The COVID-19 pandemic has had an unprecedented detrimental impact on mental health in people around the world. It is therefore important to examine factors that may buffer or heighten the risk of mental health problems in this context.

The current study explores the buffering effects of different flows of compassion (for self, for others, from others) and the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on indicators of mental health and psychosocial wellbeing.

4057 adult participants collected from the general community population across 21 countries from Europe, Middle East, North America, South America, Asia and Oceania, completed self-report measures of perceived threat of COVID-19, compassion, fears of compassion, social safeness, loneliness, depression, anxiety, stress, posttraumatic stress and growth.

Self-compassion moderated the impact of perceived threat of COVID-19 on depression, anxiety and stress, whereas compassion from others moderated the effects of fears of COVID-19 on social safeness. Fears of compassion moderated the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of fears of COVID-19 on social safeness. Furthermore, social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. The effects were consistent across countries.

Our findings highlight the universal protective role of compassion and social connection in promoting resilience and buffering against the harmful effects of the COVID-19 pandemic on mental health and psychosocial wellbeing. Furthermore, our results reveal that fears of compassion have a magnifying effect on the damaging impact of the COVID-19 pandemic on mental health.

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Psychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA). NSA are present throughout life, but are more frequent during adolescence and young adulthood. Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis.

Analyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PD

Review in the literature of the different risk factors associated with parasuicidal behaviors in early psychosis

• • Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation.

• • Social isolation

• • Longer duration of untreated psychosis.

• • Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia.

• • Traumatic events in childhood

• • Difficulty in regulating emotional, impulsivity and sensitivity to reward.

• • Consumption of substances.

• • Psychosocial stress.

We consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states.

Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required. Integrating trauma management into PEP care is critical.

Bibliography:

1.- Honings S, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2016;46(02):237–51. doi: 10.1017/S0033291715001841

2.- Honings S, et al. Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology. Psychiatry Res. 2016;245:267–75. doi: 10.1016/j.psychres.2016.08.002

3.- Nishida A, et al. Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a cross-sectional survey of 16,131 adolescents. Schizphr Res. 2014;159(2–3):257–62. doi: 10.1016/j.schres.2014.09.030 39.

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Sadness, nostalgia, deep discomfort, guilt and feelings of loss, hopelessness are just some of the emotions that overwhelm people who are experiencing the death of a loved one (Franza et al. Psychiatr Danub 2022; 34 (8) 60-63). The unusual mourning process in the time of COVID-19 challenges the usual process of coping with loss. The absence of the funeral rite and coping in time of COVID-19 affects the grieving process. The consequences of “bodiless” bereavement in survivors of people who died during the COVID-19 pandemic may be similar to Post Traumatic Stress Disorder (PTSD) (Spurio. Psychiatr Danub 2021; 33 (Suppl 9) 102-107).

To evaluate the effects of the absence of the funeral rite on anxiety, depression, PTSD and hope in family members of people who have died from COVID-19.

In our observational study, 23 family members (12 females; 11 males; mean age: 48.56 yrs) who experienced a bereavement of a loved one without participation in funeral rites due to COVID-19 restrictions were recruited. They had turned to mental health professionals (psychiatrists and psychologists) as suffering from anxiety and depressive disorders. The subjects interviewed between the months of May 2020 and July 2020 (T0) were administered the following evaluation scales: Beck Hopelessness Scale (BHS), Beck Depression Inventory -2 (BDI-II); Anxiety Zung, and PTSD Checklist for DSM-5 (PCL-5).

The same scales were administered after 1 year (T1) and after two years (T2).

All the relevant data were analysed using EZAnalyze Version 3.0, Microsoft Excel Add-ln. Repeated Measures ANOVA Variables used for analyzing scales scores.

The main results are shown in Table 1. High values of hopelessness, anxiety and depressive symptoms were observed in T0. The score was reduced in the following times. In BHS the ANOVA results indicate that at least two of the repeated measures differed significantly (P – Unadjusted: T0 and T2: .003, T1 and T2: .009; P – Bonferroni: T0 and T1: .009, T1 and T2: 0.28). Similar results were highlighted in the Zung and DBI-II scales. These results indicate high levels of anxiety and depression at the beginning of the observation period (T0). The results for the assessment of PTSD indicate statistically significant differences (P. .000, Eta Squared: .378).

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Our little study evaluated some psychological factors in the emotional process of “normal” and complicated mourning. The loss of a loved one is inevitably an extremely painful event and is accompanied by a series of highly emotional experiential pathways. In the first months after death, family members have high levels of anxiety, depression, and hopelessness. There is a need to deepen the study with a higher number of participants and with a comparison with “normal” bereavement

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The COVID-19 pandemic has affected the mental health of the global population (Dragioti et al. J Med Virol 2022;94(5):1935-49). The first lockdown brought the hardest and most sudden impact on work, educational, social, and recreational activities. Moreover, the fruition of mental health services was restricted, and non-urgent appointments were delayed or converted into telepsychiatry. Thus, it was reasonable to hypothesize different trends of urgent consultations regarding mental health.

