Psychotic depression is a subtype of major depression, with worst prognosis but underdiagnosed and undertreated. We introduce the case of a 75-year-old patient who is attended in the hospital presenting sorrow and behavioral disturbances. He also had delusions of ruin and surveillance through his phone, adding amnesia, dizziness, constipation, tremor and bradykinesia. He had suffered a limited depressive episode regarding his wife’s death.

To highlight the importance of a correct differential diagnosis in psychotic depression to prescribe an adequate treatment that provides a better outcome for the patient.

A narrative search of the available literature on the subject through the presentation of a case.

The presumptive diagnosis is Parkinson vs psychotic depression. After some weeks of treatment with venlafaxine and olanzapine, the absence of improvement and fluctuating symptoms orientates towards Parkinson. This is later excluded due to a normal DATSCAN. Therefore, the diagnosis of psychotic depression is made, explaining parkinsonism as secondary to psychotropics. Olanzapine and venlafaxine are retired, introducing clozapine because of its lower incidence of extrapyramidal symptoms. After two weeks, the symptoms disappear, recovering the patient his basal functionality.

Depression with psychotic symptoms can take several weeks to respond to treatment, requiring a proper organic screening. In our case, the slow response to treatment made the organic etiology as one of the main differential diagnoses, specifically Parkinson disease. It ruled out because of the absence of findings in the DATSCAN and the resolution of the extrapyramidal symptoms with the change of treatment.

None Declared

Burnout is a syndrome that results from chronic stress at work, with several consequences to workers’ well-being and health. It is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon and is described in the chapter «Factors influencing health status or contact with health services», which includes reasons for which people contact health services but that are not classed as illnesses or health conditions. Burnout isn’t classified as a medical condition.

To assess the consequences of health professionals’ burnout: it’s impact at personal and professional level.

Non-systematic literature review, available in English, using the PubMed database. Key search terms included burnout; physician; psychiatrist; healthcare; depression; suicide.

Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy. Burnout is particularly common on physicians and in other health professionals, like nurses. This problem represents a public health crisis with negative impacts on individual health professionals, patients and healthcare organizations and systems. Systems factors that play a role in burnout include work compression, demands of electronic health records, production pressure and lack of control over one’s professional life.

Physician burnout is an under-recognized and under-reported problem, and, unfortunately, physicians often do not recognize symptoms of burnout, and even less often do they seek help. Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. There are different clinical forms of burnout and various therapeutic strategies. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment. Psychiatrists play a key role in the multidisciplinary diagnosis and treatment of burnout.

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Mood disorders have been reported in the literature as a risk factor for developing cognitive deficits. Bipolar disorder (BD) and Frontotemporal Dementia (FTD) share many common features, often presenting as a differential diagnostic challenge to the clinician. The clinical features of mania, such as euphoria, hyper-sexuality and difficulties in impulse control can mimic the impaired judgment and loss of inhibition seen in FTD. Depressive features such as anhedonia and social isolation can mimic apathy associated with FTD. Of the various subtypes, the behavioural-variant of FTD (bvFTD) is most similar to a manic episode.

The authors aim to explore the relationship between BD and FTD, and the implications in differential diagnosis, treatment and prognosis with recourse to a clinical case example.

A non-systematized review of pertinent literature on the topic with focus on that which is most relevant to the theme was included. The authors present a clinical case of 55 year-old female with history of BD who was hospitalized in the context of a depressive episode with suicidal ideation and disorganized behaviour.

It is not uncommon for patients with bvFTD to be initially diagnosed with BD, whereas on the other hand, patients presenting in late with an inaugural manic episode are considered to have dementia. The literature also reports that patients with BD appear to be at increased risk of a later FTD diagnosis, further contributing the diagnostic difficulties. Core symptoms that present in mood disorders, also make-up the clinical picture of FTD, and vice versa. Correct diagnosis is imperative as early-intervention may have significant impact on prognosis of the clinical pictures. The patient underwent complementary diagnostic imaging testing with magnetic resonance imaging, which documented atrophy in the fronto-temporal regions which were not detected on previous exams, thus strongly suggesting a FTD diagnosis in a patient with history of BD.

