There are various ways people cope with life events. One can expect generalized positive or negative outcomes across various life domains, called dispositional optimism. This can be explained by attribution theory: how people explain past events, their causations, and outcomes. Understanding attribution styles is important to help people reframe current circumstances and improve mental wellbeing. Our hypothesis is that people of different religious groups may exhibit various levels of optimism and pessimism based on their values, teachings, and practices. Previous research has found that people of Christian faith, or those with a religious faith in general, look to their religion as a way of coping during life adversities. Certain religious practices such as prayers and Church gatherings have been found to improve mental health through increasing dispositional optimism. While the relationship between religiosity and mental health has been previously examined in different religious populations, there are few studies that focused on comparing this relationship across religions.

The objective of this scoping review is to understand the link between religiosity and mental health, focusing primarily on how people of the Christian religion demonstrate dispositional optimism or pessimism when coping with adverse life events, compared to other religious groups or atheists.

This scoping review included original peer reviewed study articles that studied mental health in terms of dispositional optimism or pessimism in people of Christian religion compared to other religious groups. This review used online databases, Ovid MEDLINE and PsycInfo, and used extraction tables to analyze the results of past research.

The results of this scoping review revealed that people of Christian religion, especially those high in religiosity, use their religion as a method of coping. This population also showed higher dispositional optimism compared to atheists or those that believe in other religions. However, when compared to other religions such as Buddhism and Muslim, Christian populations showed lower dispositional optimism.

It is evident that religious involvement is linked to aspects of mental health, but comparing the effects of different religions is still a topic of exploration that can be investigated further to allow deeper understanding of their similarities and differences, as well as the mechanisms by which religion can affect mental health. In this review, a gap in the body of knowledge regarding the relationship between religion and pessimism was revealed. Future research directions could include examining whether dispositional pessimism varies across religious groups, as it does not necessarily have a perfectly inverse relationship with optimism.

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Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia are among the most frequent developmental disorders in school-aged students, and both often cause an impact on scholar reading performance. Therefore, it is fundamental to trace the differential profile in reading performance in such diagnoses. Competent reading occurs through the interaction of several cognitive processes, such as decoding, fluency, and oral and reading comprehension, that should be assessed in an evaluation.

The study aimed to characterize the performance of students with ADHD and dyslexia.

We assessed 25 adolescents, aged between 11 and 14 years old, from 6th to 9th year of middle school of public and private schools in Brazil, divided into two groups: the group with ADHD (16 students) and the group with dyslexia (9 students). The diagnoses were established by a multidisciplinary center and there were no comorbidities for any case. The instruments used were: Comprehension Test of Words and Pseudowords II (TCLPP II) to assess decoding (indicate if the word is correct or incorrect); Reading Fluency Test (TFL) to assess fluency in single words and in text reading; Cloze Reading Comprehension Test (TCCL) to measure reading comprehension; and the WISC vocabulary subtest to assess auditory comprehension.

Non-parametric analyzes revealed statistically significant differences in measures of textual comprehension, especially in the tasks that involved decoding and fluency processes, evidencing superior performance of the group with ADHD in these tests. Participants with dyslexia had a significantly higher performance in relation to the number of word omissions, that is, they had lower omission errors. There was no significant difference between groups in auditory comprehension.

A differential profile was found in reading performance, consistent with the cognitive deficits classically pointed out in the literature for each diagnosis: phonological deficits in dyslexia, with problems in decoding and fluency; and attentional deficits in ADHD, with omission errors. In the comprehension measures, dyslexic group had significant lower performance than ADHD in the Cloze Reading Comprehension Test, but there was no difference in the Vocabulary subtest-WISC. An explanatory hypothesis is that, to understand the text, it is necessary to recognize the words previously, whereas, in the WISC, it is not necessary to read, since the questions are oral. These results corroborate the hypothesis that deficits in reading comprehension in dyslexia are more related to difficulties in word recognition and fluency skills than in general listening comprehension.

Financial support: CAPES Proex [grant 0426/2021, no. 23038.006837/2021-73]; CNPq [grant 310845/2021-1]

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As a result of Russia’s large-scale military aggression against Ukraine, many civilians were forced to leave their homes. Emotional disorders associated with fear for one’s life and relatives, loss of housing, work, and stable social ties are found in the majority of forcibly displaced persons.

The purpose of our study was to study the characteristics and expressiveness of affective disorders in displaced persons as a result of Russian aggression against Ukraine. Studied affective disorders in 24 forcibly displaced females. Age of the surveyed 30-50 years. Contacted with psychiatrist because the insistence of relatives. Patients were not identified and applied earlier about mental disorders to psychiatrists. To quantify anxiety, we used a scale HAM-A.