To detect quantitative and qualitative changes in patients presenting to our Emergency Departments (ED) during the early phase of the pandemic compared to the previous year.

We conducted a retrospective, multicenter study in Venezia (historical center, mainland) through systematically reviewing the psychiatric consultations in our ED, during the first 16 weeks since 8-Mar-2020 and the same period of 2019. The protocol was approved by the local Ethics Committee as UPSI-19 (Urgent PSychiatric consultations In COVID-19). The statistical analysis was conducted with the software R; Interval Risk Ratio (IRR) with 95% CI was calculated for absolute frequency, primary diagnosis, leading symptoms, and outcomes of these consultations.

In the early phase of the pandemic, in our ED we assisted to a significant decrease in psychiatric consultations: 372 vs 441, IRR=0.84(0.73-0.96). Data revealed a reduction of referral for suicidal behavior (IRR=0.52(0.33-0.80)) and anxiety symptoms (IRR=0.60(0.42-0.87)). Primary diagnoses of patients were not different between the two periods explored. There was a slight increase in admissions (150 vs 121), and a significant decrease in less severe clinical pictures.

In the timeframe considered, we assisted to a significant decrease in referrals from the ED, possibly related both to fewer non-locals and to less frequent non-severe presentations. Despite the type of patients (for underlying diagnoses) remained unmodified, an interesting reduction of anxiety symptoms and suicidal behavior was noticed. Literature from ED studies during the first wave are consistent with our finding regarding the number of visits; suicide attempts seemed unmodified or decreased elsewhere (Giner et al. Curr Psychiatry Rep 2022;24(1):1-10). Limitations of our study include peculiarities of the Venetian territory, limited sample and time of observation. Future directions encompass the integration with data from the community setting and later developments.

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MDD is a chronic illness characterized by complex patterns of persistence, remission and relapse. Personality disorder (PD) is a negative prognostic marker MDD and its chronicity, and dynamics of STPD and BPD in adolescence occurs most severely.

The purpose of this study was to study the effect of STPD and BPD on the course of MDD in comparative groups in youth.

Clinical psychopathological interview and follow-up assessment, SCID-II, Hamilton Depression Rating Scale (HDRS). Sample: N=102 male and female with MDD in STPD and BPD into two equal groups of 51 people respectively. MDD was assessed in each of both PD groups in two time frames: current and during depressive the last 12 months in adolescence; three and more years later during adolescence. Outcome predictors included: clinical characteristics of MDD, duration of current episode, relapse rate. The average age of first MDD in both groups was 18.9±3.2 years.

The first MDD with both PD in adolescence characterized by psychopatological variety due to type PD and age factor. Depressive was more variability of affect, and shorter duration (less then 6 months N=28 (55%)) in group BPD as opposed to the sustained mood problems seen in STPD – (6-12 months N=19 (37%); 12 months and more N=21(41%)) with MDD (p=0,004; χ2= 14,997). During the subsequent follow-up assessment among patients with BPD had the highest percent recurrences once every 6 months or more (N=36 (71%)) and those with STPD significantly rarer recurrences, every 6 to 12 months (N=21(41%)), Less than once a year N=17 (33%)), (p=0,001; χ2= 23,252). Diagnosis of PD in adolescence is based on pathological traits, and impairment in the affective disorder is measurement separately. When measuring impulsivity in the BPD group, significantly higher rates BIS-11 scale were noted (74±1) than in the SPD group (61±1).

Diagnosis of PD in adolescence is based on pathological traits, and impairment in the affective disorder is measurement separately. It has been confirmed that PDs are a negative prognostic marker of the manifestation of a MDD in adolescence, and the presence of BPD is a serious prognostic predictor of its persistence.

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Migration is a rapidly growing phenomenon in European countries and its association with psychotic disorders is a public health concern. Psychosis is more prevalent among migrants, which suggests that adverse social experiences play an important role in its pathogenesis. Throughout the migration process, migrants are exposed to several social disadvantages, including in the post-immigration context, where perceived discrimination appears to be an important stressor. In fact, the highest incidence rates of psychosis occur in the most discriminated populations, namely migrants with darker skin complexion, particularly when living in low-ethnic-density neighborhoods, where both discrimination and social isolation are more prominent.

To conduct an updated review about the association between migration, perceived discrimination and psychosis, aiming to better understand the mechanisms involved.

Narrative literature review using the keywords “migration”; “psychosis”; “discrimination”; “racism” on PubMed database, in conjunction with presentation of a clinical case concerning a patient from Guinea-Bissau, admitted to our hospital in the context of first-episode psychosis (FEP), with onset months after completing the Mediterranean migration route to Europe.