The literature establishes, especially through various case reports, an apparent clinical overlap between FTD and mood disorders. A multifaceted connection between BD and FTD appears to exist, with clinical and genetic similarities having been described, although further studies are merited demonstrating this relationship. The clinical case highlights the challenges in FTD diagnosis in a patient with prior history of a mood disorder, especially BD, as well as demonstrating the difficult task in establishing a differential diagnosis between the two conditions when the mood disorder presents late in life. The clinician is alerted to the mimicry between the two conditions, taking into account the possibility of a FTD diagnosis in patients with history of BD presenting with unexpected cognitive and behavioural decline.

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Low back pain (LBP) is common among healthcare workers (HCWs) caused by providing patient care by bending forward for long durations. Even when symptoms are short-term and not medically serious, LBP can be associated with psychological distress.

This study aimed to assess the impact of low back pain on mental health among HCWs.

The study was conducted in a group of HCWs from Hedi Chaker hospital in Sfax, Tunisia. Data were gathered between March-August 2022 using a self-administered questionnaire including socio-professional characteristics, the Nordic musculoskeletal questionnaire and Kessler Psychological Distress Scale (K6).

Our study included 74 HCWs. The mean age was 39,3 ± 10,5 years. The average job tenure was 15,5 ± 11,2 years. According to the Nordic musculoskeletal questionnaire, 29.7% of participants had low back pain during the last 12 months. Thirty participants (17.6%) had low back pain during the last 7 days. The mean score of K6 was 5,4±4,8 (range = 0–22). The proportion of respondents with high levels of psychological distress (K6 score of 13 or greater) was 9.5 %. The presence of low back pain during the last 12 months and the last 7 days was significantly associated with a high score of K6 (p = 0.008 and p = 0.01 respectively).

Low back pain was associated with psychological distress. Occupational health and safety programs should focus on building ergonomically safe working conditions to enhance the mental health of the HCWs.

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Low and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.

This protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.

Participants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.

National Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.

With increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.

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Patients with schizophrenia tend to have high rates of suicidal ideation (SI), which consists of thoughts of self-destruction, which increase the risk of self-extermination.

To determine the prevalence of SI and investigate associated factors in a sample of patients with schizophrenia.

Descriptive and cross-sectional study, in which 49 patients with the condition were selected by convenience, treated at the Psychosis Outpatient Clinic of the Base Hospital of São José do Rio Preto/SP, between August/2021 and March/2022. The following were applied: 1) Sociodemographic Questionnaire, 2) Suicide Ideation Section of the Columbia Suicide Risk Assessment Scale (SISC-SSRS), 3) Suicide Risk Questionnaire from the Mini International Neuropsychiatric Interview (SRQ-MINI). Data were analyzed quantitatively (descriptive statistics and non-parametric tests; p<0.05). The study was approved by the local Research Ethics Committee.

The age of the participants ranged from 17 to 72 years (mean=45.8 ±14.02), most were male (n=34;69.4%), had not completed elementary school (n=25; 51%), did not have a paid job (n=41; 83.7%) and had a family income of up to three minimum wages (n=23;46.9%). 40.8% (n=20) reported at least one suicide attempt. According to the SISC-SSRS, in the last month: 22.9% (n=11) wished they were dead; 18.8% (n=9) thought about killing themselves; 12.5% (n=6) considered how they could perform the act; 10.4% (n=5) had intention and active planning; and 10.4 (n=5) persisted for the purpose of execution. The mean of affirmative answers was equal to 0.75 (±1.55). In turn, in the SRQ-MINI, 79.6% (n=39) had a score indicating low risk for suicide, 18.4% (n=9) high risk and 2% (n=1) moderate risk. The overall mean was 5.77 (±10.31), which indicates a moderate risk for suicide. There was a non-significant negative correlation between the risk of suicide and the factors of education (r= -0.20; p=0.15) and family income (r= -0.21; p=0.13). There was a significant positive correlation (r=0.81; p=0.0001) between the SISC-SSRS and SRQ-MINI, which indicates that despite the adapted use of the instrument, there is consistency and reliability in the results.

