The COVID‑19 pandemic has raised multiple psychological challenges among most healthcare workers, from anxiety to depression, burnout, sleep disorders, and substance use disorders. Thus, the burden caused by this prolonged medical crisis has inevitably drastically lowered the quality of life of the medical staff. In order to mitigate the negative effects of the pandemic, healthcare workers resorted to various coping strategies, with better or worse outcomes.

The present study aims to identify Romanian physicians’ main coping mechanisms and evaluate the role of positive and negative stress-reducing strategies on quality of life.

A cross‑sectional national survey was conducted using a web-based questionnaire among physicians practicing in Romania (n=265). In addition to socio-demographic and professional information, the questionnaire addressed participants’ coping mechanisms using the COPE inventory and quality of life with the WHOQOL-Brief scale. Descriptive statistics, Pearson correlations, and multiple linear regressions were used in the statistical analysis.

In total, 265 physicians consented to their participation in the survey. Of those who responded, 84.5% identified as female, 92.1% had a permanent residence in a urban setting, 63.8% were married and 55.1% attained a master’s degree, a PhD diploma or equivalent level of education. The results showed that optimism was higher in male professionals, while avoidance coping was higher in female health professionals. The mean values of QoL subscales were: 74.7± 18.3 for the general quality of life, 70.8± 20.7 for health satisfaction, 64.0± 14.2 for the physical area, 61.7± 16.2 for the psychological area, 61.2± 20.3 for the social relationships area and 64.7± 12.7 for the environment area. Specific coping mechanisms (emotional venting, behavioral and mental disengagement) were associated with lower quality of life. In contrast, emotion-focused (positive reinterpretation and acceptance), problem-focused strategies (planning, active coping, suppression of competing activities) and humor were associated positively with most QoL subscales scores.

Our data points to specific protective characteristics and some detrimental factors on physicians’ quality of life during the pandemic, with the implication that these factors may be important considerations for mitigating distress and psychiatric disorders for healthcare workers during times of high stress. Concerted initiatives to improve wellness in healthcare workers ought to develop targeted programs to ensure adequate psychological support.

None Declared

Restricted visitations of family members of persons with mental illness in psychiatric hospitals which may occur during times of public health crises such as the COVID-19 pandemic can have potential adverse consequences on the family members and on their ability to fulfill the caregiving role. Therefore, mental health professionals may encounter difficulties implementing a family centered-care model during such periods.

Due to the limited knowledge about the effects of the restrictions during the pandemic a study was conducted in Israel. It examined the difficulties which family members experienced as a result of the restricted visitations and the effects of the restrictions on advancing a family-centered care model,

A semi-structured questionnaire was distributed via digital means to 75 family members who had a family member who was hospitalized in psychiatric hospitals during the pandemic.

The findings indicate that family members had limited opportunities in the following areas during the COVID-19 area: Developing relationships with the professional staff, being involved in the therapeutic process during the hospitalization, communicating with the hospitalized family member, and receiving help for themselves.

Mental health professionals in psychiatric hospitals should adapt family-centric procedures to circumvent restrictions on physical presence and maintain the involvement of family members during psychiatric hospitalization.

None Declared

The COVID-19 pandemic has disrupted mental healthcare delivery in many countries. The restricted access to psychiatric services and double disasters (pandemic and earthquakes) coincided in Croatia, potentially placing people with severe mental illness (SMI) in a very vulnerable position.

The aim of this study was to examine the changes in substance use in people with SMI in the first and the second COVID-19 wave and co-occurring earthquakes. The secondary aim was to explore whether the type of treatment (community mental health teams (CMHT) vs. treatment as usual) influenced those changes.

This study was nested within the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE, Horizon 2020 research and innovation programme, grant agreement No 779362). The study involved 90 participants with SMI assessed at two time points: in May/June 2020 (during the first COVID-19 wave and after Zagreb earthquake) and in December 2020/January 2021 (during the second COVID-19 wave and after Petrinja earthquake). The changes in the use of psychoactive substances (alcohol, cannabis, other drugs, sedatives) were assessed using self-reported survey.

The increase in tobacco smoking behavior and the use of sedatives was observed in both COVID-19 waves in people with SMI. No increase was reported in cannabis and other drugs use, while less than 5% of participants reported increase in alcohol consumption. Not receiving CMHT service predicted the increase in sedative use.

Ensuring accessible mental health care provided by CMHT is recommended for counteracting the negative effect of external stressors (such as pandemic and co-occurring earthquakes) on the increased substance use among people with SMI.

