Professional attitudes and ethics skills of physicians are influenced in part by the lessons of medical training. Still, few medical schools and postgraduate training programs introduce a formal curriculum. There is also the hidden curriculum which is influenced by instructions that are implicitly learned by observation of others, the cultural climate, and the social norms. The hidden ethics curriculum in psychiatry resident programs was investigated with qualitative interviews. Patient autonomy (consent for admission, coercive treatments) and ethical problems that arise during the management of difficult patient populations (medical ills, substance users, and frequent fliers) were the most common themes. Psychiatric residents perceive a need for more education on ethical issues. The speaker will present the available knowledge on psychiatry residents’ perspectives and the current programs addressing ethics training. This talk is hoped to elicit discussion in preparation for future action and inform a roadmap for addressing ethics training and subsequent educational events during psychiatry undergraduate and postgraduate education.

None Declared

Cognitive impairments, the main determinants of functional outcomes in schizophrenia, had limited treatment responses and need a better understanding of the mechanisms. Dysfunctions of the dopamine system and N-methyl-D-aspartate receptor (NMDAR), the primary pathophysiologies of schizophrenia, may impair cognition.

This study explored the effects and interactions of striatal dopamine transporter (DAT) and plasma NMDAR-related amino acids on cognitive impairments in schizophrenia.

We recruited 36 schizophrenia patients and 36 age- and sex-matched healthy controls (HC). All participants underwent cognitive assessments of attention, memory, and executive function. Single-photon emission computed tomography with 99mTc-TRODAT and ultra-performance liquid chromatography were applied to determine DAT availability and plasma concentrations of eight amino acids, respectively.

Compared with HC, schizophrenia patients had lower cognitive performance, higher methionine concentrations, decreased concentrations of glutamic acid, cysteine, aspartic acid, arginine, the ratio of glutamic acid to gamma-aminobutyric acid (Glu/GABA), and DAT availability in the left caudate nucleus (CN) and putamen. Regarding memory scores, Glu/GABA and the DAT availability in left CN and putamen exhibited positive relationships, while methionine concentrations showed negative associations in all participants. The DAT availability in left CN mediated the methionine-memory relationship. An exploratory backward stepwise regression analysis for the four biological markers associated with memory indicated that DAT availability in left CN and Glu/GABA remained in the final model.

This study demonstrated the interactions of striatal DAT and NMDAR-related amino acids on cognitive impairments in schizophrenia. Future studies to comprehensively evaluate their complex interactions and treatment implications are warranted.

None Declared

It is estimated that the prevalence of severe Intellectual Disability (ID) is 6 per 1,000 people. ID is sometimes the cause of Behavioral Disorders (BD) with aggressive and impulsive behaviors that make family and social life difficult. However, despite its high prevalence, the number of studies on it is very scarce.

When BD appears, it should be evaluated if there is a physical or psychiatric cause that causes it and assess non-pharmacological treatments. If they are insufficient, treatments such as risperidone are used to manage BD. When these are ineffective, the use of drugs with greater difficulties in their effects and clinical management, such as clozapine, is required.

The objective is to describe the use of clozapine in patients with severe ID associated with BD.

Retrospective descriptive study. Patients older than 18 years with severe ID and BD, treated with clozapine for at least two years were included. Those with medical or psychiatric comorbidity were excluded.

The sample consisted of 12 patients, 16.67% women (n=2) and 83.33% men (n=10), aged 47.57±9.27 years. Prior to the introduction of clozapine, a mean of 2.67±1.21 antipsychotics had been tested. The mean dose of clozapine was 264.24±70.50 mg/day. The patients had received treatment for 51.57±25.67 months, following the usual controls. None had hematological adverse effects or other serious adverse effects.

Clozapine can be an effective and safe therapeutic alternative in the treatment of BD in intellectual disabled patients which do not respond to other treatments. The clinical benefits of clozapine treatment seem to outweigh the potential risks associated with the treatment. However, more studies are needed to evaluate the effects of clozapine in patients with intellectual disabilities.

