Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the development of persistent and changing motor and phonic tics over time. The presence of at least two motor tics and one vocal tic that have persisted for at least a period of 1 year is required, and which developed before the age of 18. The most commonly used pharmacological treatment are antipsychotics, with a preference for atypical antipsychotics such as aripiprazole or risperidone. Clonidine and guanfacine have shown effectiveness in suppressing tics, and although generally less effective than antipsychotics, some authors are considering them as first-line treatments. The treatment is also influenced by any comorbidities the patient may present.

To enumerate in a clinical case the pharmacological alternatives for TS, which vary according to the patient’s comorbidities and the intensity of the tic symptoms.

Case study. Anamnesis of the patient and their family.

A 12-year-old boy presenting simple motor and vocal tics for over a year. At the same time that a valuation is requested by child psychiatry, the mother also requests follow-up by neuropediatrics. Other causes are ruled out, an EEG is performed, and a TS diagnosis is made. The initial treatment was low-dose aripiprazole with partial effectiveness. After 3 months, he presents an exacerbation of the tics, interfering with his social and academic life, making it impossible to attend classes. The mother takes him to emergency services, and he is admitted to pediatrics. During the stay in pediatrics, he is diagnosed with Attention Deficit Hyperactivity Disorder, in addition to confirming the TS diagnosis. Extended-release methylphenidate is initiated (neuropediatrics). After starting methylphenidate, the patient’s tics worsen, also presenting insomnia and hyporexia. Due to the diagnosis of ADHD, school failure, and affective symptoms (hypothymia), atomoxetine is initiated. The tics become constant and incapacitating. As the dose of aripiprazole is increased, the child presents extrapyramidal effects. As a therapeutic alternative, guanfacine is initiated, progressively discontinuing aripiprazole. Currently, the child is stable from motor and vocal tics, allowing him to lead a normalized life.

Although guanfacine is not as effective in reducing tics as antipsychotics, since the latter produce more side effects, it is justifiable to use it. This drug is capable of enhancing the therapeutic effect and reducing the adverse effects that antipsychotics could produce. Guanfacine may be a good alternative as a first line in the treatment of Tourette Syndrome with or without attention deficit disorder and hyperactivity .

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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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According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), post concussive syndrome (PCS) is given a diagnosis of either major or mild neurocognitive disorder (NCD) due to traumatic brain injury TBI. However Persistent post-concussion symptoms (PPCS) are more complex, and typically involve multidisciplinary assessment and management. The symptoms are varied, non-specific and the therapeutic process is defiant for psychiatrist.

To investigate the semiology of persistent post-concussion syndrome (PPCS) and the therapeutic challenges it poses.

A literature review was made on Pubmed, Google Scholar and Cochrane library using keywords: “post-concussive syndrome”,”psychiatric disorder”, “depression”,”post-traumatic stress disorder”,”treatment”, “physiopathology”.

The physiopathology of persistent PCS is controversy.The Symptoms are due to the Concept of “Symptom Generators” which results from the alterations in neurophysiology and neuropathology secondary to the injury, and pre- or post-injury psychological factors physiological concussion. The Global cerebral metabolic disturbance, the autonomic nervous system dysfunction and the cerebral blood flow dysregulation induce biochemical cascade,excitotoxic reaction and immunotoxicity.

Clinical diagnoses associated with PPCS are:Major depressive disorder,Post traumatic stress disorder,Anxiety disorder,Substance abuse disorder,Psychotic disorder and Antisocial personality disorder. For the non pharmacological management: A systematically early information and a graded physical exercise in addition to other treatment are essential.

Antidepressant, benzodiazepine and mood-stabilizer are the most recommended treatments for psychiatric symptoms. Atypical neuroleptics are indicated in delirant disorder, behavior disorder and antisocial personality disorder.Some studies suggest the methylphenidate and biperiden to treat several cognitive impairment and severe behavior disorder.

(PPCS) is far from being a subjective complaint by patients. It is a complex clinical entity that groups symptoms that overlap with other psychiatric diagnoses, such as depression, post-traumatic stress disorder, and mood disorders. Early neuropsychiatric assessment and personalized pharmacological and psychotherapeutic treatment are essential factors in the prognosis of the disease.

