Among many polypharmacy term definitions, the most common definition refers to the concurrent use of five or more medications. Multiple medication administration is highly prevalent in older populations with multimorbidity. Apart from polypharmacy impacts on physical health, it might be detrimental to mental health.

The present study aims to evaluate the association between depression and poor adherence in multimorbidity Iraqi older population using five or more medications.

This cross-sectional study was conducted in Iraq during July and August 2023, involving a sample of 196 older adults recruited from private clinics and hospital clinical medicine wards, all of whom had polypharmacy regimens. The questionnaire includes age, gender, medication regimen adherence and Patient Health Questionnaire-8 (PHQ-8) using a cutoff score of 10. Chi-square and binary logistic regression were performed to determine the association between poor adherence and the presence of depressive symptoms.

A total of 196 respondents, mean age = (61±11.4), 49 (25%) male and 147 (75%) female, 178 (90.8%) good adherence and 18 (9.2%) poor compliance, 81 (41.3%) participants have PHQ-8 score was equal or less than ten while 115 (58.7%) have PHQ-8 score was more than 10. Depressive symptoms and patient adherence showed a significant association (p = 0.02). Moreover, poor adherence polypharmacy participants were more likely to have depression odd ratio (OR) = 3.9, 95% confidence interval (CI = 1.09 – 13.9; p = 0.036).

Our findings suggest that depressive symptoms are associated with poor adherence polypharmacy older adults and, highlighting the importance of addressing medication management and mental health in this population.

None Declared

In ESCAPE-TRD esketamine nasal spray (ESK-NS) significantly increased the probability of achieving remission at Week (Wk) 8 and being relapse‑free through Wk32 after remission at Wk8 versus (vs) quetiapine extended release (Q-XR) in patients (pts) with treatment resistant depression (TRD) (Reif et al. DGPPN 2022; P-01-04). We report ESK-NS vs Q-XR effects on pt-reported health-related quality of life (HRQoL) over 32 wks.

Evaluate pt-reported HRQoL using the generic 36-item Short-Form Health Survey version 2 (SF-36v2, 4-wk recall, 2009 US population norms) in ESCAPE-TRD.

ESCAPE‑TRD (NCT04338321) was a randomised phase IIIb trial comparing the efficacy of ESK-NS vs Q-XR, both alongside an ongoing selective serotonin/serotonin-norepinephrine reuptake inhibitor, in pts with TRD. SF-36v2 was assessed every 4 wks (on-treatment and retrieved dropout visits). Domain scores and change from baseline (CfB) were analysed using a mixed model for repeated measures (MMRM; observed cases) adjusted for age, prior treatment failures, baseline score. Higher scores indicate better HRQoL. P values were not adjusted for multiple testing.

336 and 340 pts were randomised to ESK-NS and Q-XR. Baseline domain scores were below general population norms and lowest in Role Emotional, Mental Health and Social Functioning (Figure 1A). All scores improved to Wk32 in both arms (Figure 1B). At Wk4, CfB was significantly higher (better HRQoL) with ESK-NS vs Q-XR across domains (all p<0.01). At Wk8, CfB was significantly higher with ESK-NS vs Q-XR across all domains (p<0.05) except Bodily Pain and Role Physical. At Wk32, CfB was significantly higher with ESK-NS vs Q-XR for Mental Health (p=0.014), Role Emotional (p=0.001), Role Physical (p=0.046) and Social Functioning (p=0.006); a trend of numerical advantage was seen for all other domains (Figure 2).

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In addition to the superior clinical benefits provided by ESK-NS vs Q-XR in ESCAPE-TRD, pts receiving ESK-NS experienced significantly greater improvements in HRQoL vs Q-XR over 32 wks.

We thank the patients who participated. Study funding: Janssen, medical writing: Costello Medical, UK.

