Bipolar disorder is a chronic mental illness that progresses with recurrent episodes and can cause serious loss of functionality.Sociodemographic characteristics have importance on the course of the disease.

In this study,sociodemographic data such as age,gender,educational status,job,and family history of patients with bipolar disorder manic episode who were followed up and treated in the psychiatry ward of our hospital were recorded.

Our study included 50 patients diagnosed with bipolar disorder manic episode according to DSM-5 in the psychiatry service of Atatür kUniversity Hospital and 50 healthy volunteers who had not applied to psychiatry before. A 16-item sociodemographic chart in which age,gender,marital status,lifestyle,number of marriages, number of children,years of education,job,monthly income,maternal and paternal survival status, familyhistory of psychiatric illness,family history of bipolar disorder,smoking,alcohol and substance use were questioned.The data form was applied to the patients and healty volunteers.

After the statistical analysis between the groups, a significant difference was found in terms of lifestyle(p<0.001),job status(p=0.01), family history(p<0.01) and substance use history(p=0.04).

The rate of psychiatric illness in the families of individuals diagnosed with bipolar disorder increases significantly compared to the normal population,and the data of our study are in line with the literature in this respect.It is known that conditions such as lower employment and interruption of working life are common in patients with bipolardisorder due to diseases such as loss of functionality and pharmacotherapy side effects.In our study,similar to the literature,the employment status was found to be significantly lower in the BD group compared to the healthy controls.In our study,no significant difference was found between the groups in terms of smoking and alcohol use,while other substance use was found to be significantly higher in the bipolardisorder group.Since factors such as sociocultural structure,education,geographical conditions,religious belief may affect smoking,alcohol and substance use;multicenter studies with larger samples are needed in order to more clearly reveal the rates associated with bipolar disorder and other psychiatric conditions.

None Declared

Актуальность исследования накопления данных о исключении иммунологического статуса у больных с выраженными расстройствами желудочно-кишечного тракта (ФЖКТ), характерных непсихотических заболеваний легких.

изучение взаимосвязи и появление признаков иммунологического и психовегетативного статуса больных у ФЖИР

Проанализированы и рассчитаны результаты ПВА-обследования (тест MMPI) с иммунологическим статусом 57 больных (средний возраст 35,36 ± 14,43 года, мужчины-18, женщины-39) с ФАД в динамике с группой здоровых лиц 34 человека, среднего возраста 28 ,63±9,54 года

У больных с тревожной депрессией [средний профиль: пик по шкале 2 + ↑ 7-8 и ↓ 9 шкал] оценочное увеличение относительного значения Т-хелперов CD3+CD4+ (58,0 и 55,0% р = 0,015) при снижении относительного количества Т-цитотоксических лимфоцитов CD3+CD8+ (0,312 и 0,372, р=0,023; 14,0 и 19,0, р=0,001) соответственно, увеличение иммунорегуляторного индекса: Т-хелперы/Т-цитотоксические CD3+ CD4+/CD3+ CD8+ (4,143 и 2,600 , р=0,001); снижение относительного количества NK-клеток CD3-CD16+CD56+ (6% и 8%, р=0,01).

У больных с преобладанием соматизированной анестезии [ведущий пик по шкале 1]: основные выявлены в относительно сниженном CD3+ Т-лимфоцитов (53,0 и 60,0, р=0,001); снижение Т-хелперов: CD3+CD4+ (28,0% и 31,0%, р=0,001); повышение ЭКГ: CD3-СД16+СД56+ (34% и 26,0%, р=0,01; 1153 и 470, р=0,01) по сравнению со здоровыми людьми.

Выявленные изменения показателей иммунитета выявлялись в период обострения заболевания и носили транзиторный характер.

Анализ данных с позиций клинико-динамического выявления вклада иммунобиологических регуляторов организма в клиническое затяжное течение и участие иммунной системы в механизме реализации психоэмоционального контроля стресса. .

