Rumination is a transdiagnostic phenomenon that is linked to psychological and physical symptoms not only in adulthood but also in childhood. Several distal and proximal factors are believed to underlie the development of ruminative tendencies, with parental characteristics and modelling being among those with a potential association with the increased levels of children’s rumination.

The primary aim of the study was to investigate the link between rumination in children and parental functioning, including rumination, worry and depressive symptoms. Additionally, we aimed to test the association between rumination and psychological and somatic health in a sample of healthy children and early adolescents.

153 children (87 girls, mean age = 10.74; SD = 0.91 years) and their parents (130 females, mean age = 42.65; SD = 4.08 years) participated in the study. For children, Kid Rumination Interview (KRI; Baiocco et al., 2017) was used, alongside the assessment of nine subjective health complaints. KRI employes 4 images to measure the frequency of rumination. Self-reported questionnaires were also completed by parents to report on worry, rumination, and depressive symptoms.

Contrary to our expectations, there was no significant association between children’s rumination and parental rumination (r = .06, p = .506), worry (r = -.02, p = .850) and depressive symptoms (r = -.01, p = .979). Psychosomatic complaints in children exhibited a positive albeit weak association with parental depressive symptoms (r = .17, p = .046). Regression analysis revealed that the frequency of rumination occurring in the four situations associated significantly with psychosomatic symptoms (β = .266; t = 3.321; p = .001) after controlling for sex and age.

Our findings are in line with previous studies demonstrating the relationship between rumination and psychosomatic symptoms in older adolescent samples. However, parental perseverative cognitions and depression were unrelated to ruminative tendencies in children. Nevertheless, the modest sample size and the employment of a different assessment approach compared to self-report questionnaires may have influenced our findings.

None Declared

The issue of screen time usage among children has become a contentious topic for parents in contemporary society. While electronic devices offer undeniable benefits, their inappropriate use can lead to substantial mental and physical health challenges for children. Parents are tasked with the responsibility of equipping themselves and their children with the knowledge and skills necessary for mindful electronic device use.

This study aims to assess the awareness levels of mothers regarding their children’s screen time usage and to promote mindful screen usage. It also aims to understand the reasons behind parents’ decisions to allow their children access to electronic devices.

An adapted short online screen-time questionnaire (Vizcaino et al 2019), was distributed through online Google forms, primarily to mothers residing in India. The questionnaire comprised of ten questions encompassing topics related to the child’s background, mothers’ awareness and patterns of screen-time usage.

213 mothers with children aged one year to 17 years responded. 157 mothers (73.7%) were in employment (104 were working in an office, 32 were working from home and 18 were freelancing). 121 mothers had >one child. Majority of the mothers (n=170, 79.81%), believed that children should have <one hour screen-time. However, they also admitted that majority of their children spent >one hour per day screen-time. The usage was more during weekends (>one hour=161, 75.58%) than weekdays (>one hour = 145, 68%)(p=0.021). Weekend screen-time was more in children whose mothers were employed (p=0.006). There is a significant increase in weekday (p=0.044) and weekend (p=0.006) screen-time usage as the child’s age increased. Children predominantly watched television, followed by mobile phones and tablets. Except for 29 children, the rest enjoyed interacting with other people (54 with everyone, 73 with only family members and 57 only for some time). The primary context in which children engaged with electronic devices was while they were being fed/ meals-time (n = 114,54%) or when the mothers were busy with household chores (n = 85,40%).

Despite maternal awareness about healthy screen-time, majority of the children were allowed to use higher screen-time. Efficient strategies should be imparted to parents to change the current practices of using digital-media as pacifier or distractor to mindful screen-time including usage for educational purposes.

H. Atturu Consultant of: Advisor to CognitiveBotics, AI based software., S. Gujju: None Declared

The Strengths and Difficulties Questionnaire (SDQ) is a widely used assessment tool for measuring the psychological well-being of children and adolescents. It consists of 25 items that assess emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship difficulties, and prosocial behavior.

The present study aimed to investigate the relationship between parental perceptions of difficulties and the results obtained from the SDQ.

