The evolution of depression and dementia has been shown to differ in some studies. For example, a history of recent depression has been found to be associated with an increased risk of Alzheimer’s disease in women (Kim et al., 2021).

We will use data collected from several dementia studies to analyze whether the presence of depression at diagnosis is more frequent in women.

We conducted a systematic search for articles analyzing the presence of depression in patients with a diagnosis of dementia. We analyzed by Student’s t test the presence of depression according to sex, considering the alternative hypothesis that there is more depression in female than male patients.

The mean age of the sample was 71 years. We obtained a statistically significant Student’s t test (p=0.02).

The approach and approach to depression in the elderly as a risk factor could be different according to sex. For example, some studies have proposed the use of hormone replacement therapy (HRT) after menopause as a possible protective factor for the subsequent development of dementia (Kim et al., 2022). Further studies are recommended in this regard.

None Declared

We present the case of a 70-year-old man who, after presenting atypical depressive symptoms, was diagnosed with incipient frontotemporal dementia.

Through the presentation of the case, a brief review is made of the affective prodromes of frontotemporal dementia

The patient, who had no personal history of interest, suddenly began to present depressive symptoms consisting of marked irritability, dysphoric mood, anxious semiology with a subjective feeling of anguish, maintenance insomnia and a feeling of lack of self-control, with a tendency towards verbal heteroaggressiveness. The patient reported all these symptoms with great suffering.

After one year of treatment with venlafaxine 300g DMD and quetiapine 400g DMD, with one admission to the short-stay inpatient unit for self-harm threats, the patient had not experienced any improvement. In addition, during this year, the patient’s family began to observe small memory lapses that affected his daily functioning, making the patient progressively more dependent.

In view of this clinical picture, it was decided to request an MRI and a brain PET scan, where deficits in the frontal and temporal regions were observed, and a diagnosis of incipient frontotemporal dementia was made.

Frontotemporal dementia is the third most common dementia in people over 65 years of age. About half of the patients debut with psychiatric symptoms, one of them being depressive symptoms. Treatment is focused on the use of psychotropic drugs with the aim of symptom management. Olanzapine or aripiprazole are effective for psychotic symptoms or acute agitation. For more subacute conditions, SSRIs or trazodone are recommended. The iACOs are not recommended, because they are ineffective and worsen neuropsychiatric symptoms.

None Declared

We present the case of an elderly patient with a severe depressive episode who, in order to maintain psychopathological stabilisation, receives ECT on an outpatient basis.

The objective is to briefly review the use of ECT as a maintenance treatment for severe depression in the elderly.

Patient aged 76 years, multipathological, with a history of hypertension, DM and LBP. Femoral head fracture, myelodysplastic syndrome, severe osteoporosis with vertebral crushing, requiring rescue treatment with tramadol, and renal failure.

She came for consultation, reporting depressive symptoms of months’ duration, together with delusions of ruin and nihilism. Despite antidepressant and stabilising treatment with duloxetine at daily doses of 120mg, extended-release quetiapine 600mg, lorazepam 2.5mg and mirtazapine 45mg, the patient began to show negative behaviour towards accepting food, clinophilic behaviour and abandonment, which led to her being admitted to the short-term hospitalisation unit.

Due to the severity of the depressive symptomatology, it was decided to start ECT, administering a total of 12 sessions, which were effective, and outpatient follow-up was resumed. However, after a week, the patient again began to show marked apathy and abulia, as well as complete anorexia lasting more than 24 hours, which led to a new admission. It was then that it was decided to maintain the ECT treatment, on an outpatient basis, as maintenance treatment, together with pharmacological treatment.

ECT is indicated in severe depression, with or without psychotic symptoms, with malnutrition and organic pathology. According to studies, it has a beneficial response of more than 60%. However, the rate of receiving depressive symptomatology in a severe episode is high, despite ECT, so studies and clinical practice recommend maintenance ECT. It is usual to start with weekly sessions, and progressively space them out to maintain the minimum that guarantees stability.

None Declared

We present the case of a patient with schizoaffective disorder and Parkinson’s disease (PD), requiring treatment adjustment, with the use of high doses of quetiapine for the treatment of psychotic symptomatology.

The aim is to briefly review the treatment of dopaminergic psychosis in the elderly.

Patient aged 86 years, institutionalised, presenting severe episodes of behavioural alteration, high anxiety and delusions of harm, together with auditory and visual hallucinations. As relevant physical history, the patient has AHT, aortic insufficiency, and bladder cancer operated on in 2012. As psychiatric history of interest, the patient has been diagnosed since his 30s with schizoaffective disorder, Parkinson’s disease and moderate-severe cognitive impairment secondary to the previous two.

