Most of the research explored the attrition rate and predictive factors for the smartphone application of emotion monitoring in bipolar disorder patients. However, there is less focus on the efficacy of maintaining the retention rate if the incentive system is employed.

The aim of our research is to evaluate the efficacy of two different kinds of incentive systems on improving frequency of using the Smartphone Mood Relapse Warning application (MRW-APP) (Su et al., 2021) in bipolar patients.

A one-group pretest-posttest pilot study was conducted. Participants with bipolar disorder (n = 63) recorded their moods and symptoms through MRW-APP for 29 weeks with the attrition rate of 44%. Two different kinds of incentive systems, reward and lottery, were implemented. To know whether incentive implementation could play a role in motivating the participants to better adhere to the app, we used Friedman’s test and paired sample t-test to analyze the participants’ app-using frequency in the corresponding weeks.

There was no significant difference in the participants’ app-using frequency (p>.05) before and after we implemented the first incentive system, reward (n=63). For the second incentive system, lottery (n=41), a significant difference in app-using frequency was still not observed (p>.05) after the intervention. But, for those who both had experienced two kinds of incentive systems (n=35), there were significant changes in their app-using frequency (p<.05).Table 1.Demographics (n=63)

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This research found the two incentive systems, award and lottery, may help increase the using frequency of the smartphone monitoring app for participants with bipolar disorder. The results from our study can be a reference for mood monitoring apps development in the future, and it also suggested that incentive system has its potential on encouraging patients’ adherence to e-healthcare.

None Declared

One of the methods for early diagnosis in individuals at clinical high-risk state for psychosis could be the identifying specific symptoms, such as thought disorders. Thought disorders may be a separate symptom, unrelated to attenuated positive symptoms (APS) with an independent predictive value.

Correlation analysis of thought disorders and APS in patients at clinical high-risk state for psychosis.

The study included 30 young men (mean age 19.2±2.1 years) hospitalized at the clinic of the FSBSI “Mental Health Research Centre” with the APS in the first depressive episode (F32.1, F32.2, F32.28, F32.8) which is considered as clinical high-risk state for psychosis. The severity of thought impairment was assessed using the Thought, Language and Communication Scale (TLC). Subsequently was performed the search for correlations of scores on the TLC and the severity of “prodromal” symptoms, according to The Scale of Prodromal Symptoms (SOPS).

The median value of the total score on the TLC was 20 [17.25;23.5]. The most important finding is the discovery of only minor correlations of thought disorder with “prodromal” symptoms. Indeed, the total score on the TLC correlated only with the total score on the SOPS at admission (r=0.370, p<0.05). Such symptoms of the TLC scale as «Derailment», «Incoherence», «Perseveration» did not find any correlation with prodromal symptoms (p>0.05).

The obtained data indicates the independent nature of thought disorder in patients at clinical high-risk state for schizophrenia, which leads the need to determine its own prognostic value.

None Declared

ADHD is one of the most frequently diagnosed neurodevelopmental disorders and affects the daily functioning of families raising children with this condition. Among the symptoms typical for ADHD, low effectiveness of executive functions can determine the quality of family life.

This study aimed to specify whether family communication and satisfaction as reported by a parent are predictors of a child’s executive functioning quality and whether ADHD severity lies on the pathway between the two. Moreover, the child’s sex effect was checked.

The study included 200 Polish participants (nGirls = 56) from the NeuroSmog project aged 10-13 diagnosed with ADHD according to the ICD-11. Stanford-Binet 5 Intelligence Scale, PU1 Cognitive Diagnosis Battery, Conners 3 ADHD Diagnosis Questionnaire, and the FACES IV Questionnaire were used to derive needed information. Structural equation modelling (SEM) was applied to test the hypotheses.

The quality of family communication and satisfaction did not predict the child’s executive functioning of ADHD children and ADHD severity did not play a mediating role. No differences by sex were observed. We only found a significant effect between IQ and executive functioning level in the general sample (standardized β = X, p = Y) and in girls (-0,24, 0,007).

These results contrast with previous studies from other cultural contexts that have shown the existence of the hypothesized interrelations. Further research should confirm or refute these observations.

W. Walenista Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, B. Izydorczyk Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, K. Sitnik-Warchulska Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, I. Markevych Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, C. Baumbach Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, Y. Mysak Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, M. Szwed Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme, M. Lipowska Grant / Research support from: the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme.

There are animal models associating dopamine dysfunction with behavioral impairments that model attention deficit hyperactivity disorder (ADHD). Erythropoietin (EPO) has trophic effects on dopaminergic neurons.

