Refugees and asylum seekers have often been exposed to multiple or complex traumas and are known to have a high rate of trauma-related disorders. Different therapeutic approaches have been used to treat this group with varying success. Narrative Exposure Therapy (NET) is one promising intervention for refugees and asylum seekers that are suffering from post-traumatic stress-disorder (PTSD). NET is a treatment given individually or in small groups in typically 12 sessions or less. In NET, memories are reorganized through a process involving imaginary exposure to trauma.

To review the literature on NET for refugees and asylum seekers suffering from PTSD.

The data bases PubMed, Medline, PsycInfo and Web of Science were searched using a selection of search terms, including ‘Narrative therapy’, ‘refugees’ and ‘stress disorders, post-traumatic’. The identified relevant articles were qualitatively assessed and effect sizes were compared. Methodological quality was assessed according to the GRADE-criteria.

Thirteen studies were assessed with a total study population of 745. Nine of the included studies were RCTs. Overall, the studies found medium to very high effects of NET. The quality of the studies varied from very low to high. More studies of NET for refugees and asylum seekers are needed, and in particular studies reporting long-term outcomes.

The review suggests that NET shows promise as a method for the treatment of PTSD in refugees and asylum seekers. However, the review is based on relatively few studies and more studies of long-term outcomes are particularly needed.

Since ancient philosophy extraordinary creativity is associated with mental disorders, emotional and cognitive destabilization, and melancholia. We here summarize the results of empirical and narrative studies and analyze most prominent cases of highly creative persons who suffered from depression, bipolar and schizotypic disorders, drug- and alcohol addiction. Hereby, we focus on the interaction of creative processes with “bipolar” personality traits. Finally, we offer an interdisciplinary interpretation of the creative dialectics between order and chaos.

An interdisciplinary concept of the relationship between creativity and psychopathology is shown to be essential for reasonable psychopharmacological and psychotherapeutic treatment of creative individuals.

On the basis of empirical-statistical and biographical studies we offer a comprehensive concept of the interaction between creativity and psychopathology.

The exemplary cases of J. W. v. Goethe and Robert Schumann show a complex interaction of mood swings with creative achievements. Dysthymic and mild depressive phases were associated with creative efforts whereas severe depressive episodes inhibited their creativity. Mild mood swings and “bipolar personality traits” interacted constructively with their creative striving. With respect to the relationship of alcohol- and drug-abuse, we show on behalf of a detailed analysis of the life and work of prominent Pop-Icons that addiction mostly leads to psycho-social disintegration and destruction of creativity.

An interplay between cognitive coherence and incoherence, emotional stability and instability, order and chaos accompanies many creative processes. The interdisciplinary approach shows that psychopathology can motivate creative efforts. However, if expressed severely, mental disorders inhibit or even destroy creativity.

No significant relationships.

Major depressive disorder (MDD) is a highly prevalent clinical condition with a leading cause of disability worldwide. Unfortunately, about 1/3 of patients with MDD fail to achieve remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). Research showed abnormalities in glutamatergic transmission in neural circuits and antidepressant efficacy with the N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine.

The authors elaborate a narrative literature review on the intranasal esketamine as a new-class antidepressant.

PubMed database searched using the terms “treatment-resistant depression” and “esketamine”.

Ketamine, synthetized from PCP, acts as an antagonist of NMDA receptor, reducing Central Nervous System excitability. One limitation of ketamine for treating depression is that requires intravenous administration, reducing its applicability in outpatient settings. Esketamine, the S-enantiomer of ketamine, developed as an intranasal formulation has a higher affinity for the NMDA receptor. The evidence of the rapid antidepressant effect of intranasal esketamine was first made by Lapidus et al, that demonstrated intranasal esketamine ability to reduce depressive symptomatology. However, some recent studies reported significant acute cardiovascular, psychotomimetic and neurological side-effects. Thus, drug formulation, delivery device, insufflation technique, and individual factors seem to contribute importantly to the tolerability and efficacy of the intranasal administration rote.

There is the need to develop novel treatments providing effective, more rapid-acting, and sustained relief of depressive symptoms, especially in patients with TRD. Intranasal esketamine has shown antidepressant effects in patients with TRD but further investigation is required to strongly reinforce this potential and safety.

Over half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes necessary.

The present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals.

A cross-sectional web-based survey was conducted between August 22 and September 23, 2020, so that 47 responses of GP were included.

The mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%).

Patient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician.

