Borderline personality disorder (BPD) is a real source of suffering for people affected and for those around them.

The aim of this study was to describe the socio-demographic and clinical characteristics of out patients with BPD consulting the psychiatry department of Hedi Chaker hospital in sfax tunisia during the period between January 2022 and October 2022.

It was a descriptive study. The population study consisted of patients diagnosed with BPD (DSM 5) consulting the psychiatry department of the hospital Hédi Chaker of Sfax tunisia during the period from January 2022 to October 2022.

Sociodemographic and clinical data were collected using a predefined form.

All statistical analyses were performed using the SPSS software package v 18.

Among 700 adult patients referred to the psychiatric unit of hedi chaker hospital in sfax from january 2022 to october 2022, 35 patients (5%) were identified as meeting the criteria for BPD.

The average age was about 35 years, 54.3% of the patients were men. They were married in 40% of cases.Only 31.4% of the patients had a regular job.

The presence of a family psychiatric illness was noted in 48.5% of cases and 20% had a childhood psychiatric follow-up .

The rates of sexual abuse, physical abuse, psychological abuse and neglect were 17.1%, 65.7% and 68.6% respectively.

In our sample,48.6% of the patients had attempted suicide and 60% of them had committed self-harm.

The most common means of attempted suicide was phlebotomy.No prior thoughts of suicide were mentioned, all suicide attempts were impulsive. Negative feelings and family conflicts motivated the suicide attempt (37.5% ,56.25%).

Comorbid psychiatric disorder was mentioned in 54.3% and The most frequent comorbid psychiatric disorders was depression (20%).

Pharmacotherapie was used in 88.6% of cases.

The results emphasize on the comorbidities with mainly depressive episodes and a high proportion of suicide attempts and self-harm. Moreover, this study confirms the impact of family conflicts and abuse in the development of this disorder

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Depressive symptoms and suicidal behaviour are common among patients that suffered a first-episode psychosis. Depressive symptoms could occur in different phases of psychosis, including in post-psychotic period. Depression is a well-known risk factor for suicidal behaviour in psychosis with data showing that occurrence of depression in psychosis have a significant correlation with suicide risk.

The purpose of this paper is todo a brief review on the relation of causality that existes between first episode psychosis and depressive symptoms as well as suicidal ideation.

Brief non-systematic literature review on the topic.

First episode psychosis is not uncommonly followed by depressive symptoms and suicidal thoughts. The rate of suicide attempt in psychotic patients range from 10 to 50%. Individuals with first episode psychosis have a greater risk of suicidal behavior compared with normal population and chronic disorders. In several studies, factors identified as being associated with depressive symptoms after first episode psychosis were anomalies of psychosocial development, poor premorbid childhood adjustment, greater level of continuing positive symptoms and longer duration of untreated psychosis. Suicidal behavior was associated with sexual abuse, previous suicide attempt, comorbid polysubstance use, lower baseline functioning, longer time in treatment, recent negative events, older patients, longer duration of untreated positive and negative psychotic symptoms, family history of severe mental disorder, depressive symptoms and cannabis use. Data also indicate that treatment and early intervention programs reduce depressive symptoms and suicidal behavior after first episode psychosis.

There is convincing evidence that depressive symptoms and suicidal behaviour have high rates after first episode psychosis. The research for treatment of depressive symptoms and/or suicidal behaviour after first-episode psychosis is very limited, therefore this paper aims to bring to light the importance of more studies on the matter.

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Since its emergence at the end of 2019, the COVID-19 virus has spread worldwide. In Spain, mandatory home confinement was established on March 15, 2020, and lasted 99 days. Previous studies on events that required isolation situations suggest a worsening in the mental health of general population, and in particular, of especially vulnerable groups such as individuals with severe mental disorder (SMD).

The aim of this study is to evaluate the psychological effect (anxiety and depression) of confinement in patients with SMD and to study the dissimilarities among the different diagnostic groups.

