Olanzapine is a second generation antipsychotic that is approved for the treatment of schizophrenia, bipolar disorder type 1 as monotherapy, or as an add-on to lithium or valproate (manic or mixed episodes), and it is also used off label for acute anxiety, insomnia… It is one of the most effective antipsychotics but concerns remain due to its significant metabolic adverse effects. Olanzapine has one of the highest rates of weight gain among all antipsychotic drugs, which challenges patient’s adherence to treatment.

Review how much influence Olanzapine has on weight gain, its influence in treatment adherence and alternatives in clinical practice.

Presentation of a patient’s case and review of existing literature, in regards to Olanzapine and its repercussions on weight gain and the old and new alternatives available right now.

Olanzapine is an effective antipsychotic, however, it causes secondary effects that complicate treatment, especially weight gain. In the case presented, the patient does gain weight with Olanzapine and adherence is compromised. In these cases, professionals try to look for alternatives, either to try another drug or use adjunct treatment. In this patient, a change to lithium was made. In the last few years, adjunct treatment has gained traction, like for example: metformin and topiramate. The latest discovery in this matter are opioid antagonists: single dose oral tablet Olanzapine/samidorphan.

Even though Olanzapine is one of the most effective antipsychotics and medications in mental health, its impact on patients’ weight hinders treatment continuity. The use of other already known medications and the appearance of new ones, that reduce weight gain probability, are the possible ways forward.

None Declared

It remains debated in the scientific literature whether cannabis aggravates psychotic symptoms or is used as a self-medication. Regular cannabis use (RCU) was found associated with the severity of positive symptoms of psychosis i.e., delusion or hallucinations. However, the association with negative symptoms, i.e. blunted affect or social withdrawal, is less straightforward. Confounding variables such as the criteria for other Substance Use Disorders (SUDs), illness duration, or socio-demographic features can interfere with the appraisal of effect of RCU on these symptoms. Studies are rarely adjusted for these variables and no adjustment can be performed in meta-analyses which use aggregated data. For these reasons, we decided to conduct a mega-analysis based on individual patient data (IPD) allowing to control for theses variables and isolate the specific association between RCU and the severity of symptoms.

Investigate the association between RCU on the positive, negative, general, and disorganized symptoms of psychosis as assessed by the Positive and Negative Syndrome Scale (PANSS), accounting for individual-level confounding variables.

IPD were requested by email to corresponding authors of published articles that measured RCU and PANSS scores in subjects with schizophrenia-spectrum disorders, based on a screening process on PubMed, ScienceDirect and PsycINFO databases. A two-stage random effect multivariate IPD meta-analysis was then performed, to isolate the direct association between RCU and the ‘positive’, ‘negative’, and ‘general’ dimensions of schizophrenia-spectrum disorders. Confounding variables were included in the models when available in the original dataset.

65 publications were eligible for inclusion. 18 authors agreed to provide their IPD. A total of 16 datasets were usable, regrouping 3,346 individual participant data, with 2,827 complete cases. Regression coefficients extracted after the first stage were adjusted for at least sex and age across all studies. RCU was found to be significantly associated with heightened positive symptoms severity (MD = 0.41, 95% CI [0.0; 0.82], p = 0.04), whereas it appeared significantly associated with less severe negative symptoms (MD = -0.63, 95% CI [-1.1; -0.17], p = 0.008). No significant association was found between RCU and general symptoms (MD = -0.24, 95% CI [-069; 0.21]; p = 0.29), as well as disorganization (MD = -0.08, 05%CI [-0.47; 0.35], p = 0.63).

Our results allow for a general and subtle overview of the association of RCU with symptoms of psychosis. Our findings suggest a double and paradoxical effect of cannabis, which could both exacerbate positive symptoms and alleviate negative symptoms. This supports both the hypotheses of a disease aggravator and self-medication.

Results change as we receive datasets from collaborating authors and could continue to change as not all authors sent their datasets yet.

None Declared

We conducted a systematic review of the qualitative literature on the sexuality and sexual health of older adults.

The aim is to address which topics have been researched and the quality of research within this field.

All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. The Cochrane Database, Psy-EBSCO, MEDLINE, Psy-Redalyc, Scielo, Web of Science and Google Scholar were searched and 32 studies met inclusion criteria. The majority had not been reviewed in earlier review articles. A total of 95,478 references were screened and 27 studies were included in this review. The studies involved 3044 participants across seven countries, most being women (approximately 83%).

We identified a wide variety of factors that can determine SWB of older adults, such as perceived health, sexual health, demonstrations of love; non-sexual joint activities; overall well-being and quality of life; partner support; positive self-image; being independent and active; the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure.