As usual treatment, in addition to anticoagulation and antihypertensive therapy, the patient has been receiving L-dopa for his PD for years, antidepressant treatment with escitalopram 10mg, haloperidol 80 drops a day, divided into three doses, and lormetazepam 2mg as a hypnotic.

In addition to the symptoms described above, the patient had episodes of confusional features, as well as marked stiffness in the cogwheel and significant gait disturbance, having suffered several falls without serious repercussions.

Due to the comorbid neurological pathology, it was decided to progressively modify the treatment, withdrawing the benzodiazepine due to the risk of confusional disorder and replacing it with trazodone. Antipsychotic treatment was gradually replaced by extended-release quetiapine, reaching a maximum dose of 800mg. Likewise, escitalopram treatment is replaced by sertraline.

With this adjustment, there was an improvement in the psychotic symptoms, as well as in the anxious symptoms. Episodes of distress are NOT observed, and the patient’s functionality improves, allowing him/her to participate in daily activities, both cognitive stimulation and physiotherapy.

The Spanish Society of Psychogeriatrics recommends that before using antipsychotics, it is advisable to first treat the underlying potentially treatable causes (pain, infections, toxic effects of drugs…), assess non-pharmacological interventions and always, if the use of antipsychotics is required, assess the risk-benefit ratio.

In relation to the above, it is not surprising that in the elderly, the use of second-generation antipsychotics is recommended in the first place, as opposed to the classical ones. The latter are only recommended in emergency situations where an almost immediate effect is required.

For dopaminergic psychosis, there are only controlled trials with clozapine. However, due to prescribing difficulties, aripiprazole or quetiapine is recommended in the first instance.

None Declared

“Electrolyte abnormalities are commonly encountered in daily clinical practice, and their diagnosis relies on routine laboratory results. Electrolyte disturbances can affect the brain among many other organs and tissues and must be promptly recognized, as they can lead to serious and potentially life-threatening complications if neglected or not appropriately treated. Neurological manifestations reflect the severity of acute neuronal dysfunction and thus require urgent treatment. Acute and/or severe electrolyte imbalances can manifest with rapidly progressive neurological symptoms, seizures, and psychiatric manifestations. They are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia.

Were the psychiatric manifestations secondary to hyponatremia or epilepsy? Or is it a comorbidity? What are the risk factors? And what is the appropriate course of action for this type of patient?”

We present, through a clinical case, the situation of a 64-year-old patient who experienced status epilepticus secondary to hyponatremia, requiring hospitalization in the neurology department. Subsequently, she developed psychiatric manifestations with a marked change in behavior. She began experiencing symptoms of anxiety and depressive mood, headaches, somatic complaints, and social isolation. Her condition gradually worsened, necessitating hospitalization in the psychiatry department 3 years later.

The patient was placed on Carbamazepine by her neurologist, and since then, she has not experienced epileptic seizures. Her follow-up electrolyte panel initially showed slight disturbances before normalizing. Psychiatric manifestations were concurrent with these somatic symptoms and worsened over time. During her psychiatric hospitalization three years later, after a thorough evaluation, she was prescribed Sertraline ans Risperidone in combination with Carbamazepine, resulting in a significant improvement in her condition.

In summary, this case illustrates the critical impact of electrolyte abnormalities on both neurological and psychiatric health, especially in older patients. Understanding risk factors associated with electrolyte imbalances is crucial for effective diagnosis and management, particularly in the elderly. This underscores the importance of a multidisciplinary approach to address the potential serious consequences of electrolyte disturbances on overall patient well-being.

None Declared

Consideration of the reserve problem would be incomplete without an analysis of the cytoprotective mechanism. The predominant molecular hallmark of aging and degeneration is the accumulation of altered gene products. Moreover, several conditions, including protein, lipid, or glucose oxidation, disrupt redox homeostasis and lead to the accumulation of unfolded or misfolded proteins in the aging brain in case of AD, and other neurodegenerative diseases that have as a common denominator abnormal protein production, mitochondrial dysfunction and oxidative stress. Some authors classify aging, pathological aging, and neurodegeneration as “protein conformational diseases”.

scientific publications

analytical review

The central nervous system has evolved a conserved unfolded protein response mechanism to cope with the accumulation of misfolded proteins. As one of the main intracellular redox systems involved in neuroprotection, the vitagene system becomes a potential neurohormetic target for novel cytoprotective interventions. Vitagens encode the cytoprotective heat shock proteins (Hsp) Hsp70 and heme oxygenase-1, as well as thioredoxin reductase and sirtuins. The cellular stress response is the ability of a cell to withstand stressful conditions, including the heat shock response. The production of heat shock proteins, including protein chaperones, is necessary for the folding and repair of damaged proteins, which promotes cell survival to avoid apoptosis.«Molecular chaperone» are proteins that function as part of an ancient defense system in our cells. They promote cell survival by sequestering damaged proteins and preventing their aggregation. Chaperone complexes are involved in the regulation of mitochondrial functions, assembly of the cytoplasmic proteolytic system of brain cells. The cellular response to stress requires the activation of survival pathways that are under the control of protective genes called vitagens. Vitagens are involved in the production of heat-shock protein molecules, glutathione, and bilirubin. They have antioxidant and anti-apoptotic activity and provide protection against oxidative stress.

