To fully comprehend and appreciate the impact of psychosurgery on treatment-resistant depression it is pertinent to review its initial development and subsequent history. By reviewing previous studies of psychosurgery, we can build a narrative of what was, what currently is and what might be. Assessing the complex philosophical dilemma of the mind and the impact this has on individuals’ concept of psychosurgery has helped to bridge the gap between Neurosurgery and Psychiatry.

We aimed to examine this question, starting at the very beginnings of our concept of mind, working through to modern-day thinking, how we approach both neurosurgery and psychiatry and help to bridge the two.

A narrative review of the current literature concerning neurosurgery for mental disorders and said applications to modern psychiatry was conducted. Emphasis on philosophical thought processing in conjunction with the neurosurgical intervention was noted.

Psychosurgery has its roots in the early philosophy of mind, concerned with distinguishing whether the mind is a physical entity or immaterial. Psychosurgery is reliant on a physical concept of the mind, or at the very least that the mind supervenes the physical brain. History has shown us examples of this, with the archetype of this being the story of Phineas Gage. Since its onset psychosurgery has moved in and out of vogue. After being met with early scepticism it later went on to be performed thousands of times to help cure schizophrenia. In the 1800s, Gottlieb Burkhardt pioneered initial surgical interventions on the brain with intended psychiatric outcomes, moving on to work from Egas Moniz and the development of leucotomies and famously lobotomies, to modern medical techniques of Deep Brain Stimulation.

Psychosurgery has faced much opposition throughout history due to the uniquely invasive nature of not just affecting us physically but also mentally and the implications that this has for us as humans and our understanding of ourselves. As both medical and cultural views of mental health have changed over time, so has our understanding of psychosurgery and its potential applications. It is possible that early attempts to implement psychosurgery, before the advent of modern medicine, did more harm to psychosurgery’s reputation than good. However, without those early forays, we may never have progressed to the modern techniques we now utilise.

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Dementia with Lewy Bodies (DLB) is a primary degenerative dementing syndrome characterized by visual hallucinations, fluctuation in cognition, depressive symptoms and parkinsonism. Literature has shown the utility of electroconvulsive therapy (ECT) in demented patients regarding depressive symptoms and agitation. Nevertheless, the majority of cases described include patients with vascular dementia and Alzheimer’s disease. There are no cases informed concerning ECT in DLB patients with agitation and aggressive behaviors.

Evaluate the impact of electroconvulsive therapy (ECT) for agitation in a patient with diagnosis of Lewy Bodies Dementia (DLB).

Case report. 68-year-old male, with no prior neuropsychiatric history, was present for psychiatric evaluation for 5 year history of progressive dementia with fluctuations in cognition, complex visual hallucinations, delusional beliefs, depressive mood, anhedonia, irritability, associated to parkinsonism and increasing autoaggressive behaviors and agitation.

An extensive neurologic workup including neuroimaging, EEG and laboratory studies failed to reveal a specific etiology. Neuropsychological testing reveals frontal, attentional, and visuospatial dysfunction. A presumptive diagnosis of DLB was made.

Medication trials including donepezil, memantine, lamotrigine, sertraline, quetiapine, risperidone and melatonin failed to manage his depressive, psychotic and behavioral disturbances.

Considering past medication failures and prominent behavioral disturbances family consented for an acute course of ECT.

Initial acute phase consisted of 6 sessions of right unilateral, brief pulse width (0.3 ms) ECT tri-weekly utilizing Mecta Spectrum. Anesthesia was induced with propofol, and received succinylcholine for muscle relaxation. Initial charge was 115 mC (6x seizure threshold), then raised to 192 mC. Seizure duration averaged in 22 seconds. No adverse reactions reported.

Clinical outcomes were measured with the CGI-Efficacy Index. Pre-ECT CGI-SI score was 6 (severely ill) and post-ECT CGI-I was 3 (minimally improved).

Mood and behavioral disturbances are a frequent primary motive consultations in DLB patients. The treatment is challenging due to the sensitivity to antidopaminergic medications evidenced in this type of patients. This case suggests that ECT has an impact in the treatment of agitation and aggression in DLB patients, although further investigation is needed.