The sample showed low rates of active SI and variation between low and moderate risk for suicide. SI should be asked to patients with schizophrenia, with a view to preventing suicidal behavior.

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Persistent delusional disorder has some features similar to schizophrenia, although the functionality of patients with this diagnosis is usually higher and is diagnosed at an older age. Although the pharmacological treatment of schizophrenia has been studied extensively, there is not much data on the treatment of persistent delusional disorder. Regarding the use of clozapines specifically in persistent delusional disorders, there are some case reports with encouraging results. Electroconvulsive therapy is not generally used as a treatment for persistent delusional disorder.

To reflect on the relevance of using electronvulsive therapy in the treatment of persistent delusional disorder.

Through the description of a clinical case in which there was evidence of remission of resistant psychotic symptoms after clozapine-induced epileptic seizures, the authors hypothesize the existence of a direct relationship between the crisis and the resolution of a persistent delusional disorder.

A.F., 78 years old, male. No personal history of psychiatric or medical-surgical illness. Admitted for psychotic decompensation framed in persistent delusional disorder. The patient underwent pharmacological treatment with resistance to three lines of antipsychotics. With the introduction of clozapine 100mg/day, the patient had two epileptic seizures, followed by complete remission of psychotic symptoms.

The clinical case described refers to a patient diagnosed with resistant persistent delusional disorder, with almost immediate resolution of the condition after epileptic seizures induced by clozapine. Taking into account the clinical response in our patient to two spontaneous epileptic seizures, we hypothesize that electroconvulsive therapy may be effective in the treatment of persistent delusional disorder.

None Declared

The somatoform disorders are a group of psychiatric disorders that present with unexplained physical symptoms.

This study aimed at assessing the prevalence and risk factors of somatoform disorders (SD) and their types among patients attending a major psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq. Our secondary aim was to assess the common presenting symptoms of conversion disorder (CD).

637 subjects were randomly selected from the outpatient psychiatric clinic at Azadi Teaching Hospital in Duhok Governorate/Kurdistan Region of Iraq. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (Version 2.0) was applied to diagnose patients with SDs.

In our sample the prevalence of SD was 24%. CD comprised the vast majority of SD at 75.8%, followed by somatization disorder at 7.8% and undifferentiated SD at 5.2%. SD was most common (60.1%) in adolescents and young adults (ages 15-25 y.o.); (p <0.05), and female gender comprised most of the SD in our sample (75.8%; p <0.001)

Although, more than two-third of the cases were from lower educational levels (illiterate and primary educational level) (67.3%), more than fifty percent were married (52.3%), majority were housewives (39.2%) and more than half of the cases were from urban areas (52.3%), but no significant association were found between SD and educational level, marital status, occupation, and residence (p-values were 0.218, 0.659, 0.072, 0.090 respectively). Regarding the symptomatic presentation of CD, vast majority of the cases presented with pseudo-seizures which comprised (81%), followed by motor symptoms which comprised (17.2%), and sensory symptoms which constituted (1.7%) only.

SD was highly prevalent among patients attending a major outpatient psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq, and CD was the most common presenting form of SD. Younger age (adolescents and young adults) and female gender comprised the majority of cases. Interestingly, the most common presenting symptom of CD in our sample was pseudo-seizures.

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Acute dystonia is a type of extrapyramidal effect that is produced by the blockade of dopaminergic D2 receptors typical of antipsychotics. There is a subtype acute dystonia called oromandibular, which produces perioral manifestations. In extreme cases it can even produce temporomandibular joint dislocation, bilateral being more frequent than unilateral. In this abstract it is presented the clinical case of a 22-year-old female who attended to the Emergency Department due to a bilateral temporomandibular joint dislocation that was finally attributed to antipsychotic treatment.

The objective of the clinical case is to point out the importance of examination and clinical history for psychiatric diagnosis.

