Light-stimulated release of melanopsin suppresses the nocturnal production of melatonin and is sending signals to multiple brain areas, including hypothalamic suprachiasmatic nuclei and thus controlling the release of the pineal hormone melatonin and therefore control the circadian rhythm. Consumption of sedatives and hypnotics was used as an indirect measure of seasonal variations in sleep disturbances among inpatients at University Psychiatric Hospital Vrapče.

Retrograde record analysis was performed from 1st January to 31st December 2012 on commonly used hypnotics and sedatives: zolpidem, nitrazepam, flurazepam, and midazolam.

The lowest consumption of hypnotics was recorded in the months of November, August and September while the highest consumption was recorded in January, December and March which can be seen in Fig. 1. Although there were differences in the monthly prescription of hypnotics, when it comes to seasonal patterns, there are no statistically significant differences.

There is no significant difference between the consumption of hypnotics in the observed seasons although the consumption of hypnotics is higher in the months with shorter daylight. This study attempted to correlate exposure to light and insomnia through the prescription of hypnotics and it is possible there are other important variables not included in this study.

The authors have not supplied their declaration of competing interest.

For a long time, antidepressants sexual side effects have been neglected. Currently, no reliable scientific data is available regarding the nature and frequency of sexual dysfunction induced by antidepressants. The aim of our study was to evaluate the prevalence and type of sexual dysfunction induced by antidepressants, and to identify factors associated with the occurrence of these disorders.

A descriptive and analytical cross-sectional study extending over a period of two week. For the purpose of this research, a socio-demographic card, the Arizona Sexual Experiences Scale (ASEX) and the Psychotropic-Related Sexual Dysfunction Questionnaire (SALSEX) were used.

Fifty-five patients were recruited. The diagnosis of major depressive episodes was dominant (49.1%). Moreover, fluoxetine and tricyclic were in top of the list of antidepressants with respective proportions of 41.8% and 38.2% and respective dose 20.86 mg/24 h and 72.38 mg/24 h. The score using the ASEX scale was 14.63 ± 5.23. Using the SALSEX scale, 47.3% of patients claimed to have had sexual disorders secondary to antidepressants with a moderate score of 9.19 ± 2.56. Furthermore, sexual disorders were more common in the elderly aged of 45 (66.66%) as well as in patients started on paroxetine (66.66%) and on sertraline (66.66%) (P ≤ 0.05).

The sexual side effects of antidepressants have a major impact on the quality of life and adherence to treatment. They also represent an important risk factor for relapse and recurrence in major depression, in this context, the prescription of an antidepressant.

The authors have not supplied their declaration of competing interest.

Burnout is a state of mental and physical exhaustion related to work. It is manifested in a variety of professions and is prevalent in contexts in which health professionals are required to interact directly with the public.

To estimate the burnout syndrome (BOS) prevalence and to identify its associated factors among medical residents.

A descriptive and analytic study conducted during a period from 2012 until 2014, including 184 residents exerting at the two university hospitals of Sfax, Tunisia. Data collection was conducted using an anonymous self-questionnaire, including demographic items and working conditions items. Maslach Burn-out Inventory (MBI) was used to assess BOS.

The average age was 25.14 ± 1.47 years. The sex-ratio was 0.65. The majority (154 residents) was single. Over than half (58.2%) of medical residents endure a high emotional exhaustion, 62.5% a high depersonalisation and 12.5% a low personal accomplishment. About eighty percent (79.3%) of them were in burn out with 37% at intermediate and 11.3% at a severe degree. No statistical association was found between the personal characteristics and BOS. Whereas, several factors related to employment status were correlated with the presence of BOS such us: number of working hours > 30 h/week, a number of free weekends < 2/month and a number of days off ≤ 30 days/year. In addition, we found that psychotropic and alcohol consumption were significantly associated to BOS with respectively P = 0.050 and P = 0.002.

Burnout is a worrying reality among young doctors. Individual as well as organizational interventions should be targeted to prevention.

The authors have not supplied their declaration of competing interest.

Due to their frequency and negative impact on quality of life, eating disorders in schizophrenia need to be considered and highlighting.

To identify the risk of eating disorders (ED) and its correlates among mental patients.

It was a descriptive and analytic study. It included 53 inpatients with DSM-5 diagnoses of schizophrenia or schizoaffective disorder, followed in the department of Psychiatry at the Hedi Chaker University Hospital of Sfax in Tunisia, during the three months of August, September and October 2016. Data collections were conducted using questionnaire exploring sociodemographic and medical data. The SCOFF (sick, control, one, fat, food) Questionnaire was used to screen ED. A total score of ≥ 2 was used as a cutoff point to select persons at risk of ED.

