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

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

COVID19 pandemic had a significant psychological impact on the population worldwide. However, health care workers have been the most exposed to psychological effects.

To determine the psychological impact of the covid19 pandemic on health care professionals (HCPs) who were working in the covid19 setting.

Descriptive cross-sectional study carried out in May 2020, having interested the HCPs of the Charles Nicolle hospital who were working in the COVID19 settings .The data collection was carried out with a pre-established questionnaire .The visual analog scale of B. Chini was used to assess the level of work stress. This assessment was undertaken at three points in time: during the work, during the confinement period and post confinement .

Seventy five nurses participated to the study. The average age was 39.7±9.6 years. The sex ratio was 0.74. The average professional seniority was 11.6±8.14 years. During the confinement, a feeling of anxiety and apprehension of danger to others were reported by 96% of the participants. In addition, sleep disorders and irritability were noticed in 65% and 92% of cases respectively. At the end of the confinement period, 77% of the cases reported neuropsychological complaints: feelings of anxiety (57%), mood disorders (49%), a sleep disorders (32%) and concentration disorders (20%). The average level of stress was evaluated at 7.54 during the work, 7.36 during confinement and 5.28 after confinement. Faced with this psychological suffering, 88% of the cases noted the absence of psychological support or assistance.

Psychological support and early screening in psychiatry and occupational medicine are necessary to prevent any deterioration in their mental health.

None Declared

GnRh agonists are drugs used in various gynecological pathologies, among which is endometriosis. They act by stimulating GnRh receptors in the pituitary gland. This sustained and continuous stimulation of GnRh, will initially generate an increase in the release of luteinizing hormones and follicle-stimulating hormones, subsequently losing sensitivity to the receptors, internalizing them, and thus suppressing the release of these hormones, which would entail an ovarian suppression, thereby inhibiting the release of estrogens and progesterone. Psychiatric adverse effects have been described. Gonzalez-Rodriguez et al (Front Psychiatry 2020; 11:479), described this association with changes in mood, and the presence of a series of cases where the link between GnRh agonist and the possibility of presenting psychotic symptoms is observed. Wieck (Curr Top Behav Neurosci 2011;8:173-87), Frokjaer (J Neurosci Res 2020;98(7):1283-1292), Brzezinski-Sinai et al (Front Psychiatry 2020;11:693) reported that this association could be related with the relationship of the hypothalamic-pituitary-gonadal axis, hormonal fluctuation and its relationship with the dopaminergic regulation, a genetic component that would increase the predisposition to trigger psychiatric pathology in patients with greater sensitivity to hormonal fluctuations, and the loss of neuroprotection generated by the decrease of estrogens in the central nervous system. All of this in the context of multiple environmental and genetic factors that participate together in the appearance of the disease.

To describe the importance of detecting the risk factors that can precipitate a psychotic episode, including the use of certain drugs, such as GnRh agonists.

We describe a case of a 45 year old patient with endometriosis with multiple organ involvement who went to the emergency room due to behavioral changes in the context of a brief psychotic disorder with “ad-integrum” recovery.

A retrospective analysis of the case is conducted, observing an association between the introduction of GnRh agonists and the presentation of a first psychotic episode.

The importance of this case lies in the limited evidence of this association in the literature, and the implication of these drugs in the triggering of psychiatric pathology, being an aspect to be considered by psychiatrists in their patient’s follow-up.

None Declared

Current level of mental health in children and adolescents is alarming, the precursors of it disorders can appear at an early age.

The phenomenological and prognostic features of children’s anxiety and phobic states were studied.

The study conducted in 2022-2023 included 95 children of preschool age (among them 35 children under 3 years) with autistic disorders. For comparison, we used data from a follow-up study of 50 children lasting 15 years who had anxiety-phobic and autistic disorders at an early age. The control group included 30 children from the general population Assessment of the condition was carried out by clinical methods and original scales. PANSS scales were used in follow-up.

