The definition of mixed states has been changed over the years, leading to substantial heterogeneity and inconsistencies across studies, and thus limiting the understanding of this phenomenon. Given the limited data available after the introduction of the DSM-5 mixed features specifier (MFs), we conducted a cross-sectional study evaluating MFs in individuals suffering from affective disorders, i.e., major depressive disorder (MDD) or bipolar disorder (BD).

The aim of this study is to evaluate rates and correlates of MFs in a consecutive sample of inpatients with mood episodes.

We included adults consecutively admitted to our inpatient mental health unit with a current manic episode (ME) or major depressive episode (MDE). DSM-5 criteria were used to assess the occurrence of MFs. Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) were used to assess the severity of the mood episodes. We used the Kemp Compliance Rating Scale to assess medication adherence.

A total of 285 individuals were included (mean age ± SD: 48.3 ± 17.9; M/F ratio: 2/3). Among them, 94 (33.0%) were in a ME and 191 (67.0%) in a MDE. Forty individuals (14.0%) exhibited MFs. We found that MFs were significantly more frequent in participants with a diagnosis of BD (p<0.001) and during a ME (p=0.006). In addition, study participants with MFs had lower medication adherence at hospital admission (p=0.008). Finally, individuals with ME and MFs had lower YMRS scores than those without MFs (p<0.001), and, similarly, those with MDE and MFs had lower MADRS scores than those without MFs (p<0.001).

Considering DSM-5 classification, we found that MFs are a phenomenon strongly linked to BD. While the symptom severity of the prevalent polarity tends to be lower in episodes with MFs, the reduced adherence may be suggestive of a more complex clinical management requiring specific treatment approaches.

None Declared

The treatment of the person with alcohol dependence allows the possibility of a self-determined alcoholic abstinence and reducing the consequences associated with alcohol-related problems at a personal, family, work and social level.

It is important to develop therapeutic strategies that complement the different approaches in the treatment of people with alcohol dependence, enabling them to use effective coping strategies that facilitate the maintenance of their self-determined alcohol abstinence.

In recent years, scientific evidence has emerged that justifies the adoption of mindfulness-based protocols as a complement to various treatments, both for the prevention of relapses and as a treatment enhancer.

To train people with alcohol dependence to use Mindfulness;

To promote psychological well-being and positive emotions;

To reduce anxiety;

To evaluate the effectiveness of a Mindfulness-based intervention program.

The Mindfulness-based intervention program was developed with 2 groups of people hospitalized for the treatment of alcohol dependence (the institution’s treatment protocol is comprehensive and based on self-determined alcohol abstinence). The 1st G (pilot) - 6 people; 2nd G - 5 people), total of 11 participants; 4 sessions (each group), duration 45-60 minutes.

The selection criteria of the participants were evaluated in an interview and defined as follows: being in the first week of the treatment program; self and allo psychic orientation; reduced to moderate anxiety (Zung Self-Assessment Anxiety Scale - EAAZ); existence of motivation for change.

Participants gave informed consent.

In the global assessment used instruments: Psychological General Well-being Scale for the Portuguese population (BEP); Short Version of the Portuguese Scale of Positive and Negative Affect (PANAS-VRP) in the first session (before intervention). In the last session (after the intervention), in addition to the BEP and the PANAS-VRP, the EAAZ was also used.

At the end of each session, an evaluation was carried out using a grid built for this purpose.

As for the general psychological well-being, the BEP, only one participant (pilot group) had a final score lower than the initial one.

With regard to PANAS-VRP, in both groups, there was an increase in positive affection and a reduction in negative affection at the end of program implementation.

With regard to the EAAZ, 7 participants showed a decrease in anxiety after the intervention.

The evaluation grid of each session revealed good participation, good adhesion and positive evaluation.

It is concluded that after the implementation of the Mindfulness-based intervention program there was: an increase in well-being (the higher the score, the greater the state of well-being); increase in positive affection (which remained or increased); decrease in negative affection and decrease in the level of anxiety.

