Prenatal maternal stress is an important phenomenon. Evidence on this topic suggests that women who experience high stress during pregnancy are more likely to deliver preterm infants.

The goal of this study was to evaluate the influence of Yoga exercises training on stress reduction during pregnancy.

In the current study we included 20 women who participated in the Yoga exercises training during pregnancy. The control group included 20 women who were in the reading control condition during pregnancy. Women were eligible to participate if they were experiencing elevated levels of perceived stress or pregnancy-specific anxiety (PSA), as indicated by responses to the Perceived Stress Scale and the PSA scale on a screening questionnaire. Women enrolled between 12 and 26 weeks gestation were randomly assigned to either the Yoga exercises training or to the reading control condition. Effects of training were analyzed by means of an ANOVA with repeated measurements.

ANOVA has revealed (p<.05) that women in the Yoga exercises training experienced larger decreases from pre- to postintervention in pregnancy-specific anxiety and pregnancy-related anxiety than participants in the reading control condition.

This pilot study suggests that Yoga exercises training during pregnancy can effectively reduce pregnancy-related anxiety. However, it is necessary to do further research on the impact of Yoga exercises on stress reduction during pregnancy.

Over the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%).

To review the effects of monoclonal antibodies on psychosis.

Review of literature using PubMed database. A total of 16 studies were included.

The targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy.

The available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.

Major Depressive Disorder is a frequent and disabling condition. More than 20% of patients do not respond to pharmacotherapy alone, so there is the need to find alternative strategies in order to potentiate the drugs. Therapeutic alternatives include repetitive Transcranial Magnetic Stimulation (rTMS), which has shown an antidepressant effect in the last decades.

Comparison of the efficacy of accelerated repetitive Transcranial Magnetic Stimulation (aTMS) treatment (4 sessions/day for 5 days) with the standard rTMS protocol treatment (1 session/day for 4 weeks), using the FDA-approved parameters.

33 patients affected by Major Depressive Episodes treated with either Fluvoxamine or Venlafaxine were enrolled. Patients were randomly assigned to the two protocol groups: standard rTMS protocol (15 patients) and aTMS protocol (18 patients). In the standard protocol, patients received 1 rTMS session/day for 4 weeks, while in the aTMS protocol they received 4 rTMS sessions/day for 5 days. Symptomatological improvement was evaluated through MADRS, BDI-II and SSI rating scales administered on day: 0, 1, 2, 3, 4, 5, 14, 21, 28, 56. The study is single-blind, since the clinical rater was unaware of the treatment protocol group. Response and remission rates were calculated, defined respectively as a reduction ≥50% in the MADRS score and a MADRS score <10.

The analysis was carried out on 32 patients (18 in the aTMS group and 14 in the rTMS group). ANOVA for repeated measures shows a statistically significant difference in the MADRS scores on day 5 (p=0.001) and on day 56 (p=0.037). Regarding the BDI-II evaluation, the differences were not fully statistically significant on day 5 and not significant on day 56. No statistically significant differences between the two protocols were observed in the SSI assessment. The aTMS and rTMS response rates were respectively 84.6% vs 45.5% on day 28 (p=0.043) and 92.3% vs 45.5% on day 56 (p=0.012). The aTMS and rTMS group remission rates were respectively 76.9% vs 18.2% on day 28 (p=0.004) and 69.2% vs 36.4% on day 56 (p=0.107). Concerning side effects, no statistically significant differences were observed between the two groups.

Treatment with aTMS seems faster and more effective than treatment with standard rTMS in improving the clinical condition in patients with Major Depressive Episodes, allowing to treat patients in just 5 days instead of 4-6 weeks, without impacting on side effects and tolerability.

None Declared

Phenibut is a synthetic γ-aminobutyric acid (GABA) agonist used to treat symptoms of mental disorders like anxiety and insomnia. The substnce is licensed and widely used in Russia. Its recreational use is increasing in many countries as it is easily accessible online. In a recent years, several case reports of phenibut intoxication and withdrawal have been published worldwide.

We present a case report of intoxication with phenibut in a patient with psychoactive substances use disorder on regular methadone substitution therapy.

