The department of child psychiatry in Razi Hospital is the unique psychiatric unit in Northern Tunisia offering full-time hospitalization for minors with mental health disorders.

The aim of our study was to explore the clinical and therapeutic characteristics in compulsory admissions of minors in the department of child psychiatry in Razi hospital between 2011 and 2019.

We conducted a retrospective study of medical records of inpatients admitted to the hospitalization unit of the child psychiatry department in Razi Hospital in Tunisia between 2011 and 2019.

Over the nine years, the total number of compulsory admissions was 74 inpatients, aged from 11 to 16 years old. The number of compulsory admissions increased from 03 in 2011 to 22 in 2019. Most of the inpatients were boys (sex ration=1.46). The mean age was 14, 1 year old. Heteroagressiveness was the reason for admission in half of the cases followed by risk behaviors (30.1%) and suicidal behaviors (18.6%). The diagnosis of conduct disorder was found in 33.3% of the cases followed by a normal psychiatric examination in 11.8% of the cases. Mood disorders were found in 9.8% of the cases. Parental psychoeducation (100%), individual psychotherapy (91%) and family therapy (88,2%) were the treatment of choice for the inpatients. The prevalence of psychiatric medication was 45.1%. The most important forms of medication used were neuroleptics (42.3% of medicated patients) and mood stabilizers (30.7%). Child protection delegates were involved in 86,4% of the cases for social intervention.

Minors admitted in an involuntary mode to psychiatric unit have their own specifities in terms of clinical and therapeutic characteristics. More theoretical and empirical research is needed regarding the involuntary admission of minors.

None Declared

Complex regional pain syndrome (CRPS) is a rare condition associated with chronic pain. It is an inflammatory and neuropathic disorder principally characterized by involvement of the autonomic nervous system. The etiology of the syndrome is not clear and the known treatment modality is also very complicated.

Extant literature has shown the relationship between CRPS and suicidal behaviours in adults but less data are available in adolescents. This literature review aims to synthesize and evaluate the existing studies assessing suicidality in CRPS adolescents.

A narrative review of the literature focusing on CRPS and chronic pain in adolescents and their associations with suicidal behavior including suicidal ideations, suicide attempts and death by suicide.

The studies of suicidality factors in adolescents evaluated chronic pain in general. Those who studied CRPS specifically did not look for its association with suicide risk. In fact, adolescents who suffer from chronic pain present increased risk for suicide ideations and suicidal attempts. Furthermore, no available data have demonstrated the association between chronic pain and suicide. Additionally, among adolescents with CRPS, the risks of somatization, anxiety, and depression are higher. The duration of pain, depression and eating disorders has been shown to be associated with increased suicidality.

Our findings suggest that CRPS is associated with higher risks for suicidal ideation, suicidal attempts compared to the general population. The risk factors underlying suicidal behavior in CRPS patients are not studied enough and require further investigation.

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While there is some research that shows personal and psychological factors to be linked to disease-avoidant behaviour and attitudes in the time of Covid-19, this research is however mixed and inconsistent (i.e., some studies report a link and others do not).

In this study we clarify whether demographic and psychological factors specifically predict vaccination willingness and attitudes using Machine learning of a global survey sample from 137 countries (N = 24 000).

Random forest machine learning algorithm was used to identify the strongest predictors of vaccination willingness and attitudes, while regression trees were developed to identify individuals at greater risk for anti-vaccination attitudes.

Conspiratorial thinking and lack of trust in experts were associated with vaccination attitudes and willingness.

The findings underscore the role of conspiratorial beliefs in shaping the uptake of non-pharmacological and pharmacological novel pandemic protective measures.

None Declared

The most common but most hidden form of violence against women is domestic violence. One out of every three women in the world is exposed to physical, psychological or sexual violence by her close partner at any time in her life (Ünal and Gülseren, 2020). As a result of the social isolation measures and quarantine regulations brought by the Covid-19 pandemic, reports of domestic violence against women have increased.

