The University Clinic of Skopje – Skopje was part of two Horizon 2020 projects – IMPULSE and RECOVER-e that finished in December 2021. The advances in the field of community mental health in the capital of Skopje, the idea to combine the best aspects of the aforementioned projects and the need of continual implementation and research on an evidence-based community-based service delivery model for recovery-oriented care led to this study which aims to improve functioning, quality of life, and mental health outcomes for people with severe and enduring mental ill health, such as schizophrenia, bipolar disorder, severe depression.

The objectives of the study are: - to design, implement and evaluate recovery-oriented care for people with severe mental illness in community settings using a psychosocial digital intervention - DIALOG+;- to recognize the value of experiential knowledge through inclusion of peer experts as members of community mental health teams;- to develop scale-up plans for national decision-makers, as informed by the intervention’s implementation and impact, for sustained implementation and scale up after the research study’s timeline.- to improve the conditions of people suffering from psychotic disorders and to overcome financial barriers encountered in the treatment of psychotic disorders in N. Macedonia.

DIALOG+ represents an affordable and effective intervention which has already demonstrated positive outcomes in previous research. This study involves the use of the DIALOG+ intervention during home visits, so that patients themselves can decide which aspects of their life that they would like to discuss and work on improving. DIALOG+ lets them rate 12 domains that are related to quality of life, such as physical health, relationships and employment. Patient decide which of these they would like to discuss in detail during the meeting. There is then a 4-step approach to help improve this aspect of their life, using the principles of solution-focused therapy. Researchers will collect information about demographic characteristics, quality of life, and symptoms in patients taking part in the study through the administration of questionnaires and clinical scales.

The study is still in phase of completion. The results will be shown at the EPA Congress 2023.

Having the previous positive outcomes from IMPULSE and RECOVER-e, with this combined approach we expect even more improvement in functioning and better quality of life in patients suffering from severe and enduring mental ill health.

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Most studies on post-traumatic stress disorder (PTSD) have involved a small sample size and a specific traumatic event, with few studies reporting on subjects who have been continuously exposed to a traumatic event. Timely assessment and treatment are crucial for individuals chronically exposed to a traumatic event.

This study investigated the prevalence of PTSD and associated factors in all residents of Gangjeong village, who, recently, have been exposed to a traumatic event for a prolonged period.

The subjects of this study were the residents of Gangjeong village, who have been exposed to a traumatic event related to the construction of the Jeju Civilian-Military Complex Port. The survey included items related to general characteristics and PTSD symptoms, which were assessed using the Impact of Event Scale-Revised, Korean version.

The prevalence of PTSD symptoms was 26.8% (95% confidence interval=23.54–30.04). Multivariate logistic regression analysis identified age, length of residence, and marital status as factors significantly associated with PTSD symptoms.

The prevalence of PTSD symptoms was higher among the study population than in the general population. Economically active age groups, people exposed to the traumatic event throughout their duration of residence in the village, and unmarried individuals were found to be more likely to develop PTSD symptoms. Mental, social, and financial support should be directed to the affected groups of individuals.

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Two emblematic clinical cases will be addressed in this poster. The purpose of the poster is to relate the aspect of how the artistic resources of psychiatric patients are useful to improve social cohesion.

Correlate psychotherapy work on superior defenses to social cohesion and clinical improvement.

Psychopharmacotherapy. Psychoanalytically oriented psychotherapy. Psychiatric rehabilitation.

Social jutice idex (Schraad-Tishler, 2015) and BES (Istat 2015) as sources of social cohesion indicators.

In the first case we have a man with ciclotimic personality disorder and substace abuse with psicotic episodes. Previously, the patient underwent repeated hospitalizations . Once the therapeutic relationship was hooked up and introduced in addition to pharmacological treatment, a psychotherapy also aimed at activating personal resources, the patient began to take an interest in the activity of a street artist. Over time and with the improvement of this activity, aspects of social cohesion have been highlighted in the social context. Social relations both linked to work and affective activity, as well as friends; improvement of the economic situation both through the economic return of this activity and through associative loans linked to this activity; an improvement of social inclusion and non-discrimination in the cities where the artistic activities were carried out; the use of fixed environmental spaces where the activity can be carried out. These aspects have favored a recovery that has reached the complete economic independence of the patient, the establishment of a family unit of their own, the progressive remission of the toxicophilic relapses and therefore the psychotic imbalances they induce.

