Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.

In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.

No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).

Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.

Psychotic spectrum diseases are one of the most expensive illnesses in our society. Being able to recover as much social and laboral activity as possible has to be the goal. Trying to achieve this objective, we face different problems, as for example therapeutic adherence.

Show the importance of an adequate treatment and adherence in order to keep the patient as much integrated in the society as possible, and in order to reduce the economic and social cost of the psychotic spectrum diseases.

Case report and bibliography review.

The patient of this case is a 34 year old woman with a schizophrenia diagnosis given after 4 hospitalizations in psychiatry units. She had 4 years of stabilization taking an injectable antipsychotic, in which she was able to study and keep adequate familiar and sentimental relationships. After being badly recommended to retire her medication for some who identified himself as member of the “new psychiatry”, she began with new delusions and hallucinations which had to be treated at the Hospital Psychiatry Unit. She was close to get a statal job related to her architecture studies, but she was not able to go to the exam due to the exacerbation of her illness. In the review we see that the average economic cost per schizophrenic patient in developed European countries such as Germany is, at least, 14000€ per patient.

Adequate treatment adherence is highly important to keep an adequate control of the illness in order to sustain the better social live and job function.

The authors have not supplied their declaration of competing interest.

Directed by Edward Zwick “Pawn Sacrifice” is a biographical film released on September 2015. The film stars Tobey Maguire as Bobby Fischer, the American World Chess Champion, considered one of greatest player of all time. His career's peak was in 1972 when he captured the World Chess Championship from Boris Spassky of the USSR.

We tried to dig a little in the biography of Bobby Fischer who many described as mentally ill. We tried to figure out what is reality and what is just legend about Fischer. Our goal is promote chess, and also honour the great Fischer. Moreover, we wanted to explore the scientific literature published about the benefits of playing chess, especially in childhood.

We made an exhaustive review of the author's life, and also testimonies of people who knew him. Moreover, we found some articles that review the relationship between chess and IQ trying to confirm or debunk some myths about this legendary game.

It was incomprehensible to everyone that the top of the career of Bobby Fischer at the same time meant an abrupt and complete fall. One possible explanation for this attitude would be a mentally unbalance not specified disorder throughout his lifespan.

Not all geniuses are crazy, neither all crazy are geniuses. A genius is a person with extraordinary capabilities, that focused on a topic, has the ability to enlight new ways to explain this complex world, whether it is to create a symphony, paint masterpiece or the next move on the chessboard.

The authors have not supplied their declaration of competing interest.

Alcoholic hallucinosis is a rare complication of chronic alcohol abuse, characterized by acoustic verbal hallucinations and delusions, mainly of a menacing content, arising in clear consciousness, that appear during or shortly after a period of heavy alcohol consumption.

To outline the key clinical features of alcoholic hallucinosis in order to improve differential diagnosis with other entities.

We studied the evolution of an outpatient followed in a Mental Health Centre of Valladolid and compared it with present data about the condition, found in a bibliographic search of articles no older than 10 years about the topic.

Partial insight about the experience, along with clear consciousness, was key to discard other psychiatric diagnosis that also present acoustic hallucinations. Neuroimagining and functional tests in our patient showed moderate cognitive impairment and cortical atrophy, which contradicts other studies which claim that an acceptable level of cognition must be present in order to gain the necessary insight to meet the diagnostic criteria.

Alcoholic hallucinosis is a rare form of subacute encephalopathy, secondary to an abrupt stop in a previously chronic and heavy alcohol consumption. Its diagnosis is mainly clinical, and neuroleptics are the most used drug, being abstinence essential for an adequate evolution. The course is usually benign, although the acoustic phenomena may not disappear completely.

The authors have not supplied their declaration of competing interest.

Bupropion is a dual antidepressant, a norepinephrine and dopamine reuptake inhibitor. Its main use is in affective disorders as major depression. Antidepressants have been commonly associated with sexual side effects in the libido, sexual arousal, orgasm and erectile function. Bupropion has negative influence in sexual function, even it could increase the libido. Due to this, it could be a good option in patients with active sexual life and affective disorder.

