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.

The prevalence of mental disorders is considerably higher among incarcerated individuals than in the general population, but this burden is not matched by a proportional use of mental health services. Studies have found that incarcerated males are reluctant to seek help for mental health problems. Gaining knowledge of factors that influence incarcerated individuals to access or avoid professional help for mental health problems is important for tailoring interventions to address the mental health needs of this population. Promoting mental health service utilization among people in prison has the potential to reduce prison suicide rates and increase institutional functioning, thereby providing safer conditions for peers and staff, promoting rehabilitation, and reducing recidivism upon release.

This study explores personal, interpersonal, and systemic aspects that motivate incarcerated individuals to approach or avoid seeking help for mental health problems. While prior studies have primarily focused on barriers to help-seeking, this study also sheds light on facilitators for seeking professional help for people in prison.

Individual in-depth interviews were conducted with sixteen incarcerated males from three prisons in Northern Norway. The data analysis was inspired by Grounded Theory.

The majority of participants shared positive personal perspectives related to professional help-seeking, whereas the barriers were predominantly perceived to be of an interpersonal and systemic nature. Aspects that encouraged help-seeking were: regarding mental health treatment as necessary for successful rehabilitation, sufficient knowledge of when and how to contact mental health services, support from peers, having a higher ranking in the prison hierarchy, health services that are out-reaching, and prior positive experiences with professional help. The barriers to professional help-seeking were: lack of information about when and how to access mental health services, challenges with the self-referral system, perceived unavailability of services, confidentiality issues, and a prison climate that favoured a tough appearance.

The participants appeared to be more positive to seeking professional help for mental health problems than reported in previous studies with incarcerated individuals. Interpersonal and systemic aspects were emphasized by the participants as barriers to accessing mental health services; some participants even perceived these services to be unavailable to them. The results are relevant for designing interventions to promote help-seeking for mental health problems among people in prison.

None Declared

Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry and anxiety about several activities or events. Although some cognitive symptoms are common in GAD patients, there are still controversial results from their linkage. Some studies indicate intact cognitive functions in GAD patients, while others suggest that anxiety and its cognitive aspect, worry, are associated with reduced performance in several cognitive domains.

To assess the linkage and contribution of cognitive impairment to the maintenance and severity of GAD; to determine which specific domains of cognitive function are impaired in patients with GAD; and to examine age differences regarding cognitive impairment in GAD patients

A systematic literature search was executed using the PubMed and Google Scholar databases from 1960 to 2023 and the keywords “generalized anxiety disorder”, “anxiety disorder” “cognitive function”, “cognitive dysfunction”, “cognitive impairment”, “late-life”, “young”, “adult”, and their combination.

Anxiety and worry, as main characteristics of GAD, were shown to be linked and manifested by deficient attentional control, a main function of working memory. Attentional control functions are biased toward threats, which, in turn, hinders cognitive processing efficiency. Moreover, several structural and electrophysiological impairments could be linked to cognitive dysfunction in people with GAD. For example, patients with GAD showed reductions in gray matter volumes, especially in the regions of the hip, midbrain, thalamus, insula and superior temporal gyrus. The hippocampus, middle cingulate gyrus, putamen and head of the caudate nucleus also showed lower activity in response to the neutral words. Also, GAD patients have better inhibitory control, which may be associated with more severe symptomatology. These results are consistent with attentional control theory, which posits that worry might negatively impinge on inhibition and set-shifting. In terms of age differences, we observed that GAD in elderly patients is associated with impairment of short-term and delayed memory. In young adults, GAD is associated with various cognitive impairments, particularly in selective attention, working memory, cognitive flexibility, planning ability or efficiency, and other executive functions (EF).

To sum up, we observed that GAD is associated with worse cognitive functioning in several domains. Further research into cognitive dysfunction in GAD is needed to better understand the impact on daily living and to allow more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.

None Declared

Clinical trials suggest that patients receiving atypical antipsychotics are less likely to develop movement disorders than those receiving conventional antipsychotics. We determined incidence of treatment-emergent TD during long-term treatment of schizophrenia or schizoaffective disorder with aripiprazole or haloperidol.

In a post hoc analysis of pooled data collected from two 52-week double-blind trials involving 1,294 patients treated either with aripiprazole 20-30mg/d (n=861) or haloperidol 5-10mg/d (n=433), treatment-emergent TD was identified based on Research Diagnostic Criteria (RDC) extracted from the Abnormal Involuntary Movement Scale (AIMS) (Schooler-Kane criteria).

