Psychosomatic symptoms are an important problem that is frequently presented in medical consultations. These symptoms are often associated with psychiatric disorders, especially depressive and anxiety disorders.

To study the association between anxiety disorders and psychosomatic symptoms in a sample of patients referred for pathology of functional origin.

We made a descriptive retrospective study through the use of electronic medical records. The symptom onset and diagnosis were obtained for all patients referred to outpatients for psychosomatic symptoms during a 1-year period. We performed χ² Tests to assess the association of the diagnosis with the occurrence of psychosomatic symptoms.

The only diagnosis that presented statistically significant association was anxiety disorder (χ² = 11.1; p<0.001).

Our study finds results that follow the line of other studies that show this association, such as Campo’s study which finds that functional somatic symptoms are consistently associated cross-sectionally with anxiety and depressive symptoms (Campo, 2012) or Imran’s study which finds that higher levels of somatization independently and significantly predicted higher anxiety (β=.37, p=.0001) (Imran et al., 2013). However, our results show no association with depressive disorders whereas frequent associations are found in the literature; for example, a recent meta-analysis found that neuroticism and depression had the strongest influence on the association of medically unexplained physical symptoms and frequent healthcare use (den Boeft et al., 2016). This lack of association is probably due to greater ease in identifying depressive disorders as the main pathology versus anxiety disorders.

Campo J. V. (2012). Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. Journal of child psychology and psychiatry, and allied disciplines, 53(5), 575–592. den Boeft, M., Twisk, J. W., Terluin, B., Penninx, B. W., van Marwijk, H. W., Numans, M. E., van der Wouden, J. C., & van der Horst, H. E. (2016). The association between medically unexplained physical symptoms and health care use over two years and the influence of depressive and anxiety disorders and personality traits: a longitudinal study. BMC health services research, 16, 100

Imran, N., Ani, C., Mahmood, Z., Hassan, K. A., & Bhatti, M. R. (2014). Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: a case-control study. Journal of psychosomatic research, 76(2), 105–112.

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Wernicke’s encephalopathy (WE) is a severe neuropsychiatric syndrome resulting from thiamine deficiency (vit B1) wich is often associated with chronic alcoholism. The classical presentation is characterized by ophtalmoplegia, ataxia and confusion.

Unfortunately, WE is still underdiagnosed because it may not always show up with a classical presentation in one hand, and could also be seen in other non alcoholic condition in an other hand which delay diagnosis and managment of early proper treatement

This case highlights the importance of considering atypical presentations of Wernicke’s encephalopathy, it’s medical etiologies and the importance of improving diagnosis to manage early treatement

We reported a case of a pregnant women who consulted for alterated mental status , asthenia and occurs to have Wernicke’s encephalopathy due to hyperemesis gravidarum

Mrs X is a 35-year-old pregnant women with a past medical history of a cesarian, an hospitalisation in third month of this pregnancy for vomits, no known psychiatric illness or history of substance abuse. She was brought to the gynecology emergency department for asthenia and altered mental status. MRS X, was lethargic, had not eaten for several days, vomiting for more than a month. On the medical evaluation she appeared confused, disoriented, and unresponsive to verbal or manual redirection and prompting. She had also ataxia and gait incoordination. Laboratory testing was remarkable for lactic acidosis (blood lactate concentration lipasemia and normal electrolyte levels, cerebrospinal fluid (CSF) culture was unremarkable.

A brain MRI was done and showed FLAIR signal abnormalities around the third ventricle and periaqueductal, suggesting Gayet-Wernicke encephalopathy. Thiamine (vit B1) 500mg thrice a day was administrated for the next days in associtation with vitamin B6.

Wernicke encephalopathy (WE) is an acute reaction to thiamine deficiency which usually presents with a classical triad. However, Clinicians tend to ignore WE in other non-alcoholic clinical settings and the diagnosis becomes even more difficult when thiamine deficiency presents with unusual neuropsychiatric signs and symptoms like catatonia. This case highlights the importance of considering atypical presentations of WE, it’s medical etiologies and the necessity of a complete medical evaluation and appropriate investigations to make prompt diagnosis and early management.

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Absenteeism from work is considered to be a major source of disorganization and professional marginalization. Psychiatric leave is a frequent form of absenteeism in the hospital environment requiring medical control of the ability to work in order to detect certain abusive prescriptions or certain psychological disorders that can be professionally disabling.

To draw up the socio-demographic, professional and clinical profile of the health care workers examined within the framework of a medical examination of the aptitude for work following a psychiatric sick leave.