In this study, assessments were performed using the IDER and STAI questionnaires, in order to evaluate symptoms of depression and anxiety, respectively. The evaluations were carried out in patients who had required at least one admission to the Psychiatric Hospitalization Unit of the University Hospital of Basurto. The Shapiro-Wilk test was used to verify the normality of the sample. ANOVA test was used to study differences among diagnostic groups. Posteriorly, Bonferroni correction was performed.

95 participants completed the IDER questionnaire, obtaining a mean score of 24.56 (SD=8.18) for the state and 23.57 (SD=8.14) for the trait. In the STAI questionnaire, a mean score of 27.86 (SD=15.19) was obtained for the state and 30.49 (SD=14.71) for the trait. ANOVA test indicated presence of differences among groups. However, differences did not persist after Bonferroni correction.

Increased levels of anxiety and depression were found in the sample studied with respect to the general population.No statistically significant differences were found among different disgnostic groups. Further studies should be performed in order to increase the knowledge around this research area.

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Obsessive‐compulsive disorder (OCD) is a severe condition with a profound impact on the health, social and professional functioning of the patients. More than one third of the patients do not achieve remission of the symptoms after first‐line treatment with cognitive‐behavioral therapy and selective serotonin reuptake inhibitor medication. Neurofeedback is a promising technique that allows the non‐invasive self‐regulation of neural activity associated with symptomatic manifestation. Previous literature reported preliminary evidence of positive effects of functional magnetic resonance imaging (fMRI) neurofeedback on OCD symptoms. However, these studies have small samples and/or were not controlled. Additionally, these studies did not involve treatment‐resistant patients.

We aim at developing a fMRI neurofeedback task to treatment-resistant OCD patients and to explore the underlying brain changes.

We implemented a sham‐controlled double‐blinded fMRI neurofeedback protocol to target hyperactivity in orbitofrontal regions in treatment‐resistant OCD patients with contamination/cleaning symptoms. The protocol had two sessions of neurofeedback (72 min of total training). The patients included were under treatment‐as‐usual.

Our preliminary results with the experimental group (n = 10 patients) demonstrated decreased OCD and stress symptoms three months after the neurofeedback sessions. Moreover, immediately after the neurofeedback sessions, we observed reduced functional connectivity between orbitofrontal and temporoparietal regions, and increased brain activity in dorsolateral prefrontal and premotor areas during symptomatic provocation. The brain functional changes might be associated with a better control over obsessions.

fMRI neurofeedback led to long-term symptomatic reduction in treatment-resistant patients with OCD. Our results need further validation with the sham‐control group but highlight the efficacy of fMRI neurofeedback for refractory OCD and the necessity of prolonged neurofeedback protocols.

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Sexual life and sexual satisfaction are associated with psychological well-being. It has already been shown that sexual satisfaction is related to sexual myths or stereotypes, somesociodemographic and sociosultural variables, and gender. However, we have not met any study in which socioeconomic status, sexual myths and gender roles were taken together.

The aim of this study was to investigate whether socioeconomic status predicts sexual satisfaction through sexual myths and gender roles.

The Bem Gender Roles Scale (Ozkan and Lajunen Sex Roles 2005;103-110), the Sexual Myths Scale (Golbasi et al. Sex Disabil 2016; 34 75-87), the New Sexual Satisfaction Scale (Stulhofera et al. J Sex Res 2010;47 257-268), the Socio-Economic Status Measurement Tool (Kalaycioglu et al. J Soc Res 2010; 1 183-220) were applied face-to-face or online to 185 women and 74 men who had heterosexual relationships. Relationships between scale scores were examined with Pearson correlation analysis. Serial multiple mediator analysis was used to test mediator role of either masculinity or sexual myths in the relationship between socioeconomic status and sexual satisfaction.

We found significant correlations between socioeconomic status and sexual myths (r=-.22, p<.001), between socioeconomic status and sexual satisfaction (r=.13, p<.001), sexual myths and sexual satisfaction (r=.20, p>.001) and between masculinity and sexual satisfaction (r=.18, p=.004), The relationship between femininity and sexual satisfaction was not significant (r=.01, p=.845). Sexual myths (b=-.19, t(257)=-3.48, p<.01) and masculinity (b=.40, t(257)=3.26, p<.01) mediated the relationship between socioeconomic status and sexual satisfaction (b=.15, t(257)= 2.04, p<.05).

