Bipolar disorder (BD) has been consistently associated with alterations in the immune system. Evidence suggests a condition of systemic low-grade inflammation due to decreased adaptive, increased innate immunity, with higher levels of circulating cytokines, higher macrophage/monocyte inflammatory activation patterns, and higher neutrophils to lymphocyte counts; and with a dynamic pattern of premature immunosenescence and partial T cell defect starting early in adolescence, involving a reduction of naïve T cells and an expansion of memory and senescent T cells. Quantitative analysis of circulating inflammatory markers suggested persistent low-grade inflammation.

A growing literature suggests that the immune system plays a core role in maintaining brain homeostasis, with both adaptive and innate immune support, ensured by cell trafficking across the blood brain barrier, being essential for brain maintenance and repair in healthy conditions, and disrupted in brain disorders including BD. Measured in peripheral blood, these markers of altered immuno-inflammatory setpoints parallel activation of microglia and disruption of white matter (WM) integrity in the brain.

Studies in the field are in its infancy, but findings by our group showed that: circulating Th17 cells correlated with higher FA, while regulatory FOXP3+ cells correlated with higher RD and MD, and with lower fMRI neural responses in the right dorsolateral prefrontal cortex; higher circulating cytokine-producing NK cells were fostered by ongoing lithium treatment and directly correlated with better FA, and inversely with RD and MD, also partially mediating the known benefits from lithium on WM; and activation status and expression of killer proteins by cytotoxic CD8+ T cells negatively associated with WM microstructure, thus suggesting that CD8+ T cells can leave the blood stream to migrate into the brain and induce an immune-related WM damage in BD.

Implications of these findings for neuroprogression, clinical outcomes, and new treatment strategies of the disorder will be discussed.

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The healthcare environment is a special work environment. It exposes the staff to physical and psychological constraints. Interns starting their careers during this pandemic were exposed to additional stressors in the time of the COVID-19 pandemic.

We aimed to screen for depression and generalized anxiety disorder among medical interns during the COVID-19 pandemic.

We conducted a cross-sectional study, through a pre-established anonymous questionnaire for Tunisian medical interns. This questionnaire was shared online on social networks in April 2022. Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used. The collected data were processed and analyzed by IBM SPSS statistics software.

Our population consisted of 82 interns. The average age was 25.47±1.84 and 76.8% were female. Sixty-one per cent of our population had priors of COVID-19 infection. The mean of the PHQ-9 score was 10.90±6.34. Only 12.2% had a normal PHQ-9 score and nearly one-third of interns had self-harm and suicidal thoughts. Symptoms of moderate to severe depression were observed in 25.6% of interns. The mean of the GAD-7 score was 9.17±5.20. A further specialized evaluation was required in 39.1% of interns who scored 10 or greater. Bivariate analysis showed that the PHQ-9 and GAD-7 scores were correlated (p=0.002, r= 0.78). They were not associated with sex, age, or medical history.

Medical interns, who just started their professional careers during an important COVID-19 wave, suffered greatly in terms of mental health. Serious attention and evaluation are needed for this fragile young category of healthcare professionals.

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Studies have shown that family factors affect the development, maintenance and course of major depressive disorder (MDD).

The present study aimed to prospectively investigate whether dysfunctional family functioning is associated with meaningful clinical outcomes including symptom severity and quality of life (QoL) in patients with MDD.

A total of 114 patients with a clinical diagnosis of MDD (83.3% females, aged 47.25±13.98 years) participated in the study. Participants were recruited from the outpatient clinic, Department of Psychiatry and the mobile mental health unit of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group. Family functioning was assessed in terms of cohesion, flexibility, communication and satisfaction dimensions (FACES IV) at baseline. Depression severity (BDI) and QoL (WHOQOL-BREF) were assessed about 10 months after the baseline assessment (9.56±2.52).

