Bpolar disorder (BD) is a severe and chronic psychiatric disorder it is the sixth leading cause of disability among all illnesses worldwide. With regard to causes of premature mortality, patients with BD are at very high risk of suicide. Whereas risk factors for suicidal behaviors are multiple and complex, hopelessness appears to be a major independent risk factor for suicidality in BD. Compelling evidence has also demonstrated that BD is frequently associated with circadian rhythms alteration, contributing to its vulnerability, pathogenesis, and manifestations. in particular in the desynchronization of sleep and social life, has been associated with the severity of BD. Indeed hopelessness has never been studid in relation to circadian rhythms in BD

To examine the role of chronobiological rhythm alterations in suicidal ideation and behaviors and its relation with hopelessness.

One hundred twenty-seven patients (77 females, mean age of 47.4 ± 12.5 years) with a major depressive episode and bipolar disorder (BD) type I or II (according to Structured Clinical Interview for DSM-5 assessment) were recruited in 2019 and assessed for depressive and manic symptoms (Beck Depression Inventory-II, Young Mania Rating Scale) and with the Biological Rhythms Interview of Assessment in Neuropsychiatry, Beck Hopelessness Scale, and Scale for Suicide Ideation. Univariate regression and mediation analyses were performed.

Forty-one patients (32.3%) showed clinically significant suicidal ideation and were more frequently affected by BD type I (P = .029) with mixed features (P = .022). Compared to nonsuicidal individuals, they had significantly more depressive symptoms (P = .019), higher emotional component of hopelessness (P = .037), and higher dysrhythmicity of sleep (P = .009), activities (P = .048), and social life (P = .019). Passive and active suicidal ideation and suicidal plans were best predicted by dysrhythmicity of sleep and social life. Dysrhythmicity of sleep and social life mediated the direct effect of depressive symptoms on passive and active suicidal ideation and also of active ideation on suicidal plans. The emotional component of hopelessness was related to dysrhythmicity of social life and mediated its effect on suicidal plans (P = .010).

Chronobiological alterations directly contributed to passive and active suicidal ideation and to suicidal preparation, with a key role of circadian rhythm alteration of sleep, activities, and social life. Chronobiological alterations also impacted the emotional component of hopelessness, hence indirectly contributing to suicidal ideations and plans. These findings call for the systematic screening of these dysrhythmicity dimensions when considering suicidal risk in individuals with BD.

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Major depressive disorder (MDD) is a highly prevalent mental illness that often first occurs or persists into adulthood and is considered the leading cause of disability and disease burden worldwide. Unfortunately, individuals diagnosed with MDD who seek treatment often experience limited symptom relief and may not achieve long-term remission, which is due in part to our limited understanding of its underlying pathophysiology. Many studies that use task-based functional magnetic resonance imaging (fMRI) have found abnormal activation in brain regions in adults diagnosed with MDD, but those findings are often inconsistent; in addition, previous meta-analyses that quantitatively integrate this large body literature have found conflicting results.

This meta-analysis aims to advance our understanding of the neural basis of MDD in adults, as measured by fMRI activation studies, and address inconsistencies and discrepancies in the empirical literature.

We employed multilevel kernel density analysis (MKDA) with ensemble thresholding, a well-established method for voxel-wise, whole-brain meta-analyses, to conduct a quantitative comparison of all relevant primary fMRI activation studies of adult patients with MDD compared to age-matched healthy controls.

We found that adults with MDD exhibited a reliable pattern of statistically significant (p<0.05; FWE-corrected) hyperactivation and hypoactivation in several brain regions compared to age-matched healthy controls across a variety of experimental tasks.

This study supports previous findings that there is reliable neural basis of MDD that can be detected across heterogenous fMRI studies. These results can be used to inform development of promising treatments for MDD, including protocols for personalized interventions. They also provide the opportunity for additional studies to examine the specificity of these effects among various populations-of-interest, including youth vs. adults with depression as well as other related mood and anxiety disorders.

