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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During the COVID-19 pandemic, healthcare professionals worked under critical care conditions and had to adapt quickly to extreme work situations. They were confronted with several occupational stressors.

To determine the prevalence and factors associated with post-traumatic stress symptoms among healthcare personnel at Farhat Hached Hospital in Sousse during the COVID-19 pandemic.

This was a descriptive cross-sectional study conducted among care staff at the Farhat Hached University Hospital in Sousse over a 3-month period during the 4th wave of COVID-19. Data were collected using a questionnaire covering socio-professional and medical data. Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised (IES-R). Statistical analysis was performed using SPSS.23 software.

Our study included 326 health professionals from the CHU Farhat Hached. The mean age of our population was 36.38 ±10.19 years. The sex ratio was 0.23. Most healthcare staff were married (61.3%) and had dependent children (60.4%). Nurses were the most represented at 32.2%, followed by health technicians (22.7%) and medical residents (18.4%). Average job tenure was 10.62±10.69 years, with extremes ranging from 1 to 39 years. The prevalence of post-traumatic stress disorder was 32.5%. Paramedics were more likely to develop post-traumatic stress symptoms (OR=2.3 (IC95%: 1.4-3.8), p=0.001). Leisure activities were protective factors against post-traumatic stress symptoms (OR=0.4 (IC95%: 0.2-0.8), p=0.018). The multivariate analytical study revealed that being a paramedic and having a personal history of COVID19 infection were independently associated with post-traumatic stress symptoms.

Our results demonstrated the significant impact of the COVID-19 pandemic on the mental health of healthcare personnel. Lessons learned from this pandemic should help in the development of context-specific strategies to support healthcare workers and promote the protection of their mental health.

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In recent times, there has been a growing emphasis on the significance of fostering intergenerational learning and interaction. This involves individuals from diverse age groups engaging in purposeful and mutually beneficial activities aimed at enhancing their knowledge, skills, and values.

This systematic review was undertaken to explore the psychosocial consequences of intergenerational learning experiences among primary school-age children and older adults.

In accordance with the PRISMA guidelines, a comprehensive review of both quantitative and qualitative data was conducted. Electronic databases such as PubMed, Scopus, and ERIC were meticulously searched up to July 26, 2022, using the following Population (P) - Exposure (E) - Outcome (O) criteria: primary school-age children and older adults (P), participation in intergenerational learning (E), and psychosocial effects (O). Additionally, we extensively scrutinized the reference lists of included datasets and pertinent review articles (Figure 1). To evaluate the quality of the eligible studies, we employed the Mixed Methods Appraisal Tool (MMAT). Data analysis was structured around a narrative synthesis approach.

A total of seventeen studies were deemed eligible for inclusion in this review. The findings regarding the psychosocial consequences of engaging in intergenerational activities for both children and older adults predominantly underscored positive improvements in their attitudes, well-being, happiness, and various other aspects of their social and psychological well-being, although certain methodological limitations were identified (Figure 2).

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Promoting intergenerational interactions and learning experiences holds promise as a means to enhance the overall quality of life and well-being for both younger and older members of our communities.

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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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Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly associated with childhood, yet its prevalence and impact extend into adulthood. The diagnosis of ADHD in adults poses unique challenges due to the subtlety of symptoms and the presence of comorbidities.

The workshop aims to provide early career psychiatrists with a comprehensive understanding of the unique challenges associated with adult ADHD, emphasizing evidence-based approaches to diagnosis and effective management.

The management of adult ADHD involves a multimodal approach encompassing psychoeducation, pharmacotherapy, and psychosocial interventions. The integration of cognitive-behavioral therapy (CBT) and coaching strategies proves beneficial in addressing executive function deficits and enhancing adaptive skills.

Pharmacological interventions are a key component in the management of ADHD. These interventions aim to alleviate symptoms, improve cognitive functioning, and enhance overall functioning. The two main classes of medications commonly used for ADHD treatment are stimulants and non-stimulants.

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Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.

This study aimed to explore the association between hypomentalizing and SA lethality.

Our study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.

Descriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).Table 1.

Means Comparison for low and high lethality (N=1371)

While the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.

