Catatonia is a complex psychomotor syndrome that often goes unrecognized and, consequently, untreated. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. Benzodiazepines and electroconvulsive therapy (ECT) are the most widely studied treatment methods. However, no uniform treatment method has yet been brought forward and no previous attempts to treat catatonia on a patient suffering concomitant major depressive disorder (MDD) with NMDA receptor antagonists have been documented so far.

To describe the unknown and novel management of catatonia and MDD with intranasal esketamine, a NMDA receptor antagonist.

A 55-year-old woman with a diagnosis of long-standing recurrent major depressive disorder who was admitted to the psychiatric inpatient unit of UniversityHospital Marqués de Valdecilla (Santander, Spain) suffering a complex catatonic, mutative state framed on a severe MDD. Different ineffective therapeutic interventions were deployed during the course of her illness. After failing to improve under conventional pharmacological treatment and ECT, and given the complexity of peripheral venous access on this patient (which disabled the option for iv ketamine use), we decided to initiate compassionate treatment with intranasal esketamine.

Intranasal esketamine was effective in the resolution of patient’s complex catatonic state. Clinical response from catatonia was observed after 6 intranasal esketamine administrations (2-week follow-up), reaching full catatonia and MDD remission after 12 sessions in absence of significant adverse events

Esketamine showed promising effectiveness for the treatment of catatonia in the context of MDD, although further research on this topic is needed.

None Declared

The peculiar requests of postgraduate teaching could affect the students’ lives, predisposing them to mental disorders and suicide risk (e.g. Abreu et al., 2021). The Interpersonal Psychological Theory of Suicide (IPTS) (Joiner, 2005) is a model that has proved useful in explaining this risk.

We analyzed risk factors associated with current suicidal ideation (SI) and history of suicidal planning and/or suicide attempt (SP/SA) in a sample of 97 Italian residents in psychological (n= 17, 17.5%) and medical and health care area (n=80, 82.5%) (mean age 29.18±3.25 SD).

Socio-demographic, psychological (i.e. State-Trait Anxiety Inventory, Beck Depression Inventory – II; BDI-II, Rosenberg Self-Esteem Scale, Reasons For Living Inventory; RFL, Psychache Scale, Mental pain questionnaire; MPQ, Visual Analogue Scale - VAS - on mental pain, Acquired Capability for Suicide Scale-Fearlessness About Death) psychosocial (i.e. Interpersonal Needs Questionnaire; INQ, UCLA Loneliness Scale Version 3, Multidimensional Scale of Perceived Social Support; MSPSS) and somatic pain features (i.e. VAS, Pain Vigilance and Awareness Questionnaire; Self-Awareness Questionnaire; SAQ) were collected through an online questionnaire. We compared residents with SI vs No SI and residents with SP/SA vs No SP/SA and the emerged significant variables, have been inserted in logistic regression models with stepwise method, backward elimination.

The presence of depression (BDI-II), low reasons for living (RFL), psychological pain (Psychache Scale and MPQ), interoceptive awareness (SAQ), Thwarted Belongingness (TB, INQ subscale), loneliness (UCLA) and low perceived social support (MSPSS) were associated with both current SI and history of SP/SA. Concerning regression models, TB (INQ) increased the likelihood of SI while Survival and Coping Beliefs (RFL subscale) reduced it. The model explained 49% of the variance of SI by correctly predicting 88.7% of SI cases. Perceived social support (MSPSS)reduced the likelihood of current SP/SA levels while interoceptive awareness (SAQ) increased it. This model explained 40% of the variance of SP/SA by correctly predicting 82.5% of suicide risk cases.

We have identified risk and protective factors for suicide, consistent with the IPTS, which can orient the prevention, evaluation and clinical treatment of residents.

None Declared

Childbirth can be a very painful experience, especially vaginally. It can have many complications. The obstetrical complications of caesarean section are well studied but its psychological complications are little mentioned. Most women recover quickly after giving birth, but others seem to have more difficulty. Researchers have attempted to identify perinatal risk factors for the development of post-traumatic stress disorder in parturients and caesarean section seems to be one of the predictors.

The objective of our study is to detect post traumatic stress disorder in women after vaginal delivery.

