Although defined heterogeneously within the literature apathy is classified as a multidimensional deficit with emotional, behavioral, and cognitive domains in which there is a decrease in self-motivated/goal-directed activity. Recently conceptualized as a syndrome but lacking a universal screening tool.

Review current knowledge on apathy and its best therapeutic approach.

Non-systematic review of literature through search on PubMed/MEDLINE following the terms “apathy”and“psychiatry”.

Apathy is amongst the most frequent symptoms of dementia and highly prevalent across different forms and stages of dementia, including mild cognitive impairment (MCI) as well as other neurodegenerative and psychiatric disorders such as Parkinson’s disease (PD), Schizophrenia, Depression and Brain Injury. Individuals with apathy have higher frequencies of cognitive impairment and are less likely to be compliant/respond to treatment for comorbid illnesses. Apathy reduces quality of life, increases mortality and leads to caregivers distress - often identified as the most burdensome symptom. Once treatment should favor dopaminergic neurotransmission, psychostimulants were considered. Methylphenidate showed encouraging results as well as dopamine agonists but both with limited evidence. Atypical antipsychotics(APs) seem beneficial compared to typical APs. Antidepressants did not improve symptoms and may even worsen them. Previously reported benefits of acetylcholinesterase inhibitors (AChEIs) were not replicated in recent studies except for rivastigmine in PD. Nonpharmacological interventions are also important.

Apathy occurs frequently in a broad range of neuropsychiatric conditions and considering its impact on patients´ quality of life more studies are needed to find an efficient treatment. A consensus regarding definition and screening tools would allow a better approach.

No significant relationships.

Being the parent of a child followed for a chronic pathology can require different resources and coping skills.

to determine the adaptation strategies of the parents of children monitored for adrenal insufficiency in the face of their children’s pathology

We conducted a descriptive cross-sectional study carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital between February 2019 and April 2020. We used a pre-established questionnaire collecting sociodemographic data and the strategies of coping using the Brief-COPE Board.

A total of 38 parents of children with adrenal insufficiency and 38 control parents participated in the study. The Brief-Cope board’s study of Coping strategies revealed that the strategies most used by parents of children with Adrenal insufficiency were, in descending order: religion (92.1%), support emotional (73.7%), distraction (63.9%), behavioral disengagement and acceptance (57.9%), instrumental support (52.6%), expression of feelings (50%), positive reinterpretation (39.5%), blame (38.9%), denial and humor (36.8%), active coping and planning (36.1%). On the other hand, those used by the control population were in descending order: religion (94.4%), distraction (84.2%), blame (78.9%), acceptance (72.2%) %), emotional support (69.4%), humor (63.9%), behavioral disengagement (61.1%), active coping (47.2%), expression of feelings (44 , 7%), planning (41.7%), instrumental support (30.6%), positive reinterpretation (22%), denial (19.4%).

Psychological support for the parents of children with chronic illnesses would be necessary to prevent parental burnout and improve their ability to adapt to their experiences

No significant relationships.

Ketamine is routinely used for anesthetic induction because of its dissociative properties. Recently, it has attracted attention as a rapid-acting anti-depressant, but other studies have also reported its efficacy in the management of diverse psychiatric pathologies previously resistant to treatment.

We aimed to review the efficacity of ketamine in the management of mental disorders.

We conducted a litterature review through pubmed database, using the following keywords: “mental illness”; “ketamine”;”depression”;”anxiety disorders”;”eating disorders”;”substance use disorders”.

Ketamine has primarily been used in psychiatry for people with treatment-resistant depression. Its efficacy in reducing suicidal ideation has been previously reported. Furthermore, Ketamine may be a potential therapeutic option for patients with treatment-resistant anxiety disorders, especially obsessive compulsive disorder (OCD) and post-traumatic stress disorder. It has recently been reported a rapid onset anxiolytic activity in treatment-resistant social anxiety disorder and generalized anxiety disorder. Besides, Ketamine use in subjects suffering from eating disorders was associated with a complete remission of severe anorexia nervosa with a return to normal weight and a decrease in body preoccupations. The use of ketamine alone or in combination with other therapies was effective in reducing alcohol and substance use, prolonging abstinence, reducing craving and enhancing motivation. ketamine in combination with motivational enhancement therapy may be an effective pharmacotherapy for initiating and sustaining abstinence from alcoholics

ketamine shows great promise as a treatment for several mental disorders. However, its possible side effects and short duration of efficacy limit its use. Further studies exploring longer-term outcomes and administration protocols are needed.