None Declared

N-Methyl-D-aspartate (NMDA) receptors are involved in learning and memory. It is known that ventral hippocampus is a crucial structure involved in emotional memory formation mainly for fear and anxiety situations. The aim of this research is to identify the effect of the stimulation of ventral hipocampal NMDA receptors on the reextinction of an aversive emotional memory task. NMDA (0.2 ug/μl; 0.2 μl) or saline (0.9 %; 0.2 μl) was bilateral and locally administered in the ventral hippocampus of male Wistar rats, before the re-instatement trial.

The experimental group consisted of 10 animals and the control group by 9 subjects. The results suggest that the activation of ventral hipocampal NMDA receptors induces an increase in the time needed to re-extinguish the conditioned fear, suggesting a possible potentiating effect on re-installation.

To evaluate the effect of NMDA at the intrahippocampal level, on the reinstatement and re extinction of a conditioned fear response in male Wistar rats.

This study is experimental, where two groups of adult male Wistar rats were used. The bilateral cannulas was implanted, the animals were injected intraperitoneally with a mixture of ketamine (Rotexmédica) and xylacin (Bayer; 75 mg/Kg and 5 mg/Kg), respectively, then the animals were placed in a stereotaxic apparatus (Narishige) and injected with veterinary antibiotic.The (21G) caliber cannulas were bilaterally implanted in HPv at the following coordinates: AP = -5.2 mm relative to Bregma; ML = ± 5 mm in relation to the midline and DV = 5.1 mm in relation to the skull and according to the atlas (Paxinos & Watson, 1985).

It was observed that in the first phase of extinction there were no statistically significant differences between the two groups, experimental and control, as in the second phase of extinction. The results obtained for the re-extinction phase 1 and 2 showed that there were significant statistical differences between the groups. This difference was only evident in the first three minutes in the two phases of re-extinction.

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Statistically significant differences were observed between the two groups, in the phases of re-extinction, seeing a longer time of the freezing response in the experimental group, as an effect of the application of NMDA in the ventral hippocampus (HPv), which suggests that this substance has a memory-enhancing effect, and therefore contributes to increasing the permanence of the fear response. It should be noted that this difference was only evident in the first three minutes in the two re-extinction phases. These results may be related to other studies where it has been shown that LTP is dependent on the N-methyl-D-aspartate receptor in the CA1 region in vivo (Zhong, Cherry, Bies, Florence, & Gerges, 2009)

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Since the appearance of long-acting antipsychotics (LAPAs) and given the high frequency of non-adherence to treatment in psychotic disorders, LAPAs have recognized a resurgence of interest in the psychiatric literature. These long-acting drugs may pose ethical issues (e.g. limitation of freedom).

The present study aims to determine the representations of long-acting antipsychotics in patients followed at Arrazi Hospital in Salé.

Descriptive study carried out with patients hospitalized at the Arrazi hospital in Salé and those followed in consultation who are on APAP or who have already used it. The collection of information is done using an exploitation sheet

APAPs have been used for less than 5 years by 53.8% of patients84.6% of participants do not use APAP bychoice, in 79.2% of cases it was the doctor’s decision and in 20.8% of cases it was the family’s choiceMonotherapytreatment was the most cited benefit by our patients (76.9%)The route of administration of APAP by intramuscular injection is the problem encountered in 57.7% of our patients, while11.5% of patients find no inconvenience for the use of these psychotropics.

Negative beliefs associated with the treatment contribute to a very large part to the lack of compliance, onthe contrary, long-acting antipsychotics may be better accepted by patients when taking into account the patients’ beliefsand preferences in the development of the treatment. therapeutic project

None Declared

Between January and May 2022, more than 78,248 complaints were registered in Brazil, involving children and adolescents in situations of abuse. (Ministry of Women, Family and Human Rights, 2022). Childhood maltreatment includes all forms of physical, emotional, sexual abuse or neglect. Literature has shown that individuals who are victims of abuse have more difficulties with social skills than their peers.

Quantitatively evaluate the social skills of adolescent victims of abuse.

