Opioid dependence is a complex condition that often requires long-term treatment and care. Methadone, a synthetic full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are commonly used in substitution therapy for opioid dependence, typically administered as an oral liquid or sublingual tablet. Transitioning from high-dose methadone to buprenorphine for the treatment of opioid use disorder (OUD) poses a risk of precipitated withdrawal. This risk arises from introducing a high-affinity partial agonist (buprenorphine) at the mu-opioid receptor after it has been occupied by a lower-affinity full agonist (methadone). As a result, this transition is usually only performed for patients on low doses of methadone (<30-40 mg). Microdose induction has been proposed as a potential solution to facilitate a smoother transition to buprenorphine.

To present a case report of a rapid transition from high-dose methadone to buprenorphine depot, highlighting both the benefits and challenges of this process.

This case report describes a patient who was switched from 150 mg of methadone to 32 mg of sublingual buprenorphine using microdosing, and subsequently transitioned to a weekly 160 mg buprenorphine depot injection.

The patient was successfully transitioned to sublingual buprenorphine and later to buprenorphine depot without experiencing withdrawal symptoms. Even later, the patient reported no signs of withdrawal and was satisfied with the buprenorphine dosage. The patient attended monthly check-ups with the doctor; however, 15 days after the transition, he began consuming alcohol and soon after, started using cocaine.

This report supports the use of microdose induction for initiating buprenorphine, particularly for patients stabilized on high doses of methadone who may struggle with traditional buprenorphine induction methods. Although the patient remained abstinent from opioids, he quickly relapsed with alcohol and cocaine, issues that had not been present during his methadone treatment. Regular and more frequent therapeutic assessments are very important for many patients to prevent relapse.

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Infertility is a significant source of emotional stress for couples worldwide. In Tunisia, it affects approximately 15 to 20% of couples of reproductive age. Studies indicate that women experience higher rates of depression (35% vs. 15%) and anxiety (52% vs. 28%) compared to men, largely due to cultural pressures. For these reasons, understanding these gender differences in coping mechanisms is essential.

To analyze the coping styles of infertile couples and identify gender differences in coping mechanisms to inform tailored psychological support.

We conducted a cross-sectional study involving couples undergoing infertility treatment at a specialized Assisted Reproductive Technology center inTunis. The participants provided information related to socio-demographic data. Coping strategies were assessed using the Brief Cope scale administred in the Tunisian dialect. These strategies were classified into three categories: problem-focused, emotion-focused, and avoidant coping.

A total of 60 infertile couples participated in the study. The average age of men was 41.1±6 years, while the average age of women was 35.07±4 years. Among them, 68% resided in urban areas, and 73% were from a middle socioeconomic background. Educationally, 47% of women held a university degree, compared to 17% of men. Approximately half of the women were unemployed, while 52% of men were employed.

Problem-focused coping emerged as the most frequently utilized strategy (5.93±1.02), followed by emotion-focused coping (5.32±0.82) and avoidant coping (3.95±0.70).

Women significantly employed problem-focused and emotion-focused strategies more than men (p=0.017; p<0.01). They also scored higher in emotional support, expression of feelings, active coping, planning, and religious coping (p<0.05; p=0.01). Conversely, men displayed a greater inclination towards acceptance, distraction, and substance use.

In conclusion, addressing gender-specific coping strategies is essential for providing effective psychological support to infertile couples. Healthcare professionals should promote problem-focused coping to help couples actively manage their challenges.

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Treatment-resistant schizophrenia patients have the worst clinical outcomes and poor quality of life, despite the administration of clozapine. Currently, the definition of resistance is based on treatment response, but evidence differentiating resistance remains unclear. The dysconnectivity theory suggests that disrupted brain interactions contribute to schizophrenia pathology. Advances in functional and structural neuroimaging allow exploration of connectivity patterns that may characterize treatment-resistant schizophrenia.

This study aimed to describe functional and structural connectivity patterns in schizophrenia patients on clozapine.

Patients taking clozapine (CLZ) or other antipsychotic (nCLZ) were recruited from the Hospital of the Medical School of Ribeirão Preto. Healthy controls (HC) were recruited from the Hospital database. Seventy-seven participants were selected: CLZ = 35, nCLZ = 27, and HC = 27. Functional connectivity (FC) was assessed via resting-state functional magnetic resonance imaging (rs-fMRI) and ROI-to-ROI analysis using the CONN toolbox. Structural connectivity was analyzed with diffusion tensor imaging and tractography using TRACULA toolbox. ANOVA and Tukey test were used for three-group comparisons, and the t-tests for two-group comparisons. Functional analysis was performed with a significance threshold of p < 0.05 and false discovery rate (FDR) set to p < 0.01.