The average age of our patients was 30.47 ± 9.5 years old. The majority of our patients was male (71.7%) and single (71%). The mean of extra Body mass was 27.9. The mean duration of disease was 9.9 ± 8.1 years and patients were mostly (54%) in atypical neuroleptics. According to the SCOFF Questionnaire, 35.8% had a risk of ED. Female gender and treatment with atypical neuroleptics were significantly associated to ED risk with respectively P = 0.02 and P = 0.038.

Eating disorders remain underestimated among patients suffering from schizophrenia. Yet, its screening prevention and management are crucial and must be multidisciplinary for optimal care.

The authors have not supplied their declaration of competing interest.

This study was conducted to examine sexual dimorphic effects of highly palatable food access during adolescence and youth on psychoemotional behaviors of rats and its underlying neural mechanism.

Male and female Sprague Dawley pups had free access to chocolate cookie rich in fat (highly palatable food) from postnatal day 28 in addition to ad libitum chow, and the control groups received chow only. The food conditions were continued though out the entire experimental period, and the neurochemical and behavioral measurements were performed during young adulthood. Corticosterone levels during 2 h of restraint stress were analyzed with radioimmunoassay, and ΔFosB and brain-derived neurotrophic factor (BDNF) expression in the nucleus accumbens (NAc) with western blot analysis.

Cookie access did not affect body weight gain and total caloric intake in both sexes; however, it increased retroperitoneal fat depot only in males. The time spent in open arms during elevated plus maze test was decreased and immobility during forced swim test was increased in cookie-fed males, but not in cookie-fed females. Main effect of food condition on the stress-induced corticosterone increase was observed in males, but not in females, and cookie access increased BDNF expression in the NAc only in males.

Increased BDNF expression in the NAc and fat depot, in addition to the HPA axis dysfunction, may play roles in the pathophysiology of depression- and/or anxiety-like behaviors induced by cookie access.

The authors have not supplied their declaration of competing interest.

Increasing prevalence of obesity in the world and increasing role of processed foods in daily life has led to become the focal point of food addiction. This study aims to investigation of food addiction and impulsivity relations biological rhythms differences and insomnia in university students.

One thousand and five hundred students planned to participate who studies in Konya Selcuk University central campus. Participants were to fill out the test during their classes under physician supervision. The volunteers completed a package of psychological instruments including the Morningness–Eveningness Questionnaire, Yale Food Addiction Scale, Insomnia Severity Index, and Barratt Impulsiveness Scale administered by two investigators in their classrooms.

In total, 1323 forms were suitable for statistical analysis. The mean age was 20.83, mean BMI was 22.02. Food addiction prevalence was 18.2%. Our study showed that association between the eveningness type and food addiction (P < 0.045). Also, the eveningness type and insomnia were in positive correlation in impulsivity (P < 0.001).

This study has explored the association between eveningness type of biological rhythms, food addiction, insomnia and impulsivity.

The authors have not supplied their declaration of competing interest.

Despite an increasing focus on cognitive functions in eating disorders, only limited and contradictory knowledge regarding the relationship between cognitive functions and anorexia nervosa symptomatology currently exist.

The aim of this study was to investigate potential associations between cognitive functions and anorexia nervosa symptomatology in children and adolescents.

Eating disorder symptoms and cognitive functions were examined in this cross-sectional, multi-centre study. Diagnostic scores i.e. BMI, psychological symptoms, and global EDE-16 were stratified on cognitive function. Children and adolescents suffering from severe recent-onset anorexia nervosa (n = 94) and healthy controls (n = 94), between the age 10.6 and 17.9 years (mean age 14.9 years, SD 1.8), participated in the study. The patients were divided into two groups, respectively above and below the median of cognitive functions.

The study findings revealed that Global EDE score significantly increased with age (P = 0.002, CI 0.08–0.36). Besides this, no significant associations between low body weight or psychological symptoms and cognitive functions were found. However, a large variability in cognitive functions was found on all measure in patients with anorexia nervosa than healthy controls.

While age seems to be significantly correlated to symptom burden the study results indicate that patients with anorexia nervosa is a much more heterogeneous group with regard to cognition than healthy controls. However, cognitive functions and anorexia nervosa symptomatology does not appear to be associated.

The authors have not supplied their declaration of competing interest.

