Meta-analyses suggest that patients with schizophrenia show deficit in working memory – both verbal and visual – and are more distractible. Working memory disturbances are even regarded as the central deficit in schizophrenia by some researchers. Theta synchronization (especially over fronto-central areas) is related to cognitive control and executive functioning during working memory encoding and retention.

The main goal of the study was to gain more understanding of the nature of working memory deficit and attentional distractibility in schizophrenia.

35 patients with schizophrenia and 39 matched controls were enrolled in our study. Participants performed a modified Sternberg working memory task that contained salient and non-salient distractor items in the retention period. A high-density 128 channel EEG was recorded during the task. Event-related theta (4-7 Hz) synchronization was analyzed during working memory encoding (learning) and retention (distractor filtering) in a later time window (350-550 ms).

Patients with schizophrenia showed weaker working memory performance and increased attentional distractibility compared to the control group: patients had significantly lower hit rates (p < 0.0001) and higher distractor-related commission error rates (p < 0.0001). Theta synchronization was modulated by condition (learning < distractor) in both groups but it was modulated by salience only in controls (salient distractor > non-salient distractor, p[patients] = 0.95, p[controls] < 0.001).

Our results suggest that patients with schizophrenia show diminished cognitive control compared to controls in response to salient distractors. Difficulties in cognitive control allocation may contribute to the behavioral results observed in this study.

No significant relationships.

TEACCH program (Treatment and Education of Autistic and related Communication Handicapped Children) represents a model for management of five major autistic behavioral problems:

1. (1) Self abuse,

2. (2) Aggression,

3. (3) Disruptive behaviors,

4. (4) Repetitive Behaviors,

5. (5) Other behavioral deficits.

Present study introduces TEACCH based model for behavioral intervention of autistic preschoolers in school setting.

Studying effectiveness of usage of (TEACCH) program in decreasing commonly experienced behavioral disorders among autistic preschool children according to Parent/Teacher assessment and follow up.

5 autistic children aged (2-6) years (4 boys and 1 girl) were selected according to the study inclusion criteria and legal guardian consent. They were subjected to psychiatric assessment (psychiatric interview sheet and DSM IV criteria for autistic disorder), psychological assessment using:

1. (1) Childhood Autism Rating Scale” (CARS)(2000) (Arabic version),

2. (2) Vineland Adaptive Behavior Scale(2004)(Arabic version), as well as

3. (3) Autistic Behavioral Checklist for preschool children and

4. (4) Disordered Behavior Intervention Program (3 and 4 were made by researchers).

Study subjects were assessed by their mothers and teachers for their behavioral problems. Pre- intervention assessment were arranged for each child and commonly experienced behaviors both at home and school as regard both severity and frequency were listed for intervention. Mother/Teacher Post-intervention and follow up assessment were also arranged for each child.

Both Pre/post and Post /follow up assessment and comparison were statistically significant both for mother and teacher ratings. Behavioral problems were significantly decreased using TEACCH model for behavioral intervention of disordered behaviors among study subjects.

Early identification, Individualized intervention and follow up of significant behavioral problems using study model helps reducing them.

This study aimed to determine the effect of Electroconvulsive Therapy (ECT) on serum serotonin level of patients with major depressive disorder (MDD).

In this experimental study, 36 patients (age: 20–65 years old) with MDD were allocated to ECT group (n = 21) and non-ECT group (n = 15). Serum serotonin level of the ECT group was measured before ECT, 15 minutes and two, six, and 24 hours after the first session, and 24 hours and 30 days after the last ECT session. Measurements were performed at the time of admission and one month after hospitalisation in the non-ECT group. Data analysed with t-tests, repeated measures analysis of variance by SPSS16.

The mean serotonin levels of the two groups were significantly different 24 hours and 30 days after the last session of ECT (P = 0.048 and P = 0.04, respectively). The difference of mean serotonin levels in the ECT group before & 15 min after ECT (P = 0.044) before & 6 hour after ECT (P = 0.015), before & 24 hour after ECT (P = 0.007), before & 24 hour after last ECT (0.002) was meaningful.

