Admission to hospital is a stress-inducing experience for children. Informing children helps to reduce anxiety according to their developmental stage.

To explore the associations between Greek teenager patients’ characteristics and their desired information during the perioperative period.

Eighty children (52 boys, 28 girls; median age: 12 years old) admitted for surgery into a large Greek paediatric hospital self-completed a 40-item questionnaire on Children’s Desire for (perioperative) Information (CDI). The respondents’ desire for perioperative information was calculated by summing responses (‘I really have to know’ plus ‘I might want to know’) to all 40 items. Ethical issues were addressed. We used multiple linear regression to explain the relationship between participants’ characteristics (demographic, attitudes, coping strategies) and their desire for information when facing surgery. A p value of less than 0.05 was considered statistically highly significant. SPSS 21.0 was used for statistical analysis.

The 40/80 (50%) Greek teenager patients admitted for surgery had a CDI score more than 33 out of 40 score. Their desired perioperative information was positively associated with their fear of surgery [β=0.59; 95%CI:0.10-1.08; t=2.39; p=0.020] as well as their being raised in a single-parent household [β=3.9; 95%CI:0.13-7.65; t=2.06; p=0.043]. Their desire for perioperative information was negatively associated with their missing friend support network [β=-1.10; 95%CI:(-2.12)-(-0.08); t=-2.16; p=0.034]. The revealed statistically significant associations explained almost 30% (R-square=0.29) of Greek teenager patient desire to be informed perioperatively.

The high CDI score of Greek teenagers facing surgery in paediatric hospitals implies that they have a proven right for perioperative information. Identification of what influences the perioperative information desired by teenager patients would play a vital role in planning effective perioperative intervention programmes.

None Declared

Obstructive sleep apnea (OSA) is characterized by recurrent pauses in breathing during sleep leading to sleep fragmentation and further excessive daytime sleepiness. Therefore, OSA patients are at high risk of suffering from complications from psychiatric disorders. Serotonin is a known neurotransmitter and together with serotonin transporter (SERT) is involved in the development of depression and insomnia.

The study aimed to evaluate serotonin and SERT levels among OSA and healthy individuals and their association with insomnia and depression symptoms.

Forty individuals following polysomnography (PSG), based on the apnea-hypopnea index (AHI), were divided into 2 groups: the OSA group (AHI30; n=20) and the control group (AHI<5; n=20). Participants filled out questionnaires: Beck Depression Inventory (BDI) and Athens Insomnia Scale (AIS). Peripheral blood was collected in the morning after PSG. Protein concentrations were measured using ELISA. Further groups were divided into subgroups based on the standard cut-off points: without (AIS (-)) and with (AIS (+)) insomnia symptoms (AIS>5) and without (BDI (-)) and with (BDI (+)) depression symptoms BDI (BDI>19).

No differences between the OSA and control groups in serotonin (128.8 (73.4 – 209.0) vs. 132.7 (69.9 – 214.6) ng/ml, p=0.805 and SERT (55.8 (39.7 – 64.80) vs. 576.4 (424.2 – 658.3) pg/ml, p=0.564) levels were observed. In OSA group SERT level correlated with AHI (r=0.409, p=0.043), desaturation index (r=0.504, p=0.024) and mean oxygen desaturation during night (r=-0.522, p=0.018), while serotonin level was associated with BMI (r=0.550, p=0.012), but not PSG parameters. Serotonin level was higher in the AIS (+) group but only in healthy individuals. Further, serotonin levels decreased in the BDI (+) group, yet this finding was observed only in the control group.

The results show that serotonin levels are associated with the presence of insomnia in depression, but quite interestingly only among healthy individuals. The association between oxygen desaturation and SERT levels suggests the involvement of hypoxia in the serotonin signaling pathway. Yet further studies on larger populations are needed to better understand the mechanisms responsible for the development of psychiatric complications in OSA patients.

None Declared

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).

Gaining competitive advantage is essential to modern organizations, for which it is fundamental that workers are engaged with their work. Perceived age discrimination in the workplace is a factor that may influence workers’ engagement.

The present study aimed to analyze the moderating role of emotional regulation in the relationship between perceived age discrimination and work engagement.

