Children with non-syndromic orofacial clefts are at higher risk for developmental difficulties. Speech and language as commonly affected developmental domains in these children.

The aim of the current study was to explore the effects of early interventions for speech and language on later cognitive outcomes in this patient population.

A combined retrospective/prospective-comparative study was carried out at the Department of Pediatrics of the University of Pécs in Hungary. The participants were children between 6 and 16 years of age. The study consisted of a self-designed demographic questionnaire and an IQ test (WISC-IV).

A total of 41 children with non-syndromic orofacial clefts and 44 age-matched controls participated in the study. Children of the cleft group were examined by pedagogical professional services and required special education plans significantly more often than controls (p<0.001 and p=0.02, respectively). Participants of the cleft group who received early speech and language therapy score higher on the Verbal Comprehension Index (p=.005). Full-Scale IQ score was also higher for cleft participants who received therapy, however not significant but borderline (p=0.08).

Early language and speech interventions for children with non-syndromic orofacial clefts may have a positive effect on verbal skills and overall cognitive development. Future longitudinal studies examining baseline cognitive functioning of infants are needed to provide more conclusive evidence on the effects of interventional programs on speech and language development in cleft patients.

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Anorexia nervosa (AN) is a widespread chronic mental disorder with severe negative medical and social consequences. Treating patients with AN is a complex and time-consuming process, as persistent forms are often encountered. The studies’ results indicate a possible influence of psychoemotional state and/or existing psychopathological manifestations in parents on AN development.

To investigate the clinical and psychopathological characteristics of parents of patients with AN based on the study of emotional regulation, alexithymia, depression, and anxiety.

The study population (N=110) consisted of fathers (N=47 (42.7%)) and mothers (N=63 (57.3%) of patients with AN. The mean age was M=44.90 (SD=5.9; SE=0.567). All participants completed the emotional regulation scale (DERS), Toronto Alexithymia Scale (TAS-26), Hospital Anxiety and Depression Scale (HADS).

According to DERS: “rejection” - 21.86 (SD=5.675; SE=0.541); “goals” - 19.13 (SD=2.028; SE=0.193); “impulse” - 24.17 (SD=4.908; SE=0.468); “awareness” - 21.93 (SD=1.999; SE=0.191); “strategies” - 30.75 (SD=2.173; SE=0.207); “clarity” - 18.58 (SD=1.486; SE=0.142). The sum was 136.42 (SD=8.119; SE=0.774). The TAS results of the study group were 80.45 (SD=13.699), which characterizes the average personality type as alexithymic. According to HADS, the average values were distributed: the anxiety scale M=7.96 (SD=1.347) the depression scale M=7.95 (SD=1.442). These indicators can be considered as the extreme limit of the norm or subclinically expressed anxiety and depression. The next step was to find statistically significant relationships between the DERS methodology and the HADS and TAS for the study group. According to Spearman’s correlation coefficient, there is a direct stable relationship between the variables “anxiety” and “impulse” (r=0.257), awareness (r=0.255), and the total score of emotional regulation according to “DERS” (r=0.246); A direct correlation was found between the indicators “depression” and “rejection” (r=0.151), “goals” (r=0.233), “awareness” (r=0.138); Alexithymia, in turn, has a direct correlation with the “goals” scale and an inverse correlation with the “strategies” scale (r=-0.141)

Parents of patients with AN have various manifestations of psychoemotional disturbances, namely subclinical levels of depression and anxiety, high levels of alexithymia, and emotional regulation problems. The correlation analysis showed that the anxiety score for parents of patients with AN is higher if difficulties with impulse control, emotional awareness, and general emotional regulation are problematic. Depressive tendencies are also associated with the subjects’ rejection of emotional reactions and problems with goal-directed behavior. The inverse correlation indicates that the higher the index of alexithymia, the less limited access to emotion regulation strategies, and vice versa.

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Adherence to treatment for addictive disorders remains a clinical challenge. Despite detoxification admissions being scheduled and initiated voluntarily by the patient, several factors may contribute to treatment discontinuation.1 Understanding these factors will enable the development of specific interventions for a more effective approach.2

To identify and analyze the relationship between specific clinical factors and voluntary treatment discontinuation.

