Neuroimaging studies show that schizophrenia is linked to reduced grey and white matter volumes and increased cerebrospinal fluid. Cannabis use, a widely known risk factor for psychosis, is associated with poorer clinical outcomes, although the mechanisms underlying this association remain unknown.

This study aims to explore the effect of cannabis use on brain volumes in individuals with a first episode of psychosis, comparing users and non-users.

A cross-sectional study with 207 participants was conducted at the Cantabria Early Psychosis Intervention Program (ITPCan) in Santander, Spain, from January 2020 to July 2024. Clinical, sociodemographic, and cannabis use data were collected. Structural magnetic resonance imaging (sMRI) scans were obtained using a Philips 3.0T MRI machine with T1-weighted sequences. Voxel-based morphometry (VBM) analysis was conducted using the CAT12 toolbox to assess relative volume measures of white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF), accounting for individual differences.Statistical analyses were performed by SPSS 23.0, with a significance of 0.05, including mean comparisons and multivariate analysis of covariance controlling for age, sex, and educational level.

Out of the total sample, 106 patients underwent sMRI, including 44 men and 62 women, with an average age of 36.9 years. In terms of education, 47.2% had achieved basic level, while 52.8% had higher education. Regarding cannabis-related variables, 28 participants (26.5%) were identified as users; the average age of initiation was 17.1 years, with consumption occurring around 6.5 days per week and 6. 7 joints per day.

Non-user group showed slightly higher mean CSF and WM volumes compared to users (CSF=18.65 vs. 17.56; WM=36.49 vs.35.99), but these differences did not reach statistical significance (p= 0.154; p = 0.265). In contrast, cannabis users showed a significantly greater relative mean GM volume (46.37 vs. 45.12, p = 0.037). However, these differences did not reach statistical significance after adjusting for age, sex, and education.

Cannabis use is associated with greater GM volumes among individual with a first episode of psychosis. However, these differences did not remain significant after adjusting for age sex and education. GM differences could largely be attributed to the age disparity between both groups, with cannabis users being significantly younger than non-users (27 vs. 40.8 years).

Further research into the underlying mechanisms and long-term studies are needed to provide a clearer understanding of how cannabis use affects brain structure over time.

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Prolonged Grief Disorder (PGD) has been recently included in the “Trauma and Stressor-Related Disorders” chapter of the latest edition of the DSM (DSM-5-TR), being fully acknowledged among mental disorders. PGD extend the period of acute grief and increase the risk for a wide range of health impairments. The availability of biomarkers for mental disorders is thought to be crucial in the development of precision psychiatry. The hypothalamus-pituitary-adrenal (HPA) axis activity and cortisol reactivity have frequently been investigated in mental disorders. Data on neurobiology of PGD is lacking. Some studies found that PGD might be associated with increased HPA axis activity and impaired autonomic nervous system regulation.

Aim of the present study was to examine the levels of cortisol excreted in urine during the night and first morning and to assess any differences and specificity of HPA axis functioning in a group of individuals with PGD and in one of healthy controls.

Thirthy-three subjects, comprising 16 subjects diagnosed with PGD (PGD group) and 17 controls (CTL group), were recruited at the Psychiatric Clinic of the University of Pisa (Pisa, Italy). Psychometric assessments included: the Structured Clinical Interview for Mental Disorders-Clinician Version (SCID-5-CV), the Inventory of Complicated Grief (ICG) and the Impact of Events Scale-Revised (IES-R). Enrolled subjects, previously informed on collection procedures, delivered urine samples to the health care providers the same day of the clinical evaluation. Urine cortisol levels were measured by indirect enzyme-linked immunosorbent assays (ELISAs). Analyses were carried out at the Department of Pharmacy of the University of Pisa. Between-groups differences were performed by the non-parametric Mann-Whitney (MW). A p-value <.05 was considered statistically significant.

Descriptive results showed a higher variability (SDs and interquartile ranges) of urinary cortisol levels (total

μg) in the PGD group in respect to the CTL one; by inferential statistics, MW comparisons showed significantly higher urinary cortisol levels in PGD group vs CTL one (p< .05).

Results report that PGD patients had impaired cortisol outputs with respect to control subjects, suggesting a different pattern of production of the hormone during the night and the sleep-wake shift. If this prelimary data will be confirmed in wider samples, there will be a need to understand whether the increased cortisol profile reported in PGD may be due to increased production of the hormone at night (sleep alterations), to an increased peak on awakening (hyperarousal) or both conditions. Such findings might help to define more accurate patient-tailored therapeutic interventions.

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The Locus Coeruleus (LC), the first brain region affected by TAU aggregates in Alzheimer’s disease (AD), is the primary source of noradrenaline (NA). Given the importance of NA in cognitive functions, noradrenergic interventions may benefit patients with AD pathology.

This study aims (i) to examine memory delay and related fMRI activations in brainstem and midbrain regions in healthy aging and amnestic mild cognitive impairment (aMCI); and (ii) to explore the impact of atomoxetine on memory delay and inhibitory control in aMCI.

For aim (i), event-related fMRI was used. Fifty-three subjects (28 healthy older adults and 25 with aMCI) completed an incidental recognition memory task with emotional and neutral images. Memory tests were administered four hours later, brain BOLD fMRI activations for remembered versus not remembered images were assessed. For aim (ii), seven participants attended the lab over four days. On visit 1, they received either a placebo or atomoxetine, followed by a stop signal task and an incidental memory task. On visit 2, they completed a recognition memory task. Visits 3 and 4 repeated this protocol. T-tests were used to compare results between groups and visits.