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Switzerland is a country in which the liberal tradition is cultivated and every citizen’s free decision is honoured. Associations such as EXIT or Dignitas, which advocate the right to self-determined death, were formed here early on. They see themselves as completing the Age of Enlightenment, where the end result is an individually self-determined death. The Swiss federal government is therefore reluctant to define criminal offences. However, it is regulated that active euthanasia is prohibited. The organisations mentioned are also not allowed to act for their own benefit.

Meanwhile, the number of assisted suicides is higher than the number of suicides. The extent to which the one phenomenon is related to the other is open to debate.

The topic is controversial among the general public and the medical profession. Nevertheless, the Swiss Academy of Medical Science has published guidelines on dealing with dying and death, which also deal with physician-assisted suicide.

Various associations, including the umbrella organisation for suicide prevention in Switzerland, Ipsilon, are in favour of special protection for vulnerable groups. Some of them also recommend that civil law provisions be made for the process of assisted suicide.

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In Ontario, Canada, patients may be admitted to the hospital involuntarily if they are deemed to be suffering from symptoms of a mental disorder that may result in imminent serious bodily harm to themselves or others, or that may cause serious physical impairment to themselves (e.g., inability to keep themselves safe and warm in the winter). This measure can be life-saving. However, in addition to ethical and human rights considerations, resorting to coercive admissions may be an indication that those who are suffering from mental illness are not able to access or receive timely and appropriate intervention. While recent studies have suggested that the rate of involuntary hospital admission may be increasing, data on social determinants of involuntary hospital admissions are limited.

We examined social factors associated with involuntary admissions using a Canadian provincial database.

Binary logistic regression models were conducted to examine the associations between social factors (low income, indigeneity, rurality, housing type) and involuntary admissions, controlling for age, sex, and psychiatric diagnoses. Data from March 2019 to March 2021 was extracted from the Ontario Mental Health Reporting System admission dataset, comprising of a sample of 9,848 patients admitted to eight psychiatric hospitals in Ontario. Odds ratios and 95% confidence intervals are reported.

In 2021, the proportion of involuntary patients increased significantly by 6.8 percentage points to 55.7% compared to the previous year (48.9%). Indigenous status (First Nations, Metis, Inuit) [1.75 (1.38-2.21) **], living in rural areas [2.78 (2.48-3.12)], living in assisted residence [1.41 (1.21-1.64) **], homelessness [1.63 (1.38-1.91) **], male sex [1.21 (1.10-1.33) **] and younger age [0.99 (0.98-0.99) **] were associated with involuntary admissions, while income was not a significant factor. Compared to a diagnosis of a psychotic disorder, substance use disorders [0.11 (0.10-0.13) **] and mood and anxiety disorders [0.32 (0.29-0.36) **] showed decreased odds of involuntary admission, while neurocognitive disorders increased the odds of involuntary admission [3.86 (2.91-5.11) **].

Consistent with other findings, involuntary psychiatric hospital admissions in ON, Canada, have increased recently, which may in part be related to the pandemic. Rurality, indigenous status, and unstable housing have been found to be associated with involuntary admissions. The study findings support the need for better preventive and intervention strategies to serve vulnerable psychiatric patients, including addressing the social determinants of health such as housing, and increasing access to culturally competent and safe community-based mental health supports and services.

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Schizophrenia is a major mental disorder that affects approximately 1% of the population worldwide. Social cognition impairments and negative symptoms such as blunted affect or emotional withdrawal strongly contribute to the psychosocial functioning deficits and long-term disability in schizophrenia. The state-like and trait-like components of social cognition are impaired in schizophrenia

Treatment effects of conventional approaches with antipsychotics or psychosocial interventions are limited when it comes to reducing negative and cognitive symptoms in schizophrenia. While there is emerging clinical evidence that new, augmented protocols based on theta-burst stimulation can increase rTMS efficacy dramatically in depression, data on similar augmented therapies are very limited in schizophrenia. The different patterns of network impairments in subjects may underlie that some but not all patients responded to given stimulation locations.