To determine the medical fitness-for-duty decisions in interaction with the prescribed psychiatric leave

Retrospective descriptive study on the files of health care personnel who had psychiatric leaves and who were examined in a framework of multidisciplinary medical commission of absenteeism carried out in the department of professional pathology and aptitude for work at the Charles Nicolle Hospital of Tunis. The study period was from January 1, 2020, to October 1, 2022

We collected 63 records. The average age was 44.75 years +/-11.28 years. A female predominance was noticed (71%). The patients were married in 75% of cases with at least one child in charge of 77% of cases. The main professional categories were nurses (29%), workers (24%), followed by anesthesia technicians and medical secretaries (8% each). The average professional seniority was 16.07 years +/- 10.34 years. Psychiatric history was found in 34.9% of the patients, 91% of whom had anxiety-depressive disorders, 4.5% bipolar disorders and 4.5% schizophrenia.

The main psychiatric reasons for the prescribed rest were characterized depressive episodes (75%), obsessive-compulsive disorder (3.2%), bipolar disorder type 2 with psychotic features (3.2%), postpartum major depressive episodes (3.2%) and post-traumatic stress disorder (3.2%). Professional conflicts with colleagues and/or superiors were reported in 21% of cases.

Psychiatric leave was prescribed by a free practice psychiatrist in 90% of cases. The average duration of leave was 50.1 days [14-180] days.

According to the opinion of the multidisciplinary commission, the healthcare professionals were considered fit to resume their professional activities in 59% of the cases, including 9 patients with restrictions (5 cases of eviction from night work, and 1 case of eviction from contact with the public, 1 case of professional reclassification and 1 case of early retirement). The leave was considered justified in 36% of cases for temporary unfitness for work.

The medical examination of fitness for work for health care workers on psychiatric leave remains a delicate decision which can run into numerous difficulties requiring a collegial opinion from the psychiatrist and the occupational physician.

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Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system that is associated with a range of devastating symptoms including fatigue. In addition, the accumulation of disability that occurs in most MS patients can have a detrimental effect on their quality of life.

To assess fatigue and quality of life in patients with MS.

Descriptive cross-sectional study that interested MS patients referred to the occupational pathology consultation of Charles Nicolle Hospital, during the period from 1 July 2020 to 30 September 2022. The data collected concerned socio-demographic and occupational characteristics. The impact of MS on quality of life was studied using the SF-12 quality of life scale. Fatigue was assessed by the Fatigue Severity Scale (FSS).

Twenty-six cases of MS were identified. The mean age was 38 ± 9 years with a sex ratio (M/F) of 0.3. The average occupational seniority was 11 ± 8 years. The health sector was the most represented (23%, n= 6) followed by the transport sector (19%, n= 5). The main occupations were manual workers (31%), drivers, and administrative agents (19% each). The occupational constraints were physical in 44% of cases and psychological in 24% of cases. Fourteen patients (87% of the cases) lost their jobs because of the disease. The decision on occupational fitness was definitive incapacity in 44% of cases. The mean FSS score was 4±1.74. Sixteen patients (62%) had moderate fatigue (FSS 36-52), eight patients (31%) had mild fatigue (FSS <36) and two patients (8%) had severe fatigue (FSS >52). In addition, the mean scores for the physical and mental components of perceived health were estimated to be 37.04±7.67 and 44.93±7.23, respectively. The mean global score (SG) of SF12 was 40.98±7.23. The majority of patients (92%, n=24) had an average quality of life (SG- SF12 between 30 and 60) and two patients (8%) had a poor quality of life (SG <30).

The impact of MS on the socio-professional quality of life of patients was noted in the majority of cases. It is therefore imperative to improve the care of our patients on both the physical and psychological levels.

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Occupational exposure to organic solvents remains a real risk for exposed employees, particularly in mental health and quality of life.

- To evaluate the quality of life of employees exposed to organic solvents

- To research the professional and extra-professional determinants of this quality of life.

This is a descriptive cross-sectional study that compared 196 employees exposed to organic solvents with 64 non-exposed employees from the same socio-professional environment. The investigation took place in four different companies in the governorate of Tunis. An environmental study combining an evaluation of working conditions and atmospheric monitoring was carried out to identify and quantify exposure to solvents. Quality of life was assessed using the SF36 questionnaire in its Arabic version.

