The physiopathology of patients with treatment-resistant obsessive-compulsive disorder (OCD) may differ from that of treatment-responsive patients. Cognitive evoked potentials may be one of the ways to detect these differences. The error-related negativity (ERN) is an electrophysiological correlate of error detection during the execution of a motor task, which is larger in patients with OCD than in typical people. According to the literature, the ERN could vary according the patients’ treatment-resistance.

The main goal of this study was to assess whether the ERN, which begins 20 ms before the motor response and reaches its maximum 80 ms later, was different between non-resistant and highly resistant OCD patients.

Forty-seven OCD patients and their age- and gender-matched controls were asked to perform a flanker task while the potentials evoked by their motor responses were recorded. For each participant, the difficulty of the task was adjusted to get an error rate of about 20%. Treatment-resistance was evaluated using Pallanti and Quercioli’s (Prog Neuropsychopharmacol Biol Psychiatry 2006; 30 400-412) resistance scales.

In all participants, response errors evoked an ERN at fronto-central electrodes [Fz, FCz, red and green lines on the figure], whereas the negativity was absent or smaller for correct responses (black and blue lines on the figure, both ps < .01). As expected, the ERN of OCD patients was consistently larger and of longer duration than that of control participants (compare the green and blue lines with the red and black ones, respectively). Interestingly, the amplitude of the potentials evoked by correct responses at central and centro-parietal electrodes on the left side of the brain [C5, C3, CP5] was significantly less negative in treatment-resistant patients (all ps < .05). In control participants, the ERN recorded at fronto-central electrodes were followed by a positive wave which reached its maximum between 170 and 270 ms after the response, and was larger after errors than after correct response. In OCD patients in contrast, this positive wave was absent whether the response was correct or not.

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The significant correlation observed between OCD patients’ treatment resistance and the potential evoked by correct responses on the left side of the brain suggest that this potential could be used as a marker of treatment-resistance. The absence in OCD patients of the positive wave that follows the ERN in control participants suggests that OCD patients were not fully aware of whether or not their response was correct.

None Declared

Obsessive-compulsive disorder (OCD) is a disorder diagnosed on the basis of the presence of obsessions (persistently recurring, intrusive thoughts, images, impulses) and compulsions (compulsive and transiently satisfying actions performed in response to obsessions). A separate clinical phenomenon in the broadly understood anankastic spectrum is obsessive-compulsive disorder (OCPD). OCPD is characterized by scrupulousness, over-normative morality, perfectionism and an inability to make concessions in terms of cooperation. It is assumed that the incidence of OCPD in the course of OCD is 25-32% and it is a report with an unfavorable course and a more difficult therapeutic prognosis. It also means an early onset of OCD with a greater intensity of compulsions and a predominance of symptoms related to the sphere of purity, symmetry and gathering.

The main aims of the study were as follows:

1. To assess the prevalence of OCPD in OCD patients.

2. To compare both groups of patients for the severity, level of insight, aggression, impulsiveness and affective symptoms.

3. To verify whether the presence of OCPD depend on factors such as age, gender, treatment duration and delay in starting treatment.

The study was conducted in a group of 78 patients diagnosed with and treated for OCD. The patients were divided into two groups: patients with OCD and OCPD (group 1, n=43) and patients with OCD without OCPD (group 2, n=35). The groups were subsequently compared for the severity of anankastic symptoms, the level of insight, aggression, impulsiveness and its components and affective symptoms (depression, mania). The following tools were used for the diagnosis: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression-Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Brown Assessment of Beliefs Scale (BABS) and DSM 5 criteria for OCPD.

Our results confirmed that OCPD is common in OCD and occurred in 55,12% of patients with OCD (n=43; m=21; f=22). The study shows that the presence of OCPD in the course of OCD negatively affects the severity of obsessive-compulsive symptoms, the level of insight, the level of aggression and impulsiveness, and affective disorders. Patients with OCPD obtained higher scores on the YBOCS, BABS, HDRS, and YMRS scales compared to patients with OCD without OCPD. The occurrence of OCPD in the study group did not depend on gender, duration of OCD treatment, or delay in starting it.

The occurrence of OCPD is common in OCD and can cause delay of treatment, worse course, greater intensity of egosyntonic symptoms, and thus worse insight. The presence of OCPD can lead to more hostility and more affective disorders. Screening for OCPD in patients with OCD should be an integral part of an OCD diagnostic process.

None Declared

Obsessive-Compulsive Disorder (OCD) is a chronic disabling condition, with considerable lifetime prevalence. There are interindividual differences regarding personality dimensions and how they affect obsessive- compulsive (OC) symptomatology. Furthermore, there is a connection between OC symptoms and the use of maladaptive emotion regulation strategies (expressive suppression) instead of using more cognitive reappraisal.