A 58-year-old female with a long history of depression disorder for 5 years. History of lots of side effects with different treatments, sexual dysfunction with serotonin-antidepressants. Treated with bupropion SR 150 mg/day and alprazolam, she suffered a relapse. The bupropion was increased to 300 mg/day. Three days later she appeared in the consultation room, presented a sense of pre-orgasmic of 72 hours of evolution, high increased libido, tiredness, muscle tension and insomnia. This sense did not improve after the sexual act. It had never happened previously. The side effect improved when the bupropion was reduced to 150 mg/day and disappeared with its withdrawal.

The case made a relationship between the increased of bupropion's dose and the appearance of unusual sexual side effects (increased of libido and pre-orgasmic sense). Not only bupropion is one of the antidepressants that do not cause sexual dysfunction, if not it was reported in some trials that could be a treatment against this dysfunction due to its prosexual effects. The mechanism is unknown but could be related with norepinephrine or dopamine transmission.

The authors have not supplied their declaration of competing interest.

Traumatic event related disorders (ASD, PTSD and dissociative disorders) could share a common dissociative psychobiological origin. Patients diagnosed with dissociative identity disorder present a high sexual abuse rate (85–90%), way above the rest of the traumatic spectrum disorders.

The goal of this study is to analyse the existing relation between different types of trauma, especially sexual abuse, and the onset and continuity of dissociative disorders.

We report the case of a 37 years old woman with a long sexual abuse history. The symptoms appear by age 30, in the form of flashbacks, ushering a persistent identity fragmentation in individual differentiated opposed components, shaping a dissociative personality disorder, which was present for years taking a fluctuating and invalidating nature.

When a traumatic event occurs, acute dissociative reactions frequently appear, usually briefly, disappearing spontaneously afterwards. In this case, we can discern the persistence of the dissociative symptoms and the repercussion they had in the patient's functionality.

The existence of a correlation between the duration of a chronic traumatic event and the persistence of dissociative symptoms in the evolution of a dissociative personality disorder is possible.

The authors have not supplied their declaration of competing interest.

The personality disorders are defined according to the DSM-5 like “an enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's cultures. These patterns develop in adolescence and the beginning of adulthood, and are associated with significant distress or disability”. The personality disorders can be a risk factor for different processes of the psychiatric pathology like suicide. The personality disorders are classified in 3 groups according to the DSM-5:

– cluster A (strange subjects): paranoid, schizoid and schizotypal;

– cluster B (immature subjects): antisocial, bordeline, histrionic and narcissistic;

– cluster C (frightened subjects): avoidant, dependent and obsessive-compulsive.

To describe the influence of personality disorders in suicide attempts.

Exhibition of clinical cases.

In this case report, we exhibit three clinical cases of suicide attempts which correspond to a type of personality disorder belonging to each of the three big groups of the DSM-5 classification, specifically the paranoid disorder of the cluster A, the disorder borderline of cluster B and the obsessive compulsive of cluster C.

The personality disorders have a clear relation with the suicide attempts, increasing this influence in some of them, especially the borderline personality disorder.

The authors have not supplied their declaration of competing interest.

Smoking is an addictive and chronic disease. Twenty-four percent of the Spanish population in 2012 smoked daily.

To evaluate a smoking cessation program in a Primary Care Center.

Observational, prospective study. We describe an individualized smoking cessation in Plaza del Ejército Health Center (Valladolid). Inclusion criteria: active smoker, ≥ 18 years old and belonging to the Health Center. Exclusion: severe mental illness. Included patients from November 2013 until January2014. Ended in July 2014. Four Medical residents participated, we present the results of one of them. During the first consultation motivational interviewing was conducted, physical examination and treatment was prescribed (cognitive behavioral therapy or drug treatment: varenicline). In subsequent consultations interview and follow-up. Variables: age, gender, pack-years, nicotine dependence (Fagerstrom) and Prochaska and DiClemente phase, weight, treatment used, dropout rate and final withdrawal of snuff.

Eleven patients, mean age 48.18 (13.61), 7 (63.6) women. Comorbidity: 6 (54.5) anxious-depressive pathology, 1 (9.1) dysthymia, 2 (18.2) endocrine pathology and 1 (9.1) respiratory disease. Four (36.4) showed high dependency and 2 (18.2) extreme. Media packages 20.50/year (19,20). Seven (63.6) were in action phase of Prochaska and DiClemente and 2 (18.2) in preparation. Visits range: 1-11. The average was 4.55 (3.64). Three (27.27) patients attended only the first visit. Four (36.4) achieved complete abstinence, 3 (27.27) met maintenance phase. One (9.1) reduced consumption in half. Patients gained average 0.5 kg (2.47).

