Positive psychiatry is broadly defined as the science of understanding and promoting well-being through interventions that involve positive psychosocial characteristics (PPCs) in people suffering from, or are at high risk of developing mental and physical illnesses (Jeste et al. JCP 2015; 76 675-683). Over the past 3 years, as the pandemic tested the limits of what our minds and bodies can handle, there has been an upward trend in the incidence of mental health conditions, including overdoses, suicide, and substance use (Czeisler et al. MMWR 2020; 69 1049-1057). COVID-19 has highlighted the relationship between the environment and individual mental health, most notably as people have faced increased social isolation, loneliness, and stress (Jeste. SB 2022; 48 533-535). The tools of positive psychiatry can be utilized to further address and target these deteriorations in mental health in hopes of improving outcomes.

To educate about the modality of positive psychiatry and how it can be an especially critical tool in treating mental health in the post COVID-19 era. To advocate for the incorporation of positive psychiatry practices into the training curriculum of mental health care providers.

A literature review was conducted using Google Scholar and Pubmed databases with the term “positive psychiatry” in the title. The search showed 26 results, including 6 systematic reviews and 1 clinical trial. Subsequent searches of “COVID-19” and “mental health” were conducted to create formulations and recommendations for the post COVID-19 era.

Growing evidence shows that PPCs are modifiable constructs that may be associated with improved mental and physical health outcomes. Research during the pandemic has demonstrated that PPCs such as resilience and optimism moderated the trajectory of OCD, depression, and anxiety, and that those with more resilience and optimism displayed lesser decline in their function (Hezel et al. JPR 2022 150 165-172). Beyond mental health, various PPCs, such as social support, have also shown positive outcomes in medical conditions such as hypertension and cardiovascular disease, and ultimately improved well-being (Jeste et al. JCP 2015; 76 675-683).

Based on our literature review, practices of positive psychiatry in conjunction with traditional psychiatry can serve as an invaluable modality in treating patients with various psychiatric conditions and improve mental health outcomes. These positive factors have historically been under-recognized among individuals with or at-risk for mental illnesses. As social distancing, fear of the “unprecedented” and loss of agency became more prevalent over the past couple years, the need for tools to target these notions increases. Further research into optimal incorporation of positive psychiatry into routine clinical practice can help address the trends in mental health brought on by the pandemic.

None Declared

A new mental health service specialising in intellectual disabilities in Ireland was set up in January 2022. Its current compliment of staff includes is a Consultant Psychiatrist, Trainee Psychiatrist, Social Worker and Administrator. The current National Directive in Ireland is to prioritize Mental Health of Intellectual Disabilities services.

The aim of the project is to establish the current baseline level of diagnostics and interventions within the new service. Our aim is to develop this service by implementing and following the gold standard guidelines and determine what extra resources does the service need.

The first fifty case notes of patients assessed by the new service were inspected. The reviewer looked for evidence of the following clinical descriptions:Diagnosis of Intellectual Disabilities and its severity; Mental Capacity; Psychiatric Diagnoses; Physical health diagnoses; Medications and evidence of a Positive Behavioural Support Plan to manage complex challenging behaviours.

The fifty patient audit contained 38 (76%) men and 12 (24% women) . One patient had Mild Intellectual Disabilities (ID), 39 (78%) had Moderate ID and 10 (20%) had Severe ID. All patents were very vulnerable and had limited or lacking Mental Capacity. Common diagnoses of the following were recorded in the following numbers and percentages; - Autism diagnosis 30 ( 60% ); Epilepsy 19 (38%); & Down Syndrome 9 (18%). A Formal Psychiatric diagnosis was identified in 26 (52%) of patients. Challenging Behaviour (severe and complex) was identified for 41 ( 82%) of the patients. The full breakdown of psychiatric diagnoses was ‘Psychotic illness’ – 9 (18%); Anxiety – 7(14%); Bipolar Affective Disorder 5 (10%): Depression – 4(8%); Attention Deficit Hyperactivity Disorder (ADHD) 3 (6%); Obsessive Compulsive Disorder (OCD) – 2(4%); Dementia – 2(4%): Post Traumatic Stress Disorder (PTSD) – 1 (2%); & Schizoaffective Disorder 1(2%). A Positive Behavioural Support plan (PBS) was available to support 33 (66%) of patients.