Interventions on sexual myths will reduce the effect of socioeconomic disadvantage on sexual satisfaction.

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Little is known about the epidemiology of suicide in young people exposed to the youth justice system (YJS).

We aimed to estimate the suicide rate in a large cohort of young people exposed to the YJS in Australia, and to identify the demographic/criminogenic risk factors associated with these deaths.

Data relating to all young people who had any contact with the YJS in Queensland between January 1993 and December 2014 (N=49,228) were linked to Australia’s National Death Index. We calculated the incidence rate of suicide within the cohort, stratified by sex and Indigenous status. Poisson regression was used to assess the change in suicide rates over time. Crude mortality rates (CMRs) were calculated for all-suicide and method-specific suicides, both overall and within subgroups.

Of the 48,228 participants, 1452 (3%) died during the follow-up period. For 31% (458) of decedents, the cause of death was suicide. The proportion of deaths due to suicide was highest for Indigenous females (37.9% of all deaths), followed by Indigenous males (36.8%), non-Indigenous males (30.1%) and non-Indigenous females (25.8%). Hanging was the most common method of suicide (83%).

The disproportionately high incidence of suicide following contact with the YJS is a cause for concern. There is a pressing need to better understand the trajectories of young people after discharge from the YJS. This missing epidemiological knowledge would inform targeted, preventive interventions to be implemented during the window of opportunity when these vulnerable young people are under the care of the YJS.

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Burnout (BO) is a syndrome combining psychological and somatic symptoms caused by exposure to several years of chronic stress at work. Far from being a theoretical problem, it is a real social problem that has become globalized as societies change. Anesthesiology is among the most stressful medical disciplines which expose to BO in Tunisia and around the world.

Identify associated factors to BO among anesthesia technicians.

We conducted a cross-sectional study during two months, from October 1st, 2015 to December 31th, 2015, among anesthesia technicians affected in the different operating rooms of the Farhat Hached teaching Hospital in Sousse. Data collection was based on a self-administered questionnaire with validated tools assessing BO (Maslach Burnout Inventory) and stress (Siegrist and Karasek)..

Forty-six senior anaesthesia technicians was included in the study. The mean age of our population was 43.76 ±7.74 years with a female predominance (89.1%). According to the Karasek model, 59% of the workers were in job strain, and according to the Siegrist model 23.9% of the participants had an imbalance between high effort and low reward. The BO rate among anaesthesia technicians at the Farhat Hached University Hospital was 39.1%. The results showed a statistically significant association between working at the gynaecology-obstetrics department (p=0.001), the seniority in the department superior or equal to 20 years (p=0.006), the absence of break time at work (p=0.003) and the risk of the occurrence of BO. Furthermore, the last 2 consecutive day rest dates back to more than 15 days (p=0.001), the number of free weekends during the last 3 months less than four (p=0.044) were also significant associated to BO.

Our study confirms that BO is a tangible reality in our country especially among anesthesia technicians, so it must be addressed by adopting effective preventive strategies.

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In this fourth session of our motivational interviewing workshop, we will go from theory to practice through simple and direct examples from clinical practice. The participants will be able to watch previously filmed clinical cases and participate in role plays, where they can practice using different motivational interviewing techniques that they had learned before.

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Functional Movement Disorders (FMD) are characterized by the presence of neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. First evidence showed that, compared to healthy controls (CTR), FMD patients presented increased levels of glutamate+glutamine in the anterior cingulate cortex/medial prefrontal cortex, and decreased levels of glutamate in the cerebrospinal fluid, suggesting that a glutamatergic dysfunction might play a role in FMD pathophysiology.

According to the evidence of these abnormalities in many neuropsychiatric disorders at level of brain network activity, connectivity, and specific anatomic areas of altered metabolic, and given the evidence of a potential role of glutamate and BDNF in the pathophysiology of FND, in this study we aimed to assess circulating levels of glutamate, BDNF, dopamine, oxidative stress biomarkers, creatinine, neopterin and uric acid in patients with FMD and in a control group of healthy subjects.

