In Spain and other European countries, patients coming to the emergency room (ER) are usually classified as “organic” or “psychiatric” on arrival, but this may be complicated when psychiatric history is present as the focus can be misplaced (Leeman. IJPM 1975;6(4):544-40; Alam et al. Psychiatr. Clin. North Am. 2017;40(3):425–33).

To describe three cases seen in the psychiatric emergency room (PER) in which triage errors occurred and to review whether it is widespread for psychiatric patients with organic pathology or in need of medical care to be wrongly triaged.

We retrospectively reviewed three cases seen in the PER of Hospital Clínic in July 2023 in which triage errors happened. Triage error was considered when patients triaged directly to the PER presented symptoms that either needed medical treatment or required medical clearance before being considered purely psychiatric.

Case 1: A 27-year-old woman with history of depressive syndrome was triaged for a speech disturbance that had occurred fifteen minutes after intercourse. After being evaluated, she was referred to neurology where she was diagnosed with an acute ischaemic stroke in left middle cerebral artery territory, requiring thrombectomy and posterior admission to neurology.

Case 2: A 50-year-old man with history of alcohol use disorder was brought to the PER after saying that “he was seeing people doing magic” at home. When evaluated, significant distal tremor, tachycardia and hypertension were observed, being compatible with withdrawal symptoms, so he was transferred to the ER. There he was monitored and treated, finally requiring admission to internal medicine due to persistent symptoms.

Case 3: A 26-year-old man with history of substance use disorder was triaged for loss of consciousness and “spasms”. After evaluation, he was transferred to the ER, where organic screening was carried out, being oriented as a probable tonic-clonic seizure and discharged with outpatient follow-up.

The cases presented are instances in which somatic diseases in patients pre-labelled with psychiatric histories were wrongly assumed to be recurrences of their psychiatric disorders. In all cases, they needed to be re-examined by the corresponding medical specialty and required diagnostic tests, in two cases hospital admission was needed. Emergency physicians and emergency psychiatrists often disagree on how to medically clear patients (Alam et al. Psychiatr. Clin. North Am. 2017;40(3):425–33; Janiak et al. JEM. 2012;43(5):866–70), some authors have even proposed protocols for doing this in a more systematic way (Shah et al. JEM. 2012;43(5):871–5). To avoid a delay in diagnosis and treatment and the consequences that may result from it, establishing guidelines for proper triage of patients with psychiatric history should be considered.

None Declared

Zolpidem is a nonbenzodiazepine, which acts as a sedative- hypnotic that binds to GABA (A) receptors at the same location as benzodiazepines and increases GABA effects in the central nervous system (Kovacic et al. Oxidative medicine and cellular longevity 2009, 2(1), 52–57). Literature shows that behavioral changes including amnesia, hallucinations, and other neurocognitive effects are some of the known side effects (Edinoff et al. Health psychology research 2021, 9(1), 24927). We present a case about Ms. A, a female in her sixties with a history of major depressive disorder with psychotic symptoms who was brought into the hospital by the EMS under police custody after stabbing her granddaughter with a knife. During the evaluation she was dissociating with impaired memory of the circumstances of her presentation. Collateral information about Ms. A revealed that she had no history of being violent, or any history of psychoactive substance use. Ms. A’s home psychiatric medications consisted of Sertraline 100mg, Bupropion 150 mg, Zolpidem 5mg.

To better understand the potential risks with prescribing zolpidem in patient with insomnia.

In depth literature review about zolpidem. In addition, observation of Ms. A in the emergency with a full medical workup including but not limited to urine drug screen, brain imaging, lumbar puncture, etc.

Ms.A medical workup was positive for a urinalysis revealing asymptomatic bacteriuria and she was treated empirically with cefdinir. Her medication regimen consisted of Bupropion 150 mg and Sertraline 100m, both daily. Zolpidem was discontinued and changed to Clonazepam 0.5mg for insomnia. She was also started on Olanzapine 5mg in the AM and 10mg in the PM. Her mental status was noted to have improved after discontinuation of Zolpidem. Patient received one dose in the hospital but after two days since discontinuation her mental status improved. Upon literature review previous reports have been published citing cases of patients on Zolpidem physically acting out while sleeping in a parasomnia-like behavior, with no recollection of memories upon awakening. (Inagaki et al. Primary care companion to the Journal of clinical psychiatry 2010, 12(6)). There are case reports of Zolpidem associated homicide (Paradis et al.The primary care companion for CNS disorders 2012, 14(4).

