The mental health care system in Ukraine is centralized and largely focuses on capacity for inpatient psychiatric treatment with 90% of funding allocated to inpatient psychiatric care at hospitals, much higher than countries who already have more decentralized care. Community-based mental health care options, including mental health provided at the primary health care level are currently limited or absent in the mental health system. Psychosocial support, as well as self-care and mental health promotion are also insufficiently developed. Covid-19 pandemic is serious challenge for health care system, especially for consultation liaison psychiatry.

Mental health monitoring and psychological support in University Clinic of Kharkiv National Medical University, Ukraine during COVID-19 epidemic.

HADS, SCL-90, HDRS, HARS

During COVID-19 epidemic, implemented combination of off-line and eye-to-eye methods of mental health monitoring and psychological counselling for patients and medical staff in University clinic of Kharkiv National Medical University. Model of early detection and management of mental disorders based on multidisciplinary teamwork principles, сombination of off-line and eye-to-eye methods of screening, monitoring and psychological counselling for patients and medical staff. The online format proved beneficial because many patients of University clinic have trust issues and preferred not to deal with psychiatric services locally when it comes to mental health problems and it was accessible on epidemic conditions. An important part of the outreach work by the project was to destigmatize mental health problems.

Combined model (off-line and eye-to-eye services) of mental health care is preferred compare to traditional approach in modern conditions.

Benzodiazepines (BZDs) are psychotropic drugs that are predominantly prescribed in psychiatry and that can have serious side effects. BZDs prescribing is well codified by several guidelines, yet the epidemiological data on their prescribing remains alarming.

Our study aimed to evaluate the general modalities of BZDs prescribing in psychiatry in Tunisia.

This is a descriptive cross-sectional study conducted through a Google-forms self-administered questionnaire, intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. The purpose of treatment with BZDs was explained to the patient at its initiation in 98.2% of cases and the risks associated with it in 87.7% of cases. Special precautions were taken in elderly patients (96.5%), at risk of respiratory failure (94.7%), and in cases of personality disorders (80.7%). Only three quarters of physicians took precautions before prescribing BZDs to a pregnant woman (77.9%). In cases of rebellious or refractory symptoms, 14.4% of the participants stated that they combine two BZDs. Before reproducing/repeating a BZD prescription, 18.4% of the participants indicated that they did not systematically and regularly assess its necessity.

The severity of the side effects associated with BZDs, especially those of tolerance and dependence, are at the origin of strict prescribing rules, dictated by several guidelines. According to the results of our study and to the literature data, the prescribing practices of these molecules remain nonetheless in many cases non-compliant with the recommendations.

More than in other conditions, fear is associated with infectious diseases, and is directly associated with its transmission rate, morbidity and mortality. High levels of fear can affect the individual’s ability to think clearly, react proportionately and make rational decisions in the context of COVID-19. Recently, Mertens et al. (2020) developed the Fear of Covid-19 Scale (FCV-19S) to measure this construct.

To analyse the psychometric properties of the FCV-19S Portuguese version, namely construct validity, internal consistency and convergent validity.

A community sample of 234 adults (75.6% women; mean age= 29.53±12.51; range:16-71) completed an on-line survey with the Portuguese versions of the FCV-19S, the Covid-19 Perceived Risk Scale (CPRS) and the Depression Anxiety Stress Scale (DASS-21).The total sample was randomly divided in two sub-samples: sample A (n=117) was used to perform an exploratory factor analysis/EFA; sample B (n=117) to make a confirmatory factor analysis/CFA.

EFA resulted in one component. CFA revealed that the unifactorial model presented acceptable fit indexes (X2/df=3.291; CFI=.977; GFI=.932; TLI=.919; p[RMSEA≤.01]=.091). Cronbach alpha was α=.855. The total score significantly correlated with Covid-19 Perceived Risk (r=.529, p<.01) and with anxiety from DASS-21 (r=.132, p<.05).

This study provides preliminary evidence for the validity and reliability of the Portuguese version of FCV-19S, which will be used in an ongoing research project on the relationship between fear of Covid-19, personality, cognitive processes and adherence to public health measures to contain the pandemic.