This is a cross-sectional descriptive study conducted among women from the general population who have given birth vaginally. The information was collected using a questionnaire distributed on social networks. Symptom severity was quantified using the PTSD checklist for DSM-V (PCL-5).PCL-5 is a 20-item self-assessment that measures the 20 DSM-5 symptoms of PTSD. She rates each symptom from 0 (not at all) to 4 (extremely). The score varies from 0 to 80. A threshold of 33 allows screening for post-traumatic stress disorder.

61 women took part in this study, 81.5% of whom gave birth vaginally between the ages of 20 and 30.70.3% of the participants gave birth vaginally once, 44.4% twice and 7.3% of the women in our sample had a caesarean three times.Regarding the indication of the high way in our sample: the narrowing of the pelvis and fetal distress were in 22.2%. Exceeding term was in 18.5% of cases.In our sample, 59.3% of the women had planned their vaginal delivery and 40.7% had given birth urgently.Regarding the results of the PCL-5 scale (PTSD checklist for DSM-V), the score varies between 0 and 48 with a median score equal to 12. 3.7% of the participants had a score greater than 33.

Post-traumatic stress disorder can accompany childbirth, especially when it is high and in an emergency. Postpartum post traumatic stress disorder affects the mother-child relationship and can be complicated by depressive disorder. Medical monitoring of pregnancy, good medical and family support for the parturient and preparation for childbirth are necessary to better start the maternity experience.

None Declared

The Psychogeriatric Department of the Institute of Mental Health (IMH) in Singapore provides acute inpatient services for elderly patients with severe mental health problems. The average length of stay for inpatients in 2020 was 46 days, which was significantly higher than the ideal length of stay set by the hospital of 21 days. This contributed significantly to healthcare costs and reduced bed capacity for acute admissions from the Emergency Service. Prolonged inpatient stays can lead to physical decompensation including reduced muscle strength, pulmonary capacity and osteoporosis.[i]

[i] Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993 Feb 1;118(3):219-23. doi: 10.7326/0003-4819-118-3-199302010-00011. PMID: 8417639.

We aimed to profile and identify patients in acute psychogeriatric wards who had prolonged inpatient stays.

A cross-sectional audit was performed. We used a data collection sheet to capture demographic, social and clinical information of all inpatients residing in the acute psychogeriatric wards on 1st November 2020, whose inpatient stays exceeded one month (over-stayers).

Demographic profile: Out of 57 inpatients (28 male patients and 29 female patients), 26 patients (46%) were over-stayers. Out of these 26 over-stayers, 18 patients (69%) were female and 14 patients (54%) were above age 70.

Clinical profile (n=26): 19 patients (73.1%) were diagnosed with dementia. 18 patients (69.2%) had severe Behavioral and Psychological Symptoms of Dementia (BPSD). 22 patients (84.6%) required assistance in their basic activities of daily living.

Social profile (n=26): Caregivers of 18 patients (69%) were burnt out by patient’s behavior problems, which is commonly seen in caregivers for patients with dementia[ii]. Family members of 3 patients (11.5%) were estranged from them. Caregivers of 3 patients (11.5%) had difficulty engaging additional caregiver support for ADL assistance.

[ii] Reuben DB, Romero T, Evertson LC, Jennings LA. Overwhelmed: a Dementia Caregiver Vital Sign. J Gen Intern Med. 2022 Aug;37(10):2469-2474. doi: 10.1007/s11606-021-07054-3. Epub 2021 Aug 13. PMID: 34389938; PMCID: PMC9360256.

The above profiles enabled the department of Geriatric Psychiatry in IMH to identify elderly patients at risk of prolonged hospital stay at the beginning of their admission and improve the care of these patients to reduce their length of stay.

None Declared

As written by Warsan Shire, “no one leaves home until the home is the mouth of a shark”. UNHCR defines forced displacement as “displaced because of persecution, conflict, generalized violence or human rights violations"

to study the prevalence of common Mental health disorders among forcibly displaced people and comparing with the common mental health disorders among host community members.

The OPD of BIPBS in SPH and BMCH of Quetta attends 800+ patients per month the data of the OPD of both hospitals was collected for Jan-May 2022 and was analyzed to numerate both the host community and refugees. out of 4120 for 354 refugee patients identified using their POR card and for 3776 of host community using their CNIC, data was analyzed for the prevalence of mental health disorders among them.