This study aimed to investigate the relationship between psychological violence, psychological maltreatment and depression, anxiety among Turkish immigrant women living in Germany during the COVID-19 pandemic.

The Profile of Psychological Abuse of Women, Psychological Maltreatment of Women Inventory, Generalized Anxiety Disorder-7 (GAD-7) Scale, and The Patient Health Questionnaire-9 (PHQ-9) were delivered to participants.

Our results show that participants who had been exposed to psychological abuse and domestic violence reported to have higher depression and anxiety scores. Furthermore, participants with low income and married to spouses with no formal education or only primary school graduates were reported to have higher depression, anxiety, domestic abuse and psychological maltreatment scores during the COVID-19 outbreak.

Our findings demonstrated that Turkish immigrant women who had experienced psychological abuse and domestic violence by their partners during the pandemic were reported to have higher depression and anxiety.

None Declared

Facebook Instagram, tik tok are popular platforms for interacting with others to build or maintain relationships. Compared to other interpersonal exchanges, these social networks do not require face-to-face interactions. Therefore, they may represent an important social sphere for people with social anxiety disorder (SAD). This study investigated the relationship between social anxiety symptoms and different patterns of social media use. We also looked at the role of brooding, a known risk factor for Social Anxiety Disorder.

establish the relationship between the misuse of social media and the symptoms of social anxiety

This is an analytical cross-sectional study conducted through the distribution of a self-questionnaire, which was published online, through different platforms. The questionnaire in the 1st part includes socio-demographic data and general questions about social networks. And a Social Phobia Scale (SPS) which has 20 items in a second part.

preliminary results showed that greater social anxiety symptoms were associated with spending more time on social media and using passively (i.e. viewing other people’s profiles without interacting). .

Social anxiety is a fear associated with certain social activities or performance situations where the person might feel observed, embarrassed, humiliated, rejected or concerned about the judgment of others.

In people with social anxiety, however, these fears become excessive, persistent and pervasive. The affected person may panic and attempt to avoid situations or conditions that remind them of the object of their fear. While the use of social networks especially among adolescents can create a virtual space in which users can act and react freely without coming into direct contact with people, which increases the signs of social anxiety in this type of user.

the relationship between social media use and social anxiety symptoms highlights the need for further research on this topic. Future research should use experimental manipulations and replicate current findings in clinical samples.

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Attitudes toward people with mental disorders in Arab countries have undergone huge transformations throughout history. Stigmatization of the mentally ill has been a long tradition in our communities. The public’s views have evolved since then, however, little is known about the current situation regarding mental illness stigma in our context.

Explore attitudes towards mental illness and mental health knowledge in Arab countries.

We carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries.The Community Attitudes toward the Mentally Ill scale,the Mental Health Knowledge Schedule scale and the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form were administered to participants from the general public.

The study sample was predominantly female (77%), married (41%), educated (89% with tertiary education), living in urban areas (85%), with a mean age of 29.6 ± 10.8 years.

Based on the CAMI, MAKS, and ATSPPH-SF total scores, 75th, 50th, and 25th percentile were considered as cut-off points for the high, medium, and low scores. We found that 26.5% exhibited stigmatizing attitudes towards people with mental illnesses, 31.7% had poor knowledge, and 28.0% hold negative attitudes toward help-seeking. Regarding attitudes toward mental illness, the highest mean score was on the social restrictiveness subscale (35.1 ± 5.6), reflecting the lowest amounts of stigma in this dimension; while the lowest mean score was on the Authoritarianism subscale (32.0 ± 4.6).

We found a significant difference between countries regarding attitudes (F=194.8, p<.001) and knowledge (F=88.7, p<.001).

Although much scientific progress has been made in the fields of diagnosing and treating mental illness, at a societal level the stigmatization of mental illness is still an important societal problem. The general population is largely ignorant about mental disorders, and fear of the mentally ill remains prevalent.

