Alendronate is a nitrogen-containing biphosphonate that inhibits osteoclastic bone resorption. Lethal dose (LD50) was aproximately 626mg/kg in male rats, and 552mg/kg in female. Signs and Symptoms of overdose clammy skin, CNS depression, dysphagia, hiccups, miosis, respiratory depression, seizures and wheezing. Supportive therapy and monitor of urine flow, calcium and phsophorous level is essential for the management of voluntary overdose.

To present the case of a 76-year-old woman who made a suicide attempt by ingestion of 8 tablets of 70 mg of alendronate.To describe the treatment of alendronate poisoning and the follow-up parameters for the control of complications.

Clinical case presentation through retrospective review of clinical notes and non-systematic literature review.

A 76-year-old woman was taken to the emergency department after voluntarily ingesting 8 alendronate tablets (70 mg per tablet) 1 hour ago reporting “suicidal thoughts”. After clinical evaluation, gastric lavage, administration of activated charcoal, and IV ranitidine were used. After 24-hour observation and after psychiatric evaluation, the patient was discharged.

Hypocalcaemia, hypophosphataemia and upper gastrointestinal adverse reactions, such as upset stomach, heartburn, oesophagitis, gastritis, or ulcer, may result from oral overdose. In case of overdose with alendronate, milk or antacids should be given to bind alendronate. Giving milk or antacids, to bind the bisphosphonate and minimize absorption, has been suggested for oral overdose. Due to the risk of esophageal irritation, vomiting should not be induced and the patient should remain fully upright. For decontamination is recomended activated charcoal and gastric lavage.

No significant relationships.

The authors have not supplied their declaration of competing interest.

Most experienced psychotherapists use an eclectic approach in their practice, combining techniques of different schools of psychotherapy to treat their patients. However, there are no good teaching models to train the new generation of psychotherapists in the technique of psychotherapy integration. FEP is a form of psychotherapy that combines techniques from four different psychotherapies: psychodynamics, CBT, IPT and supportive therapy. It also incorporates mindfulness, motivational interviewing, exercise and nutrition. A strong therapeutic alliance is crucial to the success of FEP. Techniques are tailored to the patient's current clinical state. Several techniques from different psychotherapies may be used in the same session. The therapist is empathic, flexible adaptive to the patient's needs and assumes an active role in the therapeutic process.

To present a model of psychotherapy integration that can be used by psychotherapists in their clinical practice.

We aim to present a model of psychotherapy integration that can be taught and implemented by psychotherapists in their clinical practice.

We present ten case examples were FEP was effective clinically and we compare it to the standard of care received by these patients and show the savings to the healthcare system.

The results of our study suggest that FEP could be a cost effective treatment that could be added to the psychotherapists toolbox. Teaching and training methods, like manuals and workshops can be developed to train the new generation of psychotherapists.

The authors have not supplied their declaration of competing interest.

Longer duration of untreated illness, longer duration of current episode, and severity of medication side effects may negatively influence the psychosocial functioning in major affective and anxiety disorders. Studies also suggested the involvement of sensory perception in emotional and psychopathological processes.

The objective of this study is to investigate the nature of the association between duration of untreated illness, duration of current episode, and severity of medication side effects.

The study is aimed to examine the relationship between sensory processing disorders (SPD), duration of untreated illness, duration of current illness episode, and the severity of side effects related to psychoactive medications.

The sample included 178 participants with an age ranging from 17 to 85 years (mean = 53.84 ± 15.55); psychiatric diagnoses were as follow: unipolar major depressive disorder (MDD) (50%), bipolar disorder (BD) (33.7%), and anxiety disorders (16.3%). subjects completed a socio-demographic questionnaire, the Udvalg for Kliniske Undersøgelser (UKU), and Adolescent/Adult Sensory Profile (AASP) questionnaire.

Longer duration of current episode correlated with greater registration of sensory input and lower avoidance from sensory input among unipolar patients, lower registration of sensory input, and higher tendency for sensory sensitivity/sensation avoidance among bipolar participants. In addition? longer duration of current episode correlated with lower sensory sensitivity/avoidance among anxiety participants, respectively. Mean UKU total scores were associated with lower sensory sensitivity among bipolar individuals as well.

SPD expressed in either hypo-/hypersensitivity may be used to clinically characterize subjects with major affective and anxiety disorders.

