Cannabis use poses a significant risk to the psychological wellbeing of youth, affecting academic performance and potentially triggering the onset of mental health issues. Providing young people with comprehensive information about patterns of cannabis use and specific factors that increase an individual’s health risks is crucial. The ability to critically assimilate this information is known as health literacy (HL).

To design a psychoeducational intervention to increase HL on risky cannabis use among students aged 16-25, and to assess its usability and feasibility.

We designed a psychoeducational intervention based on the outcomes of a 3-hour co-creation session involving healthcare professionals and students. 29 university students and 25 high-school students completed this intervention and assessed its usability and feasibility with the SUS (System Usability Scale), PSSUQ (Post-Study System Usability Questionnaire) and additional open questions regarding the most and less-liked aspects of the intervention.

The design phase resulted in an informative website (http://www.cahlyclinic.cat/) and a 1-hour structured onsite educator-facilitated session, comprising 3 group activities (completed on paper or online) addressing three dimensions of cannabis HL: searching for, interpreting and applying reliable information. Usability of the intervention was rated as excellent (SUS mean score>80). PSSUQ results indicate that students were satisfied with the intervention; found the HL information clear, relevant, and adequate for their needs; found the interface of the digital version pleasant and usable without support; and would recommend it to other students.

We propose an innovative structured and usable intervention, designed using a participatory approach, which aims to disseminate information on risky cannabis use to a key target population, namely young people.

None Declared

Adolescents often lack vital information for making wise sexual and reproductive decisions, leading to risks like abuse, unwanted pregnancies, and infections. Comprehensive, early, and age-appropriate sex education is crucial. While parents should play a significant role, many underestimate their responsibility. The perception of sex education is changing, with younger parents being more open to participating in their children’s education.

This study compares the approaches of Tunisian parents with adolescent and pre-adolescent children towards sex education.

This study used a cross-sectional design to collect data from Tunisian parents of children between the ages of 1 to 18 using an online survey. Two groups were recruited based on the age of their children, one group had parents of children younger than 10 years old, and the other had parents of adolescents. The survey included questions about the participants’ demographics, approach to sex education, reasons for their approach, and opinions on sex-related education in public schools. The survey was anonymous and confidential, and data were collected from January to March 2023 through various social media platforms.

This study surveyed 232 Tunisian parents with children between the ages of 1 and 18, divided into two groups based on the age of their children. The majority of participants were female (62.1%) and married (81.9%). The majority of participants in both groups agreed that sex education is important and indispensable, but only 54.7% of parents in the older children group responded positively to teaching sexual education as an independent subject. There was a significant difference between the two groups regarding their opinions about the appropriate age of sexual education for their children, and who they think should discuss sexual and reproductive health with young people. Most participants indicated that the human body and its development, sexual and reproductive health, prevention of sexually transmitted diseases and infections, contraception as well as puberty are the most important subjects to be addressed. Sexuality and sexual behaviors, the concepts of violence and safety, interpersonal relationships, consent, insults, harassment, and sexist cyberbullying were less frequently mentioned.

In conclusion, this study highlights the importance of sex education in Tunisia. Parents in both groups support it but differ on timing and integration. Barriers like communication challenges and religious beliefs exist. These insights can guide tailored sex education programs for Tunisian parents, promoting youth sexual and reproductive health.

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Interest in the co-occurrence of gender dysphoria and autism spectrum disorder has gained prominence in recent years. Gender dysphoria refers to the distress experienced when there is an incongruence between gender identity and sex assigned at birth. On the other hand, autism spectrum disorder is characterized by difficulties in communication and social interaction, as well as restrictive and repetitive patterns of behavior.

The aim of this paper is to review the current available literature in order to expand our knowledge about gender identity and dysphoria in the population with autism spectrum disorder.

A qualitative review was conducted over the last 20 years, using the Medline database through PubMed. Combinations of MeSH terms related to gender identity and people with autism spectrum disorder were used, selecting those studies in English, French or Spanish that met the objectives of the review, excluding references in other languages. The scientific evidence obtained was analyzed and synthesized.

The development of gender identity of people with autism spectrum disorder can be a complex process. Comparing the general population with the population with autism spectrum disorder, a higher prevalence of gender dysphoria has been evidenced in the population with autism spectrum disorder, and within this group when segmented by gender, greater in women than in men.

This review highlights the importance of increasing knowledge about sexuality and gender dysphoria in people with autism spectrum disorder in order to facilitate the development, understanding and acceptance of their gender identity and sexual orientation of these people.

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Appropriate sleep habits play a pivotal role in the physical and psychological development of children. However, sleep deprivation or sleep problems can have a significant impact on children’s mental health and daily functioning. This study investigates the sleep habits and problems in children aged 7 to 10 who attend the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.