Digital solutions and interventions for mental health have increasingly been taking place in many societies in the last several decades. There are significant differences among countries due to economical and organizational situations. On the other hand, despite digital gap, there is a significant increase in the use of telepsychiatry and e-mental health applications with the Covid-19 pandemic throughout the world. Experiences of this pandemic times make many opportunities and challenges more apparent in this field. Safety and security, legislation, regulations, good practice standards, evidence based data, ethics and education are several of main areas of needs. EPA with the Council of National Psychiatric Associations (NPAs) is one of the crucial organizations in Europe which may play an important role to work on these challenges and opportunities. EPA-Council of NPAs consists of 44 associations represent psychiatrists (and other mental health workers in some) from 40 European countries. NPAs are crucial organisations in contact with local and national mental health stakeholders; competent in national, local, authentic and cultural issues and sensitivities; and could serve as crucial junctions for Europewide policies and their widespread implementations. Some reflections on challenges and opportunities from the Council of NPAs will be presented, based on a rapid survey and personal communications with presidents and official representatives of NPAs for future perspectives.

No significant relationships.

One of the central debates in the psychiatric community is the difficulty in distinguishing Dissociative Identity Disorder (DID) from Borderline Personality Disorder (BPD). The fact that core symptoms of these pathologies such as emotional dysregulation, alterations in sense of Self, amnesia, depersonalization, self harm, hearing voices, difficulties in maintaining relationships, are symptoms that feature in both disorders can lead physicians to a misdiagnosis, thus depriving patients with DID of adequate treatment.

To report a complex clinical case of a DID patient initially misdiagnosed as BPD.

Clinical case report.

A 45-year-old Caucasian woman with a history of childhood intrafamilial sexual abuse and domestic violence, substance use disorder, autolesionistic and suicidal behaviour with an active diagnosis of BPD presented to our ambulatory mental health care service. A more thorough examination revealed a history of emotional and affect dysregulation, depersonalization, amnesia, intrusive traumatic memories and nightmares with affective, cognitive, and sensorimotor aspects, persistent negative Self-perception. Auditory verbal hallucinations were also present described as inner space with commentary and derogatory nature with one of them being a child voice. The diagnosis of tertiary structural dissociation and DID was finally made when three Apparently Normal Personalities emerged with several Emotional Personalities, authorising for cautious partial pharmacological washout and initiation of three phase-orientated treatment approach.

DID is more common than is assumed and the overlap of core symptoms with other disorders can lead to a misdiagnosis. A careful clinical interview and evaluation of symptoms is mandatory to a correct DID diagnosis with a consequent appropriate therapy.

No significant relationships.

Evaluate the impact of the initial health assessment service for asylum seekers provided by the Asylum Practice Service.

Examine the inputs of Asylum practice service to asylum seekers. Investigate the activities and outputs of the Asylum practice service. Identify the outcomes of Asylum practice service to asylum seekers. Assess the impact of Asylum practice service to asylum seekers.

The conceptual framework for measuring impact at the asylum practice service was based on a Logic Model to engage stakeholders and service users in order to evaluate the impact of services provided by the service. Also the Refugee Health Screener – 15 (RHS15) was used to screen the emotional distress/trauma to identify those individuals who would benefit from further mental health evaluation and treatment. Both quantitative and qualitative data were used to articulate and evidence social value performance and to tell the story of change created.

The study shows that newly arrived asylum seekers benefit from the services of asylum practice, even though the impact could be marginal in some cases.

There is a need to revisit the current Initial Health Assessment tool, as in its current form, vital information on the causes of trauma such as rape, torture, human trafficking, and witnessing the death of parents, child, and close relatives which may underpin mental health problems, may not be captured, thus preventing access to appropriate interventions.

No significant relationships.

There is a need to study therapies that may contribute to the successful rehabilitation of veterans with traumatic brain injury (TBI) and increase their effective interaction with the stressful environment, reduce the severity of symptoms. Combined short-term therapies may have potential.

To analyze the clinical case of combined psychological treatment of TBI in a Ukrainian combat veteran with reduced resilience

The clinical case of Ukrainian combat veteran with TBI is presented. Montreal Cognitive Assessment (MoCA) was used to assess cognitive domains. Neurobehavioral symptom inventory (NSI) was used to assess neurobehavioral symptoms of TBI. CD-RISC was used to assess resilience. In addition to pharmacotherapy, the patient agreed to undergo a combined program of psychological therapy of 3 short-term positive intervention sessions and 3 cognitive training sessions.

MoCA result prior to treatment was 24 p., NSI – 38 p., CD-RISC – 44 p. (lower than in population). After the combined therapy, the results of the assessment with MoCA were 26 points, NSI was 17 points, CD-RISC – 47 points. Subjectively, the patient noted an improvement in emotional state, better resilience, and a significant reduction in the intensity of cognitive symptoms.