Methodological issues related to sampling procedures, such as purposive sampling through the older samples and limited generalisability due to the homogeneity of participants. Additionally, there was a widespread lack of non-heterosexual control groups. However, most studies used appropriate measures and acknowledged inherent limitations. There is a lack of research with the older population, those with significant health needs, those outside the Western countries, and those with additional characteristics associated with discrimination.

None Declared

A descriptive study is presented on three cases in which the adjustment of antipsychotic treatment has led to an improvement in the patients’ quality of life.

The objective is the description of the process of treatment optimization in elderly people, with the secondary improvement in the quality of life.

These are three female patients, with an average age of 73 years, institutionalized in the ORPEA Puerta de Hierro Specialized Mental Health Center for the Elderly. Two of them have a diagnosis of paranoid schizophrenia, and the third has a diagnosis of delusional disorder. The average age at the onset of symptoms was 21 years old.

All three were receiving treatment with biweekly zuclopenthixol, 200mg DMD together with haloperidol at a mean dose of 7.5mg of haloperidol. For the extrapyramidal side effects presented they were on treatment with biperiden 4mg DMD.

In addition to psychopathological examinations and subjective impressions, previous and current status were compared with the Barthel Scale, GDS and family satisfaction scale.

The treatment of the three patients was modified, in a period of three months, replacing the treatment with zuclopenthixol 200mg DMD to paliperidone extended release 150mg every 21 days, as well as with oral paliperidone, at an average dose of 10mg DMD. Also, biperiden treatment could be completely withdrawn and the dose of haloperidol could be reduced to 2.25mg.

In addition to the reduction of polypharmacy doses, an overall improvement is observed in relation to psychotic symptoms, without presenting exacerbations and improvement in the control of chronic psychotic symptoms. Likewise, they have improved at the affective level, presenting less negative symptoms, improvement of the affective flattening, being more resonant in the interaction with peers and with increased participation in joint activities. On the other hand, at a cognitive level, a significant improvement has been observed.

First generation antipsychotics produce a high rate of side effects, such as prolactin increase, affective blunting and extrapyramidal symptoms. In contrast, second-generation antipsychotics, in addition, act as 5HT2A antagonists, thus reducing the rates of unwanted effects.

Some studies have shown that paliperidone increases prolactin to a lesser extent than risperidone and causes fewer extrapyramidal and cognitive effects. Furthermore, because of its safety profile, paliperiona may be a first-choice strategy in psychosis in the elderly, even in its intramuscular extended-release form in nonadherent patients.

In conclusion, the elderly are a vulnerable population and to a greater extent when they suffer from a severe mental disorder. The aim of any treatment must be directed not only to control positive symptoms, but also to slow down the deterioration of the disease itself, as well as to improve quality of life and functionality.

None Declared

The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a reliable and valid tool developed for assessing unhealthy coping strategies that arise due to fear and threat of COVID-19.

The main aim of this study was to validate the Turkish version of the C-19ASS. Additionally, we explored the relationship between COVID-19 anxiety syndrome, personality traits, and psychological variables.

We recruited 296 Turkish adults using the convenience sampling method. Participants completed the Turkish version of the C-19ASS and a battery of measures assessing COVID-19 anxiety, health anxiety, well-being, personality traits, and social adaptation. A Confirmatory Factor Analysis (CFA) was conducted on the C-19ASS, and validity was evaluated by analyzing correlations with other instruments.

The results of CFA have confirmed a 9-item two-factor structure. The Turkish version of the C-19ASS showed adequate internal consistency, convergent validity, and incremental validity. Hierarchical regression analysis revealed that C-19ASS Perseveration is a significant negative predictor of well-being when controlling for age, COVID-19 anxiety, health anxiety, personality traits, and social adaptation.

The Turkish version of the C-19ASS was found to be a reliable and valid measure of the COVID-19 anxiety syndrome. C19-ASS may be a helpful follow-up tool for examining specific psychological symptoms of the COVID-19 pandemic.

None Declared

Severe mental illnesses characterized by periods of relapse that require intensive resource management. Caregivers of schizophrenia and bipolar disorder patients feel a considerable burden of care (Tanna et al. Ind Psychiatry J 2021, 30(2):299-304).

The main objective of Hospital at home for psychiatric patients is to provide intense care to patients with severe mental disorders at home as an alternative to acute admission (Alba et al. Rev Psiquiatr Salud Ment. 2019, 12 (4) 207-212).

The aim of this study is to describe the characteristics of patients attended at the Psychiatric Home Hospitalization Unit of our hospital (HAD-CAEM) and to assess the of burden of care that caregivers feel while giveing care to this patients.