In a second case, we have a 30-year-old patient with a severe depressive disorder, with narcissistic, paranoid and obsessive personality traits, graduated from the Academy of Fine Arts and with an artistic production both before and after the illness. In addition pharmacological therapy, the patient began psychotherapeutic interventions on the enhancement of superior defenses such as sublimation through artistic activity. So she began to rededicate herself to the artistic activity , she however progressively improved the recovery aspects for a long period of time up to living, working and emotional autonomy. During this path the aspects of social cohesion were also decisive, such an economic autonomy linked to the work activity of an employee in an art gallery, a progressive social inclusion, the conquest of spaces where you can exhibit your works and an increase in trust both towards the family and towards health workers and towards friends and work relationships.

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In this Clinical cases and others not reported exist correlation between psychotherapy work on superior defenses to social cohesion and clinical improvement.

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The recent approval of euthanasia in the Spanish legal code and its posible extension to psychiatric patients opens an unprecedented scenario in the Iberian country. We analize the experience of the Netherlands, a country where euthanasia has been in practice for over two decades, in order to foresee epidemiological trends that could be replicated in Spain.

To review the legislation on euthanasia in Spain and the Netherlands, as well as the epidemiological data regarding euthanasia applicants affected by mental health conditions in the Netherlands, to predict future epidemiological trends in a similar population in Spain.

We studied the legislation on euthanasia in Spain and the Netherlands, as well as the directives of the Regional Commisions for Euthanasia in the Netherlands to analize differences and similarities between the legal codes on both countries. We also sought epidemiological data regarding the application of euthanasia on psychiatric patients in the Netherlands, gathering data from seven articles in English language obtained through a search in PubMed using the MeSH terms “Euthanasia” AND “Netherlands” and “Psychiatry”.

Euthanasia on psychiatric patients in the Netherlands has been a practice on the rise during the last decade, despite the elevated proportion of rejected applications and the high survival rate of this patients in later longitudinal studies. Affective disorders and personality disorders stand out as major psychiatric causes between the applicants. The Spanish legislation bears important resemblance to its Dutch predecessor, but also significant differences.

The available data on the application of euthanasia on mental health patients in the Netherlands show an in increasing trend regarding the execution of this practice, specially on patients who gather distinct clinical features. The data provided by the Dutch experience could have some replication in Spain, as well as anticipate possible future ethical conflicts regarding the application of this service.

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Suicide is a real public health problem. Like many other countries, Tunisia seems to be experiencing an amplification of the phenomenon. Suicide attempts are much more frequent and are estimated to be around 20 times the number of suicides

The objective was to describe the sociodemographic characteristics and clinical profile of suicide attempters in patients hospitalized in the emergency room.

This study was carried out with patients admitted to vital emergencies for attempted suicide over a period of 6 months.

A pre-made questionnaire was used to collect sociodemographic and clinical data. We used the SIS “suicide intention scale” to assess the intent of the suicide attempt and the PHQ9 “PATIENT HEALTH QUESTIONNAIRE” to assess the presence and severity of depressive symptoms.

We excluded Patients with major cognitive impairment, which prevents understanding of the questionnaire.

Our sample consisted of 101 patients. Of the participants, 69.3% were female. Their age varied between 18 and 65 years with an average age of 30.93 years. The socioeconomic level was low in 23.8% of cases. The level of education did not exceed secondary school for 91% of suicides. Almost half of suicide attempters (45%) have been professionally inactive. Participants included in our study were single in 51.5% of cases. Participants had a family history of attempted suicide in 15% of cases. Prior psychiatric follow-up was found in 34% of suicides attempts. More than a third (36.6%) of participants had moderate to severe depression according to the results of the PHQ-9. Recurrences concerned 44% of suicides attempt in our survey and the average number of previous suicides attempts was 3.9. Suicidal intent was rated strong in 47% of suicides attempts .