Reduced frontotemporal FC and increased FC in the frontal-occipital were common in CLZ and nCLZ compared to HC. An increased FC between sensorimotor and the cerebellum was notable in CLZ compared to HC. Structural findings included increased axial diffusivity (AD) and mean diffusivity (MD) in 8 of 10 tracts in CLZ compared to HC. The corticospinal tract and inferior longitudinal fasciculus exhibited increased AD and MD in CLZ compared to nCLZ. The cingulum angular bundle showed significantly altered diffusion measures in nCLZ: increased AD, MD, and radial diffusivity (RD), and reduced fractional anisotropy (FA).

This study described a widespread functional and structural dysconnectivity in CLZ, characterized by reduced frontotemporal FC and increased frontal-occipital and sensorimotor–cerebellum FC. Altered AD and MD measures in the corticospinal tract and inferior longitudinal fasciculus were observed in the CLZ. Alterations in AD, MD, RD, and FA measures in the cingulum angular bundle, particularly noted in nCLZ, may be associated with antipsychotic administration. Further studies are necessary to establish whether these dysconnectivity patterns consistently characterize these patient groups.

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Pain has a significant impact on a person’s quality of life, limiting general activity (work, social interaction, problems with family relationships, hobbies/interests, self-care ability), contributing to the development of mental disorders such as depression and anxiety.

Our study aimed to determine the level of anxiety, depression, and functional disabilities caused by chronic pain among outpatients in order to further dynamic research of the long-term consequences.

The study group included 85 outpatients with chronic pain. As a part of psychiatric screening, the HADS depression and anxiety scale was used to study psychopathological symptoms. The WHO self-questionnaire WHODAS 2.0 was used to study the dysfunction caused by chronic pain.

The study found that a significant part of patients with chronic pain had symptoms of anxiety 38% and depression 46% of varying severity. The medial WHODAS 2.0 score among all patients with pain and patients with comorbid depression and anxiety was 23.62 (95% CI: 21.19-24.63), 32.80 (95% CI: 30.33-35.16), and 34.35 (95% CI: 32.11-37.60), respectively. Disability was significantly higher in patients with depression (1.72, p <0.01) and anxiety symptoms (1.60, p <0.01) than in patients with chronic pain without anxiety and depression.

Effective treatment of chronic pain requires a comprehensive approach using psychotherapeutic, psychopharmacological, and physical therapy.

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Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that often persists into adulthood, significantly impacting daily functioning and quality of life. Studying sex differences in ADHD is crucial as females are frequently underdiagnosed or misdiagnosed, which can delay treatment and worsen outcomes. ADHD presents in three main subtypes: inattentive, hyperactive-impulsive, and combined. The combined subtype tends to cause more significant impairments, particularly in academic and social contexts. Males are more likely to be diagnosed with hyperactive-impulsive or combined types, while females often present with the inattentive subtype. A subtype-specific approach is essential, as it guides targeted interventions to address distinct behavioral and cognitive challenges, enhancing treatment efficacy and outcomes.

This study aims to analyze differences in ADHD severity, comorbidity with other conditions, and socio-functional impact by ADHD subtype and sex, as well as to evaluate interactions between these variables.

This population-based study included 900 adults diagnosed with ADHD from a specialized ADHD clinic. Participants were classified by ADHD subtype and sex. Diagnostic and severity assessments were conducted using validated tools, including the CAADID-I, DIVA-5, ADHD Rating Scale (ADHD-RS), Wender Utah Rating Scale (WURS), and Clinical Global Impression Severity Scale (CGI-S). Comorbid psychiatric conditions and psychosocial functioning were evaluated using the BDI-II, STAI, BIS-11, PSQI, FAST, and WHODAS scales. Statistical analyses included bivariate, multivariate, and General Linear Model (GLM) methods.

Females were diagnosed with ADHD later than males (p=0.001) and exhibited greater severity (ADHD-RS, p<0.001) and higher levels of depression and anxiety. No significant sex differences were observed in impulsivity or sleep quality. The combined ADHD subtype was associated with greater clinical severity and functional impairment. An interaction effect was found between sex and ADHD subtype only for WHODAS scores, with females in the combined subtype showing greater impairment.

ADHD presents differently across sexes and subtypes, with specific interactions observed in functional impairment. These findings emphasize the importance of considering sex and ADHD subtype independently to enhance diagnostic accuracy and inform targeted treatment strategies.

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Esketamine has been linked to dissociation, which was claimed to predict or not to predict antidepressant response. Speculations regarding predictivity were based on results obtained with the CADSS, a scale investigating dissociative symptoms, with higher scores indicating more symptoms.

To investigate the effect of intranasal esketamine on dissociation and its subsequent influence on clinical response, we administered the CADSS 40 minutes after inhalation at the first esketamine administration and 40 minutes after the ninth inhalation and measured clinical response through the Clinical Global Impressions-Severity (CGI-S), the Young Mania Rating Scale (YMRS), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the 24-item Brief Psychiatric Rating Scale (BPRS).