The authors have not supplied their declaration of competing interest.

To analyze the qualitative answers profile of an anonymous standardized survey, with qualitative and quantitative questions, about the Brazilian psychiatrists' perceptions on their use of the multiaxial diagnostic systems ICD 10 and DSM-IV and on their expectations about future revisions of these classifications (ICD-11 and DSM-V).

the questionnaire, elaborated by Graham Mellsop (New Zealand), was translated into Portuguese and sent through mail to 1050 psychiatrists affiliated to the Brazilian Psychiatry Association. The quantitative analysis is presented elsewhere.

One hundred and sixty questionaries returned (15,2%). From these, 71,1% of the open questions where answered. The most needed and/or desirable qualities in a psychiatric classification were found to be: simplicity, criteria clarity, objectivity, comprehensibility, reliability and ease to use. The axis I of the ICD-10 was reported to be the most used due to its instrumental character in addition to being the official classification, including for legal and bureaucratic purposes. The DSM-IV was also used in the everyday practice, mostly for education and research purposes, by psychiatrists with academic affiliations. The less frequent use of the multiaxial systems was justified by the lack of training and familiarity, the overload of information and by the fact they are not mandatory. It was evaluated that some diagnostic categories must be reviewed, like: mental retardation, eating disorders, personality disorders, sleeping disorders, child and adolescence disorders, affective and schizoaffective disorders.

This material offers a systematic panorama about the psychiatrists' opinions and expectations concerning the diagnostic instruments used in the daily practice.

Ketamine is an anesthetic agent, also used for other medical purposes (pain, depression). Due to its pharmacological properties, ketamine is diverted and abused. This recreational use has become widespread in France.

we explore different kinds of ketamine diversion in order to analyze its abuse liability.

based on data collected from addictovigilance tools and from different surveys, we present the characteristics of patients and their various ketamine misuses.

We have studied notifications received between 2000-2014 and 4 recent surveys. Results are reflected in the below table:

Notifications reported 6 cases DSM-IV of dependence. In 2 cases, ketamine was used to manage withdrawal of medically prescribed opioids for pain. In 2 cases, ketamine was identified as an adulterant in ecstasy. We report also 5 victims of criminal use of ketamine for sexual assault.

Results provides insight into the myriad uses of ketamine. Abuse increase and avaibility of ketamine extends in general population.

Health professional must be informed about the widespread use of ketamine and its consequences. Our results point out the necessity to reinforce its monitoring in France.

Although numerous studies agree that bipolar patients demonstrate extensive cognitive deficits, it is still unclear to which extent these impairments persist across different mood states, including euthymia. Given that the emotional and cognitive processes are closely intertwined, we aimed to examine selective attention, cognitive inhibition, and social cognition within different emotional context in the group of remitted bipolar outpatients.

80 euthymic bipolar outpatients and 66 healthy volunteers matched for sex, age and education participated in the study. Internal State Scale and Barratt Impulsiveness Scale were used to assess self-reported affective states and trait impulsivity. Computerised versions of Colour-Word Stroop, Emotional Stroop, Affective Go/NoGo and Ekman Recognition of Facial Expression task were administered to assess selective attention, inhibition of cognitive control and social cognition.

Several cognitive deficits in selective attention, inhibition of cognitive control and social cognition tasks have been identified in the group of euthymic bipolar outpatients. They revealed worse recognition of negative, positive and neutral affect than controls. Besides cognitive disruptions which were reflected in longer reaction times and more erroneous performance to different emotional stimuli and in different emotional contexts, also trait impulsivity was considerably elevated in the group of bipolar euthymic outpatients.

Bipolar outpatients in our study demonstrated relatively marked impairments in cognitive functioning within different emotional contexts also during the euthymia. Applied neuropsychological inventory proved as useful tool for assessing specific cognitive impairments in bipolar mood disorder, and could contribute to more effective diagnosing and treatment of patients.

Vitamin B12 deficiency may cause neurological and psychiatric symptoms, especially among elderly patients. Two clinical cases are presented of patients admitted to an Acute Inpatient Psychiatry Unit due to psychotic symptoms, being reported a B12 deficiency.

Review clinical information about vitamin B12 deficiency as a factor involved in the development of psychiatric disorders, specifically psychotic symptoms, pointing out the peculiarities regarding clinical presentation, diagnosis, prognosis, and treatment management.