Project-based leisure would be conducive to enabling people to project themselves into the future and to move away from the eating disorder, which involves a constant preoccupation with food and one’s body. According to this, travel could be a leisure opportunity that invites to challenge oneself by going out of one’s comfort zone. Coping is a real dilemma for people living with eating disorders and the motivations of a tourism experience could refer to motivation to leave one’s current environment. Consequently, travel would be helpful in reducing the individual’s focus on the illness in a different environment.

The aim of this study is to investigate the use of travel to help people living with eating disorders to live in the present moment and to “let go”. Then, to understand what are the components of travel that are essential for an optimal leisure experience.

This multiple case study uses mixed data from a sample of five participants with an ED and living in France. They were invited to live a tourism experience in Québec for one week. This data collection was before, during and after the trip, using the Experience Sampling Method with a mobile app pocket and guided interviews to assess sensations and emotions in the ecological context of patients.

The trip allowed a letting go and developed a greater ability to live in the present moment. It was a significantly positive moment in the lives of the participants.

Travel associate with digital diary are an innovative approach for ED.

No significant relationships.

The patterns and clinical correlates related to antidepressant drugs (ADs) prescription for BD remain poorly understood.

This study aimed to compare socio-demographic and clinical features of BD patients treated vs. not treated with ADs.

The sample consists of 287 currently euthymic bipolar patients. Among participants (mean age=51.9±15.02), 157 (40.1%) were receiving ADs.

Based on the main findings, subjects given ADs were older and more frequently retired than those without receiving ADs. Moreover, patients given ADs were more likely to have had a first major depressive episode and present with psychotic symptoms at illness onset. Lifetime substance abuse/dependence history was less frequently reported among patients given ADs. Furthermore, ADs given patients have a higher number of affective episodes, and longer duration of their illness. Additionally, subjects treated with ADs reported higher hopelessness levels, and lower positive reinterpretations than those who were not treated with ADs. Factors associated with ADs-use by multivariate modeling were reduced personal autonomy (OR=.070), and hopelessness levels (OR=1.391).

These results may help clinicians to better understand the clinical correlates of BD subtypes and improve their differential management. Additional studies are needed to replicate these findings, and facilitate the differential trajectories of BD patients based on socio-demographic/clinical profile.

No significant relationships.

Burning mouth syndrome (BMS) is a chronic condition characterized by a burning sensation of the oral cavity and is often associated with taste disturbances and xerostomia.

To study the psychotropics as part of the possible etiologies of this síndrome.

A 67-year-old woman complained of burning pain in the tongue and oral mucosa, taste disorder, and sensory impairment. Slight improvement after treatment with Gabapentine 300mg (1-0-0). The pain is constant, with sharp characteristics. Improves when eating, the ability to taste is preserved. Subsequently, treatment with 2% lidocaine rinse (3-4 times / day) is tested, with temporary pain relief. Lorazepam 1mg (1-0-0), without improvement. Patient in follow-up by the Neuropsychiatry consultation for 3 years, due to major depressive disorder in treatment with Quetiapine 100mg (0-0-1).

In the first consultation the treatment is modified, adding Duloxetine 60 mg (1-0-0) and Alprazolam 0.5mg (1 / 2-1 / 2.0), and reducing the dose of Quetiapine to 75 mg and then 50mg. In the subsequent consultation, one month later, she only manages to reduce the neuroleptic dose by half, without noticing clinical improvement. After two months, she has completely removed the quetiapine, and completely disappearing the burning mouth sensation, improving his affective clinic in the same way.

There are a large number of drugs that produce xerostomia, in intimate relationship with the burning mouth. Among those we can find antihistamines, neuroleptics, antihypertensives, and benzodiazepines. In many cases, correcting or eliminating these etiologic agents does not improve or stop the initial symptoms, but sometimes, it does.

While prison inmates have an increased risk of mental illness, psychiatric services are often less accessible and insufficient for this group. A low level of awareness or a fear of becoming stigmatised could also influence the help-seeking behaviour of some inmates.

