Le trouble bipolaire est une pathologie chronique qui nécessite la mise en place de stratégies non médicamenteuses éducatives [2]. Récemment, le concept de Serious game (jeu sérieux) [1] a fait son apparition dans les programmes d’éducation thérapeutique [4]. BIPOLIFE®[3], programme d’information ludoéducatif sur le trouble bipolaire accessible sur Internet, a été développé afin de s’intégrer dans la panoplie psychoéducative. BIPOLIFE® consiste à faire évoluer son avatar au quotidien. Ce jeu est basé sur 3 cibles : les règles hygiénodiététiques, l’observance médicamenteuse, le recours au médecin/psychiatre.

Mise en place d’une étude pilote évaluant l’acceptabilité de BIPOLIFE® et son effet sur la connaissance de la maladie auprès de 63 patients bipolaires sur 3 semaines. Les patients ont été évalués avec l’échelle de connaissance du trouble bipolaire et une échelle d’acceptabilité de BIPOLIFE®.

BIPOLIFE® semble être mieux accepté par des jeunes (p = 0,011) et plus efficace sur des hommes (p = 0,043) ayant une moins bonne connaissance de la maladie initiale (p ≤ 0,001). La majorité des patients a rapporté en avoir tiré bénéfice sur leur vie quotidienne, leur connaissance ou leur gestion de la maladie. Les patients ont déclaré que BIPOLIFE® est à conseiller à des personnes souffrant de TB (32 %), à leur proche entourage (32 %) ou au grand public (16 %).

Notre étude montre que BIPOLIFE® est déjà un outil pertinent dans la prise en charge des patients bipolaires. Des études complémentaires sont nécessaires pour évaluer précisément sa place dans les programmes de psychoéducation.

Displaced refugee children with a history of war exposure are at risk of developing complex and severe forms of post-traumatic stress disorder (PTSD).

Search for the most relevant causal predictors of complex PTSD in a prospective cohort of Syrian refugee children living in informal settlements in Lebanon (N=1007).

A latent class unsupervised analysis was carried out to determine clusters with complex PTSD presentation at the follow-up assessment. A new exploratory causal discovering modelling approach was applied using 97 multilevel psychosocial variables as predictors (Biazoli et al., 2021). Associations between discovered candidate causal factors assessed at baseline with a presumed diagnosis of complex PTSD one year later were calculated using a multiple logistic regression model.

Several putative causal factors emerged: perceived social coherence of the neighbourhood (Positive Predictive Value increase: 1.22); impulsivity (1.25), self-efficacy (1.23) and depressive symptoms (1.15) at the parental level; positive home experiences (1.16) at the family level; and child-level factors such as being forced to work (1.22), being a victim of verbal or physical bullying (1.19), loneliness (1.17) and well-being (1.18). In further confirmatory multiple logistic regression analysis and after correction for multiple comparisons, verbal or physical bullying victimization (p=.005) and caregiver depressive symptoms (p=.0004) at baseline were associated with complex PTSD presentations one year later.

Our results support the need for a multi-level psychosocial care model to prevent psychological distress and promote mental health in refugee children. Specifically, our results suggest that programs tackling caregiver’s mental health and children’s exposure to violence might effectively prevent complex PTSD.

No significant relationships.

The authors have not supplied their declaration of competing interest.

No significant relationships.

The family of a child with a mental illness is a significant source for his support in harmonizing his development and achieving successful socialization.

The objective of the survey is to develop a psychoeducational program for parents.

Questionnaire “Parental attitude to children’s illnesses” (V.E. Kagan, I.P. Zhuravleva) Parents of 39 (22 mothers and 17 fathers) children aged from 3 to 6 with ASD - autism spectrum disorders (F84.01; F84.02; F84.11).

Parents of children with ASD often do not realize the morbid nature of changes in the children`s behavior and interpret them as spontaneity, pamperedness or even giftedness. Most parents underestimated the doctor’s recommendations for compliance with the treatment regime. Taking into account the parents` complaints and the difficulties of understanding the child`s problems, a psychoeducational course was developed, including 7 sessions: 1. acquaintance; 2. the concept of ASD, etiological factors, features of manifestation; 3. the role of the family in the treatment and rehabilitation process; 4. development of mental functions in children with ASD; 5. emotional development of children with ASD; formation of communication skills and social adaptation; 6. training organization and correctional and developmental classes for children with ASD; 7. summing up. The psychoeducational course is carried out in the form of group thematic seminars 7 meetings once a week for 1.5-2 hours. After completing the course, some families remain on individual psychological follow-up.

