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In April 2020, after decades of discussions and controversy, the Lebanese parliament voted a law legalizing the cultivation, production, and sale of cannabis for medicinal purposes. Although the law leaves several unanswered questions and awaits implementation, the symbolic nature of this step in recognizing a positive role of cannabis in the local economy is significant on a regional level. The Arab world has traditionally been conservative when it comes to all drugs-related policies. Cannabis is largely demonized with heavy sentences served to anyone suspected of using selling, let alone planting cannabis. Despite a few countries considered producers and consumers of substances, governing authorities have remained immune to the liberalization trend encountered in western countries. The social experiment taking place in Lebanon is fraught with risks, given the unstable political situation and chronic economic challenges. The reactions to the law have been mixed with several scientific bodies such as the Lebanese Psychiatric Society criticizing the absence of proper consultation of stakeholders. The absence of consistency in enforcing established drugs policies or seriously debating the decriminalization of cannabis use raises concerns over the establishment of a two-tier approach toward drugs, driven solely by economic imperatives.

The aim of this study is to demonstrate the presence of a framing effect that influences residents' decision-making and to assess decontextualisation as an intervention strategy to reduce the influence of framing on their decision.This is a randomised controlled trial in which researchers sent an evaluation questionnaire to all residents of … University including clinical vignettes, with questions formulated in two different ways on the same subject and a decontextualisation test involving logical reasoning problems. The researchers then sent to all participants different clinical vignettes evaluating the same dimensions as those addressed in the previous part.The response rate was 86 (28.2%), of which they included 52 (60.4%) in the analysis. The framing effect was present in 37 (71.1%) of responses and then decreased to 35 (67.3%) after the decontextualisation test, especially at the level of the type of framing involving risky decision-making (p = 0.03).Decontextualisation is an effective strategy for reducing bias related to the framing effect among residents, particularly the type of framing involving risky decision-making. In medical teaching, decontextualisation exercises may help improve critical thinking and reduce the framing effect.

Despite research advances, recently identified biological markers for depression are either non-specific or impractical in daily clinical practice. Hence, we aim to identify a novel biomarker: δEPCD, the electrophysiologic coefficient of depressiveness. δEPCD must be sensitive and specific to the vulnerability towards depression. It should also detect the presence of a depressive clinical state and be able to quantify its severity. Moreover, it should be easily accessible and cost-effective. Accordingly, combining high-frequency heart rate variability (HF-HRV), which reflects a reduction in vagal tone, and tryptophan metabolism, which influences serotonin synthesis pathway, may have a good diagnostic and prognostic accuracy in depression. δEPCD is the multiplication of the intrinsic difference between state 0 (rest) and state 1 (exposure to stress) of HF-HRV and the plasma concentration ratio between quinolinic acid and kynurenine. δEPCD theoretically fluctuates between -1000 and 0 where being closer to 0 signifies no vulnerability to depression. Individuals with a score between -16.7 and -167 have a high vulnerability to depression. Finally, individuals with a δEPCD closer to -1000 have the most severe forms of depression. δEPCD is theoretically conceived to be easy to assess and monitor which makes it a candidate for further evaluation of reliability and validity.CLINICAL SIGNIFICANCEDepression is currently diagnosed based on emotional and behavioural symptoms; however there is currently a rising interest in the field of neurobiological markers that could improve diagnostic accuracy.Many current biological approaches are primarily based on single neurobiological markers that are either non-specific or impractical in daily clinical practice.Among other neurological effects, depression may modify the parasympathetic nervous system tone and disturb the tryptophan metabolism.The electrophysiological coefficient of depressiveness δEPCD combines heart rate variability (HRV) and tryptophan metabolism to reflect the intrinsic individual vulnerability towards depression and the inherent severity of an index depressive disorder.δEPCD is the intrinsic difference between state 0 (without stress) and state 1 (exposed to a stressful task) of the high-frequency heart rate variability multiplied by the intrinsic difference between both states, e.g. state 0 and 1, of the plasma concentration ratio of quinolinic acid over kynurenine.

Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.

