Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.

Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.

The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.

To draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.

Case report and non-systematic literature review of the current data.

A 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.

Psychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.

None Declared

The incidence of psychological disorders in patients with cancer is very high (30–60%), with approximately 29–43% fulfilling the diagnostic criteria for psychiatric disorders. The most commonly encountered mental problems encompass depressive symptoms associated with mixed anxiety and adjustment disorder or depressive mood or major depression.

The aim of this research is to highlight the characteristics of psychiatric manifestations in patients with cancer and to analyse the risk factors that influence the occurrence of these psychiatric manifestations.

Α bibliographical review was performed using the PubMED platform. All relevant articles were found using the keywords: cancer, psychiatric manifestations, risk factors.

Sleep problems, irritability, tendency to cry easily, sadness, and pain were among the leading symptoms at baseline. Women reported sleep problems, tendency to cry easily, irritability, pre-occupation with the illness, and sadness as the first five most frequent issues, and men reported sleep problems, irritability, pain (usually incompatible with their medical conditions), sadness, and tendency to cry easily as the most frequent problems.

Significant risk factors that increased the mood disorders were recurrence, presence of secondary cancer, other chronic medical illnesses, history of psychiatric disorder, low income level, poor social support, and being single or divorced.

None Declared

Habituellement, nous voyons dans la consultation psychiatrique des patients épileptiques pour des plaintes psychologiques. Souvent pour un trouble anxieux ou dépressif. Dans d’autres cas, nous prenons en charge des patients psychiatriques atteints d’épilepsie.

L’objectif de notre travail est d’étudier la prévalence de la comorbidité psychiatrique dans une population de patients épileptiques.

Nous avons mené une étude transversale auprès de la consultation de l’hopital ar-razi de salé, à l’aide d’un questionnaire et d’échelles d’évaluation préétablies : le MINI (mini entretien neuropsychiatrique international), l’inventaire de la dépression de Beck, et Échelle d’anxiété de Hamilton.

55 patients ont répondu aux critères d’inclusion. L’âge moyen de nos patients est de 25,9 ans. Le sex-ratio F/H est de 1,6. Plus de la moitié de nos patients sont célibataires (78%). Seuls 21 % des patients ont une activité professionnelle régulière. La prévalence des troubles psychiatriques dans notre étude est de 66,6%. L’anxiété est retrouvée dans 68,2 % des cas, alors que la dépression est évaluée à 58,9 % des cas dont 23,7 % ont une dépression sévère qu’il faut traiter, avec une prédominance du sexe féminin (66,8 %).

Dans notre étude, l’ anxiété et la dépression sont les troubles psychiatriques les plus rapportés en cas d’épilepsie. Ils doivent être systématiquement recherchés pour tout épileptique et traités pour améliorer la qualité de vie des patients.

None Declared

Coping and emotional regulation mechanisms may play a significant role in the neurodevelopment and in the subsequent psychopathological trajectories, especially in youth. The boredom dimension may also have a pathoplastic role.

Considering the poor literature in adolescents and young people (15-24 years-old), our study aims at investigating the relationships between coping patterns and emotional dysregulation as well the mediatory role of boredom, by particularly focussing on a sample at early onset of mood disorders.

Cross-sectional, observational design study. Descriptive analyses were performed considering a set of socio-demographic and clinical variables (DERS, MSBS, COPE-NVI). Kruskal-Wallis, Spearman correlations and linear regression models were performed between DERS (dependent variable) and COPE-NVI (independent variable), together with mediation analyses (MSBS as mediator).

86 subjects (mean age=18.4±2.8) were enrolled. DERS score was 114.8±33.3, COPE-NVI was 129.1±22.1, MSBS was 136.22±45.8. Positive correlation between DERS total and avoidance strategies (r=+0.6,p<0.001) and negative correlation between DERS total and problem orientation strategies (r=-0.467,p=0.023) were found. Linear regression analyses showed statistically significant differences between DERS and COPE-NVI avoidance strategies (p<0.001) and COPE-NVI problem orientation (p<0.023). Mediation analyses confirmed the mediatory role of boredom dimension in the association between COPE-NVI avoidance subscale and DERS total (B=0.6849, p <0,001), between avoidance subscale and DERS lack of acceptance subscale (B=0.1286, p<0.001). Moreover, a mediatory role of MSBS inattention subscale was found in the association between COPE-NVI avoidance subscale and DERS lack of control subscale (B=0.1027, p<0.001).

