Suicide in older people is a critical public and mental health issue which requires attention, given that the ageing population is increasing.

Multiple factors, including biological, psychological, and social stressors increase suicidal susceptibility. Unfortunately, elderly are more susceptible to these, such as psychiatric disturbances, physical comorbidities, prior suicide-related behaviours, lack of social support, grief, and increased difficulty in problem-solving

In order to review the risk and protective factors, assessment and prevention of suicide in older adults.

Bibliographic research through PubMed and Web of Science.

Older people can be subdivided into three age groups (from “young old” at 65 years old to “oldest old” after 85 years of age), with suicide being more prevalent in the oldest-old, and overall in men above 75 years old.

Previous psychiatric background, suicidal attempts, substance abuse, poor physical health or disability, family psychiatric history, low social support or isolation, and finantial stress most frequently predispose to suicidal ideation, suicide attempts or death by suicide in this community.

Besides this, ageing relates to a tendency to cognitive impairment, which affects coping mechanisms, leading to deficits in reasoning and decision-making under stressful circumstances during depressive episodes. This can mediate suicidal ideation and associates to greater lethality methods. Geriatric suicidal attempters have been shown to have greater degrees of cortical and subcortical cerebral areas, including the frontal, parietal and temporal regions, as well as significant loss of volume in the dorsomedial prefrontal cortex, insula, midbrain, cerebellum, lentiform nucleus and putamen. Abnormalities in these regions can impair executive and cognitive function, attention, problem solving and ultimately be responsible for suicidal behaviour.

On the other hand, there are suicide protective elements such as physical and cognitive fitness, quality of life and life satisfaction, marital status, religiousness and social support. A prompt identification of modifiable risk factors and strengthening the protective ones by health professionals can reduce this prospect.

Suicidal ideation in older people is a multifactorial public health concern given the very high frequency of completed suicides in this population. Therefore, it is urgent to review and further research to build more effective suicide prevention strategies.

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In mental health settings, there is no place more social than where people smoke tobacco, patients and healthcare professionals alike much as many social activities in other settings even nowadays.

Yet mental illness is associated with higher levels of social anxiety. Those who suffer are doing their coping and may appear to be doing better than the others but in fact may need special attention for smoking cessation because they are still smoking more than other patient populations.

To reflect on tobacco smoking and social anxiety.

Pubmed search using terms: tobacco and smoking and social anxiety/ social anxiety disorder

Social anxiety:

1. 1. Is associated with higher smoking initiation and progression to dependence

2. 2. is more frequent in smokers

3. 3. is used as a coping mechanism for distress caused by social interactions and may alleviate negative affect and thus serve as negative reinforcement

4. 4. may be associated with higher nicotine dependence

5. 5. has not been definitely associated with heavier smoking

6. 6. may differ in its effects according to gender

7. 7. may be associated with less quit attempts

8. 8. may hinder success in quitting smoking and may be associated with higher rates of relapse

Identifying and treating social anxiety may lead to better outcomes in smoking cessation in a sub-group of patients who present elevated social anxiety with or without social anxiety disorder.

Patients with mental illness, especially serious mental illness, will likely present with higher levels of social anxiety which may represent a significant factor contributing to an increased difficulty in quitting tobacco smoking in this patient population.

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The response to placebo is robust in studies of various antidepressant treatments. The strong placebo response, combined with the absence of side-effects, has prompted suggestions to use the ethically sound open-label placebo (OLP) as a treatment for depression.

The aim of the present study was to assess the efficacy of OLP in the setting of a randomized controlled trial for the treatment of unipolar depression.

Thirty-eight patients (28 females, 73.7%) were randomized to either an eight-week treatment with OLP (n=18) or four week of treatment as usual (TAU) followed by four weeks of OLP (n=20). Clinical and socio-demographic measures were assessed at baseline, after four weeks, and at the end of the trial. Response to treatment was determined using the Quick Inventory of Depressive Symptomatology (QIDS SR-16).

There was an overall decrease in depression levels over time, F(2,35) = 3.98, p = .028). A significant group x time interaction was found only among non-geriatric patients (<65y) with an early onset of depression (<50y), F(2,22) = 3.89, p = .036]. Post-hoc tests indicated a significant decrease during the first four weeks, but only in the OLP group, t(11) = 2.29, p = .043.Table 1:

Demographic measures of OLP and TAU patients.