Combining positive interventions with cognitive training can have the potential to significantly improve the neurobehavioral and cognitive functioning of war veterans with traumatic brain injury, and also possibly increase resilience. Further research in this direction will be conducted to obtain more reliable results.

ECT is an effective treatment for depression. Beyond its therapeutic effect on mood it has a unique impact on psychomotor and cognitive symptoms.Its mechanism of action remains still unclear. To investigate this, we set out to study the brain’s response to ECT from a large-scale brain-network perspective.

The aim of this study was to investigate changes in resting-state functional connectivity following ECT at the whole brain, between-network and within-network level, in patients with a depressive episode.

Resting-state FMRI data were collected from 17 patients with depression before and after an ECT course. Using a group independent component analysis approach, we focused on four networks that are known to be affected in depression: the salience network (SN), default mode network (DMN), cognitive executive network (CEN) and a subcortical network (SCN). Clinical measures including mood, cognition and psychomotor symptoms were assessed.

ECT increased connectivity of the left CEN with the left angular gyrus and left middle frontal gyrus. An increase in left CEN within network connectivity was observed. Both the right CEN and the SCN showed increased connectivity with the precuneus. Furthermore, the anterior DMN showed increased connectivity with the left amygdala. Finally, improvement of psychomotor retardation was positively correlated with an increase of within-posterior DMN connectivity.

We demonstrate that ECT induces a significant increase of connectivity at both the whole brain and within-network level. Furthermore, we provide first evidence on the association between an increase of within posterior DMN connectivity and an improvement of psychomotor retardation, a core symptom of depression.

No significant relationships.

Psychotic-like experiences (PLEs) are often referred to as psychotic experiences, such as hallucinations and delusions, in the absence of a psychotic disorder. PLEs as part of the continuum of psychosis suggested that healthy population can endorse PLEs without having significant distress or impairment which would warrant them a clinical diagnosis. While PLEs are usually associated with psychotic disorders, previous research has also shown the link between PLEs and many other mood symptoms.

The present study aims to identify PLEs in community youths and explore the underlying risk and protective factors.

This is an ongoing study in which young people aged 15-24 were recruited from community through a random stratified sampling method. Sociodemographic, lifestyle, functioning, and other psychosocial factors were assessed in a face-to-face structured interview. In particular, PLEs were assessed using the Composite International Diagnostic Interview Screening Scales (CIDI-SC). Six domains of lifetime PLEs were measured, including auditory and visual hallucination, thought insertion/ withdrawal, delusion of control and reference, and persecutory delusions.

To date, 746 participants were recruited and of these, 3.2% of them has endorsed lifetime PLEs. Results showed that significantly higher depressive, anxiety and stress scores were found in those who has PLEs (p<0.001), and additionally, these scores significantly predicted the presence of PLEs in regression models (p<0.001).

Our preliminary findings highlighted the inter-related phenomena between PLEs and mood symptoms. Further investigation is needed to examine the likelihood of PLEs in predicting psychosis over time.

The COVID-19 outbreak poses a challenge for health care professionals due to a surge in care demands, overwork, fear of contagion and concerns on the availability of protective equipment, and coping with distress of patients and their families. Although there is emerging evidence on prevalence of stress and its predictors, less is known on the trajectory of stress symptoms and the differences between cohorts of health care professionals.

To sustain and restore health care professionals the Leiden University Medical Center has launched the Digital Stress Buddy, a mobile app, to assess psychological stress, depressive symptoms, anxiety and posttraumatic stress symptoms.

Participants fill in a 14-item questionnaire on stress and resilience resources, followed by a COVID-related questionnaire and finally a set of validated questionnaires on depression and anxiety (DASS-21), posttraumatic stress-symptoms (IES-R), burn-out (CBI) and resilience (RES).

To date, 959 health care workers have completed the stress monitor, of whom 223 (23%) showed relevant stress levels. Within this group, anxiety and posttraumatic symptoms were most prevalent (45%), followed by depressive symptoms (15%). Predictors of stress were being female, coping with distress of patients and their families, teleworking, and overwork.

By identifying vulnerabilities and resilience for psychological distress, we are able to tailor the support interventions for health care workers within our hospital. This is an ongoing study and future follow-up during the second wave of the pandemic will provide more insight on the trajectories of stress-related symptoms.

No significant relationships.

This systematic review estimates the pooled prevalence (PP) of anxiety disorders (ADD) among 5-to-18-year-old YP living in Europe, based on prevalence rates established in the last five years (LFY).

