Tianeptine is prescribed as an antidepresant in Europe. The prescription drug is produced as tianeptine sodium. However, it can also be found on the Internet as tianeptine sulfate sold as a nootropric. Misuse of tianeptine sodium has been documented, but there’s little scientific evidence of tianeptine sulfate use.

Review the use of tianeptine sulfate without prescription.

Present a clinical report of tianeptine sulfate use.

PubMed review of tienptine use without prescription.

Clinical report of a patient using tianeptine sulfate adquiered on the Internet.

Systematic review on PubMed using the search term “tianeptine abuse” conducted on 01/10/2022. A total of 71 articles were found from wich 33 mentioned the use of tianeptine use without prescription. A total of 23 case reports of tianeptine use without prescription were found. None of them made the difference between tiaenptine sodium or tianeptine sulfate. Only one article mentioned the use of tianeptine sulfate from an Internet search on Internet fora (Smith et al. Am J Drug Alcohol Abuse 2021 47(4), 455–466).

The case report of a 23 years old patient is presented. Diagnoses: ADHD (F98.8); Psychotic episodes four (F23) and two (F16.150) years ago; Major depressive disorder (F32.2). Use of psychedelics, cannabis, psychoestimulants and opioids meeting substance use disorder (SUD) criteria. The patient brought proof of the tianeptine sulfate bought on the Internet (image 1) for self-treatment of his depressive symptoms. Tianeptine sodium is prescribed. The patient then restarts opioid use with fear of a new opioid use disorder episode and an oxicodone prescription is maintained. The patient then interrupts the antipsychotic medication and suffers a psychotic relapse. After this psychotic episode a LAI treatment with paliperidone is started. Currently, the patient is recovered and maintains psychopathological stability and abstinence from other substances. Blod test result unaltered. Current treatment: lisdexamphetamine 70mg /day, tianeptina sodium 12.5mg/day; oxicodone 40mg/12h and paliperidone 150mg /28d.

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Tianeptine sulfate is believed to present some diferences versus tianeptine sodium: it is sold only through the Internet without prescrption, the daily dose is 25mg per day versus 12.5mg every 8 hours and it might be more potent and long lasting. Those differences were confirmed by the patient after the prescription of tianeptine sodium.

Self-medication with psychoactive substances is one of the theories for substance use and might lead to a substance use disorder. This case shows how the prescription of a drug similar to the one used without presription might favour the therapeutical alliance and reduce the risk associated to the use of non-regulated substances.

Further research is needed to better understand the use of tianeptine sulfate.

None Declared

Addiction is a disease that comes with a range of consequences. Its physical, mental, personal, social and financial repercussions could not be neglected. Yet, this issue is still stigmatized. It is a public health problem that may affect people from different backgrounds including healthcare professionals.

To investigate the risk factors for a substance addiction: cigarette addiction and behavioral addiction: internet addiction among health care professionals.

A cross-sectional bi-centric study was conducted among healthcare workers from two public hospitals in the center-east of Tunisia. A questionnaire was distributed to those who gave their oral consent to take part in the study. It included items related to participants’ socio-demographic characteristics, medical history, self-esteem and mood assessment. It combined questions from the Rosemberg self-esteem scale (RSES) and the Beck Depression Inventory alongside with validated tests: Adverse Childhood Experiences (ACE-IQ), the Fagerstrom Test for Cigarette Dependence and the Internet Addiction Test (IAT).

Among respondents, 16.1% were smokers. Risk factors for smoking were: being a male (OR=9.62), being in contact with patients (OR=4.75), a job tenure exceeding ten years (OR=3.11), having regular alcohol consumption (OR=7.27), unprotected sex (OR=9.24), depression (OR=3.87) or having suffered from sexual abuse during childhood (3.07). Nevertheless, practicing sport regularly (OR=0.32) and anxiety (OR=0.23) were identified protective factors. A high level of cigarette addiction was observed with 34.3% of cigarette smokers. Predictors of high cigarette dependence were: job tenure over ten years (OR=20.69), regular alcohol consumption (OR=6.11) and unprotected sex (OR=7.14). Among healthcare workers, 70.8% reported a normal internet use. Internet addiction was specially seen with those who were not engaged (OR=2,92) and those who worried about being unsuccessful (OR=1.91). Good self-esteem and being older were protective factors with OR=0.49 and OR=0.38 successively. Depression did not contribute to the development of internet addiction, on the opposite it protected against it (OR=0.36).

Cigarette and internet addiction are threatening health problems that need more effort to screen and address. This public health issue has never stopped growing with the emergence of new types of illicit drugs and behaviours. Finally, this study draws attention to the importance of assessing the prevalence of different categories of addiction in Tunisia and highlights the necessity of updating policies used to address these addictions in a timely and appropriate way.

