The leaky pipeline is a visual metaphor for the under-representation of women in leadership positions in Academic Psychiatry despite their over-representation in medical schools, residency programs, and junior academic positions. The presentation focuses on the key obstacles that pertain to personal and societal attitudes and institutional barriers and proposes empirically tested and pragmatic solutions.

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When newborns are born prematurely, it is often necessary to be hospitalized in a Neonatal Intensive Care Unit (NICU). As a result, they are immediately separated from both parents, who experience an intense emotional burden throughout their baby’s hospitalization. Newborns’ entrance in Intensive Care Unit can trigger negative emotions in both parents.

To assess the feeling of loneliness, depressive symptoms and post-traumatic stress of parents with premature infants who are hospitalized in Neonatal Intensive Care Units (NICUs).

Our sample consisted of 251 parents, whose newborn was hospitalized in the Neonatal Intensive Care Unit (NICU) of three hospitals in Athens, the capital of Greece. The data were collected through a questionnaire which included (a) questions related to socio-demographic and clinical data, (b) the Center for Epidemiological Studies-depression scale, (c) the UCLA Loneliness Scale (d) ) the Impact of Event Scale- Revised- Greek version (IES-R-Gr) for the detection of post-traumatic stress.

The majority of our sample were women (69.7%) with a mean age of 32.2 years (SD = 15.4 years). Mothers experienced significantly higher scores on each scale, suggesting more symptoms of depression and post-traumatic stress as well as a higher sense of loneliness compared to fathers. Parents whose infants were underweight and parents with previous experience of hospitalization in NICU exhibited a statistically significant higher sense of loneliness. 62.6% of parents developed depressive symptoms. There was a statistically significant positive correlation between feeling lonely and the onset of depressive symptoms and a statistically significant negative correlation between psychological support from hospital staff and the appearance of depressive symptomatology. The 60.1% of our participants showed symptoms of post-traumatic stress. The more depressive symptoms the participants exhibited, the more symptoms of avoidance, resuscitation, and overstimulation were noted. The greater the feeling of loneliness, the more symptoms of avoidance the participants exhibited.

Early detection of depressive symptoms, loneliness and post-traumatic stress in parents whose newborn is hospitalized in NICU is of major importance. Consequently, a systematic and well-organized training of the staff working in NICU should be provided. Specific protocols, as well as individualized interventions should be implemented to manage the needs and feelings of this vulnerable population.

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Despite the well-established anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide.

In the present study, we aimed to quantify this risk and identify risk factors for suicide among patients receiving ECT.

We used nationwide Danish registers to identify all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. First, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Second, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional-hazards regression.

A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients receiving ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR)=44.5, 95%CI=31.1-63.6). Among those receiving ECT, we identified the following risk factors for suicide: Male sex (HRR=2.3, 95%CI=1.7-3.1), age 60-70 years (HRR=1.6, 95%CI=1.0-2.6), Medium-term higher education (HRR=1.5, 95%CI=1.0-2.2); Long-term higher education (HRR=1.9, 95%CI=1.1-3.1), history of substance use disorder (HRR=2.0, 95%CI=1.4-2.8) and history of intentional self-harm/suicide attempt (HRR=4.0, 95%CI=2.8-5.8).

Among patients receiving ECT, those who are male, aged 60-70 years, have mediumterm to long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide. These findings may guide initiatives to reduce the risk of suicide.

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It is suggested that parenting intervention programs can play a core component in early child development. Given the limited healthcare resources in developing countries, a group design intervention might be cost-effective.

Our objective was to assess the effect of parenting interventions in a cost-effective setting through group sessions CCD interventions on children’s development and behaviors in a non-Western, low/middle income country.

This randomized controlled trial was conducted in a public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women in their third trimester, and then followed their children for 18 months. The intervention group underwent 5 educational group sessions. The main outcomes were the children’s development and behaviors based on Bayley Scales of Infant and Toddler Development-III (BSCID-III) at 12 months and Children Behavior Checklist (CBCL) at 18-month of age.

