Electroconvulsive Therapy (ECT) is one of the most effective treatments for Depressive Disorder. Although its safety and tolerability have been throughout the years, it still holds common mild and rarely persistent side effects.

The aim is to review some of the most recent data on the connection between inaugural seizures in psychiatric patients being submitted to ECT for treatment of Major Depressive Disorder, while also discussing the possible contribution of the concomitant use of clozapine and clomipramine.

The authors present a case report of an episode of an inaugural seizure in a patient submitted to ECT, with concomitant use of clozapine and clomipramine. A search on Pubmed and Clinicalkey was performed, from which the relevant publications were selected and reviewed.

The authors present a 62 year old woman who developed an inaugural generalized tonic-clonic seizure after being submitted to ECT for treatment of Recurrent Major Depressive Disorder (RMDD), while also carrying out clozapine and clomipramine dosage reduction, with the purpose of discontinuation. The patient had no history of previous seizures, nor were there relevant findings in the patient’s neurological examination, blood work, brain CT or EEG.

There is a plethora of possible factors involved in the development of an inaugural seizure. Although, the risk of spontaneous seizure during ECT is low, it may be increased by the concomitant use of drugs which can lower the seizure threshold. In most cases, when ECT was resumed after removal of such triggers, there were no further complications.

Burn-out is quite common in hospitals especially among young doctors. It results from a mismatch between expectation and professional reality.

To determine the prevalence of sever burnout and to identify its associated socio-demographic and psychological factors among young residents.

Analytical and descriptive cross-sectional study conducted among residents and interns working at the Hedi Chaker and Hbib Bourguiba University hospital in Sfax, Tunisia, during the month of July 2019. The characteristics of the participants were collected using a questionnaire. Burnout was evaluated using the Maslach Burnout Inventory(MBI) differentiating 3 components: emotional exhaustion, depersonalization and luck of personal achievement.

Out of 85 questionnaires disturbed,60 were selected corresponding to a response rate of 72.94%. The sex ratio (M/F) was 0.87. The middle age was 28.22. Forty three percent of the participants were married. More than half consumed tobacco and 45% of them consumed alcohol. The majority of doctors were residents(81.7%). The average working time was 55 hours per week. Burn-out was severe in 30% of our population. Furthermore, doctors who suffered from physical aggression(p=0.001) were more likely to develop severe burn-out. The dissatisfaction with the internship (p=0.01) and the feeling of do not satisfy seniors(p=0.02) were statistically associated with severe burnout. Severe burn-out was associated with anxiety (p=0.0073), conflictual partnership (p=0.0001),conflicts with colleagues(p=0.001) and the paramedical framework (p=0.0001)

The risk of burn-out is quite high among young doctors. Some factors seem to be associated with this phenomenon. This could affect not only the quality of life, but also the quality of care provided.

burnout-young doctors-prevalence-associated factors

Autism Spectrum Disorders (ASD) have been associated with decreased spontaneous attention to social stimuli. Several studies further suggest that a higher expression of autism traits (AT) in the neurotypical population (NTP) may also be related to decreased social attention, although the evidence is still scarce, especially when considering faces as task-irrelevant distractors.

This study aimed to explore the relationship between the expression of AT in the NTP and exogenous attention to social stimuli.

Fifty-one adult participants were recruited and asked to complete the Autism Spectrum Quotient (AQ), to measure AT, and to perform an attentional capture task. In the latter, they were instructed to detect a target letter in the middle of perceptually similar (high perceptual load) or dissimilar (low perceptual load) distractor letters. In 25% of the trials, task-irrelevant distractors, consisting of images of faces (social) or houses (non-social), were shown flanking the letter stimuli.

Response times were found to be affected by distractor-response compatibility, increasing for contralateral distractors, but decreasing for ipsilateral distractors, in relation to trials with no distractors (baseline). Importantly, these trends were magnified for distractor faces in the group with less AT, considering the social skills dimension of AQ, while the same tendency was observed in the group with higher AT, but for distractor houses.

Our results support an altered attentional performance in the subclinical phenotype of the autism spectrum. Furthermore, they also add to existing literature documenting similar attentional abnormalities in both the clinical and subclinical extremes of the spectrum, hinting possible shared mechanisms.