The aim of this study was to examine the Erythropoietin (EPO) plasma levels and determine whether there was any correlation between plasma EPO levels and clinical characteristics of Attention-Deficit/Hyperactivity Disorder(ADHD).

Plasma EPO levels were measured in 78 drug naïve children with ADHD and in 81 healthy children. The severity of ADHD symptoms was determined by scores on the Korean ADHD Rating Scale (K-ARS) in children and healthy controls.

The ADHD group consisted of 64 boys and 14 girls, and the healthy control group of 31 boys and 50 girls. The median plasma EPO levels in ADHD children was 12.9 mIU/mL, whereas it was 12.0 mIU/mL in the healthy controls. This difference was not statistically significant. Participants in the highest tertiles of plasma EPO had a 1.49 times higher risk of ADHD than those in the lowest tertile, and those in the second highest tertile had a 2.39 times higher risk of ADHD than those in the lowest tertile. Plasma EPO levels correlated positively with some K-ARS scores, including hyperactivity-impulsivity score and total score. The significant difference in hyperactivity-impulsivity score comparing participants in the second highest with those in the lowest tertile. total K-ARS score was significantly higher in the second highest tertile of plasma EPO compared to those in the lowest tertile.

These findings suggest that plasma EPO levels were related to some ADHD symptoms, which could be used in the monitoring of the disorder. Further studies are required to clearly understand the source and role of EPO in ADHD.

None Declared

Adolescents presenting with a first psychotic episode often have a long history of pediatric treatment. However, there is insufficient evidence of children’s subclinical characteristics in non-psychiatric settings. To address this issue, we retrospectively studied schizophrenia spectrum disorder (SSD) patients to identify characteristic patterns of subclinical psychological, behavioral, and physical problems in childhood. In the previous study, we had developed the child psychosis-risk screening system (CPSS) that incorporates this pattern as a risk evaluation algorithm (Hamasaki et al. BMC Psychiatry 2021; 21, 57).

In this present cross-sectional study, we evaluated the specificity of the CPSS to identify the risk of psychosis in pediatric and psychiatric patients and determine its discriminatory power and cutoff values.

To identify the risk of developing psychosis in pediatric and psychiatric outpatients, we evaluated data from 336 patients aged 6–18 years selected for the present study using the CPSS. We defined six major diagnostic categories i.e., Neurodevelopmental Disorders, SSD, Depressive Disorders, Anxiety Disorders (including Obsessive-Compulsive Disorder), Somatic Symptom Disorders, and Others to examine the specificity of the CPSS variance in diagnosis. We analyzed the receiver operating characteristic (ROC) curve using the onset of schizophrenia spectrum as the outcome and determined the discriminatory power and cutoff values of CPSS.

We found significant differences in CPSS variance among the diagnostic categories (Kruskal–Wallis test; p<0.001), especially between SSD and neurodevelopmental disorders (Bonferroni method; p=0.001). Similarly, significant differences were identified in variance when comparing the CPSS for each neurodevelopmental disorder category and SSD, particularly between SSD and attention deficit hyperactivity disorder (ADHD) (Bonferroni method; p<0.001) and SSD and autism spectrum disorder (ASD) (Bonferroni method; p=0.004). CPSS showed sufficient discriminatory power for SSD diagnosis (area under the ROC curve=0.853 [95% confidence interval: 0.774–0.931]). The cutoff value for the risk of SSD was determined to be 3.94, achieving the best mean of the sum of sensitivity (90.9%) and specificity (84.0%). 18.3% of patients (12.5% pediatric and 29.1% psychiatric) were identified as risk groups above the cutoff value.

These results suggest that CPSS can be applied in pediatric clinical practice not only for early detection and risk identification of psychosis but also for differentiation from neurodevelopmental disorders. If early identification of psychosis risk in pediatrics becomes possible, discussions regarding effective prevention during the critical period of psychosis will become increasingly important.

None Declared

Around 2010, the number of hikikomori cases increased rapidly. Hikikomori is a global problem that characterizes the current era, and has become an increasingly deep-rooted social issue that affects the younger generation, especially during the coronavirus disease-2019 (COVID-19) pandemic. In our previous comparative study of adolescent hikikomori between Japan and France (Hamasaki et al. BMC Psychiatry 2022; 22, 477), we investigated its psychopathology, including potential cultural influencing factors. The study showed no difference in terms of psycho-behavioral characteristics of hikikomori between Japan and France. However, the sociocultural factors that make hikikomori more severe differed between the two countries, i.e., in Japan: lack of communication between parents, in France: lack of communication between the family and the community.