For aim (i), a greater activation in the left caudate nucleus was observed in older adults compared to aMCI when contrasting remembered items with not remembered ones (SVC, cluster-level pFWE-corr = 0.08). A significant increase in activation was also found in the locus coeruleus (SVC, cluster-level pFWE-corr = 0.018). However, after adjusting for LC integrity and global grey matter volume (GMV), these differences were no longer significant, suggesting structural changes contribute to LC activation differences between healthy controls and MCI participants. For aim (ii), inhibitory control improved slightly but was not statistically significant, while delayed memory decreased during the atomoxetine visit compared to the placebo visit (p<.05).

Our findings highlight the caudate nucleus’s role in memory encoding in healthy older adults versus those with aMCI, linking LC dysfunction in aMCI to reduced LC integrity. The lack of improvement in executive functions and decreased memory during the atomoxetine visit may stem from individual differences in aMCI. Studies suggest atomoxetine is more effective in patients with high apathy and reduced LC integrity. In future analyses we will stratify participants by apathy and LC integrity to explore atomoxetine’s potential benefits. This study contributes to understanding neural mechanisms in aging and aMCI and informs personalized interventions for cognitive decline in AD.

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Lewy Body Dementia (LBD) is the second most common neurodegenerative disease, after Alzheimer’s disease. Initial neuropsychiatric manifestations such as depression, delusions and hallucinations are frequently observed and sometimes make it difficult to diagnose the neurocognitive disorder underlying the symptoms, so it is important to perform a proper clinical examination, as the use of certain neuroleptics may worsen neurological symptoms.

This case aims to investigate the psychiatric clinical features of Lewy body dementia from a clinical and therapeutic perspective.

A comprehensive search on psychiatric manifestations that may cover up dementia.

71-year-old female with depressive symptoms for the last 8 years. She is admitted to a psychiatric inpatient unit due to worsening of depressive symptoms despite correct adherence to treatment. Her psychiatric history includes a diagnosis of specific phobia, obsessive-compulsive disorder and depressive episodes with inhibitory symptomatology.

During her stay at the hospital, the patient is inhibited, perplexed and experiences feelings of embarrassment and guilt, along with persistent insomnia and poor response to different lines of treatment. Initially, there is notable intolerance to antipsychotics, resulting in worsening of motor and cognitive functions, as well as hypotension, using risperidone and olanzapine. After the withdrawal of treatment, the patient begins to exhibit delusional ideas and visual hallucinations, leading us to consider that she may be suffering from depression associated with an undiagnosed organic brain pathology.

Clinical tests (MoCA,MMSE) reveals cognitive symptoms which, along with the motor symptoms, suggests a Parkinson’s-dementia complex.

A PET-CT scan with fluorodeoxyglucose-F18 reveals severe hypometabolism in the left parietotemporal and prefrontal regions. These findings are consistent with LBD.

Treatment is initiated with rivastigmine and quetiapine. However, due to the presence of hypotension, quetiapine is replaced with clozapine 25 mg, resulting in a slight improvement in rest and affective responses to the psychotic symptoms.

This case illustrates how depression and psychotic symptoms can serve as early indicators of dementia, stemming from the loss of dopaminergic and acetylcholinergic pathways as part of the neurodegenerative process.

These patients may present with a range of cognitive, neuropsychiatric, sleep, motor, and autonomic symptoms. Depression is prevalent in approximately 28% of these patients. Currently, clinicians diagnose LBD based on the presence of core clinical features and indicative biomarkers. Treatment can be complicated by patients’ sensitivity to certain medications, needing careful evaluation of potential side effects. Current guidelines recommend the use of antipsychotics such as quetiapine or clozapine at low doses, as these have a reduced risk of extrapyramidal effects.

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Depression is a prevalent disease and 30% of affected patients are resistant to pharmacological treatment. Home-Based transcranial Direct Current Stimulation (HB-tDCS) has been proposed as a treatment option due to its low cost, minimal invasiveness, and scalability.

We present preliminary results on safety, feasibility and efficacy of a remotely supervised HB-tDCS intervention in patients with treatment-resistant depression.

7 patients (5 women, age =55.67 ± 6.93) underwent a psychiatric evaluation, pre and post stimulation, that included the Montgomery-Asberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), and the Quick Inventory of Depressive Symptomatology (QIDS). HB-tDCS intervention consisted of 42 daily sessions administered through the Sooma tDCS™ device by a patients’ companion, trained by the research team. The anode was placed on the left prefrontal cortex, the cathode on the right prefrontal cortex, and 2mA current was delivered for 30 minutes.

After each session participants fulfilled an on-line survey for monitoring safety and feasibility.

86.73% of the sessions were completed. Due to impedance 7.84% of the sessions could not start on the first attempt, while 7.45% of the session were temporarily interrupted. Adverse effects included headaches (9.67%), sensations under electrodes (24.89%), and scalp dryness (7.88%).

We observed a significant reduction in depressive symptomatology as measured by the MADRS (-33.56%; t=-7.99, p<0.001). All patients showed partial response (>25%), and two a relevant response (>50%).

Self-reported scales indicated a reduction in symptomatology (QIDS:-21.66; t=-3.139, p=0.010; BDI:-13.92%; t=-1.780, p=0.063).

In line with previous studies, these results indicate that HB-tDCS is a feasible, safe, and potentially effective intervention for treatment of resistant depression.

