Glucagon-like peptide-1 (GLP-1) is an endogenous peptide that stimulates insulin secretion and decreases glucagon secretion. The use of GLP-1 receptor agonists (GLP-1RA) showed efficacy reducing the weight and glucose levels in patients with and without type 2 diabetes. This effect was also associated with a decreased risk of major cardiovascular events.

Our aim is to review the role of GLP-1RA in psychiatric patients at cardio-metabolic risk due to antipsychotics treatment.

We reviewed articles published in PubMed using the keywords: “GLP-1” “glucagon like peptide” “antipsychotics” and “psychiatry”.

The number need to treat (NNT) to achieve clinical meaningful weight loss was 3.8. GLP-1RA treatment was also associated with greater reductions in body mass index, fasting glucose, HbA1c and visceral fat. This effect is true for antipsychotic treatment in general and for those on clozapine and olanzapine in particular. Overall, the GLP-1RA are well tolerated with nausea being the most common related adverse effect. Other variables such as age, sex, psychosis severity, nausea or any adverse drug reaction did not affect the weight loss.

Studies showed a promising role in the management of antipsychotics induced weight gain, particularly in clozapine and olanzapine treated patients. Although these promising results, the route of administration, with a daily or weekly subcutaneous injection, and the GLP-1RA associated financial costs, can be viewed as important factors which can limit the wide use of this type of treatment in psychiatric patients.

No significant relationships.

Ethanol is widely consumed by the world’s population, especially young people as part of their university life. In Tunisia, surveys and studies about consumption of ethanol among students are rare or even exceptional.

To evaluate the extent of the consumption of ethanol among pharmacy students in Monastir University, from the first year to residency, and to define the factors associated to this consumption.

This study was used to collected information about the participants using a questionnaire that covers the different parameters of the consumption of ethanol during student life and the factors influencing this consumption.

154 participants aged 23.61 years +/- 2.63 among them 37.7% were men and 62.3% women. The prevalence of ethanol consumption was 44.8 %. The main reason for dirking was to party (79.2%). The consumption of ethanol was significantly associated with sex (p=0), place of residence (p=0.047), frequency of hang-outs (p=0), sex life (p=0) and students perception of the alcohol-health relationship (p=0). Various health problems were related to the frequency of consumption of ethanol, such as memory problems (p=0.002), violence and injuries (p=0.014).

The findings of this study underline the need to develop specific studies and general population surveys in order to better assess the situation in Tunisia and to put in place appropriate prevention strategies, such as information and awareness campaigns, aimed at reducing or at least rationing the consumption of ethanol.

No significant relationships.

Ramadan happens in the ninth month of the Muslim lunar calendar. The cycle of the sun marks the beginning and the end of fasting. Its duration varies depending on the season: approximately 18 h in the summer to approximately 12 h during winter. The obligation to eat only during the night leads to an important change in the circadian rhythm There are certain psychiatric illnesses wherein people are very sensitive to this circadian disruption, bipolar disorder in particular. We know that a regulated circadian rhythm with adequate sleep are essential for symptom regulation and mood stability, with the risk of relapse or worsening symptoms. Additionally, some medications have to be maintained at a specific therapeutic index, namely lithium, a common mood stabilizer used to treat bipolar disorder.

To review the impact of Ramadan on patients with bipolar disorder

Pubmed and Google Scholar search using the keywords Bipolar disorder, Ramadan, circadian rhythm, fasting, sleep deprivation

All physiologic parameters are influenced by the circadian rhythm, which is influenced in its turn by the food rhythm. Studies on the effects of Ramadan on mood and mental health in the general population provide contradicting evidence. The inability to take medications during the day, dehydration and other somatic changes that necessitate dosing modification may lead to psychiatric symptom exacerbation.

Patients with bipolar disorder might be particularly sensitive to circadian rhythm disturbances and could require increased monitoring of their symptoms during this month.

No significant relationships.

Prescribing antidepressants in the treatment of bipolar depression remains highly controversial due to the inconsistency between routine clinical practice and the results of controlled trials.

To assess the validity of antidepressants use in bipolar depression from the point of view of evidence-based medicine.

Database search (Scopus and MEDLINE) followed by analysis of studies concerning the efficacy and safety of antidepressants in the bipolar depression treatment.