The solvent mixtures to which the employees were exposed mainly contained hexane, toluene, ethyl acetate, methyl ethyl ketone, cyclohexane, and perchloroethylene. Exposure to these solvents is primarily from glues and paint products. The study population was relatively young (34.1 years +/-9.8), predominantly male (sex ratio=2.2), with an education level of no more than secondary school in 90% of cases, with an average work experience of 10.3 years (+/-8.2) and represented mainly by manual workers (75.4%). The pathological history of the exposed patients was dominated by chronic neuropsychological disorders (48.1%). The global score of SF36 (SFG) was significantly poorer in the solvent-exposed group (SFG= 64.1+/- 21.1 versus 70.1+/-23.3) (p=0.05). Among the eight dimensions of the SF36, a very significant alteration of the dimensions: “perceived health ”, “psychological health” and “repercussion of psychological health on daily activities ” was noted in the solvent-exposed group.

The main determinants of the quality of life of workers exposed to solvents were: level of education, frequency of exposure, length of exposure, and company.

According to the job-exposure matrix, only “perceived health” appeared to be impaired by high levels of cumulative solvent exposure (p= 0.0006).

According to this study, organic solvents can affect the quality of life of exposed employees by acting essentially on perceived health, psychological health, and the “impact of psychological health on daily activities”.

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Adolescents represent a vulnerable population, with a high prevalence of mental illness and increased levels of subsyndromal psychological distress. Educational settings are central to the lives of young people, and their potentiality to promote mental health is increasingly recognised. The acknowledged role of peer influence on adolescent behaviours indicates peer-led interventions as a promising avenue of youth mental health support.

The intervention stems from a pilot called The Vineyard Project, which engaged a group of young people with different forms of mental ill-health in local practices of hand-harvesting grape. The pilot was hosted in the region of Langhe (Italy) and was meant to address social anxiety symptoms and poor self-efficacy through the involvement in a culturally meaningful activity within the transformative process of winemaking. The pilot formed the basis of a peer led-intervention in a local Arts high school, aimed to improve mental health knowledge, reduce stigmatising attitudes and promote help-seeking through the mediated connection between students (n = 80) and young people who participated in the Vineyard Project.

Semi-structured interviews with young people participating in the pilot have been conducted and audio-recorded. Interviews explored their experience in the vineyard and its relation with their personal story and the mental health challenges they have been facing. Following a preparatory work with high school teachers, recordings have been anonymized and shared with students to become the object of an art-based workshop.

The practical purpose of the workshop with Arts students was to draw wine labels inspired by their peers’ narratives as they were recorded during interviews. This activity had a double objective: i) to stimulate the ability to listen and foster connection with the experiences shared by young people participating in the vineyard activities; ii) to auction wine bottles labelled by the students to provide financial support for new projects for young people. Feedbacks gathered with students and members of the education community showed that stories shared by participants were considered relatable, experience-near and close to the difficulties that students were familiar with. Consistently with scientific literature on peer support in youth mental health, the intervention showed beneficial effects on the interviewees as well: the opportunity to share their story, making it available to other adolescents who could learn from it and take the project further, stimulated feelings of self-acceptance, personal growth and sense of value.

Emerging results from the Vineyard Project suggest that a dialogue between peers, undertook in a non-medicalised framework, can foster connection and empathy, breaking down taboos about mental health, reducing self-stigma and eventually increasing help-seeking intentions.

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Chronic pain can lead to depression, weariness, sleep problems, decreased physical and cognitive function, personality changes/shifts, and social interactions, all of which can lead to social marginalization and financial loss.

The aim of the present study was to investigate how psychological variables affects pain intensity.

193 patients diagnosed with chronic pain conditions, men 67 (34.8%) and women 126 (65.2%), participated in the study. This study used a quantitative between-subjects design to investigate the effect of psychological factors on pain intensity using the VAS scale. Analysis was performed with the use of SPSS23.

The analysis produces a coefficient of determination R2 = 0.448 – suggesting that a total 44.8% variability in pain intensity in the previous month can be explained by Age, Fear-avoidance belief about physical activity, Commitment to activity, fear avoidance beliefs about work and Pain catastrophizing magnification. A repeated measure analysis of variance shows that the regression model is statistically significant F (1, 187) = 30.381, p = 0.000. The predictors variables (Age, fear-avoidance belief about physical activity, commitment in activity, fear avoidance beliefs about work and pain catastrophizing magnification) are found to statistically significant t (187) = 9.627, p = 0.001, t (187) = 4.616, p = 0.001, t (187) = 2.982, p = 0.003, t (187) = -2.599, p = 0.010, t (187) = 2.253, p = 0.025 respectively.

The findings of this study are in agreement with previous literature and also provide insight into the major psychological factors correlates with pain intensity

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Sexual life and sexual satisfaction are associated with psychological well-being. It has already been shown that sexual satisfaction is related to sexual myths or stereotypes, somesociodemographic and sociosultural variables, and gender. However, we have not met any study in which socioeconomic status, sexual myths and gender roles were taken together.

