Although 85% of inpatients with Borderline Personality Disorder (BPD) receive psychotropic drug treatment, no drug is approved for this indication so far. A dysregulation of the endogenous opioid system (EOS) has been posed to underly the neurobiology of BPD. Accordingly, the opioid antagonist naltrexone might be helpful to treat symptoms of BPD. Two small studies showed limited differences of naltrexone vs. placebo on dissociation, which were not significant, perhaps due to the low power of the studies:

Naltrexone was administered in treatment-refractory patients with BPD in a university department of psychiatry. This study aimed to assess the relative contribution of naltrexone and other psychopharmacological drugs to the improvement of overall symptomatology in patients with BPD.

A retrospective analysis of the charts of inpatients (n=161) with BPD was performed. Patients were classified as either treatment responders or non-responders. As all patients received multiple psychopharmacological treatments, stepwise logistic regression analysis was performed to detect, which drug contributed most to improvement of symptomatology.

None of the drugs applied contributed significantly to improvement, with the exception of naltrexone (odds ratio, p=2,9) Patients treated with naltrexone (n=55, 34,16%) recovered significantly more often and faster and, in particular, showed highly significant reduction of self-harm and suicidal thoughts. Higher doses of naltrexone treatment were more effective than low-dose treatment; however, the latter was still better than any other treatment.

Large-scale double-blind studies are warranted to examine the efficacy of opioid antagonists (naltrexone, nalmefene) in BPD.

To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.

The authors have not supplied their declaration of competing interest.

Healthcare professionals report about anxiety, depression, and fear during pandemic COVID-19 worldwide. Resilience becomes the high-powered important mechanism that reduces stress impact on the emotional state of healthcare professionals.

We suggested that effective resilience is associated with less COVID-19’s fear, as well as less anxiety, and depression; healthcare professionals’ mental health depends on age, gender, as well as involvement in the care of patients with COVID-19.

211 healthcare professionals participated in the study and were evaluated with the Connor-Davidson Resilience 10-item scale (CD-RISC-10), Fear of COVID-19 Scale, PHQ-9, GAD-7.

A negative correlation between resilience and fear of COVID-19 (p≤0,01), anxiety (p≤0,01), and depression (p≤0,001) was found. Positive correlations were found between depression, anxiety, and fear of COVID-19 (p≤0,001), between age and fear of COVID-19 (p≤0,05). No statistically significant association between age and depression, anxiety, or resilience was found. The significant difference of COVID-19 fear depending on gender – female vs male (p≤0,05) was found. No statistically significant difference in resilience and emotional state in healthcare professionals depending on the involvement in the care of patients with COVID-19 were found.

Resilience is associated with better mental health in healthcare professionals during the COVID-19 pandemic. Anxiety and depression are connected with the fear of COVID-19 and highly comorbid in healthcare professionals. The elder age and female gender are among the risk factors for a more deteriorated mental state. Fear of COVID-19, mental state, and resilience are not associated with healthcare professionals’ involvement in the care of patients with COVID-19.

For populations with intellectual disability and autism spectrum disorder, it is essential to complete cognitive assessment with an adaptive behavior scale.

To translate VABS-II from English to French and establish norms for the French population.

We used the Parent/Caregiver form in order to assess psychometric characteristics of the VABS-II and to develop norms for the French population. VABS-II comprises 4 domains, 11 subdomains, and an optional maladaptive behavior index. The French translation of the VABS-II followed standard cross-cultural translation methods. The study was performed in the Rhône-Alpes-Auvergne department comprising 12 % of France inhabitants and well representing the French general population.

From 4576 VABS-II questionnaires distributed, 1707 were returned and 1654 were analyzed. The reason for exclusion was the impossibility to score one of the subdomains. From 174 questionnaires included in the test-retest, 95 were analyzed, and 79 questionnaires were excluded because 86 under 34 days, 8 > 3 months, and one participant that changed age group between test and retest. Scores based on French norms fluctuated around values based on US norms on all subdomains.