Conceptually, the cohesion dimension contains Balanced Cohesion (central area) with Disengaged (low unbalanced) and Enmeshed (high unbalanced) dimension, and the flexibility dimension contains Balanced Flexibility (central area) with Rigid (low unbalanced) and Chaotic (high unbalanced) dimension. Multivariable analysis adjusting for confounding variables such as patients’ educational level, residence, family structure, pharmacotherapy, psychotherapy, and history of suicide attempts indicated that Balanced Cohesion was positively associated with increased levels of patients’ psychological QoL. Moreover, two out of four unbalanced scales - Enmeshed and Chaotic - were negatively related to lower psychological QoL. The findings also demonstrated that Enmeshed scale was positively associated with higher depressive symptoms. Finally, lower family communication was related to increased depressive symptoms, whereas lower family satisfaction was associated with patients’ lower psychological QoL.

Family environmental factors appear to play an important role in clinical outcomes of MDD. Family interventions targeting dysfunctional family interactions by promoting awareness of family dynamics could improve the emotional well-being of patients with MDD.

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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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The United Nations Convention on the Rights of Persons with Disabilities as well as the new guidance on community mental health services recently published by the World Health Organization formulate clear goals for the future of psychiatry and psychosocial support. Innovative concepts of psychiatric care that focus on full participation, recovery-orientation and the prevention of coercion play an important role in achieving these goals. Implementing and scientifically evaluating the effects of such models in mental health services needs to be prioritized in national mental health planning and budgeting decisions.

In 2010, a new recovery-oriented treatment concept, the "Weddinger Modell", was developed and implemented at the Psychiatric University Clinic of the Charité in St. Hedwig Hospital (PUK-SHK). After 13 years of working with the Weddinger Model, there are, in addition to good practical experiences, numerous scientific findings that prove its effectiveness with regard to relationship promotion and reduction of coercive measures on various dimensions. These effects have encouraged many clinics, especially in German-speaking countries, to adopt principles of the "best-practice" model.

The "Weddinger Modell" shows that consistent adjustments of clinic structures and a recovery-oriented attitude of staff lead to a comprehensive improvement of treatment (Mahler et al. 2014; Mahler et al. 2019) and thus to a reduction of coercive measures to an absolute minimum (Czernin et al. 2020; Czernin 2021). Additionally, current studies found that coercive measures can be reduced almost exclusively to the first 24 hours of treatment (Cole et al. 2020). Working with the "Weddinger Modell" shows that coercion can be minimized "without evading responsibility for people with severe mental illness and without denying them responsibility for themselves" (Mahler et al. 2014).

In this lecture, the basic components of the "Weddinger Modell", the attitudes behind it, and the scientific data on effects of the model will be presented and discussed.

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Delirious mania is a potentially fatal neuropsychiatric syndrome of unknown etiology often characterized by the acute onset of delirium, symptoms of mania, and psychosis. The presentation is often punctuated by catatonia.

Delirious mania may constitute up to 15% of all acute mania cases. When delirious mania is unrecognized or improperly treated, it can progress rapidly in severity and can become life-threatening.

Despite being relatively prevalent, literature on delirious mania is sparse, and there are no formal diagnostic criteria or treatment guidelines.

Review delirious mania as an entity, its symptoms, type of patient and treatment.

Presentation of a patient’s case and review of existing literature regarding delirious mania and its characteristics.

In delirious mania symptoms present abruptly, within hours. Symptomatology varies from psychotic (hallucinations, delusions…), maniac (agitation, dysphoria…) and altered sensorium (desorientation, fluctuation of symptoms…). A differential diagnosis has to be done, as well as discarding an organic origin, which in the end, as illustrated in this case, was the etiology of the symptomatology in this patient.

Delirious mania is a clinical entity very underdiagnosed given that patients exhibit an array of different symptoms, making diagnosis very challenging for professionals. It should always be considered in differential diagnosis when these symptoms are present, especially in elderly people, given that early treatment is key. However, discarding an orgnanic origin should always be the first thing to do in clinical practice.

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Schizoaffective disorder is a mental health disorder frequently associated with somatic and addictive comorbidities. This association can be dangerous as it may change the expression of the disease and its prognosis and may even affect the quality of life (QOL) and the overall functioning of patients.

This study aimed to investigate the impact of somatic and addictive comorbidities on QOL and the overall functioning of patients with schizoaffective disorder.