The aim of this study was to investigate whether socioeconomic status predicts sexual satisfaction through sexual myths and gender roles.

The Bem Gender Roles Scale (Ozkan and Lajunen Sex Roles 2005;103-110), the Sexual Myths Scale (Golbasi et al. Sex Disabil 2016; 34 75-87), the New Sexual Satisfaction Scale (Stulhofera et al. J Sex Res 2010;47 257-268), the Socio-Economic Status Measurement Tool (Kalaycioglu et al. J Soc Res 2010; 1 183-220) were applied face-to-face or online to 185 women and 74 men who had heterosexual relationships. Relationships between scale scores were examined with Pearson correlation analysis. Serial multiple mediator analysis was used to test mediator role of either masculinity or sexual myths in the relationship between socioeconomic status and sexual satisfaction.

We found significant correlations between socioeconomic status and sexual myths (r=-.22, p<.001), between socioeconomic status and sexual satisfaction (r=.13, p<.001), sexual myths and sexual satisfaction (r=.20, p>.001) and between masculinity and sexual satisfaction (r=.18, p=.004), The relationship between femininity and sexual satisfaction was not significant (r=.01, p=.845). Sexual myths (b=-.19, t(257)=-3.48, p<.01) and masculinity (b=.40, t(257)=3.26, p<.01) mediated the relationship between socioeconomic status and sexual satisfaction (b=.15, t(257)= 2.04, p<.05).

Interventions on sexual myths will reduce the effect of socioeconomic disadvantage on sexual satisfaction.

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people suffering from multiple sclerosis (MS) can experience post-traumatic growth (PTG), a sense of personal growth and benefit gain. Patients mental health can play an important role in PTG development.

to explore possible differences in mental health according to PTG levels.

the sample was composed of 392 outpatients with MS from Virgen de la Macarena University Hospital (268 women; 124 (31.6 %) men, ages 19-78 years old (mean 45.61 years, SD=11.16 years). Expanded Disability Status Scale (EDSS) mean score was 3.38 (SD=2.06). Relapsing remittent (n=327) and progressive (n=65) MS type were reported. Post-traumatic Growth Inventory (PGI-21) measured patients perception of personal benefit gain after MS experience. General Health Questionnaire-28 (GHQ-28) evaluated Mental Health distress symptoms. Unpaired t-test was used to identify differences in mental health distress between “low PTG ≤49 score” and “high PTG ≥50 score” groups.

Significant differences were found in social dysfunction (t=2.521, p=0.012) and severe depression (t=2.442, p=0.015), “high PTG group” (n=194) presented lower scores compare to “low PTG group” (n=198). No significant difference was detected in somatic symptoms (t=0.185, p=0.087) and anxiety and insomnia (t=0.859, p=0.391).

patients with higher PTG reported a better mental health. This suggests the relevance of mental health status in positive outcomes development after an adverse life event. Particularly, social dysfunction and depressive symptoms should be considered in interventions aimed to promote positive outcomes as personal gain and benefit finding in MS population.

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Uchida & Yamasaki (2012, 2022) have developed a universal prevention program to enhance understanding and regulating others’ emotions for elementary and junior high school students. In recent years, affect and emotions are popular research topics in the domains of psychology and brain science. Most research has thus far focused on the effects of explicit affect on health and adjustment. However, an increasing number of studies have started to examine the effects of implicit affect on psychological outcomes. Although the program was developed for enhancing coping of explicit emotions for health and adjustment, the effectiveness needs to be examined also in terms of implicit affect.

The purpose of this study was to examine the effectiveness of this program in terms of implicit and explicit affect.

Participants were 6th-grade children in a public elementary school in Japan. The final sample was 61 children (32 boys and 29 girls). Participants completed a battery of two questionnaires just before (Time 1) and just after (Time 2) the intervention program. The questionnaires were the Implicit Positive and Negative Affect Test for Children (IPANAT-C) for assessing implicit positive and negative affect (IPA and INA) and the Japanese version of the Positive and Negative Affect Schedule for Children (PANAS-C) for measuring explicit positive and negative affect (EPA and ENA). The universal intervention program that was one of the programs we developed for children’s health and adjustment was implemented over four regular classes targeting all children in their homeroom classes.