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The admission of children to PICU is a painful experience for parents. Regularly, they are asked to make important decisions about treatment options in collaboration with the care team, which causes them stress, uncertainty and trauma.

To investigate the needs of parents during the child’s hospitalization in a pediatric intensive care unit (PICU).

A systematic review of the literature and a search of articles in the international databases PubMed, Cinahl, Google Scholar, Cochrane Library and Greek scientific journals was performed with a peer review process during the period between April and July 2022. A time limit was set regarding the date of publication of the articles (articles published in the last 15 years).

Nine studies were found that met the criteria for inclusion in the review. The thematic analysis of the results deduced the following sections A: Need for information from health professionals regarding the child’s health status and the possible treatment options available, B: Need for psychological support from health professionals (psychologists, nurses, doctors) in order to be able to manage the difficult situation they are experiencing due to the hospitalization of their child, but also to be able to manage their grief and sorrow in case of loss of the child. C: Need for safe hospitalisation of the child.

Parents have needs during their child’s hospitalization in the PICU, which if put in boundaries-frames and guided by health professionals (who possess knowledge and composure in difficult moments) can bring about a smooth course of the child’s health during hospitalization.

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An important component of the russian-Ukrainian war is information war. russia conducts psychological diversions the purpose of which is harming and disorganization the population’s mental health by reducing the ability of criticality thinking and formation of various stress-associated, anxiety-depressive, phobic, etc. disorders.

To study the impact of information about the war on the mental health of Ukrainian population.

186 Ukrainian people voluntarily completed the questionnaire in Google format. It contains tools for assessing the level of stress PTCI, anxiety response GAD-7, depression PHQ-9, the intolerance to the uncertainty (IUS-12 in G.Gromova’ adaptation) and developed by us “Test for the detection of disorders related to the obsession with news about the russian-Ukrainian war” (M.Markova et al, 2022).

Most of the civilian population of Ukraine demonstrate excessive fascination with news associated with the war, with almost 50% have all the signs of clinically formed addiction.

Psychopathological anxiety and depressive manifestations of varying intensity are characterized by more than 30% of the population. Almost 80% suffer from the effects of psycho-traumatic factors, of which 45% are observed by post-stress maladaptation, 25% - by signs of PTSD (23%) or PTSD (2%).

The presence of anxiety-depressive response does not depend on the level of obsession of the news: among persons with signs and/or clinical psychopathological symptoms, there are persons both excessively passionate about information and with a safe level of use.

Any high level of interest of news (addiction/dangerous/risky) has a close direct correlation with the intensity of pathological stressful response and the level of tolerance to uncertainty.

All persons with anxiety-depressive and pathological stressful response symptoms, and 58% of people with excessive fascination with news are characterized by low tolerance to uncertainty. This can serve as a prognostic marker of development of maladaptation and testify to the leading role of a lack of tolerance to uncertainty in its development in wartime.

42 % of people who have an excessive interest in news, haven’t signs of maladaptive response. They use the interest of information as a stress management’s resource, which has a positive effect on the mental state and increases the ability to successfully function in uncertainty.

The development of information and psychological stability by increasing tolerance to uncertainty is a perspective area of research in the field of mental protection of the population of Ukraine.

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The incorporation of artificial intelligence (AI) in healthcare, especially in mental health services, offers potential advancements in efficiency and personalization. As AI technologies like machine learning and natural language processing (NLP) continue to evolve, it’s vital to evaluate their applications in psychiatry comprehensively.

This review aims to summarize and characterize studies that used AI, particularly machine learning and NLP, in mental health. Additionally, it endeavors to understand how these technologies may enhance diagnostic tools, symptom monitoring, and delivery of personalized treatment in psychiatry.

Adhering to PRISMA guidelines, a systematic search was executed across multiple medical databases, including PubMed, Scopus, ScienceDirect, and PsycINFO. Keywords encompassed machine learning, data mining, psychiatry, and mental health. Exclusion criteria included non-English papers, anonymization process descriptions, case studies, conference papers, and other reviews. Data from various segments in the provided information were synthesized to capture the broader picture of AI’s application in psychiatry.