Data were collected retrospectively at admission and discharge of all patients treated at HAD-CAEM between August 2018 to March 2022. Incomes of patients who met DSM-5 criteria for schizophrenia, bipolar disorder and major depressive disorder. Severity of disease and patient’s level of functionality was evaluated with the global assessment of functioning scale (GAF) and the Clinical Global Impression Scale (CGI). Burden Caregivers was evaluated with The Zarit Caregiver Burden Scale (ZCBS). Statistical analysis was performed by using SPSS program.

109 patients were included in the study. 49.5% were women. The mean age was 48 years (SD 18.47 years). 44% met criteria for schizophrenia, 25.7% for depressive disorder, and 30.3% for bipolar disorder. Most of them lived with their own family (47.7%); had secondary education (51.4%) and were unemployed (33%). 81% had a history of at least one admission to an acute psychiatric unit.

The mean duration of admission in HAD-CAEM was 33.8 days (SD 15.72 days), with a mean follow-up of 8.75 visits (SD 3.58 visits).

The mean CGI severity item at admission was 4.36 and there was an improvement at the time of discharge according to the CGI improvement item (mean CGI-I=2.43).

The GAF scale on admission was 46.74 (SD 11.2) and on discharge 64.24 (SD 13.85), showing an improvement of 17.5 points at discharge (p<0.001).

The mean ZCBS of the sample was 48.21 (SD 15.11). Mean ZCBS in Schizophrenia group (n=22) was 46.13 (SD 16.53), in depressive group (n=18) was 43.61 (SD 12.89) and for bipolar group (n=17) was 55.76 (SD 13.19). A statistical test is performed with ANOVA, showing significant differences between groups (p=0.039). Post-hoc analyzes show significant differences between bipolar disorder group and the depressive disorder group (p=0.04). No significant differences are found between the other groups.

Caregivers of schizophrenia, depressive and bipolar disorder patients feel a considerable burden of care. ZCBS was administered to the caregivers on the last day of admission, when the patient presented clinical and functional improvement. More studies are needed to support these results.

None Declared

Coronavirus disease 2019 (COVID-19) modify voluntary admission rates to psychiatric wards in the early phases following pandemic onset. Older patients have higher COVID-19 distress scores because elderly people are at risk for COVID-19 infection.

The present investigation aimed at admission rates of elderly patients to a General Hospital Psychiatric Ward during the lockdown due to the COVID-19, compared to similar periods of 2018 and 2019.

Anonymized data on psychiatric admissions (n=55) from one general hospital psychiatric ward have been obtained and analysed. We compared admission characteristics between April and June of 2018 and 2019 with the same period of 2020 (lockdown).

During the COVID-19 lockdown, a significant reduction in psychiatric hospitalizations of older patients (aged >65 years) was observed in the lockdown (69.2%; χ2=4.823,df=1,p=0.028) in contrast with young patients (26.7% reduction). There was a reduction of 14% in admission due to suicidal behaviour (IRR = 0.57; 95% CI: 0.11-2.75; p=0.48), 25% in depression (IRR = 0.28; 95% CI: 0.64-1.25; p=0.09) and 50% in psychotic disorders (IRR = 0.33; 95% CI: 0.07-1.48; p=0.15). There was none admission by dementia during the lockdown.

Changes in the number of psychiatric admissions, particularly for older patients, were observed during the COVID-19 lockdown. During this period, their fear levels could modify their psychiatric admission rates. We suggest that the decrease of psychiatric admissions in the elderly was due to fear of contagion in hospitals.

None Declared

Studies have shown that dementia family caregivers to be significantly more burdened than non-dementia caregivers.

The aim of the present study was to analyze factors affecting the quality of life and the burden of dementia family caregivers.

70 dementia family caregivers who lived in the Attica Region, Greece participated in the study from February to April 2022. An anonymous questionnaire was used including 16 items regarding demographic and socio-economic factors. The 22 -item Zarit Burden scale was used to estimate the burden of dementia family caregivers. Statistical analysis was performed with SPSS 21.

1.4% of caregivers showed minimal to no burden (n = 1). 28% of caregivers (n = 20) a mild to moderate burden. 40.6% (n = 29) presented a moderate to severe burden, while 28% (n = 20) a very serious burden. According to the results of the present study, there are three main factors that affect the quality of life of caregivers. Caregivers who spend more time with the patient have an increased burden compared to caregivers who spend less time. The patient’s low Mini Mental score is associated with an increase in burden. Caregivers who have attended training and management programs for the care of a patient with dementia have a lower burden than those who have not attended programs.

The study highlights an increased burden on caregivers. Social supports with multiple coping strategies focusing on different levels of patients with dementia and caregivers’ needs should be planned to relieve the caregiver burden.

None Declared

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.