The search found 23 studies. There was a high degree of inconsistency in the results, apparently related to the methodology. Only two studies compared the effectiveness of antidepressants in monotherapy with placebo. No differences were found in the study with 740 participants but in the study with 70 participants with type 2 bipolar disorder antidepressants were found to be more effective than placebo. Nevertheless, both studies had significant methodological issues. In 6 studies comparing the effectiveness of the combination of antidepressants with mood stabilizers against the combination of mood stabilizers with placebo, only the effectiveness of fluoxetine in combination with olanzapine was confirmed, other antidepressants were ineffective. At the same time, studies where antidepressants were compared with each other in combination with mood stabilizers revealed a significant clinical response to therapy. Risk of the treatment emergency adverse events were relatively low for SSRI.

Despite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors.

For almost three decades, botulinum toxin type A (BT-A) has been used for medical purposes. Evidence of the potential use of BT-A is emerging for psychiatric disorders, like unipolar and bipolar depression, borderline personality disorder (BPD), late dyskinesia, amongst others. This may represent a new role of BT-A treatment and could expand the therapeutic arsenal in psychiatry.

The goal is to review current evidence regarding BT-A and psychiatry disorders.

Literature review of BT-A use in psychiatric conditions using Medline database.

There’s evidence supporting the use of BT-A in resistant unipolar depression, with studies showing an 8 and 4 times higher response and remission rates comparing with placebo. Beneficial effects were also found in bipolar depression. Preliminary data suggest that BT-A therapy may also be effective in the treatment of mental disorders characterized by an excess of negative emotions, such as BPD. The underlying mechanism might be the “facial feedback hypothesis”. Hyperhidrosis is a common comorbidity in social anxiety disorder and may itself give rise to depressive or anxiety symptoms. BT-A has proved to be a safe and effective treatment for hyperhidrosis. BT-A can also be safely used for dystonia secondary to the use of psychiatric medication, when there’s an inadequate response to anticholinergic medication. Also, BT-A injections in the salivary glands have been investigated for treating clozapine-induced sialorrhea and studies reported successful reduction in hypersalivation.

Although more studies are needed to evaluate the potential of BT-A in psychiatry, there is growing evidence of its potential use for some psychiatric conditions.

The dual diagnosis among patients with primary psychotic disorders is frequent and causes diagnostic and treatment challenges. In clinical practice, differentiating between substance-induced psychoses and independent (primary) psychoses when the patient is actively using drugs of addiction, is difficult, especially in the acute phase of the psychosis.

The aim of the study is to identify clinical data relevant for differentiating between primary psychoses triggered by addictive drug misuse and substance-induced psychoses, using psychometric scales.

The study was conducted on 111 patients divided in four samples: 28 dual diagnosis psychotic patients (DD), 27 bipolar patients (BD), 25 schizoaffective patients (SCA) and 31 patients with schizophrenia (SCZ). The subjects were assessed using scales for the severity of psychiatric symptoms, cognitive functions and social acuity (theory of mind): BPRS-E (Brief Psychiatric Rating Scale – Expanded), MoCA (Montreal Cognitive Assessment), CBS (Cambridge Behavioral Scale), and RMET (Reading the Mind in the Eyes Test). The tests were performed when patients were in the remission phase of the psychosis.

BPRS-E scores showed significant differences between DD subjects and patients from the other three samples (primary psychoses). CBS revealed significant differences between the DD subjects and patients with schizophrenia spectrum psychoses (SCA and SCZ). RMET identified significant differences between DD and BD patients.

Although differentiating between substance-induced and primary psychoses remains a difficult task, social acuity assessment performed in remitted patients may be helpful in guiding the clinician to establish a more accurate diagnosis.

Globalization as lead to a more heterogeneous population than ever which makes intercultural communication an issue of modern times. Although this is positive in many ways, the differences in culture and beliefs, as well as a linguist barrier may impair clinical communication.

The authors aim to shed light in the issues regarding intercultural communication.

Review of the literature including studies focusing on the the various facets of intercultural communication.

People from different cultural backgrounds have less access to health care and are less referenced to specialized care. Also, these patients report less satisfaction after their appointments. Although language proficiency in pointed as one of the most determinant factors, acceptance and comprehension of the patient beliefs regarding health and disease seems to play a very important role. Different cultures express symptoms differently and have different expectations when meeting a doctor. When these factors are overlooked, the doctor-patient relationship suffers and so does the treatment adherence. Doctors tend to have an identical approach to intercultural patients and native patients and to evaluate their interview as very positive, even when the same doesn’t happen with the patients.

