Glaucoma is a heterogeneous group of conditions which result in optic neuropathy and visual defects, majorly linked with the increase of intra-ocular pressure (IOP). It is known that psychotropic drugs have been implicated in drug induced angle-closure glaucoma, mostly through its anti-cholinergic effect.

Systematize the drugs most and least implicated in its appearance and worsening and understand the care needed on prescribing.

A search on Pubmed database was made having in consideration the Mesh Terms Glaucoma and Psychotropic Drugs and its different classes. Specific searches were made when appropriate on different platforms.

Implications on the appearance and worsening of glaucoma are clear for tricyclic antidepressants. The evidence is not clear for SSRIs, SNRIs and mirtazapine, but they might be related with increased IOP. Other classes of antidepressants seem to be of lower risk. Antipsychotics do not seem to be greatly associated with angle closure, although there are some case reports. There are descriptions of the potencial use of haloperidol, anti-convulsive mood stabilizers, with exception of topiramate, melatonin and anti-dementia drugs on the treatment of this condition. In practice, benzodiazepines do not seem to precipate angle-closure. Methamphetamines are contraindicated. Eletroconvulsive therapy its an option.

Although not prevalent, angle-closure glaucoma can have serious implications and culminate in irreversible blindness. In patients with known risk-factors its important to have it on consideration at the time of the prescription and warn on seeking immediate help if having acute ocular pain, redness and/ or cloudy vision.

No significant relationships.

Executive function (EF) deficits are often associated with Autism Spectrum Disorder (ASD), even in the absence of Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. To date, no approved medication treatments exist for EF deficits associated with ASD.

To assess the efficacy of transcranial photobiomodulation (tPBM) on EF in adults with ASD.

Adults (18-59) with high-functioning (HF)-ASD received twice a week tPBM for 8 weeks in an open-label single group design. ASD and EF deficits were assessed by clinician-rated Clinical Global Impression Scale and patient-rated scales of Behavior Rating Inventory of Executive Function-Adult (BRIEF-A).

Eleven participants were enrolled. Ten participants completed the study. Nine participants who completed the study had comorbid ADHD diagnosis. All 10 participants were included in efficacy analyses of EF deficits. Statistically significant improvements in executive function deficits were found in BRIEF-A total score and in subdomains of Inhibition, Emotional Control, Planning and Organization, Organization of Materials, Behavioral Regulation, Metacognitive Index and Global Executive Control. All participants were found to have mild to moderate improvement in their ADHD symptom severity per clinician rated CGIs. Statistically significant improvements in ADHD symptoms were noted in self-rated scales. No adverse events required changes in tPBM protocol.

tPBM is a safe and feasible treatment approach that has the potential to treat core features of ASD. Further research is necessary and warranted.

This work is funded by Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder and the MGH Pediatric Psychopharmacology Council Fund.

No significant relationships.

Telepsychiatry is the best-documented e-Mental Health application. It refers to the use of videoconferencing in the provision of mental health services. During the COVID19 pandemic, in response to physical distancing, mental health services worldwide have turned to online consultations. For the vast majority of clinicians, it was the first time they use telepsychiatry, and very few have received training in how to do it.

- to present the main objectives and messages of the WPA Global Guidelines for Telepsychiatry related to competencies & skills, educational & legislative needs, and international collaboration.

A structured review of the main challenges, innovations, and settings in the first Global Telepsychiatry Guidelines, published by WPA in February 2021.

The benefits of increased access to telehealth services are apparent for telepsychiatry, but benefits can only be realized if the tools are used by clinicians who have the appropriate training and guidance. With proper preparation and thoughtful risk management, telepsychiatry can be an invaluable tool for allowing greater access to care. However, certain prerequisites must be fulfilled to achieve the desired goals. These prerequisites are e.g. choice of the technology, settings, patient/provider preferences as well as competencies and skills described in this document.

The need for training among health care professionals is the highest priority. The urgent need for clinical training and skills building around e-mental health inclusive telepsychiatry, will determine the influence that psychiatry can have in addressing the mental health sequelae of the COVID19 pandemic via competent practice and increased international collaboration.