None Declared

CHARGE syndrome is a genetic entity caused by mutations in the chromodomain helicase DNA-binding protein 7 gene (CHD7) at 8q12.1. There are pleiotropic signs among individuals with this disorder. Diagnosis is clinical using medical criteria. CHD7 gene mutations are usually found in 90% of affected patients.

The aim of this study was to report behavioral signs of CHARGE syndrome and their phenotype-genotype correlations.

Four Tunisian males from Sfax (Tunisia) with clinical features suggestive of CHARGE syndrome were examined at our genetic counselling at the medical University of Sfax. Assessment of facial dysmorphic and behavioral features, karyotyping using RHG banding and molecular screening of CHD7 mutations were performed. Molecular analysis was made using direct Sanger sequencing of the entire CHD7 gene.

Molecular genetic analysis revealed two deletions of the CHD7 gene at exon 3 for the first patient and at exon 8 for the second. The two genetic alterations were associated to retarded growth development and genital hypoplasia. Sensory impairments included for the first visual defects and for the second auditory and olfactory defects. Besides constant delayed psychomotor development, the two patients shared receptive and expressive communication disorders, anxiety, attention deficit, cognitive impairment and intellectual disability. There were no aggressive traits nor major autistic features. Learning disabilities were also present for the two patients.

The CHD7 gene controls the developmental pathways as a transcriptional regulator in the nucleoplasm through chromatin organization. Mutational alterations lead according to the affected domains, and the structure of the nonfunctional CHD7 protein, to the perturbation of the regulation of the developmental pathways’ genes expression. CHD7 is demonstrated as an important component of neurogenesis through two neuronal determination factors: Sox4 and Sox11. While nonsense, frameshift and missense mutations are most common, deletions and duplications are less frequent. Moreover, while exon 3 is commonly altered, mutations of exon 8, which is related to the CHD7 protein chromodomain, are very rare. Phenotype-genotype correlations according to the type of genomic alteration of CHD7 gene are rarely published, particularly concerning behavioral and psychological features of CHARGE association. Here, physical disorders of our two patients seem to be different but behavioral features seem to be common. Multidisciplinary care is thus required for CHARGE syndrome and molecular analysis must be indicated because the type of the genomic alterations may be a key step for a more accurate management of physical and behavioral disorders.

None Declared

Subjective hyperosmia, as a manifestation of belief of exposure to Bluetooth transmission, with testing demonstrating the absence of true hyperosmia, has not heretofore been described.

Correlation of Bluetooth transmission with subjective hyperosmia.

This 53-year-old right-handed single woman presented with a 10-year history of increase in sensitivity to aroma and enhanced perception of smells upon exposure to Wi-Fi electromagnetic radiation. She noted an intensity-duration effect: with higher intensity and duration of Wi-Fi exposure, her sense of smell would escalate and persist: after a few hours of exposure, her smell would jump to a 190% of normal and last for two weeks. When she drives toward a metropolitan area, she can feel that the Wi-Fi is more intense and gets an electrical sensation like “I am an antenna”. Because of this, she refuses to use a cell phone or have Wi-Fi in her home.

Mental Status Examination: Able to recall 3 out of 4 objects in 3 minutes without reinforcement. Chemosensory Testing: Olfaction: Brief Smell Identification Test: 9 (normosmia). Alcohol Sniff Test: 8 (hyposmia). Gustation: Waterless Emperical Taste Test: brothy: 4/8 (hypogeusia), total: 46 (normogeusia).