At an early age, these were fears of a protopathic nature, horror during sleep or during short-term sleepy states, the so-called “night terror”. Infants showed fears of touch, fear of manipulation: cutting hair, nails, pouring water while bathing in the shower, etc., due to a violation of sensory sensitivity. Also (among toddlers) frilly fears were found - water flowing into the bath, animalistic toys, along with autistic symptoms. In the catamnesis, there was an increase in symptoms. There were differentiated affective anxiety-phobic disorders, fragmentary phenomena and extended symptoms of a procedural nature (the total score on the PANSS scale exceeded 60 points, in 15 it reached 80). In the control group, normal development took place without psychopathology.

A direct relationship was found between the age of onset, the severity of early ontogenesis, and the phenomenological features of the disorders. In the premorbid of unfavorable forms of the course of schizophrenia, phobias were noted, comorbid outposts to symptoms of psychotic disorders resembling delusion, depersonalization symptoms.

The findings suggest that phobic anxiety disorders in early childhood may be a precursor to mental illness later in life.

None Declared

Although studies have demonstrated that younger people are at high-risk of instigating alcohol, substance use and development of related disorders, the trend is gradually changing. An observed gradual initiation and substance use among older persons, especially during the COVID-19 pandemic. However, there is dearth of data on about the prevalence and determinant of substance use during COVID-19 pandemic in Uganda.

Determine the prevelence and determinants of susbstance use during COVID-19 pandemic in Uganda

A cross-sectional design and probability based sampling was applied. Data was collected among 474 older persons aged 50 years and above, that resided in the central region of Uganda. A multivariate logistic regression was used to assess the socio-economic, demographic and health related correlates of alcohol and tobacco use.

9.2% and 5.4% of older persons were taking alcohol and smoking before the COVID-19 pandemic. However, an observed increase of 14% of smoking and alcohol intake among older persons during the pandemic. Being male had higher odds of substance use than their female counterparts. Older persons with tertiary education and low (poor) wealth quantile, had lower odds of substance use than their counterparts.

Our finding highlights increased substance use among older persons during the COVID-19 pandemic. Designing targeted measures and policies to deter the substances use among older persons is critical to address this vice, especially during the pandemic and possible future disease outbreaks.

None Declared

Difficult patients are not something new and we can find innumerous definitions for this concept. However, they form a very heterogenous group and we need a less abstract definition focused more on the clinical reality and the difficulties experienced by patients and mental health professionals.

Our goal was to find a more precise and clinical definition of the difficult patient based on quantitative measures using a statistical analysis of a series of hospitalizations.

A cluster analysis of our hospital’s in-patient treatment from the last 5 years was made concerning the duration of the stay and the number of previous hospitalizations.

A sample of 8576 inpatient treatment episodes was used. 52.4% were male and 47.6% female patients between the age of 15 and 103 years old. The length of the treatment varied from 0 to 1007 days and the number of previous hospitalizations from 0 to 109; excluding the outliers the means were, respectively, 21 days and 2 previous hospitalizations.

The cluster analysis excluded 85 episodes and it found the presence of 3 clusters, being the number 1 the wider one (n=5861 episodes) and the other quite similar.

The Cluster 1 was characterized by a smaller length of hospital stay and number of hospitalizations; the Cluster 2 was defined by the episodes with the highest number of previous hospitalizations (`x =8.77) and the Cluster C by the longest hospital stays (`x =58.09 days). With a Kruskal-Wallis test we found both variables statistically different between all clusters (p<0.001). In Cluster 2 and 3, respectively, we found that 40,24% and 34.61% was taking the medication before being hospitalized, 6.42% and 3.15% were compulsive hospitalizations, and 40.5% and 21.89% had LAI prescribed.

Concerning the diagnosis, Cluster 1 had more Depression, Neurotic and Somatoform disorders; Cluster 2 more Bipolar and Intellectual disability disorders and Cluster 3 more Dementia and Delusional disorders. Substance use disorders and Personality disorders were found more common in both Cluster 1 and 2, Schizophrenia in Cluster 2 and 3 and Psychosis non specified in Cluster 1 and 3.

