Despite being one of the oldest treatments in the field of Psychiatry, Electroconvulsive therapy (ECT) is used worldwide for various severe and treatment-resistant psychiatric disorders, establishing itself as one of the fastest and most effective treatments.

The primary aim of this study was to describe a nationwide epidemiological perspective of the use of ECT in hospitalized psychiatric patients. The secondary aims were to characterize clinical and sociodemographic trends of hospitalized patients who needed ECT.

A retrospective-observational study was conducted using an administrative database which gathered all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 - Other electroshock therapy defined by the International Classification of Diseases version-9, Clinical Modification.The variables included in the study were birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status from each single hospitalization episode.

There were a total of 879 hospitalizations with ECT during the 8-year period of the study. Most of the hospitalizations occurred in female patients (53.4 vs 46.6%), belonging to the age group of 51-70 years old, with a mean age of 50.5 years old. The median LoS was 43.0 days with an IQR of 27.0-68.0 days. The specific primary diagnosis most frequent in all hospitalizations was Major depressive disorder, recurrent episode representing 19.6% of all ECT related hospitalizations.

In Portugal most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication.

A 15-year-old man who comes to the consultation referred from neurology for a poorly progressive tic disorder that is resistant to treatment. This is a patient with no relevant medical history. He has good academic performance, without symptoms of inattention, hyperactivity or impulsivity. He does not present buccophonatory tics

To Show guanfacine as a efficient treatment fot tics disorder

Case report

He has presented complex motor tics as cervical contractions that have had to receive physiotherapeutic treatment. He also presents simple ocular tics. The patient at our evaluation is on a 4 mg dose of pimozide without response. He was previously on risperidone. It was decided to start treatment with guanfacine up to 5 mg with reduction of pimozide, to 1 mg. The patient with this dose adjustment shows a notable improvement in the frequency and intensity of the tics, both cervical and ocular. The patient also refers to a feeling of being calmer and being able to face stressful situations such as being exposed to social relationships, intervening more in class without increasing their anxiety levels.

Guanfacine is a selective alpha-2a adrenergic receptor agonist that has an indication for attention deficit hyperactivity disorder. Like its precursor, clonidine, there is more and more literature that proposes this medication and others for ADHD as useful drugs in pathologies such as tic disorder. It has a safe use profile, which with progressive adjustment and hardly any side effects is placed as a treatment to take into account in this pathology.

No significant relationships.

People with personality disorders (PD) share some impairments in personality functioning (e.g. identity, intimacy, empathy) that are also associated with inner or interpersonal conflicts, and sometimes also with different strategies of moral disengagement (MD). It is unclear whether MD strategies are related to individuals with/without PD and their willingness to have social contacts with representatives of otherness (like minorities, physically handicapped, etc.).

Comparison of the differences in MD strategies and social distance to the otherness of healthy controls and people with PD, and the influence of personality functioning.

Moral Disengagement Scale which measures eight MD strategies, the Semi-Structured Interview for Personality Functioning DSM-5 assessing the Self and Interpersonal functioning, and Bogardus Social Distance Scale measuring perceived social distance toward various representatives of otherness are applied in two samples (general population and personality disorders).

People with PD showed a significantly higher propensity to use various MD strategies than healthy controls with moderate effect size (.34–.49). Moral disengagement is facilitated by different aspects of personality functioning in both samples, sharing the impairments in maintaining close relationships. Both samples differed in MD strategies connected with higher social distancing.

People with PD are more prone to moral disengagement than healthy adults. MD appears to be facilitated by different aspects of personality functioning in both samples. Some representants of otherness are more related to specific MD strategies. We hypothesize that understanding of specific MD strategies used by people with PD can provide insight and explain some of their behavior.

Electroconvulsivotherapy (ECT) one of the oldest treatments in biological psychiatry, is used nowaday mainly due to safety, efficacy and tolerability. Can be first-line treatment for mood disorders with catatonic or psychotic symptoms, and a second-line tretament to pharmacoherapy resistance or intolerable side effects.

To analyze the number of ECTs done, the number of patients submitted to this procedure in the ECT Unit in Centro Hospitalar Lisboa Norte (CHULN) comparing their diagnosis. To evaluate the number of patients that underwent maintenance and/or continuation treatment.