42 (84%) of patients were prescribed antipsychotic medication. 12 (24%) were prescribed more than one antipsychotic. 20 (40%) were prescribed an antipsychotic without a formally documented diagnosis of a psychotic disorder. 12 (24%).

The results of this first survey highlight areas in which the service can be improved. The service has requested funding for a Community Nurse and a Psychologist. Psychological evaluations and Positive Behavioural Support plans are essential for people with complex challenging behaviours. A Community Nurse should assist with Health Promotion and help supervise patients requiring Depot Antipsychotic medication or Clozapine. We also plan to set up a joint clinic with the Consultant Neurologist on a regular basis.

None Declared

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.

None Declared

Specific phobia is an excessive and unreasonable fear of an object or situation that does not represent a real danger. This disorder is widespread among the population. The suffering from the feared situation disturbs the individual’s habits and professional activities.

We report the case of a driving phobia in a professional driver.

Case report

The man was 32 years old, a smoker at 5 PA. He had no family or personal psychiatric history. He has been a Dumper machine driver in a phosphate extraction company since 2011. He presented to our institute for a fit-to-work assessment. The history of the disease dates to 2019, the patient had witnessed a work accident that caused the death of his colleague (engine driver). Since this accident, he had a state of anxiety associated with tachycardia, a feeling of suffocation, excessive sweating and headaches. This symptomatology occurred suddenly while driving and prevented the patient from performing his professional task. At the psychiatric interview, the patient had coherent and dynamic speech without psychomotor slowing. The rest of the clinical examination was normal. The patient had been referred to a psychiatrist. The diagnosis of a specific phobia had been retained. Given the anamnestic and clinical data and the opinion of a medical specialist, the patient had been placed on temporary incapacity for the driving position. A reassessment of his medical fitness for the position of the driver will be made after the end of the psychiatric intake.

Professional conduct is a complex task that requires the integrity of physical and mental abilities. The assessment of medical fitness for this position is essential for road safety. However, it can sometimes be difficult, especially in the face of psychiatric pathologies.

None Declared

Personality functioning, self-disorders and their relationship to psychotic symptoms on a continuum from mild attenuated experiences to manifest psychotic symptoms in psychotic disorders are highly relevant for psychopathology, course of illness and treatment planning in psychotic disorders, but empirical data is sparse.

This study aims at exploring personality functioning and self-disorders in individuals at ultra-high risk for psychosis (UHR) and with first-episode psychosis (FEP), compared to a clinical control group of subjects with borderline personality disorder (BPD) and healthy controls (HC).

Personality functioning was measured in 107 participants (24 UHR, 29 FEP, and 27 BPD and 27 HC) using the Structured Interview for Personality Organization (STIPO) and the Level of Personality Functioning Scale (LPFS), and self-disorders were assessed using the Examination of Anomalous Self-Experience (EASE). A hierarchical cluster analysis was performed based on the seven STIPO dimensions.

Significant impairment in personality functioning was found in UHR (M = 4.29, SD = .908), FEP (M = 4.83, SD = 1.002), and BPD individuals (M=4.70, SD=.542) compared with HC (M = 1.63, SD = .565). FEP patients showed significantly worse overall personality functioning compared to UHR patients (p = .037). Patients with manifest psychosis (FEP) also exhibited significantly higher levels of self-disorders compared to BPD patients (p = .019). Self-disturbances in patients with milder forms of psychotic symptoms (UHR) were intermediate between the other diagnostic groups (FEP and BPD). Regardless of the main diagnoses, the three clusters of patients were found to differ in levels of personality functioning and self-disorder.

Impairment of personality functioning varies in different stages of psychotic disorders. The level of self-disorders may allow differentiation between manifest psychosis and borderline personality disorder. An in-depth assessment of personality functioning and self-disorders could be helpful in differentiating diagnoses, treatment planning, and establishing foci for psychotherapeutic treatment modalities.

