To examine 5 years trajectories of secondary-treated late-life major depressive disorder (MDD), and evaluate whether pre-existing cerebrovascular disease and related risk factors are associated with more severe trajectories of late-life MDD.

Data were obtained from Danish registers. The sample included 11,184 adults ≥ 60 at index MDD diagnosis. Trajectories of in or outpatient contact at psychiatric hospitals for MDD over the 5 years period following index MDD diagnosis were modeled using latent class growth analysis. Risk factors included cerebrovascular disease, cardiovascular disease, hypertension, diabetes, and vascular dementia defined based on hospital diagnoses and prescription medications, demographic characteristics and characteristics of the index MDD diagnosis.

The final model included classes with consistently low (66%), high decreasing (19%), consistently high (9%) and moderate fluctuating (6%) probabilities of contact at a psychiatric hospital for MDD during the 5 year period following the index MDD diagnosis (Fig. 1). Older age, greater severity, inpatient treatment and > 12 antidepressant prescriptions within 5 years of the index MDD diagnosis predicted membership in more severe trajectory classes. Cerebrovascular disease and related risk factors were not associated with trajectory class membership.

A substantial proportion (34%) of individuals diagnosed with MDD in late-life require specialized psychiatric treatment for extended periods of time. We found no evidence that cerebrovascular disease or related risk factors predicted course trajectories in secondary-treated late-life MDD.

The authors have not supplied their declaration of competing interest.

It is known that there is a cognitive decline in major depressive disorder. Most studies were performed on patients whose sum on a Montgomery and Asberg depression rating scale was greater than 30.

In our work, we concentrated on mild and moderate depression, MADRS > 30 was not criteria. Patients included were diagnosed with mild to moderate depressive episode.

To determine how depressive episodes affect cognition.

We included 30 patients diagnosed at the clinic for psychiatry in Nis. We covered the age group between 20 and 40 years, regardless of the gender and educational level. For the assessment of cognition, we used digital symbol substitution test (DSST), Rey audio verbal learning test (RAVLT), trail making test (TMT), stroop color naming test (Stroop), and patients were evaluated with Montgomery and Asberg depression rating scale (MADRS). Tests were conducted on the first visit to a psychiatrist. Patients were compared with the results of the healthy population with the same characteristics, and in the same period (August 2016). Mean values were compared and groups were compared by Student's t-test.

There was a statistically significant difference in all of the tests, and all of the parts of tests conducted on the patients and the control group.

There is a statistically significant cognitive decline in patients with mild and moderate depression.

The authors have not supplied their declaration of competing interest.

Clinicians need to make the differential diagnosis between unipolar depression and bipolar disorder to guide their treatment choices. Looking at the differences observed in the emotional schemas might help with this differentiation. This study is an exploratory investigation of schema theory's Leahy's emotional schemas among individuals diagnosed with bipolar disorder and unipolar depression.

Three groups of subjects 56 unipolar depression in the remission period, 70 bipolar eutimic and 58 healthy controls were asked to fill out the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the participants according to the criteria of DSM-IV-TR with SCID-I, and rated the moods of the subjects with the Beck Depression Scale, and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on LESS.

The bipolar eutimic and unipolar depression patients’ scores on the LESS dimensions were significantly different from the healthy participants in the areas of control, consensus, acceptance of feelings, dissimilarity and simplistic view of emotions.

These results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar disorder. Bipolar disorder may be associated with a general activation of the emotional schemas.

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

COPD is a common disease, has an impact not only on psychical but also on psychological well-being. Anxiety, stress, depression are common comorbidities for COPD patients.

This paper proposes to study from a qualitative point of view the effect of depression on COPD patients.

A qualitative methodology was chosen in order to explore 75 (male n = 69, female n = 6) COPD patients’ symptoms and signs of anxiety, stress and depression.

Data were collected through semi-structured interviews. All patients also completed the Beck Inventory and the GDS 15 questionnaires. The interviews were conducted both in the general university hospital of Larissa and in patients’ homes.

We enrolled 75 patients (15: normal, 17: mild depression, 7: moderate and 1 severe). Persistent low mood and lack of interest was expressed by most of the participants. “Before I get this thing, I was in a good mood, but not now”. Poor self-management was associated with anxiety disorders and high temper: “I withdrew, due to my health”…“I was really stressed, and depressed, and quick-tempered”. COPD diagnosis was difficult for some patients: “At the beginning, I wasn’t in the mood for anything, just sleeping and more of watching TV”. Other patients seemed to be in a good mood: “I was never scared of anything, I am happy”.