Altogether, our results showed that serum serotonin levels significantly increase following ECT in MDD patients.

The article is devoted to the study of adaptation to the covid-19 pandemic conditions in Russian men and women in the first part of 2020. Respondents assessed the degree of potential danger of various types of social threats caused by the pandemic, as well as the level of their adaptation to changed living conditions during the first lockdown.

The purpose of this study was to identify key differences in adaptation to pandemic conditions in groups of men and women.

The author’s methodology was developed to assess the level of adaptation to COVID-19. The questionnaire included 6 scales on different aspects of life during the lockdown (for example, physical and emotional state, communication, employment during the pandemic, etc.). The sample was N = 80 (residents of Russia age 18-37).

Men significantly higher estimated the potential danger of an epidemic threat to themselves than women. The level of adaptation to conditions caused by the COVID-19 pandemic also differed in two gender groups according to t-test on the scale “Employment in a pandemic”: men were better adapted to work or study in conditions caused by the COVID-19 pandemic than women.

This can be interpreted from the point of view of the stereotype existing in Russian culture which postulates the performance of household duties and child care is more perceived as a woman’s responsibility. The adaptation of women to remote work during the lockdown was forced to be combined with an increased workload in the family and household sphere.

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.

Poor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence.

Aim of the present study was to assess potential differences in terms of clinical and socio-demographic characteristics specifically related to adherence to treatment features, medical comorbidities, and substance abuse in a sample of patients diagnosed with Major Depression in an Italian psychiatric department.

Patients with a DSM-5 diagnosis of Unipolar or Bipolar Major Depressive Episode, of either gender or any age were recruited from the Psychiatry Department of Luigi Sacco University Hospital in Milan. Main clinical and socio-demographic variables were collected reviewing patients’ medical records. Moreover, adherence to psychopharmacological treatment was assessed using the Clinician Rating Scale (CRS; Kemp et al, 1996; 1998). Adherence was defined as ratings of > or =5 on the CRS. Descriptive and association analyzes were performed, setting the significance level at p<.05.

80 patients with a diagnosis of Unipolar Major depressive episode (48.9%) and Bipolar Major Depressive Episode (51.1%) were included. For the purposes of the study, the total sample was divided into two subgroups based on adherence to pharmacological treatment (A+ vs A-). Significantly higher rates of inpatients from psychiatric ward were A- compared to A+ patients (84.6% vs 48.1%, p=.011). A- patients were significantly more unemployed (57.9% vs 23.8%, p=.015), were mostly living in their family of origin (50% vs 21.4%, p=.027), and had fewer years of education compared to A+ subgroup (10.52±3.28 vs 12.2±3.1 years, p=.053). Higher rates of Bipolar Depression diagnosis and a prevalent manic polarity lifetime emerged in A- compared to the A+ group (73.1% vs 42.3%, p=.010; 30.8% vs 3%, p=.011, respectively). Moreover, A+ reported significantly higher rates of depressive prevalent polarity lifetime (72.7% vs 30.8%, p=.011). A- reported significantly higher rates of comorbidity with alcohol or other substance use disorders lifetime (46.2% vs 5.7%, p=.006) and almost one involuntary commitment lifetime (23.1% vs 11.1%, p=.013).

In our sample adherence to treatments showed significant differences in terms of clinical and socio-demographic characteristics. Low levels of adherence have been associated with higher hospitalization rates, involuntary commitments, greater comorbidity with alcohol or drugs. Our data therefore seem to suggest that less adherence leads to a worse disease course and a worse quality of life. It therefore appears useful to include an assessment of adherence in the clinical practice and implement interventions to improve therapeutic adherence and ensure a better quality of life.

None Declared

In this article, a case who was prescribed duloxetine (30 mg capsule) upon the fibromyalgia diagnosis by a physical therapist and had acute dystonia and dyskinesia after approximately 1.5 hours from duloxetine intake shall be presented.

