Complex regional pain syndrome (CRPS) is a rare condition associated with chronic pain. It is an inflammatory and neuropathic disorder principally characterized by involvement of the autonomic nervous system. The etiology of the syndrome is not clear and the known treatment modality is also very complicated.

Extant literature has shown the relationship between CRPS and suicidal behaviours in adults but less data are available in adolescents. This literature review aims to synthesize and evaluate the existing studies assessing suicidality in CRPS adolescents.

A narrative review of the literature focusing on CRPS and chronic pain in adolescents and their associations with suicidal behavior including suicidal ideations, suicide attempts and death by suicide.

The studies of suicidality factors in adolescents evaluated chronic pain in general. Those who studied CRPS specifically did not look for its association with suicide risk. In fact, adolescents who suffer from chronic pain present increased risk for suicide ideations and suicidal attempts. Furthermore, no available data have demonstrated the association between chronic pain and suicide. Additionally, among adolescents with CRPS, the risks of somatization, anxiety, and depression are higher. The duration of pain, depression and eating disorders has been shown to be associated with increased suicidality.

Our findings suggest that CRPS is associated with higher risks for suicidal ideation, suicidal attempts compared to the general population. The risk factors underlying suicidal behavior in CRPS patients are not studied enough and require further investigation.

None Declared

Auditory verbal hallucinations (AVH) form a central symptom in the current diagnosis of schizophrenia in the DSM-5 and ICD-10. In both internatinal classifications, hallucinations are considered an erroneous perception without external stimulation. AVH are often viewed as a well-defined entity in itself with certain quasi objective properties. They seem not to arise from nothing but are preceded and accompanied by the anomalies of subjective experiences such as e.g. feeling different, thought aloud and thought interference and experiences difficult to distinguish these phenomena from “hearing voices”. Several recent reviews point to the complexity of the nature of AVH and advocate the involvement of contextual issues and co-occurring psychopathology.

The aims of this study were to examine the qualitative aspects of the experience of hearing voices, the period of disclosure of AVH and the concomitant subjective experiences (self-disorders) in a group of readmitted patients with a diagnosis of paranoid schizophrenia and experiencing AVH.

We performed an empirical qualitative and phenomenologically oriented investigation of the experiential and existential aspects of AVH. Twenty patients with AVH and fulfilling the ICD-10 criteria of schizophrenia were interviewed with semi-structured questionnaire, covering the aims of this study. The interview encouraged the patients to reflect and express themselves freely. We used 26 items (domains stream of consciousness and basic self) from the Examination of Anomalous Self-Experience (EASE).

The disclosure of AVH happened when the patient arrived at a situation of subjective suffering or dysfunction in life, often several years after their beginning. Several participants were not able to determine whether voices were in the “internal” or “external” space. They did not consider their AVH as being analogous to a perception of an external object. The patients were continuously in doubt whether their experiences merited the name of voices or merely thoughts. The terminological status of the AVH as “voices” was typically acquired in the psychiatric setting.

AVH themselves are not a sufficient sign of mental disturbance unless it is an aspect of a profound change in the structure of consciousness. There is an apparent continuity between thinking and hallucinations. AVH articulate themselves within the intimidate sphere of the patient in another dimension and not in the shared social world as a real perception. The patient’s difficulties to describe the detailed features of hallucinations could be an expression of the psychiatrist‘s insistence on framing the hallucination in the perceptual space to which it does not belong leading to a risk of missing the phenomenon.

None Declared

Young people represent a vulnerable population, with 75% of mental disorders first emerging before 25 years of age. This pilot stems from the acknowledged need to design and test non-stigmatizing programs that are appealing to young people and suited for the protean mental health problems that they experience.

The study involves a group of youths (aged 16-25) with different forms of mental ill-health in a locally and culturally meaningful activity, namely hand-harvesting grape in the renowned area of Langhe (Italy). The aim is to investigate viticultural practices as possibly effective in supporting recovery by promoting social interaction and fostering a sense of belonging in the broader process of winemaking.

The project is multidisciplinary in its design and implementation, involving psychiatrists, psychologists, rehabilitation specialists and sociologists. Research methods include clinical assessment, participant observation, and semi-structured interviews with the participants.

During the harvest season, a stable group of participants has been involved in a one-to-one relationship with professional vine growers. This relational geometry was built around the performance of a practical task: that of filling in a box with manually harvested grape and moving it along the rows of vines. Within each dyad, which represents the most fragile and intimate of all social forms, practical knowledge has been conveyed from the experienced worker to the youth. Most importantly, the repeated encounters provided an opportunity for human interaction and exchange that went beyond the activity being performed, involving the gradual disclosure of self, the ability to listen, connect and empathize with personal stories from diverse backgrounds. Participants’ narratives collected during and after the pilot describe the vineyard as a psychic more than a physical place – a landscape of the mind, structured around the emotional and sensorial contents of the experience. The study’s core finding emerging from fieldwork and youths’ accounts is the beneficial effects of the intervention on transdiagnostic factors such as social anxiety symptoms, low self-efficacy and poor social skills.

