Osteoporosis, a systemic skeletal disorder associated with substantial morbidity and mortality, has been suggested to be particularly common among individuals with bipolar disorder. Lithium, a mood-stabilizer used as first-line treatment for bipolar disorder, may have bone-protecting properties.

We aimed to subject both of these hypotheses to further examination in a nationwide register-based study.

We compared the incidence of osteoporosis, identified via hospital discharge diagnoses and prescribed medications, between all individuals diagnosed with bipolar disorder and age- and sex-matched controls from the general population (earliest start of follow-up at the age of 40 years) using Cox regression. Subsequently, we followed the patients with bipolar disorder and identified all prescriptions for mood-stabilizing medications. Using Cox regression, we compared the incidence of osteoporosis for patients using lithium, antipsychotics or anticonvulsants, respectively, with that of patients not using these medications.

We followed 22,912 patients with bipolar disorder (median age 50.4 years, 43.4% men) and 114,560 matched controls for 1,215,698 person-years. The incidence of osteoporosis per 1,000 person-years was 8.70 (95%CI:8.28-9.14) among patients with bipolar disorder and 7.84 (95%CI:7.67-8.01) among controls, resulting in a hazard rate ratio (HRR) of 1.15 (95%CI:1.09-1.21). Lithium treatment was associated with reduced risk of osteoporosis (HRR=0.62; 95%CI:0.53-0.72) in a treatment-duration-response-like manner. Treatment with antipsychotics and anticonvulsants was not associated with reduced risk of osteoporosis.

This is the first longitudinal study to show that the risk of osteoporosis is elevated among patients with bipolar disorder, and that treatment with lithium is associated with reduced risk of osteoporosis.

Dr. Østergaard has received the 2020 Lundbeck Foundation Young Investigator Prize. Furthermore, SDØ owns units of mutual funds with stock tickers DKIGI, DKIDKIX, MAJGRO, NBIDE, SPIC20CAPK, SPVILRKL and WEKAFKI.

Covid19 has led in major changes in our lives, while fear was one of the major psychological symptoms that emerged in psychological first aid evaluations.

The aim of the present study was to report the major factors creating anxiety and fear, affecting everyday life of people in Greece during the two years of the pandemic.

A sample of 1,158 Greeks (280 males [24.2%] participated voluntarily in the study through online platforms. The Fear factors was assessed through an open question which was then analyzed with SPSS 24.

According to the findings, the main source of anxiety and fear arises from the situation that prevails in other European countries with increasing death rates (20.9%) presented in television, followed by what is shown in the news and news programs on television (14, 8%), the fear that the individual may get sick, watching television and radio (9.7%), the experts announcements in public (7.8%), the announcement of new measures by the government and the Ministry of Health in media (6.1%), the existence of elderly parents in the family (4.6%) and social networks (3.8%), while 12.6% stated that they have no fear or anxiety. Gender differences were significant in most of the factors x2=51.167 p=.001.

According to the findings the effect that media have in anxiety and fear creation (64.1%), a result that can be used in designing effective health measures that can help people deal with the psychological aftermath of the pandemic.

No significant relationships.

Asperger Syndrome (AS) exhibits a particular set of difficulties, the foremost of them being the impairment in social interaction. Furthermore, adolescence by itself is a period burdened with many social challenges and distress. The attempt to adjust to them while having AS is much harder, thus it may constitute the premise for the onset of internalizing symptomatology, in particular depression.

This study aimed to observe what factors either improved or hindered the long-term outcome. It was analyzed how the different types of interventions influenced the outcome of these individuals in terms of academic performance, social functioning, psychiatric relapses and quality of life.

Our lot was represented by 16 patients diagnosed with Asperger Syndrome and Major Depressive Disorder (MDD), followed up on a period between 1 to 10 years. The lot was divided into two groups, each with a different therapeutic plan. The main instruments used were clinical observation and parents’ assessments.

In the first group, the adolescents, treated with a complex intervention which included also a psychotherapeutic component, were found to have a positive outcome, 71,42% of them having no other psychiatric comorbidity than Major Depressive Disorder. The adolescents in the second group, who were treated only with pharmacological treatment, were found to have a negative outcome.

The factors that were found to have the most important impact on the long-term outcome were: the integration in a psychotherapy programme, having family support, compliance with the pharmacological treatment and having MDD as the only psychiatric comorbidity.

No significant relationships.

No significant relationships.