We can say Cluster 1 comprises the non-difficult patients and it’s not surprising that it includes more Depression and Neurotic and Somatoform disorders. The other diagnostic distributions among clusters were also expected and we can also theorize that Cluster 3 had higher percentages of social cases. Treatment with LAI is linked to a decrease in rehospitalizations and we found that in the majority of these episodes it wasn’t been applied. This research is important in order to identify the difficult patients and what challenges they can bring to the mental health services. Creating these patients’ profile will allow us to better understand their needs to create guidelines for a personalized inpatient treatment and to improve community services to prevent the rehospitalizations and prolonged hospital stays.

None Declared

T1D is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore may result in a psychosocial problem for the whole family. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. It is assumed that anxiety and depression symptoms negatively affect glycemic control. A correlation was observed between anxiety and depression level and glycaemic control, as well as a three-way interaction among HbA1c, frequency of blood glucose monitoring, and diabetes-related stress (Buchberger et al., 2016). Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management.

To evaluate the relationship between parental depression and anxiety and metabolic control of their adolescents with T1DM.

The cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). The 7-item Generalized Anxiety Disorder (GAD-7) scale measured anxiety level. The Patient Health Questionnaire – 9 (PHQ-9) detected depressive symptoms. Glycaemic control of patients was assessed using the last glycated haemoglobin (HbA1c) values. GLM mediation analysis was performed to determine the potential mediating effect of parent’ mental health depression and anxiety on the relationship between depression and anxiety of child on the level of HbA1c.

502 respondents were eligible for screening. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between HbA1c and child GAD-7 and child PHQ-9. the results relevated that the total effect of child GAD-7 on HbA1c was significant but the total effect of child PHQ-9 was not significant. With the inclusion of the mediating variable (parent GAD-7) (Figure 1), the impact of child GAD-7 and child PHQ-9 was founding insignificant (p ≥ 0.05) but the indirect effect of child GAD-7 and child PHQ-9 on HbA1c though parent GAD-7 was found significant (p ≤ 0,01) (Table 1). This indicates that the relationship between HbA1c and child GAD-7 and PHQ-9 is fully mediated by parent GAD-7.

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Glycated haemoglobin in adolescents with Type 1 diabetes is related to adolescents’ mental health via parents’ anxiety. It means that parents’ anxiety plays more significant role in the level of glycated haemoglobin in adolescents than depression and anxiety of the adolescent.

None Declared

Long term cannabis use has been expanding drastically over the last two decades and has become a major health issue worldwide. Recent studies demonstrate that brain complications in adults with cannabis use are associated with cognitive and emotional impairments, but little is known about the relationship between structural alterations and behavioral manifestations. Therefore, studying the relationship between alterations of emotional system, in parallel with structural degenerative phenomena is very critical.

Hence, the aim of this study is to demonstrate such alterations by making use of appropriate paradigms during BOLD-fMRI scans. Positive, negative and neutral emotions were examined, in relations with DTI and functional connectivity.

11 cannabis addicted patients volunteered for the study. Volunteers were fully healthy. However, any additional comorbidity was a strict criterion of exclusion, and a healthy general state was an indispensable criterion of inclusion. Additionally, it was excluded any patient that have any additional substance use such as tobacco, alcohol, cocaine, etc. And strict use of cannabis was a must.

All patients underwent blood and urine assessments to ensure the selection criteria.

All patients underwent BOLD-fMRI and anatomical MRI using both motor and emotional paradigm.

The motor task consisted of rest alternating with finger tapping. The emotional task included 3 conditions. Positive, neutral and negative were each alternating with silent mental counting. The fMRI data was processed using SPM12 package. A sample of 12 age-matched controls was also included.

The present results are based on analysis of behavioral and BOLD-fMRI data of 11patients and similar age-matched controls. Analysis of behavioral data showed an alteration of emotional abilities in cannabis addicted patients compared to controls. Analysis of fMRI data revealed significant changes of activation within a large cortical network including prefrontal cortex and parietal cortex, and that emotional responses and BOLD signal were inversely correlated.