The pilot provides suggestions to orient meaningful and non-stigmatising programs for vulnerable young people, hosted in landscapes that can become therapeutic not by virtue of their aesthetic features, but because of the access they provide to social (i.e. opportunities for new relationships), material (occasions to create and share something tangible) and affective (promotion of positive emotions, containment of loneliness and feelings of inadequacy) resources.

None Declared

Preventing psychiatric admissions holds benefits for patients as well as healthcare systems. The Clinical Global Impression-Severity (CGI-S) scale is a 7-point measurement of symptom severity, independent of diagnosis, which has shown capability of predicting risk of hospitalisation in schizophrenia. Due to its routine use in clinical practice and ease of administration, it may have potential as a transdiagnostic predictor of hospitalisation.

To investigate whether early trajectories of CGI-S scores predict risk of hospitalisation over a 6 month-follow-up period.

A retrospective cohort study was conducted, analysing Electronic Health Record (EHR) data from the NeuroBlu Database (Patel et al. BMJ Open 2022;12:e057227). Patients were included if they had a psychiatric diagnosis and at least 5 recorded CGI-S scores within a 2-month period, defined as the ‘index’ period. The relationship between early CGI-S trajectories and risk of hospitalisation was investigated using Cox regression. The analysis was adjusted for age, gender, race, number of years in education, and psychiatric diagnosis. Early CGI-S trajectories were estimated as clinical severity (defined as the mean CGI-S score during the index period) and clinical instability (defined as a generalised Root Mean Squared Subsequent Differences of all CGI-S scores recorded during the index period). The primary outcome was time to psychiatric hospitalisation up to 6 months following the index period. Patients who had been hospitalised before or within the index period were excluded.

A total of 36,914 patients were included (mean [SD] age: 29.7 [17.5] years; 57.3% female). Clinical instability (hazard ratio: 1.09, 95% CI 1.07-1.10, p<0.001) and severity (hazard ratio: 1.11, 95% CI 1.09-1.12, p<0.001) independently predicted risk of hospitalisation. These associations were consistent across all psychiatric diagnoses. Patients in the top 50% of severity and/or instability were at a 45% increased risk of hospitalisation compared to those in the bottom 50% (Figure 1).

Image:

Early CGI-S trajectories reflecting clinical severity and instability independently predict risk of hospitalisation across diagnoses. This risk was compounded when instability and severity were present together. These results have translation potential in predicting individuals who are at high risk of hospitalisation and could benefit from preventative strategies to mitigate this risk.

E. Palmer Employee of: Holmusk, M. Taquet Consultant of: Holmusk, K. Griffiths Employee of: Holmusk, S. Ker Employee of: Holmusk, C. Liman Employee of: Holmusk, S. N. Wee Employee of: Holmusk, S. Kollins Employee of: Holmusk, R. Patel Grant / Research support from: National Institute of Health Research (NIHR301690); Medical Research Council (MR/S003118/1); Academy of Medical Sciences (SGL015/1020); Janssen, Employee of: Holmusk

The kynurenine pathway has been suggested to be involved in the pathophysiology of psychiatric disorders, including schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD).

To conduct a systematic review and meta-analysis of the kynurenine pathway metabolites from cerebrospinal fluid samples in SZ, BD, and MDD.

PubMed and Scopus databases were searched from inception to April 2022 to identify case-control studies assessing kynurenine metabolites [tryptophan (TRP), kynurenine (KYN), kynurenic acid (KA), quinolinic acid (QA), and 3-hydroxykynurenine (3-HK)] in SZ, BD, and MDD vs. healthy controls (HC). PRISMA guidelines were followed in the literature review. The random effects model parameter was selected when comparing the standardized mean differences (SMD) between groups.

A total of 23 articles met inclusion criteria (number of articles k=8, 8, 11 for SZ, BD, and MDD, respectively). For SZ, KA levels were increased in SZ compared to HC (SMD=2.64, CI=1.16-4.13, p=0.0005, I2=96%, k=6, n=384). KYN levels were not significantly different between SZ and HC (SMD=4.19, CI=-0.70 to 9.09, p=0.0933, I2=99%, k=4, n=188). For BD, TRP levels (k=7) did not differ significantly between BD and HC. There was a limited number of studies to conclude increased levels of KA in BD (k=2). For MDD, although some studies tended toward increased levels of KYN in those with remission vs. decreased levels in those with current depression, there were no significant differences in any of the kynurenine metabolite levels. There was a limited number of studies to conclude increased levels of QA in MDD (k=2).

KA, which has possibly neuroprotective effects, is increased in SZ. QA, which has neurotoxic effects, may be increased in MDD. There may be alterations in this pathway based on population characteristics and mood states.