Therefore, we propose an augmented theta-burst stimulation protocol in schizophrenia by stimulating both locations connected to negative symptoms, namely the vermis of the cerebellum and the left Dorsolateral Prefrontal Cortex (DLPFC). Ninety subjects with schizophrenia presenting negative symptoms and aging between 18-50 years will be randomized to active and sham stimulation in a 1:1 ratio. The TBS parameters we adopted follow the standard TBS protocols, with 3-pulse 50-Hz bursts given every 200 ms (at 5 Hz) and an intensity of 100% active motor threshold. We plan to deliver 1800 stimuli to the vermis and 1800 stimuli to the left DLPFC daily in two 9.5-minute blocks for four weeks.

The primary endpoint is the change in negative symptom severity measured by the Positive and Negative Syndrome Scale (PANSS). Secondary efficacy endpoints are the change in cognitive flexibility measured by the Wisconsin Card Sorting Test and the change in social cognition assessed by the ‘Reading the Mind in the Eyes’, facial emotion recognition, and the ‘Faux pas’ tests. The safety outcome is the number serious adverse events.

In conlucion the aim of our study is to proove the safety and efficacy of theta burst stimulation for treating negativ sympotoms of schizophrenia.

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Nowadays, following the increasing digital technologies, the cyber aspect of violence is becoming more common (Willard, Journal of Adolescent Health 2007; 41) At this point, we can think that cyber violence victimization, environmental factors such as childhood traumas, exposure to violence, and moreover psychological and biological factors play a role (Fan et al., Front. Psychol 2921;12)

Our aim was to conduct a study to determine the prevalence of cyber violence victimization among university students and to examine whether this prevalence would be related to negative childhood traumas.

We reached university students in many cities of Turkey through an online survey between 01 January 2023 and 31 March 2023. A total of 600 students participated. In our survey, we used the Turkish forms of the Childhood Adverse Experiences Scale and the Cyber Victimization Scale, for which sociodemographic data, validity and reliability studies have been completed in Turkish.

University students from 8 different provinces participated in our study. According to the results of our study, it was evaluated that university students who had negative childhood experiences were more likely to become cyber victims. We are exposed to many traumas from the moment we are born, and this exposure is the relationship with the mother, then relatives, friends, teachers, colleagues, etc. It continues throughout life through relationships. There is a moderate relationship between victimization of blocking and damaging behaviors in cyberspace and negative childhood relationships (r = 0.304), a low level relationship between victimization of sexual bullying in cyberspace and negative childhood relationships (r = 0.289), and victimization of spreading rumors in cyberspace. A low degree of correlation (r = 0.277) was found between and negative childhood relationships. (p <0.05)

The widespread use of technology today facilitates the digitalization of violence, as in every field. As a result, cyber violence, like other types of violence, may be associated with childhood traumas, and this can be prevented by being exposed to the least trauma during childhood, and moreover, if we look from Bronfenbrenner’s perspective, if the next generation grows up in a suitable ecological environment, cyber violence victimization can be prevented to that extent.

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Excoriation disorder (ExD) is a pathology recognized by DSM-5, and it is considered a part of the obsessive-compulsive spectrum. ExD is associated with a high rate of psychiatric comorbidity (e.g., depression, ADHD, substance use disorders, etc.).

The main objective of this review was to explore the available evidence to support the diagnosis and treatment of skin picking in elderly population.

A literature review of the available sources reporting on ExD in elderly patients, realized by searching three electronic databases (PubMed, Cochrane, Clarivate/Web of Science) but also the grey literature. All papers published between January 1990 and July 2023, including the terms “excoriation disorder”, “compulsive skin picking”, “dermatillomania” and “elderly” or “old-age patients” were reviewed.