This paper is a cross-sectional descriptive study conducted at the Department of Psychiatry within outpatient settings over six months. We evaluated the QOL using the SF-36 and Global Assessment of Functioning scale (GAF). We included all patients suffering from a schizoaffective disorder and excluded patients with associated mental impairment, those we could not assess because of another disability, and those with missing records.

Fifty-two patients with schizoaffective disorder met our inclusion criteria with an average age of 38. This study found somatic comorbidities in 30.8% of patients, where diabetes ranked first (13.5%), followed by high blood pressure (9.6%). We noted addictive comorbidities in 63.5% of patients, with tobacco, alcohol, and Cannabis being the most consumed substances, with respective rates of 57.7 %,28.8 %, and 13.5%.

The QOL assessment revealed an impaired QOL score in 80.8% of patients, whereas 65.4% had a GAF score lower than 70 indicating a deterioration of functioning level. Our results showed that dimension D1 (physical activity) of the SF-36 was strongly influenced by somatic comorbidities, according to an analytical investigation of the association between these two variables (p = 10-4). We also found that the deterioration in the patient’s global functioning was not significantly related to somatic comorbidities (p = 0.28). Furthermore, our studies showed no association between impaired quality of life and substance abuse.

Somatic comorbidities and substance abuse have a detrimental effect on patients with pre-existent schizoaffective disorder, and the goals of patient care with a schizoaffective illness go beyond the remission of clinical symptoms to the improvement of quality of life and socio-professional functioning.

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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.

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Research on past coronavirus outbreaks, including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), indicates a high likelihood of symptoms and psychiatric disorders in survivors, including symptoms of stress. post-traumatic stress disorder (PTSD) and post-traumatic stress disorder (PTSD)

This study therefore set out to highlight the impact of COVID-19 infection on mental health by screening them for posttraumatic stress

It is a retrospective study that includes patients who were tested positive with COVID 19 (RT PCR using a nasopharyngeal test ) and who have seeked medical care at emergencies during a month . The post traumatic stress score disorder: PCL-5 was calculated on day 30 and day 90. The evolution of the patients health state (Recovery or deterioration) was marked. All data were analyzed by SPSS.

we included during the study period 200 patients complying with the inclusion criteria. Post traumatic stress was diagnosed in 146 patients (73% of patients). Post-traumatic stress was diagnosed in rather elderly patients; the average age was 51.8 years with a female predominance (57.5%). 63.6% of patients with PTSD had a cough; 35.7% had dyspnea; 49.7% were febrile, 43.9% had arthromyalgia, 15% had anosmia.The disappearance of the signs was after 8.3 days on average, it lasted longer (14.6 days) in the patient who developed PTSD.In this series, 47.3% of patients diagnosed with PTS infected their relatives

This study contributes to a better understanding of the factors that determine the impact of traumatic events such as a pandemic on people’s mental health.Post traumatic stress disorder is so common among COVID 19 patients and it has a huge influence on the evolution of their health state . This is why all health workers have to fight against COVID and its effects on both physical and mental health . Highlighting the fact that a psychological assistance is highly recommended in the management ofCOVID19 patients in order to improve their prognosis

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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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Women get hospitalized for various serious mental disorders that are gender specific, half of them married with children, the other half single\divorced women stigmatized and marginalized in our society.

The aim of this study is to describe mentally ill women admitted into the psychiatric hospital, socio demographically and clinically, highlighting differences, specificities and multiple roles distress deviate with the course of disorder.

This is a prospective cross-sectional study involving 50 patients admitted to Ar-razi Psychiatric Hospital

The average age is 39years, 41% of them are single, with a low educational level (primary school). 77% of our women are from the urban region, 59% are jobless. 19% of patients in our study have positive family history, 65% of them suffered from schizophrenia. 65% of patients are admitted for schizophrenia, followed by bipolar I disorder 22%, MDD is only represented by 10%. 25% of inpatients deal with a toxic habit, 18,5% abuse nicotine and only one woman have tried quitting. Suicide attempts are closely linked to major depressive episodes of MDD and BID, in patients were already under a combination of antidepressants and anxiolytics for at least 3 months. Psychotic features are observed in most of admitted disorders, 80% in BIP and 64% in MDD. According to HAMILTON-DEPRESSION 62,9% of women are admitted for a severe depressive episode, 30% present anxiety comorbidity and a history of CBT sessions months prior hospitalization.