Clinico-psychopathological.

Affective disorders in the examined patients can be confidently attributed to adjustment disorders. According to the ICD-10, an adaptation disorder (F43.2) was diagnosed. Most of them were dominated by depressive and anxiety-depressive modalities of affective disorders. According to the HAM-A scale, the level of anxiety was 14±2.7. Most patients showed few irritability and anger, which is probably due to the inability to respond to the cause of their troubles and problems. However, some patients (6 people) expressed gloomy irritability, anger (clinical sighnificant) a feeling of hostility towards others. It is necessary to note the undulation of these manifestations, often aggravated under the influence of external factors.At the same time, the immediate environment often suffered, on which all the troubles fell. The behavior of such patients became maladaptive, significantly disrupting communication.

Therapeutic impact on internally displaced persons should be aimed not only at overcoming anxiety and depressive syndrome, but also irritability and anger. This should be taken into account when planning psychotherapeutic programs, it is possible to prescribe normotimics.

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The COVID-19 pandemic has affected the mental health of the global population (Dragioti et al. J Med Virol 2022;94(5):1935-49). The first lockdown brought the hardest and most sudden impact on work, educational, social, and recreational activities. Moreover, the fruition of mental health services was restricted, and non-urgent appointments were delayed or converted into telepsychiatry. Thus, it was reasonable to hypothesize different trends of urgent consultations regarding mental health.

To detect quantitative and qualitative changes in patients presenting to our Emergency Departments (ED) during the early phase of the pandemic compared to the previous year.

We conducted a retrospective, multicenter study in Venezia (historical center, mainland) through systematically reviewing the psychiatric consultations in our ED, during the first 16 weeks since 8-Mar-2020 and the same period of 2019. The protocol was approved by the local Ethics Committee as UPSI-19 (Urgent PSychiatric consultations In COVID-19). The statistical analysis was conducted with the software R; Interval Risk Ratio (IRR) with 95% CI was calculated for absolute frequency, primary diagnosis, leading symptoms, and outcomes of these consultations.

In the early phase of the pandemic, in our ED we assisted to a significant decrease in psychiatric consultations: 372 vs 441, IRR=0.84(0.73-0.96). Data revealed a reduction of referral for suicidal behavior (IRR=0.52(0.33-0.80)) and anxiety symptoms (IRR=0.60(0.42-0.87)). Primary diagnoses of patients were not different between the two periods explored. There was a slight increase in admissions (150 vs 121), and a significant decrease in less severe clinical pictures.

In the timeframe considered, we assisted to a significant decrease in referrals from the ED, possibly related both to fewer non-locals and to less frequent non-severe presentations. Despite the type of patients (for underlying diagnoses) remained unmodified, an interesting reduction of anxiety symptoms and suicidal behavior was noticed. Literature from ED studies during the first wave are consistent with our finding regarding the number of visits; suicide attempts seemed unmodified or decreased elsewhere (Giner et al. Curr Psychiatry Rep 2022;24(1):1-10). Limitations of our study include peculiarities of the Venetian territory, limited sample and time of observation. Future directions encompass the integration with data from the community setting and later developments.

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Antipsychotic agents (AP) are widely used drugs to treat psychotic symptoms. For decades, some studies suggested that there is a relationship between using (AP) and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). The causality of this association, its risk factors, and its implications for clinical practice have not been fully elucidated.

We undertook a systematic literature review to evaluate the evidence for an association between antipsychotic medication and venous thromboembolic events (VTE) and to identify risk factors for these adverse effects.

To identify relevant studies, we searched the PubMed, Science Direct databases up using the following keywords « pulmonary embolism », « venous thromboembolism » « antipsychotics agents ». We also searched the reference lists relevant articles for related studies.

Twelve articles are included in this analysis and indicate an elevated risk of VTE in antipsychotic drug users. The results showed that compared with non-users, current AP users have significantly increased risks of VTE. The risk of venous thrombosis in obese people was higher than that in overweight people, patients not less than 65 years old had an increased risk compared with younger patients . In addition, women taking antipsychotics had a higher risk of pulmonary embolism than men. The other factors that increased risk were use of second-generation antipsychotics and antipsychotic polytherapy. The highest risk was noted in the first 3 months of treatment. Data also suggested a dose-dependent increase in the risk of thrombotic complications. For individual drugs, increased risk of VTE and PE was observed in taking clozapine , haloperidol, risperidone and olanzapine. Clozapine was associated with the highest risk. However, careful interpretation is needed because of high heterogeneity among studies and scarce data.

The use of antipsychotics will increase the risk of venous thromboembolism and pulmonary embolism, which will be affected by AP and patient characteristics.

