The Eye Movement Desensitization and Reprocessing (EMDR) therapy has shown to be useful in the treatment of PTSD, general anxiety, stress and burnout. Nonetheless, assessing therapy progress has been limited to subjective appreciations of the patient and therapist, which compromise therapy efficacy, and the continuum of care (clinic and at home) and scalability that digitized approaches can offer.

The aim of the present study was to validate the potential of a smartphone-based biofeedback digitized approach for EMDR usage in burnout therapy, as a means to provide quantitative progress assessment and personalized therapy optimization.

A digitized burnout status assessment app based on Maslach Burnout Inventory was first implemented and tested. Then, an EMDR app was developed by making use of adjustable audiovisual stimuli (e.g. different velocity and horizontal/vertical visual stimuli; and different pitch and left-right surround sound effects) and also of the smartphone’s camera photoplethysmography finger recordings from which heart rate, heart rate variability and breathing rate are derived and used for modulating stimuli (biofeedback). Finally, interviews with several EMDR experts were conducted to assess the potential of the app as a therapeutic adjuvant.

The preliminary interview results showed that the app can be useful for online therapy, to optimize the stimuli presentation, and to quantify the therapy experience and outcomes. The interviews also validated the technical specifications and usability of the tool.

Results so far have shown a promising receptivity and interest from EMDR experts. As such, patient testing is currently on-going.

The work of the present abstract is the basis of the research conducted at the Faculty of Sciences of the University of Lisbon, co-lead with NEVARO, a spin-off company of the same Faculty.

People with mental disorders who had same-sex experience (SSE) are at increased risk of self-injurious behavior probably due to the double stigma phenomenon, which severity varies in different societies. So far, there is a knowledge gap on factors associated with SSE in Russian psychiatric patients.

We aimed to investigate variables associated with homosexual experience in Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation (SI).

In a case-control study (1:1.5): 92 female patients with NPMD and SI with lifetime SSE were compared with 138 patients without homosexual experience. All patients underwent a psychiatric examination, Self-Injurious Thoughts and Behaviors Interview (Nock MK, 2007) and semi-structured interview to assess demographic, clinical, and behavioral features. Mann-Whitney, Fishers exact test and Pearson’s chi-squared were used as statistical methods.

Groups did not differ in education level, marital status, family history of suicidal behavior, traumatic events exposure and lifetime eating disorders (all:p>0.05). More patients with SSE had family history of non-suicidal self-injuries (NSSI), were dissatisfied with their parenting style, had a higher number of unprotected sexual contacts with unfamiliar persons, practiced group sex, had a history of sexual abuse, illicit drug use experience, were smokers, had piercing and severe body modifications. Lifetime history of suicide plan, attempts and NSSI were significantly more common in people with SSE (all:<0.05).

A number of suicide risk factors were found to be more prevalent in people with SSE. Homosexual experience in people with mental disorders is associated with an increased risk of NSSI, suicide plan development and suicide attempts.

No significant relationships.

Several neuroimaging studies on psychosis spectrum have been published in the last decades, most of them based on schizophrenia. In the context of neuroanatomical dysfunctions, clinical and prognosis implications have been reported. Nevertheless, only a few studies have been focused on delusional disorder (DD).

To present the case of a patient diagnosed with DD who suffered from two cerebrovascular events after the onset of the psychiatric disease. Our aim is to elucidate potential implications of those lesions on the course of DD. We also reviewed the literature to assess evidence for specific changes in DD on brain structures and functions.

Case report and non-systematic narrative review in PubMed (2000-2020).

Case report: A 66-year-old female with DD presenting, during the course of the disease, general atrophy and consecutive ischemic lesions on parietal, occipital and cerebellar areas. Clinical stabilization was achieved 12-16 months after risperidone 1.5mg/day treatment. Review: 19 studies were included: Structural brain data (n=15), Functional data (n=13). Most of the structural neuroimaging studies reported white and gray matter abnormalities, particularly in temporal, parietal and frontal lobes, and in limbic structures. Functional neuroimaging studies pointed to temporal and parietal lobes, as well as basal ganglia and limbic related structures.