Shading the light into admitted women in psychiatry and deciphering specific demographic, clinical and therapeutic features may improve the global care system and women’s adherence to treatment and follow up.

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Recently, the diffusion of sophisticated neuroimaging techniques has tremendously advanced our understanding of brain structure and function. Nevertheless, the current knowledge of the neurobiology of complex mental illnesses - like major psychoses and depression - is limited, hindering the development and validation of biomarkers for diagnosis, prognosis, and prediction of treatment response.

Increasing evidence is suggesting a crucial role of environmental, personal, and behavioral processes, interacting among themselves and with genetics, in shaping mental functioning and psychopathological risk. In this context, the study of brain maturation trajectories and of their association with genetic and environmental factors can provide key insights on the risk for the emergence of mental illnesses over lifetime.

The present lecture will provide an overview of our recent research on the brain underpinnings of psychotic and affective disorders onsetting during either adolescence/young adulthood or late adulthood. Evidence obtained from young samples of twins will be presented to provide useful information on the genetic and environmental determinants of physiological and pathological neurodevelopmental trajectories. The complex relationships among life events, brain morphology and connectivity, and psychopathology will be discussed by showing our recent findings on multicentric transdiagnostic samples of young adults and elders. Special focus will be given to the brain mechanisms affected by social stressors, including discrimination and bullyism, as well as chronic stress, and their possible role in facilitating the onset or in enhancing the severity of psychotic and affective disorders.

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Deficit in Theory of Mind (ToM) is a core feature of schizophrenia (SZ), while adverse childhood experiences (ACEs) can contribute to worsen ToM abilities through their effect on brain functioning, structure and connectivity.

Here, we investigated the effects of ACEs on brain functional connectivity (FC) during an affective and cognitive ToM task (AToM, CToM) in healthy control (HC) and SZ, and whether FC can predict the performance at the ToM task and patients’ symptoms severity.

The sample included 26 HC and 33 SZ. In an fMRI session, participants performed a ToM task targeting affective and cognitive domains. Whole-brain FC patterns of local correlation (LC) and multivariate pattern analysis (MVPA) were extracted. The significant MVPA clusters were used as seeds in further seed-based connectivity analyses. Second-level analyses were modelled to investigate the interaction between ACEs, the diagnosis, and the task, corrected for age, sex, and equivalent doses of chlorpromazine (p<0.05 FWE). FC values significantly affected by ACEs (Risky Family Questionnaire) were entered in a cross-validated LASSO regression predicting symptoms severity (Positive and Negative Syndrome Scale, PANSS) and task performance measures (accuracy and response time).

In AToM, LC showed significant different effects of ACE between HC and SZ in frontal pole, caudate and cerebellum. MVPA showed significant widespread interaction in cortico-limbic regions, including prefrontal cortex, precuneus, insula, parahippocampus, cingulate cortex, temporal pole, thalamus, and cerebellum in AToM and CToM. SBC analyses found significant target regions in the frontal pole, cerebellum, pre and postcentral gyrus, precuneus, lateral occipital cortex, angular gyrus, and paracingulate gyrus. LASSO regression predicted PANSS score (R2=0.49) and AToM response latency time (R2=0.37).

Our findings highlighted a widespread different effect of ACEs on brain FC in ToM networks in HC and SZ. Notably, the FC in these regions is predictive of behavioral ToM performance and clinical outcomes.

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The prevalence of mental disorders in Higher Education Students (HES) is high and has shown a worrying growth. However, only a small percentage of HES in need of psychological support request it, due to the stigma related to mental illness, requesting informal help from friends and family. Training and increasing Mental Health Literacy (MHL) have been stated as appropriate strategies to reduce stigma and increase the demand for professional psychological support. However, with the increase in the demand for help, the difficulty of providing an adequate response from psychological support of HE services also increases. Therefore, procedures that develop socio-emotional skills in the HES and strategies that enhance the responsiveness of these services are necessary.

