Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents. It is characterized by age-inappropriate inattention/impulsiveness and/or hyperactivity symptoms.

However, emotional symptoms are frequent in patients with ADHD and may, in some cases, be responsible for a major part of the negative impact on functioning and outcome.

It is now well established that a large number of children with ADHD and without any comorbid disorder exhibit symptoms of emotional lability.

Recently , given the importance of the impact of emotional symtoms , several authors have argued that emotional intelligence affects health and is essential for success in academics as well as life in general and it is defined as the ability to perceive, appraise, and express emotions; the ability to access and/or generate feelings when they facilitate thought; and the ability to regulate emotions to promote emotional and intellectual growth.

•Our research aimed to evaluate and compare the emotional and social functioning of two groups of children, with and without ADHD , aged 6 to 19 .

•One hundred twenty child (N=60 ADHD, N = 60 Control cases) were assessed with the BarOn Emotional Quotient Inventory: Youth Version (BarOn EQ-i:YV™), providing an estimate of their underlying emotional and social intelligence.

•The BarOn EQ-i:YV is specifically designed to assess the coping skills, adaptability, and well-being of children and teenagers.

•Children with ADHD and control cases were compared with each other.

•The results showed that the Emotional Quotient (EQ) was significantly lower in the group of children with ADHD (p=0.01).

•Also, our results showed that there are statistically significant differences in intrapersonal skills (p˂0.0010) Adaptability Scale(p=0.005) ; General Mood Scale (p=0.004) and positive impression (p = 0.001) of emotional intelligence between children with ADHD and control cases. Thus, the first group got lower scores than the second one in all aspects.

•ADHD is a disorder that affects the life quality of the person who suffers from it in the personal and social areas. Therefore, the emotional intelligence study in individuals with this diagnosis is important.

•And considering the fact that abilities associated with emotional intelligence can be learned and improved, emotional intelligence can be thought as a target for therapy by individualized education for patients with ADHD who have inadequate abilities compared to the healthy population .

None Declared

Cornelia De Lange syndrome (CdLS) is a dominant and rare genetically heterogeneous syndrome. It is characterized by a large phenotypical spectrum going from a classical to a non-classical form affecting multiple organ systems including central nervous, locomotor, skin, gastrointestinal, immune and endocrine systems in association with specific dysmorphic features. Neuropsychiatric manifestations represent a hallmark of CdLS phenotype.

The aim of this study is to describe the neuropsychiatric features of Cornelia De Lange syndrome.

This is a descriptive and retrospective study compromising unrelated Tunisian patients diagnosed clinically and genetically with CdLS during the period between 2002-2021. Each patient underwent a comprehensive clinical evaluation. In this study, we focused on neuropsychiatric and behavioural phenotype specifying intellectual disability(ID), language delay (LD), autism spectrum disorder (ASD), hyperactivity, aggressivity, specific learning disorder(SLD), sleep problems, compulsive behaviours and social anxiety disorders during adolescence.

A total of nine patients were included in this study. ID was present in all the evaluated patients with different level of severity evolving from mild (8/9) to severe (1/9). LD in absent of hearing problems was detected in two patients. Hyperactivity was found in three patients. Aggressivity was discovered in one patient in a form of self-injurious behaviour in one patient and hetero-aggressivity in another. None of our patients was diagnosed with ASD. Sleep problems such as frequent night-time awakenings were observed in one patient. All patients at age of schooling presented different levels of SLD. None of our patients was diagnosed with anxiety or compulsive behaviours.

Our results support the implication of behavioural and psychiatric features in CdLS phenotype. All of symptoms described in the literature were present in our patients. Further evaluation of our patients during their life is important to reveal age-related features such as anxiety or compulsive behaviours. These features can be used to inform specific psychiatric assistance for family psychoeducation, psycho-social interventions, and cognitive-behavioural education treatment approaches in individuals with CdLS.

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Autism spectrum disorder (ASD) is a highly heterogeneous neurodevelopmental disorder with many contributing risk genes. Multiple intellectual disability (ID) susceptibility genes have been identified in ASDs to date. The trafficking protein particle complex subunit 9 TRAPPC9 (OMIM#611966) in an autosomal recessive intellectual disability (ID) gene associated with not fully penetrant phenotype combining secondary microcephaly, dysmorphic facial features, obesity, autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD).

The aim of this study is to consider TRAPPC9 deficiency in autosomal recessive ID with ASD.