None Declared

The concept of ESSENCE was created to coin a set of clinical symptoms in early childhood , before the age of 5 to 6 years, that may be present in several specifically undefined disorders and that may be associated with the development of more specific psychiatric disorders in adolescence and adulthood, such as Autism Spectrum Disorder, Schizophrenia or Bipolar Disorder.Those symptoms may include deficits in development, communication, language, social skills, motor coordination, attention, behavior, mood and sleep.

To evaluate the association between Neurodevelopmental Disorders, which manifest by uncharacteristic and diffuse symptoms in early childhood, and AutismSpectrum Disorder, Schizophrenia and Bipolar Disorder.

We performed a non-systematic review of the existent literature with the keywords: “Attention Deficit”; “Hyperactivity Disorder”; “Autism Spectrum Disorder”; “ESSENCE”; “Schizophrenia”; and “Bipolar Disorder”.

Although ESSENCE is not a diagnostic term, some symptoms regarding ESSENCE are shared with early symptoms of different Major Psychiatric Disorders, namely speech and language delay, impulsivity, inattention, feeding difficulties, hypo/hyperactivity or other behavior problems.

There is a growing acceptance that the co-existence of disorders and the sharing of symptoms (so-called comorbidity) is a questionable concept, since we are usually not dealing with completely separate disorders.

Neurodevelopmental disorders present with frequent comorbidities and the overlap between the disordersstill needs to be better studied, as in autism spectrum disorder and attention deficithyperactivity, through a greater understanding of shared genetic and environmental factors and that reflect how early symptomatic syndromes can coexist in childhood, and later in adolescence and adulthood .

The concept of ESSENCE emphasis the difficulty when making adiagnosis, specifically in Neurodevelopmental Disorders due to the fact that a variety osymptoms overlap. It is known that some disorders that will manifest in adulthood sharesymptoms with ESSENCE. Therefore, it is of great need to associate the current clinical findings with the present and future technologies, e.g. genetic markers, in order to dentify a common core with ESSENCE and Major Psychiatric Disorders.

None Declared

According to the WHO, approximately 280 million people in the world have depression. It is known that pharmacists are in an ideal position to offer proactive interventions to people with depression or depressive symptoms. However, pharmacists’ stigmatizing attitudes towards depression and patients with mental illness may decrease the quality of pharmaceutical care services provided to those patients. No research has been conducted on pharmaceutical care and pharmacists attitudes towards patients with depression in Lithuania.

The aim of the study is to evaluate stigma, confidence, attitudes, barriers and incentive factors in providing pharmaceutical care to patients with depression in Lithuania.

The prospective 3 years follow-up study will be carried out among the pharmacists in Lithuania. The sample size of 269 respondents is calculated. First of all, pharmacists will be provided with a training lecture by trained investigator (M.Z.) about depression and its pharmaceutical care. At the same day, after the lecture, pharmacists‘ stigma, confidendence, attitudes, barries and incentive factors in providing pharmaceutical care to patients with depression will be evaluated by 5 questionnaires:

1. 1. Participants will be asked to provide sociodemographic information included age, gender, years of practice, etc;

2. 2. The pharmacists’ stigma of patients with depression will be evaluated using eight likert-scale items that measure how patients with depression are perceived;

3. 3. Pharmacists’ attitudes toward depression will be evaluated using Depression Attitude Questionnaire;

4. 4. Pharmacists’ confidence in medication consultation for patients with depression will be evaluated using The Pharmacists’ Confidence scale about Medication Consultation for Depressive patients (PCMCD);

5. 5. A list of possible barries and incentive factors identified in the literature will be provided to pharmacists and they will be asked to choose as many barriers and incentive factors as they think are relevant.

Next trainings lectures will be performed repeatedly at the month 6, 12, 18, 24, 30 and at the end of the study - month 36. Also, pharmacists‘ position will be re-evaluated after each training lecture by the same 5 questionnaires.

The Lithuanian Bioethics Commitee approval is going to be received after the training program is confirmed (estimated time – the 1st quarter of 2023).

Stigma, confidence, attitudes, barriers and incentive factors in providing pharmaceutical care to patients with depression in Lithuania will be evaluated.

Conclusions will be drawn on stigma, confidence, attitudes, barriers and incentive factors in pharmaceutical care of patiens with depression in Lithuania. Also, practical recommendations will be introduced to The Ministry of Health of The Republic of Lithuania.

None Declared

Bipolar disorder is one of the leading causes of disability among young adults. Given the heterogeneity of the disorder and the complexity of its etiopathogenesis, combination therapy is often considered as part of the treatment regimen.

To assess the place of non-pharmacological interventions as a co-adjuvant to pharmacological treatment, to discuss the role of polytherapy in the management of bipolar disorder and to underline the drug to drug interactions to keep in mind.

