Alcohol consumption is part of the global youth culture and represents a dimension of young people’s social identity. Even if at-risk drinking in the young population is lower in Italy compared to other countries, the increasing complexity and changes in global values may influence risky behaviours, which therefore require attention and preventive strategies.

The intervention followed a pilot named The Vineyard Project, which engaged a group of young mental health service users in local practices of hand-harvesting grape. The initiative was hosted in the wine-producing area of Langhe (Italy), which shows lower rates of at-risk drinking also due to the protective role played by the cultural dimension of winemaking craft. The pilot inspired a peer led-intervention in a local high school, acknowledging the crucial role that educational settings play in the lives of young people and the relevance of peer influence on adolescents’ behaviours.

Semi-structured interviews with young people participating in the Vineyard Project have been conducted, audio-recorded and shared with high school students (n=80) to become the object of dedicated workshops. Interviews explored participants’ experience in the vineyard, the relationship they developed with the vines and with professional vine growers, their role in the winemaking process, and the emotional and sensorial contents of their immersion in the viticultural landscape.

The peer-led intervention showed promising results in producing benefits beyond the group of young people directly involved in the vineyard activities. By narrating their experiences through the interviews, participants acted as cultural mediators with the students who subsequently listened to their stories. Their narratives represent unusual accounts of the world of wine and its production, drawing on the perspective of non-expert, young people that are not familiar with the viticultural landscape. The embodied knowledge they could learn from professional vine growers, concerning the harvest as well as other activities of care for the vines, contribute to portray wine as a cultural product, which is the result of traditions handed down from generation to generation, hard work, competent interventions on the vines and the other living beings of the vineyard. This unusual perspective on wine was perceived as particularly surprising for students who lived in the area, who became so acquainted with the viticultural landscape and the discourses around its products to the point of taking it for granted in a non-reflexive attitude.

Findings suggest that peer-led interventions concerning wine and other drinking products, narrated in their cultural dimension (e.g. their story, identity, local traditions, practices and the tacit knowledge implied in their production), may encourage a limited and competent consumption among young people.

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Clozapine is an effective Atypical antipsychotic used in the treatment of resistant schizophrenia .However it can induce liver dysfunction from a simple transient asymptomatic cytolisis (30 to50 %) toa serious fulminant liver failure (0.001 %).

To show the heptotoxicity potential of Clozapine and adress the importance of monitoring the liver function tests in clozapine titration to prevent sever conditions

A case report of a fifty-year old Tunisian male patient diagnosed with resistant schizophrenia who developed a hepatototoxicity under a low dose of clozapine within five days of treatment .

Mr F is a 50 year old patient diagnosed with schizophrenia in 2018 . He had received various antypical and typical antipsychotic treatments including ( Haloperidol , Risperidone , Amisulpride , Olanzapine ) at effective doses and minimal periods of six weeks . He had no history of systemic diseases or substance use disorder . He smokes 10 cigarettes a day . He had a history of hepatotoxicity on olanzapine. These medications have failed to resolve the persecutory delusion and auditory hallucinations , and the trial of clozapine was institued . Baseline examination and laboratory tests were normal . The previous antipsychotic medication was not continued and a dose of 25 mg clozapine was administred . A marking drowsiness was present in the fisrt days , so we decided to keep the same dose . Five days later , he had high levels of Liver function test (LFT) : Elevated aspartate ( 5 times above normal) and alanine aminotransferase levels (4 times above normal ) , white blood cell count and bilirubine levels were normal . He had no fever or jaundice . The abdominal examination showed a mild sensiblity in the right upper quadrant . Clozapine was immediatly discontinuated . 24 hours later LFT continued to escalate to 5 times greater then normal . Then it decreased continueosly

Clozapine has a potential of hepatotoxicity even at lower dose . Screening liver function tests must be integrated in survey recommendations of clozapine treatment . Further researches must be conducted to understand the mechanism of this side effect in order to avoid sever conditions .