S. Levaj Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., S. Medved Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., J. Gerlach: None Declared, L. Shields-Zeeman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., F. Bolinski Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Bradaš Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Madžarac Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., I. Rojnić Palavra: None Declared, M. Rojnić Kuzman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362.

The worldwide COVID-19 pandemic leads to the development of stress disorders, increased anxiety in the society. One of the strongest factors leading to the development of anxiety, stress in society during a pandemic is the Mass Media. The mechanisms of stressogenic effects of Mass Media remain not completely clear.

The aim of this study was to evaluate age-specific characteristics of gaze behaviour related to the perception of anxiety-provoking information.

189 volunteers took part in the study (164 participants aged between 17 and 22 years old (students, control group), 25 people aged between 59 and 71 (experimental group)). Participants were asked to fill in Psychological Stress Measure (PSM-25), Patient Health Questionnaire (PHQ-9), and Generalised Anxiety Disorder Assessment (GAD-7) questionnaires in order to determine their levels of stress, depression, and anxiety. The second stage of the research was an eye-tracking study of text perception - we analysed eye-tracking data during the text perception by using web-eye tracking (EyePass).

To identify the relevance of COVID-19 information, we compared the perception of positive, neutral and negative texts and detected rather a negativity bias than attraction to the positive or neutral stimuli: fixations positive vs negative (p-value < 0.01), positive vs neutral (p-value < 0.01), neutral vs negative (p-value < 0.01). Under the competitive conditions (higher relevance of negative information during Pandemic) the perception of negative text is characterized by attentional priority. Moreover, it should be taken into account that highly anxious participants showed a negativity bias than attraction to the positive stimuli, and this is typical during quarantine.

Therefore, participants showed a negativity bias than attraction to the positive stimuli, and this is typical during quarantine. There are significant age-related differences in gaze behavior while reading text with negative text elements. While the origin of these differences between older and younger adults remains unknown, further research may provide more evidence about the origin of this effect.

None Declared

Healthcare workers (HCWs) are on the front line in the management of the COVID-19 pandemic. They are at higher risk of acquiring SARS-CoV2 infection and might transmit the virus to other person or their family members. All these gave rise to stigma toward society, family, and HCWs.

to measure social and professional stigma and guilty feelings among HCWs in a Tunisian hospital.

A cross-sectional study using a questionnaire (sociodemographic and professional characteristics and three questions (yes/no) related to social and professional stigma and guilty feelings) was conducted from September 1 to December 31, 2020, at Charles Nicolle hospital of Tunis. The survey was distributed among HCWs consulting the department of occupational health after a COVID-19 infection.

A total of 259 HCWs were included in the study. The mean age was 41±10 years with a sex ratio of 0.25. The HCWs were married in 66.8% of cases. The professional categories were represented mainly by nurses in 33.5% of cases followed by technicians and physicians in 26.2% and 17.4% of cases respectively. The average professional seniority was 13 years (min=1 year; max=13 years).

The social stigma was reported by 30.5% and professional stigma by 20.1%. The stigmatized population was predominantly female (86%), and the proportion of married people was 63%. The predominant professional category was nurses (36%) followed by senior technicians and workers (25% and 16% respectively). The average length of employment was 13 years. Guilt was felt by 57.1% of the cases.

Based on the results of this study, the social and professional stigma during COVID-19 among HCWs was significant as well as the feeling of guilt. This may have an adverse impact on HCWs’ mental health.

None Declared

The effects of the COVID 19 pandemic manifests in all segments of society, and they have special impact on the vulnerable population of persons with mental disorders. After two years of pandemic, the vaccines against COVID 19 are still the most important strategy against infection, disease, transmission and reinfection.

The aim of our research was to compare the attitudes of different subcategories of people with mental disorders towards vaccination and to discover potential factors that could participate in the decision-making process.

The research was conducted in the outpatients population, from January to March 2022, in Special Hospital for Psychiatric Disease Kovin, Serbia. All patients included in the research signed a voluntary consent to participate in the research. The data was collected from a self-assessment questionnaire, consisted of 4 segments: sociodemographic characteristics, a set of questions related to the COVID pandemic, history of influenza vaccination and attitudes towards vaccination.