An observational and descriptive study was conducted using a retrospective database of 1146 patients admitted to the “Hospital Universitari Vall d’Hebron” Detoxification Unit between June 2008 and December 2019. Bivariate analysis was conducted to identify individual associations between clinical factors and voluntary discharge. Subsequently, a multivariate analysis was performed to assess the combined influence of these factors while controlling for potential confounding variables.

A total of 135 patients (11.8%) requested voluntary discharge. Significant differences were found between the voluntary discharge and non-voluntary discharge groups in patients with dual diagnosis (91.1% vs 80.9%, p<0.0001), specifically the presence of psychotic disorder (18.7% vs 12%, p<0.05) and cluster B personality disorder (66.7% vs 31%, p<0.0001). Significant associations were also observed with prior detoxification admissions (64.5% vs 54.1%, p<0.05), heroin as the main admission substance (29.6% vs 13.3%, p<0.0001), lifetime use of more than three substances (65.3% vs 45.3%, p<0.0001), and pre-admission binge-pattern substance use (72.1% vs 51.4%, p<0.0001). A significant relationship was found with therapeutic discharge in the diagnosis of major depressive disorder (14.6% vs. 24.8%, p<0.05), admission for alcohol detoxification (25.9% vs. 42.8%, p<0.0001), and participation in group therapy during admission (27.4% vs. 49.9%, p<0.0001).In the multivariate analysis, it was found that cluster B personality disorder (p<0.0001), heroin as the primary substance of admission (p<0.05), and pre-admission binge-pattern substance use (p<0.05) were independently related to voluntary discharge.

Cluster B personality disorder, admission for heroin detoxification, and pre-admission binge-pattern substance use are factors associated with voluntary treatment discontinuation.

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Bipolar disorder (BD) is a chronic and severe psychiatric disorder, characterized by the alternance of episodes of (hypo)-mania and major depression. Lithium (Li) is the first-line treatment for BD but unfortunately response to Li is highly variable: after at least two consecutive years of treatment, only a fraction of patients receiving Li will display significant improvement in the frequency and/or severity of mood recurrences. This interindividual variability of treatment response is difficult to predict, in the bipolar disorder context. This could be determined by genetic factors still misidentified by available genetic studies. In addition, no clinical or biological markers are available to reliably define eligibility criteria for a lithium treatment in bipolar disorder. A consequence is a long process of therapeutic trials (18-24 months) to phenotype Li response, delaying the stabilization.

To identify objective biomarkers of the prophylactic response to lithium in order to improve patient care and propose therapeutic alternatives to patients who do not respond to lithium.

Using a genome-wide methylomic approach, and then logistic regressions incorporating as covariates the different types of treatments, we were able to identify differentially methylated regions (DMRs) whose methylation difference between responders and non-responders was not impacted by co-prescribed treatments. Then, we used Methylation Specific High-Resolution Melting (MS-HRM), a PCR based method than can be implemented in any medical laboratory at low cost and with minimal equipment, to estimate methylation proportion of 9 DMRs in 61 samples of bipolar patients.

In the sample of 61 individuals with BD, the 9 MS-HRM-measured DMRs combined with clinical variables (age, sex, cigarette smoking status, lifetime number of hospitalizations, age at onset of BD, polarity at onset, psychotic symptoms at onset, family history of BD, lifetime alcohol/cannabis misuse, panic disorders, Li prescribed as the first mood stabilizer (vs 2nd or 3rd choice)) correctly classified 83,6% of individuals as good or non-responders (n=61, prophylactic response phenotype defined using the “Alda” scale). Excluding the partial responders, the percentage of correctly classified individuals is as high as 100% (n=43, 18 non responders and 25 responders). The AUC are respectively AUC=0.913 and AUC=1.0.

The MS-HMR method allow to identify the response status of individuals with BD with 9 DMR. These DMRs discriminate good from non-responders and can be used in combination with clinical variables.

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Lithium is one of the main drugs used in Bipolar Affective Disorder. However, it has a narrow therapeutic window, which requires close monitoring and progressive dose adjustment, according to serum levels, clinical response and the appearance of side effects. The term ‘SILENT’ explains descriptively persistent neurological sequelae related to lithium salt intoxication when symptoms persist for more than 2 months after stopping treatment. SILENT Syndrome is more common in females, at ages ranging from 21 to 77 years and is characterized mainly by avermian-type cerebellar disorder, persistent extrapyramidal syndrome, brainstem dysfunction and dementia of varying severity. It can also result in apraxia of the body, changes in the coordination and balance, dysarthria, as well as intentional and kinetic cerebellar tremor, involuntary movements of orofacial dyskinesias or resting tremor.

The authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.

Non-systematic literature review.

Complications from the use of lithium known in the medical literature include mainly nephrotoxicity, endocrine alterations and neurotoxicity. The neurotoxic effects of lithium usually occur at high serum concentrations. However, they can also occur with lithium in the therapeutic range, and memory, attention and ataxia impairment may be some of the permanent sequelae. The etiopathogenesis is unclear, but demyelination has been detected in multiple brain regions, mainly in the cerebellum. The mechanism of lithium-induced cerebellar injury is believed to be mediated by the entry of calcium into the cells of this organ. The main factors that predispose to greater side effects and risk of toxicity are patients with decreased renal function, advanced age, use of diuretics, dementia, pregnancy, low sodium intake and physical illness with vomiting and/or diarrhea.

Lithium is a drug used mostly in affective disorders and given the narrow therapeutic window, it requires close monitoring in order to avoid side effects that can be permanent. In this way, it is important to review the factors that increase the lithium toxicity and make recommendations about it.

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It is known that the formation of aggressive behavior is accompanied by neurodegenerative and neuroinflammatory changes. Immune cells have a regulatory effect on the central nervous system functions, including regulation of behavior.

We first demonstrated that ex vivo chlorpromazine - modulated immune cells have a positive aggressive behavior editing effect. The aim of the study was to investigate the influence of the indicated cells on some central mechanisms underlying the development of aggressive reactions.

(CBAxC57Bl/6) F1 aggressive male mice, developed in conditions of chronic social stress, were undergoing the transplantation of syngeneic spleen lymphocytes with ex vivo chlorpromazine-modulated functional activity. In recipients the immunohistochemical analysis was performed assessing the expression of the microglial marker Iba1. The levels of brain-derived neurotrophic factor (Bdnf) and cytokines was assessed by ELISA. For histological examination Nissl staining was applied.

Aggressive behavior editing after the chlorpromazine-modulated immune cells transplantation registered against the background of some structural and functional changes in the brain. It was found an increase in the density of pyramidal neurons in CA1 and CA3 hippocampal regions and augmented level of Bdnf. The decreased expression of microglial activation marker Iba1, accompanied with decreased levels of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, INF-γ) and increased  anti-inflammatory (IL-4) cytokine was found. Visualization of functionally active lymphocytes pre-treated with chlorpromazine in the brain parenchyma of aggressive recipients suggests a direct effect of injected lymphocytes on CNS.

The effect of chlorpromazine - modulated immune cells that edits aggressive behavior is realized by stimulating neurogenesis, neuroplasticity and reducing neuroinflammation.

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Heavy academic loads imposed on medical students explain why it is so important for a university to pay more attention to the issues of maintaining their students’ mental health.

To compare the level of mental health and the need for mental health services in domestic and international medical students

The survey covered 305 domestic and 241 international university students of the Faculty of Medicine. Their mental health level was measured with the SCL-90R questionnaire, their interest to mental health services - by means of a 5-point questionnaire.

The data achieved by measuring the level of mental health with the SCL-90R revealed that in both groups this level is within standard limits. However, the international students showed a higher level of psychopathological distress reflected by GSI index (χ2=2.14; р=.03). Both groups have experienced a visit to a psychiatrist or psychotherapist (12.13% and 8.3% correspondingly). Some of them have undergone treatment in connection with their emotional and behavioral problems (3.28% и 3.73%). Currently, they claim, with the same frequency, that they are in need of a psychiatrist’s or psychotherapist’s help (14.43% и 13.28%). Domestic students, as compared with international students show higher need (χ2=24.55; р=.001) for a psychologist’s help (34.75% and 16.18%).With different frequency, 65.15% of the international students and 89.5% of the domestic students consider mental health services as necessary.

When providing medical support to medical students, it is important to take into account their need for mental health services and to keep in mind their different cultural backgrounds.

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People experience various negative emotions when they encounter stressful events, and these negative emotions contribute to the onset of illnesses. These emotional responses are not limited to just one; a person can experience multiple emotions at once, and the primary emotional reactions can vary depending on the severity and duration of the illness or life events. This is reason why we created a self-report scale to assess short-term emotional responses, focusing on the current emotional state experienced subjectively by patients.