The French Vineland questionnaire is the single test with the adequate norms to allow identifying children with adaptive behavior difficulties. It should be used as a complement of the assessment of the intellectual quotient, according to DSM V, for the diagnosis of intellectual disabilities. It must be done in reference to the developmental and cultural standards specific to the environment in which the person is evolving.

No significant relationships.

The aim of this study was to examine the the effectiveness of psycho-education delivered via a printed booklet for Schizophrenia patients and their primary caregivers’ in Jordan. It was hypothesised that treatment as usual and psycho-education delivered by a booklet would improve patients’ and primary caregivers’ knowledge of schizophrenia, improve patients’ positive and negative symptoms and reduce their relapse rates, and improve primary caregivers’ burden of care and quality of life better than treatment as usual alone.

A single blind parallel randomized controlled trial was conducted between September 2012 and September 2013 at four mental outpatient clinics in Amman, Jordan. 121 patients with their primary caregivers were allocated randomly to an experimental (Psycho-educational intervention plus TAU in outpatient clinic) group (n = 58) or control (TAU alone) group (n = 63).

Outcomes, measured prior randomization (pre-test), immediately post-intervention and at three months after intervention were patients and primary caregivers’ knowledge of schizophrenia, patients’ positive and negative symptoms and relapse rates, primary caregivers burden of care and quality of life.

Participants receiving psycho-education and treatment as usual had better knowledge of schizophrenia at both post-tests, reduced positive and negative symptoms at post-test 1 and further reduction at post-test 2 compared with participants in control group. Patients hospitalisation and caregivers outcomes had reduced burden of care and better quality of life (P<0.001, all outcomes).

Psycho-education delivered via printed booklets improves outcomes patients and their primary caregivers in Jordan better than treatment as usual. Our hypothesis is supported.

Rehabilitaton of concurrent psychiatric disorder and brain injury is a major challenge. E. underwent neurosurgery for right fronto-parietal astrocytoma. Before illness he was managing automatization of big companies, but was fired after the operation. E. felt into severe depression and anxiety with catastrofization of his illness, suicidal ideation. He resisted multiple prescriptions for SSRI, admitting a sect pretending to “treat” oncology by “psychological” methods. Half a year after operation he attended our center.

To help E. return to paid employment.

E. was evaluated by neurologists, psychiatrist, neuropsychologists. Current depressive episode appeared to be the second one with underlying schizoid and perfectionist characteristics. He had moderate text comprehension difficulties, confabulations, slight executive dysfunction. Neuropsychologist educated patient on his difficulties and developed compensatory strategies – an alternative to catastrofisation. After psychoeducational session E. agreed to receive fluvoxamine. However, he deformed the received information due to brain injury, so psychotherapy had only minor effects. Infra-low frequency neurofeedback at T4P4 and T4Fp2 sites was started to promote restoration of right brain functions. E. gradually did better, and 3 months later was able to complete CBT course along with relaxation training.

Improvements in emotional status along with ability to cope with cognitive difficulties allowed E. to return to a job similar to the previous. Six month after the start of treatment medications are tapered off, E. has no signs of depression and only slight anxiety.

Interdisciplinary holistic rehabilitation may be effective in concurrent psychiatric disorder and brain injury.

The authors have not supplied their declaration of competing interest.

Audit of ADHD caseload identified an open case prevalence of ADHD as 0.2% and 0.6% in Specialist Tier 2 and 3 CAMHS across 2 metropolitan boroughs of Greater Manchester, as opposed to national prevalence of 1–3%.

We carried out a survey of CAMHS clinicians to identify and address any internal factors that could contribute towards such an under-representation.

A Survey questionnaire was designed to look at staff perceptions, knowledge and training needs in identification and management of ADHD.

Questionnaires were distributed to 50 CAMHS professionals working across these two Specialist CAMHS, which were completed anonymously and returned yielding a response rate of 84%.