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Inhalants are volatile psychoactive compounds whose effect varies from disorientation, excitement, euphoria to hallucinations. Different opinions have been raised concerning the relationship between inhalant use and psychosis and several publications have studied the incidence of psychotic disorders in the context of inhalant use. These studies concluded that using inhalants was independently associated with the development of psychosis

our aim is to determine the demographic and psychiatric profile of inhalant users previously hospitalized in our department

This is a retrospective descriptive study carried out by analyzing hospitalization records in the addictology department of the psychiatric university hospital Ar-Razi in Salé over a period of one year (from August 2020 to August 2021). The diagnoses are established according to the DSM 5 diagnostic criteria.

Seventeen patients, inhalant users, were recruited after chart review, including 5 women and 11 men (68.7 %). The average age was 24.7 years (16; 41). The majority of the patients were single (81.2%), 62.5 % had a secondary education and 62.5 % were unemployed.

The psychiatric evaluation showed that 87% of these patients had a history of incarceration, 50% had a diagnosis of schizophrenia, 12.5% had bipolar disorder and 14.2% had a cluster B personality disorder (DSM 5).

The average age of onset of the addictive disorder in this population was 14.4 years and the entire sample was polyaddictive.

More than half of our sample had psychosis associated with their inhalant use disorder. these results are consistent with literature data.

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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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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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There is growing evidence of neuropsychiatric presentations in patients of COVID-19, but literature is scarce on laboratory, clinical and radiological markers as well as impact of psychotropic medications during the course of hospitalization in critically ill patients.

The primary outcome measure was variability of clinical biomarkers and CORADS scores with severity of COVID-19 infections and the impact of psychotropic medications like risperidone and aripiprazole.

We screened 430 ICU patients admitted to our tertiary care hospitals, out of whom 67 were diagnosed positively with definitive neuropsychiatric sequalae and receive psychotropic interventions during their hospital stay. We compared their D-dimer levels, C-reactive proteins, serum ferritin levels, serum procalcitonin and Vitamin D levels and further analyzed CORADS severity score with psychiatric severity and outcome.

The mean age of the patients was 42.38 years, majority (44.8%) of them belonged to 21-34 years with slight (52.2%) male preponderance and none of them were more than 60 years. We observed a 43.3% were having organic mood disorder and 37.3% of individual had significant history of alcohol dependence while hypertension and diabetes mellitus were noted in 34.3% and 29.9% respectively. Only D-dimer levels were found to be significant and positively associated with outcome of psychiatric disorders (p<0.05), accounting for 41% of covariance on linear regression analysis.

Our study has found significant association of elevated levels of D-dimer variability but not the other laboratory biomarkers among various neuropsychiatric comorbid sequalae in ICU admitted COVID 19 patients. This particular observation might have potential for serum D-dimer levels to be possibly used as an early biomarker to screen or suspect for comorbid neuropsychiatric presentations.

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While Smartphone use has been increasing all across age sectors, university students are the largest consumers group of Smartphone services. However, their excessive use or addiction can have harmful effects on the mental and physical health of their users. It is a real public health problem that is growing and affects especially the young population.

We aim to assess the prevalence of smartphone addiction among medical students in Casablanca, Morroco, describe the profile of techno-addictive students (Smartphones) and assess the risk of developing somatic and psychic conditions.

This is a descriptive analytical cross-sectional study, from October 2020 to March 2021, a sample of 878 students of the Faculty of Medicine and Pharmacy of Casablanca, Morocco, including all levels of the academic year 2020/2021. This sample was calculated on the basis of the number of medical students at the Faculty of Medicine and Pharmacy of Casablanca 4095, with an expected prevalence of 51%. Data were collected anonymously through an online questionnaire, constructed of several sections including the SAS-SV scale.

The age of the participants ranged from 17 to 32 years, average age was 22.03 with a M/F ratio of 0.43. Students ranged from first grade to eighth grade, with a majority of Moroccan nationality97.15%. The study revealed a total percentage of addiction of 37.9% for both sexes. Psychic signs such as anxiety, loss of control, disturbance and withdrawal were more frequent than physical signs such as wrist and neck pain. After the analysis of the different results, we come out with the following conclusions concerning the profile of the participants affected by smartphone addiction: Most of them are single94.76%, with a medium socio-economic level 55.5%, with another addiction 31.2%, especially to psychoactive substances,15% with psychiatric history, 45.22%with less than 5 years of smartphone use.Table I:Univariate associations of smartphone use and smartphone addiction.