None Declared

The University Clinic of Skopje – Skopje was part of two Horizon 2020 projects – IMPULSE and RECOVER-e that finished in December 2021. The advances in the field of community mental health in the capital of Skopje, the idea to combine the best aspects of the aforementioned projects and the need of continual implementation and research on an evidence-based community-based service delivery model for recovery-oriented care led to this study which aims to improve functioning, quality of life, and mental health outcomes for people with severe and enduring mental ill health, such as schizophrenia, bipolar disorder, severe depression.

The objectives of the study are: - to design, implement and evaluate recovery-oriented care for people with severe mental illness in community settings using a psychosocial digital intervention - DIALOG+;- to recognize the value of experiential knowledge through inclusion of peer experts as members of community mental health teams;- to develop scale-up plans for national decision-makers, as informed by the intervention’s implementation and impact, for sustained implementation and scale up after the research study’s timeline.- to improve the conditions of people suffering from psychotic disorders and to overcome financial barriers encountered in the treatment of psychotic disorders in N. Macedonia.

DIALOG+ represents an affordable and effective intervention which has already demonstrated positive outcomes in previous research. This study involves the use of the DIALOG+ intervention during home visits, so that patients themselves can decide which aspects of their life that they would like to discuss and work on improving. DIALOG+ lets them rate 12 domains that are related to quality of life, such as physical health, relationships and employment. Patient decide which of these they would like to discuss in detail during the meeting. There is then a 4-step approach to help improve this aspect of their life, using the principles of solution-focused therapy. Researchers will collect information about demographic characteristics, quality of life, and symptoms in patients taking part in the study through the administration of questionnaires and clinical scales.

The study is still in phase of completion. The results will be shown at the EPA Congress 2023.

Having the previous positive outcomes from IMPULSE and RECOVER-e, with this combined approach we expect even more improvement in functioning and better quality of life in patients suffering from severe and enduring mental ill health.

None Declared

Adverse childhood experiences are common and have been linked to a number of physical illnesses, as well as socioeconomic problems. Moreover, it has been proven that ACEs can increase chances of people showing criminal behaviour. The question arises whether people with ACEs also have an increased chance of joining extremist groups or violent gangs.

The aim of this systematic review is to measure the ACE rates in violent extremists and gangs and to establish whether there is a pattern linking ACEs to violent extremist organizations and gangs.

The following databases were searched to retrieve relevant studies: the ProQuest Social Science database, Pubmed, Scopus. Eligible studies were articles of any study design that reported ACE rates in either extremists or gang members. Data was extracted and organized into a table and a quality assessment was performed using standardized tools (CASP and NHLBI). A narrative synthesis of the evidence was conducted. A meta-analysis could not be performed due to the heterogeneity of the studies.

22 studies (eight on extremists and fourteen on gang members) were included. The studies varied in terms of research design, sample size, location and measured ACEs. Quality also varied across the studies. The prevalence rates were heterogenous and ranged from 0% to almost 100%.

Physical abuse was the most addressed ACE (5 studies on extremists and 11 on gang members). Sexual abuse was the second most explored ACE (4 studies on extremists and 9 studies on gang members). Neglect and caregiver loss were also common ACEs, while the other ACEs were less represented in the two subpopulations. A comparison between the two subpopulations was difficult due to the differences in the studies.

While overall ACE rates were high in the two groups and some ACEs were salient in the two subpopulations, quality of evidence varied across the studies. No solid ACE pattern across the studies could be found. Moreover, there were only two prospective studies on gang members and none on extremists, so a causal relationship between ACEs and involvement in violent gangs or extremist organizations could not be established. Future research should concentrate on studies of this design, as well as on improving the quality of the evidence.

As ACEs are extremely common, researchers should also look beyond them when searching for causes of extremism or violent gang membership. Other negative events (bullying, racism) should also be explored.

None Declared

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

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

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

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

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

None Declared

Attachment, as an interpersonal motivational system, is the relational ground that allows emotions to be regulated through action on the Autonomic Nervous System resulting in better psychological outcomes during middle childhood. Emotion dysregulation and autonomic function are often connected to psychiatric symptoms observed in adolescence (e.g. borderline personality disorder traits) and thus middle childhood becomes a critical age for psychopathological trajectories.

Examine the relationship between child’s attachment and both psychological and physiological emotional regulation.

