Treatment adherence in patients living with Bipolar Disorders can influence prognosis and quality of life. It is associated with an increased morbidity and healthcare costs.

The aim of our study was to evaluate treatment adherence in a sample of patients living with Bipolar disorders and to determine factors associated with poor adherence.

We conducted a cross sectional study where we included bipolar patients being treated in psychiatry department A. We developed a survey containing sociodemographic and clinical features. We used the medical adherence rating scale to evaluate treatment adherence.

Our sample consisted of 100 patients with a mean age of 47,5 years old. Sixty seven patients were being treated for bipolar disorder type 1. Medication adherence rate was 64%.

Factors associated with poor medication adherence were being single, an early age of onset, comorbid substance abuse disorder, severe treatment side effects and poor insight.

Poor medication adherence is a major issue for people living with Bipolar Disorders. Clinicians should pay more attention to sociodemographic and clinical factors to predict and enhance treatment adherence.

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Women with bipolar disorder often ask their treating clinician for information about family planning, as they are concerned about the impact of their illness on offspring. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. On the other hand, the risk of abnormalities and teratogenicity from psychotropic drugs is significant. The decision wether resuming or discontinuating lithium is discussed.

We present a theoretical review on the topic.

A bibliographic review is presented.

The choice to continue medication during pregnancy balances the risks of an untreated illness with the risks of medication exposure. Abrupt discontinuation of psychotropic medications is associated with an increased risk for illness recurrence. Women with BD who discontinue their medications before or during pregnancy have a 71% risk of recurrence with new episodes occurring most frequently in the first trimester. Recurrent illness during pregnancy is associated with a 66% increase in the risk of postpartum episodes. Untreated or under-treated BD during pregnancy is associated with poor birth outcomes independent of pharmacotherapy exposure, including preterm birth, low birth-weight, intrauterine growth retardation, small for gestational age, fetal distress, and adverse neurodeve- lopmental outcomes. Women with untreated BD also have behavioral risk factors such as decreased compliance with prenatal care, poor nutrition, and high-risk behaviors. Impaired capacity to function may result in loss of employment, health care benefits, and social support. The biological and psychosocial risks of a BD episode are the justification for the risk of medication exposure.

Fetal exposure to lithium has been associated with an increased risk for cardiac abnormalities. The risk for Ebstein’s anomaly with first trimester exposure is 1 (0.1%) to 2 in 1000 (0.2%), but the absolute risk remains low. Folate supplementation with 5 mg reduces the risk and severity of congenital heart disease. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn.

Strategies to minimize fetal exposure and maintain efficacy include using the lowest effective dose, prescribing lithium twice daily to avoid high peak serum concentrations, and regular monitoring of lithium serum concentrations. The effective serum concentration must be established before pregnancy. If a therapeutic concentration has not been established, the lithium dose is titrated to a concentration within the therapeutic range. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant.

Treatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy, especially during the first trimester, against its effectiveness at reducing relapse.

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Bipolar I disorder is a mental disorder with the risk of severe clinical outcomes. Bipolar disorder was initially defined based on having a better outcome than schizophrenia. However, while recent longer-term findings in schizophrenia do not support neuroprogression, bipolar disorder is increasingly depicted as having neuroprogressive elements. There are, however, remarkably few prospective longitudinal studies of representative bipolar I cohorts followed from the first treatment.

To study the clinical development of a representative cohort of bipolar disorder patients recruited at their first treatment.

Patients with DSM-IV Bipolar I or Bipolar NOS were consecutively recruited from in-and outpatient units in the larger Oslo area during their first treatment year and extensively clinically characterized at baseline. They then participated in personal one- and ten-year follow-ups.

Sixty-nine patients participated in the 10-year follow-up. Age at follow-up was 39.0 (+ 9.6) years, 59% were females. A total of 12% had unipolar mania, 58% had psychotic bipolar disorder, and 20% had experienced rapid cycling. At follow-up, 75% were in full affective remission, 60% had regained full functioning, and 54% were in stable full recovery.

Mood episode relapses clustered around the first episode. Despite occasional relapses, 2/3 were mainly euthymic during the follow-up period. A small sub-group was highly affected from the first 2-3 years of treatment, but there were no apparent signs of kindling effects or indications of neuroprogression

The follow-up of this cohort of first-treatment Bipolar I patients does not support the hypothesis of neuroprogression.

