The population ageing is a reality associated with an increase in prevalence of Dementia. The use of benzodiazepines is often postulated as a risk factor in these syndromes.

Contrary to recommendations for its short-time use, long-term and chronic use are common, with an estimated 8,7% of elderly people in the US taking benzodiazepines.

To clarify the most recent evidence on the use of benzodiazepines and the risk of developing dementia.

Non-systematic review of literature, using PubMed as database and filtering the results for meta-analysis.

Four articles were included in this review.

Zhong G et al. concluded that risk of dementia increased in consumers of benzodiazepines and it was associated with higher doses.

In turn, AlDawasari A et al., when trying to clarify the use of different sedative-hypnotic drugs, found and increased risk with the consumption of benzodiazepines. After exclusion of articles with confounders and adjustment for protopathic bias, the risk was not maintained.

Lucchetta RC et al. concluded that the risk exists but without inferring differences between doses or duration of action.

Finally, Penninkilampi R e Eslick GD investigated this association, after controlling for the protopathic bias, concluding, contrary to AlDawasari et al., that the association benzodiazepines consumption and dementia do not result from this bias.

We cannot draw robust and concrete conclusions between benzodiazepines consumption and the pathogenesis of dementia because not only is the literature limited, but results are also heterogeneous.

However, these prescriptions must be carried out cautiously, especially in the elderly, due to the known adverse effects associated with them.

None Declared

Impairment in mentalization, interpreting and perceiving social relevant information has been found to play a part in the development and maintenance of depression. Major depressive disorders showed significant impairment in social cognition and such impairment appears to be positively associated with the severity of depression. Self-referential gaze perception, as a measurement of mentalization, was predominantly measured in patients with psychosis but rarely examined in late-life depression (LLD).

To assess the effect of cognition on the interpretation bias of mentalization

This will be a cross-sectional case-controlled study on Chinese older adults with major depressive disorder recruited from outpatient departments of the public mental health service in Hong Kong. The same inclusion and exclusion criteria, with the exception of the history of major depressive disorder, will be used to recruit the control group. Assessments included sociodemographics, cognitive assessments and depressive symptoms. The primary experimental task was Gaze Perception Task using E- prime Professional 2.0. The stimuli of task are photographs of six Chinese models (3 men and 3 women) facing straight to camera with 13 different gaze directions (0°, 5°, 10°, 15°, 20°, 25° and 30° to the left and to the right, respectively). Participants shall be instructed to respond with a “yes” or a “no” to the question (for self-referential gaze): ‘Do you feel as if the person in the picture is looking at you?’.

41 patients and 41 healthy controls have been recruited. The group comparison in SRGP revealed that there was only significant difference in the unambiguous-SRGP (U=561.000, Z=-2.62, N=82, p=0.009). Patients had higher unambiguous self-referential gaze accuracy (Mean=0.16) than controls (Mean= 0.075). With a cut-off score of 22, patients with better HK-MoCA scores had better unambiguous SRGP scores than those with lower HK-MoCA scores (p=0.024). This difference was not observed in healthy controls. HK-MoCA could predict ambiguous SRGP rate F(1,80)=14.85, p<.001, R square=15.7%. and redict unambiguous SRGP rate F(1,80)=14.85, p<.001, R square=15.7%.

LLD subjects had a significant interpretation bias in the unambitious averted gaze (20°, 25° and 30°) interpretation compared with healthy controls. LLD subjects tend to have more self-referential perception of the clear averted gaze. This misinterpretation of the eye gaze is probably due to the interpretation bias in processing external information, which is commonly reported as mentalization impairment in depression (Weightman et al., 2014).

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Bipolar disorder (BD) in the elderly patient may present as the evolution of illness initiated earlier in life or as a new-onset entity. Therefore, two groups of patients are distinguished: “late onset” (LOBD) when the first mania occurs in old age and “early onset” in elderly patients with long-standing history. BD in elderly patients (≥60 years) constitutes 25% of all BD cases. Specific aspects of older age bipolar disorder (OABD) are somatic and psychiatric comorbidity, impaired cognition and age-related psychosocial functioning. The management of BD in the elderly is complex given the high sensitivity of these patients to pharmacological side effects, particularly of psychotropic drugs.

The case of a patient with LOBD is presented, followed by a theoretical review of the subject.

A case is presented with a bibliographic review.