Explore the relationship between personality, emotion regulation strategies and OC symptoms by testing a path analytic model in a sample of healthy participants and in a sample of OCD patients.

Two samples of participants were utilized. Sample 1 consists of 787 healthy participants from the general Portuguese population. Sample 2 is composed of 33 OCD patients and 32 Healthy Controls (HC). Participants completed different scales: Emotion Regulation Questionnaire (ERQ), Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) and Obsessive-Compulsive Inventory-Revised (OCI-R), through online surveys (sample 1) or a clinical interview (sample 2). These questionnaires were then analyzed with a path-analytic approach.

In sample 2, we found significant differences between OCD patients and HC in every OCI-R subscale, except Hoarding and Neutralizing. In the NEO-FFI, OCD patients scored higher on Neuroticism and lower on Extraversion. No significant differences were found regarding the ERQ. Relatively to sample 1: path analysis results showed that 13,4% of the variance of OC symptoms was explained by the best-fitting model. Only Neuroticism and Extraversion were directly associated with higher OCI-R Total scores, whereas Agreeableness predicted less OC symptoms. The use of Expressive Suppression was associated with more OC symptomology, but no significant connection was found with Cognitive Reappraisal. Regarding sample 2, no model was found, showing no modifying effect of emotion regulation strategies on OC Symptoms.

There is a deep-rooted interconnection between personality and emotion regulation regarding OC symptomatology in a sample of healthy participants but no effect of emotion regulation was seen regarding OCD patients.

To sum up, promising results were obtained and it could be an important field for the OCD in terms of diagnostic, severity and treatment.

None Declared

Obsessive-compulsive disorder (OCD) is a psychiatric disorder affecting 1.3% of the population worldwide where both genetic and environmental factors, such as perinatal events and neuroinflammation, are thought to contribute to the etiology of the disorder. In the past, the description of clinical entities such as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS), in which an acute neuropsychiatric syndrome with prominent obsessive-compulsive features emerges in children infected with group-A beta-hemolytic streptococcus (GABHS), sparked the hypothesis that infections may be a risk-modifying factor for the development of OCD. Along with streptococcal infections, other pathogens such as Toxoplasma gondii have been implicated in the pathophysiological models of the disorder, although causal associations have not been established for any of beforementioned pathogens.

To perform a systematic review and meta-analysis about the presence of biological evidence of infection in patients diagnosed with OCD.

We conducted a systematic review and a meta-analysis (PROSPERO registration CRD42021223415) by performing a standardized electronic database search in MEDLINE/PubMed, Web of Science, Embase and Scopus. Search was conducted on 17/10/2022. Eligible papers included case-control and cohort studies using a comparator group, that tested for specific biomarkers providing evidence of infection in patients diagnosed with OCD; exclusion criteria included studies without quantitative or qualitative measures of infection, case reports, systematic or scope reviews, and animal studies. Selection process was conducted according to PRISMA 2020 statement guidelines. Study quality was assessed through Newcastle-Ottawa Quality Assessment Scale.

We identified 8911 records through the search after duplicate removal. A total of 22 studies met inclusion criteria after selection process, and 15 were eligible for meta-analysis. Most evidence concerned Toxoplasma gondii (10 studies), and patients with OCD appear to have higher odds of being infected compared to controls, with a meta-analytic odds ratio of 2.39 (95% IC 1.60-3.58), when comparing 467 patients with 5411 controls. However, most studies were methodologically heterogeneous, which compromises the interpretation of meta-analytic results. Information regarding other agents, including GABHS, Borna disease virus and Toxocara canis was gathered but due to an insufficient number of papers it was not possible to perform a meta-analysis for each of them.

Our work suggests that albeit exhaustively reported in the literature, there is no strong evidence of the over-representation of biomarkers of infection in patients with OCD compared to control volunteers. Methodologically robust studies are needed to further test this hypothesis.

None Declared

Obsessive‐compulsive disorder (OCD) is a severe condition with a profound impact on the health, social and professional functioning of the patients. More than one third of the patients do not achieve remission of the symptoms after first‐line treatment with cognitive‐behavioral therapy and selective serotonin reuptake inhibitor medication. Neurofeedback is a promising technique that allows the non‐invasive self‐regulation of neural activity associated with symptomatic manifestation. Previous literature reported preliminary evidence of positive effects of functional magnetic resonance imaging (fMRI) neurofeedback on OCD symptoms. However, these studies have small samples and/or were not controlled. Additionally, these studies did not involve treatment‐resistant patients.

We aim at developing a fMRI neurofeedback task to treatment-resistant OCD patients and to explore the underlying brain changes.

