Europe is again confronted with a new dramatic emergency, a war which has already caused civil victims, mass displacement and even fear about a nuclear war and energy crisis. Again, Europe is facing new waves of war refugees, forcibly displaced people. There is increasing evidence that a large proportion of refugees or forcibly displaced persons suffer from the consequences of traumatic events and exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders, and relapses in psychotic episodes. European countries are trying to face with an extraordinary surge of solidarity and generosity, but at the same time with the awareness that the needs are much beyond reaction capacity of individual people and states. The direct and indirect consequences of this humanitarian catastrophe cannot be estimated at present. Mental healthcare services are suddenly faced with major challenges and need to develop or expand strategies to address them. In this presentation, strategies from Germany will be presented and discussed.

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Bipolar disorder comorbidity rates are the highest among the major mental disorders. In addition to other intoxicants, alcohol is the most abused substance because it is socially accepted and can be legally bought and consumed. Estimates are between 40-70% with male predominance, which further influences the severity with a more complicated course of both disorders.

The objective of this article is to highlight the impact of substance use on the course and prognosis of bipolar disorder, as well as to make a differential diagnosis of a manic episode in this context.

Bibliographic review of scientific literature based on a relevant clinical case.

We present the case of a 45-year-old male patient. Single with no children. Unemployed. History of drug use since he was young: alcohol, cannabis and amphetamines. Diagnosed with bipolar disorder in 2012 after a manic episode that required hospital admission. During his evolution he presented two depressive episodes that required psychopharmacological treatment and follow-up by his psychiatrist of reference. Since then, he has been consuming alcohol and amphetamines occasionally, with a gradual increase until it became daily in the last month. He went to the emergency department for psychomotor agitation after being found in the street. He reported feeling threatened by a racial group presenting accelerated speech, insomnia and increased activity.

The presence of substance abuse complicates the clinical presentation, treatment and development of bipolar disorder. It is associated with a worse prognosis with multiple negative consequences including worsening symptom severity, increased risk of suicide and hospitalization, increased medical morbidity and complication of social problems. In addition, this comorbidity delays both the diagnosis and treatment, by masking the symptoms, and making more difficult an adequate differential diagnosis.

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Currently, there is an active development of methods for the laboratory diagnosis of alcohol abuse using biochemical markers.

The aim of this work was to estimate the prevalence of alcohol abuse among the urban population of Belarus using the concentration of phosphatidylethanol in the blood as a biochemical marker of alcoholism.

220 blood samples from Grodno residents of both sexes aged 15 to 65 were analyzed. The AUDIT questionnaire was used as a screening tool. Determination of the concentration of phosphatidylethanol in the blood was carried out using the method of high performance liquid chromatography - tandem mass spectrometry (HPLC - MS).

The average concentration of phosphatidylethanol in the blood of men and women was 266.11±54.57 and 55.27±9.43 nmol/ml, respectively. In 9.6% of blood samples, the concentration of phosphatidylethanol exceeded the threshold level of alcohol abuse. It was found that the concentration of phosphatidylethanol in the blood does not correlate with the total score, as well as the frequency and quantitative characteristics of the AUDIT screening test.

Determining the concentration of phosphatidylethanol in the blood is a more reliable way to diagnose alcohol abuse than using screening tools.

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Working in intensive care units and in emergencies is a stressful job. Taking care of acute and serious pathologies may cause various psychological diseases.

This study aimed to screen depression among emergency and intensive care caregivers and to determine factors associated with these disorders.

This is an exhaustive, descriptive and analytical cross-sectional study that interested paramedical caregivers working in the emergency and intensive care services from south Tunisia. We used an anonymous questionnaire that included sociodemographic, medical and professional characteristics and the subscale of depression from the Hospital anxiety and depression (HAD) scale.

A total of 240 patients participated in the survey. The prevalence of depression was 30.8%. In the univariate study, depression was associated with the female sex (P=0.006), university level (p=0.04) and anxiety (p<10-3). Three risk factors of depression were found in the multivariate analysis: female gender (OR=2.4 [1.1-7]; P=0.025), and the university school level (OR=5[1.5-16.7]; P =0.009).

Depressive disorders are common among caregivers in emergency and intensive care units. This finding highlights the importance of an early screening of these disorders to improve their management.

