Today's, families of individuals with bipolar disorders are actively participating in the care of their relative. Successful management of bipolar disorder in the community relies significantly on family caregivers. The need and experiences of such caregivers have been little studies with respect to bipolar disorder.

The aim of the study was to identify of family caregivers needs of patients with bipolar disorder.

In a qualitative research of phenomenological methodology, the family member’s caregivers of bipolar disorder in farshian psychiatric hospital in Hamedanl were selected by purposive sampling in the year 2010. By reaching data saturation the number of participant was 12. Data were gathered through in-depth interviews and analyzed by “Van manen” method.

Five main themes were identified in this study analysis: educational needs, consult needs, economical needs, care and nursing needs and supports needs.

Identified the need of family member caregiver with bipolar disorder patient for mental health services to be helped and to identify the specific caring interventions that are effective in helping to sustain family caregiving.

Instruments for diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in childhood are well validated and reliable, but psychometric assessment of ADHD in adults remains problematic. To date the Conners Adult ADHD Rating Scales (CAARS) are frequently used in the assessment of ADHD.

The CAARS were translated into German and a series of studies planned to establish psychometric properties of the CAARS-self and -observer rating scales.

To evaluate the German version of the CAARS.

We recruited 847 healthy German subjects and 466 adult ADHD patients to fill out the CAARS-self report and questions on socio-demographic variables. Additionally, 896 CAARS-observer reports were filled out by significant others and clinical experts. Factor analyses were conducted to obtain factor structure and to replicate the structure of the original American-model. Comparisons between patients and controls, and analyses on influences of gender, age, and education level were calculated. Additional analyses established psychometric properties.

Confirmative factor analysis based on the original American-model showed a high model-fit for both the German healthy control and the adult ADHD patient sample. Analyses of normative data showed significant influences of age, gender, and education level on the emerging subscales for the control sample only. Differences on all subscales were highly significant between patients and controls. Test-, test-retest-reliability was very high, and criterion validity could be established with DSM-IV based clinical interviews. Sensitivity and specificity ratings are overall very satisfying.

The German version of the CAARS is a cross-culturally valid instrument for the assessment of adult ADHD.

Recent research on the obsessive-compulsive disorder (OCD) has emphasis on the moderating effects of the brain behavioral mechanisms.

The main purpose of this research was to examine the Gray's brain behavioral systems (1994) among the obsessive-compulsive disordered patients.

My aim of this research was to examine the Gray's brain behavioral systems (1994) among the obsessive-compulsive disordered patients.

Participants were included 20 obsessive-compulsive patients and 20 normal individuals who were selected respectively by available sampling and counter balance sampling methods on the basis of the age, sex and education variables. The average of participant's ages was 29/85 (SD = 7/37). All subjects were completed the Gray-Wilson Questionnaire and data were extracted for the three systems of BAS, BIS and FFS and also for its six measures of approach, active avoidance, passive avoidance, extinction, fight and flight separately.

A multivariate analysis of variance, for comparing six measures of the Gray-Wilson questionnaire were shown significantly differences for Behavioral Activation System (BAS) and also for Behavioral Inhibition System (BIS). Pairwise comparisons were shown a higher Behavioral- Inhibition system (BIS) and a lower Behavioral- Activation system (BAS) in obsessive -compulsive patients than normal individuals. No significant difference was found for Fight- Flight system (FFS).

These results were suggested higher BIS and lower BAS activity as moderator of OCD. This results supported the reinforcement sensitivity theory (RST) conveying a higher tendency to the punishment and elimination of the reward in anxious person as a consequence of Behavioral-Inhibition System (BIS).

Violence against professionals has been long documented as a source of stress and post traumatic stress. Interestingly, whereas the effects of violence directed at medical staff have been studied extensively, the frequency of exposure and effects on other practitioners of the helping professions has been scarcely studied.

To present the scope of the problem, frequency, and the moderating role of trust on the levels of PTSD experienced by the exposed practitioners.

A sample of 645 practitioners in social services in Israel. The instrument included the Client Violence Questionnaire, PTSD and related somatic symptoms.