In patients without baseline TD (n=1,177), the rate of new-onset TD at any time point following randomization was 5.09% for aripiprazole-treated patients and 11.76% for haloperidol-treated patients (p<0.0001). Using a stricter definition of RDC-defined TD on the last two study visits, new-onset TD was seen in 0.25% of aripiprazole-treated patients versus 4.09% of haloperidol-treated patients (p<0.0001), and was mild in 100% of aripiprazole-treated patients, and mild in 68.75% and moderate or severe in 31.25% of haloperidol-treated patients. Mean baseline to endpoint increase in AIMS score was significantly greater in haloperidol- versus aripiprazole-treated patients in both LOCF (n=1177, p=0.0001) and OC (n=427, p<0.0001) analyses.

Aripiprazole is associated with a significantly reduced risk of new-onset tardive dyskinesia compared with haloperidol in patients with schizophrenia or schizoaffective disorder treated for up to 52 weeks. Aripiprazole's dopamine D2 partial agonist and/or serotonin 5HT2A antagonist receptor binding profile may contribute to this.

To study the prevalence of anxiety and depression in a general hospital and to determine the ability of non-psychiatric residents to recognize the patients with clinically significant depression or anxiety.

This study was performed on a cohort admitted to Dr. Shariati Hospital in Tehran. Within 72 hours of admission, the patients were screened using the Hospital Anxiety and Depression Scale (HADS). Simultaneously, the residents who provided care for the patients were asked whether they believed the patients had significant levels of depression or anxiety. They were also asked to rate the degree of depression and anxiety of their patients in a 5 point Likert scale. Prescription of antidepressants and benzodiazepines during hospitalization was recorded by chart review. Assessments were completed for 401 patients.

According to HADS score, 136(34.25%) patients had probable depressive disorders(HADS-D score>7) and 157(39.75%) had probable anxiety disorders(HADS-A score>7). The residents only asked 26(6.4%) and 32(8.2%) patients about depression and anxiety respectively. Among the patients, only 10.2% with probable depressive disorders and10.8% with probable anxiety disorders were identified. No significant correlation was observed between HADS scores and the residents’ assessment of severity of depression and anxiety. Only 16.4% of the patients with probable depressive or anxiety disorders were given medication.

This study confirms the results of previous researches that had shown high levels of depressive and anxiety disorders among patients admitted to a general hospital. It also indicates that non-psychiatrist physicians overlook a marked proportion of depression and anxiety diagnoses identified by standardized instruments.

Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.

To emphasize the importance of defining predictors of response to ECT in OCD.

The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.

Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.

Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.

Psychiatric disorders are common in patients with learning disabilities. There are also patients with the triad of autism, schizophrenia and learning disability. Patients with this background can be admitted to general hospitals for psychiatric or non-psychiatric reasons.

We are presenting a case who had a very complicated clinical course and her discharge planning was challenging.

The objective of this work was to show the challenges in the investigation, medical management, and discharge planning of the patients with concomitant learning disability, schizophrenia and autism.

We scrutinized the patient’s casenotes, including blood results and all relevant imaging. We paid a particular attention to all the entries from the psychiatry team, general medical doctors, oncologists, learning disability team and discharge planners.

The lady had a protracted 4-month inpatient admission throughout which she was physically and verbally aggressive to hospital staff. She was deemed to lack capacity for hospital admission and treated in her best interests under Mental Capacity Act (MCA), frequently requiring sedation with Haloperidol and Lorazepam. Following consultation with the local Psychiatrist her medications were altered to: Risperidone 2 mg BD, Diazepam 5 mg OM, 5 mg afternoon and 10 mg evening, Procyclidine 5 mg BD, Chlorpromazine 25 mg BD, Promethazine 25 mg OD PRN, and Midazolam 10 mg buccal PRN.

A change in her clinical condition was noted by the Psychiatry team; increased agitation, confusion and dysarthria. A repeat blood test was advised, due to patient refusal this took weeks to achieve despite the use of buccal Midazolam following Anaesthesiologist advice. Although blood tests were not significantly deranged, she was treated for presumed urinary tract infection with a course of antibiotics. A urine sample was unobtainable.

She reported right breast pain and underwent a mammogram. This showed a hypoechoic lesion 8x7x9 mm. Following consultation with a Breast Surgeon and Oncologist, Letrozole was replaced with Tamoxifen. The Psychiatric team concluded that the clinical deterioration with dysarthria was related to anxiety, associated with Autistic patients. The movement disorder was deemed secondary to antipsychotics exacerbated by stress and anxiety.

The patient’s discharge planning was complex. She was declined by numerous care homes. At time of writing, she remains an inpatient.

The management of patients with a triad of Learning Disability, Schizophrenia and Autism is extremely difficult, particularly within an acute medical setting. Physical deterioration could be related to medication adverse effects or change in environment. Anxiety and stress are linked to these conditions. The challenging behaviour that these patients often have will make discharge planning very difficult as specialised care homes to accommodate these unique patients are very limite

None Declared

EMDR therapy is a brief form of trauma-focused therapy for PTSD. This therapeutic technique was first used by Francine Shapiro in the United States in 1987. EMDR combines exposure imagination, cognitive and psychoanalytical techniques. Designed to treat psychological trauma, emotional shock and grief, EMDR can also be used to treat neurotic problems such as phobias, anxiety and depression.