This study states that Afghan Refugees presented to OPD services of BIPBS, 47% were diagnosed as MDD with/without psychosis, 19% with GAD, 5% diagnosed as BAD, 5% With schizophrenia, 4% as PTSD, 3% as migraine, 3% conversion disorder, 2% OCD, 1% somatoform disorder and 10% of them presented with other psychiatric disorders, while in host community 21% were diagnosed as MDD with/without psychosis, 24% as GAD, 12% as somatoform disorder, 10% as OCD, 8% as migraine, 7% as conversion disorder, 4% as BAD, 3% as Schizophrenia, 3% as MBD due to substance misuse and rest of 7% presented with other psychiatric disorders.

The conclusion of this study states that mental health disorders are more common among refugees than in other populations, the result of this study shows that there is a big difference in the prevalence of mental health disorders among displaced people and the rest of the population, some of the Mental health disorders are present in higher percentage among displaced people rather than among host community, while some other disorders are present in lower percentage among displaced people rather than among host community, this study also highlights that further studies are needed to determine, risk and protective factors within the host community.

None Declared

Stress is inextricably linked to mental well-being while stressful events remain a major contributor to many common psychosomatic disorders. Traumatic events are universal stressors. Only some individuals participating in stressful events do not develop full-blown post-traumatic stress disorder (PTSD) but many of them manifest psychosomatic symptoms with a strong psychological component

The current study compared the severity of somatization, anxiety, depression, and distress in medical university students who were exposed and in those who were not exposed to a traumatic event.

Data were collected from 594 students of different faculties of the Poznan University of Medical Sciences in Poland. Participants were asked whether or not they had experienced any psychological trauma events and were asked to rate the intensity of psychosomatic symptoms they manifested. The data was collected using the Posttraumatic Diagnostic Scale (PDS) questionnaire and The Four-Dimensional Symptom Questionnaire (4 DSQ).

The study found that 78% of study participants experienced a traumatic event while 15% of them reported moderate and severe PTSD symptoms. 45% subjects reported moderate or high stress levels, 23% subjects reported symptoms of depression while 30% reported symptoms of anxiety. The analysis also demonstrated 26% of students participating in the study reported somatic symptoms.

In the subgroup of study participants with trauma history trauma sufferers, 36% subjects declared they experienced a one-time event, 23% subjects experienced trauma event twice while others experienced trauma ≥three times. The number of traumatic events was positively associated with the number of PTSD symptoms and severity of psychosomatic manifestations such as stress, depression, anxiety and somatization. In addition, the study analyzed whether traumatic events resulted from conscious and intentional harm by others. In this respect, 16% of subjects declared they participated in an event that was consciously and intentionally caused by others (e.g., battering or abuse). Students who experienced traumatic events related to intentionally harming another person were characterized by a greater severity of depression.

Study indicates that experiencing traumatic events is associated with a greater severity of a range of psychosomatic symptoms.

None Declared

Working in intensive care units and in emergencies is a stressful job. Taking care of acute and serious pathologies may cause various psychological diseases.

This study aimed to screen depression among emergency and intensive care caregivers and to determine factors associated with these disorders.

This is an exhaustive, descriptive and analytical cross-sectional study that interested paramedical caregivers working in the emergency and intensive care services from south Tunisia. We used an anonymous questionnaire that included sociodemographic, medical and professional characteristics and the subscale of depression from the Hospital anxiety and depression (HAD) scale.

A total of 240 patients participated in the survey. The prevalence of depression was 30.8%. In the univariate study, depression was associated with the female sex (P=0.006), university level (p=0.04) and anxiety (p<10-3). Three risk factors of depression were found in the multivariate analysis: female gender (OR=2.4 [1.1-7]; P=0.025), and the university school level (OR=5[1.5-16.7]; P =0.009).

Depressive disorders are common among caregivers in emergency and intensive care units. This finding highlights the importance of an early screening of these disorders to improve their management.

None Declared

The Food and Drug Administration (FDA) recently issued new warnings about the possible effects of the repeated or prolonged use of general anaesthesia and sedatives on the brain development of children under 4 years old during surgeries or paediatric procedures.

To evaluate the possible long-term neurotoxic impact the exposure to general anaesthesia has on the paediatric population from 0 to 4 years, which is the period during which the brain develops.

Initially, a search for observational studies that described the risk of neurotoxicity and alterations in the long-term cognitive development of children exposed to general anaesthesia before 4 years of age, was performed in PubMed between 2016 and 2020.

