Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

The authors have not supplied their declaration of competing interest.

The prevalence of depression based on the Patient Health Questionnaire-8 (PHQ-8) may vary depending on the scoring method.

1) To describe the prevalence of depression in Europe using two PHQ-8 scoring methods. 2) To identify the countries with the highest prevalence according to each method.

Data from 27 countries included in the European Health Survey (EHIS-2) for the year 2014/2015 were used (n=258,888). All participants who completed the PHQ-8 were included. The prevalence of depression and its 95% Confidence Interval (95%CI) were calculated overall for the whole of Europe and for each country using a PHQ-8≥10 cut-off point and the PHQ-8 algorithm scoring method. Weights derived from the complex sample design were considered for their calculation.

The overall prevalence of depression for all Europe was lower using the PHQ-8>=10 cut-off point (6.38%, 95%CI 6.24-6.52) than the PHQ-8 algorithm (7.01%, 95%CI, 6.86-7.16). Using the PHQ-8≥10 cut-off point, the highest prevalence was observed in Iceland (10.33%, 95%CI, 9.33-11.32), Luxembourg (9.74%, 95%CI, 8.76-10.72) and Germany (9.24%, 95%CI, 8.82-9.66). Using the PHQ-8 algorithm the highest rates were observed in Hungary (10.99%, 95%CI,10.14-11.84), Portugal (10.63%, 95%CI, 9.96-11.29) and Iceland (9.80%, 95%CI, 8.77-10.83).

There is variability in the prevalence of depression rates in Europe according to the PHQ-8 scoring method. These findings suggest the necessity of identify the method of choice for each country comparing with a gold standard measure (clinical diagnosis). Countries with consistent higher prevalence of depression based on PHQ-8 regardless of scoring method deserve further study.

This work has been funded by CIBERESP (ESP21PI05)

Lurasidone is an atypical antipsychotic agent with potential antidepressant effects through its antagonist activity at the 5-HT7 receptor. Although treatment-emergent affective switch (TEAS) induced by second-generation antipsychotics are not frequent, several cases have been reported. To our knowledge, there is no evidence of lurasidone-induced TEAS.

To describe a case of lurasidone-induced mania.

We describe a clinical case of a patient admitted to our psychiatric outpatient unit who developed a manic episode, presumably induced by the introduction of lurasidone. We also conduct a review of the literature on this subject.

A 37-year-old man diagnosed with obsessive-compulsive disorder (OCD) and an alcohol use disorder was hospitalized due to OCD decompensation with depressive symptomatology and suicidal thoughts, and for alcohol detoxification process. Since he had a previous history of clomipramine-induced TEAS, he was started on lurasidone up to 111mg to avoid the use of antidepressants, showing a progressive improvement of depressive symptoms. Thus, the patient was discharged when alcohol detoxification process was completed. Eight days after discharge, the patient began to show manic symptoms, so he had to be readmitted. Lurasidone was discontinued and valproic acid up to 1000mg/day as mood stabilizer was added, presenting a positive remission of manic symptoms.

According to our experience, lurasidone may have induced an affective switch in this patient. Based on our findings, patients and psychiatrists should monitor possible lurasidone-induced mood switching. However, further research is needed in order to back-up this one case report findings.

No significant relationships.

Neuropsychological methods for diagnosing neglect syndrome (NS) are focused on identifying the inability of patients to respond to stimuli localized in contralesional space. There are a large number of methods capable of diagnosing spatial neglect, but at the same time having various limitations and restrictions in their use.

To devise and to test universal diagnostic techniques for visuospatial neglect detection.

1) A.R. Luria test battery; Trail Making Test (Part A); the Bells Test; 2) Authors’ methods: the Puzzles Test, the Red Shapes Test. A total of 47 patients after stroke with right hemisphere damage participated in the study and were divided into a target (18 patients with NS) and a control (29 patients without NS) groups. The Puzzles Test consists of three tasks: turning over cards, completing a sentence using cards with letters, completing a picture. The Red Shapes Test consisted in the search for a variable number of geometric shapes. Objective indicators of the study: total task completion time, the number of left omissions.

The sensitivity of the tests to NS was examined using the Mann-Whitney U-test. Differences in the number of omissions and task completion time between patients with and without spatial neglect were statistically significant regarding all tasks: turning over cards (p=0.01), completing a sentence (p<0.001), completing a picture (p<0.001), finding geometric shapes (p<0.01).

The Puzzles Test and Red Shapes Test along with the foreign tests (the Bells Test, Trail Making Test) are sufficiently effective methods for spatial neglect detection.

No significant relationships.

Support from a different sources can have a critical impact on a person’s mental health in a stressful situation. In situations of prolonged stress, it is necessary to identify the links between specific sources of support and mental health.