Temporal, parietal, frontal, basal ganglia and limbic-related structures, as well as dysfunctions in other specific brain regions, may be implicated in the core symptoms of DD. These findings might be further investigated as potential neuroimaging markers of prognosis, such as partial or delayed response to antipsychotic treatment, as presented in our case.

The COVID-19 viral pandemic has taken the world by surprise. The pandemic has caused a great impact on the mental health and wellbeing of pregnant women with mental health difficulties. Healthcare providers veered towards video-telemedicine to safely and swiftly provide services to its users.

To determine impact of Video-telemedicine on: 1. Access to Care 2. Ease of Use 3. Quality of Care 4. Difficulties of Use 5. Future Prospects of Video Telemedicine

We have decided to conduct a targeted survey to 100 pregnant women who are known to Perinatal Mental Health services to assess the new methods of contact that the viral pandemic has enforced upon healthcare providers.

Pre-pandemic: video-telemedicine was ranked as least preferred Post-pandemic it is ranked as second favourite. 70.4% of responders have confirmed that video-telemedicine significantly facilitated access to care. 23.3% of responders insisted video-telemedicine made the service better. 50% of responders thought it was much easier to use video options to access their care services needs 95.4% of responders felt that video-telemedicine alternatives should remain post-pandemic

Video-telemedicine options have significantly improved the access and quality of services provided by Community Health Services to pregnant women during the pandemic. Video options can also make it easier to reach critical care without negatively affecting the quality of wholistic care provided, in fact, it can sometimes improve it. It is important that the psychiatric field learn from this pandemic and implement these services permanently. Bigger and wider studies need to be done in the future to support these conclusions.

No significant relationships.

Although OCD is believed to have a chronic course, little research has been conducted on this, and there are discrepant findings. Studies over the last years have found that a significant proportion of patients with OCD shows symptomatic remission over long term, however there are significant variations in sampling, clinical characteristics, follow-up, and outcome assessments.

The present prospective study aims to examine rates of OCD remission after 20 years of follow up and to explore demographic and clinical predictors of remission.

The study sample consists of adult patients with a principal OCD diagnosis and Y-BOCS total score ≥16, who have been referred to the Department of Neuroscience, University of Turin (Italy). OCD symptoms were assessed every 5 years over the 20-year follow-up period. Course data were examined using standard survival analysis methods; Cox proportional hazards regression was used to estimate relative hazards for predictors of remission.

There were 360 participants in the study. At year 20, the 28.7 % of the total sample showed OCD remission. Predictor of remission were female gender, lower Y-BOCS mean scores at study entry, longer duration of illness and comorbidity with major depressive disorder. No specific predictors of full remission were found. Lower Y-BOCS mean scores and comorbid bipolar disorder predicted partial remission.

This study suggests that a significant proportion of patients with OCD shows remission. Future studies are needed to clearly identify predictors of remission.

No significant relationships.

The need to implement a program of autonomy in the handling of oral medication has been observed at the time of discharge from the hospital.

- That the patient is able to know his medication, differentiating between active ingredient and commercial brand. - That the patient is able to interpret the guideline in the electronic prescription. - That the patient is able to prepare his weekly medication autonomously.

- The doctor in charge indicates the Program in those patients susceptible to benefit of the same and after consensus with the multidisciplinary team. He validates and prints the electronic prescription well in advance. Preferably the patient himself (alone or accompanied by family members or Educators) get their medication and a weekly “polydosis” at a pharmacy office bringing him with him to the Unit. - Occupational Therapy helps the patient interpret the electronic prescription guideline and place the weekly medication in the “polydosis” and works with the patient in forecasting execution tasks of medication needs for outpatient follow-up.

The program is well accepted by patients. None of the patients included so far have had an early relapse.

The program has helped patients interpret the medical indications given mnesical and executive difficulties of patients with severe mental disorder.

No significant relationships.