Image 3:

Our findings support the possibility that OLP is an effective treatment for the relatively young population of patients suffering from depression. Additional studies are warranted in order to explore the use of open-label placebo in clinical work.

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Obligate autoscopic mirror hallucinations of senescence have not heretofore been described.

To reveal that perception of looking older in the mirror may be the manifestation of Mirror Autoprosopometamorphopsia.

A 37 year old right handed female, with schizoaffective disorder, bipolar subtype She described that when she would gaze at herself in the mirror, she would not see her current face, but rather the visage of an “old person”. This would recur whenever she would directly look at herself in the mirror, and would avoid glancing at any mirrors because she was fearful of looking at her transform senescent countenance. She realised it was not another person but rather herself in the future, having become her geriartric self.

Abnormalities in Physical Examination: Mental Status Examination: Hyperverbal, grandiose with expansive affect, poor insight and judgment. Recalls 3 out of 4 objects in 3 minutes and all 4 with reinforcement. Proverb testing: correct abstraction. Neuropsychiatric Testing: The Patient Health Questionnaire 9:7 (mild depression). Other: Magnetic Resonance Imaging/ Magnetic Resonance Angiography of Brain with Infusion: Normal.

Autoscopic mirror hallucinations appearing only when embedded in a mirror are obligate autoscopic mirror hallucinations and suggest occipital and parietal lobe dysfunction (Virk, 2018). The inability to recognize the perception of another image or another person replacing the individual looking in the mirror, while defined as a mirror sign, may also be viewed as “a capgras syndrome for the mirror image” (Feinberg, 2005). Distortion of one’s own face only when viewed in a mirror is autoprosopometamorphopsia. With such distortion, this may be a misidentification of one’s own image. This phenomenon is classified as a form of delusional misidentification syndrome with inability to recognise one’s image in the mirror (Postal, 2005). Autoprosopometamorphopsia, obligate to mirror reflection, but metamorphosized to enhance perceived senescence, has not been specifically localized. Possibly a single lesion in the non dominant inferior parietal lobe may have caused this phenomenon. Somatoparaphrenia with somatosensory illusions involving body image are seen with parietal lobe dysfunction (Nightingale, 1982). In the general population, an individual’s focus on a mild facial imperfection often is associated with a negative view of their image. Exaggeration of this to involve the entire face, with projection of imperfection of aging, may be a somatic manifestation of such negative self image. It is possible that such senescent autoprospometamorphopsia may be prevalent, to a lesser degree, in the general population and may be a nidus for younger people seeking cosmetic and plastic surgical intervention of the face.

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Primary insomnia is frequently present in the general population, with epidemiologic research reporting prevalence values from 10% to as high as 60%. Chronic insomnia is associated with a significant impact on professional, academic, and daily life functionality, and it also may be responsible for decreasing the quality of life. Multiple generations of drugs for insomnia have been launched in clinical use in the last decades, but each class of pharmacological agents has its shortcomings (i.e., low efficacy, risk of addiction, diurnal sedation, risk of falls and fractures, etc.). Initially, research on orexin receptor antagonists has been considered with enthusiasm, due to these agents’ low risk of adverse events and good safety profile in the medium and long term.

To assess the evidence supporting the efficiency and safety of orexin receptor antagonists in the treatment of insomnia.

A literature review was performed through the main electronic databases (PubMed, Cochrane, Clarivate/Web Of Science, and EMBASE) using the search paradigm “primary insomnia” AND “orexin receptor modulators”. All papers published between January 2000 and September 2022 were included.

Suvorexant is a dual antagonist of orexin 1 and 2 receptors (DORA), FDA-approved for the treatment of insomnia, both for difficulties in falling and staying asleep. Daridorexant is another DORA, approved by FDA and EMA for the same indications as suvorexant, but EMA considers „additional monitoring” necessary for this drug. Lemborexant is a DORA approved for use in US and Japan, while vornorexant, which is included in the same class, is under development for the treatment of insomnia and sleep apnea (in phase 2 and 1 clinical trials, respectively). Almorexant is a DORA that was discontinued from clinical research due to hepatic safety concerns. Seltorexant is an orexin 2 receptor antagonist (SORA2) explored in phase II trials for the treatment of insomnia. Somnolence and fatigue are the most frequently reported adverse events of DORAs, but sleepwalking and sleep driving, sleep paralysis, or hypnopompic and hypnagogic hallucinations have been described in clinical studies. Seltorexant was associated with somnolence, headache, and nausea.