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Recent studies reported substantive clinical differences in those with a bipolar disorder who evidence elevated or irritable mood during a manic episode, which may have treatment and prognosis implications.

We aim to compare sociodemographic and clinical characteristics of inpatients admitted for bipolar mania with elevated vs. irritable mood.

Retrospective observational study of inpatients admitted between January 1st 2018 and July 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Our sample included 143 inpatients, 39,9% (n=57) with elevated mood. When compared with those with irritable mood, euphoric patients had 2.765 more odds of having previous psychiatric hospitalizations (x2(1, N = 143) = 4.93; p = 0.026). Interestingly, 78.4% of inaugural manic episodes (n=19) presented with irritable mood (x2(1, N = 143) = 3.447; p = 0.063). We also found that a patient with euphoric mood has 2.575 greater odds of being under a mood stabilizer (x2(1, N = 143) = 5.026; p = 0.025) before admission. More specifically, there is a significantly higher proportion of euphoric patients that were prescribed with valproic acid as mood stabilizer (57.9% vs 37.2%; x2(1, N = 143) = 5.016; p = 0.015). This association was not found with lithium. We found no statistically significant differences regarding the sociodemographic characteristics, previous long acting injectable antipsychotic or antidepressant treatment and psychotic symptoms during manic episode between the two groups.

Patients with elevated mood are more likely to have a previous bipolar disorder diagnosis, which may reflect an observer bias due to the fact that diagnosis is already known.

The use of valproic acid as mood stabilizer may be a protective factor to irritable mood, since it’s currently prescribed in those with bipolar disorder who have more depressive or mixed instead of manic episodes. However, future studies are essential to understand the impact of mood stabilizer on these two contrasting phenotypic expressions.

Differences related to disease severity or sociodemographic characteristics were not found.

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Bipolar Disorder (BD) is a common psychiatric disease. It has been demonstrated a long time ago that bipolar patients are more painful than the healthy subjects. Substance use disorder is a frequent comorbidity in BD, but also in painful patients. The aim of our study was to analyze if bipolar patients with a painful expression have more substance use disorder than bipolar patients without pain.

The aim of our study was to analyze if bipolar patients with a painful expression have more substance use disorder than bipolar patients without pain

We included all bipolar patients from the FACE-BD cohort which is a prospective cohort of French outpatients with BD enrolled at the 12 advanced Centers of Expertise in Bipolar Disorder (CEBD). Pain has been evaluated by the “pain item” of the EQ-5D scale and we divided subjects in four categories: “no pain”, “slight pain”, “moderate pain”, “severe or extreme pain”. A multivariate analysis was performed to identify differences between each pain’s groups according to the kind of substance use disorder, psychiatric comorbidities and clinicals data.

The cohort enrolled 1897 bipolar patients, 970 had no pain (51.1%), 507 had slight pain (26.7%), 298 had moderate pain (15.7%) and 122 had severe or extreme pain (6.4%). We found significant differences according to age, comorbidities and clinicals data with older, more anxious, and more severe patients more represented in the more painful groups. Painful bipolar patients had also more frequently lifetime substance use disorders (alcohol, opioid, sedative, marijuana) and we were able to characterize different profiles in bipolar patients.

Bipolar patients with a painful expression had more risks to have a lifetime substance use disorder, an anxiety disorder, and a higher score on MADRS. Interestingly, subjects seemed to prefer substances with anxiolytic or antalgic effects during the acute intoxication as alcohol, marijuana, opioid and sedatives.

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Lamina-specific alterations of inhibitory circuitries have been considered the crucial pathogenesis of perceptual, cognitive and behavioral symptoms presented in schizophrenia and mood disorders. Especially, with emerging evidences indicating the close lamina-specific relationship between synaptic defects and γ-Aminobutyric acid (GABA)-related gene dysfunctions, it has been suggested the mRNA dysregulations of Tyrosine kinase B (TrkB) and Glutamate decarboxylase 67 (GAD67) could particularly be implicated in middle and deep layers of neocortex of patients with major psychiatric disorders.

Giving inquiries of whether defects of these mRNA levels in Orbitofrontal cortex (OFC) would be involved as lamina-specific patterns in individuals with schizophrenia and mood disorders.