Cognitive test anxiety is acknowledged as intense anxiety that prevents the effective use of the previously learned knowledge during the exam and leads to a decrease in success. Mindfulness is indicated as the ability to bring one’s attention to experiences in the present moment in a non-judgmental way. Despite promising outcomes of mindfulness techniques in regulating stress levels, much uncertainty still exists about the specific associations between cognitive test anxiety and mindfulness subcategories.

The aim of this study was to investigate the relationship between cognitive test anxiety and subcategories of mindfulness among university students which may help improving current mindfulness interventions that show promising results to tackle cognitive test anxiety.

One hundred-eighty-two university students were recruited for the study via online forms. Mindfulness was measured with Five Facet Mindfulness (FFMQ-S) and the cognitive test anxiety was assessed with Cognitive Test Anxiety Scale-Revised (CTAR).

Total scores of CTAR-R has an association between subscales of FFMQ; act-aware and non-judge in a positive direction, whereas; observe and describe in a negative direction. In addition, according to our regression model, FFMQ subscales of describing to indicated lower levels of CTAR scores, whereas act aware and non-judge indicated higher levels of CTAR scores.

The findings of the study partially corroborated the previous results by offering inferences about the subcategories of mindfulness. Additionally, these findings suggest that current interventions may target specific subcategories of mindfulness to maximize the positive outcomes of the treatment.

No significant relationships.

Diagnostics of Apocalyptic variant of end-world Delusion with Religious Content (ADRC) in schizophrenia is related with insufficient exploration and recognizability, despite the severity of the state, social risks and resistance to psychopharmacotherapy.

To define psychopathological and phenomenological features of ADRC in schizophrenia, to identify the clinical dynamics of delusional disorders due to specifics of the delusional behavior, and to develop diagnostic and prognostic criteria.

28 patients with ADRC in schizophrenia were examined (ICD-10: F20.0, F20.01, F20.02). Clinical-psychopathological and statistical methods were applied.

Delusional ideas of end-world, Apocalyptic variant, occurred in the structure of affective-delusional state (acute sensual delusion with fantastic content). Two types of ADRC were identified: with the predominance of acute sensory delusions of perception and with the predominance of visual-figurative delusions of the imagination. These types differed in the severity and depth of psychotic manifestations and in the specifics of a delusion formation, were characterized by the mono- or polythematic delusional disorders.

Cases of ADRC differ both in the clinical-psychopathological specifics of delusional constructions, and in the socio-behavioral aspect. Among these cases, there is a high risk of delusional destructive behavior, with auto-aggressive, suicidal attempts and hetero-aggressive behavior. In cases with ADRC the strong persistence of delusional pseudo-religious beliefs occurs, with the refusal of any medical and psychological assistance, as well as implication of socially dangerous acts associated with the spread of delusional ideas and their induction of religiously inclined persons, which leads to the emergence of pathological pseudoreligiosity (distortion of traditional canonical religious views).

No significant relationships.

One of the defining features of the modern world is a large scale migration that occurs due to a range of factors, from political conflicts to personal and voluntary reasons. This process can cause a severe disruption in individuals’ biography and can be followed by a large period of adaptation and a phenomenon of acculturation. Surprisingly, there is little research on the impact of migration and settlement on risk of psychosis.

Regarding a clinical case, we aim to enphasize the current evidence about the risk of psychotic disorders in migrants.

We present a qualitative review of this topic using the Pubmed database.

27 years old portuguese female, with hyperthymic temperament and history of depressive episode. Her process of migration in 2016 was motivated by an academic purpose. In context of stressful life events she developed psychotic symptoms - messianic and persecutory delusions, with visual and auditory hallucinations.

There is an increased risk of psychosis among migrant population that is well documented. This is even the main risk factor with the exception of a family history of psychosis. The risk can be explained by socio-demographic and psychological features, factors involving the migration process, and socio-occupational environment in the host country. A socio-developmental-cognitive model theorize how exposure to a stressful environment and social defeat interacts with underlying genetic risk to create an enduring liability to psychosis. These findings can help in important decisions about mental health resources and accessibility, including protocols to identify and treat migrants at higher risk of mental diseases.

No significant relationships.

No significant relationships.