From the 327 articles initially identified, 58 were chosen for detailed review. Studies predominantly revolved around three main populations: patients in medical databases, emergency room visitors, and social media users. The primary applications of AI entailed symptom extraction, illness severity classification, therapy effectiveness comparison, and psychopathological insights derivation. Data sources mainly included medical records and social media, with Python emerging as the preferred platform for most studies.

While AI shows immense promise in revolutionizing mental health care, its current applications largely confirm existing clinical hypotheses. Ethical concerns, such as patient privacy and data biases, remain paramount. Future work should delve deeper into these challenges while further exploring AI’s potential in clinical psychiatry practice.

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“Folie à deux,” or shared psychosis, is a fascinatingpsychiatric phenomenon characterized by the transmission of delusional beliefs and psychotic symptoms from one individual (the “inducer”) to another (the “recipient”) who share a close emotional bond. Despite its rarity, “Folie à deux” presents unique challenges and insights into the understanding of psychosis and the intricacies of interpersonal relationships.

The primary objective of this review is to analyze the recent clinical literature on “Folie à deux” to better comprehend its clinical presentation, diagnostic criteria, etiological factors, and therapeutic approaches. By synthesizing the latest research findings, we aim to enhance the awareness and understanding of this intriguing phenomenon among mental health professionals.

A case report of a couple of a 34-year-old male and a 43-year-old female with a shared delirium. The male was brought to the emergency department by ambulance after being found in the street with behavioral disturbances and delusional symptoms. Individual interviews with both members of the couple revealed shared delirium. He was admitted to the psychiatric ward for the clinical picture consisting of a chronic delusional disorder of years of evolution and and new symptoms such as restlessness and behavioral disturbances.

The review reveals that “Folie à deux” remains a rare but clinically relevant phenomenon, with reported cases spanning diverse cultural and familial contexts. Diagnostic criteria, as outlined in the DSM-5, have been useful in guiding clinicians in identifying and managing cases. The literature emphasizes the importance of a thorough psychiatric evaluation to distinguish “Folie à deux” from other psychopathological conditions. Recent research has also shed light on potential neurobiological mechanisms and genetic factors contributing to shared psychosis. Therapeutically, early intervention and tailored treatment plans are crucial in achieving favorable outcomes. While antipsychotic medications remain a cornerstone of treatment, family therapy and psychoeducation have emerged as valuable adjunctive approaches to address the unique challenges posed by shared psychosis.

In conclusion, “Folie à deux” continues to be a captivating and clinically relevant phenomenon in contemporary psychiatry. This bibliographical review underscores the importance of recognizing and diagnosing shared psychosis in clinical practice. Moreover, it highlights the need for further research to unravel the underlying mechanisms and genetic predispositions associated with this condition. Ultimately, a multidisciplinary approach, including pharmacological, psychotherapeutic, and family-based interventions, holds promise in improving the prognosis of individuals affected by “Folie à deux.”

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Pre-service teachers must confront emotionally demanding situations associated with the profession, and they must be prepared for it. Previous literature has shown that two variables are important for managing mental health in this population: emotional intelligence (EI) and mindset. EI is the ability to perceive, facilitate, understand, and manage emotions, while mindset refers to beliefs about the malleability of various life domains. According to their mindsets, those who believe that attributes are malleable are called incremental theorists, and those who believe attributes are fixed are entity theorists.

This study aimed to explore the influence of intelligence and EI mindset on self-report and ability EI in a sample of 224 female pre-school pre-service teachers (M= 21.27, SD = 4.72).

Participants completed a questionnaire battery, including intelligence mindset, EI mindset, the Mayer–Salovey–Caruso Emotional Intelligence Test, the Trait Meta-Mood scale, and paternal and maternal educational status.

The results showed that incremental EI theories — but not intelligence — were related to higher scores on self-report and ability EI. Specifically, being an incremental theorist of EI predicted 11% and 20% of the variance in global EI and the managing branch of ability EI, respectively

These results suggest that EI mindset training programs could be implemented and evaluated to explore their impact on the EI of female pre-service teachers

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Lithium is a mood stabilizer often used as a first-line treatment for bipolar disorder. Its narrow therapeutic window and changes in the absorption, distribution, and elimination of the drug following bariatric surgery have important implications regarding patient safety.

