Psychotic symptoms and eating disorders can occur in the same person, sometimes at the same time. This comorbidity is not well studied despite the difficulties of management at both clinical and pharmacological levels that it may entail. We present the case of a 35-year.old female patient with anorexia nervosa with years of evolution, currently admitted to a center specializing in Eating Disorders, who comes to the emergency department with psychotic symptoms.

To know the prevalence of comorbidity of psychotic symptoms in people with eating disorders, as well as possible risk factors, severity and management of them.

Presentation of a case and review of the available literature on the presence of symptoms of the psychotic sphere in persons diagnosed with eating disorders.

The literature reflects data of a prevalence of 10-15% of patients with eating disorders presenting psychotic symptoms. The presence of psychotic symptoms is not directly related to a greater severity of the eating disorder. Some genetic associations have been found, as well as alterations at the physiological, cognitive and brain structure level that coincide in both pathologies. In some cases, an improvement in eating behavior has been observed when the psychotic symptomatology is resolved. In the case of patients with bulimia nervosa, a higher number of psychotic symptomatology has been observed, such as paranoid ideations, which some studies relate to a greater emotional capacity and histrionic expressiveness of this patient profile.

The comorbidity of psychotic symptoms and eating disorders is relatively frequent and makes us face challenges in the diagnosis, as well as in the management of these patients. This comorbidity is especially important in patients with bulimia nervosa. Future research is necessary to know a more exact management of these pathologies.

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Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia in in patients with bipolar disorder (BD) and that those are associated with an impairment of psychosocial functioning. The assessment of executive functions (EFs) is normally carried out using laboratory tests. Novel methodologies such as virtual reality (VR) allow the creation of immersive environments, to evaluate executive performance with greater potential for ecological validity than evaluations with standard tasks.

The objectives of this project are to evaluate executive performance in euthymic patients with BD with a novel virtual reality task compared to standard computerized tasks, and to find predictors of functioning associated with cognitive performance.

This is a cross sectional study in which 46 euthymic patients with BD treated at La Fe University and Polytechnic Hospital were assessed with a battery of standard computerized tasks (ST) (TMT/Stroop,/Go-No-Go/TOL/DOT) and with the Cooking Task virtual reality task. The Cooking Task presents 4 tasks of increasing difficulty in which you must cook food in a specific time. It records total time to complete the task, whether food is cooled or burned, the simultaneous use of two fires, the proper use of seasonings and the time to set the table.

Functioning was assessed with the Functioning Assessment Short Test (FAST) that evaluates the overall functioning of patients with a mental illness in 6 subscales.

Correlation analyses between cognitive performance variables and clinical variables were done. Multiple linear regression was performed with the FAST score as a dependent variable and cognitive performance variables and relevant clinical variables to executive functioning (months of euthymia, age, and number of total episodes) were included as independent variables.

A worse psychosocial functioning was significantly associated with a worse performance in standard tasks (TMTA, TMTB, STROOP, and TOL) and cooking task (total time spent on task 2, burning time and total time spent on task 3, and total time spent on task 4). In the regression analysis, the correct simultaneous use of the two fires was the best predictor of a better psychosocial functioning in BD patient. This implies the preserved ability of planning and performing dual tasks.

Our findings suggest that euthymic patients with BD present deficits in executive functions related with a worse psychosocial functioning. Among the tasks, the cooking task may have a greater sensitivity than standards task to predict real functioning. This in an opportunity to design virtual applications for diagnostic and therapeutic purposes.

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During the last decade there has been a resurgence of interest on the use of psychedelics as novel treatments for mental disorders, including treatment-resistant depression (TRD). Psilocybin, the chemical component of “magic mushrooms”, has been administered with psychotherapy in randomized clinical trials (RCTs) showing large and sustained antidepressant effects. As the use of psilocybin expands, it is becoming more important to understand whether psilocybin’s psychedelic effects are required for psilocybin’s antidepressant effects. Psilocybin’s psychedelic effects are known to be dependent on serotonin 2A receptor (5-HT2AR) activation. Given the safety concerns associated with psilocybin’s psychedelic effects, all studies have used it in conjunction with at least 12 hours of intensive psychotherapy. This makes psilocybin-assisted psychotherapy (PAP) highly resource intensive and impedes scalability given limited resources and access to trained therapists in most jurisdictions. Studies in healthy volunteers have shown that psilocybin’s psychedelic effects are blocked by 5-HT2AR antagonists like risperidone and ketanserin. In a pre-clinical study using a mouse model of depression, administration of ketanserin followed by psilocybin had the same antidepressant effect as psilocybin alone. We propose to conduct the first study to test in humans whether the antidepressant effects of psilocybin are attenuated by 5-HT2AR blockade from risperidone.

Aim 1: To evaluate the feasibility and tolerability of administering psilocybin with risperidone in adults with TRD by evaluating recruitment, retention, tolerability, and safety.