20 children (Mage = 10.7, SD = 1.25; 65% males) were recruited from general population. Attachment was measured through the Child Attachment Interview (CAI), while emotional regulation was assessed with a multimethod approach, using questionnaires i.e. How I Feel (HIF) and Positive and Negative Affect (PANAS), and physiological measurements i.e. Heart Rate Variability (ratio between High Frequency and Low Frequency, HF/LF, labeled as the child’s sympathovagal balance) and Heart Rate (Beats Per Minute, BPM, as an index of physiological reactivity).

Statistically significant correlations emerged between the HIF-Control scale and the Mother and Father Dismissal CAI scale, the PANAS-Negative Affect scale and the Mother and Father Preoccupied Anger CAI scale. Moreover, there was a non-significant but moderate effect (rs > .30) between HF/LF and the Emotional Openness and the Resolution scales of the CAI, and between BPM and the Emotional Openness scale.

Despite the small sample size, more secure children are able to connect with their emotions and properly use them in solving relational problems. Consequently, they are likely to succeed in understanding and regulating emotions as they manage to find more adaptive strategies their own. On the contrary, the presence of dismissal or anger (insecure attachment) towards parents would appear to lead to higher levels of psycho-physiological dysregulation, a core feature of Borderline Personality Disorder dimensions starting to emerge later in adolescence. Future studies should consider physiological dysregulation as an additional factor linked to psychopathological developmental trajectories.

None Declared

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

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

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

None Declared

Anorexia nervosa (AN) is a complex mental disorder mainly characterized by a voluntary food restriction and excessive physical activity resulting in dramatic weight loss. Changes in the brain-derived neurotropic factor (BDNF) have been reported in AN patients compared to controls. According to meta-analysis, functional variant rs6265 Val66Met of the BDNF gene has been found genetically associated to AN. We also reported an association of this functional variant and electrodermal response to images of thinness suggesting an association between rs6265 and a reward effect of weight loss in AN. In animal models, BDNF modulates negatively the central control of food intake and its injection in rodents induces weight loss and anorexia. Thus, besides its function on neuronal survival, synaptic plasticity and mood, BDNF was also reported to have a metabolic effect via both central nervous system and peripheral organs, which makes BDNF a good candidate for AN diagnosis biomarker.

Our study investigates the levels of expression of Bdnf, gene and protein, taking advantage of the mouse AN-like model by measuring Bdnf levels in specific brain areas and blood in food-restricted and refeed animals.

We used a mouse AN-like model combining a phase of chronic food restriction (50%) during 15 days followed by an ad libitum refeeding period of one week. Female mice have or not access to a running with wheel to create a similar metabolic environment that those patients suffering from AN during restriction and recovery once hospitalised. The Bdnf mRNA and protein levels were measured in samples of blood and brain regions (prefrontal cortex, hippocampus, hypothalamus, dorsal striatum, nucleus Accumbens, ventral tegmental area and amygdala) using quantitative PCR and ELISA methods in the different groups of mice (ad libitum, ad libitum with wheel, food restriction and food restriction with wheel). Statistical analysis will compare the measures for different samples by one-way or two-way ANOVAs depending the group of animals or brain regions and blood.

To date, no difference of the level of transcription for Bdnf was observed between the different groups of mice (ad libitum, ad libitum with wheel, food restriction and food restriction with wheel) in the prefrontal cortex, hippocampus and hypothalamus. We expect significant differences of Bdnf expression in the other brain regions of interest for the food restricted animals with or without the wheel compared to ad libitum animals. We expect also differences in the level of expression of Bdnf in fasted animals compared to the refeed animals.

The BDNF could represent a potential biomarker of AN for the diagnostic and the prognosis in the evolution to the remission when weight recover and thus will allow a better understanding of the aetiology of AN. This study is supported by Fédération pour la Recherche sur le Cerveau.

None Declared

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

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

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

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

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

None Declared

The effects of antidepressant and antipsychotic medications in the perinatal period in both mothers and children have been a subject of interest for many decades. Risks and benefits should be considered according to the illness stage, trimester of pregnancy/ postpartum period, and neonatal outcomes.

Our goal was to summarize the knowledge about the use of antidepressants and antipsychotics in the perinatal period. To illustrate the complexity of treatment decisions with clinical reports.