M. Gruber: None Declared, J. Alexopoulos: None Declared, K. Feichtinger: None Declared, K. Parth: None Declared, A. Wininger: None Declared, N. Mossaheb: None Declared, F. Friedrich: None Declared, Z. Litvan: None Declared, B. Hinterbuchinger: None Declared, S. Doering: None Declared, V. Blüml Grant / Research support from: Grant / Research support from: Heigl-Foundation, Köhler-Foundation, International Psychoanalytical Association (IPA)

The Psychiatry Foundation Fellowships were created by the Royal College of Psychiatrists (RCPsych) as a route to encourage foundation doctors to consider psychiatry as an exciting medical discipline.

This study aimed to explore the Psychiatry Foundation Fellows’ experience of applying to the Fellowship, their expectations prior to being appointed, the benefits of the fellowship, the barriers to gaining those benefits, any common factors raised, and any suggestions about how to improve the fellowship.

The researcher was a leadership fellow in medical education and simulation in the Foundation school of East of England. Ethical approval was obtained through Higher Education England as this was a service evaluation. Recruitment was purposive and participants were contacted by a gatekeeper. Four 1:1 interviews took place, the interviews were audio recorded, transcribed and the transcripts were analysed with thematic analysis.

Preliminary Themes

The Psychiatry Foundation Fellowship was generally a positive experience in terms of fostering enthusiasm for psychiatry. A sense of community among fellows and recognition among clinical supervisors in acute trusts were felt to be lacking. The themes were used to shape RCPsych’s future plans for the Psychiatry Foundation Fellowship.

None Declared

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.

None Declared

Research suggests that the COVID-19 pandemic and related stressors have triggered OCS for many individuals. However, the extent to which the pandemic and related stressors have influenced OCS seems to vary by individual factors, with some individuals being at greater risk than others. Despite the well-known role of cognitive inflexibility as a marker of risk for OCS, no study to date has examined the extent to which it influences individual susceptibility to developing OCS during the current pandemic. Toward this aim, the current study examined whether cognitive flexibility moderates whether exposure to COVID-related stressors is associated with OCS. Research suggests that the COVID-19 pandemic and related stressors have triggered OCS for many individuals. However, the extent to which the pandemic and related stressors have influenced OCS seems to vary by individual factors, with some individuals being at greater risk than others. Despite the well-known role of cognitive inflexibility as a marker of risk for OCS, no study to date has examined the extent to which it influences individual susceptibility to developing OCS during the current pandemic.

Toward this aim, the current study examined whether cognitive flexibility moderates whether exposure to COVID-related stressors is associated with OCS.

Participants were 169 students (age = 22 years, 62% female) from two student cohorts at Monash Business School who reported experiencing current OCS symptoms. All cohorts completed an online visual search task to measure flexibility of reward-related attentional capture (as an index of cognitive flexibility; measured using the VMAC-R task) and questionnaires gauging exposure to COVID-related stressors, pre-pandemic OCS, and current/lockdown OCS. A negative binomial regression examined the extent to which a) number of COVID-related stressors, b) cognitive flexibility, and c) their interaction was associated with lockdown OCS, adjusting for pre-COVID OCS.

The interaction between COVID-related stressors and cognitive flexibility was significantly associated with OCS (p = 0.048). Follow-up analyses showed that this interaction was driven by exposure to COVID-related stressors being associated with greater OCS among individuals with high cognitive inflexibility scores only (p = .029). Among cognitively flexible individuals, we did not find a relationship between COVID-related stressors and OCS (p = .470).

The result of this study highlight the role of cognitive flexibility as a potential moderator between COVID events and OCS. Critically, these findings have implications for detecting who is at risk of developing OCS following exposure to COVID-related stressors, and suggest that future interventions aimed at modifying cognitive flexibility may hold promise for boosting resilience against the effects of COVID-related stressors on OCS.

None Declared

Mental health awareness campaigns in the past few years have vastly improved how medical professionals treat mental health patients. However, prejudices and ignorance still interfere in medical practice. In this context, with the case presented we can see that even in presumed mental health diagnoses along with cultural factors (race, language…), the best medical assistance is not ensured.

Review how different intersectional factors can determine the treatment patients receive at hospitals.

Presentation of a patient’s case and review of existing literature, in regards to the influence of race, language barriers and mental health diagnoses when attending patients.

The patient is presumed to suffer from a mental health condition after a battery of initial tests with inconclusive results do not demonstrate an organic origin. Instead of continuing with the medical study, the patient is disregarded as psychiatric even though his profile doesn´t fit beforehand of a fictitious or conversion disorder. The fact that there are also cultural factors in play (race and language) probably unconsciously influence how the medical team treats this patient’s case. Cultural social factors persistently present as barriers in clinical practice.