It was learnt that a married female patient aged 38 consulted a physical therapist with the complaint of back pain and duloxetine (30 mg capsule) was prescribed. It was reported that, the patient applied to our hospital with the compliant of involuntary movements around the mouth, on the lips and neck, spasm, inability to open the mouth completely, spasm in jaw, gritting teeth, mumbling and aphasia after approximately 1.5 hours from her duloxetine intake. The patient was conscious. Her psychomotor activity was natural. As a result of cranial MR, EEG, BT examinations hemogram and the routine biochemistry examinations, any abnormality in zinc and iron levels was not detected. Complaints of the patient regressed after 1 hour from the discontinuance of duloxetine and the administration of biperiden 5 mg/mL ampoule 1000 cm3 in SF. After 72 hours, any symptoms were not found.

Dopamine neurotransmission can be inhibited through the increase in serotonin and norepinephrine. Additionally, dystonia may originate from the prevailing of noradrenaline as a result of the failure of dopaminergic–noradrenergic balance.

The author has not supplied his/her declaration of competing interest.

Psychosocial and psychological characteristics relative reference identified by means of psychodiagnostic method using a methodology for assessing the quality of life SF-36. Research resource family support was carried out by questionnaire assessment of family resources

In all groups surveyed in the dynamics of the disease there is a deterioration of social functioning and quality of life. The peculiarities suggest that with the development of schizophrenia in a family member (RR) offset empatio-affiliative tendencies and desires in interpersonal interactions with patients.

Most individuals diagnosed with schizophrenia must cope with some form of stigmatization. Different types of public stigma, self-stigma and label avoidance, may have negative consequences for these individuals.

The aim of the study was to search the degree of self-stigma in schizophrenia and its association with the clinical and demographic factors.

One hundred and ninety-seven stabilized outpatients diagnosed with schizophrenia spectrum disorders participated in the study. The mean age of the sample was 40 years. All individuals completed the Internalized Stigma of Mental Illness Scale (ISMI) and a demographic questionnaire. The disorder severity was assessed both by a psychiatrist (objCGI-S: the objective version of Clinical Global Impression – Severity scale) and by the patients (subjCGI-S: the subjective version of Clinical Global Impression – Severity scale).

The total score of the ISMI positively correlated with the severity of the disorder measured by the objCGI-S and the subjCGI-S. Additionally, the self-stigma positively correlated with the treatment duration, and the number of hospitalizations. The regression analysis identified these regressors as the most relevant to the self-stigma – the number of hospitalizations, the severity of the disorder rated by a psychiatrist, and the difference between the objective rating and the subjective rating of the severity of the disorder.

Outpatients with psychosis, who have undergone a higher number of hospitalizations, dispose of a higher severity of the disorder and show a bigger discrepancy between their rating of the severity and the psychiatric rating, display a greater degree of self-stigma.

The authors have not supplied their declaration of competing interest.

The Perinatal Anxiety Screening Scale was translated and validated for European Portuguese (PASS-29; Pereira et al. 2019), from the original PASS (composed of 31 items; Somerville et al. 2014) to allow epidemiological and correlational research and early detection, which is an health policy imperative. This need also applies to Brazil, where a specific instrument to measure perinatal anxiety is not available.

To study the psychometric properties of the PASS Brazilian version factor structure using confirmatory factor analysis (CFA), internal consistency and pattern of correlations with mood states.

350 women (Mean age: 30.01±5.452) in the second trimester of pregnancy (Mean weeks =25.17±±6.55) completed the PASS and the Brazilian version of Profile of Mood States (POMS-25; Barros et al. 2021). SPSS and AMOS software were used.