The results are similar to those reported in other series. Modest dropout rate. No pharmacological treatment was used due to high coexistence of comorbidities, the only patient who used varenicline suffered insomnia. Average age and media packages were superior to other series.

The authors have not supplied their declaration of competing interest.

Previous research suggests that hoarding aggregates in families and is associated with health, safety risks and family problems. Hoarding symptoms appear to be more common among first-degree relatives of people who hoard. A predominance of shared hoarding disorder has been observed among female relatives.

We present an atypical case report describing hoarding symptoms among first-degree male relatives who present two different subtypes of hoarding disorder.

We report the case of a 38 years old male patient, attended for the first time by the mental health services at the age of 22, and being diagnosed of severe OCD at that moment. In the home visit paid by the social services, an excessive object hoarding was observed, including the presence of over 40,000 books.

Moreover, they found a 38 years old man looking severely deteriorated; when they ask him about it, the patient's father admits to having been isolated in the house for almost 14 years. Hoarding history was gathered, through the acquisition of various objects by the patient's father, dating back to over 30 years ago.

The harmonic coexistence for over a decade between two patients affected with a hoarding disorder with two different clinical setting subtypes was only made possible by the complementary nature of their symptoms.

The hoarding disorders amongst more than one person living under the same roof are uncommon, can present themselves in both genders and can exhibit different symptoms.

The authors have not supplied their declaration of competing interest.

Hoarding often occurs without the presence of obsessive-compulsive disorder (OCD), showing distinguishable neuropsychological and neurobiological correlates and a distinct comorbidity spectrum. Furthermore, it presents itself secondarily to other psychiatric and neurobiological disorders. Therefore hoarding disorder has been included as independent diagnosis in DSM-5.

We aim to expose the possible organic etiology of a hoarding disorder case with atypical presentation.

We present a case of a 48 years old male patient who was brought to the hospital by the police after being reported for unhealthy conditions in his home. In the home visit paid by the Social Services an excessive hoarding of objects and trash was detected. A possible hoarding disorder was diagnosed in the psychiatric assessment. Among other diagnostic test, a brain CT was conducted, in which a frontal meningioma was identified. After surgical treatment, hoarding symptoms diminished significantly.

A significant part of the hoarding disorders are attributed to primary psychiatric disorders, resulting in potentially treatable organic pathology going unnoticed.

It's important to rule out organic etiology before proceeding to make a definitive hoarding disorder diagnosis, optimizing that way the treatment options.

The authors have not supplied their declaration of competing interest.

Mood stabilizers can cause many side effects. Although many of these are well known, like thyroid and renal failure after taking lithium, sexual dysfunction side effects remains unclear.

We made a systematic computerized literature search of clinical studies using MEDLINE, The Cochrane Library and Trip for clinical studies of sexual dysfunction published up to December 2015.

Only eight relevant papers were identified. All of them studied lithium sexual dysfunction in bipolar disorder patients. Valproic acid, carbamazepine and lamotrigine were not studied in patients with bipolar disorder. Nevertheless, the three were studied in epilepsy. Clinical reports usually used Arizona Sexual Experience Scale or Psychotropic Related Sexual Dysfunction Questionnaire to measure sexual dysfunction and Brief Adherence Rating Scale to measure medication adherence. They suggest lithium could decrease desire and sexual thoughts, worse arousal and cause orgasm dysfunction. In overall, those patients with sexual dysfunction had lower level of functioning and poor compliance. Taking benzodiazepines during lithium treatment may increase the risk of sexual dysfunction even more.

There are few studies that focus on mood stabilizers sexual dysfunction. This inevitably entails a number of limitations. First, the small sample size and, in some studies, the relative short period of follow-up may underestimate the results. Besides, practical management was not treated in any study. Actually, handling this side effect have not been well established.

To conclude, this revision suggest that approximately 30% patients receiving lithium experience this side effect, and it is associated with poor medication adherence.

The authors have not supplied their declaration of competing interest.

Adoption constitutes a discontinuity in child care trajectory, that falls into a separation and a lost of reference figures, and therefore, the need to set up new attachment figures into a suitable familiar atmosphere.

This case is a review of how a child adoption process, that can be something positive at first, can also produce many problems in the future, added to dificulties in order to regulate stressing situations and also solving problems.