Purpose: Anorexia nervosa (AN) is a serious mental illness that is frequently accompanied with a history of childhood maltreatment (CM) which may constitute a specific ecophenotype of the eating disorder necessitating special assessment and management. Chronic stress inflicted by CM in patients with AN may manifest through increased low grade inflammation reflected by an increase in ratios from white blood cells count such as neutrophils to lymphocytes ratio (NLR) platelets to lymphocytes ratio (PLR) and monocytes to lymphocytes ratio (MLR). Methods: N=206 participants were evaluated in an eating disorders daycare unit in Montpellier, France between March 2013 and January 2020. CM was assessed using childhood trauma questionnaire (CTQ). AN clinical severity was assessed using eating disorder examination (EDE-Q). The MINI was used to assess other clinical characteristics. Results: NLR has been found to be higher in patients with AN and a history of CM (p=0.029) as well as in patients with AN and a history of emotional abuse (p=0.021) when compared to patients with AN and without a history of CM. In the multivariate analysis, emotional abuse (β=0.17; p=0.027) contributed significantly to NLR’s variability. Conclusion: NLR is a low grade inflammation marker that is influenced by multiple sociodemographic, clinical and biological factors in patients with AN. It is more directly affected by certain subtypes of CM, especially emotional abuse than by the presence or absence of a history of CM. Future studies may focus on mediators between CM and increased inflammation such as interoceptive awareness, emotional dysregulation, food addiction and stress-sensitization.Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies

Despite research advances, recently identified biological markers for depression are either non-specific or impractical in daily clinical practice. Hence, we aim to identify a novel biomarker: δ

Background: Antipsychotic-induced sexual dysfunction is a common complaint among patients with psychotic disorders. However, few papers have discussed its impact on treatment adherence.Aims: The ai...

Background: The current study aimed to test whether food addiction (FA) might mediate the relationship between the presence of a history of childhood maltreatment and eating disorder (ED) symptom severity. Methods: Participants were 231 patients with ED presenting between May 2017 and January 2020 to a daycare treatment facility for assessment and management with mainly the Eating Disorder Inventory-2 (EDI-2), the Child Trauma Questionnaire (CTQ), and the Yale Food Addiction Scale (YFAS 2.0). Results: Participants had a median age of 24 (interquartile range (IQR) 20&ndash, 33) years and manifested anorexia nervosa (61.47%), bulimia nervosa (16.88%), binge-eating disorders (9.09%), and other types of ED (12.55%). They were grouped into those likely presenting FA (N = 154) and those without FA (N = 77). The group with FA reported higher scores on all five CTQ subscales, as well as the total score of the EDI-2 (p &lt, 0.001). Using mediation analysis, significant indirect pathways between all CTQ subscales and the EDI-2 total score emerged via FA, with the largest indirect effect emerging for physical neglect (standardized effect = 0.208, 95% confidence interval (CI) 0.127&ndash, 0.29) followed by emotional abuse (standardized effect = 0.183, 95% CI 0.109&ndash, 0.262). Conclusion: These results are compatible with a model in which certain types of childhood maltreatment, especially physical neglect, may induce, maintain, and/or exacerbate ED symptoms via FA which may guide future treatments.

International audience; The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).

International audience; Patients with anorexia nervosa (AN) present more frequently a personal history of traumatizing life events than they manifest a comorbid, clinically characterized, post-traumatic stress disorder (PTSD). The psychological impact of traumatic events on patients with AN may also manifest through a post-traumatic embitterment disorder (PTED). In PTED, the traumatic event is perceived as unjust and the patient's response involves feelings of embitterment, rage, and helplessness along with repeated intrusive memories and a persistent negative change in mental well-being. Patients with AN share several psychopathological features with the clinical disturbed dimensions described in PTED. Accordingly, the comorbidity between PTED and AN needs further characterization. Moreover, specific therapeutic intervention known to improve symptoms of PTED such as cognitive-behavioral therapy based on wisdom psychology should be tested in selected patients with AN.