After deleting two items (1 and 2) and some errors correlated, CFA indicated a good fit for the second-order model (X2/df=2.987; CFI=.903; TLI=.889; GFI=.797, RMSEA=.075; p[rmsea≤0.01]<0.001). The Cronbach alpha was α=.937, and for the four dimensions (general anxiety and specific fear, perfectionism and control, social anxiety and adjustment disorder, acute anxiety and trauma.), were all α>.800. PASS total and dimensional scores significantly (p<.01) and moderately correlated with Profile of Mood States dimensions: negative affect (.471), Depression (.294), Anxiety (.548), Fatigue (.438) and Vigour (-.288).

Similarly, to what has been found for Portuguese version, the Brazilian PASS resulted in a 29-items-and-four-factors version, with good construct and convergent validity and reliability. In the near future we will determine the PASS cut-offs to screen for anxiety disorders in pregnancy and postpartum.

Auditory hallucination is one of the most common symptoms in schizophrenia. The frequency of the auditory hallucinations and ensuing distress make the individual believe that these voices are not able to be controlled and to be coped with.

Testing the effectiveness of brief cognitive behavioral therapy for psychosis (CBTp) for auditory hallucinations, using it in modifying the beliefs about the voices and improving symptom severity and overall functioning.

Forty participants with schizophrenia were randomized into intervention and control groups. Intervention group were 20 patients who received 8 individual sessions of CBTp plus Treatment As Usual (TAU) over 8 weeks and the control group were the other 20 patients who received TAU only. The Positive and Negative Syndrome Scale (PANSS), the Arabic version of Beliefs About Voices Questionnaire (BAVQ) and the General Assessment of Functioning scale (GAF) were assessed at baseline and at the end of the study.

Intervention group showed a statistically significant increase in GAF (P = 0.012), a statistically significant reduction regarding the Positive (P < 0.001), Negative (P = 0.008), General (P < 00.001) and total (P ≤ 00.001) sub-scales of PANSS. Regarding BAVQ, Intervention group showed a statistically significant reduction in Malevolence (P = 0.008), Engagement (P = 0.001); and showed a statistically significant increase in Resistance (P = 0.049) compared to control.

Brief cognitive behavioral therapy for auditory hallucinations can improve severity of schizophrenia, increase the level of functioning and improve the beliefs about the voices.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Major Depressive Disorder is a common psychiatric diagnosis among elderly patients with cancer. More than 10% of cancer patients suffer from Depression, which negatively impacts their quality of life. Mood symptoms are treated pharmacologically with antidepressant medications, while psychotic symptoms are treated with antipsychotic medications. Electroconvulsive Therapy may be initiated early for psychotic depression.

The objective of this case is to present a patient with Major Depressive Disorder, who developed psychotic symptoms after a diagnosis of malignancy, and to suggest early initiation of Electroconvulsive Therapy for treatment.

Ms G is a 68-year-old female who presented with low mood, worries, poor sleep, anhedonia and suicidal ideation. She complained of abdominal bloatedness and was reviewed by Gynaecology, who discovered a large ovarian mass, likely malignant in nature. Within days of the diagnosis, the patient developed nihilistic delusions, believing that her body was decaying and filled with poison. She was distressed and worried that the poison would spread to others around her. Risperidone was initiated and uptitrated, with limited improvement. As early surgical removal of the ovarian tumour was advised, it was essential that the patient’s mental state be quickly stabilised. She was hence initiated on Electroconvulsive Therapy (ECT). The patient underwent a total of 11 sessions of ECT. She was initially started on daily sessions, and the frequency gradually tapered.

The patient’s mental state improved. She was then continued on oral medications, and discharged home well to proceed with her Gynaecological surgery.

This is a case of Major Depressive Disorder with psychotic symptoms that emerged after a diagnosis of malignancy. This case illustrates the importance of routine screening for psychotic symptoms, including nihilistic delusions, in elderly patients with Major Depressive Disorder who are newly diagnosed with cancer. It may be beneficial to consider early Electroconvulsive Therapy when treating such patients.

None Declared

Emotion regulation (ER) efficiency dwells among the most pressing issues of contemporary psychology and psychiatry. Further development of the methods of reliable assessments for ER makes it the task of current importance.