Dual antagonism of orexin 1 and 2 receptors is a mechanism that produced three currently available drugs for insomnia, and other clinical applications of these agents are still under investigation. At least one other agent from this class is under investigation, therefore the potential clinical utility of DORAs is far from being exhausted. Also, the selective orexin 2 receptor antagonism could be a promising mechanism of action for the treatment of insomnia.

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Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis and is a major public health problem in Morocco. The World Health Organization (WHO) recommends a four-drug combination therapy for two months (isoniazid (INH), rifampicin, pyrazinamide and ethambutol), followed by two drugs (INH and rifampicin) for 4 months, as first-line treatment for newly diagnosed pulmonary TB in children and adults. This regimen is generally considered effective, safe, and cost-effective. However, adverse effects and drug interactions often complicate the treatment of TB. Isoniazid is associated with 32% of adverse events, of which 1.9% are psychiatric.

focus on drug-induced etiologies of acute psychotic symptoms make the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition. focus on drug-induced etiologies of acute psychotic symptomsmake the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition.

The patient and guardians were interviewed to obtain information after their consent. Data from the patient profile forms and laboratory test reports were evaluated. Causality assessment was done by the WHO scale and the Naranjo scale. Oral informed consent was obtained from the patient and parents.

We report a case of acute psychosis in a child with a temporal sequence strongly in favor of INH-induced psychosis. Treatment with risperidone at an appropriate dose improved the symptomatology while waiting for the end of the antituberculosis protocol. As soon as the isoniazid was stopped, there was a clear return to the child’s premorbid state.

The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.

As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background.

The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background.

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Discrimination is seen as a behavioral response, caused by negative attitudes towards specific values of certain people, and can be considered an effective form of stigma.

The trans population has been the target of various forms of discrimination, not only through disrespect for their name and gender-appropriate pronouns, but also resorting to aggression, isolation, marginalization and consequent economic hardship. These experiences can negatively influence mental health (MH), namely a higher prevalence of substance use, depressive episodes, anxiety disorders and suicide attempts.

To identify the impact of discrimination and to determine the barriers associated with healthcare for trans person.

The P[I][C]OD methodology was used to prepare the research question: How does discrimination create barriers to health care for transgender people?. Research carried out through the EBSCOhost search engine, in the CINAHL Complete, MEDLINE Complete and Academic Search Complete databases, using the MeSH descriptors: “transgender”, “health”, “barriers” and “discrimination”, conjugated to the Boolean AND and OR, the search expression was obtained: (TI transgender OR AB transgerder) AND (TI discrimination OR AB discrimination) AND (TI health OR AB health) AND (TI barriers OR AB barriers). Inclusion criteria: studies published from 2018-2022; available in full text; English, Portuguese or Spanish languages. Sample of 6 articlesResults: Studies show that the trans person is often stigmatized, a victim of prejudice and discrimination in accessing health care, with an impact on MH. Barriers to accessing health care highlighted are: denial of care, lack of specialized services, lack of knowledge and support, failures in training and knowledge of guidelines by health professionals.

Prejudiced/insulting language and exclusion are episodes reported with high frequency. Denial and discouragement of exploration of gender identity are reported as episodes of indirect discrimination.

With regard to MH, the stress of gender minorities caused by stigma, prejudice and discrimination in health services creates a hostile and stressful social environment in the trans population, which causes MH problems.

Prescription and barriers lead trans person to avoid accessing care, with short and long-term adverse health warnings. The absence and/or lack of knowledge of health professionals contribute to this problem, making it crucial to invest in their academic training and continuous training, as well as in clinical practice guidelines and guidance, with the aim of training professionals.

It is necessary to acquire knowledge about the health of the trans person, particularly about the specific health needs and the creation of an inclusive environment between professionals and the person being cared for. Increased support, knowledge about issues related to the trans population and access to care improve MH.

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Bipolar disorder comorbidity rates are the highest among the major mental disorders. In addition to other intoxicants, alcohol is the most abused substance because it is socially accepted and can be legally bought and consumed. Estimates are between 40-70% with male predominance, which further influences the severity with a more complicated course of both disorders.

The objective of this article is to highlight the impact of substance use on the course and prognosis of bipolar disorder, as well as to make a differential diagnosis of a manic episode in this context.

Bibliographic review of scientific literature based on a relevant clinical case.