EMDR therapy can be used at any age and can be adapted to children, adolescents, adults and the elderly unless contraindicated.

In the pediatric population, several studies have shown that EMDR therapy has a remarkable effectiveness on several pathologies and particularly on PTSD.

Translated with www.DeepL.com/Translator (free version)

EMDR therapy is a brief form of trauma-focused therapy for PTSD. This therapeutic technique was first used by Francine Shapiro in the United States in 1987. EMDR combines exposure imagination, cognitive and psychoanalytical techniques. Designed to treat psychological trauma, emotional shock and grief, EMDR can also be used to treat neurotic problems such as phobias, anxiety and depression. EMDR therapy can be used at any age and can be adapted to children, adolescents, adults and the elderly unless contraindicated.In the pediatric population, several studies have shown that EMDR therapy has a remarkable effectiveness on several pathologies and particularly on PTSD. Translated with www.DeepL.com/Translator (free version)

Present the indications of EMDR therapy in children and demonstrated its effectiveness in the management of psychiatric disorders in this population.

This is a systematic review of the literature. The databases used are “PubMed” and “Google Scholar”. No language restrictions were applied.

The following keywords were entered: EMDR, Child. Recent articles published in English or “systematic reviews, meta-analyses or reviews” were included.

From this review of the literature, we note that:

EMDR is a psychotherapy that has been shown to be effective in improving the symptoms of various pathologies in children, including PTSD, major depressive disorders, intellectual disability, anxiety disorders, as well as behavioral disorders

However, the studies are still few in number and also have methodological limitations: they were exploratory studies of relatively small samples.

EMDR therapy is mentioned in the described guidelines as “promising”, as the fact that it yields positive results in a short period of time and that these results continue in follow-up studies has increased the interest in using EMDR in children.

Nevertheless, larger sample sizes are recommended in future studies to better establish the effectiveness of EMDR therapy in children.

None Declared

Catatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.

We present a clinical vignette and review the literature available on online databases about MC/NMS.

We present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.

Many studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.

The authors have not supplied their declaration of competing interest.

Social rituals refer to routine and expected social activities that are practiced in all communities in a culturally recognized manner (e.g., social greetings, eating customs, attention to dress, sleeping rituals etc.). Persistent departures from or disregard of these social rituals may be an early or prodromal sign of the onset of mental illness.

(1) To develop and evaluate psychometric properties of a measure of social rituals entitled, Social Rituals Schedule (SRS); (2) to evaluate the reliability and cross-cultural applicability of this measure.

The SRS was administered to 30 psychiatric patients and their nominated relative/friend. The cross-cultural evaluations were conducted using focus groups of Ethiopian (n = 30), Australian Indigenous (n = 100), Iranian (n = 22), and Indian (n = 50) participants.

The SRS demonstrated moderate to high inter-rater reliability and patient-informant concordance. The social ritual domains were found to be valid, well understood and applicable across the sampled cultures [1].

The concept of social rituals and the SRS instrument were demonstrated to be feasible, reliable and cross-culturally applicable tools for measuring changes in people's appearance and behavior that might be indicative of emerging mental illness.

The authors have not supplied their declaration of competing interest.

The association between economic crises and mental health problems can be attributed to a number of factors. Among these, age seems to be an important determinant.

The aim of this study was to assess whether mental health of the Portuguese population following the onset of the 2008 recession, differs by age groups.

A follow-up study (2015) on the population aged 18 to > 65 years old, using the National Mental Health Survey (n = 911). The age-group prevalence of mental health distress assessed by the ten-item Kessler's Psychological Distress Scale (K10) was calculated using Chi2 statistics and mental distress as a categorical variable (P < 0.05).

Mean mental distress score differed significantly according to age group, χ2(3) = 10.684, P < = 0.05. The results showed that the older groups (50–64 and 65 = years old) were more frequently under mental distress (17–19%) compared to younger people (18–49 = years old), which were less likely to report being distressed (8–12%).

Age seems to be an important determinant of distress levels during the economic crisis in Portugal. Older adults reported to be more distressed compared to younger individuals. There are several hypotheses for a differential expression of psychological distress between age groups such as working status and retirement, which can express differential access to coping resources under such contextual negative pressure of economic recession. Further research on age groups is thus needed to better understand how recession generates adverse effects on mental well-being.

The authors have not supplied their declaration of competing interest.

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).

The present study attempted to examine the barriers and the facilitators to the use of mental health services by Japanese university students in order to enhance early detection of and intervention for mental disorders.