We examined mRNA levels of BDNF, TrkB and GAD67 in each OFC layer I through VI. We analyzed data from postmortem brain tissue of the Stanley Neuropathology Consortium Integrative Database (SNCID). SNCID consists of 15 subjects in each of four groups (schizophrenia, bipolar disorder, major depression without psychotic features, and unaffected controls). All groups were matched for age, sex, race, brain pH and post-mortem interval.

We found TrkB mRNA levels to be significantly reduced in layer VI in both groups with schizophrenia (25.8%) and bipolar disorder (35.7%) compared with controls. GAD67 mRNA levels were also significantly reduced in layer III and IV in patients with schizophrenia (23.4% and 22.7%, respectively) and bipolar disorder (31.2% and 24.9%, respectively) compared with controls. Individuals with major depression showed only trends toward decreased mRNA levels of GAD67 in layer III and IV and of TrkB in layer VI compared with controls. TrkB mRNA levels in layer VI were significantly correlated with GAD67 mRNA levels in layer III (ρ=0.581, p=0.037) and IV (ρ=0.857, p<0.001) in subjects with bipolar disorder, but not in those with schizophrenia. When analyzed with partial correlation controlling the effects of pH and PMI, significance of correlation remained only between GAD67 mRNA in layer IV and TrkB mRNA in layer VI in individuals with bipolar disorder (ρ=0.768, p=0.006).

The resulting lamina-specific decreases in inhibitory tone across layers of OFC may contribute to the unrestrained irritability and violent behaviors in common shared by both patients with schizophrenia and bipolar disorder. Nonetheless, our findings indicate the obvious correlations between lamina-specifically altered TrkB and GAD67 mRNA levels in OFC might be a candidate for endophenotype of bipolar disorder.

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Maintaining a good sleep-wake cycle is an important factor for the prognosis and management of bipolar disorder. However, studies on the to various technological advances including smartphoe usage affecting inter-episodic sleep quality are yet relatively less thoroughly investigated.

This study aims to identify the association between smartphone usage and inter-episodic sleep quality of bipolar patients.

A total 52 Bipolar I or II subjects who were euthymic for at lest 6 months were included in this analysis. Pearson correlation analysis was used to examine the association among psychological assessments, including the Pittsburgh Sleep Quality Index (PSQI-K), Smartphone Addiction Scale (SAS), Hamilton Depression Rating Scale (K-HDRS), Young Mania Rating Scale (K-YMRS), and Multidimensional Scale of Perceived Social Support (MDPSS). Significant results were then analyzed using a multiple linear regression analysis with PSQI-K as the dependent variable to assess the impact of clinical variables on sleep quality.

PSQI-K was positively correlated with SAS (r = 0.457, p < 0.001), K-HDRS (r = 0.447, p < 0.001), and negatively correlated with MDPSS (r = -0.336, p < 0.05). Smartphone use, depressive symptoms, and perceived social support seemed to explain 35.7% of sleep quality. After adjusting for confounders, more smartphone use and more severe depressive symptoms were associated with poor sleep quality (SAS: β = 0.383, p = 0.002; K-HDRS: β = 0.339, p = 0.006), but perceived social support did not reach statistical significance (MDPSS: β = -0.204, p = 0.086).

The results of this study show that the more a person uses a smartphone, the worse their sleep is. This effect is significant, even when other factors are taken into account. These results support the possibility that improving the degree of smartphone use could be an essential intervention target for improving sleep quality during the inter-episode period in patients with bipolar disorder.

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Mental health problems have increased internationally during the COVID-19 pandemic. However, most data stems from Western countries and there is a clear lack of prevalence rates and potential risk factors from Central and Eastern Europe.

To investigate the point prevalence and to provide further information on risk factors of depressive and anxiety symptoms in adolescents and their caregivers in North Macedonia after the COVID-19 pandemic.

A cross-sectional survey study was conducted on adolescents and their caregivers through the school setting in different areas of North Macedonia. Survey items assessed symptoms of depression, anxiety, and respondents’ fear of COVID-19, as well as a number of risk factors, such as gender and living environment.

506 adolescents and 492 caregivers completed the survey. Symptoms of depression and anxiety were mild to moderate in adolescents and their caregivers. Women and girls generally scored higher than men and boys, and adolescents in high school scored higher than those in elementary school. Prevalence rates for depression were 29.2% for adolescents and 10.4% for caregivers, while rates of anxiety were 23.7% for adolescents and 6.1% for caregivers.