We present the observation of two siblings, born to Tunisian consanguineous and healthy parents, followed up for syndromic intellectual disability (ID) associated ASD and microcephaly. A clinical exome sequencing was performed to one child using a Trusight One kit of Illumina. We used sanger sequencing to validate the suspected variant for the other child and to specify the parental segregation.

A homozygous pathogenic variant in the TRAPPC9 (NM_001160372.4) gene, c.1414C > T (p. Arg472Ter) were identified in one child. Sanger sequencing confirmed the homozygosity profile of this variant for the other child while the parents were both heterozygous carriers.

Repetitive behaviours, especially hand-flapping, were the mean ASD feature in our patients. The current variant is known in the Tunisian population. It is described to lead to the creation of a premature stop codon and a truncating protein causing a TRAPPC9 deficiency. The impairing neuronal NFkB signalling due to TRAPPC9 deficiency has been suggested to be implicated in ASD. Due to the profound ID seen in both patients, we suggest the classification of ASD related to TRAPPC9 deficiency as “secondary” rather than “primary”.

Our results support the implication of TRAPPC9 in secondary ASD and shed the light on the possibility of screening p. Arg472Ter in Tunisian patients with this form of ASD as it is a recurrent mutation in the Tunisian population.

None Declared

Bipolar Disorder (BD) has been suggested to be a risk factor for development of Parkinson Disease. Psychiatric drugs used as standard treatment of BD includes many drugs that are known to induce drug-induced parkinsonism (DIP).

Clinical differentiation between PD and DIP is a clinical and scientific crucial result. It might be aided by functional neuroimaging of the dopaminergic nigrostriatal pathway.

Twenty consecutive BD patients with parkinsonism were clinically assessed and underwent 123I-ioflupane dopamine transporter SPECT. Imaging data of BD patients with pathological nigrostriatal pathway were further compared to a population of de-novo PD patients.

Four BD patients had abnormal scans; they had higher putaminal binding ratio and putamen-to-caudate ratios than PD patients, despite similar motor symptom burden.

in our initial results, up to 20% of BD patients with parkinsonism might have an underlying dopaminergic deficit, which is higher than excepted in the general population. This evidences supports that BD represents a risk factor for subsequent development of neurodegenerative parkinsonism.

None Declared

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. In Portugal, it is estimated to afflict 14.2% of the population over the age of 45 and is one of the most common causes of morbidity, with a significant social impact and excessive expenses. Moreover, COPD is associated with high levels of psychological distress and diverse psychiatric disorders that heighten the disease burden as they are associated with increased risk of exacerbations and frequent hospitalizations. Despite this overview, psychiatric conditions remain understudied compared to comorbid general medical conditions, and few studies have assessed their effect on COPD hospitalization outcomes.

This study aimed to describe the occurrence of a vast array of psychiatric comorbid diagnoses in COPD hospitalizations and to understand their impact on hospitalization outcomes.

A retrospective observational study was conducted. All inpatient episodes from 2008 to 2015 of patients with at least 40 years and a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were selected from a national administrative database that included all hospitalizations in mainland public hospitals. From these sampled episodes, secondary psychiatric diagnoses were identified (ICD-9-CM codes 290.x-319.x). Age at hospitalization, sex, psychiatric comorbidities, length of stay (LoS) in days, admission type and date, destination after discharge, in-hospital mortality and hospital charges were analyzed.

From a total of 66,661 COPD hospitalizations, 17,652 (26.5%) corresponded to episodes with a secondary psychiatric diagnosis. Patients with a comorbid psychiatric diagnosis were on average younger at admission (70.3 vs. 75.9 years, p<0.001), had a longer median LoS (9.89 vs. 9.33 days, p<0.001) and higher urgent admission rates (96.2% vs. 95.7%, p=0.009). There was also a significant association between discharge destination and psychiatric diagnoses (p<0.001).

These findings suggest that mental disorders have an adverse and quantifiable impact on COPD hospitalization outcomes. With this in mind, to provide optimal treatment for patients with both conditions, psychiatric disorders should become a matter of routine evaluation and follow-up.

None Declared

According to DSM V, substance-induced psychotic disorder is a mental health condition in which the onset of psychotic symptoms can be traced to the use of a psychotropic substance. The pathogenesis of this disease is still poorly understood; current literature traces its causes back to genetic predisposition and early traumatic events (i.e. child abuse).

The present study aims to identify specific clinical features and biochemical markers which could be addressed as predictors for the long-term prognosis of this disease. Moreover, we aim to identify specific correlations between the clinical phenotype and the underlying substance abuse, in order to allow the early start of a tailored treatment.

