Défigame is a training tool designed in collaboration with parents and specialists from the French Rare Diseases Network DéfiScience.

In this serious game, you take on the role of a general practitioner treating four young patients whose developmental trajectories raise questions. Interactively and with the help of concrete tools, you’ll learn about the recommendations for coordinating an appropriate course of prescription, care and support for a family, from the search for a diagnosis to early management of a Neurodevelopmental Disorder (NDD).

WHO IS DEFIGAME FOR?

1. – Any European doctor questioning the etiology of a neurodevelopmental disorder, prescribing genetic tests or wishing to update their knowledge in the field of NDD, particularly in relation to a rare disease.

2. – Any other healthcare professional concerned with etiological diagnosis or support for people with NDD and their families.

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Tuberous sclerosis complex (TSC) is a disorder that affects multiple systems and was first described in 1880. Its symptoms include seizures, intellectual disability, and adenoma sebaceum. TSC is caused by mutations in the TSC1 and TSC2 genes and is inherited in an autosomal dominant manner.

This report highlights a case of a patient with an unusual psychological presentation evaluated in a psychiatric hospital.

The patient presented with psychotic features and abnormal behavior. A physical examination showed neurocutaneous lesions. After assessment a diagnosis of Tuberous sclerosis complex was confirmed through MRI Brain and genetic testing. Some of his relatives also showed similar neuropsychiatric symptoms.

Tuberous sclerosis complex is diagnosed based on TSC Clinical Consensus Group guidelines of 2012. Our patient fulfilled 4 of the major criteria and genetic testing also yielded a pathogenic variant. A TAND checklist (TSC-Associated Neuropsychiatric Disorders) is used to guide clinicians on areas to prioritize when managing TSC patients.

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Given that psychiatry may be the first contact for TSC patients, especially in low-resource settings. Patients referred to psychiatry, therefore, need to be thoroughly examined to exclude neuropsychiatric disorders, and a multidisciplinary team approach is vital in investigating and managing these cases.

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One of the important tasks of modern education is the adaptation of children with autism spectrum disorders to the social space, which allows them to ensure their personal development and self-realization.

Study of the specifics of the socialization of children of preschool age with autism spectrum disorders.

The study involved 27 preschool children with autism spectrum disorders attending an educational institution for children with disabilities; 6 were girls and 21 were boys; 20 children with intact speech and 7 children with speech disorders. The following methods were used: “Map of manifestations of activity by A.M. Shchetinina, N.A. Abramova; “Map of observations of the manifestations of communicative abilities in preschool children” A.M. Shchetinina, M.A. Nikiforova; “Emotional faces” N.Y. Semago.

It was found that children with autism spectrum disorders have the greatest severity of such activity indicators as “is in a good mood” (1.67), “shows stubbornness” (1.56) and “shows great mobility” (1.56). Among the manifestations of communicative abilities in preschool children, the most developed parameter is: “sincere in his statements, in the manifestation of his feelings” (2,07). At the same time, the lowest expression of communication skills (0.96) in children with autism spectrum disorders is observed in terms of: “has organizational skills”, “the child seeks to understand the other, his thoughts, feelings”; “observant, sees and realizes the characteristics of other children and adults”. The least pronounced indicator is observed in the indicator of initiative; children do not show initiative in communication, have difficulty understanding and supporting the initiative of another child in an interaction situation. Children have a low level of operational communicative actions and skills: children are not expressive in communication, do not master verbal means of communication and are not able to maintain contact with communication partners.

The results obtained in the study confirm the need to develop and implement psychological and pedagogical programs aimed at developing social skills in preschool children with autism spectrum disorders. This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program.

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In Europe, associations between different types of nonparental care and internalizing and externalizing behaviors in children have not been adequately explored (Gialamas, A et al. J Epiemiol Community Health. 2015). Internalizing and externalizing symptoms in childhood can have lifetime repercussions, thus understanding their risk factors and the potentially protective role of family policies is highly relevant.

To explore the associations between different types of nonparental care prior to primary school and internalizing and externalizing behaviors across young adolescence.

Six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network (EUCCN) were included in the study. A two-stage individual participant data (IPD) meta-analysis on complete cases was performed. Linear regression models (one for each age group: 5-6 years, 7-9 years, 10-13 years) were applied in each cohort separately and then cohort-specific coefficients and standard errors were combined using random-effects (restricted estimate maximum likelihood (REMD) meta-analysis to attain overall effect estimates. Data were then stratified by socioeconomic position and sex.

