Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly diagnosed in school-age children. However, it can affect individuals of all age groups. This study aimed to provide a comprehensive analysis of the prevalence of ADHD in adults by conducting an umbrella review of systematic reviews and meta-analyses.

To provide a comprehensive synthesis of published evidence on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adults through an umbrella review of systematic reviews and meta-analyses, with the aim of highlighting the significance of addressing and managing ADHD in the adult population.

To conduct this study, we adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). We systematically searched databases such as PsychINFO, Web of Science, PubMed, and Scopus to identify relevant studies. Our review protocol was registered with PROSPERO (registration number: CRD42023389704). The quality of the studies included in our analysis was assessed using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). For the purpose of conducting a meta-analysis, we employed a random-effects model.

Our umbrella review examined findings from five systematic reviews that encompassed data from 57 unique international primary studies undertaken between 2009 and 2021. These studies involved a total of 21,142,129 adult participants. The meta-analysis, employing an inverse variance-weighted random effect model, yielded a pooled prevalence estimate for ADHD in adults of 3.10% (95% confidence interval: 2.60%–3.60%). Regarding ADHD subtypes, our analysis revealed that ADHD-I (inattentive type) remained the most prevalent among adults, followed by ADHD-HI (hyperactive type) and ADHD-C (combined type).

Our results underscore the relatively high prevalence of ADHD among adults, with ADHD-I emerging as the most common subtype. These findings emphasize the need for proactive measures to prevent, mitigate, identify, and effectively manage ADHD in the adult population.

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Antipsychotics disrupt intracellular cholesterol traffic and prevent the exit of low-density lipoprotein (LDL)-derived cholesterol from the endosome/lysosome compartment. It was showed that curcumin accelerated the release of cholesterol-containing exosomes from cells with impaired intracellular cholesterol traffic due to antipsychotic treatment and suggested that curcumin may help minimize the negative metabolic effects associated with chronic antipsychotic treatment.

This study aimed to investigate the effectiveness of orally administered curcumin to rats in preventing and treating metabolic syndrome-related side effects such as weight gain and dyslipidemia caused by clozapine.

In our research, a total of 32 male rats (Wistar Albino), 12 weeks old, produced at Selçuk University Experimental Research and Application Center, were used. All animals divided into 4 groups. Venous blood collection and weight measurements were taken from all groups at the beginning. 32 rats were randomly divided into 4 separate groups: control, only oral clozapine, oral clozapine + 50 mg/kg curcumin, and the oral clozapine + 100 mg/kg curcumin group. Groups II-III-IV were given 15 mg/kg clozapine orally daily for 3 weeks. AST, ALT, glucose, total cholesterol, Triglyceride, HDL, LDL and insulin were studied from the blood samples taken at the beginning and at the end of the experiment.

There was no statistically significant difference in comparisons of weight and insulin measurements between the groups at the end of the experiment (p>0.05). In glucose measurements at the end of the experiment, the control group was found to have significantly higher glucose values compared to the other groups (p <0.001). As a result of posthoc analyses, LDL measurements in the control group were found to be lower than those in the CLZ and CLZ +50 c groups (p<0.05). AST value of the control group was significantly higher than the CLZ+100c group (p=0.011). Measurements of the control group for ALT were found to be higher than those of the CLZ+50c and CLZ+100c groups (p<0.05). There was no statistically significant difference between the groups in HDL, TG, Cholesterol comparisons (p>0.05).

In the control group, the average weight at the end of the experiment was significantly higher than at the beginning (p = 0.045). In the CLZ group, the mean glucose at the end of the experiment was significantly lower than at the beginning (p<0.001).

Metabolic problems due to antipsychotics negatively affect treatment compliance. Treatment support methods that can solve or help this problem may be useful. Our study ended in conflicting results. Needs for new experiments…

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Toxoplasma gondii, a ubiquitous protozoan parasite, has been previously associated with psychiatric disorders.

To assess the prevalence of IgG antibodies against T. gondii in psychiatric patients from Western Romania.

We included 464 psychiatric patients admitted to the Psychiatric Clinic, County Emergency Hospital of Arad, Western Romania. Clinical evaluation and laboratory tests were conducted in these patients, including serological tests to determine the presence of T. gondii IgG antibodies.

Of the 464 psychiatric patients, 258 (55.5%) were residing in rural areas and 245 (52.7%) were female. T. gondii IgG antibodies were demonstrated in 325 (70.04%) of 464 study participants and the seroprevalence tended to increase with age.

A significant higher T. gondii IgG seroprevalence was found in psychiatric patients aged between 40 to 59 years (p<0.001) and in patients aged ≥60 years (p=0.001) compared to patients aged 19 to 39 years. A higher T. gondii IgG seroprevalence was determined in psychiatric patients residing in rural areas compared to those residing in urban areas (p=0.04). T. gondii IgG seroprevalence was higher in females compared to males (p=0.04).