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ectroconvulsive therapy (ECT) is a medical treatment most often used for patients with severe major depression or bipolar disorder who have not responded to other treatments, as well as for resistant schizophrenia, and consists of brief electrical stimulation of the brain while the patient is under anesthesia. It is usually administered by a team of trained health care professionals, including a psychiatrist, an anesthesiologist and a nurse or physician assistant.

The mode of action is not well known, but it is assumed that ECT is associated with a significant reduction in brain connections in the dorsolateral prefrontal cortex, which is associated with a significant decrease in depressive symptoms. This would support the hypothesis that hyper-connectivity in this area of the brain is closely linked to depression.

Despite its great effectiveness, this technique remains limited by numerous contraindications and exposes the patient to a multitude of short-, medium- and long-term side effects, notably cognitive disorders.

To shed light on the cognitive disorders affecting mnesic processes, learning and thinking after electroconvulsive therapy.

We have performed a systematic literature review using the following keywords on the GoogleScholar database: cognitive impairment post electroconvulsive therapy, cognitive effects of electroconvulsive therapy, electroconvulsive side effects, ECT.

Most of the studies on cognitive disorders after ECT have focused on mnesic abilities, in particular the deterioration of anterograde memory which is at its maximum just after the session and which recovers progressively and spontaneously. The deterioration of retrograde memory, on the other hand, depends on the administered dose, the type and the location of the electrodes, and has a greater tendency to affect recent memories than old ones.

Other studies have focused on the speed of the process of information, which is also affected, with a significant decrease, especially in depressed people, a decrease that can be progressively resolved with time. Concerning attentiveness, some studies have noted a minimal decrease, especially in the lateral visual fields, and a perseveration in verbal expression. These studies also noted a deterioration of executive functions with a decrease in performance on the STROOP and MTM tests and also in verbal fluency.

The occurrence and preservation of cognitive deficits after ECT is a much debated subject with many controversial studies, and despite the numerous studies on this subject, we are still far from conclusive and exploitable results, especially with the intricacy of the diversity of parameters, materials and techniques of ECT, and also because of other factors such as individual peculiarities, neurological co-morbidities, and polymedication to psychotropic drugs.

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Electroconvulsive therapy (ECT) is a procedure performed under general anaesthesia involving triggering an intentional brief seizure through small electrical currents through the brain. The anaesthetic depth should be adequate prior to shock and measured with BIS, a processed electroencephalogram (EEG) monitor. Adjusting the hypnotic dose allows to decrease the ictal threshold and thus improve the response to treatment and decrease side effects.

Our goal is detecting elements such as spontaneous epileptiform activity after ECT without tonic-clonic activity with the spectral density matrix (SDM).

Our patient: an 87-year-old woman, diagnosed with F20.2 catatonic schizophrenia and under antipsychotic treatment since her youth. She has required multiple hospital admissions due to psychopathological decompensations until starting monthly maintenance ECT sessions in 2014. Since then she no new hospital admissions have been required.

Images 1D and 1E shows the SDM, a spectrogram of the EEG. The X axis show time (minutes), the Y axis shows the frequency (Hz) and the Z axis shows the energy or intensity of that electrical activity in the frequency bands replaced by colors: warm colors (red) reflecting high intensity electroencephalographic activity and cool colors (yellow, blue and green), low activity. Images 2 and 3’s EDM shows spontaneous epileptiform activity after electroconvulsive therapy without tonic-clonic activity. We observed an initial EDM of an awake patient, with warm colours in practically all frequency bands, including the beta band (13-30 Hz), characteristic of waking states. Around 9:50 anaesthetic induction occurs, activity increases in slow frequencies (red colours in alpha, theta and delta), plus an increase of cold colours in beta, reflecting the disappearance of brain activity in that frequency. The asterisk reflects the EEG response to the electrical discharge, followed by a postcritical state with brain activity exclusively in slow waves and high amplitude (delta and some theta) and absence of activity in other frequencies (blue colour in the beta and alpha bands) around 9:57. At about 10:00 there is an abrupt appearance of high intensity brain activity (warm colours) in beta and alpha and delta, mainly, reflecting spontaneous epileptiform activity after treatment and clinically reflected as a patient absent and disconnected from the environment, but without tonic-clonic activity. New postcritical state in which blue colour predominates, reflecting little brain activity, and warmer colours reappear in all frequency bands, including beta, reflecting the progressive recovery of wakefulness.

