Melatonine (N-acetyl-5-methoxytryptamine) is an endogenous neurohormone produced by pineal gland. It is related to sleep-wake circadian rhythms, and nowdays it is sold without prescription as a “natural treatment” for sleep disorders. Most common side effects of melatonin overdose are drowsiness, dizziness, fatigue, headache, confusion, nightmare, hypotension, tachycardia and hypothermia. Supportive measures and control of vital signs are essential for an early discharge of the patient.

To present a case of an 42-year-old woman who was taken to the emergency department after voluntary ingestion of 60 tables of melatonin 2mg (Total amount 120mg), in a suicide attempt. To describe the most common side effects of melatonine overdose a the literature review.

Clinical case presentation and retrospective literature review.

A 42-year-old woman who was taken to the emergency department after voluntary ingestion of 60 tables of melatonin 2mg (Total amount 120mg), about 1 hour before coming, in a suicide attempt. After clinical evalutation, gastric lavage was performed. ang 50g activated charcoal given. Drowiness and mild hypothermia (34ºC) was detected. After 12 hours of vital signs observation the patient was discharged and to psychiatry consultation, where depressive mood disorder and chronic insomnia was diagnosed.

Melatonin is one of the least toxic medication. Most common side effects of overdose are drowsiness, dizziness, fatigue, headache, confusion, nightmare, hypotension, tachycardia and hypothermia. Supportive measures and control of vital signs are essential for the treatment.

No significant relationships.

The field of psychiatry is in a crisis. Developments in pharmacology and psychotherapy, reforms in services, increased spending and reduced treatment-gap have not substantially improved prognosis for patients in psychiatry. Mental disorder remains lethal short-term and disabling long term. In comparison, prognosis has improved dramatically in oncology and cardiology. Controversies in psychiatry are causing variation in clinical practice between hospitals, even within single-provider health systems. There is, for example, variation in rates of ADHD, use of coercive measures, and medication (type of drugs, dose and duration of medication). Current empirical methods are incapable of solving the major controversies in psychiatry. Epidemiology struggles with residual confounding, bias and reverse causality. Randomized controlled trials are expensive and time-consuming. Ethics may also be a barrier for clinical studies investigating variation in clinical practice. From a health management point of view, variation in clinical services within a single-provider system is usually indicative of variation in quality. However, the variability in service delivery caused by these controversies creates a lottery-like situation for the individual patient, who is generally unaware of the crisis in psychiatry, and blinded to the ongoing lottery.

We will present a third empirical approach beyond randomized controlled trials and epidemiology which may help solve the crisis.

A systematic review of preference-based instrument variable analyses.

We identified relevant high quality 185 studies, though almost none in mental health.

Causal modelling in observational data has potential as a third paradigm beyond RCTs and epidemiology, and may help solve the crisis in psychiatry.

No significant relationships.

Patients treated for chronic mental disorders and who receive atypical antipsychotics are in most cases at risk of gaining weight, the excess of which is complicated in the long term by metabolic syndrome (MS). The management of these patients is effective if it includes Therapeutic Education.

Describe the therapeutic education program developed for patients on antipsychotics who have metabolic syndrome

In this work, we present the educational program that we have developed for patients undergoing psychiatric treatment with atypical antipsychotics, who have been stabilized for at least 3 months and who suffer from SM.

It is a program that starts with the inclusion consultation and educational diagnosis with the first step of clinical (weight, abdominal perimeter and BMI), biological (blood sugar, HbA1C, cholesterol, HDL, triglycerides) and psychometric (SF12, MAQR, food and physical activity diary) assessments. Our initial program includes 6 sessions and 2 maintenance sessions at 1 month and 3 months after the 6th session. The objectives were divided between information about DM, motivation to eat a balanced diet, physical activity and improvement of quality of life. We also included stress management and positive psychology activities. Assessments are repeated at the end of the initial program and at the last maintenance session.

Our program was developed according to the Geneva therapeutic education recommendations. We plan to apply it to groups of patients in our department

No significant relationships.