The questionnaire included 147 people, 50 of whom were the control group of health professionals employed in SBPB “Kovin”, while in the subgroup of 97 respondents there were 49 people with a diagnosis of one of the non-psychotic disorders and 48 people with a diagnosis of one of the psychotic disorders. In the total population examined, the percentage of vaccinated was 53.97. In the population of persons with mental disorders, this percentage was lower compared to the control group. The results indicated that there is no statistically significant difference in attitudes towards vaccination in relation to the level of education. People who have been vaccinated are also people who would accept vaccination if another pandemic were to occur. In the unvaccinated subgroup, the greatest concern is vaccine safety. This group of respondents did not significantly differ from the vaccinated when it comes to fear of COVID 19 infection and concern about possible illness of family members.

The research showed that slightly more than half of the examined population of persons with mental disorders who use the services of the psychiatric dispensary SBPB “Kovin” were vaccinated.

There is no statistically significant difference in the vaccination status against COVID 19 infection in the subcategories of persons with non-psychotic and psychotic symptoms. In the unvaccinated category, concerns about vaccine safety are a significant cause of vaccine refusal. Such preliminary results indicate the need to raise awareness and provide contoured, timely information and education regarding the pandemic of persons with mental disorders. Promotion of mental health and finding appropriate strategies in the provision of services to persons with mental disorders is one of the key tasks of the psychiatric service.

None Declared

COVID-19 pandemic along with its social restrictions changed our burial practices and the way we bury our dead. In consequence, it affected people’s experiences and traditions which could lead to severe, persistent, or disabling grief.

Thereby, it is relevant to understand how someone may be more susceptible to developing pathological grief and what can we do to prevent it.

To assess the risk of Prolonged Grief Disorder (PGD) in family members of patients who died from COVID-19 infection and identify possible risk factors.

Prospectively, we performed follow-up interviews conducted with family members of all patients who died from COVID-19 infection in 2020 at our hospital. The sample was characterized, and clinical follow-up was performed for at least 6 months after the date of death. By that time, the PG-13 scale was applied.

A total of 269 individuals who had some type of relationship with patients who died from COVID-19 were included, with 68% being female with a mean age of 53.7 years.

After clinical follow-up, 10.8% of the patients met the diagnostic criteria for PGD.

Regarding the degree of kinship, the only predictor of PGD was “spouse” (OR 11,236, [4,762; 26,316]; p < 0,001). A closer and more regular interaction with the deceased was also associated with an increase in PDG (OR 5.682, [1.314; 24.390] p = 0.009).

Feelings of denial and guilt by the time of death notification were also risk predictors for PGD (OR 2,412, [1,091; 5,332] p = 0,026) and OR 2,888, [1,244; 6,703] p = 0,011, respectively).

The impossibility of being present at the funeral was associated with a risk of about 3 times higher of developing PGD (OR 3,817 [1,727; 8,403] p < 0,001).

Older age (p<0,001) and lower educational qualification (p=0,003) were also presented as risk factors.

Other characteristics including gender, marital status, previous suicide attempts, psychiatric or consumption history, previous significant bereavement or the social and family support of the person contacted were not predictors of PGD.

The present prospective study made it possible to reinforce and support the way in which the COVID-19 pandemic, associated with significant social modifications, changed the way people experience grief.

None Declared

There is growing evidence of neuropsychiatric presentations in patients of COVID-19, but literature is scarce on laboratory, clinical and radiological markers as well as impact of psychotropic medications during the course of hospitalization in critically ill patients.

The primary outcome measure was variability of clinical biomarkers and CORADS scores with severity of COVID-19 infections and the impact of psychotropic medications like risperidone and aripiprazole.

We screened 430 ICU patients admitted to our tertiary care hospitals, out of whom 67 were diagnosed positively with definitive neuropsychiatric sequalae and receive psychotropic interventions during their hospital stay. We compared their D-dimer levels, C-reactive proteins, serum ferritin levels, serum procalcitonin and Vitamin D levels and further analyzed CORADS severity score with psychiatric severity and outcome.

The mean age of the patients was 42.38 years, majority (44.8%) of them belonged to 21-34 years with slight (52.2%) male preponderance and none of them were more than 60 years. We observed a 43.3% were having organic mood disorder and 37.3% of individual had significant history of alcohol dependence while hypertension and diabetes mellitus were noted in 34.3% and 29.9% respectively. Only D-dimer levels were found to be significant and positively associated with outcome of psychiatric disorders (p<0.05), accounting for 41% of covariance on linear regression analysis.

Our study has found significant association of elevated levels of D-dimer variability but not the other laboratory biomarkers among various neuropsychiatric comorbid sequalae in ICU admitted COVID 19 patients. This particular observation might have potential for serum D-dimer levels to be possibly used as an early biomarker to screen or suspect for comorbid neuropsychiatric presentations.