To study the knowledge and beliefs regarding mental health and mental illness as well as the help-seeking behaviour of inmates in Norwegian prisons.

We describe a study of help-seeking behaviour and mental health literacy of prisoners. This is a qualitiative study involving in-depth interviews with inmates in prisons in North Norway.

Recruitment and data collection is ongoing. Central topics in the interviews are inmates’ associations regarding positive mental health and how they can enhance their own well-being while in prison, and how other external factors can contribute to increased well-being. Furthermore, the inmates are asked about their attitudes, beliefs, and knowledge regarding mental illness, and what they think might be factors that can contribute to the development of mental illness. Moreover, we cover topics such as the inmates’ beliefs regarding the treatment of mental illness, strategies for handling such health problems, and sources of information regarding mental health and mental illness.

The study will increase knowledge about how prisoners think about mental health and mental illness and the help-seeking behaviours of prison inmates. In a next step, this understanding can be utilized in improving information about well-being, mental illness, and psychiatric services to prisoners.

The effects of bullying can be both physical and emotional, and they can last for many years. Children that experience verbal and physical bullying are at a greater risk of developing depression later on in life, compared with children who did not.

This study aims to look into the relationship between bullying, depressive symptomatology and suicidal thoughts in adolescents of high schools in Lushnje.

Three questionaires (the Beck Depression Inventory; the Bully/victim Behavior / Victim Behavior Questionnaire by Olweus; the Suicide Questionnaire) were circulated online and were completed by 400 adolescents from 2 high schools in a small city in Albania between September-November 2019. Data has been analysed using the Software Package for Social Sciences for Windows v. 22.0 (SPSS Inc. Chicago, IL).

We found significant positive correlation between bullying (victimization) and the level of depression (r (n = 400) =. 300, p≤.05), and significant positive correlation of bullying (cause) with level of depression (r (n = 400) =. 160, p≤.05) but lower than in victimes. The victims of bullying have higher levels of depression and vice versa. We found higher rate of depression in female adolescents with the average (M = 14.710, ds = 11.263) compared to boys with the average (M = 9.609, ds = 10.723). There is an important positive correlation of suicidal ideation with the level of depression (r (n = 400) =. 616, p≤.05).

Being either a bully or a victim of bullying seems to increase the chances of being affected by depression and suicidal thoughts

The term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”.

To report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches.

Description of a clinical case based on medical records and a brief review on Munchausen syndrome.

A 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance.

Munchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs.

No significant relationships.

Lithium has been the mainstay therapy for bipolar disorder (BD) for decades, but there is little consensus regarding its possible effects on kidney function and the rate of change in estimated glomerular flow rate (eGFR) over time.

To describe patients with BD regarding their renal function and their sociodemographic and clinical characteristics potentially related to eGFR.

This is a cross-sectional study with an initial sample of 95 patients with BD. Multiple linear regression analysis was applied to investigate the association of lithium serum levels and their duration of treatment with eGFR, independent of confounding factors. We excluded patients without data regarding any of the variables from the final model.

In the multivariable analysis, the model was composed of eight variables (Figure 1). The mean duration of treatment was 10 years (Figure 2). Serum lithium level was associated with low levels of eGFR (β = -18.06 [-34.70 - -1.42], p = 0.03); among the other variables, only age remained associated with it (β = -0.72 (-1.10 - -0.33), p = <0.01).

Note: *P<0.05

We replicated the correlation between serum lithium levels and eGFR. Our results contradict the claim that duration of treatment with lithium correlates with lower levels of eGFR, while suggesting serum lithium level could be a possible early marker of lithium nephrotoxicity.

No significant relationships.

The coronavirus pandemic continues to impact all aspects of the daily life of the public worldwide. With decreased economic activity, the sports industry faces significant challenges of maintaining athletes’ mental health while seeking the best strategies for eventual return to sports competition.

We aim to evaluate COVID-19 related factors impacting on the mental health of athletes and provide appropriate management steps.