Assessment of seroprevalence by diagnostic revealed that T. gondii IgG antibodies were identified in 23 (85.19%) of 27 patients with delusional disorders, 24 (82.76%) of 29 with dementia, 51 (70.83%) of 72 with organic disorders, 75 (70.75%) of 106 with schizophrenia, 81 (70.43%) of 115 patients with depression, 17 (62.96%) of 27 with bipolar disorders, 27 (58.7%) of 46 with mood disorders and 7 (53.85%) of 13 with impulsive-control disorders.

The presence of T. gondii antibodies was demonstrated in a significant number of patients who attended the Psychiatric Clinic in Arad County, Western Romania. Results of this study suggest that T. gondii may be associated with several psychiatric disorders.

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The recent wildfires in Canada provide a clear illustration of the significant and lasting damage they inflict on the well-being of individuals and communities. Evaluating the occurrence and factors associated with post-traumatic stress disorder (PTSD) and low resilience is valuable for policymakers in public health.

The study aimed to assess the prevalence and predictors of low resilience and likely PTSD among subscribers of Text4Hope, an e-mental health program that delivered daily supportive messages to residents of Nova Scotia (NS) and Alberta (AB) during the recent wildfires.

Data collection was through a self-administered online survey completed by residents of the affected regions of NS and AB from May 14 to June 23, 2023. Data were analyzed using Statistical Package for the Social Sciences.

Out of 298 respondents, the prevalence of low resilience and likely PTSD in our sample were 52.0% and 39.3% respectively. Unemployed respondents were about 3 times more likely to experience both low resilience and PTSD symptoms compared to those employed. Respondents with a history of mental health diagnosis were about 4 times more likely to experience likely PTSD compared to those with no history of mental health diagnosis.

This research demonstrated that the likelihood of PTSD was predicted by both unemployment and a history of mental health diagnosis, with unemployment also being linked to low resilience during the wildfire. These results provide valuable insights for designing clinical interventions and developing psychosocial support programs tailored for vulnerable populations.

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Education is markedly associated with well‐being, leading to the acquisition of healthy behaviors while at the same increasing hiring and salary. However, stress among academics is worrying, especially in younger researchers who experience significant levels of job insecurity, the imbalances between life and job, stressful relationships with supervisors and funding difficulties. Several studies have indicated that most graduate students spent over 40 hours per week on their postgraduate program, more than 70 % were not able to complete their programs within the set timeframe, and had uncertainty related to their job

In this review, we discuss the mental health of postgraduate students focusing on depression, anxiety, stress, and smartphone addiction.

a review presentation of the mental health of postgraduate

According to meta-analysis, depression prevalence among postgraduate participants ranges from 6.2% to 85.4% in 36 studies. The pooled prevalence was 34% (26,579 individuals; 95% CI: 28–40). A study using the GAD-7 scale to evaluate the prevalence of anxiety concluded that 41% of postgraduate students suffered moderate to severe GAD, which is about six times the prevalence of GAD among the general population. A Study demonstrated 51.0% of the participants had smartphone addiction. A significant association was also observed between extensive smartphone use and depression (P = 0.001). Of the smokers in this study, 41.5% were addicted to smartphones (P = 0.039). Smartphone addicts had approximately two times the chance of having insomnia (OR = 2.113) (P = 0.013). In addition, they showcased more ADHD symptoms (OR = 2.712) (P < 0.001).

Studies identified a higher prevalence of mental illnesses among postgraduate students than in the general population. Although students affected are highly educated, their awareness of mental health is not sufficient to know their mental symptoms and seek help. Therefore, we suggest launching wellness programs to enhance their mental health.

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Ageist beliefs and attitudes may restrict the opportunities for older adults to participate actively in their communities, resulting in strong effects on mental health.

This study has three objectives: 1) To investigate the effect of ageism on older adults’ civic activities; 2) To analyze the influence of ageism on mental health; and 3) To explore the impact of civic participation on older adults’ mental health.

This qualitative study included 391 older people from three different nationalities (Portuguese, Brazilian and English) ranging in age from 65 to 88 years old. All the interviews went through the process of content analysis.

For the first objective, findings encompass four major themes: (1) Social disapproval (86%); (2) Perceived Ineptitude (84%); (3) Anticipated Failure (83%); and (4) Inability to Contribute (77%). For the second objective, findings indicated six categories: (1) Helplessness and Despair (89%); (2) Rage (81%); (3) Self-Perceived Inability (77%); (4) Sense of Unimportance (71%); (5) Anxiety (68%); and (6) Outbursts of Emotion (63%). For the third objective, the following five major subjects emerged: (1) Meaningfulness (81%); (2) Embracing Social Belonging (80%); (3) Cognitive Abilities (71%); (4) Personal Empowerment (67%); (5) Emotional Expression (54%). Additionally, findings indicated that the most verbalized themes for the three objectives were the same across the three nationalities.