None Declared

Despite the literature regarding the impact of the COVID-19 pandemic on education, there is little research that specifically targets medical students and their relationship with online courses in regards to engagement and feelings of inadequacy.

This cross-sectional study aims to explore such questions by evaluating a small (N=169) sample of Romanian medical students and applying self-reporting questionnaires in order to quantify subjective levels of burnout and imposter phenomenon

Responders filled an online survey with question regarding miscellaneous socio-demographic factors, alont with the Academic Burnout Scale (ABS), Clarence Imposter Phenomenon Scale (CIPS) and Ohio Resilience Scale (ORS). Results were collected and analysed for subsequent correlations.

Predictably, respondents already in favour with online courses showed less signs of burnout and higher levels of resilience. While higher-year students preferred online courses, particularly final year students, it was lower-year students who showed higher level of resilience and lower burnout and imposter phenomenon levels, possibly suggesting a more profound impact of online education on students in clinical rotations, as opposed to pre-clinical ones. No statistically significant correlations were found between socio-demographic factors and the self-reported ratings, showing that feelings of burnout and imposter phenomenon were equally distributed among genders.

The results of this study present a snapshot into the opinions of future Romanian medical professionals on their own education and, in spite of its methodological limitations, can function as a starting point for deeper and more exhaustive inquiry regarding medical education during COVID-19 times.

None Declared

The COVID-19 pandemic has affected the mental health of the global population (Dragioti et al. J Med Virol 2022;94(5):1935-49). The first lockdown brought the hardest and most sudden impact on work, educational, social, and recreational activities. Moreover, the fruition of mental health services was restricted, and non-urgent appointments were delayed or converted into telepsychiatry. Thus, it was reasonable to hypothesize different trends of urgent consultations regarding mental health.

To detect quantitative and qualitative changes in patients presenting to our Emergency Departments (ED) during the early phase of the pandemic compared to the previous year.

We conducted a retrospective, multicenter study in Venezia (historical center, mainland) through systematically reviewing the psychiatric consultations in our ED, during the first 16 weeks since 8-Mar-2020 and the same period of 2019. The protocol was approved by the local Ethics Committee as UPSI-19 (Urgent PSychiatric consultations In COVID-19). The statistical analysis was conducted with the software R; Interval Risk Ratio (IRR) with 95% CI was calculated for absolute frequency, primary diagnosis, leading symptoms, and outcomes of these consultations.

In the early phase of the pandemic, in our ED we assisted to a significant decrease in psychiatric consultations: 372 vs 441, IRR=0.84(0.73-0.96). Data revealed a reduction of referral for suicidal behavior (IRR=0.52(0.33-0.80)) and anxiety symptoms (IRR=0.60(0.42-0.87)). Primary diagnoses of patients were not different between the two periods explored. There was a slight increase in admissions (150 vs 121), and a significant decrease in less severe clinical pictures.

In the timeframe considered, we assisted to a significant decrease in referrals from the ED, possibly related both to fewer non-locals and to less frequent non-severe presentations. Despite the type of patients (for underlying diagnoses) remained unmodified, an interesting reduction of anxiety symptoms and suicidal behavior was noticed. Literature from ED studies during the first wave are consistent with our finding regarding the number of visits; suicide attempts seemed unmodified or decreased elsewhere (Giner et al. Curr Psychiatry Rep 2022;24(1):1-10). Limitations of our study include peculiarities of the Venetian territory, limited sample and time of observation. Future directions encompass the integration with data from the community setting and later developments.

None Declared

The World Health Organization declared COVID-19 as a pandemic in March 2020, and this was followed by a series of preventive measures that included social distancing, travel restrictions and lockdowns in India. Pregnancy is a vulnerable time, with several physical and psychological changes associated with it. The added burden of pandemic could lead to significant stress, and it would be helpful to understand the mitigating factors of stress in this population.

The objective of this study was to examine the mitigating factors associated with COVID-19 pandemic among pregnant women.

The study was conducted in an Urban Primary Health Center (UPHC) in Bangalore that provides maternity care to low-middle income population. Antenatal check-ups are conducted here daily. Pregnant women visiting the clinic for routine antenatal care were approached and informed consent was sought for an interview. 295 women consented to participate in the study. The qualitative interview was conducted in a quiet room. Open ended questions were used to understand the participants’ personal, familial, occupational, and social factors related to COVID-19. The transcripts of the interviews were manually coded for recurring themes by two research assistants. These were examined and similar or identical themes were grouped together. These were further analyzed, and themes were summarized.