Aim 2: To evaluate psychedelic effects (measured with the 5-Dimensional Altered States of Consciousness Rating Scale) in the three groups.

Aim 3: To evaluate antidepressant effects (measured with the Montgomery Asberg Depression Rating Scale; MADRS) in the three groups. .

A three-arm, 4-week, double blind, proof-of-concept RCT for patients with a DSM-5 major depressive episode that has failed to respond to at least two adequate trials of antidepressants. Participants will be randomized to: 1) psilocybin 25 mg plus risperidone 1 mg; 2) psilocybin 25 mg plus placebo; 3) placebo plus risperidone 1 mg. All participants will receive 12 hours of manualized psychotherapy.

Ethics approval for the proposed study has been obtained. We will present preliminary feasibility data at the meeting in March.

If the study demonstrates that psilocybin’s psychedelic effects are not necessary for psilocybin’s antidepressant effects, the combination of psilocybin and a 5-HT2AR antagonist, such as risperidone, could increase acceptability and access to the use of psilocybin to treat MDD and related conditions.

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The aim of this paper lies in demystifying, historicizing, and de-alienating the relationship between disability and development. Both disability and development inform each other and are informed by each other in various ways which are on one hand similar and on the other hand unique. Disability is heterogeneous in nature. Disability and development are about power, access, solidarity, advocacy, inequality, rights, voice, and support. It is about accessing accessibility. It is important to understand the politics of language—how we conceptualize persons with disabilities.

The paper theorizes the ‘and’ between disability and development. What is that bridging telling us? There is already an invisible ‘and’ which joins disability and development even before this visible ‘and’ was placed in between them. It is to understand how disability is related to gender, caste, class, and poverty. The paper also looks at the government policies and adds suggestions as to what can be done practically to reduce inequality for persons with disabilities for developing a new India.

This research used primary sources like books, articles, government programmes, and policies to make sense of how disability is understood and experienced in India.

It shows how disability and development inform each other and are informed by each other. The paper shows how each person has disabling parts and “normal” parts. Representation helps one to know the multifarious dimensions of what is awful, reprehensive, acceptable, possible, desirable, etc. Representation structures reality. Hence, they are a critical component of bringing about rights.

It is crucial to look at the needs and challenges at the ground level contextually. It is important to understand why survival is considered sufficient and not full participation. Policies need to resonate culturally as otherwise, they tend to be confined to particular lases and groups in societies with access to technology, information, and the English language. What matters is the visibility of disability.

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TDuring COVID-19 pandemic, it was noticed that it was students who were mostly affected by the changes that aroused because of the pandemic. The interesting part is whether students’ well-being could be associated with their fields of study as well as coping strategies.

In this study, we aimed to assess 1) the mental health of students from nine countries with a particular focus on depression, anxiety, and stress levels and their fields of study, 2) the major coping strategies of students after one year of the COVID-19 pandemic.

We conducted an anonymous online cross-sectional survey on 12th April – 1st June 2021 that was distributed among the students from Poland, Mexico, Egypt, India, Pakistan, China, Vietnam, Philippines, and Bangladesh. To measure the emotional distress, we used the Depression, Anxiety, and Stress Scale-21 (DASS-21), and to identify the major coping strategies of students - the Brief-COPE.

We gathered 7219 responses from students studying five major studies: medical studies (N=2821), social sciences (N=1471), technical sciences (N=891), artistic/humanistic studies (N=1094), sciences (N=942). The greatest intensity of depression (M=18.29±13.83; moderate intensity), anxiety (M=13.13±11.37; moderate intensity ), and stress (M=17.86±12.94; mild intensity) was observed among sciences students. Medical students presented the lowest intensity of all three components - depression (M=13.31±12.45; mild intensity), anxiety (M=10.37±10.57; moderate intensity), and stress (M=13.65±11.94; mild intensity). Students of all fields primarily used acceptance and self-distraction as their coping mechanisms, while the least commonly used were self-blame, denial, and substance use. The group of coping mechanisms the most frequently used was ‘emotional focus’. Medical students statistically less often used avoidant coping strategies compared to other fields of study. Substance use was only one coping mechanism that did not statistically differ between students of different fields of study. Behavioral disengagement presented the highest correlation with depression (r=0.54), anxiety (r=0.48), and stress (r=0.47) while religion presented the lowest positive correlation with depression (r=0.07), anxiety (r=0.14), and stress (r=0.11).

1) The greatest intensity of depression, anxiety, and stress was observed among sciences students, while the lowest intensity of those components was found among students studying medicine.

2) Not using avoidant coping strategies might be associated with lower intensity of all DASS components among students.

3) Behavioral disengagement might be strongly associated with greater intensity of depression, anxiety, and stress among students.

4) There was no coping mechanism that provided the alleviation of emotional distress in all the fields of studies of students.