A 40-year-old male was hospitalized for the first time in the psychiatrc ward due to intoxication with phenibut. Before admission, he was confused, with incoherent speech. Bradypnea and somnolence were observed. A urine screening test was positive for methadone and benzodiazepines, while there was no information on phenibut intake at that time. After receiving naloxone, the patient became, agitated and haloperidol was introduced.

The main symptoms of phenibut intoxication, which have also been described in other cases, are cardiovascular effects, insomnia, anxiety, agitation, hallucinations, and reduced level of consciousness. In our case, a more heterogeneous clinical picture of intoxication was observed, due to the simultaneous use of methadone and other PAS.

The availability of various synthetic substances available online is constantly increasing. Their use is most common in the population with substance use disorders, in patients on substitution therapy and in patients with mental disorders in general. The clinical picture of intoxication can thus be very diverse and atypical, which requires increased attention from clinicians.

None Declared

Currently, in addition to their frequent use in community medicine, the use of antidepressants is a fundamental pillar of pharmacological treatments used in psychiatry. Due to this frequent use, we must be aware of the possible side effects, in particular the SIADH produced in this clinical case by SSRIs. There are already described cases of this association including other antidepressants and many different types of drugs.

To review the current literature on the management of this pathology when it is secondary to the use of frequently used drugs such as SSRIs.

We report the case of a 64-year-old woman hospitalised in the psychiatric department for malnutrition secondary to unspecified eating disorder (ED). During admission, treatment with sertraline was started with ascending doses up to 100mg, subsequently producing slight edema with the following analytical results: plasma Na: 123 mEq/L (135-145), plasma osmolarity: 250 mOsm/kg (275-300), urinary Na: 174 mEq/L (>40), fulfilling diagnostic criteria for SIADH.

Afterwards, we reduced sertraline until discontinuation and started treatment with water restriction and urea (30 grams/24 hours) during admission and after discharge. During admission, we observed disappearance of the edema and partial improvement of the analytical values (Na:131 mEq/L), which were normalised with home treatment of daily urea.

The precise prevalence of SIADH from the use of SSRIs is unknown, it is known that patients older than 65 are at higher risk of developing severe hyponatraemia in the first 5 weeks after initiation. Similarly, treatment with water and urea restriction, together with discontinuation of SSRIs, appears to be sufficient.

SSRIs can cause SIADH a reversible but potentially life-threatening pathology, and we need to be aware of this possibility especially in the older population and being able to handle it

None Declared

Bipolar disorder (BD) is frequently underdiagnosed and due to poor screening, the average time between onset of symptoms and diagnosis is more than 7-years (Mantere et al., 2004). Improper diagnosis has serious consequences in intervention (Ghaemi et al., 2001), and previous assessment instruments are now considered insufficient to detect intervention changes, and to provide a more functional and integrated view of BD.

Our study aims to develop a new DSM-5 based Clinical Interview for Bipolar Disorder (CIBD), providing criteria to diagnose BD, but also the individual’s perceptions dealing with BD symptoms. This interview follows the same structure of CIPD (Martins et al., 2015), which has shown acceptability by the participants and experts.

CIBD was developed by a multidisciplinary team considering the DSM-5 criteria for Bipolar Disorders. There was a thorough research regarding assessment and evaluation of BD, and several suggestions from an international task force of specialist working with BD patients were considered, when writing the questions for the interview. A detailed description of CIBD development is presented. The authors of the interview have extended experience in the management and assessment of BD patients, and CIBD is now being assessed by a wider non-related panel, regarding pertinence and clarity.

Preliminary assessment and qualitative feedback from participants that were interviewed is shown, with an overall positive feedback.

CIBD assesses both the diagnosis/presence of mood episodes (hypo/mania, and depressive) and symptoms’ psychosocial correlates. CIBD detects subtle changes caused by intervention adding a much needed recovery focused perspective.

No significant relationships.

Huntington Disease (HD) is a genetic, progressive neurodegenerative disorder. Its clinical features include motor dysfunction, cognitive impairments, and psychiatric symptoms. The association between HD and suicide is well documented, and the risk of suicide in HD is higher than in patients with other neurological diseases.

We aim to review the literature regarding suicidal behaviour in HD.

We performed an updated review in the PubMed database using the terms “suicide”, “suicidal behaviour” and “Huntington Disease”. The included articles were selected by title and abstract.