E. Salagre: None Declared, B. Fernandes: None Declared, M. Inam: None Declared, I. Grande Grant / Research support from: Spanish Ministry of Science and Innovation (MCIN) (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdireccion General de Evaluacion y el Fondos Europeos de la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022), Paid Instructor of: ADAMED, Angelini, Casen Recordati, Ferrer, Janssen Cilag, and Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare , E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI15/00283, PI18/00805) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357, Paid Instructor of: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Novartis, Orion Corporation, Organon, Otsuka, Sage, Sanofi-Aventis, Sunovion, and Takeda, J. Quevedo: None Declared, Z. Zhao: None Declared

About 60% of bipolar disorder (BD) cases are initially misdiagnosed as major depressive disorder (MDD), preventing BD patients from receiving appropriate treatment. An urgency exists to identify reliable biomarkers for improving differential diagnosis (DD). Machine learning methods may help translate current knowledge on biomarkers of mood disorders into clinical practice by providing individual-level classification. No study so far has combined biological data with clinical data to provide a multifactorial predictive model for DD.

Define a predictive algorithm for BD and MDD by integrating structural neuroimaging and inflammatory data with neuropsychological measures (NM). Two different algorithms were compared: multiple kernel learning (MKL) and elastic net regularized logistic regression (EN).

In a sample of 141 subjects (70 MDD; 71 BD), two different models were implemented for each algorithm: 1) structural neuroimaging measures only (i.e. voxel-based morphometry (VBM), white matter fractional anisotropy (FA), and mean diffusivity (MD)); 2) VBM, FA, and MD combined with NM. In a subsample of 71 subjects (36 BD; 38 MDD), two similar models were implemented: 1) VBM, FA, and, MD combined with only NM; 2) VBM, FA, and MD combined with NM and peripheral inflammatory markers. Finally, the best model was selected for comparison with healthy controls (HC).

Overall, the EN model based on all the modalities achieved the highest accuracy (AUC = 90.2%), outperforming MKL (AUC=85%). EN correctly classified BD and MDD with a diagnostic accuracy of 78.3%, sensitivity of 75%, and specificity of 81.6%. The most significant predictors of BD (variable inclusion probability (VIP) > 80%) were the parahippocampal cingulate, interleukin 9, chemokine CCL5, posterior thalamic radiation, and internal capsule, whereas MDD was best predicted by chemokine CCL23, the anterior cerebellum, and the sagittal stratum. In contrast, NM did not help to differentiate between MDD and BD. However, they help to distinguish patients from HC. Psychomotor coordination and speed of information processing discriminated between MDD and HC (VIP>90%), whereas fluency, working memory, and executive functions differentiated between BD and HC (VIP>80%).

In summary, BD was predicted by a strong proinflammatory profile, whereas MDD was identified by structural neuroimaging data. A multimodal approach offers additional instruments to improve personalized diagnosis in clinical practice and enhance the ability to make DD.

None Declared

The brain mechanisms of altruism cannot be strictly localized; therefore, the analysis of brain functional connectivity (FC) can reveal intrinsic mechanisms of altruism or, conversely, anti-social tendencies in behavior.

The objective was to investigate local FC patterns of altruistic decision-making using the “Pain versus Gain” (PvsG) paradigm.

The sample included 38 participants (18 females), 21.2±2.1 y.o. who signed the informed consent form and filled in the Interpersonal Reactivity Index questionnaire (IRI). The study protocol was approved by the local ethical committee. The PvsG task consisted of the control (CC) and experimental condition (EC) with 20 trials, each with 6 possible decisions. In the CC, participants had to decide which finger the second fake participant (FP) to move (one of five fingers or no move). In the EC, they were given money (1000 rubles) and had to choose in every trial between self-benefit (to keep 50, 40, 30, 20, 10 or 0 rubles) or FP’s pain induced by the medical electromyostimulator (with 6 levels of intensity, from “highest” to absence), e.g., when a participant keeps no money, the FP receives no stimulation. The FP was not present, and his finger moves and hand reactions to the stimulation were pre-recorded and presented as feedback. 62-channel EEG was recorded simultaneously, and the time intervals for decision-making were used for the weighted Phase Lag Index (wPLI) computation between the reconstructed cortical sources. Spearman coefficients with p-values correction via permutations were calculated between FC difference (EC vs. CC) and the sum of money given out.

The money given out correlates positively with the Empathic Concern (R=0.38, p=0.01), Perspective-taking (R=0.42, p=0.01), Fantasy scale (R=0.4, p=0.01), and does not correlate with the Personal Distress scale (R=0.17, p=0.28) of the IRI. Significant correlations were found between the money given out and the FC between the right lingual gyrus (lg) and caudal ACC in 4-30 Hz band (R=0.54, p<0.001) and FC between the caudal ACC and left insula in 8-13 Hz band (R=0.58, p<0.001).

The PvsG task is a valid paradigm for the investigation of brain mechanisms of altruistic decision-making. We described local FC correlates of prosociality formalized in the money given out which is associated with the measures of empathic concern and cognitive empathy. The ACC and insula are involved in salience network and pain matrix with the lg as an afferent, and their activity is modulated by empathy towards others. Thus, we claim that altruism depends on empathic motivation, which is associated with FC between these regions.