Use of combined antidepressive treatment included high-frequency rhythmic transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is one of the ways for overcoming of pharmaco-resistance in depressive patients.

The aim of the study was the search for possible EEG predictors of antidepressive effects of rTMS of the left DLPFC in combined treatment of depression.

30 female in-patients (F31.3, F33.0, F33.1, by ICD-10; 20-50 years, mean age 36.9±10.3) with pharmaco-resistant depression were enrolled in the study. Treatment included antidepressants (mainly SSRI) and a 3-week course of rTMS (20 Hz) of the left DLPFC. Correlations between pre-treatment EEG spectral power values, and post-treatment quantitative clinical assessments of patients were analyzed. Responders/non-responders were determined by standard criteria of 50% decrease in HDRS-17 scale total scores after treatment course.

Responders (23 out of 30) revealed significant (p<0.05) negative correlations between post-treatment HDRS-17 scores and pre-treatment EEG spectral power in theta-2 (6-8 Hz) and alpha-1 (8-9 Hz) frequency sub-bands in the parietal-occipital-posterior temporal leads. Non-responders (7 out of 30) showed negative correlations between the post-treatment HDRS-17 scores and pre-treatment theta-2 EEG spectral power in the frontal-central-temporal regions of the right hemisphere.

Even brief course of rTMS of the left DLPFC enhances the action of antidepressants, and allows overcoming partially the pharmaco-resistance in depressive patients. Baseline values of theta-2 and alpha-1 EEG spectral power may serve as possible predictors of the effects of combined antidepressive therapy including rTMS. The study supported by RBRF grant No.18-01-00029a.

No significant relationships.

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.

The psychiatric care paradigm has shifted towards community-centered models. Yet, prolonged hospitalizations are still a reality, with debated impact at healthcare systems and patients.

This work aims to describe prolonged hospitalizations in acute psychiatric wards through patients’ sociodemographic and clinical data.

We analyzed a national hospitalization database that contained all hospitalization episodes registered in Portuguese public hospitals from 2008 to 2015. All episodes with a primary diagnosis of mental disorder defined as ICD-9-CM codes 290.x-319.x were included. Prolonged hospitalizations were defined as having a LoS ≥ P97.5; LOS ≥180 days or LOS ≥1 year. Age, sex, lengh of stay, in-hospital mortality were analysed.

The LoS ≥ P97.5(≥62 days) group comprised 3911 hospitalizations (2.3% of all psychiatric hospitalizations) and 1755 patients. The median LOS was 81 days and the mean age was 51 years. Sex was equally distributed, though a higher frequency of male patients was found on the ≥180 days (n=364) and ≥ 1 year (n=121) groups. Psychotic disorders were the main diagnosis at discharge (n= 1769, 45.2%), followed by mood disorders (n=1057, 27.0%) and dementia (n=451, 11.5%). In-hospital mortality increased in the higher LoS groups (1.1%; 4.4%; 9.1%, respectively).

Overall, middle aged patients with psychotic disorders represent most of the prolonged hospitalizations occurring in acute psychiatric wards. Community-based programs require further development to meet the existing needs.

No significant relationships.

Therapeutic Education (TE) is a powerful tool in the multidisciplinary intervention to improve lifestyle and acquire management skills for chronic diseases, including obesity, a clinical condition whose cure is highly threatened by low long-term adherence to therapeutic recommendations. The urgent need to promote persistent lifestyle change and concordance to treatment in PwO is globally recognized. TE programs offer a vast number of long-term management skills, but it yet deals with a consistent drop-out rate, and we believe that Assistive Technologies (AT) can become a powerful tool to boost independence and improve participation.

The goal of our study was to devise and validate an innovative multidisciplinary approach to obesity and binge eating disorder, based on the sinergy between the medical-psychological field and assistive techonolgy.

We developed “TERESA” (Therapeutic Educational Robot Enhancing Social interActions) (fig. 1), a social humanoid robot, and implemented it to collaborate in a TE programs in order to enhance social interactions, improve knowledge acquisition and adherence to treatment. The specific TE intervention, called Education towards Choice and Awareness, was based on 3rd generation cognitive-behavioral approaches and consisted in eight informative and experimental meetings.

