A phobia is a type of anxiety disorder that causes an individual to experience extreme, irrational fear about a situation, living creature, place, or object. The most common in the treatment of phobic disorders are in vivo exposures (IVEs) consisting of confrontation with feared stimulus until distress has decreased. Virtual reality exposure therapy (VRET) is a modern alternative to IVEs where patients are exposed to virtual anxiety-provoking environments, and its effectiveness has already been demonstrated in the treatment of most phobias (Freitas et al. Psychiatr q. 2021; 92(4):1685–1710).

This paper aims to present a complex virtual city developed for VRET in different types of phobia. The VRET system is composed of several interactive environments (a skyscraper, a subway, a cinema, and a hospital) that can be combined in form of different scenarios targeting various phobias, allowing controlled and gradual exposure. Selected virtual environments will be presented in case studies of agoraphobic patients (F40 by ICD-10).

The number of VRET sessions is individual, based on the need of each patient, starting with an introductory session including stimulus mapping and VR control explanation. Each session lasts about 30 minutes. During exposure, Subjective Units of Discomfort (SUDS) are assessed at various points. The scenarios for agoraphobia are typically composed of an elevator or subway ride, open spaces (city streets, the roof), or crowded interiors (the cinema). Environments allow various effects, elevator trembling, getting stuck situations and adjusting the number of people. All the scenes contain authentic ambient sounds.

We present a case of a 33-year-old male patient experiencing intense fear of getting stuck or locked, turning into panic attacks. During 10 VRET sessions, the patient was exposed to different environments (subway, underground parking, elevator, cinema) focusing primarily on elevator rides, sometimes in combination with IVE, consisting of locking the door in the experimental room. Another case is a 59-year-old female patient with a fear of open spaces and crowd situations. This patient had 5 VRET sessions combining exposure to open spaces with subway rides. In addition, the patient was instructed to watch short 360° videos of crowd situations. The last case is a 20-year-old female patient with an intense fear of subway tunnels and sounds, enclosed spaces, and heights. During 4 VRET sessions, we mainly focused on the subway with additional IVEs in a real elevator.

Subjective evaluations during exposures indicate a reduction of anxiety across sessions. Based on the patient’s feedback we can conclude on a good acceptance of the technology and an improvement in real-life situations. These case studies demonstrate the valuable use of variable combinations of virtual scenarios in the treatment of agoraphobia.

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Tunisia, a pioneer in the Arab world in terms of promoting the status of women, has adopted a strategy to combat violence against women and now has a legal arsenal to protect women’s rights.

To study the contribution of the Tunisian jurisdiction in terms of protection of women victims of violence.

A review of the different legal texts, using the key words: “Women”, “Violence”, “Jurisdiction” and “Protection”.

*The National Survey on Violence against Women in Tunisia is a long process that involved the efforts of several stakeholders.

*In 2011, Tunisia was the first country in the region to have ratified and lifted all specific reservations to CEDAW (Committee on the Elimination of Discrimination Against Women). Violence against women is considered a threat to peace and security.

*Secondly, the adoption of Article 46 of the new Constitution of 2014 obligated the State to combat violence against women and make it its priority.

*The adoption of Organic Law 58/17 of 11 August 2017 finally gave the status of victim to the abused Woman. This law came into force in 2018.

*A number of mechanisms have been put in place, including the establishment of the National Observatory to Combat Violence against Women.

*Most magistrates still resist the application of Law 58/17, which contributes to the resurgence of violence against women, especially during periods of slackening of the justice system, such as the COVID lockdown period.

Despite the revolutionary legal arsenal acquired for the protection of women in Tunisia, there is still a gap between legislation and practice, and the rate of violence against women continues to increase. Nationwide awareness-raising campaigns aiming to spread awareness among women of their rights are necessary.