We implemented a sham‐controlled double‐blinded fMRI neurofeedback protocol to target hyperactivity in orbitofrontal regions in treatment‐resistant OCD patients with contamination/cleaning symptoms. The protocol had two sessions of neurofeedback (72 min of total training). The patients included were under treatment‐as‐usual.

Our preliminary results with the experimental group (n = 10 patients) demonstrated decreased OCD and stress symptoms three months after the neurofeedback sessions. Moreover, immediately after the neurofeedback sessions, we observed reduced functional connectivity between orbitofrontal and temporoparietal regions, and increased brain activity in dorsolateral prefrontal and premotor areas during symptomatic provocation. The brain functional changes might be associated with a better control over obsessions.

fMRI neurofeedback led to long-term symptomatic reduction in treatment-resistant patients with OCD. Our results need further validation with the sham‐control group but highlight the efficacy of fMRI neurofeedback for refractory OCD and the necessity of prolonged neurofeedback protocols.

None Declared

Research suggests that the COVID-19 pandemic and related stressors have triggered OCS for many individuals. However, the extent to which the pandemic and related stressors have influenced OCS seems to vary by individual factors, with some individuals being at greater risk than others. Despite the well-known role of cognitive inflexibility as a marker of risk for OCS, no study to date has examined the extent to which it influences individual susceptibility to developing OCS during the current pandemic. Toward this aim, the current study examined whether cognitive flexibility moderates whether exposure to COVID-related stressors is associated with OCS. Research suggests that the COVID-19 pandemic and related stressors have triggered OCS for many individuals. However, the extent to which the pandemic and related stressors have influenced OCS seems to vary by individual factors, with some individuals being at greater risk than others. Despite the well-known role of cognitive inflexibility as a marker of risk for OCS, no study to date has examined the extent to which it influences individual susceptibility to developing OCS during the current pandemic.

Toward this aim, the current study examined whether cognitive flexibility moderates whether exposure to COVID-related stressors is associated with OCS.

Participants were 169 students (age = 22 years, 62% female) from two student cohorts at Monash Business School who reported experiencing current OCS symptoms. All cohorts completed an online visual search task to measure flexibility of reward-related attentional capture (as an index of cognitive flexibility; measured using the VMAC-R task) and questionnaires gauging exposure to COVID-related stressors, pre-pandemic OCS, and current/lockdown OCS. A negative binomial regression examined the extent to which a) number of COVID-related stressors, b) cognitive flexibility, and c) their interaction was associated with lockdown OCS, adjusting for pre-COVID OCS.

The interaction between COVID-related stressors and cognitive flexibility was significantly associated with OCS (p = 0.048). Follow-up analyses showed that this interaction was driven by exposure to COVID-related stressors being associated with greater OCS among individuals with high cognitive inflexibility scores only (p = .029). Among cognitively flexible individuals, we did not find a relationship between COVID-related stressors and OCS (p = .470).

The result of this study highlight the role of cognitive flexibility as a potential moderator between COVID events and OCS. Critically, these findings have implications for detecting who is at risk of developing OCS following exposure to COVID-related stressors, and suggest that future interventions aimed at modifying cognitive flexibility may hold promise for boosting resilience against the effects of COVID-related stressors on OCS.

None Declared

Body Dysmorphic Disorder (BDD) is a psychiatric, obsessive-compulsive disorder characterized by persistent, pre-occupying, intrusive thoughts regarding defects in one’s physical appearance. This leads to potentially harmful behaviors such as constant mirror checking, avoiding socialization, and the need to seek constant validation. The recent increase in social media usage and influence, especially the use of photo-editing apps, has been correlated with a steep decline in body satisfaction due to the perpetuation of unrealistic beauty standards.

This study aimed to determine the current prevalence of BDD in the general population of Pakistan and assess the association of BDD with social media usage.

A descriptive cross-sectional study was conducted from August 2022 to October 2022 on the general population of Pakistan using an online self-administered, anonymous, pretested questionnaire. It contained socio-demographic factors (age, gender, marital status, educational discipline, and household income). Participants were screened for BDD using a pre-tested Body Dysmorphic Disorder Questionnaire (BDDQ) modified to fit the revised DSM-5 criteria. They were further asked about the specifics of the defects they were concerned about, and whether or not they compared their appearance with people online. Characteristics of social media use such as the types of applications used and time spent on them were also asked. Data was analyzed using SPSS v.26.

Out of 779 participants, 5.3% (41) screened positive for BDD. The most repeated behaviors in BDD-positive participants were a comparison of how they looked with other people and checking themselves in the mirror to see how they look. Their most common defect of concern was skin (acne, scars, wrinkles, paleness, redness) followed by the shape or size of the nose, mouth, jaws, or lips. There was a significant association between age and BDD diagnosis (p < 0.001) and between the tendency to compare themselves with people online and BDD diagnosis (p = 0.001). However, no statistically significant differences were found in the BDD-positive and negative groups concerning gender, the number of social media applications used, or time spent on social media.