We present a critical review of recent international recommendations for the management of bipolar disorder. Two main evidence-based guidelines were included: The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders and The 2018 Canadian Network for Mood and Anxiety Treatment.

According to guidelines, the outcomes in bipolar disorder are improved when medication is combined with evidence-based psychological treatment and lifestyle changes. As to polytherapy, it is often recommended to maximise the treatment efficacy. Studies have shown that combination treatments tend to work faster and more effectively than monotherapy especially in episodes with higher index severity. For the management of agitation, an adjuctive treatment by Haloperidol with midazolam or promethazine can be prescribed. In acute mania, combination therapy with quetiapine, aripiprazole, risperidone or asenapine and lithium or divalproex is recommended as first-line treatment options. Combinations of mood-stabilizing drugs may be more often necessary when rapid cycling is present. In a manic episode with mixed features the use of divalproex with an atypical antipyshcotic is recommended. In bipolar I depression, lurasidone and lamotrigine are often used as adjunctive therapies. When anxious distress is present, the combination of olanzapine and fluoxetine has shown to be effective. In a depression with atypical features, tranylcypromine (IMAO) can be added to lithium, divalproex or a second generation antipsychotic for a better result. Adjunctive treatment of olanzapine with fluoxetine may be necessary in a depression with mixed features. However, in bipolar II depression and for maintenance treatment no adjunctive therapies are recommended. Finally, it is important to consider the adverse effects resulting from polytherapy. Using lithium as an adjunctive medication may increase the risk of tremor and acute dystonic reactions and can be a contributing factor for neuroleptic malignant syndrome, whereas divalproex can be an inducer or an inhibitor of some atypical antipsychotics.

Rational polytherapy allows better and faster control over symptoms of bipolar disorder and should be considered after a detailed discussion of risks and benefits.

None Declared

Having a family member admitted in Intensive Care Unit (ICU) can cause a severe psychological stress, and various psychological disorders gathered into the notion of Post intensive care syndrome-family (PICS-F). In this way, Family-centered care in ICU represents the aim of international accepted recommendations focusing on a partnership approach to health care decision-making between the family and health care provider to prevent PICS-F. During the first SARS-CoV-2 linked lockdown, social restrictions impaired the right application of these recommendations, increasing risk of PICS-F, particularly Post-Traumatic Stress Disorder (PTSD).

The main objective was to compare the PTSD prevalence at 6 months in a group of relatives including during OLAF implementation with a control group in a cohort of ICU-patient relatives.

Considering this, the psychiatric team and the ICU team of the Toulouse University, France, proposed the creation of a temporary device called OLAF (Opération de Liaison et d’Aide aux Familles in French), aiming to bring a psychological phone support to ICU-patient relatives. Besides this operational approach we designed a research approach that aimed to investigate the impact of OLAF device on PICS-F.

We noted that 12 participants (11.5 %) presented a PTSD at 6 months without statistically significant differences between the groups (p=0.8). Considering that OLAF group presented higher PDI (Peritraumatric Distress Inventory) score at screening we also considered a mediation model suggesting that OLAF could have played a role to diminish the PCL-5 score as a covariable. In the multinomial logistic regression analysis, we found that the only factor associated with the PTSD diagnosis was the level of Anxiety and Depression Signs measured with HADS (Hospital Anxiety and Depression Scale) at screening (OR= 1.2, p<0.001).

We found no difference in PTSD prevalence according to OLAF intervention. Nevertheless, our result suggested that the intervention could have play a role in reducing PTSD by acting on anxiety and peri traumatic distress in a mediated model. We found that anxiety score could serve as a risk marker to predict PTSD and should probably be precociously screened and treated in this population.

None Declared

The use of diagnostic categories, although useful, fails in capturing the psychopathological complexity of the individual case. As for schizophrenia spectrum disorders, positive symptoms are not always included in the presentation, so further dimensions should be considered for a correct diagnosis.

To describe the importance of dimensional diagnosis in schizophrenia spectrum disorder based on a clinical experience

We report the case of a late-onset schizophrenia spectrum disorder with an affective presentation

I. is a 44-year-old woman who accessed the Community Mental Health Center due to subjective memory complains. After clinical evaluation, depressive symptoms and circadian rhythm disturbances emerged. The patient also reported dissociative experiences, which emerged after her brother’s death. She underwent a neurological visit that excluded the possible early manifestation of a neurodegenerative disorder. Quetiapine was at first prescribed, due to the possible action on both insomnia and mood symptoms, with insufficient response. After a few visits, a deeper mental state examination revealed the presence of delusions. The patient also reported having experienced hallucinations. Psychotic symptoms appeared to be persistent and pervasive. We changed the antipsychotic to full-dose olanzapine, with good response. After a six-month observation, the patient was diagnosed with schizophrenia.