The information about ExD was extracted almost exclusively from reports on elderly patients with neurocognitive disorders. Tactile hallucinations, delusions of contamination, social isolation and focusing on own bodily sensations, and organic causes- dehydration, allergies, renal insufficiency, hepatic and pancreatic diseases, as well as toxic causes- e.g., adverse events of certain drugs should be investigated in elderly patients exhibiting signs of ExD. A differential diagnosis is very important in this population in order to find the most adequate treatment. Behavioral treatments, serotonergic antidepressants, and glutamatergic modulators have been explored in patients with ExD, although specific trials for elderly patients with this disorder are still lacking. However, case reports support the utility of several serotonergic antidepressants in the elderly.

ExD is a less explored disorder in the elderly, where an extensive differential diagnosis and screening for somatic/psychiatric comorbidities are needed. Trials exploring the potential treatments for ExD in old-age patients are also required for evidence-based case management.

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Various psychotherapeutic approaches could be used for the assessment, formulation, and treatment of the same case. It is of great importance to include cultural evaluation and empathetic reformulation in psychotherapy applications. This case presentation illustrates a female patient in her thirties who was consulted at the psychiatric outpatient clinic with depressive symptomatology, which presented after a psychosocially stressful life event. Following a detailed clinical evaluation, psychotherapeutic treatment was planned with the diagnosis of major depressive disorder. In this case presentation and subsequent discussion, the case-specific advantages, along with standard and differing aspects of different psychotherapeutic methods and treatments, will be evaluated.

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Cardiovascular diseases (CVD) were the cause of 40% of all deaths in Slovenia in 2016, and are the seventh most common cause of visits to the general practitioner. The prevalence of depression in people with CVD is high and is a strong predictor of mortality and additional cardiac events. In patients with coronary artery disease, depressive symptoms contribute to a lower quality of life and to physical limitations.

The purpose of this study was to translate the Cardiac Depression Scale into Slovenian (S-CDS) and to assess its psychometric properties on Slovenian patients with heart disease.

After obtaining the consent from the original authors, the Cardiac depression scale was translated by three bilingual Slovenian native speakers with medical knowledge. Afterwards, they worked jointly to reach consensus on one version, which was then back-translated (Slovenian to English) by two independent English translators unfamiliar with the original version. The original authors approved the final draft. The S-CDS was then applied to a total of 272 patients with heart disease that underwent elective coronary angiography. At the same time the Spielberger Stait Anxiety Inventory (STAI-S) and the Center for Epidemiologic Studies Depression Scale-20 (CES-D) were used. An exploratory and confirmatory factor analysis, internal consistency, test–retest reliability and concurrent validity were performed.

The total scale had Cronbach’s alpha 0.92 and test–retest reliability 0.71. Six factors were confirmed by the exploratory factor analysis, accounting for 60.88% of total variance. A two and one factor solution indicated by the confirmatory factor analysis had acceptable goodness-of-fit measures. A one factor solution was kept, considering a high correlation between the two factors and the theoretical background in previous studies. A moderate to strong correlations were confirmed by concurrent validation against the CES-D and the STAI-S.

The S-CDS with 25 questions is a reliable and valid instrument for measuring depressive symptoms in Slovenian patients with heart disease.

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In Hungary, the understanding and diagnosis of adult attention-deficit/hyperactivity disorder (aADHD) are influenced by a blend of international epidemiological data and the standardized criteria established in DSM-5. The diagnostic protocols at our aADHD Outpatient Clinic at Semmelweis University have been carefully adjusted and validated to align with the practical application of empirical evidence and the extensive clinical expertise of professionals. The current diagnostic protocol encompasses the use of diagnostic interviews (symptoms identification based on DSM criteria; SCID-5-PD; M.I.N.I.-PLUS-5.0), the Conners’ Adult ADHD Rating Scales–Self Report questionnaire (CAARS), heteroanamnesis with parents, a comprehensive neuropsychological instruments battery (including the Rey Auditory Verbal Learning Test, Stroop Test, Conners-CPT3, Trail Making Test) and WAIS-IV Intelligence Scale.

A valid and appropriate diagnosis plays a crucial social role by legitimizing individuals’ attention/health issues, confirming their concerns, and addressing cultural and moral expectations. The primary objective of this work is to refine the diagnostic methodology by extensive review of the international literature and the analysis of our own data.