Review: A narrative review was carried out using the PubMed database including papers published in 2022. Evidence about the risks and benefits of using antidepressants and antipsychotics in the perinatal period is presented. Search terms: antidepressants OR antipsychotics AND (perinatal OR pregnancy OR postpartum).

Case reports (5 clinical scenarios): (1) pre-pregnancy counselling, (2-4) first-, second- and third-trimester of pregnancy, and (5)postpartum/breastfeeding.

Review: (1)Depression/antidepressants. Treating maternal depressive symptoms is associated with a lower risk of pregnancy complications. Although placental passage of sertraline is low, drug monitoring is recommended. Antidepressant use in pregnancy is associated with preterm delivery and low weight at birth. (2)Psychosis/Antipsychotics. Antipsychotic intrauterine exposure is not significantly associated with increased risk of major congenital malformations. Minimum effective doses are recommended.

Case reports. (1)Pre-pregnancy counselling. Schizoaffective disorder receiving perphenazine, quetiapine and lithium. (2)First-trimester pregnancy. Discontinuation of treatment in major depressive disorder. (3-4)Second/third trimester. Occurrence of anxiety symptoms in posttraumatic stress disorder. (5)Postpartum/Breastfeeding. Discontinuation of antidepressants.

Shared decision-making models for antidepressants and antipsychotics prescription represent patient-centered approaches to be recommended in perinatal period.

None Declared

The process of integrating technology into mental health pathways represents a social transformation that we are gradually getting used to. But does it represent a valid alternative to face-to-face care processes? In this paper we will consider telesychology as a tool for treating anxiety and depression and its validity. Anxiety and depression are harmful to individuals, suffering from these disorders, their caregivers, and the economy. Remote delivery of psychotherapy has been established as a viable alternative to traditional in-person psychotherapy for treating anxiety and depression. However, literature comparing and evaluating the variety of remote delivery modalities of psychotherapy has not yet been integrated.

This review examines the efficiency – to - practice and the limits of e-therapy and its mediums: telephone, video, and online-administered psychotherapy, for treatment of anxiety and depression.

A comprehensive literature search, conducted using PubMed and PsycINFO included systematic reviews, randomized controlled trials, and cost-analysis studies focused on a remote delivery method of e-psychotherapy for anxiety and depression

Overall, interventions delivered through telephone, video, and online modalities, have generally demonstrated good efficiency in treating anxiety and depression; also comorbid with other disorders. The literature also suggested that telehealth psychotherapy is accessible, convenient, and cost-effective.

In evaluating the reviews on the databases, it also emerged that among the many psychological therapies for anxiety disorders, delivered digitally (CBT, Attention bias modification, Exposure therapy, Applied relaxation, Bibliotherapy, Psychodynamic therapy, Mindfulness, Behavioral stress management, Counseling), the best digital therapy is internet-based cognitive behavioral therapy (iCBT), in particular for Social Anxiety Disorder (SAD).

Despite this, overall, the efficiency and practical benefits of remote psychotherapy interventions in treating anxiety and depression across a diverse range of patient groups suggested that it is an appropriate alternative for those who cannot access in-person psychotherapy.

Further research evaluating the efficiency and practical benefits of e-psychotherapy for anxiety and depression is much needed for patients with limited access to in-person psychological care. Moreover, it remains to evaluate the maintenance of therapeutic gains after the end of the treatments.

None Declared

The OPUS trial is the largest randomized controlled trial (RCT) testing early intervention services with 20-years of follow-up among individuals with a first episode of psychosis in the schizophrenia spectrum.

A total of 547 individuals with first episode psychosis in the schizophrenia spectrum were included into the OPUS I trial between January 1998 - December 2000 and allocated to either two years of early intervention services or treatment as usual. Clinical and trained staff, blinded to the original treatment allocation, performed the five, ten and 20-year follow-up assessments.

The early intervention service consisted of two years of assertive community treatment including social skill training, psychoeducation and family involvement delivered by a multi-disciplinary team (staff patient ratio 1:10). The standard treatment was based on the available community mental health treatment (1:20 –1:30).