Paliperidone palmitate 1-month (PP1M) is a Long-acting injectable antipsychotic formulation, approved for the treatment of schizophrenia and schizoaffective disorder. Recently, paliperidone palmitate 3-months (PP3M) formulation was introduced, which maintains stability while offering a longer dosing interval for the maintenance treatment in patients previously treated with PP1M. Despite of this, many patients are treated with PP1M without transition to PP3M.

To identify variables explaining maintenance of PP1M treatment instead of going to PP3M. We hypothesize that more severe patients are delayed in transition to PP3M because of expectation to complete stabilization.

A descriptive analysis of 123 patients, diagnosed with psychotic disorders, on treatment with paliperidone palmitate 1 month or 3 months, was performed. Age, sex, type of paliperidone treatment, hospitalizations after the initiaton of treatment, years since diagnosis, polytherapy and toxic habits were some of the variables measured and compared between both groups (PP1M and PP3M).

Most of patients (63,41%) were on PP3M. Both groups shared characteristics like male sex predominance, schizophrenia as the most common diagnosis, having a recent onset diagnosis, same frequency of polypharmacy and same pattern of drug consumption. There was a slight difference between both groups regarding severity. PP1M and PP3M showed respectively 33% and 16,7% of admissions after initiation.

No clear pattern determines less transition to PP3M from PP1M. No statistical difference was found except form the difference found in admission after change of treatment (to PP1M or PP3M), which could reflect influence of severity in treatment. Future research is needed in order to better elucidate this association.

No significant relationships.

Schizophrenia and bipolar disorder are severe mental illnesses that are known to have a considerable overlap in underlying pathophysiological mechanisms. More specifically, disturbances in the kynurenine pathway have been hypothesized as processes bridging altered immune responses and clinical manifestations of these illnesses.

The aim of this study was to investigate the abnormalities in serum kynurenine metabolites in schizophrenic and bipolar patients and the impact of clinical factors.

Four patient groups were included in the current study: 1) Acute bipolar inpatients (n=205); 2) stable bipolar outpatients (n=116); 3) acute schizophrenia inpatients (n=111) and 4) stable schizophrenia outpatients (n=75); and one healthy control group (n=185). Clinical symptoms were established using symptom severity scales. The quantitative determination of serum kynurenine metabolites was performed using LC-MS/MS. General linear model and multivariate linear regression analyses were used to perform the statistical analysis with JMP Pro 15.

In line with previous research, the results indicate that serum kynurenine metabolites are disturbed in schizophrenic and bipolar patients compared to healthy controls. Whereas no differences were observed between schizophrenia and bipolar disorder, illness state and duration of illness clearly impacted kynurenine metabolite levels. Acutely ill patients had significantly lower levels compared to stable patients, which seemed to be driven by psychotic symptoms.

To conclude, the results confirm the involvement of the kynurenine pathway in the pathophysiology of schizophrenia and bipolar disorder by lowered peripheral kynurenine metabolite level. In addition, an important role of acute psychotic symptoms and longer illness duration on these metabolite aberrances is demonstrated.

No significant relationships.

PIU has not yet been recognized by diagnostic classification systems, but it has received increasing research and clinical attention. It is defined as a generalized and compulsive use of the Internet associated with a loss of control and negative consequences for the individual

The main goal was to analyze the relation between problematic Internet Use and wellbeing in adolescents

The sample included a total of 1059 adolescents (47% were males). Age range was between 14 and 18 years old (M = 15,12; SD = 1,03). We used the Compulsive Internet Use Scale to assess Problematic Internet Use and the Strengths and Difficulties Questionnaire to screen for psychological difficulties and prosocial behaviour.

The results found in the ANOVA revealed that problematic internet use was statistically significant associated with psychological difficulties and prosocial capabilities (λ = 0.475, F(3,83,000) = 25.569, P ≤ 0.001, η² = 0.215).Adolescents with higher levels of Problematic Internet Use revealed more emotional and behavioural difficulties. In addition. those adolescents with higher levels of prosocial ablities were at a lower risk for Problematic Internet Use.

Previous research have revealed that the use of Internet has almost doubled in the last decade among adolescents across different European countries. Results revealed statistically significant correlations between Problematic Internet Use and indicators of well-being such as emotional difficulties and behavioral problems, as well as prosocial behaviours. Prevention strategies should focus on detecting problematic internet use among adolescents, as it is a variable related with different psychological difficulties that are diminishing adolescents’ well-being.

No significant relationships.

Psychiatric conditions can be both a symptom and a consequence of physical disease. Although understanding of this is important for health care delivery, coverage of the relationship between physical and psychiatric illness in undergraduate medical education is sparse. This relationship is particularly pertinent in neurological disorders, where psychiatric symptomatology is commonplace. As part of a student project, the author was tasked with developing accessible teaching materials to increase interest and understanding among medical students, using podcasts.