Schizophrenia (SZ) and bipolar disorder (BD) are severe mental illnesses with large overlapping heritability. Both disorders are associated with altered neurophysiological responses, as measured with magnetoencephalography (MEG) or electroencephalography (EEG), particularly reduced mismatch negativity (MMN) and 40 Hz auditory steady-state responses (ASSR). These deficits could potentially both serve as early markers of illness and provide insight into the underlying pathophysiology as endophenotypes. First-degree relatives to patients with SZ and BD also show some neurophysiological deficits, however whether these deficits can be detected in adolescent offspring of patients is undetermined.

We aim to investigate whether adolescents at familial high risk of schizophrenia and bipolar disorder show aberrant MMN and ASSR compared to population-based controls.

We will investigate MMN and 40 Hz ASSR in 15 year old adolescents (n ≈ 175) born to parents diagnosed with either SZ (FHR-SZ), BD (FHR-BD), or neither SZ or BD (population-based controls, PBC) using MEG. We will first perform sensor-level analyses and subsequently apply dynamic causal modeling (DCM) to investigate effective connectivity and make inferences about the underlying neurobiological mechanisms. We will investigate whether current psychopathology, cognitive status, and genetic risk for SZ and BD predict neurophysiological responses in the adolescents. Investigations are part of The Danish High Risk and Resilience Study - VIA (VIA15), a population-based longitudinal cohort study integrating social, psychological and biological risk factors and outcomes for SZ and BD.

Final results are expected in 2024

The VIA15 study will allow for unprecedented insight into the neurobiological development of schizophrenia and bipolar disorder.

No significant relationships.

Few studies have investigated the level of planning of pregnancy among women with mental disorder and associated risk factors.

The purpose of this study was to determine the associated factors to UP and psychopathological consequences.

A cross sectional study was conducted at the Perinatal Mental Health Unit of the Hospital Clínic in Barcelona. The total sample comprised 675 consecutive pregnant women with diagnosis of mental disorder (DSM-IV criteria), seen between January 2006 and December 2018. Clinical, psychometric and socio-demographic variables were collected at the first visit. Pregnancy planning was assessed by a question “Was this pregnancy planned?” with three possible answers: 1) Yes, it was planned and has been well received; 2) No, it was not planned but it has been well received; and 3) No, it was an accident. Response 1 was coded as “planned pregnancy” and responses 2 and 3 as “Unplanned Pregnancy”.

38.4% of the sample had an UP. Younger age, lower levels of education, Latin-American population, multiparity, financials problems and poor relationship with the partner were associated with UP in women with mental disorder. The mean EPDS and STAI scores and the presence of self-harming thoughts were significantly higher in women with UP.

UP was associated with more depressive and anxious symptoms and more self-harming thoughts. It is necessary to promote reproductive health care for women with mental disorders and to take into account their reproductive life plan, especially in those with risk factors described.

No significant relationships.

During a public health crisis, preventive measures are essential. However, to make them effective, all citizens must be engaged.

To analyse the differential role of individual and contextual variables in the adherence to public health recommendations.

1376 adults (70.5% female; mean age=35.55±14.27) completed a survey between September/2020 and May/2021 with: Adherence Scale to the Recommendations during COVID-19 (ASR-COVID19; evaluates three dimensions of adherence), Fear of Covid-19 Scale (FC19S) and Toronto and Coimbra Prosocial Behaviour Questionnaire (ProBeQ; assesses empathy and altruism).

Adherence did not differ between individuals with or without personal or family history of COVID-19 infection. ASR-COVID19 and all dimensions were positively correlated to ProBeQ’s altruism and empathy (from r=.32 to r=.54); FCV19S correlated positively to total adherence score and house sanitation (from r=.18 to r=.26; all p<.01). Linear regressions revealed that altruism and empathy (first model), as well as fear of Covid-19 (second model), were significant predictors of adherence; however, while the first model explained ≅28% of its variance, the second (FCV19S as independent variable) only explained ≅3%. Regression models performed in a subsample of participants with personal or family history of COVID-19 revealed that only empathy, but not altruism, was a significant predictor of adherence; in this subsample, fear was no longer a significant predictor of adherence, except for lockdown and use of teleservices.

Based on our results, we suggest health care providers and public health campaigns should take into consideration social solidarity and altruism, as well as previous experiences, when appealing to public’s engagement in health behaviour.

No significant relationships.