Taking in consideration the literature review in this field, we develop a project to improve the mental health of HES. The project objectives’: a) the reduction of stigma related to mental disorders through the promotion of MHL in the academic community; b) the promotion of mental health and socio-emotional skills of HES; c) increasing detection and active search for professional mental health support, and d) the implementation of psychological intervention based on a stepped care model that provides an adequate response to most of the students’ mental health needs, according to individual needs.

The project proposes to perform the following methods: a) training in mental health open to the academic community, which will aim to train volunteers to be Gatekeepers, in order to promote awareness, detection and referral of students in need of professional psychological support; b) implementation of a Student Observatory, with tracking of psychopathological symptoms, supported on the Web; c) implementation of a psychological intervention program based on a stepped care model, which will include the following progressive phases by severity: 1) digital self-help manual; 2) web-based self-help groups; 3) psychological intervention groups supported by the Web; 4) face-to-face intervention groups and 5) individual psychological intervention.

Students will be assessed before and after each step of care, with the following psychological instruments: Mental Health Inventory (MHI); Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7).

The implementation of the presented methods expect to achieve improvements on HES’ mental health, namely improvement of MHI, reduction of PHQ-9 and GAD-7 after each step of the psychological care.

The project presented encloses evidence-based interventions, with inspiration on psychoeducation and cognitive behavioral approaches, and it is expected to contribute to the improvement of mental health of HES. The results will be collected and disseminated. We encourage other researcher and clinicians to perform studies about the mental health of HES.

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Suicide presents itself as a serious public health problem, with universal characteristics. Though world rates dropped between 2010 and 2016, they are still very high and in regions like the Americas there has been a raise in the same period in Brazil, contrary to the word trend and surpassing the avarage of the Americas (6%), the rate of suicides in each 100 thousand inhabitants has raised in about 7% in the period (WHO, 2019).

Considering the relevance of these aspects, this study presents the results of actions for treatment and prevention of suicidal behavior, developed by a psychiatry and chemical dependency inpatient service in the city of Rio de Janeiro.

This showed the necessity of the creation of a specific program of suicidal treatment and prevention and the Institution established the following actions of intervention to hospitalized patients: permanent watching , reduction of access to instruments and methods to commit suicide, strengthening of the Life Appreciation Group (LAG) and the Cognitive Behavioral Therapy group, art therapy and physical activities.

It was observed that among the 370 patients hospitalized in the Institution in the period of the study, 137 presented suicidal behavior and only 2 died. From these two cases, one abandoned treatment and the other ocurred during the period of treatment.

The developed program reached positive results in the intervention of the cases and the actions of prevention had expressive reach in the number of people, especially because the press promoted wide dissemination of information for immediate help.

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Obsessive-compulsive disorder (OCD) is connected with increased activity in cortico-striatal-thalamic-cortical (CSTC) loop. The anterior cingulate cortex (ACC) is a part of this loop and plays a role in error detection and monitoring and processing of conflicting information, core OCD clinical signs. This area also contains a high density of Von Economo neurons. Biochemistry in this area is closely connected with the pathophysiology of OCD.

Decreased concentrations of total N-acetylaspartate (tNAA) have been reported in ACC in patients with OCD compared to healthy controls (HC), with increase after successful treatment. Findings by other metabolites: choline-containing compounds (tCho), total creatine (tCr) and myo-inositol are not consistent. Differences in levels of tNAA, tCho, tCr would correlate with the severity of symptoms measured by Y-BOCS. In the comparison in the subgroup of patients with/ without medication, there will be differences in levels of metabolites.

54 patients diagnosed with OCD according to ICD-10 and DSM-IV criteria, and 54 HC matched for age and sex were included in the study. They underwent MRI and MR Spectroscopy on a 3T Magnetom Prisma scanner (Siemens, Germany) equipped with a 64-channel volume head coil (Fig. 2). After spectral quality control, 28 OCD and 28 HC subjects were included in the statistical analysis. OCD subjects were interviewed using the Y-BOCS to evaluate the severity of the symptoms. Patients enrolled in the study were without medication at least 5 days before MRI or on a stable dosage of SSRI antidepressants. To assess the intergroup differences Wilcoxon Rank Sum test or Kruskal-Wallis test was used as appropriate. The correlation between metabolite levels and clinical characteristics was assessed by Spearman’s rank correlation coefficient. The statistics were calculated using R, version 4.1.1.