In conclusion, the present study provides the first insights into smartphone use, smartphone addiction, and predictors of smartphone addiction in young people from Morocco. Future studies should extend this knowledge in order to draw clearer conclusions regarding the disease burden, and why not a more precise long-term exploration of the fate of these students and their later risk in the professional hospital setting seems worth studying.

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Catatonia is a treatable but often undiagnosed condition in children and adolescents. The majority of Pediatric catatonia cases occur at a puberal ages. It is associated with neurodevelopmental disorders. In these cases the diagnosis can be more difficult due to the overlap of symptoms.

Report the case of a 11- year - old girl who developed catatonia. She had a previous psychiatry history of intellectual disability, delayed speech and motor slowness. She had a positive Lorazepam challenge test with resolution of the most catatonic symptoms. More studies were completed and according to the clinical history the diagnosis of autistic spectrum disorder was made.

Genetic test revealed a Phelan Mc Dermid Syndrom.

A year 11-year-old girl presented to the pediatric emergency department with a 2- days history of worsening anxiety and rigidity, seeming lost and distant. The previous 4 months there was a history of progressive functional and social decline. Her speech was minimal and she required assistance with dressing and feeding. She displayed stereotypias and mannerism. All medical studies were unremarkable. A Lorazepam challenge test (2 mg IV) showed evidence of response. She recovered from catatonia and the basal situation was studied. She was diagnosed of autistic espectrum disorder attending the psychiatric and medical history. Apart from other medical studies, a genetic test showed a mutation in a gene called SHANK 3 according to a Phelan Mc Dermid Syndrom.

Pediatric catatonia is associated with neurodevelopmental disorders such as autistic spectrum disorders. There is not always a clear identifiable cause and it is necessary to rule out possible organic causes of pediatric catatonia. The treatment is similar to adults. It is essential to do a complete medical and psychiatric history to an accurate diagnosis such as an autistic spectrum disorder. Genetic testing must be included. In this case, genetics showed a Phelan Mc Dermid Syndrom with a delayed diagnosis. This disorder can cause a wide range of symptoms varying in severity. These symptoms could include global developmental disorders, intellectual disability, delayed speech, autistic spectrum disorders and minor dysmorphic features.

It is crutial to emphasize the high incidence of catatonic symptoms in individuals with Phelan Mc Dermid Syndrome as catatonia often goes unrecognized or undertreated in individuals with developmental disabilities. Significant cognitive and behavioral regression beyond a baseline level of disability has been reported. This case also highlights the relevance of genetic testing in the work of individuals with intellectual disabilities and acute psychiatric illness or regression. Symptoms indicative of catatonia may occur in context of infections, hormonal status and stressful life events. Treatment is centered on the symptoms.

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Substance use is related to higher risk of criminality among prisoner with or without co-occurring mental disorder. This contributes to a poor correctional outcome and higher risk of suicide and other psychiatric disorders.

The aim of this study is to compare offenders with substance use disorder with offenders with no addictive comorbidity.

We studied the medical files of all the offenders referred to the forensic psychiatry unit in the Razi hospital for an examination between January 2010 and October 2020 analyzed sociodemographic, psychiatric and criminological factors of this population.

We found that the first group, with substance use disorder, was substantially consisted of male offenders (99.2%) compared to the second group (92%); (p=0). A significantly higher level of education was found in the second group compared to the first (p=0.004). Offenders with no substance use disorder tended to live with their family while the rest of the cases lived on their own (p=0.018), they also had three times more family history of psychiatric disorders than the other group (p=0). Psychiatric comorbidity was more important in the second group with more cases of schizophrenia and mental disability while the first group consisted mainly of people with personality disorders (p=0.018).

The average number of anterior convictions was 3.12 first group and 1.33 in the second group, which is significantly lower (p=0)

Specific interventions, in particular addiction management, are required to reduce the criminal risk in this population.