Studies have shown that the heat shock response contributes to the maintenance of cellular homeostasis, the establishment of a cytoprotective state in a wide range of human diseases, including inflammation, cancer, aging, and neurodegenerative disorders. Endogenous proteins can be manipulated by food or pharmacological compounds, which represents an innovative approach to therapeutic intervention in neurodegenerative disorders, actually influencing reserve mechanisms and adaptive capacity.

None Declared

Impairments in energy metabolism, glutamate neurotransmitter and antioxidant systems contribute substantially in development of schizophrenia spectrum disorders, especially in late-onset psychosis (LOP).

Revealing subgroups of patients with LOP by determining activity of platelet enzymes of energy, glutamate, and glutathione metabolism.

62 women of 52-89 years old were studied, with late onset schizophrenia spectrum disorders (F20.0, F25, F22.0, F06.2 by ICD-10). PANSS with its subscales was used to assess the severity of psychotic symptoms. Scores by PANSS and activity levels of platelet cytochrome c-oxidase (COX), glutamate dehydrogenase (GDH), glutathione reductase (GR) and glutathione-S-transferase (GST) were evaluated twice: before and on the 28-th day of antipsychotic treatment. Activities of COX, GDH, GR, and GST were measured in 37 women of 50-84 years old comprising the control group.

Clustering of patients by the enzymatic activities resulted in 2 clusters (C1 and C2) significantly different by COX and GST (p<0.001). In C1 (n=40), as compared with control, reduced level of GDH activity before and after treatment (p=0.049 and p=0.032, respectively) and a reduced level of GR activity before treatment (p=0.026) were revealed. In C2 (n=22), as compared with the control, COX activity was increased before and after treatment (p=0.0001), GDH activity was decreased before and after treatment (p=0.0002 and p=0.0001, respectively), and GST activity was decreased before and after treatment (p=0.029 and p=0.0029, respectively). GR activity was not significantly changed in both clusters. Significant correlations were found between enzymatic activities and scores by psychometric scales: in C1, GR activity positively correlated with the score reduction (delta) by PANSS-Pos (R=0.45, p=0.004), by PANSS-Psy (R=0.44, p=0.005), and by PANSS (R=0.47, p=0.002), and GST activity – with the score reduction by PANSS-Psy (R=0.315, p=0.048). In C2 (n=22), GDH activity negatively correlated with the score reduction by PANSS-Pos (R=-0.41, p=0.050) and by PANSS (R=-0.49, p=0.021).

The different correlations revealed in two separated clusters between enzymatic activity levels and clinical measures characterizing the antipsychotic treatment efficacy will allow us to approach differentiated predicting the effectiveness of pharmacotherapy using the biochemical parameters.

None Declared

We have previously found significant alterations in activities of glutathione dependent enzymes in blood cells of patients with late-life depression (LLD) compared with age-matched controls.

The revealing subgroups of LLD patients by glutathione-metabolism enzymes’ activities in blood cells using cluster analysis.

LLD patients (n=101) of 60-86 age (69 patients with recurrent depression (RD), 23 with bipolar disorder (BD) and 9 patients with a single depressive episode (DE)) were assessed by Hamilton depression rating scale (HAMD-17), and Hamilton Anxiety Rating Scale (HARS). Activity levels of glutathione reductase (GR) and glutathione S-transferase (GST) were determined in patients’ platelets (-pl) and erythrocytes (-er). The control group consisted of 51 peoples 55-84 years old without mental pathology. Cluster analysis module of the STATISTICA software was used for clustering the patients by baseline blood parameters.