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Mental Health Literacy (MHL) includes four distinct but interrelated components: maintenance of positive mental health (MH), recognition of mental disorders (R), mental illness stigma attitudes (S), and help-seeking efficacy (E). A fifth component, help-seeking attitude (A) was included in a MHL model because it is a strong predictor of help-seeking behaviors. The five-factor model of MHL has been validated previously. In the study of multiple mediation model of MHL, it demonstrated the mediation role of help-seeking efficacy between recognition of mental disorders and help-seeking attitude (R-E-A path), but the roles of mental illness stigma attitudes or maintenance of positive mental health remain unknown.

The present study aimed to examine the theory-based multifaceted MHL model by utilizing a meta-analytic structural equation modeling analyses (MASEM) method.

Systematic search of articles from electronic databases, including APA PsycArticles, ERIC, MEDLINE, Psychology and Behavioral Sciences Collection, Pubmed, and Airiti Library (Chinese), from inception up to July 31, 2022, was conducted by raters independently assessed study eligibility, and extracted 127 empirical, quantitative, non-interventional studies with properly reported effect sizes (k=192). MASEM analyses were conducted via a two-stage approach. First, a pooled correlation matrix was obtained for each mediation model by applying a multivariate random-effects model using Comprehensive Meta-Analysis Version 3.3. Second, a structural equation model was fitted on the pooled correlation matrices to test for mediation effects (i.e., indirect effects) using IBM SPSS Amos.

In the single-mediator model analysis, there was a significant partial mediation effect of help-seeking efficacy and Mental illness stigma attitudes on the relationship between recognition of mental disorders and help-seeking attitude (R-E-A path & R-S-A path, p <.05). The multiple-mediator model has showed adequate fit (RMSEA = 0.09, SRMR = 0.04, CFI = 0.93, GFI = .99). It confirmed the help-seeking efficacy served as a mediator. A sequential mediation of maintenance of positive mental health and mental illness stigma attitudes was found (p <.05) between recognition of mental disorders and help-seeking attitude (R-MH-S-A path).

There is a robust mediation effect of Help-seeking efficacy on the relationship between recognition of mental disorders and help-seeking attitude either in the single mediation model or the multiple mediation model. Furthermore, increased recognition of mental disorder was related to increased maintenance of positive mental health, therefore decreased mental illness stigma attitude, and eventually increased help-seeking attitude. Future research directions regarding pathways in the MHL models were discussed.

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Food addiction (FA) is characterized by poorly controlled intake of highly-palatable, calorically-dense, high-sugar, high-fat, and usually processed foods. Although not existing in the DSM-5 or ICD, it has been a widely discussed clinical and research entity for more than a decade, in the understanding of both obesity and also disordered eating behaviours. Most studies indicate that risk factors for FA are similar to substance use disorders. FA is also found to be linked with emotion regulation problems, impulsivity, distinct personality features, and other major psychopathologies including depression and anxiety. Morevoer, in several studies, female gender is found to be associated with more prevalent food addiction, up to 7 times. Female gender is also a predictor of severe food addiction, and high reward sensitivity was significantly associated with more severe FA symptoms in females. It is known that women are more likely to self-medicate than men in the acquisition phase of addiction and show a more rapid escalation of use than men (telescoping), whereas in general substance use disorders are much more common in men. The wide availability of hyperpalatable, high-calorie, and inexpensive food and the contextual and social factors that do not necessarily prevent women from consuming these drugs, contrary to that of illicit drugs, might explain why FA is more frequently observed in women than in men. Also, biological factors, hormonal changes and body-image disturbances might also be among the reasons why females are more affected from FA. Aspects related to gender should be taken into account for proper recognition and treatment of FA, a diagnosis of growing importance.

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Depression is twice as common in women as in men, especially in the young age group. Multiple factors may contribute to this gender difference. Growing attention is being focused on the role of sex hormones, including those of hormonal contraception (HC). Some recent studies have indicated a higher risk of depression among women using HC, although the results are inconclusive.