With the aim of aggregating and analyzing the collected data based on examinations of the Hungarian adult population, our assessment methods are employed to acquire detailed information regarding ADHD prevalence, symptoms, and the related neuropsychological profiles.

While various diagnostic approaches generally demonstrated good alignment, in some cases, significant discrepancies between neuropsychological assessment and the rest of our tools were observed, indicating a number of instances of false positives or false negatives. Especially the relevance of Rey Auditory Verbal Learning Test and Trail Making Test are questionable.

The results highlight the necessity for more refined diagnostic criteria and a meticulous selection of neuropsychological techniques to enhance consistency between various approaches, ultimately enabling a more robust diagnostic accuracy.

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The spectrum of neuropsychiatric adverse effects of corticosteroids ranges from unspecific symptoms to structured psychotic or affective episodes. We present the case of a 30-year-old woman admitted to our hospital due to behavioral alterations, coinciding with the initiation of treatment with corticosteroid boluses as part of a chemotherapy regimen for gastric adenocarcinoma. She had a previous diagnose of Addison’s disease, undergoing treatment with supplemental corticosteroids.

1. 1) To describe the clinical particularities of this case, focusing on the psychopathological aspects and their correlation with the corticoid treatment.

2. 2) To review the available literature regarding the clinical characteristics and management of corticosteroid-induced psychosis, with special interest in patients with adrenal insufficiency that require long term steroid supplementation.

A review of the patient’s clinical history and complementary tests were carried out. Likewise, we reviewed the available literature in relation to the clinical presentation of corticosteroid-induced psychosis and its pharmacological management.

The patient was admitted to our hospital due to acute behavioural alterations, which temporally coincided with the 4th cycle of FOLFOX chemotherapy and corticosteroid boluses. She presented with incoherent speech, with non sequitur answers and glossolalia, as well as dysphoric affect and purposeless behavior. She presented a favorable clinical course after the initiation of treatment with antipsychotics and temporary suspension of corticosteroid treatment.

Manic symptoms are the most common presentation of “corticosteroid-induced psychosis”, with the key characteristic being the temporal association with the corticosteroids administration. Although the discontinuation of steroids generally results in a sudden decrease in symptoms, additional treatment with antipsychotics such as haloperidol or olanzapine might be required for a symptomatic control. In patients with adrenal insufficiency, long-term treatment with lithium or anti-seizure treatments are effective strategies in relapse prevention when a higer steroid dose is required.

• - Corticosteroid-induced psychosis is a well described clinical phenomenon, that usually presents with manic symptoms rather than psychotic experiences.

• - Progressive discontinuation of corticosteroid treatment usually results in complete cessation of symptoms, but additional psychopharmacological treatment might be required, especially in patients with adrenal insufficiency undergoing long-term corticosteroid treatment.

• - This case outlines the psychopathological richness in the presentation of corticosteroid-induced psychosis, and illustrates the challenges in the pharmacological management in patients with adrenal insufficiency.

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Introduction: Research indicates that 2-8% of students exhibit ADHD symptoms, a condition impacting personal, social, and academic functionality (Kwon et al., 2018). A significant proportion encounter educational and socio-emotional challenges, often leading to academic disruptions; indeed, 11-21% of such students defer enrollment for two consecutive years (DuPaul et al., 2021). Studies have highlighted pronounced issues related to academic performance within this demographic (Henning et al., 2022). These findings emphasize the critical need for innovative interventions and a deeper understanding of ADHD’s impact on young adults in academic contexts.