Three clusters of patients were obtained: C1, n=39, C2, n=31, C3, n=31, differing significantly in all biochemical parameters (Kruskal-Wallis test, p<0.001), except GST. When compared with control group by Mann-Whitney test, GST-pl, GST-er, and GR-er were significantly decreased in C1; GST-er was significantly increased in C2; GST-pl, GR-pl, and GR-er were significantly decreased in C3. Several significant correlations were found between the measured parameters and scores by HDRS or HAMD-17. In C1, baseline activity of GST-er correlated with total scores by HAMD-17 (R=0.335, p=0.043) after treatment. In C2, baseline activity of GR-er correlated with total scores by HARS (R=-0.376, p=0,037) after treatment and GR-pl correlated with delta scores by HAMD-17 under the treatment (R=0.484, p=0.006). No significant correlations were found in C3. Patients with BD distributed significantly unevenly between C1, C2, and C3, with significantly more BD patients clustering in C1 (61%) compared with C2 and C3 (Yetes-corrected Chi-square =7.73, p=0.0054), whereas patients with RD and DE distributed evenly.

Patterns of activity levels for glutathione-dependent enzymes in patients with BD differ from those in patients with RD and DE. Significant correlations of the measured biochemical parameters with scores by HDRS or HAMD-17 assessed after the treatment and evidenced for the treatment efficacy seem to be promising biomarkers for further evaluation of the treatment efficacy in heterogeneous group of LLD patients using the proposed approach to their stratification into subgroups.

None Declared

According to the two-factor theory of delusional belief (Coltheart. Ann N Y Acad Sci 2010; 1191 16-26), explaining the presence of a delusion requires a combination of two neuropsychological impairments. The first deficit initially prompts the delusional belief and defines its content, whereas the second deficit – aberrant belief evaluation – interrupts the rejection of a delusional belief and is common for different types of delusions. The second deficit is associated with compromised functioning of the right ventral frontal/anterior insular cortex (r-VF/AI; Darby et al. Brain 2017; 140 497-507). However, neural correlates of the first deficit in different types of delusions remain obscure.

The aim of the study was to search for regions whose functional connectivity with r-VF/AI is different between patients with somatic delusions (SD) and persecutory delusions (PD) and to further clarify the results by comparing clinical groups with healthy controls. We hypothesized that each clinical group is characterized by aberrant functional connectivity between a region, associated with poor belief evaluation (r-VF/AI), and a region, presumably associated with a neuropsychological impairment specific to the corresponding type of delusions.

Patients with delusional disorder or paranoid schizophrenia (n = 23) and healthy controls (n = 9; 5 females; mean age 36.2 ± 1.3) underwent resting-state fMRI (Philips Ingenia 3T). Nine patients had SD (5 females; mean age 40.3 ± 7.9) and fourteen patients had PD (3 females; mean age 35.6 ± 10.2). The clinical groups were compared in terms of whole-brain functional connectivity of r-VF/AI (ROI-to-voxel analysis in CONN; RRID:SCR_009550; www.nitrc.org/projects/conn). Statistical thresholds were p < .005 voxelwise, p[FDR] < .05 clusterwise. Each clinical group was compared with controls in terms of functional connectivity between r-VF/AI and previously identified regions with between-group differences in connectivity (ROI-to-ROI analysis). Age was a covariate of no interest in all analyses.

Patients with SD compared to patients with PD and healthy individuals had higher functional connectivity between the r-VF/AI and a cluster in the right precentral and postcentral gyri extending to supramarginal and superior frontal gyri (Figure 1).

Image:

The regions whose functional connectivity with r-VF/AI was aberrant in patients with SD are involved in the processing of tactile, proprioceptive, and visceral information. Our results coincide with a suggestion that the evaluation of beliefs related to bodily sensations is disturbed in patients with SD.

Research was supported by RFBR grant project 21-515-12007.

None Declared

Antipsychotics are currently widely prescribed for various mental disorders. A presumption of a potential carcinogenic effect of antipsychotics was raised by certain studies. There are few data in the literature on this subject.

Study the relationship between the use of antipsychotics and the risk of cancer.

A systematic literature review was carried out on PubMed looking for articles in English, published during the last decade (2013-2023), using the keywords “Antipsychotics” and “Cancer”. We included all articles studying the relationship between antipsychotics use and cancer risk.

Nine articles were included in our study, the majority of which focused on breast cancer. The results regarding breast cancer were discordant: although three studies did not show an association between the administration of antipsychotics and breast cancer, more recent studies have proven the opposite. Indeed, chronic exposure to antipsychotics, particularly those raising prolactinemia, was significantly associated with an accumulated risk of breast cancer, especially with positive estrogen receptors, whereas prolactin-sparing antipsychotics were not associated with it. Regarding hematologic malignancies, unlike other antipsychotics, long-term use of clozapine was associated with a high risk of malignancy, and had a greater effect on mortality from lymphoma and leukemia than to agranulocytosis. On the other hand, it has been proven that the use of atypical antipsychotics is associated with a reduced risk of lung cancer.