Taking part in the TE-TERESA integrated protocol determined and improvement in psychopathological domains (anxiety, negative mood, quality of life) and a stronger concordance to the therapeutic protocol.

Our research paves the way for the clinical use of Assistive technology (AT), highly promoted by the WHO to help people with numerous disabling clinical conditions improve their quality of life and acquire self-management skills.

The evaluation of the distribution of pathologies according to gender in child and adolescent psychiatry remains an interesting question both for epidemiological and etiopathogenic research.

The objective of our work was to study the influence of gender on the psychopathological expression of disorders in children and adolescents.

A retrospective study was conducted at the outpatient child psychiatry department at the Tahar Sfar University Hospital in Mahdia, Tunisia, among patients who consulted for the first time during the period from January 2015 to December 2017. To carry out this work, we used a pre-established form evaluating the sociodemographic and clinical information. We opted for grouping diagnoses according to axis I of the DSM IV- TR.

We collected 577 cases: 231 girls, and 346 boys. The analysis of the results showed a male predominance (60% of our sample were boys). A significant difference in diagnosis relating to gender was found (p = 0.02). In fact, boys were more likely to have pervasive developmental disorders, mental retardation and externalizing disorders, while girls were more likely to develop sleep and eating disorders and internalizing disorders such as mood disorders.

Demonstrating the existence of a significant gender distribution of pathologies in adolescent and child psychiatry is certainly of real importance in the context of epidemiological, clinical and etiopathogenic research. However, it would be more efficient to further investigate other epidemiological and socio-cultural data in order to better specify the involvement of each of these factors in the emergence of psychopathology.

Substance use is highly prevalent among Chilean adolescents, and the damage it causes at the neurobiological, psychological, and social levels is well known. However, there are no validated screening instruments that also assess risk and protective factors for this Chilean population.

To evaluate the psychometric properties of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap).

A cross-sectional study was carried out in 13 schools in Santiago of Chile. The sample included 2,261 adolescents of 10 to 14 years old. The linguistic and cultural adaptation was conducted using focus groups, the construct validity was evaluated using confirmatory factor analysis, and measures of its reliability were also determined. Furthermore, the associations regarding risk and protective factors with substance use were explored.

Substance use questions were well understood by adolescents. Regarding the subscales of risk and protective factors, they needed some changes, and once completed, all new subscales had good or adequate goodness of fit adjustment. Regarding reliability, all of the new subscales had good or acceptable internal consistency according to the omega coefficient (range from 0.69 to 0.89). Finally, most of the risk and protective factors measured by the questionnaire were strongly associated with different substance use outcomes, especially those related to positive and negative beliefs or attitudes towards drugs, normative beliefs, and refusal skills.

The current findings suggest that the EU-Dap questionnaire is a valid and reliable instrument, and it may help to evaluate the effectiveness of preventive interventions in the future.

No significant relationships.

There is a high degree of comorbidity between serious mental illness (SMI) and substance use disorders (SUD) and cardiovascular disorders. Other life-style related disorders are also common in patients with SMI and SUD. Consequently, comorbidity with somatic diseases contributes to a dramatic reduction in life-expectancy for these patient groups. Physical training has been shown to have positive effects also for mental health, but there has been little systematic use of physical training as part of the treatment for patients suffering from SMI and SUD in Norwegian health care.

To present a new project on physical training for patients suffering from SMI and SUD.

We briefly describe a project in a major Norwegian hospital, where physical exercise will be offered as part of the treatment for patients suffering from SMI and SUD.

The Division for Substance Use and Mental Health now offers an exercise room for inpatients at the main clinic in Tromsø, Norway. The exercise room contains various equipment including treadmills and equipment for strength training. This facility has recently been made available and is currently being used by a selection of patients. A study of user experiences is forthcoming and a systematic study of effects of physical exercise for patients suffering from SMI and SUD is being planned.