The purpose of this study was to develop an affective response scale (ARS) and examine its validity and reliability.

We established clusters of affective via a literature review and developed preliminary items based on the structure. We conducted expert content validation to converge on the final items, followed by construct validity and reliability analyses.

The research findings indicate that the Affective Response Scale was composed of three main dimensions: anxiety, anger, and depression. Content validity results confirmed the validity of most items. The scale developed in this study was found to be valid in both exploratory and confirmatory factor analyses, and it was identified to be stable and consistent through the analysis of the internal reliability.

These results indicate that the ARS is highly reliable and valid, and that it can be utilized as an effective measure of the patient’s emotion and its severity.

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Cardiovascular disease (CVD) is a leading cause of excess mortality in people with severe mental illness (SMI). Physical activity (PA) is widely acknowledged with multiple health benefits, but associations of PA with incident CVD, all-cause and CVD mortality in people with SMI remain unclear.

To determine dose-response and intensity-specific associations of PA with incident CVD, all-cause and CVD mortality in people with SMI.

This prospective cohort study was conducted on 6313 SMI participants with accelerometry data from UK Biobank (mean age 61.05 years) from February 2013 to November 2021 (median 7-year follow-up). Moderate-to-vigorous PA (MVPA) was categorized by meeting the guideline level or not, while total PA and light-intensity PA (LPA) were grouped by tertiles. Incident CVD, all-cause and CVD mortality ascertained by hospital and death registries were main outcomes.

PA was inversely associated with the risk for incident CVD (Poverall < 0.05 for total PA and MVPA, Pnonlinearity > 0.05 for all PA), all-cause mortality (Poverall < 0.05 for all PA, Pnonlinearity < 0.05 for total PA and LPA), and CVD mortality (Poverall < 0.001 for total PA and LPA, Pnonlinearity < 0.05 for all PA). Performing guideline-recommended volume of MVPA was associated with a reduced risk of 19% for incident CVD (95% CI, 0.67-0.98), 42% for all-cause mortality (95% CI, 0.43-0.79), and 50% for CVD mortality (95% CI, 0.31-0.82). A combination of recommended MVPA and a moderate volume of LPA was associated with the lowest risk, mitigating 21% risk for incident CVD, 59% for all-cause mortality, and 78% for CVD mortality.

Primary engagement of guideline-recommended MVPA, supplemented with moderate amount of LPA, was associated with lower risks for incident CVD, all-cause and CVD mortality among people with SMI.

This research has been conducted using the UK Biobank Resource under Application Number 58082.

This work was supported by the National Natural Science Foundation of China (grant number 32100880), Guangzhou Municipal Key Discipline in Medicine (2021-2023), Guangzhou High-level Clinical Key Specialty, and Guangzhou Research-oriented Hospital. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Long-term care facilities, such as nursing homes and other assisted living facilities, have been hit particularly hard by the COVID-19. The overall pandemic created an enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. However, most of the existing evidence regarding the well-being of care professionals has predominantly focused on frontline healthcare workers.

This study aimed to identify long-term psychological needs of LTCWs derived from the COVID-19 pandemic, as part of a project that is developing an intervention to reduce psychological distress in this population group.

We performed a qualitative study with a rapid research approach. Participants were recruited from long-term care facilities located in Catalonia, Spain. Between April and September 2022, we conducted semi-structured interviews inquiring about the most psychologically challenging stages of the pandemic, perceived emotions during those stages, main determinants of those emotions, and their emotional state at the time of the interview. We used a qualitative content analysis method with an inductive-deductive approach.

Thirty LTCWs participated in the study. Mean age was 44 (SD=11,4), 87% were females and one third were from foreign nationalities. The period of the pandemic with highest mental health burden was the outbreak, with almost every worker having experienced some form of emotional distress. Emotional distress persisted over time in more than half of participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, feeling that pandemic times are not over and poor working conditions that have remained since then, have been the most frequently expressed determinants of such emotions.

Long after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees’ wellbeing.

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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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Rational Emotive Behavior Therapy (REBT) fundamentally posits that our thoughts, beliefs, and interpretations exert substantial influence over how we perceive and react to life’s occurrences. Central to REBT is the process of recognizing and disputing irrational, self-defeating beliefs, in favor of adopting rational and constructive perspectives.