Suicidal behavior is one of the leading causes of death and disability worldwide. In our study, more than 1 in 3 suicide attempters had depression. Further research is needed to identify suicide risk factors and to examine the relationship between the presence of mental illness and suicidal attempt

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Burnout is a result of emotional exhaustion and lack of motivation after prolonged exposure to chronic emotional and interpersonal stressors at work. (Black et al. SAGE 2020, 609-611)

For the past decade, it has been one of the actual areas of research globally. (Ahola et al. Journal of affective disorders, 88, 2005; 55–62; Ahola et al. Journal of affective disorders,104,2007; 103–110, Shirom, A. Work Stress, 19, 2005; 263–270, Toker et al. The Journal of Applied Psychology, 97, 2012; 699–710.) However, a small number of studies exploring burnout have been conducted in Azerbaijan.

The requirement for supportive interventions for workers with an aim to improve the quality of care and prevention of burnout related to health and sociocultural problems such as difficulties in their personal life, job-shifts has led us to conduct this study.

Above all, the Second Karabakh war that took place in 2020 increased the population of patients that are in urgent need of psychiatric and psychological support.

The purpose of this study is to examine the level of burnout among all mental health workers who have been closely working with veterans and families of deceased soldiers. Similarly, the study is intended to evaluate the impact of various factors, such as secondary traumatic stress, effort-reward imbalance, and socio-demographic variables leading to burnout.

The study design is cross-sectional. 22-item Maslach Burnout Inventory (MBI) is used to measure the level of burnout. Intrusion, avoidance, and arousal symptoms triggered by indirect exposure to traumatic events are evaluated by the 17-item Secondary Traumatic Stress Scale (STSS). 22-item Measurement of the effort-reward imbalance (ERI) is used to define the level of effort, reward, and over-commitment. Demographic questionnaires consist of age, sex, marital status, professional background, years of employment, workload in hours.

The sample size has been estimated as 200 participants. Associations between occupational exhaustion, depersonalization, personal accomplishment assessment, intrusion, avoidance, arousal, effort, esteem, job promotion, job security, overcommitment and professional background, workload in hours will be explored in the current study.

The findings upraised will promote elaborating personalized approaches toward burnout prevention treatment.

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Anxiety and depressive disorders are major public health problems associated with multiple adverse occupational outcomes, including unemployment, reduced productivity, and absenteeism.

To study the socio-professional and medical characteristics of workers with mixed anxiety -depressive disorders and to evaluate their impact on work ability.

A descriptive and retrospective study conducted in the occupational medicine department at Charles Nicolle Hospital, involving all the medical records of workers suffering from mixed anxiety –depressive disorders that were referred for a medical opinion of fitness for work from January 1, 2014, to December 31, 2020.

The study included 62 females and 20 males diagnosed with mixed anxiety-depressive disorders with a mean age: 41.4± 8 years. The average professional seniority was 12.8 years±7.8 years. The most auspicious occupational sectors for these disorders were health (41%) and communication (30%). Most of these workers (62%) were fit for work with professional restrictions (10 workers to positions with a lower mental load and 20 exclusions from night shift work), though 12% were declared unfit for work temporarily. Twenty-one workers were fit to continue working and one worker was unfitted to work.

The overall prevalence of mixed anxiety –depressive disorders was found to be significantly elevated in female patients (p: <0.001).

The decision of medical fitness for work among workers with psychiatric disorders considers their physical and mental capacities as well as the conditions in which the work is carried out, aiming to annihilate the risk of psychic imbalance. Thus, an adjustment of workstations can be an important determinant in the prevention of psychosocial risks.

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Mental health disorders are among the most burdensome health concerns in the world; it affects more than 970 million people in 2019. These disorders deteriorate all aspects of life, especially the professional field, impacting mainly physical capability, daily functioning, and productivity among the working-age population.

To study the socio-professional and medical characteristics of workers with psychiatric disorders and to assess the repercussions of these pathologies on work ability.

A descriptive and retrospective study included all the medical files of workers with psychiatric disorders who were referred to the occupational medicine department at Charles Nicolle Hospital for a medical opinion of fitness for work during the period from January 1, 2014, to December 31, 2020.

The average age of the 224 cases collected was 41.74± [25-60 years] with a sex ratio of 0.67. The average professional seniority was 13.4 years±8.27 years. The most common occupational sectors were health (38.1%) and communication (20.2%). The patients were mainly suffering from either an anxiety-depressive disorder (36.6%) or psychosis (11.6%). These included 21 cases of bipolar disorder, 21 cases of schizophrenia, two cases of chronic hallucinatory psychosis and 3 cases of delusional psychosis. Forty-three patients were fit to continue working, 133 patients were fit with restrictions and twenty-six were unfitted to work.