A. Young Grant / Research support from: Received grants from Janssen; independent research funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London; the views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health, Consultant of: Received consulting fees from Allegan, AstraZeneca, Bionomics, Eli Lilly, Janssen, Johnson & Johnson, LivaNova, Lundbeck, Servier, and Sumitomo Dainippon Pharma and Sunovion, Speakers bureau of: Received speaker’s honoraria from Allegan, AstraZeneca, Bionomics, Eli Lilly, Janssen, Johnson & Johnson, LivaNova, Lundbeck, Servier, and Sumitomo Dainippon Pharma and Sunovion, B. Baune Grant / Research support from: Received research grants from private industries or non-profit funds from AstraZeneca, Lundbeck, and Sanofi-Synthélabo; received research grants from the BMBF and BMG Germany, the DFG, Germany, the National Health and Medical Research Council, Australia, and Horizon Europe 2021; received research grants from the Fay Fuller Foundation, and James & Diana Ramsay Foundation, Adelaide, Consultant of: Received consulting fees for roles with the National Health and Medical Research Council, Australia; received honoraria from Angelini, AstraZeneca, Biogen, BMS, Boehringer Ingelheim, Johnson & Johnson, LivaNova, Lundbeck, Otsuka, Pfizer, Roche, Servier, Sumitomo Dainippon Pharma and Sunovion, and Wyeth; served on advisory boards for Biogen, Boehringer-Ingelheim, Janssen-Cilag, LivaNova, Lundbeck, Novartis, and Otsuka, N. Cardoner Grant / Research support from: Received research grants from the Ministry of Health, Ministry of Science and Innovation (CIBERSAM), and the Strategic Plan for Research and Innovation in Health (PERIS) for the period 2016–2020, as well as from Marato TV3 and Recercaixa, Consultant of: Served on advisory boards for Angelini, Esteve, Janssen, Lundbeck, Novartis, Pfizer and Viatris, Speakers bureau of: Received speaker’s honoraria from Angelini, Esteve, Janssen, Lundbeck, Novartis, Pfizer and Viatris, R. Frey Grant / Research support from: Received travel fees from Janssen and LivaNova; received grants or contracts from Alkermes (Principal Investigator), Janssen (Principal Investigator), LivaNova (Principal Investigator) and Medizinisch‑Wissenschaftlicher Fonds des Bürgermeisters von Wien (academic study), Consultant of: Received consulting fees from Boehringer Ingelheim and Janssen, Speakers bureau of: Received speaker’s honoraria from Janssen and Lundbeck, T. Ito Shareolder of: Johnson & Johnson, Employee of: Janssen, Y. Kambarov Employee of: Janssen, A. Lacerda Grant / Research support from: Received grants from Azidus, Biophytis, Boehringer-Ingelheim, Cellavita, Celltrion, CNPq, Eli Lilly, EOM, FAPESP, Genova, IQVIA, Janssen, Nordisk, Novartis, Novo, Parexel and PPD, Consultant of: Received consulting fees from Aché, Apsen, Biogen, Boehringer-Ingelheim, Cristalia, Daiichi, Eurofarma, Sankyo, EMS, Janssen, Libbs, LivaNova, Lundbeck, Sanofi and Torrent, Speakers bureau of: Received speaker’s honoraria from Aché, Apsen, Biogen, Boehringer-Ingelheim, Cristalia, Daiichi, Eurofarma, Sankyo, EMS, Janssen, Libbs, LivaNova, Lundbeck, Sanofi and Torrent, B. Rive Employee of: Janssen, C. von Holt Shareolder of: Johnson & Johnson, Employee of: Janssen, A. Oliveira-Maia Grant / Research support from: Received grants from Compass Pathways, Ltd., Janssen, and Schuhfried GmBH; investigator‑driven research funded by Fundação para Ciência e Tecnologia (PTDC/SAU-NUT/3507/2021; PTDC/MED-NEU/1552/2021; PTDC/MED‑NEU/31331/2017), Fundação para Ciência e Tecnologia and FEDER (PTDC/MED-NEU/30845/2017_LISBOA-01-0145-FEDER-030845; PTDC/MEC-PSQ/30302/2017_LISBOA-01-0145-FEDER-30302), the European Research Council (ERC-2020-STG-Grant 950357), the European Commission Horizon 2020 Research and Innovation program (H2020‑SC1‑2017‑CNECT‑2‑777167‑ΒΟUNCE; H2020‑SC1‑DTH‑2019‑875358‑FAITH), and the European Joint Programme in Rare Diseases (Joint Translational Call 2019) through Fundação para Ciência e Tecnologia (EJPRD/0001/2020), Consultant of: Received payment or honoraria from MSD (Portugal), Neurolite AG, and the European Monitoring Centre for Drugs and Drug Addiction; received support for attending meetings from Janssen (Portugal); participated in advisory boards for Angelini (Portugal) and Janssen (Portugal), Employee of: Vice-President of the Portuguese Society for Psychiatry and Mental Health; Head of the Psychiatry Working Group for the National Board of Medical Examination (GPNA) at the Portuguese Medical Association and Portuguese Ministry of Health

Substance use disorder is a common comorbidity with bipolar disorder, delaying its diagnosis and making treatment of both disorders more complex and challenging.

We aim to analyze the types of substances used by patients with bipolar disorder and to find if there’s a relationship between the substance used both with treatment adherence and maintenance of abstinence.

We collected, retrospectively, data from the hospital platform and analyzed it on SPSS Statistics 26, along with a literature review. Our study looks over 3 years, and all patients analyzed have a dual diagnosis of both bipolar disorder and substance use disorder and were hospitalized in the psychiatric ward of a tertiary university hospital.

There were 2384 hospitalizations in the Coimbra’s University Hospital psychiatric ward, and 88 hospitalizations were coded with a dual diagnosis of bipolar disorder and substance use disorder.

Tobacco was the substance more consumed by the patients (53.4%), followed by alcohol (46.6%) and cannabinoids (30.7%). In 18.2% of the patients was identified consumption of cocaine and in 6.8% there was an abuse of opioids. It is important to highlight that 20.5% of the patients used 2 or more substances at the same time.

Regarding adherence to treatment for both their bipolar disorder and substance use disorder, in 25% of the patients, there wasn’t a satisfactory compliance with the treatment prescribed.

In the group of patients with polydrug use, half of them didn’t comply with the treatment. In the patients consuming only one substance, we found out that 30% of patients who use alcohol didn’t adhere to the treatment, while around 13% of the patients using cannabinoids didn’t comply with the suggested treatment.

The relationship between the type of substance used and treatment adherence was statistically significant with a p=0.004 (considering p<0.05).

Regarding abstinence from consumption, around 42% of the patients keep using at least one substance. In the group with polydrug use, around 65% of the patients were not abstinent in the last appointments, while in the cannabinoids users’ group around 50% of them were still using the drug. In the group with patients using alcohol, around 43% of them are not abstinent.

The relationship between the type of substance used and maintenance of abstinence was found to be statistically significant with a p=0.037 (considering p<0.05).