Nidus for such hyperosmic delusions may be a primary olfactory system disorder, with induction of ephaptic transmissions, causing intermittent phantosmia or otherwise misperceived odor, misattributed to the ambient environment. Paradoxically, such perceived hyperosmia may be due to a specific or isolated hyposmia or anosmia, the olfactory equivalent to monochromatic color blindness. The assignment of the source of the hyperosmia to that of Bluetooth is consistent with the zeitgeist of mistrust and paranoia of higher technology. Thus, the subjective hyperosmia would only occur when the patient perceives there was a kippage of radiation/ Bluetooth/ electromagnetic waves present, independent of these actually being present. This may be a form of expectation effect due to visual evidence (high tower wires); suggestion combined with subcultural group dynamics with belief in harm of such electromagnetic/Bluetooth waves, with distorted information recall and misattribution. Such group dynamics and shared misperceptions may act to fuel such a delusion as in the Mandela effect (French, 2018). This may represent the chemosensory equivalent of somatosensory amplification due to external intensification (Brascher, 2017). Perchance, this case represents not delusional hyperosmia, due to a functional psychiatric disorder, but rather has a neuroanatomic basis. Those with subjective hyperosmia and hypersensitivity to aromas have demonstrated hypertrophied gray matter volume in the posterior subregion of the right hippocampus, left precuneus, left superior frontal gyrus, and right hypothalamus (Han, 2020). In those with subjective hyperosmia, neurological investigation is warranted.

None Declared

Individuals with severe mental health problems are at greater risk of COVID-19 infection and increased risk of hospitalization and mortality. Vaccination against COVID-19 has demonstrated its importance in preventing and reducing these negative outcomes.

This study aims to assess the vaccination rate of people with mental illness in comparison with the general population.

We will conduct a retrospective evaluation of vaccine uptake in a sample of patients admitted to a psychiatric hospital between the 1st of July of 2021 and the 30th of June of 2022 in the Porto region. According to their vaccination plan, all patients were offered the possibility vaccination. Statistical analysis will be performed to analyse the data.

We expect to assess over 1500 patients. Regarding other studies on the same subject, although in different countries, we may predict that the vaccination rate in our sample will not, statistically, differ from the general population.

Some studies have shown higher resistance and hesitancy towards the COVID-19 vaccination in mental health patients, however others did not find differences between these patients and the general population. Therefore, this study will allow us to better understand the impact of mental illness in the vaccination rate in our population.

None Declared

Plasma zonulin is acknowledged to be a biomarker for intestinal permeability. Previous studies have demonstrated significant relationships regarding potential effects of zonulin in several major psychiatric conditions including attention deficit and hyperactivity disorder, autism spectrum disorder and depression, however its role in schizophrenia still remains unclear.

We aimed to identify the alterations of plasma zonulin levels between the different periods of the illness and we strive to reveal the associations between plasma zonulin levels and symptoms in patients with chronic schizophrenia.

30 patients with schizophrenia and 29 healthy controls participated in the study. Sociodemographic data form and Positive and Negative Syndrome Scale (PANSS) were administered. Blood sampling was performed for patients who are in exacerbation and following treatment response periods along with the healthy controls. ELISA method was utilized to measure plasma zonulin levels.

The groups did not differ in plasma zonulin level comparisons. Plasma zonulin did not fluctuate between the symptom exacerbation and treatment response periods of the patients. Besides, plasma zonulin level was found to be associated with passive/apathetic social withdrawal, active social avoidance, and somatic concern items of the PANSS in a negative direction.

This is the first follow-up study in the literature that assesses plasma zonulin in patients with schizophrenia. The measurement of plasma zonulin may not be a convenient parameter in distinguishing symptom exacerbation and treatment response periods in chronic schizophrenia, nevertheless it may have implications on reduced social interaction and somatic symptoms. Our study can provide better insight for future studies to be more cautious while interpreting the associations of plasma zonulin levels with psychiatric disorders.