The aim of this study is to examine the associations between the use of hormonal contraception and the risk of depression in childbearing age women.

The original cohorts for the study included all women aged 15-49 years with at least one redeemed prescriptions for HC in Finland in 2017 (n=294,356), and a 1:1 age-matched cohort of non-users. After exclusion of prevalent cases (n=35,102), all incident cases of depression (as recorded in the Care Register of Health Care and Register of Primary Health Care Visits) in 2018-2019 were identified (n=23,480), and a 4:1 age-matched control group (n=93,920) was selected from the above cohorts. Current use of HC in the 180 days before the event was compared in cases and controls, and associations with risk of depression were tested via conditional multivariate logistic regression models.

During the follow-up, 23,480 incident cases of depression were identified. Current use (in the 180 days before the event) of HC (OR 0.82, 95% CI 0.79-0.85), in particular of estradiol- or ethinylestradiol-containing combined HC was associated with a lower risk of depression (OR 0.83, 95% CI 0.76–0.89; OR 0.74, 95% CI 0.71–0.78, respectively) compared to non-use of HC. The results remained significant (OR 0.87, 95% CI 0.81-0.95; and OR 0.77, 95% CI 0.73-0.81, respectively) after controlling for covariates (marital and socioeconomic status, education level, chronic diseases). Use of progestin-only contraception was not associated with altered risk of depression.

Use of HC in childbearing age women is not associated with increased risk of depression. Rather, the use of estradiol- or ethinylestradiol-containing HC is associated with a lower risk of depression.

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This talk will focus on the pitfalls of using multidimensional rating scales to measure the severity of depression – with particular emphasis on the Hamilton Depression Rating Scale (HDRS-17). First, the history behind the development of the HDRS-17 will be briefly covered. Second, it will be argued that the HDRS-17 measures symptoms that overlap with common antidepressant side effects (gastrointestinal dysfunction, sexual dysfunction, somatic anxiety and sleep disturbances), making it possible that side effects of antidepressant treatment are erroneously rated as symptoms of depression.

The rest of the talk will focus on the results of a recent study (1) in which we used individual-level data from antidepressant treatment trials to assess whether side effect ratings co-vary with HDRS-17 ratings. Specifically, data from all HDRS-17-rated, industry-sponsored pre- and post-marketing trials (n = 4647) comparing the serotonin and noradrenaline reuptake inhibitor, duloxetine, to placebo and/or to a selective serotonin reuptake inhibitor were pooled. Severity was assessed for side effects related to sleep, somatic anxiety, gastrointestinal function, and sexual dysfunction. Analysis of covariance was used to assess the relation between these side effects and ratings of relevant HDRS-17-derived outcome parameters. Side effects related to sleep, somatic anxiety and sexual dysfunction significantly and exclusively associated with higher scores on HDRS-17 items measuring the corresponding domains. Side effects related to gastrointestinal function associated with higher HDRS-17 item scores on all assessed domains. Treatment outcome was significantly related to side effect severity when assessed using HDRS-17-sum (beta 0.32 (0.074), p < 0.001), but not when the HDRS-6-sum-score (beta 0.035 (0.043), p = 0.415) or the depressed mood item (beta 0.007 (0.012), p = .527) were used as effect parameters. That some HDRS-17 items co-vary with common antidepressant side effects likely leads to an underestimation of antidepressant efficacy. Finally, based on data from a recent study (2), it will be argued that the Montgomery-Åsberg Depression Rating Scale is biased in the same direction as the HDRS-17 (underestimates antidepressant efficacy), albeit to a lesser extent.

1. Hieronymus et al. Do side effects of antidepressants impact efficacy estimates based on the Hamilton Depression Rating Scale? A pooled patient-level analysis. Transl Psychiatry. 2021;11:249.

2. Hieronymus et al. The response pattern to SSRIs as assessed by the Montgomery-Åsberg Depression Rating Scale: a patient-level meta-analysis. World Psychiatry. 2022;21:472-473.