The mean (SD) age of the participants was 24.9 (4.2) years, approximately half of the participants were in their first trimester and primiparous. The majority were high school educated and self-employed. 25% of the participants reported mild to moderate depressive symptoms assessed using PHQ-9. The most predominant theme among personal factors was negative emotions that included fear and anxiety. The uncertainty about the transmission and the lack of clarity about the causes during the pregnancy were the reasons for these fears. They reported that they found news and media more stressful. They reported that even though the lockdown restricted their movement, they enjoyed the time they spent with the family, especially their husbands. Most participants reported job loss, theirs and their husbands’ and had to encounter severe economic difficulties. However, the predominant theme was the social support that they received from family, friends, neighbors, and local governing bodies.

Social support was reported to be the most predominant factor that helped the pregnant women to cope with the problems presented during the pandemic. Social support, both instrumental and emotional were important mitigating factors for stress during the pandemic. Strengthening the social support system by support groups and community networking should be a crucial component in government- led initiatives as a factor that may promote resilience in difficult situations like the pandemic.

None Declared

Mental health issues of the health care workers (HCW) are often overlooked. It’s often presumed that situations like COVID are handled well by this group of population and hence their own mental wellbeing is ignored and neglected.

The objective of this study was to evaluate the depression and anxiety levels in healthcare workers who were on COVID duty.

This study was performed over telephonic interview of all the healthcare workers who were performing COVID duty from March 2021 to December 2021. Hospital Anxiety and Depression Scale (HADS) was administered. Various factors influencing the presentation were then analyzed.

Over 534 healthcare workers were screened for psychiatric symptoms. About 76 fulfilled HADS criteria. 7.86% (42) scored above the anxiety cut off point and 6.36% (34) scored above the depression cut off point. About 373 (69.85%) expressed concerns about their safety and security as they were staying away from their families and about 469 (87.8%) expressed concerns about uncertainties about duty patterns.

Health care workers should be screened for psychiatric illness if they are in constant stress. They should be well trained to carry out COVID duties which will reduce the anxiety about the duty patterns. Better awareness about COVID 19 may lead to decreased levels of anxiety and depression.

None Declared

The importance of inflammation as a common pathophysiological mechanism underlying infectious and non-infectious diseases determines the relevance of studying the effect of coronavirus infection (COVID-19) on the course of endogenous psychoses.

Clinical and immunological study of the potential impact of coronavirus infection on the course of endogenous psychoses.

Two groups of female patients aged 16 to 48 years with depressive-delusional conditions (F20.01, F21, F31) developed after a coronavirus infection were examined. In 15 patients, psychosis developed 1-2 months after COVID-19, and in 18 patients it occured within 2-6 months after the disease. The severity of psychopathological symptoms was assessed using PANSS and HDRS-21 scales. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) in the blood of patients was determined. Neutrophil count, lymphocyte count and neutrophil/lymphocyte ratio were calculated. The standard values of indicators of healthy donors corresponding to patients by age and sex were used as controls.

Endogenous psychoses that developed later after coronavirus infection were associated with “typical” inflammation, increased α1-PI activity and increased neutrophil degranulation (by LE activity) compared to normal values. Patients with this immune profile were observed to develop depressive-delusional states with a prevalence of positive affectivity (anxiety, melancholy) and an expanded nature of delusional disorders that were predominantly non-congruent with affect. Endogenous psychoses that developed within 2-6 months after COVID-19 were characterized by decreased neutrophil count, decreased LE activity, prevalence of negative affectivity (apathy, asthenia, adynamia), and a relatively undeveloped nature of delusional disorders that were predominantly congruent with affect.

Clinical and biological correlates presumably indicate the modulating effect of the coronavirus infection on (neuro)inflammation and the structure of endogenous psychoses.

None Declared

Major depressive disorder (MDD)is one of the most common psychiatric disorders and a large number of patients present a poor response to treatment. Shortening of telomeres physiologically occurs after each cell division and their shortening is also associated with cell ageing. Studies are affirming that patients who suffer from mental illnesses have shorter telomeres in comparison with patients without such affections. 4 The effect of antidepressant medication on the biology of the telomeres was studied very little in humans and the current data suggest that the length of telomeres is a promising target regarding the prognosis and the response to psychotropic treatment.