None Declared

Specialists in biology, medicine, and psychology need to pay special attention to theoretical and practical research on the implementation of the fight or flight mechanism in humans in conditions of war and hostilities. Adaptation mechanism of fight or flight is related to individual and social forms of behavior among people and animals, and is aimed at the homeostasis preservation in difficult living conditions. The evolutionary fight or flight mechanism in the functional connection with stress as a general adaptation syndrome and stress reactivity has individual features due to the strengthening of the functions of certain body systems. The systemic mechanism of fight or flight is accompanied by the corresponding functional and clinical symptoms and significantly influences physical and mental health of a person in various conditions of activity.

In this regard, the main goal of this work was to determine the relationship between the behavioral strategy of fighting or escaping under stress and during sports activities.

The following research methods were used to realize the goal of the work: theoretical analysis and generalization of literary sources and Internet data.

In our opinion, possible versions of Walter Cannon’s concept of the fight-or-flight mechanism are: 1) attack-or-flight mechanism; 2) defense or escape mechanism; 3) pursuit or escape mechanism. At the same time, it is advisable to consider aggression as a struggle, and escape as a struggle. In addition, in line with the concept of Walter Cannon and Hans Selye, it is possible to distinguish the stress of struggle and the stress of flight. Any intense muscle activity is accompanied by changes in the hormonal and nervous regulation of metabolism, as a result of which the body adapts to a certain physical load. In the athlete, these functional changes are observed even before the start of physical exercises, in particular, in the conditions of the pre-start and start state. The nature and reaction of neuro-endocrine mechanisms in the pre-start state depend on the nature of the load, as well as on the individual characteristics of the athlete (age, gender, type of nervous system, temperament, character, training, sports experience, etc.). It is important that the pre-start changes in metabolism contribute to the mobilization of the athlete’s functional potential even before the start of the corresponding physical activity. Moderate activation of the neuro-endocrine mechanisms of the athlete’s body (“combat readiness” state) is optimal. Functionally, it is less beneficial for the athlete’s body to have a sharp strengthening of neuro-endocrine mechanisms (“pre-start fever” state) or their paradoxical inhibition (“pre-start apathy” state).

Thus, in humans, sports activities include a behavioral mechanism of fight or flight in combination with physiological and psychological stress.

None Declared

Urbach-Wiethe disease (UWD; also named Lipoid proteinosis or Hyalinosis cutis et mucosae) was first described in 1929 by the Austrian scientists Erich Urbach and Camillo Wiethe and constitutes an autosomal recessive disorder which is characterized by several changes of body and brain. Most patients – and especially older ones – show symmetrical calcifications in the medial temporal lobes, especially the amygdala and the periamygdaloid region (Siebert et al., Brain 2003, 126, 2627-2637).

Patients with UWD with bilateral amygdala calcifications show several changes, from impairments in interpreting of odors to more complex changes in socio-cognitive and emotional domains (Markowitsch & Staniloiu, Neuropsychologia,2011. 49, 718-733).

Here, we describe the rarer case of a 19-year-old man with genetically proven UWD, who – up to now – lacks significant brain calcification.

The patient was investigated medically, psychiatrically and with neuropsychological and neuroimaging methods.

Findings of CT (see Figure 1) and MRI scans yielded no evidence of significant brain calcifications. Our patient AC manifested only a subset of changes encountered in patients with UWD with bilateral amygdala calcifications, namely in emotional processing (such as in more complex subsets of the Florida Affect Battery and Recall of Emotional/Neutral photographs), social cognition (Reading the Mind in the Eyes) and personality dimensions (suggestions for obsessive tendencies). The impairments in emotion-related task performance were similar in extent to those of the three UWD patients with bilateral amygdala calcifications of Brand et al.. Neuropsychologia 2007, 45, 1305-1317., indicating a probable sub-normal amygdalar functioning, in the absence of evidence of macrostructural amygdalar changes on imaging.

In the Game-of-Dice Task 17 out of 18 trials were so-called safe trials. His intelligence quotient (IQ) was 124 (33 points; MWWT-B), likely being a prerequisite for managing the requirements of the Game-of-Dice Task, enabling him to suppress impulsive acts.

Calcifications in Urbach-Wiethe disease take place progressively- possibly underpinned by genetic and gender variables; this can subsequently allow psychosocial-social factors (such as education and socialization) and biological factors (compensatory neuroplasticity) to retard and diminish the development of socio-emotional and cognitive deteriorations,

Given that select lesions to the human amygdala are exceedingly rare, longitudinal studies of patients with the UWD provide key evidence about how slowly progressive, developmental changes of the amygdala modulate vulnerability to socio-cognitive-emotional impairments and psychopathology.