We found no differences in levels of tNAA in ACC in OCD vs. HC (p=0,21; see Tab.1, Fig.1). We found significantly increased level of tCho, tCr and Ins in OCD vs. HC (p=0,03; p=0,004 resp.; p=0,017 resp.). tCr levels corelated negatively with YBOCS compulsions subscale (p=0,046; cor=-0,38). tCho levels showed a trend to negative correlation with Y-BOCS compulsions subscale (p=0,067; cor=-0,35). Analysis on the subgroup with (13 subjects, 46,43 %) and without (13 subjects, 46,43 %) stable SSRI medication did not reveal significant differences.

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Our study found difference in ACC by OCD patients compared to HC, mainly increased tCho, tCr and Ins. Also, the study shows a significant correlation between the severity of compulsions and tCr levels. We can see this trend also in the correlation of the tCho and Y-BOCS compulsions subscale. Similar tNAA level by OCD and HC groups could indicates correctly adjusted medication or stable state by enrolled patients.

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Co-morbid depression is common in people with tuberculosis (TB) but little is known about the course over time.

Our objectives were to determine the level of remission and factors associated with failure to remit in depressive symptom scores in people with TB undergoing treatment in primary care facilities in Ethiopia.

We assessed 648 people with newly diagnosed TB for depressive symptoms using Patient Health Questionnaire (PHQ-9) at the time of starting anti-TB medication, and again at two and six months. Remission was defined as more than 50% reduction in baseline depressive symptom scores. We analyzed factors associated with failure of depressive symptom score to remit at the end of the follow up using multilevel mixed-effects logistic regression by taking individuals as nested within 14 health institutions. Adjustment was made for socio-demographic characteristics, baseline depression score, stigma, type of TB, outcome of TB treatment, perceived severity of TB, substance use, perceived social support, substance use, and HIV status.

Compared to the baseline, the mean PHQ-9 scores declined at two months (Hedge’s G: 0.82; 95%CI: 0.71, 0.94) and six months (Hedge’s G: 1.20; 95%CI: 1.08, 1.33). However, depressive symptom scores failed to remit in 176 (33.1%) of the 532 people with TB who completed the follow up. . Stigma (AOR: 2.23; 95%CI: 1.09, 4.55), older age (AOR: 2.2; 95%CI: 1.13, 4.29), and treatment completion without a bacteriological proof of cure (treatment complete as compared to treatment cure) (AOR: 2.47; 95%CI: 1.37, 4.48) were independent predictors of failure of depressive symptom score to remit. Surprisingly, baseline lower depressive symptom score was more persistent than higher baseline depressive symptom score (AOR: 2.93; 95%CI: 1.56, 5.47).

In one-third of people with newly diagnosed TB, baseline depressive symptom scores did not remit after full course of TB treatment. TB treatment guidelines require in-built mental health component. Studies are required to understand course of depression beyond six months and effective interventions in this population.

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Frequent attenders to emergency services are challenging and costly. We report the case of a woman in her mid-twenties who stands out for a total of 1447 emergency visits.

Our primary objective was to describe the emergency visits of our patient. Secondary objectives were to assess her use of other healthcare services and to calculate her health expenditure.

This is a clinical case report. We reviewed the patient’s electronic medical records for sociodemographic and clinical data. We obtained detailed information of psychiatric ED visits (length, most frequent times and days) regarding the second most-visited hospital. We assessed the efficacy of hospitalizations in reducing ED visits with a paired samples t Test, comparing the number of visits 30 days pre- and post-hospitalization. We estimated the health expenditure using the regional public health system prices, including three direct costs: emergency visits, hospitalizations and ambulance transportation. We obtained written informed consent from the patient’s legal guardian.