To analyze the telomere length (TL) from peripheral blood DNA of patients with major depressive disorder (MDD) compared to healthy controls. A second objective was to compare the TL of patients in relation to antidepressant treatment.

We analysed the clinical data from 16 patients admitted to the Psychiatry Clinic of Timisoara with the diagnosis of MDD and 10 healthy controls. The collection of clinical data was carried out in a structured and standardized manner both on paper and electronically, and the Hamilton Depression Rating Scale (HDRS) was applied to assess the severity of depression. Also, blood samples were collected, and plasma and white blood cells (WBC) were separated by centrifugation. Patients’ samples were collected before and after 12 weeks of escitalopram antidepressant treatment, and a structured diagnostic interview and a standardized depression rating scale were done. DNA was extracted from WBC using the QIAamp DNA Mini Kit (Qiagen), and TL was determined by real time PCR using the Absolute Human Telomere Length Quantification qPCR Assay Kit (Sciencell Research Laboratories) according to the manufacturers’ specifications. The TL expressed as megabases/diploid cell (Mb/DC) were compared between cases and controls using a Mann-Whitney test, and between patients before and after treatment using a Wilcoxon matched-pairs signed rank statistical test.

The mean±SD telomere length for healthy controls was 0.3614±0.082Mb/DC, for treatment naïve patients was 0.4513±0.199Mb/DC, and for patients after treatment was 0.3476±0.070Mb/DC. There was no statistical significant difference in TL between patients and controls (p=0.266), nor between patients before and after treatment (p=0.055).

In this pilot project of limited sample size there was no difference in TL between MDD patients and healthy controls. Moreover, the TL of patients did not significantly change after 12 weeks of escitalopram antidepressant treatment.

None Declared

A growing body of literature has documented that obstructive sleep apnea syndrome (OSAS) is associated with an increased risk of depressive disorders.

This study aimed to determine whether depression is associated with OSAS.

This was a descriptive prospective comparative study conducted over two years among patients with OSAS. Excessive daytime sleepiness was assessed by the Epworth Sleepiness Score (SES). The presence and intensity of depressive symptoms were screened using the Patient Health Questionnaire PHQ9. Data were analysed using SPSS software.

A total of 139 patients participated in the survey with an average age of 48.98 ± 9.80 years. According to the SES, the study population was divided into two groups: a group including 70 subjects with normal SES (< 11); and a group including 69 subjects with pathological SES (≥11). The PHQ9 depression score was higher in sleepy subjects with SES ≥ 11 compared to non-sleepless subjects; the difference being very highly significant (PHQ9=11.97 ± 4.99 and 6.54 ± 5.27 respectively; p=0.0000). The frequency of mild to moderate depressive disorders was found to be greater in non-sleepy subjects (94.3% and 78.3% respectively; p=0.007). For moderately severe to severe depression, their frequency was more marked in sleepy subjects (21.7% and 5.7% respectively; p=0.007).

Depressive disorders constitute a major comorbidity in OSAS. Therefore, it is necessary to improve the quality of these patients’ health by the early detection of the symptoms of overlapping OSAS and depression.

None Declared

Major Depressive Disorder (MDD) and Bipolar Disorder Depression (BDD) are common psychiatric illnesses characterized by structural and functional brain alterations and signs of neuroinflammation. In line with the neuroinflammatory pathogenesis of depressive syndromes (Mechawar N, Savitz J. Neuropathology of mood disorders: do we see the stigmata of inflammation? Transl Psychiatry. 2016;6(11):e946), recent studies have demonstrated how white matter (WM) microstructural impairments detected by Diffusion Tensor Imaging (DTI) are correlated to peripheral immunomarkers in depressed patients.

In this context, the aim of our review is to report an updated overview of the evidence on the correlation between the blood immuno-markers changes and the brain WM disruptions in MDD and BDD patients.

Based on PRISMA 2020 guidelines (Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372), we performed a systematic search on original DTI studies exploring the association between WM integrity, neuroimmune alterations and inflammation in patients affected by MDD or BDD.

Concerning MDD, most of the reviewed studies provided evidence of a link between systemic immune dysregulation, detected through the elevation of peripheral markers (IL-1β and TNF-alfa) or an altered ratio between proinflammatory and counterregulatory cytokines (IL-8/IL-10), and DTI alterations in specific WM tracts, such as the genu of corpus callosum and the IFOF. As for the BDD, we detected an increase of pro-inflammatory molecules (such as TNF-alfa, IL-8, IFN-γ etc.) that correlated with DTI changes in different cerebral areas such as cingulum, forceps, corona radiata, corpus callosum, longitudinal fasciculus and internal capsule. Furthermore, other molecules seem to play a specific role in BDD pathogenesis, including counter-regulatory cytokines, kynurenine and specific lymphocyte classes, such as Th1 and Th17.