Race, language barriers and mental health diagnoses as well as other intersectional factors do have a great impact in the treatment patients receive. There is yet a lot to do when it comes to educating health professionals if we want to offer the best medical assistance.

None Declared

Alcohol Use Disorders (AUDs) are highly prevalent psychiatric disorders with often a poor treatment outcome in terms of high dropout rates and relapses. A vulnerability to disinhibition or a lack of self-regulation/low Effortful Control (EC) seems to be a core risk factor associated with both the initiation and continuation of AUDs. EC is the regulative dimension of temperament that involves attentional control, inhibitory control and activation control, and reflects self-regulation abilities that develop later in life parallel with the maturation of the prefrontal cortex.

In this study we want to investigate whether EC, operationalised in terms of self-report and in terms of behavioral measures, can predict relapse. When a low EC indeed turns out to be a significant contributor to relapse, treatment interventions aiming at strengthening EC could result in better treatment outcomes and less relapse in AUD patients.

The sample consisted of 75 adult patients with AUD (68.9% males, mean age 47,4y) admitted at a specialized, inpatient treatment unit for addiction. To assess the regulative temperament dimension, we used the Effortful Control Scale (ECS) from the Adult Temperament Questionnaire Short-Form), a self-report questionnaire as well as five behavioral/neuropsychological tasks using the Cambridge Neuropsychological Test Automated Battery: Cambridge Gambling Task (CGT), Stop-Signal Task (SST), Intra-Extradimensional Set Shift (IED), Spatial Working Memory (SWM) and Spatial Span (SSP).

We performed binary logistic regression analyses with EC/CANTAB measures as predictors and relapse/no relapse (during treatment and after 3 months follow up) as dependent variable. According to these analyses, the self-report measure of EC nor the behavioral tasks CGT, SST, SWM and SSP (CANTAB) were able to significantly predict relapse neither during treatment nor after 3 months follow-up. Only the IED (outcome measure stages completed) was significant in predicting relapse (p<0.05) during follow-up.

In our study we investigated whether self-regulation as measured by self-report questionnaires and behavioral tasks could predict relapse during treatment and after 3 months follow-up in a sample of inpatients with AUD. In contrast to some findings in literature, in our sample most of the used measures were not able to predict relapse. One hypothesis for these findings is that our sample of inpatients at a specialized addiction treatment unit is too homogeneous, all presenting lower levels of self-regulation. Future research should thus focus on larger samples and less homogeneous population. Only the IEC (outcome measure stages completed) was able to predict relapse during follow-up.

None Declared

The suicidal phenomenon constitutes a real public health problem not only by the human losses it causes, but also by the psychological and social problems to which it testifies.

The objective was to describe suicide attempts in patients hospitalized in the emergency room.

A descriptive cross-sectional study was carried out with patients admitted to vital emergencies for attempted suicide over a period of 6 months.

We excluded Patients with major cognitive impairment, which prevents understanding of the questionnaire

A data collection sheet was used for the evaluation of the suicide attempts.

Our sample consisted of 101 suicide attempts. Using non-physical methods (drugs, caustics, pesticides, gases) was reported in 91.9% of cases and while physical methods (hanging, phlebotomy, drowning) in 8.9% of cases. Self-poisoning by medications was the most frequent (51%) method used in suicide attempt. The majority of suicide attempts were reactive (77.2%). Family or marital conflicts were the precipitating factor most mentioned (74%). The suicidal act was unpremeditated in 66% of cases. Communication of suicidal intent either verbally or in writing was reported in 34.7% of cases. The passage to the suicidal act was preceded by taking alcohol in 7% of cases and cannabis in 3% of cases. In 44.6% of cases, regret was the attitude most adopted by suicide attempters towards the act. The somatic state on admission was unstable on the cardiac level in 23% of the cases, on the respiratory level in 27% of the cases and on the neurological level in 38% of the cases

The data from our study suggest that suicidal attempts were mostly unpremeditated. Clinicians should not minimize the significance of impulsive attempts, as they are associated with a similar level of lethality as premeditated attempts