Six adolescents between 12 and 17 years old participated in the study. The assessment of social communication skills was performed using the Social Skills Rating Scale (SSRS) protocol. At the time of data analysis, the following variables were taken into account: gender of the participants and type of abuse suffered, as stated in their medical records.

Male participants showed a better overall performance in social skills than female participants. However, this second group scored higher on assertiveness and empathy skills. Regarding the type of abuse, in both genders, victims of sexual abuse and neglect showed better results than those who suffered only neglect. The results are described in more detail in images 1 and 2.Table 1.

Female group results

Adolescents who are victims of abuse have considerable difficulties with social skills, which can impact the performance of their basic day-to-day activities. More studies about the impacts of mistreatments on the development of social skills are needed.

None Declared

Paliperidone 3-monthly (PP3M) is a long-acting injectable antipsychotic (LAI) which has been shown to be an equally effective and more convenient alternative to Paliperidone 1-monthly (PP1M) (Hope et al. Australas Psychiatry 2018;26(2):206-209). A prerequisite for PP3M use is stability on a consistent dosing of PP1M ≥4 months, though, few studies have so far explored patients’ experiences with switching.

The aim of the study was to assess satisfaction and perspectives following the change to PP3M. A safety question with regards to the Covid-19 was also included.

This cross-sectional survey was performed within a large, urban mental health setting between May-June 2021 while the UK was still under Covid-19 restrictions. Two psychiatrists obtained verbal consent before administering the survey. Questions 1 and 2 focused on satisfaction and safety with respondents rating to what extent they agreed or disagreed using a 5-point Likert scale. Questions 3 and 4 focused on advantages and disadvantages of the medication change; suggested answers were supplied but there was also an option to provide additional responses. Additional demographic and clinical information were collected from the electronic records.

Of the 61 patients who were receiving PP3M at the time of the survey 46 (31 male and 15 female) agreed to participate. One declined to participate, while 14 were not contactable, making the response rate 98% (46/47).

89.5% of respondents strongly agreed or agreed that they were satisfied after switching, 6.5% neither agreed nor disagreed and 4% disagreed. The bulk of the respondents (93.5%) strongly agreed or agreed that they felt safer having their injection every 3 months during the Covid-19 pandemic. 6.5% neither agreed nor disagreed but no one disagreed with this statement.

Questions on whether patients experienced any advantages or disadvantages as a result of the switch allowed for multiple answers. Convenience (93.5%), was the most popular positive reply, followed by improved quality of life (59%), decreased stigma (39%), better adherence (28%) and improved tolerability (21.7%). While 6.5% did not experience any advantages, 93.5% did not encounter any disadvantages, with 4.3% reporting worsening or new side effects and 2.2% a relapse of symptoms.

The overall experience of switching to PP3M was positive. Similar to two previous studies (Pungor et al. BMC Psychiatry. 2021; 21, 300; Rise et al. Nord. J. Psychiatry 2021;75(4): 257-265) the majority of patients favoured the change quoting convenience, quality of life and reduced stigma as potential benefits. The importance of enhanced safety with less frequent medication administration under pandemic conditions was also highlighted. Shared and supported decision making should further inform clinical practice (Pappa et al. Community Ment Health J. 2021;57(8):1566–1578).

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According to the psychodynamic hypothesis in FGIDs, as well, UGIDs such as functional heartburn (FH) and functional dyspepsia (FD) are often a consequence of receiving inadequate nutrition from one’s mother during childhood, which leads to a failure to adapt to eating. Meanwhile, lower GI disorders such as IBS and functional constipation are generally accompanied by avoidant defense mechanisms and obsessive compulsive disorder.

This study aimed to identify the differences in the psychological characteristics of the anatomical location of functional gastrointestinal disorders (FGIDs) and the factors that influence the quality of life (QOL).