Since these differences in sociocultural factors are closely related to the social context in which the mothers were placed, the factors in terms of maternal gender issues were examined, along with reviewing previous studies.

Statistical data from the “Global Gender Gap Report 2022” of the World Economic Forum, the “Towards real gender equality 2021” of the Ministry of Gender Equality, Diversity, and Equal Opportunities of France, the “Women and Men in Japan 2020” of the Gender Equality Bureau, Cabinet Office, Government of Japan, and other sources were evaluated. Further, previous literature on the family environmental factors of hikikomori were reviewed.

An absent father, a subsequent mother-child closeness and over-interference, and the inhibition of children’s independence, have been repeatedly mentioned in studies as factors leading to hikikomori. The time spent on housework and childcare by Japanese men is at the lowest level globally (Japan’s gender gap index ranks 116th out of 146 countries, the lowest among the seven major G7 nations). In Japan, where generally little cooperation exists between parents, particularly in those families where communication between parents is self-rated as relatively poor, the above factors may surpass the threshold for triggering hikikomori. In France (ranked 15th in gender gap index), the isolation of mothers and children from society is an important factor associated with hikikomori. Adequate social participation of the mother may be a protective factor against hikikomori.

Gender gap-related issues among mothers may be involved in the root of the hikikomori problem. Hikikomori has emerged from various socio-familial factors. Further studies are warranted to determine the causal relationships of these factors with the onset and severity of hikikomori.

None Declared

The influence of maternal autoimmunity mediators on child development and brain function has been the subject of several studies. Clinically, most have focused on the association between maternal autoimmunity and the diagnosis of autism in children. On the other hand, data are rarer concerning the rest of the mental disorders and mainly, they are obtained from small cohorts.

The aim of this study is to discuss the association between the presence of autoimmune pathology in the mother and the development of mental disorders in the child

we conducted our study through a descriptive study of six clinical cases.

80 % the patients treated were male

57% had a characterized depressive disorder

34% had ADHD

9 % had ASD

Maternal autoimmune diseases were associated with increased mental disorders in children. These results suggest a possible shared genetic vulnerability between the two conditions or a potential role of maternal immune activation in the expression of neurodevelopmental disorders in children.

None Declared

Elevated blood levels of homocysteine have been associated with several psychiatric and neurodegenerative disorders such as schizophrenic disorders, Alzheimer’s disease, Parkinson’s disease and depression. The hypothesis is that genetic and environmental factors elevate homocysteine levels, which causes vascular diseases of the brain, and/or changes in neurotransmitters, which cause various mental disorders.

The objective of our work is to discuss the association between hyperhomocysteinemia and the characterized depressive disorder

we conducted our study through the discussion of a clinical vignette

We report here a case of hyperhomocysteinemia with vitamin B 12 deficiency in a 16-year-old female patient who presented with a characterized depressive disorder.

She was initially treated with a selective serotonin inhibitor combined with parenteral injections of vitamin B12. The patient’s clinical condition improved after the first week. The discussion will attempt to clarify the role of vitamin therapy in the improvement of the patient’s depressive symptoms and its relationship with hyperhomocysteinemia.

We report here a case of hyperhomocysteinemia with vitamin B 12 deficiency in a 16-year-old female patient who presented with a characterized depressive disorder.She was initially treated with a selective serotonin inhibitor combined with parenteral injections of vitamin B12. The patient’s clinical condition improved after the first week. The discussion will attempt to clarify the role of vitamin therapy in the improvement of the patient’s depressive symptoms and its relationship with hyperhomocysteinemia.

Statistical data, physiological and genetic aspects seem to point to the involvement of hyperhomocysteinemia in the development of characterized depressive disorder. However, the results remain variable, even contradictory, and several confounding factors must be considered in these studies: ethnic, geographical, cultural (in terms of diet) and age factors are all elements that seem to intervene and that do not always make it possible to know whether hyperhomocysteinemia is a direct cause of depression or the consequence of mechanisms linked to folate and B12 deficiencies.

None Declared

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by early onset difficulties in social communication, restricted repetitive behaviors and interests, and sensory sensitivities/differences (1). It has been determined that 90% of children with ASD have nutritional problems (2). There are many factors affecting nutrition in children with ASD, such as gastrointestinal problems, food allergies, metabolic anomalies, drug side effects such as increased appetite, problematic eating behavior, sensory processing difficulties, and family factors (3).