This empirical study included a sample of 452 Portuguese workers of various age groups, between 18 and 65 years-old and used the questionnaire as data collection method.

Results show that perceived workplace age discrimination negatively impacts work engagement. Further, results suggest that emotional regulation exacerbates the negative relationship between perceived age discrimination and work engagement.

Age management strategies to address perceived age discrimination and work engagement, particularly due to the increasing proportion of older workers, are discussed.

None Declared

Recent studies have indicated that grieving after suicide loss can be particularly complex and traumatic. However, studies have recognized the opportunity for personal growth among suicide-loss survivors.

This study signifies an effort to develop a comprehensive understanding of the underlying interpersonal facilitators of posttraumatic growth (PTG) among suicide-loss survivors in a longitudinal design.

Participants included 189 suicide-loss survivors (155 females), aged 21–73, who completed questionnaires of thwarted belongingness (TB), perceived burdensomeness (PB), and self-disclosure at T1. Moreover, participants were assessed on PTG levels at T1, 18 months (T2), and 42 months (T3).

The integrated mediation model indicated that both TB and PB contributed to the PTG trajectory. PB and self-disclosure contributed to PTG at T3 beyond the PTG trajectory across time. We also found self-disclosure to mediate the association of TB and PTG at T2 and T3.

These findings suggest that interpersonal factors play critical roles in contributing to PTG over time among suicide-loss survivors. Basic psychoeducational interventions designed to foster interpersonal behaviors may facilitate achieving PTG among survivors in the aftermath of suicide loss.

Y. Levi-Belz Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

Adverse childhood experiences (ACEs) and exposure to potentially traumatic events (PTEs) during military service are associated with mental health problems. However, knowledge about relative contributions of these factors to non-U.S women combat veterans’ posttraumatic sequalae is sparse.

To examine associations between ACEs, combat exposure, military sexual trauma (MST), potentially morally injurious events (PMIEs), posttraumatic stress disorder (PTSD) and complex PTSD symptoms among women veterans.

A volunteer sample of Israeli women combat veterans (n=885) and non-combat veterans (n=728) responded to self-report questionnaires in a cross-sectional design study.

Combat veterans reported more total average ACEs, were more likely to experience 3 or more ACEs and specific ACEs of physical abuse and emotional neglect, as compared to non-combat veterans. Combat veterans also reported higher levels of combat exposure, PMIEs, higher prevalence of MST and higher levels of PTSD symptoms, but not CPTSD symptoms, as compared to non-combat veterans. Importantly, ACEs, combat exposure, MST-assault and PMIEs of betrayal predicted PTSD symptoms, while only ACEs and PMIEs of betrayal predicted complex PTSD symptoms.

This study emphasized the relatively high exposure to PTEs and PTSD symptoms of women combat veterans as compared to non-combat veterans. Our findings also confirm prior studies demonstrating associations between ACEs, combat exposure, MST and mental health problems. Importantly, we demonstrated the unique contribution of betrayal based PMIEs and the differential associations of PTEs with PTSD and Complex PTSD symptoms among combat veterans.

None Declared

Loneliness has become a big issue in the time of the COVID pandemic. The attention to the topic also has to do with the increase in people living alone in Europe, although this also has to do with prosperity. Living alone does not yet mean being lonely. In the scientific discussion and especially in the measures, a differentiation must be made between loneliness, solitude and social disintegration. Poor social integration is easily measurable and has a lot to do with the physical health (mobility, vision and hearing) of the people concerned. However, the extent to which participation in social and cultural opportunities is possible, for example through the expansion of public transport, also plays an important role.

Loneliness, on the other hand, is by definition subjective and strongly linked to mental health. It describes the subjective suffering of missing or unsatisfactory social relationships, lack of integration and security. Loneliness is often found in two peaks, among the young and the old. Political and public health campaigns often focus on social integration measures. However, measures to combat loneliness mean first and foremost recognising mental illness in old age, especially depression. But they also mean providing help to people with long-term mental illness in old age.

None Declared

Growing attention has been drawn to workplace violence in healthcare settings and toward healthcare workers. Emergency departments have always been vulnerable to workplace violence since its is usually associated to working with people in extreme distress. Healthcare workers facing numbers of situation with either verbal or physical abuse may face an impact on their mental health.