12 FMD patients (4 males, 8 females) and 20 CTR (4 males, 16 females) were recruited and underwent venous blood sampling and urine collection: levels of glutamate, BDNF, dopamine, oxidative stress, creatine, neopterin, and uric acid were analysed. Participants also underwent a psychometric assessment investigating depression, anxiety, and alexithymia.

Levels of glutamate, BDNF and dopamine were significantly lower in the blood of FMD patients than CTR. Glutamate and dopamine levels were positively associated with levels of alexithymia.

Our findings give further evidence that glutamatergic dysfunction might be involved in the pathophysiology of FMD, possibly representing a biomarker of disease; moreover, since glutamatergic and dopaminergic system are closely interconnected, our results might have a relevance in terms of treatment options for FMD patients.

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Mental health in the workplace is a rapidly developing field of research, which involves the well-being of the individual on a psychological and social level. However, this balance can be suddenly disrupted and can have such a repercussion that the individual finds himself unable to do his job. In this case, he can benefit from a work stoppage called long term sick leave, governed for the public sector, by the decree number 59-239 of August 24, 1959.

To study the socio-demographic and clinical profile of public sector employees who have been on long-term sick leave and examined as part of the assessment of their ability to work.

It is a retrospective study that focused on all public sector employees on long-term sick leave, examined as part of the evaluation of their ability to work in the psychiatric service CHU MAHDIA during the period from January 2013 to April 2014.

We collected 73 patients. The mean age at the time of the examination was 51.1 years. There was a clear female predominance 67% and the sex ratio was 0.48. The vast majority were married (71%), of average socioeconomic status (52%) and high school level (43%). Most of the patients (67%) were from the Ministry of Public Health, followed by the Ministry of Education with 26% of the study population. The average length of service was 20.4 years with extremes between 3 and 36 years. The average length of leave was 13 months. The most frequent diagnosis of the prescribing physician was adaptation disorder (41%), major depressive disorder (27%). Somatic comorbidity was found in 38% of cases, dominated by hypertension, diabetes and cervicarthritis in 50%, 28% and 18% respectively. At the end of the leave, 82% of the patients were able to return to work. For the other patients, a professional reclassification was necessary.

Long-term sick leave has a heavy economic burden for society and serious socio-economic and psychological repercussions on the patient. Hence the interest in identifying vulnerable subjects and jobs at risk in order to prevent the occurrence of psychopathological disorders.

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Traditionally, psychiatric wards had established a “locked door” policy but secluded conditions may increase patient’s discomfort1 that could affect the perception of health quality of care2. Recently, the “open-door” policy is being adopted in several European countries but its impact on patient satisfaction remains unknown (Schreiber, LK. BMC Psychiatry. 2019 May 14;19(1):149). Since 2019 our psychiatric hospital has implemented the open-door policy.

The aim of this study is to investigate the impact of the “open-door” policy on patient satisfaction during their stay in the acute inpatient unit of our psychiatric hospital.

This is an observational study. Prior to the implementation of the open door policy 31 patient satisfaction data was collected between October 2018 to April 2019 and it was also assessed with 31 subjects between July to October 2019, after the implementation of the open “door-policy”. The inclusion criteria were being >18 years old, reading Spanish correctly and with a length of stay >72 hours. The patients with dementia disorder and intellectual disability where excluded from the study. We used the Satispsy-22-E scale, a self-administered questionnaire (Frías, V., et al. 2018. Psychiatry Res. Oct;268:8-14). It assesses patient’s experience of hospitalization through 22 items distributed into 6 dimensions. The score range is from 0 to 100. Differences in Satispsy-22-E scores were analysed by applying ANOVA using the IBM-SPSS (v. 25).

Total scores in Satispsy-22 are provided in Figure 1. We found that patient satisfaction was increased in the dimensions of “personal experience” and “food” (p<0.05). No significant differences were found in staff, quality of care, information, activity dimensions and Total score (Table 2).

