Evidence is growing for the bio-immuno-metabolic model of pathogenesis in anorexia nervosa (AN), an eating disorder with a chronic and relapsing nature. The role of the gut microbiome in this process is also receiving intense research interest. The gut microbiome and the use of probiotics and prebiotics have been extensively studied in gastrointestinal (GI) disorders such as inflammatory bowel disease (IBD) and functional GI disorders (FGIDs). Exploring links between AN and these GI disorders may open new avenues of treatment such as the use of probiotics and prebiotics in AN.

This review explores: i) GI presentation in AN and its relationship with the gut microbiome ii) factors influencing the gut microbiome presentation in AN including dietary patterns iii) whether the gut microbiome may be involved in the pathogenesis and maintenance of AN iv) gut microbiome presentation in GI disorders and commonalities with AN v) evidence for the potential use of probiotics and prebiotics as adjunct treatment in AN.

GI symptomatology and gut microbiome presentation in AN were examined through literature searches. Gut microbiome changes related to common dietary patterns in AN were explored. Microbiome changes that may influence development or maintenance of AN were considered. Microbiome alterations seen in relevant GI disorders were explored and commonalities considered between these and alterations in the microbiome in AN. Literature searches were performed for the use of probiotics and prebiotics in AN and relevant GI disorders.

GI symptoms occur commonly in AN with evidence suggesting some symptoms continuing beyond weight restoration. Significant disruption of the gut microbiome has been associated with AN with some changes related to typical dietary patterns seen during AN development. Additionally, similarities exist between microbiome alterations in AN and those seen in IBD and FGIDs indicating factors apart from the diet, such as a pro-inflammatory milieu, in play. These changes may not only influence GI presentation in AN but may also have a role in maintenance of the disorder. Some evidence suggests that the pre-morbid gut microbiome may influence risk for AN development. Preliminary evidence of the use of probiotics in AN indicates a positive influence on immune modulation although no evidence exists as yet of their influence on AN symptomatology. There has been extensive research into the use of probiotics and prebiotics in IBD and FGIDs with some evidence for reduction in disease parameters and symptomatology with the use of multi-strain probiotics.

Some theoretical, mechanistic and clinical evidence exists for the use of probiotics in ameliorating GI symptoms in AN. However, further research is needed into the context of the gut microbiome changes in AN, the specifics of efficacy and the effects that probiotics and prebiotics may have in AN.

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The most common liver diseases associated with the fat accumulation in the hepatic tissue are metabolic associated fatty liver disease (MAFLD), non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH). Many studies previously reported several key mechanisms tying hepatic injury to extrahepatic manifestations. In this way, the co-occurrence of cognitive decline, mood, and affective changes could suggest the existence of a strong neurological component predisposing to neuropsychiatric comorbidities.

In this study, we aimed to describe the neurological and neuropsychiatric comorbidities of MALFD, NAFLD, and NASH.

The main scientific databases were screened for English-written studies using the following key words: ”cognitive decline”, ”neuronal loss”, ”affective disorders”, ”anxiety”, ”depression”, ”MAFLD”, ”NAFLD”, ”NASH”. Exclusion criteria: (1) studies not focussing on fatty liver diseases; (2) not describing comorbid conditions; (3) not providing correlative analysis of disease co-occurrence or mechanistic associations.

Hepatic encephalopathy (HE) is the main NAFLD/NASH extrahepatic manifestation commonly characterized by impaired cognition, rapid mood swings, depressive and anxious behaviours, and defective sleep. It is currently reported that more than 70% of the cirrhotic patients develop HE. Cognitive impairments and brain tissue reduction were found in NAFLD patients, while MAFLD patients’ cognitive dysfunctions (mild cognitive impairment and hippocampal-dependent memory impairment) were not associated with the presence of metabolic syndrome. Similarly Alzheimer’s disease (AD) was not described as comorbid in MAFLD. By contrast, since NAFLD and NASH are often characterized by insulin resistance and dyslipidaemia – significant triggers of dementia. By far the most prevalent neuropsychiatric comorbidity in NAFLD and NASH is the major depressive syndrome, diagnosed in almost 30% of the cases. Also, a correlation between the anxiety manifestation and the progression from NAFLD to NASH was described. In this context, as a response to the vast evidence that connect liver dysfunction to cognitive impairments, the liver-brain axis function was hypothesized.

MAFLD, NAFLD, and NASH are frequently associated with cognitive decline. The main NASH neurological comorbidity is hepatic encephalopathy, but it could also be seen in NAFLD. While Alzheimer’s disease occurs in NAFLD and NASH, more studies are needed to explain the severity-dependent association. Depression and anxiety were also reported in NAFLD and NASH.