Completing a psychoeducational course makes it possible to fill the lack of information regarding the disease and treatment tactics, increases compliance and harmonizes parent-child relationships.

No significant relationships.

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

Covid-19 pandemic represents a sanitary crisis with social, economic and political negative impacts. Studies had well established the link between stress and the display or maintenance of addictive behaviour. Measures like social distancing and confinement imposed by governments during this pandemic, could explain an outbreak of internet addiction cases.

Assess the prevalence of internet addiction in times of the covid-19 pandemic and to study its relationship with personal and family factors but also with the psychiatric comorbidities.

We conducted a cross sectional analytical study during the period of the covid-19 pandemic, using an internet survey exploring socio-demographic and clinical data: through Hamilton depression and anxiety rating scale and the Rosenberg self esteem scale. The assessment of internet addiction was carried out using Young’s Internet Addiction test.

Our study included 150 users, the average age was 36 years, mainly made up of women, married, having children, with a good socioeconomic level and of university education. The prevalence of depressive and anxious symptoms were respectively 7.3% and 18.7%. The prevalence of internet addiction in our study was 9.4% including 0.7% having severe repercussions. Being married (p<10-3) and having children (p=0.006) were considered as protective factors against internet addiction. People having an internet addiction were at bigger risk of having low self esteem (p=0.023), depressive (p=0.04) and anxious symptoms (p<10-3).

Internet addiction is a new concept, though it’s impact on the well being is well established and it’s likely to worsen in times of pandemic. Therefore, it’s necessary to take preventive measures to deal with it.

No significant relationships.

Progressive hepatolenticular degeneration or Wilson's disease is a rare autosomal recessive genetic disorder of copper metabolism, which is characterised of hepatic and neurological disorders due to the accumulation of copper in organs such as the liver or the basal ganglia. The manifestations of Wilson's disease are multiple and sometimes insidious, which makes the diagnosis very complicated.

A clinical case was followed and reviewed to illustrate the psychiatric symptoms in Wilson's disease.

A 23-year-old male came to the emergency room presenting insomnia, logorrhea, euphoria, irritability and a slight tremor in the upper limbs. Symptoms started two weeks before. The previous year, he was diagnosed of bipolar disorder after a manic episode which required inpatient treatment with risperidone and lithium. During the actual hospitalization, the tremor increased progressively and affected all four limbs and his head. He was then examined by neurology and an ophthalmology service, who ordered some specific complementary exams. Low levels of ceruloplasmin and serum copper and high levels of urinary copper confirmed the diagnosis of Wilson's disease. Treatment with copper chelants was introduced and the psychiatric symptoms and the analyses got better in several weeks.

Even a typical presentation of a psychiatric syndrome can be part of the spectrum of an organic illness. So an organic etiology should always be considered in the differential diagnosis, as sometimes it is possible to be treated.

We present the case of a 54-year-old man diagnosed with mixed histrionic / obssesive personality disorder admitted in a long-stay hospital. Symptoms began at 40 years of age, predominantly anxiety and agoraphobia alongside somatic complaints. During his admission, the symptoms markedly fluctuated. The patient alternated periods in which he presented confusion with others of irritability, disinhibition, and stereotyped movements. Moreover the patient spent long periods of time in bed with little or no communication with other patients or staff.

The different pharmacological approaches which were carried out and their consequences are analyzed.

It is a common practice to increase the number of prescribed drugs or their doses when symptoms worsen. The result is polymedication and higher doses above maximum levels in the technical sheet. Reducing medication is rarely considered as a strategy.

A case report is presented alongside a review of the relevant literature regarding different long-term pharmacological treatments and their side effects.

The suspension of the antipsychotic treatment which had been administered for years represented a significant improvement. Withdrawal of Olanzapine resulted in a significant improvement.

It is important to review the prescription of each medication in time, as well as to consider their possible side effects.

No significant relationships.

Bipolar disorder (BD) and borderline personality disorder (BPD) appear as prevalent psychiatric conditions, with both being associated with increased morbidity and elevated suicide rates.