I am the main author of “WPA Telepsychiatry Global Guidelines”

Little is known about the need for mechanical restraint during non-voluntary transfers from patient’s homes to the psychiatric emergency department in patients diagnosed with Paranoid Schizophrenia. Although there is no evidence of its efficacy, one of the main tools used for the reduction of mechanical restraints is verbal de-escalation training.

The aim is to describe which symptoms predispose to mechanical restrain in patients with Paranoid Schizophrenia transferred in a non-voluntary manner from home to the psychiatric emergency department, and the effect on reducing mechanical restraints after receiving verbal de-escalation training.

All patients with Paranoid Schizophrenia who, after being visited by a home psychiatry team, have required non-voluntary transfer from their homes to the psychiatric emergency department were selected (N = 442).

Young age, being male, having a poor adherence to treatment, higher scores for de following variables; Excitement, Grandiosity, Suspiciousness, Hostility, Abstract thinking, Motor tension, Uncooperativeness, Poor attention, Lack of insight and Poor impulse control as well as lower scores in motor retardation on the PANSS, are related to a higher frequency of mechanical restrain (P<0,005). Before the verbal de-escalation training, 43.9% of the transferred patients required mechanical restraint, after the training, the need for restraints was reduced to 25.5% (P<0.001).

Training in verbal de-escalation has allowed an important reduction in mechanical restraints in patients with schizophrenia who have required non-voluntary transfers from home to the psychiatric emergency department.

No significant relationships.

Ketamine is routinely used for anesthetic induction because of its dissociative properties. Recently, it has attracted attention as a rapid-acting anti-depressant, but other studies have also reported its efficacy in the management of diverse psychiatric pathologies previously resistant to treatment.

We aimed to review the efficacity of ketamine in the management of mental disorders.

We conducted a litterature review through pubmed database, using the following keywords: “mental illness”; “ketamine”;”depression”;”anxiety disorders”;”eating disorders”;”substance use disorders”.

Ketamine has primarily been used in psychiatry for people with treatment-resistant depression. Its efficacy in reducing suicidal ideation has been previously reported. Furthermore, Ketamine may be a potential therapeutic option for patients with treatment-resistant anxiety disorders, especially obsessive compulsive disorder (OCD) and post-traumatic stress disorder. It has recently been reported a rapid onset anxiolytic activity in treatment-resistant social anxiety disorder and generalized anxiety disorder. Besides, Ketamine use in subjects suffering from eating disorders was associated with a complete remission of severe anorexia nervosa with a return to normal weight and a decrease in body preoccupations. The use of ketamine alone or in combination with other therapies was effective in reducing alcohol and substance use, prolonging abstinence, reducing craving and enhancing motivation. ketamine in combination with motivational enhancement therapy may be an effective pharmacotherapy for initiating and sustaining abstinence from alcoholics

ketamine shows great promise as a treatment for several mental disorders. However, its possible side effects and short duration of efficacy limit its use. Further studies exploring longer-term outcomes and administration protocols are needed.

No significant relationships.

Preschool Behavioural Inhibition (BI) was found to be a temperamental risk factor of anxiety disorders in later life; especially in women. Similarly, previous research revealed that parental behaviour plays a major role in the development and maintenance of anxiety disorders. Gender differences in parental responses to child’s temperament may contribute to the stronger association between BI and anxiety disorders in females.

We aimed to examine the moderating effect of child’s gender in the association between child’s BI and parenting behaviour in a non-clinical sample of parents of preschool children.

A cross-sectional sample of parents (N=94) of preschool children (girls 47.4%) filled out the Behavioural Inhibition Questionnaire (BIQ) and the Multidimensional Assessment of Parenting Scale (MAPS).

Child’s gender was found to moderate the relationships between BIQ scores and MAPS Supportive Parenting (F(3,90)=4.350, p=.007, R2=.127), as well as Hostile Parenting (F(3,89)=3.478, p=.019, R2=.105). In boys, higher BIQ scores were associated with higher levels of Supporting Parenting (b=.005, p=.027), while in girls this association was reversed (b=-.004, p=.037). Furthermore, in boys, no association was found between BIQ scores and Hostile Parenting (b=.005, p=.835); however, higher BIQ scores were related to higher levels of Hostile Parenting in girls (b=.067, p<.001).

Our results suggest that parental responses to their preschool child’s Behavioural Inhibition may vary as a function of child’s gender. This may lead to gender differences in developmental pathways to anxiety disorders.