This study provides a first insight into the mental health of adolescents and their caregivers after the COVID-19 pandemic in North Macedonia. Further research is required to investigate the relatively low reported rates of caregivers’ mental health problems compared to data from other countries.

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Treating mental health problems adequately is of paramount importance given the tremendous burden it places on the individual and on society. Knowing and realizing there is no one size-fits-all-solution, some methods do yield better results. The yardstick as such can be interpreted with scores on questionnaires, subjective accounts and/or having the need for further future follow-up treatments.

Within the Yes We Can Clinics, based in the Netherlands, we provide a very intensive 10-week residential treatment program where clients learn to acknowledge their problems and get to the root of these problems. The program is centered around confrontation in group sessions from counselors and peers, a well-thought out activity program from early morning till late evening, multiple psychotherapeutic sessions on a daily basis and if possible, minimize the use of medication.

Different Routine Outcome Measurement tests were applied.

Here we measured willingness to participate in the program, which fluctuates from average to low at the start, reaching a significant low motivational point after 2/3 weeks, in accordance with the quintessential confrontational aspect, but following the principles of the program in combination with reconnecting with parents and family (systems-approach), a tremendous increase in willingness and commitment towards the program, but also towards life and facing mental health struggles in general, arises.

Herewith confirming the effectiveness of our intensive, immersive, confrontational and protocolized 10-week residential program for youth with mental health problems

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In Japan, the effectiveness of health checkups for children aged 5 years has attracted attention as the basis for a support system for early detection and support of children with developmental disabilities. However, these have not yet become statutory health checkups, and their assessment has not been standardized. This study employed the Strength and Difficulties Questionnaire (SDQ) in examining the health of a 5-year-old child. This study aims to demonstrate the scores’ distribution and obtain the standard land and cutoff values of the SDQ.

From 2010 to 2012, children reaching 5 years of age in Kanie-cho, Aichi Prefecture, Japan, underwent a health checkup. Of the 888 children for whom parental consent was obtained, 884 responses without missing values (453 boys: 51.2%, 430 girls: 48.6%) were included in the analysis.

SDQ and medical questionnaires for 5-year-old children were sent to the parents with a formal request for approval for the child to participate in the study. Further, the parents were asked to respond to the questionnaire. The Ethics Committee of the Graduate School of Education and Developmental Sciences, Nagoya University approved this study (No.298).

A confirmatory factor analysis using the maximum likelihood method revealed a factor structure almost identical to that of Goodman (JCPP 1997; 38 581-586). Nonetheless, items 3, 10, 11, 13, 14, and 22 showed high loadings on factors different from those in the original version. Similar to the original version, we set our criteria so that Some and High Needs would be approximately 10% each. Furthermore, we calculated the percentage of children who fell into these categories and found that the scores that fell into the Need category differed from those in the previous study(Table 1).

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Although the five-factor structure of the SDQ was generally accepted, as pointed out in previous studies (Matsuishi et al. Brain Dev 2008;30 410-415 : Iida et al. 2014; 33-41), differences in expression between English and Japanese and cultural differences may have influenced the results. Therefore, it is necessary to be careful in interpreting the results. Additionally, the differences in the Need classification indicated that the difficulty level tends to be slightly lower in the 5-year-old children’s health checkups and that boys may be more likely to recognize the “Hyperactivity/inattention” problem. Based on these results, it is necessary to consider more effective ways of using the SDQ in 5-year-old children’s health checkups, such as evaluating the SDQ scores in combination with the actual condition of the children at the time of the checkup.

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Methylphenidate (MPH) is used to treat attention deficit hyperactivity disorder (ADHD) and has shown unique benefits in children and adolescents with autism spectrum disorder (ASD). In addition to improving attention, hyperactivity, and repetitive movement, it also improves cognition in ASD. Our focus is to explore the understudied benefits and safety of methylphenidate use for cognition in ASD children.

1) To study the response and benefit of methylphenidate in autistic kids to improve cognition and life function.

2) To assess the safety profile and risks of using methylphenidate at different doses in children with autism as a guiding tool for prescribing physicians.