This research shows that depressive and anxiety symptoms are common among COPD patients. Depression has a significant impact on the daily life of patients while breathlessness made patients feel housebound and social isolated.

The authors have not supplied their declaration of competing interest.

This post-hoc analysis evaluated whether the efficacy of lurasidone in major depressive disorder (MDD) with mixed features is moderated by the number and characteristics of manic symptoms present at study baseline.

Patients meeting DSM-IV-TR criteria for MDD who presented with two or three manic symptoms (consistent with the DSM–5 mixed features specifier) were randomly assigned to 6 weeks of double-blind treatment with either lurasidone 20–60 mg/d (n = 109) or placebo (n = 100). Finite mixture models were applied to identify latent class patterns of the 10 baseline manic symptoms.

Three latent class profiles were identified: 105 (50.5%) patients had manic symptom profile 1 (MIX 1) with mean MADRS 33.0, mean YMRS 9.2, mean number of manic symptoms 3.8; 63 (30.3%) patients had manic symptom profile 2 (MIX 2) with similar baseline mean MADRS (32.4) and YMRS (9.3) and lower number of manic symptoms 3.5; 40 patients had manic symptom profile 3 (MIX 3) with significantly higher severity scores in MADRS (35) and YMRS (14.9) and mean number of manic symptoms 4.6. A significant moderating effect on change in YMRS score was observed for the “decreased need for sleep” symptom, with greater lurasidone effect size (vs. Placebo) found in patients without vs. With this symptom (P < 0.05).

In this post-hoc analysis of a placebo-controlled trial involving MDD patients with mixed features, absence of “decreased need for sleep” was found to be significantly associated with improvement in manic and depressive symptoms and to moderate the treatment effect on manic symptoms.

I am full time employee of Sunovion pharmaceuticals Inc.

The goal of this study was to examine the influence of dissociation, hope, personality trait and selected demographic factors in treatment response of this group of patients.

Pharmacoresistant depressive inpatients completed clinical global impression – both objective and subjective form, Beck depression inventory, and Beck anxiety inventory at baseline and after six weeks of combined pharmacotherapy and psychotherapy (group cognitive behavioral or group psychodynamic). The Internalized Stigma Of Mental Illness Scale, Dissociative Experience Scale Adult Dispositional Hope Scale, and temperament and character inventory were completed at the start of the treatment with the intention to find predictors of treatment efficacy.

The study included 72 patients hospitalized for the pharmacoresistant major depression, 63 of them finished the study. The mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, discrimination experience (ISMI subscale), and harm avoidance (TCI-R personality trait). According to stepwise regression, the strongest factors connected to BDI-II relative change were the duration of the disorder and discrimination experience (ISMI). ObjCGI relative change significantly correlated with the level of dissociation, the total ISMI score, and hope in ADHS total score, and self-directedness. According to stepwise regression, the strongest factor connected to objCGI relative change was discrimination experience (ISMI).

According to our results, the patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment.

The authors have not supplied their declaration of competing interest.

Melancholic features of depression (MFD) seem to be a unidimensional group of signs and symptoms. However, little importance has been given to the evaluation of what features are related to a more severe disorder. That is, what are the MFD that appear only in the most depressed patients. We aim to demonstrate how each MFD is related to the severity of the major depressive disorder.

We evaluated both the Hamilton depression rating scale (HDRS-17) and its 6-item melancholic subscale (HAM-D6) in 291 depressed inpatients using Rasch analysis, which computes the severity of each MFD. Overall measures of model fit were mean ( ± SD) of items and persons residual = 0 (± 1); low χ2 value; P > 0.01.

For the HDRS–17 model fit, mean (± SD) of item residuals = 0.35 (± 1.4); mean (± SD) of person residuals = –0.15 (± 1.09); χ2 = 309.74; P < 0.00001. For the HAM-D6 model fit, mean (± SD) of item residuals = 0.5 (± 0.86); mean (± SD) of person residuals = 0.15 (± 0.91); χ2 = 56.13; P = 0.196. MFD ordered by crescent severity were depressed mood, work and activities, somatic symptoms, psychic anxiety, guilt feelings, and psychomotor retardation.

Depressed mood is less severe, while guilt feelings and psychomotor retardation are more severe MFD in a psychiatric hospitalization. Understanding depression, as a continuum of symptoms can improve the understanding of the disorder and may improve its perspective of treatment.

The authors have not supplied their declaration of competing interest.

In the Tunisian cultural context, the mother is in charge of childcare, housekeeping and the well-being of the whole family, which can lead to exhaustion and depression.

