Alcohol and illicit drug use are highly prevalent among the homeless population. Religiosity and spirituality (RS) have been widely associated with lower substance use. However, evidence of this relationship among the homeless is still scarce.

To assess the association between RS and the use of alcohol and illicit drugs among the homeless population of a large Brazilian urban center.

This cross-sectional study was conducted in São Paulo, Brazil. Aspects such as spirituality (FACIT-Sp12), religiosity (P-DUREL), religious-spiritual coping (Brief-RCOPE), and self-applied questions about current substance use (alcohol and illicit drugs) were evaluated. Adjusted Logistic Regression models were performed.

A total of 456 homeless individuals were included, with an average age of 44.5 (SD=12.6) years. More than half of the participants used alcohol (55.7%) weekly and 34.2% used illicit drugs weekly. The adjusted Logistic Regression models identified that aspects of RS were associated with a lower propensity for alcohol and illicit drug use, whereas negative religious-spiritual coping strategies were associated with a higher propensity for the use of both.

The prevalence of alcohol and illicit drug use among participants was high. Positive RS and religious-spiritual coping were significant protective factors against the use of these substances. Conversely, negative religious-spiritual coping strategies were associated with risk factors.

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Important goals of substitution therapy include: reducing the desire to use opioids - methadone enters the brain with a minimal euphoric effect, reduce the desire to use opioids, allowing to avoid the risk of overdose and control their addiction; prevention of withdrawal syndrome; improving the quality of life - can contribute to the restoration of patients, allowing them to return to a normal life, improve their social, professional and family situation; reducing the risk of transmission of infections HIV and hepatitis; reducing crime - control addiction can reduce related crime and to illicitly obtain opioids; psychosocial support helps patients develop coping strategies and increases their chances of long-term recovery.

The goal of substitution therapy is not to completely get rid of addiction, but it can help stabilize the patient’s life and facilitate the recovery process.

Many patients receiving MT also have mental disorders such as cognitive decline, depression, anxiety, PTSD, or even bipolar disorder. These conditions can greatly affect the course and results of treatment.They may also have problems with employment, housing, family conflicts, and legal issues.

In the course of the study, 134 patients aged 26 to 64 years (105 men and 29 women) with a diagnosis of opioid addiction and receiving methadone therapy were examined. Of them, 48 patients had a period of stay at MT of up to three years and 86 – more than three years. The Montreal Cognitive Scale (MoCA) was used to assess comorbid cognitive impairments. The WHOQOL-BREF questionnaire was used to assess the quality of life.

The range of indicators of cognitive functions varied from 21 to 29 points (average - 25.3). 61 patients (46%) showed a result of 26 and above, indicating the absence of cognitive impairment, 51 patients (38%) received from 24 to 21, indicating moderate cognitive impairment. 22 patients (16%) had borderline indicators.

When assessing the level of quality of life, indicators of physical and psychological components varied from 12 to 31; self-perception in the range from 10 to 27 points; microsocial support from 3 to 14 points; social well-being from 11 to 36. In general, the level of satisfaction with the quality of life was in the range of 38-83%.

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Opioid addiction therapy should be consist of an assessment of physical and psychological status, comorbid disorders, quality of life, etc. We can see, MT does not significantly affect the cognitive functions. The differences in the assessment of the quality of life were noted in the components of microsocial support and social well-being, which indicates the vulnerability of patients in these areas. Duration of opioid dependence, availability of psychosocial support, presence of comorbid conditions affect the quality of life. It is important that treatment is tailored to individual needs of patients.

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Benzodiazepine use disorder (BUD) has been associated with the presence of suicidal ideation (SI) in general population. It seems there is an overall increase in the risk of attempting suicide due to the increase of impulsivity, rebound and withdrawal of those who use benzodiazepines(1). However, this association has been scarcely studied.

To explore the prevalence, clinical features and factors related to lifetime SI in adults with BUD.

A cross-sectional study was conducted in an outpatient center for addiction treatment between 01/01/2010 and 12/31/2021. Adult patients who met criteria for active BUD were included. Patients with language barriers, cognitive impairments and those who were participating in any clinical trial were excluded. All patients were evaluated with an ad-hoc questionnaire, EuropASI (European Addiction Severity Index), BDI (Beck Depression Inventory) and HRQoL SF-36 (Health-related quality of life according to SF-36). Univariate and bivariate analyses were performed comparing BUD patients with or without SI.

554 patients were included (65.2% males; M age 42.6±12.6 years). SI was reported in 57.2% of the patients. Regarding the sociodemographic variables, any type of lifetime abuse was correlated with SI (67.8%, 73.5% and 77.8% of the patients with emotional, physical and sexual abuse respectively). Considering the different psychiatric features studied, having any psychiatric diagnosis increased SI up to 64%. Depressive and cluster B personality disorders were the ones with a higher presence of SI (67.1% and 68.1% respectively). Anxiety and cluster A personality disorders had also higher proportions of SI (56.1% and 58,7% respectively). Regarding the different assessment instruments used, a higher punctuation on BDI score was seen in the group of patients with SI (23.73±12.86). The scores also showed a worse perception of the mental quality of life of those people with SI, measured by HRQoL (13.76 and 36.82±31.93 in patients with SI and no SI respectively). Considering the EuropASI, there was an increased proportion of SI in those patients with a worse familiar situation (0.44±0.30), a higher alcohol consumption (0.26±0.28) and a worse psychological condition (0.48±0.24).