A literature search was conducted using relevant medical subject headings (MeSH) terms in PubMed, Medline, and PubMed Central. We identified all published articles from inception until September 30, 2022. Initial search results found 41 studies, of which 15 were excluded as they did not meet inclusion and exclusion criteria. After a thorough full-text review, we included 5 studies in our final qualitative synthesis review.

Methylphenidate was found to have the unique benefit of increasing cognitive processing speed, thus improving everyday life function in ASD and ADHD children compared with only ADHD, with a clinical significance of p<0.001. Stimulants may improve the processing of social situations and interactions or social functions due to this unique response (Peled, J et al. Nordic journal of psychiatry 2020; 74(3), 163–167) A clinically significant performance gain on cognitive tasks was identified with a linear dose-response at three different doses (10 mg, 15 mg, 20 mg) of methylphenidate. ASD children with ADHD made significantly fewer omission errors, [F(3,69) = 7.21, p < 0.001], and commission errors [F(3,69) = 4.64, p = 0.005] on MPH, compared to placebo. They also showed more response at higher MPH doses, [F(3,69) = 10.45, p < 0.001]. Thus, the children were faster, more accurate, and had fewer errors at higher MPH doses (Pearson, D. A. et al. Journal of child and adolescent psychopharmacology 2020; 30(7), 414–426). There were no serious side effects or suicidality reported for low dose and a medium dose of MPH in ASD children assessed with Response Impressions and Side Effects Checklist-Kids (RISC-K), A 38-item parent rating scale (Kim, S. J. et al. Journal of autism and developmental disorders 2017; 47(8), 2307–2313).

The findings support the positive response of methylphenidate on cognitive function in ASD children. No serious adverse effects or suicidality were noted. Multi-center well-designed studies are recommended to determine further efficacy and safety of MPH in ASD children for cognition.

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Parental Reflective Functioning (PRF) refers to parents’ capacity to view their child’s and their own behavior considering inner mental states, like thoughts, desires, and intentions. It has been related to attachment, mentalizing capacities, and psychopathology in children. An association between adult attachment style and reflective functioning has been described. Studies have also suggested that parental insecure attachment is related to lower levels of PRF.

We aim to study the association between specific adult attachment styles (anxious [Anx] and/or avoidant [Av]) and specific PRF modes (pre-mentalizing [PM], certainty about mental states [CMS] and/or interest and curiosity [IC]).

A sample of 238 parents (228 mothers and 34 fathers) of 263 children aged 0 to 5 years old were recruited through informal difussion of the study in social media. These parents completed the Experiences in Close Relationships-Revised (ECR-R) and the Parental Reflective Functioning Questionnaire-18 (PRFQ-18) online. Sex and age of parents and children were also gathered. In the first place, Pearson’s correlation was conducted to study the association between the ECR-R and the PRFQ-18 subscales. In a second step, general linear models were used to control for the effect of sex and/or age, when necessary.

Mothers’ mean age was 35,59±4,55 and fathers’ 38,26±4,47. Among children, a total of 119 were girls (45,2%) and 140 (53,2%) boys; in 4 (1,5%) cases the sex was not specified. The association between attachment and PRF subscales is shown in Table 1.

We observed that Anx attachment is associated with lower CMS and greater PM. With regard to CMS, both high and low extreme scores have been proposed to be less adaptative than average scores. Av attachment has also been related to higher PM scores. PM mode, which involves “an inability to hold the child’s mental states in mind and/or to have malevolent attributions about the child’s behavior”, is indicative of pathological PRF, and seems to be associated with insecure attachment (↑Anx/Av). Our results are in line with previous works (San Cristobal et al. Front. Psychol. 2017; Luyten et al. PLOS ONE 2017), and suggest that PRF could play a role in the intergenerational transmission of attachment, which should be further investigated.

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Early-life interpersonal stress, particularly childhood maltreatment (CM), is associated with social cognition deficits as well as neurobiological abnormalities including alterations in brain structure and function and heightened inflammation. However, few studies have investigated whether peer victimisation (PV) has similar effects.

This study first examines the associations between white matter tract abnormalities and childhood interpersonal stress from carers (CM) and peers (PV). Next, it explores how the observed tract alterations are in terms related to cytokine IL-6 level and theory of mind (ToM) performance in the CM and PV groups.