Physical exercise has been shown to have positive effects also on mental health. In one major Norwegian hospital, facilities are now offered for inpatients suffering from SMI or SUD. The effects of physical exercise on patients with SMI and SUD will be examined.

No significant relationships.

Approximately, 15- 26% of patients with first-episode psychosis, including schizophrenia, are likely to have attempted suicide by their first treatment contact. Studies of suicidal behavior outside of schizophrenia have indicated grey matter volume loss in the prefrontal and orbitofrontal cortex, and aberrant brain activity in relation to emotional recognition and dysfunction.

This study aimed to investigate the functional neural correlates of suicidal behavior in early schizophrenia.

fMRI faces task was conducted (fearful face versus neutral face) in 8 participants with first-episode schizophrenia together with standardised scales including PANSS and SBQ-R. fMRI activation was compared using a two-sample t-test in participants with low and high suicidal behavior. Extent threshold is 0 voxels and significance level p<0.001 (FWE corrected). Processing of images was carried out using SPM12 and Matlab.

8 participants were recruited; 5 males and 3 females, mean age of 26.5. Results suggest that participants with higher suicidal behaviour showed reduced activation on the anterior-cingulate gyrus and medial frontal gyrus, which are parts of PFC, (p= .005). There was also a significant difference in task response accuracy, where, participants with high suicidal behaviour made more accurate responses compared to low group (t (3) = 3.65, p = .035).

This is an exploratory study, investigated the differences in brain activity in patients with schizophrenia who are at risk of completed suicide and, therefore might provide new insights into the underlying mechanisms. Further work should address how PFC activity changes with risk over time and its potential utility as a biomarker in suicide.

COVID-19 is a disease with insufficiently studied diagnosis, therapy, and prevention that causes anxiety disorders in population.

To evaluate prevalence and correlates of COVID-19-related anxiety in university students during the period of their distant learning due to COVID-19 pandemic.

The on-line survey of May 2020 covered 327 Russian university students aged 17-40. The questions concerned evaluation of threats, risks and acute problems faced by the students and their closest people in the situation of COVID-19 spread. We determined the anxiety level of the students by the degree of their concern about high risk of COVID-19 infection.

We established that 17.1% of the students had maximal level of COVID-19-related anxiety that correlated with older age (r=.13), better academic performance (r=.12), expectation of higher COVID-19-related threat to their life (r=.57), to the closest people’s health (r=.44), to the aged people’s lives (r=.16). It correlated with a more serious approach to evaluating the COVID-19-related situation and dangers in the world (r=.19), in the country (r=.24), and in the region of their residence (r=.37). Students with a high anxiety level often saw in pandemic a threat to their way of life (r=.12), material wellbeing (r=.12), and plans for the future (r=.11). They more strictly obeyed the restrictions (r=.13) and they did not exclude a recurrence of COVID-19 type pandemics in the future (r=.17).

COVID-19 related anxiety is present in every sixth student and it correlates with older age and better academic performance. These students may have a high risk for depressive disorders.

Goffman defined stigma as an “attribute that is deeply discrediting” and in the last two decades research on this subject grew substantially.Opioids were ranked as the second most common form of illicit drug used worldwide and there is consensus in the literature that opioid substitution therapy (OST), methadone or buprenorphine, are the most effective treatments, although remain underutilized. People with an history of substance use disorders (SUD) are widely stigmatized, a significant barrier to detection and treatment efforts. Care workers were cited as the second most common source of stigma.

The aim is to do a review of the literature of stigma as a significant barrier to OST and present several potential strategies to reduce stigma.

Non-systematic review of the literature with selection of scientific articles published in the last 5 years; by searching the Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: Opioid Use Disorder; Stigma; Opioid Substitution Therapy

OST providers should actively bring up the topic of stigma in clinic appointments to determine whether the patient is experiencing stigma, and if so, whether it is adversely affecting their ability to continue in the treatment. More active measures need to be taken to help reducing the stigma through public awareness campaigns at local levels, continuing education of health care providers regarding substance OST, and greater incorporation of family members into the program.

In conclusion, further research is required to understand and address this issue.

No significant relationships.