In this case report; we aimed to represent multidisciplinary medical and psychiatric treatment of a 16 years old adolescent with autism spectrum disorder and obesity who was consulted for bariatric surgery. It is thought that this case will be useful for clinicians as an example of a multidisciplinary approach in the management of obesity, primarily with non-surgical, psychiatric approaches and therapeutic environment.

In our patient, it was decided to prefer non-surgical approaches primarily, considering the diagnosis of ASD, MID, and ADHD, difficulties in impulse control, the concern about the continuation of the poor lifestyle habits after bariatric surgery, and the difficulties that the family may experience in providing adequate postoperative care. Patient received Metformin 2000 mg/day for insulin resistance, Amlodipine 10 mg/day, Enalapril 5 mg/day, Perindopril 5 mg/day and Indapamide 1.25 mg/day combination for hypertension, Haloperidol 0.6 mg/day in case of impulse control problems and aggression, Topiramate 50 mg/day to take advantage of its appetite suppressing effect and Methylphenidate 10 mg/day for attention deficit hyperactivity disorder (ADHD) during hospitalization in the endocrinology clinic and the same time diet and exercise programs were applied. When his rate of weight loss decreased around 4th week, Exenatide 10 mcg/day was added to his treatment.

It was observed that the patient lost 15 kilograms at the end of 3 weeks, and his BMI decreased from 60.9 to 56.1 (BMI SDS: +4,18) and the total TG level decreased from 195 mg / dl to 154 mg / dl.

Obesity, which is an important public health problem, is also becoming a serious problem in individuals with ASD. There is no standard treatment approach for the coexistence of ASD and obesity. Whether psychopathologies constitute a definite contraindication for bariatric surgery is a controversial issue. In our patient, it was decided to prefer non-surgical approaches primarily. It can be concluded that; In children and adolescents with autism and intellectual disability, effective weight loss can be achieved without bariatric surgery with medical and psychiatric approaches.

None Declared

Major traumatic natural disasters have occurred worldwide. Post-traumatic stress disorder (PTSD) has been the most common psychiatric disorder discussed by the studies addressing the psychological sequelae of adolescents after traumatic natural disasters. In this study we have studied the impacts of natural disaster yash cyclone that took place in West Bengal on the development of PTSD; factors related to the development of PTSD; predisposing, precipitating, and perpetuating factors related to the development of PTSD.

To assess the incidence and prevalence of ptsd amongst survivors of natural disaster yash cyclone in a rural hamlet of West Bengal.

In this study ,200 survivors from Yash cyclone who belonged to Child and Adolescent age group were randomly selected .PCL 5 Scale was used to collect data and assess the incidence and prevalence of PTSD , standardized Bengali versions of the questionnaire was used in our study.

There is statistical correlation between post traumatic stress disorder and subjects exposed to climate change events such as cyclone Yash.

Initial research suggests that a PCL-5 cut-off score between 31-33 is indicative of probable PTSD across samples.

In our study the mean pcl 5 value from the data assessment is 70.67 with standard deviation of 4.61.

Further assessment by linear regression analyses shows that female subjects are more prone to post traumatic stress disorder and higher income groups are more susceptible to ptsd.

As shown by higher values as per the pcl 5 scale.

Our study clearly demonstrates the impact of climate change and natural disasters on the mental health status of people living in disaster prone areas especially the child and adolescent population. Our study group was child and adolescent population between 10 to 15 years.

The psychologist and volunteers had to collect data in disaster affected zone , yet they collected data which gave a clear cut findings and a very clear statement on climate change and mental health. The values are very high and consistent in most subjects across all twenty domains.

It is our opinion that Mental health support should be provided for all victims of climate change and natural disaster calamities such as cyclone and earthquake.

None Declared

Young people are worried about climate change but the association between climate worry and current and past mental health has not been examined in population-based samples.

To examine 1) the prevalence of worry about climate change at age 23-years and its association with contemporaneous mental health symptoms, and 2) and adolescent mental health symptoms.

We used a Canadian population-based birth cohort (n=1325) to examine associations between 1) climate change at age 23-years and concurrent anxiety, depression, and suicidal behaviors, and 2) mental health at age 15 and 17 years defined as anxiety, depression, aggression-opposition, inattention-hyperactivity. We adjusted for participants’ socioeconomic status, childhood IQ, sex, and parental history of psychopathology.

Most participants were worried about climate change: 190 (14.3%) were extremely worried, 553 (41.7%) were somewhat worried, 383 (28.9%) were very worried, and 199 (15.0%) were not at all worried. Worry about climate change was associated with significantly elevated contemporaneous anxiety, depression, and suicidal thoughts. In longitudinal analysis, adolescent anxiety was associated with higher climate change worry at age 23-years while adolescent aggression-opposition was associated with lower climate change worry.