One limitation of our study is the patient was noted to have a sudden change in behavior with altered mental status which may be attributed to an underlying asymptomatic bacteriuria. It should be noted that this may have been an incidental finding. This does not exclude the possibility of Zolpidem as the primary cause of the change of her altered mental status or further exacerbating the change in her mental status. Though Zolpidem can be therapeutic and safe, we as clinicians have to be aware of the potential side effects of Zolpidem when prescribing medications.

None Declared

Cannabinoid hyperemesis syndrome (CHS) is an underrecognized condition characterized by acute episodes of intractable nausea and vomiting, colic abdominal pain and restlessness related to chronic cannabis use. Antiemetics commonly fail to alleviate the severe nausea and vomiting. A very particular finding is the symptomatic relief with hot water. Antipsychotics (such as haloperidol), benzodiazepines and/or capsaicin cream appear to be the most efficacious in the treatment of this unique disorder. Precisely, it has been studied that transient relief of symptoms with topic capsaicin or hot water share the same pathophysiology. Nevertheless, abstinence from cannabis remains the most effective way of mitigating morbidity associated with CHS.

The objective is to study this phenomenom in our hospital and to alert of its existence in order to avoid a suspected misdiagnosis and overdiagnosis.

We report a case series of seven patients who attended the Emergency Room (ER) of a third level hospital located in Cantabria (Spain) where a psychiatric evaluation was demanded.

The reasons for consultation were agitation and/or compulsive vomit provocation and showers. They were all women, with a median age of 29 years (range 21 to 38), who all smoked cannabis and in probable high doses (seven to up to twenty joints per day, information was missing in three of the patients) and probable long duration of consumption (more than nine years up to twenty-three, information was missing in three of the patients).

One of the most striking findings is the time to diagnosis, being the median of years of more than eight (range from two to twenty-one). In all of the cases there is a hyperfrequentation to the ER for this reason (not counting other emergency centres we have in Cantabria which we don´t have access to), being the average of almost twenty-two times (thirteen up to thirty times), not diagnosing it until last visits. Another interesting fact is that Psychiatric evaluation is done approximately in a third of the visits, being the department that makes all of the diagnosis except in one case. In all of the cases there are a lot of diagnostic orientation doubts from different medical departments, being the two most common psychiatric misdiagnosis: Other Specified Anxiety Disorder and Other Specified Feeding or Eating Disorder. Two of the patients were hospitalized in an acute psychiatric unit for this reason, one of them nine times and the other patient, twice.

CHS has a very particular presentation which makes its recognition very simple. From our experience, it is an unknown entity for most of the doctors, something that needs to change in order to make a correct therapeutic management. Larger studies need to be done to make this findings more solid and for further information.

None Declared

Mental health at work is increasingly an essential element to assess, especially in sectors with a high risk of psychological and physical stress. Working in a healthcare environment and particularly work in a psychiatric environment can constitute a psychological risk for workers. Among the risks faced by emergency psychiatric medical staff is the risk of developing PTSD (post traumatic stress disorder), which occurs after a traumatic event and results in moral suffering and physical complications that profoundly alter life:personal, social and professional life.

Screening psychiatric emergency nurses for post-traumatic stress disorders.

This is a cross-sectional study carried out in the psychiatric emergency department of the Arrazi University Hospital in Salé, using an anonymous questionnaire distributed to nurses. It includes a 1st part on sociodemographic and professional data, a 2nd part focused on the evaluation of mental health through the GHQ12 and a 3rd part which evaluates post-traumatic stress made by the scale of post-traumatic stress disorder (PCLS).

60 pourcent of women are more able to have ptsd disorder

40 pourcent men 95 pourcent are under the age of 30 and 5 pourcent have more than 30 years

80 pourcent have morked less than 5 years in the emergency hospital

and 20 pourcent have worked more 73 pourcent have scored more than 44 in pcls score

23 pourcent have scored less than 44 in pcls score

This work highlighted an extremely high rate of exposure to a violent event among psychiatric emergency nurses, even if in this study the prevalence of PTSD found among nurses is lower than expected, in this professional environment overexposure a violence requires special attention to protect and prevent the development of PTSD in professionals

None Declared

Serotonin syndrome is a potentially life-threatening condition that is precipitated by the use of serotonergic medications, Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs). It usually occurs when high doses of serotonergic drugs are prescribed. It is a medical emergency that requires prompt recognition, cessation of offending drugs and supportive therapy.