The aim was to develop podcasts which explored the relationship between psychiatric and neurological illness, for use in undergraduate psychiatric training.

Literature reviews were performed on podcasting in medical education to identify the optimal methods of production to maximise educational value, and on topics covered in podcasts to inform the interview questions. Experts in the relevant areas were contacted for recorded interviews, later used to create podcasts.

Four interviews were conducted between the author and consultant neurologists specialising in the specific neurological condition. A podcast was produced for each of the following topics: depression in multiple sclerosis, frontotemporal dementia in motor neurone disease, Lewy body dementia, and dissociative seizures.

Psychiatric and physical illness are often intertwined. As the prevalence of psychiatric illness rises, it is becoming increasingly important that this connection is recognised, in order to improve patient experiences and outcomes. Novel teaching modalities, such as podcasts, can provide additional ways to support medical education on this important topic.

No significant relationships.

No significant relationships.

The COVID-19 pandemic led to the implementation of digital psychiatry (DP) in everyday clinical practice, resulting in the need for a skilled healthcare workforce.

Our purpose was to investigate the level of training, knowledge and expertise of young mental health professionals and medical students in DP, as well as exploring their beliefs and experiences in this field.

An ad hoc cross-sectional survey was designed and administered to Italian medical students, psychiatry trainees, and early career psychiatrists.

Most of the sample declared that the topic of DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on DP. Nevertheless, they mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that the academic background should include a dedicated course/module (54.4%). Moreover, most subjects declared that DP is less effective than in-person interventions (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p≤0.05).

During the current pandemic, DP represented an ideal response to the need for physical distancing by ensuring the advantage of greater access to care. However, DP interventions are still uncommon, and there remains a certain resistance to their use in mental health care. The lack of formal training during the academic training could be a limiting factor. Therefore, addressing these issues in academic settings could be crucial to spreading this innovative practice also in the post-COVID-19 era.

No significant relationships.

Obsessive-compulsive disorder is a disorder in which recurring, intrusive, unwanted thoughts, ideas or sensations cause them to feel driven to do something repetitively. The repetitive behaviors can significantly interfere with a person’s daily activities and social interactions. Not performing the behaviors commonly causes great distress.

Clinical trials are required for proper assessment and management of this group of patients.

Mrs. X, a 28 year old female coming for psychiatric consultation with the complaints of self talking, irritability and aggression, insomnia.She fantasizes a man publicly, whom she loves but he has no existence in reality. She tries to solve all kinds of problems by talking to that fantasy man. If anyone interrupts her, she becomes irritable, shouts and breaks things. But for the last 3 months she realized that its a problem. Because, she can’t eat, sleep and concentrate on her household chores for this fantasy. Even she can’t take care of her child and feeling low sexual affection for her husband. On personal history, she said that she had poor attachment with her parents.

After thorough assessment, her consultant Psychiatrist told that she was sufering from unhealthy fantasy obsession or Obsessive Compulsive Disorder.

It is very important and urgent to assess and manage this group of patients, because this has a devastating impact on relationships, specially on the conjugal life. Psychoeducation about the ilness and Psychotherapy along with pharmacotherapy should be the mode of treatment.

No significant relationships.

At Kiskunhalas Semmelweis Hospital, a special mobile container hospital was set up to care for patients infected with SARS-CoV-2 during the first wave of the pandemic.

We aimed to create a proactive integrated mental health protection system for the frontline healthcare workers that provides an opportunity for psychophysiological monitoring of stress and crisis during shifts, as well as providing staff with more lasting methods of coping with difficulties.

From the ascending branch of the second wave, every two weeks on the workers’ rest day, mental helpers initiated a phone call to each employee participating in the program. If it was necessary, we provided psychological counseling, crisis intervention, brief psychotherapy, and psychopharmacotherapy. In addition, self-operated psychophysiological screening devices were used at the frontline work site, which provided an opportunity for continuous telemedicine monitoring.

In our department, three psychologists and three psychiatrists kept in touch with an average of 150 frontline workers per month. Interventions were needed for a total of over 24% in December and January, over 17% in February and March, almost 9% in April, and only 4% in May. Helpers rated an average of two-thirds of these cases as moderate. They faced severe stress 2-3 times a month in sum, and for 2-3 workers needed medication.

Without a mental support system, self-report-based data suggest that nearly half of responders working at the frontline reached the threshold of clinically significant mental syndromes (Greenberg et al, 2021). Using our mental health support system, one-fifth of the workers needed intervention.