Data were analyzed by 2 (pre-intervention and post-intervention periods) x 2 (boys and girls) analyses of variance (ANOVA) with the hoc tests using Holm corrections. First, regarding the EPA and IPA, there was a significant main effect of periods (Fs (1, 59) = 6.82 and 4.54, p < .05, respectively), revealing in the post hoc tests that they significantly increased at the post-intervention period. In contrast, regarding ENA and INA, there was no significant main effect of periods. Moreover, regarding EPA, there was a significant main effect of sex. No significant period x sex interactions were found in any affect.

These results revealed that the current program was effective in enhancing explicit and implicit positive affect. On the other hand, no significant effects were found in enhancing explicit and implicit negative affect. The necessity of future research that will examine the sustainability of the effectiveness of the program is discussed, along with several limitations.

None Declared

Self-esteem affects people’s reaction to stressful events and the way individuals cope with stress. At the same time, stressful events negatively affect self-esteem, which is a psychological resource against psychological disorders.

To study the link between self-esteem and perceived stress in medical students.

A cross-sectional study was conducted through an online survey among medical students of the faculty of medicine of Sfax (Tunisia). Participants completed an anonymous self-administered questionnaire and two psychometric scales: Rosenberg’s self-esteem scale for the evaluation of self-esteem and Cohen’s Perceived Stress Scale (PSS) for the evaluation of the level of perceived stress.

Our sample consisted of 95 students. Their mean age was 25.8±3.4, with a sex ratio (M/F) = 0.25.The majority were single (83.2%) and live with their parents (64.2%). Only 14.7% of the participants were smokers, and 13.6% consumed alcohol.

History of psychiatric disorders was reported by 17.9% of students, 76.5% of which were anxiety disorders.

On the Rosenberg scale, self-esteem was very low in 27.1% and low in 34.7% of the students. According to the PSS scale, 21.1% had a severe stress level and 69.5% had a moderate stress level.

Female students had lower self-esteem with no significant correlation.

Students with a history of anxiety disorders had a significantly lower self-esteem (p<10-3).

Low self-esteem was significantly correlated with severe stress (p=0.01).

Our study showed significant frequencies of low self-esteem and considerable stress among medical students. Low self-esteem was associated with severe stress. Further studies should be conducted to better investigate this relationship in order to promote student’s mental health and the use of stress management techniques, which can not only reduce stress, but also improve self-esteem.

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In Greece, the Athens Multifamily Group Therapy Project (A- MFGT) provides systemic multifamily therapy to young adults after the first psychotic episode, with a purpose to deliver an early intervention program.

Few evidence is available regarding the viability of multifamily systemic therapy in an online setting in purpose of widely developing in e-mental health care (Borcsa et al., 2021). The members of ten families who participated at two online multifamily systemic groups for young adults after the onset of psychosis provided their opinions regarding their experience of 10-month therapeutic program through online platform, with two - hour sessions every 15 days.

The members of the group described in an online form what they found helpful and/or unhelpful/harmful at three separate times: in the middle of the therapy process, at the end of therapy and at 6 months follow up period. The data collected was analyzed with an inductive, “data – driven”, form of coding based on the methodology of thematic analysis (Braun & Clarke, 2006). Themes represent the prevalence of what the participants found important in relation to the perceived effectiveness of online A- MFGT.

The members highlighted the impact of the online group process on family communication, reflected on advantages and difficulties offered by the online setting, described their emotions and the effect of diagnosis and hospitalization at individual and family level, valued the problem solving and empathy techniques in the group and identified the obstacles they encountered in the group sessions.

Psychosis can affect all aspects of a person’s life, and without support and appropriate care, it can place considerable weight on the patient’s relatives, as well as the community in general. Our suggestion is that MFGT can be a viable way to support the whole system facing psychosis, with the aim of preventing relapse and implementing quality of life of all the participants.

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Psilocybin is considered a classical psychedelic and is increasingly attracting scientific and media attention as an alternative approach to the treatment of various mental disorders.

Apart from its efficacy, an important question is the tolerability and safety of psilocybin in general and in a controlled environment. Accurate knowledge of drug safety aspects might be essential for applicability in clinical practice and for drug adherence.

This paper aims to provide an overview of drug safety aspects of psilocybin.

A narrative review was conducted. The literature search was conducted using the bibliographic database MEDLINE.

The literature search of papers published in recent years showed no serious side effects under psilocybin in controlled study conditions. Common reported ADRs were headache, gastrointestinal complaints such as nausea, diarrhoea and vomiting, tachycardia and arterial hypertension. The lethal dose of psilocybin is many times higher than the therapeutic dose and overdose deaths have not been identified.