A 76-year-old woman who had no prior history of mental health issues until March 2023 when she was initially admitted to a geriatric hospitalization unit for manifesting manic symptoms. She was readmitted in July 2023 due to worsening depressive symptoms that included a declining mood, passive thoughts of death, deterioration in self-care, weight loss, insomnia, constipation, and dry mouth despite recent changes in her medications. She was on treatment with escitalopram (which was gradually discontinued and replaced with mirtazapine), quetiapine, lormetazepam, and lorazepam. Imaging tests showed chronic ischemic lesions in her brain and a small meningioma, the rest of the test were normal.

The initial diagnostic hypothesis was a bipolar depressive episode, and her treatment was adjusted accordingly. She was started on lithium, and her quetiapine dosage was increased, along with the anxiolytic lorazepam. Due to the persistence of depressive symptoms, including low mood, anhedonia, apathy, and negative thoughts, she was also prescribed antidepressant medication (venlafaxine and mirtazapine). Her condition gradually improved, with better eating and sleep patterns, increased participation in activities, and reduced somatic complaints and anxiety.

As she continued to experience somnolence and decreased morning energy, her antipsychotic medication was switched from quetiapine to lurasidone. The dose of lithium was decreased due to tremors in her extremities, although they remained within the therapeutic range. Despite these adjustments, her mood significantly improved, and she showed no signs of worsening or psychotic symptoms, leading to her discharge.

Summarizing different studies, LOBD who develop mania for the first time at an advanced age (≥ 50 years) constitute 5-10% of all BD. It is important to perform a thorough differential diagnosis, as an organic substrate and diverse etiologies may be present. Current guidelines recommend that first-line treatment of OABD should be similar to that of BD in young patients, with careful use of psychotropic drugs.

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BPSDs in patients with AD are present up to 90% and can cause serious complications in their overall health. A non-pharmacological approach and cognitive enhancers should be a priority in treatment in order to reduce the use of antipsychotics. In the pharmacological treatment of bpsd, additional therapy is inevitable in many cases

the need for adequat educatation of the medical staff in a geriatric center for the nonfarmacological approach in patients with bpsd in AD. Polypharmacy is common in farmacological treatment.

A cross-sectional study of 180 patients hospitalized at geriatric unit in period of January till May 2023 was conducted. 61(33.9%) were patients with AD, 44 or 72.1% were females and 17 or 27.9% were males, with mean age 78.6±5.6 years. 50 patients (82.0%) had potentiated BPSD in the first days of hospitalization and needed additional therapy

: 19 od 61pts (31.1%) were on dual therapy, full doses of donepezil and memantine. 17 (89.5%) needed additional therapy for BPSD; 13 (68.4%) a short-term antipsychotic and 4 (21.1%) patients antidepressant therapy. 22 patients (36.1%) were admitted with donepezil only. 18 (81,8%) needed additional therapy. The remaining 20 (32,8%) were solely on memantine. 15 (75.0%) needed additional therapy

Vast majority of patients AD (82.0%) manifested BPSD and needed additional therapy. Number of scientific papers it is found that cognitive stimulation in persons with moderate dementia has a benefit more than any pharmacological treatment. Education of caregivers of people with AD is inevitable.Opening of day care centers that will enable continuous support as well as individual access which would help delay institutionalization of people with BPSD at ADthe need

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Some studies have shown that late-life depression is related to faster cognitive decline and may increase the risk of dementia.

Identifying risk and protective factors for dementia is essential to develop preventive interventions. Some literature has suggested that mood disorders (namely depression) are potential modifiable risk factors for dementia.

Thus, it is important to know clinical presentation of depression that is associated to dementia, as a manifestation of subclinical dementia or as a risk factor for neurocognitive disorders.

We aim to identify clinical characteristics related to dementia of inpatients admitted for first time due to depressive episode after 55 years old.

Retrospective cohort study of inpatients admitted between January 1st 2010 and March 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Our sample included 57 inpatients, 15,8% (n=9) with the diagnosis of dementia 5,2 (SD 5,6) years after admission. All of these patients presented a depressive episode with psychotic symptoms, namely delusion activity. In those with hallucinatory activity, no one developed dementia.

Interestingly, 33,3% of patients with dementia (n=3) presented with delusion of ruin, 55,6% (n=5) with delusion of prejudice/persecutory delusion and 66,7% (n=6) manifested delusion of ruin and/or prejudice.

We also found that 42,9% (n=3) of patients with dementia manifested Cotard delusion while this type of delusion was observed in 13,6% of patients without dementia (p=0,095).

Our study has several limitations because is based on results of only one hospital, with a small sample size.

However, since depressive symptoms are potentially modifiable risk factors for dementia, future studies are essential to understand the mechanisms that link depression to cognitive decline as well as clinical characteristics that may constitute predictors of dementia.