80% of the practitioners were victimized in at least one form of violence over the last 3 months including verbal abuse, threats, vandalism, and/or physical violence. Positive association was found between each type of abuse and PTSD reactions. Interestingly, trust among team members has shaped the relationships between exposure to violence and PTSD reactions (moderating variable). Higher levels of trust were associated with lesser exposure on the one hand, yet higher levels of trust were also associated with higher correlation between exposure and PTSD.

Trust in team seems to serve a dual function. On the one hand, it serves as a buffer, reducing the odds for exposure to violence. On the other hand it increases the negative effects of exposure - when such occurs. In other words, trust in team may be associated with higher trust in clients, a factor that reduces the anticipation of violence, and thus increases its negative effect.

Several studies have asserted the existence of a strong and complex genetic component

in the determination of psychotic disorders. However, the genetic architecture of these disorders remains poorly understood. GWAS studies conducted over the past decade lead to the identification of only a few low effect associations, and the major part of this heritability remains unexplained, thus calling questioning the hypothesis of «common disease - common variants » for a model involving a large number of rare variants.

Here, we studied a multigenerational multiplex family in which co-exist psychotic and mental retardation disorders and a high rate of consanguinity, located in the northwest of Algeria. This study aims to identify inherited rare variants of schizophrenia and mental retardation.

This family have received complete clinical (DIGS, DSM-IV creteria) and genealogical investigations and whole exomique sequencing WES (by GAIIx Illumina / HiSeq 2000) that were performed in the departement of genetics in the university hospital of Geneva.

07 individus (02 parents and 05 siblings) has been analyzed. The parents were healthy. In siblings, 02 individus had schizophrenia diagnosis, 01 individu had mental retrdation, 01 had both schizophrenia and mental retardation diagnosis and 01 was healthy. Recessive model was retained in this family. For schizophrenia, WES have identified new rare mutations in known genes: rs17057255 (EPHX2), MAF=3%, rs35337118 (SPZ1), MAF=10%, rs2259633 (CCDC67), MAF=17%.

In total, these highly informative family have identified new genetic variants of schizophrenia. The search for these mutations in contol population in north west of algeria and a wider population of affected individuals with schizophrenia would be useful to validate these data.

To determine clinical-dynamic characteristics of combat-related PTSD for best understanding etiologocal and pathogenesis bases in mentioned category.

478 male combatants aged 22–43 y.o., observed in 1993–2008 years.

Clinico-psychopathological; quality of life self-evaluating scales, IES-R and statistical.

According to ICD-10, only one diagnostical category - “reaction to hard stress and adaptation disturbance”- is identified as having explicit etiological connection with psycho-traumatic extraordinary impact. Negative mental symptomatology in combatants is reflected there as “chronical personality changes after catastrophe”.

Contrary to “classical” position personality change may be its chronical outcome and the diagnosis should be stated not only after 2 years. That's why the period of urgent adaptation is characterized by regressive, ontogenetically more early forms of reacting; conscience disintegration.

Appearance of more prolonged and more specifical PTSD symptomatology reflects pathoplastic later development.

PTSD can be understood as a transforming reactive process, fixating in memory traces new behavioral stereotypes. Specifical adaptation in military conditions happens because of cortical behavior control's depression and deep-undercortical philogenetically old vital affects releasing (as the biological base). Positive PTSD symptomatology in combatants are repeated memories about psychotrauma, often transform into obsessive-phobic complexes. In case of increased cortex inhibition impulsive behavior's motives are formed. Initial war stress is complicated by the necessity to adapt to usual conditions and it often becomes a basis for behavioral deviations. That's why we should consider the treatment and rehabilitation of such persons one of the priority medical and social tasks in XXI century.

Vortioxetine has demonstrated sustained efficacy and favorable safety profile in multiple clinical trials.

This study aims to describe the effectiveness and safety of vortioxetine in real-world clinical practice.