Maladaptive coping strategies (particularly avoidance) were associated with increased DERS levels. A predominant use of more adaptive coping strategies (i.e., problem solving, planning) were associated with lower DERS levels. Their relationship appears to be mediated by boredom dimension.

None Declared

Complex PTSD is a new trauma-related disorder in ICD 11 and it differs from PTSD by the trauma being repetitive or prolonged and some other symptoms, while selective anosmia is the inability to detect a particular odor.

Is there any relationship between severe trauma and selective anosmia as a novel feature?

INTERNATIONAL TRAUMA QUESTIONNAIRE (ITQ), Case report and non-systematic review through literature research in PubMed database, using the key-word “selective anosmia”

Two articles suggest that selective anosmia may present in animals when olfactory epithelium exposures to some chemical substances while the other two articles indicate that cortical nucleus in the amygdala has major olfactory connections and its degeneration is likely to contribute to the early selective anosmia common in Parkinson’s disease, but no one described this feature in psychiatric trauma.

May be this is the first time ever to describe selective anosmia during severe trauma suggesting a role of amygdala as in this case report, therefore Syria and other countries that had similar crisis need more studies to get accurate statistics, explore more rare features, and test the effectiveness of treatment options.

None Declared

Suicide represents one of the most discussed mental health issues in the world today and health challenges for the future. The burden of suicide is calculated in very high numbers (800 thousand people per year) by the WHO (2014), ranking it among the other most frequent causes of death. The key criteria to determine suicidal or non-suicidal behavior is the presence of intentional self-injurious behavior, in which the individual intentionally attempts to harm himself.

Objectives: Aim of the study: was to make a presentation and evaluation of the demographic and clinical factors of suicidal self-injurious behavior in patients hospitalized

Patients’ data were obtained from the archived clinical files of the Psychiatric Emergency Department and other wards at “Xhavit Gjata” Tirana Psychiatric Hospital. The method used is a descriptive retrospective study of patients admitted during period of January-May 2019. About 75 archived clinical files were thoroughly studied and analyzed, on various demographic and clinical variables.

Albanian women remain more at risk for suicide attempts, while male suicide mortality is higher, as in the world. Higher determination and the use of more lethal methods ranked among the factors contributing to the higher mortality of men. The 29-49 age group is the most affected in our study according to suicide attempts and self-harming behavior. The most pronounced accompanying diagnoses of suicide attempts are major depressive disorders, but not leaving behind psychotic disorders. The average length of stay in the hospital is 18.4 days.

The deepening of knowledge on the etiology, on the factors influencing suicide and on the methods of treatment are only some of the issues facing public health today. Identification of self-injurious behaviors pave the way for treatment and assistance for anyone considering suicide.

None Declared

Perinatal grief is the process that occurs after the loss of a baby, either during pregnancy or during the period immediately before or after childbirth (up to a year). In recent years, the increase in specific training and development of programs focused on perinatal mental health has facilitated the creation of specific action protocols. The case of a 38-year-old woman who suffers a gestational loss during the third month of pregnancy is explored. The presence of personal and family antecedents that suppose risk factors for the adequate elaboration of the duel, raise doubts about the handling of the case.

This work has several objectives, including reviewing the published literature on perinatal bereavement in an emergency situation and, on the other hand, presenting a case.

A bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed in order to expose its own experience in this field, defining specific interventions as well as results.

On evaluation, the patient was conscious and oriented to person, time, and space. Approachable and cooperative. Overall calm, although with intermittent crying. Low mood reactive to vital situation, without apathy, apathy, or anhedonia. No previous episodes of hypomania or mania. Not another major affective clinic. Fluid and coherent speech, formally well constructed without glimpse alterations in the course or content of thought. She denied sensory-perceptual alterations, without showing a listening attitude, or suspicion or any other psychotic or dissociative symptoms. He denied ideas of self-harm, death or self-harm, presenting an adequate request for help and coherent and realistic future plans. Altered biological rhythms with insomnia of three days of mixed pattern evolution. preserved appetite. Judgment of reality preserved.

The grief reaction is an experience that must be normalized after the loss of a loved one. However, given the risk factors presented by the patient, preventive management is established in the face of possible complicated perinatal grief. A new appointment is established in less than 10 days to reassess the case with the perinatal mental health team.