These findings demonstrate that the brain of cannabis addicted patients undergoes and emotional alterations that parallel silent structural degenerative phenomena. Although the causal mechanisms are still to be investigated, the fact that functional impairments can be detected in emotional, cognitive and motor domains calls for the development of preventive measures using neurobehavioral tools for this population of patient, and even in at risk users.

None Declared

Investigations into health and social care services offered to people who have died by suicide or who have committed a homicide have the potential to facilitate improvements in future practice. Such improvements are, however, dependent on the operationalizability of the recommendations of these investigations. Operationalizability in this context means the potential of the recommendations to alter the thinking/actions of practitioners involved in the areas of practice to which the recommendations relate. Critically, the proposed learning must make sense to practitioners in a multiplicity of single instance episodes of practice when the future is unknown. Although common content themes identified by investigations have been reported, no study has yet specifically examined how the framing of recommendations in investigation reports affects their operationalizability.

Primary objective: to pilot a novel approach to the thematic analysis of investigations into serious incidents which focuses on the operationalizability of recommendations for day-to-day practice. Secondary objective: to explore the operationalizability of the specific recommendations arising from a recent UK review of child homicides.

A publicly available UK national review of child homicides by parents under social care services was subjected to a two-stage thematic analysis (firstly, to identify the types of thinking/acting that were scrutinised; and secondly to characterise the ways in which these thoughts/actions were appraised). The frame of reference for the thematic analysis was that of a practitioner involved in typical instances of practice where there is uncertainty about outcomes (i.e. real-life practice).

Stage 1 - Four types of thinking/acting were identified: (i) information gathering, (ii) interpretation, (iii) judgement formation, and (iv) decision to act (figure 1).Stage 2 - The thoughts/actions were appraised according to three key themes: (a) occurrence of thoughts/actions at a pivotal moment, (b) erroneousness of thoughts/actions, and (c) thoroughness of thoughts/actions.

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With regard to the specific report analysed, the recommendations were found to have differing degrees of operationalizability. For instance, examples of ‘erroneous thinking/acting’ were more readily applicable to future practice (since they can be operationalised in terms of general principles). However, the notion of ‘pivotal moments’ is less useful, since the labelling of moments as ‘pivotal’ is dependent on a knowledge of the outcome and therefore would not have been readily identified contemporaneously in these cases (or, by extension in future similar cases prior to any serious incident). This pilot demonstrates that the novel approach used is a feasible way to examine not just the content, but also the utility, of investigation recommendations.

None Declared

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

Existing evidence in the association between maternal pregnancy and pre-pregnancy weight and behavioural outcomes in children.

This study aimed to examine these associations at six developmental time-points between ages 3 and 16.

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), an ongoing population-based longitudinal pregnancy cohort study in Bristol, United Kingdom (UK). Data on behavioural outcomes were measured at ages 3.5, 7, 9, 11 and 16 years using the Strengths and Difficulties Questionnaire (SDQ). Over 7960 (at 3.5 years of age) and 4400 (at 16 years of age) mother-child pairs were included in the final analysis. Logistic regression analyses were used to examine the associations.

Pre-pregnancy BMI and gestational weight gain were associated with total behavioural difficulties in children across all age groups. In separate analyses using each SDQ subscale, however, we found that pre-pregnancy underweight was associated with emotional problems at ages 7 (OR = 1.66, 95% CI; 1.20 – 2.29), 11 (OR = 1.49, 95% CI; 1.02 – 2.18) and 16 (OR = 1.74, 95% CI; 1.16 – 2.60) years and hyperactivity/inattention problems at age 16 (OR = 1.96, 95% CI; 1.27 – 3.05). We also found an association between guideline-discordant gestational weight gain and peer relationship problems at age 9 and pro-social behaviour at ages 9 and 11.

Our findings highlight that pre-pregnancy underweight than overweight, obesity or gestational weight gain may influence the emotional health of children and adolescents.

None Declared

Cancer is a major public health problem worldwide and the risk of death from cancer has decreased continuously since 1991, therefore, This translates into an increasing number of cancer survivors (CS) worldwide.