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Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.

To explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.

We performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.

The phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.

The kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.

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Miroslava Vasiljević psychiatrist employed in Specialist practice of psychiatry Sunce, Belgrade, Serbia.

Substance abuse is a major public health problem with high morbidity and mortality. Treatment – seeking opioid dependent individuals frequently report mood problems in the form of depression. The aim of this study was to evaluate the depression in patients with substance abuse.

We evaluated mood problems in the form of depression and health- related quality of life (HRQoL) among patients (20) with diagnosed opiate dependance who entered detoxification program and met the criteria for abstinence in period of one month, and compared with the results of 20 healthy controls consisted of secondary medical staff.

Almost all of the patients had a total PSQI score of 6 or higher, suggestive of depression, compared with control group (PSQI < 5).Patients had problems with a depression, taking antidepressives and problem to keep up enough enthusiasm to get things done (P < 0,05), compared with the control group.

SF-36 scores for psysical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health were significantly lower mean compared to control group. Patients with disease had a reduced HRQoL, related to control group.

Majority of heroin-dependent patients reported depression and reduced quality of life. These conclusions are limited, because data was collected via questionnares of patients were small. In future we plan to include more substace abuse patients.

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Medical studies are known for being difficult and hard. They require a lot of dedication and hard work from students. This takes a toll on their mental health over the years.

Detect signs of anxiety, depression, and stress levels in 5th-year medical students.

This study was cross-sectional through a self-administered pre-established questionnaire for medical students during September and October 2022. We used the General Anxiety Disorder-7 (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9) and the Perceived Stress Scale-10 (PSS-10). The satisfaction level with the choice of the medical field as a career was assessed on a scale ranging from 1 to 10.

Our population consisted of 54 5th-year medical students. The average age was 22.94±0.78 and 64.8% were female. All our population were singles. Active smokers represented 9.3% and alcohol consumption was reported by 9.3% of the participants. More than half of the population (51.9%) had a regular leisure activity. Most of the students had no medical history (72.2%) or psychiatric history (94.4%). The mean satisfaction level from choosing the medical field was 7.43±1.84. The mean GAD-7 and PHQ-9 scores were respectively 3.50±3.80 and 4.70±4.42. The PSS-10 score had a mean of 14.07±5.29. Five students (7.4%) presented self-harm thoughts. Students who were less satisfied with their choice of the medical field as a career had significantly higher scores of PHQ-9 (p<0.001), GAD-7 (p=0.004) and PSS-10 (p=.042).

Medical studies are the first step for these young doctors in their professional careers, which presents further psychological stressors. More attention towards the mental health of this population is needed to properly prepare them for their future.

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Work stress, anxiety and depression have an enormous impact on the well-being of employees, their employers, and society. Due to the loss of productivity, common mental disorders have a substantial economic impact. Major depression alone has been attributed to 50% of long-term absences from work, and depressive symptoms are related to lowered productivity while at work. Anxiety also contributes to loss of productivity and sickness absence. Treatment of common mental disorders in a work setting may improve symptoms, however, that does not automatically lead to improved work productivity. Addressing mental well-being at the workplace might improve work functioning, and digital interventions have been introduced with that objective. However, their evaluation in research has been limited.

The European Intervention to Promote Wellbeing and Health in the Workplace (EMPOWER) digital intervention is designed to provide and evaluate an integrative user programme that meets the needs of employees and employers in addressing work stress.

This work was supported by the European Union Horizon 2020 Research and Innovation Programme Health (grant number APP1195937, 848180). The EMPOWER project started 1.1.2020 and is currently ongoing.

We aim to

1) describe the design and development of the digital intervention.

2) culturally validate the intervention in three countries

3) test the prototype and beta version for its usability in the RCT to evaluate its effect in four countries that is currently ongoing.

A user-centred design process was followed from January 2020 until November 2021 to create a beta version for usability testing. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was translated and culturally validated in four languages in Spain, the United Kingdom, Poland, and Finland. Usability testing was conducted in each country (n=31) to explore validity, usability, and user experience.