No significant relationships.

Web Journal Club as a collaborative learning method, is an effective method to enhance the knowledge base of nursing students, their presentation skills, problem-solving skills and ability to critically appraise literature.

To describe the experience of a online journal club on education of MHN undergraduate students.

We implemented a journal club in the online classroom with a total of 24 portuguese undergraduate students enrolled in clinical training of MHN (sixth semester). Over a two-week period, five 2-hour online journal club sessions were conducted in April 2020. During each session, five journal articles were presented synchronously to a live online audience via the Zoom Classroom technology. After all sessions, students were invited by e-mail to complete an anonymous and voluntary online questionnaire via Google Forms.

All students were all very positive about the journal club sessions and found the opportunity to discuss and reflect on practice issues in depth very helpful. They found the sessions supportive, they helped to bond the group, they learnt a great deal from each others experiences, and they felt that they gained in confidence as a group. Survey results also indicated that few participants experienced technical difficulties during sessions.

This pedagogical practice enhances gains in the various actors involved: 1) in students, contributing to their learning process and acquisition of competences, articulating research and clinical practice; and 2) lastly, even more indirectly, in people receiving care, since a evidence-based practice ensures safe and quality of nursing care delivery.

Exercise has been repeatedly reported as an effective means of preventing and treating mood disorders. Therefore, there is a significant research interest for the way exercise is connected with depression and the effectiveness of different exercise parameters as intensity, duration and modality. There is significant research evidence supporting the hypothesis that exercise can alleviate the symptoms of clinical depression. Nevertheless, there has not enough evidence to compare the effectiveness of deferent types of exercise as complementary therapy in depression.

The purpose of the present study was to review the available research concerning the effect of exercise modality in depression and attempt to code and analyze the programs used in elderly (>65).

A systematic review was contacted of randomized control trials published in electronic journals. The electronic data bases PubMed, EBSCOhost and Trip Medical Database were used.

Combined programs are predominate used for improving mood in elderly and the combinations used more frequently was short-term, light to moderate sub maximal aerobic exercise combined with dynamic resistance exercise following by Short-term, light to moderate sub maximal aerobic exercise combined with static exercise. Other psychosocial factors that commonly included in the combined exercise programs are group interaction, mindfulness and music.

Combined exercise programs are as effective as simple programs in alleviated the symptoms of depression in elderly. Their advantages over simple programs are that they can promote other health benefits; they are less time consuming and more pleasurable to participants. Therefore, they are good exercise choice for elderly.

Catatonia is a neuropsychiatric syndrome characterized by an onset of a dysfunction in psychomotor activity and/or muscle tone, which may be associated with changes in consciousness, affect, and thinking. It is characterized by negativism, wax flexibility, catalepsy, mutism echolalia, ecopraxia, or stupor. It was first described in 1874 by Kahlbaum, who characterized it as specific motor disorder associated with different psychiatric disorders. Kraepelin and Bleuler restricted catatonia to a specific subtype of schizophrenia. However, the association between catatonia and other disorders, notably mood disorders, has been reinstated, including Bipolar Disorder. Its etiology is multiple and there are two severe forms: Neuroleptic Malignant Syndrome (NMS) and Malignant Catatonia (MC). These are syndromes that present high mortality, and the health professional should be aware of its etiology, signs, symptoms, evaluation and treatment.

The aim of this work is to present a clinical case of MC, who was sustained by literature included on scientific platforms.

Case report

It is essential to recognize the different clinical presentations of catatonia, taking into account that these are psychiatric alterations in which urgent intervention is justified. In the presented case, the use of antipsychotic medication has worsened the motor function and its suspension, associated with the introduction of lorazepam, resulted in a slight improvement. The electroconvulsive therapy was the last resort, fully succeeded.

The relationship between SMN and Catatonia/MC remains nuclear from a psychopathological and pathophysiological point of view. Nevertheless, there is general agreement that catatonia represents a very significant risk factor for NMS.

No significant relationships.

According to Vygotsky, children with special needs follow the same trajectory of development as normally developing children, although some of the skills can be observed in a later period. This statement can be implemeted to the children with Down syndrome. The number of such children in Russia is around 25 thousand.