Between 2020 and 2022 we recruited 218 patients referring to the Policlinico Hospital in Milan and the San Gerardo Hospital in Monza, Italy. All the patients were diagnosed with substance induced psychotic disorder: 31 reported alcohol abuse (14,2%), 71 psichostimulants (32,6%), 116 cannabis, (53,2%). For each patients, we collected demographic data, medical records and a comprehensive psychometric assessment (GAF, PANSS, BPRS, Modified Sad Person Scale-MOAS). Furthermore, we collected a blood sample for dosing Na+, K+, Na+/K+, hemogram with formula and platelets, glucose , urea, creatinine, uric acid, transaminases, γGT, bilirubin, plasma proteins, albumin, LDH, CPK, PCHE, cholesterol, HDL, LDL, Tg, TSH.

Chi squared test (χ²) has been used to compare qualitative variables between the 3 subgrous (alcohol-, psychostimulants- and cannabis-induced psychotic syndromes) (fig.1). One way ANOVA test has been used to compare quantitative variables between the same 3 subgroups (fig.2). After removing one of the subgropus (alcohol-induced psychotic symptoms), the same analysis have been repeated. Significant variables have been included in a binary logistic regression model in order to confirm their validity as predictors for cannabis- and psychostimulants-induced psychotic disorders (fig 3). Finally we performed Omnibus test and Hosmer-Lemeshow test in order to verify the validity of these regression models.

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For each considered subgroups, we indentified the following features. Alcohol induced psychotic syndrome: higher age of onset and age of hospital admission, higher cholesterol and hurea levels, , high comorbidity with medical conditions anxiety/depression, low social functioning, higher suicidal risk;, higher hospitalization rate. Cannabis induced psychotic syndrome: higher hemoglobin and albumin levels, more severe psychiatric symtoms (BPRS), higher smoking rates. Psychostimulants induced psychotic syndrome: higher multi-drug abuse risk. We could assume that according to this consideration the treatment protocols for each of these subgroups should be tailored according to their specific features.

None Declared

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

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

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

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

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

None Declared

Substance use continues to be an important problem among mental health patients either as main diagnosis or as comorbidity. Acute care visits, including emergency department visits and hospitalizations, related to substance use disorders (SUD) are increasing and can be opportunities to engage individuals to get proper treatment (Suen LW et al. J Gen Intern Med 2022; 37(10):2420–2428).

Both mental disorders and SUD lead to subsequent chronic physical conditions, premature death, suicide or overdose (Bennett AC. Public Health Rep 2019; 134(1):17-26) that can be accidental or not.

24% to 32% of patients with Substance Induced Psychosis develop later a schizophrenia spectrum disorder or bipolar disorder (Starzer MSK et al. Am J Psychiatry 2018;175(4):343–350) leading to a chronic use of medication and, in several instances, to a necessity of psychiatric in-patient treatment with long hospital stays and high readmission rates (Khan S. Health Reports (2017) 28(8)3-8).

Our goal was to analyze if substance use is associated with higher psychiatric hospitalization rates.

An independent-samples t-test was run to determine if there were more hospitalizations among patients with substance use. Afterwards, the Cohen’s D was calculated to measure the effect size and to see the magnitude of the experimental effect.

A sample of 2604 in-patient treatment episodes was used. The sample had 1696 female patients, 908 male patients and 823 patients had substance use. We found that patients with substance use had a statistically significant higher hospitalization rate (6.82±5.27) than the ones without it (5.32±4.84), t(1483)=6.945, p<0.001. Cohen’s effect size value (d=.30) suggested a small practical significance.

Our findings go mainly accordingly the literature; we found a significant effect of drugs on readmission rates (Böckmann V et al. Front Psychiatry 2019; 10:828) but we might have thought it would be bigger. That could be explain by undiagnosed substance use (refusal to admit the use, drugs not detected on lab tests, not requesting toxic lab tests) or higher sample percentage of confounding comorbid diagnoses.

However, is undoubtable the several risks that drugs bring to our health and so the authors aim to raise awareness among the medical community to the importance being alert for signs of use or psychiatric symptoms to avoid reaching a no turning point. It’s known that doctors frequently fail to diagnose SUD in hospitalized patients and given the linkage between use of certain substances and particular medical reasons for admission, it would be well-advised to search for SUD in certain admission diagnoses (Weintraub E et al. Am J Addict 2001;10(2):167-77). Knowledge of substance use behavior may help reducing relapse rates and to reduce the risk of developing a SUD (Andersson HW et al. Nordic Journal of Psychiatry, 75:3, 160-169).