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Autism Spectrum Disorder (ASD) is a complex neuropsychiatric disorder characterized by deficits in social interaction, anxiety and the presence of repetitive-ritualistic behaviours. Recent studies suggest that epigenetic mechanisms, such as histone methylation, play a crucial role in the etiology of ASD by regulating gene expression linked to neuronal differentiation and proliferation. The enzyme, G9a is responsible for histone H3K9 methylation, and its inhibition has shown promise in altering epigenetic pathways associated with ASD onset and progression. Similarly, histamine H3 receptor (H3R) has long been recognized as a potential therapeutic target for ASD treatment

This study aimed to investigate the dual action of A-366, a potent G9a inhibitor with high and selective H3R antagonistic affinity, on the ASD-like behaviours and neuroinflammation of male BTBR T+tf/J mice model.

Male BTBR T+tf/J mice were housed under standard conditions and treated chronically with A-366 (0.5-2 mg/kg, i.p.) for 21 days. ASD-like behaviors were assessed using the Marble Burying Test, Nestlet Shredding Test, Self-Grooming Test, Spontaneous Alteration Test, Elevated Plus Maze, Light Dark Box, and Three-Chamber Test. Following behavioral testing, cerebellar and hippocampal brain tissues were analyzed using ELISA to quantify pro-inflammatory markers (TNF-α, TNF-β, IL-6, IL-1β, TGF-β) and immunohistochemistry for Iba-1 expression to evaluate neuroinflammation.

A dose dependent decrease of repetitive and anxiety-like behaviours as well as amelioration in social deficits was observed in response to the chronic systemic treatment of A-366 (0.5-2 mg/kg, i.p.). Moreover, A-366 decreased neuroinflammation in cerebellar and hippocampal brain tissues of treated BTBR mice, as evidenced by the reduction in proinflammatory markers TNF-α, TNF-β, IL-6, IL-1β and TGF-β, as well as the decrease in Iba-1 expression.

This in vivo study demonstrates the potential therapeutic value of A-366 as a dual-targeting agent for G9a and H3Rs, with modulatory role on epigenetic, neuroinflammation, and brain histaminergic neurotransmission. Therefore, A-366 is expected to provide a lead template for future design and synthesis of a novel, potent and selective class of drugs to target ASD features.

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The term “quality of life” is widely used in the world community, has an interdisciplinary concept that characterizes the effectiveness of all aspects of human life. But it should be understood that its main component is the psychological and psychiatric part, which is based on self-perception. And in this regard, it is obvious that the degree of quality of life of patients with pituitary tumors, manifested by a complex clinical picture, sometimes a multi-component treatment strategy, is important for understanding, diagnostics and correction.

to assess and compare the degree of quality of life in patients with pituitary tumors.

120 patients (18-79 years old) after surgery for diencephalic tumor, 2019-2022. The following scales were proposed: 1) assessment of the severity of cognitive impairment and social maladjustment - the Global Deterioration Rating (GDR) scale (stages 1 to 7, where 1 is no impairment/deficit); 2) assessment of the general condition of cancer patients - the Karnofsky index (from 0% to 100%, where 100% is normal condition, no complaints); 3) a short version of the quality of life assessment (SF-12, 2000). All patients were examined dynamically by a psychiatrist.

The quality of life was assessed during treatment, when the degree: improves, remains unchanged, worsens. Different dynamics were noted with different tumor morphology, volumes of surgical intervention, and course of recovery after surgery. Thus, after surgery, the number of patients with severe disorders in large and giant tumors, especially with spread to the third ventricle (according to the Karnofsky and GDR scales), increased, respectively, they were found to have a low degree of “quality of life”. The use of questionnaires (SF-12) showed the inappropriateness of their use, since 33-78% of patients (with different tumor morphology) showed personality changes, they were not fully aware of their condition. Assessment by scales revealed the following features: 1) A large sample, no universal; 2) Mostly self-questionnaires, which is questionable due to the high percentage of patients with lack of criticality, inadequate assessment of the situation and themselves; 3) Conducted by different specialists; 4) To interpret the results, an assessment by a psychiatrist is necessary. Patients with pituitary tumors were divided into: 1) with pronounced health problems - sufficient quality of life; 2) with minimal symptoms - deeply “unhealthy”.

In assessing the “quality of life”, the primary factors are not the symptoms of the disease and their manifestations, but the perception of oneself and the ability to feel “happiness”. In the case of pituitary tumors, non-specific scales and self-questionnaires should be used with reservations; for the adequacy of the interpretation of the results, it is worth comparing the data with the psychiatric report.

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« Disconnectivity » in schizophrenia seems to be subsequent to abnormalities of the white matter and distorted functional connectivity. That would explain the cognitive impairment, including the slowing of information processing, observed in these patients that could be one of the risk factors for conversion into clinical psychosis and a significant predictor of functional outcome.

This study aimed to search for signs of « disconnectivity » in quantitative electroencephalograms (EEG) in schizophrenic patients compared to healthy controls.

It was a case-controlled study involving 15 schizophrenic patients and 15 healthy controls. The study was carried out at units of Psychiatry Department “C” and Functional Explorations Department Sfax’ hospital in Tunisia. Participants underwent a standard wakefulness EEG recording with a resting state period and a mental calculation test.The spectral density analysis for each frequency band was studied. The absolute spectral densities (ASD) of the following frequency bands were analyzed at resting state and after calculation moment: delta [0,5 – 3,5 Hz], thêta [4 – 7,5 Hz] alpha 1 [8 – 10 Hz] alpha 2 [10,5 – 12,5 Hz] and bêta 1 [13 – 20 Hz] in bilateral frontal and occipital regions. The Pearson’s correlation was applied between the two moments in the same region (for the same electrode). Good connectivity was found if p <0,05, the inverse meant « disconnectivity ».