Literature suggests that experiences of racism and social exclusion contribute to feelings of imminent danger, fear and general anxiety, which may develop into paranoid ideas of ubiquitous persecution. Furthermore, intense social defeat experiences, common in migrants, are associated with more distressing forms of delusional content, with delusions of psychological persecution being more common. However, there is also evidence that migrants with FEP have better occupational and social functioning profiles compared to natives, suggesting that, in these patients, there is a higher burden of social-environmental risk factors, with the onset of psychosis occurring only when this burden overcomes a higher threshold. Our patient fits this description. After completing his migratory route and while living in an Italian refugee camp, he described suffering experiences of severe discrimination. Real or not, these experiences escalated to become delusional ideas of persecution involving European governments, thought to seek for his humiliation. Despite the presence of psychotic symptoms, this patient was able to maintain a reasonable level of functioning during years, up to his psychiatric admission.

Given the notorious effect of perceived discrimination and racism on the increased risk of psychosis in immigrants, it is urgent to adopt policies that promote the social protection of these vulnerable groups, namely through enhancing their integration in the host countries.

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Depressive episodes represent the most frequent mood alteration in bipolar disorder (BD). Persistent depressive episodes and subsyndromic depressive symptoms often lead to poor quality of life and increase suicide risk. Recent studies have also shown that BD patients with a history of predominant depressive episodes generally show poorer response to pharmacological treatments. Although not specifically approved in Italy for use in bipolar depression, the scientific literature produced so far suggests the possible use of cariprazine in clinical conditions of bipolar depression that do not respond to conventional treatments.

The aim of the study was to evaluate, in a real-world multicentric Italian clinical setting, the efficacy and safety of cariprazine augmentation strategy in a sample of patients suffering from treatment-resistant bipolar depression.

16 resistant bipolar depressed patients, whose resistance was defined according to The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder, were observed for 4 weeks after the add-on to previous mood stabilizing treatment of a cariprazine 1,5 mg fixed dose. Psychopathology at time 0 and at 1, 2, 3, and 4 weeks of treatment was evaluated using the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Young Mania Rating Scale and the Brief Psychiatric Rating Scale; safety and tolerability of the therapy was measured by the UKU Side Effect Rating Scale.

Clinical improvement induced by 1,5 mg cariprazine add-on was effective and well tolerated in the study sample. Improvement in depression scores started from the first week, reaching about 35% reduction within 15 days and almost 50% in the following weeks (mean HDRS score from 24,7 to 13,2, GLM r.m. p<0,001); global psychopathology improved (mean BPRS score from 29,9 to 15,3 GLM r.m. p<0,001) as well as anxiety symptoms (mean HARS score from 26,5 to 16,5 GLM r.m. p=0,003). No manic shifts were observed during the observation period and the treatment was generally well tolerated.

Despite the small number of patients examined and the short term of observation, cariprazine could represent an effective and safe enhancement strategy for patients with bipolar depression resistant to common pharmacological treatments. Further studies on larger samples are needed to confirm these preliminary findings. In addition, a more prolonged observation would be appropriate to highlight whether the beneficial effect of cariprazine add-on persists over time.

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Asthma is the most common allergic respiratory disease and is frequently associated with symptoms of depression and anxiety. However, this association remains poorly understood, especially in active military personnel with asthma who are particularly exposed to a high mental and physical load.

To investigate the presence of anxiety and depression in active military personnel with allergic asthma.

This is a descriptive cross-sectional study conducted at the pneumology department of the Tunis military hospital that interested active military personnel followed for asthma and who consulted the department in the period from January 1, 2022 to October 31, 2022. The Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety.

During the study period, 36 asthma patients were included. The mean age was 35±8 years with a male predominance of 83%. The majority of the participants were non-commissioned officers (91%), whom were in field positions in 68% of cases. The median professional seniority was 9 [6; 17] years. Active smoking was noted in 47% of the participants. Half of the patients had comorbidities. A history of major depressive syndrome was reported by 8% of patients. Current antidepressant treatment was mentioned by only one patient. Asthma was well controlled in 66.7% of cases. Definite anxiety was found in 30% of the patients while it was doubtful in 26% of the population. Depression was present in 18% of the participants. Specialist psychiatric care was recommended for patients with depression and anxiety.

Anxiety and depression are significant comorbidities in asthma patients. Screening for these risks is necessary, especially in the military population whose work requires mental and physical integrity.

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Throughout the COVID-19 pandemic, students were vulnerable to mental health issues and dentistry students were no exception. All Iraqi universities were transitioning back to face-to-face learning in the last year. Acclimatization with all pandemic regulations that schools apply might increase the vulnerability to depression.