We present a case of serotonin syndrome that occurred in a patient who was prescribed a low dose of sertraline, and aim to highlight the importance of early detection of this severe condition.

Details of the case were described. Information was gathered based on medical records.

Patient M was a 29-year-old Malay male with a history of major depressive disorder, who was previously trialed on fluvoxamine 100mg every night but subsequently switched to and maintained on sertraline 75mg every night in 2020. He then defaulted follow up appointments. In 2023, he presented to the emergency services for a suicide attempt and was diagnosed with major depressive disorder with psychotic features. He was restarted on sertraline 50mg every night and risperidone 0.5mg every night was newly started. Two days later, sertraline was increased to 100mg every night. Two days following this increase, he was noted to have altered mental state, fever of 39.3-degree celcius, tachycardia of 120 beats per minute, ocular clonus and generalized hyperreflexia. Sertraline and risperidone were immediately stopped. Blood tests including creatine kinase, lumbar puncture and magnetic resonance imaging (MRI) of the brain did not show any abnormalities. After stopping of the medications, the patient’s symptoms resolved within 24 hours. Based on clinical symptoms and a normal creatine kinase level, neuroleptic malignant syndrome (NMS) was ruled out. Subsequently, he was restarted on risperidone 0.5mg and mirtazapine 7.5mg every night. He developed symptoms of serotonin syndrome with a low dose of sertraline. Symptoms resolved after the discontinuation of the SSRI.

In this case, differential diagnoses of serotonin syndrome were also considered, such as NMS, encephalitis, meningitis and thyroid storm. NMS was less likely due to the rapid onset of onset and resolution of symptoms. Encephalitis and meningitis were unlikely in view of normal MRI brain and lumbar puncture findings.

There have been case reports of serotonin syndrome developing with lower doses of an SSRI in the pediatric population. There is, however, a lack of literature describing serotonin syndrome with low doses of SSRI in the adult population. To avoid a missed diagnosis, clinicians should monitor closely for SSRI toxicity, including serotonin syndrome, even when low doses of serotonergic drugs are used.

None Declared

In recent times, Health Professionals (HPs) people may feel a sense of discomfort and nervousness when disconnected from their smartphones, causing the emergence of the new phenomenon of “No Mobile Phone Phobia,” or Nomophobia.

We aim to study lifestyle-related factors that influence HPs’ Nomophobia.

From April- June 2023, a global cross-sectional study was conducted using the modified Nomophobia questionnaire (NMP-Q). The original 20 NMP-Q questions (Qs) were reduced to 14 to avoid repetitive Qs with similar meanings. The Qs were categorized into 4 sections, A- Not Being Able to Access Information; B- Losing Connectedness; C- Not Being Able to Communicate; and D- Giving Up Convenience. A new section, “E- Daily Habits”, and “F- Smartphone Type”, and “Hours Spent Daily” were added. Before the launch, it was internally and externally validated by trained psychiatrists as well as experienced researchers. We utilized social media, WhatsApp, text and emails to share it with HPs of different specialties worldwide. The survey was anonymous and IRB-exempt.

Total 105 countries’ HPs participation led to 12,253 responses. Total 47.3% of HPs agreed/strongly agreed (A/SA) that they prefer to use their smartphone before bedtime. Over half (57.8%) of HPs A/SA checked their notifications immediately after waking up in the morning. Only 19.4 % of HPs A/SA that woke up in the middle of the night to check notifications. Total 40.5% of HPs A/SA, 22% were neutral, and 37.3% of HPs disagreed /strongly disagreed (D/SD) with using smartphones while eating their meals. A total of 52.7% of HPs preferred smartphone usage over exercising as a break, while 454.9% of HPs A/SA that they chose smartphones over exploring other hobbies for relaxation. A total of 44.2% of respondents A/SA with smartphone usage in the restroom, 39.8% D/SD. 37.4% of participants D/SD with getting distracted by notifications and resisted the urge to answer any calls or texts while performing a focused task, whereas 39.6% A/SA and 23% were neutral. A total of 80% of respondents met the modified criteria for moderate-severe nomophobia.

