Post-traumatic stress disorder (PTSD) was described among patients with COVID-19, health professionals (HP), and the population at large. HP were in the front-line managing this pandemic which put them at a higher risk to develop such trouble.

The aim of our study was to evaluate the effect of work circumstances on the mental health of HP.

Cross-sectional descriptive study was carried out. It included HP at Abdurrahman Mami Hospital who had a positive RT-PCR test of SARS-CoV-2 on a nasopharyngeal swab over the 10-month period from January to October 2021. Data collection was performed three months after the resumption using the PCL-5 questionnaire .

Seventy six HP was included in our study. PTSD incidence was 30%. Age average was 41 ± 9 years. Women represented 84%. Seventy eight percent of the HP were married and 71% were living with their children. The average number of persons in the family was 4 ± 1. Intensive care unit was the department of origin for 17% of the HP, the laboratory in 8% of the cases, the emergency room in 3% and the Covid-19 hospitalization services in 24%. The most affected occupational category was nurses (39%), laboratory technicians (14%), and physicians (8%). General difficulties with tasks usually performed was found in 35% of HP suffering from PTSD (p=0.012). It appears that limiting the time spent at work had a protective role for PTSD with an OR of 0.25 (p=0.002).

Handling COVID-19 health issues was the concern of all medical departments. This study highlights the impact of work circumstances on the mental health of workers. PTSD was prevalent among HP according to our study. PTSD may have an impact on work ability, which should be further explored by other studies. Other psychiatric disorders should also be investigated.

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Anorexia nervosa is a behavioral mental disorder, characterized by body dysmorphia, an intense fear of gaining weight and behaviors that interfere with this, in addition to a restriction of food intake, associated usually with medical complications, even a considerable risk of death.

Several psychotherapeutic approaches have been used along last decades. Until relatively recently, parents have been recognized as part of the problem, but nowadays we involve them into the therapeutic process through family therapy based on a systemic approach, recommended in current published clinical guidelines and research findings, with consistent evidence, as the first-line treatment of patients with anorexia nervosa.

A case of a patient with anorexia nervosa, is presented followed by a theoretical review on the topic.

A case is presented with a bibliographic review.

A 24-yeard-old female was hospitalized for renutrition due to a significant weight loss and multiple physical symptoms. After 4 months without progress, the patient was transferred to the psychiatric ward.

Once there, physical stabilisation was achieved with family therapy and pharmacological treatment, based on progressive administration of Clomipramine, previously assessed by Cardiology, which improved rumination and obsessive behaviour. We conduct daily individual and weekly family interviews, working on family dynamics, emotional regulation strategies and more adaptive ways of communication. Likewise, several lines of action were found in the systemic work: peripheral father; maternal over-involvement; fraternal rivalry; difficulties of interaction between all of them, derived from “the role of the sick person” and intra-family communication around the illness. Finally, showed effectiveness in terms of an improvement in interpersonal relationships, greater assertiveness and an optimistic attitude with an active search for coping strategies.

Historically, parents have been recognized by a causal factor in the pathogenesis of this disorder. Nevertheless, the abolition of the emphasis on family responsibility, motivated by a philosophic and evidence-based, has allowed us to see them as an essential resource in aiding the patient in the improvement process. This parental involvement has resulted in a relevant reduction in morbidity, as well as a significant decrease treatment attrition rates. It has been noted a re-establishment in other individual and family factors such as self-esteem, quality of life, and some aspects of the experiences of caregiving, and behavioral symptoms have been resolved.

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Previous studies suggest that adults with mental disorders (MD) or Autism Spectrum Disorder (ASD) are more likely to be unemployed than those without MD. However, it is unclear whether working adults with MD or ASD perceive the same effort-reward balance as their counterparts without MD or ASD.

To analyze labor conditions and to identify factors associated with effort-reward imbalance among young adults with ASD, MD and those from the general population (GP).

A qualitative and quantitative study design is being conducted to analyze the rates of employment among young adults with ASD, and to identify factors associated with employment rates (Fondecyt ID11201028.). As part of this study, we conducted a quantitative analysis in young adults 16 to 30 years of age in two regions of Chile between August and October, 2022. Young adults with MD and ASD were compared with adults of similar age recruited from the GP. We applied a questionnaire to collect data on participant’s sociodemographic information, autonomy level and employment status. We applied the short Spanish version of the effort–reward imbalance (ERI) and overcommitment (OC) questionnaire, which has been widely used in Latin American countries.

Chi-square test was used and the Kruskal Wallis H Test was applied to compare among groups. The statistical significance was set at P<0.05.