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There is still a paucity of studies exploring the impacts of teenage employment on mental health and development. In many developing countries, youths participate intensively in the teenage labor force. The involvement of adolescent in the world of work would promote the development of responsibility and prepare the young person to function more effectively in adult roles.

The purposes of the present study were to examine the adolescent separation-individuation among an understudied and vulnerable population; and to examine the Separation-Individuation Test of Adolescence (SITA) for revealing the differentiation working male group from student male group.

Participants completed the SITA. The group of study 1 consisted of 618 high school and 252 university students between the ages of 14 and 24, 489 of which were girls and 381 were boys. In Study 2, participants were 269 male adolescents between the ages of 15 and 17, 141 of which were full-time worker and 128 high school students. In study 1, these results were consistent with the rapprochement subphase of the separation-individuation process in adolescence -the striking desires for intimacy and independence.

Our results support the gender specific patterns of identity formation and the argument that connectedness in close relationships plays a central role in the female identity development. Interestingly, there were no significant gender differences in the tendency to view close interpersonal relationships as threatening to their sense of independence and selfhood, and to deny or avoid dependency needs. The reason for this might be the cultural differences between the individualistic and collectivistic cultures. In study 2, working males could be distinguished from student counterparts by their increased tendency to seek close interpersonal ties with caretakers. The finding also suggested that student males reflected characteristics of the traditional view of adolescents’ independence striving. Across both studies it was found that the traditional Turkish child-rearing patterns have been characterized by an emphasis on interpersonal relationships and close ties with family than individualistic cultures

Our results revealed that the subscales of SITA –especially dependency denial, rejection expectancy, nurturance seeking, engulfment anxiety, and teacher enmeshment- can help clinicians for assessing the adolescent separation-individuation process in a reliable way. We suggested that adolescent employment would lead to the difficulties in developing bonds with parents because of the adolescents’ long work hours, the early involvement with the world of work would lead to the withdrawal from the more dependent, preadultlike student role, and student adolescents would reflect characteristics of the traditional view of adolescents’ independence striving.

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The announcement of bad news to patients is a challenging task for physicians.

The aim of our study is to evaluate the impact of a simulation experience of telling bad news to patients on Tunisian medical trainees.

A prospective and multicenter study was conducted in two different hospitals in Tunisia. The duration of the study was two weeks. Pre-prepared questionnaires evaluating the impact of a simulation experience of the announcement of a critical illness diagnosis were handed to trainees enrolled in the faculty of Medecine in Tunis.

Forty trainees were included in the study. Average age was 28,1 years old with a feminine predominance (75%). Thirteen trainees role-played the clinician announcing the bad news. The median duration of the simulated interview was eight minutes. During the moment of the diagnosis announcement, twelve trainees reported feeling stressed, 6 of them felt uncomfortable and 7 felt empathic. Five trainees were in difficulty, two felt at ease and two felt neutral. During the whole interview, all the trainees reported they felt stressed and uncomfortable. Regarding their feelings at the end of the interview, only two reported they felt relieved at the end of the interview. Three trainees felt angry with themselves. Two felt angry with the patient or his family members. Eight felt upset and four were in tears. Four reported having no feelings.

Telling bad news is a difficult moment in daily practice. Special trainings need to be implemented in the medical education program in order to prepare future doctors to this task.

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According to the WHO, breast cancer is the number one cancer in women worldwide, and its treatment can have serious effects on the bodies of young women. Surgical treatment can be disfiguring, and chemotherapy can cause an early and abrupt menopause. Each of these treatments can also affect a patient’s sexuality in the short or long term.

The aim of our study is to evaluate sexuality and body perception in women with breast cancer after treatment.

A quantitative descriptive study was carried out among 112 patients followed for breast cancer,majority in sexual activity, met at the consultation of gynecology of the hospital IBN ROCHD Casablanca, Morocco.The data collection was carried out by an information sheet and with the help of two validated scales: BIS (Body image scale) and FSFI (Female sexual function index) in order to evaluate body image and sexuality as well as the HADS (Hospital Anxiety and Depression Scale)

In our sample, 30.6% were older than 50 years, 40.2% were married, 52.2% of the patients came from urban areas, 20.7% of the patients were illiterate, 22.2%had given up their work due to the disease. In terms of family support, 49.4% of the patients were accompanied to the hospital, 52.8% received financial support and 43.8% received moral support.Regarding the relationship of the couple, there is an increase in the frequency of disputes in 49.5%of cases, a change in behavior in 44.9%. The sexual relationship was marked by a decrease in frequency in 36.7%. Concerning the type of treatment received by the 46.8% of the patients had a mastectomy, 20.9% had chemotherapy, 65.5% had radiotherapy and 45.5% had hormone therapy.The prevalence of depression was 54.1%. Its mean score on the HAD scale was 11.46±3.95; that of anxiety was 52.3% with a mean HAD of 11.41±4.04. The prevalence of sexual dysfunction was 100%with a mean FSFI of 14.26±3.68. Body image disturbance was noted in was noted in 83.8% of cases.The factors associated with a body image disorder in the univariate study were marital status (p =0.035; OR = 0.245), educational level (p =0.029; OR = 0.245), depression (p = 0.019; OR = 3.76), and anxiety (p = 0.029;OR = 3.44).