None Declared

The elderly population is rapidly growing worldwide. Depression is an important public health concern among the elderly population in terms of its prevalence and the burdens of ill health in individual sufferers and families.

A considerable number of studies focusing on the prevalence, associated factors, and treatment of depression have been conducted in Western Europe and North America. However, this kind of research is relatively limited in Nepal.

- To find out and prevalence and its associated factors of depression among the elderly in sudur paschim province Nepal.

This community-based, cross-sectional, door-to-door survey was conducted in the two representative districts of Sudur-paschim Province, Nepal. Eligible participants were assessed for geriatric depression and quality of life. the sample size was calculated at 945.

Depression was found in 43.9% of the participants.

The association of different variables with WHOQOL-8 first question. Income was significantly associated with poor quality of life (p-value 0.04).

Furthermore, we have evaluated the association of different variables across four domains of the WHOQOL-8 scale and found statistically significant differences across age, sex, residence, occupation, income, history of smoking, history of alcohol use, comorbidities, and depression.

Depression is highly prevalent among the elderly in the Sudur-Paschim Province of Nepal. So policymakers should take this research outcome seriously and should keep the mental health of the elderly population a priority during the implementation of public health policies.

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The ageing population presents complex clinical challenges, particularly in the realm of mental health among the elderly. The intersection of geriatric psychiatry and geriatrics plays a critical role in providing a holistic and comprehensive approach to addressing psychiatric issues in older adults. This abstract explores the integration of these two disciplines and their significance in elderly mental health care.

This study aims to underscore the benefits of collaboration between geriatric psychiatry and geriatrics while highlighting areas of intersection. These areas include the assessment of medical and psychiatric comorbidities, the management of neuropsychiatric disorders, and the promotion of healthy ageing, both physically and mentally.

We comprehensively reviewed the literature, encompassing research studies, case reports, clinical guidelines, and reports published in the last 10 years. The research was conducted on medical databases, including PubMed, Medline, and specialized sources in gerontology.

Effective integration between geriatric psychiatry and geriatrics provides a more comprehensive and patient-centred approach to addressing the mental health needs of the elderly. This includes enhanced assessment and treatment of a wide range of psychiatric conditions commonly found in older adults, such as cognitive disorders (including dementia and mild cognitive impairment), mood disorders (including depression and bipolar disorder), anxiety disorders, psychotic disorders, and substance use disorders. Additionally, the collaboration ensures a better understanding of the complex interplay between physical and mental health in the ageing population. The integration approach also encompasses the management of neuropsychiatric symptoms associated with various medical conditions common in older adults, such as delirium and behavioural disturbances in dementia. This coordinated care extends to the judicious use of psychotropic medications, considering the unique pharmacokinetics and pharmacodynamics in the elderly population, with a focus on minimizing adverse effects and drug-drug interactions. Furthermore, promoting emotional well-being and preventing mental illnesses emerge as critical areas of collaboration between these disciplines. Strategies for achieving this goal include psychoeducation, lifestyle interventions, and fostering a supportive environment for the elderly.

In summary, the collaboration between geriatric psychiatry and geriatrics is crucial for addressing the complex mental health needs of the elderly, providing patient-centred care, and optimizing resources. This integrated approach is essential in ensuring the well-being of older adults, emphasizing a holistic, multidisciplinary approach to mental health issues in this population.

None Declared

Alzheimer’s and Parkinson’s disease are neurodegenerative disorders with life limiting conditions. The symptomatic pharmacological therapeutic strategies unfortunately are also related to undesirable side effects. Acetylcholinesterase inhibitors administered to Alzheimer’s disease patients increase cholinergic transmission in cortex and hippocampus.

Antiparkinsonian drugs increase dopaminergic system activity, to compensate for dopaminergic neurons’ degeneration in corpus striatum, therefore supplying the imbalance of these neurotransmitters in these degenerative areas.But undesirable the increase of these neurotransmitters in other cerebral and peripheral areas brings us important side effects

To study Alzheimer’s cholinergic drugs and Parkinson’s dopaminergic drugs’ side effects

This retrospective study included 107 geriatric patients enrolled in a private long-term care institution. 79 patients with Alzheimer’s disease had mean age of 88.11 ± 5,78 years old, mean weight of 61.62 ± 13.10 kg. 28 patients with Parkinson’s disease had mean age of 84.93 ± 5.71 years old, weight mean 66.36 ± 2.83 kg.