Worry about climate change is associated with contemporaneous mental health symptoms. However, longitudinal analysis suggests that this is largely explained by prior mental health, with adolescent anxiety symptoms linked with higher worry and aggression-opposition with lower worry. Future studies should aim to better define the dimensions of climate anxiety and track it alongside symptoms using prospective follow-up studies.

None Declared

The theorization focuses on the climate change’s influence to neurobiology. In modern societies, environmental nucleon generates in everyday activities from computers to industrial pollution. The subtle psychiatric changes can be categorized into: 1) the change of media in consciousness formation processes from cognition, such as from paper to electronic reading and from linguistics to coding; 2) activity changes in local reciprocal environment especially in places undergoing industrialization or developmental energy sources; 3) global exchanges underlying the current definitions of climate change but also taken into consideration of media change in cognitive behaviors; and 4) changes from outer space environment to the effects of global-to-local changes.

The objective of the theorization seeks to develop a heuristic paradigm to quantify the climate change’s effects to psychiatry from a neurobiological perspective. Albeit climate change is a complex topical issue, especially regarding the multivariable sources and traditional paradigms of case studies in the psychological and medical sciences, common sources of impacts to psychiatric public health in collective behaviors have been less of a focus. With the higher order of autonomous human functioning governed by the brains, the theorization in psychiatric public health hopes to quantify environmental impacts to brain functionings.

The theorization accumulated from nonproliferation research and the researcher’s developments in dopamine treatments in the high risk social-natural environment on depression. Inspired by the explicit review on electronic warfare’s impact on public health and astronomical research with proton decay outcome, a correlative theorization emerged between the cosmic decay and biodiversity in biochemistry. The theorization draws on developmental psychology to the nucleon heuristics in data research in cosmology, with prior experience documenting proliferation by applied quantum chromodynamics. Psychiatric data can be retrieved from relevant clinical settings of equivalent multi-wavelength brain scans as samples.

From the perspective of cosmology, extremal graph theory can sample climate change on earth’s plasma from cosmic changes. This means earth’s dipole shifts to quantitative local population can be plotted, similar to the wild life researches in birds’ migration pattern changes. Local variants mainly derive from energy source types and energy consumption, however, bona fide data can hardly be retrieved due to deliberate transgressions for certain dire areas. Normative research can be conducted with cross-disciplinary collaborations with due consideration to privacy in public health research ethics.

Environmental monitoring and psychiatric effects in developmental psychology are necessary in fundamental research on human security. This would increase some certainties and predictabilities for human development.

None Declared

In recent years the increasing presence of refugees and asylum seekers displaced from their country of origin, determined significant social, economic, humanitarian and public health implications in host nations. Advancing the knowledge on factors contributing to these implications, could foster the implementation of new public-health plans for these population. As a matter of fact, to date, the rates of mental disorders in these population are uncertain due to the high variability of methods used in the studies on topic, and of risk and protective factors analyzed. The most replicated finding is the high prevalence of Post-Traumatic Stress Disorder (PTSD) and depression in refugees and asylum seekers as compared to the population of host countries.

The aim of the present study was to investigate the needs for mental health prevention, care and rehabilitation of adult refugees and asylum seekers in Italy, performing a multidisciplinary evaluation of migrants who were guests in two refugees’ centers in Campania (Salerno and Avellino).

The Mini-International Neuropsychiatric Interview (MINI) was assessed in 303 migrants, in order to evaluate the presence or not of a psychiatric diagnosis. Analysis of variance (ANOVA) was used to investigate differences between migrants with a mental disorder vs migrants without a mental disorder in terms of cognitive functions, depressive and anxiety symptoms, traumatic events and pre-migration risk factors. Person’s correlation was performed to investigate relationships between the Hopkins Symptom Checklist-25 (HSCL-t25) psychopathological index with all the other above-mentioned variables. Logistic regression was used to evaluate factors associated to the presence of a current mental disorder.

At least one mental disorder was found in 90 subjects (29.7% of the sample). Most prevalent diagnoses were major depressive disorder, lifetime panic disorder, PTSD, and generalized anxiety disorder. People with at least one psychiatric illness showed impaired global (F=6.62; p=.011) and social (F=8.22; p=.004) cognition, higher trauma levels (F=70.59; p<.0001) and more severe anxiety and depressive symptoms (F=61.84; p<.0001) compared to healthy migrants. Only trauma levels significantly correlated with HSCL-t25 psychopathological index. Trauma levels, global cognition, occupation, and migration status were associated to the presence of a current mental disorder.