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Psychiatric pathology can be reflected in the SDM, which allows to observe changes in the EEG, correcting the electrical stimulus of the shock and the dose of anesthetic appropriate to the patient to trigger an intentional brief seizure under general anesthesia.

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Electroconvulsive therapy (ECT) is one of the most controversial treatments in medicine, mainly because of its still unknown mechanism of action and uncertainty about cognitive side effects. ECT is used mainly when antidepressant medications do not result in an adequate response in severe depression, and may also be indicated for other disorders. During the acute phase after electroconvulsive therapy there are better cognitive outcomes with unilateral ECT compared to bilateral ECT.

This literature review aims to analyze the validity of electroconvulsive therapy despite the cognitive impairment and effectiveness of electroconvulsive therapy.

The method used was a literary review based on articles published in Scielo and Pubmed. Eighteen electronic articles in English were used in a 10-year time frame, using the term electroconvulsive therapy as descriptors in the title, as well as cognitive impairment in all fields.

We observed that older individuals benefit the most from ECT, with faster response rates and higher remission rates in rapid responders, on the other hand they have a higher risk of cognitive side effects induced by electroconvulsive therapy. Anterograde and retrograde amnesia usually resolve within months. Recovery from retrograde amnesia may be incomplete, resulting in permanent amnesia for events that occurred close to the time of ECT. Right-sided or bilateral electroconvulsive therapy was more effective in treating depression than left-sided. Patients who used right unilateral electroconvulsive therapy had less impairment of verbal memory and post-ictal recovery and faster reorientation compared to left unilateral and bilateral, whereas left unilateral ECT showed a smaller decline in visual memory and non-verbal tests. Bilateral ECT is more effective and faster acting, but is associated with more cognitive impairments compared to unilateral ECT.

We can conclude that ECT is an effective, safe and tolerable treatment, which results in faster and higher remission rates compared to treatment alone with pharmacotherapy. Cognitive effects are largely transient, usually ending within three months. The decision to use unilateral right, left, or bilateral ECT should be made individually for the patient and should be based on a careful assessment of the relative priorities of efficacy versus minimizing cognitive impairment.

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A relatively large number of studies of the efficacy of rTMS on tinnitus have been conducted. LF stimulation of the auditory cortex in combination with HF stimulation of the DLPFC, has shown efficacy in reduction of symptoms (especially loudness and anxiety).

To launch a protocol to examine the efficacy of Cool-B65 coil LF rTMS combined with H7-deep coil HF rTMS, in the treatment of idiopathic, chronic, normo-acoustic tinnitus disorder, informed by the assessment of efficacy of rTMS on idiopathic, chronic tinnitus disorder. Preliminary results will be presented.

We first conducted a meta-analysis of randomized sham-controlled, double-blind trials to access the efficacy of rTMS on idiopathic, chronic tinnitus disorder. We are now planning an industry-independent, single-center, prospective, randomized sham-controlled, two-arms, double-blind superiority clinical trial with concealed allocation and masked independent outcome assessment.

Population of this study will include Outpatients diagnosed for ≥ 12 months and ≤ 5 years with persistent, subjective, normo-acoustic tinnitus disorder of at least moderate severity defined by the THI score ≥ 38, both unilateral and bilateral, both genders, and with no hearing loss, age 18-65 years, with the tinnitus treatment unchanged for at least one months. Exclusion criteria will be: organically caused tinnitus and organic brain lesion, objective tinnitus, severe hearing loss or Menier’s disease, middle ear disease, diagnosed mental disorder, suicidality, alcohol or drugs addictions, clinically relevant neurological disorder and standard rTMS exclusion criteria. Population will include 52 in HR rTMS H7-coil arm, and 52 in sham control arm. Adjusted median of differences in instruments measuring tinnitus, annoyance, distress, anxiety, and depression will be used as an outcome.

The Cool-B65 coil LF rTMS (1Hz) placed over the auditory cortex combined with H7-deep coil HF rTMS (10Hz) placed over mPFC, applied for 15 days, is expected to have superior efficacy on tinnitus symptoms measured by the overall THI score, then the SHAM passive coil.

We are conducting a theoretically founded study, with an empirically founded patient-oriented approach. We are expecting that H7-coil in stimulating auditory cortex and mPFC may be a possible alternative target for HF rTMS of the DLPFC.

