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.

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

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

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

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

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

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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.

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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.

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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.

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Disorganized attachment has been described as an important risk factor for developing serious mental disorders in childhood, adolescence and adulthood, such as borderline personality disorder, psychoses, afective disorders, and a higher suicide risk, for instance. Bonding disorders (BD) in parents are related to insecure and disorganized attachment in children. BD can be early diagnosed at 4 to 6 weeks after birth.

Determine if there is a significant difference between the results of the prevalence of affective disorders, disorganized attachment, and suicidal risk five years after the birth of the offspring of parents with and without attachment disorders detected in the first year postpartum during the covid-19 pandemic.

Describe a pilot project of an analytical prospective study following a cohort of parents from the cohort SAMPECO/PEMHSCO (Perinatal Mental Health in Spain during the Covid-19 pandemic). The cohort is planned to be divided into two groups: with bonding disorders an without bonding disorders, which was established using the Postpartum Bonding Questionnaire (Brockington, 2006). Follow the offspring of both groups for 5 years and compare the results of disorganized attachment, affective disorders and suicide risk.

The cohort SAMPECO/PEMHSCO was recruited between March 2021 and June 2022. There was measured postpartum depression in mothers and fathers using the EPDS and bonding disorders in parents using the PBQ validated to the Spaniard population. More than 1500 families were involved at the beginning and around 450 families finished the follow-up six months after birth. Around 500 families were lost because of non-right contact information.

The covid-19 pandemic has seriously affected the mental health of the general population. Consequently, there is a higher demand for mental health assistance by public and private sanity sectors. Currently, the youth population is suffering very much from the consequences of isolation and other social factors, and many families who had babies in this period haven’t had enough support to breed and look after both their babies and themselves. Some papers suggest that the prevalence of perinatal mental disorders in parents has increased since the covid-19 pandemic because of several factors. Paradoxically, despite the high preventive potential of early intervention in the perinatal period, there are not yet exist well-equipped perinatal mental health units to solve this problem. It is urgent to boost the development of Perinatal Mental Health Services to prevent a major worsening of the situation and to prevent the increasing rate of severe mental disorders in children, adolescents and adults.

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Addiction has long been recognized as a disease that may have a dramatic influence on the addicted individual’s family members, manifesting as stress or trauma-related physical and psychological symptoms, resulting in increase in the usual family’s use of health-care services. There is little research available to identify and explore problems of families associated with such patients. In this study, we will evaluate stress among family members of substance abuse patients and try to focus on how these family members are dealing with these stress factors. The study will also compare different types of coping mechanisms among family members of patients taking licit and illicit substances.

To identify stress among families of patients abusing licit and illicit drugs and assess and compare their coping mechanisms.

175 family members of patients with licit substance abuse cases and 175 family members of patients with illicit substance abuse were taken for study after informed consent. Stress among participants was evaluated using Symptom Rating Test and The Depression Anxiety and Stress Scales (DASS). Coping Questionnaire (CQ) and Breif COPE was used to assess coping among them.

The study demonstrated that the total number and severity of symptoms, including psychological and physical symptoms, are found lesser in caregivers (participants) of patients abusing licit substances than in patients abusing illicit drugs. These symptoms among family members grow as the patient’s age rises. Symptoms in participants are more if their patient is female as compared to male. And also, total symptoms are more if they are living in nuclear family (Table 1). In our results, total coping and engaged coping mechanisms in family members are found to be not significant as per drug type and remains the same for both licit and illicit drugs abusing patients’ families. Avoidant coping mechanisms in family members are more if their patient is female and in nuclear family.Table 1

In our study, it was clearly noticed that the total symptoms, both physical and psychological, were found more in family members of patients abusing illicit drugs. Impact of substance abuse related problems is found more in female members compared to male members of family.

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

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

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

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

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

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Obsessive-compulsive disorder (OCD) is a heterogeneous and debilitating neuropsychiatric disorder. First-line antidepressants with Selective Serotonin Reuptake Inhibitors (SSRIs) and Clomipramine (a tricyclic antidepressant) are unresponsive or partially responsive in 40% of treated patients. Preclinical studies have shown that cannabidiol (CBD) can reduce compulsive behavior in animals, and considering that the release of glutamate in the action of CBD can inhibit terminal axons of neurons in the corticostriatal-thalamo-cortical circuit, we chosefor testing CBD, a drug with few side effects and low toxicity, as an adjuvant in treating OCD.