Data of 181 children were analyzed (80 in the intervention group and 101 controls. The adjusted median differences were significantly lower in the intervention group than in controls for attention problems (-3.38; SE=1.59; P=0.035), anxiety problems (-2.28; SE=1.03; P=0.007) and pervasive developmental problems (-5; SE= 1.16; P<0.001) based on CBCL results. However, the difference of proportions was not significant in none of the BSCID-III domains in the intervention and control groups.Table 1-Results of BSID-III in intervention and control groups at 12 months of age a

We found that parenting interventions through CCD group sessions were significantly effective on several child’s behavior domains, but not on children’s development. Future longitudinal studies are necessary in this field.

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Coercion in psychiatric wards may improve the safety of patients and surroundings, on the other hand, its use affects compliance and satisfaction with treatment. In Poland the coercive measures are strictly regulated by The Mental Health Act (1994). Most of published studies refers to the coercion only during hospitalisation.

Assessment of the extent of coercive measures in psychiatric emergency room and evaluation of the relationships between the use of direct coercion and selected demographic-clinical factors.

This study was conducted at the Bielanski Hospital in Warsaw on all the patients admitted to the psychiatric ward over one year. The extent of coercion in the psychiatric emergency room, demographic and clinical data were collected. Patients were assessed in Brief Psychiatric Rating Scale (BPRS) prior to admission. Patients’ sociodemographic and clinical factors were tested in a multivariate logistic regression model.

In the study 318 patients were included. Coercion of some form in the psychiatric emergency room was used in 29% of cases: admission without consent in 22% of cases and direct coercion (holding, forced medication, mechanical restraint) in 7%. Use of direct coercion in the psychiatric emergency room was associated with BPRS scoring: positively with severity of disorientation symptoms and negatively with severity of depression symptoms. Suicide attempts in the past were discovered to reduce the risk of being a subject of coercive measures. We found no demographic data associated in any way with coercion use.

Coercion in psychiatric emergency room was related to patients’ mental state and their past medical history. There is no evidence of coercive measures misuse towards any demographic group.

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Delirium is characterised by an acute, fluctuating change in cognition, attention and awareness (Wilson et al. Nature Reviews 2020; 6). This presentation can make the diagnosis of delirium extremely challenging to clinicians (Gofton., Canadian Journal of neurological sciences. 2011; 38 673-680). It is commonly reported in hospitalised patients, particularly in those over the age of sixty five (NICE. Delirium: prevention, diagnosis and management. 2010).

Our aim is to identify which investigations and cognitive assessments are completed prior to a referral to the liaison psychiatry services in patients with symptoms of delirium.

Referrals (N = 6012) to the liaison psychiatry team at Croydon University Hospital made between April and September 2022 were screened. Search parameters used to identify referrals related to a potential diagnosis of delirium were selected by the authors. The terms used were confusion; delirium; agitation; aggression; cognitive decline or impairment; disorientation; challenging behaviour. Data was collected on the completion rates of investigations for delirium as advised by the NICE clinical knowledge summaries. Further data was gathered on neuroimaging (CT or MRI), cognitive assessment tools (MOCA/MMSE) and delirium screening tools (4AT/AMTS).

The study sample identified 114 referrals (61 males and 53 females), with 82% over 65 years at the time of referral. In 96% of referrals, U&E and CRP were performed. Sputum culture (1%), urine toxin screen (4%) and free T3/4 (8%) were the tests utilised the least. Neuroimaging was completed in 41% of referrals (see Graph 1 for a full breakdown of results).

A formal cognitive assessment or delirium screening tool was completed in 32% of referrals. The AMTS and 4AT tools were documented for 65% and 24% respectively. A total of 19 referrals explicitly stated the patient was suspected to have dementia. A delirium screening tool was documented in 47% of these cases however, a formal cognitive assessment was documented in only 5% of these patients.

Following psychiatric assessment 47% of referrals were confirmed as delirium.