A total of 138 students from four universities in Japan participated in this study and completed the survey. They were asked to show if they were reluctant to consult a mental health professional and the reasons thereof (barriers). Additionally, they described when they would visit a mental health professional (facilitators).

About half (48.5%) of the students showed reluctance to visit a mental health professional. The barriers (in descending order of frequency) were'I don't want to consult other people (I feel ashamed),''I don't need it (It's enough),''I am unsure the consultation will be effective,' and'I am afraid of what others will think of me'. On the other hand, the facilitators were,'when my condition is severe,''when people close to me recommend me to do so,''when the atmosphere around the institution is good,''when I can't consult people close to me,' and'when the professional is someone I know'.

Some barriers and facilitators for consulting mental health professionals were found. Mental health professionals have to consider these factors in their daily clinical practices.

Prior studies have suggested that patients suffering from schizophrenia and ADHD may process certain sound stimuli in the brainstem in an unusual manner. When these patient groups have been examined with the electrophysiological method of brainstem audiometry, some studies have found illness-specific aberrations. Such aberrations may also exist for patients suffering from bipolar disorder.

To explore the use of the method of brainstem audiometry as a diagnostic tool in psychiatry.

5 individuals with confirmed clinical diagnoses of schizophrenia, ADHD, and bipolar disorder, respectively, were examined with brainstem audiometry in a non-blind, comparative study. The data derived from the patient groups was compared to data from a control population according to a previously arranged data algorithm (SD-BERA).

There was a full match between clinical diagnosis and diagnosis by means of brain stem audiometry for 4 of the 5 patients suffering from schizophrenia (1 mismatch), 4 of the 5 patients suffering from bipolar disorder (1 patient was given a second audiometric diagnosis of schizophrenia), and 3 of the 5 patients suffering from ADHD (1 patient was given a second audiometric diagnosis of bipolar disorder and 1 patient was a mismatch).

Brainstem audiometry shows promise as a diagnostic tool, but blinded studies are needed to examine the diagnostic properties and validity of this method.

The Positive and Negative Syndrome Scale (PANSS) evaluates different psychopathological aspects of schizophrenic patients. Scores on the negative subscale of the PANSS have been associated with clinical and neuropsychological differences in these patients. Our aim was to study the relationship between PANSS negative scores and different clinical and neuropsychological variables in a sample of schizophrenic patients.

Our sample of 174 schizophrenic patients was split into two groups according to scores on the negative subscale of the PANSS: a group of 85 patients (55 male and 30 female; mean age 38.0 years, SD 9.3) with scores below the median (“low negative PANSS” group), and a group of 89 patients (58 male and 31 female; mean age 37.3, SD 8.4) with scores above the median (“high negative PANSS” group). The neuropsychological task used was the Wisconsin Card Sorting Test.

Significant clinical differences were found between both groups. In the “high negative PANSS” group a lower age of illness onset was found (p=0.030), as well as a lower age at first psychiatric admission (p=0.002) compared to the “low negative PANSS” group, without there being significant differences in current age (p=0.570). Regarding cognitive functions, “high negative PANSS” patients achieved fewer categories (p=0.005) and made more perseverative errors (p=0.031) than “low negative PANSS” patients.

Schizophrenic patients with higher scores on the negative subscale of the PANSS had an earlier age of onset of their illness and exhibited poorer cognitive functioning than patients with lower scores.

Acceptance and commitment therapy for the treatment of panic disorder and agoraphobia has been a big boost in last years, and there are preliminary studies about its efficacy. However, most studies have used individual interventions.

Evaluate the effect of an acceptance and commitment group therapy in patients with panic disorder and agoraphobia.

The sample consisted of 24 patients, aged between 18 and 55 years old, who were referred to groups by psychologists and psychiatrists of Mental Health Center. The intervention in each group consisted of 12 treatment sessions of 1 h 30 m duration, weekly. One pretest and posttest evaluation was conducted. The variables studied were: severity of panic disorder (Panic Disorder Severity Scale [PDSS]), fear of physical sensations (Body Sensations Questionnaire [BSQ]), frequency of catastrophic thoughts (Agoraphobic Cognitions Questionnaire [ACQ]) and level of experiential avoidance (Acceptance and Action Questionnaire-II [AAQ-II]).

The mean scores for all variables studied decreased in the post-evaluation. Means in post-evaluation were significantly lower (t Student, a = 0.10) in three of the four variables studied: severity of the condition (P = 0.001), frequency of catastrophic thoughts (P = 0.038) and level experiential avoidance (P = 0.073). In other words, patients had fewer panic attacks after treatment, and those who had were less intense, they had less catastrophic thoughts about consequences of anxiety, and they were better to accept their feelings and thoughts.

Although it is necessary to continue the study with a larger sample, these preliminary results support the use of ACT in group format in the treatment of panic disorder and agoraphobia.

The authors have not supplied their declaration of competing interest.