Data were collected from 107 age-and gender-matched youths (34 CM, 35 PV and 38 controls). Tractography and whole-brain tract-based spatial statistics (TBSS) analyses were conducted.

Tractography showed that both CM and PV groups had smaller right inferior longitudinal fasciculus (ILF) tract volume than controls, which was furthermore associated with longer maltreatment duration within the CM group. At the microstructural level, the CM group had higher fractional anisotropy (FA) of bilateral anterior thalamic radiation (ATR) than both PV and control groups, which were associated with enhanced affective ToM performance in maltreated individuals only. Reduced left ATR FA, however, was associated with greater emotional and behavioural difficulties in the PV group. Using TBSS, the CM group had higher FA than both PV and control groups in predominantly right-hemispheric limbic tracts (UF, ATR, ILF, cingulum bundle and inferior fronto-occipital fasciculus), corpus callosum and corona radiata, which were furthermore associated with heightened cytokine IL-6 level within the CM group.

Early-life interpersonal stress, particularly from carers, is associated with widespread alterations of neural pathways connecting the frontal, temporal and occipital cortices involved in cognitive and affective control. The adverse caregiving experience may conceivably contribute to enhanced mental-state decoding but there exists a hidden cost of heightened inflammation in these seemingly healthy maltreated youths. Our findings thus underscore the need to further examine the mental and physical well-being of healthy individuals exposed to early-life stress as they may still be vulnerable to psychopathology later on.

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Admissions in a child psychiatry unit can be voluntary or unvoluntary in some cases when the patient meets specific criteria.

The aim of our study was to assess the frequency and trend over time of admissions of minors in the child psychiatry department in Razi Hospital between 2011 and 2019, and to examine the psychiatric diagnoses in involuntary admissions of minors.

We conducted a retrospective study of medical records of inpatients admitted to the hospitalization unit of the child psychiatry department in Razi Hospital in Tunisia between 2011 and 2019.

Over the nine years, the total number of hospitalizations was 924. There is a slight female predominance over the total number of hospitalizations (sex ratio = 0.85). There was no consistent and significant change in the number of hospitalizations between 2011 and 2019. A growing increase in the number of compulsory hospitalizations was noted. From 2011 to 2019, the number of compulsory admissions increased from 03 in 2011 to 22 in 2019.

Regarding compulsory hospitalizations, admission requests came from child protection delegates, public prosecutors or family judges. Conduct disorder was found in 33.3% of the cases followed by a normal psychiatric examination in 11.8% of the cases. Mood disorders were found in 9.8% of the cases.

Our study shows the explosion in the number of compulsory hospitalizations despite a relatively stable total number of hospitalizations. More comprehensive guidance for legal authorities is needed regarding the compulsory admission of minors.

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The department of child psychiatry in Razi Hospital is the unique psychiatric unit in Northern Tunisia offering full-time hospitalization for minors with mental health disorders.

The aim of our study was to explore the clinical and therapeutic characteristics in compulsory admissions of minors in the department of child psychiatry in Razi hospital between 2011 and 2019.

We conducted a retrospective study of medical records of inpatients admitted to the hospitalization unit of the child psychiatry department in Razi Hospital in Tunisia between 2011 and 2019.

Over the nine years, the total number of compulsory admissions was 74 inpatients, aged from 11 to 16 years old. The number of compulsory admissions increased from 03 in 2011 to 22 in 2019. Most of the inpatients were boys (sex ration=1.46). The mean age was 14, 1 year old. Heteroagressiveness was the reason for admission in half of the cases followed by risk behaviors (30.1%) and suicidal behaviors (18.6%). The diagnosis of conduct disorder was found in 33.3% of the cases followed by a normal psychiatric examination in 11.8% of the cases. Mood disorders were found in 9.8% of the cases. Parental psychoeducation (100%), individual psychotherapy (91%) and family therapy (88,2%) were the treatment of choice for the inpatients. The prevalence of psychiatric medication was 45.1%. The most important forms of medication used were neuroleptics (42.3% of medicated patients) and mood stabilizers (30.7%). Child protection delegates were involved in 86,4% of the cases for social intervention.

Minors admitted in an involuntary mode to psychiatric unit have their own specifities in terms of clinical and therapeutic characteristics. More theoretical and empirical research is needed regarding the involuntary admission of minors.