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Our data highlights the low level completion of the NICE recommended delirium screen prior to referral to liaison psychiatry. The effective implementation of a delirium screen and cognitive assessment is paramount to reduce the number of inappropriate psychiatric referrals in hospital and helps to identify reversible organic causes of delirium. This in turn will ensure timely treatment of reversible causes of delirium and reduce the length of hospital admission.

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Bipolar disorder (BD) is a multisystemic disorder affecting not only thymic regulation but also immunologic function and cardiovascular status. In fact , BD itself appears to confer risk for cardiovascular disease independent of treatments used to manage the disorder, which results in an increase in risk of morbidity and mortality compared to the general population. Indeed, according to the literature, the life expectancy of patients with BD is reduced by eight to ten years, and particularly, cardiovascular events are two to three times more frequent and occur earlier.

The objectives of our study were to determine the prevalence of cardiovascular risk factors in patients with BD in remission and to compare it to a control sample.

This was a case-control study that took place over an 18-month period, from January 2, 2020 to June 30, 2021, in RAZI hospital, in Tunisia . Statistical analysis was performed by SPSS 26.0.

Sixty patients in remission and sixty healthy controls were included in this study.

The mean age was 42.5 ± 11.1 years with extremes of 20 and 60 years in the case group, while the mean age was 42.7 ± 10.2 years with extremes of 20 and 63 years in the control group.

At least one cardiovascular risk factor was found in 91% of patients with BD vs 78% of controls, and 92% of patients were smokers vs 68% of controls, with a significant difference between the two groups (p=0.041 and p=0.001), respectively.

Given the high risk of cardiovascular disease, rigorous cardiovascular risk assessment is critical for patients with BD. Psychiatrists should be aware of this problem and carefully monitor these patients for cardiovascular risk factors, including smoking, as part of their standards of care.

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The ASD Day Therapeutic Unit of the HUMT is an interdisciplinary reference center specialized in ASD, for the care of children and adolescents with this pathology, that offers care by programs with the aim of achieving functionality altered.

The main objective of this study is to know the clinical characteristics of the patients admitted to our center and to offer preliminary data on the functional improvement achieved in a pilot program that works by processes.

This is a prospective clinical study of patients with ASD, treated at the ASD Day Therapeutic Unit of the Hospital Universitario Mutua Terrassa (HUMT), since februay 2022 till nowadays. We compare the clinical improvement and functionality acquired through the evaluation through various scales: Conners scale, SRS, BRIEF and CBCL.

Our sample is made up of 19 patients with ASD who are admitted to the HUMT ASD Day Hospital. 13 belonged to the intensive care program, 5 to recovery of low-functioning functionality, and 1 to the differential diagnosis program. 84.21% (n=16) have preserved cognitive capacity. The median age is 13.1 years. 73.7% of the sample are men.

We observed that 89% of patients admitted to our unit presented comorbid symptoms with ADHD. more than 78.9% present isolation, anxiety/depression, altered thinking and attention difficulties. 13/19 present a SEVERE RANGE of affectation upon admission, in social area. Facing discharge, the CBCL shows us a general improvement in behavior and comorbidity in the total scale. The SRS shows us an improvement in social awareness, social communication, social motivation, repetitive behavior and stereotypes and in the total score.

Specific interventions in social skills, autonomy, social understanding, daily routines, and sensory integration in patients with ASD improve core symptoms, as well as associated behavior.

Specific interventions and working on social relationships during admission improve comorbidity derived from ASD.

More studies are needed to specify the most efficient interventions to improve the quality of life in children and teenagers with ASD.

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Phubbing with smartphones becoming an integral part of life and sociotelism behavior has emerged as an important academic concern (Chotpitayasunondh et al.,CHB,2016; 63, 9-18). Expectation of social support in social networks: It can be defined as “When the individual is emotionally intense, he/she shares about this situation and emotions and expects to be paid attention to, sincere and friendly approach from the people on social networking sites, and hopes that an environment of support and trust will be created with social networks by seeing that he/she is not alone with more emotional support.” (Uzakgiden et. al., JASR 2019;2 20-24)

In the nursing profession, in addition to using the internet for professional requirements, being a member of online social networking sites and spending time on these platforms are increasing.It is important to know the status of phubbing, which damages face-to-face communication understand its effect on patient-nurse communication and nurses communication within the team. Due to the intensity of work life in the nursing profession and the length of hours spent at work, the effort to meet the need for social support virtually may increase phubbing behavior.