We included 61 adults (33 women and 28 men; age, mean, 52.69±11.80, range 20-73 years) with Thase & Rush (J Clin Psychiatry 1997;58 [Suppl 13]:23-29) treatment-resistant depression. All patients received intranasal esketamine spray and were assessed at the first and ninth administrations (one month after the first administration, i.e., the end of the induction period and the beginning of maintenance), at the day of the spray after 40 min with the CADSS and 1 month later with the CGI-S, the BPRS, the MADRS, and the YMRS.

CADSS scores dropped from 6.59±7.42 40 min after the first administration to 3.12±4.41 40 minutes 1 month later (dropped by 3.48 points, 47.27% of baseline); t=3.15; p=0.0021. CGI-S scores dropped from 5.12±0.61 at baseline to 3.95±0.76 1 month later (t=9.32; p<0.00001). BPRS scores dropped from 51.85±11.55 at baseline to 41.21±10.64 after 1 month (t=5.29; p<0.00001). MADRS scores dropped from 34.29±7.89 at baseline to 22.61±9.07 after 1 month (t=7.59; p<0.00001). Responders (≥50% drop of MADRS from baseline) were 12 patients (19.67%), while remitters (MADRS score≤10) were 2 (3.28%). YMRS scores moved from 2.18±2.59 at baseline to 1.72±2.37 1 month later (t=1.02; p=0.309, n.s.), always in the normal range. Blood pressure 40 minutes after spray at the first administration was unchanged in 35 patients, increased in 16 (maximum by 20 mmHg), and decreased in 10 (maximum drop 20 mmHg). Contrary to previous claims, CADSS scores did not correlate at any time with scores on clinical scales or therapeutic response (Pearson’s r from 0.232 with p=0.072 to 0.013 with p=0.918). As for side effects, 15 patients reported dissociation, 15 sedation, 8 vertigo, 8 dizziness, 6 confusion, 5 headache, 4 nausea/vomiting, and 0 hypertension.

Patients in our sample scored very low on the CADSS. At the end of the induction period, esketamine was associated with significant decreases in the severity of psychopathology.

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The 3-dimensional (3D) marker-less motion capturing (MoCap) systems are an emerging technique in movement analysis. Recent studies have shown that such MoCap assessment have great potential for accurate and objective assessment of motor alterations in psychiatric patients. Gait as a fundamental gross motor function is the final motor outputs of a complex network integrating sensorimotor systems, cognitive and affective stimuli. Understanding gait alterations in catatonia patients can provide insights into their sensorimotor dysfunction and help in diagnosis and treatment in future.

The primary objective of this study is identifying gait alterations using a 3D optical marker-less MoCap system in catatonia patients (CAT) compared to non-catatonia controls (Non-CAT). We hypothesize that there will be significant reduction in the spatiotemporal parameters of gait, such as speed, stride width, stride length, step length, and cadence as well as increased gait instability in CAT group. Moreover, these alterations will be correlated with general psychomotor slowing.

In this cross-sectional study, we examined a total of 61 patients with and without catatonia diagnosis (CAT; n=22, Non-CAT; n=39) according to ICD-11. Participants were assessed with the Positive and Negative Syndrome Scale (PANSS), Northoff Catatonia Rating Scale (NCRS), the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF). We conducted clinical psychomotor examination with the Heidelberger Neurological Soft Sign Scale (NSS), Salpêtrière Retardation Rating Scale (SRRS) and Unified Parkinson Disease Rating Scale (UPDRS). Gait analysis were performed using a marker-less MoCap system with 8 cameras (Qualisys, Goeteborg, Sweden). Participants walked on a marked path (18 m) with a self-selected tempo during the experiment. The spatiotemporal parameters (STP) of gait were obtained automatically through Theia Software.

The two groups did not differ in age, sex, or BMI. The CAT group showed higher scores in PANNS, BPRS, NCRS and GAF (p< 0,05). We found a statistically significant difference in clinical psychomotor parameters in NSS, SAS and UPDRS between the two groups (p <0,05) and more specifically in gait subdomain of each scale. No differences were found in any of STP of gait or gait instability measurements after controlling for covariates (age, sex, BMI and medication).

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This study exhibit a significant difference between the results of clinical psychomotor assessments and objective gait analysis through marker-less MoCap. This discrepancy suggests a potential overestimation of gait alterations in clinical evaluations. The findings underscore the importance of integrating advanced 3D MoCap technologies into the psychiatric assessment to enhance our understanding of gait alterations in mental disorders.

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Adropin is a unique hormone or biomarker that is produced in the liver, brain, and peripheral tissues such as the heart and gastrointestinal tract. It was discovered in 2008 by Kumar and others. It is encoded by a gene associated with energy homeostasis. Adropin plays a key role in the development of various CNS disorders such as stroke, schizophrenia, bipolar disorder, Alzheimer’s disease, and Parkinson’s disease.