Borderline personality disorder is characterized by emotional instability and impulsivity, and patients are susceptible to dangerous behaviors such as unsafe sexual behavior, eating disorders and substance abuse. On the other hand, mania in BD patients contributes to impulsivity, hypersexuality and poor judgment, as well as a lack of inhibition. In both cases, individuals are at a higher risk of committing suicide due to emotional dysregulation and impulsive behaviours.

The symptomatic overlap in BPD and BD is prone to discussion and may lead to misdiagnosis. Some studies suggest that BPD and BD may lie on a spectrum, while others advocate them as separate entities that may coexist.

To explore the clinical challenges associated with both the differential diagnosis and the comorbidity of BD and BPD.

We performed a non-systematic review of the literature using the database PubMed and the following keywords: bipolar disorder borderline personality disorder comorbidity

Patients with borderline personality disorder seem to have significantly greater odds of a previous bipolar misdiagnosis, but no specific borderline criterion was shown unique in predicting this outcome.

Nonetheless, research studies have reported that approximately 20% of BPD were also diagnosed with BD and, similarly, 10% of people with BD I and 20% with BD II were diagnosed with BPD.

Comorbid BPD and BD are associated with marked psychosocial disability, with patients being more impulsive and aggressive than those with BPD and BD alone. They are also highly susceptible to anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatoform disorders. Studies have shown that comorbid BPD has a negative impact on the clinical course of Bipolar Disorder, as the patients have an unfavorable illness trajectory, with earlier onset of mood symptoms,higher likelihood of hospitalization, longer treatment duration and worse response to treatment. They are also at higher risk for depression and persistent unemployment, increased risk drug abuse, higher suicide risk, and greater utilization of ECT, compared to patients with BPD or BD alone.

A careful review of the patient’s history must be done to properly distinguish between BPD and BD and to make the right diagnosis. Further studies are needed to clarify the risk factors associated with the comorbidity between these two disorders, in order to develop effective clinical strategies for optimal outcomes for patients with both disorders, improve their clinical course and prevent the increased risk of suicidality.

None Declared

Suicide is a global issue among the elderly, but few studies have explored the experiences of suicide ideation in older Asian psychiatric outpatients.

The purposes of this study were to explore triggers of suicide ideation among older first onset cases in psychiatric outpatients in Taiwan and their reasons for not executing suicide.

Older psychiatric outpatients (N=24) were recruited by convenience from one medical centre and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis.

Suicide ideation was triggered by illness and physical discomfort, conflicts with family members/friends, illness of family members, death of family members/friends, and loneliness. Participants’ reasons for not executing suicide were family members’ and friends’ support, receiving treatment, finding a way to shift their attention, fear of increasing pressure on one’s children, religious beliefs, and not knowing how to execute suicide.

Understanding these identified triggers of suicide ideation may help psychiatrists open a channel for conversation with their elderly clients and more readily make their diagnosis. Understanding these identified protective factors against executing suicide can help psychiatrists not only treat depression, but also enhance protective factors for their clients.

Depression is a pervasive and debilitating mental health disorder that affects millions of individuals worldwide. Despite the availability of various treatment modalities, a significant proportion of patients continue to experience inadequate symptom relief and persistent emotional suffering. Sleep disturbance is a common symptom of depression, and emerging evidence suggests that manipulating sleep patterns through sleep deprivation may hold potential therapeutic benefits. This literature review aims to explore the role of sleep deprivation as an adjunctive treatment for depression, shedding light on its mechanisms and potential outcomes.

To investigate the historical context and theoretical underpinnings of sleep deprivation in depression treatment; to examine the methods and protocols used in studies involving sleep deprivation as a therapeutic intervention for depression; to analyze the empirical evidence regarding the efficacy of sleep deprivation in ameliorating depressive symptoms; to assess the safety and feasibility of implementing sleep deprivation in clinical practice; to discuss the potential mechanisms underlying the antidepressant effects of sleep deprivation.

A systematic review of the literature was conducted.

The review identified a diverse body of literature exploring the potential benefits of sleep deprivation in depression treatment. Preliminary findings suggest that acute sleep deprivation may lead to rapid and transient improvements in mood among individuals with depression. Various protocols, including total and partial sleep deprivation, have been investigated, demonstrating differential effects on depressive symptoms. Additionally, potential mechanisms underlying these effects, such as alterations in neurochemical pathways and circadian rhythms, have been proposed.