The clinical case consists in a 25-year-old woman, who suffers from anxiety and self-injure behaviour. She has a diagnosis of non-specified personality disorder with limit characteristics. The patient was adopted a few months after her birth. At the moment she's living with her adoptive father, her adoptive mother passed away when she was 4. At the age of 21, the patient meets her biological mother and since that moment she spends most of the weekends with her. After a few medical appointments, she admits that she has allowed sexual relationships with her biological mother since six months ago.

It's important to appreciate the value of familiar atmosphere, and in addition, the attachment between child and his parental figures. The quality of the attachment is going to have influence in emotional regulation.

Children who have suffered neglect from their biological parents and have been adopted develop attachment behaviours characterized by negative experiences. In spite of being in a good familiar environment, they feel vulnerable and insecure. Early and appropriate attachment experiences can improve relationships between children and their new family.

The authors have not supplied their declaration of competing interest.

The side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.

To estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.

Transversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).

Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.

Twenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).

The high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.

Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.

The authors have not supplied their declaration of competing interest.

Transcultural psychiatry is a branch of psychiatry where cultural context for psychiatric symptoms is studied. It emerged as a consequence of migration of diverse ethnic groups and questions whether international diagnosis classifications fit in different cultures.

The aim of this review is to make professionals aware of the importance of cultural context for the way mental disorders present themselves depending on the patient's origin.

We report the detailed case of a 23-year-old Moroccan woman, attended for the first time by the mental health services when she was 8. Since that moment, she felt herself possessed by a strange being. Auditory hallucinations appeared. It was only when her father or her husband were at home that she felt the “being” was gone. Her husband, as formerly his father, represented a symbol of protection against that evil being and indeed against her mental disorder, which was directly related to her cultural beliefs.

Every country has a different culture and every migration brings with it a new environment. The way people adapt to it may result in mental illness. We want to discuss if symptoms fit international diagnosis classifications.

Psychiatrists should become aware of the limitations of the international classifications when used on different ethnic groups. We should have a cultural approach in order to treat the diverse populations from all around the world.

The authors have not supplied their declaration of competing interest.

Psychosis in childhood and adolescence could be defined as having hallucinations, with the hallucinations occurring in the absence of insight. A broader definition includes symptoms such as delirious thoughts, disorganized speech, disorganized behavior, cognitive and mood symptoms and what is called negative symptoms. Several researches have been done focused in the treatment of first episode of psychosis showing clozapine as a keystone in the treatment of psychosis, especially in refractory first episodes.

Clozapine has unique efficacy in improving treatment-resistant patients with chronic schizophrenia but the moment of instauration remains unclear. There have always been doubts about the right moment to start clozapine, after two or more previous anti-psychotics or as first option.

We report a 18-year- old woman with family history of severe psychosis. Her mum reasserted patient's symptoms contributing to a longer period of non-treating psychosis (about 10 months). Auditory hallucinations, incongruent mood and incoherent language appeared for the first time at the age of 17. High doses of two consecutive anti-psychotics were tried without remission and finally clozapine was initiated with clinical improvement.

In clinical practice, a subgroup of psychotic patients experience, significant ongoing positive symptoms despite of using first line anti-psychotic medication.

Most recent research; suggest that clozapine may have an important role in the early treatment of first-episode patients, even becoming a first line option to consider.

The authors have not supplied their declaration of competing interest.

Patients with schizophrenia have a higher prevalence of physical illness and a higher mortality from natural causes than the general population, which is a reason why they can be hospitalized for medical and surgical pathologies.

To determine the demand, the reason for consultation and the sociodemographic characteristics of the psychotic patient admitted at the general hospital.

Sociodemographic variables (age, sex, marital status, education, place of residence, residential housing, with who they live, work status) and health care (service of origin, type of request and its relevance, complaints, days of delay between the request and assistance, number of visits, average length of stay).

Prospective epidemiological study of 80 psychotic patients (F.2 ICD-10), from the total of 906 consults solicited from 1 January 2012 until 31 December 2014. Bioethical considerations: compliance with these principles justice, non-maleficence, autonomy and beneficence.