None Declared

Over the past decades the role of sex in the antipsychotic treatment type and dose selection has been virtually overseen. In fact, medication approval trials barely stratify for sex differences. Emerging hints from different types of data highlight the need for antipsychotic treatment personalization within the context of sex differences. Varying bioavaibility patterns of the prescribed antipsychotics between female and male patients may be easy to capture measuring plasma or serum levels of the antipsychotics ultimately guiding dose selection in clinical routine. Here we will discuss pitfalls and current evidence regarding sex affecting dose selection to enhance safety and effectiveness outcomes of antipsychotic treatment.

G. Schoretsanitis Consultant of: HLS Therapeutics and ThermoFisher

Many neurological, sensory and behavioural deficits, are linked with significant limitations in the overall functioning not only of the child but also his/her closest family, and poses a great challenge for the primary parental caregivers.

To assess the caregiver burden in parents of children with neurological impairement (NI), and itsrelated factors.

A total of33 caregivers of children with NI participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021.

The Zarit-Caregiver-Burden-Scale (Zarit-CBS) was administered.

The average age of the caregivers (27 mothers and 6 fathers) was 38,33 ± 6,53 years. Among the parents, 17.14% had another disabled child and 30.3% had a mediocre health status. Mother caregivers constitutes the majority of caregiving (82.85%).

The average of the number of children in the family was 1.97±1.18 and the average age of the children (21 boys and 12 girls) was 7,58±4,29 years. Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk. The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state.

The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%.

The total Zarit-CBS score was associated with the number of children in the family (p=0.047).

There was no significant relationship between Zarit-CBS and the severity of impairement (p=0.418).

Given the variety of factors affecting caregiver burden, specific interventions may promote parental caregivers’well-being, and consequently lead to improved quality of care provided to children with NI.

None Declared

Suicide among children, adolescents and young adults is a major health problem, as it represents the fourth leading cause of death among people aged 15-29 (WHO, 2022). A recent study showed that the years of potential life lost (YPLL) due to suicide in 2018 were 1,344,552, which is very close to the 1,591,487 YPLL caused by COVID-19 in the year 2020 (Porras-Segovia et al, 2021). In the recent years, there is a growing interest in suicide prevention research in differentiating attempter profiles in terms of lifetime suicide attempts. Specifically, studies suggest that there may be meaningful differences concerning risk factors between patients with a history of one versus multiple suicide attempts. Multiple attempters (MA) show more suicidal ideation, depressive symptoms and hopelessness than single attempters (SA) (Esposito et al, 2003; Goldston et al, 1998).

We aimed to answer the question ‘What are the factors associated with attempting suicide for the first time and are they different from the factors associated with re-attempting suicide in children and adolescents?’

We conducted a systematic literature search in four databases. Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers. Due to the different way to present data in the studies effect sizes were pre-calculated to standard mean differences (SMD). Random effects model was used to calculate the pooled effect size for all meta-analysis. Publication bias was assessed using funnel plots.

14 studies were included in the systematic review, and 13 in the meta-analysis. Original articles used in the meta-analysis included a total of 4286 participants of whom 1579 were multiple suicide-attempters and 2707 single suicide attempters.

MAs showed significantly higher proportion of anxiety disorders (SMD = 0.387, 95%CI [0.09, 0.68], p < 0.022), alcohol abuse disorder (SMD = 0.382, 95%CI [0.07, 0.70], p < 0.036) and substance abuse disorder (SMD = 0.526, 95%CI [0.21, 0.84], p <0.013) than SAs. Mean depression severity was higher among MAs than SAs (SMD = 0.515, 95%CI [0.17, 0.86], p < 0.011). MAs showed higher impulsivity (SMD = 0.28, 95%CI [-0.03, 0.60], p < 0.068) and aggressiveness (SMD = 0.688, 95%CI [0.42, 0.96], p < 0.00) than SAs. Hopelessness (SMD = 0.482, 95%CI [0.06, 0.91], p < 0.03) and suicidal ideation (SMD = 0.399, 95%CI [0.34, 0.46], p < 0.007) was significantly higher in MA.

On the basis of the current results, multiple attempters may represent a distinct patient population in terms of being a more severe clinical profile. This can provide the basis of stronger suicide prevention and vigilance programs focused in this suicidal phenotype.