Finally, 5 retrospective cohort studies comparing children exposed and not exposed to general anaesthesia were included in this study. None of these showed significant differences in their main study variables. However, three of this studies found significant differences in some of the secondary variables such as speed of processing, motor skills, internalization of behaviour and learning, and attention deficit hyperactivity disorder (ADHD).

In vitro and in vivo studies of anesthetics have shown serious neurotoxic effects in the developing brain. However, the clinical relevance of these findings for children undergoing anesthesia remains unclear.

Most of these studies suggest a strong relationship between exposure to anesthesia in children aged 0 to 4 years, this being greater after multiple exposures. Despite these results, many of these articles conclude that further research is needed on this topic.

None Declared

Risk of functional impairment and progression to chronic illness in people with a first episode of psychosis (FEP) has motivated early intervention programs, showing promising results. Defining the characteristics of people with FEP at local level enables the clinicians to adjust interventional models to the reality of the population. The area 5 of Madrid (Spain) is referred to La Paz University Hospital and it serves a catchment area of roughly 527,000 people.

We aim to identify sociodemographic and clinical characteristics of patients in the area 5 of Madrid (Spain) who meet the criteria of FEP.

A descriptive retrospective study including 179 people (age range 18-40 years) who were attended in mental health services of La Paz University Hospital (area 5 of Madrid, Spain), between January 2019 and May 2020, having suffered a psychotic episode in the last five years.

The average age of people with FEP was 29.32 years, with a higher proportion of men (62%). The mean duration of untreated psychosis (DUP) was 3.64 months and 47% of patients consume cannabis. We found disparities in DUP among the different districts in the area and we also observed differences depending on the district for inclusion in rehabilitation programs or psychotherapy. The following averages were obtained for the aggregate sample: 1.01 hospitalization/year, 1.42 emergency room visits/year, 1.81 years of illness and a mean dosage equivalent to olanzapine 6.75 mg/day. The incidence of psychosis in our area has been 7.01 cases per 100000 inhabitants/year.

The incidence of psychosis has been as expected according to data recorded at previous studies in Spain. The results obtained in our sample have included a lower DUP and a higher use of cannabis than those described in the literature. We have also found differences when observing the inclusion of patients in different treatments (psychotherapy, rehabilitation), which may be related to the differences in the DUP by districts. Further exploration in this field is needed to draw causal conclusions.

None Declared

The COVID-19 pandemic has strongly impacted mental health outcomes of healthcare workers (HWs). In spite of the large literature reporting on Post-Traumatic Stress Disorder (PTSD) symptoms, only a few studies focused on potential positive aspects that may follow the exposure to the COVID-19 pandemic, namely post-traumatic growth (PTG) among HWs.

In a large sample of Italian HWs, we aimed to investigate the prevalence of PTSD, its correlates and whether PTG dimensions independently affect the risk of PTSD during the first COVID-19 wave.

An online self-report survey was submitted to HWs throughout physicians’ and nurses’ associations, social networks and researchers’ direct contacts, between April 4th and May 13th, 2020. Sociodemographic data, information about possible COVID-19 related stressful events, Impact of Event Scale-Revised (IES-R) and PTG Inventory-Short Form (PTGI-SF) scores were collected. IES-R and PTGI-SF scores were compared between subjects based on main sociodemographic, work- and COVID-19-related variables using the Student T-test or the one-way ANOVA where appropriate. Post-hoc comparisons were conducted using the Tukey test. Participants with total IES-R score >32 were assigned a provisional PTSD diagnosis and binary logistic regression analysis was conducted to investigate the contribution of each variable to the provisional PTSD diagnosis.

Out of 930 respondents, 256 (27,1%) reported a provisional PTSD diagnosis. Female sex (p<.001), separation from cohabiting family (p<.001), family members infected with (p<.05) or deceased due to (p<.05) COVID-19, increased workload (p<.05), relocation to a different work unit (p<.05) and unusual exposure to sufferance (p<.001) were significantly associated with higher IES-R mean scores. The median PTGI-SF score was 24. Factors associated with greater mean PTGI-SF scores were female gender (p<.001), being a nurse (p<.05), being older than 40 years (p<.05), and increased workload (p<.05). The logistic regression model showed that previous mental disorders (OR=1.65; 95% CI= 1.06-2.57) working in medical (OR=2.20; 95% CI=1.02-4.75), or service units (OR=2.34; 95% CI=1.10-4.98) (compared to frontline unit), relocation to a COVID-19 unit (OR=1.90; 95% CI=1.06-3.36), unusual exposure to sufferance (OR=2.83; 95% CI=1.79-4.48) and exposure to a traumatic event implying threat to self (compared to other work-related events) (OR=2.07; 95% CI=1.10, 3.89) significantly increase the risk of receiving a provisional diagnosis of PTSD, while the availability of personal protective equipment (OR=.61; 95% CI=.40-.94) and moderate or greater scores on PTGI-SF, particularly in the spiritual change domain (OR=.552; 95% CI=.35-.85), were found to be protective factors in relation to the PTSD diagnosis.