During the survivorship seasons, CS face several short-term, long-term, persistent, and late-emerging health and psychosocial problems, including cancer-related pain, fatigue, menopausal symptoms, anxiety, depression, distress associated with the risk of cancer recurrence, chronic uncertainty, social disruption, alterations of sleep, sexual and cognitive dysfunctions.

Since 2002 that some researchers and clinicians argued that it is important to de-velop and implement rehabilitation programs for cancer patients that integrate both psychosocial and physical rehabilitation.

With the scarcity of studies on the effectiveness of combined interventions in this population, despite the strong recommendation to perform and study it, and aiming to contribute to a greater knowledge on the theme, the present work aims to build, implement, and evaluate a combined intervention program, which integrates psychoeducational intervention with physical exercise to cancer survivors and relatives, through the following indicators: psychopathological symptoms (anxiety and depression), self-concept, coping strategies, personal growth and QoL.

A non-probabilistic convenience sample of 70 cancer survivors was assigned to: control (without intervention: n=32), combined intervention (n=21) and psychoedu-cation intervention (n=17) groups. Both intervention groups were 9 consecutive weeks duration. The combined intervention group benefited from 2 weekly exercise sessions additionally. It was administered before and after intervention the following questionnaires: demographic; Hospital Anxiety and Depression Scale (HADS); Clinical Self-concept Inventory (ICAC); Cancer Coping Questionnaire (CCQ); sub-scale of Personal Growth of the Psychological Well-being Scale (EBEP) and the World Health Organization Quality of Life Questionnaire (WHOQOL-Bref).

It was observed a statistically significant reduction of anxiety and depression symptoms from the beginning to the end of the intervention, as well as a significative improvement of overall and all do-mains of self-concept and personal growth. It was not observed a significative difference on quality of life.

The findings of this study contribute to support of the beneficial effect of combined intervention on psychological functioning of cancer survivors. Positive effects of the psychological program were observed but not into the same extent as in the combined intervention.

None Declared

Mental pathology is relatively prevalent in the women, and there is often a need for treatment with psychotropic drugs, with an impact on women’s reproductive health. The use of contraception is widely spread among this population and the choice between these methods must be considered carefully.

This review aims to present the main interactions between contraceptive methods and psychotropic therapy and its impact on psychiatric disorders, in addition to the precautions to be taken in their choice.

Literature review of relevant articles on Pubmed. Query: Contraceptive+(psychiatric disorder, depression, anxiety, schizophrenia, bipolar disorder, psychotropic drugs).

Based on current evidence, no statistically significant differences regarding unplanned pregnancy rates or the psychotropic treatment outcomes were found when using combined oral contraceptives and antidepressants, benzodiazepines or atypical antipsychotics (being clozapine the exception). The impact of contraceptive methods on mood was unclear, as some articles showed an association between contraceptive use and a higher risk of beginning antidepressants and others showing no differences or even as a protective factor. Although the interactions of the aforementioned drugs are infrequent, there are cases where important interactions occur, such as clozapine, valproic acid, lamotrigine and carbamazepine, as some herbal products as the St.John’s wort. With clozapine, there is an increased serum concentrations, while the opposite occurs in the case of valproate and lamotrigine with a decrease of 32.6% and 23.4%, respectively. Treatment with valproic acid in women of childbearing age has been discouraged because of its association with polycystic ovary syndrome, elevated testosterone concentrations and menstrual irregularities, in addition to the risk of fetal malformations. In cases where this drug is prescribed, it is recommended to use highly effective methods such as subcutaneous implants or intrauterine devices. Lamotrigine and carbamazepine reduce the effectiveness of some contraceptive methods, such as oral contraceptives, transdermal patch and vaginal ring, in which case the placement of a subcutaneous implant or intrauterine device is indicated.

The magnitude of the impact between contraceptives, regarding depressive disorders, is unclear. The evidence shows that some women report the appearance and recrudescence of depressive symptoms, evidencing the need of further studies to identify the risk factors in these cases. The importance of clear and simple information and a shared decision on which contraception to choose is crucial, as clarification about their interactions with psychiatric treatment. The clinician must also be aware of the implications for reproductive health, in order to reduce the risks and side effects associated with some drugs.