Multivariate analysis of predictors of body image disorder in women with breast cancer

In total, 4 factors were significantly associated. Given the importance of the subject and the harmful psychological impact on patients further rechearch is needed, also an adequate, emphasized training on the management of women with cancer and their sexual problems and a multidisciplinary work will help improve the psychological state of the women

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Cannabis and cannabinoids have been marketed and sold for a variety of different psychiatric conditions like e.g., anxiety, sleep problems, ADHD, PTSD, and even psychosis. Some of these indications may be reasonable, but for some a more conservative approach should be upheld. There are quite a few open studies and case reports on effects, while larger blinded RCTs either fail to find these effects or are lacking. The lecture aims at presenting the most recent evidence for the use of cannabis and cannabinoids for psychiatric indications, alongside a presentation of adverse effects.

None Declared

Tricyclic antidepressants (TCAs) have an important role in pharmacotherapy of Major Depressive Disorder (MDD). TCA dosing is aimed at achieving a concentration in the therapeutic window. Due to inter-individual differences in activity of Cytochrome P450 (CYP) 2D6 and 2C19, (enzymes involved in TCA metabolism) patients require an individualized dose. Currently, finding of a suitable dosage is a process of trial-and-error, including multiple drug concentration measurements and dose adjustments. A starting dose based on a patient CYP2D6 and CYP2C19 metabolizer phenotype may contribute to achieving a therapeutic concentration more quickly, possibly resulting in higher treatment efficacy and the occurrence of fewer adverse effects.

We aimed to study whether genotype-informed dosing in TCAs leads to faster attainment of therapeutic plasma concentrations, a higher reduction of depression severity symptoms and less adverse effects.

We conducted a double-blind randomized clinical trial, in which patients (18-65 years) diagnosed with severe MDD and eligible for treatment with a TCA were randomized in two treatment arms: The intervention arm (Pharmacogenetics Informed Treatment; PIT) and standard treatment (Treatment As Usual; TAU). Patients were treated with nortriptyline, clomipramine or imipramine for seven weeks and depressive symptom severity and adverse effects were monitored weekly. The primary outcome measure, time needed to attain a therapeutic drug concentration, was analyzed using Kaplan-Meier analyses. The secondary outcome measures, reduction in depressive symptoms and adverse effects, were analyzed with mixed model linear regression.

In total, we randomized 111 patients. The PIT group (n=56) reached a therapeutic plasma concentration significantly faster (Kaplan Meier, X2 (1) = 4.3, p=0.039) compared to TAU (n=55), especially for patients treated with nortriptyline. On average depressive symptoms decreased relatively more in PIT than in TAU, although this was not significantly different: F(6) = 0.45, p = 0.84. The severity of adverse events during the study period differed significantly between PIT and TAU (F(6)=3.10, p=0.008). PIT experienced fewer adverse effects than TAU, especially in the last two weeks of the study.

Genotype-informed dosing leads to faster attainment of therapeutic TCA concentrations and does not lead to more adverse effects. Although we were not able to demonstrate that genotype-informed dosing leads to a significantly better response, we conclude that pharmacogenetics can contribute to the optimization of pharmacological treatment. Future research may focus on subgroups for which pharmacogenetics may be of great value, such as specific antidepressants or patients with an abnormal pharmacogenetic profile.

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Approximately one person commits suicide every 40 seconds, resulting in more than 800,000 deaths per year worldwide. Regarding this phenomenon, it is necessary to highlight how suicide rates increase markedly with age. These reach their highest figures in people aged 85 years or older, and this increase is very worrying in certain geographical areas. Although there is extensive literature on the risk factors that influence at the individual level, the same cannot be said when the problem is analyzed at the population level.

The study aims to review the entire Eurostat database, relating suicide data from different European countries to any possible variables that may influence suicide. In this pilot phase, certain socioeconomic variables were chosen based on criteria of suitability and availability of the information provided, selecting data from 2015, as it was the most recent year in which most countries reported their data on suicide in people over 85 years of age.

Firstly, a comparison was made of suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries (suicide rate in people over 85 years of age divided by the total rate in the country). Secondly, socioeconomic variables that may be more strongly related to suicide in this age group in these European countries were studied. After calculating the conditional suicide rate in people over 85 years of age with respect to the overall suicide rate in each country (Fig. 1), Spearman correlations were performed between the conditional rates and different demographic variables, economic variables, social variables, and health variables.

Conditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, several significant associations were found. Suicide in those over 85 years of age was associated with economic variables (social deprivation, economic impossibility to buy new clothes, impossibility to dedicate money for personal matters and Gini coefficient), demographic (old-age dependency ratio) and health (self-perceived health). After performing a multivariate regression with the variables that were significant in the Spearman correlation, included the variables “old-age dependency ratio (X1)” and “economic impossibility to buy new clothes (X2),” with a value of R-square = 0.612 and a value of p < 0.01.