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The Mood Disorder ward, in San Raffaele Turro Hospital, is one of the reference centers for the cure of Treatment-Resistant Depression (TRD), mainly due to the use of Electroconvulsive Therapy (ECT). During the pandemic period, in particular, in 2020, such a procedure was discontinued because it is considered aerosolizing. For this reason, we enhanced already available treatments for TRD; among those one of the most effective is the use of endovenous (EV) ketamine. It’s been more than 20 years since the first time a double-blind randomized placebo-controlled study demonstrated the rapid antidepressant effects of endovenous (EV) ketamine after a single dose (0.5 mg/kg infused in 40 minutes) in 7 patients. Ketamine, an anesthetic drug, has also analgesic, anti-inflammatory, and antidepressant properties. These effects are mainly due to non-competitive antagonism on the NMDA receptor (N-methyl-D-aspartate). We introduce our clinical experience in 7 cases of treatment-resistant depressed (TRD) inpatients; all of them show a high level of pharmacoresistance, assessed in the third degree of Thase Stages (2 or more SSRI/SNRI + at least 1 TCA); 3 of them were previously treated with a complete cycle of Electroconvulsive Therapy (ECT).

Assess the efficacy and tolerability of EV ketamine with particular regard to patients previously treated with ECT.

7 TRD patients (4 females; 3 males) were recruited in San Raffaele Turro Hospital in April 2020. All patients (6 unipolar and 1 bipolar) were diagnosed with a Major Depressive Episode according to DSM-5 criteria. We administered, under anesthesiological supervision, EV ketamine, 0.5 mg/kg in 40 minutes, twice a week, for three weeks. Every morning medication was postponed on the days of infusion. Clinical scales (HAM-D, SSI, HAMD-A; MADRS, CADSS) were administered to assess symptoms and side effects before, during, and after every administration. Moreover, clinical efficacy’s been assessed in 2 follow-ups: at 3 and 6 months.

4 patients were in remission (final HAM-D score <8) at the end of the treatment. 4 patients confirmed clinical response (final HAM-D score < 50 % respect baseline value) at the first follow-up. 4 Out of 7 patients were in complete remission at 6 months, and just one of them was between those remitted at the end of the treatment. 4 Out of 4 patients were in complete remission at six months follow-up; 3 of them underwent a cycle of ECT during the course of their illness.

The use of EV ketamine in our TRD patients showed good effectiveness and tolerability. Data on long-term effectiveness are promising, a previous ECT seems to be a predicting factor of remission at follow-up, but not of the end-treatment response. Given that, future research is needed in order to identify predicting factors on relapse prevention efficacy.

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Psychiatry is often perceived “different” by other medical professionals as well as by the general population. This perception of “difference” may give rise to stigma toward both patients with psychiatric disorders and mental health professionals.

The aim of this study was to investigate the attitudes of non-psychiatric and their perception of psychiatry and mental disorders.

It was a cross-sectional, descriptive and analytical study, conducted among Tunisian undergraduate and graduate non-psychiatric physicians. Data were collected during September and October 2022, through an anonymous online questionnaire, spread throughout social media (Facebook), using the Google Forms® platform. We used the “Attitude toward Psychiatry-30” (ATP-30).

A total of 168 participants completed the questionnaire. Among them, 81 (48,2%) were undergraduate and 87 (51,8%) were graduate doctors. Their mean age was 26,4± 4.4 years, with a sex-ratio (F/M) of 3.4.

Among doctors, 79,2% had overall favorable attitudes toward psychiatry but only 38,2% among the undergraduate considered psychiatry as a potential career choice.

Psychiatry was considered as an unscientific and imprecise specialty by 20,3%; while 35,7% considered it as the least exciting.

The total score ATP-30 increased significantly with age (p= 0.023). It was significantly higher in those with psychiatric history (p=0.01).

Our study showed a dissonance between favorable perception of psychiatry and the choice of psychiatry as a potential career. Therefore, it is crucial to identify factors that potentially account for this dissonance and enhance enthusiasm among undergraduate doctors as the shortage of psychiatrists may influence mental healthcare.

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Schizophrenia is a neurodevelopmental process affecting approximately 1% of the population. Multiple studies have found that Childhood trauma is an important risk factor in the emergence and clinical course of schizophrenia.

The purpose of this study was to assess the characteristics of schizophrenic inpatients with childhood trauma among a tunisian sample.