A professional reclassification was recommended for 37 patients in positions with a lower mental load. One employee suffering from advanced schizophrenia was offered early retirement on grounds of disability. Permanent unfitness was pronounced in 11.6% of cases.

The impact of mental disorders on cognitive abilities can be so significant as to result in temporary or permanent unfitness for work. However, the decision of medical fitness for work for the same psychiatric pathology may vary from one individual to another and from one workstation to another.

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While a growing corpus of literature regarding the stress suffered by caretakers for people living with dementia (PLWD) already exists, very little data is available regarding this subject among Romanian caretakers.

This cross-sectional study aims to compensate for this by assessing a small (N=72) sample of caretakers through the use of self-reporting questionnaires for subjective feelings of stress and burden.

Responders filled and online survey containing miscellaneous socio-demographic questions and the Kingston Caregiver Stress Scale (KCSS) along with the Caregiver Health Assessment Self Questionnaire (CHASQ). Results were collected and analysed in SPSS for subsequent correlations.

The majority (77%) of caretakers are women and 86% of responders are offering their care at home, emphasizing pervasive gender roles and lack of availability or accessibility of social services for the PLWD in Romanian society. Three thirds of caregivers were children of PLDW. More than half of responders (51%) had KCSS scores that suggested severe stress while less than 9% related only mild stress. Most responders (52%) related social aspects of their lives as most affected by their caregiver status.

While in line with most other findings and limited in scope and means by its methodology, this study offers a quick snapshot on the subjective levels of stress affecting caretakers of Romanian PLWD and can lead towards further points of inquiry on the matter in the Romanian population.

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Depression can be considered to be a common psychological response to adversity or loss from which an individual may recover quickly based on a natural resilience mechanism. In major depressive disorder, however, we see that biopsychosocial factors exist that can prevent this natural resilience mechanism from taking effect.

To investigate neurotransmitter pathways linked with antidepressant response, genetic epidemiological studies and a literature assessment of biopsychosocial factors were conducted.

Newly admitted patients with a depressive episode according to the criteria of ICD-10 (F32 or F33) who had not been on antidepressant medication for at least 6 months were recruited. More than half the patients have never been treated with antidepressant medication during their entire life. The patients’ depression was of at least moderate severity as measured by the Hamilton’s Depression Rating Scale (HAMD-17).

To determine the effect of adrenergic pathway genes to antidepressant response, the outcome was measured by the difference in HAMD-17 score between entry and two weeks of treatment after two and four weeks of treatment and entry and four weeks of treatment. Multiple linear regression was conducted to identify the independent factor associated with ΔHAMD-17 between the three time periods, including age, sex, depression diagnosis, type of antidepressant taken and selected SNPs.

Literature assesement utilised a snowball technique, building on prior literature reviews conducted. The selection of included literature was determined by the authors.

The Tomosk cohort was mainly women, with less than 20% of patient being male. The cohort was dynamic thus the number of participants involved in each investigation varied. Most patients took SSRIs, specifically sertraline, paroxetine, escitalopram, fluoxetine and fluvoxamine. Comparing the medication taken, ΔHAMD-17 was significantly more improved in participants taking tricyclic antidepressants at 0 - 2 weeks and 0 - 4 weeks.

From our literature assesment, we determined that targeted therapy can undermine the influence of biopsychosocial factors and allow natural resilience to bring depression to an end. Many mental activities is not exclusively individual, but depends on the sociocultural context as people are part of a community.

Depressive disorders can be understood as a rather habitual dysregulation of human behavior which, unlike normal behavior, is not limited by natural resilience in time and severity. Our investigations looked at polymorphisms impacting serotonergic, dopaminergic and adrenergic neurotransmissions and enzymes.

While some associations were found, it did not match our literature findings. For future investigation, epidemiological and pathogenetic biological psychiatric research should be aimed at identifying biopsychosocial factors that frustrate the natural recovery process.