To evaluate the clinical effects of CBD add-on to the usual pharmacological treatment of outpatients diagnosed with OCD.

Methods: This is an open-label study in which patients received CBD 300mg-day for 30 days in addition to their usual treatments and CBD 600mg-day for an additional 30 days if they have not reduced at least 25% of symptoms compared to the baseline evaluated by the Yale-brown obsessive-compulsive scale (Y-BOCS). Psychometric scales were used to assess the effects of CBD: Y-BOCS, General Anxiety Disorder 7 (GAD-7), Clinical Overall Impressions-Severity (CGI-S), Clinical Global Impressions-Improvement (CGI-I), Patient Health Questionnaire-9 (PHQ-9), Epworth Sleepiness Scale and Udvalg Scale for Kliniske Undersogelser (UKU) scale.

Participants: We initially assessed 33 participants in the study. So far, 19 patients have completed the study. Eleven did not complete the study, and 03 patients are still in the study trial.

Mean (SD) Y-BOCS scores decreased from 28.0 (4.8) at baseline to 13.8 (8.6) at week 8, corresponding to a - 50.7% reduction (P<.0001). Anxiety symptoms (GAD-7 scale) (P=0.001) and CGI-Severity scales scores (P<0.001) improved significantly.

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We concluded that there was an important reduction in the psychometric scales used with statistical significance. This is a partial analysis of the results as the study progresses. We believe that in the future we will be able to complete this study and have a better analysis of the results that are promising. At the end of the study, other psychometric scales such as CGI-I, epworth scale and UKU will be analyzed.

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Changes in physiological and hormonal balance occurring during pregnancy and post-partum period can have relevant implications on woman’s mental health. Up to 65% of pregnant women experience depressed mood, low self-esteem, cognitive impairment, fatigue, loss of appetite as well as suicidal ideation. Anxiety and depressive symptoms have been described as impactful on the newborn’s health at the time of delivery. Despite this, few evidence exist on this topic.

The present paper aimed at assessing: 1) prevalence and risk factors of antenatal depression (AD); 2) the impact of AD on adverse obstetric outcomes and the onset of post-partum depression.

Pregnant outpatients attending the Department of Gynecology and Obstetrics of University of Campania “Luigi Vanvitelli” in Naples were asked to complete the Italian version of Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-reported questionnaire developed as screening tool of postnatal depression up to one year after delivery. Sociodemographic, clinical and gestational information was collected at baseline.

A total of 268 pregnant women were recruited: 9.7% of them already suffered from depressive disorders and 22% from anxiety. EPDS mean total score was ≥10 in 36.2% of cases (97 out of 268). The presence of AD was longitudinally associated to a lower gestational age at the time of delivery and a higher 1 and 5 minutes APGAR scores. Moreover, AD was associated to a higher incidence of labor induction and the need of intensive care for the new-born. Finally, in our sample AD constituted a stable risk factor for EPDS scores within three days, one month and six months after delivery.

The presence of depressive symptoms during pregnancy should deserve a higher clinical attention by health professionals, given the correlations with adverse obstetric outcomes and post-partum mental health. Training programmes should be encouraged and digital psychiatry could represent a strategy to monitor pregnant women at risk.

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The Jackson Hospital Crisis (Psychiatric ED) Center serves the entirety of Miami-Dade County in Florida and is considered one of the top three busiest and per capita of clinical staff likely the busiest nationally across the United States. Simultaneously, the management of mental health emergencies has ascended near the top of international priorities driven by multiple trends (e.g., growing social isolation associated with the pandemic, de-stigmatization). The crisis environment presents a uniquely difficult challenge in applying high quality medical care: frequent suicidal gestures, impulsive often intoxicated or psychotic patients, unprecedented demand, diminishing staff capacity, and requirements to consistently apply specific medical and psychiatric protocols. These challenges are specifically difficult for new trainees who are not yet accustoms to the high acuity situations found in psychiatry. Moreover, academic, institutional, and governmental policies change on a monthly, or even weekly basis, often with the objective of improving care. Nevertheless, such constant shifts in workflow result in opportunities for errors that impact patient trajectories.