Participants were recruited from the initial consultation of Child and Adolescent Psychiatry (N=132). Parents completed a questionnaire assessing their subjective perceptions of their child’s difficulties in various domains (home, school, learning activities, relations with friends) on a 4-point scale ranging from “no notion of difficulties” to “very severe difficulties”. They also completed the SDQ scale. Data were analyzed using SPSS software.

In this study, 74% of participants had scores on the SDQ indicating potential psychological difficulties. Additionally, 17.4% of participants had scores on the borderline between normal and abnormal results. 47% of patients scored above the cut-line for problems on the hyperactivity/inattention subscale, indicating higher levels of difficulties in this area. Conversely, only 3% of participants scored problematic scores on the peer relationship difficulties subscale. There was no statistical difference between sexes in terms of SDQ scores. A correlation analysis revealed a significant positive correlation (p < 0.01) between parental perceptions of difficulties and higher SDQ scores and the mean score on the SDQ scale was found to be significantly higher in patients who were rescheduled for another consultation following the evaluation by doctors, compared to those patients who received clinical discharge from the initial consultation (p-value 0,040).

This study provides valuable insights into the concordance between parental perceptions and objective assessments of difficulties in children and adolescents. Parents who perceived their child to have more difficulties also reported higher levels of psychological difficulties on the SDQ. This study highlights the importance of using tools like the SDQ to assess psychological well-being in children and adolescents. It also emphasizes the practical utility of the SDQ as a time-efficient assessment tool for use during initial consultations in child and adolescent psychiatry.

None Declared

The Contrast Avoidance Model (CAM) was developed to explain pathological worry in generalized anxiety disorder (GAD). The CAM posits that those with GAD are sensitive to sharp increases in emotions, and use worry to maintain heightened states of negative arousal to avoid these emotional shifts. Research has widely supported the CAM in the conceptualization of GAD, and has extended these findings to other disorders, including major depressive disorder (MDD) and social anxiety disorder (SAD). Despite the utility of the CAM model in informing the etiology of these conditions, research has yet to expand these findings beyond GAD, MDD, and SAD. Specifically, obsessive-compulsive disorder (OCD), which co-occurs with GAD, MDD, and SAD in adults at a rate of 15.0%, 40.7%, and 14.7%, respectively, and shares many of their etiological features, has yet to examined in the context of the CAM. Thus, examining CA as a relevant mechanism and therapeutic target for OCD is an unstudied conceptual framework that may offer meaningful clinical utility.

The present study used receiver operator curve (ROC) analyses to examine the predictive utility of the CAQ-W and CAQ-GE in detecting probable OCD in a large undergraduate sample. We hypothesized that the CAQ-W and CAQ-GE would be higher in participants with probable OCD and would offer sufficient sensitivity and specificity in predicting probable OCD.

1259 undergraduates were recruited for a mass University screening. Participants were included in the OCD group (N = 291) if they met diagnostic criteria for OCD (DOCS total score > 20). Participants were included in the nondisordered group (n = 249) if they did not meet diagnostic criteria for any of the screened disorders (SAD, MDD, GAD, OCD, panic disorder, post-traumatic stress disorder, OCD, borderline personality disorder), denied suicidality, and denied receiving mental health treatment in the last 12 months. ROC analyses were used to examine the accuracy of the CAQ-W and the CAQ-GE in detecting probable OCD.

Results of ROC analyses are reported in Table 1. AUC values for the CAQ-W and CAQ-GE were significantly different from the null hypothesis (AUC = .50, p < .001), and demonstrated excellent (.89) to outstanding (.91) accuracy in predicting probable OCD (Figure 1), respectively. Optimal sensitivity and specificity to detect probable OCD (Table 2) was achieved at a cut off score of 67.5 for the CAQ-W (Sensitivity = 81.4%; Specificity = 82.3%) and a cutoff score of 43.5 for the CAQ-GE (Sensitivity = 84.9%; Specificity = 85.5%).