S. D. Østergaard Shareolder of: SDØ owns/has owned units of mutual funds with stock tickers DKIGI, IAIMWC, SPIC25KL and WEKAFKI, and has owned units of exchange traded funds with stock tickers BATE, TRET, QDV5, QDVH, QDVE, SADM, IQQH, USPY, EXH2, 2B76 and EUNL., Grant / Research support from: SDØ is supported by grants from the Novo Nordisk Foundation (grant number: NNF20SA0062874), the Lundbeck Foundation (grant numbers: R358-2020-2341 and R344-2020-1073), the Danish Cancer Society (grant number: R283-A16461), the Central Denmark Region Fund for Strengthening of Health Science (grant number: 1-36-72-4-20), the Danish Agency for Digitisation Investment Fund for New Technologies (grant number 2020-6720) and Independent Research Fund Denmark (grant numbers: 7016-00048B and 2096-00055A).

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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Research indicates that co-morbid diabetes and depression is common; however, the implications for clinical practice remain unclear

The aim of the study was to check the prevalence of depression in patients with T1DM who are provided with optimal conditions of diabetes care and to identify possible risk factors connected with affective traits

Out of the 107 patients, 78 (54 females, 24 males) were included for the analysis (HbA1c [%] 7.11±1.0, BMI [kg/m2] 25.3, ± 5.6; Years of T1DM [N] 13.7±8.3). The patients filled in a set of questionnaires during their regular visit to the outpatient clinic. Three patients from the whole group were on intensive insulin therapy with Multiple Daily Injections (MDI) and Self-Monitoring of Blood Glucose (SMBG), all the rest were on various types of personal insulin pumps (years on insulin pump [N] 9.1±4.5). All the patients were on regular diabetologist care, with regular visits in a Centre for Advanced Technologies in Diabetes (at least every 6 months).

In QIDS-S 26 patients (33.8%) were screened positive for depression, in PHQ 57.7% of the patients (45 patients) had symptoms of depression (age was negatively correlated with PHQ score (r= -0.26; p=0.023)). In CES-D 16 (20%) of the patients assessed their present affect as depressed. Quality of sleep was highly correlated with depressive symptoms CESD (r=0.61, p=0.001), PHQ Score (r=0.62; p=0.001), QISD (r=0.68; p=0.001).

The prevalence of affective disorders and poor sleep quality in the examined T1DM patients was much higher than in the general population. Even if the patients have in general good glycemic control, their mental health condition should not be neglected. Well organized cooperation between patients, diabetologists, psychiatrists and psychotherapists is needed.

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Substance use disorders(SUDs) are a major health concern and current treatment interventions have proven only limited success. Despite increasing effectiveness, still about 50–60% relapse within 6–12 months after treatment [Cornelius et al., Addict Behav. 2003;28 381-386]. SUDs are defined as chronic disorders of brain reward system, motivation, and memory processes that have gone awry. Medication reducing craving and substance use is mainly available for alcohol dependence and to a lesser extent for other substances.

Hallucinogens may represent a group of agents with potential anti-craving properties subsequently reducing substance use in SUD patients. For instance, lysergic acid diethylamide(LSD) and psilocybin have previously been shown to effectively alleviate symptoms of alcohol and nicotine dependence.

New treatments preferably focusing on reducing craving and subsequent substance use are therefore urgently needed. The hallucinogen psilocybin may provide a new treatment option for SUD patients, given the beneficial results observed in recent studies

Systematic revision of literature.