There is a need to educate the public about the risk of BDD, especially the more susceptible age, and promote safe social networking. Counseling about the harmful effects of social media could be helpful. This is the first study of its kind done on the Pakistani population and one of the few studies that exist on this topic worldwide. Hence, to reach a conclusive decision, there is a dire need to carry out similar investigations with larger sample sizes and on populations that have yet not been studied.

None Declared

The purpose of the research project is to analyze the long-term evolution of obsessive-compulsive disorder (OCD) from of a study of a cohort of patients prospectively followed over a period ranging from 5 to 20 years, treated for according to therapeutic guidelines mediating serotonin reuptake inhibitors (IRS) and drug enhancers (antipsychotics) and cognitive behavioral therapy and evaluated in a standardized manner.

To assess the long-term course of Obsessive-Compulsive Disorder (OCD) in a cohort of patients treated according to current clinical guidelines; to analyse possible prognostic factors associated with the long-term course of the disorder including clinical and sociodemographic variables, as well as genetic and neuroimaging biomarkers, and their interaction, and finally to study neuroanatomical and functional cerebral connectivity changes after 15 years of treatment in a subsample of patients.

Prospective, descriptive, and observational study of a cohort of OCD patients, receiving treatment at the Department of Psychiatry of Hospital de Bellvitge since 1998, according to a standardized protocol. Follow-up period ranges from 5 (n=423), to 10 (n= 247) and 15 years (123). Baseline clinical and sociodemographic assessment, long-term evolution and information on treatments provided are available for the whole sample. Data on whole exome sequencing is available for 300 of the patients included in the cohort and baseline structural neuroimaging and cerebral functional connectivity has been analysed in 168 subjects. To expand the analysis of genetic biomarkers, we propose the study of de novo variants through exome analysis of 50 trios (patient and both parents) selected among those subjects that have reached 15 years of follow-up (25 trios with patients within the “long-term remission” group and 25 trios with patients with chronic OCD). De novo variants detected in the trio analysis will be replicated in the rest of the sample. A structural and resting state MRI will be obtained in a subsample of 100 patients recruited among those who have completed a minimum follow-up period of 15 years, to assess cerebral changes associated with the long-term course of the disorder.

in the current moment the recruitment period of the study has ended and all the data is being statistically analysed in order to provide solid results in a short period of time.

The identification of those factors associated with an increased risk of chronic disease is an element essential to offer personalized treatment to our patients and improve their prognosis, emphasizing the intensive use of those therapeutic strategies for which we can predict a better response and modifying to the extent of, if possible, environmental factors or factors of access to treatment that contribute to perpetuate obsessive symptoms.

None Declared

Obsessive-compulsive disorder (OCD) is one of the most severe and potentially disabling disorders among all anxiety disorders (Hendriks et al. J Affect Disord 2014; 166:227-33). There is no available information about the prevalence of OCD in the general population of Latvia.

The aim of our study was to assess the one-month prevalence of OCD in the general population of Latvia and determine the associated factors.

The study was conducted on a representative sample of the Latvian adult population (n=2687), selected using a stratified random sampling method. Computer assisted face-to-face interviews were carried out between November 2019 and March 2020 in the households of the respondents. The OCD, and possible comorbid diagnoses, were assessed using the MINI International Neuropsychiatric Interview (M.I.N.I.). Anxiety symptoms were assessed with 7-item Generalized Anxiety Disorder (GAD-7) scale: a score of ≥5 indicated the presence of at least mild symptoms of anxiety. Patient-Health Questionnaire-9 (PHQ-9) was used for assessing comorbid depressive symptoms and a score of ≥10 indicated the presence of clinically relevant depressive symptoms. Descriptive statistics and binary logistic regression were applied.

In total 1238 males (46.1%) and 1449 females (53.9%) were recruited. Detected one-month prevalence of OCD was 0.6% (n=16). After adjustment by all analysed factors (n=13) simultaneously, the odds ratio of having OCD adjusted for confounders (aOR) was higher in respondents younger than 44 y.o (vs. >44, aOR 14.2, p=0.007): 81.3% of all respondents with diagnosed OCD were younger than 44 y.o.; The odds were statistically significantly higher in respondents with diagnosed severe anxiety (vs. no anxiety, aOR 26.0, p<0.001), alcohol use disorder (vs. no disorder, aOR 7.9, p=0.004) and suicidal behaviour disorder (vs. no suicidality, aOR 5.3, p=0.01).

One-month prevalence of OCD in Latvian general adult population is 0.6%. Young age, diagnosed severe anxiety, suicidal behaviour and alcohol use disorder are significantly associated with the OCD.