A 26-year-old woman from Barcelona (Catalonia, Spain), diagnosed with mild intellectual disability, made 1447 emergency visits between 2009 and 2021 (figure 1). 946 visits (65%) took place in psychiatric emergency departments (EDs), whilst 353 (24%) in non-psychiatric EDs and 148 (10%) in urgent primary care. She attended 24 hospitals (ranking number one the closest to the patient’s home, with 387 visits) and seven primary care centers, distributed across 17 cities in Catalonia. Most visits were self-referred, being the main presenting problems anxiety and instrumental suicidal behaviour. Saturday was her favorite day for hospital visits (24,1%), while she seeked care on Tuesdays much less often (4.5%). She made 73.5% of consultations between 1pm and 6pm, with a median length per visit of 2.8 hours (range 0.33-20.9 hours). Regarding other therapeutic approaches, she attended day hospitals, psychiatric rehabilitation programs and family therapy, among others (figure 2), for which she showed low adherence and scarce benefit. She had ten acute hospitalizations, interventions that did not reduce ED visits (t=-0.9835, p=0.36). Health expenditure reached 410.035€.

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The most common definition of frequent attendance is a patient who has five or more visits per year. Many times, but not always, repeat visits are also inappropriate. The case we report is a grotesque example of both frequent and inappropriate attendance, which has been resistant to all kinds of interventions and has quality-of-care, financial and ethical implications. As of today, it is still a pending case. Maybe it is worth considering residential treatment?

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Primary delusional infestation is a rare psychiatric condition in which patients mistakenly believe that their skin or other body parts are infested by small, living organisms, despite the fact that no organisms can be found upon investigation. The delusion occurs concurrently with abnormal cutaneous sensations. Therefore, they typically have a history of prior negative evaluations by dermatologists and general practice physicians. In addition, patients may have also received repeated courses of dermatologic and anti-infective therapies, despite the lack of an objective diagnosis.

To describe the clinical case of a patient who suffered from an undiagnosed primary delusional infestation for 12 years.

Description of a clinical case and a non-systematic review of the literature.

We describe the clinical case of a 65-year-old woman who spent 12 years being evaluated by multiple medical and surgical specialties for the following complaint: “sensation of something moving beneath the skin.” At the onset of the complaint, the patient believed that this “strange sensation” was due to a recent tooth procedure. However, as she felt the discomfort not improving, she believed it to be a consequence of a cutaneous anthrax infection. Thus, the patient started using tweezers to grasp the living organism that was bothering her and that behavior caused intense scaring in her face. Meanwhile, the patient was also submitted to 3 cutaneous biopsies (prescribed by a dermatologist) that refuted the hypothesis of any living organism underneath her skin. In addition, the patient was prescribed sertraline, bromazepam and lorazepam that, although improved her sleep and anxiety levels, were inefficient to treat the root of her suffering. Finally, after 12 years of dispersed medical follow-up, this patient was evaluated by a new psychiatrist and prescribed paliperidone that rapidly made the agonizing “strange sensation” disappear.

Even though primary delusional infestations are a rare psychiatric diagnosis, all medical doctors should consider it when their patients report bothersome dermatologic complaints associated with the belief of infestation and negative diagnostic examinations. It is incredibly important to consider this diagnostic, as the early treatment of this entity might prevent the patient from undergoing multiple years of suffering and discomfort.

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Patients taking lithium complain of cognitive impairment. This was assumed to be real by expert clinicians for years until relatively recent objective neuropsychological studies have failed to verify much impairment.

Second and perhaps underemphasized side effect from lithium is sexual dysfunction.

The objective of this review is to highlight for the cognitive and sexual problems, which are two very important areas for discussion with patients. It should be brought up right when beginning to prescribe.

Data was obtained through an internet-based literature review, using the research platform PubMed and the World Health Organization website. Eight articles from the last five years were included.

Due to the lack of evidence in neuropsychological studies, what was considered to be impaired cognitive function in the past has been recently considered a loss of sharp thinking in manic states or mild persisting depressions.

About sexual dysfunction it is important eliminating other possible causes, lowering lithium dose, timing sex, and taking sildenafil and 240 mg/day of aspirin may help.

Cognitive impairment and sexual problems are two important subjects that involve the issues of dosing, of managing and dealing with people’s willingness to take lithium.

Providing psychoeducation about these possible effects can head off abrupt discontinuation impulses.

None Declared