None Declared

Social network addicts may differ significantly from non-addicts in terms of personality traits, such as agreeableness, neuroticism, and conscientiousness. Addicts may be prone to negative emotions and unpleasant experiences, which may be associated with a higher level of neuroticism. Addicts often fail to cope in the real world, often experience negative emotions, quickly give up their goals, see themselves and others in a negative light, and escape into virtual reality. The virtual world is devoid of the anxiety that an individual faces in real life interactions, hence the tendency for addiction among people with higher levels of neuroticism. The primary cause of Internet Addiction may be innate temperamental traits (i.e., impulsiveness of behavior and impulsiveness of decisions) that influence the susceptibility to functional and chemical addictions. According to the concept of addictive personality, people who have this problem are prone to addiction as such, regardless of what they are addicted to.

The purpose of this study was to generally assess the degree of women’s dependence on social networking sites on the example of Facebook, taking into account personality traits according to the five-factor model of personality, the so-called Big Five by Costa and McCrae

The study included 556 women. This survey-based study was carried out using the questionnaire technique. The following research tools were used to analyze behavioral addictions in adult women: the Bergen Face- book Addiction Scale (BFAS), the NEO Five-Factor Inventory (NEO FFI) and the author’s questionnaire.

Among the surveyed women, 69.6% were average Facebook users, of whom 16.4% had scores indicating possible Facebook addiction, and 14.0% had scores indicating addiction. The higher the neuroticism, the more serious the Facebook addiction (r = 0.26; p < 0.001; R2 = 6.7%). A weak negative correlation was obtained for the agreeableness subscale e (r = -0.08; p < 0.05; R2 = 7.2%). A weak negative correlation was also obtained for the subscale of conscientiousness (r = -0.16; p < 0.001; R2 = 2.6%). There was no statistically significant correlation between the log10 score obtained on the BFAS and the score on the NEO-FFI subscales of extraversion (r = 0.04; p = 0.40) and openness to experience (r = 0.04; p = 0.30).

The personality types of the studied women indicated relationships in terms of behavioral addictions. Women characterized by neuroticism showed stronger addiction to Facebook. Women characterized by high conscientiousness were at lower risk of behavioral addictions, while agreeableness as a personality trait significantly protected the surveyed women against Facebook addiction.

None Declared

Behavioral addictions are a growing problem in the society. Digital technologies are used by people of different ages, and their number is increasing every year. The precise reasons for the development of addictions remain unknown. In the case of behavioral addictions, especially Internet addiction, the significance of personality traits and behaviors predisposing an individual to addiction, such as depressiveness, anxiety, hostile attitude, aggression, impulsiveness, psychotic behaviors, shyness and self-esteem disorders, are emphasized. Personality predispositions play an essential role in Internet addiction.

The aim of this study was a general assessment of the level of Internet addiction with regard to personality traits according to the Big Five model by Costa and McCrae among women from the West Pomeranian Voivodeship.

The study involved 556 women, whose average age was 34 years and who met the inclusion criteria: female sex, age of 18 years or above, place of residence in the West Pomeranian Voivodship, an informed consent for participation in the study, and completion of the set of questionnaires. The study was conducted using a diagnostic poll method with a questionnaire technique. To carry out the analysis both author’s own and standardized tools were used: the author’s questionnaire covering socio-demographic data, the NEO-Five Factor Inventory which assesses the levels of personality traits, and the Internet Addiction Test used to measure behaviors and characteristics related to compulsive use of the Internet.

Most (70.9%) of the women were average users of the Internet, 25% of respondents were at risk of addiction, and the least numerous group of women (4.1%) was addicted to the Internet. Conscientiousness negatively correlated with Internet addiction (r = -0.22; p < 0.001; R2 = 4.9%). Openness to experience was conducive to Internet addiction (r = 0.15; p < 0.001; R2 = 11.1%). A positive link between neuroticism and Internet addictions was established (r = 0.33; p < 0.001; R2 = 11.1%). No significant relationships between Internet addiction and extraversion (r = 0.03; p = 0.45) as well as agreeableness (r = -0.07; p = 0.10) were demonstrated.

The type of personality of the studied women implicated relationships to Internet addiction. Neuroticism might be a personality trait that particularly predisposes to an increased risk of Internet addiction. Openness to experience was conducive to Internet Addiction. Low levels of conscientiousness more often become addicted to the Internet.

None Declared

Up to 80 % of patients with alcohol use disorders (AUD) display cognitive impairments. Some studies suggested that cognitive functions could be worsened by hepatic damage, particularly cirrhosis. Cirrhosis is widespread in patients with AUD, indeed one third of them develop cirrhosis during their lifetime (Zhang et al. Alcohol Clin Exp Res. 2022). Currently, patients treated for cirrhosis do not benefit from a systematic assessment of alcohol related cognitive impairments. The Brief Screening Tool for Alcohol-Related Neuropsychological Impairments (BEARNI) is a specific tool developed to screening for those impairments.

The primary objective of this study was to compare BEARNI mean scores in a group of AUD patients with (AUD/C+) or without cirrhosis (AUD/C-).

We conducted a prospective, monocentric study at the Amiens University Hospital. Subjects were consecutively recruited from the hepato-gastroenterology department of Amiens University hospital and from the local substance abuse treatment department. All patients were assessed using BEARNI test, demographical (age, gender, number of years of scholarship), and clinical variables, using Child-Pugh scores and Alcohol use disorders identification test (AUDIT). The BEARNI mean score in the AUD/C+ group was compared to the mean score in the AUD/C- group using an Analysis of covariance (ANCOVA) with age and educational level as covariate. Between group comparisons were performed using post hoc analysis with Tukey HSD test.