Perinatal mental health is an area of knowledge that could provide assistance to mothers, fathers and family systems plunged into a crisis of perinatal grief.

Prevention in situations of possible complicated perinatal mourning is no less important than treatment when the disorder is already established.

None Declared

Poly use of psychoactive substances (tobacco, alcohol and cannabis) is a major health issue, especially among younger children, mainly adolescents and students. The prevalence of addictive behaviour in Tunisia is clearly increasing. This development attracts the attention of the scholarly society from the point of view of the effects and consequences on the short or long term. Since this is still a taboo subject given the socio-cultural and religious constraints, there are still difficulties in conducting epidemiological investigations on this subject.

In this context, we conducted this study with the Tunisian student population during the academic year 2020/2021. The objectives of this work were: To determine the prevalence of the use of the three psychoactive substances (tobacco, alcohol and cannabis) and to evaluate school performance as associated factors of substance use.

We proceeded to a descriptive and analytical cross-sectional study conducted with a sample of the Tunisian student population during the 2020/2021 academic year (from November 2020 to February 2021).

We included in the analysis 772 students. The average age of the study population was 23.29 3.25. Alcohol was the most reported substance in 35.8% of participants. The prevalence of tobacco use was 32.1% and that of cannabis use was 14.4%. Academic achievement was assessed by the notion of repetition, from which we noted that 81.3% of respondents did not experience repetition. Repetition was statistically significantly associated with the use of all three substances (p < 10-3). The concept of repetition increased the risk of smoking by 2.616 (95% IC95 [1,724-3,969]). The concept of repetition increased the risk of consumption by 2.33 (IC95%[1,522-3,578]). The notion of repetition multiplies the risk of cannabis use by 2,250 (IC95%[1,369-3,699]).

The relationship between the use of psychoactive substances and low academic performance has been explained from different medical and psychological perspectives. It is crucial to recommend the development of support cells in academic institutions as well as to strengthen psychological management especially for people who have experienced a drop in school because they would be people at risk of developing a substance use.

None Declared

Mental illness is not uncommon among males. While the estimates of the males who are dissatisfied with their lives, die by suicide, become alcohol-dependent and drug users are high, low numbers seek mental health support.

In this study, we aimed to assess Text4Hope, a texting mental health support service, provided to people in Alberta during the COVID-19 pandemic, and examine its effectiveness among male subscribers.

In a naturalistic randomized controlled trial design, a comparison was run between two populations of Text4Hope male subscribers; an intervention group (IG, Text4Hope subscribers who received once-daily supportive text messages for 6 weeks) and a control group (CG, Text4Hope subscribers who joined the program in the same time frame but were yet to receive text messages). The severity and the prevalence of likely stress, anxiety, and depression were examined between the two groups, using the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9), and defined the Composite Mental Health (CMH) score as the sum of these three. T-test, Chi-squared association, and binary logistic regression analyses were applied.

There were 286 male subscribers to Text4Hope. The majority were above 40 years, white, employed, had postsecondary education, were in a relationship, and owned a home. Mean scores of PSS-10, GAD-7, and PHQ-9 scales and the CMH were significantly higher for the CG compared to the IG, 11.4, 28.8, 25.8, and 18.7%, respectively. Similarly, there was a statistically significant lower prevalence in IG, compared to the CG, on likely MDD (58.15 vs. 37.4%) and likely GAD (50 vs. 30.8%), with a small effect size. The IG was a significant predictor for lower odds of both likely MDD and likely GAD while controlling for sociodemographic characteristics.

Text4Hope is an effective tool for mental health support for male subscribers, during the COVID-19 pandemic. Compared to the subscribers who didn’t receive the service, those who received it were in a better mental health condition. Further efforts are still needed to encourage males to participate in such online services that can provide adequate support, particularly during crisis time.

None Declared

There is a high prevalence of stress, anxiety, depression, and substance use disorders in college students globally. Financial stressors, course workload, peer pressure and other personal, family, and societal stressors contribute to the high incidence of mental disorders among college students. Despite the high prevalence of mental disorders in college students, barriers such as lack of mental health literacy, stigma of mental health, inadequate numbers of mental health counsellors and clinical psychologists supporting students in colleges in both low- and high-income countries, financial and geographical barriers often hinder college students from accessing the needed mental supports.