Data from the literature regarding the carcinogenic potential of antipsychotics remain discordant and inconclusive. The most recent studies are worrying and highlight in particular an association between the use of antipsychotics and the increased risk of breast cancer. If these data are confirmed in future studies, this will undoubtedly impact the benefit-risk balance when making therapeutic decisions.

None Declared

Cancer patients, namely breast cancer survivors, are highly vulnerable to psychological morbidity. Noninvasive interventions are incentivized to promote the mental health and quality of life of cancer survivors. Recent studies provided evidence supporting the use of meditation as a promising adjuvant tool for improving the mental health and quality of life of cancer survivors.

The present study aims to carry out a clinical trial to evaluate the effects of an online group of meditation program of Kundalini Yoga on breast cancer women, through a longitudinal and randomized research design, in the following variables: psychological morbidity, self-compassion, spirituality, and quality of life.

This study had the participation of 35 participants distributed randomly for 3 equivalent groups (N=11 EG, N=13 ACG, N=11 PCG), with the diagnosis of breast cancer, aged between 34 and 78 years.

The sample of women with breast cancer was randomly selected from a breast cancer support association.

The protocol was applied online individually on pre-test, post-test, and 1-month follow-up moments, in 3 comparison groups: 1) the Experimental Group(EG), who practiced yoga Kundalini meditation; 2) the Active Control Group(ACG) that practiced relaxation; 3) the waiting list Passive Control Group(PCG). Intervention sessions were carried out for the EG and the ACG, in an online format, lasting about 30 minutes, weekly, for 8 weeks. Statistical analyses were considered at a 0.05 significance level. All analyses were performed with IBM SPSS, version 27.

The results showed that the group that did yoga kundalini meditation (EG) had benefits, unlike the control groups, in the variables of emotional functioning, global spiritual well-being, and personal well-being. There were statistically significant differences in the overall self-compassion score when comparing the 3-time points in all groups. The sub-scale of self-kindness and transcendental well-being shows an increase significantly between the 3 moments in the active control group. The passive control group performed significantly worse over time in the self-kindness.

Based on preliminary results, the Experimental Group (EG) exhibited improvements in Self-Compassion, Spirituality, and Emotional Functioning (as evaluated by the QLQ C-30) following eight consecutive weeks of online Kundalini Yoga Meditation practice. These findings contribute to the growing body of evidence supporting meditation’s potential to enhance life quality and spiritual well-being in individuals with breast cancer. These preliminary findings suggest that further research in this promising field is warranted.

None Declared

Among the various patient experiences, cancer-related fatigue and sleep disturbances emerge as pivotal aspects that can substantially impact individuals’ quality of life. There exists a relative scarcity of research focusing on the intricate relationship between symptoms, functioning, fatigue, and sleep disturbances in colorectal cancer (CRC) patients.

In this context, the current research endeavors to apply advanced statistical methodologies to elucidate the complex relationships between symptoms, functioning, fatigue, and sleep disturbances. By exploring the intricate web of patient characteristics, clinical factors, psychosocial elements, this study aims to construct a holistic model that not only captures the nuances of colorectal cancer patients’ experiences but also uncovers potential avenues for intervention and support.

In our cross sectional study, we administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Quality of Life Questionnaire Colorectal Cancer Module (QLQ-CR29) to 987patients who were surgically-treated for CRC from the tertiary hospital from 2013 through 2018. To confirm the relationship between symptoms of CRC patients, univariable logistic regression was used to examine the potential relationship between independent variables and the occurrence of fatigue and sleep disorders. Least Absolute Shrinkage and Selection Operator (Lasso) was used for variable selection. The selected variables were then applied to a multivariate logistic regression analysis to examine the most influential predictors of fatigue and sleep disturbance. Finally, gaussian graphical models (GGM) were used to identify potential interactions between characteristics, symptoms, functioning, with fatigue, and sleep disturbances in CRC. In this study, Directed Acyclic Graph (DAG) was used to identify causal dependancy and path of variables.

About 10.4% of study participants reported experiencing fatigue. Sleep problems were reported by 15.8% of the study participants. Multivariable logistic regression analysis using Lasso showed that sleep problem (odds ratio [OR]=2.34; 95% CI, 1.03-5.31), physical, role, and emotional functioning, pain, dyspnoea, and appetite loss were significant predictors of fatigue, while emotional functioning, dyspnoea, and appetite loss were significant predictors of sleep problem. The variables that were directly linked to fatigue were role functioning, emotional functioning, dyspnoea, appetite loss, body image and trouble with taste. The variables that were directly linked to sleep problem were emotional functioning and appetite loss.

In conclusion, there were complex relationships between symptoms, functioning, fatigue, and sleep disturbances. The symptom network of CRC patients showed different patterns toward fatigue and sleep.