None Declared

Smoking is highly prevalent in patients with mental health disorders and although most literature describes the physical health impact of smoking, there is little which addresses the poverty and social consequences associated with nicotine addiction. In 2022, Ireland’s HSE (Health Service Executive) published clinical guidelines, regarding smoking cessation in healthcare settings, with special attention to mental health settings.

The aim of this study was to assess the current prevalence of smoking among inpatients in a psychiatric unit with a “Tobacco Free Campus” policy in place, and the associated patient factors. We also assess the efficacy at which mental health professionals are addressing smoking in this setting.

We performed a cross-sectional analysis of all patients admitted to the inpatient psychiatric unit on a single date. All inpatients were interviewed using a standardised format to ascertain smoking history and employment status. Case records were examined to record diagnoses and assess the patient’s inpatient care plan, nursing admission proforma and medical admission proforma. Medication charts were examined to ascertain whether Nicotine Replacement Therapy (NRT) was prescribed to those identified as smokers. Using Microsoft Excel, we analysed the smoking behaviours data gathered, and the identification of smokers and their orientation to the Tobacco Free Campus policy, on admission.

Of the 51 inpatients, 78% (n=40) had an Axis 1 diagnosis according to the DSM-4, 72% (n=37) were unemployed and 67% (n=34) were receiving Social Welfare. 57% (n=29) of inpatients were current smokers. 63% (n=25) of smokers had an Axis 1 diagnosis, 51% (n=19) were unemployed and 53% (n=18) were receiving Social Welfare. Since admission, 52% (n=15) of smokers have been smoking more, and 48% (n=14) have been spending more money on tobacco. 7% of smokers (n=2) started smoking on the unit. 50% (n=9) of smokers receiving Social Welfare were smoking more, with the majority in receipt of long-term disability allowance (n=7). Only 10% (n=3) of smokers were prescribed NRT, with only 1 patient taking NRT. 90% (n=26) of smokers did not have smoking addressed in their care plan. 38% (n=11) had a fully completed smoking history in the nursing admission, while only 14% (n=4) had one in the medical admission.

Despite a Tobacco Free Campus policy, smoking continues to be highly prevalent in an inpatient psychiatric setting. Smoking was particularly prevalent in patients with Axis 1 diagnoses, and in the unemployed. A large proportion increased their smoking on admission, and their expenditure on tobacco. More can be done to identify smokers on admission so as to promote quitting, and in turn, reduce the social consequences related.

None Declared

There is an urgent need for sustainable thinking and practices in healthcare systems to meet the challenge of climate change (Charlesworth & Jamieson, 2019; Corvalan et al., 2020; Luykx & Voetterl, 2022; Madden et al., 2020). This need is accelerated by the recent energy crisis. According to an international NGO policy paper (Karliner et al., 2019) healthcare institutions are large energy consumers and major emitters. The (mental) health sectors of the Netherlands and Flanders, the northern part of Belgium, also greatly contribute to the global climate crisis. Both regions have per capita emissions (between the 0.50t and 1t) that fall just below the world’s healthcare top emitters.

To evaluate the state of sustainability in Dutch and Flemish mental health institutions (including psychiatric hospitals, rehabilitation centers, and community mental health centers) and assess whether certain differences can be found in the climate policies of these institutions between both regions.

Board members of mental health institutions were asked to complete a 20-item online survey in which concrete actions, objectives and ambitions in the field of sustainability were questioned. Frequencies and percentages were calculated for each question. For certain topics chi-squared tests were performed to test differences in sustainability issues addressed in the questionnaire between Dutch and Flemish mental healthcare institutions.