Overall, 422 participants were included in the analysis (mean age 22±3.2, 64.2% women, 65.2% students, and 4.4% unemployed). Of the total respondents, 22% of young adults from GP, 17.8% with MD, and 4.8% with ASD were working at the moment of the survey. Regarding autonomy level, a higher proportion of participants with ASD needed support (36.4%), compared with 9.7% and 0.8% of young adults with MD and GP, respectively. Of the population who reported working (n=125), about 56.0% have a permanent job, and 44% a seasonal or occasional job. The median value for the effort–reward ratio was 0.96 (range 0.4–1.8), with no significant differences between the groups. Of those participants working, 44.3% showed an ERI ratio higher than 1, which was higher in participants with ASD (60%). ERI-esteem was significantly different (P=0.01) among ASD (7.0; range 5-8), MD (6.0; range 2-8) and PG (6.0; range 2-8). In the OC questionnaire, young adults with ASD were more likely to think about work (P=0.01) and having trouble sleeping at night due to work issues (P=0.03) than GP and MD groups.

The ASD group showed higher overcommitment and a considerable proportion of subjects at risk of effort-reward imbalance at work, were more likely to think about work at home, and had trouble sleeping thinking about work. Our preliminary results highlight the importance of considering the working conditions of young adults diagnosed with ASD and the need to provide them with enough support to promote labor inclusion.

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Intellectual Developmental Disorder (IDD) is diagnosed with cognitive and adaptive behaviour evaluations. There is increasing evidence of a high prevalence of psychiatric disorders comorbid with IDD. The relationship between specific cognitive dysfunctions and psychiatric vulnerability may provide the basis for a paradigm shift from “intellectually below average IQ” to “neuropsychological characterization”.

1) reassessing an IDD sample in cognitive profile and psychiatric comorbidities 2) investigating the correlations between specific cognitive dysfunctions and specific psychiatric diagnoses in IDD.

120 individuals with IDD from 3 Italian facilities were consecutively evaluated, one group with mild IDD, using WAIS-IV or Leiter-3, TMT, Stroop and TOL tests, after which a professional caregiver did individual interviews (Vineland Adaptive Behavior Scale-II, SPAIDD-G, and STA-DI) to evaluate the patient adaptive behaviour, psychiatric comorbidities and presence of ASD. The second group (more severe IDD), was evaluated only with professional caregiver assessment tools.

90 males and 30 females, mean age 57 years, institutionalized for a mean period of 36.44 years. 52% had no education, 19% a middle school diploma. IDD diagnoses: borderline 3%, mild 16%, moderate 11%, moderate-severe 4%, severe 59%, profound 0%.11% comorbid ASD diagnosis, 29% with ASD after diagnostic re-assessment (STA-DI). 89% physical comorbidities, 58% psychiatric comorbidities, 56% psychoses (Fig. 1). Psychiatric comorbidities re-assessment (SPAIDD-G) identified a significant number of disorders (Fig. 2), despite the medical records showed a low prevalence of psychiatric diagnoses. The consistent quantity of psychotropic drugs prescribed in the sample, possibly reflects the real prevalence of psychopathology. Pearson correlations (p<0.05). WAIS-IV and SPAIDD-G (N=29): Verbal Comprehension Index correlates with anxiety disorder and impulse control disorder; Perceptual Reasoning Index correlates with nutrition/feeding disorder; Processing Speed Index correlates with nutrition/feeding disorder and sexual disorder; IQ correlates with ASD, nutrition/feeding, anxiety, sexual disorders. Leiter-3 and SPAIDD-G (N=14): Form Completion and non-verbal IQ correlate with OCD negatively.

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In conclusion, the SPAIDD-G evaluations revealed a greater prevalence of psychopathology than reported in the medical records. Using psychopathological screening tools can improve the diagnostic process in residential facilities for IDD cases. Pearson’s analyses revealed the need to further investigate the correlation between cognitive dysfunctions and psychopathological vulnerability, studying intelligence as a multi-component model and identifying specific behavioural and cognitive phenotypes in IDD cases.