The primary objective of this study is to assess the sleep habits and problems in children aged 7 to 10, aiming to establish data that can guide the development, implementation, and reevaluation of future interventions tailored to this age group.

This study is observational in nature and involved the participation of 21 patients from the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal, throughout the year 2022. Questionnaires related to sleep habits were administered to this population. Parents were invited to complete the Children’s Sleep Habit Questionnaire (adapted from the Children’s Sleep Habit Questionnaire by Prof. Owens, 2000), while the children (patients) were asked to fill out the Sleep Self Report-PT (adapted from Owens 2000 Research Version) and the Strengths and Difficulties Questionnaire (SDQ-Por, by Robert Goodman, 2005).

As of now, the results of this study are still being processed. The data collected from the questionnaires will be analyzed to gain insights into the sleep habits and issues of children aged 7 to 10 years attending the Child and Adolescent Psychiatry Service in Vila Real, Portugal. Findings will be discussed, and any significant observations or trends will be highlighted.

This research aims to provide valuable insights into the sleep patterns and problems experienced by children in the specified age group. By understanding these issues, we can develop and implement targeted interventions to improve sleep quality and overall mental well-being. The conclusions drawn from this study will contribute to the development of evidence-based strategies for enhancing the sleep health of children in the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.

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Teachers encounter various challenges that can significantly affect their professional well-being. This issue stands as of paramount importance, for it not only wields influence over job satisfaction but also carries weighty implications for the quality of education provided.

This study aims to investigate the factors that affect teachers’ well-being, specifically examining the relationship between perceived stress, psychosocial risks, and burnout among public high school teachers in Tetouan, Morocco.

A questionnaire survey was conducted among 258 teachers, resulting in a response rate of 57%. Three distinct instruments were used to collect data: The Perceived Stress Scale (PSS) to evaluate perceived stress levels, the Job Content Questionnaire (JCQ) to assess psychosocial risks at work, and the Maslach Burnout Inventory (MBI) for burnout measurement. We examined the bivariate correlations among these three concepts.

The results demonstrate significant associations among the studied factors. Perceived stress has a positive correlation with emotional exhaustion (r=0.51; p<0.01) and depersonalization (r=0.56; p<0.01), and a negative correlation with personal accomplishment (r=-0.31; p<0.01). Additionally, emotional exhaustion has a positive correlation with psychological demand (r=0.38; p<0.01). Depersonalization shows a positive correlation with psychological demand (r=0.18; p<0.05), but a negative correlation with decision latitude (r=-0.30; p<0.01) and social assistance (r=-0.24; p<0.01). Conversely, personal accomplishment presents a positive correlation with decision latitude (r=0.58; p<0.01) and social assistance (r=0.50; p<0.01).

This study underscores the importance of decision latitude and social assistance in promoting personal accomplishment and mitigating burnout among teachers. Nonetheless, further research is required to substantiate these results and determine the fundamental cause and effect relationships.

None Declared

Attendance at university can result in social support network disruption. This can have a negative impact on the mental health of young people. Demand for mental health support continues to increase in universities, making identification of factors associated with poorer outcomes a priority. Although social functioning has a bi-directional relationship with mental health, its association with effectiveness of psychological treatments has yet to be explored.

To explore whether students showing different trajectories of change in social function over the course of treatment differed in eventual treatment outcome.

Growth mixture models were estimated on a sample of 5221 students treated in routine mental health services. Different trajectories of change in self-rated impairment in social leisure activities and close relationships (Work and Social Adjustment Scale (WSAS) items 3 and 5) during the course of treatment were identified. Associations between trajectory classes and treatment outcomes were explored through multinomial regression.

Five trajectory classes were identified for social leisure activity impairment (Figure 1), and three classes were identified for close relationship impairment (Figure 2). For both measures the majority of students remained mildly impaired (Class 1). Other trajectories included severe impairment with limited improvement (Class 2), severe impairment with delayed improvement (Class 3), and, in social leisure activities only, rapid improvement (Class 4), and deterioration (Class 5). There was an association between trajectories of improvement in social functioning over time and positive treatment outcomes. Trajectories of worsening or stable severe impairment were associated with negative treatment outcomes.

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Changes in social functioning impairment are associated with psychological treatment outcomes in students, suggesting that these changes may be associated with treatment effectiveness or recovery experiences. Future research should look to establish whether a causal link exists to understand if additional benefit for students can be gained through integrating social support within psychological treatment.

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Disturbances in the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-adrenal (HPA) axes have been frequently reported in treatment resistant depressed patients (TRDs). So far, the effects of intermittent theta-burst stimulation (iTBS) treatment—a form of repetitive transcranial magnetic stimulation (rTMS) technique—on the activity of the HPT and HPA axes are poorly understood.