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Depression is predicted to become one of the major sources of disease burden worldwide, leading to numerous adverse consequences that complicate the daily rhythm of life. Non-adherence is a serious issue in patients suffering from depression. Premature discontinuation of treatment is repeatedly encountered in depression, bringing on to increased disease severity, greater number of relapses, more hospitalizations and decreased remission rates. Given the impact of medication non-adherence among patients with depressive disorders, it is important to recognize factors associated with non-adherence and find ways to influence them.

Our objective was to find out the frequency, as well as potential differences in self-reported psychological distress of medical adherence in patients diagnosed with major depressive disorder.

Sample consisted 83 patients (Mage = 45.4, SD = 14.8, 76% were female, 24% were male) with major depressive disorder (MDD) hospitalized at the Clinical Department of Crisis and Affective Disorders. After the informed consent of patients, the following assessment tools were administered: A socio-demographic questionnaire, Mini International Neuropsychiatric Interview (M.I.N.I.-6), Depression Anxiety Stress Scales (DASS-21), and The Morisky Medication Adherence Scale (MMAS-8).

Thirty-three (39.8%) patients were considered non-adherent (MMAS-8 adherence score < 6) while 45 (54.2%) had moderate adherence (MMAS-8 adherence score < 8) and 5 (6%) high adherence (MMAS-8 adherence score = 8) to their medication respectively. Negative associations were found between medication adherence and self-reported levels of depression (r = -0.30, p < 0.01), anxiety (r = -0.29. p < 0.01) and stress (r = -0.31, p < 0.01). One-way ANOVA yielded significant variation on the self-reported anxiety subscale of the DASS-21 questionnaire among adherence groups of patients with MMD (F (2,80) = 3.73, p < 0.05, η2 = 0.26). A post hoc Tuckey test showed that the non-adherent and moderate adherent groups of patients significantly differ on the level of experienced anxiety; the high adherence group was not significantly different from other two groups. Results indicate that the non-adherent group generally experiences more symptoms of anxiety than the moderate adherent group.

Patients with major depressive disorder show significant non-adherence to medical treatment. More research is needed in this direction, as well as the development of recommendations and strategies to improve the level of adherence in this group of patients.

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In modern society, mental health in the workplace is increasingly considered an im-portant issue and a major political agenda. Many studies have reported negative mental health risk factors or psychopathologies such as depression, anxiety, and suicidal inclination among workers. Accordingly, there are ongoing debates on the importance of establishing a system to screen and treat psychopathologies, such as the assessment of depression and anxiety. However, the absence of psychopathology or negative psychiatric factors does not guarantee good mental health. Mental health is a more comprehensive and complex concept. According to the World Health Organization, mental health is the state in which an individual can cope with routine stressors in life, work productively, and contribute to their organizations. Hence, it is needed to directly measure workers’ mental health in terms of happiness and life satisfaction.

To comprehensively investigate workers’ mental health, we explored factors associated with happiness and life satisfaction among workers using nationally representative data.

We performed multiple regression analysis, with happiness and life satisfaction set as the outcome measures, and sociodemographic factors and work-related factors as the predictive variables.

A total of 7,797 participants (4,428 men [56.8%]) with a mean age of 46.58 years (SD = 13.50) were included in the analysis. Job satisfaction (β = 0.154, p < 0.001) and self-rated health (β = 0.175, p < 0.001) were the most strongly associated with happiness. Organizational commitment, region of work, average monthly income, education level, and number of guaranteed leaves were also strongly associated with happiness and life satisfaction. Life satisfaction had the highest adjusted R2 at 0.423. The adjusted R2 for happiness and the ladder approach were 0.283 and 0.213, respectively. The variance inflation factor was below 10, and residuals were below 0.1 for all predictor variables.

Our results indicated that personal and work-related factors were associated with the happiness and life satisfaction of workers. Among work-related factors, subjective, intrinsic rewards such as job satisfaction and organizational commitment were more strongly associated than external rewards such as average monthly income or guaranteed vacations. These findings may be useful foundational data in devising policies and interventions to promote workers’ happiness and life satisfaction.