None Declared

Bipolar Mood Disorder (BD) and Obsessive-Compulsive Disorder (OCD) are psychiatric conditions that frequently co-occur and express a challenging phenomenology for treatment and diagnosis, since obsessive-compulsive symptoms tend to fluctuate according to mood phases of BD patients. Understanding the shared psychopathology of this comorbidity has relevant implications for the treatment of these patients, and the hypothesis that BD and OCD would have a shared neurobiology is currently being discussed. Most studies of this comorbidity have examined differences between BD and BD/OCD patients or between OCD and BD/OCD patients. This study aimed to analyze in detail the clinical, phenomenological and psychopathological characteristics of patients with BD, OCD, and BD/OCD.

This study aimed to analyze in detail the clinical, phenomenological andpsychopathological characteristics of patients with BD, OCD, and BD/OCD.

This study consisted of a sample of 21 BD patients, 21 OCD patients and 21 BD/OCD patients who underwent the application of the MINI, Y-BOCS, DY-BOCS, HAM-D, HAM-A, YMRS, of Sensory Phenomena (USP), as well as questions about sociodemographic characteristics, personal and family psychiatric history. We performed the YBOCS scale asking patients with BD to respond 3 times the scale: in the current time (during euthimya) and retrospectively for previous manic or depressive episodes.

BD/OCD group had a higher rate of having stopped working due to comorbid disorders, a higher history of family suicide attempt and completed family suicide, a higher prevalence of substance use disorder in the family, and a higher prevalence of hoarding symptoms. In the BD sample, 47,6% had obsessive-compulsive symptoms. The presence of OCD conferred a higher prevalence of sensory phenomena. Patients reported a 19% (median, 0.19, range -1.00 to 1.88) worsening of OCD during depression, and a 9.5% worsening (median, 0.095, range of -1.00 to 1.36) during the manic phase.

The results suggest that BD/OCD patients have greater loss of functionality, higher rates of hoarding symptoms, family history with greater suicidality and higher rates of substance use disorder (SUD) and worsening of OCD in both mania and depression. The psychopathological findings of this study allow us to conclude that BD/OCD patients have higher morbidity.

LIMITATIONS: Small size sample and possible recall bias in the interview, as questions wereasked retrospectively.

None Declared

During the second wave of Russia-Ukraine war, around 8 million were internally displaced. Negative mental health impact of the war cannot be underestimate. Among internally displaced persons (IDPs), particularly vulnerable category is people with neurocognitive deficits. Stress associated with displacement may cause a change not only in cognitive functions, but also affect the onset or evaluation of behavioral and psychological symptoms.

to study the prevalence of neuropsychiatric disorders in hospitalized patients with dementia, who were internally displaced and to compare with general population frequency.

64 IDPs with dementia (moderate and severe neurocognitive deficits) who were examined during March-September 2022. Cases of newly arrived persons were taken into account, after 1 to 30 days had passed since their relocation. The diagnosis was verified based on the ICD-10 criteria (F00-F01). The degree of neurocognitive deficit was determined using the MMSE and MoCA tests. Affective pathology was studied using the HAM-D, HAM-A, PHQ-9, AES scales. Psychotic symptoms and behavioral disorders were studied based on clinical examination and medical records. The study was conducted in Lviv Regional Psychiatric Hospital.

among the examined patients, 60 (94% of all examined) had neuropsychiatric disorders. Among this sample, neuropsychiatric symptoms (an isolated symptom or a combination of two or more symptoms) occurred with the following frequency: apathy 16 (26.7%), anxiety49 (81.7%), depressive symptoms 32 (53.3%), agitation and aggression 41 (68.3%), hallucinatory symptoms 8 (13.3%), delusional disorders 34 (56.7%), wandering and disorientation 18 (30%), refusal of food and medicine 12 (20%)

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In this study the frequency of occurrence of certain neuropsychiatric syndromes among IDPs with dementia differed from the studied average frequency of occurrence of the same symptomatology among the general population. In particular, anxiety symptoms among IDPs with dementia occurred 42% more often than on average among patients with dementia in the general population (with a frequency of 81% vs 39%), agitation and aggression - 28% more often (68% vs 40%), and delusions - 16% more often (57% vs 31%). At the same time, symptoms such as apathy (by 19%) and refusal to eat (by 14%) were observed less often among IDPs with dementia than among dementia patients from the general population

None Declared

Rheumatoid arthritis (RA) is typically known for its intra-articular manifestations in the joints, and steroids are considered one of the first-line medications for it. Steroids are known for neuropsychiatric manifestations, but it is rarely reported in low-dose steroids.

We describe a case of psychosis in an older adult with RA precipitated by low-dose prednisone with no past history of neuropsychiatric symptoms from steroids in the past five years.