Our results shed light on possible protective factors against PTSD symptoms in HWs facing COVID-19 pandemic.

None Declared

The concept of social vulnerability arises in the individual-collective relationship and points to changing social conditions, built on the basis of power relations. In this context, vulnerability can be directly related to the deterioration of social and civil rights, resulting in the weakening of individuals’ citizenship. On the other hand, vulnerability can also lead to the deterioration of mental health. Stigma and discrimination generate low self-esteem, decreased self-confidence, reduced motivation, and less hope for the future.

This study aimed to explore the perceptions and experiences of vulnerability from the perspective of vulnerable people and identify strategies they used to reduce vulnerability.

This study employed a qualitative descriptive design. Using a purposeful sampling method, data were collected in April 2022. The following criteria were applied in the selection process: (1) adults with a personal sense of vulnerability or the experience of being vulnerable; and (2) understanding the Portuguese language and having reflective capacity.

A total of 12 respondents (6 male; 6 women) participated in study, mostly of middle-age. The manifestations of vulnerability reported by participants included being homeless, being a migrant, having an infectious disease, being drug dependent, experiencing a process of loss and grief and living socioeconomic difficulties. The data was summarized in terms of three major themes: (1) Conceptions about vulnerability, (2) Barriers imposed by vulnerability, and (3) Strategies for dealing with vulnerability. “Three subthemes were identified within the first theme: ontology condition that spreads, being alone “without network” and being exposed to external pressure (others). In the second theme, there were also three subthemes: discrimination/stigma, difficulties in social reintegration, and “my condition is difficult”. Lastly, in the third theme, we found four subthemes: the ability to ask for help/seek support, motivation, and commitment to behavioural change, not exposing others to the same risks, and ignoring the disapproving look of others” (Laranjeira et al., 2022, p.5).

Our findings demonstrated that vulnerability is a dynamic process of being exposed to circumstances that influence individual outcomes. However, there is a conceptual gap: vulnerability is regarded negatively, but vulnerability also has the capacity to shift life priorities for the better.

Laranjeira C., Piaça I., Vinagre H., Vaz AR., Ferreira S., Cordeiro L., Querido A. (2022). Vulnerability through the Eyes of People Attended by a Portuguese Community-Based Association: A Thematic Analysis. Healthcare. 10(10):1819. https://doi.org/10.3390/healthcare10101819

None Declared

One fairly common side effect of psychopharmaceuticals is sexual dysfunction. They can influence various aspects of sexual function, including lubrication, desire, ejaculation, and orgasmic intensity… This may worsen mental health conditions and make it challenging for patients to adhere to the Treatment. We’ll examine how these drugs affect the area of sexual activity.

To emphasise how different antipsychotics and antidepressants may affect sexual function.

We conducted a narrative review about the available literature on the subject. Articles were selected based on their clinical relevance.

All SSRI antidepressants carry a considerable risk of sexual dysfunction. According to some research, escitalopram and paroxetine may pose the greatest risk among this group. Similar risks of sexual issues exist with SNRIs. Bupropion, on the other hand, has a lot of evidence demonstrating low or no risk. Agomelatine, mirtazapine, and moclobemide also have a minor impact on sexual performance.

Hyperprolactinemia has been specifically linked to sexual impairment in antipsychotic medication, hence antipsychotics that cause hyperprolactinemia such as haloperidol, risperidone, paliperidone, and amisulpride are more likely to induce sexual disturbances. Aripiprazole, quetiapine, and ziprasidone have been demonstrated to be less or not connected to sexual dysfunction.

Although sexual dysfunction is not an unusual side effect of psychiatric medications, it is frequently underdiagnosed. Sexuality needs to be explored by therapists because it may affect patient’s treatment compliance and well-being. It’s critical to understand how each psychotropic drugs can impair sexual function in order to select the best option based on the individual traits of each person.