To identify the connections between different sources of social support and mental health indicators in different periods during the COVID-19 pandemic.

DASS (Lovibond, Lovibond, 1995) and MSPSS (Zimet et al., 1988) were applied. The study involved 855 people aged from 18 to 60 years (M=32.9; SD=13.88). The study was conducted online in the spring of 2020 (N=426) and in the winter of 2021 (N=429).

Post Hoc Scheffe revealed that perceived peer support in spring 2020 was significantly lower than in winter 2021 (p<0.05). With Pearson correlation coefficient, we tested the connections between perceived social support from family, friends, and significant others and the level of depression, anxiety, and stress. In spring 2020, all mental health indicators were associated with the perceived social support from all three sources (friends, family, and significant others). In the winter of 2021, depression levels were still associated with the perceived social support from all three sources, while the levels of anxiety and stress were associated only with perceived family support.

Thus, the study has revealed the dynamics in dependence of mental health indicators on the perceived social support from various sources at different stages of the COVID-19 pandemic. The reported study was funded by RFBR, project number 20-04-60174.

No significant relationships.

Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later-life emergent neuropsychiatric symptoms, which represent an at-risk state for incident cognitive decline and dementia.

Our obective was to prospectively evaluate the impact of MBI on global functioning in patients ≥ 50 years with a major depressive episode (MDE) at baseline.

We recruited 51 patients ≥ 50 years presenting with a MDE at the outpatient clinic of the 2nd Psychiatric Unit of the University of Pisa. Then we selected those patients who had a follow-up of at least two months and excluded subjects with a neurodegenerative disease. The included patients (N = 25) were subdivided in a subgroup with MBI and a subgroup without MBI. The subgroups have been compared for the difference between baseline and follow-up score in global functioning according Global Assessment of Functioning (GAF) scale. Comparative analyses were conducted by means of mixed anova.

There was a significant interaction effect between time and the MBI condition (F[1, 23] = 4.12, p = 0.05 η p 2 = 0.15). Descriptive statistics showed that while patients without MBI showed higher GAF score at follow-up (mean = 65.12) compared to GAF score at baseline (mean = 54.37), patients with MBI showed, on average, the same GAF score at follow-up (mean = 54.44) and at baseline (mean = 54.44).

In patients with MDE, the presence of MBI is related to a lack of improvement in psychological, social, and occupational functioning in the short-term

No significant relationships.

Hwa-Byung is a mental syndrome classified as a “cultural-related syndrome” which reflects the cultural characteristics of Korea in DSM-IV. Hwa-Byung is caused by anger, which is characterized by feelings of anger or resent about unreasonable social violence and trauma. Kwon et al (2008) had developed self-report measure to assess severity of Hwa-Byung but it has several limitations to use in current clinical settings. Therefore, we investigated opinions of experts who have professionality in giving treatment of Hwa-Byung patients in the clinical settings.

The present study aimed to reach consent of oriental neuropsychiatrists’ opinions about the direction of revision of the Hwa-Byung scale.

The Delphi method is a survey method that induces people to freely present their opinions without face-to-face processes and reaches consent through continuous feedback of survey results while ensuring anonymity. The Consensus Panel consists of 16 experts who are Oriental neuropsychiatrists and have experience in diagnosing patients with Hwa-Byung. A total of four surveys were conducted as consensus was reached on the fourth round. Each questionnaire was distributed by mail to a panel of experts and was asked to submit a response after receiving the questionnaire.

The results of the study are as follows. First, common factors for Hwa-Byung include anger, resent/blame, modify memory bias and attention bias for anger events. Second, characteristics of young Hwa-Byung patients include stress caused by social factors and excessive immersion in certain things such as drinking or smoking.

Therefore, when revising the Hwa-Byung scale, it would be necessary to include these factors.

No significant relationships.

The evolution of various pharmacological therapies for schizophrenia has given rise to several pharmacological models for the neuroreceptor targets of antipsychotics and the influence of various neuroreceptors on specific symptoms and side effects.

Experience in clinical practice affirms clozapine's position as the treatment of choice for patients with treatment-refractory schizophrenia. Unlike clozapine, risperidone has a more targeted profile of neurotransmitter binding, with particular predilection for dopamine and serotonin receptors. Risperidone is, to date, the most extensively documented clozapine augmentation agent.

The aim was to evaluate clinical efficacy, safety and tolerability of augmenting clozapine with risperidone in patients with treatment-resistant schizophrenia.

In a randomized, double-blind, placebo-controlled 8-week trial, 10 patients unresponsive or partially responsive to 300 mg/day of clozapine monotherapy (n = 5) received a steady dose of 450 mg/day clozapine combined with or up to 4 mg/day of risperidone (n = 5). Patient psychopathology was assessed at 2-week intervals with the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS) and Clinical Global Impression (CGI) improvement scale.