The most relevant risk factors associated with suicidality in HD are depression, anxiety, and aggression, so the presence of psychiatric diagnoses should be closely monitored. No consistent results have been found regarding gender. Evidence for periods of elevated risk of suicidal behaviour in HD is mixed and the data on specific pharmacological interventions for alleviating suicidal ideation in HD is scarce.

Patients with HD are at a high risk for suicide. This risk is further increased when a comorbid psychiatric disorder is present. It is important for the practicing psychiatrist to be aware of this association to correctly manage patients with HD, thus helping prevent suicidal behaviour.

Catatonia is characterized by a bizarre and severe psychomotor change. According to DSM-5, the presence of three or more symptoms is necessary to affirm the diagnosis: stupor, catalepsy, brain flexibility, mutism, negativism, posturing, mannerisms, stereotypes, agitation not influenced by external stimuli, grimaces, echolalia or echopraxia. The association between first- and second-generation antipsychotics (AP) and the onset of catatonia is well established in the literature. In contrast, clozapine is one of the second-generation APs that is recognized for its effectiveness in treating catatonia, rather than inducing it. However, it has been documented that abrupt discontinuation of clozapine can induce rapid clinical deterioration with multiple presentations including: psychoses, cholinergic rebound states, serotonergic syndromes and catatonia.

Review the literature on catatonia associated with abrupt interruption of clozapine. Describe a clinical case.

Observation of the patient and consultation the clinical file. Non-systematic literature review on catatonia, clozapine, side effects associated with rapid discontinuation and respective treatment.

34-year-old man, with the diagnosis of Schizoaffective Disorder. Admitted due to an acute decompensation with psychotic symptoms resistant to treatment requiring the introduction of clozapine. In the absence of a clinical response, clozapine was suspended, with the consequent appearance of catatonia resistant to benzodiazepines in high doses.

Its already well established that the abrupt discontinuation of clozapine can trigger catatonia. This clinical case and literature review suits to emphasize the importance of educating psychiatrists on the adverse effects of psychiatric drugs and, in this case, the cautious discontinuation of clozapine in order to avoid its rebound effects.

Suicide is a challanging problem for a global public health and Latvia remains in the list of European countries with the highest rates of suicide deaths. Information about the epidemiology of suicidal behavior is required for suicide prevention strategy development.

To determine the prevalence of suicidal behavior (suicidal ideation, plan, and attempts) and associated factors in Latvian general population.

Computer assisted face-to-face interviews were carried out between November 2019 and March 2020 to gather information on a representative sample of the Latvian adult population (n=2687). The study sample was selected using a stratified random sampling method. The Mini-International Neuropsychiatric Interview (MINI; version 7.0.2) was used to assess suicidality. Multinomial logistic regression was applied.

There were 1238 males (46.1%) and 1449 females (53.9%) recruited. Mean age of respondents was 49.9 (SD 18.2). According to the MINI, 10.6% (n=285) of respondents reported at least some level of suicidal behaviour during the last month before interview and 7.1% (n=191) had shown current suicidal behaviour at the moment of interview, 4.0% (n=108) of respondents reported about previous suicide attempts. Non-cohabitation status, unfinished primary education and economical inactivity were statistically significant associated factors for suicidal behaviour among men, but only lower level of education was for women.

Comprehensive national suicide prevention strategy is required for reducing suicidality in Latvia. Special attention should be paid to women with lower education, and economically inactive, unmarried or non-cohabitant men, as well as man with unfinished primary education.

There is a fine line separating psychiatry and neurology. Most movement disorders can have psychiatric symptoms, not only those caused by the disease itself, but also those induced by the drugs used to treat them.

Presentation of a clinical case about a patient diagnosed with Parkinson’s disease presenting a several-month-long delirious episode due to dopaminergic drugs.

Literature review on drug-induced psychosis episodes in Parkinson’s disease.

A 57-year-old patient with diagnosis of Parkinson’s disease for six years, who went to the emergency room accompanied by his wife due to delirious ideation. He was being treated with levodopa, carbidopa and rasagiline for years, and rotigotine patches whose dosage was being increased over the last few months.

His wife reported celotypical clinical manifestations and multiple interpretations of different circumstances occurring around her. He chased her on the street, had downloaded an app to look for a second cell phone because he believed she was cheating on him, and was obsessed with sex. He had no psychiatric background. It was decided to prescribe quetiapine.