Review of various scientific articles related to acute dystonia.

It is a report of a 22-year-old female with no medical-surgical or psychiatric history who was imprisoned for legal conflicts. During her stay in prison, she presented reactive depressive and anxiety symptoms, receiving antidepressant and anxiolytic treatment. After two months in prison, she was released and, two days after her release, she attended to the Emergency Department due to rigid akinetic symptoms, drowsiness, mutism and urination difficulties. Complementary tests revealed bilateral temporomandibular joint dislocation, with no other organicity wich could justify the rest of the symptoms, so she was admitted to the Acute Psychiatry Unit for study.

During her admission, the physical examination (akinetic rigid picture, muscle contraction and galactorrhea) raised the possibility that it was extrapyramidal symptomatology secondary to antipsychotic treatment. Given that suspicion, intramuscular biperiden 5 mg/ml was administered, improving the condition in two hours. In a second time, the initial anamnesis was redone; the patient added that during her stay in prison she had presented psychomotor agitation for which she had recieved an intramuscular treatment that she was not able to specify. All this information confirmed the initial suspicion; it was extrapyramidal symptomatology induced by antipsychotic treatment. Thus, treatment with oral biperiden 4 mg/12 hours was continued and the condition completely remitted in five days.

In this abstract it is presented the case of a bilateral temporomandibular joint dislocation induced by antipsychotic treatment. Although it is a rare presentation, other cases like that have been described in the literature, specifically with the use of haloperidol, risperidone, amisulpride and aripiprazole. Given the high frequency of adverse effects of antipsychotics, it is essential that psychiatrists remain trained in their prediction and management.

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Approximately 21.2 million people with im- migrant backgrounds live in Germany, which constituted 26% of its total population in 2020. Approximately 67% of immigrants are from European countries, including Turkey. Turks account for 13.2% of immigrants and constitute one of the largest immigrant groups (Statistisches Bundesamt, 2020). The integration processes and life satisfaction of new wave Turkish immigrants are differ from the first and second generation Turkish immigrants.

The aim of this study was to investigate the impact of perceived discrimination on their integration process and life satisfaction of new wave Turkish immigrants living in Germany.

The Community Integration Measure (CIM), Satisfaction with Life Scale (SWLS), The Perceived Discrimination Scale (PDS) were used. Pearson correlation and Regression tests were used in our analyses to observe the differences in scale scores according to the variables. The relationship between the scale scores was analysed with the Pearson correlation test. The effect between the scale scores was analysed with the regression test.

The findings demonstrated that there was a significant negative relationship between perceived discrimination and social integration (p=0,05) as well as life satisfaction (p=0,05). In addition, there was a significant and positive relationship between social integration and life satisfaction of new wave Turkish immigrant participants.

The integration process and life satisfaction of new wave Turkish immigrants decreased when they perceive discrimination in their daily lives. However, the level of life satisfaction increased when they integrate into German society without any perceived discrimination.

None Declared

Instagram is one of the most popular social media platforms among young people and it has specific features leading to problematic and addictive use.

To study instagram addiction and the particularities of its use in a population of tunisian doctors.

A cross-sectional, descriptive and analytical study conducted on tunisian doctors (interns, residents and university hospital doctor) during the months of septembre and octobre 2022.

An anonymous self-questionnaire with different items was used via google-forms in order to collect data that co-occur the use of instagram.

Instagram Addiction Scale (IAS) Was used to assess Instagram addiction levels. A score above 37 indicates addiction to instagram.

The study included 106 doctors. The average age of the first connection to instagram was 28.17 years (SD=6.93 years). The total number of friends on instagram was 240.

The average time spent on instagram was 84.5 minutes per day and the number of connections to instagram was 2.78 per day(SD=1.31).

The majority(74.5%) used the cell phone as a means of connection while being alone(73.6%).

The use of instagram was observed during the whole week(73.6%).

The mean score for addiction to instagram was 31.18(SD=11.64). Instagram addiction has been found in 42.5% and 36.8% were mildly addicted.