No significant relationships.

Tuberous sclerosis is a multisystem genetic disorder. It is associated with significant psychiatric comorbidity mainly autistic disorders, hyperkinetic disorders, depression and anxiety. It is rarely associated with psychosis and bipolar disorder.

To describe the case of a 34-year-old male with concomitant diagnosis of bipolar disorder and tuberous sclerosis.

Case report based on clinical records. Brief literature review using articles searched in the PubMed/MEDLINE database using the terms “tuberous sclerosis”, “bipolar disorder” and “neuropsychiatric”.

The patient presented at our Emergency Department 3 years ago with a mixed episode with psychotic symptoms with 1 month of duration. Prior history of two hypomanic episodes, but no depressive episodes. High baseline functionality. Sporadic use of alcohol and cannabis. No family history of psychiatric or neurological diseases. Diagnostic work-up showed no relevant results, aside from small calcifications in brain CT. He was admitted to our ward and medicated with aripiprazol (titrated up to 30 mg), leading to full remission of the clinical picture. The patient was referred to our outpatient clinic and stayed with medication for 1,5 years. One year after, he presented a sudden episode of mutism and perplexity with quick remission. The EEG wielded no relevant results. New brain CT showed signs of tuberous sclerosis. He was referred to Neurology and subsequent assessments, including brain MRI, led to the fulfilment of clinical criteria for tuberous sclerosis.

This case illustrates the possibility of concomitant diagnosis of bipolar disorder and tuberous sclerosis. The possible association between these disorders is discussed.

No significant relationships.

Kleptomania is characterized by recurrent failure to resist the impulse to steal items of little value despite the ego-dystonic impulse and awareness of the wrongfulness of the act. Its prevalence is considered to be 0.6–0.8% in the general population and it is mostly comorbid with other psychiatric disorders. Kleptomania is a disabling disorder since patients suffer from emotional distress and impaired functioning.

Although there is no cure, treatment may help prevent Kleptomania worsening and its negative consequences. We propose a review of the therapeutic approach to this disease.

Non-systematic literature review.

No effective treatment is available for Kleptomania. Better efficacy can be achieved by combining psychotherapy with pharmacotherapy. Different treatment interventions can be selected based on clinical similarities to other disorders, co-occurring conditions or behavioral core features. Patients with significant mood symptoms may benefit from mood stabilizers or antidepressants. For patients with shoplift cravings and/or family history of substance use disorders, Naltrexone may reduce symptoms. Stimulants may be useful for Kleptomania bassociated with Attention Deficit Hyperactivity Disorder impulsivity. Benzodiazepines are effective in tension relief when used as adjuvants, at the beginning of treatment. Electroconvulsive therapy should be reserved for patients with treatment-resistant symptoms and comorbid depression. Cognitive-behavioral therapy has replaced Psychoanalytic and Psychodynamic psychotherapies.

Treatment helps decrease disruption to the person’s life, preventing the intense shame, legal, social, family, and occupational repercussions of Kleptomania. Although pharmaceutical and psychosocial interventions are available, we still lack specific treatments for Kleptomania.

No significant relationships.

Looking back into history, infectious diseases played an important role in human history being responsible, in terms of pathologies, for more deaths than any other disease.

Considering that infectious diseases have a high rate of transmissibility, with an acute debut and sometimes with a fast evolution to exitus, the impact of the news on families of the departed patient diagnosed with an infectious disease can come as a shock. We conducted a literature review regarding the the psychological symptoms, moruning and staging of processing a loss using the international database.

We conducted a literature review regarding the the psychological symptoms, moruning and staging of processing a loss using the international database.

Processing the unexpected death of a family member needs not only the implication of the physician but also the counseling of a specialized psychologist which can help the families through all stages of loss and grief.

For the family of deceased patients in hospitals, mourning and depression are a reality that the psychologist and the attending physician face every day. The team of psychologists and medical doctors are facing cases of severe shock and depression in parents, varying with the age of the child and of the young adult, in cases with an acute or severe disease leading to death.

No significant relationships.

Neuropsychological methods for diagnosing neglect syndrome (NS) are focused on identifying the inability of patients to respond to stimuli localized in contralesional space. There are a large number of methods capable of diagnosing spatial neglect, but at the same time having various limitations and restrictions in their use.

To devise and to test universal diagnostic techniques for visuospatial neglect detection.