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Despite the critical role of motivation in psychosocial treatment and rehabilitation, as well as functional outcomes in schizophrenia, service user voices are not always present in setting research agendas on this topic. This is important since the service user’s involvement in the research process helps prioritize research questions (Wykes et al., 2015).

We have begun a consultation process to bridge the gap between research and practice on ‘motivation in schizophrenia.’ The study’s main objective was to produce the means to increase motivation in schizophrenia from the perspective of users.

In the current study, we asked the service users about the priorities for ‘motivation and schizophrenia’ research and also suggested involving service users in research itself as partners. Expert Panels with peer leaders previously involved in psychosocial rehabilitation programs took place. A total of 12 Panels (group meetings) were held during the year with three users (schizophrenia spectrum outpatients) aged 45, 47, and 50, male. The reports were analysed using content analysis to generate main themes and findings (Braun & Clarke, 2006).

The users’ elements of motivation may differ from organizationally defined ones; this may be related to different opinions and ethical standards among clinicians on patients’ autonomy and right to refuse treatment. A discussion of the topics patients have developed to improve the motivation, engagement, and management of patients with schizophrenia in psychosocial treatment and rehabilitation is presented.

The approach successfully generated items for questionnaires that usesr participants declared with a sence of pride in and ownership of. It is, therefore, possible to create measures of motivation that users feel reflect their understanding and experiences. The outcome of this research is that other Russian researchers will be inspired to follow the same patrnership path and encourage service users to participate rather than be subjected to research.

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Research shows the benefits of music therapy for various mental health conditions, including depression, trauma, and schizophrenia. Music acts as a medium for processing emotions, trauma, and grief.

Playing instruments can encourage emotional expression, socialization and exploration of various therapeutic themes (i.e. conflict, communication, grief, etc.).

Group music therapy, measured by questionnaires and described in qualitative interviews, improved quality of life and self-esteem for people with severe mental illness (SMI).Group singing and song writing provide creative options for social connections. Music therapy should be considered as a component of holistic care for people with SMI. Jungup Lee, Thyer BA. May 2013Journal of Human Behaviour in the Social Environment 23(5):597-609

Music therapy sessions are held in our hospital for people admitted to short-term hospitalization units and to psychosocial rehabilitation units. The goal of the sessions is to create a connection space, promote people’s confidence in their own resources for their recovery, and evoke valuable experiences and memories. Sometimes musicians from the community have been present in the sessions, contributing to overcoming the stigma towards mental illness.

We describe self-assessment of people admitted to psychiatric units after attending music therapy sessions. People from brief hospitalization unit filled out a survey, after each session, voluntarily, about their emotional state at the beginning of the session and after it. People from rehabilitation units, voluntarily filled the SRS V.3.0. 2002-Miller. Duncan & Johnson escale.The SRS was designed for use by clinicians to assess the therapeutic alliance during therapy (Duncan BL et al. The Session Rating Scale: Preliminary Psychometric Properties of a “Working” Alliance Measure JBT 3(1) 3-12 12/14/04 3:53 PM Page 3).

23 sessions took place for each unit. 39 patients from brief hospitalization, 22 women and 17 men, attended the sessions. 15 had a diagnosis of schizophrenia and related disorders, 13 were affective disorders, and 11 others diagnosis. All of them liked the participation either fully or partially. 76% men and 77% women felt better after, none of them reported to feel worse. 82% men and 86% women replied they would repeat the session.

Patients from rehabilitation units were 7 women and 10 men. 14 had a schizophrenia related disorder and 3 had bipolar disorder. All items on the scale were scored above 9 over 10, (I felt heard, understood, and respected/ We worked on and talked about what I wanted to work on and talk about/ The therapist’s approach is a good fit for me) with an overall score of 9,62 over 10 (Overall, today’s session was right for me).

Music therapy sessions achieve benefits on an emotional level in any of the diagnoses, improving alliance with care teams, who value sessions as normalizing spaces, helping to overcome stigma.