In this article, we provide a perspective on the ResilienceNHope program, an evidence-based text and email messaging innovation to close the psychological treatment gap and improve the mental health literacy of university and college students.

Review of literature. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. College students are well adapted to the use of mobile technology, particularly text and email messaging daily, which presents a unique opportunity for an innovative way to offer support for their mental health.

There’s evidence to support the findings that ResilienceNHope program, which involves the use of text and email messaging is an innovative tool which can be adopted to close the psychological treatment gap and improve the mental health literacy of university and college students

Supportive text messaging can be adopted to help support and improve the mental health of university and college students.

None Declared

Numerous preclinical and clinical studies established the contribution of childhood adversity to acute stress vulnerability at adulthood. Several different physiological, psychological and behavioral factors have been suggested as putative mediators of this association. Sleep, and more specifically sleep disruption, has emerged as one such promising candidate. First, adverse childhood experiences have been repeatedly associated with adult sleep disorders. Second, individuals that suffer from stress-related psychopathology at adulthood often exhibit sleep disturbances, to the extent that sleep difficulties are diagnostic criteria for many of these disorders. Third, inefficient sleep pre and post exposure to acute stress was shown to increase the likelihood for maladaptive outcome, potently by impairing critical processes that occur during sleep as arousal regulation and memory consolidation.

To date, very few studies integrated these independent lines of research. Also, previous studies mostly assessed sleep via self-reported diary or a single night measurement at laboratory settings. The current study aimed to provide a more ecological and continuous account for sleep patterns, and their putative associations with childhood adversity on the one hand and vulnerability to acute stress at adulthood on the other hand.

Ninety-six healthy adult female participants completed the well-established childhood trauma questionnaire (CTQ) before wearing a wearable sensor for seven consecutive days and nights while maintaining their regular life routine. Following that, participants all underwent an acute laboratory stress induction procedure while their psychological and endocrine responses were recorded at multiple time points throughout.

Sleep patterns fully mediated the association between childhood adversity and psychological response to acute stress at adulthood (Figure 1). Specifically, elevated levels of childhood trauma were associated with more variation in sleep duration across the recording period, which in turn was associated with higher stress-induced negative affect. Interestingly, this association did not emerge with respect to mean sleep time nor with stress-induced cortisol release.

Results imply that childhood trauma may lead to irregular sleep patterns which in turn contribute to exaggerated emotional response to acute stress at adulthood. These findings support the mediating role of sleep in the link between childhood adversity and acute stress vulnerability at adulthood, and highlight sleep as a viable target for early or even preventive intervention.

None Declared

Several studies have shown that the relationship between migraine and psychological factors is significant, but few have evaluated the relationship between these psychological factors and patients’ social life.

Exploring the role of personality and psychopathology in people with migraines.

The sample consisted of 180 people, more specifically 140 people from the general population and 40 people who have been diagnosed with migraine and receiving treatment for migraine, who completed the following questionnaires voluntarily and anonymously: a) Migraine Experience Questionnaire and Headache Impact Test-6 (HIT-6), b) Eysenck Personality Questionnaire, c) Symtom Checklist 90-R (SCL-90) and socio-demographic and self-reported questionnaire.

Patients scored higher somatization rates (10.21 ± 8.08), phobic anxiety (3.00 ± 4.45), neuroticism (4.09 ± 1.37), than people from the general population who scored lower somatization rates (14.63 ± 3.12), Phobic anxiety (5.28 ± 1.89), Neuroticism (6.53 ± 2.12), with a statistically significant difference between them (p = 0.001), (p = 0.002), (p = 0.000), respectively.

Patients with symptoms of migraine show statistically higher rates of somatization, phobic anxiety, neuroticism and further study is considered necessary.

None Declared

Recovery from substance use disorder requires sustained effort and perseverance. Grit is a resilience factor that may be important for people in recovery. Little research has been conducted on grit in patients with substance use disorder, especially in a large and varied sample.

To examine the Short Grit Scale (Grit-S) in patients with substance use disorder, our aims were to analyze its psychometric properties and use demographic and clinical characteristics to predict variance in Grit-S scores.

In this study of patients in treatment for substance use disorder, participants completed the Grit-S and other self-report measures. The psychometric properties of the Grit-S were assessed in outpatients (N=94) and a hierarchical regression was used to predict Grit-S variance in inpatients (N=1238).