1) A.R. Luria test battery; Trail Making Test (Part A); the Bells Test; 2) Authors’ methods: the Puzzles Test, the Red Shapes Test. A total of 47 patients after stroke with right hemisphere damage participated in the study and were divided into a target (18 patients with NS) and a control (29 patients without NS) groups. The Puzzles Test consists of three tasks: turning over cards, completing a sentence using cards with letters, completing a picture. The Red Shapes Test consisted in the search for a variable number of geometric shapes. Objective indicators of the study: total task completion time, the number of left omissions.

The sensitivity of the tests to NS was examined using the Mann-Whitney U-test. Differences in the number of omissions and task completion time between patients with and without spatial neglect were statistically significant regarding all tasks: turning over cards (p=0.01), completing a sentence (p<0.001), completing a picture (p<0.001), finding geometric shapes (p<0.01).

The Puzzles Test and Red Shapes Test along with the foreign tests (the Bells Test, Trail Making Test) are sufficiently effective methods for spatial neglect detection.

No significant relationships.

Anthony Burgess’ novel ‘Clockwork Orange’ identifies the topical debates surrounding the use of aversion therapy (or aversive conditioning) as an effective treatment for addictive behaviours. Widely popularised in literature as ‘Ludovico’s Technique’, Burgess attempts to credit the misunderstanding and dramatization of its effects when the main protagonist is released from a prison sentence after undergoing this treatment.

We aimed to highlight the depictions of aversion therapy in modern popular literature.

A narrative review of the current literature concerning aversion therapy and Anthony Burgess’s novel ‘A Clockwork Orange’ was conducted. Emphasis on the misinterpretation of aversive therapies was noted.

Since the introduction of pharmacological alternatives and additional forms of psychological therapies, there has been a decline in the use of aversion therapy in recent decades. However, it is still effective when conceding the conditioning process. Likewise, its predecessor’ visual imagery’ is believed to be a more acceptable and effective form.

The depiction of aversion therapy in literature and media has played a role in shaping societal views on aversive conditioning techniques and the degree to which they are deemed acceptable forms of treatment. The “Ludovico Technique” featured in the novel ‘A Clockwork Orange’ and its film adaptation is arguably the most salient depiction of aversion therapy in popular culture.

No significant relationships.

Stress is part of the daily life of many people, especially in Western countries. Recent studies have shown that cortisol has been listed as the primary hormone linked to stress. Currently, to measure cortisol values there are only tests that quantify it at a determined time point, without taking into account its variability and its changing pattern over time, depends on the circadian rhythm and other stress-related factors.

This randomized clinical trial of the Hospital Clínic de Barcelona proposes to study the utility of accumulated hair cortisol concentration (HCC) as a measure to correlate the levels of this hormone over time with the stress suffered by the patient.

Patients are classified into two groups: a control group and an intervention group. In the second group, the participants will follow a mindfulness-based cognitive therapy (MBCT) with the aim of reducing stress and, consequently, cortisol levels.

The purpose of this study is to validate the utility of HCC in order to, retrospectively, obtain cortisol secretion curves as a measure of the level of stress of each individual and personalize the treatments. Simultaneously, we intend to present new perspectives for treatment in psychiatric disorders where stress predominates, such as generalized anxiety disorder (GAD) or major depression (MD), which are becoming increasingly important in our society.

HCC contributes to the practice of personalized medicine as it allows us to detect cortisol exposure in the months prior to obtaining the capillary sample, and thus to draw the trend of this hormone over time.

No significant relationships.

The internshipis a period in which the studentimplements what they have learned from their training to obtain or certification and to promote their professionalintegration, the difficulty of taking initiative and the lack of self-esteemrepresenting an obstacle to their training

This is a quantitative descriptive study conducted at the different placement departments among all 2nd-year students in all sections. Our data collection was done using two questionnaires administered, one for the supervisors and the other for the students.

Theoretical Framework: Theorist Patricia Benner

According to the results found, in oursample, thereis a predominance of females 89.17%, with a sex ratio of 0.121. 88.34% are aged between 20 - 21 years and an averageage of 22.4 years. According to the interpretation of the Rosenberg Self-Esteem Scale scores, 17.5% of the trainees have a “Very Low Self-Esteem”, 47.5% have a “Low Self-Esteem”, 25.83% have an “Average Self-Esteem”, and only 9.17% have a “High Self-Esteem”. In addition, more than half of the respondents, 53.33%, state thatthey “often” have difficultytaking the initiative in the traineeshipenvironment, while 30.83% do not have such difficulty but “rarely”. Indeed, 53.33% of confirmedsupervisorssaythatthey “often” have difficultytaking the initiative in the placement environment

It isnecessary to take into account these obstacles to the trainee’s training through better psychological supervision, which could be the first steptowardssolving the problem

No significant relationships.