None Declared

Studies reported an initial decrease in the number of presentations and incidence of self-harm in young people during the pandemic. As the pandemic progressed young people may have experienced increased levels of distress, contributing to worsened mental health. There is a need for mental health services to evaluate the presentations of young people presenting to the Emergency Department (ED) so that services can meet the needs of young people.

To examine the mental health presentations of young people (aged 16-25) to the ED and how this may have changed since the start of the pandemic.

This study reviewed all 16–25-year-olds presenting to the Mater Misericordiae University Hospital (MMUH) who were triaged with a mental health issue in a 2 month period (September-October) over three years – 2019 (Period A), 2020 (Period B), 2021 (Period C). Approval for this service evaluation was granted by the Clinical Audit and Effectiveness Committee at the MMUH.

Of 232 presentations across all periods, there was no significant difference in the number of presentations in each study period - Period A (n=76), Period B (n=79) and Period C (n=77). In all three periods, most presentations occurred out of hours (A: 57.9% [n=44]; B: 74.7% [n=59]; C: 68.8% [n=53]) statistically significant (p=0.034) from before (A) to during the pandemic (B and C). Out of hours arrival by ambulance was most common in in Periods A and B (45.5% and 55.9%). Over all three periods discharge home was the most frequent outcome of assessment (A: 69.7% [n=53]; B: 70.9% [n=56]; C: 76.6% [n=59]). Overall, there was a decrease in self-harm presentations over the period (A: 47.4% [n=36]; B: 41.8% [n=33]; C: 40.3% [n=31]). The percentage of presentations with self-laceration increased during the pandemic (A: 33.3% [n=12]; B: 39.4% [n=13]; C: 48.4% [n=15]). There was a significant increase in attendees who were already taking psychotropic medications (p<0.001).

The findings suggest that the majority of 16–25-year-olds present out of hours and do not require admission. Although the number of presentations remained similar, the increase in out of hours presentations and arrivals by ambulance in Period B may reflect increased distress in the initial stages of the pandemic, and restricted access to services. The higher rates of medication prescribing suggests that these young people are already receiving health care, but that their needs are not being fully met. Mental health services should be designed to provide access to mental health care out of hours when young people are most likely to require them.

None Declared

Habituellement, nous voyons dans la consultation psychiatrique des patients épileptiques pour des plaintes psychologiques. Souvent pour un trouble anxieux ou dépressif. Dans d’autres cas, nous prenons en charge des patients psychiatriques atteints d’épilepsie.

L’objectif de notre travail est d’étudier la prévalence de la comorbidité psychiatrique dans une population de patients épileptiques.

Nous avons mené une étude transversale auprès de la consultation de l’hopital ar-razi de salé, à l’aide d’un questionnaire et d’échelles d’évaluation préétablies : le MINI (mini entretien neuropsychiatrique international), l’inventaire de la dépression de Beck, et Échelle d’anxiété de Hamilton.

55 patients ont répondu aux critères d’inclusion. L’âge moyen de nos patients est de 25,9 ans. Le sex-ratio F/H est de 1,6. Plus de la moitié de nos patients sont célibataires (78%). Seuls 21 % des patients ont une activité professionnelle régulière. La prévalence des troubles psychiatriques dans notre étude est de 66,6%. L’anxiété est retrouvée dans 68,2 % des cas, alors que la dépression est évaluée à 58,9 % des cas dont 23,7 % ont une dépression sévère qu’il faut traiter, avec une prédominance du sexe féminin (66,8 %).

Dans notre étude, l’ anxiété et la dépression sont les troubles psychiatriques les plus rapportés en cas d’épilepsie. Ils doivent être systématiquement recherchés pour tout épileptique et traités pour améliorer la qualité de vie des patients.

None Declared

Despite the well-established anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide.

In the present study, we aimed to quantify this risk and identify risk factors for suicide among patients receiving ECT.

We used nationwide Danish registers to identify all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. First, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Second, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional-hazards regression.

A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients receiving ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR)=44.5, 95%CI=31.1-63.6). Among those receiving ECT, we identified the following risk factors for suicide: Male sex (HRR=2.3, 95%CI=1.7-3.1), age 60-70 years (HRR=1.6, 95%CI=1.0-2.6), Medium-term higher education (HRR=1.5, 95%CI=1.0-2.2); Long-term higher education (HRR=1.9, 95%CI=1.1-3.1), history of substance use disorder (HRR=2.0, 95%CI=1.4-2.8) and history of intentional self-harm/suicide attempt (HRR=4.0, 95%CI=2.8-5.8).