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The conclusions suggest that of the different variables studied, the great majority in which an association has been found belong to the field of economics, specifically poverty and economic inequality, and demographics, highlighting the old-age dependency ratio. Furthermore, marked north/south differences can be observed in the different European countries.

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Emotional competence is fundamental in the communication that nurses establish with the people they relate to, and therapeutic communication is a crucial tool in nursing care.

This study aimed to understand the influence of nurses’ emotional competence in therapeutic communication with people with manifestations of mental disorder in a portuguese general hospital.

A descriptive-correlational and transversal study was performed. The sample consisted of 171 nurses from a general hospital in the Azores. Data were collected between May and July 2021, using an instrument that includes the sociodemographic and professional questionnaire, the Veiga Scale of Emotional Competence–Reduced version [EVCE-Reduced] (Veiga-Branco, 2021) and the questionnaire “Therapeutic communication: use by nurses” (adapted from Coelho, 2015).

Nurses, mostly female, aged between 31 and 40 years, show moderate levels of emotional competence. Specialized nurses with more time in professional practice demonstrate to be more emotionally literate. The EVCE-Reduced demonstrates good internal reliability. Self-motivation was the most predictive capacity of emotional competence, and self-awareness the capacity with the highest average. Three communication profiles were delineated, with Profile 1 (Nurse centered on the person and on themselves) the most representative. Although there is no correlation between emotional competence and therapeutic communication, it was evident that the more empathetic nurses perceive themselves, the more they use therapeutic communication techniques; and the better they manage emotions, the more they mobilize therapeutic communication techniques and attitudes towards people with manifestations of mental disorder.

In view of the results, it is important to deepen the way in which therapeutic communication and emotional competence are manifested in professional practice, what facilitates or inhibits its expression, and how its development can be enhanced. In this sense, health institutions must implement actions for the education and training of nurses, through the contribution of specialized practice in Mental Health Nursing, allowing for the improvement of emotional literacy and performance in work contexts.

- Coelho, M. T. (2015). Comunicação terapêutica em enfermagem: utilização pelos enfermeiros. Porto University [doctoral thesis]. Available from: https://repositorio-aberto.up.pt/bitstream/10216/82004/2/33990.pdf (accessed on 15 september 2022); - Veiga-Branco, M. A. (2021). Competência emocional, os Dados Tomam a Palavra. Jornadas da Associação Portuguesa de Inteligência Emocional. Bragança: Instituto Politécnico de Bragança;

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Population surveys often present prevalence estimates of children meeting criteria for psychiatric disorders, which are used to plan services. However, studies have shown that those with ‘subthreshold’ or’ subclinical’ symptoms also experience poorer outcomes, and benefit from identification and support.

This study uses data from the 2017 NHS Digital Mental Health of Children and Young People in England survey (MHCYP-2017), a large probability sample, to examine prevalence of ‘sub-threshold’ difficulties and contact with services.

Secondary analysis of data from MHCYP-2017, using data on 6,718 children aged 5 to 16. The main measures of mental health were the Strengths and Difficulties Questionnaire (SDQ), a validated dimensional measure, and the Development and Wellbeing Assessment (DAWBA), a standardised diagnostic assessment which was clinically-rated to assign diagnoses based on ICD-10 and DSM-V criteria. Parents also reported on mental health related service contacts for their child in the previous year. Descriptive analysis reported the proportion of participants with ‘sub-threshold’ difficulties. This was defined as a high or very high score on the parent-rated SDQ total difficulties score and/or impact score, but not meeting criteria for a DSM-V diagnosis on the DAWBA. Levels of service contact in this group were reported.

According to provisional findings (subject to final weighting strategy), 7.2% (95% CI 6.5-7.8%, n=486) of 5- to 16-year-olds fell into this ‘sub-threshold’ category, 79.1% (95% CI 78.1-80.1%, n=5,295) had no disorder and did not have raised impact or total difficulty scores on the SDQ, and 13.7% (95% CI 12.9, 14.6%, n=937) had a DSM-V diagnosis. Almost half of those with ‘sub-threshold’ difficulties had contact with professional services in the previous year (47.4%, 95% CI 42.8, 52.1%). Teachers were the most commonly reported professional service contact (39.8%, 95% CI 35.3, 44.4%). Contact with child mental health specialist services was reported in 6.5% (95% CI 4.5, 9.1%).

This initial analysis demonstrates that a small but significant (on a population level) proportion of children in this sample had elevated levels of mental health difficulty and/or impact on functioning but did not meet criteria for a disorder. As these data are cross-sectional, it is possible that some children may meet, or have met, diagnostic criteria at an earlier or later point. Almost half of this group had had mental health related contact with a teacher, providing opportunities for early intervention, but only a small proportion had contact with specialist services. These analyses can inform planning and targeting of support for children who may not meet criteria for specialist services.