None Declared

The construct of a clinical high-risk (CHR) state of psychosis has been established to describe potentially prodromal symptoms which typically appear during adolescence and young adulthood. This is a very sensitive developmental period and the clinical high risk (CHR) is associated with increased functional impairment. To address the specialities in the care for this patient population a specialized outpatient care unit for early intervention in psychosis at the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, of the University Zürich (CAPS) is established. The interdisciplinary team (psychiatrists and psychologists) supports children and adolescents with psychotic disorders or at clinical high risk for developing psychosis. The early intervention service offers specialized assessment, treatment and case management for minors with a first psychosis or CHR-state in an outpatient or inpatient setting as well as by day clinic care.

The evaluation main objective was to get a better understanding about this vulnerable patient group. Therefore we analysed the clinical data about CHR-state, comorbid diagnosis, treatment, medication and hospitalisation of the patients who entered the service for early intervention in psychosis.

Participants who entered the service for early intervention in psychosis were followed up in the years 2017-2021 and descriptive analysis was used to summarize the data. For the evaluation of the risk construct the participants have been classified in “no increased risk”, “CHR” or “early onset psychosis” (EOP). Additionally, ICD diagnosis, demographics and treatment (medication, psychotherapy, treatment setting) were assessed. Therapy was either psychotherapy and/or group training called DBT2P (Dialectical behavioral group training for adolescents, to prevent psychiatric disorders). Additionally, the use of a smartphone application “Robin Z”(add-on treatment tool to support the patients between the sessions) was assessed.

In the last five years we saw 300 patients (112 female, mean age 15.7) who sought the care unit for early intervention. The evaluation of the risk showed that 44 patients had no increased risk, 205 were classified with a CHR and 51 fulfilled the criteria of an early onset psychosis (18.5%). Most of the patients showed comorbid diagnosis, mainly depressive disorders (42%). The data about the treatment will be analyzed for the congress.

Despite clinical implications, there is little data about early detection and early intervention in psychosis for children and adolescent. Therefore, the evaluation of the clinical data of the CAPS is of clinical importance and expected to add essential information in the fields of prevention and early intervention in psychosis.

None Declared

According to the literature, about 35% of patients with Anorexia Nervosa (AN) also have a diagnosis of Autism Spectrum Disorder (ASD), and this comorbidity occurs more frequently in males.

With this work, the authors intend to address the characteristics present in this comorbidity and what is the impact of this comorbidity in the diagnosis, approach and prognosis of AN.

Non-systematic research of the literature through the PubMed database with the terms “autism spectrum disorder” and “anorexia nervosa”. Only surveys conducted in the last 10 years were considered for inclusion.

Although AN and ASD may seem to be quite distinct conditions, the studies found suggest the existence of four characteristics that overlap the two diagnoses: deficits in theory of mind, inability to switch between courses of action fluently, inability to see the whole pictures to the detriment of detail and alexithymia. Studies also point to greater resistance to treatment in AN when an ASD is present in comorbidity.

Scientific evidence suggests that autistic characteristics in people with AN are not a consequence of being underweight, but rather stable characteristics present before and after the onset of AN. The studies thus conclude that comorbidity between the two disorders exists and is frequent enough to warrant greater attention to the diagnosis of ASD in people with AN. However, there are still no specific guidelines for the treatment of AN in people with ASD, which leads to a worse response to treatment, evolution and prognosis of AN in people with ASD.

None Declared

Lithium is one of the main drugs used in Bipolar Affective Disorder. However, it has a narrow therapeutic window, which requires close monitoring and progressive dose adjustment, according to serum levels, clinical response and the appearance of side effects. The term ‘SILENT’ explains descriptively persistent neurological sequelae related to lithium salt intoxication when symptoms persist for more than 2 months after stopping treatment.

SILENT Syndrome is more common in females, at ages ranging from 21 to 77 years and is characterized mainly by avermian-type cerebellar disorder, persistent extrapyramidal syndrome, brainstem dysfunction and dementia of varying severity. It can also result in apraxia of the body, changes in the coordination and balance, dysarthria, as well as intentional and kinetic cerebellar tremor, involuntary movements of orofacial dyskinesias or resting tremor.