The following day, he returned because he refused to take the medication since he thought he was going to be put to sleep or poisoned. It was decided to admit him to Psychiatry.

During the stay, rasagiline and rotigotine were suspended. Olanzapine and clozapine were introduced, with behavioral improvement and distancing from the psychotic symptoms which motivated the admission. The patient was also motorically stable. Although levodopa is best known for causing psychotic episodes, the symptons were attributed to rotigotine patches for temporally overlapping the dose increase.

Psychiatric symptoms are the third most frequent group of complications in Parkinson’s disease after gastrointestinal complications and abnormal movements. All medication used to control motor disorders can lead to psychosis, not only dopaminergics, but also selegiline, amantadine and anticholinergics.

Excessive stimulation of mesocortical and mesolimbic dopaminergic pathways can lead to psychosis, which is the most common psychiatric problem related to dopaminergic treatment.

In the face of a psychotic episode, antiparkinsonian drugs which are not strictly necessary for motor control should be withdrawn. If this is not sufficient, levodopa dose should be reduced, considering the side effects that may occur. When the adjustment of antiparkinsonian treatment is not effective, neuroleptics, especially quetiapine or clozapine, should be administered. In a recent study, pimavanserin, a serotonin 5-HT2 antagonist, was associated with approximately 35% lower mortality than atypical antipsychotic use during the first 180 days of treatment in community-dwelling patients.

Medication should always be tailor-made to suit each patient and we usually have to resort to lowering or withdrawing the dopaminergic medication.

None Declared

The Kessler Psychological Distress Scale (K6) is a psychometrically robust measure of psychological distress for adult populations, the most commonly used screening measure in the general population. It is used in epidemiological surveys globally, including the World Health Organization and World Mental Health Survey. Recently, there has been a research interest in examining the psychometric properties of the K6 in college students’ populations.

To examine the reliability, validity and factor structure of the Arabic adaptation K6 in Kuwaiti college students.

The participants were 1402 individuals (509 males, 893 females) Kuwait University undergraduates, aged 18–35 years-old mean age = 21.50 ± 4.87. The Arabic versions of The Kessler Psychological Distress Scale (K6), The Depression Anxiety Stress Scales DASS-42, Beck Depression Inventory-II, and Beck Anxiety Inventory –BAI were administered to participants including demographics. The internal consistency reliability, factor structure, and convergent validity of the (K6) with DASS-42, BDI-II, & BAI were computed.

Internal consistency was satisfactory for the K6 (Cronbach’s alpha =0.80 for males & 0.79 for females). The results revealed significant gender differences in distress with a favor for females (f=8.95, p. >.003). Principal component analyses (PCA) showed that a K6 one -component solution explains %61.51 of the total variance for males and %57.23 for females. The k6 correlates with DASS Stress (r=.76), DASS Depression (r=.57), DASS Anxiety (r=0.76), BAI (r=.73) and BDI-II (r=46).

The K6 provides satisfactory validation, and can be recommended as a measure of distress among Arab college students.

None Declared

Although mania is commonly associated with bipolar disorder, it can have many etiologies. Thus, “primary mania” results from bipolar disorder, whereas “secondary mania” results from pharmacological, metabolic, or neurologic causes. Older adults are at risk for secondary mania because of increased medical comorbidities and neurological changes. In one retrospective study of 50 patients with mania who were older than 65 years, it was the first manic episode for 28% of the patients and 71% had a comorbid neurological disorder.

The etiology of mania is important because although acute symptomatic treatment of both primary and secondary mania may be similar, appropriate treatment of secondary mania includes addressing the cause. We present here two case histories of secondary mania in older adults, discuss their presentations and differential diagnosis in turn, and discuss treatment.

We will present a clinical case of a patient. Ms. A, a 63-year-old divorced woman with no prior medical or psychiatric history, was seen for an acute manic episode with mixed features. She was in her usual state of health until 2 weeks before admission, when she presented with a status epilepticus requiring a one-week hospitalization in the neurology département and treated by Carbamazepine. She then developed an abnormally excited and labile mood, motor excitability accompanied by rapid thoughts, with a total loss of desire and pleasure and thoughts of death.