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Although the rates of response to first-line pharmacological treatments (serotonin reuptake inhibitors – SRIs) are generally twice that of placebo, only 40-60% of patients respond sufficiently or are able to tolerate traditional first-line pharmacotherapy. Augmentation with dopamine antagonist medications is associated with the strongest evidence, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Based on evolving pathophysiologic models of OCD, a variety of agents targeting serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Similarly, approximately 50% of patients do not respond optimally to first psychotherapeutic treatments including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP), even when combined with pharmacotherapy. The psychotherapy outcome literature is heterogeneous and very few psychological strategies have been developed specifically to treat treatment resistant OCD. However, a recent systematic review concluded that CBT improved treatment response in individuals with pharmacotherapy resistance. This presentation will present an update on the pharmacological and psychotherapeutic treatment of refractory OCD including novel strategies such as the use of psychedelics.

M. Van Ameringen Grant / Research support from: Elvium, CIHR,Hamilton Academic Health Sciences Organization, Consultant of: Abbvie, Bausch Health, Boehringer Ingelheim, Elvium, Jazz, Vistagen, Speakers bureau of: Abbvie, Elvium (Purdue), Lundbeck, Otsuka, Sunovion, and Takeda

Theory of Mind (ToM) is defined as the cognitive ability that infers other’s mental states (Premack & Woodruff. J Behav Brain Sci 1978; 1 515-526).The interest in the study of ToM distinguishing its affective and cognitive components has been growing. Its study in psychopathology has been evolved from its original studies in autism spectrum disorders (ASD), schizophrenia (SCZ) and, borderline personality disorder (BPD), to other mental disorders like major depressive disorder (MDD), bipolar disorder (BP), anorexia nervosa (AN) and social anxiety disorder (SAD).

1) review the most commonly used instruments for ToM assessment; 2) to compile the evidence on ToM deficits across mental disorders. For both objectives, target disorders are previously mentioned.

The search was carried out on the PubMed, PsycInfo and Scopus databases, using the terms “Theory of mind”, “Mentalization” and the previously mentioned mental disorders and pertinent thesaurus. Articles in English, published since 2010 were considered. A 2-step strategy (first, article screening and full reading) was followed to select articles of interest.

Reading the Mind in the Eyes (Baron-Cohen et al., J Child Psychol Psychiatry 2001; 42 241-251) and Movie for the Assessment of Social Cognition (Dziobeck et al. J Autism Dev Disord 2006; 36 623-636) were the most commonly used tasks to assess ToM. Regarding mental disorders, studies showed deficits in cognitive and affective ToM skills in ASD, SCZ, BPD, MDD and BP. Hypomentalization was mainly observed in ASD and MDD, while BPD and SCZ were featured by errors associated with hypermentalization. Studies in AN and SAD are scarce, but they mainly highlight a cognitive ToM deficit, with hypomentalization in AN and hypermentalization in ASD. In all of them, depressive symptomatology seems to be a critical moderator of ToM performance.

Although ToM impairments are well described for some mental disorders, more research is needed to reach solid conclusions for others. The use of different and heterogeneous ToM assessment instruments can strongly influence the results of studies. The study of ToM is essential to gain a better understanding of the diseases and to develop effective treatments targeting specific ToM deficits.

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Workshop War in Ukraine – a Big Challenge for the Mental Health Care

Abstract of presentation Mental health of internally and externally displaced persons in war period (Ukrainian experience)

Maruta

“Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine” State Institution

The presentation is devoted to mental health problems of internally and externally displaced persons during the war. Issues of etiology, pathogenesis and clinic-psychopathological manifestations of mental disorders in displaced persons are considered.

The main focus is on risk, anti-risk factors and stress coping strategies that prevent the development of mental disorders.

The presentation also provided a system of therapy and rehabilitation for internally and externally displaced persons, as well as an evaluation of their effectiveness.