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Our results provide preliminary evidence indicating that the open-door policy could have a positive impact on patient satisfaction, especially in relation to the personal experience on an acute inpatient psychiatric unit.

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Organic solvents (OS) constitute a considerable occupational risk in industrial environment. Long-term exposure can cause several neuropsychic manifestations which are the subject of several studies conducted in Tunisia.

To identify the main psychological disorders in workers exposed to OS in Tunisia and to determine the occupational sectors at risk.

This is a review of the Tunisian literature, focusing on studies carried out on OS in the workplace and published in the form of articles or defended in the form of theses or dissertations in medical faculties over a ten-year period.

The total number of employees was 9 499 of which 4 259 were exposed to OS. The total number of companies studied was 169 with 164 occupational pathology cases. The most studied sectors were the chemical industry (20 studies) and the leather industry (21 studies). Atmospheric concentration of OS was measured in 20 studies. A mixture concentration index was calculated in 70 cases, it did not comply with the standard in 30 cases. Pathologically, the syndrome of acquired intolerance to organic solvents had a prevalence of 1.8% to 38.2%, while the syndrome of psychic dependence had a prevalence of 8.9% to 35.3%. The prevalence of organic psycho-syndrome ranged from 0.8% to 26.5%.

Despite the methodological differences of the studies, this work can contribute to the evaluation of the extent of the problem posed by OS in the workplace for a possible implementation of an adapted preventive approach.

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Darier’s disease, also known as Darier-White disease or keratosis follicularis, is a rare autosomal dominant genodermatosis. Clinical experience has long suggested an association between neuropsychiatric abnormalities and Darier’s disease. Moreover, associations with mental retardation, schizophrenia, mood disorders and suicide have been reported.

We studied the association between Darier’s disease and schizophrenia.

We illustrate a case of schizophrenia and Darier’s disease comorbidity with a small review of the literature that summarizes the characteristics of such an association.

Mrs SD, 48 years old, with a prior history of schizophrenia, moderate intellectual disability and several hospitalizations in psychiatry.

She was hospitalized in our department of psychiatry "A" of the Hedi Chaker university hospital after she was brought by the police for odd and disorganized behavior, environmental violence and refusal of treatment.

On somatic examination, the presence of crusty maculopapular skin lesions, non-pruritic, yellowish brown in color and a few millimeters in diameter, located on the back of both hands and feet, face and neck was noted. The patient reported that her brother has similar skin lesions. A dermatological consultation was sought for assessment of her skin condition and a skin biopsy confirmed the diagnosis of Darier’s disease.

Schizophrenia and intellectual disabilities are frequently associated with Darier’s disease. Physicians should be aware of this association in order to allow a rapid diagnosis and early management of psychiatric disorders associated with this genodermatosis.

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Syndemics are synergistically interacting epidemics (for example, the epidemics of substance use disorders and forced displacement) in a particular context with shared drivers such as pre-existing political, structural, social and health conditions. Policymakers may ask what the risks of and needs are for forcibly displaced people with regards to substance use disorder (SUD). Working from a syndemics framework, we would argue that multiple risk and resiliency factors relating to both forced displacement and SUD work synergistically, and impact more significantly upon some populations than others. These risk factors include structural inequality and racism, social deprivation, violence, homelessness, trauma, childhood adversity, and co-morbid physical and mental health disorders. Individuals may become vulnerable while experiencing displacement, during transition, settlement or resettlement, and also through their life across and across generations. In this perspective, our answers to policymakers becomes more nuanced. We may argue for integrated, multi-modal interventions, cross-disciplinary collaborations, cross-pollination of ideas and knowledge and embedding lived experience to bridge gaps and make use of limited resources in sustainable ways. This presentation will detail aspects of the application of a syndemic lens to the evidence base on SUD among forcibly displaced people and generate discussion on what scientists, clinicians and policymakers can and may do with these insights.