The framing effect in medical decision making is a type of cognitive bias that can lead a medical trainee at undergraduate and graduate level to reach a diagnosis or take action based on emotional states induced by the frame in which the information has been approached. This literature review on the framing effect in medical decision making will be done in the context of a case presentation in which the framing of scientific information may lead to conflicting decisions in psychiatry. As a matter of fact, debiasing techniques which help medical students/residents become aware of the fact that they might be easily influenced by the frame used in scientific data, have started to be implemented in medical teaching programs. It is important to incorporate exercises that improve debiasing skills in the curriculum at all levels of medical education. An example of such exercises is decontextualization which consists of improving problem-solving in a non-medical context in order to consolidate the use of the same schema of critical thinking in a medical context afterwards.

AIMS The "concept-reality mismatch" in the globalization era is a novel conceptualization of psychosocial stress due to difficulties in experiencing five of the most important positive emotions for psychological well-being. These emotions are love, trust, faith, pleasure and self-esteem. METHODS a narrative overview of the literature using the terms "positive emotions," "positive psychology," "globalization" and "self-discrepancy" has been done. Selected articles are those considered to support the basic ideas mentioned in this hypothesis. RESULTS Differences in how adolescents and young adults experience positive emotions in real life in relation to their conceptual background exist. Authentic love described in books and movies might become perceived as more difficult to find. Trust, in the era of long distance relationships, is being built based on different criteria than those adolescents and young adults are taught to apply. Faith is challenged by the facility of accessing scientific data and by the lack of parental positive influence towards religiosity. Pleasure is being claimed as a right to cope with stress even artificially. Self-esteem is becoming more and more restricted to wealth, beauty and fame as promoted by modern communication technologies. CONCLUSIONS The "concept-reality mismatch" may be considered as an essential and preventable psychosocial stressor contributing to the development of mental and substance use disorders in the modern world. Studies evaluating this hypothesis and elaborating on its management strategies are needed in the near future.

Purpose the study aims to assess the depressive symptoms, the disgust feeling and the impulsivity index in subjects showing a high risk of binge eating disorder (BED) and/or bulimia nervosa (BN) through a cross-sectional study of 150 participants. Results There was no significant difference regarding age, sex, employment and marital status between subjects at high risk for BED/BN (Group A) and controls (Group B). However, participants in group A presented higher scores of depressions (p = 0.021), impulsivity (p = 0.027) and Disgust (p = 0.030) with significant associations. Conclusion The neurobiological basis for these associations might be related to a dysfunction in the insular cortex.

Anorexia nervosa (AN) is an eating disorder, mainly affecting women, with a lifetime prevalence of about 1%, that can run a chronic course. While an effective pharmacotherapy is lacking, it is hypothesized that the progesterone and type II glucocorticoid receptor antagonist mifepristone (RU486) might be useful, as it is well known that the hypothalamo-pituitary-adrenal axis (HPA) is activated in AN. Even if secondary to the eating disorder, an active HPA axis may contribute to maintaining the neuroendocrine, emotional and behavioral effects observed in AN. More specifically, it is suggested that the HPA axis interacts with limbic structures, including the insular and prefrontal cortices, to uphold the changes in interoceptive and emotional awareness seen in AN. As such, it is proposed that mifepristone (RU486) reverses these effects by acting on these limbic regions. In conclusion, the theoretical efficacy of mifepristone (RU486) in improving symptoms of AN should be tested in randomized clinical trials.

Retrospective psycho-historical personality analysis of “Iron” Felix Dzerzhinsky presents an opportunity to evaluate development and progression of events and behaviors associated with the killing of hundreds of thousands during the “Red Terror”. A biopsychosocial assessment provides evidence suggestive of the presence of post-traumatic embitterment disorder (PTED) as an underlying pathological catalyst for his actions. The introduction of PTED as a possible psychopathology leading to such violent and destructive events promotes the significance of understanding the diagnosis and how negative events may lead to maladaptive behaviors on a broad scale.