Alzheimer’s disease patients 41.77% (33) received. Acetylcholinesterase inhibitors (Donepezil, galantamine and rivastigmine) Psychomotor agitation and aggressive behavior 63.666% and nausea (15%) were observed in the patients treated with these drugs. The association of L-DOPA and DOPA decarboxylase inhibitors (benserazide) were administered to 53%(15) of the Parkinson’s disease patients in doses between 2.0-19.0 mg/kg/day. L-DOPA associated to catechol-O-methyltransferase inhibitor (entacapone) 3 mg/kg/day were given to 7.14% (2) patients. Bromocriptine 0.04 mg/kg/day was given to 3.57% (1) patients. Mental confusion and hallucination side effects were observed in 53.33% (8) patients treated with L-DOPA associated with the DOPA decarboxylase inhibitor (benserazide).

The increase of cholinergic activity due to the acetylcholinesterase inhibitors in the Nigro- striatal pathway could be related to psychomotor agitation in Alzheimer’s disease patients in a similar way to akathisia induced by neuroleptics. The increase of dopamine levels due to the administration of L-DOPA, in corpus striatum improved Parkinson’s disease symptoms although the increase of dopaminergic activity at mesocortical pathways may be related to confusion and hallucination observed in these patients. Adjustments in dosage of these drugs could provide improvement in these patients’ daily life conditions.

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Obsessions and compulsions often focus on routine life actions such as consuming, bathing and living in public, so the disorder interferes with the social, family and occupational functioning of both the individual and their caregiver. In OCD, caregivers are often involved in the ritual behaviors of the individual, either by providing avoidance or by assisting in ritual behaviors. Individuals with OCD are often exposed to aggression from family members because of these behaviors. Research has shown that individuals with OCD may experience illness-related domestic violence. In the literature review on the subject, there were no qualitative studies examining the experiences of individuals diagnosed with OCD towards domestic violence caused by the symptoms of the disease. A mix-method study conducted by aimed to explore the illness-related domestic violence experiences of individuals diagnosed with OCD. The study utilized both quantitative and qualitative methods to gather data from individuals with OCD. The findings of the study revealed that a significant number of individuals with OCD reported experiencing domestic violence related to their illness. This study highlights the importance of addressing the issue of domestic violence in individuals with OCD and the need for appropriate interventions and support.

This study was planned to examine the experiences of individuals diagnosed with OCD regarding domestic violence caused by the symptoms of the disease in Turkey.

The sample of the study was determined by purposive sampling method. The study was conducted with individuals diagnosed with OCD who were being treated in the psychiatric clinics of two university hospitals. The study used mixed methods and was planned in two phases. In the first stage, Socio-Demographic Data Form and Yale-Brown Obsession Compulsion Scale were used. After reviewing the results of these scales, individual in-depth interviews were conducted with 20 patients who had a history of domestic violence and scored above 16 on the Yale Brown Obsessions and Compulsions Scale. Data saturation was deemed to have been reached and data collection was terminated.

The analysis of the data is still ongoing in detail by the researchers. The findings and relational implications of the study will be presented.

It is thought that the results of the study will provide a basis for further research and intervention programs and contribute to the literature by determining the types of violence experienced by individuals diagnosed with OCD from family members due to the disease, how patients feel in the face of the problems they experience and how they cope with it. In addition, the results of the study are expected to help intervention programs to be developed for families to strengthen treatment adherence.

None Declared

Excoriation disorder (ExD) is a pathology recognized by DSM-5, and it is considered a part of the obsessive-compulsive spectrum. ExD is associated with a high rate of psychiatric comorbidity (e.g., depression, ADHD, substance use disorders, etc.).

The main objective of this review was to explore the available evidence to support the diagnosis and treatment of skin picking in elderly population.

A literature review of the available sources reporting on ExD in elderly patients, realized by searching three electronic databases (PubMed, Cochrane, Clarivate/Web of Science) but also the grey literature. All papers published between January 1990 and July 2023, including the terms “excoriation disorder”, “compulsive skin picking”, “dermatillomania” and “elderly” or “old-age patients” were reviewed.

The information about ExD was extracted almost exclusively from reports on elderly patients with neurocognitive disorders. Tactile hallucinations, delusions of contamination, social isolation and focusing on own bodily sensations, and organic causes- dehydration, allergies, renal insufficiency, hepatic and pancreatic diseases, as well as toxic causes- e.g., adverse events of certain drugs should be investigated in elderly patients exhibiting signs of ExD. A differential diagnosis is very important in this population in order to find the most adequate treatment. Behavioral treatments, serotonergic antidepressants, and glutamatergic modulators have been explored in patients with ExD, although specific trials for elderly patients with this disorder are still lacking. However, case reports support the utility of several serotonergic antidepressants in the elderly.