The present study aimed to evaluate the effects of iTBS sessions, applied to the left dorsolateral prefrontal cortex, in TRDs with abnormal chronobiological HPT functioning at baseline (BL) possibly associated with hypercortisolemia.

The ∆∆TSH test (i.e., the difference between the thyrotropin response to protirelin tests [∆TSH] performed at 8 AM and 11 PM on the same day) and the dexamethasone suppression test (DST) were performed in 12 TRDs and 14 healthy hospitalized control subjects (HCs). To be enrolled in this study, patients had to show at BL reduced ∆∆TSH values (i.e., < 2.5 mU/L) and a score of 18 or greater on the 17-item Hamilton Rating Scale for Depression (HAMD-17). Post-DST cortisol maximum (CORmax) serum level in excess of 120 nmol/L defined DST non-suppression (i.e., hypercortisolemia)—6 TRDs were DST non-suppressors at BL. After 10 and 20 iTBS sessions the ∆∆TSH test and the DST were repeated in all inpatients. A positive clinical response was defined by a final HAMD-17 score ≤ 8.

Compared to HCs, ∆∆TSH values were lower in TRDs at BL (p < 0.00001), and remained reduced after 10 and 20 iTBS sessions (p < 0.001 and p < 0.02 respectively). Post-DST CORmax levels were higher in TRDs than in HCs at BL (p < 0.01), but were comparable to those of HCs after 10 and 20 iTBS sessions. Responders (n = 5) were characterized by 1) a normalization of their ∆∆TSH values after 20 iTBS sessions (whereas after 10 iTBS sessions ∆∆TSH values were still reduced compared to HCs [p < 0.05]), and 2) a normality of post-DST CORmax levels at BL—while after 10 and 20 iTBS sessions post-DST CORmax levels were decreased compared to HCs (p < 0.006 and p < 0.03 respectively). Non-responders (n = 7) showed 1) no significant change in their ∆∆TSH values which remained lower than those of HCs at each assessment (all p < 0.001), 2) while increased post-DST CORmax levels found at BL (p < 0.0008 vs. HCs) normalized from the 10th iTBS session.

The present pilot study suggests that successful iTBS treatment can restore the chronobiological activity of the HPT axis. Although iTBS may increase glucocorticoid receptor signaling, baseline hypercortisolemia could negatively impact subsequent response to iTBS treatment.

None Declared

The purpose of the study is to measure anatomical and dosimetric changes experienced by patients with head and neck cancer undergoing intensity-modulated radiation therapy and evaluate the need for adaptive radiotherapy using predefined relative thresholds as benchmarks.

This study involved 31 consecutive patients. Two computed tomography (CT) scans were utilized for initial treatment planning and a midpoint assessment. The study employed rigid registration and contour transfer techniques to apply primary dose calculation to midpoint CT, generating a hybrid plan, and an adaptive plan was generated on the midpoint CT.

The results revealed statistically significant volume reductions mainly in PTV70, PTV60 and PTV54 volumes. The volume of the parotid glands exhibited volumetric reductions in most of the patients. Hybrid plans demonstrated inferior dose coverage of the tumour regions, and comparisons between hybrid and adaptive plans showed significant variations in the maximum doses.

Anatomical deviations necessitating a repeat CT scan, along with the application of a new immobilization mask, emerged as a primary rationale for replanning. Indicators that could potentially encompass a breach of 95% dose coverage for 95% of the tumour volume, maximum doses surpassing 50 Gy in the spinal cord and 59 Gy in the brainstem<>, as well as lateral neck displacement exceeding 1cm from the initial position act as benchmarks before implementing a replan.

Nowadays children and adolescents are exposed to cyber victimization.This modern form of aggressive behavior has a negative impact on the psychological of victims,self esteem, and social interaction

To investigate the relation between cybervictimization and depression in tunisian preadolescents and adolescents

The Arabic validated version of the “cyberbullying assessment instrument” was distributed through social media groups of preadolescent and adolescents in Tunisia.The participants were also invited to answer items about social and demographic characteristics.The participation was voluntary,without confidential data.

Fifty four preadolescent and adolescent aged between 9 and 16 years old have participated. The average age was 12.4 years old. 64% of participants were girls.More than 80% of children have their own smartphone and a personal count on social media.Among those respondents,12 (22.2%) reported being cyberbullied at least once in the year.the children most likely to be bullied were girl aged between 9 and 12 years old with a poor socioeconomic level.low self esteem, depressive symptoms, anxiety symptoms are associated with cyber victimization.

The level of cyber victimization among preadolescents and adolescents is underestimated. Psychiatric disorder associated to this phenomena have to be considered in order to develop strategies and intervention to reduce the cyberbullying among vulnerable population.