We present the case of a 45-year-old male patient. Single with no children. Unemployed. History of drug use since he was young: alcohol, cannabis and amphetamines. Diagnosed with bipolar disorder in 2012 after a manic episode that required hospital admission. During his evolution he presented two depressive episodes that required psychopharmacological treatment and follow-up by his psychiatrist of reference. Since then, he has been consuming alcohol and amphetamines occasionally, with a gradual increase until it became daily in the last month. He went to the emergency department for psychomotor agitation after being found in the street. He reported feeling threatened by a racial group presenting accelerated speech, insomnia and increased activity.

The presence of substance abuse complicates the clinical presentation, treatment and development of bipolar disorder. It is associated with a worse prognosis with multiple negative consequences including worsening symptom severity, increased risk of suicide and hospitalization, increased medical morbidity and complication of social problems. In addition, this comorbidity delays both the diagnosis and treatment, by masking the symptoms, and making more difficult an adequate differential diagnosis.

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The conditions of the COVID-19 pandemic, as well as the risks associated with it, led to a deterioration in the emotional state of many people: during the pandemic, an increase in the frequency of anxiety disorders was noted, especially among patients with chronic diseases of the respiratory system. Since the beginning of the COVID-19 pandemic, the respiratory system has been described as very “vulnerable” to the coronavirus.

To study the severity of anxiety and symptoms of dysfunctional breathing (DB) in patients with chronic respiratory diseases in the conditions of the COVID-19 pandemic.

We used: «The Perceived Stress Scale-10», «State-Trait Anxiety Inventory», «Short Health Anxiety Inventory», and Nijmegen questionnaire.The sample: 89 patients with respiratory diseases, the average age was 49.21±18.3. Of these, 38 patients with upper respiratory tract diseases (URTD) (J30-J39) and 51 patients with lower respiratory tract diseases (LRTD) (J40-J47). 49 people had a history of COVID-19 disease.

The sample of patients with both URTD and LRTD diseases is characterized by a high level of stress (27.13±6.937 vs 28.59±6.014, p=0.293). The average indicators of health anxiety in patients with LRTD diseases significantly exceed those of patients with URTD diseases (20.18±8.881 vs 15.68±7.022; p=0.01), which is consistent with data on a greater assessment of the disease threat compared with patients with upper respiratory tract diseases.The severity of DB symptoms in the group of patients with LRTD diseases significantly exceeds that in the group of patients with URTD (19.05±12.340 vs 24.29±11.470; p=0.042). Also in this group, there is a greater severity of individual symptoms of DB: spasm of the mouth muscles (p= 0.015), accelerated deep breathing (p= 0.002), shallow breathing (p=0.001) and the inability to take a deep breath (p=0.001).When analyzing the symptoms among patients who had and did not have a history of COVID-19, significant differences were found in such manifestations of DB as dizziness (1.98±1.351 vs 1.27±1.232; p=0.024) and confusion in the environment (0.61±0.891 vs 0.18±0.465; p=0.010), and also according to the severity of the symptoms of DB in general (23.76±11.996 vs 17.81±8.461; t=2.007, p=0.043).During the analysis, a relationship was established between the severity of DB symptoms and alertness to bodily sensations (R=0.259, p=0.014), which may indicate both an increase in DB symptoms with increased attention toward sensory sensations, and greater screening activity with an increase in DB symptoms. Increased alertness to bodily sensations is associated with situational stress (R=0.530; p=0.001) and personal anxiety (R=0.495, p=0.001).

The results obtained make it possible to identify categories of patients with chronic respiratory diseases who need psychological counseling and psychotherapy.

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People with eating disorders (EDs) exhibit a prevalence of childhood maltreatment higher than general population and, as for other psychiatric conditions, a history of childhood maltreatment in the context of EDs has been found associated with an earlier age at onset, a greater clinical severity, a more frequent comorbidity with other psychiatric conditions and a poorer treatment response . Neuroendocrine modifications as well as a heightened biological and emotional vulnerability to acute social stressor exposure and cortical measures alterations have been reported in people with EDs and history of childhood maltreatment. This evidence suggests the possibility to identify a “maltreated ecophenotype” also in people affected by EDs which recommends grouping individuals affected by the same psychiatric condition into subgroups characterized by different clinical and biological correlates in order to tailor treatements.