Generalized anxiety disorder (GAD) and Obsessive compulsive disorder (OCD) are common psychiatric disorders. Researchers studying the pathophysiology of these two disorders evaluated the effect of metacognition. However, there is no research examining the metacognition differences of these two psychiatric conditions.

This study was performed to compare the metacognitions in OCD, GAD and healthy controls.

The sample of this study consisted of 158 GAD and 137 OCD patients aged 18-65 years who presented to outpatient psychiatry clinic and applied to the health committee 168 healthy controls without psychopathology. Sociodemographic data form, Meta-Cognitions Questionnaire-30 scale(MCQ-30), Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) were applied to the volunteer participants who met the criteria for participation in the study. The data obtained were evaluated statistically and subjected to statistical analysis.

The mean age was 31.89 ± 10.86 years and was 60.5% (n = 208) women. There was statistical difference between marital status, occupation and income(p <0.05). In addition, there was a statistically significant difference between MCQ-30 total and subscales, BDI and BAI (p <0.001). According to the comparison of OCD and GAD patients, ’positive belief’, MCQ-30 total and BAI scores were found to be statistically different (p <0.05), ’Uncontrollability and danger’, ’Cognitive Confidence’, ’Beliefs about The Need to Control Thoughts’, ’Cognitive Self-Consciousness’, BDI there was no statistical difference between them (p> 0.05).

Our results are contributing to the understanding of the uncertainty of development and maintenance of OCD and GAD. Additionally, metacognitions could be important for the diagnosis and treatment of OCD and GAD.

No significant relationships.

Tuberous sclerosis is a multisystem genetic disorder. It is associated with significant psychiatric comorbidity mainly autistic disorders, hyperkinetic disorders, depression and anxiety. It is rarely associated with psychosis and bipolar disorder.

To describe the case of a 34-year-old male with concomitant diagnosis of bipolar disorder and tuberous sclerosis.

Case report based on clinical records. Brief literature review using articles searched in the PubMed/MEDLINE database using the terms “tuberous sclerosis”, “bipolar disorder” and “neuropsychiatric”.

The patient presented at our Emergency Department 3 years ago with a mixed episode with psychotic symptoms with 1 month of duration. Prior history of two hypomanic episodes, but no depressive episodes. High baseline functionality. Sporadic use of alcohol and cannabis. No family history of psychiatric or neurological diseases. Diagnostic work-up showed no relevant results, aside from small calcifications in brain CT. He was admitted to our ward and medicated with aripiprazol (titrated up to 30 mg), leading to full remission of the clinical picture. The patient was referred to our outpatient clinic and stayed with medication for 1,5 years. One year after, he presented a sudden episode of mutism and perplexity with quick remission. The EEG wielded no relevant results. New brain CT showed signs of tuberous sclerosis. He was referred to Neurology and subsequent assessments, including brain MRI, led to the fulfilment of clinical criteria for tuberous sclerosis.

This case illustrates the possibility of concomitant diagnosis of bipolar disorder and tuberous sclerosis. The possible association between these disorders is discussed.

No significant relationships.

Measurement-based care (i.e., the systematic use of rating scales to guide clinical decision-making) has shown great promise in the treatment of major depression in clinical trials. Unfortunately, measurement-based care has not yet gained ground in clinical practice, possibly because clinician-rated scales are time-consuming and limited by the availability of trained raters. Hence, brief and valid self-rated scales (questionnaires) may serve as an alternative or supplement to clinician-rated scales. The self-rated 6-item Hamilton Depression Rating Scale (HAM-D6-SR) has shown some promise in this regard, but its validity among inpatients remains unclear.

The objective of this study is to evaluate the criterion validity and responsiveness (sensitivity to change) of the HAM-D6-SR among inpatients using the clinician-rated 17-item Hamilton Rating Scale for Depression (HAM-D17) as gold standard reference.

Inpatients with depression will complete the HAM-D6-SR twice during admission (at least one week between the two self-ratings). At both occasions, the patients will subsequently be rated on the HAM-D17 by trained raters, who are blind to the HAM-D6-SR ratings. The agreement between the HAM-D6-SR and the HAM-D6 extracted from the HAM-D17 will be evaluated using intra-class correlation.

A total of 100 inpatients will be recruited for the study. Data collection is ongoing, and the results of the study will be presented at the 2022 EPA meeting.