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Long COVID is a condition characterized by long-term health problems persisting or appearing after the typical recovery period of COVID-19. Physical symptoms such as respiratory, neurological and musculoskeletal complaints were initially described in the foreground. A little after, psychological disorders have been widely reported.

The aim of this study was to screen for somatic and anxio-depressive disorders of Long COVID.

A cross sectional descriptive study included the patients consulting within a minimum of 1 month after a COVID-19 infection. It was conducted at Taher Sfar university hospital of Mahdia over a period of one year from March 2020 to March 2021. A questionnaire and physical examination were used to look for physical symptoms and the Hospital Anxiety and Depression scale (HAD) was used to screen for anxio-depressive disorders.

We recruited 137 patients. The median age was of 60 years with a sex ratio M/F at 0.073. Obesity was the most frequent comorbidity (36%) followed by diabetes (35%) and hypertension (32%). More than a quarter of patients was hospitalized (30%) during the acute phase, while the others (70%) were confined at home. The median stay duration at home or hospital was of 10 days with extremes ranging from 0 to 21 days. The most frequent post-COVID symptoms were dyspnea, mood disorders, myalgia, arthralgia, dry cough, sleep disorders and anorexia in 45%, 30%, 30%, 20%, 16%, 15% and 14% of cases, respectively. Pulmonary auscultation was normal in 86% of our patients, for the others we noted crackles, ronchi and wheezing among 9%, 1% and 1% of patients. The median oxygen saturation was 97% with a range from 93 to 99%. The majority of our patients (120) had saturation more than 95% in ambient air. The median HAD score was situated at 19 [8, 33]. Anxio-depressive disorders were present 61% of cases. A severe depression was noted among 24% of patients. and a severe anxiety among 28% of them.

Our study highlighted a high prevalence of anxio-depressive disorders (62%) which exeeds the prevalence described in the literature. The systematic use of the HAD scale among consultants could be the explanation. Thus, psychological screening and support should be considered when managing patients having a history of COVID-19 infection. Citizens should comply with the relevant legal provisions making vaccination compulsory as it was found that COVID-19 vaccination reduced long COVID risk.

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Therapeutic Alliance (TA) is a fundamental aspect of clinical practice, in particular with psychotic patients. In this population, TA has been associated with better clinical outcomes, such as symptomatic and functional impairment reduction and greater life quality. Several aspects have been suggested to negatively interfere with this patient-therapist relationship, including different beliefs about mental health/disease, the role of mental health systems or mental disease-associated stigma. Showing empathy, stimulating metacognition, searching for shared meaning and working as a team seem to be an adequate way to surpass these obstacles - just like we do when we enter an escape room.

To understand the importance of TA in the successful clinical management of psychotic patients; and to propose an original hierarchical framework of TA with these patients.

Review of the scientific literature on the subject and proposal of an original framework of TA with psychotic patients doing an analogy with escape room dynamics.

In an escape room, a team works together to solve a series of mysteries, each leading to another, thus accomplishing one final goal. To do such, every element must agree on the solution to proceed; and there is no access to one level without successfully completing the former.

In a clinical environment with a psychotic patient, such rules may also apply. Although the starting level in each patient-therapist relationship may vary, it is here proposed that proceeding to the next level without at least partial agreement in the previous one may be inefficacious or even counterproductive for the intentions of the therapist.

So, shall we begin?

Level 0 - Who am I? Prior to the encounter with the patient, it is important that the therapist knows himself reasonably well, specially regarding his beliefs, shortcomings and biases in his clinical practice.

Level 1 - What is this? The teamwork starts here. Both therapist and patient must discover why this encounter is happening, what does it mean to be in this medical facility or to be mentally ill, in general.

Level 2 - What is wrong? Trying to understand what is detrimental in the patient’s mental health.

Level 3 - What to do? Tailoring a therapeutic intervention to the impairments of the patient.

Level 4 - How to do it? Finding a way to suit the therapeutic intervention to patient’s personal preferences and availability.

Level 5 - The way out. Helping the patient escape this room and fulfill his maximum potential in all of the other “rooms” of his life.

TA is indispensable to therapeutic success when dealing with psychotic patients.

There is a need for shared meaning and understanding in multiple aspects of the therapist-patient relationship; an approach that only focus some of these aspects while ignoring others may be ineffective or even detrimental to clinical outcomes.

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CT of the endocranium is an indispensable step in the differential-diagnostic evaluation of a patient with the first episode of psychotic disorder. In this context, the main goal of this diagnostic procedure is to “exclude” the so-called organic disorders of the brain tissue, which could be manifested by psychotic phenomenology. However, during the past decades, pathological changes in the brain parenchyma have been found during neuroimaging studies of psychiatric patients.