The current study aims to assess the levels of depression among Iraqi dentistry students after transitioning from online to onsite learning during the pandemic period.

A cross-sectional study was conducted online after transitioning from online to the onsite learning method during the pandemic period. Sociodemographic data and Patient Health Questionnaire-8 (PHQ-8) were included in the questionnaire.

A total of 307 respondents, 216 (70.4%) female and 91 (29.6%) male, 276 (90%) live with family, 20 (6.5%) live with friends and 11 (3.5%) live alone, 268 (87.3%) of student claimed that post-COVID-19 regulations face to face learning is more stressful while 39 (12.7%) answered no difference. 39 (12.7%) of dentistry student with normal level of depression, 199 (38.8%) have mild depression 101 (32.9%) moderate depression, 32 (10.4%) moderately severe, 16 (5.2%) severe. Depression level and students’ perception of teaching mode transition showed a significant association (p<0.05).However, there are no significant associations between gender, living conditions, or dentistry stages with depression levels (p>0.05).

A high prevalence of depression symptoms among Iraqi dentistry students was found during onsite learning, along with all educational institutions’ pandemic rules and regulations. Psychological supporting preventive programs are needed to apply for supporting students’ mental health.

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Depressive disorder is one of the most typical psychiatric disorder that occurs after a traumatic event. However, there has been minimal research regarding the prevalence and associated factors of depression after a traumatic event.

Therefore, this study aims to investigate the prevalence of depressive symptoms and associated factors in the residents of the Gangjeong village, who have been exposed to a traumatic event recently for a prolonged period.

The subjects of this study were the residents of the Gangjeong village, who have been exposed to a traumatic event related to the construction of the Jeju Civilian-Military Complex Port. The questionnaires were used to assess the participants` general characteristics (sex, age, marital status, occupation, self-perceived health, etc.); in addition, for the clinical evaluation, overall stress was assessed through the Global Assessment of Recent Stress Scale (GARS), social support through Functional Social Support Questionnaire (FSSQ) and suicide risk through Mini-International Neuropsychiatric Interview-Plus (M.I.N.I-Plus). In order to evaluate the depressive symtpoms, CES-D (Center for Epidemiologic Studies Depression Scale) was used.

In 713 subjects, the prevalence of depressive symptoms was 18.5% (95% CI=15.66-21.36) (Table 1). Multivariate logistic regression analysis identified the length of residence and marital status as factors associated with depressive symptoms (Table 2). Furthermore, the depression group has a significantly higher score of overall stress (GARS), suicide risk and the lack of social support (FSSQ), in comparison with the non-depression group (Figure 1) group (depression gr. vs non-depression gr. : 28.8±15.0 vs 12.8±10.1, 4.9±8.0 vs 1.1±3.6, 44.8±13.2 vs 34.0±13.9, respectively).

The prevalence of depressive symptoms was higher among the study population compared to the general population. People exposed to the traumatic event, especially after prolonged exposure, should be assessed environment factors, the status of overall stress, social support and the suicidal risk.

None Declared

According to DSM V, substance-induced psychotic disorder is a mental health condition in which the onset of psychotic symptoms can be traced to the use of a psychotropic substance. The pathogenesis of this disease is still poorly understood; current literature traces its causes back to genetic predisposition and early traumatic events (i.e. child abuse).

The present study aims to identify specific clinical features and biochemical markers which could be addressed as predictors for the long-term prognosis of this disease. Moreover, we aim to identify specific correlations between the clinical phenotype and the underlying substance abuse, in order to allow the early start of a tailored treatment.

Between 2020 and 2022 we recruited 218 patients referring to the Policlinico Hospital in Milan and the San Gerardo Hospital in Monza, Italy. All the patients were diagnosed with substance induced psychotic disorder: 31 reported alcohol abuse (14,2%), 71 psichostimulants (32,6%), 116 cannabis, (53,2%). For each patients, we collected demographic data, medical records and a comprehensive psychometric assessment (GAF, PANSS, BPRS, Modified Sad Person Scale-MOAS). Furthermore, we collected a blood sample for dosing Na+, K+, Na+/K+, hemogram with formula and platelets, glucose , urea, creatinine, uric acid, transaminases, γGT, bilirubin, plasma proteins, albumin, LDH, CPK, PCHE, cholesterol, HDL, LDL, Tg, TSH.

Chi squared test (χ²) has been used to compare qualitative variables between the 3 subgrous (alcohol-, psychostimulants- and cannabis-induced psychotic syndromes) (fig.1). One way ANOVA test has been used to compare quantitative variables between the same 3 subgroups (fig.2). After removing one of the subgropus (alcohol-induced psychotic symptoms), the same analysis have been repeated. Significant variables have been included in a binary logistic regression model in order to confirm their validity as predictors for cannabis- and psychostimulants-induced psychotic disorders (fig 3). Finally we performed Omnibus test and Hosmer-Lemeshow test in order to verify the validity of these regression models.