Acknowledgements: B.I.-M. and R.M.-A. is currently supported through the Project entitled “Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E” (CENEMED, code: 127606), cofinanced through the Operational Program of Competitivity, Prioritary Axis: Research, Technological development, and Inovation (CDI).

I. M. Balmus Grant / Research support from: Project entitled “Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E”(acronym: CENEMED, mySMIS code: 127606), cofinanced through the Operational Program of Competitivity, Prioritary Axis: Research, Technological development, and Inovation (CDI)., M. -.-A. Robea Grant / Research support from: Project entitled “Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E”(acronym: CENEMED, mySMIS code: 127606), cofinanced through the Operational Program of Competitivity, Prioritary Axis: Research, Technological development, and Inovation (CDI)., R. Lefter: None Declared, A. Ciobica: None Declared, L. Huiban: None Declared, C. Stanciu: None Declared, A. Trifan: None Declared

Inhibition is a core component of executive functions but is not a unitary construct. Instead, different inhibitory processes have specific behavioral effects and neural bases. Three important inhibitory functions explored by the literature are 1) interference control (i.e., inhibition of distractive information); 2) inhibition of prepotent responses and 3) inhibition of ongoing responses. These functions were described in the self-regulation theory as the possible main impairment in attention-deficit hyperactivity disorder (ADHD) and since then they have shown an association with several psychiatric disorders.

The current study investigated the neural bases of interference control, inhibition of prepotent responses, and inhibition of ongoing responses as they were assessed by a Stroop-matching/stop-signal task developed by our group.

The Stroop-matching/stop-signal employs different conditions to create the demands for each inhibition which allows the assessment of these functions using a single protocol. Brain activations were acquired using fNRIS in a block-design method. The concentration of oxygenated hemoglobin (HbO). The first level analysis of HbO signals used a general linear model (GLM) to estimate individual brain activations. The second level analysis was performed using a linear mixed model to generate brain activations at the group level. Alpha level = 0.05 and the false discovery rate was applied when necessary. The sample was composed of 25 young adults (mean age = 21.8, SD = 4.39).

task Interference control showed activation in the left and right temporoparietal junction (TPJ), the right dorsolateral prefrontal cortex (DPLFC), and inferior frontal gyrus (IFG); inhibition of prepotent responses showed increased activity in the right IFG and left DLPFC; the suppression of ongoing responses showed a deactivation of the IFG and DLPFC bilaterally.

These results indicate that the three inhibitory functions assessed present distinct brain patterns of function. The lateralization role was evident in DLPFC and IFG activities and recruitment of parietal areas seems to be limited to interference control in this protocol. Also, the stop-signal demand led to the deactivation of areas associated with the resolution of the primary Stroop-matching task. This study elucidates the role of brain mechanisms associated with specific inhibitory processes that are impaired in psychiatric disorders such as ADHD.

Financial support: FAPESP [grant 2019/20757-5, 2019/21773-4, 2020/14800-2]; CAPES Proex [grant 0426/2021, 23038.006837/2021-73]; Mackpesquisa; CNPq [grant 307443/2019-1]

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Schizophrenia is a severe mental illness but especially important in terms of its impact on the subject. The stigmatization of these patients is major, leading to a significant decrease in their quality of life. This is partly due to the media coverage of the rare cases of hetero-aggression.

The aggressiveness of schizophrenic subjects remains poorly known and little studied.

The objectives of our study are to determine whether the prescription of second-generation antipsychotics is associated with lower levels of aggression than the prescription of first-generation antipsychotics and to identify aggravating factors.

Materials and methods: We used an anonymous questionnaire based on, in addition to individual status and conditions, a self-administered questionnaire to assess the degree of aggression (the Buss and Perry Aggression Questionnaire (BPAQ)).

Our study demonstrated superiority of second-generation antipsychotics in preventing aggression in subjects with schizophrenia, as well as an association between increased aggression and low insight, low compliance and low social support. In addition, younger age, male gender, and lower education were associated with increased aggression.

The prevention of aggression would then begin with the management of psychotic symptoms and comorbid disorders, as well as work on the compliance and insight of these patients. However, the aggressive dimension persists in some of them.

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Mixed states, the co-occurrence of manic and depressive symptoms, were recognized and described from the time of antiquity. DSM-5 first, and DSM-5-TR after, introduced the ‘’mixed features’’ specifier, defined by the presence of at least three non-overlapping opposite-pole symptoms during a syndromic depressive, hypomanic, or manic episode. Various manifestations, including irritability, distractibility, anxiety, psychomotor agitation, were excluded from the specifier, since they can occur during both depressive and hypo/manic episodes and other mental illnesses.

