiety and negative thoughts that can favor the onset of MPA.

The authors have not supplied their declaration of competing interest.

Music performance anxiety (MPA) is a persistent and distressing experience that involves apprehension linked with musical performance in public (individual or collective). Anxious individuals concentrate their anxiety in situations that involve social scrutiny, favoring distorted, dysfunctional, and negative interpretations of that situation followed by experiences of physiological symptoms associated with the exposure. The most commonly used substances in the pharmacological management of MPA are beta-blockers and benzodiazepines. However, these options are not fully efficient and cause relevant side effects that interfere mainly with performance. Therefore, investigations on alternative substances to treat MPA are highly opportune.

To assess the acute effects of oxytocin (OT) on physiological and cognitive variables during an experimental model of simulated performance.

We assessed 12 musicians with MPA pre-treated with intranasal OT (24 UI) or placebo in a crossover trial involving an experimental situation of public performance. Cognitive and physiological measures (heart rate, blood pressure, salivary cortisol) were recorded before/during performance (anticipatory performance anxiety). Statistical analyses were made using Stata Direct.

The results showed no effects of OT on physiological symptoms (P > 0.190). In respect to anticipatory anxiety, however, we found a tendency for OT to reduce negative cognitions associated with music performance (P = 0.06). No side effects were reported by musicians throughout the trial.

These tendencies, if confirmed through the expansion of the sample, have important implications for the practice of amateur and professional musicians who could benefit from interventions as the one described, possibly with a lesser impact of side effects.

The authors have not supplied their declaration of competing interest.

The understanding of the causes of music performance anxiety (MPA) and of strategies to cope with it is important for the comprehension/management of this common condition in musicians.

To investigate the causes of MPA reported by Brazilian musicians and the efficacy of the most commonly used strategies to cope with it.

Two hundred and fourteen Brazilian musicians (53% professional/musicians from orchestras, 67% male, mean age: 34.02 years, 65% with over 11 years of education, 42% of which played string instruments) completed different self-rating scales to assess the presence/absence of MPA.

Thirty-nine per cent of the musicians had indicators of MPA. The most commonly reported causes were repertoire difficulty (57%), concerns about audience response (52%), and self-pressure (51%). The most common coping techniques included breathing/relaxing techniques (66%) and increased practice (53%), regarded as efficient by at least 49% of the musicians. Strategies like seeing a doctor/psychiatrist/psychologist and taking antidepressant/anxiolytic medication were among the least frequently used in the sample. Also, 18% of musicians with MPA used beta-blockers and 6% used non-prescribed medications. Comparatively, musicians with MPA believed that it was associated with a higher number of conditions and regarded coping techniques as less efficient.

Musicians consider internal situations to be the most frequent causes of MPA and use different coping strategies with average effectiveness. Results highlight the poor use of well-established therapeutic resources and the occurrence of self-medication in the sample, which together point to the need for attention on the part of mental health professionals to this specific group.

The authors have not supplied their declaration of competing interest.

Results from part of this trial were published as abstract in european psychiatry, Volume 30. Supplement 1, 28–31 March 2015, Pages 534 – “Somatoform Disorders-a New Target for Pregabalin”, http://dx.doi.org/10.1016/S0924-9338(15)30418-1.

Goal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.

The sample consisted of inpatients who met the ICD-10 criteria for the Depressive disorder, Panic disorder, GAD, Mixed anxiety-depressive disorder, Agoraphobia, Social phobia, OCD, PTSD, Adjustment disorders, dissociative/conversion disorders, Somatoform disorder or other anxiety/neurotic spectrum disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of clinical global impression-severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program.

The total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment in outpatients basis and were referred for hospitalization for the six-week complex therapeutic program, were enrolled in this study. Six hundred and six of them were statistically analyzed. The patients’ mean ratings on all measurements were significantly reduced during the treatment. The patients without comorbid personality disorder improved significantly more than patients with comorbid personality disorder in the reduction of depressive symptoms. However, there were no significant differences in change of anxiety levels and severity of the disorder between the patients with and without personality disorders. The higher degree of dissociation at the beginning of the treatment predicted minor improvement. The higher therapeutic change was connected to the greater reduction of the dissociation level.

Dissociation presents an important factor influencing treatment effectiveness in the treatment-resistant patients with anxiety/depression with or without personality disorders.