None Declared

Patients’ cooperation, especially in medication taking, constitutes a significant challenge in psychiatric care. Psychiatric patients are often reluctant to take a specific pharmacological treatment because of side effects. Akathisia and other extra pyramidal symptoms are side effects that could result into real danger and are thought to be the main reasons of discontinuing pharmacological treatment. Despite this, some gaps in research knowledge exist on the rate of psychiatric patients that suffer from Akathisia. For example, Clozapine treatment, despite its efficacy, is often disqualified due to side effects concern. The research literature barely refers to the development of extrapyramidal symptoms, and more specifically Akathisia. There are few reports about Akathisia when taking Clozapine. It results into a lack of objective studies and knowledge based only on subjective clinical evaluations.

This study aims at comparing Clozapine and Risperidone in general, with or without polypharmacy and more especially, in terms of Akathisia.

This research was carried out in Abarbanel Mental Health Center over a period of six months. The study population included 100 patients, including hospitalized and ambulatory patients. They were equally divided into two groups: 50 patients who received Clozapine, and 50 patients who received Risperidone. It should be noted that due to polypharmacy, 17 patients in the Clozapine group and 6 patients in the Risperidone group received additional anti-psychotic treatment. Akathisia was evaluated using Barnes Akathisia Scale (BAS).

The demographic and clinical data was found identical in both groups. We found that Akathisia symptoms appeared 1.4 times more in patients who took Risperidone only, compared to those who took Clozapine only (p < 0.05). This research emphasizes the irrelevance of existing data on anti-psychotics’ treatments, while 24% of the patients treated with Clozapine and 34% of the patients treated with Risperidone showed Akathisia symptoms.

Akathisia symptoms are very common in patients who take anti-psychotic treatment as Clozapine and Risperidone. Previous research revealed that Akathisia is very common for Risperidone patients, however the symptoms are often neglected in patients taking Clozapine. We show in our research that the rate of Akathisia is high in both treatments. Therefore, the importance of diagnosing akathisia should be emphasized in patients treated with Clozapine. Moreover, Akathisia should receive much more importance when choosing anti-psychotic treatment.

None Declared

Benzodiazepines (BZDs) have a broad spectrum of therapeutic effects, with undeniable efficacy and low toxicity/lethality. The high prevalence of anxiety and sleep disorders makes them one of the most prescribed drugs in the world.

We have chosen to focus on these drugs because of the interest they arouse nowadays due to the potential danger linked to their prolonged or abusive use, which can have major consequences on the state of health of populations.

The objective of this study is to evaluate the knowledge and attitudes of general practitioners in relation to the prescription of benzodiazepines, with a view to possibly proposing recommendations aimed at rationalizing the use of these drugs in Morocco.

The method used is therefore the semi-structured interview, lasting on average 40 minutes, a fairly free method which allows the collection of valuable information.

This method is relevant for analysing the meaning that prescribers give to their practices, to highlight the knowledge and reference points from which they orient themselves and determine their practices. It allows for a “continuous process of verification and reformulation of hypotheses”. As the survey progresses, new questions can be addressed.

A questionnaire was therefore developed and used as the basis for the interview. It included practical questions relating to the activity of the doctors, their practice in consultation, their training, their management of psychiatric pathologies, their knowledge of benzodiazepines, and finally, their opinion on the overprescription of this molecule.

The survey was conducted among 10 general practitioners, 8 of whom prescribed benzodiazepines for the treatment of anxiety, insomnia and depression.

The first molecule prescribed was alprazolam, for an average duration of more than three months.

To this end, several measures have been taken in some developed countries to regulate prescribing in order to improve proper use, control consumption and avoid misuse of these drugs.

None Declared

l’actualité de la recherche en psychiatrie se focalise sur la possibilité de nouvelles pistes de prise en charge notamment celles qui sont basées sur la chimiothérapie, et ce, en dépassant le spectre de la prescription des neuroleptiques.