The prevalence of SI in patients with BUD is significative and is related to several clinical factors. Those factors should be taken into account in daily clinical practice, research, and any health policies on suicide. Further research should be developed.

1. Dodds, T.J. ‘Prescribed benzodiazepines and suicide risk’, The Primary Care Companion For CNS Disorders 2017; 19(2).

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Adherence to treatment for addictive disorders remains a clinical challenge. Despite detoxification admissions being scheduled and initiated voluntarily by the patient, several factors may contribute to treatment discontinuation.1 Understanding these factors will enable the development of specific interventions for a more effective approach.2

To identify and analyze the relationship between specific clinical factors and voluntary treatment discontinuation.

An observational and descriptive study was conducted using a retrospective database of 1146 patients admitted to the “Hospital Universitari Vall d’Hebron” Detoxification Unit between June 2008 and December 2019. Bivariate analysis was conducted to identify individual associations between clinical factors and voluntary discharge. Subsequently, a multivariate analysis was performed to assess the combined influence of these factors while controlling for potential confounding variables.

A total of 135 patients (11.8%) requested voluntary discharge. Significant differences were found between the voluntary discharge and non-voluntary discharge groups in patients with dual diagnosis (91.1% vs 80.9%, p<0.0001), specifically the presence of psychotic disorder (18.7% vs 12%, p<0.05) and cluster B personality disorder (66.7% vs 31%, p<0.0001). Significant associations were also observed with prior detoxification admissions (64.5% vs 54.1%, p<0.05), heroin as the main admission substance (29.6% vs 13.3%, p<0.0001), lifetime use of more than three substances (65.3% vs 45.3%, p<0.0001), and pre-admission binge-pattern substance use (72.1% vs 51.4%, p<0.0001). A significant relationship was found with therapeutic discharge in the diagnosis of major depressive disorder (14.6% vs. 24.8%, p<0.05), admission for alcohol detoxification (25.9% vs. 42.8%, p<0.0001), and participation in group therapy during admission (27.4% vs. 49.9%, p<0.0001).In the multivariate analysis, it was found that cluster B personality disorder (p<0.0001), heroin as the primary substance of admission (p<0.05), and pre-admission binge-pattern substance use (p<0.05) were independently related to voluntary discharge.

Cluster B personality disorder, admission for heroin detoxification, and pre-admission binge-pattern substance use are factors associated with voluntary treatment discontinuation.

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Brain maturation is associated with adolescent socio-cognitive development. The lateral posterior region of the cerebellum plays a critical role in higher cognitive processes, and deviations of this region are associated with autism-related behaviors. Hence, it is plausible that developmental changes in this region of the cerebellum during adolescence are different along a variation in autistic traits. Additionally, its difference may be moderated by parental age at birth and weight growth during infancy, which have effects on brain development.

The aim of this study was two folds: (1) to test whether cerebellar development during adolescence is different along a variation in autistic traits (2) to test whether parental age at birth and weight growth during infancy moderate the results of (1).

Longitudinal study was conducted over a 6-year period with 256, 230 and 187 participants ranging from 10.5 to 17.6 years, observing adolescent development respectively at 2-year time periods. We undertook a detailed investigation into differences in the lateral posterior region of the cerebellum volume. The 50-item Autism-Spectrum Quotient (AQ) was rated by primary parents. Weight growth and parental age were evaluated using maternal and child health handbook records. A multiple regression analysis was performed to examine whether AQ subscales, sex, and their interactions affected cerebellar development. Moderation analysis assessed whether parental age and weight growth moderated associations between cerebellar development and autistic traits. All participants provided written informed consent, and the study was approved by the Ethics Committee (No.10069).

Interactions between sex and attention switching and sex and attention to detail were significantly associated with cerebellar development in the bilateral gray matter (GM) and white matter (WM) of Crus I and Crus II (Fig1, 2). Simple slope analyses showed that the slopes of cerebellar development were significant for girls (pFDR < 0.001). Although no significant interaction was found between them, the main effect of attention to detail was significantly associated with cerebellar development in WM of VIIB (pFDR = 0.006). Further, moderation analysis found that the association between the cerebellar development and autistic traits were significantly moderated by maternal age; the magnitude of its effect was significant for high maternal age in boys (pFDR = 0.036, Fig3). Paternal age, early (0-9 months) and late weight growth (4-18 months) also moderated associations between them, however, no significance remained after FDR controlling.

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There are significant associations between cerebellar development during adolescence and autistic traits, and its pattern of association can be moderated by parental ages at birth and weight growth during infancy in a cerebellar region- and sex-specific manner.

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Parental Reflective Functioning (PRF) refers to parents’ ability to view their children’s and their own behavior by considering internal mental states, such as thoughts, desires, and intentions. Depression has been described as compromising reflective functioning in female samples, whereas other studies have not detected differences in RF between depressed and non-depressed mothers.

We aim to study whether a group intervention focused on postpartum depression, which we have already observed to cause significant changes in the mother-child bond and the severity of depressive, also improves parental reflective functioning.

To that end, we analyzed pre-post data from two different groups (N=12), composed of mothers who had been clinically diagnosed with postpartum depression. They received the 6-week Mothers & Babies Program© and completed the Parental Bonding Questionnaire (PBQ), the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Reflective Functioning Questionnaire (PRFQ) before and after group therapy. Pre-post data from the PRFQ were analyzed using the repeated measures t-test. The correlation between changes in the three questionnaires was also analyzed using Pearson’s correlation test.