To estimate the frequency of depression among mothers aged between 20 and 40 years, its consequences and the possible solutions.

Transversal study using an anonymous questionnaire of 26 questions published through social media sites to mother with young aged children.

Three hundred and twenty-seven mothers participated in the study: 20% of them aged between 20 and 30 years and 80% between 30 and 40. Ninety-seven percent of the participants were married; 96% of them had university education. Seventy-nine percent of them were working mothers and 50% of them did not get any help in childcare. Forty-two percent of the participants had only 1 child, 49% had 2 children, 8% 3 children and only 1 mother had 4 children. Depressive symptoms were present in 73% of the participants and were significantly higher among mothers aged between 30 and 40. However, depression was certain in only 36% of them and there was no significant difference between the two age groups. Eighteen percent of the participants noticed an increase in consummation of cigarettes, 31% resorted to tranquilizers, 25% needed sick leaves, and 2% resorted to alcohol use. Less working hours was suggested as a solution in 36% cases, sharing house chores in 30% cases.

Depression among young mother is a public health problem in Tunisia. It is underestimated and not always treated, which can have a serious impact on the whole family well-being.

The authors have not supplied their declaration of competing interest.

The aim was to investigate the dietary status of adults with ADHD. Furthermore, we compared the group with a representative sample of a healthy adult Danish population.

Data were collected from the ADHD database operated by the ADHD outpatient clinic at Aarhus university hospital. We used data from newly referred patients in a seven months period from April 2014 through October 2014. The collected data include weight, height, blood pressure, somatic or psychiatric co-morbidity, blood sample, physical activity scale. Concerning the diagnosis of ADHD: DIVA, ASRS, BRIEF-V. Inter99 was used to assess the dietary status. The representative sample was obtained as a part of a public health survey from 2010 called “how are you” conducted in the same region of Denmark as the location of the psychiatric hospital. Preliminary results, one hundred and forty-three patients were included in the study, 52% males. The mean age was 30.9 years. A larger proportion of ADHD patients fall in the category “unhealthy dietary pattern” compared to the representative sample population (26% vs. 12%), while the proportion in the “healthy dietary pattern” category is markedly lower (14% vs. 24%). The differences seem to be explained by lower than recommended intakes of fruits and vegetables.

Our findings suggest a general shift towards more unhealthy dietary patterns among patients with ADHD. This exposes them to higher risk of somatic diseases, notably diabetes mellitus and cardiovascular disease. Lifestyle interventions could be a necessary part of standard treatment for patients with ADHD.

The authors have not supplied their declaration of competing interest.

Negative attitudes towards psychiatric patients still exist in our society. Persons suffering from mental illness frequently encounter public stigma and may internalize it leading to self-stigma. Discrimination occurs across many aspects of economic and social existence. It may represent a barrier for patients to receive appropriate care. Many anti-stigma campaigns have been taken to decrease people's prejudice, but its effects are not well documented.

To characterize anti-stigma initiatives and its effects on diminishing negative consequences of stigma.

Bibliographical research using PubMed using the keywords “stigma” and “mental illness”.

Despite several approaches to eradicate stigma, it shows a surprising consistency in population levels. It was expected that focus on education would decrease stigma levels. The same was expected following concentration on the genetic causation of pathology. Most studies have revealed that education has little value and endorsing genetic attributions has led to a greater pessimism on the efficacy of mental health services, sense of permanence and guilty feelings within the family.

Public stigma has had a major impact on many people with mental illness, especially when leading to self-stigma, interfering with various aspects in life, including work, housing, health care, social life and self-esteem. As Goffman elucidated, stigma is fundamentally a social phenomenon rooted in social relationships and shaped by the culture and structure of society. Social inclusion has been pointed as a potential direction of change.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Maternal depression during pregnancy is common. However, reports of the adult offspring with maternal antenatal depression are scarce.

Our aim was to study whether offspring of antenatally depressed mothers have increased risk for substance use disorder when taking account parental mental disorder.

In the Northern Finland 1966 Birth Cohort, the mothers of 12,058 children were asked at the antenatal clinic if they felt depressed. The offspring were followed for over 40 years. Substance use disorders were detected using the Finnish Care Register for Health Care, which was also used for identifying severe mental disorders in the parents till 1984.