None Declared

The abuse of prescription drugs (especially sedatives, hypnotics and opioid analgesics) is a serious and increasingly common phenomenon occurring across addiction clinics. Medications are prescribed for the treatment of chronic pain, sleep difficulties or as mood stabilisers in response to the rush of time and demands of performance. The onset of addiction is often protracted and subtle, but has a major impact on the quality of life and the health, economic or social status of the user. Patients may experience, among other things, cognitive impairment, fatigue, sleep disturbances, irritability, loss of motivation, headaches or impaired coordination of movements. This study is focused on cognitive impairment due to prescription drug dependence and how this impairment affects patients in everyday life.

This poster aims to introduce the audience to the possibilities of occupational therapy intervention in the context of addiction medicine.

Data will be taken using standardized tests and questionnaires dealing with cognitive function. It will be conducted upon the patient’s admission to addiction treatment and again after six months of cognitive rehabilitation following the initial survey. Data are collected at the General University Hospital in Prague, Department of Addictology, Prague, Czech Republic.

Data are being collected.

The case study manifests multidisciplinary approach in care of patients addicted of prescription medicine. The aim is a comprehensive view of all aspects of the patient’s life affected by prescription drug abuse with cognitive impairment.

Grant affiliation: This paper was made possible by the institutional support programme Cooperatio, research area Health Sciences and Grant No. 260632 within the Specific Academic Research.

None Declared

Parkinson’s disease (PD) is the most common serious movement disorder in the world, affecting about 1% of adults older than 60 years. The disease is attributed to selective loss of neurons in the substantia nigra, and its cause is enigmatic in most individuals. Patients with PD display both motor and non-motor symptoms. For some patients, the non-motor symptoms are more bothersome than the motor symptoms. One of the most common non-motor symptoms of PD is depression.

Treatment of depression with antidepressant drugs is well established. In the last 20 years use of antidepressant has risen mainly due to the introduction of the selective serotonin reuptake inhibitors (SSRIs). Our primary aim was to demonstrate an improvement in depressive symptoms in patients who started treatment with vortioxetine. A secondary aim was to show those who was successfully treated with vortioxetine but was unresponsive to paroxetine and escitalopram without worsening the extrapyramidal symptoms of PD.

In collaboration with the Department of Neurology, we included patients who are being treated for Parkinson’s disease and who meet the criteria for depressive disorder after a psychiatric examination. We divided the patients into two groups: those who had not previously taken any antidepressant drugs and those who were already on therapy with paroxetine and escitalopram but without the expected therapeutic response. All patients were prescribed vortioxetine in their treatment, and the Hamilton Depression Rating Scale (HDRS) was determined during their first meeting with the psychiatrist, and then again after 6 weeks of taking the medication. Also, we used Mini mental state examination (MMSE) to measure cognitive impairment.Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)

Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)

In our research, vortioxetine has proven to be effective in treating depressive symptoms without worsening Parkinson’s disease, unlike paroxetine and escitalopram, which resulted in partial effects.

None Declared

An alteration of inflammatory indices has been reported in several major mental disorders. This alteration seems to be related to disease severity and treatment resistance, but its pathophysiological meaning remains to be established. Patients with severe mental disorders tend to have increased levels of circulating cytokines and increased microglial activity in the central nervous system, suggesting that inflammation may contribute to the onset, or chronicity, of mental disorders. Detecting inflammation‐relevant symptom clusters across mental disorders may represent an important step towards precision medicine in psychiatry.

The SMInflam project is a longitudinal, observational, real-world study which aims to: assess a set of inflammatory indices at baseline in a sample of patients with the diagnosis of a major mental disorder; identify inflammatory profiles of these patients using a latent class analysis approach; assess the response to pharmacological treatments of patients with different inflammatory profiles; re-assess the inflammatory indices and profiles at several times during follow-up and test their correlation with the evolution of psychopathology.

The sample will consist of 50 patients with a diagnosis of a major mental disorders consecutively enrolled at the outpatient unit of the Department of Psychiatry of University of Campania. All enrolled patients will be administered a set of reliable and validated psychopathological assessment tools. We will perform a complete physical evaluation, and a battery of laboratory tests. Peripheral markers of chronic inflammation will be assessed. Clinical and biological assessments will be performed at baseline (T0) and after 3 and 6 months (respectively, T1 and T2).

Expected results include the evaluation of the levels of inflammatory indices in a varied sample of patients with severe mental disorders. According to the pre-post design, these aspects will be evaluated before the start and at the follow-up. We will also take into consideration the role of confounding factors such as age and gender, which represent a critical biological variable influencing such inflammatory pathways.

Collected data will be used for having a more informative, reliable and valid characterization of psychopathology in a vast sample of patients with severe mental disorders. Our study may represent the first of a new wave of methodologically-sound studies on the role of inflammation and psychopathology in patients with severe mental disorders.