Altogether, 233 patients who were diagnosed with FGIDs were classified into the upper gastrointestinal disorder (UGID; n=175) group and the lower gastrointestinal disorder group (LGID; n=58). Psychological characteristics were identified using the Korean version of the Beck Depression Inventory 2nd ed.; Korean version of the Beck Anxiety Inventory; Korean version of Childhood Trauma Questionnaire; Multi-dimensional Scale of Perceived Social Support; Korean version of Type-D Personality Scale-14; and Korean version of the Connor–Davidson Resilience Scale. QOL was evaluated using the World Health Organization Quality of Life - Brief Version.

The UGID group demonstrated higher scores in ‘emotional’ than the LGID group. (t=-3.031, p<.01) A significant difference was observed between groups in ‘significant others’. (t=2.254, p<.05) Significant differences were observed between the groups in hardiness (t=2.259, p<.05) and persistence (t=2.526, p<.05), while the LGID group demonstrated significantly lower scores than the UGID group in ‘negative affectivity’. (t=-1.997, p<.05) Additionally, the LGID group demonstrated lower QOL than the UGID group. (t=2.615, p<.05) The stepwise regression analysis on OQL involved depression, resilience, social support, and childhood trauma, which accounted for 48.4% of the total quality of life explanatory variance

Psychological characteristics and QOL significantly differed when FGIDs were classified according to anatomical location. Thus, psychological interventions customized for each type of FGIDs may be necessary for effective treatment.

None Declared

Bipolar patients (BP) frequently have cognitive deficits, that impact on prognosis and quality of life. Finding biomarkers for this condition is essential to improve patients’ healthcare. Given the association between cognitive dysfunctions and structural brain abnormalities, we used a machine learning approach to identify patients with cognitive deficits.

The aim of this study was to assess if structural neuroimaging data could identify patients with cognitive impairments in several domains using a machine learning framework.

Diffusion tensor imaging and T1-weighted images of 150 BP were acquired and both grey matter voxel-based morphometry (VBM) and tract-based white matter fractional anisotropy (FA) measures were extracted. Support vector machine (SVM) models were trained through a 10-fold nested cross-validation with subsampling. VBM and FA maps were entered separately and in combination as input features to discriminate BP with and without deficits in six cognitive domains, assessed through the Brief Assessment of Cognition in Schizophrenia.

The best classification performance for each cognitive domain is illustrated in Table 1. FA was the most relevant neuroimaging modality for the prediction of verbal memory, verbal fluency, and executive functions deficits, whereas VBM was more predictive for working memory and motor speed domains.Table 1.Performance of best classification models.

Overall, the tested SVM models showed a good predictive performance. Although only partially, our results suggest that different structural neuroimaging data can predict cognitive deficits in BP with accuracy higher than chance level. Unexpectedly, only for the attention and processing speed domain the best model was obtained combining the structural features. Future research may promote data fusion methods to develop better predictive models.

None Declared

Home confinement was implemented worldwide as a response to the covid-19 pandemic. Therefore, almost all school-age children started to receive home-schooling from the beginning of 2020, it was necessary due to the length of the lockdowns. Being quarantined at home imposed an increase in psychological burden and the situation was aggravated because of school closure, lack of outdoor activity, aberrant dietary and sleeping habits, disrupting children’s usual lifestyle and promoting monotony, distress, impatience, annoyance, and varied neuropsychiatric manifestations.

This study aims to understand the correlation between quarantine and psychosocial effects on school-age children.

An integrative literature review was developed in 3 steps: Development of the research question, search for scientific articles in the Pubmed database, and critical analysis of included articles. The search was conducted in September 2022, and articles between 2019 and 2022 were selected, for a total of 510 articles, of which 28 were used.

The confinement caused by the coronavirus imposed an immediate and lingering psychosocial impact on children due to drastic changes in their physical activity, lifestyle, and mental excursions. Even a short-term shutdown of educational institutions and home confinement is indeed troublesome and anticipated to have detrimental effects on children’s physical and mental health and shatter the sense of normalcy that schools used to provide. Another important factor to note is that some children`s had to be detached from their parents due to several factors, this juncture caused ever-lasting psychiatric consequences including post-traumatic stress disorder, anxiety, psychosis, depression, delinquency, and even suicidal tendency.