A total of 164 participants (30%) of 547 were interviewed at the 20-year follow-up. No significant differences were found between the early intervention group (OPUS-group) compared to the Treatment As Usual group (TAU-group) on global functional levels, psychotic and negative symptom scores after 20 years. Likewise, no differences was found ten to 20-years after randomization between the OPUS-group and TAU-group on days of psychiatric hospitalizations (Incidence Rate Ratio (IRR), 1.202, 95% CI 0.733 - 1.997, P=0.46), or number of outpatient contacts (IRR: 1.197, 95% CI 0.889 - 1.612, P=0.24). Of the entire cohort, 40% were in symptom remission and 18% were in clinical recovery at the 20-year follow-up. The mortality rate 20 years after randomization was 13.1% in the OPUS-group and 15.1% in the TAU group, P=.47.

New initiatives are needed to maintain the positive outcomes achieved after two years of early intervention services

None Declared

Treatment adherence in patients living with Bipolar Disorders can influence prognosis and quality of life. It is associated with an increased morbidity and healthcare costs.

The aim of our study was to evaluate treatment adherence in a sample of patients living with Bipolar disorders and to determine factors associated with poor adherence.

We conducted a cross sectional study where we included bipolar patients being treated in psychiatry department A. We developed a survey containing sociodemographic and clinical features. We used the medical adherence rating scale to evaluate treatment adherence.

Our sample consisted of 100 patients with a mean age of 47,5 years old. Sixty seven patients were being treated for bipolar disorder type 1. Medication adherence rate was 64%.

Factors associated with poor medication adherence were being single, an early age of onset, comorbid substance abuse disorder, severe treatment side effects and poor insight.

Poor medication adherence is a major issue for people living with Bipolar Disorders. Clinicians should pay more attention to sociodemographic and clinical factors to predict and enhance treatment adherence.

None Declared

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

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

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

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

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

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

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

None Declared

Adolescents presenting with a first psychotic episode often have a long history of pediatric treatment. However, there is insufficient evidence of children’s subclinical characteristics in non-psychiatric settings. To address this issue, we retrospectively studied schizophrenia spectrum disorder (SSD) patients to identify characteristic patterns of subclinical psychological, behavioral, and physical problems in childhood. In the previous study, we had developed the child psychosis-risk screening system (CPSS) that incorporates this pattern as a risk evaluation algorithm (Hamasaki et al. BMC Psychiatry 2021; 21, 57).

In this present cross-sectional study, we evaluated the specificity of the CPSS to identify the risk of psychosis in pediatric and psychiatric patients and determine its discriminatory power and cutoff values.

To identify the risk of developing psychosis in pediatric and psychiatric outpatients, we evaluated data from 336 patients aged 6–18 years selected for the present study using the CPSS. We defined six major diagnostic categories i.e., Neurodevelopmental Disorders, SSD, Depressive Disorders, Anxiety Disorders (including Obsessive-Compulsive Disorder), Somatic Symptom Disorders, and Others to examine the specificity of the CPSS variance in diagnosis. We analyzed the receiver operating characteristic (ROC) curve using the onset of schizophrenia spectrum as the outcome and determined the discriminatory power and cutoff values of CPSS.

We found significant differences in CPSS variance among the diagnostic categories (Kruskal–Wallis test; p<0.001), especially between SSD and neurodevelopmental disorders (Bonferroni method; p=0.001). Similarly, significant differences were identified in variance when comparing the CPSS for each neurodevelopmental disorder category and SSD, particularly between SSD and attention deficit hyperactivity disorder (ADHD) (Bonferroni method; p<0.001) and SSD and autism spectrum disorder (ASD) (Bonferroni method; p=0.004). CPSS showed sufficient discriminatory power for SSD diagnosis (area under the ROC curve=0.853 [95% confidence interval: 0.774–0.931]). The cutoff value for the risk of SSD was determined to be 3.94, achieving the best mean of the sum of sensitivity (90.9%) and specificity (84.0%). 18.3% of patients (12.5% pediatric and 29.1% psychiatric) were identified as risk groups above the cutoff value.

These results suggest that CPSS can be applied in pediatric clinical practice not only for early detection and risk identification of psychosis but also for differentiation from neurodevelopmental disorders. If early identification of psychosis risk in pediatrics becomes possible, discussions regarding effective prevention during the critical period of psychosis will become increasingly important.