None Declared

Major Depressive Disorder (MDD) is a complex mental health condition characterized by a wide spectrum of symptoms. According to the Diagnostic Statistical Manual 5 (DSM-5) criteria, patients can present with up to 1,497 different symptom combinations, yet all receive the same MDD diagnosis. This diversity in symptom presentation poses a significant challenge to understanding the disorder in the wider population. Subtyping offers a way to unpick this phenotypic diversity and enable improved characterization of the disorder. According to reviews, MDD subtyping work to date has lacked consistency in results due to inadequate statistics, non-transparent reporting, or inappropriate sample choice. By addressing these limitations, the current study aims to extend past phenotypic subtyping studies in MDD.

(1) To investigate phenotypic subtypes at baseline in a sample of people with MDD;

(2) To determine if subtypes are consistent between baseline 6- and 12-month follow-ups; and

(3) To examine how participants move between subtypes over time.

This was a secondary analysis of a one-year longitudinal observational cohort study. We collected data from individuals with a history of recurrent MDD in the United Kingdom, the Netherlands and Spain (N=619). The presence or absence of symptoms was tracked at three-month intervals through the Inventory of Depressive Symptomatology: Self-Report (IDS-SR) assessment. We used latent class and three-step latent transition analysis to identify subtypes at baseline, determined their consistency at 6- and 12-month follow-ups, and examined participants’ transitions over time.

We identified a 4-class solution based on model fit and interpretability, including (Class 1) severe with appetite increase, (Class 2), severe with appetite decrease, (Class 3) moderate, and (Class 4) low severity. The classes mainly differed in terms of severity (the varying likelihood of symptom endorsement) and, for the two more severe classes, the type of neurovegetative symptoms reported (Figure 1). The four classes were stable over time (measurement invariant) and participants tended to remain in the same class over baseline and follow-up (Figure 2).

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We identified four stable subtypes of depression, with individuals most likely to remain in their same class over 1-year follow-up. This suggests a chronic nature of depression, with (for example) individuals in severe classes more likely to remain in the same class throughout follow-up. Despite the vast heterogeneous symptom combinations possible in MDD, our results emphasize differences across severity rather than symptom type. This raises questions about the meaningfulness of these subtypes beyond established measures of depression severity. Implications of these findings and recommendations for future research are made.

C. Oetzmann Grant / Research support from: C.O. is supported by the UK Medical Research Council (MR/N013700/1) and King’s College London member of the MRC Doctoral Training Partnership in Biomedical Sciences., N. Cummins: None Declared, F. Lamers: None Declared, F. Matcham: None Declared, K. White: None Declared, J. Haro: None Declared, S. Siddi: None Declared, S. Vairavan Employee of: S.V is an employee of Janssen Research & Development, LLC and hold company stocks/stock options., B. Penninx : None Declared, V. Narayan: None Declared, M. Hotopf Grant / Research support from: M.H. is the principal investigator of the RADAR-CNS programme, a precompetitive public–private partnership funded by the Innovative Medicines Initiative and the European Federation of Pharmaceutical Industries and Associations. The programme received support from Janssen, Biogen, MSD, UCB and Lundbeck., E. Carr: None Declared

Mental health-related stigma occurs not only within the public community but is also an issue among healthcare professionals. The relationship between national culture and provider stigma remains yet to be empirically attested.

We performed a cross-sectional multicentre study across 32 European countries to investigate the attitudes of psychiatrists towards patients with mental health problems. We aimed to examine the relationship of attitude with country-specific indicators.

We measured stigmatizing attitudes using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) within an online survey among specialists and trainees in general adult, child and adolescent psychiatry. Its total score was correlated with the Human Development Index (HDI), the Democracy Index (DI), the Social Progress Index (SPI), the number of psychiatrists per 100,000 people, and the Hofstede dimensions. Latent class analysis was done to find subgroups of countries according to the stigmatizing attitudes of psychiatrists and the six Hofstede dimensions.

Altogether, n=4245 participants completed the survey. The total score of the OMS-HC significantly correlated with the long-term orientation (r=0.453, p=0.015) and indulgence dimensions (r=-0.629, p<0.0001) and with the HDI (r=-0.503, p=0.005), DI (r=-0.418, p=0.024), SPI (r=-0.348, p=0.040). The latent class analysis separated high- and low-stigma countries. High stigma was associated with high power distance and uncertainty scores.

Findings from this study not only expand knowledge of factors related to stigmatizing attitudes of healthcare professionals, but also enlighten the cultural aspects of the stigma that could contribute to the further development of anti-stigma programs.