Retrospective study involving patients submitted to ECT from 1 of January to 31 of December of 2019. A literature review exploring the use of ECT in psychiatry was conducted.

During the 12-month period were performed 179 sessions, corresponding to 18 patients. The diagnosis were schizophrenia, 55%, bipolar disorder, 39% and 6% with major depression. Only 28% underwent continuation and/or maintenance treatment.

In this sample, of those diagnosed with schizophrenia, 90% were submitted to ECT due to oral therapy failure and 10% due to catatonia. Of those diagnosed with bipolar disorder 42.9% had a depressive episode and of these 14.2% had psychotic symptoms. This Unit is integrated in the biggest hospital of Portugal, it is import to understand the small number of patients submitted to this treatment and identify factors that may be preventing the referral of patients to this treatment. Clinicians may have the impression that ECT should be left as a last resort treatment which may explain the low percentage of major depression among our patients.

No significant relationships.

This presentation focuses on two major problems in psychiatric hospital care: patient violence and lack of patient engagement. Interventions already exist for managing patient violence. However, the challenge in using these interventions is poor integration to clinical practice and these methods do not entail elements of patient engagement.

The aim of the presentation is to give on overview of a project aiming to develop and test new structured intervention for violence risk management. Intervention aims to increase safety in care environments and engagement of patients.

Intervention Mapping protocol together with staff and patients will be used in the project. Quasi-experimental design is used to test the intervention in 4 month period in two psychiatric hospital units.

By the end of the year 2020, development of the the new violence risk management intervention is nearly finished. The presentation will give an outline of the developed intervention and how staff and patient engagement in the development phases were ensured.

The project described in this presentation is an example how a feasible violence risk management method can be developed together with staff and patients receiving psychiatric care. By ensuring engagement of the target groups, here staff and patients, it is possible to promote real integration of a new working method to psychiatric inpatient care. This project was funded by the Academy of Finland (316206).

The course of affective disorders varies significantly in clinical practice. There are many symptoms that are not related to affective disorders that cannot be described in other nosologies. In the present study such pathopsychological phenomena similar to psychotic symptoms and related to symptoms of “schizophrenia risk” were designated as positive thought disorders (PTD). These symptoms are understood as manifestations of delusional and hallucinatory register.

Aim of the study is to identify and validate the differences of neurocognitive functions among patients with positive thought disorders and at high risk of schizophrenia and patients without thought disorders.

In the research there were 17 patients with high risk of schizophrenia dominated by PTD (affective disorders, personality disorders, schizophrenic spectrum disorders) and 18 patients without thought disorders (affective disorders, personality disorders) in the research. Patients aged 17-25 years.

According to the results of the The Complex Figure test, the group with a high risk of schizophrenia had significantly low results on the “simultaneity” scale and points for copying the figure (p-value 0.04 and p-value 0.03). According to the results of the Verbal fluency test, the main group had significantly lower indices on the “loss of instruction” scale and on the number of repetitions (p-value 0.021 and p-value 0.009).

In the group of patients with a high risk of schizophrenia with positive thought disorders there are neurocognitive features in the form of reduced inhibitory control and a lack of simultaneity. The most sensitive methods are the Complex figure test and Verbal fluency Test.

The reported study was funded by RFBR, project number 20-013-00772

Mental retardation (RM) is defined as by a deficient intellectual capacity as well as by alterations of the adaptive capacity that are externalized in two or more functional areas (Personal autonomy, Communication, Orientation in the environment, Work and Free time).

Present a patient with a severe behavioural disturbance with an associated intellectual deficit, who remained hospitalized for 2 months and after observing an oral alteration her symptoms improved.

A descriptive study of a clinical case

54-year-old woman, single. You have a moderate intellectual disability. In January 2019, she began mental health consultations with a diagnosis of adjustment disorder, on treatment with aripiprazole 5 mg/day, mirtazapine 15 mg/day, lorazepam 0.5 mg/day and dipotassium clorazepate 10 mg/day. Went to the emergency room with mutism, hyporesponsiveness and refuse to intake, having lost 25 kg in 6 months. Abdominal and thoracic CT and upper gastrointestinal endoscopy without significant findings. Consultation with otorhinolaryngology, dermatology, traumatology without significant findings. Odontostomatology consultation: Deep cavities are observed, so it is necessary to carry out extractions of the pieces in poor condition. After this intervention, the patient returns to accept oral intake.