Substance use disorder can have a huge impact on adherence to treatment, worsening the prognosis of the comorbid bipolar disorder. On the other hand, this dual diagnosis can impact the maintenance of abstinence.

Early detection of both diagnosis and simultaneous treatment from an early phase are essential to improve the prognosis of both diseases.

None Declared

Parkinson’s disease (PD) is the most common serious movement disorder in the world, affecting about 1% of adults older than 60 years. The disease is attributed to selective loss of neurons in the substantia nigra, and its cause is enigmatic in most individuals. Patients with PD display both motor and non-motor symptoms. For some patients, the non-motor symptoms are more bothersome than the motor symptoms. One of the most common non-motor symptoms of PD is depression.

Treatment of depression with antidepressant drugs is well established. In the last 20 years use of antidepressant has risen mainly due to the introduction of the selective serotonin reuptake inhibitors (SSRIs). Our primary aim was to demonstrate an improvement in depressive symptoms in patients who started treatment with vortioxetine. A secondary aim was to show those who was successfully treated with vortioxetine but was unresponsive to paroxetine and escitalopram without worsening the extrapyramidal symptoms of PD.

In collaboration with the Department of Neurology, we included patients who are being treated for Parkinson’s disease and who meet the criteria for depressive disorder after a psychiatric examination. We divided the patients into two groups: those who had not previously taken any antidepressant drugs and those who were already on therapy with paroxetine and escitalopram but without the expected therapeutic response. All patients were prescribed vortioxetine in their treatment, and the Hamilton Depression Rating Scale (HDRS) was determined during their first meeting with the psychiatrist, and then again after 6 weeks of taking the medication. Also, we used Mini mental state examination (MMSE) to measure cognitive impairment.Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)

Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)

In our research, vortioxetine has proven to be effective in treating depressive symptoms without worsening Parkinson’s disease, unlike paroxetine and escitalopram, which resulted in partial effects.

None Declared

The tumors of the diencephalon region (thalamic-hypothalamic-pituitary system) include a large group: pituitary adenomas, craniopharyngiomas, gliomas, and others. Tumors differ in the histological structure, and manifestations of the clinical symptoms; by hormonal data; by approaches and methods in treatment.

Psychic symptoms are revealed in disease in addition to cerebral, neuroendocrine symptoms, neurological disorders. Psychoorganic syndrome is represented by emotional, motivational, personal, cognitive impairments, inversion of the sleep-wake cycle, seizures.

Disorders of mental activity are detected in all tumors of this localization in varying degrees, according to the different authors from 20 to 100%; affective pathology varies from 2 to 80% by the literature.

To study the emotional disorders in the structure of psychoorganic pathology in tumors of diencephalon region

290 patients (18-78 years old, mean age 38+2): pituitary adenomas (PA), as the most common – 170 (58,6%), craniopharyngiomas (CG), as with the most varied manifestation of mental symptoms – 120 (41,4%). Methods: psychopathological, data from endocrinological, neurological, neuroimaging methods.

Emotional disorders were detected in patients from 30 to 68% of cases, depending on the histology of the tumours: PA with excessive secretion of growth hormone - emotional disorders are in 60%; PA with excessive secretion of adrenocorticotropic hormone - in 50%; PA with excessive secretion of prolactin - in 30%; with excessive secretion of thyroid-stimulating hormone - in 40%; non-functioning PA - in 16%; CG - in 68%.

Emotional disorders were more often represented by changeable mood, depression, apathy, sleep disturbance, and visceral symptoms. Symptoms differed depending on the histology of the tumor (type and level of hormones), the volume of the lesion and direction of growth, and concomitant hypertensive-hydrocephalic symptoms. Emotional disturbances often include memory impairment, personality and behavior changes.

Emotional disorders are detected in patients in 30-68% of cases in the structure of psychoorganic pathology with damage to the diencephalon region (in particular, with pituitary adenomas and craniopharyngiomas); are determined by the topography of the tumor and histology with the involvement of the corresponding structures and nuclei in the pathological process.

None Declared

Bipolar disorder (BD) is a complex mental illness described by recurrent episodes of mania and depression. One subtype of the illness is rapid cycling BD, characterized by experiencing four or more extreme mood swings within a year. Diagnosing and treating BD can be complicated by comorbid conditions, such as atypical anorexia nervosa (AAN), marked by disordered eating and disturbing weight-related thoughts.

To discuss the diagnosis and treatment plan of a patient with rapid cycling BD, who experienced adverse effects from prescribed medication and later was diagnosed with comorbid AAN.

We present a case of a 21 year-old man initially presenting with anxiety, low mood, and obsessive weight-related thoughts, ultimately diagnosed with major depression and mixed anxiety disorder.

21 year-old man was diagnosed with major depression and mixed anxiety disorder, initially treated with mirtazapine and fluoxetine (limited success), later attempting escitalopram and bupropion combination (partial remission). After 2 years the patient discontinued the treatment due to feeling “euphoric”, subsequently experiencing depression and manic episodes – the initial diagnosis was rapid cycling BD. The treatment was changed to sodium valproate (up to 1500 mg/day) and aripiprazole (up to 10 mg/day), however extremely rare adverse medication effects (nosebleeds, diarrhea with blood admixture, “high-frequency sounds”) were reported. Throughout valproate treatment, the patient experienced persistent diarrhea. During hospitalization for treatment adjustment lithium carbonate was introduced at a starting dose of 900 mg/day, maintaining blood lithium levels between 0.4 mmol/l and 0.49 mmol/l. Later the dose was adjusted and a therapeutic lithium blood level was reached with 1575 mg/day of lithium carbonate. Additionally, risperidone was prescribed, however, the patient experienced an uncommon adverse reaction – nasal congestion. Subsequently, amisulpride was introduced, which provoked severe anxiety and fear, resulting in medication discontinuation. During the latest outpatient visit, fluoxetine was added to the treatment due to observed depressive symptoms. Throughout the treatment, the patient episodically intermittently starved, had persistent distressing thoughts about weight and was diagnosed with AAN. While planning further treatment it was hypothesized that comorbid AAN might affect drug metabolism and the patient was referred to a specialized inpatient facility for eating disorder management.