In a large-scale survey-based study on Nomophobia, additional Qs in NMP-Q may help recognize that nomophobia can be a result of daily lifestyle decisions rather than an isolated issue.

None Declared

The Screen for Disordered Eating/SDE was created as a primary care screening method for eating disorders, including binge eating disorder (Maguen et al. 2018). The SDE comprises five items (yes/no answers), extracted from other validated self-reported questionnaires assessing eating psychopathology. Its validity and reliability has proved in a Portuguese psychometric study, that only included woman (Pereira et al. 2022). It psychometric properties have yet to be evaluated in men.

We aim to assess the psychometric properties of the Portuguese version of SDE in males.

Participants were 227 male individuals with a mean age of 30.41 years (±13.96; range: 14-73). They answered an online survey including the Portuguese preliminary versions of the seven-item Eating Disorder Examination Questionnaire/EDE-Q7; the Body Image Concern Inventory/BICI and the Muscle Dysmorphia subscale of the Eating Disorder Assessment for Men/DM-EDAM.

Confirmatory Factor Analysis showed good fit for the unidimensional model (χ2/df=1.483; RMSEA=.0460; CFI=.980 TLI=.961, GFI=.988). Cronbach’s alpha was .621 which although inferior to .7 can be explained by the small number of items and the fact that each one assesses different dimensions. All items contributed to the internal consistency and presented high internal validity. Pearson’s correlations of SDE with BICI (.317) and EDE-Q7 (.361) were significant and moderate. The correlation with DM-EDAM was non-significant, probably due to its focus on muscle dysmorphia, which is not included in SDE’s items.

The Portuguese version of SDE demonstrated adequate validity (construct and convergent) and reliability.

None Declared

Although symptom presentation varies by gender, almost all eating disorder/ED instruments have been developed and validated on females. The Eating Disorder Assessment for Men (EDAM; Stanford & Lemberg 2012) is a male specific self-report measure, composed of four sub-scales, proved to be useful to assess gender differences in ED presentations (Nagata et al. 2021). The MD comprises 5 items about the overwhelming concern with muscularity and the false perception of having an underdeveloped body.

Having already valid measures of body image and eating behaviors in men, we now aim to analyze the psychometric properties of the Portuguese version of MD, in order to have a quick and rigorous measure of this specific construct.

Participants were 227 male individuals (mean age=30.41 years±13.96; range: 14-73 years). They answered an online survey including the preliminary DM and the Portuguese validated versions of the Eating Disorder Examination Questionnaire (EDE-Q7) and the Body Image Concern Inventory (BICI).

Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=.6829; RMSEA=.0000; CFI=1.00 TLI=1.01, GFI=.995). Cronbach’s alfa was .891; all the items contributed to the internal consistency and had high internal validity. Pearson correlations of DM with EDE-Q7 and BICI were significant (p<.001) and moderate-high, respectively,.384 and .522.

The Portuguese preliminary version of DM-EDAM demonstrated validity (construct and convergent) and reliability. can be used for clinical and research purposes, namely in an ongoing project we have in progress, about body image, disordered eating, gender and age.

None Declared

The Eating Disorder Examination Questionnaire short version (EDE-Q7) presented better psychometric properties than the Fairburn’s 28-items original version, not only in girls (Machado et al. 2018), but also in older women (Pereira et al. 2021; Pereira et al. 2022). It comprises 7 items in three subscales: Dietary Restraint/DR; Shape and Weight Overvaluation/SWO and Body Dissatisfaction/BD. In a more recent clinical study in men (Laskowski et al. 2023) the factors associated with body concerns and dissatisfaction weren’t fully represented in the questionnaire, possibly indicating differences in body ideals, specially relating to musculature.

We aimed to analyze the psychometric properties of the Portuguese version of EDE-Q7 in males.

Participants were 227 male individuals with a mean age of 30.41 years (±13.96; range: 14-73 years). They answered an online survey including the Portuguese versions of the Screen for Disordered Eating/SDE; the Body Image Concern Inventory/BICI and the Muscle Dysmorphia subscale of the Eating Disorder Assessment for Men/DM-EDAM.

Confirmatory Factor Analysis showed that the second order model presented good fit (χ2/df=2.437; RMSEA=.0794; CFI=.986 TLI=.974, GFI=.967). Cronbach’s alpha was .856 for the total, .876 for DR and .917 for SWO and .900 for BD. All items contributed to internal consistency and presented high internal validity. Pearson’s correlations of EDE-Q7 with BICI (.465), DM-EDAM (.384) and SDE (.361) were significant (p<.001) and moderate.