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Relationship to physical pain (Joiner, 2005, O’Connor, Kirtley, 2018, Galynker, 2017) and psychological pain (Eisenberger et al., 2003) are related to the risk of suicidality in adolescents.

The aim was to reveal the relationship between interpersonal needs, relation to pain and suicidality in adolescent with or without suicidal thought and/or attempts.

92 adolescents without suicidal thoughts (16 males, 12-21 years old), 132 adolescents with experience of suicidal thoughts in the past or present (22 males, 12-21 years old) and 55 adolescents (7 males, 12-21 years old) ongoing clinical treatment due to suicidal actions or attempts filled Interpersonal Needs Questionnaire (Van Orden et al., 2012), Discomfort Intolerance Scale (Schmidt et al., 2006), The Pain Catastrophizing Scale (Sullivan et al., 1995).

Adolescents with suicidal actions score lower in the fear of physical pain (χ²=18.19, p<.01) but higher in powerlessness (χ²=6.58, p<.05). They also experience higher burdensome and thwarted belongingness (χ²=34.50-87.92, p<.01). Their burdensome is more related to avoidance of pain (r=-.38 comparing to r=.06 and r=.04 in the control groups) while fear of pain is related to burdensome in the two control groups only.

In adolescents with suicidal actions their avoidance of pain could be the target of psychotherapy while in adolescent with suicidal thoughts or without it there is a fear of pain.

Study is supported by Russian Science Foundation, project 22-28-01524.

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Hyperprolinemia is defined by high proline levels of blood and its primary type consists on a metabolic disorder that is the result of a number of different genetic defects affecting the degradation of proline. The complex relationship between this disease and different psychiatric phenotypes has been an important subject of study in recent years, suggesting a “common psychiatric phenotype” (Namavar et al. Am J Med Genet B Neuropsychiatr Genet 2021; 186(5), 289-317), though its exact characteristics are yet to be determined. A higher prevalence of psychotic disorders (Guo et al. Metab Brain dis 2018; 33 89-97) explained through altered glutamate metabolism, autism spectrum disorders, developmental delay and intellectual disability has been proposed.

To describe the case of a patient, recently diagnosed of hyperprolinemia type I, presenting a conduct disorder alongside with ADHD, oppositional defiant disorder and an unspecified pervasive developmental disorder.

We present the case of a 15-year-old male that has received follow-up care by our mental health services. The patient was born preterm (35+5 weeks) and required reanimation, oxygen therapy, antiretroviral therapy (biological mother was HIV positive) and pharmacological therapy with phenobarbital (in order to treat methadone withdrawal syndrome). It was adopted nationally when he was 18-month-old and experimented an adequate development during his first years, only highlighting slight psychomotor restlessness and distinctive facial features. During the next years, he receives diagnosis of ADHD (with little to no registered response to amphetamine derivatives), oppositional defiant disorder, social pragmatic communication disorder and fetal alcohol syndrome.

During his first hospital admission, a neuropediatrician was contacted to study the patient and recommended for a metabolic screening to be done, where high blood levels of proline were detected (940.1μmol/L). After this, a procedure of massive exome sequencing of genes that were known to be related to alterations in the metabolism of proline was conducted, finding the mutation c.[1357C>T] in the gen PRODH. This translates to an amino acid replacement in the protein proline dehydrogenase (p.[Arg453Cys]; [Arg453Cys]), which has been studied (Bender et al. Am J Hum Genet 2005; 76 409–420) that it reduced its activity in a 70%, making it a very probable cause of the hyperprolinemia.

There is still scarce evidence of the psychiatric phenotypes presented in patients with hyperprolinemia. Further research is needed in order to accurately define the complex relationship between this metabolic disorder and its effect on the central nervous system.

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Adverse Childhood Experiences (ACEs) are potential traumatic events that occur from birth to the end of adolescence (0-18 years), including various types of neglect, abuse and violence in a child’s domestic and community life. Experiencing Adverse Childhood Experiences (ACEs) is associated with the onset of anxiety in adolescence. According to recent studies, pandemic COVID-19 is a novel ACE that has been found to increase anxiety in adolescents.