We present a 51-year-old female patient with bipolar disorder and a medical history of morbid obesity, type 2 diabetes mellitus, hypothyroidism, hyperlipidemia, and essential hypertension. She was mentally stable on lithium 1200 mg/day, valproate 500 mg/day, and quetiapine 400 mg/day. She had undergone laparoscopic sleeve gastrectomy. After a month, she showed up to the emergency room (ER) with nausea, vomiting, diarrhea, and fatigue. Gastroenteritis was suspected until the patient started showing neurological symptoms such as delirium, dysarthria, ataxia, chorea, and athetosis.

The patient was monitored and received aggressive intravenous hydration (3000 cc of 0.9% serum isotonic) in the intensive care unit (ICU). She was prescribed intramuscular biperiden injection of 5 mg/ml/day, pheniramine 45.5 mg/2 ml/day, and lorazepam 1 mg/day. Her lithium levels were checked every six hours. She was agitated and disoriented for the first five days despite lithium levels being in the therapeutic range. On day six, her blood lithium levels dropped to 0.399 mmol/L. Her psychiatric examination revealed that she resumed cooperation and orientation, her dysarthria subsided. However, her thought content and attitude were grandiose, and she had a labile affect. We prescribed 5 mg/day of olanzapine routinely and 1 mg/day of lorazepam on a needed basis. The next day, her labile affect became calmer, and her sleep improved so she was discharged from the ICU and admitted to general surgery inpatient service, and olanzapine was titrated to 10 mg per day since she had elevated mood symptoms.

After 7 days of intravenous hydration and supportive treatment, her neurological symptoms completely subsided except for a fine tremor, which lasted for another 3 days and then ceased. She was clinically stabilized without further need for intervention. Her lithium level was 0.206 mmol/L before her discharge.

We believe it is of utmost importance to build a consensus in guidelines and inform physicians about lithium toxicity and its symptoms after bariatric surgeries. We recommend a careful follow-up of the patient pre-and postoperatively. Preoperative psychiatric intervention includes decreasing the lithium dose gradually and discontinuing it. After the operation, lithium can be started with a much lower dose and may be increased by checking lithium levels every week for at least 6 weeks after the operation until the patient can digest solid food again, and then every 2 weeks for 6 months, and thereafter every month for one year.

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This work aims to provide an updated overview of the eating disorders (EDs) which are a widespread pathology nowadays. Informations related to the clinical-nosographic characteristics, an in-depth analysis about systemic-relational theories and historical evolution are provided. In addition, current informations about epidemiological data, recovery, treatment related implications, new neuroscientific theories and risk factors are shown. Given the complexity of these disorders, the lack of resources and the the increasing demands for treatment, the main object is related to the construction of a questionnaire to manage the waiting lists.

Building a waiting list management model for EDs, Study and compare advantages and disadvantages of the source allocation ethical models (utilitarianism, prioritarianism, egalitarianism), Analyze EDs leading experts (doctors, dietitians, psychologists, psychiatrists) and EDs patients positioning with respect to priority treatment factors. Promote constructive dialog between EDs experts from different backgrounds and EDs patients.

In order to know the various treatment alternatives available, the different levels and reference structures are illustrated. In addition, it is also suggested different reasoning based on the ethical models of egalitarianism, utilitarianism and prioritarianism in order to build a waiting list management model, which is the maximum goal of this work. This model needs to be supported by a series of validated tools such as the clinical interview and self-administered questionnaires to investigate psychopathological aspects and psychiatric symptoms. Going into more details, a questionnaire is proposed to the EDs leading experts, so that they can provide their own priority factors list and related thoughts in order to build “the most ethical” waiting list.

It is expected that both patients and clinicians tend to give priority to patients with greater psychophysical severity, not exclusively on the basis of physical parameters. Further hypothesis related to clinicians lead us believe that they tend to use utilitarian logics, in compliance with the demonstrated efficacy of early intervention. An evaluation that could lead to a disagreement between experts and patients is related to prioritize patients in the initial phase of the disease, which could be supported by clinicians, but not by patients, probably in connection with their personal experiences. In fact, this favoritism could have a negative impact on the care of the most serious cases who risk to be left to themselves.