Trends of prevalence rates across countries, gender and level of education were analysed. The random effects pooled prevalence rate (REPPR) for AD was calculated.

A search strategy was conducted on three databases. Studies were also identified from reference lists and grey literature. Eligible studies were evaluated for reliability, validity, bias, and the REPPR for AD was calculated.

The European REPPR for AD is calculated at 7.9% (Figure 1). The REPPR for each anxiety disorder is shown in Figure 2.

Based on the results in this systematic review, AD are the most prevalent mental disorders among young people in Europe. Early diagnostic and intervention strategies for AD may improve the mental health and wellbeing among young people.

No significant relationships.

Sleep problems are a common presenting symptom of elderly patients to Primary care physicians and Psychiatrists. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation.

The aim of this article is to sumarize and explore the facts envolving sleep disorders, discusses approaches to treatment and highlights new research in the area of geriatric sleep disorders.

An online bibliographic search was carried out on PubMed and Medline using the keywords “Elderly”, “sleep” and “Psychiatry”.

Management of sleep disorders is complicated by the risk of side effects of pharmacologic treatment approaches, and thus nonpharmacologic strategies are preferred when possible. Additionally, many of the pharmacologic strategies used in treating younger adults have not been studied adequately in the geriatric population, and more specifically in patients with underlying cognitive disorders, making treatment choices difficult.

This review has provided insights into the biopsychosocial impact of sleep disorders in the elderly, as this group pose unique challenges for diagnosis and treatment. Sleep changes in the elderly may have a far broader impact on geriatric health than originally thought, with implications for AD and delirium, and further research is needed in these areas as well.

Depressed patients with early traumatic experiences may represent a clinically distinct subtype with worse clinical outcome. Since early traumatic experiences alter the development of systems that regulate the stress response, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behaviour.

To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behaviour in patients with major depressive disorder (MDD).

The sample included 190 patients [mean age (SD)=53.71 (10.37); females: 66.3%], with current MDD. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity. We developed mediation models by bootstrap sampling methods.

81 (42.6%) patients had previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b=0.007, 95% CI=0.001, 0.015), after controlling for sex, HDRS-Total, and LTE-Total.

Impulsivity could mediate the influence of childhood trauma on suicidal behaviour. This will help understand the role of risk factors in suicidal behaviour and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.

The filliation delusion was first described in 1950 by Ey as a false belief about belonging to a family group other than one’s own. Since then, 70 years have passed and litterature is still scarce on this type of presentation.

Using a case report as a starting point, the aim of this article is to review data on the various frameworks of delusional development, while discussing in what capacity social cognition impairment, theory of mind and overall lack of insight, typical in schizophrenic patients, could be related to this type of delusion.

The authors present a case report of an episode of a filliation delusion in a patient with chronic schizophrenia. A search on PubMed and ClinicalKey was performed, from which the relevant publications were selected and reviewed.

The case referes to a 64 year old woman previously diagnosed with schizophrenia who developed, over the period of two years, a filliation delusion. The patient believed having been born in Russia and being subsequently adopted by different families. There was history of irregular attendance to consultations and non-compliance to treatment.

There is still lack of proper investigation regarding the development of delusions in schizophrenic patients. Social cognition and insight are important predictors of functioning, and might behave as a marker of liability to psychosis. This should have strong implications in these patients’ treatment approaches. The lack of consensual measurement instruments make it difficult to draw solid conclusions, and this should be the main focus moving forward.

The Coronavirus pandemic has been causing a significant psychological impact on the population, showing symptoms such as anxiety, depression, post-traumatic stress disorder, among others. In addition, health professionals, who are on the front line, need to act promptly seeking unceasingly to save lives, predisposing to psychosocial events due to the risk of contamination, family distance and frustration in relation to death.

To analyze the profile of the psychosocial care performed in workers of a Brazilian university hospital who sought care to control the anxiety-stress resulting from the pandemic

Cross-sectional observational study, using a questionnaire to survey psychosocial demands and evaluate the care of workers who sought assistance in this service (n=61). As a dependent variable, the sector of action was stipulated and as independent the sex, age and the demands that justified the need for assistance. The data were analyzed by Pearson’s correlation with 5% of significance through the statistical software SPSS.

There was a statistic difference between the groups in the variables age and psychosocial interventions for anxiety and stress management. The most part of the sample was composed of health professionals, women, with an average of 33 years old, motivated, technically prepared, scared and not overloaded.

Psychosocial care to health professionals for the management of anxiety and depression is indispensable either during or after the pandemic by seeking Mental Health interventions to minimize the suffering of these workers.