The diagnosis of late-onset schizophrenia should take into account clinical history, drugs response, and the evaluation of different psychopathological dimensions

None Declared

It is well known that eating disorders are related to comorbidity. At least, half of these patients have other mental disorders and, in addition to it, the presence of physical comorbidity (cardiovascular, kidney, nervous system, digestive tract, metabolic or endocrine disorders) comes with a decline in life expectancy.

Description of a patient with a diagnosis of anorexia nervosa (AN) who developed a gastric bezoar during hospitalization.

Case treated in a specific Eating Disorder Unit in a Third-Level Hospital.

26 years old woman with a diagnosis of AN hospitalized in General Psychiatric Unit with BMI of 11,78 kg/m2. Nasogastric tube was necessary and, after 1 month with a progressive weight recovery (BMI 13,84 kg/m2), the patient was transferred to the Eating Disorder Unit in order to follow specific psychological therapy. No incidence related to physical exploration or clinical analyses happened during this month apart from pancytopenia due to malnutrition.

However, 8 days after, patient developed nausea and had 3 vomit episodes, constant abdominal pain at hipogastrium (moderate intensity), dizziness, instability and constipation. The patient refused possibility of pregnancy. The physical exam showed bowel sounds augmented but no mass or peritoneal irritation appeared. Blood test results were normal. Abdominal X-Ray showed gastric dilatation with small bowel faeces sign, which suggested diagnosis of gastric bezoar.

The treatment was the dissolution of the bezoar by Coca-Cola, solving the symptoms completely.

The patient refused having eaten hair or any other kind of object or indigestible material but admitted to be following a strict vegan diet. Finally, after an endoscopy was done, the patient was diagnosed of phytobezoar.

Based on literature, bezoars are rare in AN, being phytobezoars the most common between the types of bezoars. Nevertheless, there are some risk factors, such as delayed gastric emptying, dehydration or, in the case of phytobezoar, ingestion of food containing high amount of cellulose, hemi-cellulose, lignin, and tannins (celery, pumpkin, grape skins, prunes, raisins and, in particular, persimmons). Some of the symptoms caused by phytobezoar can be similar to those of the AN (abdominal pain, intestinal obstruction, poor appetite, vomiting, malnutrition, weight loss). Therefore, gastric bezoar could be an underdiagnosed or even undiagnosed disease in this group of patients. Taking this into account could reduce time until diagnosis and treatment, decreasing the risks associated.

None Declared

Ayahuasca is a traditional brew containing the psychedelic 5-DMT (a tryptamine that acts as a 5HT2A-R agonist) used to achieve non-ordinary states of consciousness, with a long tradition among various cultures in ritual and therapeutic contexts. Ayahuasca is being studied as potential treatment in Mental Health, which has led to non-controlled and recreational use. This has led to a rise in the description of side effects, such as substance-induced psychosis.

To describe a case of a possible psychotic episode related to the intake of ayahuasca brew in a ritual context.

Clinical assesment and bibliographic review of pertinent literature.

We will present the case of a 43 year old woman, who participated in three ayahuasca sessions in three consecutive months. Two days after the last session, she suffered and episode of loss of consciousness, convulsions, loss of streng and paraesthesia in right forearm and righr side of the face and head; and apparition of perceptual alterations and delusions that she did not experience during the trip. Such alterations included the perception of electromagnetic fields (EMF) robbing her of her vital energy and lifeforce. She required ICU treatment for four days, after which se was hospitalized in Internal Medicine Unit and was assessed by Mental Health team. Though the symptoms were coherent with the previous beliefs of the patient, they were clearly exacerbated and interfered with her normal and previous functioning. She was treated with risperidone 1,5 mg, with complete symptom remission.

The case presented is consistent with other reports of ayahuasca-induced psychotic symptoms, though with less intensity and duration. We discuss prevalence and repercussions of the rising use of this powerful substance; that must be taken into consideration by clinicians worldwide.

None Declared

The spectacular progress of the last decade in the field of genetics is allowing a new development of medicine and the ability to make a better diagnosis. A great example of this is the diagnosis of chromosome 22q11 deletion, which occurs in 1:4000 live births.

This case wants to illustrate the difficulties in the diagnosis, despite technological advances.

Exhaustive review of the literature

This is a 38-year-old male patient diagnosed with chromosome 22q11 deletion in adulthood.

Family history of medical problems: mother with genetic diagnosis of chromosome 22q11 deletion, in adulthood, after the diagnosis of her own son.