An often mentioned problem is the occurrence of hallucinogenic persisting perception disorder (HPPD) which, however, did not occur in the studies examined and is most likely to be a problem in the context of recreational use. The results on the safety of psilocybin must be regarded as preliminary; in the studies conducted, risk populations were predominantly excluded, which is, however, relevant for everyday clinical practice. The risk of delusional experiences and so-called “bad trips” is also a relevant safety risk, as it can be associated with risky behaviours. However, these would also be observed more in the area of recreational use.

The use of psilocybin in rigorously controlled study designs appears to be predominantly safe and without serious side effects. At the same time, it should be noted that the results must be considered preliminary and many questions remain open. Many of the risks are more likely to occur in uncontrolled recreational use of psilocybin. At the same time, we see a certain risk in the use of a substance associated with high expectations and a certain “fame” that, without appropriate regulations, the boundaries between sensible therapeutic use and abusive use could become blurred and permeable.

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Drug-Induced Liver Injury (DILI) is one of the most common causes of hospitalization due to liver failure and represents a considerable challenge in clinical practice. One risk factor is the long-term use of a drug. Antipsychotics are regularly prescribed over a long period of time. Therefore, potential hepatotoxicity is of particular importance here. However, DILI related to antipsychotics are still insufficiently understood.

Within a combined pharmacoepidemiologic and pharmacodynamic approach, we examined the association between DILI and the receptor affinity of various common prescribed antipsychotics.

Disproportionality analyses were used to calculate reporting odds ratios (RORs) for reports in which drug-related hepatic disorders were reported as an adverse reaction related to antipsychotics. MedDRA terms for Drug related hepatic disorders were used to identify cases. Data were extracted from VigiBase the WHO global database of reported potential side effects of medicinal products. For pharmacodynamic evaluation, we calculated Pearson correlation coefficients between affinity for various receptors and the corresponding RORs.

We observed a statistically significant (r (12) = -. 74, p = 0.002384) negative correlation between 5-hydroxytryptamine receptor 1A receptor affinity and drug related hepatic disorders. Furthermore, we observed a statistically significant (r (8) = -. 69, p = 0.02577) negative correlation between 5-Hydroxytryptamine receptor 2B receptor affinity and drug related hepatic disorders. No statistically significant association was found for other receptors.

In this exploratory pharmacoepidemiological and pharmacodynamic approach, no particular risk for increased hepatotoxicity related to affinity for a specific receptor was found. Interestingly, a negative correlation to two serotonin receptors was found. These findings are consistent with results from the animal model, in which improved liver function and reduced fibrogenesis were observed under 5HT2B antagonists.

None Declared

Nowadays, In the exercise of psychiatric clinical activity, the prescription of atypical antipsychotics is a widespread practice.

However, despite the approval in the treatment of psychoses and bipolar affective disorder, where its effectiveness is clearly demonstrated, these drugs are off-label prescribed in most of the clinical situations.

This work aims to clarify which atypical antipsychotics are most frequent prescribed and the clinical conditions where their off-label prescription is more common.

Bibliographic research in the Pubmed® database using the terms “atypical antipsychotics and off-label use”

According to the scientific literature consulted, the off-label prescription of atypical antipsychotics may represent about 70% of the total prescription of these psychotropic drugs.

Risperidone, olanzapine, quetiapine and aripiprazole are the most off-label prescribed among the atypical antipsychotics.

The psychiatric conditions where atypical antipsychotics are most often off-label prescribed are addictive disorders, anxiety disorders, post-traumatic stress disorder, personality disorders, eating disorders, insomnia and dementia, where therapeutic benefits are demonstrated when carefully selected.

The off-label prescription can be interpreted from two points of view. On the one hand, it can guide innovation in clinical practice and improve symptoms in patients who do not respond to standard treatments. On the other hand, it may be associated with negative consequences due to the lack of data on safety and efficacy in these situations.

Despite widespread prescribing of atypical antipsychotics, there is no evidence-based recommendation beyond psychoses and bipolar affective disorder.

Thus, when prescribed, we must proceed with careful monitoring and consider the risks and benefits in relation to off-label prescription.

None Declared

Benzodiazepines are the most widely prescribed drugs worldwide for insomnia and anxiety disorders. However, few studies have been conducted on the professional practice of these drugs for patients with psychiatric disorders .

To describe the prescribing practices of benzodiazepines for patients with psychiatric disorders at the Psychiatry Department of the EPS Taher Sfar Mahdia.

This is a retrospective study of patients who were admitted for the first time to the psychiatry department of the EPS Taher Sfar in Mahdia and had a prescription of benzodiazepines during their hospitalization.