107 patients (75 AUD/C+, 32 AUD/C-) were included in this study. AUD/C- patients were significantly younger than AUD/C+ patients (respectively, 45.5 ± 6.8 vs 59.3 ± 9.3; p<0.0001). There were no differences regarding gender and years of scholarship. Child-Pugh mean scores were 6.9 ± 2.4 in the AUD/C+ group. AUDIT mean scores were significantly lower in the group of patients with AUD and cirrhosis than in the group of patients with AUD without cirrhosis. After adjusting on age and educational level, we found that mean BEARNI total and cognitive scores in the group of patients with AUD and cirrhosis were significantly lower than in the group of patients with AUD without cirrhosis (respectively, 13.8 ± 0.7 vs 7.8± 0.4 F=46.8; p<0.0001 and 10.6 ± 0.6 vs 6.9± 0.3; F=30.1; p<0.0001). The mean subscores of delayed verbal memory, alphabetical ordination, alternating verbal fluency and ataxia subtests were also significantly lower in the group of group of patients AUD/C + (respectively, 1.8 ± 0.1 vs 2.8 ± 0.2, F= 13.9, p<0.0001; 1.8 ± 0.1 vs 2.6 ± 0.2, F= 10.6, p<0.0001; 2.4 ± 0.1 vs 3.6 ± 0.2, F= 13.4, p<0.0001; 0.9 ± 0.2 vs 3.1 ± 0.2, F= 30.6, p<0.0001).

In the present study, the patients with AUD and cirrhosis had more cognitive impairments than their counterparts without cirrhosis. Longitudinal studies are needed to investigate how cirrhosis can influence cognitive impairments.

None Declared

Contemporary children practically live in cyberspace, constantly using various devices,and many of them have an addiction that leads to violations of their mental and physical formation.

Based on the mental and the physical examination of children suffering on cyber addiction with the sings of clinical manifestations determine the targets and form of ccmbined correctional rehabilitation system.

The clinical investigation based on psychiatric examination with the narrative motivation interview,psychological examination by Eysenck “extra/introversion”test and physical examination with special attention to the musculoskeletal system.

The randomized investigation of childhood population was performed.198 children of different age (7 – 14 years old) were examined.72 (36.4%) of them showed significant signs of cyber addiction with a narrowing of interests, a reduction in social ties, and a decrease in school performance. They spent from 3 to 10 hours on gadgets per day.140 (71%) of them, also showed signs of fubbing, that is, the priority of telephone communication over direct communication with the interlocutor.The significant results of Eysenck test examination were following: 126(64%) of them were introverts and 72(36%) of them were extraverts. During the physical examination,91 (46%) of these children had different spine and musculoskeletal disturbances.In the group of addictional children the vast majority of subjects, 87%, have characteristic defects of the musculoskeletal system. The most symptomatic in the diagnosis of cyberaddiction and phubbing of school-age children are: round back, stooping, scoliotic posture and types of lateroflexion.The severity of cyber addiction and the degree of musculoskeletal disorders were inversely proportional. The results served as the basis for the development of a combined system of psycho-physical rehabilitation. The psychotherapy based on CBT according to A. Beck, modified for children’s in concordance with specialized program “Vertebra-Dinamik” to correct defects of the musculoskeletal system. The basis of the corrective “Vertebra-Dinamik” technique includes a comprehensive approach to the use of isometric and statodynamic exercises of moderate intensity with elements of relaxation. Approbation of the developed system showed its high( 80%) and moderate(20%) efficiency.

To successfully overcome cyber addiction and its negative consequences, the most optimal system is the complex application of psychotherapeutic and physical rehabilitation methods.

None Declared

Alcohol Use Disorder (AUD) is one of the most significant public health problems in Europe, being highly associated with several medical and psychiatric comorbidities. Sleep disturbances are in this interface and may include insomnia, alterations of sleep architecture and circadian rhythm abnormalities, breathing-related sleep disorders, and sleep-related movement disorders. Also, considering the three stages of the addiction cycle (binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation) and since these domains are reflected in key regions of the brain, it is possible to map these nearly ubiquitous sleep disturbances.

This review aims to summarize the current literature related to the association between sleep disorders and AUD, with a focus on its clinical aspects and neurobiology.

Non-systematic research was made recurring to the PubMed database, with the keywords “alcohol use disorder”, “sleep”, “sleep disorder”. The most relevant articles were selected, focusing on articles published in the last decade.

In patients with AUD, the prevalence of insomnia ranges from 36-91%. A possible mechanism underlies in a mismatch involving maintained activity in wake-promoting structures during non-rapid eye movement sleep (NREM) and a blunted homeostatic drive. On the other hand, alcohol consumption also affects the normal sleep-wake cycle, due to a disruption in the underlying circadian rhythms, a mechanism compassed by the suprachiasmatic nucleus and by photic and non-photic cues. Considering this, it seems highly likely that insomnia and circadian abnormalities may coexist in some individuals. Moreover, AUD is implicated in initiation or worsening of breathing-related events in sleep, especially when having a history of snoring or sleep apnoea syndrome and in period limb movement disorder.