Eating disorder have an impact on SSRI treatment efficacy including antidepressive and procognitive effects. It is necessary to reveal eating disorders as a co-morbidity in patients with depression.

The authors have not supplied their declaration of competing interest.

Twenty-six female patients with AN (diagnosed using DSM-5) were enrolled at the Psychiatry Department of Florence. Psychopathological features were assessed at the time of enrollment using the following scales: SCL-90-R, BUT, EDE-Q. Salience alteration was assessed by the means of the ASI. Statistical analysis were realized using SPSS 20.0 with Spearman bivariate correlation.

Mean age was (mean ± SD) 26.2 ± 8.72 and mean Body Mass Index (BMI) 16.1 ± 2.46. Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Symptom Index (PSDI) were estimated for BUT and SCL-90-R and compared to total value of ASI. Thus, we found a statistical significant (P < 0.05) direct correlation between ASI and BUTpsdi and ASI and SCL-90-Rgsi (correlation coefficient of 0.446 and 0.398, respectively).

In this study, we found a significant direct correlation between Aberrant Salience Inventory (ASI) values and one dimension of body uneasiness in anorexic patients. These preliminary data need further studies with a wider sample to confirm the above-mentioned data.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Dissociation has been related to emotional dysregulation and eating psychopathology. Dissociation may interfere with the learning process, affecting at the therapy negatively. The aim of the study is to analyse if at the eating disorders (ED), dissociation is linked to temperamental traits or also to character traits, which are susceptible to be modulated during the therapeutic process.

We studied 119 females that started an outpatient program for their ED. We used the Dissociative Experience Scale (DES), Temperament and Character Inventory (TCI), Eating Attitudes Test (EAT-40), and the State Trait Anxiety Inventory (STAI). We used multiple regression analysis.

Dissociation was associated with high scores on the EAT-40, even controlling the effect of anxiety traits, which also was related to dissociation. The temperament dimension “searching for novelty”, has been related in an opposite way to the DES. Also, the “dimension of transcendence “character and “self determination” influenced on the DES.

This study confirms the importance of improving Self Determination levels at ED therapy, which influence on a lot of prognostic aspects, such as protecting from dissociation, which is related to anxiety and alimentary psychopathology and can interfere with the therapeutic progress.

The authors have not supplied their declaration of competing interest.

Neuropsychological impairments in anorexia nervosa (AN) have been considered both as putative risk factors and as a target for treatment. However, the role of neuropsychological variables as predictors of outcome is not clear.

Our aim is to investigate the role of neuropsychological variables as predictors of response to treatment in a group of individuals affected by AN.

The study sample consisted of 144 patients diagnosed with acute AN, according to the DSM-5 criteria, referred to the Eating Unit of the Hospital of Padova, Italy. All participants were assessed by means of a neuropsychological and clinical test battery at intake and followed during outpatient treatment for an average of 531 days. Eighty-three percent of the patients underwent cognitive behavioral therapy, the families of 75% of the patients were included in the treatment and 48% of the patients took antidepressants (SSRI).

Both body mass index at assessment and illness duration appeared to be independent factors significantly affecting the outcome. The role of neuropsychological variables was explored including cognitive performance in a multivariate analysis including BMI at intake, duration of illness and diagnostic subtype. The inclusion in the model of the Wisconsin Sorting Card Task performance and the central coherence index (calculated by the Rey Figure Test) significantly increased the prediction ability of the model for full remission at the end of treatment.

This is the first study to show that neuropsychological characteristics may predict treatment response in AN. These data support the implementation of cognitive remediation techniques in the treatment of AN.

The authors have not supplied their declaration of competing interest.

Emotional distress–specifically symptoms of anxiety and/or depression–in undergraduate medical student represent a major health issue for university life and for the entire society, as the onset of negative affectivity in young age is lowering quality of life of the affected individual and implicitly, the professional evolution.

The purpose of this study is to investigate the prevalence of perceived stress in medical undergraduates and relationship between perceived stress and emotional distress.

The study comprised a randomised population of 356 students from 1st and 2nd year in Faculty of Medicine who signed the informed consent for the research. Mean age in the group was 20.04 ± 0.9 years old. Instruments used in the study were self-rated Zung Anxiety Scale and Zung Depression Scale and Perceived Stress Scale. Data were analysed with SPSS 16. Statistical significance was at P < 0.05.

Perceived stress of medium and high intensity was found in 62.5% of the students in the study. There is a significant effect of perceived stress on presence of emotional distress (F(3,352) = 36,431, P < 0.001). In the emotional distressed group, perceived stress in the period before the exams session is predicting emotional distress in the period of exams (academic stress) with OR = 1.145, P = 0.04, IC 95% = 1.006–1.303.