This presentation endeavors to introduce the foundational principles of REBT, elucidate its applied techniques, demonstrate its efficacy through compelling case studies, and delineate its spheres of applicability.

Case Studies:

1. 1. Overcoming Social Anxiety: Illustrating the transformation from debilitating social anxiety to enhanced social functioning.

2. 2. Managing Work-related Stress: Exemplifying the alleviation of chronic stress in a high-pressure work environment.

3. 3. Overcoming Depression: Demonstrating the journey from persistent despondency to restored vitality and engagement.

In total, REBT furnishes a methodical and pragmatic approach to therapy, affording individuals agency in steering their emotional well-being towards positive and enduring transformation. It is imperative to acknowledge that the suitability of REBT hinges on the idiosyncratic needs, inclinations, and circumstances of each patient.

By internalizing and applying these foundational principles, REBT empowers individuals to identify and dispute irrational beliefs, paving the way for more adaptive emotional responses and an enhanced overall state of mental well-being. It equips individuals with tangible tools to navigate life’s challenges with heightened resilience and emotional equilibrium.

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UK healthcare is undergoing significant challenges in facing borderline personality disorder (BPD) and accommodating the increased demand to allocate sufficient care and carers to deal with BPD’s growing number and emotional and suicidal crises.

To generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service in suicide prevention (NHS).

The underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com).

Persons with BPD become suicidal because the team cannot comprehend and address the cycle of dysthymia, rumination and suicide. The BPD crises start from Stage 1 (α), assessing the comorbidity between BPD with dysthymia, cyclothymia, autism and ADHD. Teams shall avoid overmedication as ineffective. Stage 2 (β) is introspection and rumination, which do not respond to pharmacotherapy. The health carers establish if rumination is present and suggest distraction techniques. Stage 3 (γ) is when constant rumination with catastrophising leads to hopelessness. Stage 4 (δ) is when BPD starts feeling more anxious, depressed and unable to stop rumination. We suggest thought-stopping techniques and discourage social isolation, which triggers rumination. As BPDs use external locus of control and aim for higher dosages of antidepressants and anxiolytics with minimal effect, we explain that medication is not the only solution. Stage 5 (ε) is a crisis and panic attack because constant rumination brings back traumatic thoughts focused on the past, present and future. This is when BPDs self-refer to the hospital, attempt suicide, and feel that hospital admission is the only solution. The stages combined generated Model I. The Model II forecast Δ from this study is that we will observe a higher frequency (Δ) of hospital occupancy (Δbo = A), suicidal attempts (Δsa = B), and heavy service use (Δsu = C) by BPDs.

The predictive model algorithm has thus extracted (1) Model I (Analysis): [α → (β → (γ → (δ → ε)))] = Z; The truth density for Model I and its strength of prediction for stage progression is 96.87% in the dysthymia-rumination-suicide cycle; and (2) Model II (Prediction): Z implies (A And B And C), Z→A ∩ B ∩ C; the truth density for the Model II is 56.25% for predicting a national shortage of healthcare resources. The combined models predict a truth of 73.81% in the outcomes of BPD crises in the UK NHS due to the dysthymia-suicide cycle.

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Adolescence is a period marked by highest vulnerability to the onset of depression, with profound implications for adult health. Neuroimaging studies have revealed considerable atrophy in brain structure in these patients with depression. Of particular importance are regions responsible for cognitive control, reward, and self-referential processing. However, the causal structural networks underpinning brain region atrophies in adolescents with depression remain unclear.

This study aimed to investigate the temporal course and causal relationships of gray matter atrophy within the brains of adolescents with depression.

We analyzed T1-weighted structural images using voxel-based morphometry in first-episode adolescent patients with depression (n=80, 22 males; age = 15.57±1.78) and age, gender matched healthy controls (n=82, 25 males; age = 16.11±2.76) to identify the disease stage-specific gray matter abnormalities. Then, with granger causality analysis, we arranged the patients’ illness duration chronologically to construct the causal structural covariance networks that investigated the causal relationships of those atypical structures.