With the group of schizophrenic psychoses, the following are most often associated: Expansion of the ventricular system, cortical reductive changes, agenesis of the corpus callosum, a higher frequency of some congenital anomalies of the brain, such as cavum septum pellucidum and cavum verga.

Consequently, the main goal of our study is to demonstrate the possibility of diagnosing these changes and examine the frequency of cases of so-called secondary psychotic syndromes, where psychotic phenomenology arose on the basis of some other illness.

Data were collected for 145 patients from the Acute Male Department, who were treated in the period 2011-2019. CT scan of the endocranium was performed as part of the diagnostic evaluation during the first psychiatric hospitalization.

Out of the total number of examinations (145), 20.7% of patients had a pathological finding, with the following structure: In 6.9% of the age group up to 45 years, moderately expressed (disproportionate for the age) cortical reductive changes were found. Concomitant occurrence of cavum septi pellucid et cavum vergae was observed in 3.4% and isolated septum pellucidum cyst in 1.3% of patients. Post-stroke changes, post-contusion foci, and benign congenital brain tumors were found with a frequency of 1.3%, pronounced cortical reductive changes and pathological calcifications with a frequency of 3%, while in individual cases (0.68%) the presence of a subarachnoid cyst and atrophy of the cerebellar cortex was recorded

CT of the endocranium represents a significant aid in the evaluation of a patient with the first episode of psychotic disorder. However, its use in order to analyze more complex changes in psychiatric patients is significantly limited compared to more modern neuroimaging modalities.

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Oligodendroglioma is a rare form of glioma developing in oligodendrocytes which are glial cells. Oligodendrogliomas are divided into two types; benign oligodendrogliomas and anaplastic oligodendrogliomas; the malignant form.

The aim of our study is to detect the cognitive troubles caused by a frontal anaplasic oligodendroglioma in a man admitted to the neurosurgery department at the Specialties Hospital, Rabat, Morocco.

A case study was realized among a man aged of 46 years , suffering from frontal right anaplasic oligodendroglioma, with no medical and surgical history and who presented since two months headaches and forgetfulness, and presented two hours ago a fortuitous epileptic seizure followed by notion of amnesia for 5 min. At the admission, the patient was conscious, the glasgow score was of 15 and did not present a motor deficit. Cognitively, the patient was confused. We decided then to make him pass the MOCA test to evaluate his cognitive state as soon as he was admitted to our service and before the surgical act .

After passing the MOCA Test, our patient had a score of 4/30. The results in detail gave 0/5 in the visuospatial/executive part, 3/3 in the naming part, 0/6 in the attention part, 1/3 in the language part, 0/2 in the abstraction part, 0/5 in the memory part and 0/6 in the orientation part. The score of 4/30 is less than 10/30 and shows a severe cognitive impairment.

According to his wife, his cognitive state was normal before the epileptic seizure and had a normal life.

The frontal anaplastic oligodendroglioma in this patient case deteriorated his cognitive state rapidly. 13 days after surgery and excision of this tumor, the patient’s cognitive state improved, the Moca score became 12/30, which is in the area of moderate cognitive impairment. The patient is currently continuing his treatment in an oncology department.

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The COVID-19 pandemic disrupted specialist training across Australia and New Zealand particularly in the area of assessments. Large-scale face-to-face exams were especially vulnerable to disruptions including lockdowns, travel and density restriction and required the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to introduce alternatives.

Following several small-scale Objective Structured Clinical Exams (OSCEs) in late 2020 and 2021 (both AV and multi-site), the RANZCP introduced an Alternative Assessment Pathway (AAP) after an exam cancellation in November 2021.

To discuss the introduction of an Alternative Assessment Pathway at the RANZCP and share progress regarding the broader changes to assessment models under consideration.

The AAP was co-designed with trainees and Specialist International Medical Graduates and introduced in December 2021 as an interim measure to assess clinical competence in the absence of an OSCE. It comprises a portfolio review of completed end-of-rotation forms and, if required, a case-based discussion held via Zoom.

The AAP has been held over two rounds (December 2021 and March 2022) with 97% and 90% pass rates respectively (data correct as at 6 October 2022). An evaluation into the pathway is currently underway.

In July 2022, the RANZCP introduced the Clinical Competency Assessment as a continuation of the AAP (with some modifications) for the remainder of 2022 and 2023.

While the pandemic has become a catalyst for change, the RANZCP has been considering broader changes to the theory and practice of its assessments for some time. The presentation will provide an overview of its short-term clinical assessment model and share progress regarding change to the long-term assessment strategy.

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The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health.

The objective of this study was to compare the psychopathological characteristics between users whith sexualized intravenous substance use (slamsex) versus those who did not slamsex attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You”.