To investigate challenges and evaluate supportive counseling approaches for students with Attention Deficit Hyperactivity Disorder (ADHD)”

This study utilized a qualitative approach, employing semi-structured interviews to understand the experiences and perspectives of university students with ADHD from across the country. The diverse sample comprised students from various academic disciplines and levels. Data were collected, ensuring participants’ comfort, and were analyzed using content analysis method, revealing insightful themes and patterns about ADHD’s impact in students’ quality of life and academic issues. The findings aim to contribute to a better understanding of ADHD

The results of the study highlight the significant academic and organisational difficulties faced by participants with ADHD. Many struggled intensely to maintain concentration in class, with distractions causing significant attentional lapses and increased anxiety. Procrastination was a recurring problem, leading to last-minute submissions and increased stress. Forgetting to complete academic tasks, such as course registration, had a cumulative negative impact on participants’ academic journeys. These findings highlight the complex challenges faced by people with ADHD in educational settings, and the need for comprehensive interventions. Addressing these multifaceted issues goes beyond academic accommodations and requires inclusive learning environments, counselling, peer support, and specialised faculty training to create a supportive ecosystem conducive to the success of individuals with ADHD.

This study highlights the multifaceted challenges, notably in concentration and task management, faced by individuals, presumably with ADHD, within academic settings. The reported struggles emphasize the urgent need for specialized interventions and support structures, focused on fostering concentration, effective task management, and administrative diligence. The insights provided are instrumental, guiding future research and intervention strategies aimed at addressing the identified needs and fostering an inclusive and supportive learning environment.

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Borderline Personality Disorder (BPD) and Attention-Deficit/Hyperactivity Disorder (ADHD), relatively common psychiatric pathologies (5% and 1-2% respectively), share several characteristics, specially impulsivity and emotional dysregulation. With different therapeutic approaches, it is therefore important to distinguish the entities for a correct approach to the patient. Clinical evidence has also demonstrated high comorbidity between two entities, and therefore this recognition is of equal relevance.

Analyze the clinical evidence, in order to better understand the dynamics between the two pathologies as comorbid or differential diagnosis, for an appropriate approach to the patient.

Authors used the Medline database through the Pubmed search engine, with the keywords: “PBP”, “PHDA”.

These two pathologies share impulsive and spontaneous actions with poor thinking about the consequences; nonetheless, ADHD individuals tend to show this impulsivity by being more impatiente when they have to wait, talking over other people, interrupting others; on the contrary, in BPD impulsivity can be showed more as self-harm behaviors.

As for the emotional dysregulation, that both entities share, in the comorbid case it is known that it is the most severe form. This characteristic is part of the central characteristics of BPD where these individuals experience intense and unstable emotions. They have difficulty regulating their emotions which can lead to rapid changes in mood, and they report feelings of emotional emptiness and difficulty in establishing stable relationships. As for ADHD individuals, despite present, it’s not a core symptom, as they have more control over their emotions, and have more adaptative cognitive strategies.

Attention deficit can be a core symptom of a subtype of ADHD and has not yet been reported in patients with PBP, except in comorbid situations. According to studies, 30-60% of patients with PBP report and score on attention deficit scales. Truth is both entities have intelectual disfunctionalities.

Results of genetic studies are very inconsistent, however epigenetic research and reseach focusing on hypothetized vulnerability genes or sites have been promising.

A complete clinical history is particularly important in these cases and sometimes difficult, as so, clinicians should be aware to prevent misdiagnosis and provide the best care for both disorders and the comorbidity. Given that treatment differs between both pathologies, psychotherapy in BPD, and the multimodal approach in ADHD, it is imperative to distinguish the two entities. In comorbid cases, a combination of the two therapies has demonstrated effectiveness but much more studies are needed.

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The COVID-19 pandemic caused an unprecedented major health crisis. Current data suggest that psychiatric sequelae may persist for a long time in survivors after infection.

The objectives of our study were to determine the frequency of anxiety, depression, sleep disorders, and posttraumatic stress disorder in patients after hospitalization for COVID-19 infection, and to investigate factors associated with their occurrence as well as to identify coping behaviors in these patients.

This was a descriptive cross-sectional study conducted at Ibn Jazzar Kairouan Hospital between September and December 2021 among patients who consulted three months after their hospitalizations for COVID-19 infection. The assessment of the different psychiatric disorders was performed using the validated Arabic versions of the Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist for DSM-5 and the Pittsburgh Sleep Quality Index. Coping behaviors were studied using the Brief-COPE scale.

