The term “Hikikomori” refer to the modern phenomenon–severe (acute, prolonged) social withdrawal (SSW). Recently, there have been increasing reports of Hikikomori around the globe, Ukraine is not an exception.

To describe epidemiological and psychopathological features of Hikikomori from Ukraine.

Hikikomori was defined as a six-month or longer period of spending almost all time at home, avoiding social situations, social relationships, associated with significant distress/impairment. Lifetime history of psychiatric diagnosis was determined by the M.I.N.I. 7.0. Additional measures was Alexithymia Scale (TAS-20), Life experience questionnaire (LEQ), Buss-Durkee Hostility Inventory (BDHI), Chaban quality of life scale (CQLS).

In total, 65.4% of Hikikomori group (HG, n = 26) had at least one psychiatric diagnosis, 34.6% had not. Personality disorders (15.4%), PTSD (11%), MDD (7.7%), SAD (7.7%), OCD (7.7%), bulimia nervosa (3.8%) were the most common. Onset of SSW in 41.7% started before 18 y.o. Healthy individuals formed the control group (CG, n = 25). Individuals with Hikikomori had high level of alexithymia (TAS-20 M = 71, SD = 11.6 vs. M = 60.8 SD = 13.8, P = 0.006). Childhood trauma was reported by 31.8% of CG vs. 52% of HG. Hikikomori had higher trauma index (LEQ M = 3.03, SD = 0.98 vs. 2.31, SD = 1.1, P = 0.019), larger number of lifespan traumatic events (LEQ 95%CI 4.57–7.35 vs. 2.8–5.28, P = 0.039); higher levels of irritability, resentment, suspiciousness, higher aggressiveness (BDHI M = 23, SD = 6.4 vs. M = 16.6, SD = 6, P = 0.001), low quality of life (CQLS M = 12.4, SD = 3.3, Р ≤ 0.001).

Hikikomori exist in Ukraine, SSW quantitatively and qualitatively related to childhood trauma, manifests in adolescence, can be characterized by defined psychopathological features and affects quality of life.

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

Depression is a frequently seen but under-recognized and under-treated syndrome in community. Stigmatization is an important barrier for care-seeking and treatment.

In this study, we aimed to investigate the relationship of sociodemographic factors and attitudes towards depression between young and old age groups in a clinical population.

A total of 133 patients (18–88 years old, n = 37 old-age group, n = 96 young-age group) with a diagnosis of depression were recruited in this study. All the patients were evaluated with a semi-structured clinical interview and using stigmatization scales.

As young and old age groups compared, RHIDO total scores, RHIDO alienation sub-scale scores, social withdrawal subscale scores, and resistance to stigmatization subscale scores were found to be higher in young-age group than old-age group. Except working status, other sociodemographic factors were not found to have any effect on the scores of stigmatization scales.

Regarding the clinical features; number of episodes, comorbid physical disorders and time since first admission had an effect on RHIDO total and subscale scores. Negative attitudes towards depression were seen to be common in all the subjects, but no statistically significant difference was found between young and old age groups.

Stigmatization is very common also for depression, and it is found to be related to different features including age, working status, and time since first admission. In order to help for decreasing the negative attitudes and increasing the help seeking behavior, some interventions should be conducted both in psychiatry clinics and society.

The authors have not supplied their declaration of competing interest.

We present three community case studies for how community development and cultural enhancement affected mental health as an epiphenomenon.

An initiative was undertaken in 3 Northern Canadian aboriginal communities to enhance spiritual and cultural fluency and to provide opportunities to healthy interaction among community members. We began each process with a narrative investigation of the community by eliciting stories about perceived problems in the community. We collected further narratives at the end of the intervention about how it had affected people personally. We reviewed the narratives for commonalities and themes using modified grounded theory and dimensional analysis. We measured numbers of patients presenting to behavioral health services with mental health diagnoses, number of people sent to hospital for mental health treatment, and number of suicide attempts. We collected quality of life data using the My Medical Outcome Profile 2.

Community development and cultural enhancement efforts reduced all of the variables we were tracking. Follow-up interviews revealed common themes of people becoming more present-centered, feeling higher quality in their relationships; feeling more connected to god, creator, nature, or higher power; feeling more peaceful; feeling more accepting of death and change; and having a greater sense of meaning and purpose. As an interesting side effect, people began to eat more traditional diets and to be more active.

Creating opportunities for community interaction and shared community projects and enhancing interactions with spiritual elders resulted in improvement in indices of mental health in three indigenous communities in Northern Canada.

The authors have not supplied their declaration of competing interest.