The aim is to study the conditions of negation formation in children with Down syndrome.

The sample consisted of 22 dyads of children with Down syndrome of 24-36 months old and their mothers. The research methods included: parents’ questionnaire; analysis of problematic situations; Tkacheva’s inventory Parent’s Psychological Type; Varga &Stolin Inventory of Parental Attitude; Toronto Alexithymia Scale, Bass-Darky Hostility Questionnaire, Leonhard-Schmieschek Test, Spielberger’s Test Anxiety Inventory.

Firstly, we have studied how a child expresses his or her negative reaction: whether he or she uses a gesture or a sound for “no” or reacts with the whole body. According to those results we have divided the sample into two groups and then have compared them. The research shows the connection between mother’s aggressiveness and formation of the child’s negation reaction (gesture/sound or the whole body) as well as differences in the level of alexithymia and anxiety: all the characteristics are lower in the first group.

Mothers of the children with Down syndrome demonstrate a high and a medium level of anxiety. However, the mothers of the children who expresses negation with a gesture/sound show a lower anxiety level comparing with the mothers whose children react with the whole body.

No significant relationships.

Attrition rates in smoking cessation treatments are high, particularly in persons with substance use disorders. It is estimated that about 55%% disengage prematurely at treatment, meaning that a large portion will not benefit from smoking abstinence. So far, no previous studies have examined predictors of dropouts in a smoking cessation treatment with persons with SUD.

The study was two-fold: 1) to analyze the percentage of early-, late-dropouts and completers, and 2) to examine sociodemographic, psychological, and substance-related predictors of dropouts.

A total of 86 participants (69.8% males; Mage=43.84, SD=9.917) were randomly assigned to two psychological smoking cessation treatment: cognitive-behavioral treatment (CBT) (n=51) or CBT + contingency management (CM) (n=35). Interventions were delivered during eight consecutive weeks

Of the 86 participants who completed the baseline assessment, 21 did not start treatment, 17 dropped out of treatment during treatment, and the remaining 48 completed the treatment. Predictors of early-dropout were younger age (B=-.234; p=.024; OR=.792) and lower number of days in SUD treatment (B= -.005; p=.026; OR=.995). Patients’ primary substance of use was associated with reduced early-dropouts; compared to cocaine users, alcohol (B=-1.827; p=.043; OR=.161) and opioids (B=-3.408; p=.018; OR=.033) related to improved attrition. Late dropout was directly related to higher number of tobacco use cessation attempts (B=.407; p=.039; OR=1.502).

Incorporating strategies to improve attendance and completion rates in SUD populations should be a priority. Mobile reminders, offering online therapies, or CM to reinforce attendance to therapy may be considered.

No significant relationships.

Climate change is a major global public health challenge that will have wide ranging effects on human psychological health and wellbeing through the increased incidence of acute (e.g., storms, floods, wildfires), sub-acute (e.g., heat stress, droughts, lost agricultural yields) and long-term stressors (e.g., changes to landscapes and ecosystems). Children and adolescents are particularly at risk because of their rapidly developing brain, vulnerability to disease and limited capacity to avoid or adapt to climate change-related threats and impacts. They are also more likely to worry about climate change impacts than any other age group.

To produce a new conceptual framework that describes climate change-related threats to youth mental health from a developmental life course perspective.

We critically review and synthesis literature documenting the pathways, processes and mechanisms linking climate change to increased mental health vulnerability.

We show that climate change-related threats can additively and interactively increase psychopathology risk from conception onwards, that these effects are already occurring and that they constitute an important threat to mental health and therefore human capital worldwide. We then argue that birth cohort studies are uniquely positioned to examine climate change-related threats and that incorporating relevant measures into existing and planned birth cohorts is a matter of social justice and crucial long-term investment in mental health research.

Climate change is affecting the healthy psychological development of children and these risks are increasing worldwide. New theoretical and empirical work is urgently needed so that threats can be tracked and mitigated.

COVID-19 pandemic and lockdown has brought a serious impact on physical and mental health.

The purpose of the present study was to estimate the impact of the first lockdown in Greece, on both quality of life and anxiety levels in different occupational groups.