ExD is a less explored disorder in the elderly, where an extensive differential diagnosis and screening for somatic/psychiatric comorbidities are needed. Trials exploring the potential treatments for ExD in old-age patients are also required for evidence-based case management.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.

To evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.

Clomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.

The dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.

The pre and post results are summarized in tables 1 and 2.Table 1.

Hamilton Depresion Rating Scale (0-52)

Dimensional Y-BOCS (0-15)

Vortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.

None Declared

Obssesive Compulsive Disorder (OCD) is characterized by impaired neuropsychological functions that are also influenced by clinical variables and aging.

According to the literature, several of these neuropsychological deficits could be potential endophenotype markers.

The present study aimed to study what kind of cognitive deficits OCD patients have and how aging and clinical course modify their cognitive profiles campared with general population.

This study examined a sample of 60 adult outpatients with OCD diagnosis, who were matched with 70 healthy controls (HC). Cognitive performance in both groups was assessed using a neuropsychological battery including Rey-Osterrieth complex Figure (ROCF) and Digit Span Test (DGS). Based on previous research on neuropsychology of OCD, it was specified that these neuropsychological measures could be divided in two composites. The first composite, Executive function, includes Total Digit Span and the domain of organization of ROCF. The second composite, Non-Verbal Memory, includes the copy of ROCF, immediate recall, delayed recall and recognition of ROCF.

Severity of OCD symptoms was assessed by YBOCS and HDRS was used for symptoms of depression.

Both cognitive performance and clinical data were documented before and after a follow-up of 11 years.

During analysis, group differences between patients with OCD and HC regarding demographic and clinical characteristics at baseline and follow-up were calculated with independent t-tests and Pearson tests.

The main analysis tested if the change in cognitive function over time differed between patients and controls. To this end, a linear mixed model was used, examining the interaction between age, gender and time in both groups.

Older age, in patients with OCD and HC, was associated with poorer performance on executive function and nonverbal memory. Executive function was influenced by severity of OCD, and non-verbal memory by depressive symptoms at baseline. While, after the follow-up, as obsessive and affective symptoms improve along de follow-up, there is no significant change in the neuropsychological pattern.

At baseline, patients with OCD showed a poorer performance than HC in areas of nonverbal memory and executive function. After de follow-up, there is a poorer performance in the cognitive function in both groups, as they get older. However, there is no significant difference in this change between patients and HC.

Results suggest that OCD is characterized by the existence of dysfunction in several neuropsychological areas that are influenced by time and clinical variables.

Nevertheless, this alteration is no solely attributable to these factors, as they remain stable through time compared to the general population. Therefore, certain neuropsychological functions might be endophenotype traits of the disorder.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic condition characterized by time-consuming and distressing obsessions and/or compulsions, often accompanied by avoidance behaviours. It is a highly prevalent and incident disorder that results in considerable disability and quality of life reduction.

Current pharmacological treatments are hindered by their delayed onset and the limited evidence on how to approach first and second line treatment-resistant patients.

Recent research showcased the involvement of glutamatergic pathways in the pathophysiology of OCD prompting research into the potential therapeutic use of ketamine, which binds to the N-methyl-D-aspartic acid receptor and acts as a non-competitive antagonist of glutamate.

The aim of this study is to conduct a literature review on the use of ketamine and its enantiomers as a treatment for OCD and report a clinical case involving an OCD patient who experienced significant improvement following ketamine use.

A search was performed on PubMed using a combination of keywords and Medical Subject Headings terms, including “Ketamine”, “Esketamine” and “Obsessive-Compulsive Disorder”. Only studies that involved patients with OCD aged ≥18 years who had received ketamine or its enantiomers as an intervention and that reported treatment response using a validated scale were included.

Nine studies were included, 4 case reports, 3 open-label trials and 2 randomized controlled trials, totalling 71 patients. Ketamine was administered intravenously in 7 studies and intranasally in the remaining 2. The results were heterogeneous, with some studies reporting no effect on obsessive-compulsive (OC) symptoms and others demonstrating significant and rapid improvement, albeit some only transitorily.