The objective of this study was to evaluate the phenomenology and prevalence of mixed states among bipolar disorder (BD) patients. We first assessed the frequency of specific features during different mood states. Then, we estimated the prevalence of mixed states by applying DSM-5 criteria, comparing it qualitatively with the one detected from psychometric questionnaires.

In a naturalistic study, 903 adult outpatients with BD participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,213 visits for 7 years. The scores at the Inventory of Depressive Symptomatology–Clinician-Rated Version (IDS-C) and at the Young Mania Rating Scale (YMRS), administered at each visit, were used to define the mood episode and to assess the frequency of specific symptoms. In addition, we applied DSM-5 criteria for “with mixed features” to our sample, to examine a DSM-5-based construct.

Specific symptomatic profiles differentiate mixed states from pure ones (Figure 1 and 2). Mainly, a higher prevalence of irritability was found during mixed episodes, both depressive and hypo/manic, compared to pure depression (0.60 vs. 1.20, p < 0,001) and hypo/mania (0.82 vs. 1.54, p < 0,001), as reported at the 6th item of IDS-C.

Figure 1. Individual YMRS items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.

Figure 2. Individual IDS-C items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.

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Preliminary results of the present study showed that symptoms like irritability are strongly prevalent during mixed states. Moreover, the DSM-5 diagnostic criteria for “with mixed features” specifier for any of the mood episodes detected lower rates of mixed states, hence this criteria may yield inadequate sensitivity in recognizing patients suffering from such conditions.

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Evidence from contemporary research has highlighted abnormal subjective pre-psychotic experiences as an expression of schizotropic vulnerability, for which trajectories up to First Rank Symptoms have been described. Embodiment is crucial to the conceptualisation of these experiences as the distinctive feature of schizophrenic phenomena. In fact, these are embedded in precise experiential frameworks such as Diminished Self-Affection and Hyperreflexivity, which constitute in nuce the experience of Dis-Embodiment. The latter responds poorly to conventional therapies, thereby affecting considerably the prognosis quoad valetudinem of Schizophrenia.

This study is intended to explore the use of specific psychomotor therapy protocols aimed at fostering Embodiment in patients with Schizophrenia, especially by investigating its efficacy and specificity on self-perceived body disorders, on characteristic motor abnormalities and on psychopathological dimensions.

The study involves the participation of 20 patients throughout 10 weekly 90-minute meetings of Embodied Psychomotor Therapy (EPT) in groups of approximately 5 participants. Despite being partially inspired by current approaches, EPT is conceived as a specific activity intended for patients with schizophrenia: each meeting combines intersubjective coordination activities (complex motor sequences, harmonious control of voluntary movement and movement in space, body-awareness), intra-subjective coordination (mirroring, demarcation and identification of one’s own boundaries, single-group dynamics), and exercises aimed at developing motor skills (proprioception, balance, posture, rhythm and speed). At the beginning of the activity (T0) and after 10 meetings (T1) participants will carry out self-administered and externally administered assessments, for the evaluation of motor (BMS, LOFOPT, BBS, AIMS, SRRS), psychopathological (PANSS, FBF, ABP), social functioning (SOFAS) and daily physical activity level (IPAQ) dimensions.

The study is still ongoing, due to limitations dictated by the Sars-CoV-2 pandemic. Preliminary results at T0 indicate a positive correlation between low levels of daily physical activity (IPAQ) and poor functioning (SOFAS). Significantly higher motor impairment with respect to the general population is also confirmed in all motor scales used. Moreover, a positive correlation between low levels of motor coordination (BMS_MC) and balance (BSS_TOT) was found together with basic symptoms related to loss of control or self-agency (FCQ_KO). Furthermore, the first results suggest an overall improvement in motor performance at T1.

The longitudinal analysis will enable the extent of the impact of EPT on functioning, motor and psychopathological dimensions of the patients to be determined, providing useful elements for planning specific rehabilitation interventions for schizophrenia.

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By the end of October 2022, COVID-19 had infected more than 629 million people, with more than 6,5 million deaths worldwide.

During the pandemic, there have not been any specific antiviral drugs to effectively treat COVID-19, but non-specific drugs have been used and may improve the prognosis of high-risk patients with the disease. A vaccine is then considered the effective choice to stop this pandemic. The vaccine campaign against COVID-19 has been launched in Morocco since February 2021. This campaign has sparked great controversy over its effectiveness and safety in Morocco, as well as abroad, especially after the launch of the 3rd booster dose of the vaccine.