In our study, the patient presented a manic episode with mixed characteristics secondary to a status epilepticus.

The patient was treated both somatically and psychologically, and the evolution was positive. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.

In our study, the patient presented with a manic attack with mixed characteristics secondary to a status epilepticus.The patient was treated both somatically and psychologically, and the evolution was favourable. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.

Late onset psychiatric disorders often represent a challenge for the psychiatrists as far as the diagnosis and management issues are concerned. The elderly patients have generally been reported to have associated medical, especially neurological illnesses and are also prone to side effects of various psychotropic medications.

None Declared

Social inclusion is a multidimensional concept, referring to ample participation in key social, cultural, economic and political activities. Since the turn of the century, social inclusion has become a guiding principle in policy recommendations of many international (United Nations, WHO, EU) and national bodies, aiming to improve the lives of people with mental ill-health. More recently, social inclusion has been increasingly used as an outcome measure, to test the effectiveness of complex interventions, especially in the field of global mental health.

This presentation will focus on: (1) current definitions and controversies in research on social inclusion for and with people with mental ill-health; (2) measuring social inclusion; and (3) the evidence-base of interventions to improve social inclusion. Special attention will be given to recovery-oriented interventions in global mental health such as peer support.

In summary, over the last years, impressive conceptual and methodological advances have been made to transform policy rhetoric into meaningful and effective interventions. However, challenges remain, including consensus on culturally appropriate measurement of social inclusion, and balancing the roles and responsibilities of all stakeholders (service users, mental health service providers, wider society) across the entire exclusion-inclusion continuum to promoting social inclusion and mental health.

None Declared

Psychoneuroimmunology is a discipline that has emerged over the past decades as a broad interdisciplinary field that closely observes the relationship between the psychological state, the nervous system, the endocrine system, and the immune system. The natural aging process leads to alterations in the immune functions, involving lymphocyte dysregulation, and therefore leading to a higher risk of developing coronary artery diseases, infectious diseases or even cancer.

The aim of our inquiry is to evaluate the existing body of work with a focus on studies that observed the intricate connections between psychosocial factors and immunity.

We performed a systematic review on PubMed and a targeted literature search concentrating on all the factors involved in immunosenescence and their consequences.

The causality between emotional stressors (acute or chronic), lack of social support, adverse life events, coping mechanisms, personality traits, as well as endocrine changes and multiple age-related pathologies is often undeniable. Other relevant factors include nutrition, sleep, physical activity and substance use. As people grow older, they face a number of psychosocial stressors, such as retirement, social isolation, loss of independence, low income, a decrease in productivity and also somatic comorbidities. These factors, together with an age-related decline in immune function, can constitute not only a psychosocial disadvantage of the elderly, but also a risk factor able to trigger further deterioration of the immune system.

Age-associated alterations of the immune response represent a complex concept. Given that we are dealing with the phenomenon of aging in the general population, the field of psychoneuroimmunology can make a significant contribution in establishing the different mechanisms through which seniors can cushion the impact of stressors in regards to health and illness. Therefore, we can pave the way for an individualized approach and support for patients, as well as provide better therapeutic outcomes.

None Declared

Due to the convenient and easy access to the Internet, there is an increasing tendency to seek online health information instead of formal help-seeking. To date, there is a very little amount of research on online help-seeking behaviors for mental health problems, with no studies having been performed in Tunisia.

We aimed to explore mental health information-seeking behaviors and e-health literacy in a sample of Tunisian community adults.

We performed a cross-sectional descriptive study among adults from the general population. All participants were administered the Barriers to Access to Care Evaluation scale (BACE-30), the Columbia Suicide Severity Rating Scale (SIS-5), the Depression Anxiety Stress Scales (DASS-21), and the eHealth Competency Scale (eHEALS).

A total of 44.2% participants reported having searched the Internet for mental health-related information during the last 12 months. Google was the most used tool by participants when searching for mental health related information. The main topics searched were symptoms and management (n=49%), followed by finding a diagnosis (n=47%), researching for medications and physicians (n=41%). We conducted a multivariate analysis to identify factors related to participants’ e-health literacy. A higher depression score (p=0.037), lower levels of education (p=0.011), and perceived barriers to access to care (p=0.004) were substantially linked to worse e-health literacy.