None Declared

Intimate partner violence is an under recognized problem in our society that is misjudged and often overlooked.

Violence in women has been linked to chronic health, emotional complications, one of which includes low self-esteem

To study the prevalence and predictors of low self-esteem among women victims of domestic violence.

Our study was descriptive and analytical cross-sectional, carried out with women examined in the context of medical expertise, from May until January 2022.

An anonymous survey was asked to these ladies.

The Rosenberg questionnaire was used to assess the self esteem

122 responses was collected.The average age of the assaulted women in our study was 35.66 years(from18 to 64 years) 98.4%were victims of verbal violence, 95,1% of physical violence, 97,5% of psychological violence and 54.7 %of sexual violence.

Self esteem was very low among 43,4% of women ,low among 18,9%,average among 15,6%,high among 15,6% and very high among 6,6%.

Women with children had lower self-esteem (p=0.02).

Low self-esteem were significantly correlated with: the husband cannabis consumption (p=0.01).

The ladies victims of sexual violence such as an unusual type of relationship had lower self-esteem (p=0.01).

Women who were threatened by their spouses had lower self-esteem (0,01).

An history of aggression during pregnancy was a risk factor for low self-esteem (p=0, 01).

Results suggest domestic violence has on women, not only physically effect but mentally and emotionally, this is why an urgent reaction must be taken by the state to reduce this scourge and hs repercussions on the mental health of the victims.

None Declared

Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains.

Study of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis.

Bibliographic review of scientific literature based on a relevant clinical case.

We present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis.

In the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.

None Declared

Cannabis use disorder (CUD) is a complex issue, even more so when it is comorbid with a psychotic disorder or a mood disorder. Indeed, this population seems more vulnerable to this substance since the incidence of developing CUD is five to six times higher. Psychotherapies have only shown a modest short-term effect that is not maintained in the long term. The emergence of the use of virtual reality (VR) in psychiatry could be the tool that will make it possible to overcome this lack of efficiency. Indeed, VR has shown its considerable potential in a variety of psychiatric conditions. However, this modality has not been investigated for treatment for CUD. The Avatar intervention for substance use disorder allows the creation of an avatar and voice transformation that represents a significant person in relation to the patient’s substance use and is interpreted by the therapist. During the immersive sessions, patients are invited to work with their avatars on self-affirmation and refusal techniques, the management of negative emotions, stress and cravings, conflict resolution, self-esteem and motivation for change.

The purpose of this pilot project is to collect preliminary data on a new intervention.

For the realization of this research project, we intend to recruit 40 participants, aged 18 and over, with a diagnosis of a CUD of at least moderate intensity, with a regular cannabis use and who also has a psychotic and/or mood disorder. The intervention consists of 8 weekly one-hour long sessions. Clinical research interviews were conducted and after therapy, and follow-ups occured at 3, 6 and 12 months. These evaluations will allow us to analyze the quantity of consumption, the severity of CUD measured with the cannabis use problem identification test (CUPIT), as well as objectively the concentration of THC thanks to samples. urinary tests which are carried out at the first and last intervention session as well as at the 3-month follow-up. Also, the psychotic symptoms and the quality of life will be evaluated.

In November 2022, 32 participants had been recruited of which 17 participants had completed the Avatar intervention. Preliminary results from this sample show that a decrease of moderate effect size for amount of cannabis consumed was observed, as well as on severity of the cannabis use problem after the intervention. The quantity of cannabis consumed and the severity of the problem was also significantly reduced at follow-up Quality of life tends to increase and disease symptoms decreased significantly at 3 and 6 month follow-up.

To our knowledge, this intervention is a first in the world to target CUD in this particular population while using innovative technology The Avatar intervention under study in this project presents itself as a new avenue for cannabis use disorders.