Also in men, the Portuguese version of EDE-Q7 demonstrates good validity (construct and convergent) and reliability.

None Declared

Orthorexia is defined as a dependence on healthy food or an obsession to consume healthy food. One area deemed influential upon disordered eating and dietary intake is perfectionism.

To investigate the relationship between orthorexia and perfectionism in medical students.

We conducted a cross-sectional, descriptive, and analytical study in the faculty of medicine of Sfax (Tunisia), between February and April 2023. A self-reported questionnaire was distributed to students via social media. We used ORTO-15 for the assessment of orthorexia, and the Big Three Perfectionism Scale (BTPS) to assess perfectionism.

The research has enrolled 220 students. Their mean age was 21.40±1.68 years, with female predominance (70%). The ORTO-15 mean total score was 36.88±6.76. A total of 60% of participants had an orthorexic behavior. The BTPS mean total score was 45.52±12.45 with a mean score of 13.25±4.35 for rigid perfectionism, 18.31±6.37 for self-critical perfectionism, and 13.99±5.47 for narcissistic perfectionism.

Students with orthorexic behavior had significantly higher scores of perfectionism (p= 0.048).

Our study has drawn a significant association between orthorexia and perfectionism among medical students. This result suggests that students experiencing highly critical and judgemental beliefs associated with perfectionism are more susceptible to orthorexic eating behaviors.

None Declared

The relationship between obesity and mental health in old age is complex and widely impacted by different biological, psychological, and social factors.

The primary objectives of this qualitative research study are: a) To understand the influence of obesity on older adults’ well-being; b) to assess emotional experiences related to obesity in old age and; c) to explore how obesity influences the mental health of older adults.

This study included 346 participants aged 65 to 84 years (M=73.9; SD=5.61) from three different nationalities (English, Spanish, and Portuguese). All interviews went through content analysis.

This study identified four main themes regarding the influence of obesity on older adults’ well-being: (1) Insatisfaction with Body Image (66%); (2) Feeling embarrassed (65%); (3) Feeling Social Isolated (57%); and (4) Lost Opportunities (46%)Three main themes for emotional experiences were frequently verbalized by the participants: (1) Shame (81%); (2) Guilt (78%); and (2) Incompetence (76%). Finally, three main influences in mental health due to obesity were reported: (1) Self-concept (88%); (2) Stress (78%); and (3) Melancholia (63%).

These results highlighted that obesity negatively influences older adults’ well-being and emotional experiences and has serious mental health-related negative outcomes for older adults. Interventions like community-based weight loss programs can be effective in controlling weight and improving the social interaction of obese older adults.

Keywords: Emotional experiences; mental health; obesity; older adults; well-being.

None Declared

Eating disorders (ED) are one of the most pressing problems of modern society. Eating disorders, due to their heterogeneity, can be considered both an independent form of mental disorders and as part of the manifestations of other mental illnesses. In the vast majority of cases within these pathologies, eating disorder coexists with depressive symptoms, which significantly worsens the prognosis of the disease.

Identification of the association of depressive disorders with eating disorders to improve the criteria for nosological diagnosis, prognosis and therapeutic approaches.

A total of 74 patients aged from 15 to 25 years old (all female, average age 16.2), who were on outpatient and inpatient observation of the clinic were studied.

The study made it possible to establish the characteristics of depressive disorders and the nature of the current course of depression associated with eating disorders. In eating disorders with a predominance of anorexia nervosa, the structure of depression was more dominated by the asthenia radical with symptoms of apathy, melancholia, anhedonia, irritability, episodes of anxiety after eating, and sleep disturbances. Patients noted a decrease in performance, mental activity, and a narrowing of their range of interests and communication. Depression became severe as exhaustion progressed. For eating disorders with bulimia nervosa. depressive states varied in the severity and polymorphism of their manifestations. Their structure was largely dominated by the apatho-adynamic radical of affect, along with asthenia and anxiety, which often reached the level of panic states. Often, along with this, there were pronounced a guilt feeling and low self-esteem ideas with self-deprecation and self-hatred, which led to the manifestation of auto-aggressive behavior (both non-suicidal and suicidal). Depression reached a severe degree as exhaustion progressed, as well as against the background of more frequent attacks of overeating and vomiting.