There were 74 453 parent-offspring dyads to study children’s internalizing difficulties and 72 462 parent-offspring dyads to study children’s externalizing difficulties. Center-based care attendance was associated with lower levels of internalizing difficulties 5-6 years [-1.13 (95%CI:- 2.68, 0.42), p=0.15]; 7-9 years [-1.38 (95%CI:- 2.85, 0.10), p=0.07]; 10-13 years [-1.06 (95%CI:- 1.95, -0.17), p=0.02]. Children who attended other forms of nonparental care appeared to have higher levels of internalizing difficulties: 5-6 years [0.02 (95%CI:- 1.96, 2.01), p=0.98], 7-9 years [0.91 (95%CI:0.23, 1.58), p=0.009]; 10-13 years [0.52 (95%CI:- 0.23, 1.27), p=0.17]. Other forms of nonparental care (not including center-based care) had a positive association with externalizing symptoms : 5-6 years [2.45 (95%CI:0.35, 4.55), p=0.02]: 7-9 years [2.78 (95%CI: 0.60, 4.95), p=0.01];10-13 years [1.93 (95%CI:-0.45, 4.32), p=0.11]. We found some evidence of effect moderation by the child’s sex and socioeconomic position (SEP).

The results suggest that center-based care may protect children from developing internalizing behaviors, but other forms of nonparental care may put children at more risk of developing more internalizing and externalizing behaviors. Also, factors such as sex and SEP may interact with nonparental care in influencing externalizing behaviors.

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The COVID-19 pandemic prompted a transition from in-person to telehealth psychiatric treatment. There are no studies of partial hospital telehealth treatment for bipolar disorder.

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the effectiveness of partial hospital treatment of patients with bipolar depression treated virtually versus in-person.

Outcome was compared in 76 patients with bipolar depression who were treated virtually from April, 2020 to December, 2022 to 130 patients who were treated from May, 2017 to January 2020. The patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being.

In both the in-person and telehealth groups patients with bipolar depression were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning. Suicidal ideation was reduced in both groups. No patients attempted suicide. A large effect size of treatment was found in both treatment groups. The length of stay and the likelihood of staying in treatment until completion were significantly greater in the virtually treated patients.

Telehealth delivery of partial hospital level of care for patients with bipolar depression was as safe and effective as in-person treatment.

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The diagnosis and treatment of depression are complex due to its diverse forms. Recent focus in clinical practice has been on identifying markers for mono- and bipolar depression, as early diagnosis significantly impacts treatment.

To identify clinical characteristics of unipolar and bipolar depressive disorders and assess their correlation with aggression levels in patients.

We studied patients at the Mental Health Research Institute of Tomsk NRMC: ICD-10 codes: Bipolar Affective Disorder (BD) (n=28), Recurrent Depressive Disorder (RDD) (n=33). Patients with BD were older (49 (33; 52) years) than those RDD (40 (31; 51) years) (p=0.018). The current depressive episode duration was shorter for BD (3 (2; 7) months) compared to RDD (5 (2; 12) months) (p=0.018). Gender distribution was comparable (p=0.568). We measured clinical symptoms (depression, anxiety, anhedonia) using psychometric tools (HAM-D, HAM-A, SHAPS) at admission and after 3 weeks of therapy. Aggression was assessed with the Buss-Durkee Hostility Inventory (BDHI) at admission.

Patients with RDD demonstrated a higher severity of depressive symptoms upon admission (Table 1).Table 1.

Clinical Characteristics of Unipolar and Bipolar Depression Course

The severity of some aggressive patterns was higher in patients with bipolar disorder (Table 2).Table 2.

The severity of aggressiveness in unipolar and bipolar depression.

As a result of the study, no statistically significant correlations were found (p>0.05, Spearman’s test).

The conducted research did not yield convincing data that would allow us to make judgments about specific clinical patterns in the course of unipolar and bipolar depression. Thus, the problem of searching for unique biological markers of the courses of affective disorders remains relevant. Support by the Russian Science Foundation grant No. 23-75-00023.

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Alcohol and sedative substance use disorders are escalating global public health challenges. Lebanon has grappled with multiple crises, including economic, healthcare, and social issues.

This study aimed to assess the correlates of the alcohol and sedative substance use risk scores with sociodemographic and clinical factors, including sleep disorders, chronotype, anxiety, and depression.