Significant changes were observed in the Pre-Mentalization Modes (pre=2.37±.457, post=2.03±.520, t=2.0206, p=0.027) and Certainty About Mental States (pre=2.87±1.141, post=3.68±.908, t=-2.814, p=0.010) subscales of the PRFQ, with no significant changes in the Interest and Curiosity subscale (t=-.516, p=0.309). A significant correlation was also observed between pre-post change in EPDS scores and pre-post change in the Certainty About Mental States subscale of the PRFQ (r=-.640, p<.05), while no significant correlations were observed with the rest of the PRFQ subscales, nor with the PBQ.

A brief cognitive-behavioral group therapy developed specifically to treat postpartum depression improves pre-post scores on the Pre-Mentalization (lower post- than pre- score) and Certainty About Mental States (higher post- than pre- score) subscales of the PRFQ. Although a control group is needed to determine the actual effect of the intervention, as time could also play a role in the observed changes, this is an encouraging result. Moreover, the improvement obtained in Certainty About Mental States is inversely correlated with the pre-post changes observed in the EPDS, meaning that the greater the improvement in depression, the greater the improvement in the aforementioned subscale of the PRFQ. A larger sample is needed to assess a hypothetical mediating effect of depression in the observed change.

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Problematic smartphone use is twice as common among teenagers as it is among adults. Smartphone addiction is associated with anxiety, depression, attention deficit disorder, impulsivity, and sleep problems, among other issues.

To assess whether interpersonal relationship problems mediate the relationship between smartphone addiction and depression among adolescents (ages 12-17) currently enrolled in middle and high school.

A cross-sectional study was conducted among 653 middle and high school students living in Wonju, South Korea between September 1 and November 30, 2019. Depression was measured by Center for Epidemiologic Studies Depression Scale (CES-D). In order to evaluate smartphone addiction, the Smartphone Addiction Scale Short Form Version (SAS-SV) was used. To examine interpersonal problems, the Korea Inventory of Interpersonal Problems Circumplex scale (KIIP-SC) was employed. We used the dplyr package to check for skew, kurtosis, and create density plots. Scatterplots and Pearson correlation analysis were used to examine the relationships between the main variables. For the mediation analysis, we used the 8 sub-scales of KIIP-SC (Domineering, Vindictive, Cold, Socially avoidant, Nonassertive, Exploitable, Overly Nurturant, Intrusive) as mediators and conducted a mediation analysis with 10,000 bootstrap samples using the lavaan package in R, version 4.2.2. Each analysis was evaluated based on a 95% confidence interval to determine significance.

Depression, interpersonal problems, and smartphone addiction exhibited significant positive correlations with each other. The direct effect of smartphone addiction was found to be significant. The association between depression and smartphone addiction was mediated by the KIIP-HI (Nonassertive), the KIIP-JK (Exploitable) and the KIIP-NO (Intrusive).

Interpersonal problems mediate the relationship between depression and smartphone addiction. Identifying the high-risk group is essential for treatment strategy development.

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Existing systematic reviews have suggested mixed effects of the Covid pandemic on the mental health of children and young people. Those with pre-existing mental health and neurodevelopmental conditions have been suggested to be disproportionately affected, but this has not been meta-analysed. Most reviews of studies in clinical populations to date only include cross-sectional studies during the first lockdown or longitudinal cohorts up to early 2021, which limits our understanding of causality and long-term effects. To our knowledge, this is the first systematic review and meta-analysis to examine the longitudinal impact of the pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions.

To compare 1) mental health pre versus during Covid, and 2) mental health during Covid.

Medline, Embase, APA PsycInfo, and Global Health databases were searched up to August 2023. Longitudinal studies reporting mental health outcomes in children and young people (≤18 years old) with pre-Covid mental health and/or neurodevelopmental conditions were included. Cohorts were deemed eligible if children and young people were diagnosed using a diagnostic assessment, scored above clinical threshold on validated measures, or attended mental health services pre-Covid. Outcomes included internalising, externalising, and other symptoms. Studies were narratively synthesised by symptom category and meta-analyses performed where number of studies reporting the same outcomes were sufficient (≥5).

6,083 records were identified and 21 studies (N=2,617) were included. These widely differed in country, setting, diagnosis, outcome, and timepoints under study. The narrative synthesis highlighted mixed findings in mental health changes during the pandemic for all three symptom categories showing increases, reductions, and no changes. Only studies reporting changes in internalising symptoms pre- versus during the pandemic were in sufficient number to be amenable to meta-analysis.

Our findings suggest the pandemic’s impact on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions were complex and varied. We highlight an urgent need for longitudinal Covid research on long-term mental health outcomes in this vulnerable group. Understanding risk factors and longitudinal trajectories is warranted to guide clinical practice and policy.

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Therapy of adolescent depression is accompanied by a number of difficulties associated with the influence of the age factor, which include the following aspects: social - with the possibility of forming a fear of stigmatization, biological – with low tolerance of psychopharmacological agents due to the immaturity of the functional systems of the body, psychological – with a combination of oppositional behavior of adolescents and their desire to “be like everyone else”. All these factors may lead to a decrease in patients’ compliance in the treatment of adolescent depression and premature refusal to continue treatment, which may provoke a relapse of the disorder.