None Declared

Formal Thought Disorder (FTD) is a cluster of symptoms and signs, and can be summarized as a multidimensional construct, reflecting idiosyncrasies in thought, language, and communication in general. The inquiry into its etiology is complicated by the ambiguity of the construct itself, and many theories regarding its pathogenesis have been put forward. Two main neurocognitive models, however, have been garnering attention in mainstream FTD research: the “dyssemantic” and the “dysexecutive” hypotheses. These concepts have been classically pitted out against each other as mutually exclusive, but recent studies have proposed a more integrative view.

In this presentation, we aim to explore the two main models for explaining FTD pathogenesis, and to show how an integrative model which accounts for both the dyssemantic and dysexecutive deficits seen in patients with FTD might be better at explaining its etiology.

We conducted a systematic review of the available literature according the PRISMA 2020 statement. We began by researching the Pubmed and Cochrane databases using the following search string: ((“Formal thought disorder*”[Title/Abstract]) AND (dysexecutive[Title/Abstract])) OR ((“Formal thought disorder*”[Title/Abstract]) AND (dyssemantic[Title/Abstract])) OR ((“Formal thought disorder*”[Title/Abstract]) AND (pathogenesis[Title/Abstract])) OR ((“Formal thought disorder*”[Title/Abstract]) AND (etiology[Title/Abstract])). 20 articles were retrieved, along with 2 ongoing trials. We screen for a total of 12 included articles. We also included 17 articles from citation searching, resulting in a final count of 29 included articles. We then summarized the main findings.

Two influential hypotheses explaining the neurocognitive pathogenesis of different FTD symptom are the “dyssemantic” and “dysexecutive” hypotheses. The “dyssemantic” model emphasizes abnormalities in language-processing related brain regions and functional networks. Some studies suggest that the dysfunctions might involve higher-order semantics and the syntactic component. The “dysexecutive” hypothesis suggests that impaired planning and monitoring might lead to poorly formulated or prone-to-error speech. Recent studies, however, have suggested that FTD might be related to a combination of both executive dysfunction and impaired semantic processing, which would then combine in different proportions and yield the different FTD manifestations.

While disfunctions in both semantic and executive cognitive faculties have been independently explored as potential explanations for the pathogenesis of FTD, a more integrative picture has surfaced in recent research. It proposes that FTD might actually be the reflections of a combination of different proportions of disfunctions in the executive and/or linguistic processes. More research is needed, with better defined FTD dimensions, in order to further explore this model.

None Declared

During the last decade, a growing digitalization allowed to implement technologies in daily life activities. Conversely, the increased use of technologies in general population, particularly in youths, facilitated the emergence of new web-based psychopathologies, including Pathological Internet use (PIU).

Our study aims at investigating the relationship between PIU and boredom as well as loneliness dimensions in youths, by also focusing on the association with the main psychopathological symptomatology (i.e., depression, anxiety and stress).

A nationwide population-based cross-sectional case-control study was conducted by recruiting a sample of Italian young adults (aged 18-24), using a snowball sampling strategy. After data cleaning, only 1,643 participants were selected for analysis based on age and classified according to the presence/absence of PIU/non-PIU. Linear regression analyses as well as Pearson correlation analyses were conducted to check for possible associations and correlations between PIU and stress/anxiety/depression. Subsequently, mediation analyses regarding boredom and loneliness were conducted on these relationships.

Participants were predominantly females (68.7%; n = 1,129). The mean age was 21.8 years (SD = 1.7), particularly ranging 20-24 years-old (88.5%; n = 1454). Around 41.7% (n = 685) of the sample declared previous psychological issues without a history of professional support (psychological and/or psychiatric), while 32.7% (n = 538) stated that they had an overt mental disorder and were currently receiving professional support. Mediation analysis demonstrated that both boredom and loneliness act as mediators in the association between PIU and depression.

Further studies are needed to evaluate how boredom and loneliness dimensions could be managed in order to alleviate the emergence of PIU in youths with clinically relevant depressive symptomatology.

None Declared

Premenstrual dysphoric disorder (PMDD) is a newly introduced category in the 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is highly underdiagnosed worldwide, despite its strong connections to anxiodepressive symptom severity and perceived well-being.

Firstly in Hungary, our aim was to: (a)assess whether even a probable PMDD diagnosis is associated with elevated levels of depressive and anxiety symptoms, and decreased perception of well-being on an adult women sample; (b)to evaluate whether women with a probable PMDD diagnosis report greater fluctuation of their affect during the different phases of their menstrual cycle; (c)to examine whether the elevated levels of anxiodepressive symptoms and lower well-being increase the statistical likelihood of having a probable PMDD diagnosis.

An online test battery was designed to examine probable PMDD diagnosis, severity of anxiodepressive symptoms and well-being. 393 adult women were screened for eligibility in the study (exclusion criteria involved: irregular cycle; use of hormonal contraceptives), from which 112 were included in the final analyses. DSM-5-Based Screening Tool for Women’s Perceptions of Premenstrual Symptoms, Beck’s Depression Inventory, Spielberger’s State Anxiety Inventory, and the WHO-5 Well-Being Index were assessed.