Atypical dysgeusia such as having the sensation of a sweet tooth is an uncommon clinical presentation in severe depression. First, we present the case of a 67 year-old-man admitted to the psychiatric ward for depression after a suicide attempt by drug ingestion. The patient manifested a sweet taste sensation in the upper and lower gums that increased with mood swings and notably with severe depressive symptoms. Blood tests showed an elevated serum creatinine level (115 μmol/L), a normocytic anemia (hemoglobin 6.5 mmol/L; MCV 96 fL) and a deficit in vitamin B12 (122.4 pmol/L). The patient received vitamin B12 supplementation and was treated with clomipramine, lithium, mirtazapine, modafinil, and olanzapine. He was discharged after improvement of his depressive symptoms and decrease in the sweet taste. On follow-up, the patient’s dysgeusia had subsided. Second, we hypothesize that the atypical dysgeusia may have been induced by vitamin B12 deficiency and medical comorbidities, leading to deafferentation (development of erroneous mouth mucosae sensations felt by the patient). This could have been increased by depression. Dysgeusia in elederly patients with depression should be extensively investigated in order to elucidate somatic contributing factors but it may not resolve until improvement of the depressive symptoms.

Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Suicide rates have been suspected to increase in Lebanon during the last couple of years. While these rates might be increasing due to an increase in the probability of declaring suicide, it seems important to study why suicide, as a phenomenon, might be possibly increasing in the Lebanese society. One of the most important reasons behind this rise in suicide rates could be related to the economical crisis that has been striking the country for more than two years.

An increasing number of case reports are concerned with hypomanic/manic symptoms induced by some atypical antipsychotic drugs, especially quetiapine [1]. In the current volume of Drug Safety—Case Reports, the case series published by Rovera et al. [2] demonstrates that quetiapine-related hypomania is an interesting event that is worth being appropriately diagnosed and managed in patients with bipolar disorder. Quetiapine is a second-generation dibenzothiazepine antipsychotic drug approved for the treatment of schizophrenia, major depression, bipolar disorder, bipolar depression, and mania. Several randomized, double-blind, placebo-controlled studies with quetiapine in bipolar depression included treatment-induced hypomania/mania as a secondary outcome, although the incidence of treatment-induced hypomania/mania with quetiapine at a dose of 300 or 600 mg/day seems no higher than that with placebo [3–5].

This study evaluates the efficacy of mifepristone on weight restoration in rats subjected to dietary restriction and methylphenidate administration. 25 female rats aged between 9 and 12 months were divided into 2 groups: 5 controls (exposed only to dietary restriction) and 20 rats that were administered 5 mg/kg/d of methylphenidate before meal exposure, for 36 days. Among rats who responded to methylphenidate (weight loss of 15-25%) weeks after its administration, a group of 6 rats continued to receive only methylphenidate ("Met" group), and another group received 10 mg/kg/d of mifepristone in addition to methylphenidate for 18 days ("Met+Mif" group; n = 6). The mean weight of the "Met+Mif" group remained significantly lower when compared to the control group (87.63 ± 2.83% vs 96.29 ± 3.26%; p 0.001 respectively) but was significantly higher than that of the "Met" group (87.63 ± 2.83% vs. 80.61 ± 3.52%; p 0.001 respectively). Plasma concentrations of adiponectin and gene expression of its receptors in rats brain were significantly higher in the "Met" group as compared to the "Met+Mif" and control groups (p 0.01). Accordingly, mifepristone reduces HPA axis activation and restores weight through adipose tissue recovering. It might be considered a promising treatment for anorexia nervosa patients in future studies.

The current article aimed to determine the 12-month prevalence and correlates of DSM-IV alcohol abuse and dependence in a nationally representative sample of Lebanese adults. One thousand participants collaborated in face-to-face interviews in 2011. Prevalence of 12-month alcohol dependence was 5%, with a higher risk for those who were men, unmarried, the youngest adults (aged between 18 and 34 years old), students, participants with a liberal occupation, participants with a low income, participants with a positive family history of alcohol misuse, and smokers. Prevalence of 12-month alcohol abuse was 6.2%, with a higher risk for those who were men, students, employees, and Druze and Christians compared to Muslims. Current alcohol abuse and dependence were found to be very highly prevalent in Lebanon.