Although the difficulties regarding intercultural communication are widely known, most doctors fail adequate their interventions to the specific needs of their patients, not taking into consideration their different beliefs and expectations. This raises very important questions as patient dissatisfaction leads to failure to report symptoms and consequent misdiagnosis and non-compliance to the proposed treatment which ultimately results in a less efficient health care in these populations.

No significant relationships.

Previous research from our group showed that, after a single yoga class, Interoceptive Accuracy (IAc), tested through the Heartbeat Counting Task, improved in a group of Healthy Controls (HC), but not in a group of patients with Anorexia Nervosa (AN).

To evaluate three levels of interoception (accuracy, confidence (IC) and awareness (IAw)) before and after eight sessions of Yoga in a sample of patients with Eating Disorders (ED: AN, Bulimia Nervosa (BN) and Binge Eating Disorder (BED)).

15 patients with ED were included. Before the first yoga session (T0) and 72 hours after the last session (T1), participants underwent: (i) the Heartbeat Counting Task for the evaluation of IAc, IC and IAw; (ii) a psychometric assessment evaluating depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders symptomatology.

At T1, ED patients’ IAc appeared higher than at T0, but not IC and IAw. A trend towards significance (p = 0.055) emerged for the interaction effect between IAc and diagnosis, with BED patients having a higher increase of IAc at T1 than AN and BN patients. Significant correlations between IAc and Alexithymia, Anxiety and Depression emerged at T0, but were not maintained at T1.

After a program of eight Yoga sessions, IAc in ED patients (but not IC and IAw) increases, especially in BED patients. Moreover, the improvement of IAc following the yoga course seems to be unrelated to the course of depressive, anxious and alexithymic symptoms of ED patients.

Bipolar disorder (BD) has the highest suicide attempt rate among psychiatric disorders. Many factors are associated with the risk of suicide attempt in BD, but the relation between them has still not been explicitly stated.

This study aimed to examine the clinical variables characterizing patients with BD with prior suicide attempt (PSA).

This was a descriptive and analytical study, conducted over 3 months, involving 31 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. Quality of life (QOL) was assessed with the «36 item Short-Form Health Survey» (SF-36). Impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11).

The mean age was 47.25 years and the sex ratio was 1.6. Family history of suicide attempts was found in 25% of cases. Mean score of SF36 was 34 and high degree of impulsivity was noted in 62.5% of cases. The frequency of BD patients with PSA was 12.3% (N=8), with two of these (25%) having more than one PSA. Comorbid alcohol abuse (p=0.000), somatic illness (p=0.013), high degree of impulsivity (p=0.032), and impaired quality of live (p=0.003) were significantly more frequent in BD patients with PSA.

We found several clinical variables associated with PSA in BD patients. Even though these retrospective findings did not address causality, they could be clinically relevant to better understanding suicidal behavior in BD and adopting proper strategies to prevent suicide in higher risk patients.

The dark triad is composed by the personality traits Machiavellianism, narcissism and psychopathy (MNP). Their complexity can make them difficult to interrelate. Artificial intelligence (AI) could help in this endeavour.

To investigate whether AI could predict MNP from themselves.

Data from 210 questionnaires were analysed using an AI. The short Dark Triad questionnaire (SD3) was used to assess MNP. Two of the MNP scores were employed to predict the third one and the procedure was repeated for all of them alternatively. The AI was conservatively tuned to maximize the one-way random intraclass correlation coefficient (ICC) between predicted and real values. Pearson’s r was calculated too. The free and open source programming language R was used for all the analyses. Dataset source: Borráz-León, Javier I. (2020), “Dark triad, attractiveness, mate value, and sexual partners”, Mendeley Data, V1, doi: 10.17632/87vx6jfnrp.1

Machiavellianism, narcissism and psychopathy predictions obtained ICC of 0.593, 0.335, 0.505 and Pearson’s r of 0.608, 0.346, 0.548 respectively. The results were indicative of fair performance, mainly for Machiavellianism and psychopathy.