Among patients receiving ECT, those who are male, aged 60-70 years, have mediumterm to long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide. These findings may guide initiatives to reduce the risk of suicide.

None Declared

The field of treatment and understanding in psychosis is evolving at an unprecedented pace with advances in neuroscience. It takes time before research findings are translated to clinical practice. Daunting as it is, clinicians need to keep up with findings which change our practice straightaway (new medication), findings which suggest that changes are expected in future (new theories about how illness develops and can be predicted) and findings which remind us of continuing practice and the evidence behind them (long term follow-up studies which give no big surprises but consolidate existing knowledge).

In a snap shot, I bring to you a range of five papers published in 2022 which enrich our understanding of psychosis, its development and treatment.

None Declared

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a cerebrovascular disease, tht appears in 1.98/100,000. It´s caused by a mutation of the Notch3 gene and is characterized by accumulation of granular osmiophilic material in the middle layer of the small and median sized cerebral arteries.

Sypmtoms are migraine, recurrent cerebral ischemic episodes, dementia, neuropsychiatric disorders (anosognosia, character disorders, apathy and cognitive impairment). It usually appears between 30-60 years, although there is an important variability. There is no curative treatment, only palliative.

Clinical review of anosognosia and its presence in CADASIL disease.

Clinical case and literatura review.

We presented the clinical case of a 68-year-old man, who was diagnosed with CADASIL after a stroke 3 years earlier. In his family, his brother was diagnosed also with CADASIL. The patient had previously presented disturbances in impulse control (hyperorality) and important executive failures. He currently presented anosognosia, deficits in verbal memory, spatial perception and executive functions, in addition to behavioral alterations and apathy. Due to these deficits he was prohibited from certain activities (driving, hunting).

The patient was not aware of these deficits and becouse of his “no knowledge of his illness”, he disagreed with these prohibitions, so he showed rage and anger at the impotence of not understanding why certain actions are prohibited.

In the consultation, mnesic errors and in naming objects were also objectified, for which it was recommended to carry out cognitive stimulation on a daily basis. In addition, he presented failures of sphincter incontinence, especially of urine and occasionally also of the anal sphincter. He had previously had episodes of myoclonus or fasciculations.

A genetic study by massive sequencing confirmed the heterozygous presence of the pathogenic variant c.1819C>T p.(Arg607Cys) in the NOTCH3 gene, a CADASIL disease.

The anosognosia that many patients with CADASIL disease present constitutes a problem because it contributes to the delay in consultation and, therefore, the delay in the adequate diagnostic approach, therapeutic possibilities and family genetic counseling. Due in part to anosognosia, CADASIL is considered an underdiagnosed entity. Due to the lack of awareness and the consequent lack of recognition of the deficit, these people are often seen as stubborn and difficult to deal with by people in their immediate environment.

In addition, there is general difficulty in the rehabilitation process, since patients do not think the neccesity to be treated. This can generate frustration and despair both in their relatives and in the health personnel.

For all these reasons, both in anosognosia and in CADASIL disease, adequate psychological support is needed for both those affected and their families.

None Declared

A 28-year old male patient was admitted involuntarily to the 4th PICU of the Mental Health Hospital of Thessaloniki, due to severe psychotic symptoms and disorganised behaviour. Upon mental health examination the symptoms included auditory hallucinations, tangible speech, delusional ideas of somatic and persecutory type and significant neglect of his personal hygiene. The onset of his psychotic illness was 3 years prior, with two hospitalizations in the UK, and several unsuccessful attempts of outpatient monitoring.

The study of persistent hiccup as an adverse effect of antipsychotic medication.

Monitoring for adverse effects during admission.

On the 8th day of admission, oral olanzapine 10 mg was commenced at night. On the 9th day, olanzapine was increased to 20 mg per day. Discontinuation of intramuscular medication occurred on the 16th day. After presenting no clinical improvement for 27 days with the administration of olanzapine as monotherapy, amisulpride at 2ml per day was initiated alongside the Olanzapine. In the context of medication titration, amisulpride reached 8ml per day, equivalent to 800mg per day after 2 months of hospitalisation.