No significant relationships.

The COVID-19 pandemic generated a health emergency and led to the adoption of different measures, including home quarantine and social isolation, which, as we have seen, has had an impact on the mental health of the majority of citizens, with the possibility of psychiatric disorders appearing. in people without prior mental illness, such as acute decompensations in patients with known disorders, more vulnerable to environmental stressors.

Learn and rethink alarm signals in extreme situations such as the one experienced in recent months, as well as observe the impact, negative in many cases, but positive in others, of the patients we treat daily.

Description through brief clinical cases of the impact of the COVID-19 pandemic on psychotic patients and the decompensation that it has entailed, including due to confinement measures and social isolation, associated with over-information through the media, chaos initial and the uncertainty that it caused and the associated fear.

Restrictions as a result of COVID-19 have played a very relevant role as an external stressor for the appearance of psychopathological alterations, including psychotic symptoms. In addition, people who suffer from psychosis or at risk of psychotic disorder can be especially affected and trigger acute psychopathology with social isolation, loss of daily routines, unemployment, homelessness.

These cases are an example that shows the need for an early and effective approach to the rise in mental illnesses in circumstances of this caliber.

No significant relationships.

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse health effects due to exposure to common chemicals which may lead to disability. The pervasive nature of stigma associated with MCS and similar conditions, including that which exists among providers, creates unbearable barriers to healthcare access.

The main objectives of this study are: (1) to describe the symptoms associated with MCS, (2) determine whether environmental exposure has an impact on psychological well-being of patients with MCS.

The qualitative phenomenological study consisting of 42 individuals presenting with medically-unexplained symptoms was conducted using semi-structured interviews.

The symptoms experienced by participants with MCS are diverse, with common symptoms being migraine, paresthesias, seizure-like attacks, allergic reactions, respiratory symptoms (e.g., SOB, swollen throat), GI distress, muscle pain, chronic fatigue and persistent insomnia. These symptoms always develop in response to low level exposures to various toxicants, recur reproducibly and improve when toxic agents are removed. Finally, the adults with MCS are more likely to experience significant affective and PTSD-like reactions. The participants stated the stigmas and misconceptions against those with toxicant sensitivities affected their mental wellness.

Multiple clinically significant behavioral and psychological symptoms are associated with MCS. Our data suggested that diagnostic overshadowing is pervasive in the healthcare system. This study also highlights the importance of psychological interventions and doctor–patient relationship in the management of MCS in various settings. Public education to increase knowledge around environmental illness is paramount.

No significant relationships.

No significant relationships.

The major clinical outcomes of COVID-19 in the brain are associated with its deleterious neurological and mental health actions.

Today, there are limited findings concerning the studying of neuropsychiatric action for SARS-Cov-2 in humans after COVID-19 disease.

The aim of the present study was to compare the efficacy of SSRIs (escitalopram, sertraline and fluoxetine) for 6 months therapy on the affective profile of man and women with the clinically confirmed Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) cases following COVID-19 disease.

. For the assessment of affective profile in man and women (30-55 years) with the initial clinically confirmed MDD or GAD cases after COVID-19 disease, we used the different tests: Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety scale (ShARS Scale). The hormonal and monoamines levels in the serum blood were measured by ELISA tests before and after SSRIs therapy.

After 6 months of SSRIs therapy, MADRS Scale showed a incomplete disappearance of the depressive/anxiety manifestations in both men and women with the initial clinically confirmed MDD case after COVID-19 (p<0,05). We found that SSRIs were able to reduce depression/anxiety levels only on 20% in man or on 30% in women with the initial MDD case after COVID-19 before treatment.

SSRIs treatmet alone failed to produce the decrease of depression/anxiety in the patients of both gender with the initial MDD or GAD diagnosis after COVID-19. The further randomized clinical trials involving new pharmacological therapies for psychiatric pations after COVID-19 disease are needed.

No significant relationships.

Honoraria, advisory board, or consulting fees from Angelini, Astra Zeneca, Bristol-Myers Squibb, Gedeon Richter Bulgaria, Innova-Pharma, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer, and Pierre Fabre, for services not related to this abstract

Personalized approach in drug therapy is an essential line of modern psychiatry. Experimental and clinical studies of anxiolytics have shown differences in drug effects in dependence on genetically determined reactions to stress and personal features.

To evaluate of the therapeutic effects and effectiveness of bromodihydrochlorophenylbenzodiazepine and fabomotizole in dependence on individually-typological features of patients with anxiety disorders.