People with intellectual disabilities have a wide range of medical problems that in many cases are directly associated with the underlying disease or syndrome and, in others, with poor physical health due to problems in basic self-care skills or the ability to express verbally. Usually, the first manifestation of pain is an alteration in behaviour, which must be taken into account when making a differential diagnosis.

No significant relationships.

The current pandemic has only confirmed the need for international collaboration and more extended use of telepsychiatry than before. Unfortunately, regulatory constraints and lack of standardization are posing significant barriers to the internationalization of telepsychiatry. A need for global guidelines and service standardizations is of utmost importance in this rapidly growing but not yet well-established field. By mastering telepsychiatry, the professionals also may enable the remote provision of other eMH approaches complementary to well-known, traditional service(s). However, first, one ought to become familiar with the basics of telepsychiatry. Globally standardized telepsychiatric service and uniform regulations are prerequisites for fruitful international cooperation.

- to present the main objectives and messages of the WPA Global Guidelines for Telepsychiatry.

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

With proper preparation and thoughtful risk management, telepsychiatry can be an invaluable tool for allowing greater access to care. However, certain prerequisites must be fulfilled to achieve the desired goals. These prerequisites are e.g. choice of the technology, settings, patient/provider preferences as well as competencies and skills, all outlined in this document.

This WPA document may pave the way for the development of global regulations in order to break down the barriers of accessibility for both the professionals as well as for the patients worldwide. Further, it may help professionals in setting up a standardized telepsychiatry service(s) in addition to the existing mental health system(s).

I am the author of WPA Global Guidelines for Telepsychiatry but have no financial interest.

In depression (MDD) treatment there is a clear need for novel treatments, biomarkers and individualized treatment approaches. One of the most promising and most widely investigated biomarkers for antidepressant treatments is the EEG. Most EEG biomarkers however, still lack robustness and reproducibility and suffer significant publication bias as highlighted in a recent meta-analysis (Widge et al., 2018). Therefore, large controlled validation studies are needed with a focus on robustness, replication and clinical relevance. In this presentation results will be presented from the largest EEG Biomarker study to date, the international Study to Predict Optimized Treatment in Depression (iSPOT-D), where 1008 MDD patients were randomized to Escitalopram, Sertraline and Venlafaxine. Drug-class specific (Arns et al., 2016) and drug-specific (Arns, Gordon & Boutros, 2015) biomarkers will be highlighted as well as preliminary data from a prospective feasibility trial. Furthermore, data will be presented on repetitive Transcranial Magnetic Stimulation (rTMS) treatment in MDD on EEG and clinical predictors (Krepel et al., 2018; 2019) and a new method called Neuro-Cardiac-Guided TMS (NCG TMS), that exploits network connectivity in the frontal vagal pathway, as a target engagement approach (Iseger et al., 2019). Finally, clinical implications and implementations will be discussed from a ‘treatment stratification’ perspective, which might be a more realistic goal relative to ‘personalized medicine’ perspective.

MA is unpaid research director of the Brainclinics Foundation, a minority shareholder in neuroCare Group (Munich, Germany), and a co-inventor on 4 patent applications related to EEG, neuromodulation and psychophysiology, but receives no royalties related

Paraphrenia is a psychotic disorder characterized by an insidious development of a vivid and exuberant delusional system, accompanied by hallucinations and confabulations, without a personality deterioration. It is considered to be an intermediate entity between the disorganization of schizophrenia and the systematization of a delusional disorder.

Develop knowledge about paraphrenia as an individualized diagnostic entity and its historical path through the classical authors’ texts.

Extensive research on the historical path of the paraphrenia diagnostic entity was carried out, as well as the current situation of the term.