Search in the medical database PUBMED, MEDSCAPE and UPTODATE.

Vitamin B12 deficiency is associated with hematological, neuropsychiatric, and digestive disorders, is estimated that around 5-40% of the elderly population may present it. Neuropsychiatric syndromes may be the first, and sometimes sole, manifestation, related to a different etiological mechanism. Vitamine B12 deficiency implies enzymatic defects that cause an accumulation of methylmalonic acid and homocysteine, which is proportionally related to the severity of the neuropsychiatric symptoms. The range of clinical features includes psychotic and affective episodes, behavioral disorders, cognitive impairment, along with other neurological manifestations such as polyneuropathy and encephalopathy. The diagnosis delay is crucially important, as early detection could lead to reverse the neuropsychiatric symptoms and some of the neuroradiological alterations. Parenteral and oral vitamin B12 supplementation should be initiated, monitoring levels in plasma, together with psychiatric drugs until the symptoms are controlled.

Vitamin B12 deficiency is a factor that may be involved in the etiopathogenesis of psychiatric disorders. Thus, screening must be considered among the vulnerable population when presenting neuropsychiatric disorders as early diagnosis and treatment are key to clinical prognosis.

Structured clinical interviews are the gold standard for assessing mental health. However limited resources may allow the use of only self-report questionnaires. In the context of emergency, such as terrorist attacks, the performance and thresholds of such tools still unclear.

We investigated the performance of the Posttraumatic stress disorder CheckList Scale (PCL-S) and of the Hospital Anxiety and Depression scale (HADS), both compared to the MINI Interview, among civilians and first responders involved in terrorist attacks.

The data came from the IMPACTS survey which was conducted from 6-10 months among civilians (N=190) and first responders (N=232) after the January 2015 terrorist attacks in the Paris Region, France. Sensitivity and specificity of the PCL-S and HADS were estimated by the ROC curve, and the optimal threshold was defined using the Youden index.

Regarding the PCL-S: for civilians and first responders respectively, the overall AUC was 0.947 and 0.899, and the optimal threshold were 38.5 and 39.5. Regarding the HADS-D: for civilians and first responders respectively, the overall AUC was 0.908 and 0.617 and the optimal thresholds were 7.5 and 1.5. For the HADS-A for civilians and first responders respectively, the overall AUC was 0.823 and 0.717, the optimal threshold were 9.5 and 6.5.

In the context of a terrorist attack, compared to the MINI, our study underlined satisfactory performance of the PCL-S and the HADS-D in screening for PTSD and depression respectively, while the screening of anxiety using the HADS-A was unsatisfactory.

No significant relationships.

Haloperidol is one of the first-generation antipsychotics which is used widely around the world and still has its place in psychotic disorders along with his documented antimanic properties.

It acts by blocking essentially dopaminergic receptors but also serotonergic and alpha-adrenergic receptors.

Haloperidol has many side effects, especially extrapyramidal symptoms. Oedema associated with haloperidol is a rare side effect.

The aim of this presentation is to describe the case of a young female who developed a rare side effect of haloperidol.

we conducted a review of literature on different data base about this side effect in order to discuss its potential underlying mechanisms.

Here we report a case of a 24-year-old female with the history of bipolar disorder type 1, and an allergy to chlorpromazine. She was admitted to our psychiatric department for a manic episode with psychotic features and was initially treated with 50 mg of Haloperidol in addition to 30 mg of valium per day. She developed pronounced oedema of the face and upper limbs after two weeks of treatment. All of the paraclinical examinations including blood cell count, liver function tests, renal function tests, serum electrolytes, ECG, urine test didn’t show any abnormalities. We solicited the opinion of both nephrology and pharmacovigilance and concluded to an allergic oedema.

The symptoms disappeared 10 days after the discontinuation of haloperidol which suggested a potential incrimination of this drug

As far as we know, there are very few reports of allergic oedema with haloperidol in the literature. Potential underlying mechanisms will be discussed.

Through this case study, we aimed to focus attention on this very rare but still possible side effect.

None Declared

To ensure rational drug use, there is a need to continuously monitor the use of ADHD medication among children and adolescents.

To describe the use of ADHD medication among Danish children and adolescents from 2010-2020.