The digital intervention consists of a website and a mobile application (app). The website has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. The app provides algorithm-based personalised content after assessing a user’s physical and psychological symptoms, work functioning, and psychosocial risk factors for work stress. The usability testing improved the flow through the app and high ease of use and completion of tasks by participants.

The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. Usability testing provided validation of the app as version to be evaluated in the EMPOWER RCT.

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Suicide is the fourth leading cause of death among adolescents and young adults (AYA) (Czyz EK, King CA. J Clin Child Adolesc Psychol.2015;44(1):181-19), and psychiatric disorders are a major contributing factor (WHO Global Health Estimates 2000-2019). Studies focusing on suicidality in Italian inpatients samples are scant.

The present cross-sectional study aimed to define clinical variables associated with suicidality related phenomena in a sample of young inpatients. The main objectives were to assess the prevalence of suicidal ideation and deliberate self-harm in inpatients aged 16–24 years and to determine the relationship between suicidal behaviours and psychiatric disorders.

This retrospective study was conducted in a naturalistic setting, at the Psychiatric Inpatient Unit, Perugia Hospital/Local Mental Health Unit 1, from January 2018 to December 2019. Sociodemographic information, clinical history, diagnostic and treatment features were collected. Descriptive and bivariate analyses were performed (p<0,05).

Among 120 patients (14,2% of the overall 850 hospitalizations in the index period) admitted for suicidality-related phenomena, 21 (17,5%) were AYA. Admission was due to deliberate self-harm in 85,7% (n=18) and to suicidal ideation in 14,3% (n=3) cases. Personality disorders (p=0.006), were significantly more prevalent among AYA, while mood disorders were more frequent among adults (p=0.0018) (Tab.1).Tab.1.Differences in diagnostic features between AYA and adult population.

Personality is under construction among youths, and affective symptoms may have unusual characteristics (Lack CW, Green AL. J Pediatr Nurs. 2009;24(1):13-25), as demonstrated by the fact that irritable rather than depressed mood is a core diagnostic mood symptom for adolescents (Rice F, et al. J Affect Disord. 2019;243:175-181). We hypothesized that symptoms of irritability, emotional dysregulation, and impulsivity could be linked to suicidality (Ghanem M, et al. Arch Suicide Res. 2013;17(3):262-274). Further investigations are needed for the characterization of AYA inpatients who experience suicidal thoughts or self-injurious behaviours, in order to redefine preventive tools and reduce suicide mortality rates.

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Previous functional neuroimaging studies have demonstrated a brain network responsible of time discrimination (TD) processes, which may play a significant mediating role in other cognitive processes, such as change detection and cognitive control. The study of TD and its dysfunction in psychosis has become a matter of growing interest. We hypothesize that the impairment of the TD network is involved both in the mechanisms of psychosis and in the cognitive deficit presented by patients.

1. 1. To delimit the brain regions involved in TD.

2. 2. To examine the dysfunction in TD brain network in patients diagnosed with psychosis.

3. 3. To sudy the integrity of brain white matter pathways in psychosis.

4. 4. To verify whether the neuroimaging findings and TD test performance predict the neurocognitive profile of the patients.

Participants included 20 patients with psychosis (PSY group) and 13 healthy controls (HC group). PSY group participants met remission criteria for 6 months prior to the study. Participants were interviewed for sociodemographic information and clinical assessments. They underwent a detailed cognitive assesment using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Neuroimaging study was performed on a 3 Tesla MRI scanner. We designed an experimental task including a test tool to assess TD and Oddbal detection (OD) paradigms with a cognitive control component. The task was conducted under functional magentic resonance imaging (fMRI). We used the general linear model analysis of the individual data of the fMRI images and the random effects model for group inference. Group differences in DTI were tested using tract-based spatial statistics (TBSS).

We find statistically significant differences (fMRI) in the activity related to TD (in HC), with greater activity in frontal cortical regions, the insular cortex and the cerebellum. In the PSY group, differences in the functionality and activation pattern of brain networks responsible for TD are observed, although voxel clustering does not reach the cluster significance limit when compared to HC. Compared to the HC, the PSY group has a significant deficit of fractional anisotropy (DTI) in the whole brain and in 21 specific brain regions. The PSY group has significantly lower scores in six of the seven cognitive domains than the control group, as well as in the overall composite. We correlated FA values in the groups of interest with MCCB scores.