To modify Rosenzweig Picture-Frustration Test for the study of ER in health and in disease.

In the initial stage of testing participants had to look through a succession of Rosenzweig's pictures, and select potentially traumatizing situations.

In the second stage they answered the following questions:

• – what would you say in this particular situation?

• – what would you have in mind, saying this?

• – could you think of an answer that would taper down the traumatizing character of the situation in your own perception? (Zinchenko, Pervichko, 2014).

A total of 85 patients with stress-induced hypertension (mean age was 45.9 ± 2.8) and 82 healthy subjects (mean age was 44.9 ± 3.1) took part in the study.

We came to distinguish among four classes of ER strategies: internal, cognitively non-mediated; internal, cognitively transforming; external, cognitively non-mediated; and external, cognitively transforming (Pervichko, 2015). Hypertensive patients significantly more frequently than healthy subjects reveal wider set of emotionally grave events (19.8% vs 11.2%, P < 0.001), they are more prone to rumination, disasterization (19.0% vs 11.1%, P < 0.001) and suppression in display of their emotions (31.9% vs 20.2%, P < 0.001). The patients will seldom employ the strategy of interactive subject–subject transformations; their capability to actualize new meanings in traumatic situations is diminished.

Application of the described modification of Rosenzweig Picture-Frustration Test allows to distinguish and classify various ER strategies, and to demonstrate peculiarities in ER related behaviour of hypertensive patients as opposed to healthy subjects.

The authors have not supplied their declaration of competing interest.

Despite the unclear nature of catatonia, the treatment response of catatonia to benzodiazepines is widely known for its typical, dramatic recovery. The neurobiological correlates of this phenomenon regarding specific receptors and neurotransmitters are unclear, as are the potential treatment options. This is important to consider when the most commonly recommended treatments of catatonia with Lorazepam or Electroconvulsive Therapy (ECT) are unavailable or unsuccessful. In this report, we describe a case of severe, malignant catatonia and psychosis mostly unresponsive to Lorazepam during two different hospitalizations, but with eventual return to baseline after successful treatment with Valproate.

• - To describe a unique case of malignant catatonia that was unresponsive to Lorazepam

• - To illustrate the potential utility of Valproate as an alternative treatment strategy for catatonia

This is a case report.

A 19-year-old Hispanic male presented to our hospital initially with family reports of severe and sudden depression with bizarre behavior. Prior to this admission, the patient had been discharged recently from another tertiary hospital following a 2-week admission for severe catatonia. Chart review from that admission scored the patient’s Bush-Francis Catatonia Rating Scale (BFCRS) at 16, which remained mostly unchanged after numerous additional intramuscular doses and standing oral doses of Lorazepam, with a reduction of BFCRS the next day of only 2. During the patient’s admission at our hospital, the patient endorsed bizarre, guilt-related delusions, and his catatonia was more severe and malignant with a BFCRS of 19, with tachycardia and diaphoresis. The patient was initially given a total of seven doses of a mix of intramuscular and oral Lorazepam (total 18mg), with a minimal 2-point reduction in BFCRS. As ECT was unavailable, Lorazepam was discontinued in favor of a trial of oral Valproate 500mg twice daily, and after his catatonia subsided (with a serum level of 60.8), he was started on oral Risperidone 0.5mg once at night, titrated up to 3mg twice daily, and eventually returned to baseline as confirmed by his family members.

The treatment of catatonia with Lorazepam is usually reliable and has been found to be up to 80% effective, but when the recommended use of benzodiazepines and ECT fail or are unavailable, there are few studies exploring the viability of alternative treatment options. With the use of Valproate, previous studies have shown it can treat even severe catatonia (KrÜger, J Neuropsychiatry 2001; 13:303-304), or can actually be its cause (Lauterbach, Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1998 Jul;11(3):157-163). As such, this case report highlights the importance of exploring alternative treatments for catatonia, including Valproate, in order to better tailor the management of this unique syndrome.

None Declared

Arithmetic reportedly involves left parietal areas.