This case report highlights the complexity of psychiatric disorders and the importance of monitoring and adjusting treatment based on patient response and side effects. Additionally, it emphasizes comorbid conditions significance in influencing the primary disorder’s dynamics as well as the metabolism and effectiveness of psychiatric medications.

None Declared

Delaware’s recent longevity and aging trends predict a continual increase in the number of cancer survivors. As the cancer survivors live longer and age, the prevalence of comorbid chronic conditions tends to increase. Dual burden of cancer and comorbid chronic conditions can have significant and wide-ranging ramifications for cancer survivors. Comorbidity potentially affects the development, stage at diagnosis, treatment options, recurrence and long-term survival of people with cancer. Detailed delineation of Delaware adult cancer survivors including an exploration of comorbidity is critical.

The primary objective was to characterize selected chronic conditions among Delaware adults with cancer in order to present: (i) disparities amongst cancer survivors by select sociodemographic and survivorship characteristics, and (ii) compare the prevalence of chronic conditions among cancer survivors and adult Delawareans without a cancer diagnosis.

Combined data (2018, 2020 and 2021) for Delaware were obtained from the Behavioral Risk Factor Surveillance System. The final data set included 927 Delawareans with at least one type of cancer (excluding skin cancers other than melanoma) and 11,917 participants without a cancer diagnosis. Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without a cancer diagnosis.

Amongst adult Delawareans, 5.1% (CI: 4.6–5.5) were cancer survivors. Across the state, the majority of cancer survivors (76.8%) reported having only one cancer diagnosis. In this sample of Delaware cancer survivors, 83.5% identified as White. Majority were female (57.4%), aged 65 or older (58.9%), had some college or more education (63.7%), and with an income of $50,000 or more (51.1%). Arthritis (46.3%), diabetes (21.5%), depression (18.7%), asthma (14.1%), chronic obstructive pulmonary disease (13.7%) angina (11.9%) and heart attack (11.6%) were the most prevalent comorbid conditions. Prevalence of certain chronic conditions was 2-3 times higher among cancer survivors. Nearly 23% reported not receiving instructions regarding cancer follow-up care.

Cancer survivors have unique concerns. Results aim to facilitate targeted interventions aimed at coordinated managed care among cancer survivors in Delaware. This study bolsters the ongoing public health effort towards the Healthy People 2030 goal of increasing the proportion of cancer survivors.

None Declared

Familial adenomatous polyposis (FAP) is a condition characterised by multiple polyps inside the colon or rectum, leading to colorectal cancer in all patients who do not perform prophylactic colectomy and a higher risk of cancer in other organs. Nevertheless, it has been reported that 14-48% of patients do not comply with regular endoscopic surveillance, which seems to be related to the lower levels of emotional distress observed in these patients. Also, APC gene polymorphisms have been described as being related to neurodevelopmental disorders, such as autism.

To study the prevalence of alexithymia, autistic traits and emotion regulation strategies in patients with FAP.

We conducted a cross-sectional study of patients with a genetic or clinical FAP diagnosis and assessed for alexithymia, autistic traits and emotion regulation using psychometric tests - Toronto Alexithymia Scale - 20 items (TAS-20), Autism-Spectrum Quotient Test (AQ) and Emotion Regulation Questionnaire (ERQ), respectively. The control group were patients with Lynch Syndrome. Statistical analysis was performed using SPSS vs.26.

We recruited a total of 20 patients (10 with FAP vs 10 with Lynch Syndrome). Nine patients were male (45%) versus 11 female (55%). The mean age was 53,35 years (SD 18,4). Half the sample presented a low educational level (equal or inferior to 4th grade).

The overall prevalence of alexithymia was 65%, with an 80% prevalence in FAP patients and 50% in Lynch Syndrome. TAS-20 total score was higher in FAP patients (69,0 vs 60,7; p=0,68). Externally-oriented thinking subscale score was statistically higher in FAP patients (p=0,024).

The overall prevalence of autistic traits was 25%, and the mean AQ score was higher in FAP (23,4; SD 4.97) compared to Lynch Syndrome patients (20,2; SD 5.57), but there were no statistically significant differences between the diagnoses (p=0,192).

A moderate positive correlation exists between Total AQ and Total TAS (r=0.51; p=0.020).

Concerning the scores obtained on the ERQ scale, most participants (14; 70%) use Expressive Suppression as a regulation strategy. Patients with Lynch Syndrome had higher scores than those with FAP, both in the Cognitive Reappraisal (4.22; SD 1.58 vs 4.28; SD 0.90) and Expressive Suppression (4.58; SD 1.08 vs 5.15; SD 1.03) domains.

The average AQ score for patients who mostly use expressive suppression is significantly higher than for those who use cognitive reappraisal (23.86 (3.63) vs 17.00 (6.6); p=0.039).