Personal history of medical problems:

- Psychiatry: he has been followed up intermittently in psychology since he was 6 years old, due to cognitive difficulties and behavioral alterations. He has had several hospital admissions in psychiatry during adolescence for behavioral disorders and intellectual disability, with possible psychotic symptoms. In treatment with antiepileptics and antipsychotics.

- Cardiology: aortic aneurysm and bicuspid aortic valve were detected. The patient underwent surgery in 2018.

- Genetics: he is diagnosed with chromosome 22q11 deletion in 2019. This is an inherited mutation of maternal origin that is detected later.

- Rheumatology: seropositive rheumatoid arthritis, non-erosive.

- Rehabilitation: treatment to improve psychomotor skills, from 6-12 years of age.

It is important to emphasize that the diagnosis was made at the age of 35 years, after a more deep study which had been carried out after the debut of the cardiac pathology. In addition, it is very striking that the diagnosis of his mother was made later than the one of the patient himself.

Currently, the patient presents serious difficulties in respecting the rules of coexistence at home and in understanding social norms, so that he has not been able to integrate in any environment and remains isolated at home. Serious behavioral alterations with tendency to physical and verbal heteroaggressiveness, difficulty in accepting limits and sexualized and uninhibited behaviors.

Clinical judgment: chromosome 22q11 deletion.

Early diagnosis is essential to be able to treat and, above all, prevent the possible complications that this syndrome may present. However, diagnosis is sometimes very complex, despite advances in molecular diagnostic techniques. Therefore, an integrative approach is very valuable, looking at the individual as a whole and not only by systems or medical subspecialties. In addition, it would be very interesting to establish a means of communication between specialties. Finally, it would be a real step forward to integrate all the medical information of each person in a single medical record, an apparently simple aspect, but so far from being possible.

None Declared

Antidepressant discontinuation may cause withdrawal syndrome in some cases. However, evidence on this syndrome related to individual antidepressants is limited, as well as about individual risk factors for severe reactions.

To ascertain whether each individual antidepressant is associated with an increased reporting of withdrawal syndrome as compared with other medications, and to examine clinical risk factors for severe reactions.

We conducted a pharmacovigilance study, with a case/non-case design. We included reports of antidepressant-related withdrawal syndrome from the VigiBase, the WHO global database of individual case safety reports of suspected adverse drug reactions. We performed a disproportionality analysis (calculating reporting odds ratio (ROR) and the Bayesian information component (IC)) of reports of antidepressant-related withdrawal syndrome, comparing antidepressants to all other drugs and to buprenorphine (as a positive control). Antidepressants with significant disproportionate reporting were ranked in terms of clinical priority. We compared serious versus non-serious reactions to determine clinical risk factors for severe reactions.

Based on 31,688 reports of antidepressant-related withdrawal syndrome, we detected a disproportionate reporting for 23 antidepressants. The ROR for antidepressants altogether, compared to all other drugs, was 14.26 (95%CI:14.08-14.45), 17.01 for other antidepressants (95%CI:16.73-17.29), 13.65 for SSRIs (95%CI:13.41-13.90) and 2.8 for tricyclics (95%CI:2.59-3.02). Based on clinical priority ranking, the strongest signals were found for paroxetine, duloxetine, venlafaxine and desvenlafaxine (figure 1), being comparable to buprenorphine. Severe reactions were more frequently reported in males, adolescents, persons with multiple medications, and with longer treatment duration.

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Antidepressants are associated with increased reporting of withdrawal syndrome compared with other medications, with differences between individual antidepressants. Clinicians should be aware of such differences, when prescribing and discontinuing these drugs, as well as of the risk to experience more severe withdrawal symptoms in specific cases.