Miss X is a 63-year-old female with past history of RA, major depressive disorder, hypothyroidism, chronic obstructive pulmonary disease, and hypertension, presented with one-week history of irritable mood, increased psychomotor agitation, decreased need for sleep and appetite, and delusions of grandeur and persecution. Her depression had been treated with oral duloxetine 60mg twice daily, oral buspirone 10mg at night, and oral trazodone 150mg at night. She did have a urinary tract infection a week prior, but the psychotic symptoms persisted with antibiotic treatment. Miss X had also been on a monthly taper regimen of low-dose oral prednisone for RA (from 15mg to 5mg) for the past three months and had completed the regimen one week ago. On mental status examination, she was alert and oriented to time, place, and person. Her mood was irritable with lability. She demonstrated tangential speech along with persecutory and grandiose delusions. Attention and concentration was normal with intact immediate and remote memory and impaired recent memory. Abstract ability, judgment, and insight were impaired. Physical examination and vital signs were within normal limits. Laboratory investigations of complete blood count, urine analysis, urine drug screen, thyroid function panel, renal function panel, hepatic function panel, serum sodium, potassium, calcium, thiamine, vitamin B12, folate, and vitamin D did not show any significant abnormalities.

Miss X was admitted to the inpatient psychiatric unit with the diagnosis of medication-induced psychotic disorder, with onset after medication use as per The Diagnostic and Statistical Manual of Mental Disorders 5th edition- Text Revision. Oral olanzapine 10mg at night and oral lithium 300mg twice daily was started along with her home medications of oral duloxetine 60 mg twice daily and oral trazodone 150mg at night. During hospital stay, oral olanzapine was gradually increased to 15mg in the night but had to be reduced back to 10mg in the night due to sedation. Miss X’s symptoms improved during hospital stay and she was discharged on the 13th day of hospitalization with the same psychotropic medication regimen.

Our case demonstrates the need for caution in prescribing steroids in older adults as it can precipitate neuropsychiatric symptoms even with a change in use or after withdrawal of steroids.

None Declared

Coronavirus disease 2019 (COVID-19) modify voluntary admission rates to psychiatric wards in the early phases following pandemic onset. Older patients have higher COVID-19 distress scores because elderly people are at risk for COVID-19 infection.

The present investigation aimed at admission rates of elderly patients to a General Hospital Psychiatric Ward during the lockdown due to the COVID-19, compared to similar periods of 2018 and 2019.

Anonymized data on psychiatric admissions (n=55) from one general hospital psychiatric ward have been obtained and analysed. We compared admission characteristics between April and June of 2018 and 2019 with the same period of 2020 (lockdown).

During the COVID-19 lockdown, a significant reduction in psychiatric hospitalizations of older patients (aged >65 years) was observed in the lockdown (69.2%; χ2=4.823,df=1,p=0.028) in contrast with young patients (26.7% reduction). There was a reduction of 14% in admission due to suicidal behaviour (IRR = 0.57; 95% CI: 0.11-2.75; p=0.48), 25% in depression (IRR = 0.28; 95% CI: 0.64-1.25; p=0.09) and 50% in psychotic disorders (IRR = 0.33; 95% CI: 0.07-1.48; p=0.15). There was none admission by dementia during the lockdown.

Changes in the number of psychiatric admissions, particularly for older patients, were observed during the COVID-19 lockdown. During this period, their fear levels could modify their psychiatric admission rates. We suggest that the decrease of psychiatric admissions in the elderly was due to fear of contagion in hospitals.

None Declared

One of the most common mental disorders in the elderly is depression.

Because of the high frequency of side effects of pharmacotherapy and the comorbid medical illnesses, there are not many ways to treat it.

Non-drug therapies, such as repetitive transcranial magnetic stimulation (rTMS), could help overcome the limitations of standard drug therapy for this type of mental disorders.

Development of approaches to improving improve the provision of psychiatric care to elderly patients using rTMS.

30 patients over the age of 60 with anxiety-depressive spectrum disorders meeting criteria F30-39, F06.3, F06.4 (ICD-10) and a control group with similar criteria that were not treated with rTMS, were recruited from the psychiatric department at a university hospital (Moscow Scientific Research Institute of Psychiatry). Clinical, psychopathological, anamnestic, psychometric (Montgomery-Asberg scale (MADRS), Hamilton scale (HARS), Mini-mental state examination scale (MMSE) instrumental (electroencephalography) research methods were used. Patients of the experimental group underwent 15 sessions of low-frequency rTMS on the right dorsolateral prefrontal cortex (RDLPC). Conditions for the application of 1200 pulses were as follows: frequency - 1 Hz; intensity - 120% of the threshold of motor response (RMT) of the subject; pulse number - 1200; pulse sequence - 300; sequence duration - 300 seconds; sequence interval - 60 seconds; and stimulation time - 23 minutes. Subsequently, the patients were re-examined using the above-mentioned scales to assess their mental state in dynamics.