Stabilized inpatients with schizophrenia at the Psychiatry C department at University Hospital in Sfax were involved in our study. Sociodemographic and clinical data of patients were collected from medical records.

We used Childhood Trauma Questionnaire-Short Form (CTQ-SF) to evaluate the occurrence of childhood maltreatment.

We recruited 33 patients, all men with a mean age of 35 years and 4 months (SD=9.44 years).

They were married in 6.1% and 24.2% of patients had regular work.

The mean age of onset of the disorder was 24.42(3.25).The level of poor psychotropic medication adherence was 72.7%.

According to CTQ-SF, 78.8% of patients had experienced child trauma with a mean score of 35.67 (SD =8.61).

A rate of 39.4% reported having experienced one child trauma, while 60.6% reported having experienced more than one.

We found high rates of emotional neglect (87.8%) while emotional and physical abuse during childhood were experienced by 39.4%, and 6% respectively and physical neglect were found in 30.3% of cases.

Patients with more than one childhood trauma were found to have an earlier onset of psychosis (p=0.004)

The occurrence of childhood trauma was not associated with the socio-demographic characteristics of the respondents or the clinical features of the disease.

The results point toward childhood emotional neglect being of specific importance to schizophrenia, which may be an area for future prevention and clinical attention.

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Neuropsychiatric manifestations in human immunodeficiency virus (HIV) infection are uncommon but salient once they emerge to the surface. These symptoms can be the result of direct or indirect effects of the virus on the central nervous system (CNS). In particular, HIV related mania can complicate any stage of the infection but increases its frequency with the progression of HIV infection to the final stage.

The objective of this case report is to rase awareness about secondary mania due to HIV infection and the importance of etiological treatment in mental disorders.

We herein report the case of a 27-year-old, male patient, who was admitted to our Psychiatric Clinic I Cluj-Napoca, with a 3-week history of typical manic symptoms such as: elated mood, alternating with episodes of irritability, talking too much, familiarity, multiple future plans, hypersexuality, social disinhibition and decreased need for sleep. Throughout the hospitalization, the course of the manic symptomatology did not improve, additionally the patient started to exhibit neurological symptoms accompanied by complex visual hallucinations. Prior to this episode he reported depressive symptoms, predominantly anhedonia, apathy, and social withdrawal but without meeting the clinical severity threshold. The patient had no family history of a mental disorder. A psychopharmacological treatment was initiated (atypical antipsychotic Quetiapine XR 300 mg/day initially, and then switched to Olanzapine 10 mg/day, mood stabilizer Valproic Acid 1,5 g/day), but he developed significant extrapyramidal side effects.

Blood tests revealed: leukopenia, lymphopenia, thrombocytopenia, subsequently hepatic cytolysis, and high CRP. Psychometric evaluation revealed: Young Mania Rating Scale (YMRS) score 33/60 – moderate mania, Positive and Negative Syndrome Scale (PANSS)- total score 51 (16/49 Positive; 7/49 Negative; 28/112 General Psychopathology). MRI: T2 and FLAIR hyperintense extended areas in the bilateral periventricular white matter and in the internal capsule. The anamnesis, heteroanamnesis, paraclinical investigations led us to a diagnosis of secondary mania related to HIV infection. The patient was transferred to the Infectious Diseases Clinical Hospital for a targeted antiretroviral therapy (Raltegravir 800 mg/day, Emtricitabine/Tenofovir disoproxil 200mg/245 mg).

Recognizing and controlling HIV secondary mania should be of high importance given its association with heightened sexual behavior and substance abuse which can result in an elevated risk of transmitting the infection to other people.

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Although generally effective in ameliorating the core manifestations of schizophrenia, antipsychotics (APs) may lead to only suboptimal responses or may be associated with a variety of treatment-related adverse events which require additional treatment strategies. Under such clinical circumstances, switching APs represents a rational treatment option.

The present study aimed to identify the variables that predict AP switch and to quantify the frequency of this phenomenon in people with schizophrenia in real-life.

A secondary analysis was conducted on the data collected at baseline and at a 4-year follow-up from a large sample of community-dwelling Italian people with schizophrenia. Demographic and clinical variables as well as information about AP treatment were recorded at two time points. Over the 4-year period, 34.9% of the 571 participants switched the AP; in particular, 8.4% of participants switched from first-generation APs (FGAs) to second-generation APs or vice versa, while 8.2% of them switched to clozapine.