Describe the psychological impact of workplace violence towards nurses in the emergency department

This is a questionnaire-based cross-sectional study including nurses working in the emergency department of different hospitals of Tunis. The respondents’ data were collected from March 2022 to September 2022.

We included 164 nurses. They were mainly women (Sex ratio of 0.6) with a median of age was 30.7±7.6 years. Nineteen nurses had history of one or more mental disorders such as anxiety disorder (12 cases) and depressive disorder (11 cases). All nurses were victim of workplace violence, while most (104 nurses) were witness to at least one act of violence. Study population had different degrees of concern about safety in workplace, 29.8% had little to no concern while 29,9% were mildly concerned and 40.2% were severely concerned for which they felt their security compromised (14.6% often and 12.2% always). Violence in workplace had consequences on the quality of their service for 26.8% of nurses. Many (49.4%) felt prejudice on their mental health contrasting with little resort (14%) to mental health providers. Number of nurses presented nightmares (44 cases), avoidance (56 cases) or flashbacks (48 cases) about workplace violence. Psychosomatic symptoms were described by most of the study population (58.5%) such as throbbing (46 cases), nervousness (56 cases), aches (23 cases), fatigue (29 cases) or non-specific digestive signs (17 cases).

Workplace violence in emergency departments, first interface of the care chain, is a real problem with serious consequences. Healthcare workers are forced to provide care in situations that compromise their health and safety. Implementing a national action plan is essential in order to address this dangerous phenomenon.

None Declared

Both women and men experience potentially stressful events during their reproductive periods and both are at risk of developing peripartum depression. Men have a reproductive period that is difficult to define, and research on their mental health has rarely considered the effects of paternity. A prevalence of postpartum depressive symptomatology of 10.4% has been described worldwide (Paulson J et al. 2010). Paternal depression is also a risk factor for peripartum maternal depression (Escribá et al, 2011; Paulson et al., 2016). Among the risk factors for developing postpartum depression in men are identified: personal history of depression, conflictive relationship, lack of family and social support, unemployment, older age, lower educational level, and the father’s ability to support his new role as a father (Morse et al., 2000).

Screening to investigate and identify early objective biomarkers in recent fathers of early depression.

An anonymous survey is carried out through GoogleForms, to 57 men, fathers, with children born alive under 1 year of age, which includes biopsychosocial aspects and a questionnaire for depression: PHQ9.

Of the total of 57 parents, the average age is 36 years. 4 of them are unemployed, 1 is a student, the rest have active work or parent´s licency. Only 10% refer to present economic problems. 36% reported that their partner had a risky pregnancy and 22% had a peripartum complication. 9% describe an unsatisfactory or very unsatisfactory relationship with the mother of their child(ren). 51% have a personal and/or family history of depression and/or anxiety. 57% are overwhelmed in their role as fathers. 33% feel they have little or no social/emotional support. 5% have increased the consumption of alcohol/psychotropic medication and 94% report that their sleep pattern has been affected. 3.5% refer self-injurious thoughts or that they would be better off dead. 14% have considered requesting/consulting with a psychiatrist/psychologist since the arrival of the baby.

In relation to PHQ 9, 5% present moderate/severe depression.

In conclusion, it seems relevant to think about a screening to investigate and identify early objective biomarkers and rapid intervention, not only in mothers but also in fathers and thus take a first step to broaden the view from the mother-child dyad to the triad, thus understanding that mental health does not exist in isolation, it is a contextual and relational phenomenon and also reduce the negative impact of this problem, such as: dysfunction and family well-being, marital satisfaction, growth and development of your child/ren . In this context, primary care health professionals (midwives and primary care doctors) could play a fundamental role in recognizing the importance of incorporating parents as relevant figures in health .

None Declared

Lithium has been used for the management of psychiatric illnesses over the years and it continues to be the first-line mood stabilizer used in treatment and prevention of bipolar disorder. Due to its narrow therapeutic index, other prescribed medications can increase lithium levels and potentiate its toxic effects. Among the most described drugs, non-steroid anti-inflammatory drugs and diuretics (mainly thiazides and loop diuretics) are the most commonly implicated. Risk factors for developing lithium toxicity include old age, polypharmacy, renal impairment, hyponatremic and hypovolemic conditions. Although there is interindividual susceptibility, older patients are at particularly higher risk.