The instagram addiction was significantly correlated with : the age of the first connection (p=0.0001), the total number of friends on instagram (p=0.0001), time spent on that social network (p=0.0001), the number of connections to instagram per day (p= 0.0001) and the mode of connection (p=0.001).

Our results stated that addiction to instagram affects almost half of the doctors. Many factors were contributing to this addiction.

Interventions targeting these factors seems to be crucial in order to deal with this type of addiction.

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Patients admitted into Forensic Clinics for Dependency Diseases (FCDD) in Germany are diagnosed with at least one substance use disorder. Opioid use disorders is common in this clinical population. Surprisingly, data on the availability and practice of opioid substitution treatment (OST) options in German FCDD according to Sect. 64 of the German Criminal Code (StGB) is scarce. Additionally, important data on the prevalence of adverse incidents such as violent behavior, relapse or escape from the clinic are missing for this highly specific treatment setting.

Our aim ewas to describe the clinical practice regarding opioid substitution therapy in forensic psychiatry in Germany and to identify the prevalence of relevant adverse incidents during the therapy process.

We conducted a observational study including all FCDD units in Germany via a questionnaire. We assessed the clinical practice and total number of patients that received an OST, clinical reasons for beginning and ending the OST, number of treatments terminated without success, number of successful treatments and relevant adverse incidents such as violent behavior, relapse, escape and reoffending. The data was analyzed descriptively.

15 of the existing 46 FCDD participated in our study (33%). In total, 2483 patients were treated in the participating FCDD, 18% of the patients were relocated into prison due to treatment termination and 15% were discharged successfully. 275 adverse incidents were reported: violence against a patient (4%), violence against staff (1,6%), escape (4,7%) and reoffending (0,5%). Merely in seven FCDD treating 1153 patients, an OST was availabe. Available options included buprenorphine/naloxone, buprenorphine, methadone and levomethadone. Regarding adverse incidents and successful discharge, no differences were detected in the clinics with or without an OST. In the clinics that offered an OST, we found a significantly higher rate for treatment termination without success (p<0.007) in comparison to clinics without this program. 99 patients received an OAT and this treatment was ended due to illegal drug abuse (57%), refusal to give an urine drug sample (71%) and in cases were the OAT was given away to other patients (85%).

Surprisingly, opioid substitution therapy is only accessible in a part of the FCDD in Germany. Reasons for this are unclear. Critical incidents such as violent behavior against staff/patients and escape are not uncommon in this forensic psychiatric treatment setting. Further studies are needed to enhance the understanding of the limited OST practice and the risks for patients and staff in this specific forensic treatment setting.

None Declared

Elevated levels of lipopolysaccharide (LPS) in circulation support chronic inflammation, which is involved in the pathological process in the brain and may be a contributing factor to treatment resistance in schizophrenia.

To compare inflammatory markers and indicators of systemic endotoxemia (SE) in patients with treatment-resistant schizophrenia and in those with a good response to treatment.

The study involved 34 patients with schizophrenia (27±7,5 years) (F20) in an acute psychotic state: 15 patients with TRS (non-responders), 19 patients responded to treatment with reduced symptoms (responders). The markers of systemic inflammation (leukocyte elastase (LE) and a1-proteinase inhibitor (α1-PI) activity, CRP concentration, antibodies (Abs) to S100B and myelin basic protein) and the indicators of SE (LPS level and Abs to LPS) were determined in the blood of patients.

The responders showed a significant increase in LE and α1-P1 activity (p<0.001), CRP concentration (p<0.05), and Abs to neuroantigens (p<0.05) compared to controls. LPS levels did not differ from control values. In non-responders, a moderate increase in LE and α1-PI activities (p<0.05) and a significant increase in CRP concentration (p=0.01) were accompanied by no significant differences in Abs to neuroantigens. These patients had elevated LPS level and Abs to LPS deficiency compared with both responders (p<0.01) and controls (p<0.05).