There is a high prevalence of perceived stress and perceived stress in the period before session of exams is a predictive factor for having emotional distress in session of exams. Therefore, we are signaling the necessity of implementation of stress management programs in medical undergraduates from the pre-clinical years.

The authors have not supplied their declaration of competing interest.

REM sleep behaviour disorder (RBD) is associated with psychiatric symptoms, such as anxiety and depression. RBD is characterized by loss of normal skeletal muscle atonia during rapid eye movement (REM) sleep with prominent motor activity and dreaming and is a usual symptom of the early stages of Parkinson's disease (PD). Diffusion MRI connectometry was used to carry out group analysis between age and gender matched PD patients with RBD in with and without depression to characterize possible depression-related white matter microstructural changes in the Parkinson patients with RBD.

DWI images were obtained for 15 PD-RBD with depression and 27 PD-RBD without depression. This dataset was acquired on a 3 Tesla Siemens scanner, producing 64 DWI at b = 1000 s/mm2 and one b0 image. Diffusion MRI data were corrected for subject motion, eddy current distortions, and susceptibility artefacts due to the magnetic field inhomogeneity. Diffusion MRI connectometry was conducted in a total of 27 subjects using percentage measurement.

PD-RBD Patients with depressive symptoms showed decreased anisotropy (FDR < 0.05) in the fornix bilaterally, right cingulum, inferior longitudinal fasciculus bilaterally, right corticospinal tract and Genu of corpus callosum compared to PD-RBD patients without depression.

Since RBD is considered to be an early symptom of PD and also a marker of progression to PD, these results might PD-RBD patients with depression may progress dementing processes and visuospatial dysfunction earlier since fornix, cingulum and ILF have proven to be associated with these cognitive dysfunctions respectively.

The authors have not supplied their declaration of competing interest.

Electric indoor lighting can disturb sleep and increase depressive symptoms; both common complaints in psychiatric inpatients.

To improve quality of sleep in patients using an indoor hospital lighting environment simulating nature in intensity, color, and circadian timing.

Investigator-blinded parallel group randomized controlled effectiveness trial supplied with qualitative interviews in an inpatient psychiatric ward with fully automatic and adjustable lighting. Admitted patients received a room with a naturalistic lighting environment (intervention group) or lighting as usual (control group). The primary outcome was the Pittsburg Sleep Quality Index and secondary outcomes included the Major Depression Inventory and WHO-five Well- Being Index.

In this ongoing trial, we included 28 patients (16 treated and 12 controls). Patients in the intervention group reported higher subjective sleep quality and sleep efficiency, lower use of sleep medication (mean difference, 4.68 mg; 95% CI, 0.54; 53.5), fewer depressive symptoms (mean difference, 5; 95% CI,–2; 13), but lower well-being (difference,–4 percentage points; 95% CI,–20; 16), compared with the control group. At discharge, fewer patients in the intervention group had experienced use of involuntary treatment. Qualitative data indicated no side effects apart from issues in performing indoor leisure activities in dim light.

A naturalistic lighting environment was safe and improved sleep and mood in our small patient sample. The trial integrated well with routine clinical care and our sample reflected the heterogeneity of the target population (Funded by Region Midtjylland and others; Clinicaltrials.gov number, NCT02653040)

The authors have not supplied their declaration of competing interest.

‘Hypertension at work’ today is found one of the most frequent forms of stress-induced hypertension.

To inquire into the specifics of psychological and psychophysiological mechanisms of stress reaction in patients with ‘hypertension at work’, as compared with ‘classical’ essential hypertension (EH).

The study developed simulation of emotional stress with the aspiration level (AL) modeling. The level of state anxiety (SA), BP values, urine catecholamine levels and levels of renin and angiotonin I in blood plasma were taken before and after the experiment. Eighty-five patients with ‘hypertension at work’ (mean age was 45.9 ± 2.8) and 85 patients with ‘classical’ EH (mean age was 47.4 ± 4.5 years) took part in the study.

Rates of ‘hypertension at work’ patients, when compared with second group patients, revealed a significant increase (Р < 0.001) of systolic BP in response to stress loads (on average, for 16.1 ± 1.9 mmHg and 4.1 ± 0.7 mmHg, respectively). Initially ‘hypertension at work’ patients had significantly lower levels of catecholamines, than the second group, while the levels of renin and angiotensin I were comparable. During the experiment, the patients in the first group showed a significant decrease in all parameters. After the experiment, the patients with ‘HTN at work’ did not show increase of SA, but revealed more frequent inadequacy (69.4%) and instability (56.5%) on the AL. Patients with ‘classical’ EH more often demonstrate adequate AL and lower growth of BP after the experiment.