The aim of this study was to examine the relationship among phubbing, online social support and trait anxiety, and the related factors in nurses.

The population of the research consists of nurses who actively use their social media accounts. Nurses were accessed by snowball method on online Whatsapp groups, Instagram and Facebook platforms through a digital survey between May and November 2021. Data collected by using an individual descriptive characteristics form, generic scale of phubbing, online social support scale, trait anxiety inventory. Mann-Whitney U, Kruskal-Wallis H tests, t-test and pearson correlation coefficient was used for data analysis.

The phubbing scores of the nurses ranged from 15 to 98; the trait anxiety levels of the nurses were at a moderate level. It was observed that marital status, presence of WhatsApp groups with teammates, and being warned about the frequency of phone use from teammates was related to phubbingg (p<0.001). There was a positive moderate correlation between the phubbing score and the online social support score; a weak positive correlation was found between the general phubbing score and the trait anxiety score.

It was determined that social support from social media significantly affected the phubbing behavior of nurses and that trait anxiety mediated this relationship. In future studies, researchers can conduct extensive research on the effect of sociotelism on nurse-patient communication and care. This study was also important in terms of making significant contributions to the literature, where there are only a limited number of studies on phubbing.

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Risk of functional impairment and progression to chronic illness in people with a first episode of psychosis (FEP) has motivated early intervention programs, showing promising results. Defining the characteristics of people with FEP at local level enables the clinicians to adjust interventional models to the reality of the population. The area 5 of Madrid (Spain) is referred to La Paz University Hospital and it serves a catchment area of roughly 527,000 people.

We aim to identify sociodemographic and clinical characteristics of patients in the area 5 of Madrid (Spain) who meet the criteria of FEP.

A descriptive retrospective study including 179 people (age range 18-40 years) who were attended in mental health services of La Paz University Hospital (area 5 of Madrid, Spain), between January 2019 and May 2020, having suffered a psychotic episode in the last five years.

The average age of people with FEP was 29.32 years, with a higher proportion of men (62%). The mean duration of untreated psychosis (DUP) was 3.64 months and 47% of patients consume cannabis. We found disparities in DUP among the different districts in the area and we also observed differences depending on the district for inclusion in rehabilitation programs or psychotherapy. The following averages were obtained for the aggregate sample: 1.01 hospitalization/year, 1.42 emergency room visits/year, 1.81 years of illness and a mean dosage equivalent to olanzapine 6.75 mg/day. The incidence of psychosis in our area has been 7.01 cases per 100000 inhabitants/year.

The incidence of psychosis has been as expected according to data recorded at previous studies in Spain. The results obtained in our sample have included a lower DUP and a higher use of cannabis than those described in the literature. We have also found differences when observing the inclusion of patients in different treatments (psychotherapy, rehabilitation), which may be related to the differences in the DUP by districts. Further exploration in this field is needed to draw causal conclusions.

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There has been an exponential rise in SSRI prescribing, between 2021 and 2022 there was a 5% increase. The majority of SSRI prescription initiation takes place in primary care. This is a national trend and mirrored internationally.

The study was undertaken to understand barriers to deprescribing both prescribing clinicians and patients and the potential of dependence caused by continued prescribing of SSRI and SNRI. We wanted to understand deprescribing challenges and both clinical anxiety and difficulty experienced and see if there is a correlation with the Drug use screening tool (DUST) tool.

Those patients who were stable on SSRI were offered lowering of dose and deprescribing as part of routine medication reviews. During medication reviews patients were asked about willingness to embark on a deprescribing schedule. Patients were screened during medication reviews on the DUST to see if this can be used to predict difficulty with deprescribing. We designed a deprescribing difficult questionnaire to assess the difficulty experienced by clinicians during a deprescribing consultation. We were able to study the is a correlation with DUST scores and Clinician experience of difficulty and challenge in deprescribing of the SSRI and SNRI.