We examined MeSH terms “Athletes,” “Sports,” “COVID-19,” in the context of “Mental Health,” “Mental Disorders,” “Behavioral Medicine,” “Risk Factors.” We identified seven studies for the qualitative synthesis per the PRISMA guidelines, searching Medline, PubMed, PubMed Central, and PsychInfo databases until July 2020.

The pandemic has negatively impacted athletes’ mental wellbeing due to decreased physical activities, limited resources, fears, and delays or cancellations of the sporting event. The negative psychological impact on athletes is due to self-isolation measures leading to worries of less preparedness for the lockdown, reduced physical activity, loss of competitive advantages, fear of being infected, social isolation, and loneliness. During this period, athletes struggled to maintain baseline routine and engaged in excessive calorie intake, eating low-quality food, substance use, and sleep disruption. It has caused anxiety, depression, PTSD, and mood disorder at varying degrees of severity in athletes.

Limited resources during a pandemic have caused adverse mental impact on athletes. We recommend improving physical activity through confined or virtual training programs with colleagues. A collaborative approach is required by clinicians, psychologists, coaches, sports organizations, government bodies to limit the pandemic’s mental health impact.

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.

In their professional work, mental health professionals are continually working with individuals in distress, who may express a wish to end their lives.

To understand the perspectives of mental health professionals towards a person’s right to die.

A mixed-method technique was used: Stage 1 involved a validated online questionnaire sent to all professionals working within the public mental health services in Malta. Stage 2 consisted of a multidisciplinary discussion between six professionals asked to hypothetically manage a terminally ill patient requesting physician-assisted suicide. Thematic analysis was subsequently applied.

The majority of mental health professionals disagreed with allowing a person to commit suicide, even in situations of crippling debt, overwhelming despair and family dishonour. Terminal illness elicited a varied response (Figure 1)

Older professionals and spiritual beliefs negatively impacted acceptability of suicide (Figure 2).

The discussion revealed that professionals would assess individuals requesting to end their lives, with the aim of treating any mental illness and determining mental capacity. Figure 3 highlights factors explored during the assessment. Greatest emphasis is ultimately placed on individual autonomy.

Mental health professionals consider autonomy and self-determination as imperative in evaluating a person’s right to die. Professionals agreed that, after a comprehensive psychiatric assessment and within a regulatory legal framework, they would not impede a person with terminal illness to request physician-assisted suicide, provided that one is acting autonomously. The majority would however conscientiously object to actively assisting the terminal patient in ending one’s life, since this is deemed contradictory to their professional vow of non-maleficence.

Coronavirus disease (COVID-19) has been associated with the development mental and behavioural symptoms and psychiatric disorders. This association is stronger in severe cases of the disease and in those needing inpatient treatment, particularly in intensive care units (ICU).

To determine the incidence of psychiatric disorders in a Portuguese hospital-based sample of patients with COVID-19. To describe relevant demographic and clinical data.

We reviewed all COVID-19 inpatients assessed by liaison psychiatry at our hospital between April and September 2020. Patients admitted due to a psychiatric disorder were excluded from the analysis. We reviewed medical records and retrieved relevant clinical data. ICD-10 was used to classify diagnoses.

We identified 36 cases with a mean age of 62.64 years-old (SD 19.23). The most common disorder was delirium, which occurred in 41.7% of our sample (15 patients), followed by adjustment disorder (22.2%, n=8), and depressive episode (16.7%, n=8). Most patients had no personal (61.1%, n=22) nor family (75%, n=27) history of a psychiatric disorder. Mean length of admission was 36.89 days (SD 28.91). Seventeen cases (47.22%) had at least one risk factor for severe COVID-19 disease and 14 (38.89%) were admitted at some point to the ICU.

In our sample, delirium was the main cause for mental or behavioural symptoms in COVID-19 patients. However, we observed a wide array of presentations in our center. A larger sample would allow to better characterize this often-overlooked symptoms and identify risk factors to psychiatric syndromes.

No significant relationships.

Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.

To emphasize the importance of defining predictors of response to ECT in OCD.

The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.

Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.

Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.