Global estimates suggest over 130 million girls and women have undergone FGM. While practiced in Africa, Asia and the Middle East, due to immigration trends it is now prominent in Western society. While studies have focused on physical health consequences, post-2000 a small but growing number of studies have reported on the psychological impact of FGM. This paper reports on a project exploring the mental health consequences of FGM, the effectiveness of therapeutic support, and the sustainability of a new service through training peer mentors.

To establish and evaluate 3 drop-in clinics, offering emotional support to women who have experienced FGM. Build capacity through training peer mentors to continue the work of supporting women.

Community-based participatory research (CBPR) was used for this two-part project. In part 1, 30 women participated, data being collected via the Warwick-Edinburgh Mental Well-being Scale (WEMWS) and follow-up interviews. Part 2 involved the training of 12 peer mentors. Data was analysed using descriptive statistics and thematic analysis and evaluation respectively.

Improvement was found in the women's mental well-being, with themes (1) Speaking the unspoken (2) Emancipation of emotion (3) Harnessing hope, being identified. Of the 12 peer mentors successfully completing the course, 9 are now volunteering.

Mental health professionals are best placed to enable women to address FGM traumas and improve their mental well-being. Additionally, they can raise public and professional awareness and, through research, can help develop more appropriate and sensitive services for migrant women from practicing communities.

The authors have not supplied their declaration of competing interest.

The aim of this study was to examine (1) public knowledge and perceptions about attention-deficit hyperactivity disorder (ADHD) and (2) factors influencing the public's decisions to adhere to ADHD pharmacotherapy.

In this study, 396 participants responded to the Internet survey regarding their experiences, beliefs and treatment preferences about ADHD.

Two hundred and fifty-two respondents (63.6%) were reluctant to pharmacological treatment of ADHD. The respondents chose the functional impairment of the brain as the main cause of ADHD were favorable to pharmacological treatment and scored significantly high on the ADHD Knowledge Questionnaire. On the other hand, the respondents who regarded ADHD as an overly active personality rather than a disease were skeptical to pharmacotherapy and scored significantly low. The respondents who were acquainted with someone who had been diagnosed with ADHD perceived themselves relatively well informed about ADHD. However, the subjective perception of the degree of knowledge of ADHD was not correlated with the objective score of the ADHD Knowledge Questionnaire.

The Korean public is not well informed about ADHD and its treatments. Culturally appropriate psychoeducational strategies based on the media and the Internet are needed. Providing biomedical conceptualization of ADHD to the public may aid with treatment decisions and promote adherence to pharmacological treatment.

The authors have not supplied their declaration of competing interest.

Koro syndrome has traditionally been considered a culturally bound syndrome, characterized by the delusional belief that one's genitalia are retracting and the anxiety caused by the perception of imminent death. Although it is widely regarded as an epidemic in South-east Asia, there are some isolated cases in other cultures as well.

We present a Koro case study and a systematic review, focusing on the presentation and its treatment, in order to make visible this syndrome to Western culture and provide the tools to identify it.

To provide an overview of Koro's presentation, phenomenology and treatment. We also want to clarify the nosology classification of this syndrome and its influence in the reported cases.

We begin describing a new case of Koro syndrome: a Spanish male presented an acute psychosis, the patient had an intellectual disability and a family history of mental illness. A systematic review was done based on articles published in Pubmed following the PRISMA guidelines.

From 117 studies, only 29 met the inclusion criteria. Data were analyzed on several epidemiological and clinical characteristics. We found that Koro syndrome is more often presented as a result of intoxication or as a part of a previous known psychotic disorder. Cases involving patients sharing their delusion have been only reported in Asia.

No specific data could be obtained about epidemiology and pathogenesis, as our conclusion about Koro syndrome was based mainly on few case studies. Pharmacotherapy and social support may be effective in ameliorating the symptoms.

The authors have not supplied their declaration of competing interest.

There is a lack of cross-cultural comparison of patients and staff perceptions of quality of care in the psychiatric care. One reason is the absence of standardized instruments.

The international research programme “Quality in Psychiatric Care” aims at adapting the instrument QPC versions for patients and staff to different international settings.

The aims are to test the psychometric properties and equivalence of dimensionality of the different language versions of QPC and also to describe and compare the quality of inpatient, outpatient and forensic in-patient psychiatric care across different countries.

The QPC is a family of self-reported instruments from the patients’ perspective. In this programme, we used different languages versions in three areas for patient and staff; inpatient (QPC-IP/IPS), outpatient (QPC-OP/OPS) and forensic inpatient care (QPC-FIP/FIPS).