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Psychosis onset is a transdiagnostic event that leads to a range of psychiatric disorders, which are currently diagnosed through clinical observation. Since several years, the role of immune system in the pathophysiology of psychosis has been well-recognized, showing differences from the onset to chronic phases. In this lecture, I will show the results of our recent study that tested the hypothesis of the existence of subgroups of first-episode psychosis (FEP) patients identified by distinct peripheral immunomarkers’ profiles, possibly underpinning a subgroup-specific immunopathogenesis. More in detail, I will show the results obtained by the unsupervised machine learning model that we applied to the set of 12 peripheral blood immune gene transcripts, which we recently demonstrated to classify with high accuracy a cohort of FEP patients and HC. Also, I will report the results obtained by performing post-hoc univariate analyses using selective clinical, cognitive, and brain structural phenotypes of FEP patients and HC belonging to each subgroup identified by the computational model. I will extensively discuss two key clusters identified and validated by our model: 1) a FEP cluster characterized by the high expression of inflammatory and immune-activating genes; 2) a cluster consisting of an equal number of FEP and HC subjects, which did not show a relative over or under expression of any immune marker (balanced subgroup). Therefore, in this lecture I will emphasize that our study has been the first to demonstrate the existence of a psychosis onset subgroup identified by a peculiar multivariate pattern of immunomarkers, independently of clinical features or categorical diagnosis. This is paramount as if validated in independent samples, our clustering model could enable the sample selection in clinical trials aiming to test the efficacy of novel immunomodulant or anti-inflammatory therapies tailored to the specific inflammatory subgroup of psychotic patients.

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Over a quarter of U.S. children have at least one immigrant parent. Mental health disparities in children need to be assessed to better identify disproportionate burdens and promote health equity.

To assess the associations between race, ethnicity, and parent-child nativity, and mental health conditions in the U.S.

Data were from the 2016-2019 National Survey of Children’s Health (n=114,476 children aged 3-17 years), a nationwide, cross-sectional survey. Outcome variables included three mental health conditions (depression, anxiety, and behavior or conduct problems) reported by the parent/guardian. Additional measures included questions about healthcare access and use, demographics, and nine household challenge adverse childhood experiences (ACEs) used to quantify a total ACE score (0-9). Information on nativity was used to define immigrant generation (1st, 2nd, and 3rd+). Weighted logistic regression was used to assess the associations between race/ethnicity (Asian, Black, Hispanic, White, and Other), household generation, and outcome variables, among children who reported access to or utilized health services, adjusting for demographics. Multiple imputation was used to handle missing data.

Asian, Black, Hispanic, and White 3rd+ generation children had increased odds of depression compared to their 1st generation counterparts, same as among White, 2nd generation children. Race/ethnicity was not associated with depression among 1st and 3rd+ generation children, but Asian, Black, and Hispanic children had lower odds of depression compared to White children among 2nd generation children. Asian, Black, Hispanic, and Other-race 3rd+ generation children had increased odds of anxiety compared to their 1st generation counterparts, with similar findings also observed for Black and Other-race 2nd generation children. Being racial/ethnic minorities was generally associated with decreased odds of anxiety among 1st and 2nd generation children compared to White children from the respective generations. Asian, Black, Hispanic, and Other-race 3rd+ generation children had increased odds of behavior/conduct problems compared to their 1st generation counterparts. The observed associations remained significant after adjusting for the modified ACE score.

We found significant differences in several mental health conditions in children by parent-child nativity, race, and ethnicity that could not be explained by demographics, childhood adversity, and healthcare access and use. Lower odds of mental health conditions among minority children could represent differences due to factors such as differential reporting, and higher odds of mental health conditions, including in third- and higher generation children, need further investigation to develop approaches to promote mental health equity.

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According to CEOWORLD Magazine‘s 2019 “Health Care Indicators” rating of 89 countries in the world, Taiwan ranks first in the world. The coverage of the National Health Insurance covers all necessary medical treatment, including outpatient, hospitalization, and prescription drugs etc. The psychiatrist was wondering which item with the highest service cost–performance (CP) ratio of the psychiatrist performance in a general hospital and used proportion of PPF as performance indicator. He used allocation to distribute the hours across job activities.

The purpose of this study is to investigate items allocation proportion for outpatient and inpatient ward in a specific month, examining the distribution of performance and figure out an appropriate model to optimal medical service.

Demographic data were collected through PPF projects included 15 outpatient items and 19 inpatient ward items from the third-month of the psychiatrist’s employment in the general hospital, as shown in Table 1. Items related to physiological examination has been excluded. The performance is calculated by combining outpatient and inpatient wards.

Demographic data analysis found that proportion of inpatient ward PPF (67.01%) was significantly greater than proportion of outpatient PPF (32.99%) (Figure 1). The inpatient ward performance was 2 times the outpatient performance. This result showed that most performance came from inpatient ward. Among all items of the proportion of PPF unit, the highest two for inpatient ward items were general hospital bed inpatient consultation (32.58%) and special treatment for psychiatric inpatients (14.35%), and for outpatient, the highest was psychiatric outpatient consultation - more than two (11.31%) (Table 1).