A cross-sectional on- line survey was conducted from 20th of April to 4th of May 2020. A 24-item anonymous questionnaire was administered to collect basic demographic and socioeconomic data. The 5-item WHO Well-Being Index (WHO-5, 0-100%, cut-off 52%) and the Generalized Anxiety Disorder Assessment (GAD-7) tools were used to assess well-being and anxiety, respectively. Statistical analysis was performed with SPSS for Windows v.24.0 Statistical Package.

A total of 575 participated in the study, 62.8% females, 48.5% aged between 40 to 59 years. 32.5% were employed in education sector, 32.5% in health sector and 20.3% as season workers in tourism sector. Males showed slightly higher levels of wellbeing (52.1 vs. 47.3, p=0.023) and lower levels of anxiety (7.1 vs. 8.2, p=0.023) compared to females. Factors associated with higher wellbeing and lower anxiety were higher education and income level, optimism, taking less protection measures, and being seasonal worker. Furthermore, participants with comorbidities and symptoms like headache, musculoskeletal pain, as well as feeling depressed or stressed revealed lower wellbeing and higher anxiety scores.

Our study revealed an overall poor wellbeing and mild to moderate levels of anxiety during the lockdown. Actions should be taken to address and to prevent its serious impact on mental health.

No significant relationships.

Both the COVID-Anxiety Scale and the Fear of Coronavirus-19 Scale have been recently developed to facilitate research on COVID-19 anxiety.

To examine the psychometric properties of Russian translations of the COVID-Anxiety Scale and the Fear of Coronavirus-19 Scale.

In order to examine the psychometric properties of Russian translations of the COVID-Anxiety Scale and the Fear of Coronavirus-19 Scale, a total of 341 Russian adults completed both measures.

First, a high level of COVID-19 anxiety was found in the sample. Second, confirmatory factor analysis demonstrated that the Russian translations of both the COVID-Anxiety Scale and the Fear of Coronavirus-19 Scale had satisfactory psychometric properties, with both scales having a hypothesised one-factor structure. Third, a significant positive association was found between both the COVID anxiety scales. Fourth, higher COVID anxiety scores were associated with being female, and being older.

These findings provide initial evidence for the satisfactory properties of the Russian translations of the COVID-Anxiety Scale and the Fear of Coronavirus-19 Scale. Further research is suggested that examines the prevalence and psychological correlates of COVID-19 anxiety.

Sleep disorders are the most common health problem among the health care staff, mainly those who perform night shifts.

To assess the prevalence of sleep disorders among health care workers in emergency department and to determine its associated factors.

It was a cross-sectional study, including health care workers assigned to emergency ward and intensive care unit of Hedi Chaker and Habib Bourguiba hospitals in Sfax and regional hospital of Kebili, during the first six months of 2017. We used an anonymous and confidential self-administered questionnaire. We used hospital anxiety and depression scale (HAD) to assess anxiety and depression. Sleep quality was assessed by the Pittsburgh Sleep Quality Index and day time sleepiness by the Epworth Sleepiness Scale.

240 nurses were included. Mean age was 37 years-old, 59.2% were female and 64.2% were married and 79.2% assured night shifts. The prevalence of sleep disorders was 70.4%. Sleep difficulties were significantly correlated with anxiety (p=0.001) and depression (p=0.02). In multivariate study, sleep disorders were related to the absence of leisure activity (OR=0.42 [0.19-0.94]; p=0.035) and anxiety (OR=3 [1.4-6.1]; p=0.002). 40.8% of nurses experienced drowsiness. Sleepiness was significantly correlated with the absence of leisure activities (p=0.04) and with psychiatric family history (p=0.02). In the multivariate study, sleep disorders were correlated with female gender (OR=0.43 [0.19-0.9]; p=0.042) and with no leisure activity (OR=2.6 [1.2-5.6]; p=0.01).

Sleep disorders were common among emergency nurses, in order of that; working conditions should be improved to provide less stressful conditions for nurses.

No significant relationships.