1 in 10 CAMHS clinicians did not believe in giving children and young people diagnosis of ADHD and a third believed ADHD was medicalization of behavioural problems rather than neurobiological disorder. Only half of CAMHS clinicians were aware of co-morbidities such as conduct disorder and other developmental disorders.

Although ADHD is a professionally well established condition, scepticism amongst significant number of CAMHS clinicians about the validity of diagnosis, relative risks and benefits of diagnosis continues to exist. This may result in under diagnosis of children who are referred to CAMHS with behavioural difficulties. This has an impact on quality and appropriateness of service provided.

Specific training on ADHD is especially important among CAMHS teams, with clinicians from a multidisciplinary background and differing attitudes towards ADHD.

We anticipate this will help identify missed ADHD cases and improve the quality of care.

Older adults constitute the age group in which suicide more often reaches its most categorical expression: consummation.

Identify risk factors for suicide in older people.

Systematic review of the literature on the subject. The databases consulted were Dialnet and Pubmed. The descriptors used have been: “suicide”, “risk factors” and “elderly”, accepting the works found in English and Spanish, with a total of 501 references found after the search, from which 75 have been selected.

As shown in the reviewed studies, there is a progressive increase in suicide rate with age in males. The purpose of dying in the old man is usually characterized by his firm conviction, not infrequently reflexive and premeditated. In the multifactorial etiology of suicidal behaviour in this age group, the main elements to be considered would be psychosocial factors, psychiatric diseases and chronic somatic diseases, resulting in a potentiation among them due to their frequent interaction. The feeling of abandonment, the feeling of emptiness, the despair of the organic collapse and the self-perception of being a useless person, without projects, generates deterioration in the quality of life.

In the multifactorial etiology of the suicidal behaviour of the elderly, they usually play coprotagonic roles, loneliness, isolation, somatic illness and depression. The most likely profile of the suicidal elder would be represented by a man with a history of depressive episode after age 40, who lives alone, with a family history of depression or alcoholism and a recent loss.

The authors have not supplied their declaration of competing interest.

The severe mental disorders are the subject of growing research in the area of emotional intelligence because of his relationship with psychosocial functionality loss. Despite treatment advances, patients continue to experience high levels of social, professional and personal disabilities, related to the presence of deficits in cognition. These changes are manifested in two areas: the neurocognitive and social cognition.

To better understand the relationship between neuro- and sociocognition in schizophrenia and bipolar disorder.

The aim of this research is to study the factors related to emotional intelligence, with particular interest in neurocognitive deficits.

A total of 75 adult patients with schizophrenia and bipolar disorder type I were evaluated. The assessment protocol consisted of a questionnaire on socio-demographic and clinical-care data, and a battery of clinical and cognitive scales, including MSCEIT, WAIS-IV, TMT and Rey Figure.

MSCEIT was negatively correlated with age, the severity of the clinical symptoms (BPRS, CGI-S), the TMT-A and the Test of Complex Figure, and positively with the intelligence quotient.

The deficits in emotional intelligence are part of a set of cognitive, social and non-social skills, which are altered in these severe mental disorders. Emotional intelligence worsens with the deterioration of cognitive functioning, executive dysfunction and severity of psychiatric disorder.

The authors have not supplied their declaration of competing interest.

Depression is a psychiatric disorder characterized by low mood and anhedonia. The diagnosis of depression and the initiation of treatment is important for improving quality of life and avoiding disability. Machine learning (ML), can be used for solving classification and regression problems.In this study, scores of multiple psychiatric scales were used to detect depression and different ML algorithms were used to study if they can help for diagnosing depression accurately.

The purpose of the study is to detect with high accuracy whether people are depressed or not by using widely used ML algorithms. It is also aimed to compare the algorithms used to predict depression with each other.