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Major depression is a common condition. Despite significant advances in psychopharmacology since the 1950s, the onset of action and drug resistance remain therapeutic challenges for traditional antidepressant agents, such as serotonin reuptake blockers. The recent discovery of the rapid antidepressant effect of ketamine, receptor antagonist, has revolutionized research in this field.

demonstration of the antidepressant properties of ketamine

For this purpose, major search engines such as Pubmed, medline, Science Direct, and journals specializing in sociology were contacted, with the introduction of keywords (ketamine-Esketamine-resistant depression) and the selection of literature reviews but also articles deemed relevant for this review.

The initial demonstration of ketamine’s antidepressant effects was gradual, rather unusually in a treatment-resistant patient population. First administered in single doses in studies, ketamine showed a rapid and robust antidepressant effect, but not sustained over time. However, studies of repeated doses, spread over a period of a few weeks, then revealed that it was possible to prolong and even improve the clinical response. It is important to mention that the use of ketamine to treat depression still remains.

In 2000, the first randomized-controlled, double-blind clinical study used a crossover design, in which each participant received two infusions over 40 minutes, alternating between one week and one infusion of ketamine (0. 5 mg/kg) and a placebo infusion. A statistically significant antidepressant effect of ketamine compared to placebo was observed as early as 240 minutes after treatment and reached a maximum after 3 days; of the 8 patients treated with ketamine, 7 had an improvement in their symptoms of at least 30% and 4 of at least 50%

In 2006, Zarate et al. carried out the first replication study of the results obtained by the group from Yale University . In this study, 71% and 29% of the 17 patients who received ketamine achieved a response and remission, respectively ,the significant effect of ketamine was revealed after 110 minutes of treatment and until the end of the 7-day post-infusion follow-up.However, one week later, only 35% of patients had reached the clinical response threshold.

In 2010, Diazgranados et al. published the first study of ketamine treatment for bipolar depression. While the first two studies required patients to take no other psychotropic drugs, patients in this study had to show unresponsiveness to a therapeutic dose of lithium or valproic acid, two agents used in the treatment of bipolar disorder. Again here, 71% of patients who received ketamine achieved a clinical response

Finally, note that the discovery of the antidepressant action of ketamine has opened the door to the search for other molecules targeting the glutamatergic system, which will possibly provide an even greater

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Severe mental disorders (i.e., schizophrenia spectrum disorders and bipolar disorders) have been associated with a high incidence of metabolic dysfunctions, diabetes mellitus (DM) included. There are multiple factors converging to this phenomenon, and not all of them are yet known (i.e., a specific genetic vulnerability, lifestyle factors, adverse events of antipsychotics and antidepressants, etc.). Glucagon-like peptide 1 receptor agonists (GLP1RAs), dipeptidyl-peptidase-4-inhibitors (DPP4Is), and sodium-glucose cotransporter 2 inhibitors (SGLT2Is) are new hypoglycemic drugs which are generally well tolerated and associate good glycemic control in clinical trials (usually in combination with classical antidiabetics).

To explore the available evidence supporting the use of new-generation hypoglycemic drugs (NGHD) in patients with severe mental disorders with comorbid DM.

A literature review was performed through the main electronic databases (PubMed, CINAHL, Clarivate/Web of Science, and EMBASE) using the search paradigm “schizophrenia spectrum disorders” OR “bipolar disorders” OR “major depression” AND “diabetes mellitus” AND “new-generation hypoglycemic agents” OR “glucagon-like peptide 1 receptor agonists” OR „dipeptidyl-peptidase-4-inhibitors” OR „sodium-glucose cotransporter 2 inhibitors”. All papers published between January 2000 and September 2022 were included.

Based on the reviewed papers, GLP1RAs may be useful (n=20 sources identified) in order to obtain glycemic control in patients with severe mental disorders receiving antipsychotics; SGLT2Is added to metformin could be beneficial to the same population, but data that support their use is extremely limited (n=4 sources); extremely limited data (n=2) about DPP-4Is do not allow to formulate any recommendation about this class in patients with severe mental disorders and associated DM. A number of ongoing trials have also been identified during this search (n=5), especially focused on GLP1RAs, which are expected to bring more information regarding the efficacy and safety of these drugs in this specific population. Most of the collected data in this review were of low and moderate quality.

Based on the currently available evidence, GLP1RAs and SGLT2As may be useful in the management of DM in patients with severe mental disorders, but more data about their long-term efficacy and safety is required before making any categorical recommendation.