C. Gastaldon: None Declared, G. Schoretsanitis Consultant of: Dr. Schoretsanitis has served as a consultant for HLS Therapeutics, E. Arzenton : None Declared, E. Raschi : None Declared, D. Papola: None Declared, G. Ostuzzi: None Declared, U. Moretti: None Declared, E. Seifritz Grant / Research support from: Dr. Seifritz has received educational grants, consulting fees and lecture honoraria from Janssen Cilag, Lundbeck, Angelini, Otsuka, Servier, Ricordati, Vifor, Sunovion, Schwabe and Mepha, Consultant of: Dr. Seifritz has received educational grants, consulting fees and lecture honoraria from Janssen Cilag, Lundbeck, Angelini, Otsuka, Servier, Ricordati, Vifor, Sunovion, Schwabe and Mepha, J. Kane Shareolder of: LB Pharmaceuticals and Vanguard Research Group, Consultant of: Dr. Kane has been a consultant and/or advisor for or has received honoraria from Alkermes, Allergan, LB Pharmaceuticals, H. Lundbeck, Intracellular Therapies, Janssen Pharmaceuticals, Johnson and Johnson, Merck, Minerva, Neurocrine, Newron, Otsuka, Pierre Fabre, Reviva, Roche, Sumitomo Dainippon, Sunovion, Takeda, Teva and UpToDate, G. Trifirò Grant / Research support from: he was the scientific director of a Master program on pharmacovigilance, pharmacoepidemiology and real-world evidence which has received non-conditional grant from various pharmaceutical companies; he coordinated a pharmacoepidemiology team at the University of Messina until Oct 2020, which has received funding for conducting observational studies from various pharmaceutical companies (Boehringer Ingelheim, Daichii Sankyo, PTC Pharmaceuticals). He is also scientific coordinator of the academic spin-off “INSPIRE srl” which has received funding for conducting observational studies from contract research organizations (RTI Health Solutions, Pharmo Institute N.V.)., Consultant of: Dr. Trifirò has served in the last three years on advisory boards/seminars funded by SANOFI, Eli Lilly, AstraZeneca, Abbvie, Servier, Mylan, Gilead, Amgen;, Speakers bureau of: Dr. Trifirò has served in the last three years on advisory boards/seminars funded by SANOFI, Eli Lilly, AstraZeneca, Abbvie, Servier, Mylan, Gilead, Amgen;, C. Barbui: None Declared

Social life has moved toward the digital world in many aspects. As the original inhabitants of virtual life, young people face several adversities while flirting and dating online. The anonymity of the online environment enables aggression without consequences. Cyberviolence has no boundaries as time or place. Thus it may cause psychological distress.

Young people frequently use online dating and social networking sites, which makes them vulnerable to cyber dating violence, sextortion, and revenge porn. Cyberdating violence usually targets young women and girls. It is mainly related to stereotypical gender beliefs: presented as controlling behavior and psychological violence. Survivors of cyber dating violence tend to feel anger, hostility, and loneliness. Sextortion is image-based sexual abuse, which includes threats with intimate pictures or videos. Perpetrators of sextortion can be hackers, ex-partners, or admirers. Exposure to sextortion is related to shame, fear, and helplessness. Former partners may use revenge porn to control one’s behavior. It is another kind of image-based sexual abuse. Perpetrators may use nonconsensual pornography to punish or humiliate their ex-partners.

Cyber victimization is as traumatic as real-life victimization. That results in depression, anxiety, and posttraumatic stress. Moreover, the absence of time and space restrictions can make cyberviolence even more debilitative. I aim to inform European psychiatrists about the current shapes of cyber psychological trauma in the context of online flirting and dating. So that psychiatrists can better understand its content and outcomes, especially while working with young people.

None Declared

ECT is a recognised, safe and effective treatment for severe/psychotic depression. Neuro and functional brain imaging has indicated what specific changes take place with ECT and at what stage. This study aims to explore the specific impact on depression and mood symptoms as ECT progresses, using longer version of Hamilton Depression Rating Scale at star, mid poitn and end point of ECT.

Patient themselves are often keen advocates of ECT (if they found it effective and tolerable).

specifically to consider the impact of ECT on mood and depressive symptoms as ECT progresses.

This is to reconsider and reflect on if ECT is effective and also to consider at what satge of treatment ECT appears to have the greatest impact or brings about the greatest change

All patients having ECT will be assessed and clerked as per routine but will also be assessed using Hamilton Depression Rating Scale (17 item version), an observer rated scale to assess severity of depressive symptoms. This will be used with all ECT patients, regardless of diagnosis or indication for ECT. Basic demographic details, diagnosis, co morbidities and previous ECT recorded.

Findings

Patients are are ideally assessed before ECT has started to give a baseline/true reflection of their depressive illness and then at the mid point (around session 6) and then at the end of treatment (ideally session 12).

Hamilton depression Rating scale (HDRS) longer version is used - 17 questions with scores out of 40. Higher scores indicate more severe depression. HDRS is an observer rated scale, with numerous questiosn about biological symptoms of depression and is a well established assesment tool. The same rater was used to try to rule out observer bias.

Patients had a significant drop in HDRS scores as ECT progressed, with the biggest drop being between the start of ECT and the midpoint. Thsi trend continued from mid to end point but with a less steep gradient.

mean HDRS scores at start were 24/40 (indicting severe depression).

Mean HDRS at midpoint 12/40 (indicating mild depression)

Mean HDRS at end opf ECT 5/40 (indicating nromal range/no depression)

ECT works for mood symptoms associated with depression. All patients having ECT had a reduction in their HDRS scale as ECT progressed, most marked in the 1st half but this trend continued in 2nd half (but at slower rate). This was the case even for patients who were not having ECT for mood symptoms (eg for aggression or psychosis).

None Declared