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

Non-systematic literature review.

Complications from the use of lithium known in the medical literature include mainly nephrotoxicity, endocrine alterations and neurotoxicity.

The neurotoxic effects of lithium usually occur at high serum concentrations. However, they can also occur with lithium in the therapeutic range, and memory, attention and ataxia impairment may be some of the permanent sequelae.

The etiopathogenesis is unclear, but demyelination has been detected in multiple brain regions, mainly in the cerebellum. The mechanism of lithium-induced cerebellar injury is believed to be mediated by the entry of calcium into the cells of this organ.

The main factors that predispose to greater side effects and risk of toxicity are patients with decreased renal function, advanced age, use of diuretics, dementia, pregnancy, low sodium intake and physical illness with vomiting and/or diarrhea.

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

None Declared

Disruption of cerebral thermal homeostasis accompanies various CNS diseases. Presumably, (neuro)inflammation and the changes of temperature heterogeneity of the cerebral cortex may be interrelated links in the pathogenesis of schizophrenia.

to study the association between the brain thermal balance indicators, inflammatory markers and clinical features of the disease in patients with schizophrenia during therapy.

37 patients aged 16 to 46 years with schizophrenia (F20, ICD-10) were examined. Clinical examination included psychometric assessment using PANSS, HDRS, and YMRS scales. Cortical temperature was determined by microwave radiometry. Temperature heterogeneity was assessed by calculating the Pearson correlation coefficient between temperature indicators in 9 symmetrical areas of the cerebral cortex. The activity of the proteolytic system of inflammation (ratio of leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity) and the level of autoantibodies to S100B and MBP antigens were determined in patients’ blood.

Low temperature heterogeneity is related to an increase in the activity of the proteolytic system of inflammation and a good response to therapy in most patients. High temperature heterogeneity is associated with insufficient activity of the proteolytic system of inflammation and the development of autoimmune reactions, which is accompanied by a more severe course of the pathological process and, in most cases, treatment resistance.

The association between the features of the thermal balance of the brain and inflammatory markers confirms the hypothesis of their role in the pathogenesis of schizophrenia. Temperature heterogeneity of the brain can serve as a criterion for predicting of therapeutic response in patients with schizophrenia.

None Declared

The effect of self-esteem in eating disorders has been investigated in several studies, but it’s still not extensively investigated in orthorexia nervosa.

To study the prevalence and factors associated with orthorexic eating behaviors in medical students and it’s relation with self-esteem.

A cross-sectional study was conducted through an online survey among medical students of the faculty of medicine of Sfax (Tunisia). Participants completed an anonymous self-administered questionnaire. We collected their sociodemographic and clinical data. Orthorexia nervosa (ON) was assessed using the self-reported scale, ORTO-15. We used the Rosenberg’s self-esteem scale to assess self-esteem.

Ninety five medical students completed the survey. The mean age was 25.8±3.4 years and the sex ratio (F/M) was 3.75. The average body mass index was 23.64±3.53 kg /m2.

Fifty-eight percent of the students (58%) reported that they were dissatisfied with their eating habits, and 27.4% tried to control their weight. Several methods of weight control were used, the most frequent (65.4%) were diet and physical exercise, none resorted to laxatives and 8.4% consulted a nutritionist.

Self-esteem was very low in 27.1% and low in 34.7% of the students.

Overall, the prevalence of orthorexia among our participants was 52.6%. The mean score of the ORTO-15 was 39.19±4.48.

Orthorexia was significantly correlated with the use of weight control measures (p=0.035) and physical activity (p=0.042).

Students with low self-esteem had higher tendency for orthorexia but with no significant correlation.

Our study supports a non-negligible frequency of orthorexic behaviors in medical students but future studies are needed to assess the direct effect of self-esteem on orthorexia.