None Declared

Alcohol is considered a social evil worldwide owing to its vast array of associated problems and complications, which may manifest in medical, legal or social domains. Excessive and prolonged alcohol use may lead to permanent structural and functional damage to the brain. The evidence from neuroimaging, neuropathological reports and autopsy evaluations suggest some degree of brain pathology in individuals diagnosed with an alcohol related disorder.

The aim of this study is to characterize the structural imaging findings on computed tomography (CT) and magnetic resonance (MR) imaging of our sample and provide an overview of the literature on the subject.

Retrospective observational study with inpatients of Coimbra Hospital and University Centre (CHUC), who had alcohol use disorder diagnosis associated with dementia or cognition deficit. Patients were admitted from 2017 to 2021 and submitted to neuroimaging: CT and MR. Data was collected in May 2021 at informatic system.

Among 38 participants, the median age was 64 years; 86,8% were male. 35 realize CT, 34 with alterations: 23 with microvascular lesions, 17 with cortical atrophy, 8 with white matter hypodensities and 7 with subcortical atrophy. From all patients, only 14 realize MR, 13 with alterations, the most common vascular leukoencephalopathy and cortical atrophy.

Our results support the hypothesis of neuroimaging changes resulting from alcohol consumption. The severity of alcohol dependence also correlates with neuropathophysiological and neuroimaging changes. Volume shrinkage, altered glucose metabolism and perfusion along with evidence of markedly decreased neuron density are commonly reported. The evidence of neuro-circuit disturbances is seen in form of significant loss of white matter (most prominent in the prefrontal cortex, cerebellum and corpus callosum) on functional imaging. Greater cognitive impairment has been associated with multiple and repeated withdrawal due to greater neuronal damage, and can limit the psychotherapeutic intervention, the adherence to pharmacological therapy and abstinence maintenance. The sheer presence of alcohol use disorder should encourage a neuroimaging evaluation.

None Declared

Acute mental health presentations such as suicidality or psychosis are frequently accompanied by intoxication, substance use disorder, deliberate self-poisoning and social crises. There is a need to break down silos and provide integrated multi-disciplinary acute care for such individuals.

Here we describe outcomes of the Psychiatry And Drug ANd Alcohol (PANDA) Unit, a unique physical space collocated with the emergency department (ED) along with a unique model of care, providing multidisciplinary care to individuals presenting with acute mental health concerns plus complex comorbidity.

A description of the PANDA model of care and Service characteristics along with process and outcome measures across the first 12 months that the PANDA Unit was operational. These include number of patients admitted, patient demographics and characteristics, length of stay, referral destinations and impact on the occurrence of behavioural disturbance across the ED.

PANDA opened in November 2020 and since then has admitted an average of 122 patients per month (15% Aboriginal) with an average bed occupancy of 79% and average length of stay of 1.3 days. An average of 12% of patients were scheduled under the mental health act and an average of two patients were stepped down from ICU each month, with the remainder being admitted via the ED. An average of 80.7% of these were discharged home directly while 7.2% were transferred for inpatient withdrawal management and 8.9% to inpatient mental health services. The top three substances of concern were alcohol methamphetamine and heroin and an average of 16.5% of people reported injecting drugs in the prior 3 months. An average of 37.8% patients had been seen by an emergency physician and admitted to the PANDA Unit within 4 hours, one of the best performing units hospital-wide. In the 6 months prior to PANDA becoming operational there was a median of 20 episodes of behavioural disturbance requiring restraint per month across the ED. This dropped to 12 episodes in the six months following the PANDA Unit opening.

The PANDA Unit model of care has proven feasible to implement and has made a positive impact on a previously underserved patient population. It has also contributed to improving the integration of care for mental health patients with comorbidity as well as reducing behavioural disturbance and improving patient flow across the emergency department.

None Declared

Nowadays the disorders of Mental sphere are still the clinically significant disturbances in an individual’s cognition, emotional regulation, and behaviour. They are usually associated with distress or impairment in important areas of functioning. In recent years, more than 280 million people were living with depression, including 23 million children and adolescents. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Heart failure (congestive heart failure) is the leading cause of hospitalization in people older than 65. Soluble ST2 is regarded as a key molecule regulating immune system as well as cell proliferation. Elevated serum concentrations of soluble ST2 have been reported in patients with neuropsychiatric disorders, suggesting pathophysiological roles of soluble ST2 in behavioral phenotypes.

measurement of the amount of ST2 molecule levels in the blood of patients with depressive disorders and comorbid heart failure.

there were examined 180 patients with depression of varying severity together with the syndrome of HF of ischemic genesis, FC II-IV (NYHA). Depressive disorders were diagnosed and determined using the Hamilton Depression Rating Scale (HDRS) with the result in 20 and more points. Transthoracic echocardiography was performed; the plasma content of soluble ST2 (sST2) and the titers of the N-terminal fragment of the brain natriuretic peptide (NT-proBNP) in the blood were determined by ELISA. Statistical analysis was performed using the standard software package “Statistica for Windows 12.0” (StatSoft, Tulsa, OK, USA).