The Danish versions for QPC-FIP and QPC-FIPS show that the confirmatory factor analysis revealed that the factor structure was equivalent to the original Swedish version. Patients rated the quality of care generally lower than staff and lowest in the participation dimension. The Indonesian version of QPC-IP is under analysis. The first result show that patients rated the quality of care lower than Swedish inpatients and lowest in the discharge dimension. Several studies in Indonesia are still ongoing as well as in Brazil and Spain.

There are few standardized instruments for measuring quality of care in the psychiatric care. Therefore, QPC is expected to makes an important contribution to the development in this field.

The authors have not supplied their declaration of competing interest.

There is a notion that emotional expression is universal, yet it is subject to cultural variations. Research in this field has studied cultural extremes in European, American and East Asian cultures. However, very little is known about the differences in emotional expression in the Arab subcultures.

Exploring the differences between the emotional reactions among the nine Arab subcultures.

Aims (1) Examining the cultural differences in emotional reactions; (2) examining the differences between Muslim and non-Muslim individuals; (3) exploring the differences between Arabs and non-Arabs.

Several real life scenarios including 15 different stressful situations and 15 non-stressful situations were presented to 40 individuals from the nine Arab subcultures. The participants were aged between 18 to 40 years of age. The subjects were randomly classified into groups depending on whether they were Arabs or non-Arabs and according to whether they were Muslims or non-Muslims. The subjects’ emotional reactions were measured by means of Likert-like items.

The results showed that there were no significant differences among the nine Arab subcultures in their emotional reactions to the non-stressful situations. However, there were significant differences among the Arab subcultures in the stressful situations. Moreover, both religion and ethics were strong predictors of the differences in the emotional reactions that varied between subjects in their cultural group. The Arab Muslims tended to express more anger but the Arab non-Muslims expressed more sadness.

Emotional expression is impacted by ones’ cultural background and is particularly influenced by religion and ethics. Although Arab countries share the same language, they express emotions differently.

The authors have not supplied their declaration of competing interest.

The extension project “UNIRIO is madness: the improvement of mental health competences and skills.” work since 2015 with “Ponto de Cultura Loucura Suburbana” on the promotion of mental health and culture style in Brazil. The project work on the development of psychosocial rehabilitation for psychiatric patients, their families and the community.

Participate on the production and execution on the artistic/therapeutic workshop that demystify the social stigmatizing vision about psychiatric patients.

The activities developed are: administrative actions; institutional strengthening for social inclusion initiative through work; and the Carnival Block organization.

This study work on constituting a social inclusion initiative through workshop that generate employment, e.g.: sale material production, financial management, material replacement. Although we do all the preparative to the Carnival Block–“Loucura Suburbana”.

The relationship with the psychiatric patients shows that social inclusion through carnival workshop practice is the primary means for the identity of people suffering from mental disorders and contribute to reduce community social stigma.

The authors have not supplied their declaration of competing interest.

DUP is the time from the emergence of first psychotic symptom to the commencement of adequate antipsychotic treatment. Psychopathological and sociocultural factors influence patient's treatment seeking behavior. Better understanding of DUP could help in development of improved therapeutic strategies and public health initiatives. Emphasis on early detection of psychosis and reduction of DUP has led to a huge interest in pathways to care.

To understand the differences in baseline demographics, presentation, care-pathways and DUP in ethnically diverse population of Lancashire, UK.

Our cross-sectional study involved a subset analysis of National EDEN data for Blackburn and Preston in Lancashire.

Of the 183 patients, 78% were Whites and rest belonged to BME population. Median DUP was 188 days. Whites were significantly younger at onset of both non-specific symptoms and psychosis and at acceptance into EIS. Whites were significantly less likely than non-whites to be married, more likely to be in paid work and to have used illicit drugs. There were no significant differences with respect to other demographics/delays in help seeking or DUP. Non-White group had shorter DUP of 95 days (but not statistically significant, P = 0.060).

Better understanding of mental illness and local services in White patients could have led to early help seeking. Having a supportive family may have promoted early help seeking and thus shorter DUP in BME group. Further studies are needed exploring socioenvironmental variables, substance misuse and knowledge of local psychiatric services amongst the BME population and the influence of these variables on DUP.

The authors have not supplied their declaration of competing interest.

In the rubber hand illusion (RHI) [1], sense of body ownership is changed by synchronous touches to the hidden participant's hand and a visible rubber hand. It was previously shown [2] that medically unexplained symptoms were associated with the weaker RHI (n = 40).

We used data from our previous research [3] and supplementary questionnaires to test the hypothesis that somatoform symptoms would be associated with the decreased response to RHI.