Depressive disorder affects a large number of people worldwide, with symptoms such as loss of energy and motivation, sadness, fatigue, and weakness significantly impacting quality of life and functionality. Numerous studies have shown that depression has various neurobiological mechanisms. Deregulation of energy metabolism in the brain is one of the mechanisms associated with the onset of depressive disorder. Adropin can activate BDNF, and since BDNF plays a crucial role in neurogenesis, synapse formation, plasticity, learning, memory, and has a neuroprotective function, adropin may play an important role in the development of depression.

We conducted a study in which we examined adropin concentrations in depressive disorder in individuals who were diagnosed with depression for the first time and compared adropin levels with healthy controls. We followed up with depressive patients after six months of introducing SSRIs (Selective Serotonin Reuptake Inhibitors) antidepressants.

The adropin values after the introduction of antidepressants and improvement of depressive symptoms were significantly higher after six months compared to the initial blood draw.

Our study measured serum adropin levels in patients who had not previously been treated for depressive disorder. After introducing SSRIs (Selective Serotonin Reuptake Inhibitors) and six months after the initiation of therapy, we repeated the adropin measurements. The results showed a statistically significant difference between the first and second measurements. In the second measurement, adropin levels were higher than in the first. We can conclude that with the improvement of depressive symptoms, the serum adropin levels, as a neuroprotective biomarker, also increased.

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There exponential rise in prescribing SSRIs and antipsychotic medication have highlighted the paucity of shared decision making, holistic therapies and weight management programmes. Guidelines are vague about checkpoints and deprescribing, seeming to ignore the metabolic consequences, failing to advocate for physical health monitoring.

We undertook a retrospective analysis of (n =492) patients initiated on psychotropic medication to understand the physical consequences, assessing the metabolic consequences of long-term prescribing of psychotropic medication in a rural primary care population.

Electronic patient records were analysed from depression and serious mental health registers across three primary care sites. Data collected included the start date of treatment, BMI measurements before and after treatment.

Among the 220 patients studied, 150 (67.7%) experienced weight gain, while 70 (31.8%) lost weight. The average treatment duration was 11.5 years. Weight gain was more prevalent among males (71.6%) compared to females (66.7%). Patients who gained weight were, on average, prescribed cumulatively more psychotropic medications (3.21) than those who lost weight (2.89).

Shared decision making and acknowledgement of the metabolic consequences of these medications at the point of initiation, and identification of pre-existent metabolic risks, monitor weight gain, and ensure adequate life-style changes to mitigate side effects. These methods should continue throughout the duration of treatment, and when possible, the option of deprescribing should always be available to the patient. It is time care bundles for patients with mental health illness are resourced for primary care.

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As part of our comprehensive early intervention program for psychotic disorders (RIPEPP), we have been conducting psychodynamic group psychotherapy for family members since 2005. This type of therapy intended for family members of patients that are motivated for psychological work and the correction of maladaptive forms of family interactions. The 90-minute sessions are held every two weeks under the guidance of a psychiatrist – group analyst.

At the beginning of this new experience, we applied group analytical principles in the group. Due to the large drop out and specific dynamics, we gradually changed the therapeutic technique and became more flexible and supportive.

During the years of therapy, with the strengthening of group cohesion, it was gradually possible to switch again from a more flexible and supportive method to the classic group analytical technique.

In this presentation, we will show vignettes from the therapeutic process.

An overview of the need to modify the group-analytic technique in the treatment of family members of individuals with psychotic disorders.

Following the protocol of group sessions.

Over the course of the therapeutic process, the group members become more ready for group analytical work, which is adapted and applied in sessions in which they openly talk about themselves, their feelings and partner relationships. The modification of the group analytic technique is still at work with a continuously present psychodynamic understanding.

A group-analytic approach is applied in the treatment of family members of individuals with psychotic disorders. The frequent occurrence of dropouts among group members highlighted the need to modify the group-analytic technique, with the potential to revert to the classical method by strengthening group cohesion and improving family dynamics.

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Adolescence, around the time of puberty, is the life stage most prone to the emergence of eating disorders, with bodily and psychological transformations at the center of the issue. The body serves as a key medium for expressing distress in adolescents.

To estimate the prevalence of eating disorders (ED) among adolescents and to determine associated factors to ED

This is a cross-sectional, descriptive, and analytical study conducted between June 2024 and September 2024 among adolescents resident at Sfax, Tunisia. Data were collected via an online Google Forms questionnaire exploring sociodemographic and relational data. We used the “Eating Attitudes Test 40 (EAT-40)” to detect the presence of ED, with a score of ≥ 30 indicating the presence of an eating disorder.

We collected data from 120 adolescents, with an average age of 16 years and a predominance of females (69.2%). The majority of participants (84.6%) lived in urban areas, 80.8% were enrolled in secondary schools, and 33.3% of adolescent have reported relational difficulties with peers. 41,5% of Adolescents were living in particular family situations( death of one parent, parental separation, relational difficulties with parents).