Of the mothers, 14% had rated themselves as depressed during pregnancy. Of the parents, 10% had had a hospital-treated mental disorder. The risk for substance use disorder was slightly increased in the offspring of antenatally depressed mothers (crude OR 1.6; 95% CI 1.2–2.1), when compared with the cohort members without maternal antenatal depression. The risk for substance use disorder was higher in the offspring with both maternal antenatal depression and parental mental disorder (2.8; 1.7–4.7) than in those with maternal depression but without parental mental disorder (1.4; 1.1–2.0) or those without maternal depression and with parental mental disorder (1.5; 1.1–2.2). The reference group was cohort members without maternal antenatal depression and without parental mental disorder. The association remained significant after adjustment [1].

Offspring with both maternal depression during pregnancy and parental severe mental disorder have elevated risk for substance use disorder.

The authors have not supplied their declaration of competing interest.

Persecutory delusions, a key symptom of schizophrenia, may be associated with the experience of early childhood trauma as well as with cannabis dependence. Little research has, however, addressed these associations in people with schizophrenia on the African continent. We examined if persecutory delusions were significantly associated with childhood trauma in people with schizophrenia from South Africa, and we investigated whether cannabis dependence mediates or moderates this association.

Seven hundred and twenty-eight people with schizophrenia completed several scales including the childhood trauma questionnaire (CTQ) which captures several domains of childhood trauma. Logistic regression and structural equation modelling methods were employed to examine the relationship between persecutory delusions and specific experiences of childhood trauma, and to determine if cannabis dependence is mediating or moderating this relationship.

Preliminary results suggest that of the various childhood traumas, the strongest predictor of the presence of persecutory delusions was emotional abuse [OR: 1.02 (0.94–1.08)]. There was no evidence of mediation by cannabis dependence. However, all experiences of childhood trauma, measured by the CTQ (with the exception of physical neglect) interacted with cannabis dependence to increase the risk of the onset of persecutory delusions (P < 0.001).

These results are consistent with previous data in demonstrating that both childhood trauma and cannabis dependence are associated with persecutory delusions in schizophrenia. These findings suggest that it is important to examine the role of early childhood trauma as well as substance use in predicting the onset of psychosis to inform treatment strategies.

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

To determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder(MDD).

While post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking.

We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AF and MDD as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

We analyzed total of 3,887,827 AF hospital admissions from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD.

Our study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population.

The authors have not supplied their declaration of competing interest.

To determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.

DA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.

We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

We analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.

We demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.

The authors have not supplied their declaration of competing interest.

To determine trends and impact on outcomes of acute myocardial infarction (AMI) in patients with pre-existing psychosis.

While post-AMI psychosis has been extensively studied, contemporary studies including temporal trends on impact of pre-AMI Psychosis on AMI and post-AMI outcomes are lacking.

We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project(HCUP) from 2002 to 2012. We identified AMI and psychosis as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

We analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.77% had psychosis. Proportion of hospitalizations with psychosis increased from 6.94% to 11.85% (P-trend < 0.001). Utilization of percutaneous coronary intervention (PCI) was lower in patients with psychosis (29.98% vs. 40.36%, P < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with psychosis (8.01% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with psychosis (aOR 0.677; 95% CI 0.630–0.727; P < 0.001) but discharge to specialty care higher (aOR 1.870; 95%CI 1.786–1.958; P < 0.001). In addition, median length of hospitalization (3.77 vs. 2.90 days; P < 0.001) was higher in hospitalizations with psychosis.

Our study displayed increasing proportion of patients with psychosis admitted due to AMI in last decade with lower mortality but higher morbidity post-infarction, and significantly less utilization of PCI and CABG. There was also increased length of stay patients with MDD. There is need to explore reasons behind this disparity in outcomes and PCI and CABG utilization to improve post-AMI outcomes in this vulnerable population.

The authors have not supplied their declaration of competing interest.

Internet addiction (IA) is considered part of the so-called “new technologies addictions” group, that in turn belongs to a wider, novel group of abnormal behaviors defined “no-drug addictions” or “behavioral addictions”. Similarly to substance abuse, there is the risk either to arouse symptoms like craving, tolerance and habituation either to develop a full-fledged addiction to the Internet.

The aim of this study is to examine the current pattern of Internet use and eventually of IA, as well as their main characteristics, in a group of high-school students from Calabria, a Southern Italian region.

Five hundred high-school students (42% boys, 58% girls, mean age SD ± 16.23 years) volunteered for this study. A specific questionnaire of 45 items with 5 possible answers ranging between “never” and “very often” on a Likert scale was developed.

Most of the young subjects interviewed owned a smartphone with Internet, and claimed to spend more time online than at the beginning. Nearly everybody had an active account in a least one social network. A small withdrawal from social relationships and from sport activities emerged in this group.