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National Health Insurance is an important system to assist in epidemic prevention during the COVID-19 period. The most PPF of psychiatrist service in a general hospital came from the service of inpatient ward items, including the general hospital bed inpatient consultation with the highest CP ratio. These findings may suggest that the inpatient service could offer psychiatrists fair PPF, and the hospital environment could be favorable for recruitment.

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Pandemic caused by the virus COVID-19 had a significant impact on mental health of the population, not only by increasing the levels of stress and anxiety, but by affecting the most vulnerable ones, aggravating the symptoms of mental illnesses in people suffering from one of the mental health conditions [1], including the people suffering from schizophrenia. Pandemic made the increased need of that particular patient population for various psychotherapeutic and sociotherapeutic interventions even more evident. Art therapy is a form of psychotherapy that in itself integrates expressive characteristics of art with explorative characteristic of psychotherapy using the visual language of arts as the main media of communication and expression. Art therapy has been used from its beginnings with people suffering from one of the psychotic disorders [2] and it is enlisted today in NICE guidelines as one of the psychological therapies of schizophrenia [3].

To understand and to activate the potential of artistic expression in patients suffering from psychotic disorders during the pandemic of virus COVID-19.

During the period of lockdown in pandemic of virus COVID-19, a young male patient suffering from schizophrenia was admitted to the Acute ward of the University psychiatric hospital Sveti Ivan in Zagreb. As the patient was keen on visually expressing himself, five individual psychodynamically oriented art therapy sessions were carried out on a weekly basis with professionally trained art therapist during the period of patient’s hospitalization. The patient was offered various art materials allowing him to visually express himself in a free manner and the artistic artefact created during the process served as a catalyst for later therapeutic work.

During the therapeutic process, single image was being gradually made and developed session by session. As new layers of color and form were added to the painting, each session revealed new layers of meaning and symbolism to both patient and therapist. First sessions pertained to the anxiety caused by the experience of pandemic, but as the process moved forward, deeper subject matters were brought to the surface, such as the nature of the therapeutic relationship, patient’s splitting, hidden aggressive potentials and, in the end, the nature of father-son relationship connecting the image of coronavirus causing fear and discomfort with the image of the oppressive father.

Circumstances caused by the pandemic of virus COVID-19 aggravated the patient’s symptoms and his internal conflicts. The art therapeutic process, with its possibility of projections and its multilayered interpretations, enabled the patient to express the true conflict and disturbing content hiding underneath the anxiety related to the pandemic of coronavirus which the patient was primarily complaining about.

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One of the subtypes of schizophrenia is the deficit syndrome (DS). Because of different risk factors, course, response to treatment weak prognosis, researches on this group of patients are important. Etiology of schizophrenia is often hypothesized as the inflammation process. Due to the imbalance of certain cytokines (interleukin-10 (IL-10) -antyinflamation cytokine, among others) changes in the function and structure of central nervous system may occur. That process could stand behind the outbreak of psychotic and deficit symptoms of the illness. Subinflammation can have an impact on the white matter structure. Disturbances in this area can cause impairment of cortical communication and hence, produce psychopathology. One of the structures that seem to have the basis of the deficit syndrome isinferior longitudinal fasciculus (ILF). ILF is a bundle of association fibers with interconnects temporal cortex with ocapital cortex.

The aim of our study was to investigate a relationship between the integrity of ILF and interleukin – 10.

39 schizophrenia subjects divided into two groups DS (16) and non-deficyt sydrome (NDS) (23) and 18 healthy controls (HC) participated in the study. A DTI analysis was performed on all study participants. The psychopathology of schizofrenia was assessed using the Positive and Negative Syndrome Scale (PANSS). The ILF analysis was then conducted using fractional anisotropy (FA) and mean diffusivity (MD) parameters. Blood samples were obtained to analyze serum level of IL-10 level.

The differences in FA value in left ILF between DS and HC group were confirmed. The difference in values of IL-10 between groups were not confirmed. A negative correlation was found between FA values in left ILF and IL-10 (p = 0.033) among DS group.

The imparment of the structure of ILF may be involved in ethiopatogenesis of DS. Moreover, changes in IL-10 levels may be related to the microstructure of ILF bundle.

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The longitudinal course of bipolar disorder (BD) is related to an active process of neuroprogression, associated with brain changes and functional impairment (Berk et al., Bipolar Disord 2014; 16(5):471-7). Several clinical factors may influence illness trajectories, including the number of episodes and hospitalizations, the presence of comorbidities, stressful life events and familiarity for psychiatric disorders (Post. Braz J Psychiatry 2020;42(5):552-557). Trying to better define such progression, several authors conceptualized different staging models for BD, each one emphasizing different aspects of illness.