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Results suggest that OCD can be accurately characterized by CA. Findings also highlight the utility of examining CA as a relevant maintenance factor for OCD symptoms. Future research should examine the impact of CA on OCD symptoms in-laboratory and ecological settings.

None Declared

Neuropsychiatric disorders can develop following a group A β-hemolytic streptococcal infection, through autoimmune inflammation of the nervous system. Sydenham’s chorea and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection) are the two most well-known syndromes, primarily affecting children but rarely observed in adults.

Our aims are to contribute to the scientific understanding of adult PANDAS-like syndrome and provide a comprehensive literature review on the subject.

Case report using clinical records and a non-systematic literature review.

A 24-year-old female presented to the emergency department with profound emotional distress triggered by intrusive thoughts of existential dread, accompanied by compulsive praying. She reported that these symptoms had commenced five days earlier. Two days prior to the onset of her obsessions, she had experienced a high fever, odynophagia, cough, and chills and received an empirical diagnosis of tonsillitis following a physical examination. She was prescribed antibiotics with good response. She revealed that she had experienced two prior episodes of similar anxiety and obsessions when she was approximately seven years old.

She developed acute obsessive thoughts, including doubts about the meaning of her life, and engaged in compulsive prayer and seeking reassurance from relatives. Notably, there were no signs of affective, dissociative, or psychotic disorders during her admission to the ED or in the preceding months. She reported suffering from anxiety, insomnia, and loss of appetite in the past five days but did not express any suicidal ideation.

Physical examination indicated mild laryngeal erythema, and laboratory tests showed non-specific signs of infection with no further significant findings. Symptoms were alleviated within a week, aided by treatment with benzodiazepines (lorazepam 1 mg/8h), and she did not require further psychiatric counselling.

It is worth noting that adult patients can experience a PANDAS-like reaction after a streptococcal infection and may also undergo symptom relapse following new immunological challenges upon reinfection. The existence of a PANDAS spectrum has been postulated, encompassing various manifestations. Thus, when presented with acute obsessive symptoms, healthcare providers should consider this diagnosis, inquire about previous episodes, and conduct a comprehensive medical history and etiological assessment.

None Declared

Instrumental learning involves goal-directed and habitual systems. The Slips-of-Action Task (SOAT) is extensively used to measure habit tendencies and the likelihood of making erroneous responses for devalued outcomes. The SOAT provides a Devaluation Sensitivity Index (DSI), a measure of the balance between relative goal-directed and habitual learning. Individuals with Obsessive-Compulsive Disorder (OCD) often engage in repetitive actions, suggesting a potential deficit in goal-directed control and an increased reliance on habitual learning. Previous literature has shown that medicated OCD adults performed worse on the SOAT task than healthy controls.

To compare habit learning performance in an unmedicated sample:

• - Goal 1: Between OCD and Healthy Controls (HC)

• - Goal 2: Across four groups: adult OCD, adult HC, children OCD, and children HC

Participants: Eighty-three participants (44 OCD patients and 38 healthy controls) completed the study with usable task data. The 44 OCD patients comprised 17 adults (mean age: 26.76 years, SD: 8.61 years) and 27 children/adolescents (mean age: 12.84 years, SD: 2.59 years). The 38 healthy controls included 17 adults (mean age: 30 years, SD: 7.49 years) and 21 children/adolescents (mean age: 14.1 years, SD: 2.19 years). All participants were unmedicated. Measures: Participants completed an adapted version of the “Fabulous Fruit Game”, which included an instrumental training phase to learn Stimulus-Response-Outcomes (S-R-O) associations and a SOAT to assess the strength of learned S-R-O associations. DSI was calculated by subtracting the percentage of responses made toward devalued outcomes from the percentage of responses made toward still valuable outcomes. Behavioral Analyses: Student’s t-test comparing individuals with OCD to HC and a ONEWAY ANOVA to examine group differences across multiple categories.

Goal 1: DSI comparison between individuals with OCD and HC revealed a significant difference, with HC demonstrating superior performance (t (60.9) = 2.60, p = .012, Cohen’s d = .546). Goal 2: The overall DSI comparison across adult OCD, adult HC, children OCD, and children HC showed a non-significant difference (F(3) = 3.407, p = 0.22). However, post hoc analysis revealed significant differences between Adult HC and Youth OCD (I-J Scheffe = 28.82, p = .033), indicating superior performance in adult HC.