While a high proportion of participants reported mental health information-seeking behaviors, those with higher depression and who perceived more barriers to care access exhibited lower e-health literacy. These findings may have practical clinical implications.

None Declared

Lithium, a mood stabilizer, is a commonly prescribed and effective treatment for bipolar affective disorder. It´s excreted almost exclusively by the kidneys with a half-life primarily determined by renal function. Chronic intoxication results from an insidious accumulation of lithium in a chronically medicated patient (due to a reduction in renal function secondary to volume depletion, a new medication, et cetera). Patients often present with neurologic findings, including tremor, ataxia, dysarthria, confusion and neuromuscular excitability.

The objective of this report is to describe a clinical case of lithium neurotoxicity (myoclonus and encephalopathy), along with a review of the literature on the topic.

We describe a case of lithium neurotoxicity, along with a brief non-systematic review of the literature on lithium toxicity. We conducted a PubMed bibliographic search using keywords such as “lithium intoxication”, “lithium neurotoxicity”, “lithium encephalopathy” and “lithium intoxication treatment”.

A women aged 81 was brought to the emergency department by her daughter following 1 week of asthenia, diarrhoea, periods of confused speech and involuntary movements. In the previous week, the patient had been diagnosed with COVID-19. Her past medical history is significant for bipolar affective disorder, hypertension, diabetes mellitus, dyslipidemia and asthma. The patient has been treated with following drugs: lithium carbonate (no recent change of dose and previous serum levels around 1mmol/L), quetiapine, lisinopril, metformin, simvastatin, formoterol and budesonide. On the first examination, she had an exuberant multifocal myoclonus. Posteriorly, she became somnolent, with language impairment (verbal perseveration, echolalia) and dysarthria. Investigations revealed renal impairment (creatinine 1,5 mg/dL, blood urea nitrogen 42 mg/dL) and supratherapeutic lithium levels (lithium serum level 1,7 mmol/L). Computed tomography scan of the brain was negative for acute injuries. The electroencephalogram showed triphasic waves (1-1,5 Hz). Encephalopathy secondary to lithium intoxication was diagnosed (probably in the context of acute kidney injury precipitated by hypovolaemia – diarrhoea). Lithium was stopped and intravenous isotonic fluids were given. After 1 week, her myoclonus resolved and over the following week the other signs resolved as well. The patient was later discharged to her daughter’s home, with follow-up neurology and psychiatry visits.

Both reversible and irreversible neurotoxicity related to lithium have been reported, specially occurring alongside chronic intoxication. If not addressed, impaired consciousness can lead to coma and death. A high clinical suspicion is needed for prompt diagnosis and treatment (intravenous fluids and sometimes haemodialysis are warranted).

None Declared

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity, which begins in childhood and often persists into adulthood. ADHD has a heterogeneous expression with diversity in behavioral symptoms, cognitive deficits, and comorbidities. So, it is possible to consider it a spectrum with different losses.

To describe clusters of multiple neuropsychological, attentional, and behavioral measures in adults with symptoms of ADHD. It could help to seek new directions to examine heterogeneity from a dimensional approach to ADHD.

120 adults between 18 and 52 years old (m= 29.5) with ADHD symptoms participated in this study. Performance indices on computerized neuropsychological tests of attention (voluntary, automatic, temporal, and sustained), behavioral self-report scales for ADHD (ASRS-18), impulsivity (BIS-11) executive dysfunction (BDEFS), and functionality, emotional and behavioral problems (Adult Self-Report - ASR of ASEBA) were analyzed. Cluster analysis processed the data to find subgroups based on the scores of instruments. The NbClust tested the best number of clusters that converge to a solution.

The 3 clusters solution was obtained by comparing Z scores for each indicator. In cluster 1, the ADHD symptoms were equivalent but expressed more hyperactivity than in other clusters. Also, higher levels of functional impairments and executive dysfunctions (motivation, emotional regulation, and anxiety/depression) were identified. In the attentional neuropsychological tasks, the indices express a lower level. Cluster 2 expressed a higher level of inattention and attentional, motor, and non-planning impulsivity, and functional impairments in the academic, professional, and legal risk areas. Cluster 3 was the subgroup with the lowest level of symptoms of ADHD.