From baseline to week 4 and week 8, mean BPRS total and positive symptom subscale scores were reduced significantly in both groups, but the reductions were significantly greater with clozapine/risperidone treatment. Reductions in SANS scores were also significantly greater with clozapine/risperidone treatment than with clozapine monotherapy group. Clozapine/risperidone treatment did not induce additional weight gain or agranulocytosis compared with clozapine monotherapy treatment.

Clozapine augmentation with risperidone appears to be well tolerated, safe and may provide additional clinical benefit for patients who are nonresponsive or only partially responsive to clozapine alone.

The authors have not supplied their declaration of competing interest.

Previous studies in other countries have reported that cyberbullying was related to Information and Communication Technology (ICT) use. Helweg-Larsen, (2011) reported that knowledge about safe internet use did not decrease the prevalence of cyberbullying. Less is known about this relationship with family functioning.

To examine the rates of cyberbullying and their relationships with ICT use and family functioning in a sample of secondary students in the UK

To study 1) associations between cyberbullying and ICT use 2) associations between family functioning and parental controls with ICT-use and cyberbullying.

A cross-sectional questionnaire of 2218 secondary students was completed

included demographic data, ICT use (levels and nature), Olweus bullying questionnaire adapted for cyberbullying, General Functioning subscale of the Family Assessment Device and parental controls (type and levels).

Response rate 80%, 45% males, mean (SD) age 14.97 (1.9) years. Cyberbullying seems to be related to the time spent online and to the general family functioning. Bullies or bully-victims spend significantly more time online than those who are not involved. The majority of students have been told how to be safe online; however only a few have parental controls on their computers. There is a significant positive correlation between worse family functioning and time spent online and with being involved in cyberbullying, even after controlling for the time spent online.

Our results suggest that increasing family communication may contribute to reduce children involvement in cyberbullying

The authors have not supplied their declaration of competing interest.

To explore the feature of functional connectivity of default mode network (DMN), central-executive network(CEN), and salience network (SN) in patients with schizophrenia during a resting state by functional magnetic resonance imaging (fMRI).

The SPM8, DPARSFA, conn, REST softwares combined with data-driven region of interest analysis were used to compare the functional connectivity (FC) of the DMN, CEN, and SN in 74 patients with schizophrenia(SZ) and 79 age- and gender-matched normal controls(NC). Medial prefrontal cortex(MPFC)was selected as seed region for identifying DMN and CEN; right anterior insula(rAI) for SN.

Compared with NC, SZ showed increased FC with bilateral dorsolateral prefrontal cortex(DLPFC) and bilateral putamen of the MPFC, and increased FC with left middle frontal cortex and precuneus/ posterior cingulate cortex(Pcu/PCC) of the rAI. SZ also showed enhanced interconnectivity strengths of CEN-DMN, CEN-SN, and DMN-SN(p>0.05). Correlation analyses showed that the increased FC between MPFC and left DLPFC significantly negatively correlated with PANSS-negative symptoms(r=-0.224,p=0.030) and increased FC between rAI and Pcu/PCC significantly correlated with PANSS-positve symptoms (r=0.243,p=0.020).

This study provides evidence for resting state functional abnormalities of DMN, CEN, and SN in schizophrenia patients. These aberrant functional connectivities in some key brain regions of the three network could be responsible for the schizophrenic symptoms.

It has been estimated that around 10-20% of all pregnant women suffer from antenatal depressive or anxiety symptoms. These symptoms have been associated with multiple adverse child outcomes including obstetric problems, e.g. preterm delivery, Apgar score and low birth weight. Therefore, considerable health gains may be achieved if depression and anxiety during the perinatal period are adequately treated. Nevertheless, to date, no previous trials have published on the effects of Cognitive Behavioral Therapy (CBT) during pregnancy on child outcomes.

The ´Pregnancy Outcomes After a Maternity Intervention for Stressful Emotions´ (PROMISES) trial is a randomized controlled trial, which compares the effects of CBT vs. care as usual (CAU) during pregnancy among a group of women with (sub)clinically depressive and/or anxiety symptoms (n=226) on both maternal and child outcomes. Child outcomes comprise a range of obstetric outcomes including birth weight, Apgar score, and gestational age. Independent samples t-tests were performed to investigate differences in mean values.

No significant differences were found between the CBT- and the CAU-groups, in gestational age (39+0 vs 39+2 weeks+days, p=.99), birth weight (3447 vs 3509 grams, p=.24), or Apgar score at 1 (8.6 vs 8.6, p=.99), 5 (9.5 vs 9.6, p=.31), and 10 minutes (9.7 vs 9.8, p=.26).