Sleep deprivation as an adjunctive treatment for depression is a promising but complex intervention that requires further investigation. While some studies have reported significant improvements in mood following sleep deprivation, the sustainability of these effects and the potential long-term consequences remain uncertain. Moreover, the optimal protocols, safety guidelines, and patient selection criteria need to be established for clinical application. Future research should focus on elucidating the mechanisms involved and conducting well-designed randomized controlled trials to determine the efficacy and safety of sleep deprivation in the context of depression treatment. This review underscores the importance of considering sleep as a modifiable factor in the comprehensive management of depression.

None Declared

Alcohol consumption is a widespread behavior across Europe. It can adversely influence health on a biopsychosocial level, being the leading cause of mortality among young adults. Gender differences regarding drinking patterns are supported by a strong evidence base.

To investigate gender differences regarding drinking patterns of Greek young adults.

207 Greek young adults participated in the study, 75 (36.2%) males and 132 (63.8%) females, with a mean age of 29. Analysis of data was conducted with t-test and chi-square, using SPSS software.

The findings showed clear differences among the two genders with regards to their drinking patterns. Males consumed more alcohol compared to females (t: 3.122 p<0.01), consuming on average 18.64 alcoholic drinks per month compared to 9.80 drinks per month on average for women. Men were also more likely to engage in binge drinking behaviour (x2:18.493 p<0.001), with 13.3% of men (N=10) reporting engaging at least once in heavy episodic drinking. There were also clear differences regarding the preference of alcoholic beverage (x2: 19.967 p<0.01), with men preferring beer (N=27(36%)) and women wine (N=63(47.7%)), over other beverages. There were no differences among the two groups with regards to their drinking motivations (x2: 2.704 p=NS), with most of the participants reporting social drinking motivations.

The results of this research are generally consistent with previous literature on this subject. Further studies on this population could concentrate on gender differences regarding the health effects of alcohol in Greek young adults.

Gynecomastia refers to the abnormal development of breast tissue in males, often posing a concerning symptom. Often, gynecomastia is associated with multiple factors, including the use of various drugs, notably certain atypical antipsychotics. Gynecomastia is a significant side effect that affects the quality of life of male patients taking antipsychotic medications. Among these, risperidone and paliperidone have been identified as the most prone to causing gynecomastia, although aripiprazole has garnered attention for its superior profile in controlling prolactin and gynecomastia. The relationship between these drugs and the development of gynecomastia lies in their ability to elevate prolactin levels, a hormone that regulates reproductive function and is involved in milk production. Several studies have shown that prolactin levels are more commonly elevated with risperidone and paliperidone prescription, thus triggering gynecomastia.

The study aims to investigate the management of gynecomastia in male patients receiving antipsychotic medications.

This research employs a retrospective analysis of patient records to examine the association between specific antipsychotic drugs, prolactin levels, and the development of gynecomastia, while also evaluating the effectiveness of aripiprazole as an alternative treatment.

We present the case of a 21-year-old male with no prior medical history who initiated treatment with oral paliperidone and later switched to 100 mg of long-acting injectable paliperidone once monthly during his initial admission for psychotic symptoms. After six months, he developed gynecomastia, which was ruled out as breast tissue and was determined to be an increase in adipose tissue. Since his hospital discharge, he has gained 25 kg (30%) in body weight, and his baseline prolactin level has decreased. This weight gain, a common side effect of several antipsychotics, was linked to gynecomastia. However, a promising approach for gynecomastia antipsychotic-associated treatment is aripiprazole, which has a milder impact on prolactin levels. In this case, during the next appointment, a switch to 400 mg of long-acting injectable aripiprazole once-monthly was made, which led to weight loss, a reduction in breast size and blood prolactin levels in the following weeks.

The detection and management of gynecomastia in these patients are crucial to improving their quality of life and treatment adherence. This management encompasses changes in medication, hormonal therapy, or surgery in severe cases. Physicians must be aware of this potential complication when prescribing antipsychotics and closely monitor at-risk patients. In summary, antipsychotic-associated gynecomastia in men represents a medical challenge that requires careful attention and an individualized treatment strategy for each affected patient.