A cross-sectional study was conducted among the Lebanese population using several validated scales to assess the risk of alcohol and sedative substance use, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype, sleep, and mood disturbances. Bivariate and multivariable analyses were then performed, taking the alcohol and sedative scores as dependent variables.

A total of 646 participants were included. Multivariate analysis revealed positive and significant correlations between higher ASSIST-alcohol scores and personal history of alcohol abuse (B=4.61), family history of prescription substance abuse (B=1.763), psychiatric disorders (B=2.898), and worse Insomnia Severity Index scores (Beta=0.14). Conversely, ASSIST-alcohol scores negatively correlated with weight (B= -0.39) and morning chronotype (B=-0.084). Positive correlations were identified between higher ASSIST-alcohol scores and personal history of illicit substance abuse (B=2.834), prescription substance abuse (B=2.252), sleep quality (B=0.130), and sleep severity (B=0.082), while negatively correlating with cigarette smoking (B=-0.038).

This study elucidates the role of several predisposing factors to alcohol and sedative use disorders in Lebanon, including history of substance abuse, psychiatric disorders, sleep disorders, and chronotype. These findings advocate, in particular, for the integration of sleep disorder assessment and management into addiction rehabilitation programs.

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Alcohol use and alcohol use disorder (AUD) is related to numerous somatic and psychiatric disorders resulting in a high contribution to global burden of disease and premature death. The need to identify and treat alcohol use disorder is high. Yet there is a large treatment gap. Too few people with AUD are recognized and are being offered treatment. In some countries well under 10 percent of those with a treatable AUD are ever offered treatment. Furthermore, there is a dearth of effective treatments and relapse rates remain high. This symposium will address some topics that may change this situation.

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Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to significant morbidity and especially to psychiatric disorders. Depression and anxiety are common symptoms in RA patients, and seem to influence disease activity, pain, and treatment response.

The aim of this study was to investigate the prevalence of depression and anxiety and their related factors in RA patients.

100 patients diagnosed with rheumatoid arthritis according to ACR1987 or ACR/EULAR criteria 2010 were investigated. Demographic, clinical and laboratorial data were obtained from hospitals records.

The RA severity Disease Activity was assessed by the Disease Activity Score (DAS 28). Physical function was assessed by the Health Assessment Questionnaire-Disability Index (HAQ).

The Hospital Anxiety and Depression Scale (HAD a/d) was used to evaluate the depression and anxiety symptoms. Patients with results greater than 11 are considered depressed or anxious.

The group studied included 87% of women and 13% of men. The median age was 55.2 years [27-83]. The median disease duration was 11.7± 8.9 years.

The majority of the patients were unemployed, they were housewives in 65% of the cases, retired in 6% and 2 % had taken sick leave.

The median ESR was 44 ± 31.6 mm, and the median of CRP level was 26 ± 35.3 mg/l. The median disease activity (DAS 28) was 4.6 ± 1.4. Forty-five % had moderate disease activity (3.2 ≤DAS 28 ≤ 5.1), and 27% of the sample had high disease activity (DAS 28 > 5.1). The mean of the HAQ was 1.1 [0-3].

The anxiety and depression questionnaire (HAD a/d) showed means of 10.6 for depression, and 10.25 for anxiety respectively. Depression was presented in 46 % of RA patients. Anxiety was presented in 48 %.

There was a correlation of HAD a/d with employment status (p<0.05), and functional disability (HAQ) (p<0.001).

There was no significant association of anxiety and depression scales with RA disease activity.

Chronic inflammation impairs the physiological responses to stress, resulting in depression, anxiety which leads to a worse long-term outcome in RA.

Physical disability and social factors, are predictive of psychiatric disorders in RA. This fact must be taken into account when evaluating therapeutic response.

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Schizophrenia is a complex psychiatric disorder that changes the patient’s life by influencing how they think, behave, express emotions, percept reality and their interpersonal relationships.

The aim of this study was to evaluate sociodemographic and therapeutic factors that act as risk and protective factors in the clinical outcomes of patients diagnosed with schizophrenia.

This was an observational retrospective study including patients diagnosed with schizophrenia, treated at the “Xhavit Gjata” Psychiatric Hospital, Tirane, Albania, who were discharged between May 1- October 30, 2022. The follow-up period was six months. Data on further hospitalizations during the follow-up were obtained from the Department of Statistics, QSUT, and confirmed by family members for hospitalizations in other psychiatric hospitals in the country. Univariate and multivariate analyses were conducted to identify potential factors associated with emergency room stays, length of stay, and time until the next admission.