None Declared

Meningiomas are the most frequent primary brain tumor. Although most Meningiomas are benign, their location in the central nervous system can predict symptomatology which could result in significant morbidity and mortality. However, due to the slow-growing nature, meningiomas are usually asymptomatic, and diagnosis is often made incidentally on neuroimaging or at an autopsy. The incidence rate is 1.2-fold higher in Black Americans than White Americans. Neuropsychiatry manifestation might be only initial presentation; thus, psychiatrists are often the first to see these patients, and the correct diagnosis may be made only when the tumor has grown to a considerable size and begun to displace the brain.

The aim of this study is to understand the biological basis of psychiatry symptoms in patients with Frontal Lobe meningiomas.

A review of literature and individual patient data analysis was conducted. The literature review was conducted on PubMed, Medline, MeSH, Google Scholar, and mount Sinai’s levy Library using the key words; meningioma, meningioma with psychiatric symptoms, psychosis, depression, neuropsychiatry manifestation of meningiomas.

The review revealed that 88% of brain tumors and psychiatric symptoms are located in the frontal region. Meningiomas accounts for 13%-26% of intracranial tumors. There is a reported low incidence due to its slow growing nature and are usually asymptomatic. Incidence of meningiomas is predominant in females, and is attributed to hormonal factors, this is associated with estrogen and progestogen cycles. Reports shows that smoking has been linked to increase risk of meningiomas in men. Frontal lobe meningiomas may present with only psychological symptoms that resemble depression, anxiety states, hypomania and schizophrenia. Personality and mental status changes are also noted in Frontal lobe tumors. Left sided lesions are associated with inhibition of motor activity, impairment in motor and initiative aspect of speech, diminished generalization ability and general inertia of mental process.

Given the absence of frank neurological symptoms, to help localize the lesion, most meningiomas are missed due to diagnostic overshadowing of the primary psychiatric illness. Peritumoral edema indicates the underlying mechanism and location of the lesion predicts symptomatology. Like our patient who is an 81-year-old male with no past psychiatry history, presenting to our comprehensive psychiatry emergency program with psychiatric manifestation as the initial presentation and subsequently with MRI suggestive of Right Frontal extra-axial meningioma. This study shows that primitive frontal lobe tumors are likely to be misdiagnosed as patients with such tumors are often referred first to psychiatrist. High index of suspicious is needed.

None Declared

“What can and what cannot I do in a sexual relationship?” |In this way, a middle-aged man with HNC - Head and Neck Cancer, under chemotherapy or radiotherapy, asks. This doubt is raised to the oncologist, radiotherapist, nurse or psychotherapist. Apparently, his concern is objective, considering he has a severe diagnosis and important treatments. However, underlying the manifest doubt, there are symbolic constructions in his mind that generate anguish. The health professionals’ response must go beyond information. They also must understand the symbolic emotional meanings associated with the patient’s speech. This attitude will bring a psychotherapeutic effect to the ill man.

To interpret symbolically sexual and emotional experiences reported by male patients diagnosed with HNC under outpatient treatment in a public specialized clinical unit.

We used the CQM - Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). For data collection, the main researcher used the Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes. The employ of the Seven Steps of the CQCA - Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) brings us to discussion categories. The sample was closed with 12 patients according to the information saturation strategy (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27). The interviews were conducted by the first author of this abstract, a male nurse, as part of his master’s research at a postgraduate course in Oncology. The findings were validated by peer reviewers from the Lab of Clinical-Qualitative Research at the State University of Campinas.

Two categories were chosen for this presentation: ‘The dyad perceived in the felt body and the experienced body’, and ‘The body re-signified between the sexual and affective dimensions’. The body symbolized before and after the illness experiences a movement in phenomenological consciousness that leads to external changes in its attitudes. The patient needs now to ask himself and others what this body can - or cannot - do. The severely ill body imposes new meanings for life and sexuality. It does not cancel the wish but asks for a new channelling of your psychic/sexual energies.

These findings indicate that patients with HNC want to talk about sexuality and ask about the risks of sexual activity, contrary to what the common view supposes. Traditional Balint groups met with the multidisciplinary team can be beneficial for doctors and nurses to deal with their own emotional limitations. Furthermore, the Consultation-Liaison Psychiatry, under the approach of psychosomatic medicine, focuses on the care of patients with behavioural and emotional manifestations, together with the work of the oncologists.

None Declared

Background:

Somatic symptoms disorders are usually comorbid with depressive disorders despite that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) have been approved by FDA for mildly resistance depression. From this point we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder.

case report

case report

Case Report:

A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complains in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedure for somatic treatments, all of them where normal.

Then patient was seen by different psychiatric clinic multiple anti-depressant and adjuvant anti-psychotic medication were try, patient still not improve.