If the agreement between the HAM-D6-SR and the HAM-D6 extracted from the HAM-D17 is satisfactory, the HAM-D6-SR could inform decision-making in the treatment of depression.

The presenting author, PK, declares no conflict of interests. Co-author, SDØ, has received the 2020 Lundbeck Foundation Young Investigator Prize. Furthermore, SDØ owns units of mutual funds with stock tickers DKIGI, DKIDKIX, MAJGRO, NBIDE, SPVILRKL and WE

No significant relationships.

While decreased alpha-band functional connectivity (FC) and changes in network topology have been reported in Alzheimer’s disease, it is not yet entirely known whether these differences mark cognitive decline in the early stages of the disease.

Our study aimed to analyze EEG FC and network differences in the alpha frequency band during visuospatial memory maintenance between Mild Cognitive Impairment (MCI) patients and healthy elderly with subjective memory complaints.

FC and network structure of 17 MCI patients and 20 control participants were studied with 128-channel EEG during a visuospatial memory task. FC was measured by amplitude envelope correlation with leakage correction (AEC-c), while network analysis was performed by applying the Minimum Spanning Tree approach.

Increasing memory load enhanced the mean alpha-band FC in the control group. In contrast to that, after an initial increase, the MCI group showed significantly (p<0.05) diminished FC in the highest memory load condition. Mean alpha AEC-c correlated significantly with the size and mean diffusivity of medial temporal lobe structures in the entire sample. The network analysis revealed a rerouted network in the MCI group with a more centralized topology and a more unequal traffic load distribution compared to the control group.

Alpha-band FC correlates with cognitive load-related modulation, with medial temporal lobe atrophy, and with the disruption of hippocampal fiber integrity in the earliest stages of cognitive decline. The more integrated network topology of the MCI group is in line with the “hub overload and failure” framework and might be part of a compensatory mechanism.

No significant relationships.

Huntington’s Disease (HD) is an autosomal dominant, neurodegenerative condition with a prevalence of 10.6-13.7 per 100,000, caused by the trinucleotide CAG (cytosine, adenine, guanine) repeat expansion in the HTT gene. HD is characterized by a range of motor, cognitive, and psychiatric symptoms, the latter of which usually manifest prior to the onset of motor or cognitive disturbances. Amongst psychiatric symptoms, changes in personality are most common, followed by depression. Psychosis has a higher prevalence in those with early-onset HD.

This case report aims to demonstrate an apporach to the management of neuropsychiatric disturbances in HD as well as expose the need for development of an evidence-based apprach to treatment.

PubMed was searched for the criteria Huntington’s Disease AND Psychosis, with a secondary search for Management of Psychosis in Huntington’s Disease.

The patient is a 54-year-old male with no psychiatric history and reported past medical history of Huntington’s Disease, diagnosed one month ago. He was brought to the Psychiatric ED due to agitation and disorganized behavior at home. On admission, he demonstrated disorganized behavior, grandiose delusions, neurocognitive deficits, and reported auditory hallucinations. With the initiation of tetrabenazine and risperidone his psychiatric symptoms improved and he was able to be discharged to a long-term care facility.

Literature is scarce regarding treatment of psychiatric manifestations of HD. We catered our approach towards safe and effective symptoms management in a multidisciplinary manner. Further research is required to reach an evidence-based consensus as well as develop specific guidelines for managing psychiatric conditions related to HD.

No significant relationships.

Traditional cultural healers -- their methods and their results -- are often invisible to conventional medical practitioners. When confronted with a result that does not make sense, we often ignore it.

We wanted to understand the process that happened between people and traditional cultural healers when these people experienced substantial improvement in mental health without psychiatric treatment.

We collected 56 case stories from people who consulted traditional cultural healers instead of conventional medical practitioners for serious mental health problems. We confirmed the stories with family members and interviewed the healers as well. We used constructivist grounded theory to explore commonalities in the stories from the clients’ points of view and from the healers’ perspectives. The context is indigenous people in North America.

Patients had a range of diagnoses, including psychotic disorders (12), bipolar disorder (28), and evere unipolar depression (16). Co-morbid anxiety disorders were common (22). Improvement in mental health was associated with participation in ceremonies within a community, building relationships with members of that community, engaging in prescribed daily practices endorsed by that community, with a resulting report of feeling increases in social and spiritual connectedness. The healers believed strongly that the embeddedness in community contributed to the results and that spirit beings played important roles in helping people feel better. The use of psychiatric medications was minimal.