The identified spectra of systemic inflammation markers, elevated LPS level, and insufficient anti-endotoxin immunity in patients with treatment-resistant schizophrenia may be related to endotoxin tolerance. Further research in this field can help develop new approaches to overcoming resistance to therapy in patients with schizophrenia.

None Declared

Factitious hematemesis is the bleeding type of Munchausen’s syndrome together with dual diagnosis of school refusal is rarely reported in the literature. It is a condition in which the patient intentionally produces symptoms to assume a sick role and gain medical attention. Underdiagnosis of this disorder results in the unnecessary use of medical resources, i.e. unnecessary medical tests and evaluations.

case

We present this rare case of a patient with chronic factitious disorder who presented to the emergency with hematemesis. The 12 year old male patient grade 6 student presented with curious history of hematemesis just before the entrance of school and in the new school premises since 2 years resulting in school refusal and multiple doctor shopping. The patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, complete blood evaluations) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, endocopic studies etc), because he continually presented with hematemesis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when he was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient’s history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hematemesis in Munchausen’s syndrome was made.

The typical characteristics that should prompt the physician to include Munchausen syndrome in the diagnosis include deliberately lying, repeatedly coming to the clinic/hospital with similar complaints in a short span of time, taking excessive drugs (especially insulin and warfarin) to induce side-effects, recurrent abdominal pain, scars on limbs, and rheumatologic and hematological disorders.

We recommend that physicians all across the globe should report more cases of Munchausen syndrome. More research is required in this arena to understand the cultural, social, and psychological aspects of Munchausen syndrome and to find out which treatment strategy can be most beneficial for such patients

Munchausen syndrome is a diagnostic dilemma that needs to be given adequate medical and social attention by encouraging further research and spreading awareness not only amongst the general population but also health care providers. With proper evaluation, diagnosis, and psychotherapy, the disease will not remain a diagnostic dilemma and would be easier to control and treat. This case report will contribute towards the awareness of physicians about Munchausen syndrome and the strategies to diagnose and treat it.

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To investigate gender-related differences in the connection between psychosis and exposome, we conducted a systematic review and retrieved 47 research publications in the PubMed database that examined the association of psychosis with childhood adversity, substance use, urbanicity, migration, season of birth, and obstetric complication. The results show that childhood abuse may be more significantly related with psychosis risk and an earlier age of onset in women than in men. In addition, childhood adversity has been linked to the severity of different symptom dimensions in men and women. Urban upbringing and immigration are much more strongly related to psychosis risk in men than in women. Despite the higher prevalence of substance abuse comorbidity in men with psychotic disorders, it seems that the relationship between substance abuse and psychosis risk is stronger in women. Due to several methodological limitations, the small number of studies, and the lack of consistency across studies, these findings should be regarded with care. Overall, although further research is required, it appears that there are gender-related differences in the relationships between environmental exposures and psychosis. There is an urgent need to gain insight into the gender-related patterns underlying the association between psychosis and exposome. Future studies should thus go beyond considering gender only as a covariate and study gender as a possible effect-moderating factor.

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Decreased sound tolerance amongst individuals can be divided into two conditions: Hyperacusis and Misophonia. Hyperacusis is the perception of certain everyday sounds as too loud or painful. Misophonia is characterized by heightened emotional reaction to a sound with a specific pattern and/or meaning to an individual, with the context in which occurs being relevant. Scattered evidence from clinical research suggests that Hyperacusis and Misophonia can co-occur with a wide range of psychiatric disorders. These factors can have an impact on the severity of the symptoms and subsequently, in the clinical management of these patients. A better understanding these comorbid conditions is important as it could help to clarify its underlying mechanisms and ultimately, to improve the care of these patients. Despite this, no attempt has been made to synthesize the spectrum of such co-occurring disorders.

To conduct a systematic review of the available evidence on the prevalence of psychiatric disorders in patients with Hyperacusis and Misophonia, and to explore which factors may influence prevalence estimates.