To elucidate the possible role of adiponectin, an adipokine secreted by white adipose tissue that plays an important role in the neuromodulation of food intake, in the pathogenesis of eating disorders.A comprehensive review of the available literature via MedLine is done using the term "adiponectin" in association with one of the following terms: "anorexia nervosa", "bulimia nervosa", "binge eating disorder" or "eating disorders".The majority of studies evaluating serum adiponectin levels in patients with eating disorders show that serum adiponectin levels are increased in patients with anorexia nervosa. After refeeding, adiponectin levels tend to rejoin the levels of healthy individuals. Data concerning serum adiponectin levels in patients with bulimia nervosa show that these levels can be equal, higher or lower than those found in healthy controls and lower than those found in anorexia nervosa patients. Binge eating disorder is accompanied with lower serum adiponectin levels than normal. Adiponectin receptor type 1 seems to be more related to the central pathological effect of adiponectin on eating behavior.The potential role that plays adiponectin in the pathogenesis of eating disorders needs to be elucidated by further studies.

The relationship between smokers' knowledge about smoking related health problems and the motivation to quit smoking in a sample of Lebanese smokers was evaluated. The first group of smokers was composed of hospitalized subjects for a cardiologic or a respiratory health problem (n = 42). The second group was composed of smokers who have not suffered from any smoking-related health problem (n = 69). A positive correlation was found between the Richmond test score and the knowledge level about smoking related health problems (r = .302; p = .0013).

To date, no curative psychopharmacologic treatment exists for the core symptoms of autism spectrum disorder (ASD) as well as for schizophrenia. Bumatenide is a specific antagonist of the first isoform of the Na-K-Cl cotransporter (NKCC1). It is usually used as a diuretic but may also promote a decrease in intraneuronal chloride ion concentration leading to hyperpolarization in neuronal membrane and subsequent decrease in neuronal hyperexcitability. This physiologic effect has been considered to be behind the relative efficacy of bumetanide in improving symptoms of ASD and, to a lesser extent, schizophrenia. However, insulin growth factor-1 (IGF-1) shows the same physiologic effect. In addition, it may improve brain network dysconnectivity which is known to be an important neurobiological feature in ASD and schizophrenia. IGF-1 has started to prove its efficacy in improving symptoms of children with Rett syndrome, a genetic disorder that shares several clinical similarities with ASD. IGF-1 may also improve oxytocin secretion through the enhancement of the transient potential receptor V2 channel function. Accordingly, IGF-1 should be studied as a potential treatment of ASD and other mental disorders characterized with brain dysconnectivity such as schizophrenia.

Alzheimer's disease (AD) is a chronic neurodegenerative disorder presenting as progressive cognitive decline with dementia that does not, to this day, benefit from any disease-modifying drug. Multiple etiologic pathways have been explored and demonstrate promising solutions. For example, iron ion chelators, such as deferoxamine, are a potential therapeutic solution around which future studies are being directed. Another promising domain is related to thrombin inhibitors. In this minireview, a common pathophysiological pathway is suggested for the pathogenesis of AD to prove that all these mechanisms converge onto the same cascade of neuroinflammatory events. This common pathway is initiated by the presence of vascular risk factors that induce brain tissue hypoxia, which leads to endothelial cell activation. However, the ensuing hypoxia stimulates the production and release of reactive oxygen species and pro-inflammatory proteins. Furthermore, the endothelial activation may become excessive and dysfunctional in predisposed individuals, leading to thrombin activation and iron ion decompartmentalization. The oxidative stress that results from these modifications in the neurovascular unit will eventually lead to neuronal and glial cell death, ultimately leading to the development of AD. Hence, future research in this field should focus on conducting trials with combinations of potentially efficient treatments, such as the combination of intranasal deferoxamine and direct thrombin inhibitors.