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We introduce and present a psychotherapic technique initiated by Wilhelm Reich (1897-1957) in the 1920’s and thereafter expanded and refined with essential contributions by Elsworth Baker among others. We outline its theory and technical foundations and also provide an epistemologic interpretation of its peculiar body-mind representation based on character- and muscular armoring as a reaction to suffering; armoring of the ocular segment in the etiology of Bleuler’s schizophrenic splitting; and finally the consequences of armoring on the energetic functions as the logical development of Freud’s theory of libido, with significant theoretic, therapeutic and nosologic consequences.

The goal of my presentation is to avoid extinction of a valuable technique for future psychiatrists; moreover, to catch the interest of young collegues to a technique that integrates Bleuler’s psychiatric discovery with Freud’s psychoanalytic contribution and demonstrates that the old nosology and theoretical achievements in the psychic field were not as obsolete as today many think.

Research, book summaries, practical experience

Poster presentation

Poster presentation

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Chronic diseases, with the development of medicine, the extension of life expectancy and the reduction of dying from infectious diseases, have become a leading public health problem. Rheumatoid arthritis (RA) is a chronic, progressive, multifactorial, autoimmune, systemic inflammatory disease of connective tissue, and sufferers are at greater risk of developing psychological disorders, depression and anxiety being the most common. Optimal treatment of RA should include periodic screening of somatic and psychological comorbid disorders and diseases with a multidisciplinary approach to treatment.

Presenting a psychotherapy program as an additional method of treating patients with rheumatoid arthritis.

In University Hospital Dubrava, a psychotherapy program was organized for patients with rheumatoid arthritis, which took place once a week for 12 weeks, and consisted of autogenic training, education about the disease and group psychotherapy. The program would begin with autogenic training held by a clinical psychologist, and the main goal was to achieve psychophysical relaxation. This was followed by an education on rheumatoid arthritis, in which a clinical rheumatologist was involved, and the goal was to provide basic information about the disease, thereby achieving better cooperation with health care personnel and a more active role in their own treatment. In the end, there would be a time-limited dynamic group psychotherapy conducted by a psychiatrist/psychotherapist with the basic therapeutic effects of group therapy.

As a result of a 12-week psychotherapy program for somatic patients, which was held in a clinical hospital, patients’ anxiety and depression decreased, the experience of pain decreased, and there were positive changes in the perception of the quality of life.

A multidisciplinary approach is recommended in treating patients with rheumatoid arthritis and psychotherapy progam can be used as an additonal way of treatment.

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We have investigated the relationship between the Psychosomatic Classification method (Marty) and the Rorschach Test, with respect to the diagnosis of psychosomatic disorders, within the framework of the degree of mentalization measured by both.

A) To verify statistical coincidence with respect to the degree of mentalization (risk of generating psychosomatic disorders in a subject) between the Rorschach Test and the diagnostic technique Psychosomatic Classification, by P. Marty. B) To test the hypothesis: Patients diagnosed with infertility, whose degree of mentalization is good, will have a greater probability of achieving a successful pregnancy throught Assisted Reproduction Techniques.

Two evaluation tools were used: a) Psychosomatic Classification based on the criteria established by this diagnostic method; b) The Rorschach test (based on the evaluation of 29 indicators, selected according to their greater relevance in the generation of somatic symptoms).

A sample of 120 patients (women) diagnosed infertility at the Assisted Reproduction Unit (U.R.A.) at Hospital Universitario 12 de Octubre in Madrid was recruited. The method of ‘statistical correlation of coincidence’ between the results of the two diagnostic instruments used was used. Once both tests had been assessed by the “inter-judge” method and the quantitative values of the selected items had been weighted, the KAPPA statistical method was applied to establish the “correlation of coincidence” between the results of the two assessment instruments.

Considering that the KAPPA method takes values between “0" and ”1" and that between 0.6 and 0.8 the agreement or coincidence is considered good, and above 0.8 very good, the result applied to the hypothesis is 0’76 (’good’).

A) Using the Rorschach Test and P. Marty’s Psychosomatic Classification in a complementary manner, these two instruments together provide high reliability, with respect to the degree of mentalization (a subject’s risk of suffering psychosomatic disorders). B) The degree of mentalization has a significant impact on the success or failure in the application of Assisted Reproduction Techniques in infertile women.