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We have defined the TD network, its relationship with other brain networks and cognitive processes of more complexity. The inclusion of participants with stable psychosis allowed us to analyze de TD disfunction in the PSY group. We compared the integrity of TD related brain pathways and correlated the findings with various clinical characteristics and the cognitive impairment present in psychotic patients.

None Declared

This study investigated the influence of synesthetic experiences on working memory and hypothesized that Grapheme-Colour Synaesthesia causes enhanced working memory for the materials in the congruent condition.

The current study uses the existing experiments conducted within the field of Synaesthesia as a basis in order to find out whether synaesthesia influences working memory for the letters, words, and days of the week that elicit synesthetic experiences

Experimental research design was used to identify the extent of the causal relationship between Synaesthetic and non-Synesthetic experiences and enhanced working memory in both Synesthetes and non-Synesthetes. A short screening questionnaire, Stroop task, and N-back task was used to measure the relationship between the two variables for quantitative measurement. (Radvansky, 2011), This study uses materials such as Stroop task and n-back task from Robinson’s (2015) work, Radvansky’s (2011), and Terhune et al. (2013) work. However, certain changes in the methodology of the current study makes it easier and efficient to conduct this study with a different population.

Grapheme-Color synesthetes (Mean= 1276.682 milliseconds) appear to take less amount of time in responding correctly to the incongruent stimulus in the Stroop Task than non-Synesthetes (Mean= 1487.89 milliseconds). Secondly, Grapheme-Color Synesthetes (Mean=1170.929 milliseconds) have a significant difference in accuracy of responding in the congruent condition of the Stroop Task with the non-Synesthetes (Mean= 1491.159 milliseconds). Further evidence from the N-back Task also demonstrated a significant relationship between the variables in both incongruent and congruent conditions; Grapheme-Color Synesthetes (Mean= 2621.390 milliseconds) showed a significant difference in correctly responding to the nonmatching stimulus in N-back Task with Non-Synesthetes (Mean= 2854.351 milliseconds). Similarly, Grapheme-Color Synesthetes (Mean=1330.130 milliseconds) showed a large difference in responding correctly to the matching stimulus in the N-back Task with Non-Synesthetes (Mean= 2301.071 milliseconds). Grapheme-Color Synesthetes were faster in responding correctly than non-Synesthetes in all conditions.

Regardless of what have been concluded as a result of the current study, it is difficult to reach at any conclusions taking into account the oppositions about working memory of Grapheme-Color Synesthetes in different studies. Therefore, the data suggest that future studies should further test the capacity of working memory in Grapheme-Color Synesthetes.

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With the rapid advancement of modern technology, many countries have adopted mental health care systems supplemented by digital means of communication. Are Tunisian patients “ready” for the “digital revolution”?

The aim of our study was to assess perceptions of people living with mental illness on digital mental health.

We developed a cross-sectional study where we randomly included patients who were treated for a psychiatric disorder in a public or a private practice. Inclusion criteria were: subject 18 years old or older, clinical remission for at least three months. We developed a questionnaire on sociodemographic and clinical variables. We also included questions on patients’ level of interest in using digital mental health services such as teleconsultation and mental health smartphone apps. Perceived obstacles in using digital mental health by patients were also evaluated.

Our sample size was 260 patients. The mean age of our population was 36,4 years old with. The mean distance from the household to the mental health care provider was 17,3 km.

Two thirds of the sample had access to a wifi connection at home (172 patients). When asked about the content of internet searches, 66% have already looked for information on their mental health or mental disorders on web pages. Patients were very interested in video teleconsultation with their therapists (72%), psychoeducation apps (68%) and online mood journals (61%). They expressed little to no interest in online exchanges with other patients and medication reminder apps. The most reported obstacles in implementing digital mental health as noted by patients were : lack of perceived effectiveness, virtual communication with their therapist and confidentiality issues.