The results of the present study demonstrated that almost 1/3 of the guests of refugee centers in Campania have a mental disorder. The identification of risk factors associated to the onset of mental disorder and to severity of psychopathology in refugees and asylum seekers, may contribute to plan preventive and early psychiatric care in this population.

None Declared

Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees has the mission to improve psychiatric training in transcultural psychiatry and trauma-related topics in Europe. It started conducting a survey in 2016, to assess trainees’ experiences in forcibly displaced people mental health (Frankova et al. Transcult.Psychiatry, in press).

To investigate European psychiatric trainees’ and Early Career Psychiatrists’ (ECPs) training about trauma and refugees’ mental health, focusing on educational and clinical difficulties occurring while assisting war refugees or in Eastern Europe, due to the ongoing conflict.

A new survey for European psychiatric trainees and ECPs was designed. A web questionnaire was shared through various channels, including social media, in September 2022. It included an informed consent form and investigated socio-demographic data, training in trauma and refugees’ mental health, clinical practice in war areas or with war refugees.

As of 16/10/22, 31 were the responders, mainly adult psychiatrists (93.6%). Although the 87.1% worked with forcibly displaced people, only 29% received a specific training, and 53.6% didn’t feel prepared to face war trauma-related disorders. However, 64.3% could reach out to a teamwork member specialized in the topic, and 72.2% to interpreters. The 67.7% worked with actual war refugees, mainly addressed to psychiatric services due to new onset of psychiatric symptoms, especially insomnia (66.7%), often diagnosed with Acute Stress Reaction (66.7%) and treated with psychiatric drugs (83.3%). Two colleagues working in war areas participated in the survey: both lost patients at follow-up and experienced increased workload or lack of means (i.e., drug supply) or support.

This survey can spot educational needs in transcultural psychiatry, helping to program targeted interventions for psychiatric trainees and ECPs, aimed at implementing clinical practice towards the common goal of social cohesion.

None Declared

As written by Warsan Shire, “no one leaves home until the home is the mouth of a shark”. UNHCR defines forced displacement as “displaced because of persecution, conflict, generalized violence or human rights violations"

to study the prevalence of common Mental health disorders among forcibly displaced people and comparing with the common mental health disorders among host community members.

The OPD of BIPBS in SPH and BMCH of Quetta attends 800+ patients per month the data of the OPD of both hospitals was collected for Jan-May 2022 and was analyzed to numerate both the host community and refugees. out of 4120 for 354 refugee patients identified using their POR card and for 3776 of host community using their CNIC, data was analyzed for the prevalence of mental health disorders among them.

This study states that Afghan Refugees presented to OPD services of BIPBS, 47% were diagnosed as MDD with/without psychosis, 19% with GAD, 5% diagnosed as BAD, 5% With schizophrenia, 4% as PTSD, 3% as migraine, 3% conversion disorder, 2% OCD, 1% somatoform disorder and 10% of them presented with other psychiatric disorders, while in host community 21% were diagnosed as MDD with/without psychosis, 24% as GAD, 12% as somatoform disorder, 10% as OCD, 8% as migraine, 7% as conversion disorder, 4% as BAD, 3% as Schizophrenia, 3% as MBD due to substance misuse and rest of 7% presented with other psychiatric disorders.

The conclusion of this study states that mental health disorders are more common among refugees than in other populations, the result of this study shows that there is a big difference in the prevalence of mental health disorders among displaced people and the rest of the population, some of the Mental health disorders are present in higher percentage among displaced people rather than among host community, while some other disorders are present in lower percentage among displaced people rather than among host community, this study also highlights that further studies are needed to determine, risk and protective factors within the host community.

None Declared

Violence among the mentally ill population has long been a subject of stigma, and controversy. Clinicians’ ability to assess the violent potential is still limited.

The objective of this work is to identify the positively correlated indicators of aggressive behavior in patients admitted to hospital emergency departments.

It is a retrospective and descriptive paper based on the records of patients admitted to the emergency department of Arrazi University Psychiatric Hospital in Salé during a one-month period.

The psychiatric diagnosis was formulated using the DSM-5 diagnostic criteria and Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS). The existence of aggressive behavior was defined by a MOAS score ≥3.

We used SPSS 15 to analyse results

Sixty-five case files were selected during the study month. The average age was 35.3 (19;64).