This work aims to encourage a constructive dialogue between experts and patients with EDs in order to build a functional intervention model which should be “the most ethical as possible” in order to save the greatest number of lives in respect of mental suffering.

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Anorexia Nervosa (AN) is common in adolescents and has a high mortality and morbidity rate with a lifetime prevalence of 0.5% to 2%.1,2 We aim to review the neurobiology correlation of Anorexia Nervosa in Autism Spectrum Disorder as they are often associated together.

1. Understand the correlation between the neurobiology of Autism Spectrum Disorder (ASD) and Anorexia Nervosa.

2. Assess the association and prevalence of Anorexia nervosa in the ASD population.

3. To focus on the implications for the pathogenesis of Anorexia Nervosa and treatment of this disorder in the ASD population.

We searched PubMed, APA PscyINFO, Embase, CINAHL, and Google scholar databases with the keywords Autism Spectrum Disorder AND Anorexia Nervosa and included 6 relevant human studies out of 187 published in English.

Neilson et al. studied the outcome of ASD in teenage onset AN, and a statistically significant negative dose-response relationship is found in all the 3 Morgan-Russell Outcome Assessment Schedule (MROAS) domains in stable ASD over time, and the results on the subscales ‘mental state,’ ‘psychosexual state’ and ‘socio-economic state, “personal contacts,’ ‘social activities’ and ‘employment record.’3 The outcome of AN onset in adolescence is generally favorable regarding mortality and the persistence of eating disorders in adulthood. A study by Pruccoli et al. noted a high prevalence of ASD traits in a group of young AN patients, predominantly seen in 4 specific EDI-3 subscales and independent of BMI.4 Margari et al. found only AN diagnosis had a statistically significant difference (p = 0.04) in females vs. males when comparing sex differences for comorbidities.5

Morphological changes in brain areas are linked to social cognition and increase the risk of eating disorders in ASD. We recommend future studies with robust study design to explore the full spectrum of pathogenesis and association of AN in ASD.

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Psychiatric patients have a higher risk of premature mortality primarily due to cardiovascular diseases (CVD). One significant contributing factor is the presence of dyslipidemias . Current studies are shifting focus towards lipoprotein ratios, believed to better reflect cardiovascular risk. These studies have demonstrated that ratios associated with high-density lipoprotein (HDL) are stronger predictors for CVD compared to traditional lipid parameters. One of these ratios is the logarithmic transformation of the triglyceride (TG) to HDL ratio, known as the plasma atherogenic index (PAI).

Our study aimed to compare the PAI between patients diagnosed with psychotic disorders who presented to our outpatient clinic and healthy control groups.

Fifty patients diagnosed with psychotic disorders, including 50 residing in a nursing home and 50 outpatient in such facilities, presented to our psychiatric outpatient clinic and were included in our study. Additionally, a healthy control group consisting of 49 individuals was recruited. A socio-demographic data form was administered to all groups. Peripheral blood levels of HDL, Triglycerides (TG), and LDL were recorded for each participant included in the study. Ethical approval for the study was obtained from the local ethics committee.

The patient groups were compared in terms of age and gender. While there was no statistically significant difference in gender between the groups, a significant difference was observed in terms of age (p=0.099, p=0.004). When examining the age distribution of the groups, it was observed that the care facility group was older compared to the other groups. The age and gender distributions of the groups are shown in Table 1 and Table 2.

Psychotic patients in the outpatient group and the nursing home group were compared in terms of age and atherogenic index. Age was statistically significant, indicating that thenursing home group was significantly older (p=0.001, p=0.478). In the comparison of the control group with psychotic patients, there was no statistical difference in age, but a significant difference was found in terms of the atherogenic index (p=0.510, p=0.001). The statistical analysis and data between psychotic patients and the control group are presented in Table 3.