None Declared

Software-driven therapeutic interventions aiming at preventing, managing or treating medical or chronic diseases are referred to as Digital Therapeutics (DTx). DTx are developed to target a specific disorder or disease, including mental disorders. DTx are regarded as an emerging class of medicines and, hence, have obtained the approval of the relevant regulatory authorities, based on clinical evidence for the effectiveness similar to conventional medicine supplies and medicines. Social media-based DTx can represent both a means to quantify mental health as well as a source of both positive and negative interactions, including a source of social support for many who have been socially isolated and lonely. Recent researches using monitored social networks as interventions has shown promise in youth with several mental health issues, despite it is noteworthy that social media are not without risks.

None Declared

Neuroleptic malignant syndrome is a rare but also life-threatening adverse reaction associated with mostly antipsychotic use. It is mostly related with the administration of D2 dopamine receptor-blocking antipsychotics or sudden discontinuation of antiparkinsonian drugs.

In this article, we present a 55-year-old male patient diagnosed with schizophrenia who was admitted to the emergency department with acute onset confusion and fever. He had been on haloperidol and quetiapine treatment for several years.

His Creatine kinase (CK) levels were elevated (2928 - 11462 U/l within 1 day. U/l). She was admitted to the intensive care unit with an initial diagnosis of NMS. The patient’s all antipsychotic treatment was discontinued.

At a follow-up examination after 6 days, myoglobin, CK, and leukocyte values were noted to start decreasing. The rigidity and altered mental status improved after 6 days. After 9 days he was discharged. He was admitted to the psychiatry outpatient clinic. He was suffering from auditory hallucinations therefore the antipsychotic treatment has been started and it was planned to reach the target dose of 10mg olanzapine PO by increasing the weekly dose to 2.5 mg. However, due to the increase in the patient’s auditory hallucinations, the treatment was rearranged and the target dose of 15mg was reached. After that, the patient’s positive symptoms regressed significantly. The patient has been on 15 mg olanzapine treatment for the last 1 year with no positive symptoms.

What is the most appropriate treatment choice after NMS? There is no easy, single answer to this question. Although we were aware that there have been reported NMS cases with olanzapine use for this patient it was chosen since it is one of the second-generation antipsychotics that the patient did not use by examining the treatment history. This case shows that this syndrome may develop even after a long and stable neuroleptic treatment and the patient may continue to benefit from different antipsychotic treatments.

None Declared

Conventional Bayesian network meta-analysis (NMA) of multiple outcomes are performed using non-informative prior distribution, independently for each outcome.

This study aimed to estimate pharmacological intervention effects against placebo within a multivariate Bayesian framework using an informative lognormal prior distribution.

13,188 participants were evaluated for two dichotomous study outcomes, namely, treatment response and all-cause dropouts, in 57 double-blinded randomized controlled trials (RCTs) for the treatment of acute bipolar mania (ABM) in adults. Both the study outcomes were measured from baseline to week 3. 10 pharmacological drugs or interventions consisted of mood stabilizers, anti-psychotics, antidepressants, combinations of the above and other agents, and were compared against each other as well as with placebo either as monotherapy or add on agents. These treatments include placebo, aripiprazole, haloperidol, quetiapine, ziprasidone, olanzapine, divalproex, paliperidone, carbamazepine, lithium; and lamotrigine. Aggregated arm-based data on both the study outcomes were considered. We used the logit scale to model the probability of event occurrence and adopted multivariate modelling approach; wherein both the study outcomes were included in a single NMA model. Further, the between-study variance-covariance matrix was decomposed using the Cholesky and spherical decomposition techniques and the results were compared. The deviance information criterion (DIC) indices were used to assess the model fit. Analyses included 16,00,000 Markov Chain Monte Carlo (MCMC) iterations with 6,00,000 burn-in period and thinning of 100; tested by running three chains with different starting values. All the analyses were carried out in WinBUGS software.

Under Cholesky and spherical decompositions, the correlation between the study outcomes were estimated as -0.51 (-0.68, -0.29) and -0.56 (-0.68, -0.50), respectively. DIC model fit index values for Cholesky and spherical decompositions were 667.74 and 667.53, respectively; indicating both decomposition techniques were equally good. Further, the Gelman-Rubin convergence statistics were stable and all Monte Carlo errors were around 0.005. Overall, olanzapine, paliperidone and quetiapine were both significantly more effective and acceptable than placebo; whereas aripiprazole, haloperidol ziprasidone, divalproex, and carbamazepine were not. In addition, both lithium and lamotrigine failed to be effective and acceptable.