The preliminary results of this study point to high levels of alexithymia and autistic traits in this population, and a higher tendency to regulate emotions by expressive suppression.

The main limitation of the study was the small sample size, which reduced the power of the study to find statistically significant differences. Also, in future studies, a different control group should be considered.

None Declared

Motor Conversion Disorders (also called Functional Movement Disorders, FMD) are a group of neuropsychiatric conditions characterized by neurological symptoms of altered voluntary motor function that cannot be explained by typical neurological diseases or other medical conditions. In the last decade, several hypotheses have been formulated with respect to their pathophysiology, and a major line of research, trying to integrate psychological, cognitive, and neurobiological factors, focused on the subjective experience that patients feel of their own bodies. However, no study has, so far, directly investigated their Body Schema (the implicit sensorimotor representation of one’s own body) and its plasticity.

To investigate the Body Schema in patients with FMD through a paradigm specifically designed to assess their perceived body metrics, through a spatial estimation of body parts length, and to compare their results with the ones obtain on a group of healthy control subjects (HC)

10 patients with FMD and 11 HC underwent the Forearm Bisection Task, aimed at assessing perceived body metrics, which consists in asking the subject, blindfolded, to repeatedly point at the perceived middle point of their dominant forearm with the index finger of their contralateral hand, and a psychometric assessment for anxiety, depression, alexithymia, and tendency to dissociation.

FMD patients bisected their forearm more proximally (with an increased shift towards their elbow equal to 7.5%) with respect to HC; average bisection point was positively associated with anxiety levels in the whole sample, and with the tendency to dissociation in the FMD group.

FMD patients seem to perceive their forearm as shorter than HC do, which might suggest an alteration of their Body Schema. The Body Schema can go through short- and long-term plastic changes in the life course, mainly related to the use of each body segment; we speculate that, despite FMD being a disorder of functional nature, characterized by variability and fluctuations in symptomatology, the lack of sense of agency over a body part might be interpreted by the nervous system as disuse and hence influence the Body Schema, as deficits of organic aetiology do.

None Declared

Delirium is common in hospital settings, with approximately 3% to 45% of older patients in hospitals developing delirium during their stay. Among the elderly and those with severe or advanced medical conditions, the reported percentage of patients with delirium is over 56%. The three motor subtypes of delirium are hyperactive, hypoactive, and mixed. Another way to characterize delirium is based on whether it is reversible, irreversible, or terminal.

Identifying appropriate pharmacological treatment options among antipsychotics and their correlation with various precipitating and predisposing factors in the in-hospital context

This was a retrospective, cross-sectional, observational study that utilized a database created by the psychiatry department at the National Medical Center 20 de Noviembre, with data collected from April 2021 to April 2022. The database contains anonymized administrative and clinical data of patients who were seen in the psychiatry department for the diagnosis of any type of delirium, using the CAM scale for classification. The database includes records and data of hospitalized patients, encompassing all specialties at this medical center

A total of 139 patients were included in the study, of which 39% were female and 61% were male, with a mean age of 67 and a median age of 68 years. It was observed that the average duration of delirium symptoms, from receiving the consultation to remission, was approximately 6 days (p <0.005) (OR 5.12-6.62), and the average length of hospital stay was approximately 20 days (OR 17.3-22.09). Among the patients, 50.39% were overweight, 63% had hypertension (HTA), 29% had chronic kidney injury, 24% had a history of delirium, and 73% had recent surgical interventions. Patients with diabetes mellitus had a 3.1 times higher risk, those with HTA had a 2.8 times higher risk, and those with kidney injury had a 3.8 times higher risk of having a positive CAM result. It was observed that haloperidol, used in 84% of the patients, showed the highest percentage reduction in CAM scores

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The results of this study emphasize the importance of identifying risk factors associated with delirium and implementing effective treatment for this condition. It was observed that the average duration of delirium symptoms was approximately 6 days, which is relevant for understanding the course and management of this illness. Furthermore, it was found that the average hospital stay was 20 days, underscoring the burden that delirium can place on healthcare systems.

In conclusion, this study highlights the importance of identifying risk factors and providing appropriate treatment, such as the use of haloperidol, to improve outcomes in patients with delirium.

None Declared

Substance use disorders (SUDs) are a growing public health concern in the Arab world. To our knowledge, no previous study in Lebanon assessed the characteristics, management, and outcomes of patients with SUDs seen and managed by a consultation-liaisoin psychiatry (CLP) service.

This study explores the characteristics and management of individuals with SUDs who were referred to the CLP service in a tertiary care center in Lebanon.

As part of the Consultation-Liaison at the American University of Beirut (CLAUB) analysis, we conducted a retrospective record review of patients referred to our CLP service between February 2019 and May 2020. We assessed differences between SUD and non-SUD consults using Chi-square analysis, Fisher’s exact test, or Mann-Whitney U test, as appropriate.

Of 1475 patients, 278 (18.8%) received a diagnosis of SUD. They were mostly males (73.7%) with an average age of 38.8 years. The most used substances were alcohol (60%) and cannabis (28.4%). Compared to non-SUD consults, patients with SUDs were more likely to be males (odds ratio OR=3.18, p<0.001) and to get intubated during admission (OR=1.81, p=0.048). Predictors of intensive care unit admission in patients with alcohol use disorder included pulmonary or endocrinological disease, benzodiazepine use disorder, and days until CLP referral.