Thus, frontline physicians must be aware of the psychosocial needs of the quarantined children. Hospital authorities need to make arrangements for children to communicate with parents via audiovisual devices. Government should invest in operational strategies to provide mental healthcare for the quarantined children.

None Declared

Cognitive impairment has been commonly found in patients with bipolar disorder (BD).(1) Recent evidence supports the view that global and cognitive functioning decrease as a function of number of prior mood episodes, but the relationship is still not clear. (2)

We conducted a cross-sectional study to explore the associations between the lifetime number of affective episodes and functioning, in particular, cognitive functioning in a cohort of patients with BD.

Adult patients with BD were recruited if euthymic for at least 3 months. Socio-demographic and clinical variables were recollected at the baseline evaluation. Functioning was evaluated at baseline with the functioning assessment short test (FAST). The strength of the association between the lifetime number of affective episodes and FAST subscores was explored with Spearman’s correlation test. Linear regression was computed using cognitive functioning as the dependent variable and a set of clinically relevant variables including the lifetime number of affective episodes as independent variables after controlling for illness duration.

261 BD patients were recruited. Patients with a higher number of lifetime affective episodes showed a significant positive correlation with higher FAST global score (r=0.334, p<0.001) and FAST cognitive functioning subscore (r=0.331, p<0.001). At the linear regression, a higher number of affective episodes was associated to worse cognitive functioning (b=0.037, 95%CI [0.011-0.064], p=0.005).

Poor cognitive functioning in BD could be the result of multiple affective relapses. A timely diagnosis with subsequent effective prophylactic treatment may prevent poor functional outcomes in real-world patients with BD.

None Declared

Catatonia is a syndrome characterized by physical symptoms ranging from immobility to excessive motor activity. Besides being historically associated mainly with schizophrenia, it is widely known that it can be the expression of different psychiatric, neurological or medical conditions. The treatment of choice is benzodiazepines, indicating electroconvulsive therapy in refractory cases. Amantadine is considered a second-line therapy in setting when electroconvulsive therapy is not available.

To describe the case of a patient with treatment-resistant catatonic schizophrenia. Not having responded to benzodiazepines or electroconvulsive therapy, potentiation with amantadine was subsequently started.

Our patient presented at a psychopathological level; psychomotor inhibition, a perplexing attitude, and mute speech. At the motor level; ambitendency, indecision, automatic obedience, motor stereotypes, and facial grimaces. He did not present other alterations at the neurological level. Regarding complementary explorations, we performed neuroimaging and blood tests, which resulted all anodyne. With an alternative diagnosis, we considered that sequelae of a neuroleptic malignant syndrome could have produced the symptoms that he had suffered. Due to the persistence of the symptoms and their typical characteristics, catatonia was our first diagnostical impression. As treatment with benzodiazepines was ineffective, electroconvulsive therapy was started. No clinical improvement was observed. Given the refractoriness of the case, a review of the existing literature was carried out. We found reports of a good response to amantadine in similar cases. Amantadine was introduced up to a dose of 200mg.

After four weeks of treatment with amantadine at a dose of 200mg, the patient showed meager improvement at both psychopathological and motor level.

We find the case of a patient with long-term schizophrenia who is nowadays dependent on all daily living activities and requires sustained care.

None Declared

The degree of success and effectiveness of the child’s socialization largely depends on the timely formation of social emotions, the ability to understand the emotional states of the participants in the interaction and manage their emotions.

studying the features of understanding the emotional states of peers and adults by children of preschool age with special educational needs.

The study involved 227 children aged 5-7 attending educational institutions: 95 children without developmental disorders; 73 children with severe speech disorders; 9 children with motor disorders; 25 children with visual impairment (strabismus, amblyopia, astigmatism); 15 children with hearing impairment (3rd and 4th degree sensorineural hearing loss); 10 children with autism spectrum disorder. The “Emotional Faces” method (Semago) and the method of studying the child’s understanding of tasks in situations of interaction (Veraksa) were used.