Benzodiazepines (BZDs) and related drugs (BZRDs) are widely used to reduce agitation, anxiety and sleep disturbances in the elderly, despite concerns raised about their modest efficacy for such indications and risk of severe adverse effects, including acute consequences on cognition. Recently, some studies have also raised concerns about the long-term effect of BZDs, suggesting their association with an increased risk of cognitive decline and dementia.

To review published synthesis studies on the risk of dementia development due to BZDs/BZRDs use.

An electronic search was conducted in PubMed. Meta-analysis, systematic and non-systematic reviews examining the association between BZDs/BZRDs and subsequent dementia were included. No language nor publication date restrictions were applied. Search results other than synthesis studies were excluded. Studies were screened for relevance based on predefined inclusion and exclusion criteria.

Overall, 246 results were obtained. After initial screening, nine studies were included. From these, three were systematic reviews with meta-analysis of observational studies (cohort and/or case-control), one was a systematic review from observational studies and five were non-systematic reviews. Most studies found an association between BZDs/BZRDs and subsequent dementia, with meta-analysis studies reporting an increased risk (OR) between 1,38 and 1,78, even after controlling for protopathic bias. However, difficulties in establishing a causal relationship are reported due to the considerable clinical and methodological heterogeneity of the primary studies.

Most studies suggest an association between the use of BZDs/BZRDs and dementia risk, highlighting that their prescription should be cautious, prevented or reduced to attenuate this risk.

Depression is commonly present among HF patients and is associated with adverse clinical outcomes. However, research regarding its association with New York Heart Association (NYHA) class is still scarce.

To evaluate the presence of depression symptoms in HF outpatients and analyze its association with NYHA class.

This study is part of a larger research project (Deus Ex-Machina/NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Exclusion criteria were: unable to communicate, severe visual acuity deficit or NYHA class IV. Sociodemographic data and NYHA class were registered. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, with a score ≥10 indicating clinically relevant depression.

A sample of 136 HF patients was included, with a median age of 59 (range: 24-81) years old, where 66% were men. Almost half of the patients (49%) were in NYHA class II, followed by class I (36%) and class III (15%). The median score of PHQ-9 was 4(range:0-18), with 26% showing clinically relevant depression. PHQ-9 total score was associated with NYHA class (p=0.001), with higher median scores in worse NYHA classes [class I: 3 (IQR: 5.5), class II: 4 (IQR: 8) and class III: 8.5 (IQR:9.3)].

In this study, depression was present in 26% of HF outpatients and was associated with more severe HF symptoms. Consequently, preventing, monitoring, and treating depression in the management of these patients is recommended. Further research is needed for a deeper analysis of this association.

Physical abuse of children in schools is common in Nigeria, but its prevalence and forms are yet to be clearly studied.

To determine the prevalence and pattern of physical abuse of children in Secondary Schools in Ilorin Nigeria

Cross sectional survey of secondary school students aged 11-18 years in Ilorin Nigeria using multistage random sampling technique with proportional allocation was done. Respondents completed the ICAST-CI questionnaire which covers child abuse in educational institutions. Prevalence and pattern of child abuse was computed.

Table 1: Pattern of physical abuse in School in the last 12 months

Physical abuse of children is extremly commonplace in public secondary schools in Nigeria. it is neccessary to explore other ways of dealing with children in educational institutions.

No significant relationships.

Despite the availability of remote consolation and the evidence for its effectiveness, its adoption has been relatively limited (Hashiguchi, 2020). In light of COVID social distancing measures, there was an immediate requirement to adopt this technology into routine practice.

The objective of this evaluation was to examine clinicians’ experiences of the urgent adoption of digital technology in a NHS provider of mental health and community physical health services.

From a staff survey (n=234) of experiences of working during a period when there were significant levels of Covid-related restrictions, data was extracted and subject to thematic analysis by a research team made up of clinicians, academics, and quality improvement specialists.

Five key themes relevant to the urgent adoption of digital technology were identified (figure 1): (1) Availability of staff for patient contact was generally felt to be improved; (2) Quality of contact was reported to be variable (e.g. some respondents reporting better rapport with patients, whereas others found remote contact interfered with rapport building); (3) Safeguarding concerns were reported to be more difficult to identify through remote consultation; (4) Contingency plans were recommended to allow for vulnerable patients for whom remote consultation was a problem; (5) Multi-agency working was reported to be strengthened.