We sought to assess individual perceptions among the medical profession regarding vaccination against COVID-19 in Morocco and to determine preferences among this particular population in order to facilitate vaccination coverage.

It is a descriptive and analytical cross-sectional study on doctors of different medical specialties and general medicine students in Morocco. Data collection was done through an anonymous self-administered questionnaire completed online. The measuring instruments used were a questionnaire containing 29 questions. In addition to socio-demographic questions (age, sex, household composition and employment), the rest of the questionnaire aims to examine Moroccan doctors’ perceptions on COVID-19 vaccination, attitudes, beliefs and knowledge about the vaccine. Some survey items were adapted from other similar surveys, while others were created by the research team of the psychiatry laboratory of the CHU of Tangier. The data is grouped and then analyzed by statistical software (SPSS v26).

There were 162 respondents with an average age of 26.52% with 66.7% of participants being female. 96% of doctors were vaccinated, 87.3% of them with 2 doses. 74% were vaccinated by Sinopharm, 23.5% by Astra Zeneca, 9.4% by Pfizer and 0.7% by Janssen. 68% had post-vaccination side effects. For unvaccinated doctors, 43% say they are not convinced of its usefulness, 28.5% find that there is not enough experience on its effectiveness and 14.3% report that they have a disease that contraindicates the vaccine.

For vaccinated doctors, 80% declare that they were vaccinated out of conviction and 20% out of obligation. 60% of our sample are against the obligation of the vaccination pass in public places, on the other hand 67% find that vaccination can stop the spread of the virus and 60% are ready to receive an annual vaccination if necessary.

Physicians’ acceptance of the COVID-19 vaccine is important, as they are often a trusted source of vaccine information. Their vaccination can then positively influence the population, hence the need to integrate them into future awareness and prevention programs.

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EPA 2023SP-1290

Objective

In medicine, women are still understudied because they are considered less reliable research subjects than men, due to hormonal changes during the lifespan. Women with ADHD have been even more understudied, while exactly their hormonal mood changes and increased severity of ADHD urgently need our research attention.

Methods

In a selfreport questionnaire study (Dorani 2021) among 209 women with ADHD, hormonal mood changes during the menstrual cycle, after childbirth and during menopausal transition were investigated, and compared with available data from women of the general population, using the same instruments.

Results

The data showed that in every episode of hormonal changes, women with ADHD suffered from a 2-3 fold increase in frequency and severity of mood changes.

Conclusions

This first study points to increased severity of mood changes and probably also ADHD symptoms during episodes of hormonal changes in women with ADHD during the lifespan. During this talk, the findings and their etiological background will be clarified, such as interaction between the sex hormones estrogen and progesteron with dopamine and other neurotransmitters in the brain. Treatment options will be discussed as well.

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Growing evidence supports a possible link between gut microbiota and attention-deficit/hyperactivity disorder (ADHD) via the gut-brain axis. Short-chain fatty acids (SCFAs), the major metabolites produced by gut microbiota through anaerobic fermentation, may influence gut-brain communication.

To determine the alterations of gut microbiota and fecal SCFAs in children diagnosed with ADHD compared to healthy subjects.

Fecal samples were collected from children with ADHD (n=10), and age- and sex-matched healthy controls (n=10) for gut microbiota and SCFAs analysis.

There were no significant differences in the abundance of any bacterial phyla in feces between groups. However, fecal concentrations of acetic acid, propionic acid, and butyric acid were significantly lower in children with ADHD compared to those of controls (Figure1). Interestingly, acetic acid and propionic acid levels were negatively correlated with ADHD symptoms (Table 1). Macronutrient and fiber intake, determined from food frequency questionnaires, did not differ between groups.Table 1.The regression analyses predicting ADHD symptoms scores from fecal short-chain fatty acids level.

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Our findings suggested that gut dysbiosis was possibly developed in children with ADHD, as indicated by a significant decrease in fecal SCFAs. In fact, fecal acetic acid, propionic acid, and butyric acid may potentially be the early detector for ADHD. In addition, fecal acetic acid and propionic acid could be potential biomarkers for the severity of ADHD.

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Phubbing with smartphones becoming an integral part of life and sociotelism behavior has emerged as an important academic concern (Chotpitayasunondh et al.,CHB,2016; 63, 9-18). Expectation of social support in social networks: It can be defined as “When the individual is emotionally intense, he/she shares about this situation and emotions and expects to be paid attention to, sincere and friendly approach from the people on social networking sites, and hopes that an environment of support and trust will be created with social networks by seeing that he/she is not alone with more emotional support.” (Uzakgiden et. al., JASR 2019;2 20-24)

In the nursing profession, in addition to using the internet for professional requirements, being a member of online social networking sites and spending time on these platforms are increasing.It is important to know the status of phubbing, which damages face-to-face communication understand its effect on patient-nurse communication and nurses communication within the team. Due to the intensity of work life in the nursing profession and the length of hours spent at work, the effort to meet the need for social support virtually may increase phubbing behavior.