Our work included 104 patients. The median age was 55.5 years [IQR:47-64]. The gender ratio M/F was 1.12. Anxiety and depressive symptoms were found in 26.9% and 25% of cases, respectively. The frequency of post-traumatic stress disorder was 22.1% and that of sleep disorders was 41.3%. Problem-solving strategies were the most widely adopted, followed by emotion-focused strategies. Younger age, female gender, persistence of a physical symptom, impairment of daily activity, and stigma were factors independently associated with psychological distress. No association was found between the intensive care unit stay and psychiatric disorders. Problem-focused and emotion-focused coping were negatively correlated with the different psychological outcomes studied.

Psychological distress in COVID-19 survivors persists beyond the acute phase and results from an intricacy of several factors. This highlights the importance of regular psychiatric follow-up after hospitalization in order to identify and treat, as early as possible, psychiatric disorders.

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Dissociative Identity Disorder (DID) is the presence of two or more distinct personality states within an individual. It is a rare dissociative disorder where usually self-non-integration arises as a response to significant stress. As is the case for many other psychiatric disorders, the diagnosis and management of DID is highly dependent on cultural variables and contexts.

To present a case of DID in Palestine in which the diagnosis was dependent on noticing minor changes in the patient’s dialect at different times. To highlight the importance of understanding each patient’s environment, values, and culture when assessing DID to avoid under- or over-diagnoses.

A case report in which we present a case of a 17-year-old Palestinian girl who suffered from three months of general fatigue, restlessness, poor coordination, and peripheral numbness. She was seen by several doctors who excluded organic causes and several spiritual healers without benefit. This caused severe deterioration of social and academic functioning. The family noticed a change in her articulation and memory issues, so they presented her to a psychiatrist. Data was collected by interviewing the patient and her family weekly for a month. The psychiatrist noted that the patient has subtle differences in accent, and directed the family to record any change in tone of voice or articulation. The patient was found to have three different accents on top of her native one, representing a total of four personalities with no memory integrity among them. She was started on Escitalopram (gradually increased) and Alprazolam (gradually decreased).

The psychiatrist detected the theme of being “stuck” throughout the personalities, each in its own way, according to the context of their roots. It was revealed that the patient is engaged to a man she doesn’t approve of and has “no way out” due to the social and familial significance of this relationship. Family counseling and trauma-informed psychoeducation were done, where the patient’s choice was reaffirmed. This led to significant improvement in terms of mood, identity integration, and social functioning with complete resolution of split personalities in just short of one-and-a-half months.

This case report asserts the importance of cultural understanding and sensitivity when assessing psychiatric patients. Symptoms, triggers, psychotherapy, and psychoeducation have a universal baseline, yet are highly culturally-dependent. Through this case study, we emphasize the importance of translating universal criteria into context-specific practices.

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Major depressive disorder (MDD) is a tremendous global disease burden and the leading cause of disability worldwide. Unfortunately, individuals diagnosed with MDD typically experience a delayed response to traditional antidepressants and many do not adequately respond to pharmacotherapy, even after multiple trials. The critical need for novel antidepressant treatments has led to a recent resurgence in the clinical application of psychedelics, and intravenous ketamine, which has been investigated as a rapid-acting treatment for treatment resistant depression (TRD) as well acute suicidal ideation and behavior. However, variations in the type and quality of experimental design as well as a range of treatment outcomes in clinical trials of ketamine make interpretation of this large body of literature challenging.

This umbrella review aims to advance our understanding of the effectiveness of intravenous ketamine as a pharmacotherapy for TRD by providing a systematic, quantitative, large-scale synthesis of the empirical literature.

We performed a comprehensive PubMed search for peer-reviewed meta-analyses of primary studies of intravenous ketamine used in the treatment of TRD. Meta-analysis and primary studies were then screened by two independent coding teams according to pre-established inclusion criteria as well as PRISMA and METRICS guidelines. We then employed metaumbrella, a statistical package developed in R, to perform effect size calculations and conversions as well as statistical tests.