Our findings exhibit an excellent concordance with the one used in clinical practice. Moreover, the Canadian Network for mood and Anxiety Treatments, and Royal Australian and New Zealand College of Psychiatrists guidelines also recommended these drugs as first-line medications for treating bipolar disorder.

None Declared

Gene-environment interactions increase psychosis risk (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657). However, identifying the genetic variants involved and how they interact with environmental risk factors underlying psychosis remains challenging.

To investigate whether there are gene-environment interactions in the relationships of childhood trauma, lifetime cannabis use, and single nucleotide variants (SNVs) of dopamine D2 receptor (D2R: DRD2), N-methyl-d-aspartate receptor (NMDAR: GRIN1, GRIN2A and GRIN2B) and cannabinoid receptor type 1 (CB1R: CNR1) with psychosis.

In a population-based case-control study nested in an incident study (STREAM, Brazil) (Del-Ben et al. Br J of Psychiatry 2019; 215(6):726-729), part of the EU-GEI consortium (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657), 143 first-episode psychosis patients and 286 community-based controls of both sexes aged between 16 and 64 years were included over a period of 3 years. Twenty-three SNVs of D2R (rs1799978, rs7131056, rs6275), NMDAR (GRIN1: rs4880213, rs11146020; GRIN2A: rs1420040, rs11866328; GRIN2B: rs890, rs2098469, rs7298664), and CB1R genes (CNR1: rs806380, rs806379, rs1049353, rs6454674, rs1535255, rs2023239, rs12720071, rs6928499, rs806374, rs7766029, rs806378, rs10485170, rs9450898), were genotyped from peripheral blood DNA using a custom Illumina HumanCoreExome-24 BeadChip. Environmental adversities were evaluated using the Cannabis Experience Questionnaire (Di Forti et al. The Lancet Psychiatry 2009; 6(5):427–436) and the Childhood Trauma Questionnaire (Grassi-Oliveira et al. Rev Saude Publica 2006; 40(2):249-55). Associations between SNVs and environmental risk factors were performed using the nonparametric multifactor dimensionality reduction software (version 3.0.2).

Single locus analysis showed no association among the 23 SNVs with psychosis; however, gene-environment analysis was significant for the polymorphic loci rs12720071 and rs7766029 in CNR1. The best association models were the two-factor representing by the combination of CNR1 rs12720071 with lifetime cannabis use (p<0.001), and CNR1 rs12720071 with childhood trauma (p<0.05), both suggesting an increased risk of psychosis. Additionally, when considering the interaction of both environmental factors in the same model, we found CNR1 rs7766029 to be associated with psychosis (p<0.001).

Our study supports the hypothesis of gene-environment interactions for psychosis involving the T allele carriers of CNR1 SNVs (rs12720071 and rs7766029), childhood trauma and lifetime cannabis use in psychosis.

None Declared

According to data from the National Statistical Office of the Republic of Korea, the number of suicides increased with increasing age, and the elderly over the age of 65 had a higher suicide success rate using lethal means.

Among mental disorders, depression is known to be the most associated with suicide, and suicidal thoughts help predict the risk of suicide. Dementia, depression, and sleep disorders, which are typical mental health problems of the elderly, require treatment, but only 10% of the elderly receive appropriate treatment at the right time.

The purpose of this study was to identify suicide risk factors among the community dwelling elderly and to reveal their correlations. In addition, the differences of suicide risk factors were analyzed in the cognitively impaired group and the cognitively normal group.