The results of this study offered insight into how ageism, mental health, and civic engagement are related. Ageism seems to have a negative impact on mental health. Ageism also made it difficult for people to participate in civic life, which has been linked to better mental health. These findings emphasize the need to identify ageism and encourage inclusive civic involvement to improve older individuals’ mental health.

Keywords: Mental health; ageism; civic participation; older adults.

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Promoting mental health during adolescence is an essential health education objective and a crucial time for the formation of healthy mindset and behaviors. During this period, individuals are more likely to engage in health risk behaviors that can contribute to mental health problems that manifest in later adulthood. It has been demonstrated that optimal psychological health and the quality and application of students’ emotional and social skills may prevent and reduce the onset of risky health behaviors, such as subtance abuse. Students with specific learning difficulty (SpLD) are at higher risk to develop problem behaviors and they require special attention for promoting their mental health.

The aim of the present study is to investigate mental health and well-being, and health behaviors as well as substance use in a sample of adolescents including those with SpLD, using the SDQ ‘Strenghts and Difficulties Questionnaire’, a widely utilized instrument for the multidimensional assessment of mental health in children and adolescents.

Our study included 276 school-aged children (mean age: 13.57 years; SD: 1.81; boys: 54.7%), 143 of whom had SpLD. We utilized a self-administered, anonymous questionnaire that included the Adolescent Psychological Well-Being Questionnaire, the Life Satisfaction Scale, and the WHO Well-Being Questionnaire. Peer support, individual internal psychological resources, and health risk behaviors were also assessed.

The statistical analyses revealed a number of noteworthy differences. First, the SDQ scores of smoking and drinking adolescents were substantially different from those of their peers on the dimensions of emotional symptoms, conduct problems, and hyperactivity in the case of smoking (p<.05), and on the dimensions of hyperactivity and prosocial behavior in the case of drinking (p<.05). On the other hand, significant differences were found between boys and girls, particularly in the domains of prosocial and affective symptoms (p<.05). Individuals with SpLD exhibited distinct patterns, particularly in the domains of emotional symptoms and peer relationship problems (p<.05). Furthermore, all of the investigated components of mental well-being had significant negative correlations with the SDQ dimensions of emotional symptoms, conduct problems, hyperactivity, and peer relationship problems, whereas the dimension of prosocial behavior showed a significant positive correlation (p<.05).

Our findings support differences in mental health domains according to the adolescents’ substance using status or the presence of SpLD. The results of this study may contribute to the development of health promotion programs and intervention strategies as well as draw attention to the unique challenges faced by children with special education needs.

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Patients with severe mental illnesses (SMI) are often exposed to polymedication. Additionally, the risk of somatic diseases is twice as high in patients with SMI as in individuals without a psychiatric disorder. Furthermore, drug–drug interactions (DDI) between psychiatric drugs and somatic medications are a well-known cause of adverse drug reactions (ADR).

The aim of this study was to analyse whether already known DDI related to psychiatric drugs and somatic medication still occur in everyday clinical practice.

Therefore we identified all spontaneous ADR reports contained in the European ADR database EudraVigilance from Germany received between 01/2017 and 12/2021 reported for patients older than 17 years in which antidepressants, antipsychotics and mood stabilizers were reported as suspected/interacting (n= 9,665). ADR reports referring to intentional overdoses and suicide attempts were excluded (n= 9,276 left). We used the ABDATA drug information system in order to identify all potential DDI (pDDI). The identified reports with pDDI were then assessed individually to determine whether the respective DDI occurred.

1,271 reports with 728 potentially interacting drugs pairs related to psychiatric drugs and somatic medications with 2,655 pDDI were found. Restricted to potentially interacting drug pairs with more than 10 reports, (i) hyponatremias related to antidepressants and diuretics (n= 362, 32.6%), (ii) bleeding events related to selective serotonin reuptake inhibitors (SSRI) and platelet aggregation inhibitors, anticoagulants or non-steroidal antiinflammatory drugs (NSAID) (n= 295, 17.5%), and (iii) increased beta-blocker effects related to SSRIs and beta-blockers (n= 126, 11.3%) were the most frequently identified pDDI. After individual case assessment, in 33.3% (14/42), 23.7% (45/190) and 17.4% (8/46) of the reports bleeding events related to SSRIs and anticoagulants, SSRIs and platelet aggregation inhibitors and SSRIs and NSAIDs were reported. Hyponatremia was reported in 7.6% (22/289) of the reports related to antidepressants and diuretics and increased beta-blocker effects in 6.9% (8/116) of the reports related to SSRIs and beta-blockers.

According to our analysis, well-known DDI still occur in the treatment of psychiatric patients with psychiatric drugs and somatic medication. Whenever possible, alternative drug combinations with a lower potential of DDIs may be considered or appropriate monitoring measures should be conducted.