In the German psychiatry it was Karl Kahlbaum who first introduced the term of paraphrenia. Later many authors of the German psychiatry delved into this diagnostic entity. Emil Kraepelin described four different subtypes of paraphrenia: paraphrenia systematica, expansiva, confabulans and phantastica. However, other authors such as Kleist or Bleuler, considered paraphrenia should not be judge as an individualized diagnostic entity as it should be considered inside schizophrenia, so the term disappeared in the German psychiatry. In the French psychiatry, unlike the German, the independence of chronic psychosis from schizophrenias was recognized, so the term had a longer path. Henry Ey recognized four important clinical features in this disorder: paralogical thought dominance, megalomania, confabulation and integrity of relation with reality.

Currently the term paraphrenia is no longer considered an individualized diagnostic entity. In fact, in today’s textbooks of psychiatry paraphrenia is considered a psychotic disorder that has nothing in common with the one described by the classical authors, and it is part of the late-onset psychosis.

Primary psychopathy, although not included in DSM-5, is a personality trait characterized by callousness, unemotionality and a low sensitivity to anxiety and fear. From a psychophysiological standpoint, individuals with this trait exhibit a number of alterations, most notably lower heart rate at rest and lower heart rate variability (HRV).

We investigated the relationship between primary psychopathy and heart rate dynamics in response to emotional stimuli in a healthy community sample. In the high psychopathy participants we expected to find lower HRV and a general lower cardiovascular responsiveness to aversive emotional stimuli.

The study was carried out on male students with high (HP) and low scores (LP) of primary psychopathy according to Levenson’s LSRP. The stimuli were 15 short movie clips of different emotional content (Erotic, Scenery, Neutral, Compassion and Fear), lasting 2 minutes each and presented during ECG recording. Mean heart rate (HR) and HRV were analyzed.

Concerning HR, a Category by Group interaction revealed that participants in the HP group did not differentiate among emotional movie clips, whereas those in the LP group manifested significant reduced HR to Fear and Scenery compared to the other clips. Concerning HRV, the main Group effect showed in HP participants a lower HRV than LP subjects, irrespective of the film categories.

Using ecological stimuli is considered more effective in evoking spontaneous emotions, and our results point to a clear alteration of emotional cardiovascular response in high primary psychopathy trait individuals selected from a community sample.

The global COVID-19 pandemic has had an unprecedented effect on human behaviour and wellbeing. However, researchers have not yet considered how coping responses to stress related to COVID-19 could influence mental health.

This study aims to evaluate the mental health status of Portuguese during the national lockdown; examine how study participants cope with stress during the national lockdown; and assess the association between coping and mental health status.

We cross sectionally analysed data from a convenience sample of 430 adults living in Portugal. Mental health was measured using the five-item Mental Health Inventory. Coping strategies were assessed using the Brief COPE. We examine the univariate associations between mental health status and coping responses. We performed a multiple hierarchical regression analysis controlling for sex and age, to test the predictive importance of coping responses on mental health status.

Participants’ mental health was lower than the cut-off point for poor mental health (p<.001). The use of instrumental support, emotional support, self-blame, venting, denial, behavioral disengagement, and substance use were positively significantly associated with mental health, while active coping, positive reframing, acceptance, and humor were negatively significantly associated with mental health. The multiple hierarchical regression analyses showed that sex and age accounted for 6% of the variance of mental health. Coping strategies accounted for an additional and statistically significant 30% of the variance of mental health.

The findings provide support for the impact of the coping strategies on mental health. We encourage future research on the present topic.

A standardized approach to reduce or decrease the tobacco consumption is not performed. It is being used as a medium to socialize having an educational character on nursing and medical relationship.

Current cessation program are thought for patients without relevant cognitive impairments. Evidence about alternative management for this patient subgroup was collected.

This investigation examined the state of the implementation of nicotine cessation therapy for chronic psychiatric patients in Germany, Austria and Switzerland. German- and English-speaking publications since 2010 were selected. 12 different reviews and control trials were included.

Inpatient experiences from maximum hospital care in Germany have been published in the last 10 years, but mostly by oncologist departments in collaboration with pulmonologists and cardiologists showing a poor interest from psychiatrists, not even for harm reduction strategies in patients with severe mental illness. Therefore, the identification and treatment of nicotine addiction remains very low in patients with mental health conditions. Cognitive and pharmacological interventions are not covered by the German health system.