In a large-scale analysis of 1,182 participants across 51 primary studies, repeated-dose administration of intravenous ketamine demonstrated statistically significant effects (p<0.05) compared to placebo-controlled as well as other experimental conditions in patients with TRD, as measured by standardized clinician-administered and self-report depression symptom severity scales.

This study provides large-scale, quantitative support for the effectiveness of intravenous, repeated-dose ketamine as a therapy for TRD and a report of the relative effectiveness of several treatment parameters across a large and rapidly growing literature. Future investigations should use similar analytic tools to examine evidence-stratified conditions and the comparative effectiveness of other routes of administration and treatment schedules as well as the moderating influence of other clinical and demographic variables on the effectiveness of ketamine on TRD and suicidal ideation and behavior.

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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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Several research already proved the role of certain immunological factors (neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratio, and C-reactive protein (CRP)) in the background of suicidal behaviour.

The aim of this research was to study the association between routinely measurable low-grade inflammation parameters and suicidal behaviour among patients in the acute psychiatric care setting.

The study population included psychiatric in-patients (N=100) consecutively treated with depressive disorders and/or suicidal behaviour in a University Clinic between December 1, 2020 and December 31, 2021. Three different patient-groups were generated based on their suicidal behaviour: suicide attempters (N=55) including recent attempters(N=36) and past attempters (N=19) and non-suicidal patients (N=45), who never had a suicide attempt. Basic socio-demographic data, the severity of depression and immunological parameters (white blood cell count: lymphocytes, monocytes, neutrophil, eosinophil, basophil granulocytes; thrombocytes; C-reactive protein) were recorded.Descriptive analyses and multivariate regression model were performed with RStudio version 4.2.3.

CRP was significantly higher (2.00 vs. 1.00; p=0.007) in suicidal patients (N=55), however other immunological parameters did not differ significantly between the suicidal and the non-suicidal groups (NLR: 2.02 vs. 2.19; MLR: 0.22 vs. 0.11; PLR: 118 vs. 130). NLR and MLR showed significantly higher values (NLR: 2.83 vs. 1.93, p=0.021; MLR: 0.28 vs. 0.11, p=0.01) for those who currently attempted suicide (N=36) compared to the patients with no or past suicide attempt (N=64). In the regression analysis, the NLR and MLR showed significantly higher values in current suicide attempters even when gender, age, suicidal risk and severity of depression were included in the model. However, no significant differences were found when comparing current and past suicide attempters with the non-suicidal patients.

Despite the small number of cases in the samples, our results confirmed the association of certain immunological parameters (NLR, MLR) and acute suicidal behaviour. This relationship was found to be independent of depression and its severity. Our data suggest that, unlike the NLR and MLR parameters, the higher CRP value may not be related to acute suicide attempt, but rather to suicidal vulnerability, as a trait-marker. Markers of chronic systemic inflammation may help in the prediction of suicidal behaviour and in the development of new therapeutic options, however, further prospective studies are needed to identify the specific role of immunological factors in suicidal behaviour more precisely.

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Increasing popularity of Generative AI systems such as GPT provides us with new dilemmas concerning the future of diagnosis and novel tools to improve daily psychiatrits’s work.

The aim of the study was to assess the abilities of generative AI to diagnose and propose treatment in comparison with real psychiatrists and performing a Turing test.

We examined the ability to diagnose and propose treatment of various Generative AI versions (CHatGPT/CHATGPTpro etc.) and then compare the results with 10 clinicians performing the same task. Then a group of 10 psychiatry specialists not involved in the first evaluation assessed wether the diagnose and treatment were established by Generative AI or a clinician.

The reults showed that the generative AI systems were able to provide valid diagnosis in most of the cases with favour to newer and most proficient version of CHATGPT. Proposed treatment results were less accurate. The comparison between human and AI group was hard to accurately acces, with tendency to favouring psychiatrists group assesment as the right decision.

There is huge need to further explore the possibilites and limitations of Generative AI use in psychiatry.

There is huge need to further explore the possibilites and limitations of Generative AI use in psychiatry.

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