Survey response rates for Dutch and Flemish mental health institutions were 38% and 20%, respectively. Ninety-five percent and 38% of respectively the Dutch and Flemish institutions fully agreed that sustainability is a very important theme (χ2(1)=2,25, p=0,13). Key focus areas in both regions included sustainable energy transition (with half of the mental health institutions sourcing at least half of their energy via renewable energy resources and technologies) and recycling (almost 80% of the institutions). Statistically significant differences were found between both regions with regard to monitoring the environmental impact (Flanders 24% vs. The Netherlands 60%, χ2(1)=6,41, p=0,01) and fostering more sustainable commutes (Flanders 72% vs. The Netherlands 15%, χ2(1)=17,35, p<0,0001). The climate impact of medicines and food, as well as investments in sustainable projects, received little attention.

Although a substantial part of Dutch and Flemish mental health institutions consider sustainability (very) important, a systemic ‘transformation’ will be necessary to make them climate neutral, as tenets of practicing mental healthcare sustainably include more than sustainable energy transition and recycling (Monsell et al., 2021). Moreover, a lack of sufficient investment opportunities, partly due to a lack of financial resources, seems to be the main barrier for many mental healthcare institutions for quickly reaching sustainability goals.

None Declared

Psychotropic drugs are sometimes taken outside of any medical context and can be diverted or even trafficked. This phenomenon affects more adolescents and young adults, more specifically those who are already struggling with other consumption problems. This vulnerable population is thus exposed to several negative health and social repercussions.

The objective of our work is to determine the sociodemographic characteristics of the patients, the main drugs used, the dose, the route of administration, the mode of obtaining the drug and the intentionality of the use.

It is a retrospective study spread over 1 year on a series of patients who were hospitalized in the service of addictology at the psychiatric hospital Ar-razi of Salé. The data collection was carried out from the medical files and an exploitation form.

A total of 141 patients were hospitalized during this period of which 53 37.5 had a diverted use of medication. Our sample is characterized by a predominance of female patients (90%) with a median age of 33 years. The most misused drugs were benzodiazepines (85.7%), analgesics (11.7%), hypnotics (9.4%) and antihistamines (1.9%). Misuse is related to exceeding doses (up to 40 times the maximum dose of the AMM) and duration of treatment, to use or obtaining drugs without a prescription 79.2 , to the route of administration and to drug addiction. 11.3 of patients were dependent on a single drug; 88.7% of patients had a co-addiction: tobacco 86.8%, cannabis 77.3%, alcohol 58.5%, cocaine 34.5%, solvents 15 , heroin 1.8% or a history of addiction. Hospitalization was only related to drug misuse in 11.3% of cases. The effects sought: anxiolysis 58.5%, euphoria 30.2%, analgesic 5.7%, disinhibition 3.8%, increased performance 1.9%

The misuse of psychotropic drugs is a well-known public health problem. However, this phenomenon remains unknown and neglected in Morocco.

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Neuropsychiatric symptoms (NPS) are common during the course of neurocognitive disorders. NPS have been previously reported in early and late stages of Alzheimer’s Disease. However, our understanding of NPS in high-risk states for dementia such as mild cognitive impairment (MCI) and major depressive disorder (MDD) is poor.

To compare the frequency and factor structure of neuropsychiatric symptoms among individuals with Mild Cognitive Impairment (MCI), Major Depressive Disorder (MDD) in remission, and comorbid MCI and MDD (in remission) (MCI-D).

We used baseline data from the Prevention of Alzheimer’s Dementia with Cognitive Remediation Plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression (PACt-MD) study, a multicenter trial across five academic sites in Toronto, Canada (clinical trial No. NCT0238667). We used ANOVA or χ2-test to compare frequency of NPS across groups. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items in the three groups.

We included 374 participants with a mean age of 72.0 years (SD = 6.3). In the overall sample, at least one NPS was present in 64.2% participants, and 36.1 % had at least moderate severity NPS (36.1%). Depression (54%, χ2 < 0.001) and apathy (28.7%, χ2=0.002) were more prevalent in the MCI-D group as compared to MCI and MDD groups. In factor analysis, NPS grouped differently in MCI, MDD, and MCI-D groups. A “psychotic” subgroup emerged among MCI and MCI-D, but not in MDD. Night-time behaviors and disinhibition grouped differently across all three groups.