Tasks for the categorization of emotional states cause difficulties in children with speech disorders, since they require a certain mastery of vocabulary for the designation of emotional states. As a result of limited communication in children, there is a lack of understanding of the meaning, causes and motives of the actions of other people, as well as the consequences of their actions, their impact on others.

Preschool children with motor disabilities are inferior to peers without developmental disabilities in accurate verbalization of emotional states, manifested in a primitive description of emotions.

Visually impaired preschool children do not have sufficiently clear ideas about socially acceptable actions in communication situations, about ways of expressing relationships with peers and adults.

Children with hearing impairment better understand the emotional states of their peers than the states of adults, but they do not know how to show their attitude towards their peers. Difficulties in verbalizing emotions are observed.

Children with autism spectrum disorder experience significant difficulties in recognizing various situations of interaction, isolating tasks and requirements set by adults in these situations; children practically did not try to depict an emotion, having difficulty in differentiating it.

The research confirmed the assumption that children with disabilities have significant difficulties in differentiating similar emotions, they do not accurately determine the emotional state of their peers and people around them. This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program.

None Declared

Bipolar disorder is a chronic psychiatric illness of an episodic and recurrent nature with marked mood and behavioural dysfunction and causes substantial psychosocial morbidity, as it frequently affects independent living, vocational, and social activities. But there is a relative dearth of Indian research about the factors associated with risk of recurrence in patients with BPAD receiving treatment according to contemporary practice guidelines.

The study was under taken to assess the association of psycho-social and treatment factors with frequency of episodes in BPAD

A cross-sectional study consisted of first 120 subjects with bipolar disorder who availed psychiatry services in a general hospital setting in central Kerala from January 2014 to July 2014. Diagnosis was made by DCR-10 criteria. Data for 114 subjects with BPAD were analyzed. Episode frequency was estimated as the number of episodes of depression, mania, and hypomania and mixed per year of illness. Stressful life events were assessed by Presumptive Stressful Life Event scale and treatment adherence by Drug Attitude Inventory. Modified Camberwell Family Interview were used for assessing expressed emotions and Kuppuswamy’s Socio Economic Scale for assessing SES

Episode frequency was significantly associated with young age group, female sex, low educational status, unemployment, lower socio-economic class, marital status, number of children, earlier age at onset, family history of BPAD, high stressful life events, high expressed emotions and poor treatment adherence. The association of co-morbid general medical condition and psychiatric condition with episode frequency were not significant. The influence of religion, family type and co-morbid substance use on episode frequency could not be commented

Episode frequency was significantly associated psycho-social and treatment factors. Hence specific interventions are required to change the modifiable risk factors to reduce the recurrence in BPAD

M. Mundottu Kandy Consultant of: NIL

The current SARS Covid-19 pandemic has negatively affected primary care and health system services provided to chronically ill patients, such as patients with Diabetes Mellitus, Dyslipidemia and Hypertension.

The recording of the number of unfulfilled scheduled visits of Psychiatric patients who are monitored in the Pathological Outpatient Clinic of Arterial Hypertension at the Psychiatric Hospital of Attica due to non-attendance, before the pandemic (9/2018 -2/2020) and during its evolution (3/2020-2 /2022).

The study was done retrospectively and included 1515 patients with a Psychiatric history and concomitant Hypertension who were examined at Outpatient Clinics during the aforementioned time intervals. The rates of missed scheduled visits, as well as discontinuation of treatment without a doctor’s indication were compared and the statistical method used was χ2 with a significance level of p<0.05.

The percentage of scheduled appointments that did not take place due to patient no-shows during the pre-pandemic period was 22% (550/2500). During the pandemic the non-attendance rate increased to 36% (1132/3145). The increase in the rate of missed appointments was statistically significant with p<0.001. Correspondingly, the difference in recorded discontinuation of treatment was statistically significant, 26% (523/2011) versus 33% 743/2252).