Good connectivity was found for schizophrenics in the frontal region ( for alpha1 band in the right one (r=0,721 ; p=0,002) and in the left one (r=0,597 ; p=0,019), for beta1 band in the left one (r=0,616 ; p=0,014), and for thêta band in the right one (r= 0,569 ; p=0,027) and the left one (r=0,661 ; p=0,007)) and in the occipital region (for alpha2 band in the right one (r=0,726 ; p=0,002), for bêta1 in the right one (r=0,565 ; p=0,028), and for thêta band in the right one (r=0,836 ; p<0,001) and in the left one (r=0,829 ; p<0,001)). Disconnectivity was admitted for other bands in the same regions. However,for healthy controls, highly significant correlations (p<0.001) were observed in the right and left frontal and occipital regions for all frequency bands.

These results support the « disconnectivity » theory in which it seems that relay neurons connecting the nerve cells between the thalamus and the cortex could not control the thalamic neurons. A dysfunction of these relay neurons, mainly GABAergic, is known as one of the main etiopathogenesis of schizophrenia.

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Autism spectrum disorders (ASD) are developmental deviations that cause social, communication and behavioral problems. Valproic acid (VPA) works as an inhibitor of histone deacetylases. One of the presumed causes of ASD development is neuroinflammation. A low-grade inflammatory process in nervous tissue can cause serious disorders, leading to the death of neurons, impaired myelination and anatomical and biochemical changes in brain structures. Currently, there are known inflammatory markers that are detected in the blood and used to assess the level of inflammation in the brain, for example, leukocyte elastase.

To investigate the effect of postnatal administration of VPA on the behavioral manifestations of ASD and the activity of leukocyte elastase in blood serum in male white rats.

The study was performed on male rat pups. The conditions for keeping animals and the experimental procedures used were approved by the Bioethics Commission of Moscow State University (registration No. 12.3 of 17.11.2022). The animals were administrated intraperitoneally with water (H2O) or VPA at a dose of 150 mg/kg from the 6th to the 12th day of life. The study used standard behavioral tests: weight monitoring from 6-12 days of life, “Social behavior” in the sibling/stranger modification on 55 day. The animals were decapitated on the 57th day. Blood was collected into tubes with serum separating gel (BD Vacutainer® SST™II Advance), centrifuged at 2000 g, serum was frozen -78°C. The activity of leukocyte elastase in blood serum was measured spectrophotometrically by the rate of hydrolysis of the substrate BOC-Ala- ONp (Biomedical, Inc.).

An important physiological indicator for ASD in the model used is a slowdown in weight gain. As a result of the study, it was revealed that the weight of males after 6 days of VPA administration was lower compared to control individuals (p = 0.003). In the “Social Behavior” test, in males who received VPA, the latent period for leaving the starting compartment was significantly longer than in the control (p = 0.019); also, experienced males later approached a stranger as if they were a stranger (p = 0.037), compared to controls. In this study, the activity of leukocyte elastase in the rat’s blood serum receiving VPA was significantly higher than in control individuals (p = 0.04). Similar deviations are observed in patients with ASD.

These results allow us to conclude that the administration of valproic acid to rats in the early postnatal period causes changes in physiological and behavioral characteristic typical for ASD. This confirms the validity of the created experimental model. The increase of leukocyte elastase activity in the rat receiving VPA indicate the role of inflammation in pathogenesis of ASD.

None Declared

The burnout develops gradually, unnoticed by the person, and its symptoms may appear after several years and leads to serious mental and behavioral changes. The processes underlying burnout are largely unknown due to the lack of specialized studies aimed at identifying specific biomarkers. Based on this, it is necessary to detect the first, critical moment - the first symptoms of burnout.

We aimed to examine the EEG frequencies changes relating to severity of Anxiety Tension stage of Emotional Burnout.

In this study 752 participants, students and staff of Taras Shevchenko National University of Kyiv (Kyiv, Ukraine) were involved (209 males, mean age = 19.2, 543 females, mean age = 18.28). We used the 84-item Boyko’s Syndrome of Emotional Burnout Inventory to measure the emotional burnout formation. We analyzed separate artefact-free EEG segments in all frequency bands from 0.2 to 45 Hz during resting state (3 min, closed eyes condition). In order to identify the EEG signs of emotional burnout the normalized power spectral densities (PSD) were calculated on the segment from 61 to 70 seconds of recordings.

The revealed burnout-related (Anxiety Tension stage) variables in the spectral characteristics of the EEG characterized by the significant changes in the theta 2 (frontal area and left temporal-parietal cortex), alpha 2 (right parietotemporal cortex) and beta 1 subbands (left frontal-central-right parietal axis).

These data pointed to the influence of Anxiety Tension development mostly on the processes associated with short-term memory and focused attention.