D. Őri Grant / Research support from: Research grant form the Fulbright Association, P. Szocsics: None Declared, T. Molnár: None Declared, L. Bankovska Motlova: None Declared, O. Kazakova: None Declared, S. Mörkl: None Declared, M. Wallies: None Declared, M. Abdulhakim: None Declared, S. Boivin: None Declared, K. Bruna: None Declared, C. Cabaços: None Declared, E. A. Carbone: None Declared, E. Dashi: None Declared, G. Grech: None Declared, S. Greguras: None Declared, I. Ivanovic: None Declared, K. Guevara: None Declared, S. Kakar: None Declared, K. Kotsis: None Declared, I. Klinkby: None Declared, J. Maslak: None Declared, S. Matheiken: None Declared, A. Mirkovic: None Declared, N. Nechepurenko: None Declared, A. Panayi: None Declared, A. Pereira: None Declared, E. Pomarol-Clotet: None Declared, S. Raaj: None Declared, P. Rus Prelog: None Declared, J. Soler-Vidal: None Declared, R. Strumila: None Declared, F. Schuster: None Declared, H. Kisand: None Declared, A. Reim: None Declared, G. Ahmadova: None Declared, M. Vircik: None Declared, H. Yilmaz Kafali: None Declared, N. Grinko: None Declared, Z. Győrffy: None Declared, S. Rózsa: None Declared

In recent years, a global debate has emerged regarding the protection of Internet users from exposure to harmful content. Content moderation is defined as the organized practice of filtering user-generated content posted on internet, social networks, and media to determine the appropriateness of the content for a site, locality, or jurisdiction. The growing volume of this content along with the psychological impact of this activity have promoted the application of automated approaches based on artificial intelligence and machine-learning. However, the changing characteristics of content, as well as the cultural differences that influence its appropriateness, mean that human moderation of Internet content currently continues to exist. Psychological effects of this activity such as symptoms of post-traumatic stress disorder (PTSD) could represent an example of secondary trauma.

Our aim is to describe a clinical case of post-traumatic stress disorder presenting with specific traumatic exposure idiosyncrasy that could lead to a better consequence characterization of a recent social phenomena such as internet content moderation.

We expose the clinical case of a woman with emotional distress who was reffered to our outpatient psychiatric unit in Barcelona in 2022 after five years working as an internet content moderator.

We describe the case of a 35-year-old woman without relevant medical, toxicologic or psychiatric record that presents to our out-patient psychiatric clinic with post-traumatic stress disorder after five years of working as an internet content moderator and being exposed to visual traumatic content such as sexual assault and paedophilia. The clinical presentation consisted with one year of recurrent daily panic attacks, intrusive images about the traumatic exposure, intrusive thoughts, insomnia, vivid nightmares, avoidance of exposure to her son, distrust of the environment and intense fear for her son security. The disorder interfered in her capacity to work. The patient received psychological treatment and ISRS (Sertraline) was prescribed, however only partial response was reached with persistence of the majority of symptoms.

The presented case suggests a temporal and symptom content relationship between the described work exposure and the appearance of emotional distress in a patient without PTSD history. Although previous evidence of secondary trauma in people exposed to indirect traumatic experiences has been reported, for example in healthcare professionals, the exposure to alien trauma through digital exposure as a workactivity is yet to be specifically examined. It is necessary to expand knowledge on the clinical expression of this phenomenon due to the observed recurrence of anxious and depressive symptomatology related to repeated exposure to traumatic content.

None Declared

We present the case of a 56-year-old patient with two depressive episodes with psychotic symptomatology in a period of three years, who began with mania and developed Alzheimer’s disease.

The case is presented with the aim of providing a brief review of psychiatric symptomatology as a prodrome of Alzheimer’s disease.

A 56-year-old patient, with no psychiatric antecedents of interest, who presented a depressive episode with psychotic symptoms, requiring admission to a short hospitalisation unit, as well as antidepressant treatment with sertraline at 200mg daily and olanzapine 20mg. He remained stable for two years and was able to withdraw treatment progressively. However, after remaining euthymic without pharmacological treatment for six months, he had another episode with psychotic symptoms. In this last episode, he did not require hospital admission, but he did require a change in antidepressant treatment, given that he did not tolerate treatment with sertraline. Treatment was therefore started with duloxetine 120mg, aripiprazole 20mg and as no clear improvement was observed, months later it was decided to use lamotrigine 100mg as a stabiliser.

In this last episode, despite the significant affective improvement and maintaining psychopathological stability, without presenting psychotic symptoms, the patient presented marked dysfunction in day-to-day life due to a striking attention deficit, lack of concentration and reduced short-term memory. At the same time, he also exhibits mannerisms which are observed in the consultation room, in the form of repetitive hand movements.

For these reasons, it was decided to request MRI and SPECT, obtaining results compatible with possible incipient cognitive deterioration.

It seems that up to 40% of patients with dementia have depressive symptoms. It seems that depression at an advanced age may in fact be a prodromal symptom of dementia.