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Far less is known about the preceding factors of antipsychotic use among persons with substance-induced psychosis (SIP) and first-episode psychosis (FEP). There is no prevention research on how persons with SIP differ from persons with other psychosis episodes like FEP. Antipsychotic medication is the general essential and necessary element in the treatment of SIP and FEP1. Antipsychotics are used as first-line therapy, commencing with a low dose and titrating upwards2. There are no exciting treatment guidelines for treating Substance-induced psychosis in the long term. (A review of some studies published by the Oxford Journals Schizophrenic Bulletin indicated that drug-induced psychosis lasted longer than a month in individuals between 1 and 15% of the time.3)

The aim of the study was to investigate antipsychotic use and associated factors in persons with SIP and compare it with persons with other FEP

1 To study the antipsychotic use among persons with SIP compared with FEP from 3 years before until three years after their first diagnosis first incident of psychosis)

2.To study associating background factors with antipsychotic use among patients with SIP

Incident Swedish SIP cases (n=7320)during 2006-2016 were identified from health care registers and matched 1: with persons with FEP (n=7320) by age, gender, and calendar year of diagnosis. Prevalence of antipsychotic use was assessed as point prevalence every six months, from 3years before until 3years after the first diagnosis. Factors associating with antipsychotic use among SIP were analyzed with multivariable logistic regression, including information on sociodemographic and work-related background, including disability pension and sickness absence, SIP types, and psychiatric diagnoses.

Among SIP and FEP, the prevalence of antipsychotic use was low before the first diagnosis (3-7% in SIP, 8-16% in FEP), peaked 6 months after the first diagnosis (23% in SIP, 54% in FEP) and stabilized after that. After 3 years of first diagnosis, 19% of persons with SIP and 45% of persons with FEP used antipsychotics. Antipsychotic use one year after diagnosis among SIP was associated with previous substance use disorder, depression, anxiety, and personality disorder diagnoses, being on disability pension or on long-term sickness absence (>90 days), and cannabis- or multi-substance-induced psychosis.

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As expected, patients with FEP were using more frequently antipsychotics compared to SIP except for long-acting antipsychotics.

Although SIP is considered short-lived, antipsychotic use after an incident SIP episode is relatively common, especially among those with cannabis SIP with the highest prevalence of antipsychotic use.

Previous substance use disorder and cannabis SIP were highly associated with patients who use antipsychotics frequently.

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Ketamine, originally an anesthetic, has emerged as a potent tool in the fight against treatment-resistant depression and suicide. Clinical trials have demonstrated its ability to induce remission of severe depressive symptoms, with effects that can extend over several weeks.Furthermore, research highlights Ketamine’s potential to rapidly reduce suicidal ideation. This suggests Ketamine’s role as an intervention in suicide prevention, especially when conventional treatments prove ineffective. While isolated cases report severe respiratory depression, primarily when combined with other medications, most incidents involve temporary apneic episodes following high-dose intravenous administration. Understanding Ketamine’s safety profile is vital for its clinical optimization and ensuring patient well-being during use

This presentation serves to describe, and evaluate our clinic’s safety protocol implemented for intravenous (IV) Ketamine infusions at the General Hospital of Corfu. Our primary goal is to rigorously assess the safety and tolerability of IV Ketamine in a clinical setting

Patients must meet stringent criteria:

• - Exclude those over 70.

• - MMSE score above 25.

• - Controlled blood pressure.

• - No cardiac insufficiency, myocardial ischemia, or high intraocular/intracranial pressure.

• - Absence of thyrotoxicosis, psychosis, or seizures.

Pre-infusion comprehensive evaluation:

• - Includes ECG, blood biochemistry studies, and frequent blood pressure checks.

• - Requires a 2-hour fast.

Ketamine infusion:

• - IV Ketamine administered at 0.5mg/kg in 100ml N/S.

• - Continuous monitoring of oxygen saturation (PO2) and cardiac rhythm.

• - Blood pressure checks every 15 minutes.

Treatment typically involves 7 sessions over a span of a month, with an initial test dose of 0.25 mg/kg.

Ketamine infusions were administered to a total of 208 patients. The majority of participants experienced a slight increase in blood pressure, while there were no significant changes in cardiac rhythm. Additionally, almost all patients reported experiencing dizziness or headaches during the infusion. Notably, nearly half of the patients reported an alteration in taste perception as a side effect. It’s important to highlight that all observed side effects, spontaneously resolved within an hour after the conclusion of the infusion. However, in a small subset of cases (six instances), the side effects were severe enough to necessitate the premature termination of the ketamine infusion

Although ketamine demonstrates a favorable safety profile with minimal major side effects when administered following our established safety protocol. However, we want to underscore the critical importance of vigilant patient monitoring during ketamine administration and the prompt addressing of any adverse effects. This proactive approach is paramount to ensure the safety and overall well-being of patients receiving ketamine treatment

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ADHD medication prescribing trends are increasing in North America and both Northern and Western Europe (Raman, Sudha R et al. Lancet Psychiatry. 2018;5(10):824-835). Methylphenidate and atomoxetine are two substances available for use in ADHD in children and adolescents in Poland. To our knowledge, there is the lack of data on prescription trends for Poland and Middle-Eastern Europe.