Data were collected from 96 university students. Beck Depression Inventory (BDI), Beck Anxiety Inventory, Neo Personality Inventory, Chronic Stress Scale (CSS), Perceived Stress Scale (PSS), Childhood Trauma Questionnaire, Post-Traumatic Stress Disorder Checklist (PTSD), SHAPS, Relationship Scales Questionnaire and Dissociative Events Scale were applied. 14 points from the BDI was accepted as the cut-off value as depressed. Total scores of each scale was used as the dependent variable in the Xgboost (XGB) to classify the depression. By XGB, the most important 4 of these surveys and scales were selected to use in the Non-Linear (NL) models such as XGB, Decision Trees (DT), Support Vector Machines (SVM), K-Nearest Neighbor (KNN). Lastly, a linear model as a Logistic Regression (LR) model was also used to compare with the NL algorithms. The success of the models was measured with the Cross Validation method, which is the gold standard in ML.

In the model in which all measurements are used as Independent Variables (IV), the XGB highlighted 4 scale scores: these are CSS, PSS, SHAPS and PTSD. All scale scores were used as IV, both XGB and DT classified depression with a success of 87.5%, while this score increased to 89.6% in both models when 4 prominent scales’ scores were used as IV. In the KNN, the classification made with prominent scales increased the success from 83% to 86%. The variance explanation rate of the LR model using 4 prominent scales remained at 58%.

With ML’s ability to solve NL relationships and dimensional reduction ability, models in which a large number of variables are input and there is no high correlation between dependent variables and IV can be classified with high success. Also, the success of the models was increased by choosing the most importants of the many IV and the variables that contributed negatively to the model could be excluded. The use of ML can yield promising results in fields such as psychiatry where linear relationships cannot be observed much.

None Declared

Depression is one of the most common mental illnesses in the elderly and its consequences are severe.

To measure the prevalence of depression in elderly cancer patients and subsequently determine the sociodemographic and clinical factors correlated with this disorder.

We conducted a descriptive and analytical cross-sectional study of patients aged over than 65 years old, suffering from cancer and who had no cognitive impairment, admitted in 2013 in the Oncology and palliative care unit of Gabes regional Hospital (Tunisia). We used a self-rating questionnaire to detect sociodemographics and clinical variables, the Geriatric depression scale (GDS) to assess depressive symptoms, and the Activity of Daily Living to determine the degree of autonomy.

At the end of our investigation, we included 60 patients. The prevalence of depression was 48%. Depression was significantly correlated with: marital status (widower subjects were more depressed (74% vs. 34%, P = 0.007)), less degree of autonomy (80% vs. 38%, P = 0.04), fatigue (62% vs. 26%, P = 0.007), pain (59% vs. 26%, P = 0.02), family psychiatric history (80% vs. 20%, P = 0.02), family history of death by cancer (72% vs. 38%, P = 0.01), WHO condition (67% vs. 34%, P = 0.04) and the presence of co morbidity in particularly diabetes (69% vs. 41%, P = 0.05).

Depression is prevalent in oncogeriatric environments. This could compromise quality of support and care of these patients. Close collaboration between oncologist and psychiatrist is needed to support and relieve these patients.

The authors have not supplied their declaration of competing interest.

Chronic tics and Tourette syndrome (TS) can be comorbid with several neuropsychiatric conditions and may add to the complexity of children's clinical presentation and need for inpatient input.

To review the clinical notes of all children admitted to a National Children's Inpatient Unit (aged up to 12 years) over a 5-year period and analyse their demographic and clinical characteristics including the presence of chronic tics/TS.

To assess the clinical correlates of comorbid chronic tics/TS in an inpatient preadolescent population.

A retrospective naturalistic study of all patients admitted to our unit from 2009 to 2014 was conducted. Children with and without chronic tics/TS were compared in terms of age, gender, family history of mental illness, history of neurodevelopmental problems in siblings, medication on admission and at discharge, length of admission and functional outcomes using Chi2 and t-tests for categorical and continuous data respectively.