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Globally, burns are responsible for around 11 million injuries and 180 000 burn-related deaths yearly. Unfortunately, 9 of 10 burn injuries and deaths happen in low-and-middle-income countries (LMICs) such as Pakistan. One in three people admitted to hospitals with burn injuries die within three weeks, and survivors face serious lifelong physical, emotional and psychosocial problems. This may result in anxiety, depression, post-traumatic stress disorder, increased mortality and social disintegration. This study aims to evaluate if implementation of a culturally adapted multidisciplinary rehabilitation programme for burn survivors is clinically and cost-effective, sustainable and scalable across Pakistan.

• - To understand lived experiences of burn survivors, families, and other stakeholders including the experience of care and impact of burns To work together with key stakeholders (such as burn survivors, family members) to adapt a culturally appropriate affordable burn rehabilitation programme

• - To undertake social media campaigns to promote burn prevention and risk assessment at communities, workplaces/industries/households; improve first aid; and address burn related stigma

• - To work with policy makers/parliamentarians to develop national guidelines for burns care and prevention in Pakistan

There are 6 work-packages (WPs). WP1 is to co-adapt a culturally appropriate burn care and rehabilitation programme. WP2 will develop and implement national burn registry on WHO’s initiative. WP3 is a cluster randomised controlled trial to determine clinical and cost-effectiveness in Pakistan. WP4 will evaluate social media campaigns for burn prevention and reduce stigma. WP5 involves working with key-stakeholders for burns-related care and policy and WP6 offers sustainable capacity and capability for burns treatment and rehabilitation.

A clinical and cost-effective burn care quality and rehabilitation programme may have a huge potential to save lives and contribute health and socio-economic benefits for patients, families, and the healthcare system in Pakistan. The nation-wide implementation and involvement of burn centres across all provinces offer an excellent opportunity to overcome the problem of burn care access experienced in LMICs.

To date, burns prevention, care and rehabilitation have not received sufficient attention in policy initiatives in Pakistan and other LMICs. This study is an excellent opportunity to evaluate culturally adapted burn care and rehabilitation programmes that can be implemented across LMICs. We will disseminate our findings widely, using a variety of approaches, supported by our stakeholder and patient advisory groups.

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Sunshine increases placebo effect in major depressive disorder (MDD) patients (Gailledreau et al., 2015). Kokras et al. (2014) showed that sunshine induces different responses in female than male mice in preclinical models of depression.

To determine if the sunshine induced placebo effect exhibits gender differences in human

Data from 9 double-blind, randomized, placebo-controlled studies of antidepressants conducted by the French GICIPI network were reviewed. MADRS (5) or HAM-D 17 (4) were used as the main efficacy tool. For each patient, variation of scores (Delta MADRS/Delta HAM-D) between two consecutive visits were correlated with the average sunshine index observed at noon between these visits. Sunshine indexes were provided by Météo-France. Correlations were computed with Microsoft Excel.

Sunshine increases placebo effect: however analysis of both genders (n=52) demonstrates no statistically significant (NS) correlation (r²=0.0064). Analysis of the males (n=8) demonstrates NS correlation in cloudy (< 1000 Joules/cm²), variable (1000-2000 Joules/cm²) or sunny (> 2000 Joules/cm²) weather. Although analysis of the females (n=44) demonstrates NS correlation as well for cloudy or variable weather (r²=0.0016), there is a strong correlation between sunshine index and Delta MADRS/Delta HAMD for females exposed to sunny weather: r²=0,315, n=20, p<0.01. This correlation is even stronger in the subpopulation of females aged less than 50 years: r²=0.6398, n=12, p<0.001.

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Sunshine increases placebo effect in female patients aged less than 50. This insufficiently known effect may be responsible for failure of a number of double-blind, randomized, studies of antidepressant compounds.

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Neuropsychiatric manifestations in human immunodeficiency virus (HIV) infection are uncommon but salient once they emerge to the surface. These symptoms can be the result of direct or indirect effects of the virus on the central nervous system (CNS). In particular, HIV related mania can complicate any stage of the infection but increases its frequency with the progression of HIV infection to the final stage.

The objective of this case report is to rase awareness about secondary mania due to HIV infection and the importance of etiological treatment in mental disorders.