As such we endeavored to apply an evidence-based approach to improving the likelihood of success. One such vetted approach, the use of checklists, benefits from 10+ years of peer-reviewed research in “operational” medical specialties (e.g., surgery, ED, ICU) where work is segmented around interventions or time-shifts which share commonalities with the Psychiatric ED model. Yet the difficulty in implementing such models is typically not in the “hard” aspects of defining the checklist, but in the “soft” implementation dimensions of syndication, distribution, and enablement in the context of the individual unique settings.

We developed a checklist that will be implemented on the Jackson Crisis emergency department, with the aim of having first year trainees complete the check list on each individual patient. Surveys were administered before implementation of checklist and will be distributed on a quarterly basis to trainees to evaluate for changes in resident confidence and clinical care.

Over six months, we launched this initiative with drivers of adoption focused on accelerating and easing new resident training, safety incident targeting, and in the balancing of “push” top/down and “pull” bottom/up dynamics. Initial learnings include rapidly improving resident satisfaction as well as various other impacts currently being observed throughout the institution.

Overall reception to the checklist has been positive from attendings and new trainees alike, further evidence will be analyzed and presented as the checklist is utilized throughout the psychiatric ED.

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Bipolar disorder is one of the top 10 medical causes of disability according to the WHO and despite this, its diagnosis can be delayed up to 10 years after the appearance of the first symptoms of the disease. A major reason for the difficult diagnosis is the challenge of differentiating bipolar disorder type II from unipolar depression and borderline personality disorder, especially in those patients with no clear history of hypomania.

To present a case report of a bipolar disorder undiagnosed for years to remark the importance of recognizing premorbid symptoms of the disease in order to implement an early intervention that potentially improves the prognosis of patients.

We compiled the patient’s complete medical history and we carried out a non-systematic review of literature containing the key-words “bipolar disorder type II” and “diagnosis”.

We present the case of a 48-year-old woman going through a depressive episode, multiple suicide attempts and more than 10 admissions in the Acute Inpatient Psychiatric Unit. For 3 years, the evolution was torpid with a significant multidomain cognitive impairment in a previously functional patient. Different antidepressant treatments were tested, however they were not tolerated due to adverse effects such as anxiety, insomnia and nervousness. After considering multiple differential diagnoses, bipolar disorder type II was finally diagnosed. A hypomanic episode that took place after 3 sessions of electroconvulsive therapy during an admission for depression, allowed to guide the diagnosis and after the introduction of Lithium and Quetiapine as treatment, the patient experienced a complete remission of the symptoms.

1. 1. It is important to consider the differential diagnosis of bipolar disorder type II due to its impact on the patient´s life.

2. 2. An early diagnosis improves the course and prognosis of the disease.

3. 3. Patients resistant or intolerant to antidepressant treatment could have undiagnosed bipolar disorder.

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

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

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

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

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

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

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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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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).

Resilient potential of 100 young male offenders (aged 16-17), in Buenos Aires was assessed using a translated and revised version of the Resilience Scale (RS) of 14 items (Wagnild, 2009). Data on family criminality, school achievement and socioeconomic status was also obtained for both groups. The greater the resilient potential the greater the opportunity of not to reoffend irrespective of being controlled by key risk factors.

1-Do repeat offenders have lower resilient potential than one-time offenders? 2. If a relationship between resilience and repeat offending does exist, is this explained by family criminality, low school achievement or low socioeconomic status?

Psychosocial interviews with each participant were conducted by the named author, under strict judicial conditions considering privacy in all cases, based on informed consent, with the condition of maintaining the concealed identity of the participants. In all cases it was clarified that youth participation was voluntary.

Table 1.