The aim of this study was to examine the relationship among phubbing, online social support and trait anxiety, and the related factors in nurses.

The population of the research consists of nurses who actively use their social media accounts. Nurses were accessed by snowball method on online Whatsapp groups, Instagram and Facebook platforms through a digital survey between May and November 2021. Data collected by using an individual descriptive characteristics form, generic scale of phubbing, online social support scale, trait anxiety inventory. Mann-Whitney U, Kruskal-Wallis H tests, t-test and pearson correlation coefficient was used for data analysis.

The phubbing scores of the nurses ranged from 15 to 98; the trait anxiety levels of the nurses were at a moderate level. It was observed that marital status, presence of WhatsApp groups with teammates, and being warned about the frequency of phone use from teammates was related to phubbingg (p<0.001). There was a positive moderate correlation between the phubbing score and the online social support score; a weak positive correlation was found between the general phubbing score and the trait anxiety score.

It was determined that social support from social media significantly affected the phubbing behavior of nurses and that trait anxiety mediated this relationship. In future studies, researchers can conduct extensive research on the effect of sociotelism on nurse-patient communication and care. This study was also important in terms of making significant contributions to the literature, where there are only a limited number of studies on phubbing.

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The last decade has seen an enormous expansion on our knowledge of the human gut microbiome and its importance for human physiology. The gastrointestinal inhabitants have taken centre stage as regulators of the bidirectional gut to brain communication. The gut microbiota is not only critical for metabolism, glucose homeostasis and body composition, but increasing evidence is demonstrating the significant effects of the gut microbiota on mood and mental wellbeing and its role in the development of affective disorders, such as anxiety and depression, and other neuropsychiatric conditions. Studies in the field of nutritional neuroscience and nutritional psychiatry are now increasingly including the gut microbiota as a key factor mediating the impact of diet on central nervous system function. Accumulating evidence from cell-based in vitro studies, animal models and preclinical intervention studies are linking the gut microbiota to the effects of diet on brain function, but the precise mechanism are still not fully understood and studies have had limited translation to human intervention studies. Overall, the increase in our understanding of interconnectedness of the gastrointestinal microbiota of human health and disease, has led to a strong focus on the development of microbiota-targeted strategies to influence all host physiological responses, including those that can modulate central nervous system function. In this talk, I will provide an overview of the most recent advances in the nutritional psychiatry–microbiome field, highlighting significant opportunities for future research.

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Insomnia is a robust risk factor for depression. Treating insomnia with digital CBT-I (dCBT-I) has been shown to prevent future episodes of depression; however, remission rate of insomnia following dCBT-I is lower compared to face-to-face CBT-I (fCBT-I), which may reduce the effect on depression prevention. A stepped-care model can optimize care by starting with a least resource intensive intervention (step 1: dCBT-I) and stepping-up non-remitters to specialized treatment (step 2: face-to-face CBT-I).

This study examined the efficacy of a stepped-care approach to prevent depression.

1018 individuals with DSM-5 insomnia and no depression were randomized into two conditions at step 1: dCBT-I (n=613), or an online sleep education control (n=624). Participants in the dCBT-I condition who did not show remission for insomnia (ISI>9) were further randomized to either face-to-face CBT-I (n=103) or sleep education (n=104). Rates of clinically significant depression (moderate severity and above) was assessed at one-year follow-up.

Insomnia remission rates were higher in the dCBT-I group (40%) compared to the control group (22%). Those who did not remit following step-1 dCBT-I showed step-2 insomnia remission rates of 75% following fCBT-I compared to 38% following the step 2 control.

At one year follow-up, the incident rate of clinically significant depression was 2.4 times higher in those who received control (13.2%) compared to fCBT-I (5.5%) at step 2. Depression rate was 10.1% in those who did not receive dCBT-I at step-1.

Preliminary evidence from this study provide supported that a stepped-care approach may produce greater protection against incident depression than dCBT-I alone.

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Accelerated biological ageing might contribute to the higher prevalence of age-related diseases and excess mortality amongst individuals with mental disorders. Recent advances in machine learning and the collection of high-dimensional molecular “omics” data allow for the quantification of biological age.