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There is evidence that the concentrations of the main inhibitory neurotransmitter (GABA) may be altered in schizophrenia. The purpose of this study is to find the changes in the GABA concentration in the area of anterior and posterior cingulate cortex of patients with early-stage schizophrenia using the spectral-edited magnetic resonance spectroscopy.

To measure the cerebral concentrations of the gamma-aminobutyric acid in schizophrenia patients at early stage.

Thirty-one subject, 18 controls (11m+7f, 29.6±5.7 y.o.) and 13 schizophrenia patients (F20.0, 8m+5f, 27.5±3.1 y.o.). Philips Achieva dStream 3T MRI scanner, standard head coil. The 3D T1w head images and MEGA-PRESS GABA spectra in ACC and PCC areas were acquired with the following parameters: 50x25x25 mm, TR = 2 s, TE = 64 ms, 180-editing pulses applied at 1.9 ppm and 7.6 ppm, NSA = 288 (acq.time ~10 min). GABA spectra were processed in Gannet program. The intensities of the GABA, Glutamate+glutamine (Glx), creatine (Cr) and unsuppressed water signals were acquired. T-test was used in search for between-group differences.

In ACC region, significant reduction of the GABA/Water was observed (by ~15%, p=0.02) as well as a trend to a decrease in GABA/Cr (by ~10%, p=0.07) in schizophrenia. In PCC, no significant GABA/Water or GABA/Cr differences were observed. Glx/Water and Glx/Cr in both areas were also unchanged.

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This study provides insight into neurotransmitter alterations at early-stage schizophrenia. The results demonstrate the region-specific changes in the balance of the main neurotransmitters. Since this balance is crucial for the normal cerebral functioning, the results may facilitate better understanding of the dynamics of the pathological process and provide additional information for understanding the biological mechanisms of the schizophrenia development.

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Depression shows a moderate heritability of 37-42%, which can be up to 75% in severely depressed samples 75%. At the same time SNP-based heritability of depression in GWAS-s is around 8-9%. Heterogeneity of the depressive phenotype may contribute not only to the lack of understanding its genetic background but may also hinder the identification of novel targets. Thus clinically relevant intermediate endophenotypes are needed for. The affective temperaments in the Akiskal model may be considered high-risk states or subclinical manifestations of mood disorders. Considering their strong genetic and biological background, high heritability in family studies, and their temporal stability, they may prove to be relevant endophenotypes for depression.

The aim of the current study was to investigate the genetic determinants and heritability of affective temperaments based on a GWAS approach.

775 subjects aged between 18-60 years recruited in Budapest, Hungary provided genetic samples and completed questionnaires including the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego) scale. A genome-wide association analysis was performed with the five affective temperaments as outcome variables. Age, gender, the top 10 principal components of the genome, and the other 4 phenotype were added in the model as covariates. Summary statistics derived from the GWAS analyses were used to estimate the heritability, i.e. the genetic variance explained by the different affective temperaments. LD score regression using LDPred2 [4] was performed to estimate heritability from the beta values and effect size in case of all 5 affective temperament phenotypes.

rs3798978 showed a genome-wide significance (p=4.44x10-8) for anxious temperament, and several other variants showed suggestive significances for all five temperaments. The highest estimated heritability (h2 = 0.5224) was observed for the depressive temperament, and similarly high heritability was observed for the hyperthymic temperament (h2 = 0.4956). Anxious and cyclothymic temperaments showed almost the same heritability (cyclothymic h2 = 0.1651, anxious h2 = 0.1663), whereas for the irritable temperament, we got negative heritability estimation (h2 = -0.0567), which means that all of the phenotypic variance is explained by environmental factors.

Our analyses yielded remarkably high heritability values for depressive and hyperthymic temperaments explaining 52% and 50% of phenotypic variances. In contrast to the 8-9% SNP-based heritability in depression studies our findings suggest that these temperaments may be relevant endophenotypes for mood disorders.

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Attention Deficit Hyperactivity Disorder (ADHD) affects about 9.4% (6.4 million) children in the United States. Pharmacological treatment, including stimulants, is a known therapy for ADHD. However, its possible subtherapeutic effectiveness, residual symptoms, and adverse effects have prompted us to explore the current evidence of Yoga as an add-on therapy that has shown synergistic effects in recent studies.