We present the case of a 42-year-old man who experienced OC symptoms since the age of 20 but was only formally diagnosed with OCD 3 years ago. During his first consultation, the patient described obsessive thoughts related to contamination and dirtiness, accompanied by handwashing rituals and avoidance behaviours (e.g., avoiding touching handles and switches). His Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 29. Escitalopram was initiated with a progressive dose titration, resulting in partial improvement (Y-BOCS 23). In a follow-up appointment, the patient disclosed that he had purchased and self-administered a single intravenous dose of 2g of ketamine 2 months earlier for recreational use. This led to an immediate and significant improvement of his OC symptoms. Subsequent re-evaluation 4 months later confirmed that he remained asymptomatic (Y-BOCS 2).

Ketamine may be a therapeutic alternative for OCD patients who are treatment resistant due to its rapid anti-obsessional effect. Further studies with improved designs and larger sample sizes are warranted to better assess the efficacy of ketamine in OCD treatment.

None Declared

Obsessive-compulsive disorder (OCD) has a high prevalence and causes a significative reduction in functionality and quality of life.

First and second line treatment is ineffective in a variable percentage of patients. In such cases transcranial magnetic stimulation (TMS) may be considered.

The goal of this study is to evaluate the impact of TMS treatment on obsessive-compulsive, anxious and depressive symptomatology in patients with OCD.

A prospective observational study was conducted, including all patients diagnosed with OCD who underwent TMS in the Psychiatry department of Centro Hospitalar Universitário de São João since March 2023.

Symptomatology was assessed using the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) before and after treatment.

Statistical analysis was performed using the SPSS-Statistics program. A significance level of 0.05 was considered.

As of October 31, 2023, nine individuals with OCD completed treatment with TMS, 33% male and with a median age of 40 years (range 33-57).

The median Y-BOCS score pre-TMS was 30 (range 20-33) and post-TMS 28 (range 16-34). The median difference was 2.5 (range -5-14) and was not statistically significant (p=0.128).

The median score on the HAM-A pre-TMS was 21 (range 9-41) and post-TMS 18 (range 11-24). The median difference was 0 points (range -4-21) and was not statistically significant (p=0.345).

The median HAM-D score pre-TMS was 26 (range 14-40) and post-TMS 19 (range 10-32). The median difference was 2.5 (range -3-20) and was not statistically significant (p=0.225).

Preliminary findings suggest that the impact of TMS on obsessive-compulsive, anxious, and depressive symptomatology in patients with OCD does not appear to be clinically or statistically significant.

Further results are necessary to confirm this trend.

None Declared

In recent years, there has been a growing interest in the potential consequences of disruptions in the inflammatory and immune systems on the onset of obsessive-compulsive disorder (OCD) and associated conditions, such as Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) and Tourette syndrome (TS). While this area of inquiry is undeniably captivating, the available data remain somewhat controversial and limited in scope.

The aim of this paper is to conduct an exhaustive examination and evaluation of the existing body of literature concerning aberrations in inflammatory and immune system processes within the context of OCD, PANDAS, and TS.

This narrative review entailed a comprehensive search of English language papers on PubMed and Google Scholar from January 1985 to July 31, 2023.

The data collected up to this point suggest that the underlying mechanisms at play may differ depending on the age of the patients and the specific disorder being investigated. Notably, PANDAS seems to have a stronger connection with infections that trigger autoimmunity, which may not necessarily be limited to those resulting from Group A beta-haemolytic streptococcal (GABHS) infections, as previously assumed. In the case of TS, autoimmunity appears to play a significant role, especially when combined with individual susceptibilities stemming from both genetic and environmental factors. As for adult OCD, while the available data are somewhat scattered and occasionally based on relatively small groups of patients, they do indicate that the immune system and inflammatory processes are involved in the disorder’s pathophysiology. However, it remains uncertain whether these processes are primary driving forces or secondary reactions.

In summary, when viewed collectively, the current research findings unveil promising avenues for exploring the underlying causes of OCD and related disorders. They also hold the potential for the development of innovative therapeutic approaches that go beyond the current pharmacological paradigms.

None Declared

Body dysmorphic disorder (BDD) was considered an anxiety disorder in the DSM-IV, but in the DSM-V was added to the obsessive-compulsive and related disorders category. BDD is a psychiatric disorder characterised by an excessive, persistent, and distressful preoccupation with a perceived defect in appearance. These perceived defects are slight and are unnoticed by others. People with BDD usually have poor insight and are preoccupied with a perceived physical defect which causes them to check on it repeatedly. This leads to an impairment in psychosocial functioning, depression, and an increase in suicide risk.

Review how dismorphophobia (BDD) and obsessive compulsive syndrome intersect, the differences they present in symptomatology, prevalence and treatment.