RELIEVE is a prospective, multi-national, observational cohort study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion and followed for 6 months. Data were collected at routine clinical visits. The primary outcome was functioning measured by Sheehan Disability Scale (SDS). Depressive symptoms measured by Patient Health Questionnaire 9-item (PHQ-9), cognitive symptoms measured by PDQ-5 and DSST were key secondary outcomes. Safety outcomes including adverse events were reported. This interim analysis presents results of 527 patients who completed the study and were followed for 6 months. Mixed models of repeated measures were used to assess improvements between baseline and month 6, adjusted for relevant confounders.

A total of 527 patients (mean age, 50.2 years, 65% female) were enrolled from US, Canada, France and Italy, and included in the analysis. Mean SDS total score, PHQ-9, PDQ-5 scores decreased by 8.6, 7.4 and 4.7 respectively from baseline to last visit. Mean DSST score improved by 6.5 from baseline to last visit. Patients’ overall functioning and quality of life significantly improved, sick leave days and underproductive days (both absenteeism and presenteeism) decreased over the entire follow up period. The overall incidence of adverse events(AE) was 25%, with the most common AEs being nausea and headache.

The results confirm the effectiveness and good tolerability of vortioxetine in a broad range of patients in routine clinical practice.

Dr. Mattingly has served as researcher, consultant or speaker for Akili, Alcobra, Alkermes, Allergan, Axsome, Boehringer, Forum, Genentech, Jansen, Lundbeck, Medgenics, Merck, Neos, NLS Pharma, Otsuka, Reckitt Benckiser, Roche, Sage, Shire, Sunovion, Supe

Clozapine is an atypical antipsychotic medication which is mainly used in cases of treatment-resistant schizophrenia. Although it has several advantages over other typical and atypical antipsychotic medication, such as fewer relapses and lowering the risk of tardive dyskinesia and suicide it also has a range of adverse effects which makes compliance an issue for many patients.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis clinically characterized by painful pustules or nodules that rapidly evolve in ulcers with violaceous, undermined borders and raised periphery. The etiopathogenesis of the disease remains unclear, however PG is usually manifested in the setting of an underlying immune-mediated disease, more commonly inflammatory bowel disease, rheumatoid arthritis and haematological malignancies.

Nevertheless, in the literature there are scarce reports of drug-induced PG.

We present the case of a 56-year-old woman with a diagnosis of refractory schizophrenia on clozapine treatment for 4 months, who was admitted to the emergency department for a skin eruption localized on the trunk, genital area and extremities. The clinical examination revealed numerous, discrete erythematous macules, papules and plaques with central necrosis, and multiple, sharply marginated ulcers with undermined, red to purple border. Further physical examination disclosed no systemic findings and laboratory analyses and skin biopsy were performed.

On work-up, white blood cell count and C-reactive protein (CRP) were elevated, while blood and pustule cultures were negative. Histologic examination revealed dermal necrosis and inflammation, features consistent with the diagnosis of PG. The pathergy test was positive.

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Pyoderma gangrenosum is a rare autoinflammatory skin disorder of unknown etiology. The pathogenesis of the disease is not well understood, but drug-induced PG is considered to result from neutrophil dysfunction and dysregulation of the inflammatory response. Cases of drug-induced PG are rare and attributed to certain drugs. Clozapine is an antipsychotic medication for the treatment of refractory schizophrenia. It is suggested that clozapine alters plasma TNF-α levels and thus can modulate the inflammatory response. To date, a variety of adverse skin reactions (Stevens- Johnson syndrome, DRESS syndrome etc) have been previously described in the literature. However, to the best of our knowledge, this is the first case which strongly indicates the likely association between clozapine and drug-induced PG.

None Declared

Studies have shown ethnic inequalities in health, with a higher incidence of illnesses among people of some minoritised ethnic groups. Furthermore, it has been observed that people with severe mental illnesses have a higher risk for multimorbidity. However, no study has investigated ethnic disparities in comorbidity in people with a schizophrenia spectrum disorder.

This study investigates potential ethnic disparities in physical health comorbidity in a cohort of people with psychosis.

Using a cross-sectional design, we identified service-users of the South London and Maudsley NHS Trust who were diagnosed with a schizophrenia spectrum disorder between 2007 and 2020. We assessed the prevalence of asthma, bronchitis, diabetes, hypertension, low blood pressure, overweight or obesity, and rheumatoid arthritis. Latent class analyses were used to investigate distinct profiles of comorbidity. Multinomial regression was then used to investigate ethnic disparities in these profiles. The regression model was adjusted for gender, age, neighbourhood deprivation, smoking and duration of care.