This study highlights altered Habit Learning in unmedicated OCD individuals, supported by significant DSI differences compared to HC. Age-related distinctions were observed, emphasizing the need for age-sensitive interventions in understanding and addressing habit-related challenges in OCD.

None Declared

The time period between the onset of a mental disorder and its first adequate treatment (duration of untreated illness - DUI) influence long-term prognosis and outcome in patients with severe mental disorders. The relationship between DUI and outcome was originally found in people affected by schizophrenia spectrum disorders, however in patients with Obsessive-Compulsive Disorder (OCD) DUI is significantly longer compared with that of patients with other severe mental disorders, such as schizophrenia and bipolar disorder.

Aims of the present study is to assess the impact of DUI on long-term outcomes in OCD patients across published studies.

A systematic review was carried out by selecting relevant articles on the topic present in three common on-line databases, such as PubMed, APA PsycInfo, and Scopus, up to June 2023.

Among included studies, DUI ranged from 7,0±8,5 to 20,9±11,2 years. Patients reporting a longer DUI have a poor long-term outcome, in terms of greater symptom severity and lower level of treatment response, whether pharmacological treatment or psychotherapy or a combination of these two. This is particularly true when the onset of the disease is insidious and subthreshold. However, there are severe early-onset forms of OCD in which the request for help is anticipated due to the severity of the symptoms, the DUI is shorter, but the prognosis is still negative.

The present review confirms that longer DUI has a negative impact on the long-term outcome of patients with OCD. Furthermore, it is reasonable to hypothesize that cultural factors, such as the perception of the disease and the ability to access treatment, may result in a prolongation of the DUI. All these elements cannot be evaluated in our review due to the paucity of studies on the topic. Future studies could be useful to better understand the causes of a longer DUI, to guide and to promote the dissemination of early interventions with a specific focus on OCD symptoms.

None Declared

Engaging in moderate physical activity holds a vital role in our daily lives, serving as both a means of social recreation and a fundamental contributor to physical and mental wellbeing. It is also worth noting that such activity can potentially produce mood-enhancing effects by promoting neurogenesis and neuronal adaptability. Intriguingly, certain individual psychological traits such as rituals, compulsions, obsessional thinking, and superstitious beliefs, as well as inflexibility in daily routines, appear to serve a purpose in competitive athletic endeavors.

The aim of our study was to investigate the possible presence of obsessive-compulsive symptoms or disorders, as well as of superstitions or magical thinking, in a group of professional tennis players, by means of standardized assessment scales, as compared with healthy subjects who did not professionally perform any kind of sport activity.

Twenty-five current or former professional tennis were recruited within the Italian Tennis Federation during an international competition and during a master meeting of coaches. All of them underwent a psychiatric interview with a structured scale and a psychopathological assessment carried out with the Mini-International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Data were analyzed and compared.analysis was performed by means of contingency tables, χ² tests, group statistics, paired, independent and Mann Whitney’s tests.

The Y-BOCS total score was significantly higher in both current and retired athletes than control subjects (5.96 ± 5.76 versus 1.24 ± 2.65, p = 0.001, t = 3.72). Current athletes showed more frequently current aggressive obsessions (χ2 = 0.041, r = 5.24) and current miscellaneous compulsions (χ2 = 0.030, r = 5.94) than past athletes. The Y-BOCS (t = 3.4, p = 0.002) obsessions (t = 3.48, p = 0.002), and compulsions subscale (t = 3.11, p = 0.005) scores were higher in current players than in the other group.

Our results support the hypothesis that high-level competitive sports activities, which suppose compliance with strict daily routines and extensive training, could constitute a risk factor for the onset of full-blown obsessive-compulsive disorder in more vulnerable subjects. Similarly, there is a growing demand for sport psychological support experts in order to prevent high stress in training and competitions.