In the present study, we focused on the Kupka & Hilleghers staging model, owing to its favorable ratio between the number of classes and transitions (Kupka & Hilleghers. Tijdschr Psychiatr 2012; 54(11):949-956). The aim was to investigate the transition of a sample of 100 BD patients through the different stages of illness across 10 years of observation, analyzing the potential role of clinical variables on the risk of illness progression.

Clinical stages of 100 BD patients (53 BDI and 47 BDII) were retrospectively assessed according to the model proposed by Kupka & Hilleghers at four time points: T0 (2010), T1 (2015), T2 (2018) and T3 (2020, at inclusion). Multistate Model using the mstate package in R and Markov model with stratified hazards were used for statistical analysis, to assess transition intensities across illness stages and the potential role of clinical variables on the risk of progression.

A significant stage progression emerged during the observation period (Figure 1). More in detail, high hazard of transition from stage 2 to stage 3 was observed (Figure 2). A significant effect on the transition rate from 3 to 4 was found for higher number of affective episodes lifetime (> 3 episodes) (p=0.03) and for elevated predominant polarity (p=0.01). Overall, the average time subjects spent in stage 0 was 30.8 years and for stage 1 was 0.78 years. After BD onset, patients spent an average of 0.78 years in stage 2, 6.21 years in stage 3 and 2.23 in stage 4.

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Present preliminary results confirm the progressive nature of the disorder. An increased risk of transition across stages emerged for patients with higher number of episodes lifetime and with elevated predominant polarity, confirming the need of improving timing and accuracy of diagnosis and therapeutic interventions. Further studies are warranted with the aim of define a universal staging model for BD.

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Dissociative amnesia (DA), one of several dissociative disorders, is characterized by the inability to recall autobiographical information that is inconsistent with normal forgetting. Generalized amnesia is a rare subtype of amnesia distinguished by the acute onset of complete loss of memory for one’s life history, in which the patients may lose semantic knowledge, procedural knowledge or personal identity.

The objective of this paper is to highlight that the diagnosis of generalized DA can be controversial and a comprehensive history, as well as collateral information, are essential for an accurate diagnosis.

We present the case of a 37-year-old female, with no premorbid medical illness and one year psychiatric history which was admitted to our clinic for severe deficits of the memory and attention functions, emotional lability, social withdrawal, strong socio-professional dysfunctionality, altered behavior marked by the subjective changes of memory and thinking processes, affective ambivalence towards parents, mixed insomnia. The hetero-anamnesis revealed that our patient presented two fugues during the last 4 months. During her mental status evaluation, she showed temporal and spatial orientation, demonstrative attitude, spontaneous speech centered on her mental suffering, euthymic disposition, delusional ideas with somatic content, intermittent and inconstant facial motor stereotypes.

Multiple neurological examinations were performed, all being within normal limits. The magnetic resonance imaging of the brain identified an enlarged adenohypophysis and a possible microaneurysm that do not correlate with the symptoms. The endocrinological investigations invalidated the suspicion of acromegaly. The psychological examination suggested the tendency to mask less acceptable feelings, inadequacy, rigidity, the presence of conflicts of a sexual nature, regression to an infantile stage, with a deficit of concentrated attention. The emergent symptoms and signs were resistant, failed to resolve with antidepressant and antipsychotic medication and continued to persist across all settings. Corroborating evidence, we established the diagnosis of DA.

DA represents a controversial diagnostic entity that incorporates elements of psychogenic fugue states, repressed memory, traumatic amnesia, and conversion. Some clues in the history such as psychological traumas can support a diagnosis of DA rather than medical causes. As with most other psychiatric disorders, it is important to rule out organic causes first before considering psychiatric etiologies. A thorough sequential history and collateral information are key components in effective diagnosis and management of this condition. In the absence of a favorable response to psychotropic drugs, psychotherapy represents the best treatment approach for DA.

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Bipolar disorder (BD) is a common psychiatric condition. However, it is underdiagnosed. Electroencephalography (EEG) has been proposed as a neurophysiological biomarker to delineate psychotic disorders.

To compare the EEG tracings of patients with BD with those of normal subjects to aid in diagnosis.

This was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for BD in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Patients were assessed by the Young Mania Scale (YMRS), the Hamilton HDRS-17 Scale, and the Medication Adherence Report Scale (MARS). Healthy controls were included. All participants benefited from an EEG. It was undertaken in resting eyes closed testing conditions at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. The powers of each band were measured using the power spectral density method called absolute power (AP). Statistical analyses were carried out.