Logistic regression models showed that combination of APs at baseline was negatively associated with AP switch, while treatment with FGAs and the presence of extrapyramidal symptoms at baseline were associated with AP class switch.

Although the aim of the present study was not to assess predictors of clinical relapse in people with schizophrenia, we might speculate that switching APs represents a surrogate indicator of treatment failure in some patients and could lead into relapse, which is a costly aspect of schizophrenia management in both economic and human terms. The sooner such a negative outcome can be predicted and managed, the sooner the treatment can be optimized to avoid it.

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Despite being a clinical identifiable entity, major depressive disorder (MDD) is an heterogenous clinical syndrome, with a variety of clinical presentations which likely reflects different biological underpinnings. The identification of biologically-based depression symptoms profiles would be of great importance to unravel different pathophysiological pathways in MDD and therefore to achieve more precise and personalized therapeutical approaches as well as preventive strategies.

Converging evidence from epidemiological and clinical studies, points to the importance of inflammation in MDD, shown by increased levels of pro-inflammatory proteins and increased inflammation-related comorbidities, including metabolic diseases. In fact, there exists a bidirectional relationship between inflammation and metabolic dysfunction that could be linked to multiple factors, including life style, stress and genetic predisposition. MDD patients exhibit several metabolic disturbances such as overweight, insuline resistance and dyslipidemia, among others, which are not always fully explained by life style factors. These findings have led to the formulation of an immunometabolic hypothesis, which could be present in a subgroup of MDD patients, associated to specific symptoms and clinical features.

In this presentation, data reflecting the complex relationships and interactions between immune and metabolic disturbances in MDD will be shown. In particular, it will be shown how machine learning approaches can be useful to disentangle the clinical and biological heterogeneity of MDD, using immunometabolic biomarkers.

P. Lopez-Garcia Grant / Research support from: Grant from Carlos III Health Institute ref PI15/00204 and FEDER funding from the EU

Suicidal behavior is quite common in individuals with anxiety and mood disorders (AMD). One of the coexistence factors in suicidal behavior is thyroid dysfunction, however the results are still controversial (Shen et al. J Affect Disord 2019;(1)180-185; Zhou et al., Transl Psychiatry. 2021;11(1):97). The role of thyroid function in suicidal ideation among individuals with comorbid AMD have not been thoroughly investigated.

The aim of this cross-sectional study was to identify potential associations between thyroid function and suicidal ideation in a sample of individuals with anxiety and mood disorders.

This exploratory study comprised 77 consecutive individuals with AMD (age range 18-73 years, 76% were females) attending the Psychiatry Day care unit. All individuals have been evaluated for current psychiatric diagnoses, suicidal ideation using the Mini International Neuropsychiatric Interview [M.I.N.I. 7.0.2]) as well as for socio-demographic factors and for current psychotropic medication use. Severity of depression and anxiety symptoms have been evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). The biochemical blood tests were performed for the concentrations of thyroxine (FT4), triiodothyronine (FT3) and thyroid stimulating hormone (TSH). The univariate and multivariable logistic regression analyses were used to assess the association between biochemical parameters and suicidal ideation.

Of all study individuals with AMD – 56% have been identified as having current SI. There were not significant differences according to age, gender, education, BMI, smoking, depression and anxiety symptoms and current psychotropics use between SI and non-SI individuals. Serum FT4, FT3 and TSH concentrations were within normal range. However individuals with SI had significantly lower TSH concentrations in comparison to the non-SI (1.54 (0.77) vs. 2.04 (1.22) IU/L, respectively; p = 0.049), without significantly differences in FT4 and FT3 concentrations. A multiple logistic regression, adjusting for sociodemographic factors and severity of mental symptoms revealed, that non-SI individuals with AMD were likely to have higher TSH levels than SI (odds ratio = 2.15 (95% CI 1.10–4.22; p = 0.027).

Among individuals with AMD, lower levels of TSH concentrations have been associated with presence of suicidal ideation, independently of sociodemographic factors and severity of depression and anxiety.