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Brief Psychotic Disorder (BPD), defined according to the DSM-5 by the presence of delusions and/or hallucinations and/or disorganised speech persisting for at least one day and less than one month, the disturbance not being due to a bipolar disorder or a schizophrenia spectrum disorder or to the effect of a substance. Classically, the prognosis of a BPD is considered to be divided between restitution ad integrum (30%), progression to bipolar disorder (30%), progression to schizophrenia (30%) or repetition of the same form (10%).

The objectives of our study were to evaluate the evolutionary modalities after the first hospitalization for BPD after a follow-up of at least one year and to compare them with the data in the literature.

Our study was retrospective and descriptive. We reviewed the records of patients hospitalised in our department from 1 January 2014 to 31 December 2018 for a first BPD and assessed the subsequent course over a minimum period of one year.

We included 70 records of patients hospitalized. Twenty-five patients (35.71%) were lost to follow-up after their first hospitalisation. The remaining patients (64.29%) were divided into 3 groups according to the above-mentioned evolutionary modalities (recovery, recurrence of BPD, progression to schizophrenia, progression to bipolarity). Results were in favour of an evolution towards bipolar disorder (35.55%), towards schizophrenia (44.44%), a relapse of the BPD (4.44%), while 13.33% of the BPDs had no future after an aftercare of at least one year. In addition, one case of evolution towards a chronic delusional disorder of the persecution type was observed.

In the present study, our results tend to be in line with the law of one-third described by some authors despite a slight discrepancy partly explained by the limitations of our study. Although, the outcome of BPD remains unpredictable. The minimum five years of evolution are decisive in assessing the subsequent prognosis.

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Smoking prevalence in patients with mental illness ranges between two to 4 times higher than general population. This higher prevalence has a multifactorial origin, and some of the possible causes are still unknown.

They have a higher prevalence of tobacco-associated diseases and higher mortality.

Additionally, these patients have greater difficulty in treating and quitting smoking.

A relationship has been found between severity of mental illness and smoking. Risk of suicide seems to be higher in patients with higher tobacco consumption. Schizophrenia is the mental illness that has been most closely related to smoking, with a prevalence close to 90%.

The aim of this work is reviewing the current bibliography referring to smoking treatments for patients with mental illness

A literature search using electronic manuscripts available in PubMed database published during the last ten years and further description and discussion of a single-patient clinical case

The treatment of tobacco dependence in patients with mental illnesses is sometimes waited until there is psychiatric stability, which can take a long time in those cases with more severe mental disorders, which can have negative physical and psychiatric consequences.

The combined treatment of cognitive behavioral therapy and pharmacological treatment is the most effective approach. Nicotine replacement therapy can be useful, while combined use of antidepressants or anxiolytics is also recommended.

Bupropion has shown efficacy. In patients with schizophrenia it does not seem to worsen positive symptomatology, but improving the negative one. It should not be used in patients with bipolar disorder or bulimia.

Varenicline has shown efficacy in the general population, but limitations were established in patients with mental illness, although it is the drug that has shown greater efficacy. However, is not currently available in our country.

Cytisine is a drug with limited number of studies in the psychiatric population but it may be a reasonable treatment alternative.

The prevalence of tobacco use in patients with mental illness is higher than the general population, especially in paranoid schizophrenia. The consequences on physical health and the evolution of psychiatric illness are very relevant. Based on above, a multidisciplinary and coordinated management involving psychiatrists and other specialists in the treatment of these patients should be desirable.

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The Profile of Mood States is one of the most widely used instruments to assess mood states. It is a rapid and economic method of assessing transient affective states (McNair et al. 2003) and it has been translated and validated to several languages including Portuguese. In our country we have several versions, with different factorial structures and number of items. The scale presents a list of feelings and emotions (adjectives) that people commonly experience.

With university students, we have used a version composed of 36 items that evaluates three factors, with good validity and reliability: Depression, Anxiety/Hostility and Positive Affect (Amaral et al. 2013).

However, to be included in digital apps that in addition to ecological momentary assessment parameters require a weekly or even daily assessment of mood states, this version has little usability.