Current alcohol drinkers and smokers were less likely to deprescribe from their antidepressants. Clinicals should do a risk assessment using the DUST screening tool checking for risk of dependence. There is an R value of 0.1586 (P-value is 0.018848) between the correlation of patients increased length time and increased DUST score causing an increased risk of dependence. The average R-score across the three practices between patient’s length of time being on medications and their DUST score is R= 0.18705 (P value of 0.01)

Inability to access IAPT therapies, shortened length of CBT sessions and lack of post IAPT support caused poor patient experience and contributed to reluctance to re-engage with IAPT services. Both cascade and incremental prescribing following lower doses without documentation of the limitations of medication results in unrealistic expectations generated from the prescribing. There is positive correlation between length of SSRI and SNRI prescribed, DUST scores, and Clinical challenge scores with patients’ unwillingness to be deprescribed. Patients should have a DUST score review prior to having been put onto any antidepressant as there is a potential link between increased DUST score and lower chances of willingness to deprescribe. Clinicians need to counsel patient of risk of dependence. The likelihood is these are drugs of dependence and clinicians should counsel patients of these risks and given review dates and offered deprescribing.

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Autism Spectrum Disorder (ASD) is a multifactorial neurodevelopmental disorder, with both contribution of genetic and non-genetic factors. A collaboration of de novo mutations and prenatal with postnatal environmental factors are likely to play a role. ASD can be syndromic or non-syndromic. The etiology of non-syndromic ASD is still relatively undefined due to its genetic heterogeneity. Contrary to non-syndromic ASD, syndromic ASD is often associated with chromosomal abnormalities or monogenic alterations. Familial cases of ASD support the strong genetic component of ASD.

To collect clinical arguments supporting a genetic cause of autism spectrum disorder.

We present a clinical study of familial cases of ASD. The families were recruited as part of a collaborative project between the department of Medical Genetic and the department of Child Psychiatry in Hedi Chaker Hospital, Sfax, Tunisia. The clinical and paraclinical data were collected retrospectively.

Our study included 11 unrelated families from southern Tunisia, each with two ASD children, among them four couples of twins. Most families (80%) are consanguineous belonging to a middle socioeconomic class. None of the parents suffered from psychiatric disorder and a familial history of autism was reported in one family. Perinatal history, including advanced maternal or paternal age, fetal suffering and/or gestational problems, was found in 35% of cases.

The average age was 9.89 ± 3.787 (3 to 17 years) with a balanced sex-ratio.

ASD was syndromic in seven out of 11 families: facial dysmorphism in half of cases (6/11 families) and/or another comorbidity in 25% of cases (celiac disease, congenital heart disease or idiopathic hydrocephaly). ASD was associated with other(s) neurodevelopmental disorder(s) in all children. Most of cases (14/22) had delayed psychomotor development and all of them had intellectual disability with various degrees. Epilepsy was identified in three cases belonging to unrelated families. Other behavioral problem was identified in 65% of cases.

When the autism spectrum disorder is syndromic and/or associated with other(s) neurodevelopmental(s) disorder(s), this points more towards a genetic origin.

Our study highlights the interest of clinical investigations to determine genetic risk factors of ASD. The identification of a genetic cause in familial cases would contribute not only to better understand the pathological processes of ASD but also to provide an appropriate genetic counseling.

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Early neurodevelopmental deviations, such as abnormal cortical folding patterns, are a candidate biomarker for major depressive disorder (MDD). Previous studies on patterns of abnormal cortical gyrification in MDD have provided valuable insights; however, the findings on cortical folding are controversial.

We aimed to investigate the association of MDD with the local gyrification index (LGI) in each cortical region at the whole-brain level and the association of the LGI with clinical characteristics of MDD, including recurrence, remission status, illness duration, severity of depression, and medication status of patients with MDD.