None Declared

Bipolar disorder is a frequent condition in the general population with a high morbimortality, which consists in dysfunctional temporal fluctuations between different mood phases during which frequently there is a lack of insight. Besides the pharmacological treatment, psychoeducational programs have proved to be a cost-effective approach to help patients recognize early signs and symptoms in order to prevent full-blown episodes, although its broad implementation is still difficult and costly [1].

The main aim of this study is to develop and clinically validate a smartphone application to monitor symptoms and signs in stable bipolar patients along with customized embedded psycho-education contents and empower the self-management of their disorder to avoid relapses and hospitalizations.

The study will be carried out in three different but complementary phases in order to fully include patients and therapist's preferences: 1. Feasibility study using SIMPLe 1.0 app (subjective information only). 2. Feedback-based improvement process which will incorporate the objective information. 3. Randomized controlled trial with two arms of 74 patients each (SIMPLe 2.0+TAU vs. TAU).

After the collaborative development of clinical algorithms to ensure adequate sensibility and specificity to detect relapses and personalize psychoeducational messages, a technical pilot test of SIMPLE 1.0 app is underway and the first patients are being recruited to start the 1st phase of the study in Mid-October of 2014.

The possibility to deliver personalized psychoeducation contents based on monitoring signs and symptoms through a smartphone seems a promising cost-effective method, although a clinical validation is necessary.

Frontotemporal Demential (FTD) is a neurodegenerative disorder evolving the frontal or temporal brain lobes. They have been described six variants. Behaviour variant (BvFTD) is the most common, and is characterized by changes in social behaviour and conduct, with loss of social awareness and poor impulse control. Hebephrenic schizophrenia (HSz), or disorganized schizophrenia, was recognized as a schizophrenia subtype, characterized by desorganized behaviour and a cognitive deteriorization. Subtypes of schizophrenia are no longer recognized as separate conditions neither in the Diagnostic and Statistical Manual of Mental Disorders, nor in the new International Statistical Classification of Diseases.

To review the literature about the concepts of hebephrenic schizophrenia and their similarities with the concept of frontotemporal dementia

Narrative review of the literature on PubMed/MEDLINE, using the keywords “hebephrenic szchizophrenia” AND “frontotemporal dementia”. Only articles in English were included.

Some authors described dificulty in establish a diferential diagnosis between HSz and BvFTD. HSz has an earlier onset. However, BvFTD is an early age dementia. The fenomenology of both diseases is similar, and schizophrenia was historical conceptualized as praecox dementia. Frontotemporal abnormalities are common neuroimagiological findings in schizophrenia. Clinically, FTD shows a profound alteration in personality and social conduct, emotional blunting and loss of insight. Memory, intellectual functions, executive and attentional abilities may be disturbed in both.

A diferential diagnosis between HSz and BvFTD is dificult to establish (clinically and imagiologically). The response to treatment is weak in both. It should be investigated the possibility they could be the same syndrome, onseting in diferent ages.

No significant relationships.

In the past decade, millions of Syrians have sought refuge in neighboring countries and Europe. Refugees are at increased risk for the development of common mental disorders (CMD), such as depression and posttraumatic stress disorder (PTSD), but only a small percentage access mental health services. Problem Management Plus (PM+) is a brief, scalable intervention targeting symptoms of CMDs that can be delivered by non-specialist helpers in communities affected by adversity, such as refugees.

The aim of this randomized controlled trial (RCT) is to evaluate the effectiveness of PM+ among Syrian refugees in the Netherlands.

Adult Syrian refugees and other Arabic-speaking refugees of 18 years and older with self-reported psychological distress (K10 >15) and functional impairment (WHODAS 2.0 >16) are included. Participants are randomized into PM+ or care as usual. Follow-up assessments are conducted at one-week, three-month and twelve-month follow-ups. Clinical outcomes are symptoms of depression/anxiety (HSCL-25), PTSD (PCL-5), and functional impairment (WHODAS 2.0).

By November 2021 [recruitment ends by December 2021], 214 participants were screened for eligibility and 184 participants were included. Participants are M=36.5yrs old (range 18-69yrs), and 73 participants are female (39.7%). We will present preliminary results for the effects of PM+ on depression, anxiety, PTSD, and functional impairment at one-week follow-up, as well as barriers and facilitators for implementing PM+ in a European country.

After positive evaluation of peer-refugee delivered PM+, the Arabic manual and training materials will be made available through WHO to encourage scaling-up.

No significant relationships.