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Grief is a normal psychological response in relatives after the loss of their loved ones, which has shown to be associated with psychological reactions like depression, anxiety, and significant stress that many relatives have to cope with. In Thailand, there are limited research studies on grief, especially in palliative settings.

To examine grief reaction, depression, anxiety, and coping of relatives after palliative patients’ death.

A multi-method design was applied. The authors completed the demographic data questionnaire, and the participants finished other measures which included the Hospital Anxiety and Depression Scale (HADS), the Inventory of Complicated Grief (ICG), and the Brief-Coping Orientation to Problems Experienced (Brief-COPE). The qualitative data from the focus group interview was analyzed with thematic analysis.

From the quantitative study, the mean scores of HADS for anxiety and depression subscales were 5.05 and 6.34, respectively, which indicated no anxiety and depressive disorders. The mean score of ICG was 19.51 with highest score on acceptance coping subscale. In contrast, the lowest score was on dealing with the substance subscale. There were significant correlations between anxiety subscale from HADS and ICG (r=0.73), depression subscale from HADS and ICG(r=0.85), and anxiety and depression subscale from the HADS (r=0.79). From the qualitative study, the factors associated with grief reaction could be thoroughly explained according to the perceived character of deceased, perceived character of relatives, relationship characteristics, disease, medical care, and support systems.

The correlations among grief reaction, depression, and anxiety of relatives after palliative patients’ death were high. The grief reaction was associated with many factors, including communication from medical personnel. This finding emphasized the importance of assessing the reactions after loss and associated factors in the relatives after palliative patients’ death. Also, evaluating the ways that the relatives use to cope with their loss, expressing empathy, and supporting the relatives to cope with loss in an adaptive way were recommended.

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An institutional ethical committee receives patients’ complaints regarding ethical side of physicians’ work, behavior and communication.

This case report presents an example of unethical communication by a psychiatrist toward patients serving a prison sentence, who sought a psychiatrist’s examination. The main objectives were to evaluate the physician’s insight into objections as well as adherence to ethical rules and regulations defined by ethical code, law and other related acts. Identity and other identification data have been modified in relation to the real case for confidentiality.

The case of a written anonymous complaint to the institutional ethical committee and the psychiatrist’s statement on the patients’ accusations were taken as data source.

Prisoners seeking psychiatrist’s help complained about the behavior of their attendant prison psychiatrist and stated that he insulted and humiliated them, shouted at them, was telling them horrible things (like “you are going to dye slowly”), was talking about them behind their back, ignored their disturbances, listened to several patients at the same time and revealed their diagnoses in front of other patients. The physician denied all the accusations in his feedback report, but stated that there have been conflicts with these patients. He concluded that he wondered why he could not communicate with them more roughly, that there was too much work to do and a lack of time. Furthermore, he worked too much for a small fee and he did not respect their problems while they constantly asked for something, and thus that they made a burden to the health system. Finally, he would not have even respond to an anonymous report.

In the presented case, there were many violations of ethical regulations and legal provisions. The psychiatrist made serious mistakes and misjudgments about numerous regulations of the Law on medical practice’s Article 21 regarding medical confidentiality (“Official Gazette” no. 117/08), Physician’s Oath Latest Version 2017, amended at the 68th Assembly of the World Medical Association as well as the Croatian Code of Medical Ethics and Deontology („Official Gazette” no. 55/08, pages 1-7, Article 1, paragraphs 1,2,3,4,5,6, Article 2, paragraphs 1,2,14, Article 8, paragraphs 1,2, Article 9, paragraph 12, Article 10, paragraphs 1,2) regarding obligation to preserve the noble tradition of the medical profession by maintaining high standards of professional work and ethical behavior toward the patient, respecting the patient’s rights in physical and mental aspects, taking care of his personal dignity and securing a medical secret. Additional efforts must be made by various stakeholders in health care so that ethical postulates are more strongly embodied in everyday physician’s work, without arbitrary interpretations.

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Rapid increase in the number of elderly patients in the world who need dialysis treatment. High age with dementio depression and anxiety negatively affects the outcome of hemodyalisis patients on (HD).

The goal is that patients get the ability to choose by themselves will they start HD treatment or not. The old population is often exposed doctors, family or guardian’s descisions that are against their wishes, either due to a lack of communication or lack of knowledge of working methods and procedures. Procedures can leave mental and physical consequences (suffering), no matter they were all done professionally.