None Declared

Knee osteoarthritis is one of the most common causes of functional impairment, significantly impacting patients’ quality of life and leading to severe mood disorders. Our objective is to assess the prevalence of depression and anxiety in knee osteoarthritis patients.

Evaluate the prevalence of depression and anxiety in patients with knee osteoarthritis.

This was a cross-sectional study conducted over a three-month period from February to April 2022, including consecutive patients who consulted in a Rheumatology department. We assessed each patient using a validated version of the HAD (Hospital Anxiety and Depression) scale, which includes 14 items, each rated from 0 to 3, measuring two components: depression and anxiety.

We enrolled 82 patients (67 women and 15 men) with an average age of 60.4 years [44-89 years]. The average disease duration was 10 years [2-30]. Knee osteoarthritis was bilateral in 79% of cases. Knee deformities were observed in 74.4% of cases (40.2% had genu valgum, and 29.3% had genu varum). Radiological assessment showed that most of our patients were at Kellgren-Lawrence (KL) stage 3 (50%). All patients received analgesics, with 92.7% receiving NSAIDs, 67.1% local corticosteroid infiltrations, and 18.3% hyaluronic acid injections. The mean visual analog scale (VAS) score was 6.9 out of 10 [1-10]. The mean anxiety score was 7.5 [4-16], with 25.4% of patients exhibiting no anxiety symptoms (score ≤7), 40.3% displaying doubtful anxiety symptomatology (score between 8 and 10), and 34.3% having certain anxiety symptomatology (score ≥11). The mean depression score was 9.6 ± 4 [0-19]. 40% of patients had no depressive symptoms (score ≤ 7), 53.3% had doubtful depressive symptoms (score between 8 and 10), and 6.7% had certain depressive symptoms (score ≥11). The statistical analysis revealed a significant association between anxiety scores and KL stage, but no association with age, sex, mobility limitation, or VAS. Regarding depression, there was no significant association with epidemiological, clinical, or radiological parameters of knee osteoarthritis.

Although knee osteoarthritis may appear to be a benign pathology, its impact can be severe, including depression and anxiety. These mood disorders are primarily influenced by the disease stage. Therefore, psychological care is sometimes necessary in the management of these chronic degenerative diseases.

None Declared

Several studies have called atention to the mental health disorders associated with chemsex -the intentional use of drugs before or during sexual intercourse GBMSM (gay, bisexual and men who have sex with men) population-. Sexualized intravenous drug use is also known as slam or slamsex. There are few studies that analyze the mental health differences between intravenous drug users compared to non-intravenous drug users in chemsex context.

We aim to describe the mental health outcomes including current and past anxiety disorders diagnosis in a sample of users with sexualized drug use (chemsex) attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” and to compare the differences of current and previous diagnosis of anxiety disorders between intravenous drug users compared to non-intravenous drug users.

A cross-sectional descriptive analysis of a sample of users attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” between 2016-2019 was performed.

We included 217 participants. Current or past diagnosis of anxiety disorders was found in 142 participants. Anxiety disorders were significantly higher in the intravenous drug use group compared to the non-intravenous drug use group (p<0.05).

Previous studies have reported that MSM who practiced chemsex were more likely to experience from anxiety. In our study, anxiety disorders where higher in participantes who engaged in intravenous drug use. A multidisciplinary team is necessary to address chemsex and provide care and treatment for mental health problems such as anxiety, depression, suicidal behaviour or drug-induced psychosis.

None Declared

Yoga has been demonstrated to have a range of beneficial effects on individuals with substance use disorders, including opioid use disorders. We initiated a randomized clinical trial to find out the efficacy of add-on yoga among patients with opioid dependence stabilized on treatment to find out whether it led to improvement in sleep and quality of life. However, the rate of enrolment into the study was quite low.

In this interim analysis, we present the preliminary data on the reasons for non-enrolment in the yoga trial.

The single-centre trial involved 1:1 randomization of patients with opioid dependence stabilized on medications (naltrexone or buprenorphine) for a period of at least 4 weeks into two groups (add-on yoga or wait-list control). The yoga included asanas and panchakosha meditation, taught for a period of 7 days and to be practiced by the participants for a period of 12 weeks. We recorded the reasons for non-participation among those who did not participate and asked them questions about their views on yoga.