In the 1950s, a group of drugs with potential to alter consciousness were discovered (hallucinogens). Several studies suggested their anti-SUD potential, improving self-acceptance and interpersonal relationships, reducing craving and alcohol use. As a result of its recreational popularity during the 1960s, they were banned in 1967, greatly hampering scientific research in this field. Recently, psilocybin, an hallucinogenic substance in psilocybin-containing mushrooms has gained popularity in neuropsychological research, showing to increase trait openness, cognitive and behavioral flexibility, and ratings of positive attitude, mood, social effects, and behavior and even reported persistent positive changes in attitude and behavior. These findings might suggest a valuable compound for the treatment of psychiatric conditions with several additional studies providing supportive evidence for the therapeutic potential of psilocybin for SUD treatment and relapse prevention.

With the reported limited amount of side effects and potential beneficial effects of psilocybin in SUD, there are valid reasons to further investigate the therapeutic efficacy and safety of psilocybin as a potential SUD treatment. On the one hand, psilocybin may exert its anti-addictive properties by beneficial effects on negative emotional states and stress. On the other hand, psilocybin may improve cognitive inflexibility and compulsivity. Research on the efficacy of psilocybin on SUD is still limited to a handful of published studies to date. As a result, many important questions related to the use of psilocybin as a complement to current treatment of SUD and its working mechanisms remain unanswered. Before psilocybin can be implemented as a treatment option for SUD, more extensive research is needed.

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The human body carries large and diverse communities of symbiotic microbes that are important for human health and development. While the impact of the bacterial microbiota, which are mostly found in the human gut, on host physiology is relatively well described, much less is known about the interactions between the mycobiota and the host and the resulting effects on human health. At the level of the nervous system, there is increasing evidence implicating the gut microbiota in a variety of neurological disorders. Similar demonstrations of a causal or supportive role of the mycobioma in neurological disorders are still rare, but several studies linking fungal dysbiosis to disease in humans suggest a contribution of symbiotic fungi to neurocognitive and behavioral disorders.

We aim through this review to show the role of mycobiota in neurocognitive and behavioral disorders.

We comprehensively review the scientific literature using Pubmed database and other search platforms such as Google scholar to state the role of mycobiota in neurocognitive and behavioral disorders.

Our bibliographic review revealed that, according to recent studies, Candida species are overrepresented in the stool of individuals with autism spectrum disorders and Rett syndrome compared to healthy controls. Other studies revealed mycobiome signatures specific to cognitive impairment and demonstrated that different diets modulate the mycobiome in association with Alzheimer’s disease markers and fungal-bacterial co-regulatory networks in patients with cognitive impairment.

Our understanding of the role of the mycobiota in the biology of neurocognitive disorders-whether causal, consequential, or predisposing-could open up new hypotheses in this area and inspire further research on potential mycobiotic signatures, associated dysbiosis and dysfunction in the neurocognitive developmental-homeostasis spectrum that may contribute to neurocognitive and behavioral developmental disorders and predisposition to cognitive decline, dementia, and progression of neurodegenerative diseases including Parkinson’s and Alzheimer’s disease in high-risk subjects.

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Coronavirus 2019 (COVID19) is a contagious disease. Infected patients are not only the vectors of the disease but also often the victim of the social stigma attached to it.

To assess the social stigma perceived by post-COVID19 patients.

This is a descriptive and analytical cross-sectional study that took place during the period from 1st March to 15th May 2021 with 154 patients who were hospitalized at the COVID19 unit at Hedi Chaker Hospital in Sfax.

The anxiodepressive disorders were screened using the “Hospital Anxiety and Depression Scale”. Post-traumatic stress disorder was assessed using the Impact of Event Scale-Revised.

Perceived stigma due to COVID19 was assessed by items from the psychometric tool: self-reported instrument measuring COVID19-related stigma.

The mean age was 66.62 ± 13.34 years. Male patients represented 60.4% of the study population.

In our study, the prevalence of anxiety, depression and post-traumatic stress disorder was 24.7%, 11% and 13.6% respectively.

In our study, 21.4% of the participants felt discrimination and social stigma, especially from neighbors (18.2%).

Anxiety was statistically correlated with the presence of stigma related to COVID19.