V. Liaugaudaitė Grant / Research support from: European Union (project No P-PD-22-150) under the agreement with the Research Council of Lithuania (LMTLT)., A. Podlipskytė: None Declared, J. Burkauskas Consultant of: Cronos, N. Mickuvienė: None Declared, V. Adomaitienė: None Declared, E. Zauka: None Declared, V. Steiblienė: None Declared

The context of the COVID-19 pandemic has changed the daily life of families and children. Screen exposure was increased during this period to maintain social relationships, work remotely, and occupy leisure time.

To explore the association of continued above-recommendation screen use for one year since May 2020 with behaviour problems in the summer of 2021 in children aged 3 to 14 years.

Data came from the French EpiCov cohort study, and were collected in May 2020 and at first (Autumn 2020) and second follow-up (Summer 2021) among 1,089 participants with children aged 3 to 14. Children had a 1-year above-recommendation screen use if their daily mean time exceeded recommendations at the three follow-up times (one hour, for children aged 3-5, two for the older ones). Behaviour problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) and valid cut-offs for Internalizing (emotional or peer problems) and Externalizing (conduct problems or hyperactivity/inattention) problems completed in summer 2021. Data were analysed using adjusted logistic regression.

1-year above-recommendation screen use was not associated with internalizing problems (OR [95% CI]: 1.20 [0.90-1.59]). Regarding the subscales, it was associated with a higher risk of peer problems (1.42 [1.04-1.95]). A higher risk of externalizing problems was found only in 11-14-year-olds (1.63 [1.01-2.63]), especially conduct problems in 11-14-year-olds (1.91 [1.15-3.22]) but not in other age groups.

This study found that maintaining screen time beyond recommendations for 1 year since the onset of the pandemic was associated with peer problems in children aged 3-14 years and externalizing and conduct problems in 11-14 years. Despite this very specific context, exposure to screens is not trivial. If this situation were to occur again, we would have to anticipate, with prevention messages, by keeping schools open.

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Childhood trauma (CT) is associated with severe sequelae, including personality disorders and stress-related mental health disorders that can perpetuate long into adulthood.

We aimed to investigate (1) whether childhood trauma is associated with anger in adulthood, and, if so, (2) to explore which types of childhood trauma predominate in the prediction of anger, and (3) to explore whether the association is independent of psychopathology in a cohort that included participants without lifetime psychiatric disorders, with current or remitted depressive and anxiety disorders, or comorbid depressive and anxiety disorders.

In the Netherlands Study of Depression and Anxiety (NESDA), childhood trauma was assessed with a semi-structured Childhood Trauma Interview (CTI) at baseline, and analyzed in relation to anger as measured at 4-year follow-up with the Spielberger Trait Anger Subscale (STAS), the Anger Attacks Questionnaire, and cluster B personality traits (i.e., borderline, antisocial) of the Personality Disorder Questionnaire 4 (PDQ-4), using analysis of covariance (ANCOVA) and multivariable logistic regression analyses. Post-hoc analyses comprised cross-sectional regression analyses, using the Childhood Trauma Questionnaire – Short Form (CTQ-SF) obtained at 4-year follow-up.

Participants (n = 2,276) were on average 42.1 years (SD = 13.1), and 66.3% were female. Childhood trauma showed a dose-response association with all anger constructs. Zooming in, all types of childhood trauma except for sexual abuse were associated with higher levels of trait anger, and a higher prevalence of anger attacks and antisocial personality traits in adulthood, independently of depression and anxiety. Additionally, all types of childhood trauma were significantly associated with borderline personality traits. Cross-sectionally, the effect sizes were larger compared to the analyses with the childhood trauma measured four years prior to the anger measures.

Childhood trauma is linked with anger in adulthood, most strongly for trait anger and borderline personality traits. It is of clinical importance to explore childhood traumatic experience and start trauma-focused interventions when appropriate.

None Declared

Creating appropriate and sustainable treatment plans for patients with concurrent disorders presents a challenge to psychiatrists and addiction medicine specialists alike. Although varenicline has been found to be one of the most effective medications for smoking cessation and abstinence, caution is needed when starting patients on this medication. In this case, a young female provisionally diagnosed with bipolar I disorder was hospitalized for a manic episode in the context of substance abuse and medical noncompliance. She also endorsed a long history of smoking, alcohol, cocaine, cannabis and ketamine use. In addition to being stabilized for bipolar disorder, the patient was started on varenicline for smoking cessation on Day 14 of admission.