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Opioid-related deaths continue to rise in the U.S. A clinical decision support (CDS) system to help primary care clinicians (PCCs) identify and treat patients with opioid use disorder (OUD) could help address this crisis.

To implement and test an OUD-CDS system in three health systems for the diagnosis and treatment of OUD in 90 primary care clinics.

In this cluster-randomized trial, primary care clinics in three healthcare systems were randomized to receive or not receive access to an OUD-CDS system. The OUD-CDS system alerts PCCs and patients to elevated risk of OUD and supports OUD screening and treatment. It includes guidance on OUD screening and diagnosis, treatment selection, starting and maintaining patients on buprenorphine for waivered clinicians, and screening for common comorbid conditions. The primary study outcome is, of patients at high risk for OUD, the percentage receiving an OUD diagnosis within 30 days of index visit. Additional outcomes are, of patients at high risk for or with a diagnosis of OUD, (a) the percentage receiving a naloxone prescription, or (b) the percentage receiving a medication for OUD (MOUD) prescription or referral to specialty care within 30 days of an index visit, and (c) total days covered by a MOUD prescription within 90 days of an index visit.

The intervention started in April 2021 and continues through December 2023, with successful implementatio and uptake. PCCs and patients in 90 clinics are included; study results are expected in 2024.

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If effective, this OUD-CDS intervention could improve screening of at-risk patients and rates of OUD treatment for people with OUD, a significant step in decreasing the morbidity and mortality associated with OUD.

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Cognitive dysfunction affects the development, treatment compliance, significantly worsens the quality of life and social functioning of the patients with epilepsy.

146 patients with epilepsy aged 18 to 65 participated in the study (М-40.7±2.42) were diagnosed with focal, idiopathic epilepsy and epileptic syndromes (G40.1, G40.2, G40).

Clinical-anamnestic, social-demographic, clinical-psychopathological, psycho-diagnostic and statistical.

The study of the attention selectivity was carried out using the Munsterberg test. Only 9 examined patients (6.16%) of the total group had sufficient indices, 35 (23.97%) patients refused from the test, while the rest – 102 (69.87%) had low test results. The overall treatment group score was 7.72, which is by 13.28 lower than in the control group, where the attention selectivity index was 21 (р<0,001), which shows a considerable attention selectivity decrease in patients with epilepsy compared to the healthy persons. According to the МоСА test results, the first treatment group patients showed better cognitive functions (1.4, р<0.001), higher attention selectivity under the Munsterberg test (0.63, р<0.001), lower anxiety level under HARS (1.45, р<0.001), lower depression level under HDRS (1.7, р<0.001) and higher subjective assessment of the life quality (2.77, р<0.05). According to the МоСА test results, the second treatment group patients showed better cognitive functions (0.73, р<0.001), higher attention selectivity under the Munsterberg test (0.27, р<0,05), lower anxiety level under HARS (4.27, р<0.05), lower depression level under HDRS (2.32, р<0.05) and higher subjective assessment of the life quality (1.21, р<0.05). According to the МоСА test results, the comparison group patients demonstrated lower cognitive functions (0.22, р<0.05), higher attention selectivity under the Munsterberg test (0.15, р<0.05), lower anxiety level under HARS (2.61, р<0.001), lower depression level under HDRS (2.49, р<0.001) and higher subjective assessment of the life quality (1.0, р<0.05). The cognitive training showed its effectiveness in healthy persons of the control group: according to the МоСА test results, cognitive functions improved (0.79, р<0.001), compared to the treatment group 2 patients (0.73, р<0.001).

According to the follow-up study data 12 months after the cognitive training and psychoeducation, follow-up study showed better values under depression and anxiety scales, and improved life quality levels in the patients of treatment groups. Patients with epilepsy show a reliable cognitive functioning improvement after a 3-month computerized cognitive training. The study results indicate a more significant cognitive functioning improvement in the patients provided the combined use of the methods of psychoeducation and cognitive training, compared to the use of a cognitive training only.

None Declared

Conventional Bayesian network meta-analysis (NMA) of multiple outcomes are performed using non-informative prior distribution, independently for each outcome.

This study aimed to estimate pharmacological intervention effects against placebo within a multivariate Bayesian framework using an informative lognormal prior distribution.