In our study, 30% of adolescents have a psychiatric disorder. The average total score on the EAT-40 scale was 35.03, the prevalence of eating disorders was estimated at 47.5%. The factors correlated with ED included: female gender (p=0.012), relational difficulties with peers (p=0.002), the death of one parent (p=0.024), and personal psychiatric history (p=0.00).

This study reveals a significant prevalence of eating disorders among adolescents in Sfax, Tunisia. Gaining a deeper understanding of this condition and its underlying factors could greatly improve the care and support provided to these young individuals.Bas du formulaire

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Obsessive-compulsive disorder (OCD) is a chronic condition that frequently co-occurs with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD), complicating both prognosis and treatment. The presence of MDD or BD in OCD patients is associated with more complex clinical presentations and worse outcomes.

Despite the high prevalence of these comorbidities, few studies have thoroughly compared the traits and states of OCD patients with comorbid mood disorders. This study aims to explore the differences in traits and states among OCD patients with comorbid mood disorders, including MDD, bipolar disorder I (BD1), and bipolar disorder II (BD2).

The study included 114 OCD patients: 21 without mood disorders, 32 with MDD, 47 with BD2, and 14 with BD1. Demographic variables such as family history of psychiatric disorders and history of pharmacological treatment for OCD were analyzed. Participants were evaluated using standardized tools such as the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), Obsessive-Compulsive Inventory (OCI), Depressive Symptom Inventory Suicidality Subscale (DSI-SS). Statistical analyses including one-way analysis of variance (ANOVA) and chi-squared tests were conducted to identify significant differences between groups.

Patients with comorbid bipolar disorder (BD), particularly those with BD1, had a significantly higher prevalence of psychiatric family history (85.7%, p = .031). Pharmacological treatment for OCD was less frequent in patients with BD, with the lowest rate in the BD2 group (61.7%, p = .008). Compared to patients without mood disorders or those with MDD, OCD patients with BD showed higher scores in several temperament dimensions, including cyclothymic temperament (p < .001), depressive temperament (p = .007), hyperthymic temperament (p = .006), anxious temperament (p < .001), and irritable temperament (p < .001). These patients also exhibited more severe depressive symptoms (p < .001), higher anxiety levels (p < .001), and greater suicidality (p = .002). Obsessive-compulsive symptoms, particularly neutralizing behaviors (p = .010), ordering behaviors (p < .001), and hoarding behaviors (p < .001), were more pronounced in the BD groups.

OCD patients with comorbid BD show distinct clinical profiles compared to those with MDD. They have a stronger genetic predisposition to psychiatric disorders and are less likely to receive pharmacological treatment for OCD. These patients also experience more severe depressive symptoms, anxiety, and obsessive-compulsive traits, complicating treatment. The findings highlight the need for comprehensive evaluations and personalized treatment plans for OCD patients with mood disorder comorbidities.

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Medical students face high demands in college, which may cause significant psychological stress and mental health problems, such as depression and anxiety. Several studies worldwide have shown that such individuals are more likely to experience anxiety. However, few studies have examined how generational status and being a first-generation medical student lead to mental health issues.

In this study, we aimed to estimate the prevalence of depression and anxiety in first-generation medical students (FGMS) compared with non-FGMS and to determine the correlation between socioeconomic factors and other variables with depression and anxiety in FGMS.

This cross-sectional study was conducted among medical students at the College of Medicine. A self-administered questionnaire was distributed to the students using convenience sampling. The questionnaire comprised socio-demographic information (e.g. age, gender, marital status), a General Anxiety Disorder (GAD-7) scale to assess anxiety, and a Patient Health Questionnaire (PHQ-9) to assess depression among medical students.

Among the 309 medical students who completed the questionnaire, 65.4% were female and 75.7% were FGMS. The prevalence of anxiety and depression among medical students was 36.2% and 39.5%, respectively, and was higher among FGMS, but not significantly different (p<0.05). Independent risk factors for anxiety and depression among FGMS included a previous history of mental disorders and lack of social and emotional support, while fair sleep quality was identified as a significant independent preventive factor for anxiety and depression. The prevalence rates of anxiety and depression among patients with FGMS were 39.3% and 41.9%, respectively. A previous diagnosis of mental disorder was a significant risk factor for anxiety and depression, whereas fair sleep quality was a significant protective factor. Further research is needed to identify the factors that influence anxiety and depression among FGMS in our region.

Anxiety and depression are common among first-generation medical students. FGMS with a history of mental disorders tended to exhibit symptoms of both anxiety and depression compared to the rest of the FGMS. However, satisfactory sleep quality could result in better mental condition in FGMS. Institutional measures should be adopted to help students improve their living conditions. Furthermore, institutional leaders should spearhead the destigmatisation of psychological disorders and advocate help-seeking behaviours when students need mental help, particularly when they are anxious or depressed.