The aim of this study was to use machine learning methods to predict biological age from nuclear magnetic resonance spectroscopy metabolomics data and to identify psychiatric traits associated with accelerated biological ageing.

The UK Biobank is a multicentre community-based observational study that recruited >500,000 middle-aged and older adults. 168 metabolomic measures were quantified using the Nightingale Health platform. Phase 1 release of these data included a random subset of 118,462 UK Biobank participants. Metabolomic age delta (MetaboAgeΔ) was defined as the difference between predicted biological age and observed chronological age. We estimated group differences in MetaboAgeΔ between individuals with and without mental disorders and examined whether polygenic scores for mental disorders predicted MetaboAgeΔ.

Up to 110,780 participants with complete data on all metabolomic measures were included in the analysis. Individuals with a history of mental disorders had higher MetaboAgeΔ values than people without a mental illness. For example, MetaboAgeΔ suggested that the difference between predicted biological age and observed chronological age was about two-years greater amongst individuals with bipolar disorder than amongst people without mental illness. Polygenic scores for mental disorders were positively correlated with MetaboAgeΔ.

These findings suggest that individuals with a history of mental disorders or with higher polygenic scores for mental disorders were biologically older than their chronological age.

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Accumulating studies have pointed out that gut-blood and blood-brain barrier dysfunctions due to the alterations in permeability may play a role in the pathophysiology of neurodevelopmental disorders. Tight junctions are crucial components of these barriers and some peptides including claudin-5, occludin, zonulin and tricellulin are important components of these structures.

This study aimed to investigate the relationship between these molecules and attention deficit hyperactivity disorder (ADHD) in children and adolescents.

A total of 57 children with ADHD and 60 controls aged between 6 and 12 years were included in the study. The severity of ADHD symptoms was assessed through a parent-rated questionnaire and Conner’s Continuous Performance Test. Serum levels of biochemical variables were measured using enzyme-linked immunosorbent assay kits.

Serum claudin-5 and tricellulin levels were significantly lower in the ADHD group compared to the control group. The difference between the groups in terms of serum claudin-5 and tricellulin levels remained significant after controlling for confounding factors such as age, gender and autistic characteristics. There was no significant difference between the groups in terms of serum zonulin and occludin levels. (Table 1)Table 2.

Serum claudin-5, occludin, zonulin and tricellulin levels of ADHD and controls

These results suggest that claudin-5 and tricellulin may be involved in the etiopathogenesis of ADHD. Alterations in these peptides may affect the brain by leading a dysregulation in intestinal or blood-brain barrier permeability that eventually affects the gut-brain axis. The causal relationship between these peptides and ADHD requires further investigation.

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Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia are among the most frequent developmental disorders in school-aged students, and both often cause an impact on scholar reading performance. Therefore, it is fundamental to trace the differential profile in reading performance in such diagnoses. Competent reading occurs through the interaction of several cognitive processes, such as decoding, fluency, and oral and reading comprehension, that should be assessed in an evaluation.

The study aimed to characterize the performance of students with ADHD and dyslexia.

We assessed 25 adolescents, aged between 11 and 14 years old, from 6th to 9th year of middle school of public and private schools in Brazil, divided into two groups: the group with ADHD (16 students) and the group with dyslexia (9 students). The diagnoses were established by a multidisciplinary center and there were no comorbidities for any case. The instruments used were: Comprehension Test of Words and Pseudowords II (TCLPP II) to assess decoding (indicate if the word is correct or incorrect); Reading Fluency Test (TFL) to assess fluency in single words and in text reading; Cloze Reading Comprehension Test (TCCL) to measure reading comprehension; and the WISC vocabulary subtest to assess auditory comprehension.

Non-parametric analyzes revealed statistically significant differences in measures of textual comprehension, especially in the tasks that involved decoding and fluency processes, evidencing superior performance of the group with ADHD in these tests. Participants with dyslexia had a significantly higher performance in relation to the number of word omissions, that is, they had lower omission errors. There was no significant difference between groups in auditory comprehension.

A differential profile was found in reading performance, consistent with the cognitive deficits classically pointed out in the literature for each diagnosis: phonological deficits in dyslexia, with problems in decoding and fluency; and attentional deficits in ADHD, with omission errors. In the comprehension measures, dyslexic group had significant lower performance than ADHD in the Cloze Reading Comprehension Test, but there was no difference in the Vocabulary subtest-WISC. An explanatory hypothesis is that, to understand the text, it is necessary to recognize the words previously, whereas, in the WISC, it is not necessary to read, since the questions are oral. These results corroborate the hypothesis that deficits in reading comprehension in dyslexia are more related to difficulties in word recognition and fluency skills than in general listening comprehension.