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This study, examining the comparison of Plasma Atherogenic Index (PAI) in patients diagnosed with psychosis with healthy controls, represents a significant step in understanding the cardiovascular health profile of this population and developing appropriate treatment strategies. Future research will further contribute to a deeper understanding of the impact of psychiatric disorders on cardiovascular health and aid in the development of effective interventions to minimize these effects.

Disclosure of Interest: None Declared.

None Declared

Major Depressive Disorder (MDD) is associated with a high burden of disease and notable economic costs. Standard treatments (e.g. medication or cognitive therapy) have been shown to be effective, but some patients remain unresponsive. With the knowledge that MDD patients have been shown to display an attentional cognitive bias towards negative stimuli, Cognitive Bias Modification (CBM)-training to focus attention on positive information is thought to improve emotional processing and depressive symptoms. Some studies imply reduced duration and occurrence of microstate D in MDD compared to healthy controls. However, the effect of CBM on microstates is still unclear.

(1) To replicate previous findings that duration and occurrence of microstate D is reduced in patients with MDD compared to healthy controls in an independent sample and (2) to investigate the effect of an active CBM-training versus a control-training on microstates and its association with symptom improvements.

Thirty patients receiving outpatient treatment with MDD according to DSM V (aged 18-60) will be recruited in Essen and Aachen. The control group will consist of 30 healthy age-and-sex-matched participants. Psychological testing will be administered and all participants will be randomized to either an active or a control training. During the next visit, resting state EEG and a GoNoGo Task with positive, neutral and negative pictures will be measured. The participants will take a tablet home to undergo 10 sessions of CBM within 14 days. The training will be consisted of a dot-probe-task. In the active condition the probe will be more likely to appear behind a positive versus a neutral picture, while appearing randomly in the control condition. After 14 days, a second EEG will be recorded.

Differences in duration and occurrence of microstate D between patients and healthy controls will be analyzed by conducting ANCOVAs with age and sex as covariates. ANCOVAs for repeated measurements will be calculated to study effects of time (pre- vs. post-training) and group (patients vs. healthy controls in active training; patients in active vs. patients in control-training), on duration and occurrence of microstate D.

CBM-training is proposed to be an effective treatment option for MDD patients, reflected in a reduced topographical bias of microstate D in EEG.

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Discrimination is known to have different effects on health. In particular the mental health of affected people diminishes. Although it is known that marginalized groups are discriminated against more, at present only research on gender and ethnicity has been done. Further diversity domains like socioeconomic status, care responsibilities, sexual orientation, disability, mental and physical health, and their intersections have been scarcely looked at.

The aim of the study was to determine the effects of discrimination on the mental health for employees and students of a university hospital taking diversity domains into account.

A web-based survey between June 22 to October 23 was conducted using the PHQ-4 and WHO-5 as well as innovative Diversity Minimal Item set to measure different diversity domains.

Preliminary data shows that discrimination among employees and students is common, widespread and most frequent based on gender, ethnicity and health. The mental health of those who feel discriminated against tends to be poorer, especially looking at the intersectionality of diversity domains.

The results of this study suggest that both more measures to prevent discrimination in a university hospital have to be implemented and individuals from marginalized groups need special psychosocial support to ensure a safer working environment. In addition, greater attention to diversity and inclusion in medical research is needed to develop appropriate responses and interventions, including diversity policies.

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Anti-NMDAR encephalitis is an autoimmune disorder, characterized by neuropsychiatric symptoms, such as mood instability, psychosis, catatonia, dyskinesia, seizures and vegetative lability. Psychiatric symptoms usually occur in the initial phase, therefore almost half of the patients are first observed at a psychiatric unit, however in later phases the patients’ condition often show progression with the characteristic neurological symptoms, such as perioral dyskinesia and seizures. Although, early recognition and treatment is essential to reach good outcomes, delay in the diagnostic process often happens due to the unspecific early symptoms and the lack of knowledge of this disorder amongst psychiatrists.

Moreover, there are cases, where neurological symptoms do not appear, which can lead to diagnostic failure and mismanagement of these patients. Since anti-NMDAR encephalitis is a rare condition, it is important to treat such cases in specific centres, where sufficient knowledge and multidisciplinary approaches are available.