We analyzed old (70-75 years) and very old patients (over 80 years). Cross-sectional analysis of survival of patients at the Hemodialysis (HD) Center with standard methods.

For patients who started hemodialysis at the age of 70 or more, the average survival was: 20.27±18.62 months, those who died 15.54±17.35, and living ones 30.29±17.85. 35% of the patients survived up to one year, two years 18%, and 3 or more 8%.

Most of old people that started dialysis treatment afterwards complained and concluded that it wasn’t necessary mostly because of the lack of communication, or simply it wasn’t their own decision.

Based on these facts, and knowing that these procedures can leave mental and physical consequences subjective assessment about starting dialysis treatment should respect, in the first place, patient’s decision.

The plan for medical procedure involves great ethical, legal and psychological engagment. It often occurs in people who, for some reason, are not in contact and do not adequately test reality.

We are of the opinion that it is, therefore, important that every person, while in mental, physical and social well-being, makes a decision about his medical treatment and communicates it to his family, but it is also very difficult because it touches on his own mortality and helplessness.

None Declared

Active euthanasia is currently permitted in Netherlands, Belgium, Colombia, Luxembourg, Canada, Australia and India. Assisted suicide is allowed in Switzerland, Germany, South Korea, Japan, as well as in the states of Washington, Oregon, Colorado, Hawaii, Vermont, Montana, California of the USA.

The right to die is considered to be a basic human right. In 2018, 2,357 euthanasia procedures were carried out in Belgium, most of them for the elderly. Factors that contribute to the decision to euthanize older people are: existential crisis; loss of autonomy, dignity and control; worry about future loss of autonomy, dignity, and control; lack of understanding of the processes of dying; concerns about medical intervention and treatment at the end of life; increasing disunity between generations; decline of people’s spiritual culture and religious faith. In the Netherlands, euthanasia is allowed from the age of 12, sometimes for infants up to two years old. Some countries allow assisted suicide of the mentally ill.

The possibility of suicide for people «who are tired of life» is discussed.

Investigation of the ethical aspects of the role of a psychiatrist in the commission of assisted suicide

In order to study ethical aspects of the role of a psychiatrist in assisted suicide, the materials of the Department of bioethics of UNESCO and the positions of the legislation of a number of countries were studied.

The decision about euthanasia is taken by a commission of 3 doctors, one of whom is a psychiatrist.

According to psychiatrists, the desire to die in a patient with a mental disorder should be considered the same as the desire of a patient with cancer.

The role of psychiatrists in euthanasia and assisted suicide is reversed. These are: the study of assisted suicides, assistance in their implementation and popularization, determination of legal capacity to permit suicide, creation of a psychotherapeutic space and providing psychological assistance to patients in the process of dying, writing of a prescription for a lethal drug, consulting patients and their families.

The role of psychiatrists in Russia is to prevent suicides and treat patients with suicidal tendencies. Assistance by a psychiatrist in the suicide is a critical problem in psychiatry.

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Simulation as a pedagogical strategy contributes to improving the acquisition, consolidation and retention of knowledge and is very attractive for students.

In simulation learning, students come into contact with real clinical practices, allowing them to develop personal, psychosocial, ethical and clinical skills, facilitating learning for decision-making.

The creation of different and complex simulation scenarios within the scope of Mental Health and Psychiatry (MHP) allows the empowerment of nursing students, through the anticipation and prevention of errors and the creation of training opportunities, which culminate in the development of critical thinking and reflective on the ethical dimension of caring for people experiencing mental illness.

To analyze the simulation as a strategy to develop ethical competences in MHP; To reflect on respect for autonomy, capacity for self-determination and dignity of the person; To reflect on care practices that promote respect and dignity for people experiencing mental illness.

After the careful design of the situation simulation scenario in MHP, the steps are as follows:

Prebriefing - transmit generic information about the scenario to the participants/students; request the participation of some students to assume the role of actors in the context they will encounter and prepare to start the case; explain to observers what will happen and the goals of the scenario.

• - Scenario development.

• - Debriefing - ask observers to analyse and reflect on positive aspects of performance; lead participants to analyse and reflect on their actions; investigate the basis of gaps/errors.