Resilience has attracted much attention, not least since the pandemic. It is characterised by a person’s ability to bounce back from adversity. Although there is no exact definition of what adversity means, it assumes that the individual is aware of the event. Here, we would like to challenge this preconception by putting forward a case of an individual who shows remarkable resilience without being aware of his disadvantages.

We present a case of a fully-functioning middle-aged man with corpus callosum agenesis of which he has been unaware. We sought to demonstrate that personality traits which have been associated with resilience may not necessarily be characteristic of a resilient individual.

T.C. is a 44-year-old individual who enrolled as a healthy participant in a research study at the University of Cambridge, which involved cognitive and personality assessments and a structural brain scan.

T.C.’s psychological profile portrayed a well-balanced man who had attained a high level of education, stable employment, a healthy personal life and good community integration. T.C.’s cognitive performance fell well within normal ranges, but was superior in terms of self-control, as measured by the stop-signal task. To our surprise, he scored below-average on questionnaires of resilience and sense of coherence beliefs and reported subclinical tendencies of obsessive-compulsive behaviours.

Resilience does not require awareness of adversity. Our case report shows that resilience may present itself fairly normally and may go unrecognised in daily life. Hardship should not be limited to traumatic events but also include brain abnormality.

No significant relationships.

The term “Sexual and Gender Minorities” includes lesbian, gay, bisexual, transgender, queer, intersex and/or asexual populations. It was introduced in the MeSH Database in 2018. Mental health research on sexual and gender minority populations is gaining momentum.

To describe mental disorders among sexual and gender minorities.

This is a review of the literature via Medline. The database was searched using the keyword combination “sexual gender minorities” OR “homosexuality” OR “bisexuality” OR “transgender persons” OR “intersex persons” AND “mental disorders”. The filters applied were Full text, Meta-Analysis, Systematic Review and in the last 5 years.

A total of 59 articles were included. The lowest rates of depression and anxiety were reported among heterosexual people. Depressive symptoms, suicidality, interpersonal trauma exposure, substance use disorders, anxiety, and general distress have been consistently elevated among transgender and gender non-conforming people. Among transgender people, the prevalence of binge drinking ranged from 7%-61%. Depression was the most frequent mental disorder among sexual minority men (43.2%) followed by anxiety (32.2%), suicidal ideation (21.2%), suicide plans (6.2%) and suicide attempts (7.3%). Eating disorders were more frequent among sexual minority women compared with heterosexual peers. Compared with heterosexual youth, sexual minority youth had 123% to 623% higher odds of lifetime substance use, 82% to 317% higher odds of depressive symptoms and suicidality and 20% to 280% higher odds of violence victimization.

The prevalence of mental disorders is high among sexual and gender minorities for whom mental health prevention and treatment programs are needed.

No significant relationships.

Oral health behavior is based on an acquired experience and cultural traditions. University education may smooth out cultural differences in oral health practice.

Our goal is to study self-reported oral health attitudes and behavior of university students and the cultural basis for it.

We used the English version of the Hiroshima University Dental Behavioral Inventory to carry out an online survey of 136 university students of Morocco and Russia.

Over half of the students (60.3%) do not feel anxious when visiting a dentist. Most of them take care of their gums (41.2%), teeth color (49.3%) and the degree of their cleanness (38.2%). The overwhelming majority of the students brush their each tooth very thoroughly (62.5%), they regularly examine their teeth in the mirror after brushing them (90.4%). They are well aware that tooth brushing alone cannot prevent a gum disease (63.2%), and they feel concerned about the possibility of having bad breath (73.6%). At the same time, over half of the students (61.7%) put off their visit to a dentist until they have a toothache, which is a negative behavioral factor. We did not reveal any gender or cultural differences between the students of the two countries, which can be regarded as a universalization factor of oral health behavior in young people who get higher education in universities.

The majority of the surveyed Russian and Moroccan university students have similar patterns of oral health attitudes and behavior. This assumption needs verification on a larger sample of students.

No significant relationships.

The new adoption law, which was introduced in Greece in 2018, brought radical changes in adoption.

This presentation aimed to investigate the emotions of the prospective stepparents, based on the changes which were effectuated by the new law of adoption.