To summarize the latest literature about this field and to present a case report as a basis for discussion.

A brief review of the latest literature was performed, using PubMed and the keywords “lithium” and “acute renal injury”. Also, a case report about a 73 year-old man who suffer from lithium intoxication due to lithium-furosemide interaction is presented.

In the presented case, Mr. F, 73 years old, independent for activities of daily living, was admitted to the Internal Medicine ward due to acute renal injury and lithium intoxication. Initially he was non-collaborative, sleepy, disoriented in all references and speechless. The creatinine was 1.28 mg/dL, urea 63 mg/dL, unspecific leucocitosis 17000/mm3, C-Reactive Protein 8 mg/dL, lithium 2.22 mEq/L. The psychiatrist was called to approach the psychiatric status, but as the patient awareness was impaired, the mental state examination was not possible. The patient’s daughter was interviewed. The patient had bipolar disorder (BD) type 1 and was diagnosed with mild cognitive impairment (MCI) a year ago. He had been stable for BD and MCI until the last month. He began to present nocturia, so he went to a urologist who prescribed him furosemide 40 mg daily for benign prostatic hyperplasia (BPH). Since that moment, he started being confused and progressively went to the state that was previously described at the admission of internment. Furosemide, quetiapine and lithium were stopped. He got better, to his previous state, and then started quetiapine 200 mg/day and tansulosine 0.4 mg/day.

Initiating diuretics in patients under lithium should be carefully considered and lithium blood levels must be monitored more regularly when new drugs are prescribed. Other medications must be regarded as alternatives but, if it is not possible, they should be used in the lowest dose and shortest duration as possible. With this case report, we highlight the importance of considering patients as a whole, taking both their physical and mental well-being into account. Healthcare professionals are invited to coordinate their efforts to deliver the best standard of care.

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

The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Sexual health issues related to chemsex practice have been described such as difficulties in achieving sober sex, erectile dysfunction or problems with sexual desire.

The objective of this study was to understand the impact of chemsex on sexual health and sexual response by the participantes of a sexual health program for chemsex users in two Substance Use Disorder Clinics in Madrid.

Qualitative research approach. We analyze an anonymous survey with chemsex users with open answer questions about the impact of chemsex practice on sexual response and sexual health. Data analysis was based on thematic analysis of content.

Several differences were identifed between chemsex and sober sex. In sober sex it can take longer to feel aroused, sexual desire is more context-dependent and more easyly controled. They connect easily with other people needs when they had sober sex. They described difficulties with consent with some sexual practices when they were on drugs. Shame and guilt was associated with chemsex. They describe more arousal, more independent of the erotic context, longer sexual intercourse and delayed ejaculation when they had sex under the influence of drugs.

Chemsex is a phenomenon that needs a multidisciplinary approach and mental and sexual health must be taken into account including sexological perspective. Interventions that provide sexual counselling and sexual therapy for chemsex users must be developped.

None Declared

Patients suffering from psychiatric illness represent a population that is particularly vulnerable to the SARS-CoV-2 virus and to the pandemic situation due to several factors.

We aimed in our study to determine the rate of COVID-19 infection and to identify its correlated factors in outpatients of the psychiatry department of Monastir, Tunisia.

This is a descriptive and analytical cross-sectional study conducted on 178 outpatients at the department of psychiatry (Monastir, Tunisia) over a period of one month (from March 2022 to April 2022). Data was collected via a questionnaire focused on two main attributes: (1) sociodemographic and clinical characteristics; (2) questions about the COVID-19 personal and family history.

The mean age of our population was 44.9±13.7 years. The majority of them (81.5%) had a chronic evolution of their psychiatric disorder (> 2 years) and 68.7% were hospitalized at least once in psychiatry. Psychosis was the most represented disorder with 57.3% compared to mood disorders and anxiety disorders. Among our population, thirty seven patients (21%) had a SARS-CoV-2 infection and 3.1% required hospital care. The infection by the virus of a family member was reported by 46% of cases and 2.5% had intrafamilial death due to COVID-19 disease. Patients with depressive disorder were the most affected (55%). COVID-19 infection was significantly associated with gender (p=0.02), marital status (p=0.016), diagnosis (p=0.001), treatment (p=0.02) and intrafamilial spread of the disease (p<10-3).