A total of 158 patients were included in the study, 63 women and 95 men (p=0.03). The average age of the patients was 42.9 years, with women averaging 45.3 years and men 40.6 years (p=0.01). 43.7% of them had elementary education. The average age of disorder onset was 24.7 years. Haloperidol was the ambulatory therapy used in 54.3% of patients, while atypical antipsychotics were used in 75.1% of patients. The most commonly used atypical antipsychotic was Risperidone in 34.1% of patients, followed by Olanzapine in 17% of cases. Depo antipsychotics were used in 35.1% of patients. Clozapine was administered to 29.3% of patients, where 12.8% for the first time. 54.2% of patients starting Clozapine for the first time had three or more admissions. Clozapine was more frequently used in men, showing a significant difference from women (p=0.05). In 44.7% of cases, monotherapy was prescribed. The average hospital stay was 21.9 days, ranging from 2-68 days. Living with a family member, male gender, and being “married” helped reduce the length of hospital stay. In the 6-month follow-up period, 31.4% were re-hospitalized. Significant factors affecting the reduction of time spent outside the hospital until the next hospitalization were social problems, the number of previous hospitalizations, civil status “not married,” living arrangements, negative symptoms, and alcohol use (nearly significant). Protective factors included Clozapine, which reduced the prevalence of hospitalization by 57% compared to patients not taking it. Additionally, the use of Clozapine and Haloperidol increased the time spent outside the hospital.

Social and family support, positive compliance, and antipsychotic therapy such as Clozapine serve as protective factors for patients diagnosed with schizophrenia.

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Dimensional diagnosis of personality disorders has as its main criterion the assessment of the level of functionality. And in patients with other diagnostic categories, there is a difference in the degree of functioning, as well as a difference in the course and prognosis of the disorder. The reason for such a different course may be the existence of a certain degree of personality dysfunctionality.

The aim of the study is to determine the prevalence of personality disorder in patients with neurotic disorder and predominantly anxiety symptomatology.

A descriptive cross-sectional study was made to determine personality disorder in patients with neurotic disorder (F40-F48, excluding those where the disorder is related to stress F43) and predominantly anxiety symptomatology. The HAM-A scale was used to assess anxiety, and the LPFS-BF-2.0 was used to assess the level of personality functioning. The results were processed by descriptive statistical analysis.

The study included 25 individuals (N 25, 64% women), aged between 18 and 65 years (mean age 44.16, SD 13.20) with a diagnosed neurotic disorder. All subjects had elevated anxiety symptomatology, mean HAM-A score was 35.36 (SD 7.76). The assessment of the level of personality functioning with the LPFS-BF-2.0 gave the following results: 20% of people have a personality difficulty, 12% have a mild personality disorder, 32% have a moderate and 4% have a severe personality disorder.

According to the obtained results, 68% of people with a neurotic disorder and a high degree of anxiety have a certain degree of personality dysfunction. The prevalence of personality disorder in individuals with neurotic disorder is high (48%). These results lead to the conclusion that people with pronounced anxiety often have a disruption in personality. In people with a high level of anxiety, an assessment should be made for the level of functioning of the person, as well as for the existence of a personality disorder, and the treatment should be adjusted according to the results obtained. In addition to the treatment of the emerging symptoms, the personality dysfunctions should also be treated.

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Personality Disorders (PD) - specifically Borderline Personality Disorder (BPD), and certain Eating Disorders (ED) share common clinical features. One of these features is impulsivity, studied individually in each diagnostic group, and scarcely used to encompass specific profiles of these patients.

Understanding the common clinical variables of this patient population would facilitate therapeutic efforts and enable greater precision regarding the prognosis of these patients.

This study aims to study impulsivity in a group collectively formed by BPD and ED, compared to a control group, in contrast to the individualized study approach typically conducted in the literature.

A cross-sectional descriptive study is conducted to assess impulsivity as a common diagnostic variable in a group of PD and ED in comparison with a healthy control group. The sample was collected between 2016 and 2019 at the Hospital Clínico San Carlos, totaling 108 subjects.

A statistically significant difference is observed (p<0.005 in all scales) in total impulsivity, cognitive impulsivity, motor impulsivity, and unplanned impulsivity in the cases group comprising patients diagnosed with PD and ED, compared to the control group from the general population.