We investigated 20,127 elderly over aged 65, from January 2019 to December 2019. The participants were asked to complete questionnaires. Cognitive function, depression, anxiety, sleep disturbance, suicidal idea data was obtained by mini-mental status examination for dementia screening (MMSE-DS), short geriatric depression scale (SGDS), geriatric anxiety inventory (GAI), Athens insomnia scale (AIS), and scales for suicidal ideation (SSI). We used the Chi-squared test and logistic regression analysis for these data to examine the suicidal risk factors and to analyze the relationships. And differences in suicide risk factors according to cognitive function were also analyzed.

Age, cognitive function, depression, anxiety, and sleep disturbance were identified as risk factors for suicide among the community dwelling elderly. Depression was the factor that increase the risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, the late elderly (85 years or older), and the middle aged elderly (75-84 years old). In addition, depression increased the risk of suicide by 1.86 times in the cognitively impaired group.

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Among community dwelling elderly, depression was the most contributing suicide risk factor. Prevention and treatment of depressive symptoms should be more active in the cognitively impaired group.

None Declared

Air pollution is related to a global increase in mortality and morbidity. The literature on the adverse effects on mental disorders is still limited.

This study aims to investigate the associations between air pollutants and traffic noise with incidence of different categories of mental disorders and drug prescriptions in a large cohort administrative cohort.

We enrolled 1,739,277 individuals 30+ years living in Rome at 2011 census, and followed them up until 31st December 2019. We excluded subjects with prevalent mental disorders at baseline to evaluate the incidence of schizophrenia, bipolar, anxiety, personality and substance use disorders, as well as prescriptions of antipsychotics, antidepressants and anticonvulsants. We assigned annual average concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), Black Carbon (BC), ultrafine particles (UFPs) and noise exposure to baseline residential addresses. We applied Cox regression models with adjustment for individual and area-level covariates.

This study identified variable numbers of incident cases, from 1,280 cases for personality disorders to 200,549 for antidepressants. Each interquartile range increase in PM2.5 (1.13μg/m3) was associated with a hazard ratio (HR) of 1.07 (95% confidence interval: 1.017, 1.127) for schizophrenia spectrum disorder, 1.135 (1.086, 1.186) for depression, 1.097 (1.030, 1.168) for anxiety disorders and 1.112 (1.030-1.200) for substance use disorders. Positive associations were also detected for the other exposures and with the three categories of drug prescriptions. In two-exposure models, PM2.5, UFPs and noise remained associated with schizophrenia spectrum disorders, depression and antidepressant drugs use. The effects were higher in the age group 30-64 than in the 65+. Sensitivity analyses generally yielded similar results

Long-term exposure to air pollutants and noise was associated with increased risks of schizophrenia spectrum disorders, depression and anxiety disorders. The associations with prescriptions of specific drugs increase the credibility of the results.

None Declared

In this interactive session, we will attempt to create a roadmap toward a research career in psychiatry, particularly in challenging settings. Participants will be able to share their experiences and ask questions. Through dialectical discourse, we will identify the essential skills and key competencies for a research career and how to develop them through key strategies and practical exercises. We will try to answer these questions and more. “I like research, but I don’t know where to start?” “I know writing is important, but how can I make the process less painful and even perhaps enjoy writing?” “There is no research tradition in my workplace; how can I find a mentor?” “How can I build confidence in presenting at scientific conferences?” “It’s important to master hard skills, but what could we do with soft skills?”

None Declared

Recent research on Schizophrenia (SCZ) suggests that reduced sleep spindle and slow wave density could be particularly informative of underlying thalamocortical and cortical synchronization mechanisms and dysfunctions. Although sleep disturbances are also highly prevalent across all stages of Bipolar Disorder (BD), the objective evaluation of sleep macrostructure and microstructural oscillatory activity remains understudied in this population.

We aimed to investigate sleep EEG activity in BD, with a focus on sleep architecture, sleep spindles and slow waves.

We recorded high-density EEG (64–channel BrainAmp, Brain Products GmbH, Germany) during sleep in 18 euthymic patients with BD and 18 age/gender-matched healthy control (HC) subjects. After sleep scoring and EEG artifact rejection, several parameters of sleep spindles (12-16 Hz), including density and amplitude, and slow waves (0.1-4 Hz) were identified for the first cycle of sleep using automated algorithms and compared between groups using non-parametric statistics.