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In this work, I will try to approach birth and growth from my stay in therapy groups, including psychotherapy in multi-family groups from a simple observer, to a driver, alone and in co-therapy, to a member of the experience, to a driver member.

Explain why we are interested in our work center in multifamily therapy groups

Qualitative and narrative of the course of my experience in group therapy over 25 years

Based on my experience, I do not see any probability that coordination/direction will be achieved at the same time as symmetry in participation. Knowledge is power, said Foucault, so I must divest myself of my knowledge in order not to have power, and that power be executed by each of the participants with her own life.

It is in this process that I have been going through, it makes me think to what extent one makes the effort, I have made the effort not to be in the place of excluding the other, the other sick, of segregating him, as if to feel that I have a place of healing, the other must be someone who is the object of being healed. We have the possession of knowledge, to give light to others, in this disciplinary society, of disciplining in prison institutions, as Foucault would say, prisons, hospitals, army.

In this group work, multi-family, we must go to the singularity of the participants, to make them stand out, to get out and overcome the need for those relatives, who prevent them from growing and thawing, and roughly, hold on and take out the healthy virtuality , but that does not mean that we will achieve, even if we get out of the stereotyping and the sickening circle, that we have arrived at what is healthy, because in some way it will end up being just the way in which we look at what is healthy.

In this process, not only do the participants change, but we do too, because otherwise, we would be in a stereotype, regarding our role and the institution itself.

The mentally ill is not only a justification of families, but of society itself, and that other, that other excluded, will be determined by the historical period itself, and social context, the sick of today were not those of the past nor will they be those of the future.

Power, as Foucalt would say, entails resistance, and what is our resistance, that is the question I ask myself, resistance is needed so that power can establish itself, think about counter-power, fissures so that things are renewed, and that is actually what is sought in groups, to work from the cracks of the established

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Cognitive Behavioral Therapy (CBT) provide a means of improving mental health among people with depression. However, few studies have explored its effectiveness with the presence of comorbid somatic disorders.

We aimed throug a case report to describe the cognitive and behavioral management of a patient with depression comorbid with systemic lupus erythematosus.

We present the case of a 47-year-old woman followed since 2012 for a systemic lupus erythematosus. In september 2013, she was diagnosed with depression. The cognitive behavioural therapy took place in 12 sessions of 45 minutes each, one session per week. Initial and final evaluations included Beck’s Depression Inventory and the « Questionnaire des pensées automatiques ».

During the course of the therapy, we noticed an improvement of the patient’s mood, a decrease in anhedonia and somatic complains. We also observed a decrease in instinctual disorders. The final evaluation showed a significant improvement of the different scales. The objectives set with the patient were achieved.

Cognitive behavioral therapy is an interesting option for the management of cases of depression, including its comorbid form with a disabling disease such as systemic lupus erythematosus.

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In treating schizophrenia, there is growing interest in introducing and renewing psychosocial therapies, including psychotherapy. In recent years, this has specifically entailed the adaption of particular cognitive behavioral therapy (CBT) approaches, which were previously only utilized for treating anxiety and mood disorders. The negative symptomatology of schizophrenia, which has proven to be especially difficult to treat, can be a challenge for CBT, particularly in terms of enhancing relationships with family and friends and work engagement.

The objective was to summarize the advantages of CBT treatment in schizophrenia briefly.

Patients with schizophrenia frequently have comorbid problems, such as anxiety disorders (and disorders) and traumatic experiences, which can be effectively treated with CBT. In addition to pharmacological therapy, CBT is acknowledged as the gold standard in several countries for the treatment of schizophrenia. According to studies, combining CBT with medication can minimize psychotic symptoms.

Regarding treatment, Beck describes the use of typical CBT techniques: building trust and engagement; working collaboratively to understand the meaning of symptoms; understanding the patient’s interpretation of past and present events, particularly those that the patient believes are related to the development and persistence of his or her current problems; normalizing these experiences and educating the patient about the stress-vulnerability model, and socialization. Clarifying the emotional and behavioral repercussions of a delusion’s activation leads to an initial examination of the evidence-based on more peripheral interpretations. It is recommended to treat negative symptoms such as amotivation, anergia, anhedonia, and social disengagement with behavioral self-monitoring, activity scheduling, ratings of mastery and enjoyment, graded work assignments, and assertiveness training.