L’actualité de la recherche en psychiatrie se focalise sur la possibilité de nouvelles pistes deprise en charge notamment celles qui sont basées sur la chimiothérapie, et ce, en dépassant lespectre de la prescription des neuroleptiques.

la place des anti-inflammatoires dans la prise en charge de la schizophrénie

Une étude publiée dans l’American Journal of Psychiatry suggère qu’une plus grande activité microgliale peut être un signe de schizophrénie. Ainsi, la détecter et la réduire pourrait être un élément de prévention de cette maladie. Une étude publiée dans l’American Journal of Psychiatry suggère qu’une plus grandeactivité microgliale peut être un signe de schizophrénie. Ainsi, la détecter et la réduire pourraitêtre un élément de prévention de cette maladie.

Il a été constaté qu’une activité microgliale élevée coïncide avec la réduction du volume de la matière grise chez les sujets atteints ou à risque de développer la schizophrénie. Ce paramètre est aussi un signe de gravité symptomatique chez les patients atteints de cette maladie.

Il a été constaté qu’une activité microglialeélevée coïncide avec la réduction du volume de la matière grise chez les sujets atteints ou à risquede développer la schizophrénie. Ce paramètre est aussi un signe de gravité symptomatique chezles patients atteints de cette maladie.

Cette étude ouvre une nouvelle voie dans le traitement de la schizophrénie, par l’ajout au traitement de molécules ayant des propriétés anti-inflammatoires chez les patients présentant une résistance au traitement antipsychotique.

None Declared

Acute clinical deterioration in hospital inpatients can be caused by a range of factors including dementia, delirium, substance withdrawal and psychiatric disturbance, creating challenges in diagnosis, often requiring a management plan with input from multiple disciplines. Staff forums and broader literature have confirmed that healthcare staff working in non-mental health settings, may not be as skilled in recognising and managing early signs of emerging and/or escalating clinical agitation. The BoC RRT is a consultation service within the Division of Medicine and CL Psychiatry. Staffed by Medical Registrars and Mental Health Nurses, the collaboration provides a unique healthcare response to acute general wards. The BoC RRT has been implemented to address the rising number of incidences whereby staff and patient safety are compromised. Using evidence-based skills the team aimed to: respond to episodes of clinical agitation that require an internal security response, assist ward referrals by exploring biopsychosocial contributants to behaviour, develop individual patient support plans and review and reduce restrictive intervention practices.

To determine if the rapid response model has influenced:

- The impact on staff/patient safety

- Frequency of emergency responses for aggression

- Frequency of restrictive intervention use

This project was approved as a quality assurance project (QA2022018). The patients within scope of the BoC RRT include inpatients in medical and surgical wards. It excludes patients in Emergency Departments, mental health units, outpatient clinics, and visitors. The evaluation of the pilot has used a PDSA (Plan, Do, Study, Act) cycle when implementing new improvements. A mixed methods approach explored the impact of the BoC RRT. Staff consultation will identify challenges in responding to scenarios whereby there is risk of harm to staff and patients. Staff feedback and the emergency response data was monitored.

In 2021, there was approx. 720 code greys per month, requiring a security response. Since the implementation of BoC RRT, these numbers have reduced to 527. Reviewing restrictive intrvention practices has identified areas for policy review and need for education. Staff consultation found that nurses were confident caring for those patients exhibiting clinical agitation associated with delirium and dementia. However, caring for people with mental health or substance use disorders were more challenging.

These interim results indicate that BoC RRT has been generally well received by clinical staff. The decline in code grey responses indicates that it is likely having a positive impact in early identification and management of clinical agitation for hospital inpatients. There is support for this response model to continue beyond the pilot phase and further area for research.

None Declared

The problem of eating disorders has become increasingly important in recent years, due to the increase in the number of cases among children and adolescents, as well as the insufficient effectiveness of therapeutic measures. An important role in the course of eating disorders is occupied by the depressive syndrome associated with it, which complicates the process of treatment and rehabilitation in this pathology.

Study of the stages of treatment of eating disorders in the structure of depressive states.

The sample consisted of 63 patients aged from 15 to 25 years old (all female, average age 16.2), who were on outpatient and inpatient observation in the clinic were studied.

In the process of treatment, several stages of treatment of patients were carried out. The first stage was aimed at normalizing the body’s vital functions and management of somatoendocrine impairments (the duration of the stage is about 14 days). The next stage was aimed at the psychotropic treatment of eating disorders and concomitant mental pathologies (the duration of the stage is 3-4 weeks). The final stage included rehabilitation, which consisted of working with a psychotherapist (the duration of the stage was 8 weeks or more). It should be noted that in the process of rehabilitation, patients continued to receive psychopharmacotherapy and underwent a comprehensive examination to assess the dynamics of their condition.