Although about 10% of examined students presented IA symptoms, our findings cannot be considered representative of the total high-school population, these results underline the need of further investigation and awareness. In fact, many underestimated, vague, and other unspecific neuropsychiatric symptoms, such as alterations of sleep-wake pattern, chronic fatigue, headache, visual problems, carpal tunnel syndrome and eventually anxiety or depression may be underlying to an unrecognized condition of IA.

The authors have not supplied their declaration of competing interest.

Our ICM Project was implemented in 2012, with the primary objective of preventing hospitalizations and unburdening services. Here, we present a description.

ICM is a type of multi-professional assertive community treatment (ACT) and case management, although our concept has a stronger focus on social work than ACT and uses less resources. It aims at patient's stabilization at home, better life quality, less inpatient/residential treatments, and more access to crisis intervention.

Presently we have 118 spots. Target groups are persons with severe psychiatric conditions at high risk for institutionalization or already institutionalized, including heavy users of mental health services. An initial eligibility assessment is required. At least 3 workers are providing a minimum of 2 h face-to-face contact per week per person. Care is offered predominantly at home environment and anchored in: careful distance-closeness ratio, structured and restructuring, autonomy enhancing, respectful, non-judgmental, confidential, regularity and commitment. Each treatment plan is individualized and based on two axes: intensive assistance and day-structure. It comprises comprehensive psychiatric treatment, counselling, assistance in everyday life, support groups, crisis management and interdisciplinary organizational meetings.

The program was evaluated in 2014 using the CANSAS and FLZ scales and its effectiveness was validated. Most significant improvements were found in day-structure, housing, social contacts and performance, nutrition, and psycho-education. Life satisfaction improvement was found mostly in areas of general health, performance, relaxation and autonomy.

Since its implementation ICM has steadily expanded. Further research tools are currently being developed. Results will be presented in future publications.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is classified as neurodevelopmental disorders. ADHD is one of the major problems in childhood encountered most often in schools. A study realized by Platt in 2011 show that children with ADHD often experience difficulties in mathematics. The aim of this study is to assess whether there is a relationship between school performance in scientific subjects (mathematics and natural science) and attention deficit hyperactivity disorder.

The study was realized among 239 children studying in a urban school in Kenitra city (North-West of Morocco), and aged from 6 to 16 years. To evaluate the relationship between ADHD and the average class results of mathematics and natural science, Conners rating scale (parent and teacher short version) and the academic transcripts are used.

The results show that there is a significant correlation (P < 0.05, P < 0.01) between the average class results in each natural science and mathematics and three components of Conners rating scales (parent's version), which are behavioral difficulties, learning difficulties and hyperactivity/impulsivity. Furthermore, the Conners rating scale (teacher's version) show, also, that there is a significant correlation (P < 0.05, P < 0.01) between behavioral difficulties, hyperactivity/impulsivity and Inattention passivity and the average class results in natural science and in mathematics.

As known, children with ADHD are not less intelligent than other children, although our study show that children with ADHD represent low marks in natural science and in mathematics. In fact, deeper investigations are needed to study the possible factors that could affect ADHD children's school performance.

The authors have not supplied their declaration of competing interest.

Knowledge about how patients perceive mental illness and how it possibly influences help seeking behaviour is important in development of proper plan for mental health reform.

This study planned to study disease related perception, first help seeking behaviour and stigma among schizophrenia patients admitted at a hospital.

(1) To know about patient's view regarding the problems; (2) attempt to predict help seeking behaviour.

Fifty-one patients suffering from schizophrenia according to DSM-5 and fit to be interviewed were assessed using EMIC (Explanatory Model Interview Catalogue) to get emic (insider or person's own cultural) perspective of disease related perception, help seeking behaviour and stigma.

Terms used to describe their illness included “depression” (21.6%), “mental” (17.6%) “matha kharap” (9.8%). Most common perceived cause was stress (25.5%) and sorcery (23.5). Mental health specialist was visited by 27.5% Faith healer consultation was high (29.4%). Stigma score was higher with marriage related issues and social isolation. Using exhaustive CHAID analysis, it was found that patients with negative themes as disease name like “matha kharap” (loosely meaning crazy) are more likely to visit faith healers, while patients naming the condition with some medical related term like depression were more likely to visit mental health specialist.

Clearly perception of patients regarding mental illness and its causation varies greatly from the way psychiatrists’ viewpoint and this perception is likely to influence help seeking behaviour. Understanding these issues is likely to enable better patient awareness and proper formulation of plans to address mental health issues.

The authors have not supplied their declaration of competing interest.