None Declared

Dissociative identity disorder (DID) also referred as multiple personality disorder is a chronic post-traumatic condition. It is characterized according to DSM-5 by “disruption of identity characterized by two or more distinct personality states”, with “marked discontinuity in sense of self… accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.”

Here, we present a case of a 33-year-old Caucasian female with no psychiatric history until 2 years ago, privately. The patient is admitted to the Psychiatry Service due to worsening. During admission, consultations are made to the Neurology Service and the Neurophysiology Service, who request an electroencephalogram, an MRI and a brain scan, resulting in normality.

After discharge, she returns home with her parents, and the crisis become more frequent and of longer duration. She acknowledges that during these periods she is dominated by her alternate personality, which she is unaware of until her family informs her. This personality is a demon, who verbally assaults and even physically threatens her surroundings, and can hardly be controlled by the prayers of her family.

Despite psychopharmacological treatment, as well as the cognitive-behavioral therapy carried out by the patient for more than two years, there was no improvement. Once she comes to the consultation, it is decided to carry out a therapy guided by the central Rogerian attitudes, originating a process of empathic resonance of the therapist, which influences the experience of the patient. Three main interventions are carried out, the awareness of the disease, the regulation of the intensity of this experience, to maintain the attention and the exploration of what guides the change. After carrying out this intervention, the patient is currently asymptomatic.

Currently, there are not evidence-based treatment guidelines. The most common approach is individual psychodynamic psychotherapy according to practice-based guidelines initiated by the International Society for the Study of Trauma and Dissociation.

To handle the present case, we used a model with two pillars, the patient’s commitment and the investigation of microprocesses within a process of experiential exploration, in which the therapist is a facilitator of reflective attention and experimental awareness.

The torpid evolution suffered by the patient, with little clinical improvement to the interventions carried out, and the absence of evidence on the treatment, led to a therapeutic approach focused on the empathic resonance process of the therapist, with good results.

None Declared

Schizophrenia is a chronic, frequent, and disabling psychiatric condition. The prognosis is more severe in the absence of treatment.

The aims of our study were to evaluate the quality of treatment adherence and the quality of insight of patients with schizophrenia and to assess the implication of these factors as predictors of poor adherence.

We conducted a cross-sectional and analytical study. We recruited 150 patients with schizophrenia treated at Razi Hospital of Manouba, divided into 113 patients with good adherence compared to 37 patients with poor adherence. We used the Medical Adherence Report Scale (MARS) to assess the quality of therapeutic adherence and the Birchwood Insight Scale for Insight Assessment.

Poor treatment adherence in patients with schizophrenia was significantly associated with poor insight (p=0.001). Good adherence was associated with positive perception of treatment effectiveness (p<0.001). The predictive factor for poor adherence to therapy in multivariate analysis, after adjusting for the confounding variables was the negative perception of side effects (p=0.02). The predictive factor for good adherence was the presence of insight into the need for treatment (p=0.002).

To prevent poor treatment adherence, a systematic screening for predictive factors and adequate management of schizophrenia would be imperative.

A. Rami Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, E. Sana Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, C. Mejda Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, D. Rahma Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

Cognitive Behavioral Therapy (CBT) provide a means of improving mental health among people with depression. However, few studies have explored its effectiveness with the presence of comorbid somatic disorders.

We aimed throug a case report to describe the cognitive and behavioral management of a patient with depression comorbid with systemic lupus erythematosus.

We present the case of a 47-year-old woman followed since 2012 for a systemic lupus erythematosus. In september 2013, she was diagnosed with depression. The cognitive behavioural therapy took place in 12 sessions of 45 minutes each, one session per week. Initial and final evaluations included Beck’s Depression Inventory and the « Questionnaire des pensées automatiques ».

During the course of the therapy, we noticed an improvement of the patient’s mood, a decrease in anhedonia and somatic complains. We also observed a decrease in instinctual disorders. The final evaluation showed a significant improvement of the different scales. The objectives set with the patient were achieved.