A total of 133 children (mean age = 11.2 years) were included. Twenty-five (18.8%) were diagnosed with chronic tics/TS. Autism spectrum disorder was the most commonly comorbid diagnosis (84%), with the second most common being an anxiety disorder/OCD (52%). Statistically significant higher percentages of learning disability, neurodevelopmental problems in siblings, medication at discharge and longer inpatient admissions were identified in children with tics compared with the rest of the sample. No other differences were found.

The prevalence of chronic tics/TS in children needing inpatient treatment is significant. In our sample, chronic tics/TS seem to represent a marker of increased neurodevelopmental deviance and overall symptom severity.

The authors have not supplied their declaration of competing interest.

Self-Concealment Scale (SCS) is composed of ten items to measure self-concealment, defined as a tendency to conceal from others personal information that one perceives as distressing or negative (Larson and Chastain, 1990).

To investigate the psychometric properties of the SCS-10 Portuguese version and of an adapted version containing two additional items specifically focused on self-concealment related do health problems (physical and psychological)–SCS-12.

The Portuguese version of the SCS-12 and other validated questionnaires designed to evaluate self-reported health, perfectionism and optimism-pessimism were administered to a convenience sample of 555 adults from the community (60.5% females; mean age = 43.49 ± 10.565).

The SCS-10 and SCS-12 Cronbach's alphas were α < 0.80. In both versions, all the items contribute to the internal consistency. The factor analysis, following the Kaiser and the Cattel's Scree Plot criteria, revealed that SCS-10 is unidimensional and that SCS-12 reliably and validly evaluates two dimensions: F1 Keeping secrets (Explained variance = 48.60%; α = 0.816), F2 Personal concealment including health problems (9.65%; α = 0.797). The pattern of correlations of the SCS dimensional and total scores was as follow: negative low correlations with physical health (@−0.20), negative moderate correlations with psychological health (@–.30), moderate correlations with self-oriented perfectionism, social-prescribed perfectionism, pessimism (@0.25) and optimism (@−0.20).

The Portuguese versions of SCS have good reliability and validity (construct and convergent-divergent). The factorial structure partially overlaps with the original. SCS could be useful for research proposes, namely in an ongoing project on the role of the mentioned personality traits on illness and health behavior.

The authors have not supplied their declaration of competing interest.

Minor but positive changes occurred in the dyadic mother-baby relationship. This was more patent concerning breastfeeding, relationships with their couple and extended family and pediatricians, and attitudes toward job seeking. In addition, the frequent contact with these mothers elicited markedly positive reactions in the 8-9 children/adolescents currently residing in our community.

The authors have not supplied their declaration of competing interest.

Borderline Personality Disorder (BPD) describes pervasive and stable impairments in personal identity and interpersonal functioning with pathological personality traits. Most patients are prescribed multiple psychoactive medications despite none being indicated for BPD. Current evidence proposes long-term, BPD-appropriate psychotherapy as the most efficacious treatment

A residential BPD patient cohort was evaluated to determine whether BPD-focused psychotherapy reduced prescribing and BPD and co-morbid symptom severity

The pattern of psychotropic drug utilization at admission, discharge and one year follow-up was measured. Changes in the utilisation of pharmacotherapy were examined in the context of improvements in BPD and/or co-morbid disorder symptom severity

There were 74 female participants, most with more than one Personality Disorder diagnosis and co-morbid mood disorders. Residential treatment included individual and group psychotherapy for BPD. Self-reported use of psychotropic medications was ascertained at admission (T1); discharge from the program (3 to 6 months; T2), and one year post discharge (T3). The SCID (Structured Clinical Interview for DSM-IV) was used to confirm the BPD diagnosis and associated co-morbid conditions. The Beck Depression Inventory was completed at each time point

A significant reduction in the prescription of psychoactive medications was accompanied by significant decreases in the incidence and severity of self-rated depression as well as clinician assessed personality disorder, including BPD. These were most pronounced 12 months after discharge

Three to six months of BPD-specific psychotherapy provided lasting benefit for a range of mental health problems and reduced prescription medication use