A cross-sectional descriptive analysis of a sample of users attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You” was performed.

230 participants were included. Slam was associated with higher risk of having and anxiety or depressive disorder, suicidal ideation, induced psychosis and suicidal behavior, the differences were statistically significant (p<0.05) in all cases.

Slamsex is usually reported in our sample. Substance use disorders in slam users are usually associated with other mental disorders. This challenge requires adapt the therapeutical interventions of the professionals who work with patients with chemsex practices, specially with those who practice slamsex.

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Schizophrenia (SCZ) is one of the most severe mental disorders. Several elements involved in pathogenesis have been characterized recently. However, tools for diagnosis and risk prediction are limited. Elucidation of the underlying genomic and molecular mechanisms of SCA remains a challenge.

In this study, we aimed to identify plasma biomarkers for SCZ using targeted metabolomics.

All enrolled patients were drug-free for at least 3 months prior to admission. Plasma from 31 SCZ patients and 70 matched controls were analyzed using the LC/MS- Api 4000 QTrap Sciex. A total of 188 targeted metabolites, including 21 amino acids, 21 biogenic amines and 145 lipids or lipid-related metabolites were analyzed. All data modeling and analysis is done using MetaboAnalyst 5.0

There was no significant difference in the studied groups regarding BMI. Plasma Triglycerides, LDL-C, total proteins levels were significantly decreased in SCZ compared to controls. Heatmap identified 2 clusters with 25 significantly differentially expressed metabolites (FDR <0.05) between the drug-naïve group and the matched controls. The OPLS-DA score plot showed that the groups are clearly separated according to plasma phospholipids concentrations. Among these differential metabolites, the expression level of very long chain Phosphatidylcholines (PC 36 – PC p42) and acylcarnitines were significantly decreased in SCZ compared to controls, whereas sphingomyelin (SM) and lysoPC were significantly lower in drug-naive patients.

In this study, we found that plasma phospholipids were significantly dysregulated in the SCZ patients and could be a promising pathway to explore SCZ.

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Transcranial Magnetic Stimulation is a non invasive brain stimulation technique used for several neuropsychiatric conditions. The treatment of Acute Lymphoblastic Leukaemia (ALL) involves many cytotoxic drugs that inhibit the rapid growth of cancer cells, but also damage healthy cells, resulting in a wide range of adverse effects (Śliwa-Tytko et al., 2022). Studies have shown that approximately 10-30% of paediatric ALL patients suffer from psychiatric disorders. Therefore, new therapeutic tools are needed, and repetitive transcranial magnetic stimulation (rTMS) has demonstrated tolerability, effectiveness and safety in children (Allen et al., 2017).

We discuss the first case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in who underwent Continuous Theta-Burst Stimulation

Case Presentation. In this study, we describe a case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in November 2016 who completed treatment in July 2019. Since April 2018 she presented symptoms of intracranial hypertension and encephalopathy with behavioural alterations, attention deficit secondary to toxicity. Psychotic outbreaks after toxicity from different treatments was also present. Since starting pericyazine (July 2022) there has been a slight improvement, but her symptoms continue to have a severe impact in her daily functioning. Baseline developmental profile assessed with the Battelle Inventory was significantly below the expected level in all developmental areas except for gross motor skills. Treatment. The TMS intervention consisted of the application on right DLPFC (F4), inhibitory cTBS protocol (5Hz bursts and 3 pulses of 50 Hz each). The protocol consisted in delivering 2 sessions per day for 15 days (separated by 55 minutes), 4 minutes per session (3600 pulses/session), 30 sessions in total. An intensity of 100% of resting motor threshold (C4). TMS was performed with the Magventure Magpro X100 MagOption equipment, Cool DB-80 double cone coil. The Child Behaviour Checklist (CBCL) for parents was used to assess intervention effects.

CBCL results reflect improvements in both internalising and externalising total scores after treatment. Specifically, the patient presents clinically significant decreases in several dimensions such as anxious/depressed symptoms, somatic complaints, and social problems. No adverse effects have been reported since the beginning of the intervention.

Internalising and externalising behaviours severity were reduced after 30 TMS sessions. In accordance with the latest systematic reviews on the safety of TMS in the paediatric patient (Zewdie et al, 2020) we propose the development of paediatric guidelines to offer this technique to patients with a history of intolerability or poor drug response.

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Multiple studies show an association between inflammation –characterized by increased blood levels of C-reactive protein (CRP) and pro-inflammatory cytokines– and major depressive disorder (MDD). People with chronic low-grade inflammation may be at an increased risk of MDD, often in the form of sickness behaviors. A cross-sectional relationship between low-grade inflammation and anxiety has also been reported, but the potential longitudinal relationship has been less well studied.