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Schizophrenia remains a complex psychiatric disorder characterized by varying symptoms and levels of insight. The Frankfurt Complaint Scale (FBS) and the “My thoughts and feelings” questionnaire provide quantitative measures of symptom severity and insight, respectively. Previous literature has emphasized the importance of these tools in both clinical assessment and therapeutic planning.

Exploring the Relationship Between Schizophrenia Symptom Severity and Insight based on the Frankfurt Scale and the “My thoughts and feelings” Questionnaire.

The study utilized data extracted from an Excel dataset comprising demographic information and specific scores from the FBS and the Insight questionnaire. The sample was divided into four subgroups based on their FBS scores, and the average Insight score for each subgroup was calculated.

The study found the following average Insight scores across FBS-defined subgroups: Mild symptoms: 9.67, Moderate symptoms: 8.25, Severe symptoms: 8.22, Very severe symptoms: 9.29. The correlation analysis revealed a weak and non-significant correlation between FBS scores and Insight scores (r = -0.017, p = 0.925). The demographic analysis showed a prevalence of male patients (n=20), with the most common age group being 36-45 (n=11). Most participants resided in large cities (n=16), with the highest educational attainment being a Bachelor’s/Master’s degree (n=12), and the majority were single (n=21). The study group displayed diverse demographic characteristics,

with a significant male predominance and a concentration in urban environments. This demographic distribution may influence the generalizability of the findings and provides a context for interpreting the varied experiences and perceptions of illness within the group.

This study underscores the complexity of schizophrenia, where symptom severity does not straightforwardly correlate with insight into the illness. It highlights the importance of using a range of assessment tools to fully capture the multifaceted nature of patient experiences. Future studies should explore these relationships further to refine the tools used for assessments and to tailor intervention strategies effectively.

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Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia and is clinically characterised by progressive behavioural changes, executive dysfunction and language difficulties. FTD is often confused with Alzheimer’s disease and other psychiatric disorders. Clinical features of FTD include personality changes, agitation, loss of inhibition, apathy, social withdrawal and impulsivity. In some cases, the disease is accompanied by mood or psychotic symptoms, resulting in the diagnosis of an additional psychiatric disorder. (Gliebus G.(2014). SAGE open medical case reports,2, 2050313X13519977.). This article presents the case of a middle-aged woman who was diagnosed with an anxiety spectrum disorder before developing and being diagnosed with FTD.

A 57-years-old right handed female with previous history of anxiety disorder admitted to psychiatry clinic with restlessness, decreased sleep, and complain of constant non-purpose walking. Physical examination revealed bradymimia and grabellar reflex. Additionally in her psychiatric evaluation she had short-term memory impairment, disinhibition and verbal perseverations. She had been given multiple combinations of medications by outpatient providers and her restlessness only increased. At the time of admission she was taking mirtazapine,olanzapine and clonazepam. The initial impression was that she had akathisia, and her medications were tapered. She was then started on propanolol and lorazepam. After several days her symptoms had not changed.

In routine biochemical and hematological tests, electroencephalogram (EEG) were within normal limits. 18F-FDG PET/MRI revealed hypometabolism in the bilateral temporal-frontoparietal region, more pronounced in the frontal region which is consistent with FTD.

Trazodone was started to control behavioural symptoms and the dose was gradually increased to 150 mg/day. The dose of propranolol was increased to 80 mg/day, and lorazepam was tapered and discontinued. During the follow up with this treatment, there was an improvement in her restlessness and anxiety symptoms, but her memory problems were persistent.

Frontotemporal dementia may overlap and be confused with other psychiatric disorders. Therefore, a comprehensive history, physical and neurological examination are required to differentiate each clinical entity (Khan I, De Jesus O. (2023).Frontotemporal Lobe Dementia. In: StatPearls ). Additionally, the use of functional neuroimaging, such as 18F-FDG PET/MRI, enables the different distribution of pathology in dementing disorders to be highlighted, as can be seen in our case. This case report highlights the importance of re-evaluating patients with psychiatric diseases, especially when symptoms are resistant to treatment.

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This study includes the characteristics of Compex PTSD among Ukrainian IDPs who experienced the horrors of the war - during the Russia-Ukraine war in 2022-2024. It also reflects the new and permanent stressors characteristic of the digital age.

Objective of the Study was to identify how cyber age and modern technologies affected on outcomes of traumatic stress.

The study was carried out iamong the victims of the Ukrainian war temporarily displaced in Georgia. A specially developed questionnaire based on the guidelines of the Istanbul Protocol was used.