Taken together, these pathogenetic insights could outline an integrated clinical perspective to affective disorders, helping psychiatrists to develop novel biotype-to-phenotype models of depression and opening the way to tailored approaches in treatments.

None Declared

Seasonal affective disorder (SAD) is a type of depression that comes and goes in a seasonal pattern. Symptoms of SAD can include: a persistent low mood, a loss of pleasure or interest in normal everyday activities, irritability, feelings of despair, guilt and worthlessness, feeling lethargic (lacking in energy) and sleepy during the day, sleeping for longer than normal and finding it hard to get up in the morning, craving carbohydrates and gaining weight, difficulty concentrating.

The purpose of this study was to evaluate the response to different therapeutic interventions of seasonal depression

Α biographical review was performed using the PubMED platform. All relevant articles were found using the keywords: seasonal affective disorder, treatment, and winter depression.

The main treatments are: lifestyle measures – including getting as much natural sunlight as possible, exercising regularly and managing your stress levels, light therapy – where a special lamp called a light box is used to simulate exposure to sunlight, talking therapies – such as cognitive behavioral therapy (CBT) or counseling, antidepressant medicine – such as selective serotonin reuptake inhibitors (SSRIs)

Light therapy can be a very effective treatment for SAD, with most seeing an improvement of symptoms within the first week. A powerful lamp that replicates natural light, high-quality light boxes are recommended as they allow patients to spend a shorter time (up to 30 minutes at a time) using them.

None Declared

Suicidal behavior is quite common in individuals with anxiety and mood disorders (AMD). One of the coexistence factors in suicidal behavior is thyroid dysfunction, however the results are still controversial (Shen et al. J Affect Disord 2019;(1)180-185; Zhou et al., Transl Psychiatry. 2021;11(1):97). The role of thyroid function in suicidal ideation among individuals with comorbid AMD have not been thoroughly investigated.

The aim of this cross-sectional study was to identify potential associations between thyroid function and suicidal ideation in a sample of individuals with anxiety and mood disorders.

This exploratory study comprised 77 consecutive individuals with AMD (age range 18-73 years, 76% were females) attending the Psychiatry Day care unit. All individuals have been evaluated for current psychiatric diagnoses, suicidal ideation using the Mini International Neuropsychiatric Interview [M.I.N.I. 7.0.2]) as well as for socio-demographic factors and for current psychotropic medication use. Severity of depression and anxiety symptoms have been evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). The biochemical blood tests were performed for the concentrations of thyroxine (FT4), triiodothyronine (FT3) and thyroid stimulating hormone (TSH). The univariate and multivariable logistic regression analyses were used to assess the association between biochemical parameters and suicidal ideation.

Of all study individuals with AMD – 56% have been identified as having current SI. There were not significant differences according to age, gender, education, BMI, smoking, depression and anxiety symptoms and current psychotropics use between SI and non-SI individuals. Serum FT4, FT3 and TSH concentrations were within normal range. However individuals with SI had significantly lower TSH concentrations in comparison to the non-SI (1.54 (0.77) vs. 2.04 (1.22) IU/L, respectively; p = 0.049), without significantly differences in FT4 and FT3 concentrations. A multiple logistic regression, adjusting for sociodemographic factors and severity of mental symptoms revealed, that non-SI individuals with AMD were likely to have higher TSH levels than SI (odds ratio = 2.15 (95% CI 1.10–4.22; p = 0.027).

Among individuals with AMD, lower levels of TSH concentrations have been associated with presence of suicidal ideation, independently of sociodemographic factors and severity of depression and anxiety.

V. Liaugaudaitė Grant / Research support from: European Union (project No P-PD-22-150) under the agreement with the Research Council of Lithuania (LMTLT)., A. Podlipskytė: None Declared, J. Burkauskas Consultant of: Cronos, N. Mickuvienė: None Declared, V. Adomaitienė: None Declared, E. Zauka: None Declared, V. Steiblienė: None Declared

Ketamine has been increasingly used to treat mental health conditions yet there is a lack of safety data on intramuscular (IM) and sublingual (SL) dosing in a community setting. The Roots to Thrive Ketamine assisted Therapy (RTT-KaT) program is a 12-week program with 12 Community of Practice (CoP) group therapy sessions and three ketamine sessions.