To develop a shorter version of the POMS-36 based on Exploratory Factor Analysis and to analyse its construct validity using Confirmatory Factor Analysis in a sample of Portuguese college students.

765 students (69.2% females; mean age=22.09±2.433; range: 17-26) fill in the POMS-36 and the Perceived Stress Scale (Amaral et al. 2014). The total sample was randomly divided in two sub-samples. Sample A (N=380) was used to EFA and sample B (N=385) was used to CFA.

Through EFA (with varimax rotation and extracting three factors), the four items with the highest loadings in their respective factor were selected. Then, the CFA, carried out with the AMOS, revealed that this three-factor model, with two pairs of correlated errors, indicated a good fit (X2/df= 4.6010; CFI =.9561; GFI =.9406; TLI=.9559; RMSEA=.0687, p[rmsea=0.04]. The internal consistency analysis resulted in α (Cronbach alphas) <.75 for the three factors. Pearson correlations of the three factors - Depression, Anxiety/Hostility, Amability/Vigour – with Perceived stress were all significantly (p<.01) and moderate, respectively: .533, .614 and -.461.

Although much shorter, the new POMS-12 has good validity (construct and divergent-convergent) and reliability, being more suitable in studies that require frequent and rapid self-monitoring of affective states, such as ISABELA (“IoT Student Advisor and Best Lifestyle Analyser”), an app targeting student mental health and well-being in which we have been working.

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VR-Assisted Therapy (VRT) for auditory verbal hallucinations has been demonstrated to have a significant impact on the symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and on which aspects these improvements occur.

This study aimed to qualitatively explore changes in the quality of life of patients who underwent VRT in the context of an ongoing clinical trial.

Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as 3 months after VRT. These encounters have been recorded and transcribed. Then, the content of the participants’ discourse was thoroughly analyzed, leading to the generation of an extensive theme grid. Each utterance was then coded by at least two members of the research team, and each disagreement was then discussed in a group format until a consensus was reached. As the cases were analyzed, the grid was adapted in a back and forth manner. New participants were included until data saturation occurred.

The content analysis allowed the identification of nine main themes representing different aspects of the patients’ quality of life: psychiatric symptomatology, identity, occupations, wishes, interpersonal relationships, lifestyle, psychiatric follow-up, life events, and attitudes/behaviors during the interview. Each theme was then subdivided into more specific codes. By analyzing the evolution of the frequency of each subtheme, it was observed that, following therapy, patients presented with less psychotic symptoms, which were also perceived more positively, a better self-esteem, more hobbies and projects, as well as an overall improved lifestyle and mood.

Investigating how VRT impacts the patients’ quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process.

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People with mental disorders (MD) may experience social stigma in various spheres of their lives. This phenomenon is based on negative social beliefs and hostile perceptions about mental disorders. Stigma may lead to social exclusion and discrimination (unjust treatment compared to people without MD). It may also result in resistance to using professional medical help (psychiatrist, psychotherapist) by people who experience symptoms of MD.

The study aims to analyze the attitude of Polish society toward people with mental disorders and the attitude toward psychiatric treatment. The study investigates the correlation between the abovementioned attitudes and socioeconomic parameters of the respondents.

The study was conducted on a group of 1,230 respondents with the anonymous, authorial questionnaire disseminated by the CAWI technique. The questionnaire consisted of 10 single-choice questions concerned with the socioeconomic parameters of the respondents (age, place of residence, education, gender) and their attitudes toward mental health problems. The chi-square test and Kendall’s tau-b correlation coefficient (τb) were used to analyze the correlations between the above parameters (with p<0,05).

Over 33% of respondents believes that people with MD are more aggressive than people who do not present this type of disorder. In turn, 16.4% of respondents admitted that they would feel uncomfortable in the presence of a person with mental disorders. There was no statistically significant correlation between the above beliefs and any socioeconomic parameter. Every tenth respondent would not hire a person with MD. Resistance to employment increased with the respondents’ age and level of education, whereas it decreased with the population of respondents’ domiciles. More than 17% of respondents would feel resistance to contacting with psychiatrist, and 4.1% of them already hide the fact of treatment from their family. The resistance to using psychiatric help was higher in villages and smaller towns than in bigger centers.