The average age is 58.34 years old, 60% were male, 73.8% single, 81.3% with primary education, 52.5% living in urban areas; and the 88.8% of cases were pensioners. The Departments that generate a greater demand are Internal Medicine (53.8%), Orthopaedic Surgery (10%), Pneumology (8.8%) and ICU (8.8%). The most frequent reasons for consultation are assessment/treatment setting (77.5%), abnormal behavior (30%), disorientation (18.8%) and psychotic symptoms (18.8%).

The typical profile of psychotic patients hospitalized for medical-surgical diseases is a male, middle-aged, single, with primary education and pensioner; from whom it's sued consultation for adjusting of treatment, and secondly for abnormal behavior.

The authors have not supplied their declaration of competing interest.

Histrionic Personality Disorder is one of the most common personality disorders diagnosed in Psychiatry. This disorder has been known to be present in more than 40% of patients. There is also a high tendency for those diagnosed with this disorder to be female.

The case is to show all the difficulties caused by this pathology, differencial diagnosis with other personality disorders, groups of characteristics from different clusters and also, complications produced in daily routine.

The purpose is to study a clinical case of a 27-year-old woman, with a degree in journalism, who began with a depressive episode after a failed relationship. After being diagnosed of infertility, she debuted with dissociative episodes and somatization symptoms. After that, she suffered several depressive episodes. At the moment, all the clinical symptoms support the diagnosis of histrionic personality disorder.

Histrionic Personality Disorder can be found in the cluster B group of personality disorders. They often present in an overly dramatic, erratic or emotional manner. They may fulfil their need for attention through speech and behaviour that draws one's focus of attention toward themselves, and also demanding and manipulative in interpersonal relationships. There are high comorbidity rates in those who suffer from HPD with other diagnoses.

Histrionic Personality Disorder appears to be one of the least threatening diagnosis among personality disorders as those affected are high functioning and do not seek relief for the disorder itself. There is also very little research on HPD which makes treatment options limitless.

The authors have not supplied their declaration of competing interest.

Male and female social roles were built on a historical inequality. Gender violence is a public health problem of the first order. We consider it important to conduct a study to improve diagnosis and interventions. From the Theory of Roles Moreno, each role has a complementary role that maintains the link. In gender violence predominates control, domination, submission and asymmetry of functions as dysfunctional elements of a relationship, which should be symmetrical.

We reviewed 48 stories of women who come for abuse mental health team from 2013 to 2016. We analyzed the following aspects: socio-demographic data (age, nationality, marital status, education, jobs, dependent children); reason for consultation and number of queries; violence; roles, because of maintenance and interventions.

Eighty percent Spanish. It occurs at all levels of education; 60% have children; 70% were derived from primary care for others reasons; almost 90% suffered psychological violence, 25% physical and economic, sexual only 3 women, 52.08% of women adopt a submissive role, passive-aggressive 20.83% and 25% ambivalent; maintenance of the violence is reinforced by the psychological dependence that occurs in all women (one in 45.83%).

Roles analysis is an effective method in the diagnosis of abuse and designing appropriate intervention. Psychotherapy, benefits of a psychopharmacological treatment that lessens the suffering and lets face their difficulties. It is important to ask about abuse at any level of care, because it contributes more to cover a hidden reality. The Psychological and economic dependence. They establish and maintain the mistreatment.

The authors have not supplied their declaration of competing interest.

Medical students have higher levels of depressive symptoms than the general population. Additionally, depressed students are more likely to commit suicide. Recent studies find up to 10% of medical students experiment depression and suicidal ideation, which is meaningfully higher than general population of similar age (5–8%). However, little is known about depression and suicidal ideation in medical students in Spain.

This study aims to create a self-administered questionnaire to investigate the prevalence and factors involved in depression and suicidal behaviour in medical students from a Spanish University.

We evaluated the main risk factors leaning to suicide in students. In addition, we selected an appropriate scale to assess depression among the existing ones. The evaluated items included demographic reports, academic information (academic course, unfinished subjects and accomplishment) and sanitary data (psychiatric family history, psychiatric personal history, psychotropic drug consumption, distress emotional events in the last twelve months and drugs consumption). Furthermore, we selected the 9-item Patient Health Questionnaire (PHQ-9) because of its rapidly implementation and proven efficacy.

Rates of depression and suicidal ideation are high in medical students. Currently, there is no program to detect and prevent depression neither suicide in students. For that reason, we consider that creating a new instrument to evaluate mental health in student is useful in order to offer early detection and treatment at medical school.

The authors have not supplied their declaration of competing interest.