This case report highlights the potential risk of de-stabilization in a vulnerable youth with newly diagnosed bipolar I disorder and precarious social circumstances, in attempts to further concurrent approaches to psychiatric care.

In addition to qualitative observations, the main objective exam used to track patient progress through the duration of her hospitalization was the mental status exam (MSE). This is standard practice for psychiatric care and qualitatively assessed factors related to a patient’s behavioral and cognitive functioning. Important factors assessed for this patient include appearance and behavior, speech, affect and mood, thought form, thought content, perceptual abnormalities, insight and cognition.

Perceptual abnormalities, including auditory hallucinations, were not recorded at admission and the patient’s symptoms of mania were resolving clinically on Day 18. Two days after starting varenicline, the patient developed auditory hallucinations, paranoia and referential beliefs. However, her insight was intact, and she had minimal thought-form disorganization. The patient also reported hearing auditory hallucinations of a derogatory nature, with her mood appearing more distressed during varenicline use. Symptoms were found to be resolved shortly after the discontinuation of varenicline on Day 18 and the patient appeared to be less distressed on following days. In this case, these symptoms were not in keeping with her bipolar diagnosis and thought to be secondary to varenicline after the consideration of potential alternative contributors.

The occurrence of side effects as a result of varenicline use in patients with diagnosed mental health conditions is rare and underlying psychiatric illness is not labeled as an absolute contraindication in the prescription of varenicline. However, it is important to advocate for increased guidance and research on the treatment of substance use disorders in patients with bipolar I disorder.

None Declared

Throughout the COVID-19 pandemic, students were vulnerable to mental health issues and dentistry students were no exception. All Iraqi universities were transitioning back to face-to-face learning in the last year. Acclimatization with all pandemic regulations that schools apply might increase the vulnerability to depression.

The current study aims to assess the levels of depression among Iraqi dentistry students after transitioning from online to onsite learning during the pandemic period.

A cross-sectional study was conducted online after transitioning from online to the onsite learning method during the pandemic period. Sociodemographic data and Patient Health Questionnaire-8 (PHQ-8) were included in the questionnaire.

A total of 307 respondents, 216 (70.4%) female and 91 (29.6%) male, 276 (90%) live with family, 20 (6.5%) live with friends and 11 (3.5%) live alone, 268 (87.3%) of student claimed that post-COVID-19 regulations face to face learning is more stressful while 39 (12.7%) answered no difference. 39 (12.7%) of dentistry student with normal level of depression, 199 (38.8%) have mild depression 101 (32.9%) moderate depression, 32 (10.4%) moderately severe, 16 (5.2%) severe. Depression level and students’ perception of teaching mode transition showed a significant association (p<0.05).However, there are no significant associations between gender, living conditions, or dentistry stages with depression levels (p>0.05).

A high prevalence of depression symptoms among Iraqi dentistry students was found during onsite learning, along with all educational institutions’ pandemic rules and regulations. Psychological supporting preventive programs are needed to apply for supporting students’ mental health.

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A wide variety of traits is heritable and has genetic loading, including schizophrenia spectrum disorders (SSDs) and its associated neurocognitive features. The genetic architecture of SSDs is polygenic, with the contribution of thousands of single nucleotide polymorphisms of small effect with an estimated SNP-heritability of 24%. The same occurs with neurocognitive phenotypes such as intelligence or educational attainment. Therefore, the method of polygenic risk scores (PRS) is useful in estimating the genetic burden of such traits. Moreover, the use of PRS in a sample of genetically related individuals would allow analyzing the contribution of genetic and environmental factors involved in the development of the disorder and its candidate endophenotypes.

To estimate PRS for schizophrenia, and polygenic scores for intelligence and educational attainment in patients with First Episode Psychosis (FEP), their first-degree relatives (siblings and parents), and a group of healthy controls.

The sample is comprised of 579 participants of the PAFIP-FAMILIAS project in Santander, Spain (133 FEP patients, their 244 first-degree relatives, and 202 healthy controls). All provided sociodemographic information and completed the same neuropsychological battery. Participants’ DNA was extracted from venous blood samples, and genotyping was performed at the Centro Nacional de Investigaciones Oncológicas (CeGen) by the Global Screening Array v.3.0 panel (Illumina). Data quality control, imputation, calculation of PRS, and genetic association analysis are being performed using PLINK, SHAPEIT, IMPUTE2, SPSS and R.