Latest evidence suggests that more flexible, open-ended, combination approaches of pharmacotherapy and counselling may be more successful. It will hence contribute to redressing the significant health and social inequities experienced by this. population sub-group as a consequence of tobacco smoking.

In the last decade, literature reports evidences of a growing number of patients diagnosed with Bipolar Disorders (BD), however, only few data are available regarding the distribution of BD diagnosis in the two genders. In fact, although many studies show differences in presentation and comorbidities of BD in the two genders, BD are commonly perceived as equally affecting both women and men. On the other hand, BD in female patients can often be misdiagnosed as MDD, especially because of the higher number of depressive episodes that characterize BD in women.

We aimed to analyse the gender composition of large samples, recently published studies on BD, in order to evaluate a possible modification of representation of BD in the two genders.

An electronic review of literature was conducted, and results were filtered by year of publication (2011-2020) and number of patients (> 1,000).

Our results show a higher number of female patients in every study evaluated (N=10). Of note, we found a higher number of females also in BD-I subsamples, in contradiction with previously published literature.

Even if with limitations connected to the design of the study, our study supports the hypothesis of a gender specific increment in BD diagnosis, and could lead the way for large epidemiological studies assessing gender specific prevalence of BD in the general population. Given the risks connected with untreated BD, and with antidepressants monotherapy, a better understanding of BD epidemiology could help physicians adequately diagnose and treat affected subjects.

Personality traits like neuroticism and trait-anxiety, as well as the predisposition to a greater sensitivity to pain, are risk factors for dental anxiety. Although perfectionism has been associated with both anxiety and pain, particularly when mediated by repetitive negative thinking/RNT (Macedo et al. 2015; Albuquerque et al. 2013), its role in dental anxiety has not yet been studied.

To analyze the role of perfectionism and RNT in dental anxiety.

A community sample of 552 adults (68.2% women; mean age=35.15±15.79 years) completed the Portuguese versions of:Hewit and Flett Multidimensional Perfectionism Scale–13, State-Trait Anxiety Inventory, Sensitivity to Pain Traumatization/SPT Scale, Fear of Dental Pain/FDP Questionnaire, Perseverative Thinking Questionnaire and Dental Fear Survey/DFS.

Trait-anxiety (r=.225), socially prescribed perfectionism/SPP (r=.177), SPT (r=.286), FDP (r=.509) and RNT (r=.274) were significantly (p<.01) correlated with dental anxiety (DFS total score). Serial mediation analysis using the PROCESS-macro 3.5 for SPSS (Hayes, 2020; Model 6) showed that even controlling for trait-anxiety and gender (as SPT, FDP and RNT mean scores were significantly higher in women, p<.01) SPP plays a significant indirect effect through SDT, FDP and RNT on dental anxiety, which are (isolated or sequentially) full mediators of this relationship (Total effect: .553, p<.001).

This study shows for the first time that negative perfectionism is a predictor of dental anxiety; its influence operates through the increase in levels of sensitivity to pain, DPA and RNT. We suggest that when intervening in this health problem it is important to evaluate perfectionism and try to mitigate its negative impact, namely diminishing RNT and the focus on pain and fear.

Fear of evaluation and a negative view of the self are the key characteristics of social anxiety, which is one the most prevalent anxiety problem. Self-esteem refers to views of oneself, including individual’s personal feelings towards self, whereas self-compassion refers to caring attitude toward oneself. Both constructs are two distinct positive views of the self, and were found to be related to each other, well-being and good mental health. To date, however, little is known, how they interplay in people with predominantly negative view of themselves, that is in socially anxious individuals.

The current research aims at evaluating how social anxiety interacts with self-esteem and self-compassion and to assess whether self-compassion, mediates the relationship between social anxiety and self-esteem.

In this research, 388 adult participants with elevated social anxiety level (LSAS score M = 81.47, SD = 21.20) were recruited via open calls posted on the Internet and completed measures of social anxiety, self-compassion, and self-esteem.