We have a highly significant relationship between depression and stigma. (p=0.002)

No correlation was found between stigma and post-traumatic stress disorder.

In addition to social stigma, people with COVID 19 may perceive themselves as different from normal in terms of physical or mental abilities, leading to a high likelihood of self-stigma and social isolation.

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Studies in adult psychiatric patients consistently call attention to premature mortality and its association with metabolic syndrome. However, the utility of the metabolic syndrome construct is controversial in older adults in the general population, since literature shows that some components, such as obesity, can be protective against mortality. In older adults with mental illness, only one study explored the relation between metabolic syndrome and mortality and found no association.

To examine whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders, and to determine if this association differs across diagnostic groups.

We used a multicentric prospective design to follow, over 5 years, a cohort that included 634 in– and outpatients with schizophrenia, bipolar or major depressive disorder (MDD). Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality, suicide and accident.

We found no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, an association with increased all-cause and disease-related mortality was found in the subpopulation of older adults with MDD, even after adjustment for age, sex and smoking status (p=0.032 and p=0.036, respectively). A significant interaction was found between metabolic syndrome and psychiatric diagnoses indicating that in participants with MDD, metabolic syndrome had a significantly greater effect on all-cause mortality (p=0.025) and on disease-related mortality (p=0.008) than in participants with either bipolar disorder or schizophrenia.

In older adults with psychiatric illness, our findings do not support an association between metabolic syndrome and increased mortality, in contrast with the literature findings on their younger counterparts. We discuss several possible explanations, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The lack of a ceiling effect in the depressive subgroup, because of a less marked premature mortality, could explain the positive association, in contrast with bipolar disorder or schizophrenia subgroups.

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It is known that cognitive impairment is one of the main symptoms of schizophrenia, which determines the functional outcome. The question of the effect of antipsychotics on the cognitive functions of these patients is still unresolved. Cognitive impairment while taking antipsychotics is thought to be mostly related to extrapyramidal abnormalities. In practice, it is difficult to distinguish what causes a patient’s complaints of cognitive decline. Is it related to taking the medication? Or a worsening mental state? Age, lifestyle, etc.?

We analyzed the relationship of cognitive impairment with the severity of extrapyramidal symptoms, mental status gravity, age, and dose of antipsychotic and cholinergic medication at weeks 2 and 8 of treatment.

We examined 37 patients with schizophrenia on stable antipsychotic treatment at weeks 2 and 8 of therapy. Thirty patients received a 2nd-generation antipsychotic, and seven patients received a 1st-generation antipsychotic. The anticholinergic drug was trihexyphenidyl. The antipsychotic dose was estimated in olanzapine equivalent. Extrapyramidal symptoms were assessed by The Scale for Extrapyramidal Symptoms (SAS), severity of mental condition was rated by The Positive and Negative Syndrome Scale (PANSS), cognitive function was measured by The Brief Assessment of Cognition in Schizophrenia (BACS).

As previously described, patients with more severe extrapyramidal symptoms tended to have lower BACS composite scores (rxy = -0.318, p-value = 0.055) at week 8 of therapy. The total score on the SAS scale, as expected, only negatively correlated with scores on the Token Motor Task test (rxy = -0.412, p-value = 0.011) at the 8th week of therapy. There were also negative correlations between Token Motor Task scores and trihexyphenidyl dose (rxy = -0.496, p-value = 0.002). At both weeks 2 and 8, there was a negative relationship between age and Symbol Coding scores (rxy = -0.387, p-value = 0.018; rxy = -0.35, p-value = 0.034, respectively). Verbal Fluency scores were lower in patients with high scores on the PANSS excitement component and at week 2 (rxy = -0.42, p-value = 0.01), this trend continued at week 8 (rxy = -0.31, p-value=0.063) . Tower of London scores were negatively associated at week 8 with cognitive and positive PANSS scores (rxy = -0.46, p-value = 0.004; rxy = -0.336, p-value = 0.042, respectively).