Impulsivity is closely related to the concept of borderline personality disorder. This analysis also includes eating disorders, with the difference from the control group still statistically significant.

The presence of common clinical variables in these groups (PD and ED) may have clinical and therapeutic implications that differ from those pursued thus far. This allows moving away from the categorical model and understanding these disorders from a more enriching and advanced dimensional perspective.”

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Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication and behaviour. Timely identification of ASD is pivotal for effective intervention. However, significant gaps persist in our understanding of early signs and biomarkers, particularly among infants with older siblings already diagnosed with ASD. Furthermore, factors during the perinatal and neonatal period remain underexplored.

This systematic review aims to investigate early autism markers within this specific cohort and assess their potential impact on intervention strategies.

A thorough search of electronic databases, including PubMed, PsycINFO, and Scopus, was conducted, initially identifying 161 relevant papers related to ASD and resilience published from 2013 to 2023. After excluding studies focused on environmental determinants of resilience in ASD, 75 papers remained. We concentrated on studies examining early identification of autism, especially in infants with older siblings with ASD, biomarker discovery, or predictive factors within this unique population. The search strategy employed a diverse set of keywords encompassing ASD, genetics, neurobiology, and the perinatal period to ensure comprehensive coverage of pertinent studies. Quality assessment of each study followed standardized criteria, and data synthesis utilized a thematic analysis approach.

Our systematic exploration revealed a spectrum of early markers associated with ASD in high-risk infants, spanning behavioural, neurodevelopmental, genetic, and perinatal domains. Recognizing these early indicators offers promise for timely and potent intervention strategies, potentially refining long-term outcomes for children at risk of ASD.

The synthesis of existing research in this systematic review underscores the significance of studying early markers within high-risk populations. Early intervention, guided by these markers, holds the potential to enhance the quality of life for at-risk children with ASD and their families. This review contributes to our understanding of the early identification of autism and emphasizes the imperative need for continued research in this critical area.

This systematic review sheds light on the current state of research on early signs and biomarkers of autism in infants with older siblings diagnosed with ASD. The findings carry significant implications for the development of targeted interventions that can be implemented at an earlier stage of development. Future research should further investigate these markers and their potential role in guiding early and effective intervention strategies.

Keywords: Autism Spectrum Disorder, early signs, biomarkers, infants, older siblings, early intervention, high-risk population.

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Psychological Flexibility (PF) is a complex and extensively studied concept within the Acceptance and Commitment Therapy (ACT) framework. PF denotes one’s capacity to effectively navigate psychological distress and challenges while aligning one’s actions with deeply held values. Given its association with mental health and overall well-being, it is crucial to develop assessment tools able to capture the various facets of flexible behaviour and design strategies for its enhancement.

To adapt the Portuguese version of the Multidimensional Psychological Flexibility Inventory (MPFI-24; Grégoire et al., 2020) for the adolescent population.

The study involved 269 adolescents aged 12 to 18 years old. Participants completed a set of self-report instruments, including the MPFI24-A, the Depression, Anxiety, and Stress Scales-21 (DASS-21), Mental Health Continuum - Short Form (MHC-SF), and the PsyFlex-A, which also assesses PF. A subsample also completed the MPFI24-A four weeks later to assess test-retest reliability.

Two models, specifically the six-factor correlated model and the bifactor model, emerged as presenting the best fit when analysing data separately for the Flexibility and Inflexibility indices. The MPFI24-A demonstrated good reliability for both overall scores (α = .90 and α = .85, respectively) and good test-retest reliability. The PF index showed significant positive associations with PsyFlex-A scores, perceived mental health, and a moderate negative association with depression and anxiety. Conversely, the Psychological Inflexibility (PI) index presented the opposite association pattern with these variables and showed no significant correlation with PF as measured by the PsyFlex-A. The two indices of the MPFI24-A demonstrated a weak positive correlation. Significant differences between boys and girls were found for the PF index, with boys showing higher scores. No significant differences were found between boys and girls concerning the PI index.

Results suggest that the MPFI24-A is a reliable and valid instrument for assessing adolescents’ psychological flexibility and inflexibility competencies. Although further clarification of the MPFI24-A factor structure and the utility of different factors is warranted, the findings support its overall applicability.

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Covid-19 does not only have repercussions on the physical level, representing a new way of life, both individually and in society. The pandemic results in invisible consequences for the population’s mental health.