The aim of the study is to estimate the increase in the total number of prescriptions for methylphenidate and atomoxetine and factors influencing it, like the impact of the proportion of prescriptions for women and for people aged 18-24 on.

Methylphenidate and atomoxetine prescription data for the period between 2012-2022 and for patients aged 5-59 were obtained from e-Health Centre, which contains data on prescribed medications in Poland. We conducted a series of linear regression models to explore the relationship between the number of prescriptions as the dependent variable and calendar year as the independent variable. Additionally, we considered two more variables: Percentage of prescriptions for women and percentage of prescriptions people aged 18 – 24. Further, we decided to run a mediation analysis to see whether the effect of calendar year was mediated by percentage of women.

We analyzed data on 925,536 prescriptions for methylphenidate and atomoxetine.

The model demonstrates a robust and statistically significant ability to explain the variance in the log-transformed dependent variable (R² = 0.98, F(2, 8) = 201.14, p < 0.001). The model’s intercept, corresponding to calendar year = 0 and percentage of prescriptions for women = 0, is estimated at -93.95, with a 95% confidence interval of [-152.74, -35.15]. The t-statistic for the intercept is -3.68, and the associated p-value is 0.006, demonstrating its statistical significance.

Within this model, the effects of the independent variables are as follows:

1. 1. Calendar year (β=0.05, t=4.07, IC95%: (0.02, 0.08), p<0,004)

2. 2. Percentage of prescriptions for women (β=0.06, t=4.18, IC95%: (0.02, 0.09), p<0,003)

The inclusion of the percentage of prescription for people aged 18-24 doesn’t improve the model’s ability to explain the variation in the number of prescriptions.

Mediation analysis showed that the indirect effect of percentage of prescriptions for women were significant.

These results provide robust evidence for the predictive power of the model, with both calendar year and percentage of women emerging as statistically significant and positively associated with the log- transformed dependent variable.

Between 2012 and 2022, the number of prescriptions for methylphenidate and atomoxetine increased exponentially in Poland. The percentage of prescriptions for women significantly contributed to the increase in the total number of prescriptions for methylphenidate and atomoxetine in Poland.

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Bipolar disorder (BD) is a recurrent disorder, causing functional impairment and raised mortality, particularly due to suicide. However, the difficulty in predicting suicidal behaviors relies in the lack of clear biomarkers.

Machine learning (ML) has emerged as a promising tool to enhance suicidal prediction. However, most ML studies focused on lifetime attempts, without having a predictive time window, and did not employ time-dependent variables. Moreover, most studies lie on cross-sectional databases, without including more than one time-point.

First, we aimed to predict 12-months suicide attempts in a naturalistic sample of BD patients, using clinical and demographic data.

Second, we aimed to improve the prediction by including information from intermediate visits (1, 3, and 6 months), mimicking more closely the clinician’s way of thinking and the multiple observations a patient receives.

A sample of 163 BD patients (53% females, mean age 44.7, SD 15.3) were recruited.

Based on EHR, 56 clinical and demographic features were extracted, including hospitalizations, suicidal behaviors lifetime and in the last 12 months, along with comorbidity, family history, work, and therapies. Patients were followed up for 12 months.

Support Vector Machine (SVM) was used to differentiate subjects who attempted suicide versus those who did not in a 12-month time window, within a repeated nested Cross-Validation. The SVM was optimized weighting the hyperplane for uneven group sizes.

Then, we repeated the analysis including information from intermediate visits (1, 3, 6 months after the first contact). For each visit, we created a composite score based on current therapy, new admissions, and ER presentations. To avoid circularity, all the information (ER, admission etc.) related to a suicide attempt were not included.

During the 12-months follow-up, 9.8% of patients attempted suicide. The results from the 12-months suicide prediction model obtained an Area Under the Curve of 0.71(with a Balanced Accuracy (BAC) of 68%).

After incorporating the composite scores based on intermediate visits in the model, the prediction raised to an Area Under the Curve of 0.78 (BAC 73%), suggesting that including intermediate visits is a valid method to improve prediction.

The features that contributed the most to the prediction were the composite score at 6-month visit, lifetime number of suicide attempts, suicide attempts in the last 12 months, substance of abuse (other than cannabis), and antipsychotics.

ML proved a good prediction accuracy for suicide in a 12-months time window, and the prediction was improved by including data from intermediate visits. The model showed the importance of time-dependent features, such as attempts in the last 12 months. Our analysis might help in identifying early clinical risk factors and underlies the importance of multiple evaluations in populations at risk.