Psychiatry can acknowledge that people can have substantial improvements in mental health when working with traditional cultural healers outside of conventional settings. Studying these settings and results can improve conventional practice.

No significant relationships.

Obsessive-Compulsive Disorder (OCD) is a common mental disorder and a major cause of disability worldwide. Typically, it has a chronic course, marked by recurrent intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Its pharmacological first line of treatment has been well established for several years now, with the Serotonin Reuptake Inhibitors (SRIs). However, about half of the patients are resistant to this approach, representing a therapeutic challenge for clinicians. Evidence suggests that other medications can augment SRIs, enhancing its effects and achieving a bigger efficacy in these patients’ treatment. Also, there is an increasing interest in neurosurgical interventions in these patients.

The main goal of this work was to assess the clinical efficacy of adjunctive therapeutic strategies in patients with OCD resistant to SRIs.

A literature review was conducted searching PubMed and ScienceDirect databases from the 1st of January 2000 to the 1st of September 2021 to identify clinical trials comparing an active drug/neurosurgical intervention with placebo as an adjunctive therapeutic strategy in SRI-resistant OCD.

Sixteen studies were selected for data extraction, including a total of 585 patients. Risperidone, aripiprazole, N-acetylcysteine, lamotrigine, pindolol, riluzole, memantine and methylphenidate were efficacious for augmenting SRIs in OCD. Ablative surgery (ABL) and deep brain stimulation (DBS) were equal effective in the treatment of refractory OCD.

Several therapeutic options presented as potentially effective in OCD when it is resistant to SRIs, although this is still an area for further research.

No significant relationships.

Fondamental Foundation supported the developement of the application EMMA

Though BDSM interest (bondage & discipline, dominance & submission and sadism & masochism) has proven to be quite prevalent (46.8% in recent research), there is still significant stigma surrounding it, both in general society and among mental health practitioners.

This research explores the biological mechanisms associated with a BDSM interaction in the hope to strengthen the argument that it does not belong in the psychiatric field.

The present study collected data on peripheral hormone levels, pain thresholds and pain cognitions before and after a BDSM interaction and compared these results to a control group.

show that submissives have increased cortisol and endocannabinoid levels due to the BDSM interaction and that these increases are linked. Dominants showed a significant increase in endocannabinoids associated with power play but not with pain play. BDSM practitioners have a higher pain threshold overall and a BSDM interaction will result in a temporary elevation of pain thresholds for submissives. Additionally, pain thresholds in dominants will be dependent upon their fear of pain and tendency to catastrophize pain and submissives will experience less fear of pain than the control group

Even though this is one of the first studies of its kind, several biological processes can be associated with BDSM interactions, strengthening the hypothesis of BDSM as a healthy form of intimacy and promoting its distinction from paraphilias as they are described in the DSM or ICD classifications.

No significant relationships.

Depression in pregnancy is common and often requires treatment with antidepressant drugs. Most antidepressants are metabolized by the cytochrome P450 system (CYP), in particular CYP2C19 and -2D6, both of which are genetically polymorphic. Additionally, the activity of these enzymes is altered during pregnancy.

To investigate pharmacogenetic variability regarding CYP2C19 and -2D6 in pregnant users of antidepressants and treatment outcomes.

The study population comprises all women born between 1981-1999, who gave birth to at least one child before December 2015 identified from the large Danish population-based iPSYCH2012 case-cohort study sample linked to information on genetic variants, prescription drug use and outcome data. Pharmacogenetic genotypes and phenotypes of CYP2C19 and CYP2D6 will be categorized into poor, (PM), intermediate, (IM), extensive, (EM), rapid (RM) and ultra-rapid metabolizers (RM) using array-based SNP information. Antidepressant drug use and comedication during pregnancy will be assessed based on prescription data. Outcomes include treatment discontinuation, switching and psychiatric hospitalizations. Cox regression analysis will be performed to estimate the hazard ratios comparing the rates of the different outcomes in people with different phenotypes, compared with EM adjusted for a number of confounding factors.