To assess the adherence of adolescent patients with a first depressive episode regarding the continuation of therapy after discharge from the hospital.

124 patients (average age – 19.4) were examined after discharge from the hospital where they were treated for a depressive episode (according to ICD-10: F32.1, F32.2, F32.38, F32.8). The severity of depression during hospitalization and at discharge was assessed according to the HDRS scale. During hospitalization, 45.9% of patients (n=57) were diagnosed with severe depression (HDRS score of more than 24), 54.1% (n=67) were diagnosed with moderate depression (HDRS score of 17-23) (Zimmerman M. et al. JAD 2013; 150(2):384-8). At discharge, 35.5% of patients (n=44) had moderate depression, 38.7% of patients (n=48) had mild depression (HDRS score of more than 7-16) and only 25.8% of patients (n=32) had no depression (HDRS score of less than 7 points). This indicated the need to continue therapy after discharge. The degree of adherence to therapy and the main reasons for its refusal were analyzed using the Medication Compliance Scale (Lutova N. NIPNI, 2007; 26).

The average duration of treatment continuation in patients with adolescent depression was 7.4±9.6 months. At the same time, 42 patients (33.9%) refused to continue therapy within 30 days after discharge from the hospital. 15 patients (12.1%) turned out to be fully compliant, following the doctor’s prescriptions. The main reasons for refusing therapy were: negative attitude to the fact of receiving therapy and visiting a psychiatrist (n=50, 40.3%), the development of side effects of therapy (n=46, 37.1%), negative attitude of relatives to the continuation of therapy (n=11, 8.9%), and negative attitude to the attending psychiatrist (n=2, 1.6%). In general, formally, the average duration of continuation of therapy coincides with the recommended 6-12 months (Sim K. et al. IGN 2015;19(2) pyv076), however, it is noteworthy that some patients tend to self-cancel therapy without the approval of the attending physician.

The results indicate a low level of adherence to therapy in patients with adolescent depression and require additional measures to improve it.

The work was carried out with the financial support of the RSF grant 22-15-00437.

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The existing body of evidence on the association between maternal diabetes and attention deficit/hyperactivity disorder (ADHD) in offspring is inconsistent and inconclusive. Thus, we need to synthesise the available evidence to examine the association between maternal diabetes and risk of ADHD in offspring.

The aim of this meta-analysis was to examine the association between maternal diabetes and the risk of ADHD in offspring.

We conducted a comprehensive search across PubMed, MEDLINE, EMBASE, Scopus, CINAHL and PsychINFO databases from their inception to September 8th, 2023. The methodological quality of the included studies was evaluated using Joanna Briggs Institute (JBI) and Newcastle-Ottawa Scale (NOS). Between-study heterogeneity was assessed using I2 statistic and potential publication bias was checked using both funnel plot and Egger’s test. Randomeffect model was used to calculate the pooled effect estimates and subgroup, sensitivity, and meta-regression were further performed to support our findings

Twenty observational studies (two cross-sectional, five case-control and thirteen cohort studies) were included in this systematic review and meta-analysis. Our meta-analysis indicated that intra-uterine exposure to any type of maternal diabetes was associated with an increased risk ADHD in offspring [RR=1.33: 95 % CI: 1.23–1.43, I2=79.9%]. When we stratified the analysis by maternal diabetes type, we found 17%, and 37% higher risk of ADHD in offspring exposed to maternal gestational [RR=1.17: 95 % CI: 1.07–1.29] and pre-existing diabetes [RR=1.37: 95 % CI: 1.27–1.48] compared to unexposed offspring respectively. Results of subgroup and sensitivity analysis further supported the robustness of our main finding.

Our review suggested that exposure to maternal diabetes increased the risk of ADHD in offspring. These findings underscore the need for early screening and prompt interventions for exposed offspring.

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In Europe, associations between different types of nonparental care and internalizing and externalizing behaviors in children have not been adequately explored (Gialamas, A et al. J Epiemiol Community Health. 2015). Internalizing and externalizing symptoms in childhood can have lifetime repercussions, thus understanding their risk factors and the potentially protective role of family policies is highly relevant.

To explore the associations between different types of nonparental care prior to primary school and internalizing and externalizing behaviors across young adolescence.

Six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network (EUCCN) were included in the study. A two-stage individual participant data (IPD) meta-analysis on complete cases was performed. Linear regression models (one for each age group: 5-6 years, 7-9 years, 10-13 years) were applied in each cohort separately and then cohort-specific coefficients and standard errors were combined using random-effects (restricted estimate maximum likelihood (REMD) meta-analysis to attain overall effect estimates. Data were then stratified by socioeconomic position and sex.

There were 74 453 parent-offspring dyads to study children’s internalizing difficulties and 72 462 parent-offspring dyads to study children’s externalizing difficulties. Center-based care attendance was associated with lower levels of internalizing difficulties 5-6 years [-1.13 (95%CI:- 2.68, 0.42), p=0.15]; 7-9 years [-1.38 (95%CI:- 2.85, 0.10), p=0.07]; 10-13 years [-1.06 (95%CI:- 1.95, -0.17), p=0.02]. Children who attended other forms of nonparental care appeared to have higher levels of internalizing difficulties: 5-6 years [0.02 (95%CI:- 1.96, 2.01), p=0.98], 7-9 years [0.91 (95%CI:0.23, 1.58), p=0.009]; 10-13 years [0.52 (95%CI:- 0.23, 1.27), p=0.17]. Other forms of nonparental care (not including center-based care) had a positive association with externalizing symptoms : 5-6 years [2.45 (95%CI:0.35, 4.55), p=0.02]: 7-9 years [2.78 (95%CI: 0.60, 4.95), p=0.01];10-13 years [1.93 (95%CI:-0.45, 4.32), p=0.11]. We found some evidence of effect moderation by the child’s sex and socioeconomic position (SEP).