This survey was conducted through mixed methodology. Quantitative research was addressed to investigate the emotions of the to prospective stepparents. Qualitative research was addressed to social workers and its goal was to depict their opinion about the new law and the prospective stepparents’ expressed emotions.

The findings of the survey have demonstrated that the stepparents had a variety of emotions that changed throughout the adoption process. The dominant feelings of parents at the first visit with the social worker were stress and anxiety. However, at the end of the training process, these feelings were replaced by confidence and impatience. This emotional rotation of prospective stepparents was confirmed in the social workers’ interviews. In addition, social workers interviews highlighted the importance of the amendment of the old law of adoption’s process.

To sum up, this research has shown the importance of the new law and therefore the significance of its right application from all children’s placements in Greece. Nevertheless, it seems that due to the recent application of the new law, many placements have not yet complied with it and therefore there is urgent need for reinforcement of its application, according to the guidelines of the European Union that demanded gradual deinstitutionalization using the alternative types of child care.

No significant relationships.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis commonly begins with a prodromal phase characterized by flu-like symptoms, subsequently the patients experience a rapid deterioration with psychiatric symptoms that may include anxiety, irritability, insomnia, paranoia, aggression, auditory or visual hallucinations, sexual disinhibition, mania, cognitive disorder, and psychosis; seizures; motor and autonomic dysfunction. The triggers of the disorder comprise viral infections, tumors, and other unknown factors. Taking in count the prominence of psychiatric symptoms, it is relevant to rise the question whether patients with anti-NMDA receptor encephalitis are being misdiagnosed with psychiatric disorders.

Non-systematic literature review of the relationship between anti-NMDA receptor encephalitis and psychiatric disorders.

From the review performed, 2 studies stand out: In one study, 459 serum samples for NMDA receptor antibodies were evaluated. The analysis compared samples from patients diagnosed with schizophrenia, major depressive disorder, and borderline personality disorder with nonpsychiatric controls. In another study, serum was obtained prospectively from a cohort (n = 46) of patients at first presentation of psychosis and NMDA receptor antibodies were measured.

In the first study, the authors found that 9.9%, 2.8%, and 0% of patients with schizophrenia, major depressive disorder, and borderline personality disorder, respectively, were antibody positive. In the second study, it was found that 7% of the patients were serum NMDA receptor antibody positive.

It is unclear yet if patients with primary psychotic disorders have higher rates of pathogenic NMDA receptor antibodies. More evidence is needed to study this relationship.

No significant relationships.

Psychiatry is not immune to the effects of trends and fads, which are ideas that elicit short-lived enthusiasm, are quickly adopted, and abandoned when they fail to live up to expectations. Trends meet a deeply felt need to explain, or at least name, what would alternatively be unexplainable human suffering.

The authors aim to explore the trends and fads that have occurred in psychiatric diagnostic and treatment throughout history and assess if any modern trends can be identified as well as assessing the effects or consequences of these.

The authors conducted a non-systematized literature review with focus on those articles most pertinent to the topic in question.

The literature demonstrates that fads and trends not only plague fashion and diet, but also psychiatry. Trends in psychotherapeutic options can be observed by the swing from psychoanalysis to psychopharmacological focus. Overdiagnosis is one of the consequences of these trends, and can be seen from hysteria, schizophrenia, multiple personality disorder, attention-deficit and hyperactivity disorder to gender identity disorder. These trends impact the way diagnosis are made and the treatments implemented.

Fads in psychiatry have occurred not only on the edge, but in the very mainstream of theory and practice. A balance is called for, with caution needed in order not to fall into the temptation of the fad, however, an open mind should also be maintained when cutting-edge treatments and theories emerge. The sensible antidote to falling for fads and trends in psychiatry is commitment to evidence-based medicine.

No significant relationships.

The aim of this study is to investigate mobbing in the Hospitals of Etoloakarnania, Greece. Additionally, this research aims to find out which coping strategies are used by health care professionals who have suffered mobbing and how their quality of life has been affected.

This research aims to depict mobbing phenomenon’s extent and investigate the coping strategies and quality of life of working staff, victims of mobbing.

The research methodology was based on two questionnaires: LIPT scale and the scale of assessing bullying management strategies, as well as demographic data, which were answered by 130 people. A sufficient sample for the needs of this study to produce comparable results with the existing literature.