Fibromyalgia (FM) is a chronic central pain sensitivity syndrome manifesting as widespread pain and tenderness with no evidence of soft tissue inflammation [1]. It affects around 2% to 8% of the general population, with a prevalence that increases with age, and marked female predominance [2]. The main clinical manifestations are chronic widespread pain (CWP) with multiple tender points on physical examination, fatigue [3], headaches [4], sleep difficulties, and cognitive disturbances referred to as “fibro fog” [5]. Individuals with FM may also present with nonspecific symptoms of chest, abdominal, or pelvic pain, paresthesias, and lower urinary tract symptoms [6–9]. The 2010 ACR preliminary diagnostic criteria for FM offer nonspecialists a new diagnostic approach that does not require tender point examination and counting, as was the case with the 1990 criteria, and provide a symptom severity scale and a recognition of the importance of cognitive and somatic symptoms in this disorder [10]. Moreover, several functional somatic syndromes (e.g., chronic fatigue syndrome and irritable bowel syndrome), rheumatic diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, and ankylosing spondylitis), and psychiatric disorders occur with FM with a frequency that is significantly higher than that of the general population [6,11–15]. Major depressive disorder (MDD) and/or anxiety disorders are found in one-third to one-half of patients at the time of diagnosis [6]. Furthermore, depressed women with FM presented with more severe symptoms, worse overall physical condition, and lower quality of life compared with controls [16]. While the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine and the anticonvulsant pregabalin are both FDA approved as first-line therapies [17,18], nonpharmacological therapies (i.e., aerobic exercises, physical therapy, cognitive behavioral therapy [CBT], and patient education) remain …

The photograph (Figure 1) shows one of the camps established by churches for displaced Iraqis in Ainkawa, a suburb of Erbil, the capital of Kurdistan. Located in northern Iraq, Kurdistan is an independent region that has received displaced Iraqis from different religions (Christians, Muslims, and Yazidis) sinceJune2014,whenacaliphate was established in Iraqi and Syrian territories occupied by the Islamic State (IS).There areno reliable statistics on the numbers of persons who have been displaced since that date, but it is estimated that the number of Iraqi families that have been installed in Kurdistan is around 145,000, comprising some 872,000 individuals (1). These families were forced to leave their cities and villages of origin either because of the numerous violent strikes by IS or in response to different authorities’ instructions. The families were initially received in outdoor spaces such as gardens after arriving on foot or in shelterless caravans—that is, as groups of refugees who traveled together—and then were supplied with tents a few weeks later.Eventually, each familywas suppliedwith its owntrailer inside the campofMarElia.However, inmanyother camps in Kurdistan, families are still living in tents. Some families have managed to rent apartments near the camps, although in order to afford the rent, they have had to live together with two to five families in the same apartment. Several nongovernmental organizations (NGOs) are currently working with the displaced Iraqis, offering help with school reinsertion; social and professional reinsertion; food, clothing, and medication supplies; psychological support; and so on. It is well known that the risk of developing mental disorders such asmajor depressive disorder, anxietydisorders, posttraumatic stress disorder, and psychotic disorders is higher among displaced populations compared with that of stable populations (2–4). The interaction between the traumatic event precipitating the displacement and the psychosocial adverse factors that result after thedisplacementare themain reasons for development of mental disorders in these populations (2–4). On the psychological level, besides the recent trauma of witnessing conflict-related events, displaced Iraqi families are facing another equally important set of stress factors. In addition to their poverty, displaced families have different cultural, religious, and ethnic backgrounds that make them a minority group facing difficulties in adapting to their new environment. While one might theoretically consider living outside the displaced-person camps as a step toward adjustment, this is not practically thecase for thedisplacedIraqis. Living outside the camp means that the displaced familywill have less privacy, less income, and less psychosocial support from NGOs that concentrate their efforts inside the camps. As a result, Iraqi families who manage to find a shelter inside the camps have more protective factors from psychological distress. This fact creates a paradoxical flux of family movement toward the camps, which may have the effect of slowing down the social insertion

Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. In this report, we review the available case reports in the literature in order to enhance psychiatrists’ and physicians’ comprehension of this disorder. A search for the case reports available via MEDLINE was done since the first case report published by Money et al in 1977 till May 2011, using the following terms: apotemnophilia, self-demand amputation, body integrity identity disorder, and BIID. In all, 14 case reports were found relevant to our search. The desire to amputate one’s healthy limb seems to be related to a major disturbance in the person’s perception of one’s own identity, where limb amputation can relieve temporarily the patient’s feeling of distress without necessarily and uniformly adjusting the patient’s own identity misperception. More investigations are needed in this domain in order to develop noninvasive treatment strategies that approach this aspect of the patient’s distress within a globalist perspective. In addition, the health professionals’ awareness regarding this disorder is required to ensure professional management of patients’ suffering.