BD subjects showed significantly higher Wake After Sleep Onset and lower Sleep Efficiency (Table 1). Total (12 - 16 Hz), slow (12 - 14 Hz) and fast (14 - 16 Hz) sleep spindle parameters of density (Image 1) and amplitude did not differ significantly between groups. On the other hand, slow wave density was reduced in a large frontal cluster of electrodes in the BD group (Image 2).Table 1

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The absence of sleep spindle deficits in the BD group suggests that the systems involved in generating and maintaining these thalamocortical oscillations are presevered during periods of clinical stability in Bipolar Disorder. Conversely, reduced sleep slow wave density points to an altered cortical synchronization, which might represent a common neurophysiological feature shared with Schizophrenia. Further research is needed to confirm these preliminary observations in all–night recordings and with a direct comparison of larger cohorts of patients with both diagnoses.

None Declared

REMSs (Residenze per l’Esecuzione delle Misure di Sicurezza, which roughly translates into Facilities for the execution of security measures) are psychiatric residential facilities introduced in Italy following the discontinuation of Forensic Psychiatric Hospitals, a process started between 2012 and 2014 and concluded in 2017. REMSs are forensic psychiatric communities, focusing on treatment and rehabilitation, managed exclusively by the italian NHS. They host psychiatric patients, who have committed crimes, but are not sended into the ordinary jail circuits because judged as mentally impaired and socially dangerous, with the aim that of stabilizing and treating psychiatric symptoms and that of their gradual social re-insertment. After the closure of psychiatric hospitals in 1978, the overcoming of forensic psychiatric hospitals is the big new thing happening in Italy when it comes to mental health. The introduction of REMSs has spotlighted how much is needed a care program used as a prevention tool, putting the mentally impaired with a social danger profile back into their dignity as human beings. Notwithstanding, after 10 years from its greenlight, some remarkable issues about REMSs system are at hand, starting from long waiting lists, which triggers the double risk of illegal jail detention of the mentally impaired; or leaving free without containment socially dangerous subjects.

Purpose of the present study is to offer an overview of the italian REMSs system, focusing on its critical issues such as waiting lists to be admitted and treading prospects for improvement.

Our work involves a research review on litterature on REMSs, forensic psychiatric services and admitting procedures.

There are 33 REMSs in Italy. As of 31st December 2021, 573 in-patients are hosted in REMSs. The most frequent diagnosis is schizophrenia (33%), followed by personality disorders (32%) and substance abuse (21.4%). 80% of the crimes committed involve violence towards human beings. As of 25th March 2022, the REMSs waiting lists include 605 individuals, 42 of whom were already imprisoned and 561 released. The average waiting time for admittance is about 10 months. Positioning on the waiting list follows the exclusive chronological criterion (date of sentence) and is not related to any clinical risk criteria whatsoever. It is estimated that one third of waiting patients remain without adequate care.

Rethinking the admittance criteria to REMSs is crucial. The use of alternative safety measures, the improvement of community mental health services and a real integration between both legal and heatlh systems in terms of management of the offending psychiatric patient are among ways suggested to avoid breaking the dream of deinstitutionalisation.

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When completing the medical record of a patient with bipolar disoder (BD), hardly anything is more impacting than a family history of completed suicide (FHS). In fact, FHS is a main risk factor for personal suicide attempts and death in this population. There are few modifiable protective factors against suicide in BD, such as lithium treatment and absence of substance abuse.

We aimed to explore the relationship between a FHS and clinical characteristics in patients with BD. Given the impact that FHS has on the individual and on healthcare professionals, we hypothesized that it would modify behaviors towards a higher prevalence of the modifiable protective factors against suicide, namely more treatment with lithium and less drug addiction.

This is a cross-sectional study that included all patients with BD that were followed up in a specialised unit between 1998 and 2020. Only subjects with complete information on FHS were retained for the analysis. We assessed sociodemographic and clinical data and described it with measures of frequency, central tendency and dispersion. Differences between subjects with and without FHS were calculated with χ², Fisher’s exact test and Student’s t-test as appropriate. We set the significance level at p≤0.05. All tests were two-tailed.