None Declared

Treating young patients with schizophrenia is a challenge, as these patients have much to gain from controlled pharmacotherapy and even more to lose with a possible relapse. Treating patients with long-acting injectable antipsychotics avoids the issue of non-compliance, the biggest risk factor for relapse, while also improving the quality of life. Receiving a drug once-a-month can provide greater flexibility and convenience to our patients.

Aim of the paper is to assess the efficacy and quality of life in monthly dosing of long-acting injectable antipsychotic in young adult schizophrenia patients.

The research included 7 patients aged 19 to 25 years who were diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients were assessed eight times over two years using the following clinical scales: Positive and Negative Syndrome Scale, Clinical Global Impression – Severity and Improvement Scale, Treatment Satisfaction Questionnaire for Medication (TSQM-9) and Quality of Life Scale (QOLS).

All treated patients achieved remission. There was a statistically significant improvement in measured scales in all patients. There were no side-effects reported during the study period, with no relapse or new hospitalizations

The monthly formulation of aripiprazole has proven to be effective and safe in our study and has great potential to improve patient quality of life as well.

None Declared

Researches has shown that a subset of the autism spectrum disorder (ASD) population presents with immune dysregulation. Based upon the immunological abnormalities, various treatment modalities have been applied to children with ASD. One immunomodulatory treatment that has been studied in ASD is intravenous immunoglobulins (IVIG).

This report is based upon two hypotheses: autism etiology may be closely related to neuroinflammation; and, an effective treatment should restore the individual’s comminication skills. In this report, we present two cases who were diagnosed with ASD and received IVIG treatment.

Case A is a 5-year-old female patient who was diagnosed with ASD at the age of 3. The second case, B is a 9 -year-old male patient who is a 7th grade student and was also diagnosed with ASD at the age of 3. The first patient’s autism symptoms was noticed by her family at the age of 2. Although she had the ability to coordinate eye contact, understood simple commands, she was observed to lose all her acquired developmental skills one by one at around 18-24 months. Towards the age of 3, stereotypical movements such as turning around and flapping wings, started. Similarly, the second patient’s acquired skills were lost around at the age of 2-3, after having recurrent infections. Based on deficits in social‐emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction and restricted/repetitive patterns of behavior, both patients were diagnosed with ASD. Considering that autoimmune mechanisms may have been affected in ASD, IVIG treatment was initiated at 1 g/kg/month. Case A received IVIG once in a month, total 5 infusions had been applied. Case B received total 12 infusions with the same protocol. Treatment response was assessed with the Childhood Autism Rating Scale (CARS).

In these two ASD cases which were treated with IVIG ,a subjective partial reduction in autism symptoms and an objective decrease in CARS scores were detected. Current evidence suggests that there are various factors contributing to the development of autism and different combinations of these aspects give rise to different variations of some ASD subtypes. Recent studies in this field indicate a possible connection between the immune system impairments and ASD. This report, therefore, provide support for the notion that at least a subset of children with ASD might have immune abnormalities and may respond to the immune modulating effect of IVIG therapy.

Although, autoimmune or inflammatory etiologies may not explain the majority of cases of autism, it might at least be useful to understand some. Further studies with larger number of patients should be conducted about the use of IVIG in selected patients with ASD.

None Declared

Research suggested that psychosis and mental illness-related experiences can be extremely traumatic, and that psychosis could theoretically also lead to posttraumatic growth (Mazor et al., 2019; PTG). The promotion of PTG may contribute to the treatment of people who experienced massive traumas such as people with severe mental illness (SMI). Psychotic symptoms are a common feature of SMI, and individuals who have experienced psychosis are also more likely to have been exposed to trauma and are more vulnerable to developing posttraumatic symptomatology (Ng et al., 2021). Negative symptoms such as amotivation could also contribute to the traumatic experiencing of psychosis (Mazor et al., 2016). Amotivation is specifically relevant to the possible traumatic sequelae of psychosis (Mueser et al., 2010). Alongside the adverse consequences of psychopathological symptoms is the unique outcome of coping with adversity (Tedeschi & Calhoun, 1995)- PTG. Two important factors that contribute to PTG is coping self-efficacy (CSE), and meaning making (Mazor et al., 2018). We investigated the possibility of PTG in individuals with SMI, through the mediating effect of CSE and meaning making.