13,188 participants were evaluated for two dichotomous study outcomes, namely, treatment response and all-cause dropouts, in 57 double-blinded randomized controlled trials (RCTs) for the treatment of acute bipolar mania (ABM) in adults. Both the study outcomes were measured from baseline to week 3. 10 pharmacological drugs or interventions consisted of mood stabilizers, anti-psychotics, antidepressants, combinations of the above and other agents, and were compared against each other as well as with placebo either as monotherapy or add on agents. These treatments include placebo, aripiprazole, haloperidol, quetiapine, ziprasidone, olanzapine, divalproex, paliperidone, carbamazepine, lithium; and lamotrigine. Aggregated arm-based data on both the study outcomes were considered. We used the logit scale to model the probability of event occurrence and adopted multivariate modelling approach; wherein both the study outcomes were included in a single NMA model. Further, the between-study variance-covariance matrix was decomposed using the Cholesky and spherical decomposition techniques and the results were compared. The deviance information criterion (DIC) indices were used to assess the model fit. Analyses included 16,00,000 Markov Chain Monte Carlo (MCMC) iterations with 6,00,000 burn-in period and thinning of 100; tested by running three chains with different starting values. All the analyses were carried out in WinBUGS software.

Under Cholesky and spherical decompositions, the correlation between the study outcomes were estimated as -0.51 (-0.68, -0.29) and -0.56 (-0.68, -0.50), respectively. DIC model fit index values for Cholesky and spherical decompositions were 667.74 and 667.53, respectively; indicating both decomposition techniques were equally good. Further, the Gelman-Rubin convergence statistics were stable and all Monte Carlo errors were around 0.005. Overall, olanzapine, paliperidone and quetiapine were both significantly more effective and acceptable than placebo; whereas aripiprazole, haloperidol ziprasidone, divalproex, and carbamazepine were not. In addition, both lithium and lamotrigine failed to be effective and acceptable.

Our findings exhibit an excellent concordance with the one used in clinical practice. Moreover, the Canadian Network for mood and Anxiety Treatments, and Royal Australian and New Zealand College of Psychiatrists guidelines also recommended these drugs as first-line medications for treating bipolar disorder.

None Declared

Non-Medical Use of Anxiolytics (NMUA) and sedatives is a focus of scientific interest worldwide. In Tunisia, no national epidemiological data related to this issue, are published.

We aimed to determine the prevalence of NMUA in Tunisian adolescents and assess specificities from a gender scope.

Data from the 2021-Mediterranean school Survey on Alcohol and other Drugs (MedSPAD) were used. Based on random sampling method (three-stage stratification), high school teenagers in first and second year of secondary education, were enrolled. Data were collected using a self-administered standardized questionnaire assessing socio-demographic characteristics, and specific questions related to NMUA (among adolescents and close environment), perceived accessibility and initiation age. We studied weighted prevalence estimates of NMUA at least once in a lifetime, presented with 95% Confidence Interval (CI). Epi data software was used for data entry and statistical analysis was performed with STATA software.

The survey included 6.201 adolescents with a mean age of 16.8 years and sex ratio F/M equal to 1.5. Only half of surveyed adolescents, perceived accessibility to NMUA as “impossible” and almost 20% had at least one family member or friend using a nonmedical prescription of anxiolytics. The overall prevalence of NMUA was (8.4%; 95% CI [7.6-9.2]), significantly higher among girls (9.8% Vs 6.1%, p-value<10-4). Initiation age was over 13 years for almost 70% of consumers.

Our study highlighted high prevalence of NMUA, mainly among girls. Although COVID mental health impact might have a role in explaining our findings; however, decisions makers should be aware of non-medically prescribed anxiolytics accessibility especially among this vulnerable population. Audit prescription monitoring programs should be reinforced, and multisectoral collaboration should be reinforced to promote adolescents mental well being and avoid falling into addiction trap.

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Suicide among children, adolescents and young adults is a major health problem, as it represents the fourth leading cause of death among people aged 15-29 (WHO, 2022). A recent study showed that the years of potential life lost (YPLL) due to suicide in 2018 were 1,344,552, which is very close to the 1,591,487 YPLL caused by COVID-19 in the year 2020 (Porras-Segovia et al, 2021). In the recent years, there is a growing interest in suicide prevention research in differentiating attempter profiles in terms of lifetime suicide attempts. Specifically, studies suggest that there may be meaningful differences concerning risk factors between patients with a history of one versus multiple suicide attempts. Multiple attempters (MA) show more suicidal ideation, depressive symptoms and hopelessness than single attempters (SA) (Esposito et al, 2003; Goldston et al, 1998).

We aimed to answer the question ‘What are the factors associated with attempting suicide for the first time and are they different from the factors associated with re-attempting suicide in children and adolescents?’

We conducted a systematic literature search in four databases. Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers. Due to the different way to present data in the studies effect sizes were pre-calculated to standard mean differences (SMD). Random effects model was used to calculate the pooled effect size for all meta-analysis. Publication bias was assessed using funnel plots.

14 studies were included in the systematic review, and 13 in the meta-analysis. Original articles used in the meta-analysis included a total of 4286 participants of whom 1579 were multiple suicide-attempters and 2707 single suicide attempters.