None Declared

The pathogenesis of Parkinson’s disease (PD) is associated with simultaneous damage to the nervous, endocrine and immune systems. Therefore, drugs that have a regulatory effect on all of these systems should be used to treat PD. Similar properties are possessed by the synthetic analogue of fragment 41–46 Human Leukemia Differentiation Factor (Thr-Gly-Glu-Hse-His-Arg-NH2, HLDF-6-H)

To study the effects of HLDF-6-H in an experimental model of PD and its impact on the severity of motor and non-motor symptoms in patients with PD

The study used a preclinical PD model based on the administration of moderate doses of MPTP toxin (18 mg/kg) and chronic intranasal administration of HLDF-6-H peptide (300 μg/kg) to C57Bl/6 mice. Mice behaviour was assessed in the Grid test and the Forced Swim (FS) test. After 3 weeks of peptide administration, mRNA of neurotropic factors (BDNF and NGF) and key cytokines (IL-1β, IL-6, IL-10, gamma interferon, tumour necrosis factor α and transforming growth factor β1) was analyzed in five brain regions (striatum, hippocampus, hypothalamus, pituitary gland, cortex). Serum levels of 10 steroids, including testosterone, estradiol, progesterone, and corticosterone, were determined using MS analysis. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) was determined using kinetic methods. Patients (24 people) with a disease duration from 1 to 16 years received HLDF-6-H intranasally as part of the balm “Rinohealing” (9-31 μg/kg per day, up to 6 months) in addition to standard pharmacotherapy for PD. The effectiveness of therapy was assessed based on the patients’ subjective assessment of their condition according to the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)

HLDF-6-H blocked motor disorders (Grid test) and depressive-like syndrome (FS test) caused by MPTP in mice, restored the level of neurotropic factors and cytokines in the brain of animals (p<0.05). In the model used, a decrease in the level of estradiol and cortisol in the blood was reversible by the peptide (p<0.05). The development of the inflammatory process under MPTP action is indicated by an increase in the activity of α1-PI, the anti-inflammatory effect of HLDF-6-H is expressed in a decrease in the serum activity of LE and α1-PI (p < 0.05). A decrease in the severity of a number of motor (rigidity, tremor, movement and balance disorders) and non-motor (anxiety-depressive state, impairment of memory, cognitive functions, sleep, etc.) pathological symptoms of PD was noted with chronic use of “Rinohealing” as an additional therapy.

HLDF-6-H peptide has antidepressant, neuroprotective and anti-inflammatory activity. This has been demonstrated both in the experimental model of PD and when used as an additional therapy for PD. The obtained results indicate the prospects for further studies of HLDF-6-H for the treatment of PD.

None Declared

Global epidemiological research suggests that approximately 1% of the global population is affected by schizophrenia, with 2 to 3% experiencing obsessive-compulsive disorder (OCD). Additionally, a noteworthy proportion of individuals with schizophrenia also exhibit comorbid OCD. This overlap often complicates differential diagnosis, especially as many schizophrenia patients display obsessive and/or compulsive symptoms akin to those seen in OCD.

This literature review is designed to examine how frequently schizophrenia and OCD co-occur and to summarize the treatments reported in various studies.

A comprehensive literature review was carried out focusing on the co-occurrence and treatment of schizophrenia and OCD. This review involved an extensive search of scientific publications, selecting articles pertinent to the subject from databases such as Scopus and PubMed using keywords like “schizophrenia and OCD” and “schizophrenia and OCD treatment,” yielding over 1500 articles from 1988 to 2024. Additional sources included Google Scholar and various grey literature sources. After applying specific exclusion criteria, 44 recent articles were selected that addressed the frequency of co-occurrence and the treatment modalities used for schizophrenia and OCD. These articles were categorized by country, frequency of co-occurrence, and treatment methods.

The review revealed that roughly 14.5% of individuals with schizophrenia also suffer from OCD. Among treatments, Clozapine was commonly associated with the worsening of OCD symptoms, while Haloperidol showed better tolerability. Other antipsychotic medications like Olanzapine, Risperidone, and Quetiapine were noted to either aggravate existing OCD symptoms or initiate the onset in some cases. In contrast, some antipsychotics, such as Amisulpride and Aripiprazole, helped reduce symptom severity. Non-pharmacological treatments, particularly Cognitive Behavioral Therapy (CBT), have proven effective in reducing symptom severity with favorable outcomes noted in numerous cases. The integration of pharmacological and psychotherapeutic strategies is generally recommended to maximize therapeutic outcomes, underscoring the potential of combined modalities in treating OCD.

Our literature review investigated the prevalence of comorbidity between schizophrenia and obsessive-compulsive disorder (OCD), as well as the pharmacological and non-pharmacological treatments utilized. The significant overlap between these disorders highlights the complexity of managing patients with these co-occurring conditions, underscoring the need for systematic screenings and integrated treatment approaches.

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Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) typically describe the sudden onset of neuropsychiatric symptoms, such as Obsessive-Compulsive Disorder (OCD), following streptococcal infections. However, cases that present with comorbid motor abnormalities, such as myoclonic jerks, are rare and pose diagnostic challenges. We report the case of a child who developed severe OCD accompanied by myoclonic movements after a streptococcal pharyngitis infection, representing a rare neuropsychiatric syndrome with an atypical clinical course.

To present a rare case of post-streptococcal OCD in a child with comorbid motor myoclonus, highlighting the unusual presentation and the multidisciplinary therapeutic approach.

An 11-year-old male presented to the emergency department with sudden-onset severe compulsive behaviors, including repetitive prayers and ritualistic actions. These symptoms were accompanied by involuntary, rapid, jerky movements in both upper and lower limbs, consistent with myoclonus. Two weeks prior, the patient had been treated for streptococcal pharyngitis. A comprehensive evaluation was performed, including throat culture, elevated antistreptolysin O (ASO) titers, and electroencephalogram (EEG) to rule out seizures. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used for assessing OCD severity.