• - Reflection - facilitating students’ structured thinking (reflection-in-action and reflection-on-action); review learning.

• - Assessment - focus group interview; observation and/or filming.

The evaluation revealed that the use of a simulation scenario allows the connection between the theoretical contents of ethics (principles, dignity of the person, human rights, informed consent, …) with what they saw and experienced in the scenario; facilitates understanding of concepts, helps to internalize knowledge and retain information; favors reflection, development of critical thinking through discussion and argumentation; makes it easier to understand the relationship between the subject taught and reality; and the discussion of the situation helped to structure the thought.

The diversity of scenarios is interesting and useful, it allows understanding the different role of nurses in the hospital context and in the context of primary care.

It is concluded that the use of a simulation scenario in MHP is of great interest and usefulness for the development of ethical competences, allowing reflection on care practices that promote respect and dignity of the person with experience of mental illness.

None Declared

Sexual violence is a worldwide public health concern. Nevertheless, the psychopathology of perpetrators of sexual assault still nowadays poorly documented.

The aim of this study was to assess the characteristics of sexual aggressors with mental disorders.

It was a retrospective study that included a series of sexual aggressors examined in forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021. Data were collected from psychiatric expert reports.

The sample was exclusively composed of men with an average age of 37 years and 07 months (± 12.75 years). 54.4% of sexual aggressors suffered from mental disorder. Personality disorder was the most prevalent psychiatric disorder and the antisocial type was noted in 23.9% of cases.

Sexual aggressors suffering from mental disorder were more likely to commit rape followed by murder (p=0.05). They used physical violence far more than the others did (p=0.007) and they were more apt to threaten their victims with weapon during the assault (p=0.038). They were also more likely to abuse the power given by their professional roles (15,2 % versus 5,6 %; p=0.07). They more frequently attacked unknown victims (p=0.019).

More than half of sexual aggressors suffered from psychiatric disorder. Therefore, the detection and treatment of psychiatric morbidity among sexual aggressors may minimize the risk of recidivism.

None Declared

In Tunisia, Sexual assaults constitute a pervasive problem that concerns the health care system and the country’s judicial authorities alike.

The aims of our study were to estimate the incidence of sexual assault encountered in the context of forensic psychiatric assessment and to assess the criminological profile of sexual assault perpetrators.

We conducted a retrospective study of a series of sexual assault perpetrators examined in a forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021.

Over the period of 11 years (2010 to 2021), we collected 374 forensic psychiatric assessment files. Among them, 49 were those of sexual assaults (13.10%). It was a rape assault in 54.4% of cases. Aggravating circumstances have been noted in 87% of cases. These were mainly assaults on minors (54.3%) and assaults associated with physical violence (38.4%).

The victim gender was female in 63% of cases, with an average age of 21 years 9 months. and was among the relatives of the sexual assault perpetrator in 28.3% of cases.

Rape seems to represent a non-negligible proportion of the offenses motivating a forensic psychiatric assessment in Tunisia. Sexual assaults against minors are frequent, despite undeniable under-reporting.

None Declared

Consent to care remains the general principle and care without consent must be the exception. However, resorting to care without consent in psychiatry may be indicated when awareness of the disorders or recognition of the need for care is impaired. For this purpose, we have focused on the questions concerning the degree of applicability of this procedure of obligation of care in Tunisia.

The purpose of this study is to describe implementation measures of the obligation of care among patients in the psychiatric department of Monastir.

This is a retrospective, descriptive and qualitative study of five patients followed in the psychiatric department at the Fattouma Bourguiba University Hospital of Monastir between January 2020 and August 2022 who were subjects to the obligation of care with reference to Article 30 of Law 92-83 of August 3, 1992, amended by Law No. 2004-40 of May 3, 2004.

All patients in the study were males. Two out of five patients had a higher level of education. Two patients had a history of family psychiatric disorders. Two patients were being followed for schizophrenia, two others had schizoaffective disorder and one patient had a chronic delusional disorder. Only one patient had a duration of untreated psychosis of 6 years. Most of the patients had been hospitalized once to four times prior to their submission to article 30 of the obligation of care. Only one patient was hospitalized at the request of a third party, four patients were hospitalized by order of the court. Four out of five patients were treated with antipsychotic drugs (delayed-release form). After their submission to article 30, three patients were readmitted for decompensation due to treatment discontinuation, one patient did not consult the doctors, and only one of the five patients was present with his family at his post-treatment appointment.

what we deduced from our observation encourages us to work better on improving laws and training dedicated to psychiatric practitioners to optimize this judicial and therapeutic practice in our country.