Based on the DSM-5-Based Screening Tool, the sample was divided into 1)women with probable PMDD diagnosis (PMDD group,n=67) and 2)women without probable PMDD (nonPMDD group,n=45). Menstruation cycles were sorted into menstrual, from-menstruation-to-ovulation, early luteal and late luteal phases. The PMDD group exhibited significantly higher depressive (F(1;56,2)=19.394, p≤0.001) and anxiety (F(1;35,6)=17.714,p≤0.001) symptom severity and lower scores of well-being (F(1;44,3)=4.288,p=0.0442) compared to the nonPMDD group regardless of which menstrual cycle they were in. Binomial logistic regression model was used to test whether higher anxiodepressive symptoms and lower scores of well-being increase the likelihood of having PMDD: the model was significant (χ2(2)=27.287,p≤0.001), and it explained 29.2% of the variance in PMDD. Elevated levels of anxiety (B=0.058, S.E.=0.022, Waldχ2(1)=7.142, p=0.008,OR=1.060) and depressive (B=0.085,S.E.=0.031,Waldχ2(1)=7.480,p=0.006,OR=1.089) symptoms increased significantly the likelihood of having a probable PMDD diagnosis.

Women with even a probable PMDD diagnosis exhibited significantly elevated levels of anxiodepressive symptoms and lower scores of well-being regardless of which menstrual phase they were assessed in compared to women without meeting the criteria of the PMDD screening tool. These preliminary results underscore the need for prospective clinical studies of differences in affective symptoms exhibited in PMDD.

None Declared

Several studies have shown that the relationship between migraine and psychological factors is significant, but few have evaluated the relationship between these psychological factors and patients’ social life.

Exploring the role of personality and psychopathology in people with migraines.

The sample consisted of 180 people, more specifically 140 people from the general population and 40 people who have been diagnosed with migraine and receiving treatment for migraine, who completed the following questionnaires voluntarily and anonymously: a) Migraine Experience Questionnaire and Headache Impact Test-6 (HIT-6), b) Eysenck Personality Questionnaire, c) Symtom Checklist 90-R (SCL-90) and socio-demographic and self-reported questionnaire.

Patients scored higher somatization rates (10.21 ± 8.08), phobic anxiety (3.00 ± 4.45), neuroticism (4.09 ± 1.37), than people from the general population who scored lower somatization rates (14.63 ± 3.12), Phobic anxiety (5.28 ± 1.89), Neuroticism (6.53 ± 2.12), with a statistically significant difference between them (p = 0.001), (p = 0.002), (p = 0.000), respectively.

Patients with symptoms of migraine show statistically higher rates of somatization, phobic anxiety, neuroticism and further study is considered necessary.

None Declared

Migraine often leads to reduction of social power and prestige of the patients, hence leading further emotions of shame.

Exploring the role of external and internal shame in people with migraines.

The sample consisted of 180 people, more specifically 140 people from the general population and 40 people who have been diagnosed with migraine and receiving treatment for migraine, who completed the following questionnaires voluntarily and anonymously: a) Migraine Experience Questionnaire and Headache Impact Test-6 (HIT-6), b) the Other As Shamer scale (OAS) c) the Experience of Shame Scale (ESS), and socio-demographic and self-reported questionnaire.

Patients scored higher level external Shame (OAS) rates (31.28 ± 6.98) than people from the general population who scored lower external Shame (OAS) rates (16.89 ± 10.00) with a statistically significant difference between them (p = 0.000). Also, patients scored lower-level internal shame (ESS) rates (45.58 ± 6.91) than people from the general population who scored higher internal shame (ESS) rates (53.36 ± 15.62) with a statistically significant difference between them (p = 0.003).

Patients with symptoms of migraine show statistically higher level of external shame and lower level of internal shame and further study is considered necessary.

None Declared

Hallucinosis has evolved out of classification systems but what about patients who present with exclusive or almost exclusive hallucinations? Auditory hallucinations are especially likely to swiftly be considered due to psychiatric illness.

An elderly patient with chronic auditory hallucinations without other significant psychopathology nor other symptoms prompted reflection and literature review.

To review differential diagnosis of auditory hallucinosis.

Pubmed search for terms: auditory and hallucinosis.

Hallucinations should be evaluated according to: type, onset and evolution, association with physical and /or neurological symptoms, association with other hallucinations and/or other psychopathology, characteristics.

Auditory hallucinations may present along a continuum from tinnitus, simple, verbal, musical.

The Pubmed search retrieved articles pertaining to auditory hallucinations associated with:

1. Sensory deprivation; 2. Hearing loss, auditory Charles Bonnet syndrome; 3. Dementia, neurodegenerative disorders; 4. Brainstem lesions; 5. Other central nervous lesions: thalamus, temporal, other; 6. Epilepsy; 7. Tic disorders; 8. Alcohol use disorders; 9. Borderline personality disorder; 10. Others.

Patients presenting with auditory hallucinosis should be carefully evaluated to exclude non-psychiatric disorders.