The authors have not supplied their declaration of competing interest.

Pharmacogenetic studies in obsessive-compulsive disorder (OCD) primarily focussing on serotonergic and dopaminergic polymorphisms, provided inconsistent findings. There is recent evidence for glutamatergic abnormalities in OCD.

Examine the association glutamatergic genes with serotonin reuptake inhibitor (SRI) response in OCD.

To study pharmacogenetic association between SLC1A1 and GRIN2B polymorphisms with SRI response in OCD.

DSM-IV OCD patients were recruited from a specialty OCD clinic and evaluated using the Yale-Brown obsessive compulsive scale (YBOCS), Mini International Neuropsychiatric Interview (MINI) plus, Clinical Global Impression scale (CGI). They were subsequently reassessed with YBOCS and CGI. To study extreme phenotypes, we included only full responders (> 35% YBOCS improvement and CGI-I score of 1 or 2) to any SRI (n = 191) and non-responders (< 25% YBOCS improvement and CGI-I score ≥ 4) to adequate trial of at least two SRIs (n = 84). Partial responders were excluded. Genotyping was performed using an ABI9700 PCR machine.

Genotype frequencies did not deviate significantly from the values predicted by the Hardy-Weinberg equation. Case-control association analyses revealed no significant association between genotype/allele frequencies with SRI response.

Our data does not show any association between polymorphisms in glutamatergic genes and SRI response in OCD though such associations have been found in other studies. More SNP's in the same gene could be responsible for the pharmacogenetic associations. More homogenous sample considering symptom dimensions and other phenotypic variables may be needed. It may be critical to go beyond “usual suspect” candidate gene research. In this regard, a novel approach to identify SRI response biomarkers is the use of cellular models.

The authors have not supplied their declaration of competing interest.

Cognitive-behavioral therapy (CBT) has been found to be an effective treatment of excessive health anxiety (HA), but the long-term effect over 18months has not been examined.

Several studies have shown effect of CBT for HA-patients. However, these effects have been short or immediate after therapy. To our knowledge no studies have examined long-term effect of CBT for HA over 18 months.

To investigate the long-term effect of CBT on HA, focusing on level of HA, quality of life, subjective health complaints and general anxiety. Follow-up time was at least 10 years. Our hypothesis was that the effect was sustained.

Patients with HA received 16 sessions of CBT over a period of 12–18 months, and were followed up over at least 10 years. All patients fulfilled criteria for F45.2, hypochondriacal disorder according to ICD-10.

The patients answered several questionnaires, exploring areas such as HA, Quality of life, somatization, and mental health problems. Questionnaires were answered before CBT, after CBT and at follow up. Mixed model analysis was performed in SPSS 23.0 for all questionnaires.

All scores were found to be significant in the Pre-CBT–Post-CBT and Pre-CBT–FU (0.034– < 0.001), and none were found to be significant in the Post-CBT–FU.

Our findings suggest that for the majority of patients with HA, CBT has a significant and lasting long-term effect. This effect lasts up to ten years post therapy.

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

Patients with serious mental illness have lower life expectancy and higher prevalence of metabolic syndrome compared to normal population. Although, we have little evidence about their first-degree relatives.

To compare metabolic syndrome in patients with bipolar disorder treated with atypical antipsychotics, their first degree relatives and healthy subjects in two age groups: under and over 40.

This cross-sectional study was conducted on 100 patients with bipolar disorder treated with atypical antipsychotics, 50 first degree relatives and 135 healthy subjects. The prevalence of metabolic syndrome was assessed based on National Cholesterol Education Program (NCEP).

Under the age of 40, the prevalence of metabolic syndrome was 15.4% in patients with Bipolar disorder, 17.6% in first degree relatives and 7% in healthy subjects. Systolic blood pressure was significantly higher in bipolar disorder patients (P = 0.004). In those over 40, the prevalence of metabolic syndrome was 31.8% in patients with bipolar disorder, 33.3% in first-degree relatives and 32.8% in healthy subjects. Serum levels of HDL were significantly lower in bipolar disorder patients (P = 0.002).

Patients with bipolar disorder and their first-degree relatives have greater chance for cardiovascular disease due to higher metabolic syndrome. Further investigations are needed for evaluating serious mental illness patients and their relatives.

The authors have not supplied their declaration of competing interest.