A total of 234 patients were included in our study. We found that 77.8% of patients on benzodiazepines had a prescription for benzodiazepines for a period of less than 3 months. Secondly, we determined that 66.2% of patients who had a benzodiazepine’s prescription had a taper dose of benzodiazepines before the withdrawal. No patients with contraindications to benzodiazepines had a prescription of these medications. The maximum indicated dosage was respected in 92.3% of the prescriptions. Lorazepam was the most used drug, accounting for 49.1% of prescriptions. Our study showed that 46.2% of prescriptions were for anxiolytic purposes only, 43.2% were for hypnotic purposes only. Our analysis also showed a higher proportion of males in the < 3 months group with 82.9% which is significantly higher than for females. (p=0.004).

Our analytical study concluded that gender (p=0.004), professional status (p=0.014), history of addiction (p=0.003), cannabis use (0.025) were related to the duration of benzodiazepine prescription. We noted that 89.9% (n=71) of patients with a documented history of addiction had been prescribed benzodiazepines for less than 3 months. We were also able to conclude that there were correlations between the duration of prescription and medical and/or surgical history (p=0.002), the molecule prescribed (p=0.0001) as well as the renewal of the prescription (0.0001).

However, we did not find a correlation between the associated psychiatric disorders and the duration of prescription. As well for associated psychotropic drugs and duration of prescription

We can conclude that misuse of benzodiazepines exists, but to a much lesser extent than in the literature. A larger-scale study would be essential to establish a Tunisian overview of benzodiazepine prescription practices.

None Declared

Omega-3 polyunsaturated fatty acids (PUFAs) have been studied in relation to mental illness. Among the most important omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) stand out, both derived from alpha-linolenic acid. Both EPA and DHA are essential fatty acids. Consequently, mammals are not capable of synthesizing them and must incorporate them through the consumption of products such as fish oil. The interest about the role of omega 3 fatty acids for the treatment of patients with impulsiveness, hostility and aggressiveness is growing and originated from the finding of a low level of EPA and DHA in the central nervous system of these individuals.

To determine the evidence on the effectiveness of omega-3 acids in reducing severe symptoms in patients diagnosed with Borderline Personality Disorder.

A literature review was carried out in Epistemonikos, using the descriptors: “borderline personality disorder” AND “Omega-3”. 7 results are obtained. The results of a time limit of 10 years with meta-analyses and systematic reviews were filtered, obtaining 7 results and selecting 3 of them for their relevance to the PICO question. Subsequently, the search was repeated using the same descriptors and time limit in the Cochrane Library, NICE, and Pubmed; no selection was made by coincidence of those previously selected.

The first systematic review studied the effectiveness of omega-3 fatty acids in symptomatology associated with BPD, with differentiation of the domains of affective, impulsive and cognitive-perceptual symptoms. Within the meta-analysis, 5 randomized controlled trials (RCTs) were included that compared omega-3 fatty acids with placebo or any active comparator, four of these RCTs verified the effect of omega-3 acids in 137 patients with BPD or behavior related to the BPD.

The second systematic review, conducted in the Cochrane Collaboration, performed a meta-analysis of randomized comparisons of drug versus placebo. Twenty-seven trials testing first- and second-generation antipsychotics, mood stabilizers, antidepressants, and omega-3 fatty acids were included. For supplemental omega-3 fatty acids, significant effects were found in one study (n = 49 ) for reduction in suicidality (RR = 0.52, 95% CI 0.28 to 0.95) and depressive symptoms (RR = 0.48, 95% CI 0.28 to 0, 81).

Available data indicate that marine omega-3 fatty acids improve BPD symptoms, particularly impulsive behavioral dyscontrol and affective dysregulation, reducing depressive symptoms and suicidal tendencies. Marine omega-3 fatty acids could be considered as a complementary therapy for the improvement of severe symptoms associated with patients with BPD.

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Treatment resistant schizophrenia still represents a major clinical and pharmacological challenge.30% of patients diagnosed with schizophrenia is characterised by a poor response to at least two different antipsychotics administered for a proper period of time and at adequate doses. Clozapine still represents the gold standard for treatment resistant patients. Unfortunately, a significant percentage of these are only partial responders. Augmentation strategies must be set up and atypical antipsychotic drugs are used in clinical practice. Promising findings have been observed in patients treated with Lurasidone as an add-on therapy with Clozapine. This novel second-generation antipsychotic has a unique receptor profile, showing 5-HT1a partial agonism and 5HT7 antagonism. These properties could also explain its procognitive effect, as several preclinical studies in literature have demonstrated.