AI might be useful to predict MNP. This could be utile in many situations, such as dealing with missing data or deciding whether to formally test someone. Finally, the AI used in this study is freely available, allowing anyone to experiment.

No significant relationships.

Openness, conscientiousness, extroversion, agreeableness and neuroticism are dimensional personality traits known as the Big Five. Study attrition is a common but often hard to anticipate problem. Artificial intelligence (AI) could examine both fronts to mitigate the unpredictability of the latter.

To investigate whether AI could predict study attrition employing personality traits scores.

Data from 2,697 questionnaires were analysed using an AI. The short form of the International Personality Item Pool was used to assess the Big Five personality traits on the first of three planned waves. The personality traits scores were employed to predict the missing of at least one wave. Overall attrition was 17.6%. The AI was conservatively tuned to minimize the negative likelihood ratio when confronting predicted and real attrition. The free and open source programming language R was used for all the analyses. Dataset source: Hansson, Isabelle; Berg, Anne Ingeborg; Thorvaldsson, Valgeir (2018), “Can personality predict longitudinal study attrition? Evidence from a population-based sample of older adults”, Mendeley Data, V1, doi: 10.17632/g3jx8zt2t9.1

Predictions obtained a negative likelihood ratio of 0.333 and a negative predictive value of 0.933. The results were indicative of fair performance.

AI might be useful to predict study retention. Furthermore, the results of this study might indicate a moderate effect of the Big Five on the probability of study retention. Finally, the AI used in this study is freely available, allowing anyone to experiment.

No significant relationships.

The six-item Positive And Negative Syndrome Scale (PANSS-6) is short psychometric valid scale quantifying the severity of core schizophrenia symptoms. Using PANSS-6 to guide treatment decision-making requires that staff members’ ratings are valid and reliable.

The objective of the study was to evaluate whether such valid and reliable PANSS-6 ratings can be obtained through a video-based training program.

One-hundred-and-four staff members from Aarhus University Hospital - Psychiatry, Denmark participated in the training. Participants conducted baseline PANSS-6 ratings based on a video of a patient being interviewed using the Simplified Positive And Negative Symptoms interview (SNAPSI). Subsequently, a theoretical introduction video was displayed followed by five SNAPSI patient interviews. After each SNAPSI video, individual ratings were performed before a video providing the gold standard scores was displayed. The validity of ratings was estimated by calculating the proportion of participants not deviating from the gold standard scores with >2 points on individual items or >6 points on the PANSS-6 total score. Reliability was evaluated after each step in the training by means of Gwet’s Agreement Coefficient (Gwet).

By the end of the training, 72% of the participants rated within the acceptable deviations of the gold standard, ranging from 60% (nurses) to 91% (medical doctors/psychologists). The reliability improved (Gwet baseline vs. endpoint) for all PANSS-6 items, except for Blunted affect.

The majority of the staff members conducted valid PANSS-6 ratings after a brief standardized training program, supporting the implementation of PANSS-6 in clinical settings to facilitate measurement-based care.

Dr. Opler is a full-time employee of MedAvante-ProPhase Inc. Dr. Correll has been a consultant and/or advisor to or have received honoraria from: Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular T

Post-traumatic stress disorder (PTSD) is often a chronic condition, despite the existence of evidence-based treatment options. Psychotherapy is the designated first line treatment for PTSD, although high rates of psychiatric and medical comorbidity are observed among patients who have undergone treatment. The psychoactive properties of psychedelics may be of particular interest within a substance-assisted psychotherapy approach, offering new treatment opportunities for this debilitating disorder.

Review current evidence, therapeutic context, and possible mechanisms of action of different types of psychedelics in the treatment of PTSD.

Literature review using Medline database.

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with treatment-refractory PTSD. Based on a small number of studies, ketamine administration appears to result in temporary symptom relief and may, in combination with psychotherapy, lead to lasting reductions in PTSD symptoms. Although these have not yet been investigated in controlled studies, it is known that psilocybin and LSD induce psychoactive effects that could as well contribute to the psychotherapeutic treatment of PTSD.

The use of psychedelic compounds within a substance-assisted psychotherapy framework offers a novel method for pharmacotherapy-psychotherapy integration, although there is still much to learn from both a clinical and neurobiological perspective. It is necessary to generate more data regarding the safety and efficacy of psychedelics, in addition to research on cost-effectiveness, its use in mental health care infrastructure and also regarding the training of specialized therapists.