Patients with psychiatric disorders experience a distinct burden of the COVID-19 disease. Awareness of the vulnerability of this population and psychiatric institutions is necessary in order to adapt mental health care planning and implement preventive measures during potential subsequent pandemics.

None Declared

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.

None Declared

There are serious adverse effects on the physical and mental wellbeing of patients with alcohol use disorders.

It is important to screen and provide brief intervention for these group of patients during their inpatient admission.

Prompt identification and treatment of patients with alcohol use disorders are contingent on the attitudes of healthcare workers towards them.

Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs.

We examined the attitudes of non-psychiatric workers in the medical and surgical wards.

The Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) was administered to 128 doctors and 785 nurses from the medical and surgical disciplines in a tertiary hospital.

75.5% of doctors and 51.9% of nurses endorsed the domain of role legitimacy in the AAPPQ.

However both groups reported low-levels of role-adequacy (combined: 41.2%), role-support (combined: 36.9%), motivation (combined: 36.5%), task-specific self-esteem (combined: 25.1) and work satisfaction (combined: 20.5%) in the AAPPQ.

While non-psychiatric healthcare workers acknowledged the importance to initiating intervention for patients with alcohol-use disorder in daily work, there were low levels of therapeutic commitments towards patients with problematic alcohol-use.

It is vital to introduce in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention.

None Declared

Vocal music has been a way for the expression of beautiful human emotions and gives a consolidated framework to words. Our review is centered on finding neuroplastic changes in exposure to music.

Our main Objective is to identify structural brain changes in different brain areas. Identification of motor and sensory changes that are produced in response to vocal music.

Detailed literature review was conducted using Pubmed and Google Scholar databases. The literature search was narrowed down to cover the research topic with the search terms [plasticity] OR [brain] OR [neurons] OR [music] OR [vocal]. Our Inclusion criteria included studies with effects of vocal music on neuronal plasticity regardless of age, gender, duration of training, type of training, medium of lanuage and profession. Exclusion criteria included instrumental music and forms of music other than vocal music.

Results showed that music impacts areas of the brain that are highly associated with human emotions. Any brain area can undergo neuroplasticity but is most commonly seen in the insular areas, paracortex, putamen, amygdala, and white matter. Music therapy promotes the formation of instant neural networks and the release of neurotransmitters like serotonin and dopamine. These microscopic changes increase depending on the duration of exposure to vocal music. Later, it appears as macroscopic changes visible with the help of neuroimaging. There is also a significant difference in the brain changes of vocalists and non vocalists. Vocal music impacts the left side of the cortex. Music activates reward system in the brain that leads to stimulation of dopaminergic pathways. It helps in neuronal division in post strock and post traumatic brain injury patients.

Music therapy is widely used as the rehabilitative process that combines music with therapeutic medications to promote therapeutic alliance and better results. It is used to direct focus toward the fulfillment of the emotional and cognitive needs of patients with psychiatric ailments. This area is needed to be explored more so that vocal music can be used for integrated therapy.

Keywords: Vocal music; Brain changes; neuroplasticity; therapy.

None Declared

Psychotic disorder is defined as a loss of contact with reality. Those who suffer from it perceive an altered reality, assuming it to be true.This feeling of unreality generates nervousness, anguish, hypervigilance and even social and emotional isolation.

We present the case of a 18-year-old woman who attended the Emergency Department accompanied by the director of her college due to behavioral alterations. The patient reports that since she has moved to Salamanca to study,she has the feeling that her father has hired spies, one of them being her classmate, being able to hear sounds and voices, which she defines as motivating her to go on with her life. She reports that she is in a lower mood in this context and that there have been some days when she has not been able to attend class.

The objectives are to study the severity of the psychotic disorder in a young patient subjected to an episode of stress and to observe the reaction of the patient when it has been properly treated.