Mental health patients in Tunisia expressed a great interest in teleconsultations and online psychoeducation programs. Further research on the willingness of mental health professionals to adopt digital mental health services are needed.

None Declared

Multiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.

To identify and haracterize DTP patients admitted in acute ward, based on practical criteria.

Through the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.

Three clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.

These findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.

None Declared

Patient-reported outcome and experience measures (PROMs and PREMs) are increasingly acknowledged as critical to enhancing patient-centred, value-based care. However, research is lacking on the function and relevance of these instruments in acute psychiatric care.

The main objective of this study was to evaluate the domain of subjective well-being as a relevant indicator of the quality of hospital care, distinct from measures of symptom improvement and satisfaction with care reported by patients, assuming they only incompletely reflect inpatients’ unmet needs and expectations. [YA5] [SE6]

We hypothesised that the patients’ measures of subjective well-being (generic PROMs) at discharge are only partially related to the satisfaction with the experience of care (PREMs), that in turn differs from the clinician’s experience of the provided care, and symptom improvement (disease-specific PROMs).

Two hundred and forty-eight inpatients of a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardised generic PROMs on well-being, symptom improvement was assessed using standardised disease-specific PROMs, and experience of care with PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of provided treatment using adapted PREMs items.

Change in subjective well-being (PROMs) at discharge was significantly (p<.001), but moderately (r²=28.5%), correlated to improvement in symptom outcomes, and weakly correlated to the experience of care (PREMs) (r²=11.0%), the latter being weakly explained by symptom changes (r²=6.9%. Patients and clinicians assessed differently the experience of care.

Findings confirmed our hypothesis showing that across mental disorders improvement in subjective well-being was weakly correlated to the experience of care and moderately, negatively, correlated to symptom outcomes. Improvement in symptoms was found to be the strongest predictor of increase in subjective well-being at discharge, but it explained only a moderate part of its variance.

In conclusion, this study shows that PROMs and PREMs have potential as key indicators of high quality care across mental health services, and supports the case for measuring subjective well-being as a relevant indicator in its own right, particularly in psychiatric hospital treatments. Patient-reported measures enable the implementation of patient-centred therapeutic management and the delivery of services focused on achieving outcomes that matter to patients across the full pathway of care.

None Declared

In organic mental disorders in people who have undergone COVID-19, it has been established that the complex use of periciazine in combination with paroxetine, diazepam, 3-hydroxypyridine succinate and hyperbaric oxygenation is superior in effectiveness to traditional therapy with an antipsychotic drug, antidepressant and anxiolytic. The inclusion of 3-hydroxypyridine succinate, hyperbaric oxygenation in the complex therapy of this pathology corrects the concentrations of adrenaline, norepinephrine, dopamine, serotonin in the peripheral blood of patients, eliminates hormonal status disorders and humoral immune responses.

The aim of the work was to optimize approaches to the treatment of hypothymic disorders in organic mental illness, to substantiate the complex use of periciazine in combination with paroxetine, diazepam, 3-hydroxypyridine succinate and hyperbaric oxygenation in patients who underwent COVID-19.

The object of the clinical study were patients with organic mental disorders who underwent COVID-19. To assess the condition, laboratory research methods were selected taking into account the etio- and pathogenesis of diseases: determining the level of catecholamines, some indicators of humoral immune responses, and the hormonal profile.

Table 2.3 - Nosological structure of patients included in the study

In patients with organic mental disorders, occurring with hypothymic symptoms, compared with healthy donors, there is a complex of disorders in plasma concentrations of catecholamines. Traditional and, to a greater extent, combination therapy increase the levels of serotonin, dopamine, norepinephrine, both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.

In patients with organic mental disorders, occurring with hypothymic symptoms, compared with healthy donors, there is a complex of disorders in plasma concentrations of catecholamines. Traditional and, to a greater extent, combination therapy increase the levels of serotonin, dopamine, norepinephrine, both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.Complex therapy with periciazine, paroxetine, diazepam in combination with 3-hydroxypyridine succinate and HBO for organic mental disorders causes a more complete reduction of hypothymic disorders both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.

None Declared