Presentation of a patient’s case and review of existing literature, in regards to body dysmorphic syndrome and its similarities and differences with respect to obsessive compulsive syndrome.

There are common features between both disorders, which are genetic overlap, physical past traumatic events, sex ratio, trait of perfectionism and body image disturbance.

Studies have found the prevalence of BDD in patients with OCD in a large patient sample was 8.7% to 15% compared to 3% in non-OCD.

The risk of comorbidity of OCD-BDD is three times higher in samples with a primary diagnosis of BDD compared to those with a primary diagnosis of OCD with 27.5% and 10.4%, respectively.

BDD as well as OCD must be managed with pharmacological and psychotherapy treatment. A selective serotonin reuptake inhibitor is the recommended first-line medication for BDD, even if appearance beliefs are delusional in nature.

Serotonin reuptake inhibitor (SRI) doses and trial durations are similar to those used for OCD; higher doses and a longer treatment trial are recommended than those typically used for depression and most other disorders. Cognitive-behavioral therapy that is specifically tailored to BDD is the psychosocial treatment of choice. Simply treating BDD as if it were OCD is not recommended.

There are limitations included a restricted number of studies overall, an absence of studies comparing biological parameters, and the frequent inclusion of participants with comorbid body dysmorphic disorder and obsessive-compulsive disorder. The current nosological status of body dysmorphic disorder is somewhat tenuous and requires further investigation, with particular focus on dimensional, biological and aetiological elements.

None Declared

Impulsivity and compulsivity are natural behaviors controlled by brain mechanisms that are essential for survival in all species. Understanding these brain mechanisms may lead to targeted treatment strategies for these symptom domains when impulsivity and compulsivity become dysfunctional.

Pathological impulsivity and compulsivity characterise a broad range of mental disorders.

This study aimed to synthesise the latest evidence about the conceptualization of the impulsivity-compulsivity spectrum.

A review was conducted, drawing on reputable sources (PubMed and Web of Science databases).

The concept of impulsivity can be defined as a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the impulsive individual or to others. However, impulsivity is not always unplanned. Impulsive behaviours can be conceptualised as the core symptoms of a broad range of psychiatric disorders.

In contrast, compulsivity refers to repetitive behaviours that are performed according to certain rules or in a stereotypical fashion. Compulsivity is a tendency to repeat the same, often purposeless acts, which are sometimes associated with undesirable consequences.

Impulsivity and compulsivity may be viewed as diametrically opposed, or alternatively, as similar, in that each implies a dysfunction of impulse control. Each involves alterations within a wide range of neural processes, including attention, perception, and coordination of motor or cognitive responses.

The neurobiology of impulsivity and compulsivity may involve inhibitory neurotransmitters, excitatory neurotransmitters, the prefrontal cortex, and/or limbic dysfunction.

Impulsive and compulsive features may present at the same time or at different times during the same illness. Although both compulsive and impulsive disorders may be related to prefrontal cortex dysfunction, compulsive disorders would be related to hyperactivity and impulsive disorders to hypoactivity of the prefrontal cortex. Compulsiveness appears to be associated with increased frontal lobe activity, while impulsiveness may be associated with reduced frontal lobe activity.

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Age-related changes of brain functional connectivity, in contrast to brain structure, are understudied in schizophrenia. Importantly, patients with schizophrenia demonstrate an increased difference between the brain-predicted age and chronological age indicating that brain structural aging may be accelerated in this mental disorder (Constantinides et al. Mol Psychiatry 2023; 28 1201-1209). Research on functional connectivity correlates of this process seems to be fruitful.

We aimed to search for the brain regions whose resting-state whole-brain functional connectivity is differently associated with brain-predicted age in schizophrenia patients compared to healthy controls.

Eighty-three male patients with schizophrenia (age range 17.3 – 52.3; mean age 32.1 ± 10.5) and eighty-seven male healthy individuals (age range 18.3 – 53.6; mean age 31.7 ± 10.0) underwent structural MRI and resting-state fMRI (Philips Ingenia 3T scanner). Brain-predicted age was individually estimated using a model trained on independent data based on 68 measures of cortical thickness and surface area, 7 subcortical volumes, lateral ventricular volumes, and total intracranial volume, all derived from T1-weighted MRI scans (Han et al. Mol Psychiatry 2021; 26 5124-39). The associations between the brain-predicted age and the whole-brain global correlation (GCOR) were compared between groups; t-contrasts were calculated (one-way ANCOVA covariate interaction via CONN; RRID:SCR_009550; www.nitrc.org/projects/conn). The chronological age was a covariate of no interest.