Compared to controls, smaller volumes in ventral medial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), middle cingulate cortex (MCC) and insula areas were identified in patients with less than 1 year illness duration, and further progressed to the subgenual ACC, regions of default, frontoparietal networks in longer duration. Causal network results revealed that dACC, vmPFC, MCC and insula were prominent nodes projecting exerted positive causal effects to regions of the default mode and frontoparietal networks. The dACC, vmPFC and insula also had positive projections to the reward network, which included mainly the thalamus, caudate and putamen, while MCC also exerted a positive causal effect on the insula and thalamus.

These findings revealed the progression of structural atrophy in adolescent patients with depression and demonstrated the causal relationships between regions involving cognitive control, reward and self-referential processes.

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Philosophy of mind grapples with fundamental questions concerning the Consciousness, the Mind-body problem, the Identity, and Free will (as opposed to Determinism). In the context of psychiatry, this philosophical groundwork provides a conceptual framework for comprehending the intricate workings of the human psyche.

We aim to discuss how the philosophical investigation of the mind influence and enhance psychiatrists understanding of psychiatric disorders and patient-centered care.

Review of the literature.

Philosophy of mind explores what it means to be conscious and the nature of subjective experience. This includes questions about the “hard problem” of consciousness, that refers to the difficulty of explaining why and how physical processes in the brain give rise to subjective, first-person experiences (or qualia). The “hard problem” posits that even if we knew everything about the brain’s physical processes and how they relate to cognitive functions, we would still lack an explanation for why these processes give rise to subjective consciousness. Psychiatry often deals with individuals who experience disturbances in their subjective conscious experiences, so the “hard problem” perspective allows psychiatrists to appreciate the diversity of conscious experiences and to empathize with their patients’ unique mental worlds.

Related with the previous topic is the mind-body problem. The elucidation of this problem highlights the challenge of reconciling mental phenomena with neurobiological processes. Integrating philosophical notions of dualism, materialism, and emergentism into psychiatric practice is essential for addressing the holistic nature of mental health.

Concerning to philosophical perspectives on personal identity, questions about the continuity of identity, selfhood, and the role of narrative in shaping one’s sense of self contribute to a deeper understanding of disorders like dissociative identity disorder, borderline personality disorder and even psychosis.

Furthermore, philosophical discussions on free will and determinism are pertinent to psychiatric ethics and the treatment of individuals with behavioral disorders, informing the ethical considerations surrounding involuntary psychiatric hospitalization, medication administration, and the delicate balance between autonomy and paternalism in psychiatric care.

Philosophy of mind provides psychiatry with a rich conceptual landscape, offering insights into the nature of mental phenomena. As our understanding of the brain and consciousness continues to evolve, the philosophy of mind remains an evolving area of philosophical inquiry.

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Sleep disturbance, particularly insomnia, is prevalent across various mental health disorders. While it is a common sign in mood disorders, emerging evidence suggests that insomnia might act as a precursor or an early sign of psychosis. Our case report and literature review emphasize the importance of evaluating sleep disturbances in the diagnosis and management of mental disorders.

• - To explore potential neurobiological underpinnings linking sleep disturbances to psychosis onset.

• - To advocate for the importance of early identification and intervention for sleep disturbances in the broader context of preventing or managing psychotic disorders.

We present a case describing a young patient’s first episode of psychosis, which was masked by an initial presentation of insomnia. Additionally, we conducted a review of the relationship between sleep disturbances and psychosis, with a comprehensive literature search from Pubmed, Scopus and psychINFO.

A 20-year-old African-American male with a history of poor sleep was initially diagnosed with Major Depressive Disorder. He was treated with Bupropion, Quetiapine, and Trazodone. However, he later presented with worsening depression, odd behavior, and signs of disorganization, suggestive of a psychotic episode. After switching his medication to Risperidone 4mg twice daily, the patient’s sleep and other symptoms markedly improved. Through our literature review, we identified that sleep disturbances, especially insomnia, can be a risk factor for developing psychosis. While a cross-sectional study recorded one-fourth of their study population experiencing First Episode Psychosis (FEP) with clinical insomnia, another study reported close to 80% of their study sample with early psychosis suffering from a minimum of one sleep disorder; insomnia and nightmare disorder being the most frequent. A large sample longitudinal analysis lasting one year also observed patients with sleep disorders to be twice at risk of onset and persistence of psychotic episodes. A growing body of evidence also suggests that structural brain abnormalities and neural development alterations in the early stages of psychosis may lead to sleep disturbances and subsequent psychotic symptoms. Findings suggest that thalamic dysfunction may in particular contribute to sleep spindle deficits and altered EEG microstate dynamics. These deficits are unrelated to antipsychotic medication exposure, and are also not observed in patients with other psychiatric illnesses.