Financial support: CAPES Proex [grant 0426/2021, no. 23038.006837/2021-73]; CNPq [grant 310845/2021-1]

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Previous researches have not distinguished between-person effects from within-person effects when exploring the relationship between self-esteem, coping styles, and anxiety symptoms among adolescents.

To address this gap, this study investigated reciprocal associations among self-esteem, coping styles, and anxiety symptoms in a three-wave longitudinal panel survey, using an analytical strategy that disaggregates within-person and between-person variance.

The data was drawn from the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research study conducted in 10 public schools in the Guangdong province of China. All participants had a baseline visit (N = 1957, age 13.6, grades 7 and 10) and follow-up interviews at one-year intervals for 3 years. A random intercept cross-lagged panel model combined with mediation analysis was performed.

At the within-person level, following results were observed. (1) Low self-esteem and anxiety symptoms bidirectionally predicted each other. (2) Low self-esteem and negative coping style bidirectionally predicted each other. (3) Anxiety symptoms predicted subsequent negative coping style but not vice versa. At the between-person level, we obtained the following main results. (1) Significant predictive effects on the random intercept were found among all three study constructs. (2) There were sex differences regarding the association between self-esteem and anxiety symptoms and the correlation strength of females was greater than that of males. (3) Self-esteem mediated the reciprocal relations between coping styles and anxiety symptoms.

These results could be an important advance by elucidating the reciprocal relationships among self-esteem, coping styles, and anxiety symptoms at the within-person level, suggesting that interventions targeted at promoting self-esteem and cultivating positive coping style may help reduce adolescent anxiety.

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Waiting and stopping are essential and distinct elements of appropriate behavioral control with its dysfunction implicated in various impulsivity related mental disorders. Although rodent and human studies have investigated both phenomena, the role of preparing to stop in waiting impulsivity has rarely been investigated. Furthermore, convergent evidence from multi-modal investigation tools remains a poorly utilized approach in addressing such questions.

Here, we conducted two separate, but hierarchical studies, using functional magnetic resonance imaging (fMRI) to map the neural circuit involved in waiting impulsivity and proactive stopping, and subsequently provide mechanistic and causal evidence of disruption of this circuit by transcranial magnetic stimulation (TMS). In the second study, based on our fMRI study data, we attempted to investigate possible causation between the LIFG and waiting impulsivity by modulating LIFG, i.e. non-invasively producing a “virtual lesion” with an inhibitory transcranial magnetic stimulation (TMS) protocol called continuous theta burst stimulation

We recruited 41 healthy volunteers who performed an adapted version (1CSRT) of the well-established 5 choice serial reaction time task to capture waiting impulsivity. We developed a novel task measuring proactive inhibition. We scanned participants while completing these two tasks. Our fMRI data showed a strong association between LIFG activity and waiting impulsivity on the 1CSRT task. We conducted a single-blind, randomized, between-subjects design of cTBS of the LIFG on a sample of 51 healthy volunteers who completed an adapted version of the 1CSRT task (2CSRT task). Our a priori hypothesis was that cTBS would transiently decrease local cortical activity of the LIFG and increase the frequency of premature responses on both fixed and delayed cue-target interval trials on the 2CSRT task.

We first show a shared neural network comprising the pre-supplementary motor area and bilateral anterior insula underlying both waiting impulsivity and proactive stopping. We further demonstrate activity in dorsomedial prefrontal cortex and left inferior frontal gyrus (LIFG) negatively correlated with waiting impulsivity in trials with additional target onset delay. We demonstrate active stimulation significantly increased waiting impulsivity.

In these two studies, we validated a novel task measuring proactive inhibition. We further validated the significance of task structure for assessing distinct aspects of impulsivity, which is of translational interest. We further established a causal role of lIFG for waiting impulsivity thus highlighting the integrity of LIFG and related neural circuitry required in waiting impulsivity.

None Declared

Creating appropriate and sustainable treatment plans for patients with concurrent disorders presents a challenge to psychiatrists and addiction medicine specialists alike. Although varenicline has been found to be one of the most effective medications for smoking cessation and abstinence, caution is needed when starting patients on this medication. In this case, a young female provisionally diagnosed with bipolar I disorder was hospitalized for a manic episode in the context of substance abuse and medical noncompliance. She also endorsed a long history of smoking, alcohol, cocaine, cannabis and ketamine use. In addition to being stabilized for bipolar disorder, the patient was started on varenicline for smoking cessation on Day 14 of admission.

This case report highlights the potential risk of de-stabilization in a vulnerable youth with newly diagnosed bipolar I disorder and precarious social circumstances, in attempts to further concurrent approaches to psychiatric care.