Analysis of the collected data shows an increase in the number of respondents and the frequency of achieving remission in the experimental group compared to the control group. No severe side effects of rTMS were observed.

rTMS may be a safe method of adjuvant therapy in groups of elderly patients with anxiety-depressive spectrum disorders. Further studies will be needed to clarify the results.

None Declared

Empathy training directed at empathic abilities and/or aspects of providing care can be effective at increasing levels of this ability. Moreover, training in different care contexts can minimize the negative impacts of providing care.

To identify empathy training models and the effects on psychological concerns in paid and unpaid caregivers of older people.

A systematic review was conducted. Searches for relevant articles were performed in the Embase, LILACS, PsycInfo, Pubmed, Scopus and Web of Science databases using the following search strategy: “Empathy AND (Education OR Training OR Intervention) AND Caregiver”. No restrictions were imposed regarding language or year of publication.

Empathy training for caregivers of older people were performed in six studies, three of which identified a significant increase in empathy levels and consequent reduction in psychological concerns. Empathy training focused on aspects of empathy and/or the caregiver had significant effects on the outcome variables. Moreover, training conducted online, by telephone and/or in person can generate satisfactory results. The other three studies that conducted training with a focus on aspects of dementia and/or old age did not present any effect on the outcome variables.

Empathy training for caregivers of older people can increase levels of this ability, especially in the cognitive domain, as well as diminish psychological concerns caused by the negative impact of providing care.

None Declared

Studies in adult psychiatric patients consistently call attention to premature mortality and its association with metabolic syndrome. However, the utility of the metabolic syndrome construct is controversial in older adults in the general population, since literature shows that some components, such as obesity, can be protective against mortality. In older adults with mental illness, only one study explored the relation between metabolic syndrome and mortality and found no association.

To examine whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders, and to determine if this association differs across diagnostic groups.

We used a multicentric prospective design to follow, over 5 years, a cohort that included 634 in– and outpatients with schizophrenia, bipolar or major depressive disorder (MDD). Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality, suicide and accident.

We found no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, an association with increased all-cause and disease-related mortality was found in the subpopulation of older adults with MDD, even after adjustment for age, sex and smoking status (p=0.032 and p=0.036, respectively). A significant interaction was found between metabolic syndrome and psychiatric diagnoses indicating that in participants with MDD, metabolic syndrome had a significantly greater effect on all-cause mortality (p=0.025) and on disease-related mortality (p=0.008) than in participants with either bipolar disorder or schizophrenia.

In older adults with psychiatric illness, our findings do not support an association between metabolic syndrome and increased mortality, in contrast with the literature findings on their younger counterparts. We discuss several possible explanations, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The lack of a ceiling effect in the depressive subgroup, because of a less marked premature mortality, could explain the positive association, in contrast with bipolar disorder or schizophrenia subgroups.

None Declared

Aging is a demographic global trend and a challenge for public mental health; however, gaps persist for a comprehensive definition of mental health, risk, protective factors, and processes involved, which represent a greater problem in middle-income countries, where evidence is scarce.

To identify combined mental health profiles in older adults, based on self-report of anxiety symptoms, depressive symptoms, and perception of well-being, and to identify risk and protective variables for each of the groups, based on a sample of older adults attending primary health care (PHC) centers in the Province of Concepción, Chile.

A convenience sample of 573 adults of both sexes, over 65 years, autonomous, attending PHC centers in the Province of Concepción, Chile, answered a set of instruments assessing anxiety symptoms (SCL-90), depressive symptoms (PHQ-9) and perception of well-being (Pemberton Happiness Index) and eventually associated variables that included sociodemographic and living arrangements, social participation, threatening life events (LTE), loneliness (ULS-3), and social support (MSPSS). Latent profile mixture analysis was used to identify groups of adults with similar mental health, and pertinence in each group was explained using random forests. The relationship between predictors and latent profiles were analyzed with multinomial regression.

A solution of 4 groups with distinctive mental health profiles was determined: Group 1 (28%) with high depressive symptoms, high anxiety, and low well-being; Group 2 (32%) with moderate depressive symptoms, high anxiety and moderate well-being; Group 3 (24%) with moderate depressive symptoms, low anxiety and moderate well-being and; Group 4 (15%) characterized by individuals with low anxious or depressive symptoms, high well-being, and absence of mental disorder.

Using random forests, this model predicts 63% variance between groups. A large number of variables were found to significantly predict membership in one of the 4 groups. Specifically: gender, satisfaction with living arrangement, economic crisis, own disease, and death or illness of friend, perception of general health, intimate, relational and collective loneliness, social support from family and significant others, and social support from friends.