In treatment settings where physicians are already utilizing high-quality psychoeducational materials to enhance adherence, an excellent foundation exists for introducing individual CBT for schizophrenia patients.

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Psychodynamic psychotherapy emphasizes the unique history, subjectivity, and psychological complexity of each individual. The core principles in the psychodynamic treatment of schizophrenia spectrum disorders (SSD) includes a stable (yet flexible) frame; attention to countertransference; and clarification of experiences, emotions, and relationships including giving psychotic symptoms context in internal and external object relationships.

This study has two aims. First, to present the progress of a patient with chronic schizophrenia treated with psychodynamic psychotherapy. Second, to provide a systematic review of comparative trials that have included psychodynamic psychotherapy as treatment for SSD.

The case presentation includes information from the therapist’s notes, video footage, and the electronic health record. The systematic review will be conducted in November and December, 2022, and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The databases of MEDLINE, EMBASE, and PsycInfo will be searched for literature.

L, a 25-year-old woman, was diagnosed with paranoid schizophrenia five years prior to starting psychodynamic psychotherapy at an outpatient unit for SSD. L grew up with a close relationship with her mother, father, and sister. She was bullied in school and clearly remembered being told by her classmates that she was “just L”. When therapy began L had been living with her boyfriend for six months. Voice hallucinations were one of the most interfering symptoms. The most present voice, M, was both her best friend and worst enemy. During psychotic breakdowns M could take control of L’s body. L was incapable of making her own decisions. Small and big decisions were consulted with a family member or the hallucinatory voices. L attended 33 psychotherapy sessions from October, 2020 to November, 2021. In the first six months, sessions were weekly and afterwards biweekly due to L feeling significantly better and she wanted to have more time to study. L benefitted from the structure and clarifying questions from the therapist. Most notably, she broke up with her boyfriend. She started dating and found a new boyfriend. At this point the voice hallucinations and psychotic breakdowns were reduced considerably. In the termination phase the themes were feeling insecure, relationships, and how having been bullied affected her as an adult.

Results from the systematic review are not available at the time of submission.

In the present case, psychodynamic psychotherapy was an effective treatment of psychotic symptoms as well as childhood trauma and interpersonal conflicts for an individual with paranoid schizophrenia. It speaks for a broad application of psychodynamic psychotherapy in the treatment of SSD as the therapy both assesses and treats psychotic and non-psychotic symptoms.

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The authors - both active psychotherapists and at the same time happily married couple - present bravely a unique case study : theirs own patchwork family. The dwelve deeply into family systems dynamic, analyze the relationship between grandparents, parents and children. The standard roles of father and mother are taken into examination, especially after the youngest baby is born. With wit and humor, the authors define the new working paradigm of patchowork love.

Define the new concept of love in patchwork family and redefine the traditional roles.

Case study.

The result - the new concept of a fully functioning patchwork family with redefined love concept and new roles - enables better understanding and richer life.

We should always seek for love in the families, which come to psychotherapy / psychiatry office for help. Understanding the dynamic of love in the patchwork family is crucial to providing high quality help.

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Major depressive disorder (MDD) is a mood disorder that can last for weeks or even months, in which there is a depressed mood accompanied by anxiety, in addition to negative changes in cognitive functions, psychomotor movement and vegetative functions. Depression with psychotic features is a psychiatric syndrome that progresses with delusions as well as severe symptoms such as psychomotor retardation or agitation, depressive ruminations, deterioration in cognitive functions, and confusion. Compared to the subtypes without psychotic features, the symptoms are more severe, the age of onset is earlier, and the duration of the disease is longer. Feelings of guilt, worthlessness and suicidal thoughts and attempts at suicide are more common. The risk of exacerbation is greater. Diagnosis of bipolar disorder and schizophrenia is more common in first-degree relatives of these patients.

An 18-year-old female patient with somatic delusions and psychotic persistence that started after a sexual trauma and persisted for 1 month was consulted after organic exclusions were made. It is understood from the anamnesis that the patient had a manic episode about 6 months ago and that his mother was followed up with a diagnosis of bipolar disorder. The patient’s current clinical picture was evaluated as depression with psychotic features, and after hospitalization, the treatment was adjusted as fluoxetine 20 mg/g, olanzapine 5 mg/g, and lithium 900 mg/g. Self as context, cognitive defusion and acceptance interventions were applied to the patient.