Preferred Reporting Items for systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE) recommendations will be followed. The CoCoPop (Condition, Context and Population) framework was used to develop the review question. Pubmed, PsycINFO, Scopus and Web of Science electronic databases will be searched, as well as grey literature, using key-terms in accordance with the pre-established research question. Additional manual searches will also be conducted. Searches will be limited to human studies and no date, language or country origin restrictions will be applied. Outcomes of interest will be the occurrence of comorbid psychiatric disorders in patients with Hyperacusis and Misophonia that are reported according to validated assessment methods. Retrieved records will be screened for eligibility by two independent reviewers using a two-phase approach (title and abstracts screening and full-text review). The methodological quality of primary studies will be assessed using the Joanna Briggs Institute (JBI) – Critical Appraisal Tools, depending on study design, and data will be extracted independently using a standardized extraction form.

Quantitative data will be synthetized and presented in text and tabular format. Studies heterogeneity will be verified and if feasible, a meta-analysis will be conducted.

It is expected that this systematic review will provide evidence of a significant prevalence of a wide range of psychiatric comorbidities in patients with Hyperacusis and Misophonia, supporting the importance of screening these patients for psychiatric disorders.

None Declared

Brain-derived neurotrophic factor (BDNF) has been associated with both emotionally unstable personality disorder (EUPD) and suicidal behavior. No study has yet investigated BDNF-associated epigenetic alterations in severely impaired EUPD and suicidal patients.

The main goal of the present study was to investigate whether epigenetic dysregulation in BDNF, CRP, IL-1, IL-2 and IL-6 were associated with EUPD and severity of suicidal behavior.

The discovery cohort consisted of 97 women with emotionally unstable personality disorder (EUPD) with at least two serious suicide attempts (SA) and 32 healthy women. The genome-wide methylation pattern was measured by the Illumina EPIC BeadChip and analyzed by robust linear regression models to investigate mean BDNF methylation levels in a targeted analysis conditioned upon severity of suicide attempt. The validation cohort consisted of 60 female suicide attempters, stratified into low- (n=45)and high-risk groups (n=15) based on degree of intent-to-die and lethality of suicide attempt method, and occurrence of death-by-suicide at follow-up.

Mean BDNF methylation levels exhibited hypermethylation in relation to EUPD(p=0.0343, percentage mean group difference ~3.8%). Similarly, this locus was confirmed as hypermethylated in an independent cohort of women with severe suicidal behavior (p=0.0469). Results were independent of age and BMI.

This study elicits emerging evidence of epigenetic dysregulation of BDNF in relation to phenotypes known to increase risk of suicide (lethality of suicide-attempt method and presence of EUPD diagnosis with history of recent SA). Further studies investigating epigenetic and genetic effects of BDNF on severe suicidal behavior and EUPD are needed to elucidate the role of epigenetic regulatory mechanisms and neurotrophic factors in relation to suicide risk.

None Declared

Extremely preterm birth (defined as birth before 28 weeks’ gestational age) has been associated with risk of developing autism spectrum disorder (ASD) in infancy. The underlying physiopathological pathways that condition the emergence of ASD on these kids remains unknown, although there is increasing evidence that oxidative stress and inflammation play an important role.

We investigated the association and the predictive value of marker levels with the primary outcome (risk for ASD at age 6 months, defined as presence of two or more clinical ASD “red flags” at this age), and with other demographic and clinical variables.

In a sample of N= 68 extremely preterm newborns, we collected urine samples from birth up to first week of life (T1= birth, T2=24-72 hours, T3=day 7), and analysed levels of biomarkers of oxidative stress and inflammation, and assessed risk for ASD at age 6-months. Through liquid chromatography mass spectrometry, we obtained levels of lipid peroxidation, DNA and protein oxidation metabolites, alongside levels of inflammation markers.

Compared to those with no risk for ASD, patients at risk for ASD showed significantly higher levels of 14(RS)-14-F4t-NeuroP at 24-72 hours of life (d=1.296, p=.018) and significantly lower levels of total isoprostanes at 24 hours of life (d=1.161, p=.048). In patients at risk for ASD, levels of 14(RS)-14-F4t-NeuroP decreased significantly over time from 24-72 hours (T2) to day 7 of life (T3), p=.032.