The 4-group classification is a parsimonious solution where group 1 characterize people with poor mental health; groups 2 and 3 languishing with high and low anxiety respectively; and group 4 healthy and flourishing. Overall, these groups highlight the role of close interpersonal relationships or primary ties, both in terms of intimacy versus loneliness/isolation and in satisfaction with living arrangements for the elderly. The importance of these psychosocial predictors on combined mental health in the elderly further the need to understand their role and mechanisms to design promotion and prevention strategies.

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The response to conventional antiparkinsonian medications is elusive in atypical parkinsonian disorders. Improvement in parkinsonian symptoms in atypical parkinsonian disorders has been reported with anecdotal use of Amantadine. The role of serotonergic control over the nigrostriatal pathway led to the use of Escitalopram.

To examine the efficacy of low dose Amantadine and Escitalopram combination treatment in atypical parkinsonian disorder

A retrospective chart review of Atypical Parkinsonian disorder patients who received the combination of low dose Amantadine and Escitalopram and had follow up assessment available for a minimum of four months were studied. The primary outcome measure was change in Progressive Supranuclear Palsy rating scale, Unified Multiple System Atrophy rating scale score and Clinical Global Improvement Scale Change score in follow up visits.

A total of 8 patients with a mean age of 68.5 years, 6 with a diagnosis of Progressive Supranuclear Palsy(PSP) and 2 with a diagnosis of Multiple System Atrophy(MSA) met the selection criteria for the study. Patients were treated with the dose of Amantadine 50mg twice daily and Escitalopram 5mg once daily. The symptom domain to respond first was autonomic symptoms followed by gait, mentation, limb and bulbar symptoms. Amantadine has unique dopaminergic and NMDA antagonist properties. Serotonin has a role in modulation of the autonomic functions and nigrostriatal circuitry. Thus, combining Escitalopram with Amantadine can help ameliorate the array of symptoms in atypical parkinsonian disorders.

The PSP and MSA patients responded to the combination of low dose Amantadine and Escitalopram as evidenced by objective rating scales and subjective clinician assessment. Further prospective trials for longer duration are needed to establish the effect size and stability of response.

KEYWORDS: steele richardson olszewski disease, shy dragger syndrome, antidepressants

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We conducted a systematic review of the qualitative literature on the sexuality and sexual health of older adults.

The aim is to address which topics have been researched and the quality of research within this field.

All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. The Cochrane Database, Psy-EBSCO, MEDLINE, Psy-Redalyc, Scielo, Web of Science and Google Scholar were searched and 32 studies met inclusion criteria. The majority had not been reviewed in earlier review articles. A total of 95,478 references were screened and 27 studies were included in this review. The studies involved 3044 participants across seven countries, most being women (approximately 83%).

We identified a wide variety of factors that can determine SWB of older adults, such as perceived health, sexual health, demonstrations of love; non-sexual joint activities; overall well-being and quality of life; partner support; positive self-image; being independent and active; the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure.

Methodological issues related to sampling procedures, such as purposive sampling through the older samples and limited generalisability due to the homogeneity of participants. Additionally, there was a widespread lack of non-heterosexual control groups. However, most studies used appropriate measures and acknowledged inherent limitations. There is a lack of research with the older population, those with significant health needs, those outside the Western countries, and those with additional characteristics associated with discrimination.

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The COVID-19 pandemic may affect sexual intimacy and have implications for overall sexual well-being.

This study comprised two main objectives: 1) To explore the influence of COVID-19 pandemic on older couples’ sexual intimacy; and 2) To assess how older couples’ sexual intimacy during the COVID-19 pandemic influences mental health.

The sample of this qualitative study consisted of 391 older participants (between 65 and 87 years of age).

For the first objective, semi-structured interview data yielded five main themes: (1) Less sexual satisfaction (68%); (2) Less sexual desire (67%); (3) Stronger affective relationships (34%); (4) Fear of contracting physical illness (29%); and (5) Less attractiveness (23%). Three main themes concerning mental health were reported by participants: (1) Less anxiety and distress (78%); (2) Greater attention to negative emotional states (55%); and (3) Less emotional outbursts (41%).

The pandemic affected older adults’ sexual intimacy, mostly negatively. Less sexual satisfaction and desire were felt by these older couples. Conversely, stronger affective relationships were reported. In spite of these mostly negative influences, existing sexual intimacy was mostly linked to less perceived anxiety and distress, greater attention to negative emotional states, and less emotional outbursts. Sexual intimacy during COVID-19 has received little attention; however, these results highlight its positive contribution to mental health and therefore a relevant approach to this topic should be taken, especially in later life.

None Declared