45 patients (mean age 33,3±9,7 years) with generalized anxiety disorder (n=22) and panic disorders with agoraphobia (n=23) participated in this open-label study. 13 patients treated with typical anxiolytics bromodihydrochlorophenylbenzodiazepine at dose 2 mg daily and 32 patients treated with atypical fabomotizole at dose 30 mg daily. The duration of treatment was 14 days. Minnesota Multiphasic Personality Inventory, Psychiatric Symptoms Severity Evaluation Questionnaire and CGI-E were administered.

Asthenic features (high pessimism, anxiety, individualism) were revealed in 26 patients and stenic features (high impulsivity, rigidity and optimism) were revealed in 19 patients. Patients with asthenic features had tranquilo-activating effect of bromodihydrochlorophenylbenzodiazepine, whereas patients with stenic features had tranquilo-sedative effect. The tranquilo-activating effect of fabomotizole was revealed in patients with stenic features. High efficacy of bromodihydrochlorophenylbenzodiazepine was observed in patients with asthenic personality traits (χ 2 = 7,8), whereas in fabomotizole-in patients with stenic individual typological features (χ 2 = 9,1).

Patients with stenic and asthenic features had differences in therapeutic effects and the effectiveness of anxiolytics. Personality features determine the sensitivity of patients with anxiety disorders to psychotropic drugs.

No significant relationships.

We have been using LAB (Buvidal) in Cardiff after its pandemic use was funded by Welsh Government.

We wished to review the benefits of introducing LAB (Buvidal) into treatment during the pandemic.

This service development review of the first 73 patients treated with LAB (24mg/96mg rapid titration Welsh protocol) was analysed using Kaplan-Meier survival curves.

43 (58%) male, 30 (41%) female. <25years=1, 38 (52%) aged 25-40, 34 (47%) 40-55. Prior to LAB 14% (10 people) using Espranor, 8% (6) Buprenorphine, 28% (20) Methadone. 50% (36) illicit opiates (mainly Heroin). We had continuous data for patients for up to 9 months of LAB. Two stopped for non-discontinuation reasons: One wanted to detox, one died of natural causes (LAB-unrelated). Both were excluded from discontinuation rate analysis. 55 people have data for over a month. Of these, 11 discontinued treatment. 80% remained on LAB for 1 month or more [95%CI 67-90%]. Kaplan-Meier plots showed similar discontinuation rates when comparing different OST programmes or none prior to LAB, and comparing by age, sex and initial illness severity (CGI severity). These rates all far exceeded data for traditional OST. CGI scores dramatically improved, even at one week. By month 2 all scores “much improved” or “very much improved”.

Buvidal (LAB) has 80% retention rates, regardless of underlying prescribed/illicit opioid /demographics. The commonly held belief that those on heroin are further from Recovery than those more stable on OAD may be incorrect. LAB may be a more acceptable and useful first line therapy that other OSTs

Dr Melichar has provided consultancy work, presentations, training and chaired panel discussions for all the companies in this area in the UK and some outside the UK. Recent work includes Althea (UK), Britannia (UK), Camurus (UK and Global), Martindale (U

Many different causes of catatonia are well-documented in medicine. Modern understanding of catatonia has evolved in the last 100 years with the suggestion that there is a root cause in neuroinflammation. This is a case report of a young woman who presented to the emergency department with altered mental status, found to have catatonia responsive to lorazepam, with the underlying etiology being a diagnosis of multiple sclerosis.

A case-based approach is used to support the following learning objectives: - Review the diagnostic criteria for catatonia - Distinguish between simple and malignant catatonia - Review the Bush-Francis Scale - Review available treatment

Mother brings 24-year-old woman into the hospital for altered mental status and changes in behavior including staring spells, periods of withdrawal, refusal to eat, lack of purposeful movement, apraxia, and mutism that worsened 24 hours prior to presentation.

The patient was afebile with negative covid-19 test. Recent diagnosis of Bell’s palsy treated with antivirals and oral steroird, which terminated just prior to presentation. Additionally, patient had outpatient treatment for vertigo. Lumbar puncture was negative for an infectious process. MRI revealed multiple stable white matter lesions in the periventricular, pontine, and subcortical regions, some oriented perpendicular to the corpus callosum.

This case of a 24-year-old woman with catatonia brought an opportunity to retrospectively review a case in detail in order to feature learning objectives that review very important considerations in the evaluation, differential diagnosis, symptom tracking, and treatment of catatonia. The future of research in catatonia is bright and diverse.

No significant relationships.