To provide preliminary data on RTT-KAT adverse events to subsequently inform safe use of IM and SL ketamine for the treatment of psychiatric disorders.

Retrospective chart review of the RTT-KaT Program on four cohorts (n=128) between September 2020 to December 2021. Eligible patients include those with post-traumatic stress disorder, depression, generalized anxiety, burnout/adjustment disorder, substance use disorder, obsessive compulsive disorder, disordered eating, and disordered sleep. Baseline characteristics and adverse events were captured including medication administration before, during, and after RTT-KaT sessions. Chi-squared test with Yates’ continuity correction was used to assess side effects in subgroups from ketamine administration.

RTT-KaT was well tolerated with no loss to follow up. There were 351 IM (mean dose = 102.553mg) and 96 SL (mean dose = 276.667mg) sessions of ketamine. Of the 448 sessions, the prevalence of elevated blood pressure increased by 12.31% from baseline (36.85%), with all post-treatment elevations being transient. The prevalence of elevated blood pressure post-KaT session was also similar between IM (+11.69% from 37.71% baseline) and SL (+15.12% from 32.98% baseline) administration. Regarding adverse effects, 12.05% of sessions experienced nausea , 2.52% had an episode of vomiting , 3.35% had a headache , and seven sessions experienced dizziness. The incidence of adverse events was not significantly associated with past psychedelic experiences (X2 = 0.0543, p-value = 0.8157), nor past psychiatric diagnosis (X2 = 0.0109, p-value = 0.917). . There was no significant association between administration route and incidence of nausea, which was the most common side effect(X2 = 1.112, p-value = 0.2916). Male gender was also significantly associated with lower incidence of nausea (X2 = 4.2841, p-value = 0.03847).

The group therapy model described provides a comprehensive approach and presents a promising model for operating a KaT program outside of a clinical trial setting.These findings suggest good safety and acceptability for RTT-KaT among individuals seeking treatment for mental health issues. Majority of participants did not experience adverse reactions and the adverse events that were recorded involved transient symptoms that were resolved with rest and/or medications.

None Declared

Multiple studies show an association between inflammation –characterized by increased blood levels of C-reactive protein (CRP) and pro-inflammatory cytokines– and major depressive disorder (MDD). People with chronic low-grade inflammation may be at an increased risk of MDD, often in the form of sickness behaviors. A cross-sectional relationship between low-grade inflammation and anxiety has also been reported, but the potential longitudinal relationship has been less well studied.

We aimed to examine whether basal and lipopolysaccharide (LPS-)induced levels of inflammatory markers are associated with depressive and anxiety symptom severity over the course of nine years. We hypothesized that inflammation is predictive of the severity and the course of a subset of symptoms, especially symptoms that overlap with sickness behavior, such as anhedonia, anorexia, low concentration, low energy, loss of libido, psychomotor slowness, irritability, and malaise.

We tested the association between basal and lipopolysaccharide (LPS)-induced inflammatory markers with individual depressive symptoms (measured using the Inventory of Depressive Symptomatology Self-Report) and anxiety symptoms (measured with the Beck’s Anxiety Inventory; BAI, Fear Questionnaire;FQ and Penn’s State Worry Questionnaire; PSWQ) over a period of up to 9 years using multivariate-adjusted mixed models in 1147 to 2872 Netherlands Study of Depression and Anxiety (NESDA) participants.

At baseline, participants were on average 42.2 years old, 66.5% were women, and 53.9% had a current mood or anxiety disorder. We found that basal and LPS-stimulated inflammatory markers were more strongly associated with sickness behavior symptoms at up to 9-year follow up compared to non-sickness behavior symptoms of depression. However, we also found significant associations with some symptoms that are not typical of sickness behavior (e.g., sympathetic arousal among others). The associations between inflammation and anxiety symptoms were attenuated by 25%-30% after adjusting for the presence of (comorbid) major depressive disorder (MDD), but remained statistically significant.

Inflammation was not related to depression as a unified syndrome but rather to the presence and the course of specific MDD symptoms, of which the majority were related to sickness behavior. With regard to anxiety symptoms, we found that participants with high levels of inflammatory markers have on average high levels of anxiety consisting of physical arousal and agoraphobia, which tended to persist over a period of nine years, albeit with small effect sizes. These associations were partly driven by co-morbid depression. Anti-inflammatory strategies should be tested in the subgroup of MDD patients who report depressive symptoms related to sickness behavior.

None Declared