We herein report the case of a 27-year-old, male patient, who was admitted to our Psychiatric Clinic I Cluj-Napoca, with a 3-week history of typical manic symptoms such as: elated mood, alternating with episodes of irritability, talking too much, familiarity, multiple future plans, hypersexuality, social disinhibition and decreased need for sleep. Throughout the hospitalization, the course of the manic symptomatology did not improve, additionally the patient started to exhibit neurological symptoms accompanied by complex visual hallucinations. Prior to this episode he reported depressive symptoms, predominantly anhedonia, apathy, and social withdrawal but without meeting the clinical severity threshold. The patient had no family history of a mental disorder. A psychopharmacological treatment was initiated (atypical antipsychotic Quetiapine XR 300 mg/day initially, and then switched to Olanzapine 10 mg/day, mood stabilizer Valproic Acid 1,5 g/day), but he developed significant extrapyramidal side effects.

Blood tests revealed: leukopenia, lymphopenia, thrombocytopenia, subsequently hepatic cytolysis, and high CRP. Psychometric evaluation revealed: Young Mania Rating Scale (YMRS) score 33/60 – moderate mania, Positive and Negative Syndrome Scale (PANSS)- total score 51 (16/49 Positive; 7/49 Negative; 28/112 General Psychopathology). MRI: T2 and FLAIR hyperintense extended areas in the bilateral periventricular white matter and in the internal capsule. The anamnesis, heteroanamnesis, paraclinical investigations led us to a diagnosis of secondary mania related to HIV infection. The patient was transferred to the Infectious Diseases Clinical Hospital for a targeted antiretroviral therapy (Raltegravir 800 mg/day, Emtricitabine/Tenofovir disoproxil 200mg/245 mg).

Recognizing and controlling HIV secondary mania should be of high importance given its association with heightened sexual behavior and substance abuse which can result in an elevated risk of transmitting the infection to other people.

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Although mastectomy is a treatment for the cleaning of cancer cells in the breast, it can also cause psychological changes in women.

This research was carried out to investigate the cognitive distortions, mental symptoms, and marital adjustment relationships in women with mastectomy.

The descriptive and comparatice study was conducted in a public hospital with 90 mastectomies and 90 healthy female samples. The data were collected using The Cognitive Distortions Scale (CDS), The Brief Symptom Inventory (BSI), and Marriage Adjustment Scale (MAS) and were evaluated by descriptive statistical analyzes, t test, Mann-Whitney U test and Spearman Correlation Analysis.

Women with mastectomy scored high in the healthy control group in all sub-dimensions of CDS and BSI and this difference is highly significant (p<0,5). Women with mastectomy scored higher in total agreement sub-dimensions than the healthy control group and the difference between them was statistically significant (p<0,5). There ara positive, very strong and statistically significant relationships between all sub-dimensions of the CDS and the total sub-dimension scores of the BSI (r=,769and, 919). There are positive, strong and statistically significant relationships between the sub-dimensions of the CDS and the sub-dimension of the agreement and the total score of MAS (r=681 and 734). There are strong and statistically significant relationships between the total and sub-dimension scores of the BSI and the sub-dimension and total score of the MAS’s agreement (r=,672 and 778).

Cognitive distortions and mental symptoms are significantly higher in women with mastectomy, and cognitive distortions are associated with mental symptoms. Cognitive distortions and psychological symptoms scores, marriage adjustment scores and agreement sub-dimension scores increase in women.

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Catatonia is a clinical syndrome characterized by behavioral alterations, which may include motor immobility or excitation. As a symptom, catatonia may be present in several mental disorders, primarily schizophrenia and mood disorders. Symptoms can be severe and can lead to dangerous and lethal conditions if not diagnosed and treated properly.

To describe the complicated evolution of a case of major depression with psychotic symptoms, which developed catatonic status. We discuss the psychopharmacological approach and non-pharmacological therapies (ECT).

Case summary. We have conducted a systematic review of the descriptions published to date, regarding this case.

We present a case of extreme severity, in a 55-year-old male, with a broad differential diagnosis with organic pathology, which required multidisciplinary management in conjunction with other specialties and multiple complementary tests.

Eventually diagnosed with major depression with psychotic symptoms evolving into a catatonic state. During more than one year of follow-up, multiple drugs have been tested sequentially: SSRI antidepressants, dual action, low-dose antipsychotics (caripracin, lurasidone, aripiprazole, olanzapine).

Finally, a good response was obtained in the treatment with lorazepam 1mg /6h and 12 sessions of ECT administered concomitantly.

In this case, the patient presented a refusal to eat and weight loss with a BMI of malnutrition. We had to be coordinated with the endocrinology service for a nutritional restitution strategy through dietary supplements. Once nutritional restitution was achieved, we started treatment with clomipramine, with good results on affective symptoms.