Cognitive behavioral therapy is an interesting option for the management of cases of depression, including its comorbid form with a disabling disease such as systemic lupus erythematosus.

None Declared

Stigma is a complex process and a universal phenomenon that is part of all social groups and that is maintained by its functions related to the establishment of one’s own identity and the facilitation of socialization processes. The stigma of the patient is important to evaluate since it is a subjective experience that can have negative correlations in relation to self-esteem, empowerment and recovery orientation of the patient with mental illness. Hospitalization in mental health takes place at times of mental illness decompensation and is an intervention closely related to the stigma towards mental illness.

The objective of the study is to evaluate the stigma perceived by patients with mental illness hospitalized in an acute mental health unit.

Observational study with 53 patients hospitalized in an acute mental health unit.

Variables collected: Sociodemographic variables (age, sex), clinical diagnosis and stigma is evaluated with the Illness Self-stigma Scale (ISMI).

Sample of 53 patients, 55% women and 44% men, the most frequent diagnoses among those admitted are psychosis spectrum 26.42%, depressive disorders 24.53%, personality disorders 22.64% and bipolar disorders 11.33%. The average age is 41.96 years, between 18 and 72 years. The self-stigma according to the scale (ISMI) we obtain as a total score the patient with the highest stigma scores 100 points and the one with the least scores 44 points. Regarding diagnoses, depressive disorders score 33-72 points, while psychotic disorders score 36-85 points. The highest scores in self-stigma in our study are in personality disorders 49-100 and borderline personality disorder stands out (100 points). In the 5 subscales such as alienation, self-stigma, perceived discrimination, social isolation and resistance to stigma. Higher scores in alienation stand out in all patients.

Patients with personality disorders, especially borderline personality disorder, followed by psychotic disorders, present greater perceived self-stigma in our study than the rest of the patients; it is a very important factor that can affect the evolution of the clinical picture. This factor is important to establish the therapeutic plan and the different interventions, it would be recommended to assess the stigma together with the measures to reduce symptoms.

None Declared

As part of the Global Mental Health (GMH) movement, WHO launched the Mental Health Gap Action Program (mhGAP). One of the key initiatives of the MhGAP is to train lay health professionals to meet the mental health needs of populations, particularly in low- and middle-income countries (LMICs) where the need far exceeds the availability and quality of services. Training modules are standardized and designed for use in many countries and settings. In practice, there is often a stereotyped reproduction of modules without consideration of specific cultural adaptation needs.

As part of a psychosocial support program in two provinces of the eastern Democratic Republic of Congo (Ituri and North Kivu), the NGO Action contre la Faim proposed a health and care system assessment aimed at adapting MhGAP modules for health center staff. The objective was to know the local practices in terms of psychic care as well as to identify the competences already existing to reinforce them, but also to contextualize the tools and the contents of the trainings.

The methodology used was mixed.

A questionnaire based on the WHO situation analysis tools was revised, simplified and adapted to the zone, allowing us to obtain quantitative data on the health centers, the care provided, referrals and supervision. Health care workers were interviewed using the questionnaire from ACF’s “Strengthening the Health Care System” guide, focusing on care methods, knowledge of mental health and the most frequently encountered symptoms. Focus Group Discussions with the Community Relais in the area allowed for the collection of information on the level of knowledge of the population in terms of mental health, their awareness on this subject, their cultural vision and the means of care.

The data collected from 9 health centers in the two provinces allowed us to learn about:

- Poor knowledge of mental health and school readiness

- Identification of barriers to access to care

- Beliefs around mental health, mental suffering and care

- Details about the different pathologies and symptoms as well as the issues related to the therapeutic framework.

The evaluation was fundamental to have a better knowledge of the context, which made it possible to adapt the content of the MhGap training modules les, to design tools more adherent to reality. The data collected may also be the subject of advocacy aimed at mobilizing the country’s policies in terms of mental health, as well as raising awareness in the international community.

None Declared