Fifteen bipolar patients and 15 healthy controls, all male, were included. The average age of bipolar was 36.07 ± 10.50 years. The one of health control was 47.93 ± 15.61 years. There were no significant differences in age between bipolar patients and healthy controls. The mean scores on the HDRS-17 and YMRS and MARS scales were 2.73±2.08, 1.67±3.53 and 5.8±2.83 respectively.

At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for alpha band particularly in the parietal and occipital lobes in bipolar patients (158,84 ± 447,71 μV2 and 188,21 ± 415,55 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). An overall increase in AP for delta and beta was found for bipolar patients compared to controls.

Our main finding was a higher delta and beta frequency activity, and lower alpha frequency activity in bipolar patients compared to controls, which may aid in the diagnosis of this disorder.

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We will give an overview of the status of early intervention services for psychosis in Germany. We recently established a website which provides people in Germany with the nearest early detection an intervention service available (https://www.psycho-check.com). However, the overall implementation rate of early detction in Germany is quite heterogenous. We will also present recent research and ongoing projects from Germany including the first evaluation of specialized inpatient services for early psychosis, first evaluations of Individual placement and support and a mindfulness based group intervention in people with early psychosis as well as a newly desigend youth mental health service called soulspace (www.soulspace-berlin.de).

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Cannabis use is associated with mental illness among men and women, especially induction or exacerbation of psychosis, anxiety, and depression. Although safety and efficacy of cannabis in most medical conditions have not been established, use of medical cannabis is growing exponentially. In particular, albeit sex-related differences in the activity of the endocannabinoid system in animals and humans, differential effects of cannabis on men and women have rarely been sought.

To characterize patterns of use and adverse effects experienced by men and women using medical cannabis.

Data from the Israeli national database of patients licensed to use medical cannabis in Israel from January 2014 to December 2021 was analyzed. The database includes indications for cannabis use, monthly cannabis quantities, Tetrahydrocannabinol (THC) and Cannabidiol (CBD) concentrations, and reports of adverse effects. Comparative statistics were used to evaluate the sex related differences.

161,644 persons (62% men) were issued a license to use medical cannabis during the study period. Men are significantly younger than women (50.5±19.1 vs. 56.5±18.4). The leading indications among both men and women are chronic pain (58% of men, 57% of women), symptoms related to oncological disease and chemotherapy treatment (21% of men, 24% of women) and post-traumatic stress disorder (9% of men, 6% of women). Men consume significantly higher monthly quantities at the beginning of treatment compared to women (31.6 gram vs. 29.3 gram) with a higher THC concentration (13.9% vs. 11.6%) and lower CBD concentration (5.3% vs. 6.7%). Over two years of use, there is an increase among both men and women in the amount and THC concentration, and a decrease in the CBD concentration. The differences between men and women remain significant throughout the whole period. Data on adverse effects are available for 28,629 men and 17,204 women (28.6% of men, 28.0% of women). Women report significantly more physical adverse effects (RR 1.48 [95%CI 1.39-1.57]), anxiety (RR 1.45 [95%CI 1.35-1.56]), depression (RR 1.36 [95%CI 0.95-1.96]) and derealization (RR 3.44 [95%CI 2.42-4.89]).

Although the prevalence of medical conditions for which medical cannabis is indicated are similar for both genders, approximately 60% more men consume medical cannabis. While consuming lower cannabis amount and THC concentration, women report more physical and psychiatric adverse effects than men. Understanding the differences in usage patterns and adverse effects between men and women will enable more accurate policy determinations and more effective and safer treatment strategies.

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Autism Spectrum Disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests (APA, 2013 DSM 5th ed.). Although the etiopathogenesis of autism has not yet been elucidated, past literature has highlighted an imbalance between glutamatergic and gamma-aminobutyric acid (GABA)-ergic neurotransmission (Harada et al. J Autism Dev Disord 2011;41:447-54.). A cortical deficiency of GABA in young people with ASD has been reported (Rojas et al. Neuroimage 2013;86:28-34.). Endocannabinoids act in numerous synapses of the central nervous system, maintaining an adequate synaptic homeostasis, preventing excess stimulation at the level of excitatory or inhibitory synapses. They therefore appear to be fundamental for the short- and long-term control of synaptic plasticity (Castillo et al. Neuron 2012;76,70-81). The endocannabinoid system appears to play an important role in some clinical presentations of autism, such as socialization. Indeed, Autism Spectrum Disorder seems to be characterized by a hypo-functionality of the endocannabinoid system (Aran et al. Mol Autism 2019;10, 2).

The present work aims to describe the current state of the art regarding the possible role of cannabinoids in the modulation of the excitatory and inhibitory systems in individuals with ASD.

We carried out a search on PubMed concerning the randomized clinical trials on the modulating effect of excitatory and inhibitory cannabinoid systems in autism. Three eligible articles were found according to the purpose of the present study.