Mobbing is observed to a large extent of 83.8% , which, however, seems to be at lower levels in relation to corresponding researches abroad. In addition, the majority of respondents who appear to have been harassed at work are mostly women (78.5%), which seems to be in line with global studies. Τhe consultants and the supervisors take advantage of their position of power and impose or change duties on other staff (45.3%), in order to punish their subordinates, exacerbating the phenomenon of mobbing, also. Finally, the participants recognize the phenomenon and look for the majority of positive ways of action (65%), while they do not resort to non-constructive ways of solving the problem.

Mobbing is a serious phenomenon that affects working staff’s mental health and quality of life. Policies should address effectively this deleterious aggressive behaviour.

No significant relationships.

There have been reports of myopathic dysfunction with creatinine kinase (CK) elevation associated with neuroleptics, particularly, in clozapine-treated patients. The patients in these reports did not have any other clinical symptoms or signs indicative of neuropleptic malignant syndrome. Myopathic dysfunction was supported by the presence of CK elevations and either proximal limb weakness or fatigue, characteristic electrophysiologic abnormalities, or both. It has also been reported that CK elevation is neither dose nor treatment-duration dependent. The underlying mechanism is still unknown although it has been postulated that it is associated with cytochrome P450 interactions and/or calmodulin antagonism.

To report a case of elevation of CK during treatment with clozapine.

The authors report a case of elevation of CK during treatment with clozapine. A non-systematic review was conducted by searching the PubMed database, using the terms “clozapine”, “myotoxicity”.

A 36-year-old man was admitted after abandoning treatment with clozapine. During the titration of the medication, he developed complaints of muscle fatigue in conjunction with an elevation of CK. CK levels normalized after intravenous hydration and with dose reduction. Furthermore, CK levels would increase with clozapine re-titration.

Clozapine has numerous side effects. Myopathic dysfunction with CK elevation is a possible side effect which could have serious consequences such as renal impairment. In such cases, appropriate treatment should be implemented. Therefore, clinicians should be aware of this potential side effect.

No significant relationships.

Psychosis in Alzheimer’s disease has an incidence of ˜ 10% per year. Recent work has focused on the presence of psychosis in people with mild cognitive impairment, as a risk factor for the development of Alzheimer’s disease.

To Study a case of Alzheimer’s disease presenting psychotic symptoms

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology.

A 40-year-old goes to the emergency room due to hetero-aggression at home. He says that his father steals his money and prostitues have been hired in his house. The patient is oriented, partially collaborative and approachable. Psychomotor restlessness is observed. He has self-referral delusions, auditory hallucinations and insomnia. Provisional diagnosis of acute psychotic episode made and low dose risperidone was prescribed. During his stay on the hospital Ward, sedation, recent memory alterations, spatio-temporal disorientation lack of initiative and disorganized behaviors appear. Risperidone is withdrawn and complementary test are performed. Imaging tests show temporal and frontal atrophy. Increased TAU protein and low levels of amyloid in CSF are found. Brain biopsy is +. His mother died of Alzheimer’s disease with 36 years-old and another affected brother with 42 yeras-old. The definitive diagnosis is Alzheimer’s disease and genetic studies are currently being carried out.

Alzheimer’s disease can debut with psychosis. It is important to investigate family history of patients who begin with memory loss in the context of psychosis

No significant relationships.

Esketamine is a novel antidepressant approved by the FDA in 2019 in the form of an intranasal spray, recommended for Treatment-Resistant Depression (TRD). The intranasal spray system appears to be more manageable than intravenous ketamine infusion. It contains ketamine’s S- isomer which is four-fold more potent for the NMDA receptor.

The aim of this case series is to describe our clinical experience in the use of Esketamine.

6 TRD patients (3 men; 3 women) were recruited in San Raffaele Turro Hospital from March 2021. All patients (2 bipolar and 4 unipolar) were diagnosed with a Major Depressive Episode according to DSM-5 criteria, resistant to at least two antidepressants. Initially, Esketamine was administrated twice weekly for one month; afterward, it was administrated once weekly for a month; finally, it was administrated once weekly or every two weeks for a month. Clinical scales (HAM-D, YMRS, SSI, HAM-A, MADRS, CADSS) were administrated to assess symptoms and sides effects before and after each administration on a weekly basis.

Three patients out of six showed an improvement in depressive symptoms: two patients had remission (final HAM-D score < 8); one patient had a clinical response (final HAM-D score < 50 % respect baseline value). Three patients withdrew the treatment: two for perceived inefficacy, after 16 and 19 administrations, one for personal reasons.

The use of Esketamine in our TRD patients showed good effectiveness and tolerability but randomized controlled clinical trials are needed to confirm our findings.

No significant relationships.