The Grit-S demonstrated good internal consistency (α=.75) and strong test-retest reliability (unadjusted r=.81, adjusted r=.79, p values<.001). The mean Grit-S score was 3.15, which was lower than other clinical samples reported in the literature. Regression modeling indicated a moderate, statistically significant association between demographic and clinical characteristics and Grit-S scores (R2=15.5%, p<.001).

Of particular interest, the positive factor of recovery protection showed the strongest association with grit of all the variables assessed. Hence the positive construct of grit was correlated with other positive constructs, as well as with risks. Longitudinal assessment of grit and substance use could measure the stability and clinical significance of grit throughout recovery.

M. Griffin: None Declared, R. Weiss Consultant of: Analgesic Solutions, WCG, & Alkermes, C. Trinh: None Declared

The most common liver diseases associated with the fat accumulation in the hepatic tissue are metabolic associated fatty liver disease (MAFLD), non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH). Many studies previously reported several key mechanisms tying hepatic injury to extrahepatic manifestations. In this way, the co-occurrence of cognitive decline, mood, and affective changes could suggest the existence of a strong neurological component predisposing to neuropsychiatric comorbidities.

In this study, we aimed to describe the neurological and neuropsychiatric comorbidities of MALFD, NAFLD, and NASH.

The main scientific databases were screened for English-written studies using the following key words: ”cognitive decline”, ”neuronal loss”, ”affective disorders”, ”anxiety”, ”depression”, ”MAFLD”, ”NAFLD”, ”NASH”. Exclusion criteria: (1) studies not focussing on fatty liver diseases; (2) not describing comorbid conditions; (3) not providing correlative analysis of disease co-occurrence or mechanistic associations.

Hepatic encephalopathy (HE) is the main NAFLD/NASH extrahepatic manifestation commonly characterized by impaired cognition, rapid mood swings, depressive and anxious behaviours, and defective sleep. It is currently reported that more than 70% of the cirrhotic patients develop HE. Cognitive impairments and brain tissue reduction were found in NAFLD patients, while MAFLD patients’ cognitive dysfunctions (mild cognitive impairment and hippocampal-dependent memory impairment) were not associated with the presence of metabolic syndrome. Similarly Alzheimer’s disease (AD) was not described as comorbid in MAFLD. By contrast, since NAFLD and NASH are often characterized by insulin resistance and dyslipidaemia – significant triggers of dementia. By far the most prevalent neuropsychiatric comorbidity in NAFLD and NASH is the major depressive syndrome, diagnosed in almost 30% of the cases. Also, a correlation between the anxiety manifestation and the progression from NAFLD to NASH was described. In this context, as a response to the vast evidence that connect liver dysfunction to cognitive impairments, the liver-brain axis function was hypothesized.

MAFLD, NAFLD, and NASH are frequently associated with cognitive decline. The main NASH neurological comorbidity is hepatic encephalopathy, but it could also be seen in NAFLD. While Alzheimer’s disease occurs in NAFLD and NASH, more studies are needed to explain the severity-dependent association. Depression and anxiety were also reported in NAFLD and NASH.

Acknowledgements: B.I.-M. and R.M.-A. is currently supported through the Project entitled “Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E” (CENEMED, code: 127606), cofinanced through the Operational Program of Competitivity, Prioritary Axis: Research, Technological development, and Inovation (CDI).

I. M. Balmus Grant / Research support from: Project entitled “Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E”(acronym: CENEMED, mySMIS code: 127606), cofinanced through the Operational Program of Competitivity, Prioritary Axis: Research, Technological development, and Inovation (CDI)., M. -.-A. Robea Grant / Research support from: Project entitled “Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E”(acronym: CENEMED, mySMIS code: 127606), cofinanced through the Operational Program of Competitivity, Prioritary Axis: Research, Technological development, and Inovation (CDI)., R. Lefter: None Declared, A. Ciobica: None Declared, L. Huiban: None Declared, C. Stanciu: None Declared, A. Trifan: None Declared

Recent studies find a high level of prolactin in naive patients with consequences on their behavior. These results have shed light on new etiopathogenic avenues in schizophrenia and suggested new preventive approaches.

The objective of our work was to investigate the links that may involve prolactin levels to agressive behavior in patients followed for antipsychotic-naïve schizophrenia or in therapeutic discontinuation.