We carry out a review of the clinical history of a 18-year-old female patient with psychotic disorder, admitted to the Psychiatric Brief Hospitalization Unit (PBHU) in Salamanca.

The patient was treated with Risperidone 2mg/24h. After a few days in the PBHU, total disappearance of the psychotic symptoms was observed and the patient is completely self-critical. Once she was discharged, it was decided that she should return home with her parents for several months and continue treatment with Aripiprazole and Sertraline.

Occasionaly, there are ethical dilemmas about beginning to treat young patients with psychotic ideas derived from external situations. Optimal treatment including drugs, psychotherapy and family support are essential. According to the scientific literature,a greater involvement in diagnosis,treatment and follow-up is recommended in patients with psychotic symptomatology derived from stress.

None Declared

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

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

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

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

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

None Declared

Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the world. The body of evidence suggesting that its main pathological features consist of amyloid-β (Aβ) plaque deposits and neurofibrillary tangles formed by hyperphosphorylated tau protein is robust. The drugs currently on the market have no effect on disease progression and provide only partial symptomatic relief, which creates a large unmet medical need. Anti-Aβ monoclonal antibodies (mAbs) have been shown to reduce amyloid plaques. Therefore, passive immunization is a major hope for treatment of AD.

This review aims to summarize the up to date knowledge and experience with Anti-Aβ mAbs with positive clinical or biomarker effects in long-duration trials.

A narrative review was conducted based on a search in Google Scholar and Pubmed, using the following terms or combinations “anti-aβ protofibril antibody”; “early alzheimer’s disease”; “immunotherapy for Alzheimer’s disease”. Peer-reviewed literature published between 2016 and April 2022 was screened on full-text for this purpose.

Aducanumab surpassed a successful Phase 1B trial demonstrating a dose and time dependency for Aß reduction with a beneficial impact on some clinical measures after 1 year of treatment. Two large Phase 3 clinical trials were initiated and already discontinued based on futility analysis done and not based on safety concerns. Further analyses including participants exposed for longer periods of time at higher doses indicated that aducanumab reduced brain amyloid and decreased the rate of decline.

Lecanemab (BAN2401) completed a Phase 2 trial (2018) with evidence of amyloid reduction and slowing of cognitive decline and has now entered Phase 3. Aducanumab and BAN2401 showed significant efficacy on both clinical and biomarker outcomes.

Crenezumab Phase 2 trial results suggested efficacy in mild AD; a Phase 3 program was recently halted due to futility. This mAb is currently being assessed in a prevention trial involving a Colombian kindred with autosomal dominant AD.

Gantenerumab showed significant biomarker effects, with no clinical efficacy reported to date and is being assessed in Phase 3 trials after a trial in prodromal disease stopped for futility suggested that higher doses might be efficacious. Gantenerumab and solanezumab showed no drug-placebo differences in clinical outcomes of specific studies included in this review.

Therapies with anti-Aβ mAbs have been developed successively and conducted in clinical trials signaling a promising new era for AD drug development and providing compelling evidence for the prominent role of neurotoxic soluble amyloid oligomers in the pathogenesis of AD and as therapeutic targets. Lessons learned from these studies may also be a bridge to more efficacious, safe drugs in AD.

None Declared

Wernicke’s encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of acute onset of confusion, gait ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, which is characterized by memory impairment associated with confabulation. Early recognition of nutritional deficiency or any portion of the triad is critical and should prompt treatment, since WE is readily reversible if treated with adequate doses of parenteral thiamine.

Starting from a case report of suspected WE, we pretend to discuss the differential diagnosis of seizures in dual pathology.

Non-systematic review of the literature was performed in PubMed database using the keywords “Wernicke’s Encephalopathy”, “Seizures”, “Alcohol” and “Benzodiazepines”. The articles were selected according to their relevance. A patient´s clinical record was reviewed and presented.

We present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient’s alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. He was medicated for seizures with clinical stabilization. At time of discharge the diagnostic discussion prevailed.

Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal, for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments.

This case illustrates the complexity of neuropsychiatric diagnoses in dual pathology. It requires a longitudinal assessment for a better understanding of clinical conditions and establishment of the best therapeutic approach.

None Declared