Simultaneously, sleep disorders in AUD can be incorporated into the three-stage addiction cycle. In the binge/intoxication stage, excessive alcohol intake leads to a faster sleep onset but poor sleep quality, explained by the effects on GABAergic systems. During the withdrawal/negative affect stage, there is a decrease in slow-wave sleep and limited rapid eye movement (REM) sleep recovery, which can be explained by the alcohol-positive allosteric modulation of GABAA receptor and other mechanisms. Lastly, during the preoccupation/anticipation stage, the glutamatergic system dysregulation contributes to persistent sleep disturbances, including insomnia, decrease in slow-wave sleep, and an increase in REM sleep.

The knowledge of sleep disturbances associated with AUD has grown and has suggested a bidirectional process that appears to play an essential role in the addiction process. Further studies investigating this association are warranted.

None Declared

There is a variety of specialized outpatient and residential Alcohol and Other Drugs (AOD) services, but research on outcomes of these services is limited. Given the chronic, relapsing nature of AOD problems, there is a need for longitudinal research on outcomes after treatment in various AOD services.

Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) are hardly used in the AOD field but provide excellent tools and a framework to monitor progress and outcomes in these services based on experiences of service users.

The objectives of the OMER-BE study are to:

1. Assess and compare patient characteristics at baseline in various treatment modalities

2. Test and prepare the routine measurement of PROMs and PREMs in AOD services using a self-report tool

3. Assess patient-reported experiences qualitatively in various treatment modalities for AOD patients

The overall goal is to continuously assess and improve AOD services.

We have set up a naturalistic, longitudinal cohort study for which we will engage and follow up 250 AOD users as they present themselves in selected AOD services in four different treatment modalities (outpatient non-pharmacological treatment, outpatient substitution treatment, residential psychiatric treatment and therapeutic communities for addictions).

Sociodemographic and clinical factors and PROMs will be assessed at baseline. PROMs and PREMs will be assessed at 45-, 90- and 180-days follow-up. The questionnaires that will be used during the baseline and follow-up assessments are based on the ICHOM Standard Set for Addictions (ICHOM SSA, 2020), a set of brief validated questionnaires to measure and monitor treatment outcomes routinely in AOD services.

Following the 6-month follow-up we will perform a qualitative study in a subset of N=20 participants (5 per treatment modality). These participants will be invited to take part in an in-depth interview with one of the researchers, where the following topics will be discussed: treatment history, recovery experiences, helping and hindering factors in recovery, and experiences with different treatment modalities.

47 participants have been recruited in the OMER-BE study up until October 2022. 38 (81%) of the participants were born male, 9 (19%) were born female. The average age of participants is 33, with ages ranging from 19 to 47 years old.

Preliminary findings will be presented at the congress.

Further recruitment of study participants up to a total of 250 will be undertaken until the end of 2023.

The OMER-BE study aims to assess and improve AOD services by using a self-report tool, measuring PROMs and PREMs.

None Declared

Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing neurodevelopmental disorder affecting 2-5% of children. These children are at risk of negative health, social and educational outcomes; ADHD incurs an estimated £670 million annual cost to health, education and social care in the UK. Children with ADHD often experience severe difficulties at school despite drug treatment: effective psychosocial interventions are needed. There is mixed evidence for the effectiveness of existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting the preferences of teachers for short, flexible strategies that suit a range of ADHD-related classroom-based problems.

To develop a prototype of a school-based intervention for ADHD.

Intervention Mapping, a framework for developing theory- and evidence-informed interventions with explicit consideration of implementation context, was used. Logic models were developed of the behaviour change steps required by each agent in the school system to improve outcomes for students with ADHD.

A comprehensive evidence synthesis was conducted for interventions that targeted the key outcomes of relevance (inattention, impulsivity, hyperactivity, peer and teacher relationships, self-esteem, executive functions and organisation skills); findings were integrated alongside behaviour change theory and theories of the underlying aetiology of ADHD, in order to develop a logic model for the intervention. Components of the intervention were then developed in line with the logic model using evidence-based behaviour change methods, with input from people with ADHD, school staff and other key stakeholders at every stage of the development process.

The development process resulted in a prototype digital platform that can be utilised to deliver a personalised behavioural intervention for children with ADHD within primary schools. It contains some core components that all teachers and children will complete, and then is individualised based on the key problems each child is currently facing. There are six optional modules, each containing a range of behavioural strategies for teachers to implement with the student or the whole class. The toolkit includes a symptom tracking graph that teachers can use to visualise the progress a child is making, and is developed to align with the current resources and capacity of primary schools in the UK.

The prototype intervention is designed explicitly to fit with existing school structures and demands, and to be low cost in terms of delivery and training. It focusses on adapting the school environment to better suit children with high levels of ADHD symptoms. It is now being feasibility tested, and in this talk I will describe the development process using Intervention Mapping, and the initial feedback from the first testing of implementation of the prototype.