In some patients, such as the one who prompted the review, an identifiable cause may not yet be found.

None Declared

State-of-the-art research highlights that borderline personality disorder have high rates of comorbid Axis I disorders, which imply uncertainty in establishing an accurate diagnosis and can be some of the most challenging patients for clinicians and researchers.

This study seeks to observe the diagnostic stability in borderline personality disorder patients, in order to increase empirical knowledge through a retrospective look at the historical line of diagnoses.

A twenty-year retrospective study at a psychiatric hospital, searching at the electronic clinical records for all patients with borderline personality disorder diagnosis, under the code 301.83 from World Health Organization’s International Classification of Diseases, 9th Revision (WHO ICD9). A 346 patients’ sample was identified aged between 18 and 83 years (Mage=44.14 years, SD=11.18; predominantly female 73.70%; Mschooling=9.31years; Madmissions=4.72times, SD=9.21; 2nd-5th comorbid diagnosis, a 75.72% sample with three diagnosis); excluding organic cerebral syndrome and no comorbidity besides drug abuse, or no comorbidity at all.

As a general observation, the following diagnoses are indicated: 44.09% major depressive disorder, 33.16% affective disorder, 13.05% schizophrenia, and 9.70% mania. As a spectrums disorders analysis (Figure 1), differential percentage occurrences are identified in patients with borderline personality disorder.

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Based on clinical diagnoses records of borderline personality disorder patients, some spectrums disorders are highlighted, to be reported in descending order of incidence: depressive, affective, schizoaffective and schizophrenia spectrums.

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There is a fine line separating psychiatry and neurology. Most movement disorders can have psychiatric symptoms, not only those caused by the disease itself, but also those induced by the drugs used to treat them.

Presentation of a clinical case about a patient diagnosed with Parkinson’s disease presenting a several-month-long delirious episode due to dopaminergic drugs.

Literature review on drug-induced psychosis episodes in Parkinson’s disease.

A 57-year-old patient with diagnosis of Parkinson’s disease for six years, who went to the emergency room accompanied by his wife due to delirious ideation. He was being treated with levodopa, carbidopa and rasagiline for years, and rotigotine patches whose dosage was being increased over the last few months.

His wife reported celotypical clinical manifestations and multiple interpretations of different circumstances occurring around her. He chased her on the street, had downloaded an app to look for a second cell phone because he believed she was cheating on him, and was obsessed with sex. He had no psychiatric background. It was decided to prescribe quetiapine.

The following day, he returned because he refused to take the medication since he thought he was going to be put to sleep or poisoned. It was decided to admit him to Psychiatry.

During the stay, rasagiline and rotigotine were suspended. Olanzapine and clozapine were introduced, with behavioral improvement and distancing from the psychotic symptoms which motivated the admission. The patient was also motorically stable. Although levodopa is best known for causing psychotic episodes, the symptons were attributed to rotigotine patches for temporally overlapping the dose increase.

Psychiatric symptoms are the third most frequent group of complications in Parkinson’s disease after gastrointestinal complications and abnormal movements. All medication used to control motor disorders can lead to psychosis, not only dopaminergics, but also selegiline, amantadine and anticholinergics.

Excessive stimulation of mesocortical and mesolimbic dopaminergic pathways can lead to psychosis, which is the most common psychiatric problem related to dopaminergic treatment.

In the face of a psychotic episode, antiparkinsonian drugs which are not strictly necessary for motor control should be withdrawn. If this is not sufficient, levodopa dose should be reduced, considering the side effects that may occur. When the adjustment of antiparkinsonian treatment is not effective, neuroleptics, especially quetiapine or clozapine, should be administered. In a recent study, pimavanserin, a serotonin 5-HT2 antagonist, was associated with approximately 35% lower mortality than atypical antipsychotic use during the first 180 days of treatment in community-dwelling patients.

Medication should always be tailor-made to suit each patient and we usually have to resort to lowering or withdrawing the dopaminergic medication.

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One of the great challenges still to be achieved in schizophrenia is the development of a staging model that reflects the progression of the disorder. The previous models suggested have been developed from a theoretical point of view and do not include objective variables such as biomarkers, physical comorbidities, or self-reported subjective variables (Martinez-Cao et al. Transl Psychiatry 2022; 12(1) 1-11).

Develop a multidimensional staging model for schizophrenia based on empirical data.

Naturalistic, cross-sectional study. Sample: 212 stable patients with Schizophrenia (F20). Assessments: ad hoc questionnaire (demographic and clinical information); psychopathology: PANSS, CDS, OSQ, CGI-S; functioning: PSP; cognition: MATRICS; laboratory tests: C-Reactive Protein (CRP), IL-1RA, IL-6, Platelets/Lymphocytes (PLR), Neutrophils/Lymphocytes (NLR), and Monocytes/Lymphocytes (MLR) ratios. Statistical analysis: Variables selection was performed with an ad hoc algorithm developed for this research. The referred algorithm makes use of genetic algorithms (GA) to select those variables that show the best performance for the patients classification according to their global CGI-S. The objective function of the GA maximizes the individuals correct classification of a support vector machines (SVM) model that employs as input variables those given by the GA (Díez-Díaz et al. Mathematics 2021; 9(6) 654). Models performance was assessed with the help of 3-fold cross-validation and these process was repeated 10,000 times for each one of the models assessed.