The results suggest that center-based care may protect children from developing internalizing behaviors, but other forms of nonparental care may put children at more risk of developing more internalizing and externalizing behaviors. Also, factors such as sex and SEP may interact with nonparental care in influencing externalizing behaviors.

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Beekeeping is a peculiar activity able to connect people both to nature and to other people. Extant research shows how it provides beekeepers with meaning, opportunities for learning, and a sense of connection to bees as well as to the surrounding ecosystem. The relationship of care and interdependence that is established supports well-being, encourages collaboration and positive social relations.

“Beenomies” is a pilot project inspired by the union of opposites symbolically associated with bees: love and war, sweetness (honey) and bitterness (venom), the individual and multiplicity (society), regeneration and death. As CG Jung observed, honey expresses, psychologically, “the joy of life and the life urge which overcome […] the dark and the inhibiting. Where spring-like joy and expectation reign, spirit can embrace nature and nature, spirit”. Drawing on this psychological and philosophical basis, the project aimed to introduce beekeeping in a therapeutic community placed in the Alpine environment (Mondovì, Italy), to explore its rehabilitative potential and its ability to promote well-being in the field of mental health.

The project stems from the collaboration between mental health services, a local agriculture high school, and a farm involved in social agriculture. Initially, some beehives have been settled on the land surrounding the therapeutic community. Activities of beekeeping have been conducted and supervised by experienced beekeepers of the farm involved, who engaged a selected group of users hosted in the community (n=15), instructed them and worked side by side for several weeks, according to the bees’ needs and the seasonal rhytms. Once the training was completed, teaching activities have been co-conducted by beekeepers and participants, to introduce and train a group of students from the local agriculture high school. A study encompassing observational data, surveys, and semi-structured interviews was conducted to monitor and evaluate the project as it unfolded.

The performance of practical activities (i.e. beekeeping operations) proved successful in relaxing social norms around talking, lowering the emotional intensity of the encounter, allowing non-verbal communication and normalizing silence. These features supported participants with relational difficulties and encouraged the gradual development of skills in the social area. In the second part of the project, the involvement of high school students that needed to be trained allowed participants to have an active role as teachers; this contributed to the development of positive feelings, increased self-esteem and self-efficacy, eventually supporting the recovery process.

Preliminary findings suggest further collaboration between different social actors and further research to develop inclusive, effective, and community-based interventions in the field of mental health and rehabilitation.

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Acute and transient psychoses (International Classification of Diseases) and Brief Psychotic Disorders (Diagnostic and Statistical Manual of Mental Disorders) constitute heterogeneous nosological groups, which have undergone successive reformulations in the past decades, remaining doubts regarding their diagnostic validity and independence.

This work aims to review the nosological evolution of these complex and neglected groups.

A review of the literature was conducted using PubMed and The Cochrane Library. The following terms were used: “acute and transient psychoses”; “brief psychotic disorders”; “cycloid psychosis”; “reactive psychosis”.

Since the early 20th century, a group of non-affective psychoses with acute onset and brief duration have been described in different countries and under various names, such as bouffeé delirante, reactive psychosis or cycloid psychosis, denominations still present in ICD-9. In presente-day classifications, as ICD-10 and DSM-IV, an effort was made to homogenise the various regional and national concepts creating the group of ‘Brief Psychoses’ (DSM) or ‘Acute and Transient Psychotic Disorders’ (ICD). The marked heterogeneity and low diagnostic stability of these groups, mainly based on temporal criteria, has posed significant obstacles to further research and conceptualization. Given these difficulties, the latest revision of the International Classification of Diseases (ICD-11) brought about a substantial change, restricting this diagnosis to polymorphic psychotic conditions of acute onset and rapid resolution, subgroup with greater diagnostic stability and characteristics distinct clinical features.

The relevance of a better clarification for this nosological group is evident in the successive changes over the last century. ICD 11, once again, substantially changed the diagnostic criteria and the scope of this nosological entity, leaving doubts about the independent nature of this group, its connection to schizophrenia, as an attenuated form (more common in women and in developing countries), or even as a form of psychosis that is closer to affective disorders (due to its clinical evolution). Although little explored, this issue remains a source of doubt and interest, calling into question the Kraepelinian dichotomy for the so-called endogenous psychoses.

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Burnout was reclassified in 2019 as an occupational phenomenon in ICD-11. The new condition includes the classic tridimensional definition with symptoms in areas of fatigue/energy depletion, mental distance/cinism and sense of ineffectiveness/lack of accomplishment.

To evaluate the knowledge and perceptions of psychiatrists regarding new ICD-11 burnout definition.

To analyse the frequency of burnout symptoms in the psychiatric consultations and among the psychiatrists as healthcare professionals.