The results of this study highlight the high prevalence of alcohol use among individuals with SUD referred to the CLP service. Additionally, they underscore the limited treatment avenues available in this part of the world. The institution of a comprehensive CLP service is crucial to address the unmet needs of patients with SUDs who present to a general hospital setting.

None Declared

Tuberculosis is a bacterial infectious disease caused by Mycobacterium tuberculosis. This disease predominately affects the lungs but also affects other parts of the body, including the central nervous system. According to the the World Health Organization (2023), tuberculosis has an incidence of 6.4 million people in 2022, with 1.5 million deaths attributed to this disease. Psychosis describes a group of disorders that affects a person’s thought process and perception. It is a serious disorder that can have a profound impact on a person’s mental and physical health. As a result, psychosis symptoms and its treatment can complicate the management of tuberculosis.

The aim of this systematic review is to explore the association between tuberculosis and psychosis. It has been shown that up to 70% of patients with tuberculosis also have comorbid mental illness, this is likely to include psychosis. There are also shared risk factors between tuberculosis and psychosis, including poverty and homelessness, substance abuse, HIV positive serology and isolation. Tuberculosis medication, including isoniazid and rifampicin have been shown to have adverse psychiatric effects and we will examine if this includes psychosis.

A systematic review was pre-registered with PROSPRO and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, OVID and PsychINFO databases were searched from beginning of records to September 2023. This included hand-search of relevant reference lists. Observational and epidemiological studies were included along with population based registries.

Over one thousand (1,154) articles were identified and screened. There was significant heterogenity in results and over half of studies were from Asia and Africa. Many studies reported cases of drug-induced psychosis from anti-tubercular agents. Studies also discussed the increased risk of TB incidence among patients with psychosis and other psychiatric disorders.

This study identifies the importance of training healthcare workers in rapid detection of co-morbid psychosis in patients with tuberculosis, along with neuropsychiatric side effects of antitubercular agents. Integration of psychiatric and medical care of these patients would be of benefit to improve outcomes in this patient population. More research is needed on co-morbidity of tuberculosis and psychosis.

None Declared

Depression is a significant issue in chronic heart failure (HF), with a prevalence of about 20–40%, which is 4–5% higher than in the general population (Mbakwem A., et al., 2016).

The purpose of this study was to evaluate plasma fibronectin levels in patients with depression and chronic heart failure.

A total of 80 patients with HF II-III NYHA classes due to chronic coronary artery diseases (CAD) were observed. All patients were divided into two groups: Group 1 - 20 individuals without signs of depression, and Group 2 - 60 individuals with depression. The diagnosis of HF was confirmed based on ESC guidelines (2021). Depression was diagnosed using several questionnaires (Zung Self-Rating Depression Scale, Beck Depression Inventory, Hamilton’s Depression Scale). Standard laboratory and instrumental tests were conducted. The plasma levels of fibronectin and interleukin-1β (IL-1β) were identified using ELISA methods. Statistical analyses were performed using Statistica system software, version 12.0.

The average plasma fibronectin concentration in patients with depression and HF was 1.24 times higher than a similar indicator in HF patients without depression: (259.63±5.71) μg/ml versus (203.41±9.51) μg/ml (p<0.05). The conducted correlation analysis indicated a moderate positive correlation between the level of fibronectin and the number of neutrophils in peripheral blood (r=0.35; p<0.05), the level of fibronectin and the magnitude of endogenous intoxication according to the erythrocyte absorption ability test (r=0.44; p<0.01), the level of fibronectin and IL-1β concentration (r=0.39; p<0.05), and an inverse correlation with left ventricle ejection fraction (r=0.32; p<0.05).

Thus, the plasma fibronectin content in patients with depression and ischemic HF serves as a marker of the progression of myocardial remodeling processes and the intensity of the inflammatory process.

None Declared

According to the literature, 25-60% of dermatological patients have mental disorders. In the case of oncodermatological disease, the patient is under the influence of two stressogenic factors – existential experiences and social discomfort from the manifestations of the disease, which imprints on the patient’s mental health and promotes the development of mental maladaptation (MM).

To study the features of mental state in patients with dermatological diseases with different levels of vital threat.

The examination included the use of clinical-psychological, psychodiagnostic and psychometric research methods.

120 dermatological patients were examined: 60 patients with non-vital dermatological diseases (L82, A63.0, D18.0, L80), and 60 patients with dermatological diseases posing a vital threat (C43, C44, D04).

The identification of clinical signs of MM proved their presence in 70 (58.4%) people in the total sample. Among patients with non-vital diseases, the signs of MM were established in 33 (55.0%), among the patients with vital diseases – in 37 (61.7%). So, among patients with dermatological diseases, there are both psychologically adapted and maladapted individuals, regardless of the vitality/non-vitality of the pathological process.

In dermatological patients with signs of MM, the clinical picture is dominated by anxious (mainly in patients with non-vital diseases) and depressive (mainly in patients with vital diseases) radicals. Auxiliary psychopathological constructs are represented by manifestations of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, and phobic anxiety. Affective symptoms are most pronounced in patients with MM and vital diseases, it is less pronounced in patients with non-vital pathology.

The presence and intensity of maladaptive pathopsychological-affective reactions in patients with dermatological pathology are not clearly associated with the vitality of the dermatological process, but are based on mechanisms of the mutual influence of biological predisposition and psychological and psychosocial factors, the mosaic combination of which determines the individual’s resource capabilities for constructive acceptance the fact of the presence of a dermatological disease and the development of an adequate strategy for its mastery, regardless of the severity of the disease.