1) We aim to assess Yoga’s efficacy as an add-on treatment for ADHD.

2) Assess the current evidence of Yoga as an add-on therapy for ADHD.

We searched PubMed, PubMed Central, Medline, Web of Science, and Biosis databases with the keywords “Attention Deficit Disorder with Hyperactivity” (MeSH) and “ADHD” in the context of “Yoga” (MeSH). Identified 4 relevant studies that were published until September 30, 2022.

A study by Jensen et al. found improvement in impulsivity, hyperactivity, and restlessness in the ADHD with medications patient group after 20 Yoga sessions. Study utilized Conners’ Parents Rating Scales and found improvement in the Yoga group on Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive, and ADHD Index scale, changes associated with the number of sessions (Jensen et al. J Atten Disord 2004; 7 205-216). In another study, children with ADHD showed significant improvement after 8 weeks of 16 Yoga sessions in accuracy rate and reaction time in the Visual Pursuit Test and Determination Test (Chou et al. Peer J 2017; 5 e2883). A nine-year-old male case showed improvement in inattentive and hyperactive-impulsive symptoms on Vanderbilt Assessment Scales from parents and teachers after 6 months of Yoga practice (Gunaseelan et al. Cureus 2021; 5, e2883). Another 6-week Yoga intervention randomized trial in pre-school ADHD children showed significant improvement in hyperactivity and inattention with fewer distractibility errors of omission and faster reaction time (Cohen et al. J Dev Behav Pediatr 2018; 39 200).

The results suggest that Yoga has beneficial effects as an adjunct treatment to pharmacotherapy in ADHD for reducing hyperactivity and inattentiveness. Additionally, studies indicate its effectiveness in managing stress, anxiety, energy levels, and impulse control by staying focused with the help of breath and mind control. To explore the full spectrum of benefits and effectiveness of Yoga as an add-on therapy for ADHD patients, we recommend robust well-design future studies.

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Different mental health care provision models coexist in prisons in Spain. The Ministry of Interior applies a traditional model to secure mental health care to 83% of the country imprisoned population. Three autonomous regions with acquired competencies for health care provision (17% of the imprisoned population) are implementing innovative care models.

To explore the views of healthcare professionals on models of mental health care provision for imprisoned persons with a serious mental illness (SMI) in Spain.

21 healthcare professionals (13 physicians, 5 nurses, 3 pharmacists) working in prisons, penitentiary psychiatric hospitals and a psychiatric in-prison unit took part in 5 online, 2 hours focus groups and one in-deep interview between 31st May and 20th July 2022. The moderator used open-ended questions to research into the characteristics of mental health care models and on the challenges for implementation. Focus groups were audiotape recorded and transcribed. Transcripts were analysed applying thematic analysis.

Healthcare professionals reported that within the traditional model of healthcare provision, the psychiatric care of SMI imprisoners relies on correctional general practitioner physicians (GP). Psychiatrists act as external care providers. There are two psychiatric penitentiary hospitals with a strong correctional character for in-hospital care. Acute psychiatric care happens in prisons or at the local general hospital. Healthcare records remain within the penitentiary organization and outside the accesible healthcare information system. In consequence, there is fragmentation and delocalization of mental health care. An innovative approach consists of a dedicated mental healthcare unit within the prison with continuous psychiatric supervision of imprisoners with SMI and good quality psychiatric care. Schizophrenia and hyperactive attention deficit disorder persons benefit the most. Continued mental health care in the community remains a challenge. Another model of care is centred in the SMI imprisoned person. Acute and rehabilitation psychiatric penitentiary units operate within a network of mental health and social care resources in the community, coordinated by a liaison nurse. Individualised care plans keep SMI persons in their social environment. Costs of implementation are high. Clear definition of roles; investment in dedicated staff and shared information systems are challenges to overcome.