The difficulties in social interaction present in individuals with autism spectrum conditions may are related with the abnormal attentional processing of emotional information. Specifically, it has been hypothesized that the hypersensibility to threat shown by individuals with autism may explain an avoidance behaviour. However, this hypothesis is not supported by research and the underlying psychological mechanisms of social interaction in autism still unclear.

The aim of the present study was to examine attentional processing biases by administering a computer-based attentional task in a sample of 27 children with autism spectrum conditions and 25 typically developed participants (age 11-15 years).

The initial orienting of attention, the attention al engagement, and the attentional maintenance to different emotional scenes in competition (i.e. happy, neutral, threatening and sad) were measured by recording the eye movements during a 20 seconds free-viewing task.

The main findings were: i) children with autism spectrum conditions showed an initial orientating bias towards threatening stimuli; and ii) while typically developed children revealed an attentional engagement and attentional maintenance bias towards threatening stimuli, children with autism spectrum conditions did not.

The findings of the present study are consistent with the affective information processing theories and shed light on the underlying mechanisms of social disturbances in autism spectrum conditions.

No significant relationships.

Treatment-resistant schizophrenia (TRS) represents a major clinical issue, characterized by worse psychopathological outcome, a more disrupted neurobiological substrate and higher healthcare costs. Cognitive impairment is a core feature of schizophrenia, strongly associated with patients’ functional outcome. Different studies showed that TRS patients exhibit poorer neurocognitive performance, particularly on verbal domains. To date Cognitive Remediation Therapy (CRT) represents the best available tool for treating cognitive deficits in schizophrenia. However, CRT outcomes are highly heterogeneous and significant treatment predictors are still lacking.

To investigate possible differences of CRT outcome among patients with schizophrenia, stratified according to antipsychotic response (TRSs vs. first-line responders - FLRs).

150 patients with schizophrenia, (95 FLRs, 55 TRSs) were assessed for neurocognition with BACS and WCST at baseline and after CRT. General Linear Models (GLMs) were performed to investigate possible differences between groups on basal cognition and CRT outcome (Cohen’s d Effect Size).

At baseline, GLMs showed significant differences in Verbal Memory (F=4,66; p=0,03) and WCST–executive functions (F=5,59; p=0,02), both worse in TRS group. Effecr Sizes of CRT outcome resulted significantly different in domains of Verbal Memory (F=4,68; p=0,03) and WCST–executive functions (F=4,62; p=0,03), with greater improvements among TRS patients.

This is the first study to indicate treatment-resistance as a possible predictor of CRT outcome in schizophrenia. Moreover, we observed that CRT resulted able to fill the cognitive gap between treatment groups. Thus, these results further highlight the importance of early cognitive interventions in order to reduce the neuropsychological and functional burden associated with the disease, especially for TRS patients.

No significant relationships.

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.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by harmful levels of inattention, hyperactivity, and impulsivity and occurs in 2.5% of adults.

This project will evaluate young adults with ADHD in computerized tasks that assess different forms of attention and inhibition, correlating them with self-report scales and physiological measurements (EMG and fNIRS) to identify impairments in specific cognitive domains.

The study will be conducted with two groups: one with ADHD - GClin and one control - CG, with 50 participants between 18 and 28 years each. Initially, participants will perform CPT-3 and respond to ASRS to be allocated to the CG or GClin, with validation by a specialist physician. After that, they will do the computerized inhibition (Stroop / Stop) temporal and spatial attention (voluntary and automatic) tests. In this phase the data will be collected using electromyographic measurements and recording of brain activity in areas of the prefrontal and temporal cortices through fNIRS. After the tests they will complete the impulsivity scales (BIS-11 and UPPS). The analyzes will comprise: (1) ANOVA of the means of TRs and the accuracy of the computerized tests; (2) Correlation analysis of RT, accuracy and ASRS scores; and (3) The fNIRS analysis will use the oxyhemoglobin signal, which will be analyzed individually.

As expected results there will be differences between CG or GClin in relation to impulsiveness, number of errors and brain activation.

The integration of physiological measurements, scales and tests will ensure integrated understanding of attentional and inhibitory processes impaired in ADHD.

No significant relationships.

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.