We conducted a one-year descriptive and cross-sectional study of thirty male patients hospitalized for a treatment-naïve psychotic relapse or who had been discontinued for more than two months. These patients were assessed using a questionnaire as well as the Overt Agression Scale (OAS). A blood sample was taken to specify the prolactin level.

Eleven patients were aggressive (37%). Seven patients (23%) had hyperprolactinemia. Hyperprolactinemia was also inversely associated with aggression since inversely significant correlations were objectified for prolactinemia and respectively the OAS score and the verbal aggression subscore (Rho=-0.391 ; p=0.033) and (p=0.016, Rho=-0.438). The score of aggressiveness towards others also evolved inversely to the prolactin level with a p close to significance (p =0.056).

Our results support the hypothesis of a probable action of prolactin as a protective factor against aggression. High prolactin levels may therefore represent a diagnostic lead for a particular profile of a certain patient group with a particular course. However, this subject is still unresolved in the literature and future studies seem necessary.

None Declared

Ekbom Syndrome is a rare condition presenting as a uni-thematic delusional belief of parasitosis. Affected individuals are often socially isolated presenile females. The syndrome is characterised by kinaesthetic hallucinations of insect infestation with persistent pruritis. First described by Karl Ekbom in 1938, presentations are rare, often presenting initially to primary care and dermatological services. We report a case of an older adult female referred to Community Mental Health Team following multiple presentations to the primary care physician with subsequent diagnosis of Ekbom Syndrome.

To illustrate a rare case report of Ekbom Syndrome, managed successfully in the community in Ireland.

A retrospective case study. Data was reviewed from available psychiatric and medical records including laboratory testing.

A 69 year old Catholic Nun was referred to the CMHT for psychiatric assessment. The patient presented to the CMHT appointment as distressed. She reported a 15 year history with significant deterioration 4 months prior, of progressive symptoms of a ‘crawling and biting sensation’ all over her body, alongside intermittent anxiety related to the infestation. The patient acknowledged that she had visited her primary care physician on multiple occasions seeking resolution. On one occasion the patient brought a sample of the alleged parasites inside a small container, ‘matchbox sign’.

A professional pest control agency had recently been employed to decontaminate her bedroom in the parish house of which she is resident in. She described a rigid routined, daily washing of clothes. Medical history was significant for pituitary gland adenoma 30years prior, with pituitary excision twice secondary to visual disturbance and reoccurrence. She was on lifelong thyroid replacement with acceptable postoperative functioning.

The patient was commenced on Aripiprazole oral medication and received psychoeducation via Specialist Mental Health Nursing Outreach. Pimozide was deemed unsuitable due to presence of numerous cardiac risk factors. Physical and delusional psychopathology resolved in a trajectory fashion with aripiprazole titration. It was hypothesised that the patient had premorbid anakastic personality traits, exacerbated by the COVID19 pandemic prior to presentation.

Patients with delusional parasitosis can have complex medical and social histories and may present to psychiatry as a last resort. These clinical presentations can occur after periods of dermatological input and following extensive efforts to decontaminate their physical surroundings. Psychotic symptoms of Ekbom Syndrome may be effectively controlled with psychotropic therapy and patients benefit from psychoeducation about their rare disorder.

None Declared

Sunshine increases placebo effect in major depressive disorder (MDD) patients (Gailledreau et al., 2015). Kokras et al. (2014) showed that sunshine induces different responses in female than male mice in preclinical models of depression.

To determine if the sunshine induced placebo effect exhibits gender differences in human

Data from 9 double-blind, randomized, placebo-controlled studies of antidepressants conducted by the French GICIPI network were reviewed. MADRS (5) or HAM-D 17 (4) were used as the main efficacy tool. For each patient, variation of scores (Delta MADRS/Delta HAM-D) between two consecutive visits were correlated with the average sunshine index observed at noon between these visits. Sunshine indexes were provided by Météo-France. Correlations were computed with Microsoft Excel.