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For each considered subgroups, we indentified the following features. Alcohol induced psychotic syndrome: higher age of onset and age of hospital admission, higher cholesterol and hurea levels, , high comorbidity with medical conditions anxiety/depression, low social functioning, higher suicidal risk;, higher hospitalization rate. Cannabis induced psychotic syndrome: higher hemoglobin and albumin levels, more severe psychiatric symtoms (BPRS), higher smoking rates. Psychostimulants induced psychotic syndrome: higher multi-drug abuse risk. We could assume that according to this consideration the treatment protocols for each of these subgroups should be tailored according to their specific features.

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With the increase of older adult population, late life depression is emerging as a major problem in many countries as it significantly deteriorates function and quality of life in older adults. Late life depression is a multidimensional disease that requires intervention in biopsychosocial perspective. Recent reduction in family size and rapid simplification of generations are making this decrease more dramatic. Thus, single older households are becoming general type of household in late life, emphasizing the importance of social engagement in late life depression

the purpose of this study is to assess the correlation between the frequency of face-to-face and non-face-to-face contact with non-cohabitating adult children and late life depression after the COVID-19 pandemic. Additionally, we hypothesized 10 possible moderators and evaluated the moderation effect of each moderator on the correlation. By identifying groups of older adults that are more affected by contact with their children, the understanding of the relationship between late life depression and family contact in older adults might provide insights to set intervention targets in the community.

Older adults who completed the Living Profiles of Older People Survey in Korea were included. In total, 7,573 participants were analyzed by measuring their contact frequency and depression symptoms. Regression analysis was done adjusting covariates. Process macro was used to verify the moderating effects of variables.

Multivariable logistic regression analysis showed that both infrequent face-to-face (OR=1.87, 95% CI=1.56-2.23) and non-face-to-face contact (OR=1.22, 95% CI=1.03-1.44) with non-cohabitating adult children group was associated with higher risk of late life depression compared to a frequent contact group. Further linear regression analysis, which viewed depressive symptoms as SGDS-K score, indicated consistent results in face-to-face and non-face-to-face contact (estimate=0.468, standard error [SE]=0.091, p<0.001 and estimate=0.262, standard error [SE]=0.079, p<0.001, respectively). Finally, using moderation analysis, association with late life depression and frequency of face-to-face contact was moderated by age, quartiles of household income, number of chronic diseases, frequency of physical activity, existence of spouse, and nutritional status (NSI) whether effect of frequency of non-face-to-face contact on late life depression was increased by participation in social activity, frequent physical activity, and good cognitive function (MMSE-DS score)(p for interaction<0.05).

Frequent contact of non-cohabitating children lowers the risk of later life depression. Several variables were found significant in moderating contact frequency-depression symptoms.

None Declared

Bulimia Nervosa (BN) is a highly prevalent eating disorder related to multiple risk factors. In this regard, familial variables can play a critical role in the development and maintenance of BN.

The existing studies frequently explored mothers and maternal factors, while fathers and paternal variables have been less extensively investigated in this field. Therefore, we aimed to systematically review the studies on the role of paternal factors in BN.

This systematic review process was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. As a result of the literature search on PubMed, Web of Science TM, and APA PsycINFO, 419 candidate papers were determined and evaluated based on the eligibility criteria. The quality assessment of the final 59 studies was conducted using the JBI Critical Appraisal Tools.

Then, we thematically arranged and narratively reported the qualitative and quantitative research findings. Paternal attitudes (e.g., critical, abusive, aggressive, uncaring, and unaffectionate), family dynamics (e.g., chaotic, rigid, less communicative, and emotionally involved), and father-specific features (e.g., personality traits, eating psychopathology features) were found as three main groups that could be directly or indirectly associated with the development and maintenance of BN symptoms. The eligible qualitative studies also indicated that fathers could positively influence the recovery process of their daughters with BN (e.g., by helping them develop healthy adaptive body image, self-adequacy, and self-esteem).

The contradictory outcomes were discussed for further research and clinical implications.

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Substance use continues to be an important problem among mental health patients either as main diagnosis or as comorbidity. Acute care visits, including emergency department visits and hospitalizations, related to substance use disorders (SUD) are increasing and can be opportunities to engage individuals to get proper treatment (Suen LW et al. J Gen Intern Med 2022; 37(10):2420–2428).

Both mental disorders and SUD lead to subsequent chronic physical conditions, premature death, suicide or overdose (Bennett AC. Public Health Rep 2019; 134(1):17-26) that can be accidental or not.

24% to 32% of patients with Substance Induced Psychosis develop later a schizophrenia spectrum disorder or bipolar disorder (Starzer MSK et al. Am J Psychiatry 2018;175(4):343–350) leading to a chronic use of medication and, in several instances, to a necessity of psychiatric in-patient treatment with long hospital stays and high readmission rates (Khan S. Health Reports (2017) 28(8)3-8).