The identified associations between depressive disorders and eating disorders allow us to form a clearer picture of the expected course of psychiatric disease and optimize therapeutic intervention algorithms.

None Declared

Bulimic behaviors (BB) are a major public health problem, due to their prognosis and serious psychological, somatic, and social consequences. The exact etiopathogenesis of BB is still poorly understood, and the literature suggests the interaction of multiple factors.

The aim of our study was to estimate the prevalence of BB in the Tunisian general population and to identify the associated risk factors.

We conducted a cross-sectional, descriptive, and analytical study of Facebook group members, using an online questionnaire, from February 17, 2023, to May 26, 2023. All respondents over the age of 18 were included in the study. All participants filled out a socio-demographic questionnaire. Body mass index (BMI) was calculated from weight and height. The Bulimic Investigatory Test, Edinburgh (BITE) was used to screen and assess the intensity of bulimic behaviors.

A total of 528 responses were included in the study. The mean age of the sample was 33.3±11.95 years, and the M/F sex ratio was 0.41. Subjects were unmarried in 63.4% of cases, of low socio-economic status in 19.5%, with a university education in 75.2%, and with a psychiatric history in 25.6% of cases. The mean BMI was 25.15±4.98. The mean BITE score was 10.76±6.85, and 6.6% of our population were at high risk of developing BB.

In the bivariate study, female gender (p<0.001), unmarried marital status (p=0.001), university education (p<0.001), and the presence of a psychiatric history (p<0.001) were significantly associated with a high risk of developing BB. Moreover, the BITE score was negatively correlated with age (r=-0.231; p<0.001) and positively correlated with BMI (r=0.307; p<0.001).

This study highlighted the magnitude of the risk of bulimic behaviors in the Tunisian general population and the need to set up programs to prevent and control these disorders.

None Declared

Child maltreatment (CM) refers to all forms of physical or psychological violence, sexual abuse, and neglect of a person under the age of 18, resulting in actual or potential harm to their health, survival, development, or dignity. It is recognized as a predictor of psychological difficulties in adulthood, such as bulimic behavior.

The aim of our study was to assess the link between CM and bulimic behaviors in the Tunisian general population.

We conducted a cross-sectional, descriptive, and analytical study among Facebook group members, using an online questionnaire, from February 17, 2023, to May 26, 2023. All respondents over the age of 18 were included in the study. CM was assessed using the Childhood Trauma Questionnaire (CTQ), which provides information on five types of maltreatment: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). The Bulimic Investigatory Test, Edinburgh (BITE) was used to screen and assess the intensity of bulimic behavior.

A total of 528 responses were included in the study. The mean age of the sample was 33.3±11.95 years. Mean AE, AP, AS, NE, NP, and overall CTQ scores were 8.30; 6.58; 6.38; 10.14; 7.26, and 49.72, respectively. A history of severe AE, AP, AS, NE, or NP was reported by 13.1%, 10.8%, 8.5%, 11.6% and 8.3% of respondents, respectively. The mean BITE score was 10.76 ±6.85 and 6.6% of our population were at high risk of developing bulimic behavior.

In the bivariate study, the BITE score was significantly correlated with all forms of MI. The strongest correlation was with AE (r=0.310; p<0.001).

In the multivariate study, only AE was associated with bulimic behaviors.

This study highlighted a positive association between various forms of child neglect and abuse, and bulimic behaviors. It is therefore worth noting that interventions for these disorders may be more effective if they target not only the behavior itself but also underlying risk factors such as maltreatment.

None Declared

While in eating disorders such as anorexia nervosa, the comorbidity of pathological personality traits is very common, and accordingly the personality traits of borderline personality disorder is considered very frequent and coexisting. The treatment of anorexia nervosa is based primarily on the psychotherapy and work on pathological personality traits even more than the treatment of the syndrome and the consequences of malnutrition itself. That achieves a longer-term and more reliable solution than symptomatic treatment of anorexia nervosa which usually does not bring satisfactory results. On the other hand, in patients with obesity, pathological personality traits, especially those of borderline personality disorder, are still very rarely associated, since obesity is usually not even considered a disorder, but a variation in the population.

The aim of this paper is to investigate the pathological personality traits of borderline personality disorder in people with obesity.