Στην παρούσα μελέτη διαπιστώνεται στατιστικά σημαντική αύξηση της μη προσέλευσης Ψυχιατρικών ασθενών στα Παθολογικά Εξωτερικά Ιατρεία τη περίοδο της πανδημίας. Επίσης το πρόβλημα της μη συμμόρφωσης στη συνιστώμενη αγωγή διογκώθηκε καθώς καταγράφηκε μεγαλύτερο ποσοστό μη συνιστώμενης διακοπής αγωγής για την Αρτηριακή Υπέρταση .

None Declared

Both natural disasters such as wildfires, earthquakes, tsunamis, and hurricanes, as well as man-made disasters such as civil wars, have been known to result in significant mental health effects on their victims.

The purpose of this general literature review is to analyze the impact and contribution of social determinants to mental health and resilience following natural and man-made disasters.

In this paper, we specifically explore some of the most studied factors relating to vulnerability and protection, such as gender, age, ethnicity, social support, and socioeconomic status on mental health and resiliency in disaster survivors. In addition, several other possible factors were discussed, such as previous trauma, childhood abuse, family psychiatric history, and subsequent life stress.

Using key words such as mental health, social determinants, disasters, wildfires, earthquakes, terrorism attacks, and resilience, we conducted a literature search in major scientific databases

A discussion of the implications for public health policy and practice is presented

None Declared

Antipsychotics are frequently used to treat certain delusional, psychotic and behavioral symptoms in the elderly. However, the data in the literature show a great variability in the practices of different teams as well as numerous misuses in the use of this therapeutic class.

The aims of this work were to evaluate the prescription of antipsychotics in the elderly admitted in a psychiatric department and to compare them with the Information in the literature.

This was a retrospective and descriptive study carried out in the Psychiatry Department at Mahdia Hospital. We included all patients aged 65 years and older, admitted between January 2016 and December 2021 and having received antipsychotic treatment.

Our sample consisted of 53 patients with a mean age of 69.8 years with a standard deviation of 4.2. The sex ratio (M/W) was 2.7. The most common diagnoses in our sample were schizophrenia and dementia with rates of 31.8% and 27.3% of cases respectively. Regarding antipsychotic treatment, 34.1% received first generation oral antipsychotic treatment (AP1G), 31.8% received second-generation oral antipsychotic treatment (AP2G), 27.3% received a combination of AP1G and AP2G and 6.8% received a long-acting injectable antipsychotic. More than a quarter of our patients (34.1%) reported adverse events due to antipsychotic treatment.

The results of our study highlighted various indications for which an antipsychotic treatment was prescribed in an elderly person despite an often poor and multi-medicated health status, to which side effects were added.

None Declared

Covid pandemic-related psychological problems mainly include anxiety, depression and sleep disturbances, while evidence regarding suicidality is conflicting between studies. Crete has the highest suicide rate in Greece.

To examine suicides’ rate, gender and seasonal distribution pre-covid, compared to Covid-19 pandemic (2020-2021). Seasonality was studied by quarter of the year.

Data on the number of suicides, demographics, and seasonal distribution by quarter throughout Crete, were collected from the records of the Department of Forensic Medicine/University Hospital of Heraklion Crete, as well as from the Forensic Agency of Crete

We found that in the years 2020 and 2021, number of suicides in Crete are 41 and 40 respectively and do not differ from those of the previous years (Mean1999-2019 = 43.5/year). Also, the distribution of suicides by gender remained stable (Mean men/women 1999-2019=4.6 vs. Mean men/women 2020-2021=4.3). The analysis of the seasonal distribution of suicides showed a reversal of the seasonal distribution in 2020 compared to the previous 5-years, which tends to return to pre-pandemic characteristics in 2021.

The overall rate and gender distribution of suicides in Crete remained stable during the Covid pandemic compared to the previous twenty years. The clear change in the seasonal distribution of suicides in 2020 compared to the distribution of previous years tends to return to previous levels in 2021. Possibly, the change in seasonality in 2020 is related to the fear of death/stress and the short/medium term economic consequences due to the pandemic.