We aimed to examine whether basal and lipopolysaccharide (LPS-)induced levels of inflammatory markers are associated with depressive and anxiety symptom severity over the course of nine years. We hypothesized that inflammation is predictive of the severity and the course of a subset of symptoms, especially symptoms that overlap with sickness behavior, such as anhedonia, anorexia, low concentration, low energy, loss of libido, psychomotor slowness, irritability, and malaise.

We tested the association between basal and lipopolysaccharide (LPS)-induced inflammatory markers with individual depressive symptoms (measured using the Inventory of Depressive Symptomatology Self-Report) and anxiety symptoms (measured with the Beck’s Anxiety Inventory; BAI, Fear Questionnaire;FQ and Penn’s State Worry Questionnaire; PSWQ) over a period of up to 9 years using multivariate-adjusted mixed models in 1147 to 2872 Netherlands Study of Depression and Anxiety (NESDA) participants.

At baseline, participants were on average 42.2 years old, 66.5% were women, and 53.9% had a current mood or anxiety disorder. We found that basal and LPS-stimulated inflammatory markers were more strongly associated with sickness behavior symptoms at up to 9-year follow up compared to non-sickness behavior symptoms of depression. However, we also found significant associations with some symptoms that are not typical of sickness behavior (e.g., sympathetic arousal among others). The associations between inflammation and anxiety symptoms were attenuated by 25%-30% after adjusting for the presence of (comorbid) major depressive disorder (MDD), but remained statistically significant.

Inflammation was not related to depression as a unified syndrome but rather to the presence and the course of specific MDD symptoms, of which the majority were related to sickness behavior. With regard to anxiety symptoms, we found that participants with high levels of inflammatory markers have on average high levels of anxiety consisting of physical arousal and agoraphobia, which tended to persist over a period of nine years, albeit with small effect sizes. These associations were partly driven by co-morbid depression. Anti-inflammatory strategies should be tested in the subgroup of MDD patients who report depressive symptoms related to sickness behavior.

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Management of patients with anorexia nervosa (AN) desires psychiatric/medical care. In average AN disease onset they represent a younger generation than 18 y.o. In this age typically children and adolescents are under regular dental care. Whether young AN patients should be included to intensive oral supervision may be still questionable. In literature little information on changes in oral cavity caused by AN were reported.

Therefore, the aim of the study was to evaluate caries incidence, tooth wear, gingival inflammation, and oral hygiene level among adolescent AN inpatients, highlighting the aspect of oral health manifestations in case-control study.

Based on clinically confirmed 130 AN restrictive subtype hospitalized female subjects (BMI <15 kg/m2, age 14.8±1.8), dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 110 female controls (BMI 19.8±2.3 kg/m2, age 15.5±1.8, p=0.744) dentally caried in public University dental clinic (p<0.05) in the same time period.

AN patients compared with healthy adolescents were found to present higher incidence of oral-related complications according to dental status (DMFT 3.9±4.5 vs. 2.0±1.8, p=0.005), erosive tooth wear (BEWE 18.9% vs. 2.9%, p<0.001), less efficient in controlling plaque (PCR 43.8% vs. 13.7%, p<0.001) and gingival inflammation (20.0% vs. 3.9%, p<0.001). AN group, a significant correlation between BOP, BEWE, and duration of AN symptoms (p<0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected (p<0.05).

Although the obtained results did not reveal any severe oral complications, AN diagnosis in adolescence may influence to numerous oral-related symptoms from dental caries, the onset of erosive tooth wear, failure in dental hygiene to be continuated as gingival inflammation. After AN diagnosis a regular preventive intervention should be performed during dental recall sessions. There is a need for professional oral hygiene/diet instructions combined with regular oral check up visits to avoid oral complications and disease progress. For clinical revelance an active collaboration between psychiatric and dental specialists is needed.

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Bipolar disorder is characterized with recurrent manic and depressive episodes with interepisodic remission periods. The course of illness including frequency and severity of mood episodes are the most evident changes at geriatric ages in bipolar disorders.

With this background, we aim to evaluate the clinical variables of bipolar patients older than 60 years and compare clinical variables before and after this age.

Bipolar patients who applied to psychiatry outpatient unit in Çanakkale 18 Mart University Medical Faculty between the years of 2017-2022 were evaluated retrospectively. Patients over the age of 60 were included in the study. 47 out of 133 people over the age of 60 with bipolar disorder were not included in the study due to lack of information. Socio-demographic data of 85 patients recruited for the study, and clinical variables of the patients before and after the age of 60 were compared with Wilcoxon test. SPSS 26 version was used for statistical analysis and p<0.05 was considered as significance level.