Data analysis is currently in progress, at the quality analysis stage, in collaboration with the Institute of Psychiatric Phenomics and Genomics (IPPG) in Munich, Germany. We expect to find higher PRS for schizophrenia in FEP patients, while their first-degree relatives will potentially show intermediate risk scores between patients and healthy controls. A similar finding is expected regarding intelligence and educational attainment, as FEP patients may show more genetic burden for low intelligence and education.

The estimation of PRS has demonstrated to be valuable in studying complex traits such as schizophrenia. We believe that by applying this method in a family design can provide interesting insights on the development of SSDs and its potential endophenotypes, and potentially useful in their prevention.

None Declared

The entity of ‘pseudoneurotic schizophrenia’ was coined in 1949 by Hoch and Polatin to define emerging psychotic symptoms, namely formal thought disorder and emotional dysregulation, in patients previously presenting with neurotic functioning. Although currently considered to be outdated, the term paved way for the concept of ‘borderline disorders’, known for their difficult assessment.

To highlight the obstacles in diagnosing clinical presentations of overlapping psychotic and neurotic symptomatology.

We report a case of an adolescent admitted for presumed psychosis, later to display fast clinical improvement and significant neurotic personality traits.

A 17-year-old male with no previous psychiatric follow-up, except for brief psychotherapeutic intervention at the age of 11, following the death of his grandfather.

He presented with a sudden change in behavior and sleep since the week before, coincident with acknowledging the loss of his best friend in a car accident. Upon evaluation, he presented with unstable gait. He seemed fatigued but displayed inappropriate restricted affect. He reported perceiving bizarre, meaningful signs everywhere concerning his own death since the event. Additionally, he detailed feelings of lethargy and unexplained sadness, relying on the nihilistic delusional beliefs that he had been in deep sleep and he would die soon. At admission, he was prescribed with aripriprazol 5mg id.

Throughout his stay in the hospital, he maintained consistently adequate, calm behavior. During inpatient clinical interviews, he showed clear insight into the aforementioned behavior. He provided clear, logical information referring to his past grief process and remaining trauma, reporting coping mechanisms based on spiritual beliefs

Prescription medication was interrupted soon after admission, with no noticeable changes. At dismissal, despite remaining sad concerning the death of his friend, there was no signs of psychotic symptoms or other significant mental distress.

In this report, we emphasize the hazards of differential diagnosis between psychosis and emotional dysregulation with underlying neurotic traits. There is conflicting evidence on the concept of ‘pseudoneurotic’ presentations, specifically ‘pseudoneurotic schizophrenia’. Available information on distinguishing between overlapping psychotic and neurotic features in adolescents is even more scarce. To perform extended, multidisciplinary evaluations might be key in accurately assessing these patients.

None Declared

The conditions of the COVID-19 pandemic, as well as the risks associated with it, led to a deterioration in the emotional state of many people: during the pandemic, an increase in the frequency of anxiety disorders was noted, especially among patients with chronic diseases of the respiratory system. Since the beginning of the COVID-19 pandemic, the respiratory system has been described as very “vulnerable” to the coronavirus.

To study the severity of anxiety and symptoms of dysfunctional breathing (DB) in patients with chronic respiratory diseases in the conditions of the COVID-19 pandemic.

We used: «The Perceived Stress Scale-10», «State-Trait Anxiety Inventory», «Short Health Anxiety Inventory», and Nijmegen questionnaire.The sample: 89 patients with respiratory diseases, the average age was 49.21±18.3. Of these, 38 patients with upper respiratory tract diseases (URTD) (J30-J39) and 51 patients with lower respiratory tract diseases (LRTD) (J40-J47). 49 people had a history of COVID-19 disease.