The results of the three articles considered highlighted a cannabinoid (CBD)-related increase in glutamate in subcortical regions (basal ganglia) and a decrease in cortical regions (dorsomedial prefrontal cortex), both in subjects with and without ASD. CBD increased GABA transmission in the subcortical regions of neurotypical subjects, while it decreased it in the same areas of the ASD group. Furthermore, CBD modulated low-frequency activity, used as a measure of brain activity and functional connectivity in the brains of adults with ASD.

Data from the three functional MRI studies demonstrated that CBD influences cortical and subcortical connectivity on an adult sample. This effect was notable only in the ASD group but not in the controls. However, further studies are needed to confirm the results obtained so far.

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Pregnancy is a period of important physical, psychological and hormonal changes. All these changes affect daily life, relationships with others, the relationship with the body and particularly the intimate and sexual aspect within the couple.

to describe the sociodemographic and clinical profile of pregnant women, explore their perceptions and practices regarding sexuality during an uncomplicated pregnancy and to assess the impact of pregnancy on the couple’s sexuality.

This is a cross-sectional, descriptive study conducted among pregnant women followed at the outpatient prenatal and women in immediate postpartum who gave birth in the obstetrics department of EPS Tahar Sfar Mahdia, during a period of 6 months from 01 September 2019 to 28 February 2020. The evaluation of women’s sex life during pregnancy was conducted using a predefined questionnaire and the validated scale translated into Arabic “Arabic Female Sexual Function Index (ArFSFI)”.

A total of 110 patients were included. The average age of the patients was 30.2 +/- 4.98 years. In 60 % of the cases, the patients were from rural areas. More than half (55%) of our patients had a primary education and were housewives (64%). They were married for love in 59% and the marriage was arranged for 41% of the women. More than 2/3 of our patients (71%) reported a good marital relationship. In relation to the current pregnancy: the majority of patients (70%) were in immediate post partum, the pregnancy was desired (98.1%), well experienced (62%).

For most of the patients (58,2%), sexual intercourse was possible and without risk during the whole pregnancy, but some women thought about the risk of abortion or premature delivery (37.3%), the risk of metrorrhagia (10%) and the risk of infection (6.4%). Most patients (87.2%) reported a decrease in the frequency of sexual intercourse during pregnancy. Most women reported a decrease in desire (51.8%), and sexual satisfaction (55.6%) during their pregnancies. For partner sexuality, desire was stationary for 89% and sexual satisfaction was decreased in 61.1% of cases. Almost half of our patients (42.7%) talked about sexuality : to the husband in 74% of cases, followed by social networks in 58% of cases. The motivation for talking about sexuality was in the majority of cases (61.7%) secondary to a complication (metrorrhagia/ Threatned premature labor..).The mean FSFI total score was 25.3 ± 2.8. More than 2/3 of the patients (70%) had a score <26.55 indicating female sexual dysfunction.

Performing sexual acts during pregnancy has very low risk, contraindications are rare and specific. It is therefore important that patients be informed and reassured on this subject. Information on sexuality during pregnancy should be systematically provided to women during their pregnancy follow-up.

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Leadership in healthcare organisations is crucial to continually improve and provide adequate and quality care. Leadership development and training empower psychiatrists to develop leadership skills. Focusing on how to enhance leadership development through leadership skills training and experiential learning should be a priority.

Nonetheless, there is a perception that, throughout Europe, the acquisition of basic or more advanced leadership skills is very seldom part of the professional training.

In 2019, a Leadership Working Group (LWG) was set up within the European Federation of Psychiatric Trainees (EFPT). Its aim is to provide trainees an opportunity to develop their leadership skills.

This presentation will show case some of the efforts by the LWG. A special focus will be given to a European-based cross-sectional survey of needs about leadership skills training in Psychiatry aimed at ECPs, that showed that a majority of ECPs had no access to leadership skills training within curricula and that all the respondents requested it to be included in a psychiatric training program in either optional or mandatory fashion.

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There is evidence that early traumatic experiences may have a negative impact on critical components of psychosocial adjustment, while they may also adversely affect mental health during adulthood.

The aim this study was to investigate the association of early traumatic experiences and in particular sexual abuse with well-being, self-esteem, resilience and close relationships during adulthood.

The study included 499 individuals (76.2% women), with a mean age of 24.2 years. Participants completed Early Trauma Inventory-Short form for early traumatic experiences’ assessment, Brief Resilience Scale for resilience evaluation, Mental Health Continuum-Short Form to assess well-being and Experiences in Close Relationships-Revised scale for adult romantic attachment assessment.