When we evaluate the sociodemographic variables of the patients, we found that 61.2% (n=52) of the patients were female, mean age was 67.6± 6.3 years and mean duration of education was 7.2±4.6 years. Most of the patients (76.5%, n=65) was diagnosed with bipolar disorder type 1 (BP1) while nearly one four of them (24.7%) had a mood disorder history among their relatives. Median of the illness duration was 19.5 years (min:2, max:60), mean age of the first episode was 43.6±14.3 years and more than half had their first episode as depression (56.5%, n=48). When we compare the number of episodes, number and duration hospitalizations before and after the age of 60 years, we found that number of depressive (p=0.001,z:-3.3), (hypo)manic (p=0.001,z:-3.3), episodes and number of hospitalizations (p<0.001,z:-3.8), were lower at geriatric ages. However, there was no difference before and after the age of 60 years in terms of duration of hospitalization.

Course of illness in bipolar disorder is highly variable and recurrence of mood episodes may increase with age (van der Markt A et al . Int J Geriatr Psychiatry. 2022;3;37(11), Dols A et al, The clinical course of late-life bipolar disorder, looking back and forward. 2017 Dec 11). However, in our study we found that number of depressive, (hypo)manic episodes and number of hospitalizations were lower at geriatric ages. This discrepancy may be related with sample selection and study design. Nevertheless, it should be taken into account for further studies. Besides, this is not a mirror image study and duration of follow-up periods were not considered for the statistical analysis. These are the additional limitation of our study. It is difficult to make further interpretations considering these limitations. Prospective follow-up studies with large sample size are required to better understand the course of bipolar disorder at geriatric ages.

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One of the most common mental disorders in the elderly is depression.

Because of the high frequency of side effects of pharmacotherapy and the comorbid medical illnesses, there are not many ways to treat it.

Non-drug therapies, such as repetitive transcranial magnetic stimulation (rTMS), could help overcome the limitations of standard drug therapy for this type of mental disorders.

Development of approaches to improving improve the provision of psychiatric care to elderly patients using rTMS.

30 patients over the age of 60 with anxiety-depressive spectrum disorders meeting criteria F30-39, F06.3, F06.4 (ICD-10) and a control group with similar criteria that were not treated with rTMS, were recruited from the psychiatric department at a university hospital (Moscow Scientific Research Institute of Psychiatry). Clinical, psychopathological, anamnestic, psychometric (Montgomery-Asberg scale (MADRS), Hamilton scale (HARS), Mini-mental state examination scale (MMSE) instrumental (electroencephalography) research methods were used. Patients of the experimental group underwent 15 sessions of low-frequency rTMS on the right dorsolateral prefrontal cortex (RDLPC). Conditions for the application of 1200 pulses were as follows: frequency - 1 Hz; intensity - 120% of the threshold of motor response (RMT) of the subject; pulse number - 1200; pulse sequence - 300; sequence duration - 300 seconds; sequence interval - 60 seconds; and stimulation time - 23 minutes. Subsequently, the patients were re-examined using the above-mentioned scales to assess their mental state in dynamics.

Analysis of the collected data shows an increase in the number of respondents and the frequency of achieving remission in the experimental group compared to the control group. No severe side effects of rTMS were observed.

rTMS may be a safe method of adjuvant therapy in groups of elderly patients with anxiety-depressive spectrum disorders. Further studies will be needed to clarify the results.

None Declared

Diagnostic overshadowing is established as a mechanism by which physical symptoms are misattributed to mental disorder, hence under-diagnosing and under-treating medical pathology. We report a case series of adult males with established neurological disorders who presented to the ED with visual hallucinations in the postictal period. The phenomena of postictal psychosis is long established in neuropsychiatric literature, with reported rates of postictal psychosis in epilepsy of 2%. Patients vsual hallucinations resolve with anticonvulsant stabilisation and rarely require antipsychotic augmentation.

To illustrate diagnostic overshadowing in a case series of postictal psychosis

Retrospective case series

Case 1:

A 36year old man self-presented to the ED 24hrs post tonic-clonic seizure of 15minutes duration. Medical history was significant for hydrocephalus as an infant with 29 surgical revisions of in-situ ventriculoperitoneal shunt since initial placement. Secondary epilepsy was reported to be poorly controlled with an estimated 50 ED attendances in the past year for management of seizure activity. On assessment new symptomatology of non-threatening visual hallucinations with associated low mood was elicited. A diagnosis of postictal psychosis was advised following psychiatric assessment and medical admission with anticonvulsant titration recommended. Despite this characteristic presentation there were repeated requests to admit this patient to the psychiatric unit and a perceived lack of understanding of his acute medical needs.