This study aimed to explore the consequences of Covid-19 on mental health in Portugal with a view to understanding and promoting the well-being and happiness of the Portuguese.

The study included 105 young people and adults, aged between 18 and 59 years (M= 21.81, SD= 5.34), with 43.3% males and 52.7% females. A sociodemographic questionnaire was applied to all participants, as well as the Échelle de Mesure des Manifestations du Bien-Être Psychologique (ÈMMBEP; Massé et al., 1998 - Portuguese translation by Monteiro, Tavares & Pereira, 2012) which translates into a response scale 5-point Likert type, with five subscales, including happiness. In addition, a semistructured interview with data collection instruments was administered.

The results obtained demonstrate the negative impact of Covid-19 on the level of well-being, regardless of the participant’s gender or age.

The data presented point to the need to sensitize individuals to the risk of the pandemic in terms of mental health, thus increasing society’s awareness of the psychological effects of this new global disease. Therefore, coping mechanisms are essential to promote well-being and successfully overcome the pandemic.

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Alcohol Use Disorder (AUD) and depression are among the most prevalent mental health concerns on a global scale. The co-occurrence of alcohol use disorder (AUD) and depression has been well acknowledged, leading to intricate issues in diagnosis, treatment, and prognosis.

This study aims to analyse the complex correlation between AUD (Alcohol Use Disorder) and depression, with a specific emphasis on examining common underlying causes, reciprocal influences, and potential implications for clinical treatment.

An exhaustive review of literature was undertaken, emphasizing epidemiological studies, neurobiological research, and the efficacy of combined treatment modalities. The review also delved into the potential role of genetics, environmental factors, and psychosocial stressors in co-occurrence.

The available evidence indicates that there exists a reciprocal relationship between depression and alcohol use disorder (AUD), wherein each disease can serve as a triggering factor for the other. This interplay between depression and AUD forms a detrimental cycle that intensifies the severity of both conditions. The comorbidity of various disorders may be attributed to the presence of shared neurochemical pathways, with a particular emphasis on the serotonin system. Furthermore, the co-occurrence of both illnesses frequently leads to heightened symptom severity, reduced treatment efficacy, and a higher risk of suicide.

The complex relationship between alcohol use disorder (AUD) and depression underscores the need for a comprehensive and integrated therapy strategy. The effective management of this comorbidity necessitates the implementation of multidisciplinary collaboration, patient education, and early intervention.

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Pharmacogenomic testing in psychiatry is an emerging area with the potential clinical application of guiding medication choice and dosing. However, this has not been adopted widely due to a combination of barriers that include a varying evidence base, clinician and patient familiarity and acceptance, uncertainty about cost-effectiveness, and regulatory requirements.

This review aims to examine recent updates in this field and provide a contextualised summary and recommendations for Asian populations. The recommendations serve to guide healthcare professionals in the utility of pharmacogenomic testing in psychiatric practice.

A review of recent literature about current evidence and guidelines surrounding pharmacogenomics in psychiatric practice was carried out with particular attention paid to literature evaluating Asian populations. Literature was reviewed for the different classes of psychotropics with supplementary information about Asian populations included where available. Existing evidence about combinatorial pharmacogenomic panels was also reviewed.

In line with the available body of evidence, we recommend that pharmacogenomic testing should be employed as an augmenting tool to guide medication selection and dosing in certain clinical situations, and not as part of standard or routine clinical practice. Pharmacogenomic testing should also be mainly limited to the known drug-gene pairs such as the anti-depressants and CYP2C19 or CYP2D6. Clinicians should also be aware that many of the gene-drug associations have not been evaluated for clinical outcomes. Combinatorial pharmacogenomic panels are not presently recommended as there is limited and inconclusive available evidence on clinical outcomes.

Pharmacogenomic testing in psychiatry is not recommended as standard or routine clinical practice. Exceptions may include concerns about drug concentrations (due to metaboliser status) or potential severe adverse drug reactions/ Pharmacogenomic testing should be mainly limited to the known drug-gene pairs such as the anti-depressants and CYP2C19 or CYP2D6.

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The perinatal period poses heightened vulnerability to bipolar affective episodes. Lithium serves as first line in the management of bipolar disorder, demonstrating efficacy in stabilizing mood episodes and preventing relapses. Therefore, it also a recommended treatment during the pregnancy period. However, its use presents potential risks for both the mother and the developing fetus. Given the prevalence of bipolar disorder in reproductive-age women, it is crucial to investigate the risks associated with lithium use during pregnancy, along with its subsequent obstetric and neonatal complications.