A total number of direct target beneficiaries applied to the Empathy was n = 68 persons; Most refugees were with experience of war crimes. Mainly two types of life threatening traumatic events was identified: Locally in place of war and Russian occupation; They flowed from Ukraine through the Russian territory and additionally are with experience of ill – treatment during the filtration procedures in the so-called “filtration camps”. Chronic Repetitive Traumatic Stressors were identified as well: Misinformation; Adhering to online war scenes, the vast amount of information flow; Inability to dissociate from warfare. Observed: Rapid development of C - PTSD in 52 persons of total 68. Alongside with PTSD symptoms reveled: Affective Dysregulation – aggression, self – aggression, depression; Feeling of Guilty – for not being in Ukraine, not supporting to their relatives and Country; Problems in interpersonal relations; Addictive behavior; Additional stressors related to the digital warfare and disinformation supported the prolongation of multi natural stressors that consequently created significant problems for recovery.

The results were discussed in the context of Carl Jaspers’ conception regarding reactive conditions. According to his concept, reactive psychoses develop on the basis of a conflict between a person and an unbearable reality for him, and at the same time, this reality is necessarily reflected in the clinical picture of the disease. However, it should be noted that by the 60s, delayed forms of reactive states were described, i.e., forms far removed from the traumatic moment, during which Jasper’s criterion of “time connection” is violated, although the traumatic event is fully reflected in the clinical picture. The reason for this is mainly the prolonged process of intrapsychic processing and final realization of the trauma. The rapid development of complex PTSD under the combined influence of endless multi-stress factors was revealed; The researchers were faced with an effective treatment - the search for ways of rehabilitation in the current multi-stress conditions. Furthermore studies have to be addressed to create new complex recovery strategies in modern multi – face unsolved stress situations.

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The Lancet Commission noted severe mental health service disparities in low- and middle-income countries facing crises. Regarding this, the World Health Organization (WHO) developed the early adolescent skills for emotions (EASE), an experimental group-based intervention delivered by non-specialists, to offer evidence-based psychological support for adolescents with mental distress.

This systematic review and meta-analysis assesses EASE’s effectiveness in alleviating post-traumatic stress disorder (PTSD) compared with enhanced treatment as usual (ETAU).

We systematically searched PubMed, Cochrane, and Scopus for randomized controlled trials (RCTs) comparing EASE with ETAU. Our outcomes included the overall improvement in post-traumatic and depressive symptoms, measured by the Children’s Revised Impact of Event Scale (CRIES-13) and the Patient Health Questionnaire-Adolescent version (PHQ-A) scores respectively. We pooled mean differences (MD) with 95% confidence intervals (CI) in RStudio using a random-effects model. Heterogeneity was assessed with I² statistics.

Six RCTs were included with 1,417 patients, of whom 642 (45.3%) received EASE treatment. In 67% of the studies, Syria was the main location of RCT’s. A total of 688(49%) were female. CRIES-13 (MD = -0.18, 95% CI [-1.88, 1.52], p = 0.84, I² = 0%; Figure 1) and PHQ-A (MD = -0.69, 95% CI [-1.47, 0.09], p = 0.08, I² = 15%; Figure 2) scores in the EASE intervention group compared to the ETAU group showed no significant difference. In both outcomes the heterogeneity was low.

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The benefit of EASE in improving mental distress in adolescents is uncertain. Additional trials will provide new evidence for EASE potential therapeutic benefits.

None Declared

Given the increasing rates of antipsychotic use in multiple psychiatric conditions, greater attention to the assessment, monitoring and documentation of their side effects is warranted. While significant attention has been provided to metabolic side effect monitoring, comparatively little is known about how clinicians screen for, document and monitor their motor side effects (i.e. parkinsonism, akathisia, dystonia and tardive dyskinesia (TD), collectively “extrapyramidal symptoms” or EPS).

This review aims to systematically assess the literature for insights into current trends in EPS monitoring practices within various mental health settings globally.

In line with our preregistered protocol (PROSPERO: CRD42023482372), we systematically searched the OVID Medline, PubMed, Embase, CINAHL and PsycINFO databases for studies published from 1998 to present day. Figure 1 shows a detailed flowchart of the selection process. Included studies were assessed for quality using a modified version of the Quality Improvement Minimum Criteria Set (QI-MQCS) and findings summarized using narrative synthesis. All stages of the review process are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

A total of 22 studies met our inclusion criteria. Studies occurred in varied settings and employed a range of study designs. The APA and NICE guidelines were most commonly used to guide practice. Baseline monitoring rates in adult settings ranged from 0 to 54%, and 3.7 to 100% in child & adolescent settings. In studies reassessing EPS monitoring rates following practice improvement initiatives, virtually all demonstrated benefits. Screening processes and instruments varied, ranging from standardized rating scales (such as the AIMS for TD screening) to locally developed tools. In some studies, no structured tool was identified. Monitoring rates were higher when structured processes and tools were used.