None Declared

The legally incapacitated major is any person who, having acquired the legal majority, should therefore enjoy his rights, and face his social duties, but because of an alteration of his physical or mental faculties, is not able to provide alone for the safeguarding of his interests, nor to face alone his social obligations; there is, therefore, a need for protection which is the placing under guardianship.

To describe the clinical and sociodemographic profile of the subjects put under guardianship in the psychiatric services of Monastir.

This is a retrospective descriptive study that focused on 71 files of subjects examined in the context of psychiatric expertise of guardianship in the psychiatric department Fattouma Bourguiba of Monastir during the period from 10-02-2016 to 08-06-2022.

In total, we included 71 files of the subjects who were examined in the framework of the expert assessments of guardianship. The average age was 53 years. The predominance of males was noted with a sex ratio M/F = 1.5. Most of the patients were of urban origin; more than half (54.9%) were single with an average socioeconomic level for most of the patients (81.7%); 53.5% were illiterate and only 11.3% had a higher education level.

Among the somatic antecedents in our population, 40.9% had neurological pathologies: stroke 8.5%, epilepsy 7%, and dementia 9.9%. The psychiatric history (71.8%) was marked by intellectual disability (47.9%) followed by schizophrenia (28.2%).

Neuropsychiatric comorbidity was noted in 25.4%. The diagnoses retained at the time of the expertise were: intellectual disability (47%), followed by psychosis and dementia with similar percentages of 21%. The duration of the evolution of the symptoms in our population varied between 1 year and 60 years with an average of 22.56 years.

The request for guardianship was made by the siblings in 40.8% of cases, followed by the ascendants in 21.1%.

All the assessments took place at the hospital on a pre-arranged appointment and were formulated in French language.

The knowledge of the specificities of the different Tunisian laws governing guardianship is essential and the meticulous drafting of expert reports requires adapted training, which should be included in the basic training modules for psychiatrists.

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The logic behind the neuropsychological rehabilitation of the impulsive criminal is to treat the behavioral manifestations of these individuals as the product of a real pre-frontal syndrome, capable of causing deficits in the planning of behavior, in self-regulation, in the inhibition of impulsiveness and more generally in social and interpersonal skills. With the term prefrontal workout, literally “prefrontal workout” Eagleman (2011) refers to a real form of rehabilitation intended for subjects characterized by strong impulsive tendencies. Neurofeedback is used in prefrontal training. This technique mainly uses electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) as indicators of brain function.

The premise of prefrontal training is that through rehabilitation, and therefore repeated practice, the frontal areas of our brain can be trained in order to improve the “control” of subcortical circuits and limbic areas responsible for impulsive and potentially destructive behavioral forces. Although this rehabilitation proposal does not specifically concern deviant individuals, it is intended for subjects with impulsive tendencies and difficulty in repressing a stimulus-seeking behavior, skills that fall within the category of frontal functions.

It is possible that similar strategies can also be used effectively against deviant individuals, working to improve their ability to inhibit a behavioral tendency and reinforcing everything with real-time feedback. There is a very high incidence of attention deficit, hyperactivity disorder and related symptoms among people convicted of crimes, and a great many criminal acts involve impulsive behavior or loss of emotional control such as anger. Better control of behavior and emotions are among the most commonly reported outcomes of neurotherapeutic treatment.

Research and clinical experience also demonstrate the positive effects of neurofeedback with alcohol and drug abuse and depression, both common accompaniments of criminal behavior ( Fielenbach S. 2019; Margarita R. 2016; Konicar L. 2015).

Certainly, research in this field is at a preliminary stage, and the limitations of these techniques are numerous. There are, for example, several doubts about which is the best strategy for the patient to use to control mental activity and inhibit, for example, the search for the substance to which one is addicted. Although promising, the literature highlights sometimes conflicting results: in this regard, see the meta-analysis by Cortese and colleagues (2016) and the document published by Youcha and colleagues (2008).

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