Patient get admitted to hospital for observation and management. Initially she was preoccupying by her somatic complain kept on Fluoxetine and Olanzapine along with that topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After complete all sessions of rTMS patient was recovering from her all symptoms, no complain report from her.

Conclusion: our case highlights the important of investigated more thoroughly in rTMS as treatment option for Persistent Somatic symptoms Disorder.

None Declared

♦Over the last 10 years, the number of cancer patients in the world has increased by almost 23%, and the number of cancer deaths has also increased by about 10%. Malignant neoplasms still remain as one of the main causes of mortality in the population. Patients with oncopathology are characterized by a high level of depression which leads to inadequate attitudes towards the disease and its treatment, and this may further act as a risk factor for disease susceptibility and aggravate its course (Schulz-Kindermann, 2021). It is relevant to search for variables that act as a personal resource in coping with cancer. It is hypothesized that one such personal resource is the specificity of attitudes towards death.

To conduct a comparative analysis of the relationship between the level of depression and the peculiarities of the attitude to death in cancer patients in Russia and Germany.

• ▪ Beck Depression Inventory to determine the level of depression severity.

• ▪ Death Attitude Profile-Revised to determine the type of attitude to death.

For statistical processing of data, the SPSS 23.0 statistical package was used with a preliminary check for normality of distribution using the Kolmogorov-Smirnov statistical criterion.

The sample consisted of a total number of 50 cancer patients with 25 each undergoing treatment in Russia (Moscow) and in Germany (Munich). The study was based on the sample obtained from the P. A. Herzen Moscow Research Oncological Institute and the Helios Munich-West Clinic. Overall, the sample was relatively gender-balanced.

The following results were obtained from the study:

1. 1. The mean value of depression level in cancer patients is higher in Russia than in Germany.

2. 2. The level of depression in cancer patients in both the countries is correlated with:

   • ▪ marital status (p=0.36)

   • ▪ stage of disease (p=0.001)

   • ▪ type of treatment (p=0.001)

   • ▪ belief in God (p=0.024)

   • ▪ adherence to a particular religious denomination (p=0.008)

3. 3. The level of depression was correlated with a certain type of attitude towards death: a higher level of depression was associated with scores on the “fear of death” scale (p=0.000), and a lower level (or lack of) with the “neutral acceptance of death” scale (p=0.000)

4. 4. The fear of death is seen to be most common in the sample of patients from Russia, while the neutral acceptance of death is more prevalent in the sample from Germany.

The results suggest that a positive attitude to death (neutral as one of these types) is correlated, along with other factors, with lower levels of depression, which may be a personal resource in coping with the disease.

This allows us to make the assumption that when providing psychological support to cancer patients, it is necessary to pay attention not only to the attitude to life and illness, but also to the attitude to death.

None Declared

Childhood cancer survivors have neurocognitive sequelae that in most survivor follow-up programs are underdiagnosed and for which there is usually no treatment plan.

Video games have demonstrated various psychological and neurocognitive benefits in different subpopulations, such as patients with organic neurological deficits or children with ADHD. However, few studies have been carried out using video games-based interventions in the paediatric oncology population.

The aim of this work is to present the WINNERS study protocol, the objectives of which are to diagnose the neurological and cognitive sequelae in child cancer survivors, and to demonstrate the benefit in these areas of a training program based on video games.

A randomized controlled and unblinded trial is presented. Fifty-six patients aged 8 to 17 years stratified into two age groups (8-12 and 13-17) who had received any of the following treatments 1 to 6 years before the enrolment will be selected: high-dose chemotherapy with blood-brain barrier crossing, intrathecal or intraventricular chemotherapy, CNS radiotherapy or hematopoietic stem cell transplantation.

A neuropsychological evaluation will be performed consisting of a battery of neuropsychological tests to assess parameters such as attention, memory, visuospatial ability or speed of response, as well as a neuroimaging evaluation by structural and functional magnetic resonance imaging. The evaluation will be repeated 3 months and 6 months after the enrolment. Patients will be randomized to a treatment group or to a recycled waiting group. Intervention will consist on a 12-week training at home using 3 video games: a brain training game, an exergaming game and a skill training game.

According to the hypotheses of this study, it is expected that the proposed program of videogame-based interventions will improve neurocognitive and other wellbeing parameters in the intervention group.

This study aims to improve the quality of care for patients who have survived a cancer disease by detecting sequelae that have so far been poorly attended, and by proposing a gamification-based intervention program that is effective and attractive for this population.

None Declared

Children who have undergone an oncological process and have received treatment with chemotherapy or radiotherapy on the central nervous system may have significant neurocognitive sequelae. Some video games have shown neurocognitive benefits in people with impairments in different areas, such as attention or memory.