None Declared

Self-esteem is a valuable personal asset and it has shown to be related to well-being across cultures and nations.

Explore the level of self-esteem among Tunisian adolescents and the different factors that modulate it.

We conducted a cross sectional study among adolescents who attend Tunisian high school from 11 October 2021 to 11 November 2021. Adolescents filled the Tunisian version of Body Esteem Scale of Adolescents and Adults, the Arabic version of the Rosenberg Self Esteem Scale and a questionnaire containing socio- demographic and clinical variables.

The population was made of 60.3% of girls and 39.7% of boys. Their age varied from 12 to 19 years’ old. The adolescents were attending the high school from seventh to third year of secondary school. Their body mass index (BMI) was normal in 58.2%, <18.5 in 31.5% and ≥ 25 in 10.3%. the score of the Rosenberg Self Esteem Scale ranged from 13 to 40 with an average of 31.02.

Female adolescents had a low self-esteem (Rosenberg Self Esteem Score <31) in 59.51%, while only 39.25% of male adolescents had a low self-esteem.

We did not find significant correlation between self-esteem and age. We found positive correlation between self-esteem and body esteem (r= 0,422; p <0.01) and a negative correlation between self-esteem and body mass index (r= -0,131; p <0,05). We found that adolescents with high self-esteem were more satisfied with their weight, their appearance and that they perceived a good external evaluation. We found also that when body mass index increased, self-esteem decreased.

It’s widely important to study self-esteem among adolescents because it’s modulated by several factors and a low self-esteem may have a negative impact on the mental health.

None Declared

Superior mesenteric artery syndrome is a gastro-vascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta and the overlying superior mesenteric artery. This rare, potentially life-threatening syndrome is typically caused by an angle of 6°–25° between the abdominal aorta and the superior mesenteric artery, in comparison to the normal range of 38°–56°, due to a lack of retroperitoneal and visceral fat (mesenteric fat). In addition, the aortomesenteric distance is 2–8 millimeters, as opposed to the typical 10–20. However, a narrow superior mesenteric artery angle alone is not enough to make a diagnosis with no symptoms.

Symptoms are fullness and epigastric tightness after meals, nausea and vomiting (often bilious) and pain in the middle of the abdomen that improves with the prone or knees flexed to the chest. The diagnosis is supported by imaging tests (esophagogastroduodenal transit or CT) showing dilation and stasis proximal to AMS in the third duodenal portion.

Relief from vomiting with feeding through a enteral probe placed beyond the obstruction to the proximal jejunum supports diagnosis.

Precipitating factors should be corrected first, whenever possible. Acute symptoms can be resolved with gastric decompression and intravenous fluids. Therefore, surgical correction should only be done in well-studied patients with chronic recurrent episodes of AMS syndrome. The most recommended surgical technique is a laparoscopic proximal duodenojejunostomy

To describe a case of superior mesenteric artery syndrome and review in literature the organic complications and associated psychopathology of this disorder

Clinical case report and brief review of literatura

17-year-old woman with a diagnosis of anorexia nervosa. Admitted for behavioral disorder, repeated self-harm and low mood. Presents a BMI of 16.6. Irregular rules. Progressive diet is started to which nutritional supplements are added with good initial tolerance. It presents a loss of 2kg and begins with nausea, vomiting and postprandial epigastralgia. Oral panendoscopy and abdominal ultrasound are performed showing possible mesenteric aortic clamp so naso-jejunal probe and exclusive enteral feeding is prescribed. She received enteral jejunal nutrition progressively with feedback syndrome prophylaxis that included parenteral vitamin B1. After a few days, oral supplementation began. He remained hemodynamically stable, with no signs of heart failure. It gained 3kg of weight up to 43.2kg, starting before discharge from the hospital successfully oral tolerance.

Superior mesenteric artery syndrome is a serious complication in anorexia nervosa with a low incidence and an estimated mortality of 33%. A multidisplinar approach that addresses both the medical and psychological needs of these patients throughout their hospital stay is necessary.

None Declared