When the Cognitive Fusion Questionnaire(CFQ), Self-as-Context Scale(SACS), Acceptance and Action Questionnaire(AAQ-II) completed by the patient during hospitalization and in remission periods were compared, it was observed that there was a significant regression in the patient’s psychological inflexibility during the period of remission. Written informed consent was obtained from the patient whose clinical picture was presented in order to contribute to the scientific literature.

Depression with psychotic features is another clinical picture in which psychological inflexibility increases, and it has been observed that interviews to increase psychological flexibility during the treatment process contribute positively to the treatment process. For this reason, the contribution to the healing process can be better clarified in further studies on interventions to increase psychological flexibility applied in addition to pharmacological treatments.

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Psychological inflexibility is an effort to control a person’s emotion, thought, behavior or experience in a dysfunctional way in the face of an undesired experience. It has been seen in studies conducted in recent years that; There is a significant positive correlation between high psychological inflexibility and somatization, depression, anxiety and other psychological disorders.

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Previous studies have shown that Peer Support Programs (PSPs) promote workforce wellness by supporting clinicians during times of heightened stress and vulnerability (Keyser, et al., 2021). Inclusion of case discussions in PSPs can provide opportunity for reflective practice, quality improvement, and professional development, in addition to strengthening clinicians’ resilience.

To describe the experience and perceived benefits reported by participants (psychiatrists) of a peer support and case discussion group meeting, of a clinical department of psychiatry (DOP) in Cape Breton, Canada, which the group calls “clinical café meeting”.

Qualitative data collected, were informal comments (with focus on the participants’ experience and perceived benefits) from the group participants during the once a month, one-hour clinical cafe meetings.

From September 2015 to September 2021, attendance ranged from 2 to 10 participants. All participants voiced that, they see each meeting as an opportunity to “analyze their feelings and knowledge relevant to clinical practice situations, especially those associated with uncomfortable feelings (Atkins & Murphy reflective model, 1993), and challenges they face, in relation to the healthcare system. Many participants voiced how input from group participants help them with gaining a new perspective on practice situations that were discussed, and ideas on how they could deal with similar clinical situations or challenges, in a more robust way, in the future. Many participants also find the clinical café meetings to be helpful in consolidating their resilience.

PSP (with case discussion) participants, in a Canadian DOP, described their experience of the group meetings, as beneficial, including contributing to strengthening of their resilience.

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A new mental health service specialising in intellectual disabilities in Ireland was set up in January 2022. Its current compliment of staff includes is a Consultant Psychiatrist, Trainee Psychiatrist, Social Worker and Administrator. The current National Directive in Ireland is to prioritize Mental Health of Intellectual Disabilities services.

The aim of the project is to establish the current baseline level of diagnostics and interventions within the new service. Our aim is to develop this service by implementing and following the gold standard guidelines and determine what extra resources does the service need.

The first fifty case notes of patients assessed by the new service were inspected. The reviewer looked for evidence of the following clinical descriptions:Diagnosis of Intellectual Disabilities and its severity; Mental Capacity; Psychiatric Diagnoses; Physical health diagnoses; Medications and evidence of a Positive Behavioural Support Plan to manage complex challenging behaviours.

The fifty patient audit contained 38 (76%) men and 12 (24% women) . One patient had Mild Intellectual Disabilities (ID), 39 (78%) had Moderate ID and 10 (20%) had Severe ID. All patents were very vulnerable and had limited or lacking Mental Capacity. Common diagnoses of the following were recorded in the following numbers and percentages; - Autism diagnosis 30 ( 60% ); Epilepsy 19 (38%); & Down Syndrome 9 (18%). A Formal Psychiatric diagnosis was identified in 26 (52%) of patients. Challenging Behaviour (severe and complex) was identified for 41 ( 82%) of the patients. The full breakdown of psychiatric diagnoses was ‘Psychotic illness’ – 9 (18%); Anxiety – 7(14%); Bipolar Affective Disorder 5 (10%): Depression – 4(8%); Attention Deficit Hyperactivity Disorder (ADHD) 3 (6%); Obsessive Compulsive Disorder (OCD) – 2(4%); Dementia – 2(4%): Post Traumatic Stress Disorder (PTSD) – 1 (2%); & Schizoaffective Disorder 1(2%). A Positive Behavioural Support plan (PBS) was available to support 33 (66%) of patients.