The sample of patients with both URTD and LRTD diseases is characterized by a high level of stress (27.13±6.937 vs 28.59±6.014, p=0.293). The average indicators of health anxiety in patients with LRTD diseases significantly exceed those of patients with URTD diseases (20.18±8.881 vs 15.68±7.022; p=0.01), which is consistent with data on a greater assessment of the disease threat compared with patients with upper respiratory tract diseases.The severity of DB symptoms in the group of patients with LRTD diseases significantly exceeds that in the group of patients with URTD (19.05±12.340 vs 24.29±11.470; p=0.042). Also in this group, there is a greater severity of individual symptoms of DB: spasm of the mouth muscles (p= 0.015), accelerated deep breathing (p= 0.002), shallow breathing (p=0.001) and the inability to take a deep breath (p=0.001).When analyzing the symptoms among patients who had and did not have a history of COVID-19, significant differences were found in such manifestations of DB as dizziness (1.98±1.351 vs 1.27±1.232; p=0.024) and confusion in the environment (0.61±0.891 vs 0.18±0.465; p=0.010), and also according to the severity of the symptoms of DB in general (23.76±11.996 vs 17.81±8.461; t=2.007, p=0.043).During the analysis, a relationship was established between the severity of DB symptoms and alertness to bodily sensations (R=0.259, p=0.014), which may indicate both an increase in DB symptoms with increased attention toward sensory sensations, and greater screening activity with an increase in DB symptoms. Increased alertness to bodily sensations is associated with situational stress (R=0.530; p=0.001) and personal anxiety (R=0.495, p=0.001).

The results obtained make it possible to identify categories of patients with chronic respiratory diseases who need psychological counseling and psychotherapy.

None Declared

The cultural meaning of suicide has been gaining attention in mainstream psychiatry literature, as an attempt to comprehend the dynamic relationship between culture and suicidality. Moreover, an understanding of the sociocultural and contextual factors in the aetiology of suicidal behaviour is important to develop culturally appropriate suicide prevention and intervention strategies.

Through the lenses of critical cultural suicidology, we aim to reflect on the relationship between suicide and sociocultural aspects, emphasizing the importance of context, cultural meanings, and the role of culture in suicide research and prevention strategies.

We conducted a qualitative review on the topic using PubMed database. Search terms used: “suicidal behaviour”; “suicidal ideation”; “suicide”; “culture”; “cultural”.

Studies revealed that culture might be significant to understand suicidal behaviour. Therefore, suicidologists have often referred to a cultural meaning of suicide. Several studies argue that qualitative studies that focus on the meanings of suicidal behaviour in different cultural contexts are more relevant for suicide prevention than much of the quantitative risk factor research that is currently being conducted. Scholars conceptualize culture as either a protective factor or a risk factor that shapes an individual’s likelihood of engaging in a suicidal act. To locate culture’s influence on suicidal behaviour is essential to begin with an examination of social interaction. The meanings of suicide from a group of people living in a cultural community might vary along subcultural groups and time. Thus, the meaning of suicide is dynamic rather than static. Such a view acknowledges culture as both occurring outside the person, as well as within the person and between persons. It provides a view of a dynamic relationship between the individual and his or her contextual circumstances in which the individual is not just a passive recipient of cultural influences but also an active meaning-making agent who interacts meaningfully with the environment.

Although the medical view of suicidality is a dominant perspective in suicidology, understanding cultural dynamics in suicidality and the conceptualization of suicide as a culturally guided act, is crucial to better understand suicidal behaviours. Further studies are needed in order to understand this complex and dynamic relationship.

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Paraphrenia is a chronic psychosis that has generally lost its status as an independent nosological entity, not being included in DSM-5. From the perspective of the particular psychopathological picture and the impact of the disease on the patient’s functioning in roles, paraphrenia remains a challenge for the clinician in terms of nosological classification and the correct therapeutic approach.

We take into account a patient who presents the classic diagnostic criteria of paraphrenia with a clinical and evolutionary picture followed for 15 years, with the aim of bringing the paraphrenic phenomenology back to the fore.

The case presentation will focus on the richness and absurdity of the delusional ideas that are in great contrast with the good insertion into reality of the subject and the preservation of the core of the personality. We will also describe the main landmarks of positive and differential diagnosis.

We believe that paraphrenia deserves to be differentiated from other psychotic disorders through the particular variant of insight that also explains the significant capacities of dissimulation and as a result of insertion into the roles of life. This attribute also explains the increased potential for danger and unpredictability of the paraphrenic patient.

Our approach is an argument for the psychopathological understanding of paraphrenic psychotic phenomenology independent of different nosographic classification systems. We are trying to contribute to increasing the quality of differential diagnosis in psychoses.

psychosis, paraphrenia, differential diagnosis

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