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This review demonstrates significant heterogeneity in clinical practice for the screening, documentation, and monitoring of EPS in patients prescribed antipsychotic medication in mental health settings globally. Adherence to existing guidelines was found to be poor in most settings, with practice improvements observed in virtually all settings where quality improvement initiatives were implemented. The best improvements were seen to occur after services introduced structured EPS screening tools with regular education on their use.

R. Aubry: None Declared, T. Hastings: None Declared, M. Morgan: None Declared, J. Hastings: None Declared, M. Bolton: None Declared, M. Grummell: None Declared, R. Shorr: None Declared, S. Killeen: None Declared, C. Coyne: None Declared, M. Solmi Consultant of: MS has received honoraria/has been a consultant for AbbVie, Angelini, Lundbeck, Otsuka.

Psychiatric patients, especially those with psychotic disorders, face an increased metabolic and cardiovascular risk, which ultimately leads to higher mortality from cardiovascular disease and reduced life expectancy. This is due to a multitude of risk factors, including those related to the course of the mental illness, lifestyle, socioeconomic and cultural circumstances, and the use of certain medications, such as atypical antipsychotics. This underscores the need for structured interventions during hospitalization to identify and manage these risks. Non-pharmacological interventions, such as physical activity and dietary education, have shown to be beneficial in managing weight and improving cardiovascular health. Pharmacological treatments, particularly the use of metformin and aripiprazol, have demonstrated efficacy in reducing metabolic disturbances such as weight gain, dyslipidemia, and hyperglycemia. The implementation of structured protocols to mitigate metabolic risk in psychiatric inpatients is recommended.

The main goal of the protocol is to guide the assessment, diagnosis, and therapeutic management of metabolic and cardiovascular risk factors in psychiatric inpatients. It also aims to guide the follow-up of these patients after discharge and coordination with other medical specialties.

The protocol was developed in an interdisciplinary manner, involving the specialties of Psychiatry, Endocrinology, and Internal Medicine, and is based on recent guidelines and recommendations from other countries on this matter. The protocol was also adapted to the current conditions of the psychiatric inpatient setting.

The protocol involves a thorough clinical evaluation, including medical history, physical examination, and extensive laboratory analysis to identify comorbidities. Cardiovascular risk is calculated using the SCORE2, PRIMROSE and QRISK3 models. Non-pharmacological interventions include physical activity programs and nutritional counseling, while pharmacological interventions involve adjusting antipsychotic medications, selecting antipsychotics with more favourable metabolic profiles, and the adjuvant use of medications like metformin, aripiprazol, and topiramate. These evaluations are conducted at regular intervals, including post-discharge, to assess the efficacy of these interventions.

Psychiatric inpatients, especially those on atypical antipsychotics, face significant metabolic and cardiovascular risks. A comprehensive assessment of risk factors and early intervention during hospitalization, combining lifestyle modifications and pharmacological treatments, can significantly reduce these risks and improve patient outcomes. Continued monitoring and coordination with outpatient services post-discharge are essential for sustained management of these health risks.

None Declared

Comorbidities in addiction: It is a rule rather than an exception. The story starts in childhood; even before, in infancy, and may be in prenatal life. The dimensional traits have already been there, existing obviously far before any DSM-5 diagnosis. Among these traits, the developmental features named as stress sensitivity, impulsivity and emotion dysregulation are the leading ones. Comorbidity research addressed childhood abuse, neglect or other childhood adverse experiences as a definite risk factor for adolescence and adult mental disorders, particularly substance use disorders. Developmental and environmental adversities in a mutually amplifying pattern make a vicious cycle in which the individual finally finds an illusionary exit, a pathway to addiction.

This presentation aims to discuss the complexities and challenges for the diagnosis and treatment of cases presenting with ASUD (alcohol and substance use disorders) and comorbid neurodevelopmental and affective or psychotic disorders . The history as well as the life and the management charts of the patients are reviewed in the light of information collected during the follow-up years revealing significant alterations with regard to diagnoses and therapeutic approaches. A specific focus of the case studies will be the missed or mis-diagnoses, and the impact of them on the treatment courses and the outcomes. One of the case studies with an eight year follow-up period, shows ADHD traits, alcohol use disorder, affective disorder and a later emerging severe stimulant use disorder. The second case with a similar ADHD history, presents with a stimulant use disorder, co-occuring with a severe psychotic disorder, that has been mis-diagnosed as schizophrenia. The life and management charts of the studied cases convey the drawbacks of the diagnostic difficulties, the treatment failures and the implication of efficient therapeutic strategies.

The challenges faced by clinicians due to co-occuring disorders that have become a common practice for addiction professionals. should be managed by transdiagnostic and integrative modalities. While big data or empirical large datasets can have their own limitations to help the practitioner for overcoming such complexities of real world situations, as stated in Stein’s article (2022, Psychiatric diagnosis and treatment in the 21st century: paradigm

shifts versus incremental integration) “the age-old single-case studies, may sometimes provide clinical insights that outweigh those from big data analyses.”

None Declared