On a sample of 23,418 service-users with psychosis, we identified two classes of comorbidity: low comorbidity and multiple comorbidities. Compared to the White British ethnicity, a higher risk for multiple comorbidities was observed for people with any Black background, Indian, Pakistani, Asian British, and mixed-race ethnicities. Furthermore, Black African women had a significantly higher risk for multiple comorbidities than their male counterparts.

Ethnic disparities are observed in multiple comorbidities among people with psychosis. Further research is needed to understand the impact of these disparities, especially in relation to mortality.

No significant relationships.

Risperidone, a second generation antipsychotic, shows high affinity with serotoninergic and dopaminergic D2 receptors, but also adrenergic and H1 histaminergic receptors. Previous studies have shown an increase in eosinophile count associated with the second-generation antipsychotics through the histaminergic path.

The presentation of a case in which eosinophilia was associated with risperidone withdrawl which has not been described so far.

A 46-year-old woman with schizophrenia diagnosed at the age of 22 was admitted in our inpatient psychiatric clinic with psychotic symptoms relapse after she voluntarily discontinued risperidone. The patient was fully evaluated with full laboratory tests, a brain CT scan, EEG and her medical and psychiatric histories were recorded.

Risperidone was reinitiated but due to the persistence of symptoms it was switched to clozapine which lead to full remission. It was observed though, that while gradually decreasing risperidone dosage (Figure 1.), eosinophile count was raising and it was normalized after complete discontinuation. Eosinophilia was also present in other instances that the patient discontinued taking risperidone according to her personal history. Other causes of eosinophilia (allergic, inflammatory) were fully excluded.

Risperidone discontinuation could lead to an elevated eosinophile count. There is limited research in this topic and it is yet to be clarified whether the elevation is due to stopping one antipsychotic or switching between two different antipsychotics. It is important to run laboratory tests regularly with every treatment modification.

No significant relationships.

Hyperhidrosis, the excessive and uncontrollable sweating, is a well-documented side effect of various medications. Among these, bupropion, a commonly prescribed antidepressant and smoking cessation aid, has been associated with the development of severe hyperhidrosis in a subset of patients. This clinical report aims to shed light on a compelling case of severe hyperhidrosis induced by bupropion use and the subsequent treatment strategies employed

The patient under discussion is a 42-year-old female with a history of recurrent major depressive disorder and a previous favorable response to selective serotonin reuptake inhibitors (SSRIs). Due to side effect concerns and a desire to quit smoking, she was transitioned to bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), at a standard therapeutic dose of 150 mg daily.

Approximately four weeks after initiating bupropion therapy, the patient began experiencing debilitating symptoms of excessive sweating, particularly affecting her palms, soles, and axillae. The profuse sweating episodes occurred throughout the day and night, significantly impairing her quality of life, social interactions, and occupational functioning. No previous history of hyperhidrosis was reported, and physical examinations revealed no underlying medical conditions or dermatological issues.

To aknowledge the importance of recognizing and addressing medication-induced side effects within the realm of psychiatry and an early implementation of patient-centered treatment.

Clinical case report and a brief literature review.

The treatment of hyperhidrosis secondary to bupropion use presents a challenging clinical scenario that requires a delicate balance between managing the distressing side effect and ensuring the continued efficacy of psychiatric therapy. Given the rarity of severe hyperhidrosis as a side effect of bupropion, there is a limited body of evidence guiding treatment strategies. Gradual withdrawal in the dose of bupropion was initiated, with careful monitoring of depressive symptoms to prevent relapse, switching to Duloxetine 90mg daily, with adecuate efectiveness.In this particular case, the combination of medication adjustment and psychological support led to a significant reduction in hyperhidrosis symptoms. The patient reported improved social interactions, enhanced self-esteem, and restored occupational functioning. Importantly, her depressive symptoms remained well-managed, underscoring the success of the treatment strategy.