An online survey (designed with Microsoft® Forms) was sent in June 2023 to psychiatrists from three regions of Spain, contacted form local scientific societies. Psychiatrists, currently working, had to consent and answer a brief survey (average time: 2 min 32 sec) of 9 questions regarding the definition of burnout, their experience in clinical practice, their own symptoms and symptoms observed in colleagues.

164 psychiatrists answered, 114 females (69.5%), mean age: 43.61 ± 11.28 years. 48.2% assured they had never used the term Burnout or the ICD codes Z73.0/QD85, whereas a 9.1% used them frequently in clinical practice. 58.5% considered burnout just a condition related to work and a 38.4% either a syndrome or a disorder.

Most psychiatrists referred that their patients exhibited symptoms of the three dimensions. Fatigue was the most common, attended frequently by 79.5% of the surveyed, followed by ineffectiveness (73.1%) and cinism (65.3%).

When reporting their own symptoms, only 16.5% psychiatrists referred not suffering any symptom. The most frequently involved was fatigue (66.5%), then ineffectiveness (56.1%) and cinism (41.5%). 28,7% reported concomitant symptoms of the three dimensions.

70.7% recognized fatigue symptoms in their colleagues, 61% ineffectiveness, 72.6% cinism and 45,5% recognized symptoms from the three dimensions. Only a 7.3% did not identify any of them.

A younger age was related to higher probability of suffering cinism (T:2.546; p=0.012) and ineffectiveness (T:2.900; p=0.004) and to a higher probability of recognizing cinism (T=3,293; p=0,001) an ineffectiveness in others (T=2.355; p=0.020)

Females showed a higher frequency of ineffectiveness symptoms (61.4% vs 44%; χ2:4.274; p=0,029).

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Psychiatrists’ concept of burnout is diverse but the main construct is convergent with ICD definition, not a medical illness but a condition related to work.

The three classic dimensions of burnout are common in clinical conditions and also in the laboral environment of psychiatrists themselves. Psychiatrists tend to recognized more easily burnout in other colleagues, particularly cinism symptoms. Cinism and ineffectiveness appear to be related to younger age that can be associated to an imbalance between work demands and individual resources.

These results highlight the challenge of preventing, detecting and addressing burnout syndrome in psychiatric services.

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Guidelines for relapse prevention in schizophrenia recommend psychoeducation for patients and caregivers (Bighelli I, Leucht S et al. Lancet Psychiatry 2021). Considering that, in 2021, we implemented in our Psychiatric community center a multifamily therapy (MFT). The program is based on systemic approach and psychoeducation, focusing on schizophrenia.

Describe participants of MFT groups focusing on schizophrenia.

* Patients’ characteristics : age, gender, duration of psychiatric follow-up, history of hospitalization

* Caregivers’ characterics: status, age.

We carried out a descriptive study of the different profile of MFT groups participants in our community center from 2021 to today.

Since 2021, 4 MFT groups took place including 50 participants: 18 patients suffering from schizophrenia and 32 relatives.

Image 1 illustrates the different participants of each group.

Each group was different. Some patients came with both their parents, even if divorced, some came only with their mother. Some came with a sibling. Nevertheless, the numbers of fathers and siblings did not always allow us to work in sub-groups.

Considering patients: 18 patients benefited from our program. 8 female and 10 male patients (55.6%) were admitted and distributed in each group as described in image 2. The mean age of patients was 31.9 years old [20.1 – 57.5]. Each group was made up of patients with psychiatric follow-up ranging from 1 year to more than 20 years, and having experienced between 1 to more than 5 psychiatric hospitalizations. It appears that Group 4 was noticeably younger than the other groups with a mean age of 22.4 years old [20.4 – 26.7] and a shorter history in psychiatry with less hospitalisations (image 3).

Considering relatives: 15 mothers, 9 fathers, 5 siblings, 1 spouse, 1 aunt and 1 uncle benefited from psychoeducation to caregivers. The relatives were from 47 to 81 years old for the parents, and from 17 to 50,7 for the siblings. Unlike parents, siblings generally attended a limited number of sessions.

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This descriptive study reflects the work carried out with 18 patients and their relatives in an MFT group providing psychoeducation to patients suffering from schizophrenia and their caregivers. 50 persons benefited from psychoeducation in 2 years. We learned from these results to improve the constitution of our groups and the benefits of our psychoeducation program. We were careful to include families with siblings as we know they are affected by the mental illness in the family and are often left aside of all care/support proposals. We questioned ourselves on the advantages of homogeneous or heterogeneous groups, considering age, history of follow up. How could it impact affiliation to the group or differentiation movements ? How useful or harmful it is for sharing experiences between the families. A proper study would be necessary to answer these questions.

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Traumatic brain injury (TBI) induces cognitive and behavioral changes due to environmental impacts on brain tissue.

Highlighting the atypical TBI presentation challenging conventional diagnostics and obscured by conversion disorders.

A 36-year-old male veteran, injured by a sniper rifle in 2011, presented with right ear tinnitus and monthly, unresponsive right hemicranial headaches. Seizures occurred every two weeks with no reported loss of consciousness or sensation. The gunshot wound to the neck in 2011 prompted emergency intervention, with entry and exit wounds located in the posterior lateral neck. Post-injury symptoms comprised hearing loss, tinnitus, restricted neck movement, and weakness in the right arm. Seizures persisted, accompanied by numbness and neck movement. Management included physical therapy, hyperbaric oxygen therapy (improving weakness but not tinnitus), and administration of piracetam (2400 mg/day), sertraline (100 mg/day), and ginkgo biloba (2400 mg/day). Psychiatric consultation suggested a diagnosis of “conversion disorder.”