Mean age(SD): 39.5(13.54); men: 63.5%; secondary education: 59.50%. Most patients in our sample had never been married (74.10%), and more than a third received disability benefits due to schizophrenia (37.70%). The mean length of the disease was 11.98(12.02) years. The best SVM model included the following variables: 1)Clinical: number of hospitalizations, positive, negative, depressive symptoms and general psychopathology; 2)Cognition: speed of processing, visual learning and social cognition; 3)Functioning: PSP total score; 4)Biomarkers: PLR, NLR and MLR. This model was executed again 100,000 times applying again 3-fold cross-validation. In 95% of the algorithm executions more than a 53.52% of the patients were classfied in the right CGI-S category. On average the right classification was of 61.93%. About specificity and sensitivity the average values obtained were of 0.85 and 0.64 respectively.

Our staging model is a robust method that appropriately distributes patients according to the severity of the disorder. Highlights the importance of clinical, functional and cognitive factors to classify patients. Finally, the inflammatory parameters PLR, NLR and MLR have also emerged as potential biomarkers for staging schizophrenia.

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To present a clinical case that reflects the causal relationship between the administration of high-dose corticosteroids and the appearance of maniform-type psychopathology.

Descriptive study of a case report and literature review on the subject.

32-year-old woman with alcohol abuse detected, added Antabus 250 mg / day to her treatment.

After 2 months of treatment, she was admitted to the Digestive Service due to acute hepatitis. After a liver biopsy and autoimmunity study was diagnosed as Autoimmune Hepatitis. Treatment with Antabus was withdrawn, and Prednisone 60 mg/day was prescribed. Seven days after starting treatment with corticosteroids, she presented maniform symptoms (psychomotor restlessness, expansive mood, dysphoria, megalomanic delusions, alteration of biological rhythms with decreased need for sleep and risk behaviors), and she was admitted in a psychiatric hospitalization unit. After considering various differential diagnoses she is diagnosed with Substance-Induced (corticosteroids) Mood Disorder with manic features. Psychiatry agrees with the Digestive Service to start treatment with Paliperidone and progressively lower the dose of corticosteroids until suspending it and prescribe an immunosuppressant. Finally, the maniform symptoms that led to admission remitted completely and control and outpatient treatment were continued.

Its important to always keep in mind the great risk of the appearance of psychiatric disorders that treatment with high doses of corticosteroids entails, especially in susceptible patients or with a psychiatric history or genetic susceptibility. It is necessary to know the possible appearance of these neuropsychiatric adverse effects in order to prevent them, and if it appear, to assess, if possible, the suspension or reduction of corticosteroid treatment.

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Mutism, defined as an inability or unwillingness to speak, resulting in an absence or reduction of speech, has a wide differential diagnosis. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. Mutism is typically associated with catatonia, usually in schizophrenia, but also depression, bipolar disorder, intoxication, and neurological conditions.

To describe a case of mutism without catatonia.

We describe a clinical case of a patient admitted to our psychiatric inpatient unit with mutism as the presenting symptom. The literature on this subject is also selectively reviewed.

A 49-year-old woman was found mute at home by her brother and brought to our emergency room. Not a word had come out of his mouth for the past month. She would show up at the restaurant where she worked as a waitress and do her job, but she didn’t talk. As a result, she had been fired. Her routine daily chores and her vegetative functions were maintained. She had no prior history of medical or psychiatric illness or substance abuse. In addition to the mutism, the patient showed an important psychomotor restlessness and performed repetitive hand movements suggestive of occupational delirium. There was no rigidity, stupor, negativism, catalepsy, echosymptoms or any other catatonic symptomatology.

She was then admitted to our inpatient unit, where a complete blood test, EKG, brain CT, brain MRI, EEG and a lumbar puncture with biochemistry and neuroimmunology studies were performed, none of them showing any abnormalities.

The clinical presentation suggested the diagnosis of either a psychotic disorder or a major depressive episode.

The patient was then started on olanzapine up to 20 mg/d, fluoxetine up to 20 mg/d and lorazepam up to 6 mg/d. Due to persistence of symptomatology despite pharmacological treatment, she was started on Electroconvulsive Therapy (ECT). At the time of issuance of this report, 7 bilateral ECT courses have been carried out and absolute mutism persists. Although she has presented an improvement of the anxiety and the repetitive behaviors noted on admission have disappeared, she hasn´t resumed speaking.

Mutism occurs in a number of conditions, both functional and organic, and an accurated diagnosis is important for the management. One must perform a thorough physical and systemic examination to rule out organic causes for mutism. An observation for some time period may be warranted and should be done to reach final diagnosis in our case.

None Declared