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Suicide is a serious and complex public health issue that affects millions of people worldwide. Among the most vulnerable populations are homeless individuals (HIs), whose suicide rate is significantly higher than that of the general population.

The aim of this study was to analyze mortality and suicidal behavior in a cohort of HIs during a seven-year follow-up. Additionally, the study sought to identify variables linked to mortality in this population.

The study was conducted in the province of Girona, Spain, and included 154 HIs who were literally experiencing homelessness. Self-report questionnaires were used to gather sociodemographic data, assess suicide risk, and measure the severity of substance dependence. The follow-up was carried out between 2015 and 2022, collecting data on mortality, suicide attempts, episodes of overdose, and violence experienced from public health services (psychiatric and primary health care services).

During the seven-year follow-up, 23 individuals (14.3% of the sample) passed away, with an average age at the time of death of 52.6 years. The main causes of death were cancer, suicide (excluding overdose), and accidental overdose. Methods used for suicide included drug overdose, jumping, and vein slashing. All deceased individuals had scores above the threshold on the Plutchik Suicide Risk Scale and had reported previous suicide attempts.

Individuals who experienced violence during the follow-up period exhibited more severe suicidal ideation, more suicide attempts, and more non-lethal overdose episodes. Substance dependence, particularly cocaine dependence and dual pathology, was significantly associated with higher mortality.

This study reveals a high mortality rate among HIs, especially due to suicide and accidental overdose. The most significant variables related to mortality were suicidal ideation, the number of previous non-lethal overdoses, and substance use disorders, with cocaine dependence being prominent. The results underscore the need for specific prevention and treatment programs to address suicide risk factors and improve the mental health of homeless individuals. The importance of conducting interventions in specialized centers that detect and address suicide risk in this vulnerable population is also emphasized.

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Several research already proved the role of certain immunological factors (neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratio, and C-reactive protein (CRP)) in the background of suicidal behaviour.

The aim of this research was to study the association between routinely measurable low-grade inflammation parameters and suicidal behaviour among patients in the acute psychiatric care setting.

The study population included psychiatric in-patients (N=100) consecutively treated with depressive disorders and/or suicidal behaviour in a University Clinic between December 1, 2020 and December 31, 2021. Three different patient-groups were generated based on their suicidal behaviour: suicide attempters (N=55) including recent attempters(N=36) and past attempters (N=19) and non-suicidal patients (N=45), who never had a suicide attempt. Basic socio-demographic data, the severity of depression and immunological parameters (white blood cell count: lymphocytes, monocytes, neutrophil, eosinophil, basophil granulocytes; thrombocytes; C-reactive protein) were recorded.Descriptive analyses and multivariate regression model were performed with RStudio version 4.2.3.

CRP was significantly higher (2.00 vs. 1.00; p=0.007) in suicidal patients (N=55), however other immunological parameters did not differ significantly between the suicidal and the non-suicidal groups (NLR: 2.02 vs. 2.19; MLR: 0.22 vs. 0.11; PLR: 118 vs. 130). NLR and MLR showed significantly higher values (NLR: 2.83 vs. 1.93, p=0.021; MLR: 0.28 vs. 0.11, p=0.01) for those who currently attempted suicide (N=36) compared to the patients with no or past suicide attempt (N=64). In the regression analysis, the NLR and MLR showed significantly higher values in current suicide attempters even when gender, age, suicidal risk and severity of depression were included in the model. However, no significant differences were found when comparing current and past suicide attempters with the non-suicidal patients.

Despite the small number of cases in the samples, our results confirmed the association of certain immunological parameters (NLR, MLR) and acute suicidal behaviour. This relationship was found to be independent of depression and its severity. Our data suggest that, unlike the NLR and MLR parameters, the higher CRP value may not be related to acute suicide attempt, but rather to suicidal vulnerability, as a trait-marker. Markers of chronic systemic inflammation may help in the prediction of suicidal behaviour and in the development of new therapeutic options, however, further prospective studies are needed to identify the specific role of immunological factors in suicidal behaviour more precisely.

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Non-suicidal self-injury among adolescents has grown in recent years, becoming a significant public health issue. The high social and psychological impacts related to it are often characterized by substance abuse and the development of anxiety and depression. Furthermore, emotional dysregulation and heightened reactivity are associated psychological characteristics.

The aim of this paper was to do a scoping review, mapping the existing literature on self-harming behaviors among Brazilian adolescents, considering their sociodemographic and clinical characteristics.

We followed the adapted PRISMA checklist for scoping reviews. We searched eight databases: APA PsycNet, LILACS, MEDLINE, PubMed, Embase, Web of Science, The Cochrane Library, and Scopus. The selection of studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, where three independent researchers examined all titles and abstracts, applying the eligibility criteria. Accordingly, six studies were selected for descriptive analysis due to the variety of study types.