None Declared

The association among suicidal ideation, plans, attempts and pain has not attracted as much attention as the association between suicidal ideation and attempts and psychiatric disorder.

The aim of this prospective study was to establish if patients with chronic pain associated or not to psychiatric disorders with ideation and planning for a suicide attempt will aways end in a suicide act.

The patients were initially examined through structured interview, scan-schedules for clinical assessment in neuropsychiatric – version 2.0 used only to diagnose. (HDRS – 17) - Hamilton Depression Rating Scale, 17 itens version, (HAMS) Hamilton Anxiety Rating Scale, (CGI) - Clinical Global Impression: (CGI – S) Severity of illness and (CGI – I) Clinical Global Improvemnt. Pain intensity through numerical rating scale. Those were repeated throughout the research.

Patients

Study 1 - 325 patients (244W, 81M aged 19 – 58) with chronic pain, suicidal ideation or plan associated or not to psychiatric disorders.

124 had chronic pain without psychiatric disorder. 54 suicidal ideation and 70 had suicidal plan.

201 had chronic pain associated with phychiatric disorders. 7 with opioid dependence after pain and suicidal plans. 4 with adjustment disorders before pain and suicidal ideation.

3 with somatoform disorder before pain and suicidal plan. 125 had chronic pain associated with: general anxiety disorder, mixed anxiety and depression, severe panic pain before or after pain with suicidal plans or ideation. 62 patients presented chronic pain associated with depressive disorder: recurrent severe depression without psychotic symptoms; moderate recurrent depression without psychotic symptoms. Before or after the occur of pain with suicidal ideation or suicidal plans.

Study 2 -132 patients remained in treatment. (79W and 53M aged 20 to 59)

54 had chronic pain without psychiatric disorder with plans or ideation suicidal. 78 Patients had chronic pain and a psychiatric disorder. 16 became dependent on opioids after pain and suicidal plans. 36 with chronic pain associated with anxiety disorder: general anxiety disorder before or after pain with suicidal plans. 26 had chronic pain associated with depressive disorder: recurrent severe depressive disorder with or without psychotic symptoms with suicidal ideation.

Study 1 - No patient attempted suicide. 54 patients with pain without psychiatric disorders considered suicidal thoughts absurd and intrusive.

Study 2 - No patient died. 51 attempted suicide

47 remained with suicidal ideation

33 did not have suicidal ideation or suicidal plans. They adapted their lives to chronic pain regardless of presenting a psychiatric illness.

The authors concluded that a suicidal act is not always necessarily an expression of chronic pain associated/not with psychiatric disorder.

None Declared

Violence in psychiatric settings poses significant challenges for healthcare professionals, particularly nurses. This study examines psychiatric nurses’ perceptions of violence and its impact on the quality of care they provide.

The primary objective is to assess the influence of violence on the quality of care in psychiatric settings, with a focus on the experiences and perspectives of nurses.

We employed a questionnaire-based survey administered to 30 psychiatric nurses working in both inpatient and outpatient psychiatric units of the Razi hospital Manouba. The survey gathered information on the prevalence of violence, types of violence encountered, and the impact on nursing practice.

Of the 30 respondents, 75% identified as female and 25% identified as male. Most of them had more than five years of experience. The primary results revealed that all the psychiatric nurses reported experiencing at least one incident of violence during their psychiatric nursing careers. Regarding exposure to verbal violence, the results indicated that 52% encountered it sometimes, 22% often, 17% very often. Regarding physical violence, 30% experienced it rarely, 26% sometimes, 13% often, and 13% very often. For sexual violence, 56% reported never experiencing it, 8% rarely, 26% sometimes, and 8% very often. These incidents had varying effects on nurses’ emotional well-being, job satisfaction, and the quality of care they were able to provide. 53% of nurses reported experiencing emotional distress and feelings of anxiety as a result of violence, 13% felt anger and frustration. One nurse declared he was not affected emotionally. Most of the respondents (75%) indicated that their job satisfaction had been negatively affected by violent incidents. 40% of respondents stated that violence has a negative impact on their relationship with patients, but they make efforts to maintain care quality. Whereas, 20% found ways to strengthen connections despite challenging experiences.The most commonly endorsed strategies to cope with violence included attempting to master their emotions by remaining calm and patient (78% of respondents), seeking assistance or the presence of other healthcare team members (65%), and maintaining a safe distance from patients (69%). Fewer participants reported raising their voice and adopting a position of authority (30%), while a minority indicated engaging in additional training on the management of violent situations (20%). These results illustrate the diverse range of personal coping strategies.

Violence in psychiatric settings has a multifaceted impact on psychiatric nurses, affecting both their emotional well-being and the quality of care they provide. Strategies for managing and preventing violence, as well as supporting nurses in coping with these challenges, are essential for maintaining high-quality psychiatric care.