MAs showed significantly higher proportion of anxiety disorders (SMD = 0.387, 95%CI [0.09, 0.68], p < 0.022), alcohol abuse disorder (SMD = 0.382, 95%CI [0.07, 0.70], p < 0.036) and substance abuse disorder (SMD = 0.526, 95%CI [0.21, 0.84], p <0.013) than SAs. Mean depression severity was higher among MAs than SAs (SMD = 0.515, 95%CI [0.17, 0.86], p < 0.011). MAs showed higher impulsivity (SMD = 0.28, 95%CI [-0.03, 0.60], p < 0.068) and aggressiveness (SMD = 0.688, 95%CI [0.42, 0.96], p < 0.00) than SAs. Hopelessness (SMD = 0.482, 95%CI [0.06, 0.91], p < 0.03) and suicidal ideation (SMD = 0.399, 95%CI [0.34, 0.46], p < 0.007) was significantly higher in MA.

On the basis of the current results, multiple attempters may represent a distinct patient population in terms of being a more severe clinical profile. This can provide the basis of stronger suicide prevention and vigilance programs focused in this suicidal phenotype.

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Early intervention on a first psychotic episode is fundamental for a more favorable prognosis, and it usually combines pharmacological treatment, which mainly affects positive psychotic symptoms, with interventions that can improve the rest of the symptoms and associated problems such as deterioration in social functioning (Harvey & Penn, 2010; Fusar-Poli, McGorry & Kane, 2017). While Mindfulness is gaining more and more prominence in the field of psychotherapy (Chan et al., 2019; Cillesen et al., 2019), social cognition and social functioning are being researched as key targets on which to intervene after a first psychotic episode (Green, Horan & Lee, 2015).

SocialMIND® is a mindfulness-based social cognition training tailor-made to improve social functioning in people who have suffered a first psychotic episode within the last five years. It is currently being compared with a group Psychoeducational Multicomponent Intervention (PMI) in a Randomized Controlled Trial (RCT) (Mediavilla et al., 2019). Both group psychotherapies include 17 sessions delivered over a 9 month period: 8 weekly sessions, 4 biweekly sessions and 5 monthly sessions.

The results of SocialMIND® at 8 weeks showed improvements in social cognition and social functioning, specifically on affective social cognition and self-care (Mediavilla et al., 2021).

To evaluate the efficacy of SocialMIND® in improving social functioning, measured by the Personal and Social Functioning (PSP) scale 16 weeks after starting the intervention, in people who have suffered a first psychotic episode in the last 5 years.

Randomized, controlled pilot trial (use of a psychoeducational multicomponent intervention or PMI as active comparator) of two parallel groups (SocialMIND® and PMI) with a 1:1 ratio using a blind evaluator.

No statistically significant differences were found in the social functioning variable between the two treatment arms. Intragroup differences are observed in other secondary variables studied (social cognition) 16 weeks after starting the interventions.

SocialMIND® has not been shown to be more effective than a PMI in improving social functioning at 16 weeks after starting the intervention in people who have suffered a first psychotic episode in the five years prior to being included in the study.

None Declared

Besides the traditionally studied group of young females, disordered eating occurs in all age groups (Eedena, Hoekena, and Hoek 2021). In recent years, there has been an increase in the prevalence of eating disorders and symptoms in middle-aged and older women (40 years old and over) (Mangweth-Matzek and Hoek 2017).

Experts in eating psychopathology in special groups such as Samuels, Maine and Taltillo (2019) suggest the use of the Screen for Disordered Eating (SDE; Magen et al. 2018) in the psychometric assessment of women in middle age and older. The SDE was developed to allow the Eating Disorders (ED) screening in Primary Health Care in people of all ages and without excluding Binge Eating Disorder (BED).

The SDE is composed of five items (yes or no answers), extracted from other validated self-reported questionnaires for the assessment of eating psychopathology.

To analyze the psychometric properties of the Portuguese Version of the Screen for Disordered Eating in a sample of women from the general population aged 40 and over.

Participants were 516 women with a mean age of 50.28 of years old (± 8.063; range: 40-80). They answered an online survey including the preliminary Portuguese version of the SDE and the Portuguese version of the Eating Disorder Examination – Questionnaire (EDE-Q-7; Pereira et al. 2021).

Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=1.502; RMSEA=.0311, p<.001; CFI=.987 TLI=.995, GFI=.965). The Cronbach’s alfa was .762. All the items contributed to the internal consistency, as they presented item-total correlations above .40 and the exclusion of each one would decrease the alpha. Pearson correlations between SDE and the EDE-Q-7 were significant (p<.01), positive and moderate/high, as follows: .516 with the total score and .318, .503 and .536 respectively with the dimensional scores of Dietary restraint, Shape/weight overvaluation and Body dissatisfaction.

As observed with the original English-language scale, the Portuguese version of the SDE has shown good validity (construct and concurrent) and internal consistency. As such, the SDE might be a useful tool to investigate disordered eating psychopathology in older women. In the near future we will determine the SDE cut-offs with the best combination of sensitivity and specificity to screen for eating disorders in this populational group.

None Declared