While the correlation between sleep disorders and psychosis has been well-established for decades, very limited literature is available on the role of sleep in FEP. Recognizing and treating sleep disturbances is pivotal in managing psychiatric disorders, including psychosis. Thus, a comprehensive evaluation of sleep issues in patients presenting with psychiatric symptoms is imperative for accurate diagnosis and management.

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Incarcerated individuals are subject to a heightened risk of both mental and physical ailments. Hence, it is important to conduct regular assessments of their mental well-being and other potential health hazards.

The aim of this study is to examine the subjective experience of fear related to COVID-19 and the psychological consequences of the pandemic among a cohort of young adult male convicts.

A research design using an institutional-based quantitative cross-sectional approach was used. The data collecting period was from July to September 2022, during which data was gathered at a juvenile correctional facility located in the center area of Portugal. The researchers used questionnaires to gather data pertaining to demographic and health attributes, fear related to COVID-19, as well as measures of depression, anxiety, stress, and resilient coping.

The study included a cohort of 60 incarcerated males who had been imprisoned for a duration exceeding 2 years. The prevalence of stress was found to be the highest among offenders, with around 75% reporting this symptom. Anxiety was the second most often reported symptom, with 38.3% of inmates experiencing it, followed closely by depression, which was reported by 36.7% of the inmate population. The average score on the Fear of COVID-19 Scale was 17.38 ± 4.80, suggesting that participants generally reported mild levels of fear. A total of 38 subjects, accounting for 63.3% of the sample, had low scores in resilience. The participants’ responses indicated that their perceptions of mental health were within a fairly high range, with an average score of 3.62 ± 0.87. Similarly, their perceptions of physical health were also moderately high, with an average score of 3.73 ± 0.95. In terms of global health, participants reported a slightly lower average score of 3.27 ± 0.82 for the preceding month. The Pearson correlation matrix revealed statistically significant associations between fear of COVID-19 and characteristics linked to mental health, with the strength of these associations ranging from moderate to high (p < 0.001). The identification of predictive variables for fear of COVID-19 was accomplished by the use of a multiple linear regression model. Four predictors were identified in the study, namely age, perception of mental health, and overall levels of anxiety and stress. These predictors together account for about 49.7% of the variance in the outcome variable.

The findings of our research indicate a significant prevalence of stress among incarcerated individuals, accompanied by moderate levels of anxiety and depression. Our research has the potential to provide valuable insights for policymakers, mental health professionals, public health specialists, and other relevant stakeholders in the identification and effective management of pandemic-induced anxieties and mental health symptoms.

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The COVID-19 pandemic has had a wide-ranging impact on economic and social phenomena worldwide, particularly affecting mental health. However, these impacts have varied significantly across countries. Previous studies have shown that the groups more vulnerable to mental health problems also differ across countries and societies(Gunnel et al. Lancet Psy 2020; 7(6) 468-471, Pirkis et al. Lancet Psy 2021; 8(7) 579-588, Nomura et al. Psy Res 2021; 295 113622). Therefore, by examining changes in self-harm and suicide attempts, which constitute mental health emergencies, at the community level, we can explore the COVID-19 pandemic’s impact on the deterioration of mental health in various age groups within the region and identify the groups most vulnerable to mental health problems.

The aim of this study is to examine the relationship between the COVID-19 pandemic and changes in the number of emergency room visits due to suicide attempts or self-harm in teenagers and young adults in Incheon, a metropolitan city in the capital area of South Korea.

We conducted a retrospective data analysis on the medical records of patients who visited the regional emergency center of Incheon Medical Institution from January 2018 to December 2022 due to suicide attempts or self-harm. As our statistical method, we employed interrupted time series analysis to determine whether the COVID-19 pandemic has a statistically significant correlation with the trend changes in the number of emergency room visits related to suicide attempts or self-harm. This study was approved by the Institutional Review Board of Gil Medical Center, Gachon University of Korea(IRB approval number GFIRB2022-335).