A total of 2,032 youngsters were studied in the age range of 10 to 19 years-old, among over 15,000 reported cases of self-harming behaviors. Females accounted for 51.3% of the cases and had higher scores of impulsivity and loneliness to self-harming behavior (P ≤ 0.05). Alcohol use was evident across both genders but showed higher measures for males in both age groups (10 to 14 and 15 to 19 years, p < 0.001).

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The study pointed to a diversity of clinical and sociodemographic characteristics; however further research is needed on this topic on Brazilian adolescents. In addition, a broader standardization of data is necessary for more specific statistical analyses.

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Ecological studies have suggested the protective effect of micro-dose lithium in drinking water against suicide, however, the association between body lithium level and suicide is unknown.

We aimed to compare body lithium levels between suicide and non-suicide fatalities.

This cross-sectional study included 12 suicides and 16 non-suicides who were examined or dissected at the Tokyo Medical Examiner’s Office from March 2018 to June 2021. The aqueous humor lithium concentration was measured twice using inductively coupled plasma mass spectrometry. Analysis of covariance (ANCOVA) was used to compare the lithium concentration between suicides and non-suicides. Mixed-effects model was conducted to account for all lithium concentration data.

The aqueous humor lithium concentration did not change after death (t(7)=-0.70, SE=0.03, 95% CI=[-0.09, 0.05], P=0.51, Cohen’s d=0.01). The aqueous humor lithium concentration was lower in suicides (mean 0.50 μg/L (variance s2 0.04)) than in non-suicides (mean 0.92 μg/L (s2 0.07)) (t(26)=4.47, SE=0.09, 95% CI=[0.22 to 0.61], P<0.001, Cohen’s d=1.71). The ANCOVA showed that death by suicide was significantly associated with lower lithium concentration (F(1, 24)=8.57, P=0.007), and the effect size was large (ηp2=0.26). The random intercept model showed a significant effect of suicide on aqueous humor lithium concentration (b=-0.261, SE=0.102, 95% CI=[-0.471 to -0.051], t(24)=-2.568, P=0.017).

The results of this study demonstrate that even micro-dose lithium is associated with suicide death. Clinical studies are warranted to examine the effects of micro-dose lithium on suicide prevention.

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Spinal radicular syndromes are currently a significant healthcare concern in society. A common manifestation of these syndromes is sciatic pain, characterized by severe pain radiating along the course of the sciatic nerve. In many patients, chronic pain can lead to psychological problems.

The aim of this study was to assess the frequency of anxiety and depression disorders in patients with sciatica and their impact on functional capacity.

We conducted a cross-sectional study, including patients suffering from documented common sciatic pain evolving for more than 3 months. The study was conducted in a rheumatology department over a period of 3 years. We used the Hospital Anxiety and Depression Scale (HADS) questionnaire, supplemented with information about the study group, pain location, and patients’ occupations. Additionally, the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) were applied.

The study included 104 patients (71 women and 33 men, with a male-to-female sex ratio of 0.46). The mean age of our patients ranged from 23 to 74 years. The most frequent etiology of sciatic pain was a herniated disc, followed by lumbar spinal stenosis and spondylolisthesis. The root path was L5 in 74 cases and S1 in 30 cases. The average duration of sciatic pain was 6.4 months. The mean Oswestry score was 25 (ranging from 15 to 38). The mean VAS score was 7.4 (ranging from 4 to 9). The mean Work Ability Index (WAI) was 25.2 (ranging from 15 to 38).

Depression was noted in 53 patients (50.9%) with a mean HADS depression score of 10.8 (ranging from 4 to 16). Anxiety was noted in 8 patients (7.6%) with a mean HADS anxiety score of 6.40 (ranging from 3 to 16). In univariate analysis, anxiety was associated with the low educational level of patients and with the duration of sciatic pain (p < 0.05). There was a significant association between depression and anxiety (p = 0.000). However, there was no relationship between these psychiatric disorders and functional status (p > 0.05).

Among patients with sciatic pain, there is a high prevalence of psychiatric disorders, including anxiety and depression. Regular screening for these disorders should be conducted by healthcare providers.

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Cannabis is the most widely consumed illegal drug in the world and one of the easiest to access. This drug provides a feeling of well-being and euphoria. However, frequent consumption is associated with several complications including increased impulsivity and an increased risk of suicidal behaviour.

Our objective was to study the link between cannabis consumption, impulsivity and suicide intentionality.

We conducted a cross-sectional study, during the period from September 2020 to October 2021, among cannabis users consulting the Sfax Detoxification Center in Tunisia. Impulsivity was studied using the Barrat Impulsivity Scale (BIS 15) and suicide intentionality was assessed using the Suicide intent scale Beck; Pierce (SIS) in subjects with history of a suicide attempt.