No significant relationships.

Numerous evidences point out how migrants use health services differently than the natives. Migrants turn more frequently to the ED for psychiatric problems and less to territorial psychiatric services than the native population. Other differences can be found in terms of diagnosis, type of discharge, type of hospitalization.

Our study has the objective of evaluating the incidence of psychiatric hospitalizations of migrant patients compared to natives in a well-defined area of the metropolitan city of Bologna and evaluate the effect of the Covid 19 pandemic on the incidence of psychiatric hospitalizations among migrants and on their clinical characteristics.

The study conducted is of an observational and retrospective type on migrant and native patients admitted to the psychiatric unit “SPDC-Malpighi” of the DSM-DP of Bologna AUSL between 01/01/2018 and 31/12/2020.

Migrants were more likely to be admitted via ED and less likely to be referred from a CMHC or from non-psychiatric hospital unit compared with natives. Most migrants were discharged at home while natives more frequently chose to self-discharge. With regard to diagnosis, migrants were more likely to be admitted due to a SSD, while natives were more likely to be diagnosed with a MD or SUD.

We confirm the presence of differences in access to care, type of discharge and type of diagnosis between migrants and natives. Further studies to investigate changes in pre and post Covid admissions in migrants would be needed.

No significant relationships.

Sleep disturbances are common following traumatic brain injury (TBI) worsening morbidity and other neuropsychiatric symptoms. Post-TBI alterations in sleep architecture require further study.

(1) To evaluate polysomnographic measures of sleep architecture in participants with history of TBI compared to controls and as meta-analyses of pooled means. (2) To evaluate effects of timing and severity of TBI on polysomnographic outcomes.

PRISMA compliant systematic review was conducted of MEDLINE, PsycINFO, EMBASE and Scopus. Inclusion criteria: 1) reporting polysomnography in the context of TBI and 2) operationalizing TBI using clear/formalized criteria. Data were pooled in random-effects meta-analyses with outcomes expressed as mean differences (MD).

In participants with TBI, sleep was comprised of 19.39% REM sleep, 8.13% N1, 51.18% N2, and 17.53% N3, as determined by meta-analyses of single means. Total sleep time was reduced in chronic (>6 months) TBI compared to acute-intermediate TBI (<6 months) (p=0.01). Compared to controls, participants with TBI differed with increased N1 sleep (MD=0.64%; 95%CI=0.02,1.25; p=0.04), reduced sleep efficiency (MD=-1.65%; 95%CI=-3.18,-0.12; p=0.03), and reduced sleep latency on the multiple sleep latency test (MD=-5.90mins; 95%CI=-10.09,-1.72; p<0.01). On sub-group analyses, participants with mild TBI differed from controls with reduced total sleep time (MD=-29.22mins, 95%CI=-54.16,-4.27; p=0.02). Similarly, participants with acute-intermediate TBI exhibited increased sleep latency compared to controls (MD=8.96mins; 95%CI=4.07,13.85; p<0.01) and differed significantly from participants with chronic TBI (X2(1,N=608)=6.54; p=0.01).

Sleep architecture is altered following TBI with potential implications regarding functional outcomes and recovery. These alterations appear to differ based on severity of injury and time since injury.

No significant relationships.

No significant relationships.

Kleptomania is characterized by recurrent failure to resist the impulse to steal items of little value despite the ego-dystonic impulse and awareness of the wrongfulness of the act. Its prevalence is considered to be 0.6–0.8% in the general population and it is mostly comorbid with other psychiatric disorders. Kleptomania is a disabling disorder since patients suffer from emotional distress and impaired functioning.

Although there is no cure, treatment may help prevent Kleptomania worsening and its negative consequences. We propose a review of the therapeutic approach to this disease.

Non-systematic literature review.

No effective treatment is available for Kleptomania. Better efficacy can be achieved by combining psychotherapy with pharmacotherapy. Different treatment interventions can be selected based on clinical similarities to other disorders, co-occurring conditions or behavioral core features. Patients with significant mood symptoms may benefit from mood stabilizers or antidepressants. For patients with shoplift cravings and/or family history of substance use disorders, Naltrexone may reduce symptoms. Stimulants may be useful for Kleptomania bassociated with Attention Deficit Hyperactivity Disorder impulsivity. Benzodiazepines are effective in tension relief when used as adjuvants, at the beginning of treatment. Electroconvulsive therapy should be reserved for patients with treatment-resistant symptoms and comorbid depression. Cognitive-behavioral therapy has replaced Psychoanalytic and Psychodynamic psychotherapies.