M (SD) M (SD) t d p

Age 16.20 (0.41) 16.45 (0.50) 2.70 0.66 0.008

Resilience M (SD) M (SD) t d p

Factor I 29.92 (7.25) 63.45 (4.92) 27.16 5.41 <0.001

Factor II 7.37 (1.95) 16.59 (1.87) 24.13 11.33 <0.001

Total Resilience 37.29 (8.67) 80.09 (6.49) 27.82 5.59 <0.001

Risk Factors % % chi d p

Family Criminality 44.9 3.9 20.81 1.03 <0.001

Low School Achievement 98.0 11.8 71.31 3.15 <0.001

Low Socioeconomic Status 42.9 11.8 10.73 0.69 0.001

Table 2. Independent Predictors of Repeat Offending

Variables β p

Criminality in the family 2.994 <0.001

Low school achievement 5.886 <0.001

Low socioeconomic status (SES) -1.727 <0.001

Note. All comparisons p<.001.

Taking into account the lack of studies on resilience in juvenile offenders in both national and international research the findings of the present study provide an important contribution in the field of juvenile offending, particularly in the view of further interventions aimed at the prevention and rehabilitation in the near and long term of juvenile offenders in Argentina.

None Declared

During the Corona virus pandemic, anxiety was one of the most felt emotions. Anxiety can lead to maladaptive coping behaviors, including decreased productivity at work. There are some mechanisms that buffer the devastaing effect that anxiety can have, and one of them is self-compassion. The impact on mental health during the pandemic has increased, especially among healthcare professionals, and needs further exploration

This study aims to investigate the relationships between anxiety, productivity and self-compassion at work among healthcare professionals, as well as, the possibility of self-compassion playing the role of a relationship’s moderator, in a pandemic context.

The study gathers the result from 202 participants, who completed a questionnaire on an online platform. We examined the link between anxiety, respectively COVID-19 anxiety, productivity and self-compassion, as well as the link between self-compassion and productivity among healthcare workers in a pandemic context. In order to emphasize the objectives, the validated BAI, CAS, SPS-SV and SCS-SV scales were used.

In terms of results, significant negative correlations were identified in the relationships between anxiety, COVID-19 anxiety, productivity and self-compassion, and a significantly positive correlation in the self-compassion-productivity relationship. Also, we studied if self-compassion could be a relationship moderator. As the results show, the study identified a statistically insignificant effect of self-compassion on the relationships anxiety-productivity and anxiety of COVID-19-productivity, among health workers.

The present study has achieved its proposed objectives, so that through future research, anxiety, productivity and self-compassion can be explored not only in a pandemic context, but also in a normal context of professional activity in the medical field, and it can also contribute to the identification of other moderators of the anxiety-productivity relationship.

None Declared

The COVID-19 pandemic has caused millions of deaths worldwide. However, unlike a natural disaster, it has also affected end-of-life care and funeral rites through social restrictions.

Understand how the COVID-19 pandemic affected the grieving process.

A PubMed literature search for all relevant studies was conducted used terms such as “prolonged gried disorder”, “grief”, “mourning”, “bereavement” and “COVID-19”. The articles were selected after two different analysis, a first one based on their titles and abstracts and a second one based on their full texts.

Based on the evidence extracted from these articles, it is clear that the COVID-19 pandemic has had an important effect on the bereaved population. More specifically, several articles found there to be an increase in the prevalence of severe grief symptoms caused by deaths that occur during the pandemic period, regardless of cause of death (Eisma and Tamminga 2020, Tang and Xiang 2021, Breen, Mancini et al. 2022, Downar, Parsons et al. 2022, Gang, Falzarano et al. 2022). These results were explained by the disruption the grieving cycle due to social restriction which occurred during the pandemic period. These restrictions prevented the bereaved person from saying goodbye and being present at the time of death, holding mourning ceremonies, as well as having the needed social support during the mourning period (Goveas and Shear 2020, Kokou-Kpolou, Fernández-Alcántara et al. 2020, Mortazavi, Assari et al. 2020, Tang and Xiang 2021, Downar, Parsons et al. 2022). Regarding causes of death, the result were inconsistent, namely one study found to be higher grief levels associated with COVID-19 deaths when compared to natural causes, but not when compared to unnatural deaths, such as accidents and homicides (Gang, Falzarano et al. 2022). While another study found COVID-19 deaths caused are severe grief reactions when compared to natural deaths (Eisma and Tamminga 2022).

The COVID-19 pandemic has increased the prevalence of severe grief symptoms and therefore it is important for the scientific community to be sensitized to this effect. However, there is still a lack of studies concerning this theme, which are essential to define a course of action.

None Declared