We obtained T1-weighted images of 234 patients with MDD and 215 healthy controls (HCs). LGI values were automatically calculated using the FreeSurfer software according to the Desikan–Killiany atlas. LGI values from 66 cortical regions in the bilateral hemispheres were analyzed. We compared the LGI values between the MDD and HC groups using the analysis of covariance, including patients’ age, sex, and years of education as covariates. The association between clinical characteristics and LGI values was investigated in the MDD group.

Compared with HCs, patients with MDD showed significantly decreased LGI values in the cortical regions, including the bilateral ventrolateral and dorsolateral prefrontal cortices, medial and lateral orbitofrontal cortices, insula, right rostral anterior cingulate cortex, and several temporal and parietal regions, with the highest effect size in the left pars triangularis (Cohen’s f = 0.361; P = 1.78 × 10-13). As for the association of clinical characteristics with LGIs within the MDD group, recurrence and longer illness duration of MDD were associated with increased gyrification in several occipital and temporal regions, which showed no significant difference in LGIs between MDD and HC groups.

Considering that the aforementioned cortical regions are involved in emotion regulation, abnormal cortical folding patterns in such regions may be associated with the dysfunction of emotion regulation-related neural circuits, which may lead to MDD. These findings suggest that LGI may be a relatively stable neuroimaging marker associated with the trait of MDD predisposition.

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It is known that the restrictions and clinical changes experienced during the pandemic period have negative effects on the care and treatment of psychiatric patients. However, insights on how the pandemic environment and the approaches of healthcare professionals serving during the pandemic affect the care and treatment of patients at risk of suicide are insufficient.

This ethnographic study aimed to identify the approaches of psychiatric nurses in managing suicide risk during the pandemic period in relation with their work environment.

This ethnographic research design used a sample of 13 psychiatric nurses in a psychiatric clinic in Ankara. Data were collected with in-depth interviews, participant observations and observant participations. Data were obtained from a total of 612 hours of observation and 13 planned nurse interviews. Data were analyzed using qualitative thematic analysis.

The emergent main theme from data analysis is explained under the title of “The risk of loss of inauthenticity in suicide risk management”. “Risk of loss of inauthenticity” means the fact that the individual suicidal risk factors and differences of the patients cannot be perceived/assessed by the nurses.

Supposing all patients having the same suicide risk level by psychiatric nurses caused insensitivity to risky patients in the care process. Nurses’ inadequate approach to patient personality disorder and limited social interactions due to the pandemic atmosphere made it difficult for nurses to have knowledge and understanding of how patients cope with suicidal ideations. These findings show the importance of the use of valid and reliable scales with risk formulations and the significance of triage in crisis periods such as current pandemic. In addition, creating available online consultancy service alternatives may have an important role in the management of suicide risk for patients who are disturbed by long-term hospitalization. Also these findings may contribute to the creation of qualified care and treatment guidelines on suicide risk management for crisis periods.

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We introduce and present a psychotherapic technique initiated by Wilhelm Reich (1897-1957) in the 1920’s and thereafter expanded and refined with essential contributions by Elsworth Baker among others. We outline its theory and technical foundations and also provide an epistemologic interpretation of its peculiar body-mind representation based on character- and muscular armoring as a reaction to suffering; armoring of the ocular segment in the etiology of Bleuler’s schizophrenic splitting; and finally the consequences of armoring on the energetic functions as the logical development of Freud’s theory of libido, with significant theoretic, therapeutic and nosologic consequences.

The goal of my presentation is to avoid extinction of a valuable technique for future psychiatrists; moreover, to catch the interest of young collegues to a technique that integrates Bleuler’s psychiatric discovery with Freud’s psychoanalytic contribution and demonstrates that the old nosology and theoretical achievements in the psychic field were not as obsolete as today many think.

Research, book summaries, practical experience

Poster presentation

Poster presentation

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Suicide is a complex problem in which individual, family social factors are interrelated. The 1997 Asian financial crisis caused a major economic crisis in Korea, and Korea received bailout support from the International Monetary Funds(IMF) from December 23, 1997 to August 23, 1997.

This study aimed to investigate the relationship between the suicide rate of children and adolescents who grew up during this economic crisis in Korea.