Innovative models of mental health care are needed to benefit imprisoned persons with a SMI in Spain. A decided national and regional will is paramount to overcome challenges.

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Three generations of antipsychotics, all of which are based on the dopaminergic hypothesis of schizophrenia, are available for clinical use. Still, more than 66% of the patients diagnosed with schizophrenia spectrum disorders (SSD) could not achieve remission. Also, the glutamatergic hypothesis of schizophrenia is supported by translational models of this disease, even if the antipsychotics derived from this conceptual framework are not yet available on the market. However, the need for new pathogenesis models for schizophrenia and new generations of antipsychotics is acute, therefore, an exploration of the antipsychotics in the pipeline could be helpful in understanding the current stage of research in schizophrenia.

To assess the evidence supporting the potential benefits of new antipsychotics in the pipeline.

A literature review was performed through the main electronic databases PubMed, Cochrane, Clarivate/Web Of Science, and EMBASE) and clinical trials repositories (US National Library of Medicine and World Health Organization Clinical Trials Registry Platform) using the search paradigm “antipsychotics” AND “schizophrenia” AND “non-dopaminergic” AND “non-glutamatergic”. All papers published between January 2010 and September 2022 were included.

Xanomeline/trospium (xanomeline is a muscarinic M1/M4 receptor agonist at the central nervous system, while trospium limits its peripheral effects) was efficient for schizophrenia in one phase III clinical trial. Pimavanserin (a selective 5HT2A inverse agonist and antagonist) was efficient in improving negative symptoms of schizophrenia in a phase II trial. Roluperidone (a 5HT2A and σ2 receptor antagonist) has been associated with favorable results in phase III clinical trials, mainly on negative symptoms of schizophrenia. SEP-363856 is a TAAR-1 agonist and 5HT1A agonist, currently explored in phase III clinical trials for schizophrenia. MK-8189 is a phosphodiesterase 10A inhibitor, investigated in phase III clinical trials for schizophrenia.

Based on the retrieved data in the literature, multiple mechanisms, other than glutamatergic and dopaminergic pathways, are currently being investigated, and many of the antipsychotics based on these mechanisms are in the advanced stage of research. This is important not only for the clinical need to find more efficient and tolerable drugs for patients with schizophrenia but also because they may shed new light on the pathogenesis of this disease.

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In this work, I will try to approach birth and growth from my stay in therapy groups, including psychotherapy in multi-family groups from a simple observer, to a driver, alone and in co-therapy, to a member of the experience, to a driver member.

Explain why we are interested in our work center in multifamily therapy groups

Qualitative and narrative of the course of my experience in group therapy over 25 years

Based on my experience, I do not see any probability that coordination/direction will be achieved at the same time as symmetry in participation. Knowledge is power, said Foucault, so I must divest myself of my knowledge in order not to have power, and that power be executed by each of the participants with her own life.

It is in this process that I have been going through, it makes me think to what extent one makes the effort, I have made the effort not to be in the place of excluding the other, the other sick, of segregating him, as if to feel that I have a place of healing, the other must be someone who is the object of being healed. We have the possession of knowledge, to give light to others, in this disciplinary society, of disciplining in prison institutions, as Foucault would say, prisons, hospitals, army.

In this group work, multi-family, we must go to the singularity of the participants, to make them stand out, to get out and overcome the need for those relatives, who prevent them from growing and thawing, and roughly, hold on and take out the healthy virtuality , but that does not mean that we will achieve, even if we get out of the stereotyping and the sickening circle, that we have arrived at what is healthy, because in some way it will end up being just the way in which we look at what is healthy.

In this process, not only do the participants change, but we do too, because otherwise, we would be in a stereotype, regarding our role and the institution itself.

The mentally ill is not only a justification of families, but of society itself, and that other, that other excluded, will be determined by the historical period itself, and social context, the sick of today were not those of the past nor will they be those of the future.

Power, as Foucalt would say, entails resistance, and what is our resistance, that is the question I ask myself, resistance is needed so that power can establish itself, think about counter-power, fissures so that things are renewed, and that is actually what is sought in groups, to work from the cracks of the established

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