Case 2:

A 45year old man self-presented to the ED <24hours post discharge following medical admission for management of seizure. Medical history was significant for a right parieto-temporal infarct one year prior, with acceptable return to functioning following rehabilitation. The man had recently been diagnosed with secondary epilepsy and titration of sodium valproate commenced. The patient presented as distressed in the context of new onset visual hallucinations and palinopsia. Medical admission with urgent neurology input and anticonvulsant titration was advised following psychiatric assessment. ED physician repeatedly stated this patients presentation was stress related and requested psychiatric admission. Following medical admission the patient was managed by neurology. Sodium valproate was augmented with clobazam and the patients psychopathology resolved in full.

Diagnostic overshadowing is prevalent in the ED. Despite established medical diagnoses there may be a reluctance for medical teams to acknowledge or treat organic psychopathology. Psychiatrists must keep abreast of medical comorbidities and physical treatment guidelines of neuropsychiatric disorders in order to advocate appropriately for due medical input. Postictal psychosis is effectively managed by neurological input for effective seizure control with collaborative neuropsychiatry input.

None Declared

Day-night changes in several molecules are studied as biomarkers of circadian rhytms (Morera-Fumero, A. L. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2017; 75 207-212). Circadian rhythmicity of the pituitary-thyroid axis has been proven in healthy individuals, with a Thyroid Stimulating Hormone (TSH) peak in serum around midnight and peaks during day hours (Bellastella, G. et al. Life 2021; 11(5), 426). A recent meta-analysis has reported differences in serum TSH levels between first-episode psychosis and multiple-episode schizophrenia (Misiak, B. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2021; 111, 110402). However, studies assessing quantitative circadian variations on TSH serum in schizophrenic patients are scant.

Comparing serum TSH levels at two different times of the day (12:00 and 24:00 hours) and the differences between the acute (hospital admission) and recovered phase (hospital discharge) of the disease.

Fourteen male patients (age 26,8±9,3 years) with the diagnosis of paranoid schizophrenia psychosis according to the DSM-IV partake in the study. Patients were admitted to the University Hospital of the Canary Islands psychiatric room because of acute relapse. Blood samples were taken in the first 24 h of admission and at 24 h. before discharge. All patients gave written consent to participate in the research study. Serum TSH was determined by ELISA methods. Paired sample t-tests were performed between TSH serum levels at admission and discharge at 12:00 and 24:00 hours. Statistical analyses were performed using IBM® SPSS® Statistics 25 software for MAC (IBM Corporation 1989, 2017).

There were statistical differences between the 12:00 h and the 24:00 h of the TSH serum levels at admission (12:00: 145,856±156,961vs. 00:00: 192,006± 122,757, p = 0.04); TSH discharge, (12:00: 134,483±72,882vs 00:00: 244,214±148,697, p = 0.002). There were no statistical differences between the 12:00 TSH levels at admission and discharge (145,856±156,961 vs. 134,483± 72,882, p = 0.66). The 24:00 h comparison of TSH levels neither elicited significant results (admission: 192,006±122,757 vs. discharge: 244,214± 148,697, p = 0.15).

Schizophrenic patients undergo TSH serum changes in a circadian pattern during the acute and stable phases of the disease; nevertheless, they experience smaller deviations during the acute phase. Higher levels of TSH were observed around midnight, as it happens in healthy individuals, with higher peaks during the stable phase compared to the acute one.

None Declared

Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse, but persists for days and weeks with no substance use. There is growing recognition that individuals with substance-induced psychosis are more likely to develop a schizophrenia spectrum disorder. Early onset of substance-induced psychosis and cannabis use are predictors of conversion. Nevertheless, more evidence is needed to identify other factors.

The objective of this study was to analyze the progression of substance-induced psychosis to several mental disorders, by reporting a case of a cocaine user, and identifying the factors that promote the progression.

We report the case of a 55 years old male, with long-term consumption of endovenous cocaine and heroin, who has experienced various episodes of substance-induced psychosis in the past.

In 2017, he presented haptic and visual hallucinations oriented as parasite delusion during rehab hospitalization. The symptoms disappear after a few days of risperidone treatment and absence of consumption. Consuming cocaine and heroin ev in previous days.In October 2018 and July 2021 the patient was hospitalized in Dual Pathology for similar episodes oriented as substance-induced psychosis.

In the current episode, the patient was hospitalized in the Dual Pathology Unit due to a psychotic episode described as parasite infestation delusion and prejudice delusion against his family. The last consumption of heroin and cocaine was 3 months ago.

This case report exemplifies the temporal relationship between substance use and the development of psychotic illness. Suggesting substance-induced psychosis as an indicator for the future development of a severe mental disorder. For this reason, more evidence is needed to identify other factors that promote the progression to severe mental disorders and stablish a higher risk group

None Declared