The average age of the examined patients was (69.33 ± 10.44) years; among them - 64 women (35.5%). It was found that the levels of soluble ST2 and NT-pro-BNP in the blood of patients with depressive disorders and HF decreased with prescribing of 3 months therapy of multimodal antidepressant. After the treatment using vortioxetine, the majority of patients with HF and depressive disorders of moderate intensity - 111 (61.6%) people –noted a reduction in symptoms of both depression and heart failure. Univariate correlation analysis showed a direct relationship between soluble ST2 levels in the blood of the examined patients and the reduction of depressive symptoms (rs= 0.33; p = 0.041); blood content of NT-pro-BNP (rs = 0.51; p = 0.015); resting heart rate (rs = 0.31; p = 0.011) and feedback from LV EF (rs = -0.39; p = 0.043).

Patients with depressive disorders and concomitant heart failure that are treated with multimodal antidepressants (vortioxetine) are more likely to have decreased levels of soluble ST2 molecule in the blood, that explain the anti-inflammatory together with anti depressive effect of this medication.

None Declared

Diabetes mellitus is a chronic progressive disease, which has been associated with various mental and physical health problems, including sexual disorders. However, especially among female patients the potential effects of diabetes on sexual functioning have been understudied.

The aim of this study was to investigate the perceived sexual functioning in patients with diabetes mellitus compared to a group of healthy controls, as well as to explore its possible association with depression, anxiety, self-esteem, well-being and adult romantic attachement.

The study included 125 patients with diabetes and an equal number of healthy controls. All participants completed the following psychometric scales: Experiences in Close Relationships- Revised (ECR-R), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSE), Mental Health Continuum Short Form (MHC-SF), as well as Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF) for female and male participants, respectively.

The results did not reveal a significant relationship between diabetes and sexual functioning, as no statistically significant differences emerged between patients and healthy controls neither among men nor women. However, in patients with diabetes, a positive correlation was found between perceived sexual dysfunction and depression, anxiety, and avoidant and anxious attachment, as well as a negative correlation with self-esteem and well-being.

The findings highlight the importance of investigating sexual functioning among individuals with diabetes mellitus, especially women, as well as its relationship with crucial psychological factors.

None Declared

Chronic heart failure causes serious mental problems in the life of the patient and caregiver due to symptoms and repeated hospitalizations.

This study was conducted to investigate the levels of depression and interdependence in caregivers of patients with chronic heart failure and to examine the relationship of the patient’s depression level with caregiver depression and co-dependence scores.

The sample of the research, which is descriptive and relationship seeking, consists of 219 volunteer patients with chronic heart failure and caregivers who meet the research criteria. The data were collected using Personal Information Form, Beck Depression Scale and Co-Dependency Assessment Tool, and were evaluated with descriptive statistical analyzes, Kolmogorow-Smirnov, student-t, oneway ANOVA, Pearson correlation analysis and Mann Whitney U Test.

The average age of caregivers was 47.36 ± 12.46 and 60.3% were women. The average age of the patients is 60.70 ± 16.30 and 57.1% are male. Depression was found in 85.8% of patients according to the Beck depression scale score. The presence of depression in the patient and the total depression score of the caregiver (p <0.001), total co-dependency score (p <0.001), self-value (p = 0.001), medical problem (p <0.001) and self neglect (p = 0.005) subscale scores were higher than those who did not have depression. Co-dependence and depression scores are related in caregivers (r=0.367).

There was a positive and significant correlation between the depression levels of the patients and caregivers and the codependence levels of the caregivers, and according to the presence of depression, the mean scores of co-dependence in the caregiver differ.

None Declared

In prenatal clinical consultations, what do adolescents talk about, in addition to physical and affective conditions and acquiring information about the general state of the evolution of pregnancy? The symbolic psychological elements that emerge during consultations are important for the handling of family guidelines with the clinical team.

To interpret emotional meanings attributed by pregnant adolescents, with the possibility of accessing public health care service in a Brazilian metropolitan city, about talking and listening about Family relationships with the clinical team in prenatal consultations.