The mean of our sample MOAS aggression scale score was 31.5 [0; 79] and 90% of patients had a score ≥ 3 (image 1)

Among the 65 admissions, heteroaggressive risk was the most frequent reason for hospitalization (N=53), followed by psychomotor excitement. IMAGE 2

Statistical analysis revealed a significant association between high MOAS scores and substance use, history of suicide attempt, educational level and socioeconomic level

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In the current research, the prevalence of aggressive behavior was high among these patients, which may be due to the conditions of psychiatric hospitalization in our region, which is often reserved for the most serious and dangerous patients.

None Declared

People presenting to hospital in a crisis of mental ill-health usually present via Emergency Departments, and are often admitted for brief interventions. Unlike drug treatments, the evidence base for brief non-pharmacological interventions has not been systematically evaluated.

1. To describe brief non-pharmacological interventions used in Emergency Departments and inpatient psychiatric units, for those in a crisis of mental ill-health, and evaluate the study types and outcome measures used to evaluate them;

2. To conduct a systematic review of this evidence

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, DARE, Embase, MEDLINE, PsycINFO, and relevant government and non-government organisation websites for peer reviewed journal articles, including both qualitative and quantitative articles. Interventions were sorted into Categories and Types to manage heterogeneity.

We found 47 studies. Interventions were highly varied, and we created a taxonomy to understand this heterogeneity. Most studies were quasi-experimental trials (n=26; 55%) or qualitative studies (n=13; 27%) and only 8 RCTs (17%). Twelve were high quality (26%). Interventions were mostly found to have no effect on measured outcomes, though outcome measures may not have been best suited to expected domains of change.There was a broad range of outcome foci reflecting inconsistency in goals of interventions. No interventions were found to reduce the incidence of self-harm on the inpatient ward. One study suggests that inpatient safety planning may reduce readmission rates. Aggression-related outcomes for inpatient sensory modulation rooms were equivocal. Brief admissions with psychotherapy may reduce suicide attempt repetition and re-hospitalization, whereas brief admissions without psychotherapy may improve function but not re-hospitalization rates. Face-to-face psychoeducation for panic in the ED was associated with a reduction in ED presentation rates, but brochure-only psychoeducation may increase ED presentation rates.

This review found little evidence to guide much of what clinicians do for people in crisis in hospital. There is a need to develop a framework for brief non-pharmacological interventions, address the quality and size of studies, and identify consistent outcome measures for non-pharmacological interventions. The data is insufficient to make clear recommendations for appropriate brief non-pharmacological interventions for people in crisis in Emergency Departments and Psychiatric Inpatient Units. Multiple promising interventions are available for further study, however there is a dearth of research and more rigorous testing is needed.

None Declared

Patient populations in psychiatry can have low cortisol for many reasons such as adrenalitis, secondary adrenal insufficiency and poor compliance with glucocorticoid replacement therapies. A literature review in 2005 highlighted the prevalence of neuropsychiatric features in those with low cortisol. Unfortunately, this has received little to no attention in the wider literature and hypocortisolaemia is often overlooked as a cause of neuropsychiatric presentations in clinical practice.

Review the literature to understand what psychiatric features hypocortisolaemic patients present with and any themes between cases.

A literature review on neuropsychiatric presentations of hypocortisolaemia was performed using PUBMED and Google Scholar. English language studies from 2005 to October 2022 were included and searched for using the following term: (Hypocortisolaemia* OR “Low-cortisol” OR Addisons OR Adrenal-crisis OR “Adrenal insufficiency”) AND (Psychiatric OR Hallucination OR Neuropsychiatric OR “Neuropsychiatric symptoms” OR Pyschosis*). Citations in relevant papers were also reviewed.

7 case reports were identified, 5 male (71%) and 2 female (29%) with an average age of 42 (28-63). The cause was identified as Addisons’ disease in 4 patients (57%) and secondary adrenal insufficiency in 3 patients (43%). Hallucination or delusion was the most prevalent symptom with 86% of patients initially presenting with it, followed by depression (43%) and speech abnormality (14%). In all cases, basic blood sets (Full blood count, urea & electrolytes and liver function tests) were done in an initial assessment. 6 patients presented with hyponatraemia, and 4 of these patients had hyponatraemia as their only abnormality within their U&E profile. In one patient this delayed their diagnosis by several years. One patient developed psychosis again when being treated with glucocorticoid therapy. In 4 patients, adrenal pathology was not suspected and cortisol was not tested until initial differentials were investigated and ruled out.