The study shows negative attitudes towards people with MD are still relatively frequent in Polish society. The stereotypical perception of this group of entities is generally not dependent on any analyzed socioeconomic parameter. Such correlations exist only in some areas (employment). Because of the negative perception of MD, some people who struggle with these problems do not use a psychiatrist’s professional help. In effect, these entities remain undiagnosed and untreated. Treatment delay may lead to exacerbating symptoms, prolong treatment time (including the necessity of hospitalization), and increase its cost. Reducing the stigma is necessary for counteracting discrimination against people with mental disorders and improving the mental health condition of Polish society. It requires educational activities and appropriate legal regulations.

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Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a potential solution in those problematic circumstances and logistic issues for which the current mental health service infrastructure is not able to adequately accommodate to the needs of most patients. Indeed, most mental health workforce does not always own an enough and appropriate theoretical either practical training in digital psychiatry and in delivering remote consultations safely and effectively. Most European countries do not have curricula-specific training requirements, either at core or higher specialty level, for psychiatry trainees to demonstrate competence in digital skills that may be considered essential to good clinical practice, including abilities and competencies needed to provide and deliver mental health interventions by using digital tools. The talk will provide an overview on the level of the current state-of-the-art of the European techno-digitalicus psychiatrist and psychiatry trainee.

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In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.

We present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.

Bibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.

We present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.

It is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.

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Patients with borderline personality disorder are often a challenge to the mental health system. Psychiatrists see people with BPD as manipulative, difficult to manage, annoying, unlikely to arouse sympathy, clinicians hold negative attitude towards personality disorder.

As the next generation of doctors, medical students’ perception of patients with personality disorder (PD) is critical.

Yet a systematic review of the literature shows this has not been studied.

The study aims to identify :

1) the understanding and perception of medical students about PD

2) factors that may relate to this knowledge and perception.

A focus group discussion (FGD) was conducted with eight medical students in their sixth year at Amoud University, Somaliland.

A case vignette of a patient with typical Borderline PD symptoms was presented to stimulate discussion. Barts Explanatory Model Inventory (BEMI) was used to explore the issue.

The FGD was conducted via MS teams, recorded, transcribed, translated and thematically analysed

The Medical students showed reasonably accurate knowledge regarding Borderline PD, recognising features of unstable mood, impulsiveness, and emptiness. Of note half the participants believed religious intervention would be helpful “I believe in Islam. So,basically so to some degree it could be managed in certain religious centers”. Importantly, medical students, when asked to divest of their professional identity, and to describe their personal views associated PD with madness.

The views of PD as ‘madness’ and that religious intervention has a role have important implications for training and service development.

The importance of a culturally sensitive training to Medical students regarding PD to match local cultural and religious views, and consideration of development of health services which are sensitive to religious practice is highlighted.

We recommend including social and cultural implications in the training of medical students to better prepare them for the complexity of managing PD.

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Depression and treatment-resistant depression (RD) are associated with suicidal behavior (SB) at a higher rate.

1) determination prevalence of RD in district outpatient psychiatric сlinics (i.e., dispensaries) and the socio-demographic characteristics of RD patients with SB.

In this multicenter (3 sites), retrospective, observational epidemiological study, patients (n=148) with diagnoses F 30-39 (ICD-10) were recruited in 2020. Patients (n=22) were assessed for RD, defined as failure to respond to ≥ two antidepressant medications of adequate dose and duration for at least three months.

The prevalence of depression is ≤ 2% of the outpatient population. RD prevalence ˜15%. SB (i.e., suicidal attempts) was noted in every fifth (n=5) for the index year. SB patients differed in the following typical features: a woman (82%) mean age, 46.8 years with long-term (≥ 10 years) depression and annual hospitalizations for three years (61.4 days per patient), and with suicidal attempts (repeated within the last two years) through (80%) self-poisoning with psychotropic drugs. Nobоdy worked, and everyone was divorced.