Clinical-qualitative design by Turato. Semi-directed interviews with open-ended questions in-depth conducted online during the pandemic. Sample closed by theoretical information saturation according to Fontanella. Interview material, fully transcribed, was treated by Clinical-Qualitative Content Analysis of Faria-Schützer, with Balintian psychodynamic concepts from Medical Psychology to generate categories of discussion after free-floating readings. Findings were validated by peers from the Laboratory of Clinical-Qualitative Research, at the State University of Campinas.

The sample was closed with 10 pregnant adolescents. Three categories emerged from the analysis: (1) emotional meanings of the non-use the access to health service as a listening space: affective obstacles and social shame; (2) the relationship of complicity with the maternal figure in “competition” with a possible broad psychological relationship with the clinical team; (3) recurrence of teenage pregnancy in the family as a possible obstacle.

The finding so far that the adolescent’s personal reference is reported as the mother figure is also accentuated because the affective relationship with the doctor figure is more fragile. The bond of adolescents is established with the health institution and not with the reference health team.

There is a mismatch between the psychic maturation, still evolving, to the adult identity and the demands of social roles of the pregnant teenager already demanded as an adult. The teenager captures it, and the medical consultation becomes an act that occurs by inertial force. There is a perception of access to the health service and not access to the doctor as someone qualified for the adolescent to talk about relevant personal matters.

None Declared

Delirium is characterised by an acute, fluctuating change in cognition, attention and awareness (Wilson et al. Nature Reviews 2020; 6). This presentation can make the diagnosis of delirium extremely challenging to clinicians (Gofton., Canadian Journal of neurological sciences. 2011; 38 673-680). It is commonly reported in hospitalised patients, particularly in those over the age of sixty five (NICE. Delirium: prevention, diagnosis and management. 2010).

Our aim is to identify which investigations and cognitive assessments are completed prior to a referral to the liaison psychiatry services in patients with symptoms of delirium.

Referrals (N = 6012) to the liaison psychiatry team at Croydon University Hospital made between April and September 2022 were screened. Search parameters used to identify referrals related to a potential diagnosis of delirium were selected by the authors. The terms used were confusion; delirium; agitation; aggression; cognitive decline or impairment; disorientation; challenging behaviour. Data was collected on the completion rates of investigations for delirium as advised by the NICE clinical knowledge summaries. Further data was gathered on neuroimaging (CT or MRI), cognitive assessment tools (MOCA/MMSE) and delirium screening tools (4AT/AMTS).

The study sample identified 114 referrals (61 males and 53 females), with 82% over 65 years at the time of referral. In 96% of referrals, U&E and CRP were performed. Sputum culture (1%), urine toxin screen (4%) and free T3/4 (8%) were the tests utilised the least. Neuroimaging was completed in 41% of referrals (see Graph 1 for a full breakdown of results).

A formal cognitive assessment or delirium screening tool was completed in 32% of referrals. The AMTS and 4AT tools were documented for 65% and 24% respectively. A total of 19 referrals explicitly stated the patient was suspected to have dementia. A delirium screening tool was documented in 47% of these cases however, a formal cognitive assessment was documented in only 5% of these patients.

Following psychiatric assessment 47% of referrals were confirmed as delirium.

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Our data highlights the low level completion of the NICE recommended delirium screen prior to referral to liaison psychiatry. The effective implementation of a delirium screen and cognitive assessment is paramount to reduce the number of inappropriate psychiatric referrals in hospital and helps to identify reversible organic causes of delirium. This in turn will ensure timely treatment of reversible causes of delirium and reduce the length of hospital admission.

None Declared

People living with HIV (PLHIV) experience higher levels of mental health issues compared to the general population. Especially depression, anxiety, impulsivity and substance use occur frequently in PLHIV. This is thought to have important consequences for quality of life, sexual risk behaviour and antiretroviral treatment (ART) adherence. Both in PLHIV as well as in the general population, divergent psychiatric symptoms often co-occur, and influence one another.

To assess the interrelatedness of psychiatric symptoms and their potential consequences in PLHIV.

Data from 1615 outpatient PLHIV using suppressive ART from the 2000HIV study (NCT03994835) were analysed. Participants reported on the severity of substance use (MATE-Q), depression and anxiety (HADS), impulsivity (BIS-11), quality of life (EQ-5D-5L), ART adherence (MASS-8) and sexual risk behaviour. For these variables, prevalence rates and mean scores were calculated. After binarizing the data, an Ising network model was constructed. Using this network, interrelations between psychiatric symptoms were assessed, the centrality of symptoms was estimated and connections with clinical consequences were explored.