42 (84%) of patients were prescribed antipsychotic medication. 12 (24%) were prescribed more than one antipsychotic. 20 (40%) were prescribed an antipsychotic without a formally documented diagnosis of a psychotic disorder. 12 (24%).

The results of this first survey highlight areas in which the service can be improved. The service has requested funding for a Community Nurse and a Psychologist. Psychological evaluations and Positive Behavioural Support plans are essential for people with complex challenging behaviours. A Community Nurse should assist with Health Promotion and help supervise patients requiring Depot Antipsychotic medication or Clozapine. We also plan to set up a joint clinic with the Consultant Neurologist on a regular basis.

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Medication Reconciliation is the formal process for creating the most comprehensive and accurate list of a patient’s current medications and comparing the list to those in the patient notes and medication record. Medication Reconciliation is a time-consuming process and numerous errors can occur during the admission, inpatient stay, transfer and discharge of a patient. Errors in this process can lead to serious clinical outcomes for the patient.

The main aim for undertaking this project is to reduce the risk of medication errors during the admission process, inpatient stay, transfer, and discharge. The ultimate goal of this project is to obtain 100% compliance regarding complete medication reconciliation.

Two audits were completed in an Irish Acute Psychiatric Unit in May 2021 and February 2022. Ten inpatient clinical notes and corresponding medication records were reviewed. The three stages of Medication Reconciliation were audited. Stage 1 involved collecting the data. This included reviewing all medication information sources on admission and then documenting the Best Possible Medication History. Stage 2 involved confirming the accuracy of the medication history by verifying with one or more sources (e.g. General Practioner, Community Mental Health Team, Pharmacy). Stage 3 involved comparing the Best Possible Medication History with the Precribed Medication List in the patient’s Kardex. A Medication Safety workshop was provided for all psychiatric trainees and consultants within the service and the guidelines regarding the importance of medication reconciliation were discussed.

The audit results demonstrate that there has been an improvement in medication reconciliation during the nine-month period. To obtain 100% compliance, the service needs to continue to highlight the importance of medication reconciliation practise amongst all medical staff through clinical practice, teaching sessions and regular audits.

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The number of incidences of violence and restrictive practices within acute inpatient psychiatric wards are significantly high which makes these units less conducive for recovery and less therapeutic. Staff and patient survey results highlighted their concerns and their desire to have a safe environment to work and a less volatile therapeutic environment.

The aim of this QI project was to reduce violence and restrictive practices within acute inpatient units.

PDSA cycle was used to achieve the objective.

Primary and secondary drivers were identified and were illustrated using driver diagram. Three units were identified for pilot study. The group has agreed to collate change ideas from service users and restraint data from internal system will be used to review the impact of changes.

Meeting were conducted with service users from these units to populate change ideas. Additionally, the Acute care group also outlined some practice related change ideas such as enhanced recruitment of substantive staff, safety pods, introducing safety huddles, revising therapeutic planner, developing safe care champions and inclusion of professionals from various disciplines such as drama therapist, sports technicians and peer support workers that are traditionally not included in MDT. The change ideas were implemented in one of the selected units.

The group reviewed the feasibility of change ideas and agreed on change ideas that got more support from service users which were projectors to play music, soothing DVDs to assist with relaxation and ear defenders.

All change ideas were implemented on the pilot units.

The QI project has enabled the trust to reduce the number of violence and restrictive practices on all the three units, with a team approach and using a multipronged approach, co-production and openness key to positive results.

In due course we also liaised with the wards to get qualitative feedback from the service users to see how they felt about this new change.

A year after the initial data was collected, to see if there had been the intended 50 per cent reduction in violence and restrictive practices. The team were delighted to find that they had exceeded this aim with a 56 per cent reduction with only 12.3 incidents being reported over the 3-month period.

The QI project on pilot wards have enabled to reduce the number of violence and restrictive practices on all the three units.

Team approach and using a multipronged approach, coproduction and openness key to positive results.

The next step is to implement these change ideas on all other units and looking into the economic value and saving as part of this project, given lesser incidents and staff requirements.

None Declared

In Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.

This study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.

Demographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.

Demographic data found PPF rises significantly over time (Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item (Figure 2) and psychiatric outpatient consultation fee for outpatient item (Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.

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In the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.

None Declared