The aim of our study is to highlight the advantages of add on therapy with Lurasidone compared with treatment as usual (i.e. Clozapine + another atypical antipsychotic) in treatment resistant schizophrenia patients.

We conducted an observational study in a sample of 20 patients diagnosed with treatment resistant schizophrenia, based on DSM-5 diagnostic criteria and psychopharmacologic history. Treatment choices were taken independently by clinicians in charge of each patient. 10 subjects underwent Lurasidone augmentation of Clozapine, whereas the remaining 10 subjects were treated as usual with Clozapine and another atypical antipsychotic. PANSS and BPRS scales to assess general psychopathology and UKU side effects scale were administered both at baseline and at follow-up (T1= 1 month; T2=6 months).

All patients treated with Lurasidone augmentation strategy achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects to be reported. In particular, Lurasidone showed no impact on metabolic parameters nor on ECG features, namely the QTc interval. The psychopathological improvement appeared higher in patients who received Lurasidone than in those treated as usual. This was particularly evident in cognitive domains.

Our observation suggests that augmentation strategy with Lurasidone to Clozapine can lead to clinically significant improvements in psychopathology when compared to Clozapine combined with another atypical antipsychotic, with a good tolerability profile. In future we will increase the number of our sample and the duration of follow-up time. In order to have more relevant statistical results, further research on this topic is needed.

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Despite being effective in schizophrenia, second-generation antipsychotics are potent histamine-H1 receptor antagonists associated with weight gain. Histaminergic agonists can potentially counteract the weight gain effects of antipsychotics. Betahistine is a centrally acting histamine-H1 agonist and, therefore, may reduce antipsychotic-induced weight gain, but it has never been examined in a meta-analysis.

This meta-analysis aims to examine the efficacy of betahistine in counteracting the weight gain effects of antipsychotics.

We searched PubMed, Scopus, Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for all relevant trials. We used Hedges’ g with its confidence interval as our effect size to correct for the small sample size. The primary outcomes of this study were changes in weight and body mass index (BMI). Changes in insulin resistance and lipid parameters were secondary outcomes.

165 studies were included in the title/abstract screening, and 5 studies with 217 patients were finally included. Betahistine led to statistically significant changes in weight (Hedges’ g -1.13, 95% CI [-1.66, -0.60], p < 0001), BMI (Hedges’ g -1.64, 95% CI [-2.39, -0.89], p < 0.0001), and waist circumference (Hedges’ g -0.98, 95% CI [-1.47, -0.49], p < 0001). Nevertheless, betahistine did not lead to any significant changes in fasting glucose (Hedges’ g 0.02, 95% CI [-0.41, 0.44], p = 0.94) or insulin levels (Hedges’ g -0.07, 95% CI [-1.78, 1.64], p = 0.94).

Betahistine is an effective add-on treatment for second-generation antipsychotics to counteract weight gain experienced with these medications. Further trials are recommended to examine its effect on blood lipids and side effects.

None Declared

Human gut microbiota plays an important role in metabolic health. Atypical antipsychotics can lead to metabolic abnormalities and changes in the gut microbiota. Multiple studies have examined the role of probiotics in suppressing antipsychotics-induced weight gain, but they have never been examined in a meta-analysis.

This network meta-analysis aims to compare the effect of probiotics + fibers, probiotics only, and fibers only on metabolic abnormalities induced by atypical antipsychotics.

We searched PubMed, Scopus, Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for all relevant studies. We used mean difference with its 95% confidence interval as our effect size. Primary outcomes were body weight and body mass index (BMI), while secondary outcomes were changes in other cardiometabolic risk factors.

We included 4 randomized controlled trials comprising 319 patients. For body weight, probiotics + fibers (MD -3.96, 95% CI [-5.16, -2.76]), fibers only (MD -1.91, 95% CI [-3.81, -0.01]), and probiotics only (MD -1.37, 95% CI [-2.07, 0.66]) were significantly superior to placebo. Probiotics + fibers (MD -1.52, 95% CI [-2.11, -0.92]), but not fibers only or probiotics only, was associated with significant changes in BMI. Probiotics + fibers was also associated with significant changes in cholesterol (MD -0.37, 95% CI [-0.67, -0.07]), insulin levels (MD -3.37, 95% CI [-5.35, -2.10]), and insulin resistance index (MD -1.35, 95% CI [-1.94, -0.76]). There were no significant adverse events reported in the included studies.

Probiotics + fibers, probiotics only, and fibers can be effective in controlling antipsychotics-induced metabolic abnormalities, with probiotics + fibers being the most effective regimen. All three treatments were safe and well tolerated by patients.

None Declared