The patient was managed with a multidisciplinary approach involving pediatricians, neurologists, and psychiatrists. A combination of antibiotics, selective serotonin reuptake inhibitors (SSRIs), and clonazepam for myoclonus was prescribed, alongside Cognitive-Behavioral Therapy (CBT).

ASO titers were elevated, indicating recent streptococcal infection, and the EEG showed no epileptiform activity. The initial Y-BOCS score was 32, reflecting severe OCD. After four weeks of antibiotic therapy, CBT, and pharmacological treatment, the Y-BOCS score decreased to 18. Myoclonic movements also reduced by 70% with clonazepam. Symptomatic improvement continued over the next three months, with residual mild OCD symptoms and no recurrence of myoclonus.

This case illustrates a rare and complex presentation of PANDAS, where post-streptococcal OCD is accompanied by myoclonic movements. The integration of antibiotics, SSRIs, clonazepam, and CBT significantly improved both OCD and motor symptoms. This highlights the importance of recognizing and treating atypical neuropsychiatric manifestations following streptococcal infections in pediatric populations.

None Declared

Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive distressing thoughts, images, or urges (obsessions), and/or by behavioral acts (compulsions) that the individual feels driven to perform. In patients with severe functional impairment, a combination of selective serotonin reuptake inhibitors (SSRIs) or chlomipramine and cognitive behavioural therapy is recommended. Evidence for use of repetitive transcranial magnetic stimulation (rTMS) as an adjunct in severe, medication-resistant cases of OCD is accumulating.

We present a case of severe OCD in a patient who responded poorly to SSRIs, and who was trialed on rTMS, with marked improvement.

Details of the case were described. Information was gathered based on medical records.

Patient T was a 34-year-old Chinese male, with a drug allergy to clomipramine, who was diagnosed with severe OCD in 2017, when he presented to the Institute of Mental Health for excessive anxiety with checking behaviour. He was maintained on fluoxetine 60mg OM and aripiprazole 10mg OM, from 2017 to 2020. He completed a course of rehabilitation during admission, as well as empowerment and job training programs in the outpatient setting. He still had residual symptoms of excessive checking and would take a long time to complete activities of daily living such as eating or showering. He then defaulted medications and follow up from 2020 onwards. In 2024, he was brought in by his father to the emergency services for an infected foot wound due to poor self-care, as well as loss of weight from only eating one meal a day, due to his excessive checking behaviour. He would take 5 hours to finish a meal and 4 hours a day showering. He had also stopped speaking to anyone for 3 years. In the ward, he was switched to paroxetine 40mg OM as he had urinary incontinence on fluoxetine and weight gain on aripiprazole. However, improvement with paroxetine was minimal and the patient was still taking 2 hours each for showering and meals. The decision was made to give him a trial of rTMS. Drug treatment remained unchanged during the rTMS trial. Prior to rTMS, his Yale-Brown Obsessive-Compulsive Scale (YBCOS) was 30 (severe OCD).

After 30 sessions of rTMS, his obsessions and compulsions were significantly reduced, with a YBCOS of 17. He was able to finish his meals and shower for less than 30 minutes each. He was also more participative in ward activities with other patients, such as playing ping pong. He also showed interest in self-care by asking questions about his infected foot wound and prevention strategies.

In this case, there was a need for early treatment to address the risk of self-neglect posed by the patient’s obsessive checking behaviour. rTMS is a safe and efficient treatment for patients suffering from refractory OCD. Further research is needed to optimize rTMS protocols and evaluate the long-term efficacy of rTMS for OCD.

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Autism spectrum disorder is a complex pathology that can occur very frequently with other disorders. It is known to co-occur with ADHD (attention deficit hyperactivity disorder), anxiety disorders or depression. Comorbidity with obsessive-compulsive disorder (OCD) can be difficult to detect since rigid and obsessive thinking, which in many cases is similar to the obsessions and compulsions of the OCD patient, is part of the core symptomatology of autism spectrum disorder.

To present two cases of patients atteded in the Adolescent Hospitalization Unit with Autism Spectrum Disorder comorbid with OCD

Two clinical cases are presented, with review of literature.

First case

This is a 16-year-old male, diagnosed with autism spectrum disorder at age 4. He begins with intense preoccupation for hygiene, developing cleaning rituals. He begins to develop the idea that his cells are released from his body and that they are sensitive to external stimuli in the same way that he is. He claims that in order for them to be eliminated and “not to suffer” he has to wash them and make flapping movements and avoid their accumulation.

He begins to treat with sertraline up to 200 mg with partial response, adding fluvoxamine 100 mg with important improvement of the symptomatology.

Second case

17-year-old male admitted to the inpatient unit for isolation and cleaning rituals and fear of contamination. The patient had no past psychiatric history. He had been out of school for 4 months. The patient began to develop a fear of pathogen contamination. He maintained cleaning and checking rituals. He ate only packaged food and spent hours, and slept, in the same corner of the bed.

Medication with sertraline up to 150 mg was started with progressive improvement. During the admission a history of evolutionary development was taken, observing a difficulty in the mentalization of other people’s emotions. Very adult and literal speech with difficulty in abstract thinking. He revealed presence of restricted interests throughout his history such as rare languages. Finally, the diagnosis of Autism Spectrum Disorder and comorbid obsessive compulsive disorder was made.