Craniocerebral injuries are serious traumatic situations

Aim of this study is to present cases of deppresive disorders after mild craniocerebral injuries in amateur athletes

10 cases are presented. Range of age between 20 and 40 years old. All of them reported depressive disorders during the post traumatic period after mild craniocerebral injuries mainly during amateur athletic activities

All of them they receive appropriate neurological, psychiatric, psycological and rehabilitation support and treatment. They managed to have a good outcome after 12 months follow up.

The development of depressive disorders after such traumatic events remains a strong predictor of a variety of difunctions (social, personal, work etc). The emergence of depressive disorders in many cases remains unexplored and poorly understood. The effect into the the overall health remains a very important factor to investigate. The combination and collaboration of the various medical disciplines is essential in order to help young people.

No significant relationships.

Studies indicated that breast cancer cause alexithymia that having adverse effect on resilience. Recognizing and expressing emotions are very crucial to cope with the difficulties.

This study aimed to examine the role of alexithymia on psychological resilience and related variables in women with breast cancer.

In this descriptive study, 70 women with breast cancer who apply to a medical oncology outpatient between June 2019-February 2020 were included. 9-questions questionnaire was used to determine the sociodemographic and cancer related characteristics of the participants. The Multidimensional Scale of Perceived Social Support (MSPSS), Toronto Alexithymia Scale (TAS-20), Psychological Resilience Scale (PRS) were used to determine perceived social support, alexithymia and psychological resilience levels. Descriptive statistics, correlations, ANOVA and t-test were used for data analysis.

The MSPSS (20.07 ± 10.54) and TAS-20 were found low (47.71 ± 11.96) and PRS were high (132.24 ± 16.47). A negative, weak, significant relationship was found between the alexithymia (r=-0.370, p=0.02) and perceived social support (r=-0.496, p=0.01) with psychological resilience. There was no significant difference between the psychological resilience and age, education level, marital status, having children, profession, employment status, duration of illness, type of treatment, having metastases, and becoming caregiver (p> 0.05).

The psychological resilience of women with breast cancer was negatively related to their alexithymia and perceived social support levels. It indicates that being able to recognize the emotions and having social support systems would positively affect the recovery process.

No significant relationships.

Incidence for depression increases during the perinatal period. Risk factors for depression may differentially affect each time period.

To assess demographic, psychological and obstetric risk factors that differentially affect prenatal and postpartum depression

A total of 169 subjects participated. Assessment was conducted during the first trimester, second trimester, third trimester, within a month after childbirth, and a month after childbirth. Demographic and obstetric measures, as well as psychological measures, including the Edinburgh Postnatal Depression Scale were conducted. Multiple regression and the Mann-Whitney U test were performed to examine the association between variables and depression scores.

Depression score was higher during the postpartum period than the prenatal period. Younger age was associated with depression during the first trimester. In the second trimester, less education, a history of depression and having stress within a year significantly affected depression scores. Smoking, artificial abortion and lack of support from family and parents correlated with depression during the third trimester. Within a month after childbirth, psychiatric and depression history, smoking, stress level within a year and lack of family support were associated with depression. At a month after childbirth, those who were primiparous and not breastfeeding had significantly higher depression scores.

This study identifies various risk factors for each gestational and postpartum period and suggests differential interventions for different perinatal periods.

The Covid-19 pandemic has limited the classic psychotherapy treatment. EAP provided temporary recommendations for online psychotherapy in March of 2020 which brought new possibilities and limitations and contains rules, ethics and techniques. From the perspective of a psychodynamic therapist, the specificity of online group psychotherapy in the context of strong stressors is described.

During the “lockdown” period and the earthquakes that occurred simultaneously in Zagreb in March of 2020, the secure Internet platform enabled the continuity of the group’s work in a video link modality.

Online group had regular weekly meetings which lasted 1.5 hours. The classic rules of group analytical therapy were adapted to the new setting in virtual space. A risk assessment was also performed.

The six group members and therapist have connected online through more freedom, developed new levels of sensitivity, flexibility and creativity. They have also accepted limitations. The online group is able to provide holding, but deeper connections require a physical presence to exchange emotions that technology interferes with as well as the process of empathizing. Previous live sessions crucial to maintaining emotional connections have served as reservoirs for a period in which communication over the Internet was insufficient.

Internet technology can temporarily enable the continuity of a group psychotherapy. Technical and institutional support is recommended. The advantages of technology can be used if the technique is adapted, realistic goals set, and clinical limitations accepted. Many questions about the possibilities of “online psychotherapy” are open and unexplored.

No significant relationships.