The importance of clinical diagnosis of autism spectrum disorders (ASD) in childhood is due to the timely detection of ASD and the appropriate early start of patient care, depending on the form of ASD. The experience of multidisciplinary collaboration between medical psychologists and clinicians in child psychiatric practice allows us to more accurately determine the depth and severity of autistic manifestations, determine the dynamics of child development, and provide personalized effective care.

Develop diagnostic, clinical and psychological approaches to the diagnosis of ASD.

Clinical-psychopathological, clinical-dynamic, clinical-catamnestic, and psychological methods were used. 254 patients aged 4-17 years (average – 7.3 years) with different forms of ASD were examined.

From the clinical and pathopsychological positions, profiles of six main forms of ASD are identified. Each of the selected profiles corresponds to a specific type of cognitive dysontogenezis. A distorted view of cognitive dysontogenezis in Asperger’s syndrome (F84. 5) and childhood autism dysontogenetic (F84.0). Distorted or deficient types of cognitive dysontogenezis in children’s psychosis (F84. 02). Deficient type of cognitive dysontogenezis in Kanner syndrome (F84. 01). Defecating type of cognitive dysontogenezis in atypical autism syndromal (F84. 11), deficient and regressive-defecating types of cognitive dysontogenezis in atypical child psychosis (F84.12).

A three-dimensional model is obtained that allows the most accurate diagnosis of various forms of ASD and the development of personalized routes for patient care and rehabilitation, taking into account the type of cognitive dysontogenezis and based on the zone of the child’s immediate development.

Dr. De Picker reports grants from University Psychiatric Centre Duffel, Johnson & Johnson Belgium and Boehringer-Ingelheim, outside the submitted work.

Many children with autism spectrum disorder (ASD) experience high levels of anxiety. However, inconsistencies between parent and child reports may complicate the assessment of anxiety in this population.

The aim of this study is to investigate discrepancies between parent and self-reported anxiety among children with high functioning ASD.

Children aged between 8 and16 years with high functioning ASD, followed in the outpatient unite of child psychiatry at the University Hospital of Monastir, Tunisia and their parents, were invited to complete the Arabic version of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD). The ASC-ASD is a 24-item questionnaire with six sub-scales, designed specifically for the assessment of anxiety symptomatology in children with ASD. A total score of ≥ 20 indicate significant levels of anxiety.

We recruited 66 children and their parents. The mean age was 10 years old. High rates of anxiety were found: children’s reports revealed that 70% of them present anxiety and 60 % were coated anxious by parent’s reports. Performance Anxiety, Uncertainty and Social Anxiety were the most frequent types of anxiety reported by both parents and children. We did not find a significant difference between the parents and children rating of anxiety except for the apprehension subscale.

This is one of the first studies to compare between parent and self-reported anxiety among children with ASD using an autism-specific measure of anxiety. No discrepancies have been found between parents and children report, however others studies are needed to investigate discrepancies in children with severe ASD.

The intravenous (IV) is one of the main parenteral routes for drug administration. Rapid onset of action, precise titration, patient-specific dosing and bypass of liver metabolism are a few of its advantages, while hypersensitivity reactions, adverse effects, infection risk and a higher overall cost some of its most debated downsides. Unlike other areas of Medicine, IV has been significantly under-utilized in Psychiatry.

This systematic review analyzed the evidence for effectiveness and safety behind the use of IV medication used for the management of acute disturbance.

APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible studies. Studies were included if they used IV medication to treat acute disturbance, in English language, had participants aged >18. The quality of the included studies was assessed using the National Institutes of Health quality checklist.

17 studies were deemed eligible. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly between each study. Findings showed strong evidence for efficacy and safety of dexmedetomidine, droperidol, midazolam, and olanzapine. These medications displayed a short time to sedation, reduction in agitation levels, or large percentage of patients adequately sedated with a low number of adverse events. Results did not provide enough evidence for the use of IV ketamine, haloperidol, diazepam, lorazepam, and promethazine.

This review supports dexmedetomidine, droperidol, midazolam, and olanzapine as safe and efficacious options for managing acute disturbance via the intravenous route, particularly in special clinical settings where trained staff, optimal monitoring, resuscitation equipment and ventilators are all at hand.

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.