Although CBT as early treatment of antenatal depression and anxiety is most likely to be effective for prevention of postpartum depression, CBT seems to have no effect on major obstetric outcomes.

Homelessness is a problem which affects all the areas of those who suffer it, affecting their health seriously. These risks increase when the affected person has carried out a migratory process. Another risk factor, apart from immigration, is to be woman.

To analyse the gender demographic differences in a total cohort of homeless people in the city of Girona in 2006 and continued until the present day.

Prospective longitudinal study of the total population of homeless people in Girona. In 2006, a list was made of all the homeless people detected by both specialized and non-specialized teams which have been followed until the present day.

The total number of women in the sample is lower (n = 106, 11.2%). There are fewer immigrant than autochthonous women (Chi2 = 23,1, df = 1, P < 0.001).

After following the total homeless population in 2006, we can confirm that currently we can still identify 62 people in the territory (6.7%). In this subsample there are no differences between genders (man: n = 54, 6.5% vs. woman: n = 8, 7.5%; Chi2 = 0.21, df = 2, P = 0.89). That is, men and women remain in their homeless condition in a proportional way. This fact presents great limitations, since we do not know what happened with the other 93% of the initial sample.

The masculinisation of the homeless people from Maghreb has tended to increase the gender differences in the homeless population, in itself more masculine. This presents a risk of increasing the invisibility of homeless women.

The authors have not supplied their declaration of competing interest.

Frontal lobe dysfunction has been considered as a core feature in schizophrenia. To the evaluation of this impairment, time-consuming neuropsychological batteries are needed. Recently, Dubois et al (2000) reported a short battery for assessing frontal lobe function in patients with neurological disorders. To evaluate the clinical efficacy of this frontal assessment battery (FAB) in patients with schizophrenia, we performed both FAB and Stroop Color Word Test (SCWT), which is suggested to be a representative task of executive function.

24 schizophrenic patients and 30 sex and age-matched controls were included. FAB, SCWT and Mini Mental State Examination (MMSE) were performed in both groups. The FAB scores were compared with the performance in SCWT and correlated with education level, age and duration of disease. No difference in the MMSE scores between two groups was found.

The FAB global score was significantly lower in the schizophrenia group compared to controls. In the patients group, the conceptualization and the inhibitory control subscores were negatively correlated with mistakes in color-naming task. The FAB total score, the mental flexibility and the programming subscores were negatively correlated with latencies in color-naming, color-reading and in color-word interference task of SCWT. Negative correlation between the FAB scores and the age and duration of disease was also evident.

The FAB is likely to be a useful and brief battery for assessing frontal lobe function in schizophrenia, as it results from the comparison with SCWT.

Suicide is one of leading cause of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in World. In 2012, 1,35,445 people committed suicide in India according to the statistics released by the National Crime Records Bureau

Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of world are sparse

The aim was to study the themes in suicide notes that might be useful in prevention strategies

A descriptive study of all Suicide notes of those individuals who committed suicide between 2010 – 2013 available with Police Department,Mysore District was obtained and analysed.

A total of 22 suicide note were available. A majority of suicide note were in age group of 16-40 years (86%) and most were males (59%). All suicide notes were handwritten, majority (16) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology, shame, guilt in 80%, love for those left behind (55%),instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% committed suicide to prove their innocence. 32% mentioned a last wish.

Majority of suicidal note contained ‘guilt’ which is strong indicator of possible depression in deceased. Creating awareness about suicide among public ensuring access to professionals trained in suicide prevention is need of the hour in this part of world.

The purpose of this study was to demonstrate the usefulness of multi-group piece-wise latent growth curve models (LGCM) in clinical research, particularly for assessing and comparing treatment effects. As an empirical example, this analytic technique was used to compare the effectiveness of Guided Self-Change (GSC) and Cognitive Behavioral Therapy (CBT) treatments for bulimia nervosa.

Sixty-two female patients (M age = 28.1, SD = 8.00) with bulimia nervosa were randomly assigned to a) a GSC treatment involving a self-care manual plus 8 bi-weekly sessions of CBT or b) 16 weekly sessions of CBT.

Both groups showed significant improvements in treatment outcomes across the treatment period, although the CBT group showed greater improvements. However, the GSC group evidenced more continued improvement post-treatment. CBT showed greater variability in effectiveness during the treatment period, while GSC showed greater variability during follow-up. For GSC patients, baseline levels on some treatment outcomes were related to follow-up improvement levels.

LGCM provided a rich analysis of these data, and addressed important questions regarding differences in the effectiveness of the two treatment programs. For example, CBT tended to show greater improvements during treatment, while GSC evidenced more continued improvements during follow-up.