We included 38 consumers. The average age is 26 years old and the sex ratio was 8.5 with an over-representation of men. The average BIS15 score was 38.2 ranging between 19 and 45. We have demonstrated that the higher the level of cannabis dependence, the higher the level of impulsivity. A high level of impulsivity was found in younger subjects (p=0,04) and with a low socio-economic level and unemployment (p =0,021). Suicidal intentionality, assessed in 10 patients with a history of suicide attempt, was low and intermediate in 40% and 60% of users respectively, which means a low to intermediate risk of subsequent completed suicide.

Impulsivity is associated with aggressive behaviour, various accidents including motor vehicle accidents, more self-mutilation and a much greater risk of dying by suicide than the general population. Frequent cannabis use is also associated with increased risk of developing all types of suicidal behaviours independently of the existence of depressive symptomatology. Overall, it is important to take into account the issues of impulsivity and substance abuse in daily clinical work as they influence the level of dangerousness.

None Declared

Substance use during pregnancy has become challenging clinical issue. Substance affects the brain, causing an addictive lifestyle. In pregnant women could lead more harm to neonatal life.

This study investigates the neonatal outcome of substance use and associated factors.

A cross-sectional study was designed. Data were collected from pregnant women who used substance during labor and refer to rehabilitative consultation between 2017-2020. Neonate data were collected from perinatal care. Chi-square test and Fisher exact test were performed to analyze associated factors. A p-value less than 0.05 is considered significantly.

162 participants were included in this study. Mean age was 27.37±6.46 years. Mean age at first substance used was 21.93±6.52years. No antenatal care was found 45.7%. Methamphetamine was the most used during the first use (67.9%) and latest used (72.2%). Average birth weight was 2,734.97±617.51 gram. Gestational age at birth was 36.75±2.83 week. Average head circumference was 32.81±1.39 centimeters. Average femur length was 47.77±2.17 centimeters. Apgar score > 7 at 1 minute and 5 minute was found 94.4% and 97.2% . Neonatal complications were preterm labor (34.6%), low birth weight (25.3%), small for gestational age (19.8%), premature rupture of membranes (4.9%), and stillbirth (3.7%). No antenatal care (p=0.048), no antenatal care and birth before admission (p=0.023), a cesarean delivery (p=0.024), and gestational age more than 37 weeks (p<0.001) were associated with neonatal outcome in maternal with substance used during labor. Using amphetamine as the first substance related to neonatal complication (p=0.028).

Preterm labor, low birth weight and small gestational age are the most found as neonatal complications in maternal substance used during labor. No antenatal care was related with neonatal complications in this group.

Therefore, an integrated system for the assessment of substances used in a pregnant woman and the system to reach out women who used substance and pregnant access to antenatal care should be established. Evaluation and rehabilitation are the interventions that should be done as soon as possible as primaray, secondary intervention.

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Functional Neurological Disorders (FND), also called hysteria or conversion disorder, have represented a challenge over the centuries in terms of comprehension of the mechanisms responsible for symptoms which mimic neurological diseases without organic damage. Charcot considered hysteria primarily a hereditary disorder, but also considered that environmental factors including physical and emotional stress served as provoking factors. The prevailing etiologic theories of FND are psychosocial and still strongly dominated by the Freudian concept of conversion – a psychologic symptom is converted into a somatic symptom as a way of dealing with the distress of the symptom. However, physiologic studies with fMRI are necessary to understand the neurological mechanisms involved in FND symptoms. Convergent neuroimaging findings have implicated abnormal limbic-motor interactions in response to emotional stimuli in FND patients, demonstrated a possible role of the limbic system (LS) in FND neurophysiology.

Understand the role of LS in the neurophysiologic mechanisms involve in FND.

Systematic review of the literature published in PubMed, using the terms “Functional Neurological Disorders”, “Limbic System”, “Emotions”.

Physiologic studies of functional weakness and sensory loss reveal normal functioning of primary motor and sensory cortex, but abnormalities of premotor cortex and association cortices. This suggests a top-down influence creating the dysfunction during the action control. Indeed, fMRI studies with FND motor patients show a hypoactivation of cortical and subcortical motor pathways, and a hyperactivity in limbic areas related with an abnormal limbic regulation with increased amygdala activity. In fact, studies have found a dysfunction in the medial prefrontal areas in FDN patients suggesting that they might have an abnormal affective representation (AR) of self-relevant information encoded in this region, which can later induce specific behavioral patterns of thought interaction with sensorimotor circuits. The abnormal AR could be influence by a dysfunction in LS regulation. Indeed, emotions are one of the major factors influencing movement choice. Moreover, limbic structures, such as the amygdala, can be influenced by genetic factors and/or early life stress. Thus, abnormal functioning of LS could lead to functional disorders by deranged top-down control.

In conclusion, FND patients may have an abnormal AR and/or emotion regulation mechanisms possibly due to prior experience or partly genetically determined which interact with lower-order functions leading to the production of the functional symptoms, where LS have an important role. However, much further empiric research is needed to better understand this fascinating and debilitating condition, as well as to derive new perspectives for more efficient therapeutic interventions in these patients.

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