The comorbidity between autism spectrum disorder and OCD occurs between 37%. This comorbidity can make it difficult to perform psychotherapeutic interventions. This work shows on the one hand an already diagnosed autistic patient who develops an OCD, and on the other hand, how the initial diagnosis is an OCD on which an autism spectrum disorder is detected. This highlights the importance of knowing the comorbidity in order to detect both diagnoses.

None Declared

Recent evidence suggest the nosological entity called Schizo-Obsessive Disorder (SchizoOCD), similar to Schizoaffective Disorder. Some authors argued that obsessions and delusions would be on a continuum, which justify the difficulty in distinguishing obsessive from delusional thoughts, and compulsions from stereotypical behaviors. In order to assist in the screening, monitoring or treatment of such disorders, instruments as scales and questionnaires may be important tools in psychiatric practice.

This systematic review investigated the most frequent instrumentsused to assess SchizoOCD.

We systematically reviewed articles up to 2015 in English, Portuguese and Spanish at PubMed, Scielo and Embase databases. We included studies with humans, no age limitation, with OCS or diagnosis of OCD and schizophrenia or psychotic symptoms. Systematic review articles, meta-analysis, letters to the editor and case reports were excluded, as well as articles that did not use assessment instruments for the diagnosis of schizophrenia comorbid with OCD. The methodological and clinical data extracted from the articles are described at the results.

A total of 9,833 articles were selected, but 53 were read. Cross-sectional studies were the most frequent (n=39; 73.6%), followed by cohort studies (n=9; 17.0%).The total sample size of Schizo-OCD patients was 2,605 patients (in 44 studies), of which 44.7% (n=1,164) were female. The mean age and the age of onset of the disorders are described in Table 1. Only 23 (44.4%) of the studies described the psychiatric comorbidities (2 (3.8%) studies reported that the patients had no comorbidities). The most frequent comorbidities were Major Depression (n=18; 34%) and Substance Use Disorder (n=9; 17.0%). The used diagnostic instruments or interviews are listed in Table 2. Table 3 describes the scales used to assess the severity of Schizophrenia and/or OCD symptoms. From a psychopathological point of view, only 9 (17.0%) of the articles described psychotic symptoms in more detail. For OCD, 15 (28.3%) of the articles detailed the obsessive-compulsive symptoms.

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Few studies in the literature used scales to discriminate psychotic and obsessive-compulsive aspects in patients with the alleged diagnosis of Schizo-OCD. Scales for measuring symptom severity such as PANSS and YBOCS were widely used in the studies, indicating that their application in clinical practice can serve as an aid during treatment management. Specific scales and instruments for Schizo-OCD were not found and we suggest as a future perspective the development of a new tool to assess symptoms and to elucidate possible symptomatic confusions.

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The relationship between obsessive-compulsive disorder and psychotic disorders has been frequently observed. Subject to diagnostic and therapeutic controversies, this association is a challenge for clinicians. Several scientific studies have observed a frequency of approximately 12% of this association in patients affected by schizophrenia. The efficacy of augmentation of SGAs with antidepressants in treatment-resistant OCD is demonstrated. Several studies have shown the efficacy of some dopamine receptor partial agonists (DRPAs) (aripiprazole and cariprazine) in augmentation with SSRIs in zOCD-psychotic features treatment-resistant. Brexpiprazole is a DRPAs with serotoninergic 5-HT1A agonism and 5-HT2A receptor antagonist.

To evaluate the efficacy of brexpiprazole in augmentation with SSRIs in OCD patients with psychotic features resistant to pharmacological treatment.

Eleven patients (6 females, 5 males; mean total age (42.818 yrs ±12.679)) were recruited into our observational study. Affected by Obsessive Compulsive Disorder with psychotic features (based on the DSM-5-TR criteria). All patients were assessed using the SCID-5-CV. Levels of insight were assigned using DSM-5-TR specifiers. A detailed interview was conducted containing information on the demographic profile of the patients. All patients were administered the following rating scales: BPRS, Y-BOCS, GAF, CGI-S, at baseline (T0), after one month (T1), two months (T2), six months (T3), and one year (T4). All patients were administered bexpiprazole, replacing other SGAs associated with SSRIs (see Table 1).

Table 2 and the graphic show the results obtained with our study. A statistically significant reduction of the mean total score was observed in the BPRS, Y-BOCS scales, an increase in the mean total score with the GAF. An improvement in the mean total score was also observed with the CIG-S. In all the scales used, the ANOVA results indicate that at least two of the repeated measures differed significantly. The preliminary data also indicate adequate safety and effectiveness.

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Our small observational study aimed to evaluate the efficacy of brexpiprazole in a group of patients affected by OCD with psychotic features. Despite the small sample analyzed, the results of our study point towards a possible use of brexpiprazole in this group of patients affected by OCD with psychotic features during normal routine clinical practice.

None Declared

Obsessive disorders occur in 2 to 3% of the world’s population. They are very often underdiagnosed, causing great discomfort to the person.

With this clinical case I would like us to be able to use new therapeutic strategies that, even though they are outside the technical specifications, work and improve the quality of life of patients with obsessive disorder.

I present the clinical case of a 14-year-old male who consulted for obsessive symptoms a year and a half ago.