Subjects (n = 78) voluntarily undergo the following procedures: RHI experiment with measurement of proprioceptive drift and self-reports, Screening for Somatoform Disorders (SOMS-2) and Symptom Check List-90-Revised (the “somatization scale”).

Robust regression was used to evaluate predictors influence: Drift/Self-reports∼SOMS-2 + somatization. SOMS-2 was a significant predictor for proprioceptive drift with positive coefficient (P < 0.05, adjusted), both predictors were insignificant for self-reports.

Thus, the results of [2] were not reproduced. We demonstrated on the larger sample, that the higher somatoform symptoms (scores of SOMS-2) predicted the stronger RHI. Since our research and [2] had been conducted on non-clinical groups, it is necessary to conduct the critical experiment on the clinical population.

The reported study was funded by RFBR according to the research project No.16-36-00394.

The authors have not supplied their declaration of competing interest.

There is a limited amount of data regarding the relationship between epilepsy and psychiatric symptoms and quality of life (QoL) in children and adolescents.

The aim of this study was to determine the levels of depression, anxiety and attention-deficit hyperactivity disorder symptoms and health-related quality of life (HRQL) in children and adolescents with epilepsy.

The sample consisted of 75 children with epilepsy and 50 healthy controls aged 8–18 years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients.

Patients had lower child-rated psychosocial and total area HRQL scores, and lower parent-rated psychosocial, physical and total area HRQL scores than the controls did. Inattention scores of the epilepsy group were significantly higher compared to controls. No significant differences were found between patients and controls in terms of anxiety and depression scores. Regarding determinants of HRQL, severity of depression and anxiety had a decreasing effect on child-rated HRQL total scores; and severity of anxiety had a decreasing effect on parent-rated HRQL total scores.

Epilepsy is associated with poor QoL in childhood and severity of depression and anxiety are among the determinants of QoL. Clinicians should be more aware of accompanying psychiatric symptoms in epileptic patients and take the necessary precautions in the early period of the illness in an effort to improve QoL.

The authors have not supplied their declaration of competing interest.

Lyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.

Identification of neuropsychiatric symptoms associated with Lyme disease.

Literature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.

Since the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.

According to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.

The authors have not supplied their declaration of competing interest.

The early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how bedside cognitive tests perform across the spectrum of delirium and motor subtypes.

The performance on a battery of bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neuro cognitive disorder and in motor subtypes.

One hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test whereas those with subsyndromal delirium were best identified using interlocking pentagons test and months backwards test. Those with subsyndromal delirium were significantly better in their ability to engage than those with full syndromal delirium.

Simple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.

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

Morbid obesity (BMI ≥ 35) has been associated with mood and anxiety disorders. Regular use of antidepressants is common among patients who are candidate for bariatric surgery. The Roux-en-Y gastric bypass (RYGB) is one of the most common techniques used in bariatric surgery for reducing nutrient absorption. This type of surgery may however result in major changes in drug absorption.

To report and discuss the consequences of bariatric surgery on changes in antidepressant drug absorption.

We present all published in vitro and in vivo studies on antidepressant drug absorption after bariatric surgery.

In vitro studies showed that only bupropion had a significantly increased dissolution in a post-RYGB environment; venlafaxine and citalopram showed no alteration of dissolution; fluoxetine, paroxetine, sertraline, and amitryptiline had an significantly decreased dissolution in a post RYGB environment. Some in-vivo studies reported that only citalopram and escitalopram had an increased dissolution.

After bariatric surgery, special caution is required in patients using antidepressant medication because of the expected changes in drug absorption, nutritional status, and electrolyte balance.

The authors have not supplied their declaration of competing interest.

There is a large consensus concerning the important aetiological role of childhood trauma in chronic fatigue syndrome (CFS). In the current study, we examine the differential effect of childhood trauma subtypes on fatigue and physical functioning in patients with CFS.

One hundred and fifty-five participants receiving treatment at the outpatient clinic for CFS of the Antwerp University Hospital in Belgium were included in this study. Stepwise regression analyses were conducted with the outcomes of the total score of the Checklist Individual Strength (CIS) measuring fatigue and the physical functioning subscale of the medical outcomes short form-36 health status survey (SF-36) as the dependent variables, and the scores on the five Traumatic Experiences Checklist (TEC) subscales as the independent variables.

Fatigue and physical functioning scores in CFS patients were significantly predicted by sexual harassment only. A significant effect of emotional neglect, emotional abuse and bodily threat during childhood on elevated fatigue or reduced physical functioning levels could not be found.