The data of 4,030 subjects(35.8% male; n=1,443) who visited the regional emergency center during the study period were analyzed. A total of 556 (13.79%) of the study participants were minors under the age of 19, and a total of 1,789 (44.39%) were young adults aged 20-39. The analysis revealed an increasing trend in the number of emergency room visits due to elevated suicidality in teenagers and young adults (20-39 years old) following the COVID-19 pandemic(figure 1 & figure 2).

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While suicide attempts and visits to the emergency room due to self-harm increased both before and after COVID-19, it is noteworthy that past suicide attempts are the most significant risk factor for future suicide attempts. Therefore, the data on vulnerable groups presented in this study can be instrumental for effective prevention and follow-up management of suicide attempts within the field of community psychiatry.

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A pandemic caused by a novel coronavirus is an immensely traumatic event. Researches indicate that such events significantly impact various aspects of individuals, including their physical, emotional, cognitive, behavioural, and social functions, affecting different components of their personality structure. However, the experience of trauma itself is influenced by implicit internal structures known as underlying beliefs. Consequently, emotional responses to traumatic events may be interconnected with these core beliefs.

This study aimed to explore fundamental beliefs among Russian university students and analyze their associations with emotional reactions such as depression, anxiety, and stress.

Data collection took place from January to April 2021 using a custom-designed Google form. The study involved 35 Russian university students. We employed the WAS-37 methodology to investigate fundamental beliefs and the DASS-21 methodology to assess the levels of depression, anxiety, and stress. Both questionnaires were adapted for use in Russia.

We found that the mean values of the “Benevolence of the surrounding world” (M = 35.5±7.3) and “Luck” (M = 31.7±5.1) scales are higher than the normative mean values for the Russian population. In contrast, the mean values of the “Fairness” (M = 21.0±3.7), “Self-image” (M = 26.6±7.0) and “Beliefs about control” (M = 26.6±4.8) scales are generally not different from the normative values. Depression has negative correlations with Self-image (rs = -0.590, p < 0.01) and Beliefs about control (rs = -0.509, p < 0.01). No statistically significant correlations of anxiety and stress with baseline beliefs were obtained.

During the second wave of the pandemic, Russian university students tend to view the world around them as less perilous than the broader population does, and they perceive themselves as more fortunate. Depressive feelings among students are linked to their lower beliefs in the value and importance of their self, as well as their perception that the world around them is not sufficiently controllable.

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Chronic mental illnesses can significantly impact an individual’s quality of life and lead to functional disabilities. Scientific interest in overall quality of life and health-related quality of life has been gradually increasing, especially in the context of chronic diseases where the relationship between patients’ long-term functionality and symptom development is not always linear.

Our research aimed to investigate the factors influencing subjective-objective well-being and in patients diagnosed with schizophrenia and schizoaffective disorder. Specifically, we examined the effects of anticipated discrimination on patients’ quality of life, satisfaction with health care, and overall functionality.

We recruited 25 patients from Semmelweis University Department of Psychiatry and Psychotherapy in Budapest, Hungary. To be eligible, patients had to meet the diagnostic criteria for schizophrenia or schizoaffective disorder according to DSM-5, cooperate with pharmacotherapy, and meet remission criteria (Andreasen et al., Am J Psychiatry 2005; 162 441-449). We collected socio-demographic data and clinical history, utilized the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Positive and Negative Syndrome Scale (PANSS) to identify our clinical sample and assess the severity of symptoms. Objective and subjective functionality and well-being were measured using the Lancashire Quality of Life Profile (LQoLP). Self-reported medication adherence were measured with Morisky Medication Adherence Scale (MMAS-8). Additionally, we assessed anticipated discrimination (QUAD), and satisfaction with healthcare (CACHE).

Our findings have unveiled a cross-sectional association between higher self-reported medication adherence and improved quality of life among patients with schizophrenia. Moreover, increased adherence levels, as well as greater satisfaction with healthcare, were linked to enhanced objective and subjective functionality and overall well-being. Additionally, the anticipation of discrimination was found to be associated with reduced quality of life and functionality.

The overall quality of life and objective-subjective functioning in patients diagnosed with schizophrenia and schizoaffective disorder can be influenced by various factors. Further research is needed to gain a better understanding of the factors associated with higher quality of life in patients.

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