None Declared

The ASD Day Therapeutic Unit of the HUMT is an interdisciplinary reference center specialized in ASD, for the care of children and adolescents with this pathology, that offers care by programs with the aim of achieving functionality altered.

The main objective of this study is to know the clinical characteristics of the patients admitted to our center and to offer preliminary data on the functional improvement achieved in a pilot program that works by processes.

This is a prospective clinical study of patients with ASD, treated at the ASD Day Therapeutic Unit of the HUMT since februay 2022 till nowadays. We compare the clinical improvement and functionality acquired through the evaluation through various scales: Conners scale, SRS, BRIEF and CBCL.

Our sample is made up of 19 patients with ASD who are admitted to the HUMT ASD Day Hospital. 13 belonged to the intensive care program, 5 to recovery of low-functioning functionality, and 1 to the differential diagnosis program. 84.21% (n=16) have preserved cognitive capacity. The median age is 13.1 years. 73.7% of the sample are men.

We observed that 89% of patients admitted to our unit presented comorbid symptoms with ADHD. more than 78.9% present isolation, anxiety/depression, altered thinking and attention difficulties. 13/19 present a SEVERE RANGE OF AFFECTATION upon admission, in social area. Facing discharge, the CBCL shows us a general improvement in behavior and comorbidity in the total scale.

The SRS shows us an improvement in social awareness, social communication, social motivation, repetitive behavior and stereotypes and in the total score.

Specific interventions in social skills, autonomy, social understanding, daily routines, and sensory integration in patients with ASD improve core symptoms, as well as associated behavior.

Specific interventions and working on social relationships during admission improve comorbidity derived from ASD.

More studies are needed to specify the most efficient interventions to improve the quality of life in children and teenagers with ASD.

None Declared

We present a case of a 15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis.

To describe a case of an Unspecified Organic Personality and Behavioral Disorder secondary to brain damage from Human Herpes Virus-6 (HHV-6) Encephalitis in an 11 year-old childand to review recent literature, in order to improve clinical practice.

Clinical case report and brief review of literature. A bibliographic research was made in the database PubMed, using the terms “Viral Encephalitis” AND “Neuropsychiatric symptoms”; “Viral Encephalitis” AND “Behavioral Disorder”; “Long-Term Neurological Morbidity” AND “Viral Encephalitis”.

15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis, secondary to immunosupression in the context of haematopoietic progenitor transplantation (HPT) at 11 years old. MRI showed supratentorial ventriculomegaly, atrophic changes in encephalon and right hippocampus with subcortical retraction secondary to previous encephalitis. Clinically, main changes appeared in behavior, presenting a serious frontal syndrome with high disinhibition, what implied severe social and academic difficulties. During the outpatient follow-up, the behavioural disorder is being pharmacologically treated with Risperidone 1,5mg per day with a partially favorable evolution. The patient presented intolerance to olanzapine, with an episode of low level of conciuosness after taking it.

Bibliographic research results indicate that the gold standard treatment for behavioral disturbances are antipsychotics. Risperdidone is proven save for treatment in children. Results point out also the importance of an early multidisciplinar intervention, involving family training, rehabilitation resources and curricular adaptations.

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Viral encephalitis may have serious neuropsychiatric consequences, especially during childhood while the brain development is not finished. When the neurological damage affects the frontal lobes of the brain, behavioural and personality disturbances are expected and an early multidisciplinar intervention should be considered. Antypsichotics are the gold standard pharmacological treatment for behavioural disturbances. During the scholar period, special curricular adaptations should be done in order to reduce study-related stress.

None Declared

Central nervous system (CNS) tumours are the most common type of solid tumour in the paediatric population. Although advances in treatment have improved survival rates, there is a substantial body of literature documenting the potential long-term effects such as psychological, neurocognitive and health-related sequelae experienced by survivors of paediatric brain tumours. TMS is a non-invasive brain stimulation technique that uses electrical stimuli applied to the cranial surface to restore neuronal connections damaged because of CNS disruption (Burke et. al., 2019).

To test the efficacy of TMS in a patient diagnosed with a CNS tumour who reported pain and suffered severe cognitive-behavioural alterations refractory to other pharmacological treatments.

Case Presentation. A 12-year-old boy diagnosed with a hypothalamic-pituitary tumour at the age of 9, having received surgical treatment, radiotherapy and chemotherapy. He suffered loss of vision, cognitive-behavioural and emotional sequelae, and pain, for which he received various pharmacological treatments without benefit. Treatment. The patient underwent a total of 25 sessions where each session took 20 minutes to complete for 3 sessions per week. TMS intervention consisted of 1200 inhibitory magnetic pulses with a frequency of 1hz on right DLPFC at an intensity of 110% of resting motor threshold. Stimulations were carried out using a Magventure MagPro X100 equipment with a double-cone coil. The clinical assessment included The Silhouettes Fatigue Scale (PHQ-9), Pain Catastrophizing Scale (PCS) and Numerical Rating Scale (NRS), verbal subtests of the Weschler Intelligence Scale for Children (WISC-V), Patient Health Questionnaire (PHQ-9) and the Sleep Disturbance Scale for Children, SDSC

In the post-treatment clinical interview with the family, qualitative changes included a decrease in subjective complaints of pain and fatigue. The family reported that the child stopped sleeping tied up after the intervention and a significant change in slowness was observed, which was accompanied by a higher level of awareness and consequently a slight improvement at the behavioural level, which at the present time does allow for psychological intervention. The psychometric results were clinically improved for psychomotor activity, sleep, emotional alterations, and all cognitive domains.