This clinical report highlights the importance of a patient-centered approach when addressing rare medication-induced side effects within the field of psychiatry. Bupropion withdrawal and regular follow-up showed effective in the treatment of the simptoms. Future research may provide additional insights and treatment options for cases like this, further enhancing patient care and outcomes.

None Declared

With measures of COVID-19, activities that cover a large part of life have started to be carried out via videoconferencing. Videoconferencing can be disadvantageous for individuals with social anxiety due to increased social presence, decreased mutual understanding and consequently causing awkward communication.

This study aims to develop a scale to explore the difficulties experienced by individuals with social anxiety during videoconferencing.

598 children and adolescents between the ages of 11-18 participated in the study. The data were collected with Sociodemographic Information Form, Videoconference Anxiety Scale and Liebowitz Social Anxiety Scale.

According to correlation analysis, all correlations between Videoconference Anxiety Scale and Liebowitz Social Anxiety Scale total score and subscale scores are above 0.50. According to EFA, the scale consisted of 25 items and a single factor. Factor loads were between 0.62 and 0.81, the single factor explained 52.95% of the variance. Model fit indices after CFA were as follows: X2/df:3.360, GFI:.850, IFI:.900, TLI:.890, CFI:.900, RMSEA:.078, SRMR:.0475. Convergent and discriminative validity of the scale was tested. Standardized factor loads of all items were higher than 0.50. AVE value was 0.47, while CR value was 0.96. Cronbach’s alpha coefficient of 25-item VAS is 0.96.

This study showed that Videoconference Anxiety is a phenomen which is higly correlated with social anxiety and Videoconference Anxiety Scale is a valid and reliable instrument for Turkish children and adolescents.

No significant relationships.

Lying can be defined as stating a deliberate falsehood with the intent to deceive. It is part of our everyday life but it can be pathological, without motivation and a symptom of psychiatric illness. Although pathological lying has been debated for a century, it remains a controversial issue in Psychiatry.

We aim to perform a review regarding pathological lying and related issues.

We performed an updated review in the PubMed database and GoogleScholar using the terms “pathological lying”, “compulsive lying”, “mythomania” and “pseudologia fantastica”. The included articles were selected by title and abstract. We also consulted reference textbooks.

We described the difference between normal and pathological lying and debated the different types of pathological lying, such as compulsive lying, mythomania and pseudologia fantastica.

Recognizing lying is crucial for a skilled patient interview and distinguishing between pathological and non pathological lying may be decisive for an accurate differential diagnosis.

Heart failure is a progressive and unpredictable heart disease. How to work with these patients to decrease their psychological distress and promote their self-care behaviors is important. Transition care is the continuity of medical care for heart failure patients returning home from the hospital. Intervention through transition care may improve the continuity of medical care for patients with heart failure but it has not been examined in clinical settings in Taiwan.

The aims of this study were to explore the effects of a newly developed transition care program on depression, self-efficacy, and self-care behavior of heart failure patients.

Using an experimental research design and block randomization, participants were divided into the experimental group (received transition care and routine care) and the control group (received routine care only). The Patient Health Questionnaire-9 (PHQ-9), the General Self-Efficacy Scale (GSES), and the Self-Care of Heart Failure Index (SCHFI version 6.2) were used to collect data before discharge and the first month after discharge.

A total of 20 patients with heart failure were recruited. No significant differences were found between the experimental (n=10) and control groups (n=10) in the degree of depression (Z=-.077, p=.938), self-efficacy (Z=-1.214, p=.225), and three self-care behaviors subscales (self-care maintenance Z= -1.214, p=.225; self-care management Z= -.401, p=.689; self-care confidence Z=-.436, p=.663) at discharge. After the one-month posttest, only self-efficacy (Z=-2.545, p=.011) and three self-care behaviors subscales (self-care maintenance Z=-3.097, p=.002; self-care management Z= -2.595, p=.009; self-care confidence Z=-3.671, p<.001) reached a statistical difference between the two groups.

Based on the preliminary results, heart failure patients can improve their self-care behavior and self-efficacy but not depression through transitional care intervention.

None Declared

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.