Treatment helps decrease disruption to the person’s life, preventing the intense shame, legal, social, family, and occupational repercussions of Kleptomania. Although pharmaceutical and psychosocial interventions are available, we still lack specific treatments for Kleptomania.

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.

Emigration is the act of leaving one’s country of nationality or habitual residence to settle in another nation. In Tunisia, this phenomenon is increasing in particular for doctors.

Evaluating the intentionality of emigration among interns and medical residents in Tunisia while studying the factors related to it.

We conducted a cross-sectional, descriptive and analytical study of interns and medical residents who participated in our study through the social network ’Facebook’ by an anonymous self-questionnaire. The level of satisfaction with the different aspects of life were assessed by a 5-point Likert scale, from “not at all satisfied” to “very satisfied”.

The total number of participants was 56 of which 64.3% were medical residents. More than 50% of the participants expressed dissatisfaction with the distribution of tasks and organization of work (66.1%), safety at work (53.6%), comfort (57.2%), time allocated to personal life (53.6%) and salary (69.6%). The political, health and educational situation in the country was considered unsatisfactory by the majority of participants (90% to 95%). Among our participants, 44.6% regretted having chosen the profession of medicine and 53.6% had plans to immigrate to work abroad. The intentionality of immigration was significantly higher among men (p=0.02), those with siblings abroad (p=0.047) and those without dependent relatives (p=0.040).

Young physicians are strongly looking for emigration. This decision could emanate from professional, personal and political factors. Further studies seem to be necessary to explain this emigration phenomenon.

No significant relationships.

Clozapine is one of the most effective antipsychotic drugs. On the other hand, it can cause serious side effects which have to be monitored. An adverse effect is myocarditis, a type B Clozapine reaction that can be fatal if it is not early diagnosed.

To report a case of a patient with Clozapine induced myocarditis.

A 48 years old women with a schizoaffective disorder was admitted to our Hospital due to a clinical decompensation. She had a manic episode with psychotic symptoms (persecutory delusions and auditive hallucinations). Clozapine was introduced after there were no improvement with Olanzapine, Risperidone and Valproic Acid. A dose increase was made reaching 100 mg/day the first week and 200 mg/day the second week. The third week she started with a 39ºC fever, decreased oxygen saturation, leukocytosis (9560 103/mm3), elevated PCR (210 mg/l) and elevated troponins (52,88 ng/l). EKG and other medical tests did not show alterations. There was not found a clear etiology, so Clozapine was retired as a cautionary measure. The differential diagnosis for etiology included viral infections, Clozapine induced myocarditis or idiopathic.

A few days after the withdrawal of Clozapine, cardiac symptoms improved, suggesting it was the most probable etiology.

Although it is not very likely to occur, it is important to consider myocarditis as a sever Clozapine side effect.

No significant relationships.

No significant relationships.

Bipolar Disorder (BD) is a severe mental disorder with a high genetic load, in which is relevant to identify potential differences in affective temperaments between both diagnostic subtypes.

To find differences between BDI and BDII patients in affective temperaments evaluated by Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego TEMPS-A.

A sample of 407 euthymic patients with diagnosis of bipolar disorder type I (BDI= 307) or type II (BDII= 100) according to DSM-IV-TR criteria being age 18 or older was recruited from the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. Five affective temperaments were evaluated using the TEMPS-A. It was initially verified that the scores of these temperaments do not fulfil the assumption of normality by means of tests. Differences in means were estimated using Mann-Whitney U and Chi square tests (p <0.05) as appropriate, and ANCOVA controlling the effect of confounding variables.

Data revealed that patients with BD II had significantly higher scores in four affective temperaments: dysthymic, cyclothymic, irritable and anxious compared to BDI. After controlling the most relevant moderating variables, BDII patients continued to show higher scores in irritable temperament .