25 sessions of TMS in the right DLPFC could show beneficial effects on pain, fatigue, cognition, health and sleep variables in patients with drug-resistant sequelae derived from CNS tumours. Longitudinal studies with larger sample sizes are needed to determine whether the effects observed after TMS intervention in paediatric patients with CNS diseases are significant.

None Declared

Transcranial Magnetic Stimulation is a non invasive brain stimulation technique used for several neuropsychiatric conditions. The treatment of Acute Lymphoblastic Leukaemia (ALL) involves many cytotoxic drugs that inhibit the rapid growth of cancer cells, but also damage healthy cells, resulting in a wide range of adverse effects (Śliwa-Tytko et al., 2022). Studies have shown that approximately 10-30% of paediatric ALL patients suffer from psychiatric disorders. Therefore, new therapeutic tools are needed, and repetitive transcranial magnetic stimulation (rTMS) has demonstrated tolerability, effectiveness and safety in children (Allen et al., 2017).

We discuss the first case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in who underwent Continuous Theta-Burst Stimulation

Case Presentation. In this study, we describe a case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in November 2016 who completed treatment in July 2019. Since April 2018 she presented symptoms of intracranial hypertension and encephalopathy with behavioural alterations, attention deficit secondary to toxicity. Psychotic outbreaks after toxicity from different treatments was also present. Since starting pericyazine (July 2022) there has been a slight improvement, but her symptoms continue to have a severe impact in her daily functioning. Baseline developmental profile assessed with the Battelle Inventory was significantly below the expected level in all developmental areas except for gross motor skills. Treatment. The TMS intervention consisted of the application on right DLPFC (F4), inhibitory cTBS protocol (5Hz bursts and 3 pulses of 50 Hz each). The protocol consisted in delivering 2 sessions per day for 15 days (separated by 55 minutes), 4 minutes per session (3600 pulses/session), 30 sessions in total. An intensity of 100% of resting motor threshold (C4). TMS was performed with the Magventure Magpro X100 MagOption equipment, Cool DB-80 double cone coil. The Child Behaviour Checklist (CBCL) for parents was used to assess intervention effects.

CBCL results reflect improvements in both internalising and externalising total scores after treatment. Specifically, the patient presents clinically significant decreases in several dimensions such as anxious/depressed symptoms, somatic complaints, and social problems. No adverse effects have been reported since the beginning of the intervention.

Internalising and externalising behaviours severity were reduced after 30 TMS sessions. In accordance with the latest systematic reviews on the safety of TMS in the paediatric patient (Zewdie et al, 2020) we propose the development of paediatric guidelines to offer this technique to patients with a history of intolerability or poor drug response.

None Declared

The Food and Drug Administration (FDA) recently issued new warnings about the possible effects of the repeated or prolonged use of general anaesthesia and sedatives on the brain development of children under 4 years old during surgeries or paediatric procedures.

To evaluate the possible long-term neurotoxic impact the exposure to general anaesthesia has on the paediatric population from 0 to 4 years, which is the period during which the brain develops.

Initially, a search for observational studies that described the risk of neurotoxicity and alterations in the long-term cognitive development of children exposed to general anaesthesia before 4 years of age, was performed in PubMed between 2016 and 2020.

Finally, 5 retrospective cohort studies comparing children exposed and not exposed to general anaesthesia were included in this study. None of these showed significant differences in their main study variables. However, three of this studies found significant differences in some of the secondary variables such as speed of processing, motor skills, internalization of behaviour and learning, and attention deficit hyperactivity disorder (ADHD).

In vitro and in vivo studies of anesthetics have shown serious neurotoxic effects in the developing brain. However, the clinical relevance of these findings for children undergoing anesthesia remains unclear.

Most of these studies suggest a strong relationship between exposure to anesthesia in children aged 0 to 4 years, this being greater after multiple exposures. Despite these results, many of these articles conclude that further research is needed on this topic.

None Declared

There is a paucity of population-based longitudinal studies examining the associations between childhood behavioural problems and alcohol use disorders in later life.

This study aimed to examine the association between hyperactivity/inattention problems in early adolescence and the risk of alcohol use disorders in young adulthood.

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based prospective cohort based in Bristol, United Kingdom. Hyperactivity/inattention problems at 11 years of age were measured using the Strengths and Difficulties Questionnaire (SDQ). Logistic regression analyses were used to examine associations. E-values (E) were calculated to estimate the extent of unmeasured confounding.