In our cohort of PLHIV, the increased prevalence of substance use was most pronounced, as shown by a prevalence rate of 28.7% for smoking, 13.6% for cannabis use, 11.1% for heavy alcohol drinking and 9.2% for ecstasy use in the past month. The network analysis revealed that symptoms of depression and anxiety were most strongly interrelated. The depressive symptom “feeling slowed down” was one of the most central symptoms, and was most strongly connected with quality of life. Substance use was associated with a higher occurrence of sexually transmitted diseases, and this relationship was mediated by a higher number of sexual partners. Notably, ART adherence did not display any connections with depression, anxiety, impulsivity or substance use.

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The high occurrence of substance use and its link with sexual risk behaviour, emphasizes it’s role as a potential target for prevention of HIV transmission. Contrary to general assumption, psychiatric symptoms are not associated with lower levels of ART adherence in our cohort. Treatment of depression in PLHIV might be improved by focussing on the symptom of feeling slowed down, since this symptom was most strongly connected with quality of life.

E. Meeder Grant / Research support from: ViiV Healthcare, M. Blaauw: None Declared, L. van Eekeren: None Declared, A. Groenendijk: None Declared, W. Vos: None Declared, Q. de Mast: None Declared, W. Blok: None Declared, A. Verbon: None Declared, M. Berrevoets: None Declared, J. van Lunzen Employee of: ViiV Healthcare, L. Joosten: None Declared, M. Netea: None Declared, V. Matzaraki: None Declared, A. van der Ven: None Declared, A. Schellekens: None Declared

Up to 50% of patients with brain tumors experience psychiatric symptoms, and rates up to 80% have been reported in malignant neoplasms such as glioblastoma multiforme (GBM). Still, clinical presentation as mania-like syndromes is a rare phenomenon, mainly occurring when frontal structures are compromised.

We present the case of a 42-year-old woman who was admitted to our hospital due to manic symptoms coinciding with a recurrence of a bifrontal GBM, for which she underwent surgery 5 months prior.

1) To describe the clinical particularities of this case, focusing on the differential diagnosis.

2) To review the association between manic symptoms and frontal dysfunction caused by brain tumors, with special interest on GBM.

A review of the patient’s clinical history and complementary tests performed was carried out. Likewise, we reviewed the available literature in relation to manic symptoms related to brain tumors.

The patient’s GBM recurrence presented with late onset symptoms of mania, including euphoric mood, increased spending, ideas of grandiosity and hyper-religiosity. She had no previous psychiatric history but, interestingly, she had an extensive affective burden in her family, with 4 consummated suicides. However, she also presented other clinical signs, such as disorientation, perseveration, mild memory impairment and stereotyped motor behaviors, that pointed to relevant frontal lobe dysfunction, suggesting Moria as a possible contribution for the symptoms described.

Manic symptoms in the context of brain tumors appear in 7-15% of patients with psychiatric symptoms, usually associated with right frontal dysfunction (75% of cases). Bifrontal affectation, such as this patient, is only described in 6% of cases. Although fast growing, malignant tumors have been associated with higher rates of psychiatric symptoms, no correlation has been described between these and brain tumor histology.

- The presence of atypical manic symptoms, such as those presented in this case, should raise clinical concern for secondary mania.

- Moria shares similarities with mania, including mood elevation, tendency to hilarity or hyper-sexuality, that may hinder diagnosis of patients with frontal dysfunction.

- This case outlines the difficulties in making a differential diagnosis in patient with both manic and neurological signs, and highlights the implication of frontal structures in the development of manic symptoms.

None Declared

Research has shown 30-40 % of people who have experienced traumatic injury are at risk of developing mental illness. Some injuries may be the result of mental ill-health, including self-inflicted injury. Furthermore, the development of psychopathology after injury appears to be a major determinant of long term disability. Early intervention can reduce symptom severity and prevent development of mental illness.

Ireland’s National Trauma System Implementation Programme, announced in April 2021, highlights the need for screening for mental disorders.

The Mater Misericordiae University Hospital (MMUH) is designated as one of two national Major Trauma Centres in Ireland. Its trauma service will expand with an expectation of an additional 450- 500 major trauma patients over the next three years.

The Consultation Liaison Psychiatry Service (CLP) currently provides expert mental health input to medical and surgical teams, in managing a range of patients with mental illnesses or psychological difficulties, including those with experience of major trauma.

To examine the current mental health service provision for trauma patients over a six-month period. We aimed to identify areas of need to inform future development of a psychiatry-led MDT service for trauma patients.