Neuropsychological Evaluation: Raven Standard Progressive Matrices Test showed borderline impairment. Psychiatric Evaluation noted monotonous mimics, occasional depersonalization, reduced emotional involvement, and slowed psychomotor activity. Elevated trait anxiety was observed per the State-Trait Anxiety Inventory. Neurological Examination identified left arm weakness and impaired resting balance. Imaging Findings: F18-FDG PET/CT Scan at 1 year post-GSW showed hypermetabolism in the right frontal lobe, and at 3.5 years post-GSW demonstrated decreased glucose metabolism in the bilateral cerebellar cortex, temporal lobe, and bilateral parietal lobe.

A high-kinetic-energy bullet passed through the right lateral base of the neck without causing apparent brain damage. Proposed is the generation of upward pressure waves in neck tissues through the transmission of kinetic energy, compressing and displacing soft tissues toward the skull. Gunshot injuries create cavities, forming high-pressure waves capable of damaging distant brain regions, leading to TBI such as crush injury, edema, and myelin and axonal damage (Courtney & Courtney, 2007). Microscopic brain damage, undetectable by current imaging, may only surface during autopsy (Yilmaz & Pekdemir, 2007). Rat studies after primary blast injuries reveal brain alterations, highlighting that high-pressure pulses can cause neuronal damage, potentially yielding related symptoms (Cernak et al., 2001). The patient’s atypical symptoms, combined with the initial conversion disorder hypothesis, underscore the need for a diagnostic paradigm shift to differentiate traumatic brain injury from other potential misnomers.

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The phenomenon of self-stigma in patients with bipolar affective disorder (BD) has been studied much less than in other mental disorders (Favre, Richard-Lepourie, 2023). However, self-stigma has equally negative psychosocial consequences for them (Shargh et al, 2015). Therefore, identifying the clinical and psychological characteristics of self-stigma in BD patients, especially in the initial stages of the disease, and developing on this basis new directions for their psychosocial rehabilitation to reduce self-stigma is relevant.

To identify clinical and psychological characteristics of self-stigma in BD patients, to identify targets for psychosocial rehabilitation.

«Questionnaire for assessing the phenomenon of self-stigmatization of mentally ill people» (Mikhailova et al., 2005), «Insight Scale for Psychosis» - ISP (Birchwood et al., 1994). We examined 17 patients (12 women and 5 men) with a diagnosis of bipolar affective disorder (F31.xxx according to ICD-10). The average age of the patients was 25.52±4.55 years. The duration of the disorder is 0.5-3 years.

It was shown, that patients with BD had a high level of self-stigma. Indicator «General level of self-stigma» was 1.22±0.73 points, that higher its average values. The main component in the structure of self-stigmatization was an overestimation of possible limitations of one’s own internal activity and self-realization (1.96 ± 0.87 and 1.62 ± 0.82 points, respectively) associated with the disease. Idealization of one’s pre-illness qualities and achievements (1.62±0.82 points) and the formation of misconceptions about the loss of previous opportunities will able to lead to negative personal changes and limit the activity of patients. Correlation analysis revealed significant (p≤0.01) correlations between the «Patient’s ability to recognize painful phenomena as symptoms of mental illness» scale of the ISP scale and individual parameters of the questionnaire for assessing self-stigma: «Imagination of one’s own failure due to illness» - r = 0, 52; «Fear of becoming insolvent due to illness» - r=0.54; «Idealization of the «healthy self», r=0.51. Thus, in BD patients, self-stigma is associated with low awareness of the disease and misconceptions about it and about themselves.

Psychoeducation programs, aimed at formation an adequate perception of mental disorder, the ability to recognize its symptoms, and destigmatization trainings to increase the social activity are needed for BD patients. Such trainings were developed during the research and are currently being tested.

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Participation in daily life occupations of personal and community meaning is an important component of health and recovery from mental illness. Limitations in participation were found to be a hallmark of serious mental illness (SMI). Still, previous research has mainly focused on objective dimensions of participation, largely neglecting the subjective aspects that hold particular relevance for health outcomes. Next, participation was addressed by specific diagnoses, approach which is divergent from the recovery model, a transdiagnostic approach and clinical practice. Hence, further research into participation is warranted to broaden our understanding.

We investigated objective and subjective patterns of participation across a range of SMI diagnoses to delineate differences, and to identify personal and illness-related factors associated with participation dimensions.

A secondary analysis of cross-sectional studies (N=14). The analysis included data from 489 men (40.7%) and women (59.3%) diagnosed with one of 4 SMI conditions: psychotic, affective (AD), post-traumatic (PTSD) or personality (PD) disorders. The participants were aged 18 to 60 (M=34.41; SD=10.9) and were in contact with intensive mental health services. All participants completed the Adult Subjective Assessment of Participation (ASAP), which comprised participation intensity, diversity, satisfaction and enjoyment, and standard evaluations of cognitive functioning, symptom severity, and functional capacity. Z-scores were calculated for independent variables to enable comparison. Demographic and illness-related (IR) information was also collected.