Summary Background The association between schizophrenia and the metabolic syndrome is frequent and well studied in the literature. The risk of induction of this syndrome by atypical antipsychotic drugs in patients with schizophrenia is well known. The aim of this study is to evaluate the association between schizophrenia and the metabolic syndrome independently from the risk of induction of this syndrome by atypical antipsychotic drugs. Methods A search was done via MedLine for articles written in English or in French, published between 1988 (date of establishment of the first definition of the metabolic syndrome) and December 2010, using the following terms: “metabolic syndrome”, “dyslipidemia”, “glucose intolerance” or “diabetes” in association with “schizophrenia” or “psychosis”. Results Evidence on the existence of a relationship between severe mental disorders such as schizophrenia and the metabolic syndrome exist before the introduction of the first antipsychotic drug in 1952. Other than atypical antipsychotic drugs, psychotropic drugs such as antidepressants and mood stabilizers, which can be frequently given to patients with schizophrenia, are also incriminated in the induction of some of the components of the metabolic syndrome. Patients suffering from schizophrenia present a tendency toward having an abdominal obesity, an excess of circulating cortisol as a consequence of this central obesity and a hepatic insulin resistance. Their reaction to continuous stress hyper activates the hypothalamo-pituitary-adrenal axis. Some genetic features are common to both schizophrenia and metabolic syndrome. Finally, the lifestyle of patients with schizophrenia is full of risk factors that can aggravate the metabolic syndrome such as sedentarism, smoking habits, low socio-economic status, low adherence to medical care etc. Conclusion The relationship between schizophrenia and the metabolic syndrome seems to contain, in the current medical literature, more than the simple fact related to the intake of atypical antipsychotic drugs.

Lycanthropy is an unusual belief or delusion that one has been transformed into an animal, or behaviors or feelings suggestive of such a belief. We report a case of lycanthropic delusions of becoming a snake in a 47-year-old woman who suffered from a major depressive disorder with psychotic features. We also present a literature review of articles published on the subject in English or French since 1975 identified via a MedLine search using the terms "lycanthropy" or "werewolf." Many case reports have described lycanthropy as a delusional disorder occurring acutely in patients who think they suffer from a demonic possession as a punishment for their acts. In these cases, symptoms are generally rapidly reversible. Lycanthropy seems to be a nonspecific manifestation of many psychiatric diseases, most commonly major depressive disorder with psychotic features. It is largely influenced by the cultural environment of the patient so that the animal species frequently represents the patient's delusional representation of evil. Lycanthropy could be considered a culture-bound syndrome that occurs in association with Axis I, DSM-IV psychiatric pathology.

Schizophrenia is a disease where brain connectivity abnormalities are present. Evidence support the fact that these abnormalities are related to demyelination. Experimental and preclinical data support the fact that IGF-1 treatment enhances the myelination process through oligodendrocytes stimulation. Clinical data in patients suffering from demyelinating diseases such as multiple sclerosis show that IGF-1 treatment is safe. Yet, there is no clinical evidence supporting the fact that IGF-1 treatment is efficient in modifying the course of this disease. Clinical evidence supports the fact that patients suffering from schizophrenia present low IGF-1 levels. Accordingly, the administration of IGF-1 for the treatment of schizophrenia symptoms might be an efficient way to treat these symptoms. Subcutaneous recombinant human IGF-1 in the dose of 0.05 mg/kg given twice daily might be administered because this form of treatment has proved its safe profile. According to some evidence, treatment initiation might be more efficient at the disease onset rendering it more appropriate to be tested in patients presenting with first episode psychosis. It can also be tested as an adjuvant treatment to antipsychotic agents.