These patterns should be considered when developing treatment measures and rehabilitation for patients with dermatological pathology.

None Declared

Lithium is a mood stabilizer often used as a first-line treatment for bipolar disorder. Its narrow therapeutic window and changes in the absorption, distribution, and elimination of the drug following bariatric surgery have important implications regarding patient safety.

We present a 51-year-old female patient with bipolar disorder and a medical history of morbid obesity, type 2 diabetes mellitus, hypothyroidism, hyperlipidemia, and essential hypertension. She was mentally stable on lithium 1200 mg/day, valproate 500 mg/day, and quetiapine 400 mg/day. She had undergone laparoscopic sleeve gastrectomy. After a month, she showed up to the emergency room (ER) with nausea, vomiting, diarrhea, and fatigue. Gastroenteritis was suspected until the patient started showing neurological symptoms such as delirium, dysarthria, ataxia, chorea, and athetosis.

The patient was monitored and received aggressive intravenous hydration (3000 cc of 0.9% serum isotonic) in the intensive care unit (ICU). She was prescribed intramuscular biperiden injection of 5 mg/ml/day, pheniramine 45.5 mg/2 ml/day, and lorazepam 1 mg/day. Her lithium levels were checked every six hours. She was agitated and disoriented for the first five days despite lithium levels being in the therapeutic range. On day six, her blood lithium levels dropped to 0.399 mmol/L. Her psychiatric examination revealed that she resumed cooperation and orientation, her dysarthria subsided. However, her thought content and attitude were grandiose, and she had a labile affect. We prescribed 5 mg/day of olanzapine routinely and 1 mg/day of lorazepam on a needed basis. The next day, her labile affect became calmer, and her sleep improved so she was discharged from the ICU and admitted to general surgery inpatient service, and olanzapine was titrated to 10 mg per day since she had elevated mood symptoms.

After 7 days of intravenous hydration and supportive treatment, her neurological symptoms completely subsided except for a fine tremor, which lasted for another 3 days and then ceased. She was clinically stabilized without further need for intervention. Her lithium level was 0.206 mmol/L before her discharge.

We believe it is of utmost importance to build a consensus in guidelines and inform physicians about lithium toxicity and its symptoms after bariatric surgeries. We recommend a careful follow-up of the patient pre-and postoperatively. Preoperative psychiatric intervention includes decreasing the lithium dose gradually and discontinuing it. After the operation, lithium can be started with a much lower dose and may be increased by checking lithium levels every week for at least 6 weeks after the operation until the patient can digest solid food again, and then every 2 weeks for 6 months, and thereafter every month for one year.

None Declared

The structure of psychiatric care has undergone many changes in recent decades. In addition, the SARS-CoV-2 pandemic has posed specific challenges for inpatient psychiatric care. In Vienna, the admission of SARS-CoV-2 positive psychiatric patients has been centralised in one department, the 1st Department of Psychiatry and Psychotherapeutic Medicine, Klinik Hietzing.

It will be investigated to what extent the admissions of SARS-CoV-2 positive and negative patients differ with regard to age, gender, diagnosis, need for involuntary admission, medication, duration of treatment, country of birth and the question of where the patients come from and where they are discharged to.

Between 15 March 2020 and 21 May 2022 (start and end of cohorting of all Vienna SARS-CoV-2 positive inpatient psychiatric patients in one department), 338 SARS-CoV-2 positive and 1312 SARS-CoV-2 negative patients were treated as inpatients at the 1st Department of Psychiatry and Psychotherapeutic Medicine of the Klinik Hietzing.

The results of the study will be shown.

The SARS-CoV-2 pandemic has presented an outstanding challenge to inpatient psychiatry. An accurate portrayal of differences in the treatment of positive and negative patients is of importance for assessing the impact of the pandemic.

None Declared

Little is known about touch hunger (longing for physical contact) during the COVID-19 pandemic, particularly for people with pre-existing mental health disorders.

We aim to investigate the dynamics of touch hunger in people with and without depressive, anxiety, or obsessive-compulsive disorders during the COVID-19 pandemic, and the potential predictors for touch hunger during lockdown.

Data were aggregated from three Dutch ongoing prospective cohorts with similar methodology for data collection. We included participants with pre-pandemic data gathered during 2006–2016, and who completed up to 9 online questionnaires between October 2020 and February 2022. We compared trajectories between subgroups with different pre-pandemic chronicity of disorders and healthy controls using linear mixed models. Sociodemographic, clinical (number and type of mental health disorders, personality traits) and COVID-19-related variables were analysed as predictors of touch hunger using multivariate linear regression analyses.

We included 1061 participants with (n = 811) and without (n = 250) mental health disorders. In all groups, touch hunger increased during lockdown (Fig. 1). Extraversion (β = 0.256, P <0.001), social distancing due to COVID-19 anxiety (β = 0.122, P = 0.001) and death of a close contact from COVID-19 (β = 0.073, P = 0.02) predicted higher touch hunger, while living with a partner (β = -0.109, P = 0.004) or with a partner and children (β = -0.147, P <0.001) were protective factors for touch hunger. Remarkably, pre-pandemic mental disorders did not predict touch hunger during lockdown.

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Social distancing measures have important psychological and emotional implications, as our study showed an increase in touch hunger during lockdown, which did not differ between people with and without mental health disorders. Extroverted individuals may benefit most from interventions aimed at addressing their need for physical contact during times of crisis.