Eating disorders in the structure of endogenous depressions require an integrated approach to treatment, including both ensuring adequate vital activity of the organism and the selection of drug treatment depending on the nosological affiliation of the underlying syndrome. Rehabilitation work aimed at social adaptation and prevention of relapses of the disease also plays an important role.

None Declared

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.

None Declared

Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions.

This presentation aims in summerizing the current research on VR in the treatment of mental disorders.

Selective literature search in PubMed and Google Scholar.

An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance.

VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.

N. Tsamitros Grant / Research support from: Berlin Institut of Health (BIH) through the Digital Health Accelerator Program

Pandemics affect the mental health of individuals as they cause specific reactions throughout society due to the measures taken to contain them, which lead individuals to change their behaviour and habits and generally change their daily routine and lifestyle. In addition, the real or perceived threat of the virus and what it may cause exacerbates the anxiety and stress experienced by individuals.

To assess the psychological distress experienced by the Greek population due to COVID-19 and to investigate the possible determinants that contributed to negative psychological experience.

Methodology: A synchronic study was conducted involving 200 participants from different regions of Greece. Data collection took place from October to December 2021. The mean age of the participants was 33.5 years. 76% of the participants had a family and/or friend who had COVID-19, while 27.5% of the participants had a family and/or friend who was hospitalized in the ICU due to coronavirus. The Impact of Event Scale-Revised (IES-R-Gr) questionnaire, adapted for COVID-19, was used to assess mental disorders

40% of participants had no symptoms of PTSD. 14.5% of participants had symptoms of PTSD and 45.5% of participants had a probable diagnosis of PTSD. Women, participants with worse self-assessed health status and participants who had a relative and/or friend hospitalized in ICU due to COVID-19 experienced worse health outcomes due to the pandemic (p<0.001). In addition, women and participants, who had a family and/or friend who was hospitalized in ICU due to COVID-19, were more worried about the pandemic, while participants with worse health status assessment had more nervousness due to the pandemic.

Pandemic is an unprecedented situation experienced by people and has an impact not only on the physical but also on the mental health of the population. Therefore, special attention should be paid to the impact of COVID-19 on the mental health of the population and measures should be taken to protect the mental health of individuals.

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Acute mental health presentations such as suicidality or psychosis are frequently accompanied by intoxication, substance use disorder, deliberate self-poisoning and social crises. There is a need to break down silos and provide integrated multi-disciplinary acute care for such individuals.

Here we describe outcomes of the Psychiatry And Drug ANd Alcohol (PANDA) Unit, a unique physical space collocated with the emergency department (ED) along with a unique model of care, providing multidisciplinary care to individuals presenting with acute mental health concerns plus complex comorbidity.

A description of the PANDA model of care and Service characteristics along with process and outcome measures across the first 12 months that the PANDA Unit was operational. These include number of patients admitted, patient demographics and characteristics, length of stay, referral destinations and impact on the occurrence of behavioural disturbance across the ED.

PANDA opened in November 2020 and since then has admitted an average of 122 patients per month (15% Aboriginal) with an average bed occupancy of 79% and average length of stay of 1.3 days. An average of 12% of patients were scheduled under the mental health act and an average of two patients were stepped down from ICU each month, with the remainder being admitted via the ED. An average of 80.7% of these were discharged home directly while 7.2% were transferred for inpatient withdrawal management and 8.9% to inpatient mental health services. The top three substances of concern were alcohol methamphetamine and heroin and an average of 16.5% of people reported injecting drugs in the prior 3 months. An average of 37.8% patients had been seen by an emergency physician and admitted to the PANDA Unit within 4 hours, one of the best performing units hospital-wide. In the 6 months prior to PANDA becoming operational there was a median of 20 episodes of behavioural disturbance requiring restraint per month across the ED. This dropped to 12 episodes in the six months following the PANDA Unit opening.

The PANDA Unit model of care has proven feasible to implement and has made a positive impact on a previously underserved patient population. It has also contributed to improving the integration of care for mental health patients with comorbidity as well as reducing behavioural disturbance and improving patient flow across the emergency department.

None Declared