Suicide rates are calculated according to gender, region, and age of 5 years (10-14 years old, 15-19 years old, 20-24 years old) using suicide death data from the Korea National Statistical Office from 2000 to 2017. The cohort of interest in the study is the group that was in childhood and early adolescence between 1997-2000 and corresponds to 1986-1995 in terms of birth year. Cohorts are divided into 1986-1989 (G1), 1990-1992 (G2), and 1993-1995 (G3) according to birth year. These groups were 8-14 years old for G1 and 5-10 years old for G2, 2-7 years old for G3 during 1997-2000, during the economic crisis. The Age-Period-Cohort analysis and linear mixed-effects regression models are used and the moderating effect on region and age is also analyzed.

The 10-24 year-old suicide rate was higher in males than females, in older age groups, earlier in birth years in the birth cohort, and in rural than urban areas. Suicide rates between the ages of 20-24 years were particularly high among men living in rural areas. During the national economic crisis, the suicide rate was higher among adolescents than preschoolers (G3 < G1) (p<0.001), and this trend was observed for both men and women. However, the main effect of the cohort was not observed at a statistically significant level.

The national economic crisis has a negative impact on the mental health of children and adolescents, and it is more negative for adolescents than for children, which can increase the suicide rate between the ages of 20-24.

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Substance use continues to be an important problem among mental health patients either as main diagnosis or as comorbidity. Acute care visits, including emergency department visits and hospitalizations, related to substance use disorders (SUD) are increasing and can be opportunities to engage individuals to get proper treatment (Suen LW et al. J Gen Intern Med 2022; 37(10):2420–2428).

Both mental disorders and SUD lead to subsequent chronic physical conditions, premature death, suicide or overdose (Bennett AC. Public Health Rep 2019; 134(1):17-26) that can be accidental or not.

24% to 32% of patients with Substance Induced Psychosis develop later a schizophrenia spectrum disorder or bipolar disorder (Starzer MSK et al. Am J Psychiatry 2018;175(4):343–350) leading to a chronic use of medication and, in several instances, to a necessity of psychiatric in-patient treatment with long hospital stays and high readmission rates (Khan S. Health Reports (2017) 28(8)3-8).

Our goal was to analyze if substance use is associated with higher psychiatric hospitalization rates.

An independent-samples t-test was run to determine if there were more hospitalizations among patients with substance use. Afterwards, the Cohen’s D was calculated to measure the effect size and to see the magnitude of the experimental effect.

A sample of 2604 in-patient treatment episodes was used. The sample had 1696 female patients, 908 male patients and 823 patients had substance use. We found that patients with substance use had a statistically significant higher hospitalization rate (6.82±5.27) than the ones without it (5.32±4.84), t(1483)=6.945, p<0.001. Cohen’s effect size value (d=.30) suggested a small practical significance.

Our findings go mainly accordingly the literature; we found a significant effect of drugs on readmission rates (Böckmann V et al. Front Psychiatry 2019; 10:828) but we might have thought it would be bigger. That could be explain by undiagnosed substance use (refusal to admit the use, drugs not detected on lab tests, not requesting toxic lab tests) or higher sample percentage of confounding comorbid diagnoses.

However, is undoubtable the several risks that drugs bring to our health and so the authors aim to raise awareness among the medical community to the importance being alert for signs of use or psychiatric symptoms to avoid reaching a no turning point. It’s known that doctors frequently fail to diagnose SUD in hospitalized patients and given the linkage between use of certain substances and particular medical reasons for admission, it would be well-advised to search for SUD in certain admission diagnoses (Weintraub E et al. Am J Addict 2001;10(2):167-77). Knowledge of substance use behavior may help reducing relapse rates and to reduce the risk of developing a SUD (Andersson HW et al. Nordic Journal of Psychiatry, 75:3, 160-169).

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Depression is a common pathology in the elderly, often unrecognized and mostly affiliated to the consequences of aging,especially in front-line services. It induces somatic and functional impact and even a suicidal risk.