This work aims to demonstrate the benefit of a video game-based training program to improve the neurocognitive profile in a child survivor of cancer.

The patient is a 9-year-old female who was diagnosed with acute lymphoblastic leukemia at the age of 4 years. She received routine treatment of this disease by chemotherapy, including high-dose chemotherapy (with blood-brain barrier crossing) and intrathecal chemotherapy. She is currently 3 years after the end of treatment.

The Continuous Performance Test 3 (CPT-3) (sustained attention/vigilance) was administered before and after a multifaceted training program consisting of playing 3 video games for 12 weeks, as follows: a brain-training game (4 days per week, 7-12 minutes per day), a skill-training game (2 days per week, 10 minutes per day) and an exergaming game (2 days per week, 10 minutes per day).

Prior to intervention, the patient had 3 atypical z-scores on the CPT-3 (z scores: mean = 0, S.D. = 1), with a pattern compatible with ADHD (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2). After intervention, she had only an atypical z-score (hit reaction time z = 3.6), with a pattern compatible with slowing, without ADHD.

The neuropsychological evaluation of this patient showed an improvement in his attentional pattern on the CPT-3 after the video game-based training.

None Declared

Paediatric cancer survivors have a risk for neuropsychological impairment due to the disease and the treatment received. These affections have been neglected in the follow-up of these patients. It is important to identify the most valid outcomes in the evaluation of neurocognitive sequelae in childhood cancer survivors.

This work aims to compare the results obtained between subjective perception of caregivers and objective cognitive performance based on validated attention tests.

In a randomized controlled and unblinded trial to demonstrate the benefit of video games on different neurocognitive areas in cancer survivors, we studied attention functioning before and after the intervention program. The attention deficit subscale from the Behavior Assessment System for Children 3rd edition (BASC-3), self- and parent-reported versions, and the Continuous Performance Test, 3rd edition (CPT 3) will be used as outcomes (z scores: mean = 0, S.D. = 1).

We observed an improvement in attention after intervention using the CPT-3 (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2 versus hit reaction time z = 3.6 without other atipycal z scores after intervention), changing the attentional pattern from “ADHD” to “slowed”. However, in the parent-reported version of the BASC-3, a worsening in the attention subscale is observed (z = 0.3 pre-intervention vs z = 1.0 post-intervention) while the self-reported version of the patient didn’t show any significant changes (z = 1.4 pre-intervention vs z = 1.1 post-intervention).

It is essential to use objective tests to measure neurocognitive sequelae in these patients. Subjective surveys can provide additional information, but not substitute the above.

None Declared

Health Psychology is aggregated to clinical studies providing physicians, nurses, and psychotherapists with psychodynamics of sick persons, facilitating interpersonal relationships and greater adherence to treatments. How do people deal with illness and treatment from what they symbolize in experiences of becoming ill? Watch & Wait Protocol for patients with rectal cancer is an active surveillance as an alternative approach in surgical medical management. Patients are followed with physical examinations, endoscopy, and imaging. Observation carried out through periodic examinations aims to avoid surgery stage while rectal cancer is maintained.

To interpret emotional meanings attributed by patients, after adhering to the W&W protocol for rectal cancer, to life experiences of watching and waiting for the disease course.

Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). For data collection, the first author used Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes, after acculturation. Sample closed by information saturation (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27). Interviews conducted by the first author, a female psychologist. We employed the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) to construct categories. Theoretical framework was the Balintian Medical Psychology. Findings were validated by peer reviewers from Lab of Clinical-Qualitative Research.

Sample had 10 patients, 3 female and 7 male, from 52 to 77 years. Interviews carried out from October 2022 to March 2023. We constructed 03 categories: 1) Fate out of hands - “I get sick just coming in here.” There is an apprehension experienced in each medical evaluation to check the clinical condition because the symbol of waiting is not having the own destiny in the hands. 2) Psychic defence - “Sometimes I even thought if I had to live on a grant for the rest of my life or die!” Imagining the worst is a psychic defence because if this probability occurs, the mind has already begun its elaboration. 3) Life upside down - “I was going to have the surgery, use a bag, my life was going to be upside down.” Anxiety generated by waiting is a mental disorganizing.

Attitudes of observing and waiting carry different symbolisms to those who work with scientific thinking and who experience the observation of their own disease and the wait for what conduct they will receive. Observing oneself in illness requires acceleration of changes in ego identity. Waiting in front of illness asks the ego to think the worst. It is not a volitional choice. Preparing for the worst is a defensive necessity in the emotional sphere to avoid surprises that take to mental rupture.

None Declared