None Declared

Survivors of the pandemic of COVID-19 suffered from multiple sequelae long time after recovery, such as tiredness and memory dysfunction, affecting daily life activities.

To assess fatigability, cognitive impairment and the severity of pain in long-COVID.

We conducted a prospective cohort study including 121 Tunisian COVID-19 inpatients who had been discharged alive from hospital. Each enrolled patient was asked about the period before the hospital stay, and the 6-9 month-period after hospital discharge, using the visual analog scale (VAS), self-completed unidimensional scale and yes/ no question about fatigability and cognitive impairments.

The median age of participants was 59 years, with extreme values ranging from 18 to 80. Among them, 51.2% were females.

Our findings showed a significant increase in VAS score after COVID infection (3.82 vs 1.69; p<0.001). Sixty-eight (56.2%) participants reported spontaneously fatigability after the infection and 52 (43%) reported spontaneously a deterioration in memory capacity either with or without previous memory dysfunction. Fatigability was statistically associated to cognitive impairment (55.9% vs 26.4%; P= 0.02). In addition, fatigability and cognitive impairment were statistically associated with pain (P=0.001 and P= 0.022 respectively).

There was no significative association of fatigability nor cognitive impairment with the gender of the survivors.

The clinician should keep in mind to screen for possible somatic or psychological distress, in particular pain, fatigability and cognitive impairment even after resolution of the COVID infection, in order to guarantee a better quality of life.

None Declared

Hospital employees are at high risk of developing mental health issues during the coronavirus (COVID-19) pandemic. Indeed, several studies have shown increased rates of anxiety, depression, stress, and other mental health issues but existing studies show inconsistencies, and each country has some local specificities.

This study aimed to investigate the influence of the COVID-19 pandemic on various aspects of the mental health of hospital employees (health workers and non-health workers) from Croatia.

This cross-sectional questionnaire study was conducted from February to April 2023 period. A validated, anonymous questionnaire that contained questions regarding demographic data, as well as the Pittsburgh Sleep Quality Index (PSQI), the Zung Self-Rating Anxiety Scale, and the Zung Self-Rating Depression Scale was self-administered to a convenient sample of hospital employees from one general hospital in northwestern Croatia.

The study sample included 360 subjects with a median age of 42 years (interquartile range 35-50), 24.7% males, and 75.3% females. According to the PSQI, 21.1% of subjects presented sleep disturbances. According to the Zung Self-Rating Anxiety Scale, there were 39.4% of subjects with anxiety while according to the Zung Self-Rating Depression Scale, there were 6.4% of subjects with depression. Sleep disturbances were more frequent among subjects who considered their socioeconomic status as under average (p=0.040), and among health workers in comparison to non-health workers employed in hospital (p=0.040). Anxiety was more frequent among females (p=0.010), and subjects with lower levels of education (only elementary school) (p=0.040). Depression was more frequent among females (p=0.030).

The COVID-19 pandemic has a significant negative influence on the mental health of hospital employees where health workers in comparison to non-health workers, females, subjects with lower levels of education, and subjects who considered their socioeconomic status as under average are more prone to the development of investigated mental health issues. The development of appropriate supportive programs that enhance the mental health of all hospital employees during pandemics is needed to address mental health issues in this vulnerable population.

None Declared

The diagnosis of a severe chronic illness represents a deeply impactful traumatic event, frequently giving rise to initial adverse consequences that can manifest as post-traumatic stress. The duration and characteristics of these effects exhibit considerable variation among individuals.

This study aims to explore the levels of post-traumatic stress, post-traumatic growth, and psychosocial adaptation among individuals coping with chronic diseases.

This cross-sectional study involved 92 participants with chronic illnesses, recruited through convenience and snowball sampling. Data collection utilized an online questionnaire that included both demographic questions to provide a comprehensive understanding of participants’ experiences, as well as psychometric scales for measuring post-traumatic stress, post-traumatic growth, and psychosocial adaptation.

Instruments used :

1.PTSD Checklist for DSM-5 (PCL-5)

2.Posttraumatic Growth Inventory (PTGI) and Tedeschi and Calhoun Posttraumatic Growth Inventory (TCGI).

3.Psychosocial Adjustment to Illness Scale (PAIS).

Analysis included descriptive statistics and inductive analysis using SPSS (p < 0.05). Ethical considerations were observed, with informed consent and data confidentiality.

The study revealed the presence of low to moderate levels of post-traumatic stress (M= 2.45), moderate levels of post-traumatic growth (M= 2.90), and moderate levels of psychosocial adaptation in various aspects of participants’ lives, including work (M= 2.36), sexuality (M= 2.11), sociability (M= 2.28), relationships with partners and family members (M= 1.92), and perception of their health (M= 1.94). Furthermore, the overall psychosocial situation of the participants was found to range from low to moderate (M= 2.48). Notably, individuals with fewer chronic illnesses tended to experience lower levels of post-traumatic stress and exhibited less adaptation in their work. Additionally, higher levels of post-traumatic growth were observed in women and patients with higher educational backgrounds. The analysis revealed a positive and statistically significant correlation (sig.<0.05) between post-traumatic stress, post-traumatic growth, and various dimensions of psychosocial adjustment among the participants.

A chronic illness diagnosis can be deeply traumatic, potentially causing post-traumatic stress. However, it’s crucial to understand that this doesn’t diminish the possibility of post-traumatic growth and effective psychosocial adaptation. To foster this positive path, individuals must receive holistic psychological and emotional support, along with essential social assistance as they navigate life with chronic diseases.

None Declared