Our goal was to analyze if substance use is associated with higher psychiatric hospitalization rates.

An independent-samples t-test was run to determine if there were more hospitalizations among patients with substance use. Afterwards, the Cohen’s D was calculated to measure the effect size and to see the magnitude of the experimental effect.

A sample of 2604 in-patient treatment episodes was used. The sample had 1696 female patients, 908 male patients and 823 patients had substance use. We found that patients with substance use had a statistically significant higher hospitalization rate (6.82±5.27) than the ones without it (5.32±4.84), t(1483)=6.945, p<0.001. Cohen’s effect size value (d=.30) suggested a small practical significance.

Our findings go mainly accordingly the literature; we found a significant effect of drugs on readmission rates (Böckmann V et al. Front Psychiatry 2019; 10:828) but we might have thought it would be bigger. That could be explain by undiagnosed substance use (refusal to admit the use, drugs not detected on lab tests, not requesting toxic lab tests) or higher sample percentage of confounding comorbid diagnoses.

However, is undoubtable the several risks that drugs bring to our health and so the authors aim to raise awareness among the medical community to the importance being alert for signs of use or psychiatric symptoms to avoid reaching a no turning point. It’s known that doctors frequently fail to diagnose SUD in hospitalized patients and given the linkage between use of certain substances and particular medical reasons for admission, it would be well-advised to search for SUD in certain admission diagnoses (Weintraub E et al. Am J Addict 2001;10(2):167-77). Knowledge of substance use behavior may help reducing relapse rates and to reduce the risk of developing a SUD (Andersson HW et al. Nordic Journal of Psychiatry, 75:3, 160-169).

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Antipsychotic-related hematological abnormalities have been reported in the literature, but remain a rare complication of some second-generation antipsychotic drugs. It has been suggested that risperidone is the preferred alternative when adverse hematological effects have been induced by conventional antipsychotic drugs. Blood dyscrasia adverse reactions have been reported rarely with risperidone.

We aims to call attention to leukopenia as a potential side effect of during treatment with risperidone.

We report a case in which a patient developed leukoneutropenia during treatment with risperidone

A 46-year-old man was admitted to psychiatric department for aggressive behavior. The patient had a history of right bundle branch block and has been diagnosed with schizophrenia at age of 36 years. This patient had only one psychiatric hospitalization in 2021 where he developed persistent leuko-neutropenia. A viral cause was retained. The patient was discharged on risperidone 4 mg and had been poorly compliant with his antipsychotic medication for the last year.

Currently, the patient was excited, very talkative and refused medication. He received an intramuscular injection of haloperidol 10 mg and chlorpromazine 50 mg. Under these doses, the patient became sedated and his balance sheet showed a leukoneuropenia amounting to 1960 cells/mm3. Then, it was decided to stop chlorpromazine and Haloperidol and put the patient on Diazepam. A complete blood count was done the next day showing that his white Blood Cells (WBC) count went up to 4360 cells /mm3 (neutrophils rate = 62,4 %). The reintroduction of haloperidol with diazepam caused the WBC to fall back to 2000. Haloperidol stopped as a possible cause of the leucopenia. The patient started taking risperidone orally 1 mg daily, which was gradually up titrated to 4 mg daily. Two weeks later the WBC went up to 4680 cells/mm3 (neutrophil rate = 60,4%) three week after stopping haloperidol. However, three days after increasing the dose of risperidone to 5 mg the leukoneutropenia recurred, (WBC = 2960 cells/mm3, neutrophil rate = 41%). When risperidone was reduced to 4 mg, his WBC count remained stable for two weeks (WBC = 2970, neutrophil rate = 48,9%). Clinically , the patient is no longer excited.

Risperidone-induced leuko-neutropenia (RILN) is very unusual and its incidence rate is unknown. Currently, there are no evidence-based alternative antipsychotic recommandations for RILN. For the case presented here, we achieved stabilisation of RILN by dose reduction.

Routine monitoring of the WBC level of patients on risperidone treatment, regardless of their hematological baseline, might be good practice for all psychiatrists. We recommend extending this practice to inpatient and outpatient services.

None Declared

Major depressive disorder (MDD) is a mental health disorder characterised by persistently low mood; anhedonia; feelings of worthlessness and guilt; altered appetite, weight and sleep and suicidal ideation. About one-third of patients do not respond to available antidepressants (AD). Treatment-resistant depression (TRD) is a clinical term used to define a lack of response to two or more AD in patients with MDD that do not respond to other lines of treatment either. TRD is associated with an increased risk of relapse, hospitalisation and suicide. Esketamine is a non-competitive NMDAR antagonist that acts as an antidepressant by modulating glutamatergic neurotransmission, disturbed in MDD patients. It has recently been approved by the European Commission as a fast-acting nasal spray therapy for depression and suicidal ideation after showing effectiveness in TRD patients (Papakostas et al. JCP 2020; 81 4).