In accordance with the view that individuals with social anxiety tend to have negative mental representation of the self, we found that both self-esteem and self-compassion correlated negatively with social anxiety, and positively with one another. More importantly, self-compassion partially mediates the relationship between self-esteem and social anxiety.

These findings suggest that self-compassion may play an important role in buffering against social anxiety and suggest that enhancing self-compassion might be beneficial for reducing symptoms of social anxiety

No significant relationships.

Eating disorders (ED) are characterized by perturbed eating habits or behaviors (APA, 2013). Even if treatments are available, they need to be more adapted to ED (Monthuy-Blanc, 2018). A complementary approach as yoga or mindfulness demonstrated positive effects with ED, such as an augmentation of mindfulness while eating (Rachel, Ivanka, Amanda, & Carlene, 2013), a better body satisfaction (Beccia, Dunlap, Hanes, Courneene, & Zwickey, 2018; Neumark-Sztainer, MacLehose, Watts, Pacanowski, & Eisenberg, 2018) and less preoccupation with food (Carei, Fyfe-Johnson, Breuner, & Brown, 2010). As the effects of yoga and mindfulness vary between the different ED and different uses, it is difficult to generalize the results obtained about the efficacy of yoga or mindfulness with ED.

A scoping review is actually done to map the evidence about the use (length, intensity, frequency) of yoga and mindfulness among ED and their effects.

The realization of the scoping review is based on the Joanna Briggs Institute Methodological Framework(Peters, Godfrey, McInerney, Baldini Soares, Khalil, & Parker, 2017). Research will be done in the following databases: CINAHL, PsycInfo, PubMed/MEDLINE, Web of Science, EBM Reviews/Cochrane. Different types of papers are going to be included and a content analysis is going to be done among the extracted data.

Preliminary results of the scoping review are going to be presented.

Among the different treatments used with ED, yoga and mindfulness have demonstrated positive effects. These approaches as part of integrative health are helpful to improve physical and mental health of individuals suffering from ED.

Frontotemporal dementia (FTD) is a group of neurodegenerative disorders characterized by behavioral or language changes with progressive executive dysfunction. It´s subdivided into two variants, the behavioral and language variants. The phenocopy syndrome of frontotemporal dementia (phFTD) mimics the behavioral variant, but doesn´t show frontotemporal atrophy in neuroimaging and doesn´t progress to frank dementia over the years.

Presenting a review of phenocopy syndrome of frontotemporal dementia.

Search on Pubmed® and Medscape® databases with the following keywords: “frontotemporal dementia and phenocopy” or “FTD phenocopy”. We focused on data from systematic reviews and meta-analyzes published in the last five years. The articles were selected by the authors according to their relevance.

Mutations in GRN and MAPT gens and genetic expansion of C9orf72 have been identified. The discovery of the C9orf72 expansion in psychiatric disorders (psychosis, bipolar disorder or depressive disorder), for some authors, represents that phFTD is a psychiatric pathology. In fact, there’s a higher frequency of psychiatric and psychological symptoms in phFTD compared to the variants of FTD. Usually are male patients who don´t have significant cognitive deficits, with preservation of executive functions and episodic memory. Until now, there are no definitive biomarkers of the disease. The prognosis is more benigne, unlike FTD, which has an average survival of 3 years since diagnosis.

phFTD is a clinical and scientific challenge. The neurobiological bases remain unknown, requiring further studies in this field. The identification of markers that can differentiate patients with typical FTD and phFTD can facilitate prognosis orientation and pharmacological an non-pharmacological treatment.

No significant relationships.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, with an estimated prevalence of 2.8% in adults. It is frequently comorbid with other mental disorders and may significantly affect global functioning, leading to stigma and social discrimination. Despite its widespread occurrence in adults, many general psychiatrists do not feel well prepared to diagnose and manage this disorder. Psychiatry training curricula rarely include rotations in specialized ADHD clinics for adults or specialized courses during residency, and in many European countries such specialized clinics for adults or the most recommended medications, are not even available. It makes the recognition and treatment of ADHD often overlooked, unless it has been diagnosed in childhood. Dr. Gondek will demonstrate the diagnostic process of ADHD in adults and main directions for differential diagnosis in cases of a complex clinical picture.

No significant relationships.