Recent research has shown high rates of exposure to trauma among people with SMI, and that psychosis and mental illness-related experiences can be extremely traumatic. While some develop PTSD, it has been noted that some may also experience PTG. However, few studies have examined PTG in this population.

121 participants were recruited from community mental health centers and administered trauma and psychiatric questionnaires. Study protocol was approved by the University of Haifa ethics board.

High levels of traumatic exposure were found in the sample. Furthermore, we found that people who endured psychosis can experience PTG, which was mediated by meaning making (MLQ) and CSE. Psychotic symptoms were found to be a major obstacle for PTG, whereas negative symptoms were found to have the potential to lead to PTG when mediated by meaning making and CSE.

Mediation analyses for the dimensions of PANSS, MLQ total, CSE total, and PTGI total (N=121)

The portrayed research provided preliminary evidence for the potential role of meaning making and CSE as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis.

None Declared

Culture is defined by the shared beliefs, attitudes, values, and practices of a particular group of people which can influence their behaviour and social interactions, including the use of substances.

The aim of this review is to identify the evidence of cultural competence in the treatment of people with substance use disorder (SUD) and encourage the professionals and organizations to take cultural context into account.

Narrative review about the topic, using PubMed/Medline database. MeSH terms: “culture”, “cultural competence”, “addictions”, “substance use disorder”.

Studies show that culture can either be a catalyst for SUD or play a protective role. However, other factors may also play a large role in client’s response substance use and the development of SUD. Acculturation and generational differences can also impact SUD treatment, especially when intergenerational conflict causes stress that leads individuals to engage in risky behaviours. Thus, treatment for SUD has to be sensitive to cultural differences and professionals should provide culturally based approaches. Culturally targeted practices have been linked to greater outcomes, better therapeutic alliance, less dropouts and consequent increased retention in the treatment. These practices include matching clinicians and clients on linguistic and cultural backgrounds as well as being mindful of the impact of culture on client’s experience of SUD. Providing therapy and materials in the client’s language, knowledge, understanding and appreciation for cultural perspectives, involving the family and community and training therapists, are some of culturally competent practices used. These strategies involve knowledge, creativity, and experience.

Cultural competence seems to be a valuable tool for healthcare professionals working in a multicultural context, particularly with people with SUD. Unfortunately, the lack of supporting evidence limits the validity of any particular model of cultural competence. Future methodologically research is necessary in order to provide quality cultural competence models for people with SUD.

None Declared

Posttraumatic stress disorder in the paediatric population has clinical features. The Clinician-Administered PTSD Scale for DSM-5,child and adolescent version (CAPS-CA-5) is the gold standard in positive diagnosis

The objectives of our work was to study the clinical characteristics of the paediatric population with the diagnosis of PTSD.

This is a descriptive cross-sectional study conducted in the child psychiatry department of Mongi Slim Hospital and the forensic medicine department of Charles-Nicolle Hospital, among children older than seven years who were exposed to a potentially traumatic event at least one month before. We made clinical assessment for PTSD using CAPS-CA-5 which is currently being validated in Tunisian dialect. Then We investigated the clinical characteristics of PTSD according to age, gender, history, and event specifics.

We conducted our study with 150 patients . The diagnosis of PTSD according to DSM 5 criteria was retained in 56.2% of patients (N=80).

The average age was 12.4 years with extremes ranging from 7 to 17 years. We noted a female predominance at 58.8% (n=47)

Male gender was significantly associated with persistent avoidance (p=0.03). Sexual assault was significantly associated with the severity of flashback symptoms (p<10-3) and reckless and self-destructive behaviors (p<10-3) and with the frequency of dissociative symptoms (p<10-3).

We also noted in our work that dissociative symptoms were significantly more frequent in victims with no personal psychiatric history with a p value of 0.021.

In our population, we found a predominance of hypervigilance and a greater severity of exaggerated startle reactions in the absence of a family psychiatric history with a p value of 0.048 and 0.008 respectively.

We noted a significant predominance of exaggerated startle reactions in relation to the absence of exposure to previous traumatic events with a p equal to 0.043

The specificities identified in relation to the child should be taken into consideration during further evaluations and further analysis in the general population.

None Declared