BDII patients present a more irritable temperament than BDI (p=0,037), which can affect the course and management of the disease. It could be suggested that presenting higher scores of these temperaments could be associated with BDII and further studies are needed to replicate this finding since it might help the clinicians in early phases to guide in the diagnostic process.

No significant relationships.

No significant relationships.

In the literature, some studies consider psychiatric patients to be vulnerable to COVID-19, in contrast to other studies that find them rather protected.

To determine the impact of the COVID 19 pandemic on patients undergoing psychiatric care.

This is a descriptive and cross-sectional study that took place in the psychiatry department A at Razi hospital in Tunisia. We conducted a comparison of patient follow-up between the period of March 2018-2019 and March 2020-2021. For this we used a form including socio demographic data, data concerning the COVID-19 situation, clinical data while comparing the follow-up of patients (hospitalizations, mode of relapses, consultations in the emergency room…)

100 patients were included, 60% were men, mean age 44 years (+/- 11 years) [19-65 years]. Ninety-seven percent of patients had no personal history of COVID-19 infection. Comparing the pre-pandemic year (2018-2019) and the pandemic year (2020-2021), we note an increase in the rate of emergency room visits of (17.5%) as well as a relapse rate requiring hospitalization in our department in 48%, this figure was 30% in 2019. A statistically significant increase was noted for depressive and anxiety relapses (p=0.04; r=0.7). Fear of catching the virus while attending hospital facilities (17.6%), geographical isolation (17.6%), unavailability of treatment (17%) and poor insight (41.2%) were the primary causes of poor adherence.

The patients followed in our department have presented during this COVID-19 pandemic several relapses of their psychiatric pathologies compared to the previous year.

No significant relationships.

The study of ideas about death and the mechanisms of their formation in adolescents with suicidal behavior is an important task for both diagnosis and psychotherapy. The parents’ notions of death, and the prohibition on discussing the topic of death in the family, can significantly distort the adolescent’s relationship with death.

Investigate differences in attitudes towards death in parents and adolescents who apply to the crisis care room of a child psychiatric clinic.

The study involved 90 adolescents with their parents who applied to the crisis outpatient care system. The following questionnaires were offered: Death Attitude Profile-Revised, Death Anxiety Scale, Experiences in Close Relationships-Revised, Multidimensional Scale of Perceived Social Support, GAD-7.

Significant differences were found for most of the scales in the samples of adults and adolescents, of particular interest to us were the scales “death avoidance” (W=317,500,z=3,089,p=0,002) and “perception of family support» (W=288,500,z=3,393,p=0,001). For the group of adolescents, there are higher indicators on the scales of anxiety (W=61,000,z=-2,546,p=0,011), anxiety in close relationships (W=83,000,z=-2,549,p=0,011), avoidance of close relationships (W=28,000,z=-3,870,p=0,000), and death as a means of escape (W=54,500,z=-3,076,p=0,002).

In families of adolescents with suicidal behavior, the severity of dysfunctional patterns of building close relationships and the presence of sharply opposite positions in relation to death in children and parents are observed without the possibility of discussing this topic.

No significant relationships.

There is a widely known stereotype about medical majors repeated by generations of medical practitioners called ,,medical student disease”. It’s based on a belief that unexperienced students are prone to develop pathological fear of medical conditions they are studying about.

The aim of the study was to examine two populations of students - medical and non-medical ones in order to compare their level of hypochondriacal behavior and health-related anxiety. Moreover we looked for other factors which might have had an influence on hypochondria and nosophobia among them.

The proprietary questionnaire was completed by 606 students (303 medical students of the Medical University of Silesia in Katowice and 293 students of the 3 largest non-medical universities in Katowice).

The results show that medical students receive same scores on a nosophobia scale as students of non-medical universities (p=0,5). The analysis of hypochondriacal behavior showed significantly higher results in non-medical students group (p=0,02) .The higher medical students were at the stages of academic education, the higher the results of nosophobia they obtained. In the entire study group female received higher score in relation to the fear of illness (p = 0.001). People with mental disorders achieve significantly higher results of nosophobia (p <0.001 in the entire group) and of hypochondria (p <0.001 for the entire cohort).

Our study challenges the widespread belief that medical students, compared to their peers, are overly anxious about their own health. Gender and having a mental illness are predictors of hypochondria and nosophobia.

No significant relationships.