This report outlines a case of severe polyhydramnios in a 42-year-old primigravida patient, under long-term lithium and antipsychotic treatment. Additionally, a systematic search for similar case reports was conducted to provide an overview of the existing literature.

The patient’s medical history and perinatal medical care are documented in this case report. A systematic literature search on MEDLINE (PubMed) was conducted using Boolean operators.

The patient was diagnosed with bipolar disorder type I and had a history of lithium treatment for over 20 years, supplemented later with antipsychotics. During her pregnancy, she experienced a polyuria-polydipsia syndrome and a severe polyhydramnios. She also suffered renal impairment. Together, it is indicative of a nephrogenic diabetes insipidus (NDI), likely induced by prolonged lithium treatment. As the pregnancy progressed, she experienced premature rupture of membranes at 34 weeks and 5 days. The newborn needed medical support and was admitted to the neonatal unit, without further complications.

Systematic research showed three published case reports describing nephrogenic diabetes insipidus (NDI) and polyhydramnios associated to lithium treatment.

Chronic administration of lithium may contribute to the development of resistance to antidiuretic hormone (ADH), leading to polyuria-polydipsia syndrome and potentially severe obstetric complications. The co-administration of lithium and antipsychotics may exacerbate these effects. Further research is needed to elucidate their combined clinical impacts.

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The integration of simulated patients and actors (SPs) into psychiatric education has long been recognized as a transformative pedagogical approach, yielding substantial benefits to healthcare students and professionals.

The aim of this investigation was to evaluate the SP methodology and to refine it for future implementation in psychiatric education at the University of Pécs, Hungary.

To investigate the feasibility and utility of incorporating SPs into psychiatric education, we conducted a preliminary study involving participants from the German Program in the University of Pécs, Hungary. This group consisted of 16 medical students in their 5th year of study. The study design involved participants forming groups of three, engaging in psychiatric interview with SPs. After the interview, SPs provided feedback from patient’s perspective, articulating their emotional responses. These sessions lasted 60 to 90 minutes.

Study participants expressed a range of apprehensive feelings, including inadequacy, the desire for correct performance, and acknowledgment of the emotional challenges involved. Another recurring issue was the students’ initial confidence contrasting with their later realization of subpar performance. A subset of students voiced concerns related to performance anxiety, particularly in light of being observed. Nevertheless, by the culmination of the course, students spontaneously recognized and valued the enriching nature of the experience. Pre-existing skills have been confirmed authentically by the feedback of the SP.

Psychiatry, given its intricate and sensitive nature, necessitates a secure and controlled learning environment. SPs precisely provide this environment, facilitating the exploration of a broad spectrum of psychiatric disorders, emotional states, and patient interactions, all while upholding patient safety and confidentiality. Additionally, this methodology promotes the development of essential skills, including empathetic communication, the cultivation of therapeutic relationships. Moreover, the adaptability of SPs enables the creation of diverse scenarios reflecting real-world practice. Our preliminary findings and student feedback have provided a promising foundation for the design of a forthcoming pilot program in the next academic year. The integration of SPs into psychiatric education presents a dynamic, immersive, and highly effective approach, capable of markedly enhancing the quality of training.

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Healthcare workers are at increased risk of Burnout due to the stressful demands of their job.

The aim of this study was to assess the prevalence and the related factors of burnout in healthcare workers at the Sahloul University Hospital, Tunisia

Data were collected from a cross sectional study using a questionnaire exploring socio-demographic and professional data, lifestyle habits and pathological history. Burnout was assessed using the French version of the Maslash Burnout Inventory (MBI).

Our study included 135 healthcare workers. The average age was 41.7 ± 9.15 years. 81.5% of the sample was female. Nurses accounted for 60% of staff. More than half (51.1%) worked shifts, with night work in 32.6%. A pathological history was noted in 17.8% of healthcare workers, and a history of work-related accidents in 40.7%. The prevalence of burnout in our study population was 42.6%, with a high emotional exhaustion score in 47.4%, a high depersonalization score in 23.7% and a low personal accomplishment score in 73.3%. Burnout was significantly associated with alcoholism (p=0.016), shift work (p=0.037) and the presence of stress at work (p=0.048).

The prevalence of burnout was high in our study population, hence the importance of setting up a burnout prevention strategy in hospitals.

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