In addition to qualitative observations, the main objective exam used to track patient progress through the duration of her hospitalization was the mental status exam (MSE). This is standard practice for psychiatric care and qualitatively assessed factors related to a patient’s behavioral and cognitive functioning. Important factors assessed for this patient include appearance and behavior, speech, affect and mood, thought form, thought content, perceptual abnormalities, insight and cognition.

Perceptual abnormalities, including auditory hallucinations, were not recorded at admission and the patient’s symptoms of mania were resolving clinically on Day 18. Two days after starting varenicline, the patient developed auditory hallucinations, paranoia and referential beliefs. However, her insight was intact, and she had minimal thought-form disorganization. The patient also reported hearing auditory hallucinations of a derogatory nature, with her mood appearing more distressed during varenicline use. Symptoms were found to be resolved shortly after the discontinuation of varenicline on Day 18 and the patient appeared to be less distressed on following days. In this case, these symptoms were not in keeping with her bipolar diagnosis and thought to be secondary to varenicline after the consideration of potential alternative contributors.

The occurrence of side effects as a result of varenicline use in patients with diagnosed mental health conditions is rare and underlying psychiatric illness is not labeled as an absolute contraindication in the prescription of varenicline. However, it is important to advocate for increased guidance and research on the treatment of substance use disorders in patients with bipolar I disorder.

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Depression during pregnancy can appear with a prevalence of up to 11% of pregnant women. Psychotherapeutic treatment in these cases is considered the first option, but treatment with antidepressants is sometimes required in these cases.

To present a clinical case of a pregnant patient diagnosed with depression.

Literature review of the psychopharmacological treatment of depression during pregnancy and possible complications.

A 25y Year old woman, 22 weeks pregnant, who lives with her partner. She has no background in mental health. Paternal aunt diagnosed with type I Bipolar Disorder. She goes to the Mental Health Center for evaluation, due to anxiety and depressive symptoms of 4 weeks of evolution, she refers sadness and apathy, continuous crying, somatic anxiety and obsessive ruminations in relation to childbirth and inability to care for your child. Suicidal ideation as a resolution of her discomfort. She presents with global insomnia and a significant loss of appetite, with a weight loss of 3 kg. Treatment with sertraline 50 mg/day was started, with good tolerance and clinical response

The psychopharmacological treatment of antenatal depression is a challenge for the psychiatric professional. In all cases, an adequate balance must be made between the risks and complications for the fetus and the psychopathological stability of the pregnant woman. Among the main risks of untreated depression are: preterm delivery and low birth weight, an increased risk of suicide and alterations in the development during the baby’s infancy. The most used antidepressants are the SSRIs, with sertraline being a good option. Paroxetine has been associated with cardiac defects in the newborn. There are studies with tricyclics and duals but no specific teratogenic pattern has been seen. They are associated with an increased risk of spontaneous abortion. Exposure during the third trimester may be associated with obstetric complications.

None Declared

Functional neurological disorders (FNDs) and autism spectrum disorders (ASDs) share common features in terms of deficits in emotion regulation and recognition, sensory sensitivity, proprioception and interoception. Nevertheless, few studies have assesed teir overlap.

Aims of the present study were: (i) to assess the prevalence of autistic traits in a sample of adult patients with FNDs and (ii) to assess the prevalence of FNS in a sample of adult individuals with ASDs without intellectual disabilities; in this sample, we also evaluated the presence of a possible association between sensory sensitivity and FNS.

We recruited 21 patients with FNDs, 30 individuals with ASDs without intellectual disabilities and 45 neurotypical adults (NA). Participants completed: the Autism Quotient (AQ); the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R); and a questionnaire assessing functional neurological symptoms (FNS). ASDs participants also completed the Sensory Perception Quotient-Short Form (SPQ-SF35), assessing sensory sensitivity.

In the FNDs sample, no patient scored above the clinical cut-off at the AQ and the 19% scored above the cut-off at the RAADS-R, a prevalence similar to the one we found in NA (15.6%; both p > 0.05). The 86.7% of participants with ASDs reported at least one FNS, a prevalence significantly higher than the NA one (35.6%, p < 0.001). In the ASDs sample, tactile hypersensitivity was found to be a risk factor for functional weakness (OR = 0.74, p = 0.033) and paraesthesia (OR = 0.753, p = 0.019).

In conclusions, FNDs individuals did not present autistic traits more than NA, but ASDs individuals presented a higher number of FNSs than NA; this rate was associated with higher sensory sensitivity, especially in the touch domain.

None Declared