When unrecognized or neglected, depression can reduce life expectancy and increases the use of healthcare and the institutionalization.

-Determine the point-prevalence of depression in the elderly in a front-line heath service in Tunis.

• - Identify risk factors of depression in the elderly.

A descriptive and evaluative cross-sectional study on a sample of patients aged 65 or more, in a tunisian front-line service of general health care regardless of the medical reason.

Sociodemographic and clinical forms along with the PHQ-9 scale (Patient health questionnaire-9)

• - validated in tunisian dialect- were used.

Thirty patients have participated in our study (21 men and 9 women). The average age was 73.23 years. Chronic pathologies were found in 96.66% of cases.

The found risk factors are: female sex in 70% of cases, loneliness and isolation in 10% of cases, widowhood in 50% of cases, grieving in 6.6% of cases and somatic comorbidity in 96 .66% of cases.

The overall prevalence of depressive symptoms was 53.33%. This is correlated with advanced age and female sex (57.14% in women vs 33.33% in men).

The depressive symptomatology found, was mild in 18.5% of cases, average in 62.5% of cases and moderately severe in 18.5% of cases.

Depression is a frequent pathology in the elderly with multiple risk factors. The aging of the Tunisian population on one hand and the change of the social model (family nucleus) on the other, encourage the early detection of depression in the elderly and the training of the health professionals in order to limit its prevalence.

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Aripiprazole is a newer atypical antipsychotic with a favorable side-effect profile, especially a low propensity to result in metabolic syndromes.It is effective at treating bipolar disorder, the positive symptoms of schizophrenia and has the potential to treat negative and cognitive symptoms.

However, prior studies suggested that aripiprazole seem to be associated to a risk of inducing certain impulse control behaviors, such as uncontrollable gambling, hyper sexuality, as well as compulsive eating.

We proposed to assess the evidence for compulsive eating associated with the use of aripiprazole.

We report a rare case of new onset aripiprazole induced compulsive eating behavior in a patient with bipolar disorder. Then, we conducted a literature review using“PubMed” database and keywords “Aripiprazole”, “Impulse Control Behaviors”, “Compulsive Eating”.

He was a 21-year-old patient, diagnosed with bipolar 1 disorder. He was prescribed Aripiprazole, after a neuroleptic malignant syndrome induced by haloperidol (which was prescribed during the first episode psychosis).

One month following the treatment initiation, the patient complained of eating excessively. He was not able to control his eating and gained 30 Kg over the period of 4 months. Metabolic assessment showed a hypercholesterolemia.

Aripiprazole is a promising novel antipsychotic in mental diseases. However current evidence associates compulsive behaviors like eating with the use of Aripiprazole, probably due to the drug affinity to 5-HT receptors. More studies are needed to confirm this rare side effect.

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Patients in psychotic relapse may exhibit violent behavior towards objects, themselves or others. These behaviors, although usually unconscious, are a common reason for hospitalization and a source of rejection and stigmatization by family and society.

The objective of this study was to evaluate the presence of aggressive behavior in relapsed inpatients with schizophrenia in the F psychiatry department at the Razi Hospital in Tunisia.

This was a descriptive, cross-sectional study of fifty male patients hospitalized for a psychotic relapse who were naïve or discontinuing treatment for at least two months. Patients were assessed using a semi-structured questionnaire and the Overt Aggression Scale (OAS).

The age of the patients included ranged from 17 to 65 years, with an average of 36.4±11.51 years. More than half of the patients were without occupation (58%, N= 29). For personnal history : Seven patients (14%) had attempted suicide ; Eight patients (16%) showed evidence of self-harm ; Thirteen patients (26%) had a history of arrests of which eleven (22%) were incarcerated.The OAS score ranged from to 0 to 35 with a mean at 9.7+/- 10.3. Twenty-seven patients were aggressive (54%).

Preventive strategies should focus more on predicting the aggressive potential of patients with schizophrenia and its socio-professional implication. Perhaps when using a less holistic approach to the disease and when approaching aggressive behavior as a symptom in its own right, we will be able to find other alternative options.

None Declared