Patients with ‘hypertension at work’ are more prone to repress their emotions. They reveal physiological features of chronic stress and psychophysiological exhaustion, if compared with second group patients.

The authors have not supplied their declaration of competing interest.

Multiple sclerosis (MS) is a chronic progressive autoimmune disease. Fatigue, depression and cognitive impairments are the most common symptoms of patients with MS. Whereas there is extant research on fatigue, depression, and cognitive impairment of patients with MS during the clinical course, no research focused on the long term changes of psychological functioning, sleep problems, and physical activity on these patients. The aims of the present study were therefore to examine changes in physical activity, sleep disturbances, and mental toughness over a 1.5-year period of time in people with multiple sclerosis after the onset their MS.

A total of 18 patients with diagnosed MS (mean age: M = 33.61 years) took part in this study. They completed a booklet of questionnaires covering socio-demographic data, mental toughness, sleep disturbances, and physical activity, at the onset of disease and 1.5 years later.

In total, 1.5 years after the onset of MS, patients had lower levels of vigorous physical activity, but not statistically significant change in moderate physical activity. Patients with sleep disturbances at the onset of disease had statistically significant sleep disturbances also 1.5 years later.

Compared to the onset of disease, 1.5 years later, patients with MS reported similar mental toughness traits, sleep disturbances and levels of moderate physical activity. The pattern of results of the present pilot study suggests that the onset of MS is not an obstacle for doing moderate physical activity. Based on the result of this study, sleep disturbances remains stable by time.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Insomnia is the most prevalent sleep disorders and affects 10% of adults worldwide. It has major social and economic consequences. The aim of our study was to evaluate the knowledge of Tunisian general practitioners (GPs) about insomnia.

A cross-sectional survey was carried out during the month of May 2016. Among the 193 GPs randomly selected from different areas of Sfax, in Tunisia, 127 participated to the study. The latter filled a questionnaire including items related to socio-demographic data and clinical features of insomnia.

Among our participants, 58.3% (n = 74) were men and 41.7% (n = 53) women. The average age was 47.91 ± 10.1 years. They have been working for 17.36 ± 10.7 years on average. Seventy-six of GPs had an individual training and a training by attending conferences or by continuous medical education. Most participants (80.3%) thought that they had some lacuna in the management of insomnia. Specific recommendations for the management and treatment of insomnia were known by 7.2% of the GPs. As for theoretical knowledge about insomnia, 74.8% of participants (n = 95) had a high score of correct answers. The latter was correlated to age (P = 0.013) and to the male gender (P = 0.008). However, it was neither correlated to the seniority of the GPs (P = 0.051) nor to the knowledge of specific recommendations for the management of insomnia (P = 0.11).

Our results showed that the GPs had a rather good theoretical knowledge about insomnia. Yet, an improvement of the continuous medical education and a better knowledge of specific recommendations for the management of insomnia are needed.

The authors have not supplied their declaration of competing interest.

Sleep disorders are common in clinical practice. However, they are relatively poorly understood by doctors. The aim of our study was to describe the management of insomnia by general practitioners (GPs).

A cross-sectional survey was carried out during the month of Mai 2016. Among the 193 GPs randomly selected from different areas of Sfax, in Tunisia, 127 completed a questionnaire about the management of insomnia.

Among our participants, 46.5% stated that they often discuss the quality of sleep with their patients even when it is not their chief complaint. Forty-three percent reported that they are often consulted by insomniac patients. Twelve percent of GPs declared they know the “sleep diary”. Homeopathic treatment was the most prescribed first line medication (45.3%). Sleep hygiene measures were commonly recommended by 82.7% of the GPs. Relaxation therapy was known by 46.7% of the GPs and used by 26.7%. Sleep-restriction therapy was known and used by respectively 15.8% and 9.2% of participants. Discussing the quality of sleep with patients was correlated to: the frequency of solicitation for insomnia (P = 0.00), the knowledge of sleep diary (P = 0.031), and the recommendation of sleep hygiene measures (P = 0.032).

Continuous medical education, especially concerning non-pharmacological treatment measures, could drastically improve the management of insomnia by Tunisian GPs.

The authors have not supplied their declaration of competing interest.