Investigating relevant scientific and professional literature from the field of personality pathology and eating disorders.

When obesity is related to impulse control disorder in the sense of emotional eating under increased stress according to today’s relevant literature, it can definitely be related to personality traits of borderline personality disorder, i.e. the presence of elements of borderline personality organization and prementalization models. Such an inability to deal with negative emotions such as increased anxiety or rejection sensitivity, which results in overeating and the related feeling of shame that overwhelms the person, regardless of whether he/she/they has any of the certain forms of compulsive behaviour afterwards, can be related to impulsive behaviour and the “all or nothing” way of thoughts. This is also confirmed by cases when certain people have a history of both one and the other disorder. Thus, some people have, for example, malnutrition in adolescence as part of anorexia nervosa, only to have problems with obesity after some time with a healthy body mass.

Since pathological personality traits in people with anorexia nervosa and obesity give indications of common characteristics in the form of borderline personality disorder traits, i.e. borderline personality organization and prementalization models in both disorders, future research will certainly shed light on the connection between these eating disorders.

None Declared

Psychotic experiences (PE) and disordered eating (DE) are frequently observed among the general population, especially in childhood and adolescence. However, the relationship between the two groups of disorders is still unclear.

To explore the hypothesis that the pathways from PEs to DE are mediated by body-image disturbances in a sample of adolescents

We conducted a 12-month longitudinal study on high school students from four different high schools from the Ariana governorate, from April 2022 to April 2023.

Participants were evaluated at baseline then every 6 months with a target length of follow-up of 1 year.

The questionnaire contained

Questions about socio demographic variables

The Eating Attitude Test (EAT-26)

The Multidimensionnal Body Self-Relations Questionnaire Appearance Scale (MBSRQ-AS)

The Community Assesment of Psychic Experiences (CAPE-42)

1) Sample characteristics

Sample was constituted of 510 individuals. Of those, 312 (61.2%) were females. Mean age was of 16.05 (SD=1.01) years.

The majority of the students resided in urban areas, accounting for 97.8% of the total.

When it comes to family income, 4.1% of the students’ families had an income of less than 1000 Tunisian Dinars (TD), 25.9% had an income between 1000 and 2000 TD, 32.2% had an income ranging from 2000 to 3000 TD, and the remaining 37.8% had a family income of over 3000 TD.

The EAT-26, MBSRQ-AS and CAPE-42 scores are shown in table 1.Table 1.

The longitudinal evolution of study variables

2) Findings of the mediating analysis

Disordered Eating scores had no significant effect in subjects across time. However, the effect of the interaction between baseline Overweight Preoccupation with Disordered Eating across time was statistically significant (p=0.036). Overweight Preoccupation (Z=85.095, p<0.001), Body Area Satisfaction (Z=25.053, p<0.001), and CAPE positive dimension (Z=59.931, p<0.001) scores had significant main effects between subjects. (figure 1 and figure 2)

Image:

Image 2:

Findings showed that body image disturbances mediated the prospective association between PEs and DE. Adolescents with increased PEs were more likely to experience body image disturbances and, in turn, DE symptoms. These findings offer promising new avenues for prevention and early intervention.

None Declared

Eating disorders have a key paper at the ongoing society. A key symptom of the Anorexia Nervosa and the Bulimia Nervosa is the alteration of the corporal image which observes that it continues being present after remitting the most flowery symptomatology. In terms of gender, we can observe that the esting disorders have a higher incidence in the feminine gender.

Research how body image affects eating disorders and how the role of gender is a risk factor for developing Anorexia Nervosa or Bulimia Nervosa.

A systematic review was conducted using PubMed. Twelve studies were identified in order to do this review.

At the twelve surveys included at the review we can observe that the incidence of Anorexia Nervosa and Bulimia Nervosa is higher in women than men. There are many facts that take part on the development of eating disorders, but there is consensus to understand them with a biopsicosocial point of view (interaction between the environment and biological facts). Body image disturbance takes part in both men and women, but it affects them in different ways.

Body image disturbances are a crucial factor when considering eating disorders’ symptomatology. One of the main components that affects its alteration is the internalization of standards of beauty. Women tend to focus on thin body types, meanwhile men’s attention tends to point to muscular and defined body types. Nevertheless, it must be taken into account that today’s gender conception may appear as one of the most important roles to understand Anorexia and Bulimia aetiology. Regarding gender, in nowadays society exists a dichotomy where masculinity and femininity lie in total opposites poles; but if the gender approach socially changed, Anorexia and Bulimia might take a different portrayal.