Further case reports highlight psychosis being a key feature of hypocortisolaemia that presents initially with neuropsychiatric symptoms. Cortisol levels should be considered in initial investigations of psychosis if hyponatraemia is discovered even in the absence of hyperkalaemia to help aid an earlier diagnosis. A rebound psychosis may be seen once starting glucocorticoid therapy. Additionally, there should be consideration of neuropsychiatric monitoring in stable psychiatric patients undergoing cortisol treatment.

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Frequent attenders to emergency services are challenging and costly. We report the case of a woman in her mid-twenties who stands out for a total of 1447 emergency visits.

Our primary objective was to describe the emergency visits of our patient. Secondary objectives were to assess her use of other healthcare services and to calculate her health expenditure.

This is a clinical case report. We reviewed the patient’s electronic medical records for sociodemographic and clinical data. We obtained detailed information of psychiatric ED visits (length, most frequent times and days) regarding the second most-visited hospital. We assessed the efficacy of hospitalizations in reducing ED visits with a paired samples t Test, comparing the number of visits 30 days pre- and post-hospitalization. We estimated the health expenditure using the regional public health system prices, including three direct costs: emergency visits, hospitalizations and ambulance transportation. We obtained written informed consent from the patient’s legal guardian.

A 26-year-old woman from Barcelona (Catalonia, Spain), diagnosed with mild intellectual disability, made 1447 emergency visits between 2009 and 2021 (figure 1). 946 visits (65%) took place in psychiatric emergency departments (EDs), whilst 353 (24%) in non-psychiatric EDs and 148 (10%) in urgent primary care. She attended 24 hospitals (ranking number one the closest to the patient’s home, with 387 visits) and seven primary care centers, distributed across 17 cities in Catalonia. Most visits were self-referred, being the main presenting problems anxiety and instrumental suicidal behaviour. Saturday was her favorite day for hospital visits (24,1%), while she seeked care on Tuesdays much less often (4.5%). She made 73.5% of consultations between 1pm and 6pm, with a median length per visit of 2.8 hours (range 0.33-20.9 hours). Regarding other therapeutic approaches, she attended day hospitals, psychiatric rehabilitation programs and family therapy, among others (figure 2), for which she showed low adherence and scarce benefit. She had ten acute hospitalizations, interventions that did not reduce ED visits (t=-0.9835, p=0.36). Health expenditure reached 410.035€.

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The most common definition of frequent attendance is a patient who has five or more visits per year. Many times, but not always, repeat visits are also inappropriate. The case we report is a grotesque example of both frequent and inappropriate attendance, which has been resistant to all kinds of interventions and has quality-of-care, financial and ethical implications. As of today, it is still a pending case. Maybe it is worth considering residential treatment?

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The Fort McMurray wildfire (2016) was one of the most expensive and devastating natural disasters that ever happened in the history of Canada. According to the Insurance Bureau of Canada (2016), the cost of this disaster was estimated at USD 3.6 billion in insured losses. Despite the fundamental role of resilience in the daily functioning of individuals in the form of a protective shield that ameliorates the devastating impact of disasters on their mental well-being, to date, the long-term impact of wildfires on resilience and its associated predictors of low resilience has not been well studied and evaluated.

The study aimed to enhance the understanding of the psychological impact of wildfires through the evaluation of the prevalence and predictors of resilience among the affected residents of Fort McMurray five years after the devastating wildfires.

This study applied a cross-sectional survey design which was used to gather quantitative data through an online-based self-administered questionnaire. The surveys included standardized rating scales for resilience (BRS), depression (PHQ-9), anxiety disorder (GAD-7), and post-traumatic stress disorder (PTSD) (PCL-C) was used to measure the prevalence of resilience and its demographic, clinical, as well as wildfire-related predictors. The data collection spanned between April and June of 2021. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25 and univariate analysis with done using a chi-squared test and binary logistic regression analysis.

A total of 249 residents accessed the online survey and 186 completed the survey. Therefore, there was a response rate of 74.7%. Most of the respondents were females (85.5%, 159), above 40 years of age (81.6%, 80), employed (94.1%, 175), and in a relationship (71%, 132). The study identified two variables, thus having PTSD symptoms (OR = 2.85; 95% CI: 1.06–7.63), and the age of respondents significantly predicted low resilience in our sample. The prevalence of low resilience in our sample was found to be about 37.4%.

The study finding demonstrated that age and the presence of PTSD were the independent significant risk factors associated with low resilience in the affected population of Fort McMurray five years after the devastating wildfire disaster. This result further provides new information about the association between resilience, demographic, and clinical characteristics while adding to the rising body of evidence on the benefits of resilience in individuals during and after disasters. However, further research is needed to enhance understanding of the pathways to

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