Prevalence of NPS seems higher in persons with MCI-D as compared to those with only MCI or MDD. The factor structure of NPS differed between MCI, MDD, and MCI-D groups. Future studies should investigate the association of NPS factors with cognition, function, and illness biomarkers.

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The Coronavirus (COVID-19) pandemic and the regulations enforced to control it caused significant alterations in daily routines worldwide. Lockdowns, remote working and schooling favoured virtual interactions and increased “free-time”, with the internet posing as a preferential means of distraction. Statistics from pornographic websites have shown a rise in traffic during lockdown periods, with problematic use of pornography (POPU) emerging as a potential mental health concern.

The authors aim to summarize current knowledge on the effects of the COVID-19 pandemic on online pornography use.

Narrative review of articles referenced on PubMed and Google Scholar.

The increased exposure to the internet during the pandemic, combined with psychosocial factors such as social isolation, diminished physical contact and intimacy may have contributed to the reported surge in online pornography use. Other associated factors include emotional distress and less availability of other addictive substances and behaviours during confinement periods. Besides the spike in pornography consumption, other aspects were also affected, such as time of usage, search keywords and type of content, with an increase in engagement in illegal pornography. In susceptible individuals, these circumstances may lead to the development of POPU, characterized by impaired control, excessive time spent and perceived negative consequences. Currently, there is a lack of consensual diagnostic criteria for POPU, hindering the detection of these patients and timely management.

Behavioural addictions are an emerging mental health problem, particularly the ones related to internet use. In the aftermath of the pandemic, considering the reported rise in online pornography use, an increase in POPU prevalence is expected. Therefore, more accurate and consensual diagnostic criteria are required, as well as a greater amount of evidence on the treatment of this disorder, in order to improve the approach to these patients.

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The neurobiological underpinnings of negative symptoms in schizophrenia remain unclear. Previous studies have revealed that in schizophrenia, the anticipatory component of the hedonic experience (anticipatory anhedonia, failure to anticipate reward or pleasurable experiences) is more markedly impaired than the consummatory aspect of pleasure (consummatory anhedonia, in the moment experience of pleasure during pleasurable situations). Several neuroimaging focused on reward prediction deficit have shown dysfunctions in the neuronal circuits that sustain these processes in patients, but findings have not been consistent.

The current study aimed at investigating the impairment of reward anticipation in subjects with schizophrenia (SCZ) during the “Monetary Incentive Delay task” (MID task), employing the topographic analysis of event-related potentials (ERPs) with EEG recordings. Furthermore, the associations with negative symptoms and anticipatory and consummatory hedonic experience were investigated.

EEG data were recorded in thirty SCZ and twenty-three matched HC, during the MID task in which reward and loss cues (incentive cues of positive and negative value) of different magnitude, as well as neutral cues were presented. Anticipation and experience of pleasure were measured by the Temporal Experience of Pleasure Scale (TEPS), while negative symptom dimensions by the Schedule for the Deficit Syndrome (SDS). For the EEG data analysis, the topographic analysis of variance (TANOVA) that uses the global field power of difference maps was used to evaluate between-group differences in scalp topography. Correlation analyses between hedonic experience, negative symptoms and ERPs were performed.

The TANOVA interaction effect (group x cue) was significant in the time window between 140.6 and 195.3 msec after cue presentation (p<.05). Post-hoc analysis showed that significant differences in topography were observed for the reward condition (p=.0006) but not for the loss one (p=.6732) between SCZ and HC. Finally, a significant correlation (p<.01) between t-maps values obtained in the same time-frame and the anticipation of pleasure scores was detected, while no significant correlations were found with the experience of pleasure scores or the severity negative symptom.

SCZ are unable to integrate the incentive magnitude and reward value of future events in the context of their ongoing task. Topographic abnormalities in ERP could be traced already during early stages of reward processing and were associated with anticipation of pleasure, but not with the experience of pleasure or the avolition, suggesting that these constructs might be partially separate.

None Declared