Nowadays, the origin and treatment of catatonia are still unclear.

We present the case of a man with melancholic depression with psychotic symptoms, who evolved into a catatonic syndrome. A good response was achieved with the combination of ECT and benzodiazepines.

We want to highlight nutritional recovery as an important point to achieve good absorption of antidepressant drugs. Once achieved, we started treatment with clomipramine with good results.

During the treatment, he has presented multiple difficulties and finally, he was able to leave after five months of hospitalization in the acute mental health unit.

None Declared

Brain-imaging findings implicate aberrant cortico-striatal neurocircuitry in the underlying pathology of OCD, so representing a potential treatment target. Ablative neurosurgery or deep brain (invasive) stimulation (DBS) of tracts or nodes within this circuitry is sometimes found to improve OCD, possibly by enhancing information-processing functions. Non-invasive neurostimulation, targeting superficial cortical nodes within cortico-striatal circuitry, is a safer and more acceptable alternative, with potential for scaling up and applying to a larger patient population, earlier in the course of illness.

Repetitive transcranial magnetic stimulation (rTMS) is the form of neuromodulation studied most in OCD. The orbitofrontal cortex (OFC), dorsolateral prefrontal cortex and supplementary motor area (SMA) have been identified as promising targets. The effect is larger for those not resistant to SSRI or failing to respond to only one SSRI trial. Thus, r-TMS may be best implemented earlier in the care pathway. rTMS is also relatively costly, involves specialist technical equipment and staff, and cannot be delivered in patients’ homes.

Transcranial direct current stimulation (tDCS) involves applying a low-amplitude (1-3mA) electric current to the brain via electrodes placed on the scalp. Compared with rTMS, tDCS tends to electrically modulate a more diffuse and superficial brain area, but it could represent a preferable option for patients with common mental disorders such as OCD, as it is cheaper, portable, simple and safe to use. In a recent randomised controlled feasibility study, the L-OFC represented the optimal target based on clinical changes. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol, longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, home-based approaches represent a rational next step.

N. Fineberg Grant / Research support from: In the past three years I have received research funding from the NIHR, COST and Orchard; . I have additionally received financial support to attend meetings from the British Association for Psychopharmacology, European College for Neuropsychopharmacology, Royal College of Psychiatrists, International College for Neuropsychopharmacology, World Psychiatric Association, International Forum for Mood and Anxiety Disorders, American College for Neuropsychopharmacology. In the past I have received funding from various pharmaceutical companies for research into the role of SSRIs and other forms of medication as treatments for OCD., Consultant of: payment for expert advisory work on psychopharmacology for the Medicines and Healthcare Products Regulatory Agency, royalties from Oxford University Press and an honorarium from Elsevier for editorial work., Paid Instructor of: payment for lectures for the Global Mental Health Academy.

The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).

The purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.

Descriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).

A 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.

In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.

She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.

In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.

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The share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.

None Declared

Chronic heart failure causes serious mental problems in the life of the patient and caregiver due to symptoms and repeated hospitalizations.

This study was conducted to investigate the levels of depression and interdependence in caregivers of patients with chronic heart failure and to examine the relationship of the patient’s depression level with caregiver depression and co-dependence scores.

The sample of the research, which is descriptive and relationship seeking, consists of 219 volunteer patients with chronic heart failure and caregivers who meet the research criteria. The data were collected using Personal Information Form, Beck Depression Scale and Co-Dependency Assessment Tool, and were evaluated with descriptive statistical analyzes, Kolmogorow-Smirnov, student-t, oneway ANOVA, Pearson correlation analysis and Mann Whitney U Test.

The average age of caregivers was 47.36 ± 12.46 and 60.3% were women. The average age of the patients is 60.70 ± 16.30 and 57.1% are male. Depression was found in 85.8% of patients according to the Beck depression scale score. The presence of depression in the patient and the total depression score of the caregiver (p <0.001), total co-dependency score (p <0.001), self-value (p = 0.001), medical problem (p <0.001) and self neglect (p = 0.005) subscale scores were higher than those who did not have depression. Co-dependence and depression scores are related in caregivers (r=0.367).

There was a positive and significant correlation between the depression levels of the patients and caregivers and the codependence levels of the caregivers, and according to the presence of depression, the mean scores of co-dependence in the caregiver differ.

None Declared