A review of all patients admitted on the MMUH trauma pathway between January 2021 and June 2021 was performed. The following data were recorded: demographics, mechanism of injury and information on referrals to the liaison psychiatry service.

There were 105 trauma cases over the six-month period; 46 females and 59 males. The mean age was 58.4 years (SD 22.16). Twelve individuals were recorded as ‘No Fixed Abode’ or living in homeless accommodation(11.4%).

In terms of mechanism of injury; 20 were assaulted of which 8 were stabbing/ knife injuries. There were 65 falls and 12 road traffic accidents. In 3 cases (2.8%), the mechanism of injury was self-inflicted. Twenty patients were admitted to critical care (19%).

Of the 105 trauma patients, 19 (18%) were referred to CLP service; 2 (10.5%) were seen in the outpatient setting, the rest as inpatients (89.5%). At least one repeat review was indicated in 10 of the 19 patients (52.6%).

Trauma patients have a high rate of comorbid mental illness. Nearly 1/5 are currently referred to the CLP service, which is likely an underestimation of the actual burden of mental health disorders and could be explained by the lack of dedicated services. The liaison psychiatry team provides valuable input into the multidisciplinary care of trauma patients and the demand for its services is likely to increase with the expansion under the Major Trauma Strategy for Ireland.

None Declared

The problem of eating disorders has become increasingly important in recent years, due to the increase in the number of cases among children and adolescents, as well as the insufficient effectiveness of therapeutic measures. An important role in the course of eating disorders is occupied by the depressive syndrome associated with it, which complicates the process of treatment and rehabilitation in this pathology.

Study of the stages of treatment of eating disorders in the structure of depressive states.

The sample consisted of 63 patients aged from 15 to 25 years old (all female, average age 16.2), who were on outpatient and inpatient observation in the clinic were studied.

In the process of treatment, several stages of treatment of patients were carried out. The first stage was aimed at normalizing the body’s vital functions and management of somatoendocrine impairments (the duration of the stage is about 14 days). The next stage was aimed at the psychotropic treatment of eating disorders and concomitant mental pathologies (the duration of the stage is 3-4 weeks). The final stage included rehabilitation, which consisted of working with a psychotherapist (the duration of the stage was 8 weeks or more). It should be noted that in the process of rehabilitation, patients continued to receive psychopharmacotherapy and underwent a comprehensive examination to assess the dynamics of their condition.

Eating disorders in the structure of endogenous depressions require an integrated approach to treatment, including both ensuring adequate vital activity of the organism and the selection of drug treatment depending on the nosological affiliation of the underlying syndrome. Rehabilitation work aimed at social adaptation and prevention of relapses of the disease also plays an important role.

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Anorexia nervosa (AN) is a severe psychiatric disorder that usually begins during adolescence and is associated with a high risk of mortality and morbidity, its treatment is complex and often ineffective. Psychiatric comorbidity is common in patients with eating disorders (with the prevalence of 20–95%), namely 39% in AN.

The purpose of the authors is to review the most common areas of psychiatric comorbidity in AN, how it affects the course of both diseases and the potential treatment approaches.

A brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.

The most common psychiatric comorbidities in AN are: Affective disorders in 24-38% (mainly unipolar depression which can appear in up to 75% of patients, compared to 11% in bipolar disorder); Anxiety disorders in 25.5% (11% with panic disorder, 20% social phobia/social anxiety disorder, 15% specific phobias, 10% generalized anxiety disorder, 13% post-traumatic stress disorder); Obsessive compulsive disorder in 12%; Substance use disorders at 17%; Personality disorders around 30%. Other pathologies occur less commonly but can have a significant impact on the patient, namely Autism spectrum disorder (predictive factor for unfavourable outcome) or Schizophrenia (there are reports of reciprocal relationships between the two pathologies).

Some of these comorbidities may increase mortality in AN, namely unipolar depression, personality disorders, alcohol and illicit drug use.

The profound impact that starvation has on mood and cognition is well known. It can condition symptoms that are confused with other psychiatric diseases and change their clinical presentation. As such, the specific clinical characteristics and the therapeutic approach will be presented for each of the psychiatric comorbidities.

Early diagnosis and treatment of psychiatric comorbidities in AN are essential to improve the prognosis of this eating disorder. The additional treatment of these pathologies will increase complexity of the already challenging treatment of AN, with the additional symptomatology often being perpetuated by an uncontrolled eating disorder and a poor compliance to treatment.

The limited evidence available for approaching these cases is based on the few studies available, most with insufficient samples.

None Declared