Based on previous research we will be able to identify approximately 6531 pregnant women with a psychiatric history. Among those, we estimate to find 14 PM, 161 IM, 285 EM, 168 RM and 25 UM of CYP2C19, and 27 PM, 218 IM and 408 EM of CYP2D6. Exposure to antidepressants is estimated at 10%.

We expect to be able to present the results at the conference.

No significant relationships.

Self-injury, defined as inflicting damage or pain to one’s own body, is a way to deal with unbearable emotions. Unfortunately, it can become addictive through the rewarding effect, and this makes it also really hard to stop with this destructive behavior. Currently, there is a lack of specific treatments.

The aim of the research is to investigate whether the “Protocol imaginary execution of self-damaging behavior” leads to a reduction of self-damaging behavior and the urge to self-damaging behavior.

We have investigated the “Protocol Imaginary execuTion of self-injury” as a potential treatment for self-injury. In this protocol the patient is asked to imagine he/she is performing the self-injury and at the same time a distracting task is offered. This ensures the working memory is double burdened as is with EMDR. We expected a reduction of patient’s self-injurious behavior. For this study, a single-case experimental design with 11 clinical patients is used, aimed to investigate whether there is a functional relationship between the treatment, the urge to self-injure and the frequency and seriousness of the self-injury. Data are analyzed with a multivariate analysis. The results of this study will contribute to expanding and improving treatment options for self-injury.

At the moment the results are not yet available, but they will be known in April 2022.

Respondents indicate that they experience more control over self-injurious behaviour. We hope to have confirmed this in April 2022 with the analyzed data.

No significant relationships.

The past years BDSM (an acronym for bondage and discipline, dominance and submission, and sadism and masochism) has gained a significant amount of attention and popularity in the general population, portraying an inaccurate image of BDSM and the people who share these interests. Yet despite this increasing popularity, only little empirical research has focused on this subject and it’s possible driving mechanisms so far, sustaining the existing misconceptions and stigma towards BDSM in general and BDSM practitioners in specific.

We aimed to gain more insights on understanding the underlying psychological mechanisms, such as sensation seeking and coping, in people who participate in BDSM-related activities, as well as into the factors which contribute to the existing stigma and discrimination

In a national survey study 256 Dutch-speaking BDSM-practitioners were compared to a matched sample of people from the general Belgian population (N = 300) who lack any interest in BDSM in two separate studies.

About 86% of the general population maintained stigmatizing beliefs about these sexual interests and practices. In regard to sensation seeking and coping, compared to controls, BDSM practitioners reported signifcantly higher levels of sensation seeking for all dimensions, as well as the use of more active coping skills.

People who do not conform to the current social standards of our society often seem to remain the subject of stigmatization and discrimination. Further research is needed to explore the psychological processes that drive BDSM interests in order to destigmatize and normalize consensual BDSM-related activities.

No significant relationships.

Acute and transient psychotic disorders (ATPDs) are a group of diagnoses with acute onset and polymorphic psychotic symptoms, divided into 6 subtypes, which may or may not associate with acute stress. Suicide is a serious public health problem, having long-lasting effects on social well-being and economics. The prevalence of suicide attempts (SA) in Latvia remains unknown, several studies are currently in progress.

To determine the prevalence of SA among patients with ATPDs and features of this subgroup of patients.

Retrospective study based on socio-demographic data and additional diagnoses of all patients with ATPDs provided by the National Center of Statistics of Diseases.

There were 1779 patients with ATDPs in 2014-2019, 44 people were admitted with a SA (24 men, 54.5%). There was a significant difference between sexes in the mean age – 39.64±14.66 for women, 31.94±11.88 for men (p<.001), as well as in case of associated acute stress – 37.61±12.95 with and 35.33±13.15 without it (p=.01). There were no differences in age or ATPDs subtypes between patients with SA and without one. Men with SA abused alcohol in everyday life more than women and men without SA (20%,p<.001), women with SA had acculturational difficulties more often than men and women without SA (45%,p<.001). Intentional self-harm by sharp objects was more common among men (p<.001), intentional self-poisoning among women (p<.001).

The prevalence of SA among patients with ATPDs was 2.47%. Factors, which were more commonly observed in patients with SA were alcohol consumption and acculturational difficulties. Types of self-harming differ between sexes.

No significant relationships.