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Shakespeare wrote that “We are such stuff as dreams are made on; and our little life is rounded with a sleep.” Sleep is a fundamental part of our being, so much so, humans tend to spend one third of their lives in this immobile and vulnerable state. Disorders of sleep have been the target of much scientific curiosity and investigation, with inumerous articles, reports and books dedicated to the theme. The bidirectional relationship between psychiatric disorders and those of sleep is also well described. Schizophrenia is a heterogenous psychiatric disorder which is often associated with sleep disturbances of various kinds.

The authors aim to briefly explore the relationship between schizophrenia and sleep disturbances. Potential underlying mechanisms and risk factors, as well as therapeutic interventions will be addressed.

The authors conducted a brief non-structured narrative literature review using articles published in the Medline/Pubmed, ScienceDirect and Google Scholar databases. The keywords used during the research, alone or in combination, included: sleep disturbance, sleep disorder and schizophrenia.The studies consulted in this work included: cross-sectional studies, cohort studies, literature reviews and clinical case reports. Works that were included, were written in the English language and deemed as pertinent to the explored theme.

Although sleep disturbances do not make up part of the criteria formal diagnosis of schizophrenia, they are present in approximately 80% of those with the condition and have been identified as a common symptom in prodromic clinical pictures. The problems in sleep are as heterogenous as the presentations in schizophrenia, ranging from insomnia, restless legs syndrome, obstructuve sleep apnea, circadian rhythm disfunctions to hypersomnia. Sleep has been identified as fundamental for the reparation and restoration of various bodily systems, it is no surprise that sleep irregularities, especially in schizophrenia, can significantly reduce quality of life and promote deterioration. Some studies have stated the role that D2 receptors have in the classic symptoms of schizophrenia as well as on sleep disturbances. Second-generations antipsychotics have not only demonstrated much promise on psychotic symptoms, but they appear to aid in sleep regulation and quality.

Sleep is fundamental for mental health. Various sleep disturbances have been identified in those suffering with schizophrenia. Slepe disturbances have been associated with worse outcomes, more florid clinical pictures and significant deterioration. Thus, bettering sleep quality in these patients, would permit better health outcomes which are fundamental in those who live with schizophrenia.

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People with psychiatric disorders are particularly vulnerable to SARS-CoV-2 infection and its associated complications. However, current literature show that not all psychiatric disorders are equally vulnerable to COVID-19.

This study aimed to assess whether individuals with distinct psychiatric disorders exhibit different risk of SARS-CoV-2 infection, COVID-19 hospitalization, and mortality.

We conducted a case-control study using data of electronic health records from Catalonia. Cases included adults with a hospital admission between 2017 and 2019 for non-affective psychosis, bipolar disorder, depressive disorder, stress-related disorders, neurotic/somatoform disorders, and substance misuse. These were matched to patients without a diagnosis by sex, 5-year age band, and living area. Outcomes included SARS-CoV-2 infection, hospitalization, and COVID-19-related death up to December 2021. Logistic regression analysis were employed to test the association between the six groups of psychiatric disorders and COVID-19 outcomes, controlling for age, sex, smoking, being in a nursing home, and physical comorbidities.

785,378 subjects were included. Preliminary findings showed that patients diagnosed with psychosis and bipolar disorder had lower risk of infection [OR: 0.85 (95% CI: 0.79-0.92), p<0.001; OR: 0.84 (95% CI: 0.76-0.92), p<0.001], whereas individuals with stress-related and neurotic/somatoform disorders had higher risk of infection [OR: 1.08 (95% CI: 1.04-1.14), p<0.001; OR: 1.06 (95% CI: 1.03-1.10), p<0.001]. People with depressive, stress-related, and neurotic/somatoform disorders had lower risk of COVID-19 hospitalization [OR: 0.87 (95% CI: 0.78-0.97), p = 0.01; OR: 0.71 (95% CI: 0.61-0.84), p<0.001; OR: 0.67 (95% CI: 0.60-0.76), p<0.001]. In line with these results, individuals with stress-related disorders also experienced lower mortality [0.49 (95% CI: 0.33-0.70), p<0.001]. Conversely, people with psychosis, bipolar disorder, and substance misuse exhibited higher risk of COVID-19-related death [OR: 2.9 (95% CI: 1.68-3.1), p<0.001; OR: 1.95 (95% CI: 1.30-2.81), p<0.001; OR: 1.82 (95% CI: 1.49-2.20), p<0.001].

We found different risks of SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19 mortality for psychiatric disorder groups. Differences in vulnerability to COVID-19 among people with psychiatric disorders might be explained by factors such as shared living facilities, physical comorbidities, psychotropic medications, and difficulties in accessing high-intensity medical care. Special attention should be directed towards individuals with psychosis, bipolar disorder, and substance misuse.

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