Using the Danish national healthcare registries, we extracted data on filled prescriptions of ADHD medication (including methylphenidate, atomoxetine, guanfacine, dexamphetamine, and lisdexamphetamine) among children (age 6-12 years) and adolescents (age 13-17 years) between 2010-2020. We examined the annual incidence rate and prevalence proportion of ADHD drug use, and the proportion of children and adolescents having an ADHD diagnosis when initiating ADHD medication.

From 2010-2020, the incidence followed a u-shaped trend with an incidence rate of 4.9/1,000 children and 4.4/1,000 adolescents in 2010, decreasing to 3.2/1,000 children and 3.0/1,000 adolescents in 2013, and rising to 4.9/1,000 children and 4.8/1,000 adolescents in 2020. The prevalence for children showed a similar trend, shifting from 17/1,000 in 2010, to 15/1,000 in 2016, and peaking at 19/1,000 children in 2020. However, among adolescents the prevalence increased steadily from 19/1,000 in 2010 to 29/1,000 in 2020. 67% of children and 53% of adolescents initiating ADHD medication had an ADHD diagnosis.

After an initial decline in incidence rates of ADHD medication use among Danish children and adolescents, there has been a rise in use the last five years. The same trend applied for the prevalence among children, whereas the prevalence among adolescents increased steadily over the entire period. More than half of children and adolescents initiating ADHD medication were diagnosed with ADHD.

No significant relationships.

INTRODUCTION TikTok is a social network (SN) that allows users to share short videos about different issues. Since the COVID-19 lockdown, there has been an increase in Pro-Ana and Pro-Mia videos in this specific SN.

OBJECTIVES To know the main characteristics about Pro-Ana and Pro-Mia contents among TikTok users.

METHODS A search was carried out using uncontrolled language with the term “TCA” (ED in English). The study included only Pro-Ana and Pro-Mia resources in Spanish. Resources under the category “recovery” were excluded. A random sample of 16 TikTok was used, since it is enough to estimate, with a confidence of 95% and an accuracy of +/- 20 percentage units, a population percentage that is expected to be around 20%. The studied variables were images, type of resources, “challenges” and misspelled words.

RESULTS In the sample, 68.75% of the profiles were created upon confinement, 56.25% had more than 500 followers and 68.75% had more than 3000 “likes”. 43.75% included more than 30% of ED advocacy content, 18.75% promoted challenges and 37.5% used misspelled words to avoid SN censorship.

CONCLUSIONS There has been a remarkable increase in ED-related content as a result of lockdown. In turn, the increasing number of users who are part of TikTok reveals that this is a SN that can be associated with ED advocacy.

No significant relationships.

European data on health-related quality of life (HRQoL) in adults with attention deficit/hyperactivity disorder (ADHD) in the general population is sparse.

To report HRQoL in UK adults with ADHD.

UK residents aged 18–55 years with a diagnosis of adult ADHD completed an online, cross-sectional survey including questions on disease history, the EuroQol Five Dimensions questionnaire with five-levels (EQ-5D-5L) and the Work productivity and activity impairment questionnaire: general health (WPAI:GH). ADHD symptom severity was assessed by telephone using ADHD rating scale version IV with adult prompts (ADHD-RS-IV).

The survey was completed by 233 participants (65.2% women; 77.3% white British), mean age 32.6 years (standard deviation [SD] 9.5), mean ADHD-RS-IV total score 43.46 (SD 7.88). Their mean EQ-5D-5L utility score of 0.74 (SD 0.21) was lower than the UK population norm of 0.86 (SD 0.23).[1] WPAI:GH scores indicated that health problems resulted in impairments of 32.04% in work productivity and 45.79% in regular daily activities. Regression analyses adjusting for gender, age and comorbidities demonstrated associations between EQ-5D-5L utility scores and gender (men had lower scores, P < 0.001), work impairment due to health problems (increasing impairment was associated with lower scores, P = 0.005) and age (for each additional year of age, scores decreased by 0.007, P = 0.010).

These results highlight the impact on health utility, work productivity and regular daily activities, and add to the description of the disease burden of adult ADHD in the UK.

This study was funded by Shire Development LLC.

Kings College London research support account for Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech speaker at sponsored events for Shire, Lilly and Novartis.

The author has not supplied his declaration of competing interest.