Thus, we have demonstrated that cognitive impairment in patients with schizophrenia is associated with various factors, and not only antipsychotic treatment.

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Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety on adulthood.

To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood.

This study used data from 8,122 participants in the ALSPAC cohort, in the UK. The Development and Wellbeing Assessment (DAWBA) was administered to capture child anxiety and depression symptomatology. We focused on the DAWBA generalized anxiety and mood subscales at 8, 10 and 13 years, and created a measure of comorbid anxiety and depression symptoms (i.e., anxiety + depression) at each time point. Further, a range of mental and physical health, and functional problems were assessed at 24 years. Latent Class Growth Analyses was used to detect trajectories of anxiety, depression and comorbid anxiety and depression, separately; and logistic regression to examine how persistent anxiety, depression or both associated with adverse outcomes at 24 years.

All three classes with persistent anxiety, depression or both associated with presenting any mental health and functional problem at 24 years. However, persistent high anxiety was not associated with any physical health problem at 24 years. Finally, high levels of comorbid anxiety and depression was the domain that exerted the greatest negative impact at 24 years.

Children and adolescents with comorbid anxiety and depressions are at highest risk for suffering from more adverse outcomes at 24 years, compared to those presenting anxiety and depression alone.

None Declared

Occupational injuries in the construction sector constitute an important health problem affecting workers in their most productive years. The professional environment influences the outcomes of these accidents. The impact of social support among this vulnerable population may explain the difference in terms of outcomes of occupational injury.

Evaluating the impact of social support in occupational injuries’ outcomes among construction workers.

A cross-sectional analysis was conducted during 9 months among construction sector workers victim of an occupational injury consulting for an Impairment Rating Evaluation and working. Socio-professional data and the accident’ outcomes were collected. Social support was evaluated by the Social Support Scale. The pain was evaluated by a Visual Analogue Scale.

Out of 51 injured workers, 96.1% were male. The mean age was 43.66 ± 10.79 years. The majority of accidents took place in 2020 (49%). Upper arm injuries represented 41.2% of injured sites. The mean pain scale was 6.98±1.69 and the mean length of absence was 227.88 days±292.23. A proportion of 9.8 % had Low social support. Twenty-three subjects (45.1%) had not returned to work. Low social support was associated with a perception of stigma and discrimination (p=0.000), negative outlook of the future (p=0.003), low job satisfaction (p=0.000) and non-return to work (p=0.009). No association was found with pain, length of absence and sleep disorders.

Social support may influence occupational injury outcomes. This finding highlights the need for further examination of social factors among this vulnerable population.

None Declared

Serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants thanks to the overall safety and tolerability spectrum. However, they can cause different side effects that not all of them are well identified.

We intend to clarify the clinical presentation of mydriasis caused by Escitalopram.

Reporting the case of a patient suffering a major depressive disorder, that presented a mydriasis after adjusting her antidepressant medication. Then, we conducted a literature review using “PubMed” database and keywords “Mydriasis”, “escitalopram”, “SSRI”,” side effects”.

A 29-year-old female with no past clinical history, presented in May 2021 a severe depression requiring an antidepressant treatment. Under 10 mg per day of escitalopram there was a partial remission of the symptoms, leading to increase the dose by another 10 mg. One month after taking 20 mg/day, she consults before the appointment suffering from a blurry vision and photophobia. Ophthalmologic examination showed a bilateral reactive half-mydriasis, eye pressure was 14 mmHg and fundus examination was normal. Iatrogenic origin of mydriasis was suspected. A gradual interruption of the medication lead to disappearance of the latter. A pharmacological investigation concluded to the suspension of escitalopram and to be vigilant if an antidepressant medication would be needed.

Mydriasis is an uncommon side effect caused by SSRI that needs to be kept in mind by clinicians. Therapeutic patient education can help to detect abnormal side effects and treat them if needed.

None Declared