None Declared

Bariatric surgery is an effective treatment for patients with obesity. Rates of obesity are increasing worldwide as are the number of bariatric procedures performed. Following bariatric surgery patients have increased contact with psychiatric services, there is an increased risk of deliberate self-harm, suicide attempts and completed suicide. Compared to the general population there is 8 fold higher than average suicide rate. In Ireland wait lists for bariatric surgery are long, resulting in many patients seeking surgery abroad. Bariatric ‘tourism’ often results in reduced psychological supports both pre and post op as well as reduced pre surgical screening for psychiatric illness. Bariatric surgery is also associated with ‘addiction transfer’. The literature suggests that patients often substitute the maladaptive coping mechanism of eating with other impulsive behaviors such as substance misuse or gambling.

Case report highlighting the issue of addiction transfer among patients that have undergone bariatric surgery.

Case report: A 38 year old woman admitted to the acute psychiatric unit with self harm, suicidal ideation, low mood, and recent overdose of venlafaxine. On initial presentation, she was intoxicated with alcohol, her toxicology was positive for cocaine and benzodiazepines. She had undergone a gastric bypass 14 months previous, having travelled abroad to have the procedure. She had not attended for any bariatric follow up with her GP post operatively. She was not taking any vitamins post operatively despite advice from the clinic. The patient was admitted to the acute psychiatric unit. She admitted to drinking excessively in the last year. She denied any history of mood disturbance or substance or alcohol misuse prior to surgery. She had no previous contacts with psychiatric services. Her GP had commenced her on venlafaxine for low mood 6 months prior to psychiatric admission. She was admitted to the acute unit for 5 days after which she left against medical advice. She was followed up in the day hospital and referred to addiction services.

case report

There is growing evidence about the psychiatric and addiction implications of bariatric surgery. Offering psychological support for patients post operatively is essential. Unfortunately, because of long wait lists in Ireland many patients chose to travel abroad and often are unable to avail of MDT support. The emerging field of bariatric psychiatry could provide a useful addition to the bariatric specialist services.

None Declared

Insecure attachment is considered a general risk factor for eating disorders (ED). Emotion dysregulation has been proposed as one of the possible mechanisms by which attachment insecurity may affect ED psychopathology.

Aim of the present study was to investigate whether difficulties in acceptance of emotions or emotional clarity may mediate the connection between insecure attachment and ED psychopathology.

One hundred and twenty patients participated and completed the Italian version of Eating Disorder Inventory‐2 (EDI-2), Experience in Close Relationship questionnaire (ECR) and Difficulties in Emotion Regulation Scale (DERS). A mediator path model was performed, in which insecure attachment dimensions were set as independent variables, ED specific psychopathology measures as dependent variables, and non‐acceptance of emotion and lack of emotional clarity as mediators.

The association between both attachment avoidance and anxiety and ED specific symptoms was mediated by emotional non‐acceptance, but not by emotional clarity.

This study showed the importance to address emotion regulation in individuals with ED, focussing on improving emotional acceptance. Exploring early developmental processes which lead to non‐acceptance of emotions could improve this psychological trait in people with ED.

None Declared

Aggressive behaviors have been reported to be more frequent in people with eating disorders (ED), especially bulimia nervosa (BN). Network Analysis (NA) is particularly useful or examining the interactions among symptoms of comorbid conditions through the identification of “bridge symptoms,” defined as those symptoms playing a key role in the connection between two syndromic clusters.

The aim of the present study was to investigate the association of ED core symptoms and ED-related psychopathology with aggressiveness in a clinical sample of women with BN through NA.

A NA was conducted, including ED symptoms and aggressiveness measures. The bridge function was implied to identify symptoms bridging ED symptoms and aggressiveness.

The most connected nodes among communities were asceticism and impulsivity from ED-related psychopathology, drive for thinness from ED- core psychopathology and guilt and suspicion from aggressiveness domain. In particular, drive for thinness connected ED-core community to verbal hostility, while impulsivity connected ED-related symptoms to guilt and suspicion of aggressiveness community.

In conclusion the present study showed that in people with BN guilt is the specific negative emotion of the hostile dimensions that may be bidirectionally associated with ED symptoms.

None Declared