Hyperactivity/ inattention problems in early adolesce were associated with a 1.75-fold increased risk of any alcohol use disorders (OR = 1.75, 95% CI: 1.20-2.56; E= 2.90, CI: 1.69) and a 4-fold increased risk of severe alcohol use disorders at age 24 (OR = 4.35, 95% CI: 2.00 – 9.47; E= 8.17, CI: 3.58). We also found a 2.09 (OR = 2.09, 95 % CI: 1.24-3.53; E= 3.60, CI: 1.79) and 1.63-fold (OR = 1.63, 95% CI: 1.07 – 2.49; E= 2.64, CI: 1.34) increased risk of alcohol dependence symptoms and alcohol abuse symptoms at age 24 in offspring who had hyperactivity problems at age 11, respectively.

Hyperactivity/ inattention problems in early adolesce were associated with an increased risk of alcohol use disorder symptoms in adulthood, even when controlling for conduct problems. Associations did not appear to differ by gender and unmeasured or unknown confounders were unlikely to alter the observed associations.

None Declared

Attention deficit and hyperactivity disorder (ADHD) and Anxiety disorder (AD) are psychiatric conditions that should be kept in mind in every child and adolescent presenting with irritability. It is known that circadian rhythm disorders and especially the evening type chronotype are associated with ADHD and AD symptoms.

In this study, it was aimed to reveal the relationship between the chronotype and sleep habits and the level of irritability between the two groups in children and adolescents with AD and ADHD.

In this cross-sectional study, 38 cases diagnosed with AD for the first time, 38 cases diagnosed with ADHD for the first time, and 76 healthy control groups without any psychiatric disorder or physical disease were included in this cross-sectional study. In the study, the sleep habits of the participants were evaluated with the Child Sleep Habits Questionnaire (CIAA); the chronotype preferences of the participants with the Child Chronotype Questionnaire (CCTQ) and the irritability levels of the children with the Affective Reactivity Index parent report form (ARI-P)

It was observed that the AD and ADHD groups had significantly higher ARI-P, CCTQ and CIAA scores compared to the control group. In the correlation analysis, when ADHD and AD were evaluated alone, no significant difference was found between CIAA and ARI-P. The ADHD group had higher CCTQ and ARI-P scores, although not statistically significant, compared to the AD group. Although there was no significant relationship in the AD group, a weak relationship was found between CIAA and ARI-P in the ADHD group.

In our study, it was observed that the evening type chronotype was more prevalent in children with ADHD and AD, and sleep disorders and irritability were more common than the control group. When ADHD and AD groups were compared, no statistically significant difference was found. In the literature, it has been stated that evening chronotype carries a higher risk in terms of psychopathology, irritability seen at a young age can predict anxiety and mood disorders in adulthood, and irritability seen in ADHD can predict mood disorders that occur during follow-up. In this context, investigating the relationship between irritability, sleep disorders and chronotype on the basis of psychopathologies can make important contributions to the literatüre.

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Temperament and mental illness are considered to be variations along the same continuum of imbalance in the neurophysiological regulation of behaviour.

This presentation presents the benefits of constructivism approach to psychiatric taxonomies.

The presentation reviews findings in neurochemistry that link temperament traits in healthy individuals and symptoms of psychiatric disorders to complex relationships between neurotransmitter systems.

Specialization between neurotransmitter systems underlying temperament traits is analyzed here from a functional ecology perspective that considers the structure of adult temperament corresponding to the functional structure of human activities. In contrast to a more popular search for neuroanatomic biomarkers of psychopathology and temperament traits in healthy individuals, this presentation focuses on neurochemistry-based biomarkers. The roles of monoamine neurotransmitters (serotonin, dopamine, noradrenalin), as well as the roles of acetylcholine, neuropeptides and opioid receptor systems in the regulation of specific dynamical properties of behaviour are summarized within the neurochemical Functional Ensemble of Temperament (FET) model (Table 1) (Trofimova & Robbins, Neurosci Biobehav Rev, 2016, 64, 382-402; Trofimova, Neuropsychobiology, 2021, 80(2), 101-133).

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The FET framework allows having a neurochemistry-based structure of a taxonomy that can classify both, healthy bio-psychological traits and symptoms of psychopathology. The presentation will give examples of how the FET framework can be used in psychiatry and clinical psychology.

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Handwriting disorders (HDs) are prevalent in elementary school children, but their nature is poorly understood. Moreover, the diagnosis of dysgraphia is often too quickly concluded on a single assessment.

In the present study, we aimed to use a transdisciplinary assessment approach. We looked for to provide objective data to better understand the nature and aetiology of HDs.

27 school aged children with HDs aged 6-11 years were included in the study and were compared to typically developing children. They performed a normed prescriptural task of copying cycloid loops. Postural and gestural inter-segmental coordination of arm movements were recorded with two video cameras allowing 2D reconstruction of the gesture. Spatial/temporal kinetic and kinematic measures were recorded with a digital pen. All children underwent normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The handwriting test (BKK) were used.

Handwriting disorders seem very heterogeneous. However, there is a significantly poorer gestural of inter-segmental coordination and of kinetic/kinematic performances of the tracings in HDs. Furthermore, it was possible to highlight three levels of HDs: mild HD not detected by the BHK test (26% of children), moderate HD with the BHK (33%), dysgraphia identified by the BHK (41% of children). The mild nature of HDs not dectected by the BHK seems to occur to a relatively low frequency with associated disorders identified during clinical assessments. On the contrary, dysgraphia appears linked to a high frequency of the associated disorders with a majority of oculomotor disorders (55% of children) leading to visual-perceptual difficulties (44%).