On the background of ubiquitous underdiagnosis of depressive disorders in routine practice, RD patients with SP represent a high-resource users group with combined clinical and social problems requiring pharmacotherapy and target psychosocial rehabilitation.

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The population in remote areas in Ghana as in other low- and middle- income countries (LMIC’s) are known to suffer from limited access to quality mental health services. The challenges include limited inpatient and outpatient mental health services at the regional and district levels, shortage of well-trained professionals, poor funding by the government and difficulties for the patients to pay for medical costs, poor telecommunication services and the lack of adequate infrastructure.

We present a novel model of professional psychiatric mobile clinic, Gye Nyame Mobile Clinics, in remote areas in Ghana. This comprehensive service package connects the current loose ends of existing structural efforts in the subdistricts, trains regularly district hospital teams and bridges the gap between district hospital, primary health posts down to every patient.

In this retrospective descriptive study we collected demographic data of all the patients who visited the Gye Nyame professional mobile clinic in Psychiatry (GNMC) from November 1, 2008 to October 31, 2019 in the ten health posts of Ghana’s Ashanti Region

Between November 2008 and October 2019, we counted 16.370 visits of patients with psychiatric/ neurological diagnosis. The patients suffered mostly from schizophrenia in 24,1%, general convulsions in 40,8 % and other psychotic disorders in 5,9% of the visits. 78,5% returned to our mobile clinic for follow-up, 100% could be treated on outreach.

This community-based approach delivers psychiatric services to subdistrict and district levels and to patients who have no other access to these professional services. According to the results, a wide spectrum of pathologies and quantity of patients are seen – especially patients with no former treatment- the most common diagnosis in the rural area are schizophrenia, other psychotic disorders and generalized convulsions, followed by intellectual disabilities/autism spectrum disorder and cerebral malaria neuropsychiatric complications.

This is the first study to evaluate the implemented impact of integrated psychiatric services into existing structures in remote areas of LMIC`s.

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Bipolar disorder (BD) is a serious and chronic mental disease of mood. Lithium is used for treatment and studies have demonstrated that it is the most efficient drug, reducing suicide risk in a high percentage of patients. However, this drug has well known side effects, such as kidney damage. Lithium could cause chronic kidney disease, specially with the presence of other risk factors.

Observational and retrospective study of creatinine levels and glomerular filtration rates observed in blood analysis (follow-up period of 11 years). Sample size of 263 patients diagnosed of BD I and BD II in treatment with lithium. We used socio-demographic (age, sex) and clinic variables (diabetes mellitus, hypertension, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or diuretics) to generate bivariate and multivariate analysis.

Our main objective is to analyze the deterioration of kidney function and the development of chronic kidney disease that chronic treatment with lithium can induce in patients with BD. Our secondary objective is to determine variables which could promote the development of chronic kidney disease, and to assess if these variables could be considered as risk factors during the treatment with lithium.

11,3 % of patients in our study developed chronic kidney disease during monitoring. The deterioration of GFR in patients in treatment with lithium was significantly associated with female sex and NSAIDs consumption. A trend towards statistical significance was found regarding the use of diuretics (p=0,060). No statistical significance was found between diabetes mellitus, hypertension or type of BD and the deterioration of kidney function in our sample. An inverse association was found between the GFR decline and the age but no statistical significance was demonstrated.

We conclude that female sex and use of NSAIDs are predicting factors of GFR decline in patients with BD in chronic treatment with lithium. We must take into account these drugs or even avoid concomitant treatment (lithium and NSAIDs) in order to prevent chronic kidney disease. In addition to it, we should recommend careful use of diuretics during treatment with lithium because of risk of dehydration. Diabetes mellitus and hypertension have universally been associated to increase risk of development of chronic kidney disease. However, we have not found statistical significance in our study. Therefore, research should be done in order to determine specific risk factors in this group of patients and, consequently, optimize their treatment.

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