The findings from this evaluation allow for an informed approach to future adoption of remote consultation in routine practice.

No significant relationships.

In times of pandemic as Covid-19, as in disaster situations, there is an increased risk of Post-Traumatic Stress Disorder, Depression, and Anxiety (Kaufman et al., 1997; Douglas, Douglas, Harrigan, & Douglas, 2009; Guessoum et al., 2020). The measures taken have affected individual freedoms for the benefit of community health by seeking to reduce the spread of the virus, although the side effects can cause profound damage to society, especially in those most vulnerable populations such as children and adolescents with ADHD.

This study aims to assess the psychopathological state and possible consequences of the first wave of the Covid-19 pandemic.

This study is part of the Kids Corona, an institutional research project of the Hospital de Sant Joan de Déu and the Fundació de Sant Joan de Déu to provide a social and research response to the Covid-19 Pandemic. To assess the impact of Covid on children and adolescents with ADHD a cross-sectional study was conducted between 20 and 30 July 2020 with a battery of questionnaires. The Child Behavior Checklist (CBCL), the Sleep Disturbance Scale for Children (SDSC), the Screen for Child Anxiety Related Disorders (SCARED), the Children’s Depression Inventory (CDI) were used.

70% of children and adolescents aged 7 to 12 years with ADHD had sleep disorders, the 54% had anxiety symptoms and 9% had a depressive disorder.

Children and adolescents with ADHD are a vulnerable population to the effects of Covid, with anxiety, depression, and sleep disorders.

No significant relationships.

Women around the world are still victims of violence and discrimination in many areas. In Tunisia, discrimination against women remains a reality, and they are often more vulnerable to violence, especially sexual violence, compared to men.

To describe the epidemiological characteristics of victims of sexual assault in the Mahdia region in Tunisia

This is a descriptive and retrospective study of 110 sexual assault cases examined at the legal medecin department of Mahdia University Hospital between January 2016 and August 2018.

The majority of victims were female (80 %). All genders, 77% were under the age of 25 years old. The median age of the men was 11.5 years. The median age of women was 18. The urban origin was more common (55.5%). Only 8.1% were married compared to 87.4% single. Only 2.7% said they were divorced and only one woman was a widow. 41.8% of the sample said they were still in school and almost 29,1% of the cases were out of work. 3.6% reported a history of sexual assault. The sexual act was the same in all situations. The perpetrator was unique in 73.6% of cases, male (100%), known to his victim (57%) or even a member of the family circle (14%). Sexual assault by penetration was mostly reported (51%), and it was almost exclusively penile(98.2%).

Sexual violence remains under-reported. The statistical data do not allow to know the phenomenon of its whole, because the majority of acts remain unknown, due to the absence of complaints or medical consultations.

Studies suggest a high prevalence of depression and PTSD among survivors of human trafficking in contact with shelter services. However, evidence for interventions to support the recovery of survivors of trafficking is lacking. The broader literature on PTSD and depression indicates that ongoing social stressors can exacerbate and perpetuate symptoms. Advocacy-based, or “casework”, interventions, which address current stressors and social support, may represent a promising avenue of enquiry. Objectives (1) Describe risk and protective factors for mental distress among trafficked people; (2) Present a preliminary theory of change describing how advocacy-based interventions may contribute to an improvement in mental health and wellbeing among survivors of human trafficking.

(1) Survey of adult male and female survivors of trafficking in contact with shelter services in England; symptoms of depression, anxiety, and post-traumatic stress disorder were measured using the PHQ-9, GAD-7, and PCL-C. (2) Theory of change workshop and review of intervention studies that assessed the effectiveness of casework, client support, or advocacy interventions delivered in health or community settings to survivors of trafficking or vulnerable migrants.

150 survivors of trafficking participated in the survey, 98 women and 52 men. In multivariate analyses, psychological distress was associated with higher number of unmet needs and lacking a confidante, suggesting that practical and social support is important in facilitating mental health recovery. The theory of change identifies common components in advocacy interventions delivered to survivors of trafficking, and proposes pathways by which these components contribute to improved mental health.

No significant relationships.