Our aim was to gather all patients’ data treated with anti-NMDAR encephalitis at two departments (Neurology and Psychiatry) of Semmelweis University. We wanted to analyse psychiatric manifestations of the disorder in details and follow these symptoms long term, with special interest on the cognitive symptoms.

One of our aims was to follow-up these patients and measure antibody titres in their serum, to be able to asses, whether there was any association between prolonged serum positivity and cognitive impairment.

We have retrospectively analysed data of previous cases and prospectively followed up recently hospitalised patients.

Neurocognitive assessment had been conducted by the same psychologist, all the patients were followed up by the same interdisciplinary team, including a neurologist and two psychiatrists. Laboratory tests (autoimmune antibody essays) were conducted by the Immunological Laboratory at Semmelweis University.

Altogether, 13 female patients were treated with anti-NMDAR encephalitis in the past ten years at Semmelweis University. All of them received plasma exchange, iv. steroids and azathioprine. 8 out of the 13 needed ventilation and intensive care treatment. 2 of these patients have mild psychiatric symptoms as residual symptoms, and 1 of them is still in the recovery stage, currently experiencing mild cognitive symptoms.

Only two patient had ovarian teratomas out of the 13, which is a lower number than expected from previous studies.

4 out of 12 had positive antibody titre at follow up, one patient is still at recovery stage, however her antibody titres are still very high.

Semmelweis University is one of the largest centre treating patients with anti-NMDAR encephalitis in Hungary. We had altogether 13 patients in the last ten years, with very good outcome, since all of them recovered, although 2 have residual symptoms.

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Climate change has a profound impact on mental health, supported by meta analytic evidence. For every degree temperature increase, there is a statistical increase in mental health problems by about 0.9%. The direct association between catastrophic events such as hurricanes or flooding and traumatization or negative mood states is evident. However, there are also interactions between pollution or heat islands in urban contexts and stress associated mental disorders, and there are indirect interactions e.g. between loss of agricultural space, poverty, displacement and mental health challenges. We provide an overview regarding direct and indirect effects of climate change on mental health and discuss possible interventions on the health care system.

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Comorbidities in addiction: It is a rule rather than an exception. The story starts in childhood; even before, in infancy, may be in utero. The dimensional traits have been already there, existing obviously far before any DSM-5 diagnosis. Developmental qualities of stress sensitivity, impulsivity and emotion dysregulation are the leading ones. Besides, comorbidity research (NESARC being one of the prominents) (Hasin and Grant. Soc Psychiatry Psychiatr Epidem, 2015;50 (11): 1609-1640) addressed childhood abuse, neglect or other childhood adverse experiences as a definite risk factor for adolescence and adult mental disorders, particularly substance use disorders. Developmental and environmental adversities in a mutually amplifying pattern make a vicious cycle in which the individual finally finds an illusionary exit, a pathway to addiction.

This presentation aims to discuss the complexities and challenges for the diagnosis and treatment of a patient with a twenty five year follow-up, a survival period for the patient herself as well as for the therapeutic alliance (Ulug, Arch Neuropsychiatr, 2015;52: 213-215).

Case study: The history and the life chart of her, diagnosed as having at least seven DSM diagnoses, indicate the depth of pyschopathology and the intensity of interventions, most of which failed due to the lack of a transdiagnostic and holistic perspective. A specific focus of the case study will be on the problematic use of Borderline Personality Disorder formulation/diagnosis and its negative, somehow short-coming, impact on the treatment, course and recovery.

The challenges brought by comorbid transdiagnostic cases, similar to the subject of this presentation, have become a common practice for addiction professionals. While big data or empirical large datasets can have their own limitations to help the practitioner for overcoming such challenges, as stated in Stein’s article “it is important to recognize the value of a wide range of complementary research designs including the age-old single-case study, which may sometimes provide clinical insights that outweigh those from big data analyses.” (Stein et al. World Pychiatry, 2022; 21(3): 393-414).

The case study indicates the necessity for transdiagnostic and holistic approach in the management and long term treatment of such difficult-to-diagnose and difficult-to-treat patients.

None Declared