The aim of this study is to determine the effectiveness, safety and tolerability of intranasal esketamine in two TRD-diagnosed patients and to assess their clinical evolution.

A prospective study was conducted describing the evolution of two TRD patients treated with intranasal esketamine. We used The Hamilton Depression Rating Scale (HDRS) to quantify the severity of their symptoms and assess their recovery over time, analyzing the score change from baseline to endpoint as a primary outcome of the study. We also applied the Addensbrooke Cognitive Examination (ACE-III) as a tool to establish their cognitive condition before therapy and its evolution. Changes in dosage during treatment, adverse effects, time required for onset of action, clinical outcomes and other variables were also measured.

Intranasal esketamine was administered twice a week during the first 4-week induction phase and weekly during the following 6-month maintenance phase. Dosage of antidepressant was determined depending on each patient’s age and clinical evolution, being 56 mg the initial dose for case 1 (57 years old) and 28 mg for case 2 (71 years old). This antidepressant was effective in both patients in a fast-acting way, with the onset of action occuring within the first two weeks. During the course of treatment, the HDRS score significantly decreased, associated with improvement and remission of depressive symptoms. Cognitive performance got better in both cases. None of the patients discontinued treatment due to adverse effects or lack of efficacy.

Our data suggest that intranasal esketamine therapy is a good alternative in TRD patients, being effective, fast-acting and well-tolerated, with a manageable safety profile. Clinical stability was also observed in the medium-term follow-up after the end of treatment. This presents esketamine as a promising therapeutic and effective strategy in MDD patients who are either treatment-resistant or acutely suicidal.

None Declared

Although generally effective in ameliorating the core manifestations of schizophrenia, antipsychotics (APs) may lead to only suboptimal responses or may be associated with a variety of treatment-related adverse events which require additional treatment strategies. Under such clinical circumstances, switching APs represents a rational treatment option.

The present study aimed to identify the variables that predict AP switch and to quantify the frequency of this phenomenon in people with schizophrenia in real-life.

A secondary analysis was conducted on the data collected at baseline and at a 4-year follow-up from a large sample of community-dwelling Italian people with schizophrenia. Demographic and clinical variables as well as information about AP treatment were recorded at two time points. Over the 4-year period, 34.9% of the 571 participants switched the AP; in particular, 8.4% of participants switched from first-generation APs (FGAs) to second-generation APs or vice versa, while 8.2% of them switched to clozapine.

Logistic regression models showed that combination of APs at baseline was negatively associated with AP switch, while treatment with FGAs and the presence of extrapyramidal symptoms at baseline were associated with AP class switch.

Although the aim of the present study was not to assess predictors of clinical relapse in people with schizophrenia, we might speculate that switching APs represents a surrogate indicator of treatment failure in some patients and could lead into relapse, which is a costly aspect of schizophrenia management in both economic and human terms. The sooner such a negative outcome can be predicted and managed, the sooner the treatment can be optimized to avoid it.

None Declared

The relationship between mood disorders, particularly depression and cognitive impairment is complex. The symptoms of depression in the elderly include confusion, sleep alterations, low concentration, cognitive deficits, and somatic complaints that may are also present in dementia, with depression being often a prodrome.

The present study aimed at investigating the presence of cognitive disturbances in outpatients over 65 years of age consulting us for a mood episode, as well as to investigate the possible relationships between cognitive and depressive symptoms.

The study included 57 older patients attending the Psychiatric Clinic of Pisa, with a diagnosis of a major mood episode according to DSM-5 criteria. The psychometric scales included: Hamilton Depression Rating Scale (HAM-D), Beck Inventory Scale (BDI), Geriatric Depression Scale (GDS), to measure the severity of depression; Short Psychiatric Evaluation Schedule (SPES), to assess organic mental deficits; Cornell Scale for Depression in Dementia (CSDD), to assess depression in people with dementia; Adult Autism Subthreshold (AdAS) Spectrum, to evaluates the eventual presence of specific features of the autistic spectrum disorder(ASD). Moreover, patients were also assessed for cognitive screening with Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Mini-Mental State Examination (MMSE).

The HAM-D total score was 10.18±6.33, that of BDI 12.79± 9.89, that of GDS 12.69±8.25 and that of CSDD 8.35±6.25. The showed a MoCA value was 21.30±4.86, that of FAB 14.12±3.92, and that of MMSE 25.06±4.20. The MoCA total score positively correlated with those of the FAB and of the MMSE, while the FAB score with the MMSE score. A positive correlation was found between SPES and the HAM-D, BDI, CSDD and GDS total scores. The AdAS score positively correlated with that of MMSE. By correlating scores of depressive dimensions with those of cognitive functions, a positive correlation was noted between FAB total score and those of the HAM-D, BDI, CSDD and SPES

These findings suggest a possible link between the presence of ASD and depressive symptoms from the one side and cognitive performance and executive functions from the another side.