Sunshine increases placebo effect: however analysis of both genders (n=52) demonstrates no statistically significant (NS) correlation (r²=0.0064). Analysis of the males (n=8) demonstrates NS correlation in cloudy (< 1000 Joules/cm²), variable (1000-2000 Joules/cm²) or sunny (> 2000 Joules/cm²) weather. Although analysis of the females (n=44) demonstrates NS correlation as well for cloudy or variable weather (r²=0.0016), there is a strong correlation between sunshine index and Delta MADRS/Delta HAMD for females exposed to sunny weather: r²=0,315, n=20, p<0.01. This correlation is even stronger in the subpopulation of females aged less than 50 years: r²=0.6398, n=12, p<0.001.

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Sunshine increases placebo effect in female patients aged less than 50. This insufficiently known effect may be responsible for failure of a number of double-blind, randomized, studies of antidepressant compounds.

None Declared

Mental disorders are among the most poorly treated illnesses in sub-Saharan Africa. It is estimated that 70-80% of South Africans consult Traditional Health Practitioners (THPs) for the treatment of psychological ailments. Few studies have examined the perceptions of THPs regarding causes of mental illness and whilst we know little about their practices, THPs maintain a strong role in assessing and treating patients with mental illness.

This research aims to be among the first studies to identify perceived causes and treatment modalities for mental illness among THPs in Johannesburg, South Africa.

Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data was managed using NVivo 12 software and thematically analyzed.

THPs interviewed generally perceived mental illness to be of supernatural causation, either as a result of bewitchment, a calling for the patient to become a THP themselves, due to angry ancestors, or due to natural causes. THPs identified eight primary treatments that they use for treating mental illness. Among these were: throwing of bones (tinhlolo) to start communicating with ancestors, steaming (ukufutha) to start the cleansing process, sneezing (umbhemiso) to forcefully dispel the spirit causing the illness, vomiting (phalaza) and laxatives (mahlabekufeni) to remove the spirits poisoning the body as well as animal sacrifice to purge spirits and communicate with ancestors. This is all followed by cutting (ukucaba) which is the final part of treatment that ensures that the evil spirit cannot return.

This study is among the first to examine the perceived causes and treatments for mental illness used by THPs in Johannesburg, South Africa. As the vast majority of South Africans continue to seek help for mental illness via THPs, it is important to understand what forms of care healers are providing to patients. Future research should continue to document ways in which THPs approach healthcare as well as investigate interventions that can foster collaboration between THPs and biomedical professionals.

None Declared

With the increase of older adult population, late life depression is emerging as a major problem in many countries as it significantly deteriorates function and quality of life in older adults. Late life depression is a multidimensional disease that requires intervention in biopsychosocial perspective. Recent reduction in family size and rapid simplification of generations are making this decrease more dramatic. Thus, single older households are becoming general type of household in late life, emphasizing the importance of social engagement in late life depression

the purpose of this study is to assess the correlation between the frequency of face-to-face and non-face-to-face contact with non-cohabitating adult children and late life depression after the COVID-19 pandemic. Additionally, we hypothesized 10 possible moderators and evaluated the moderation effect of each moderator on the correlation. By identifying groups of older adults that are more affected by contact with their children, the understanding of the relationship between late life depression and family contact in older adults might provide insights to set intervention targets in the community.

Older adults who completed the Living Profiles of Older People Survey in Korea were included. In total, 7,573 participants were analyzed by measuring their contact frequency and depression symptoms. Regression analysis was done adjusting covariates. Process macro was used to verify the moderating effects of variables.

Multivariable logistic regression analysis showed that both infrequent face-to-face (OR=1.87, 95% CI=1.56-2.23) and non-face-to-face contact (OR=1.22, 95% CI=1.03-1.44) with non-cohabitating adult children group was associated with higher risk of late life depression compared to a frequent contact group. Further linear regression analysis, which viewed depressive symptoms as SGDS-K score, indicated consistent results in face-to-face and non-face-to-face contact (estimate=0.468, standard error [SE]=0.091, p<0.001 and estimate=0.262, standard error [SE]=0.079, p<0.001, respectively). Finally, using moderation analysis, association with late life depression and frequency of face-to-face contact was moderated by age, quartiles of household income, number of chronic diseases, frequency of physical activity, existence of spouse, and nutritional status (NSI) whether effect of frequency of non-face-to-face contact on late life depression was increased by participation in social activity, frequent physical activity, and good cognitive function (MMSE-DS score)(p for interaction<0.05).

Frequent contact of non-cohabitating children lowers the risk of later life depression. Several variables were found significant in moderating contact frequency-depression symptoms.

None Declared

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.

None Declared