Of the 310 patients recruited between August 2022 and July 2023 (99.7% male, mean age 34 years, 56.5% married), 255 (82.3%) could not be enrolled in the trial. The most common reasons for non-enrolment were not having time for training (n = 206, 80.8%), not having time for doing yoga (n = 180, 70.6%), not having a smartphone for continued training or contact (n = 31, 12.2%), distance from the center (n = 17, 5.5%) do not feel the need for yoga (n = 16, 5.2%), injury or disability (n = 9, 3.5%), old age or medical condition (n = 7, 2.7%), already doing gym exercises (n = 7, 2.7%), nature of job (n = 5, 2.0%), do not have knowledge of yoga (n = 5, 2.0%), and do not think yoga would be useful (n = 4, 1.6%). Among those who could not be enrolled, 35.1% reported doing yoga sometime in the past, and 21.6% reported that at least one of the family members did yoga. When asked whether they would be interested if yoga was available online, 16 (5.2%) responded ‘yes’ and 45 (14.5%) responded ‘maybe’.

Expressed time constraints may be an important factor deterring patients with opioid dependence from engaging in yoga as an add-on yoga. There are other reasons as well that may deter patients from such an intervention. The findings should be seen in the light of the limitation of a single medically oriented center, and patients already stabilized on treatment.

None Declared

Chemsex refers to the use of drugs, typically stimulants and/or psychoactive substances, in a sexual context, often in the context of casual or group sex encounters. Currently, the practice of chemsex focuses on men who have sex with men (MSM). On the other hand, Pre-exposure prophylaxis (PrEP) is a biomedical method that has proven effective in preventing HIV transmission, particularly among individuals at a heightened risk, including those who engage in chemsex. MSM account for two thirds of new HIV cases in the US. It is estimated that in 70% of cases seroconversion occurs through “condomless anal sex” (CAS). According to the CDC, one in six MSM will be infected with HIV during their lifetime. The consumption of methamphetamine (MA) has been identified as the main driver of the practice of CAS, alteration of rectal immunological function and faster seroconversion. One in three new HIV infections have been associated with MA consumption. (Grov C et al. JAIDS 2020; 85 272-279).

The primary goal of this study is to describe the prevalence of chemsex engagement among PrEP users, delineate user characteristics and requirements, gain deeper insights into this phenomenon within the Barcelona region, and formulate customized strategies accordingly.

This study conducts a literature review to explore the current correlation between engaging in chemsex and the utilization of PrEP. We identified research articles published between January 2020 and December 2022, that discussed the utilization of chemsex drugs prior to or during sexual activities. The findings were synthesised using a narrative approach and conceptualised using a behavioural analysis framework.

According to a recent cross-sectional study performed at Hospital Clínic de Barcelona, SUD among patients who are being followed-up in the outpatient clinic of PrEP was higher (89%) compared with other European regions such as England (38.5%) or Amsterdam (41%). Moreover, according to data collected in the EMIS 2017 survey, Barcelona is the city with the highest prevalence of chemsex in Spain. (De La Mora L et al. AIDS Beh. 2022; 26: 4055-4062).

The frequency of chemsex practice among individuals using PrEP in Barcelona surpasses what has been observed in other groups. Nearly 25% of the participants express worries and a requirement for assistance regarding the management of drug use, matters associated with their sexuality, and sexually transmitted infections (STIs). MSM who suffers from substance use disorder may experience difficulty achieving effective daily oral PrEP adherence prevention levels that may serve as early indicators of increased risk of disengagement from PrEP care and discontinuation the PrEP. These results highlight the importance of adopting aninterdisciplinary approach that incorporates education about substances and the implementation of risk mitigation strategies within the context of riskier sexual behaviors.

None Declared

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

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

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

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

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

None Declared

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

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

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

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

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

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

None Declared

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

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

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

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

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

None Declared

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

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

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

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

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

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

None Declared

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

None Declared