None Declared

The clinical relevance of Routine Outcome Monitoring (ROM) to formulate longitudinal evaluations of treatment appropriateness/efficacy and to assist decision making aimed at improving the quality of person-centered interventions has been poorly implemented in forensic psychiatry, also in Italy. Indeed, very few assessment instruments have been developed in this crucial field.

As reliable ROM instruments are lacking, the aim of the current investigation was to examine psychometric properties (i.e. reliability, concurrent validity and sensitivity to measure scores’ longitudinal changes) of the Parma Scale (Pr-Scale) (a new instrument fro the evaluation of offenders with mental disorder) in an Italian sample of forensic psychiatric patients.

Participants were male adult offenders with mental disorder recruited within the Parma REMS (“Residence for the Execution of Security Measure”) or the Parma Penitentiary Institute (PPI). Exclusion criteria were known moderate/severe intellectual disability or any other medical condition inducing inability to express a valid consent for participating in the research. The Pr-Scale includes 20 items divided into 3 main domains: “Historical”, “Clinical” (observational) and “Treatment Plannining". To test psychometric properties of the Pr-Scale, we examined interrater reliability, short-term (1-week) test-retest reliability and internal consistency. As measure of concurrent validity, a correlation analysis of Pr-Scale item scores with corresponding HKT-R (the “Historisch, Klinische en Toekomstige – Revisie” instrument) item subscores was performed. Finally, we examined the Pr-Scale sensitivity to measure scores’ longitudinal changes over a 3-month treatment follow-up period.

60 male adult patients were recruited in this study. Our findings showed good to excellent interrater and test-retest reliability, concurrent validity and internal consistency for the Pr-Scale. Pr-Scale scores also display a moderate to large changeability over time (Intra-Class Correlation coefficient = 0.963, coefficient of stability = 0.997, Cronbach’s ɑ = 0.736). Statistically significant correlations of Pr-Scale item scores with the corresponding HKT-R scores were found. Across the 3-month follow-up period, we observed statistically significant sensitivity values in measuring longitudinal changes for the Pr-Scale total score and Pr-Scale domain and item subscores.

Our results support the clinical use of the Pr-Scale in different forensic psychiatric settings (i.e. prison, REMS) as reliable ROM instrument.

None Declared

Long-term benzodiazepine use is common although not routinely recommended. While their dependence potential is notorious, cognitive problems due to their chronic use have only recently been intensively studied. Residual cognitive symptoms may linger months after successful benzodiazepine discontinuation and significantly limit optimal functional outcome in abstinent individuals.

We present a series of cases, a 41-year-old man and a 33-year-old woman who successfully completed a ten-week benzodiazepine-dependence rehabilitation program at our hospital, including successful tapering and post-withdrawal integrative therapy. At subsequent monthly outpatient check-ups, abstinence was confirmed (including toxicology testing) and there was no residual anxiety or mood symptomatology. Still, patients complained of their suboptimal functioning due to residual cognitive problems, especially trouble concentrating and short-memory deficits, which were objectively confirmed via psychometric tests.

During continuous outpatient treatment (monthly controls), patients were clinically and neurocognitively evaluated. They were reluctant to try conventional psychopharmacology agents but were open to supplement therapy. After thorough literature review, a trial of piracetam and Ginko biloba extract was suggested. Piracetam, a positive allosteric modulator of AMPA-receptors, has been used in the treatment of vascular neurocognitive changes in the elderly. Bilobalides from G. biloba, act as atypical antagonists of GABA-A receptors and were found to exert neuroprotective effects in animal models, without epileptogenic or anxiogenic risks.

Patients were recommended piracetam (2.4 g a day) in divided doses and a once-daily dose of G. biloba extract (240 mg a day), in a standardized form containing 3.2% of bilobalides. No side effects were noticed. At subsequent monthly checkups, patients reported fewer cognitive problems and better everyday functioning. Neurocognitive testing confirmed subjective findings, with positive changes in all areas, but especially so in verbal memory, which may be due to this specific pharmacological combination. At the end of the observation period of sixth months, piracetam was gradually discontinued while patients were given free choice whether to continue with G. biloba supplementation.

According to our findings, piracetam and G. biloba extract may prove beneficial in the treatment of residual cognitive symptoms after benzodiazepine discontinuation, in long-term benzodiazepine users. Other treatments, focusing not only on modulation of glutamate and GABA, but also on other pathways should be evaluated. Further clinical studies are warranted.

None Declared