There is a differential effect of childhood trauma subtypes on fatigue and physical functioning in CFS patients. Sexual harassment emerged as the most important predictor variable. Therefore, childhood (sexual) trauma has to be taken into account in assessment and treatment of chronic fatigue syndrome.

The authors have not supplied their declaration of competing interest.

Joint hypermobility syndrome/Ehlers Danlos III (JHS/EDS III) is a common, connective tissue condition. This group is over-represented in panic/anxiety disorders and exhibits autonomic abnormalities and heightened interoceptive sensibility. Previous neuroimaging in healthy volunteers with hypermobility has observed differences in key emotional brain regions, notably amygdala and insula.

Aims and objective To explore, in a clinical population, the structural brain correlates underpinning the association between JHS/EDS III and anxiety.

Seventy participants were divided into four experimental groups: (2 × 2 factor design: presence/absence of hypermobility; presence/absence of anxiety). Hypermobility was assessed using Brighton Criteria. All participants underwent brief tests of autonomic function and interoception. Structural images were obtained using a 1.5 T MRI scanner. Results are reported at whole brain uncorrected significance threshold of P < 0.001.

Comparison of grey matter volume revealed increased insular volume in anxious patients with JHS/EDS-III compared to anxious patients without (Fig. 1A, B), correlating with initial peak heart rate on standing. Additionally, amygdala volume correlated with hypermobility score in anxious patients, but not in non-anxious individuals (Fig. 1C, D). Amygdala volume correlated with interoceptive accuracy.

This data implicates amygdala and insula as likely neural substrates mediating clinical relationships between hypermobility syndrome and anxiety, demonstrating the relevance of autonomic and interoceptive influences on this relationship. Further work hopes to explore functional and structural connectivity between these regions in JHS/EDS-III.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Due to the aging population worldwide, chronic pain is becoming an important public health concern. Chronic pain is bidirectional associated with psychiatric disorders including depression and anxiety. Antidepressants are widely used as adjuvant therapy for the treatment of chronic pain for many disorders.

To review available literature on the efficacy and safety of antidepressants for the treatment of chronic pain, including neuropathic pain, fibromyalgia, low back pain, and chronic headache or migraine.

We performed a detailed literature review through PubMed, EMBASE and Cochrane's Library to assess the efficacy and safety of antidepressants in chronic pain conditions.

In neuropathic pain, fibromyalgia, low back pain, and chronic headaches/migraine, tricyclic antidepressants (TCAs) showed a significant analgesic effect. Selective serotonin reuptake inhibitors (SSRIs) are not effective for the treatment of low back pain and headaches or migraine. Venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI) showed significant improvement of fibromyalgia and neuropathic pain. Duloxetine (SNRI) also reduced the pain in fibromyalgia.

TCAs are the ‘gold standard’ antidepressant analgesics. However, an electrocardiogram and postural blood pressure should be implemented prior to TCA treatment and TCAs should be initiated at low dosages and subsequently increased to the maximum tolerated dose. One should pay attention to their cardiotoxic potential, especially in the older population. For the treatment of neuropathic pain, SNRIs are second-line agents. Although better tolerated, in most types of chronic pain conditions, the effectiveness of SSRIs is limited. To conclude: start low, go slow, and prescribe with caution.

The authors have not supplied their declaration of competing interest.

Short stature caused by growth hormone (GH) deficiency is one of the causes of the “Failure to Thrive” (FTT) condition. In absence of clear organic causes, several different psychosocial conditions may play a role in explaining the FTT phenotype. Advances in developmental psychology have highlighted the role of emotions and caregiving behaviors in the organization of child's personality and psychobiology, with the mother–son attachment bond being considered a fundamental developmental experience. The objective of the present preliminary study was to assess whether there are significant correlations between attachment styles and GH levels in a sample of subjects with non-organic FTT.

We enrolled 27 children (mean age: 9.49 ± 2.63) with non-organic FTT. Perceived attachment security was assessed through the Security Scale (SS) and its subscales focused on maternal and paternal security. Pearson partial correlation was used to test associations between GH levels and SS measures adjusting for confounding factors (i.e. age, gender and BMI).

Across all subjects, GH was significantly positively correlated with general security (r = 0.425; P = 0.038) and maternal security (SSM) (r = –0.451; P = 0.027) and not significantly correlated with paternal security (SSP) (r = 0.237; P = 0.264).

These findings preliminarily suggest that perceived attachment security may play a role in the etiopathogenesis of non-organic GH deficiencies and add to the accumulating evidence that attachment styles are associated with specific psychoendocrine underpinnings.

The authors have not supplied their declaration of competing interest.