To investigate the relationship between ACEs and COVID-19 in the development of anxiety in adolescence

Α cross-sectional study was designed in a community sample of 248 adolescent boys and girls, aged 12 to 15 years (Mean: 13.5 years), from five High Schools in Eastern Attica. Four Questionnaires were used: 1) Demographic Questionnaire, 2) State-Trait-Anxiety-Inventory for Children - STAIC, 3) Adverse Childhood Experiences Questionnaire, and 4) Impact of COVID-19 Questionnaire.

The results demonstrated a strong correlation between the total number of ACEs and Anxiety (Trait and State) in adolescence (Trait Anxiety: rho=,37, p <0.001, State Anxiety: rho=,29, p<0.001).Girls scored significantly higher in Trait (U=4353, p <0.001) and State Anxiety (U=5822.5, p = 0.014), presenting higher anxiety compared to boys. Finally, a significant relationship was observed between the number of ACEs and the impact of COVID-19 (β=0.025, p <0.001).

The findings of the present study can be used to design and implement future effective, preventive and therapeutic programs for adolescents with anxiety symptoms, who have experienced the multitude of Adverse Childhood Experiences and the COVID-19 pandemic during their adolescence.

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The Covid-19 pandemic has restructured the entire health care system. As systems of care were overwhelmed, many health professionals in related professional areas became increasingly involved in providing medical aid. We highlight a comparative analysis between two psychiatric wards of the same hospital, with qualified medical staff, with similar levels of competence, one of the wards caring for patients exclusively with major psychiatric pathologies, and the other patients with associated SARS-COV2 infection.

Considering that motivation at work depends on a multitude of factors, in our case, stress related to contamination, situational anxiety generated by psychiatric patients who arepartially inside on COVID infection, can decrease the motivation to perform a quality psychiatric medical act. Resilience and organizational civic behavior are instead variables with the role of maintaining professional motivation at an optimal level and enhancing dedication.

We applied questionnaires aimed at motivation at work in relation to the dependent variables: stress, anxiety, resilience and civic organizational behavior in two different departmentsof the psychiatric hospital, a ward where patients were admitted positively confirmed COVID 19, versus a ward with non-COVID psychiatric patients.

Psychiatric medical staff are trained to treat predominantly psychomotor agitation, violent behavioral syndromes, suicide attempts, psychotic illnesses. 95% of the employees of theCOVID support department stated that they prefer to take care of 10 agitated patients, than one patient with COVID. The stress came in most cases from: insufficient supportequipment, insufficient doctor to coordinate nurses, lack of experience with somatic patients, fear of contamination generated by non-compliance with protective measures by psychiatric patients.

Resilience and civic organizational behavior kept staff motivation at an optimal level, but lower than would have been appropriate. Also, motivation at work was lower compared tothe non-COVID psychiatric ward.

None Declared

In general, forensic psychiatric patients experience major restrictions of freedom. To mitigate the risk for the coronavirus disease 2019 (COVID-19), even more restrictions were implemented in Austrian mental health institutions in 2020. Besides potential deterioration of psychopathological symptoms, exaggerated freedom-restricting measures may limit the forensic rehabilitation of offenders.

Given that rehabilitative efforts and social visits were suspended for more than a year, this study aimed to evaluate the impact of the COVID-19 pandemic on the psychosocial rehabilitation of forensic psychiatric patients.

This retrospective longitudinal observational study evaluated institutional data before and after the enactment of freedom-restricting measures in an Austrian forensic mental health institution. Data were obtained from 97 offenders treated at the institution Justizanstalt Göllersdorf during two time periods (January 2019 – March 2020 and March 2020 – May 2021). Statistical differences between both periods were assessed by means of Wilcoxon signed-rank tests. Study outcomes included the number of visits by relatives and legal guardians as well as rehabilitative activities.

After the outbreak of the pandemic, access to penal institutions was limited for external visitors, which led to a decrease in visits by relatives (1440 vs. 394, p < .001) and legal guardians (286 vs. 122, p = .003). Further, the total number of one-day temporary releases of patients (64 vs. 3, p < .001) and group excursions (103 vs. 10, p < .001) decreased in the second study period.

Focusing on social contacts and rehabilitative activities, this study highlights the impact of the current pandemic in forensic psychiatry. While COVID-19-related protective measures may reduce the risk for disease transmission, enforced quarantine and other restrictions of freedom impair the rehabilitation of forensic psychiatric patients. This implies the necessity for guidelines to uphold an appropriate standard of care during future pandemics.

None Declared