The majority of participants (98.2%) responded positively to at least one statement related to early traumatic experiences while 235 individuals (47.1%) reported that they had experienced sexual abuse. Furthermore, individuals who had experienced sexual abuse displayed lower levels of well-being (p<0.001), self-esteem (p<0.001) and resilience (p<0.001), but higher levels of anxious adult attachment (p<0.001) compared to individuals without such traumatic experiences.

The findings of the present study highlight the importance of timely detection and holistic and integrated management of psychological needs of individuals who have experienced early traumatic experiences and especially sexual abuse.

None Declared

Psychiatry has historically had difficult relationships with Indigenous people, tending to dismiss their views on mental health and illness as superstitious or primitive. Indigenous people have responded by refusing to come for services, missing appointments, and dismissing treatment offered. Canadian Mi’qmak elder Albert Marshall introduced the term, etuaptmumk, to highlight the idea that Indigenous Knowledge and Practice has equal value to contemporary psychiatry. While translated as two-eyed seeing, the term refers to explanatory pluralism and invites a respectful dialogue among cultures as equals.

We implemented a two-eyed seeing research in Indigenous communities to explore the differences of some Indigenous North American cultures in their view of mind and mental health from conventional Euro-American psychiatry and how their cultural practitioners negotiated those differences. We wondered how perception of services would change if mental health practitioners were aware and were more respectful of those differences.

We engaged in a series of discussions with traditional knowledge keepers about their views on mind and mental health. We used constructivist grounded theory methods to identify what was common among these views. We developed a training program to engage mental health clinicians in understanding and responding to these differences. We engaged community members receiving services in a discussion about their perception in the change in the quality of the services. We summarized their responses.

Differences between Indigenous views and those of conventional psychiatry included (1) greater emphasis on the role of community and socio-environmental influences on mental health, (2) inclusion of spirituality and spiritual beings in their expectation for cause of problems and treatment, (3) greater emphasis on inter-generational trauma and historical trauma in addressing mental health. After inclusion of practitioners in the mental health services who had been oriented to these differences and integration of ceremony into the mental health services, ninety-four percent of respondents asked if the service had improved responded in the positive. Attendance at scheduled appointments increased from 56% to 81%. Adherence to recommendations increased from 27% to 67%, which were significant.

Awareness of cultural differences in beliefs about causes of mental illness and acceptable types of treatment increased client satisfaction with services offered, improved attendance rates, and improved adherence rates to treatments offered among Indigenous people. These results could generalize to other populations who hold different views than those of conventional psychiatry. The concept of two-eyed seeing, or explanatory pluralism, holds heuristic value for psychiatry by allowing multiple points of view to be true at the same time.

None Declared

Obsessive-Compulsive Disorder (OCD) is a chronic disabling condition, with considerable lifetime prevalence. There are interindividual differences regarding personality dimensions and how they affect obsessive- compulsive (OC) symptomatology. Furthermore, there is a connection between OC symptoms and the use of maladaptive emotion regulation strategies (expressive suppression) instead of using more cognitive reappraisal.

Explore the relationship between personality, emotion regulation strategies and OC symptoms by testing a path analytic model in a sample of healthy participants and in a sample of OCD patients.

Two samples of participants were utilized. Sample 1 consists of 787 healthy participants from the general Portuguese population. Sample 2 is composed of 33 OCD patients and 32 Healthy Controls (HC). Participants completed different scales: Emotion Regulation Questionnaire (ERQ), Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) and Obsessive-Compulsive Inventory-Revised (OCI-R), through online surveys (sample 1) or a clinical interview (sample 2). These questionnaires were then analyzed with a path-analytic approach.

In sample 2, we found significant differences between OCD patients and HC in every OCI-R subscale, except Hoarding and Neutralizing. In the NEO-FFI, OCD patients scored higher on Neuroticism and lower on Extraversion. No significant differences were found regarding the ERQ. Relatively to sample 1: path analysis results showed that 13,4% of the variance of OC symptoms was explained by the best-fitting model. Only Neuroticism and Extraversion were directly associated with higher OCI-R Total scores, whereas Agreeableness predicted less OC symptoms. The use of Expressive Suppression was associated with more OC symptomology, but no significant connection was found with Cognitive Reappraisal. Regarding sample 2, no model was found, showing no modifying effect of emotion regulation strategies on OC Symptoms.

There is a deep-rooted interconnection between personality and emotion regulation regarding OC symptomatology in a sample of healthy participants but no effect of emotion regulation was seen regarding OCD patients.

To sum up, promising results were obtained and it could be an important field for the OCD in terms of diagnostic, severity and treatment.

None Declared