The patient reports that he cannot stop thinking throughout the day, any type of absurd thought comes to him and he is not able to stop it, it limits his functionality to the point that a significant academic decline had occurred when previously the minor scored very good grades. He has had angry outbursts at school due to the discomfort his thoughts cause him. I treated with Clomipramine 75 mg and Clonazepam solution as a rescue anxiolytic and appointment in 3 weeks.

The patient progressively improves in the organization of thought and decreases obsessive content, increasing the medication with Clomipramine up to 150 mg at night. After two months, it is the mother who consults because she sees her son very tired, he had gained a lot of weight and was complaining of dry mouth (side effects) and it continues to persist and worsen functionality. Given the patient’s lack of complete improvement and the obvious side effects, I decided to first progressively change Clomipramine to Vortioxetine up to 40 mg. Upon evaluation, the patient feels better about the obsessive content and no side effects appear, but cognitive rigidity, inflexibility, and functional and academic decline persist. That is why two months later, I started Cariprazine 1.5 mg and in a few days the patient felt more animated, eager to do things and concentrated better, even so I decided to go up to 3 mg and that is when the patient reported a notable improvement, also reported by his mother and his psychologist. He is currently continuing with this treatment.

Neither Vortioxetine nor Cariprazine has an indication in the technical specifications for obsessive disorders, but there are publications that show that it works without having the side effects of drugs with a dirtier pharmacological profile.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), which significantly impair daily functioning and quality of life. While common obsessions often revolve around contamination, symmetry, or safety, rarer forms of OCD can involve highly specific and unusual fears.

The aim of this case analysis is to comprehensively examine the possible causes and treatment approaches of obsessive-compulsive disorder, focusing on the investigation of various obsessive conditions that are rarely observed in the literature.

The patient’s history was thoroughly examined, and interviews conducted with the patient’s family were also included in the evaluation. Possible causes of the disorder (from a biopsychosocial perspective) and treatment approaches such as psychotherapy and pharmacotherapy were analyzed through a literature review. Additionally, the patient was assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS), Brown Beliefs Scale, Beck Anxiety Inventory, and Beck Depression Inventory.

The patient, N.C., is a 64-year-old woman whose general appearance is somewhat older than her age, with partially diminished self-care, having insight, divorced, and living with three of her six children. The patient experiences intense anger when any product containing sweets enters her home, including fruits. She feels discomfort even when using or hearing the word “sweet.” The patient insists that no family member brings any sweet-containing products into their home, leading to frequent arguments on the subject. She reports high levels of anxiety, difficulties in social relationships, and significant limitations in daily life activities. Her relatives have also observed and reported these challenges. The patient mentions feeling a sticky sensation on her hands when she sees sweets and experiences a compulsion to wash her hands when this sensation occurs. Her symptoms are consistent with the classical symptoms of obsessive-compulsive disorder, including obsessions (persistent thoughts about sweets and associated anger) and compulsions (the need to wash her hands). The diagnosis was made by Dr. Ece Ilgın.She has been started on fluvoxamine 50 mg/day, which will be titrated. She will return for a follow-up appointment at the clinic in one month.

The symptoms of obsessive-compulsive disorder in patient N.C. include obsessions related to sweets, fruits, a sense of ‘stickiness’ that cannot be clearly identified, and avoidance obsessions linked to these. These symptoms significantly impact the patient’s quality of life and family relationships. It is believed that a combination of psychotherapy and pharmacotherapy will be effective in alleviating the patient’s symptoms and improving their quality of life.

None Declared

Obsessive-compulsive disorder (OCD) is a psychiatric disorder that presents a wide variety of clinical features and obsessional themes. A particular form of OCD has received growing attention from researchers and clinicians. Called relationship OCD (ROCD), this form concerns obsessive-compulsive symptoms arising around the romantic relationship and the partner.

The aim of this work was to explore ROCD through a case report and a systematic review.

We report the case of a patient who visited the outpatient department of the Razi hospital (Tunisia) for obsessive thoughts evolving over 11 months. Moreover, a systematic review was conducted. PubMed via Medline, Google Scholar and Semantic Scholar were used as search engines. The keywords used were « Relationship obsessive compulsive disorder » or « ROCD » or « Relationship centered obsessive compulsive symptoms » or « Partner focused obsessive compulsive symptoms ». The publication period of the articles searched was from inception to December 2023. The language of the articles searched was either English or French.

Mr M.A, 25 years old, was in a relationship with a girl since two years. He was repeatedly wondering if he was in the right relationship and if he would be happier with another girl. He often sought reassurance from his friends and visualized photos of his girlfriend to ensure his feelings for her and to reduce these thoughts. The diagnosis of ROCD had been made. Cognitive behavior therapy sessions were carried out with the patient, with a clear decrease in obsessive thoughts and compulsive behaviors of checking and seeking reassurance.

The systematic review performed identified a total of 14 studies that were included in the final analysis. The mean age of patients was 30 years, with extremes of 19 and 84 years. In all the reviewed studies, ROCD symptoms were assessed using the “ROCD Inventory” and the “Partner-Focused Obsessive-Compulsive Inventory”. Study results suggest that obsessive symptoms linked to romantic relationships negatively affect the functioning of patients. Several cognitive distortions have been identified such as perfectionism and intolerance of uncertainty. Cognitive-behavioral therapy was the most used therapy in ROCD with a better understanding of one’s feelings and an improved decision-making ability.

ROCD is a particular form of OCD that impacts on interpersonal relationships, particularly romantic or marital ones. A better understanding of this pathology by therapists would enable partners to overcome challenges and maintain healthy and fulfilling relationships.

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