Schizophrenia patients had a higher difference between brain-predicted age and chronological age (T(168) = 2.1; p = .036; Cohen’s d = 0.32; 95% CI 0.02-0.63). Greater brain-predicted age in schizophrenia patients, compared to controls, was associated with lower functional connectivity of a region in the right Heschl’s gyrus, planum temporale, as well as central opercular and insular cortex with the rest of the brain (p < .001 voxelwise, p[FDR] < .05 clusterwise; Figure 1).

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Our results coincide with earlier findings on accelerated brain structural aging in schizophrenia. To the best of our knowledge, the present study is the first to indicate that this process is coupled with a decline of the whole-brain functional connectivity of a region located in the right temporal, insular, and parietal cortices, and this effect is not driven by chronological age. Further studies are needed to clarify the clinical and cognitive correlates of this decline of functional connectivity.

The study was supported by RSF grant project 22-25-00706.

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The modern understanding of AD allows us to consider it through the constructs of “vulnerability” and “stability” of the brain in relation to the pathological effects of neurodegeneration. To describe the resistance of the brain to a developing lesion due to a pathological process, the concept of “reserve” is proposed.

A systematic review of scientific studies was conducted.

The review includes an analysis of full-text literature sources.

Resilience models based on reserves are described, which can be broadly divided into cerebral and cognitive reserve models. The quality of the brain substrate underlies the cerebral reserve. Its role and power are determined by the ratio of healthy/affected neurons, the integrity of synaptic connections, and the size of the brain/ It seems to us that the conditions that promote or hinder the functioning of the brain should also be taken into account when characterizing the cerebral reserve. Cognitive reserve is determined by the phenomena of mental processes and functions. It includes the individual’s involvement of the individual in various cognitively stimulating activities throughout life. Cognitive reserve plays a decisive role when it comes to determining the effectiveness of the activation of additional areas or the implementation compensatory strategies, behaving more flexibly and dynamically than the passive threshold. Brain and cognitive reserve models cannot be considered mutually exclusive. They reflect different categorical levels: substrate and functional. The cerebral reserve system is the morphological basis of the cognitive reserve. In fact, we can talk about a single cerebral-cognitive reserve.

The reserve concept states that there are individual differences in the adaptability of the functional processes of the brain that allow some people to cope with age-related and disease-related brain changes better than others. The reserve plays a protective role, postponing clinical manifestations and ensuring that adequate cognitive functioning is maintained. There is a transition from the protective role of the reserve to the compensatory function. Even after anatomical signs of brain damage are observed, the time to clinical conversion can be modulated depending on the volume of the reserve. The protection mechanisms underlying the reserve concept are partially controllable, which allows building strategies for correcting cellular homeostasis, brain functions, behavioral and cognitive patterns. Understanding the mechanisms of aging and the determinants of life expectancy will help reduce age-related morbidity and promote healthy aging.

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Panksepp paved the way for neuropsychoanalysts to better delineate the differences between emotions, feelings, and affect, and their evolutionary purposes. Affect pertains to an individual’s capacity to engage in emotional responses to stimuli, events, memories, and thoughts, while feelings denote the conscious perceptions of emotions, which are primarily social in nature.

Feelings are personal and biographical, while affect remains largely impersonal. Panksepp’s theory of basic affective systems in mammals, dividing emotions into positive and negative categories, is another major contribution to neuropsychoanalysis. Three primary emotions -joy, fear, and disgust- have been identified in humans, which are associated with specific peptides and monoamines (e.g., dopamine and endorphins for joy, norepinephrine and CRH for fear, serotonin and substance P for disgust). These basic emotions are thought to have evolved to address basic life tasks in a phylogenetic and ontogenetic primary stage.

This study aims to provide an overview of Jaak Panksepp’s theories and assertions on the journal Neuropsychoanalysis.

The authors employed a neuropsychoanalytic approach to analyse articles published in the Neuropsychoanalysis journal between 2015-2023.

Emotions primarily function to maintain homeostasis and protect the organism, as in fight or flight responses. In social animals, emotions can sometimes be recognized among individuals of the same and different species. The neurobiological basis of emotional transfer and empathy-like behaviors shed light on cross-species emotion transfer.

The facial feedback hypothesis and the interoceptive inference theory are also discussed as examples of theories for the recognition of emotions as well as the neural mechanisms involved in emotion perception and recognition.

Jaak Panksepp’s valuable insights shed light on the mysteries of human affect, and lay the foundation for future work in the field.

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