Frequency of participation was found to be significantly different between diagnostic groups, but not participation diversity, enjoyment and satisfaction. Participation diversity was altered by range of demographic variables (5.26<F<10.6, p<.01, 0.3<<0.4) while participation frequency differs by employment status (t (485) =-2.84, p<0.05, Cohen’s d=0.25). No differences were found between groups in symptoms’ severity. Regression analysis indicates that cognition, functional capacity and employment status explain in a significant way integrated index of objective participation (χ2 =47.52, p<0.001). For the subjective dimension, the logistic regression was not found statistically significant (χ2 =20.99, p=0.51).

Limitations in diversity, enjoyment and satisfaction with participation, were demonstrated to be a transdiagnostic feature in SMI. Objective participation dimensions can be explained with demographic, personal and illness related factors, while modeling of subjective dimensions should be further investigated.

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Dual pathology, characterized by the simultaneous presence of substance use disorders and psychiatric disorders, is a topic of growing interest in the scientific community. In particular, obsessive-compulsive disorder (OCD) is a common comorbid psychiatric condition in patients with substance use disorders.

To evaluate the efficacy of rTMS on comorbid disorder symptoms by applying specific protocols for OCD and substance use disorder in a clinical case of dual pathology.

Case Description: A 36-year-old male diagnosed with OCD and habitual cocaine use (an average of 6 times per month). Previous unsuccessful attempts to quit substance use. Undergoing psychotherapy and psychopharmacological treatment for OCD since the age of 22 with no significant clinical improvement.

Methodology: The severity of OCD was quantified before and after the intervention using the Yale-Brown Obsessive Compulsive Scale (YBOCS). To assess addictive behavior, the Maudsley Addiction Profile (MAP) was used. During the intervention period, the occurrence of substance use was recorded based on the patient’s and family members’ reports. The intervention involved the administration of an rTMS protocol tailored to the specific case, consisting of the simultaneous application, using a double-cone coil, of rTMS at 20Hz over the right dorsomedial prefrontal cortex (DMPFC) at an intensity of 100% of the resting motor threshold (RMT) to treat OCD symptoms, followed by intermittent theta burst stimulation (TBS) over the left DMPFC at an intensity of 120% of the RMT to address substance addiction. The patient received a total of 30 sessions at a rate of one session per day, five days a week, for six weeks.

Results: The results showed an improvement in the total score on the YBOCS scale, decreasing from a value of 26 in the pre-intervention assessment to 16 in the post-intervention assessment, representing a reduction of more than 35% from pre- to post-intervention, meeting response criteria. Thus, there was a decrease in both obsessive and compulsive symptoms, with reduced associated distress and increased control. Additionally, throughout the intervention, there was a gradual decrease in substance use, decreasing from an average of 6 monthly instances before treatment initiation to a total of 1 in the month the treatment ended.

Conclusions: This unique case study represents a therapeutic window for the treatment of patients with comorbid disorders, demonstrating promising preliminary benefits of the combined rTMS intervention for both conditions, especially in the field of addictions.

Keywords: rTMS, neuromodulation, obsessive-compulsive disorder, addictions

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Psychiatric disorders are common in patients with learning disabilities. There are also patients with the triad of autism, schizophrenia and learning disability. Patients with this background can be admitted to general hospitals for psychiatric or non-psychiatric reasons.

We are presenting a case who had a very complicated clinical course and her discharge planning was challenging.

The objective of this work was to show the challenges in the investigation, medical management, and discharge planning of the patients with concomitant learning disability, schizophrenia and autism.

We scrutinized the patient’s casenotes, including blood results and all relevant imaging. We paid a particular attention to all the entries from the psychiatry team, general medical doctors, oncologists, learning disability team and discharge planners.

The lady had a protracted 4-month inpatient admission throughout which she was physically and verbally aggressive to hospital staff. She was deemed to lack capacity for hospital admission and treated in her best interests under Mental Capacity Act (MCA), frequently requiring sedation with Haloperidol and Lorazepam. Following consultation with the local Psychiatrist her medications were altered to: Risperidone 2 mg BD, Diazepam 5 mg OM, 5 mg afternoon and 10 mg evening, Procyclidine 5 mg BD, Chlorpromazine 25 mg BD, Promethazine 25 mg OD PRN, and Midazolam 10 mg buccal PRN.

A change in her clinical condition was noted by the Psychiatry team; increased agitation, confusion and dysarthria. A repeat blood test was advised, due to patient refusal this took weeks to achieve despite the use of buccal Midazolam following Anaesthesiologist advice. Although blood tests were not significantly deranged, she was treated for presumed urinary tract infection with a course of antibiotics. A urine sample was unobtainable.

She reported right breast pain and underwent a mammogram. This showed a hypoechoic lesion 8x7x9 mm. Following consultation with a Breast Surgeon and Oncologist, Letrozole was replaced with Tamoxifen. The Psychiatric team concluded that the clinical deterioration with dysarthria was related to anxiety, associated with Autistic patients. The movement disorder was deemed secondary to antipsychotics exacerbated by stress and anxiety.

The patient’s discharge planning was complex. She was declined by numerous care homes. At time of writing, she remains an inpatient.

The management of patients with a triad of Learning Disability, Schizophrenia and Autism is extremely difficult, particularly within an acute medical setting. Physical deterioration could be related to medication adverse effects or change in environment. Anxiety and stress are linked to these conditions. The challenging behaviour that these patients often have will make discharge planning very difficult as specialised care homes to accommodate these unique patients are very limite

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