To test this in independent groups of healthy persons.

Which brain regions are activated / inhibited during mental arithmetic compared to task-free resting?

We examined four independent groups of healthy adults (N = 15, 14, 14, 23, respectively) during simple arithmetic (continuous subtraction of 7) and task-free resting before and after arithmetic, all with closed eyes. Multichannel head surface EEG (19–58 channels) was continually recorded, then recomputed (using sLORETA functional tomography) into current density for 6239 cortical voxels, for each of the eight EEG frequency bands (delta through gamma, 1.5–44 Hz). Pre- and post-arithmetic resting was averaged. Using paired t-tests, frequency band-wise normalized and log-transformed current density was compared between arithmetic and resting for each group. The resulting p-values were combined across groups using Fisher’s combination procedure. For each frequency band, sLORETA voxels differing between conditions at Fisher’s (across groups) p < 0.05 were computed into centers of gravity separately for increased and decreased activation.

Activity that was stronger during arithmetic compared to resting had gravity centers in midline anterior regions for slow frequency bands (delta, theta, alpha-1) and in right posterior regions for fast frequency bands (alpha-2 through gamma). Activity that was weaker during arithmetic compared to resting was centered around left parietal areas for all eight frequency bands.

The results suggest that arithmetic compared to resting involves frontal inhibition coupled with increased right parietal activation, and left parietal reduced facilitatory and reduced inhibitory activity.

Chronic migraine is commonly regarded as one of the most disabling headache conditions. Although there has been some research indicating the severe impact of this chronic headache, there is little comprehensive evidence of its impact on quality of life, disability and cognitive function.

The aims of this cross-sectional study were to investigate cognition, disability and quality of life in patients with chronic migraine compared to healthy control subjects.

Participants were a convenience sample of 58 adult outpatients admitted to Headache Centre of the Sant’Andrea Hospital in Rome (Italy). Inclusion criteria were a diagnosis of chronic migraine (illness duration >5 years). Fifty-eight age-matched healthy subjects were recruited as controls. Participants were administered the Mini Mental State Examination, the Italian Perceived Disability Scale (IPDQ), the 12-item Short Form Health Survey (SF-12) to assess physical and mental health, and the neurocognitive task Visual Perspective Taking (VPT), as a measure of social cognition.

Patients with chronic migraine showed higher perceived disability and poorer well-being compared with healthy controls. No differences were found in global cognitive function and in the performance of the neurocognitive task.

Addressing the burden associated with subjective state of disability and well-being in migraineurs is important because of its association with a worse prognosis and a worse response to treatment. Findings did not confirm the hypothesis that migraneurs are more impaired in social cognition. Further studies are needed to assess different cognitive dimensions in migraneurs, including various measures of social cognition, to better understand neurocognitive profile of this patients’ population.

The authors have not supplied their declaration of competing interest.

Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization and low personal accomplishment. It concerns all professions especially healthcare staff.

A cross-sectional study conducted among medical residents working in hospitals located in Tunis. Three instruments are used: an anonymous self administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment.

A total of 149 résidents participated in the survey. 17,4% of participants had a severe Burnout. 42,26% reported a severely high score for emotional exhaustion, 46,92% reported a severely high score for depersonalization and 26,14% had a severely low score of personal accomplishment. Among stress factors significantly correlated to burnout: Lack of hobbies (p<0,001), bad job conditions (p=0,031), poor conditions of the workplace (p=0,046), relationship problems in workplace (p=0, 01), relationship problems with patient’s families (p=0,016), work-family conflicts (p<0,001) and far distance between home and hospital (p=0,026). Consequences of occupational stress associated with burnout: Antecedents of specialty change (p=0,017) and desire to specialty change (p<0,001).

Medical residents in all specialties are at risk of burnout. Nevertheless, it is shown that some specialties are more exhausting, which is consistent with the results reported in the literature. This syndrome deserves to be studied further in junior doctors to develop appropriate means of preventions.