The sample consisted of 480 subjects with a mean age of 45.9 years (standard deviation 14.4, range 18-88), of which 54.4% (n=261) were women. 69.2% (n=332) had a diagnosis of BD type I and 30.8% (n=148) of BD type II. 77 subjects (16%) had a FHS. Regarding differences between groups, those with relatives who had committed suicide did not show statistically significant differences in terms of sociodemographic variables (age, gender, civil status, employment) or key clinical features (type of BD, illness duration, psychotic features, predominant polarity, rapid cycling, number of lifetime manic and depressive episodes, comorbid personality disorder), neither did they have a higher use of lithium (55.8% vs 59.3%, p=0.572) nor lower substance use disorder (10.9% vs 15.5%, p=0.34). Predictably, people with FHS had a higher prevalence of family history of mental and affective disorders (96.1% vs 70.9%, p<0.001; 86.3% vs 56.3%, p<0.001) and of stressful life events (71.6% vs 58.9%, p=0.05). Personal lifetime suicide attempts also tended to be higher (36.4% vs 26.7%, p=0.088).

Contrary to our hypothesis, in our sample of subjects with BD a FHS was not associated with a higher prevalence of the modifiable protective factors against suicide. Therefore, although suicide has a major impact both in families and healthcare professionals, our results suggest it does not modify attitudes towards prevention in a real-life scenario. The main limitation of our study is its cross-sectional design, which does not allow for causal inference. In conclusion, there is room for improvement in the fight against suicide.

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Dual disorders constitute a clinical entity with increasing current prevalence (Köck et al. Front Psychiatry 2022; 24 13). There is frequent comorbidity between psychotic spectrum disorders and substance use disorders, which hinders both psychopathological stability and the approach to addictive behaviors (Fleury et al. Adm Policy Ment Health 2022; 20).

The aim of this study is to describe the clinical and sociodemographic characteristics of the consumption pattern of patients diagnosed with psychosis in outpatient follow-up.

A cross-sectional study was designed with 42 users treated at the mental health center between 2019 and 2021, aged between 18 and 65 years, who had consumed alcohol, cannabis, and/or stimulants (amphetamines or cocaine), with a diagnosis of a comorbid psychotic spectrum disorder for over 3 years. A descriptive analysis of the prevalence of consumption of each predominant substance was carried out, as well as the sociodemographic and clinical characteristics were collected through a semi-structured interview. Statistical analyzes were performed using SPSS v23.0 (significance p<0.05).

The predominant user profile was a man (85.7%), with a mean age of around 29 years, single (83.3%), with family support (52.4%), resident in rural areas (92.8%), with unqualified employment (57.1%) and primary studies (60%). Cannabis was the predominant substance (80.9%), followed by amphetamines (71.4%), with polydrug use of both in 78.6% of cases. A significant association was found between this combined use of substances, the relapse rate and the presence of comorbid personality disorder.

The paradigm of substance use in psychotic disorders has evolved towards comorbidity with polydrug use and confluence with personality disorders.

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Description of a job of training technical professionals who have personal experience with Chemical Dependency to work in the area and resocialization of the mentally ill in order to combat social stigma.

Training technical professionals who, having gone through the experience of the disease, wish to help others and by participating in the training course for therapists in chemical dependence, they will seek to combat stigma.

The Chemical Dependency Therapist Training course is a free course and takes place online, through a platform on a social network, which allows students to access it at any time of the day and can access it from outside Brazil.In the course students receive daily communication from the educational deparmtent. All patients during the hospitalization period are invited to attend the course, write down their doubts with the course professors.

The creation of a free online course, which has patient students and enrolled students from Brazil and the world, will help to train more professionals capable of working with chemical dependency.

The online course has 1,800 students enrolled in 2022. These are students from Brazil and abroad, such as Portugal, France, Italy, Angola, United Kingdom, Finland, who are developing more knowledge and becoming professionals in the area of chemical dependence.

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