In summary, we obtained a panel of urine biomarkers potentially predictive of early risk for ASD in extremely preterm newborns.

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Since the beginning of the modern psychiatry the acute units have established a “locked door” policy. Some studies show that this condition may increase patient’s discomfort and affect the perception of health quality of care (Boyer L, 2009, Eur Psychiatry Dec;24(8):540-9). Lately, several European countries such as Germany, Switzerland and Spain are starting to implement the “open-door” policy but its impact on patient’s satisfaction is still unknown (Hochstrasser, L, Frontiers in Psychiatry, 9(57). https://doi.org/10.3389/fpsyt.2018.00057) .

To help characterize the advantages of the “open-door” policy implemented in an acute inpatient psychiatric unit in order to assess the patient’s view of it.

This is a descriptive observational study carried out at an inpatient psychiatric unit. Data were collected after the implementation of the open door policy on June 2019, assessing the patient satisfaction of 31 subjects who completed the SATISPSY-22 scale at the time of discharge. Results are described using the average and its standard deviation.

Results show scores in all items above 50 points, being the care team and the quality of care the most valued ones with 82 and 79 points respectively. The overall score is above 65 points (Fig. 1).

Image:

In line with previous studies, our data suggests that the main impact of the “open-door” policy implementation is on patients’ perception of the care, being Quality of care and satisfaction with the Staff the items with highest scores. This could be explained by patients trusting more in the Care team, which would help enhance the therapeutic relationship improving therapeutic adherence, treatment adequacy and the outcome. Nevertheless, the Feeling related to hospitalisation was found to be the item with the lowest score. This could mean strategies should focus on improving patient’s insight regarding their clinical state and their need to be admitted. Our study supports the hypothesis that open-door policy in acute psychiatric units is seen positively by patients and that further research should be carried.

None Declared

Antipsychotics are the standard in the treatment of first psychotic episodes. Although the majority of patients respond to the established treatment, it is currently known that there is a subgroup of patients whose response is not satisfactory. In this group, the subsequent response to a new antipsychotic is generally poor. Clozapine is an antipsychotic with a unique profile, with demonstrated efficacy and approval in the treatment of treatment-resistant schizophrenia. Its role in the first psychotic episodes remains unclear and its use is, to say the least, controversial.

This work aims to analyze and evaluate the use of clozapine in patients with a first psychotic episode, taking into account the experience of a Portuguese Hospital Center.

We carried out a retrospective study, including all patients admitted to the inpatient clinic of adults with a first psychotic episode, in the Department of Psychiatry of Centro Hospitalar Universitário of São João, in Oporto, between 2007 and 2020. Clinical and socio-demographic data were collected.We performed a retrospective analysis of patients who, at discharge, were medicated with clozapine, proceeding to a descriptive analysis.

In this case series, we intended to describe the cases of patients in whom the use of clozapine in the first psychotic episode was initiated. All patients were discharged with the diagnosis of Schizophrenia. Prior to the introduction of clozapine, patients were treated with other antipsychotics, normally two. Patients taking clozapine were younger and had a longer duration of untreated psychosis. They had also longer length of hospital stay. The pattern of prescribing antipsychotics in the first and subsequent episodes has generally been extensively studied. However, the use of clozapine in the first episodes remains unclear.In the literature, and despite clozapine being considered one of the most effective antipsychotics, there is a high prevalence of polypharmacy and a significant delay in its use in the first episodes.Notwithstanding the unfavorable metabolic and hematological profile of clozapine, compared to other antipsychotics, in terms of hospitalization, mortality and discontinuation rates for all causes, it demonstrates a pattern of superiority.

The superiority in effectiveness of clozapine is well established, despite its underutilization and frequent delay in its introduction.The clinicians attitude remains a significant barrier to the commencement of clozapine, although it is important to define and characterize better potential groups of eligible patients. Education resources for clinicians as well as services specifically dedicated to early identification and management of eligible patients would be beneficial.

None Declared