This study identified differences in performances that contribute to understanding the cognitive, behavioral, and emotional expressions of ADHD. Three groups of different prejudices levels should be considered in the development of evaluative models in new studies to consider the spectrum of ADHD.

Financial support: FAPESP [grant 2019/20757-5, 2019/21773-4, 2020/14800-2]; CAPES Proex [grant 0426/2021, 23038.006837/2021-73]; Mackpesquisa; CNPq [grant 307443/2019-1]

None Declared

olanzapine and carbamazepine are effectively used in treatment of schizoaffective disorder but they can have numerous side effects including skin eruptions that can be severe sometimes.

To study the relationship between toxidermia and treatment with Olanzapine and Carbamazepine.

We report the case of a patient who developed a psoriasiform skin rash following the intake of Olanzapine and Carbamazepine.

Mrs SL, 46 years old, with no prior medical or surgical history, has been diagnosed with schizophrenia since the age of 26. She was initially treated with Haloperidol and Risperidone with an irregular follow-up. Then, due to the emergence of mood disorder symptoms, the patient was put on 20 mg/day of Olanzapine and 400 mg/day of carbamazepine. One month later, the patient presented a generalized rash requiring the discontinuation of the current medications. She was treated with corticosteroids, and then she was referred to our department to make the appropriate adjustment of her psychiatric treatment.

In view of the persistence of a dry erythroderma with erosive lesions of scratching and palmoplantar keratoderma, a skin biopsy was performed showing a psoriasiform and eosinophilic dermatosis that could be consistent with a toxidermia. The pharmacovigilance investigation concluded the incrimination of Olanzapine and carbamazepine in this symptomatology and recommended to avoid their prescription for this patient.

The need for a mood stabilizer presented us with a challenge, particularly in view of the potential risk of cross-toxicity. We opted for the reintroduction of Risperidone with strict monitoring of the skin condition.

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon.

None Declared

Therapists’ forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists’ views and challenges with teletherapy.

We aimed to develop predictive models of three aspects of psychotherapists’ acceptance of teletherapy during the COVID-19 pandemic; attitudes towards teletherapy, concerns about using teletherapy, and intention to use it in the future.

In an international survey, therapists (N = 795) completed a survey about their experiences during the pandemic, including quality of therapeutic relationship, professional self-doubt, vicarious trauma, and telepsychotherapy acceptance. Regression decision trees machine learning analyses were used to build prediction models for each aspects of telepsychotherapy acceptance.

Attitudes toward telepsychotherapy were most positive for therapists who reported neutral or strong online working alliance, especially if they experienced little professional self-doubt and were younger than 40 years old. Therapists who were most concerned about telepsychotherapy, were those who reported higher levels of professional self-doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance were the least likely to use telepsychotherapy in the future.

Therapists’ professional self-doubt and the quality of their working alliance with their telepsychotherapy patients appear to be the most pertinent factors associated with therapists’ acceptance of telepsychotherapy during COVID-19, and should be addressed in future training and research.

No significant relationships.

Study of clinical risk factors of violent behavior in persons with schizophrenia still remains actual in research literature. This is especially important for Georgia as ongoing mental health reform aims to shift from institutional care to community based services, which in turn requires better understanmding and management of risk of aggressive behavior in the community.

To study clinical risk factors for violence in persons with schizophrenia spectrum disorders (SSD) who have committed a violent act in the past and in persons with SSD who have not committed a violent act.

The survey design was retrospective case-control study. Case-control groups were defined according to the outcome (violent act in the past). We studied the impact of clinical symptoms on each person using standardized scales for assessment of the positive and negative symptoms and global level of functioning. Data were collected through patient interviews and medical records.

Study results showed that diagnosis of delusional disorder and ideas of persecution were associated with increased risk of violence (28.7% cases versus 7.5% controls); Hallucinations if presented were less severe compared with controls (2.1% vs. 7.5%). Negative symptoms were marked in cases but more severe in controls. Of cases 43,6% showed serious impairment of global functioning (vs 25,5% controls).

Study findings confirmed that a focus on improving controllable clinical factors, including global level of functioning, might help to prevent aggressive behavior. It is discussed that developments and implementation needs-specific services to reduce risk of violence behavior should be prioritized by mental health national strategy plan.

No significant relationships.