HDs appear to be multifactorial but have a common characteristics of immaturity of gestural synergy of the arm, associated with poorer spatio-temporal kinetic and kinematic parameters. Dysgraphia occurs with more severe disorders as oculomotor and visual perception impairments. Our findings highlight the importance to identified a nosography of HDs with a transdisciplinary evaluation to better understand the nature and aetiology of the disorders in order to better clinical decision-making processes for handwriting remediations.

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The classification system of personality disorders underlies historical transformation processes. In 1980 the DSM-III introduced a categorial approach to systematize personality disorders. With further research the alternative DSM-5 Model for Personality Disorders with categorial and dimensional elements was introduced in 2013. Latest changes manifest with a dimensional classification system of personality disorders in ICD-11. The transition from a categorial towards a dimensional classification system of personality disorders is framed as a ‘paradigm shift’.

Aim of this investigation is to describe these transitions and analyze if these changes correspond to the term ‘paradigm’ in Thomas Kuhn sense (Kuhn Uni. of Chicago Press 1962), or are more a form of continuous and gradual change. Particularly I examine how knowledge transforms within the disciplines of psychiatry and psychology, and how the arena in which the scientific discussions are negotiated is constituted.

To analyze the historical transformation processes within the scientific communities a qualitative reconstructive approach is chosen. An extensive bibliometric literature research in the databases Web of Science, PubMed and JSTOR is conducted. Back and forward citation are taken into account until a dense set of primary and secondary sources from 1970-2022 is accumulated.

Results show that the transition from a categorial towards a dimensional classification system of personality disorders is not a classical ‘paradigm shift’ in Thomas Kuhn sense. The changes have the character of gradual and fluid transitions. New knowledge is added to older knowledge and established insights are not replaced fully. Researchers from the disciplines of psychiatry and psychology argue for a dimensional approach and show scientific evidence, which makes them to driving forces behind the transformation process. Even though in the scientific communities are contrary voices who argue for a moderate approach and emphasize the practical applicability of diagnostic manuals.

In summary scientific knowledge in the disciplines of psychiatry and psychology changed. Researchers from the different scientific communities had an impact on political decision-making processes. To understand the driving forces fully and how scientific knowledge interacts with politics, the institutions APA (American Psychiatric Association) and WHO (World Health Organization) and their institutional procedures of the revision process must be investigated in more detail.

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Intellectual Developmental Disorder (IDD) is diagnosed with cognitive and adaptive behaviour evaluations. There is increasing evidence of a high prevalence of psychiatric disorders comorbid with IDD. The relationship between specific cognitive dysfunctions and psychiatric vulnerability may provide the basis for a paradigm shift from “intellectually below average IQ” to “neuropsychological characterization”.

1) reassessing an IDD sample in cognitive profile and psychiatric comorbidities 2) investigating the correlations between specific cognitive dysfunctions and specific psychiatric diagnoses in IDD.

120 individuals with IDD from 3 Italian facilities were consecutively evaluated, one group with mild IDD, using WAIS-IV or Leiter-3, TMT, Stroop and TOL tests, after which a professional caregiver did individual interviews (Vineland Adaptive Behavior Scale-II, SPAIDD-G, and STA-DI) to evaluate the patient adaptive behaviour, psychiatric comorbidities and presence of ASD. The second group (more severe IDD), was evaluated only with professional caregiver assessment tools.

90 males and 30 females, mean age 57 years, institutionalized for a mean period of 36.44 years. 52% had no education, 19% a middle school diploma. IDD diagnoses: borderline 3%, mild 16%, moderate 11%, moderate-severe 4%, severe 59%, profound 0%.11% comorbid ASD diagnosis, 29% with ASD after diagnostic re-assessment (STA-DI). 89% physical comorbidities, 58% psychiatric comorbidities, 56% psychoses (Fig. 1). Psychiatric comorbidities re-assessment (SPAIDD-G) identified a significant number of disorders (Fig. 2), despite the medical records showed a low prevalence of psychiatric diagnoses. The consistent quantity of psychotropic drugs prescribed in the sample, possibly reflects the real prevalence of psychopathology. Pearson correlations (p<0.05). WAIS-IV and SPAIDD-G (N=29): Verbal Comprehension Index correlates with anxiety disorder and impulse control disorder; Perceptual Reasoning Index correlates with nutrition/feeding disorder; Processing Speed Index correlates with nutrition/feeding disorder and sexual disorder; IQ correlates with ASD, nutrition/feeding, anxiety, sexual disorders. Leiter-3 and SPAIDD-G (N=14): Form Completion and non-verbal IQ correlate with OCD negatively.

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In conclusion, the SPAIDD-G evaluations revealed a greater prevalence of psychopathology than reported in the medical records. Using psychopathological screening tools can improve the diagnostic process in residential facilities for IDD cases. Pearson’s analyses revealed the need to further investigate the correlation between cognitive dysfunctions and psychopathological vulnerability, studying intelligence as a multi-component model and identifying specific behavioural and cognitive phenotypes in IDD cases.

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