Apart from minor constipation, no other gastrointestinal health problems were reported in his records. The onset of the hiccups occurred along the dosages of 800mg/day of amisulpride and 20mg/day of olanzapine.

There was a satisfactory response to treatment evidenced by a 30% reduction on the Positive scale of the PANSS, however, the hiccups did not recede.

None Declared

The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports trainings and competitions globally. Because engagement in sports contributes positively to the physical and psychosocial development of adolescents, restricting these activities may have led to long-term changes in mental health, especially among high school student-athletes that spend a significant amount of time training and competing.

We sought to (1) compare overall prevalence rates and symptom severity of depression and anxiety between 2021 and 2022, (2) assess cohort and class-level differences on internalizing measures, and (3) identify demographic and health risk factors for developing depressive and anxiety symptoms in 2022 and compare the composition of these models predicting depression and anxiety with those proposed by Håkansson et al. (Front. sports act. living 2022; 4 943402) on student-athletes in the 2021 sample.

Using a cross-sectional study design with repeated measures, we measured rates of depression using the Patient Health Questionnaire-2 scale (PHQ-2) and anxiety using the Generalized Anxiety Disorder-2 scale (GAD-2) in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021) and after all restrictions were lifted (February 2022).

As illustrated in Table 1, the overall prevalence of depression among student-athletes declined significantly from 19.8% in 2021 to 17.8% in 2022, whereas the percentage of student-athletes screening for anxiety did not change significantly (17.4% in 2021 to 18.4% in 2022).Table 1Depression and Anxiety Measures 2021-2022

Cohort-level analyses revealed older students exhibited decreases in depressive symptoms (Figure 1), while younger cohorts experienced increases in symptoms of anxiety (Image 2) from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one’s career in sports were significant predictors of both depression and anxiety screenings in the 2022 sample (Image 2).

Image:

Image 2:

In comparison to periods when sports participation was limited in February 2021, the lifting of restrictions in February 2022 was associated with overall reduced levels of depression, but not anxiety.

M. Andersson: None Declared, G. Kenttä: None Declared, K. Moesch: None Declared, E. Borg: None Declared, E. Claesdotter-Knutsson: None Declared, A. Håkansson Grant / Research support from: AH receives financing from the Swedish state-owned gambling operator, AB Svenska Spel, and the state-owned alcohol monopoly. Neither were involved in the study planning, execution, or decision to publish the current article.

Even though the construct of Formal Thought Disorder (FTD) is an ambiguous and disputed one, it has endured as a fundamental psychopathological concept in the clinical coalface of Psychiatry. FTD can be summarized as a multidimensional concept, which reflects difficulties or idiosyncrasies in thought, language, and communication in general. It is usually subdivided into positive versus negative and objective versus subjective, and it can be a major challenge for both mental health professionals and patients themselves.

In this presentation, we aim to explore the latest neuroscientific findings regarding FTD and its putative neurobiological substrate, ranging from the synaptic and neurotransmitter level to the structural and functional one, briefly considering some of the linguistic and neuropsychological implications.

We conducted a thorough narrative review by researching the Pubmed database using the following search string: “formal thought disorder”[Title/Abstract] and selecting only those articles published after 2010. Afterwards, we summarized the main findings from the gathered information.

Some of the most consistent findings in current meta- and mega-analyses of structural MRI studies in patients with schizophrenia and FTD are volume reductions of regional grey matter in the frontal operculum and the language-related lateral temporal cortices, namely the left superior temporal gyrus and middle temporal gyrus. Another consistent finding is the so-called reversed lateralization of the temporal cortices. Regarding functional MRI studies of FTD, amongst the most common implicated regions are the bilateral superior and middle temporal gyri, the fusiform gyrus and the inferior frontal gyrus. Alterations in the glutamatergic, dopaminergic and serotoninergic neurotransmitter systems have also been linked to FTD.

Many areas of the brain have been implicated in the pathogenesis of FTD, though some more consistently than others. The superior temporal, middle temporal and inferior frontal gyri in particular have repeatedly revealed both structural and functional alterations in patients with FTD. A reversed lateralization has also been observed at both structural and functional levels. The different neurotransmitter systems have also been connected with FTD, with the glutamate system being the one more thoroughly explored. However, the direction of causality between changes in the brain and FTD, and the influence of potential mediators remain largely unknown.

None Declared