Each year the European Psychiatric Association offers early career psychiatrists the opportunity to take part in the Gaining Experience programme, a scholarship that funds short observership placements (between 2 and 8 weeks) overseas in different psychiatric institutions across Europe to ECPs who have completed their psychiatric training. However, since COVID-19 was declared by the WHO as a worldwide emergency on 11th March 2020, it was no longer possible to provide offline overseas observerships. Therefore, the Gaining Experience programme changed its format in 2020-2021 and became virtual. It was in this context, that an Ukranian early career psychiatrist was going to participate in the virtual Gaining Experience programme at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London (United Kingdom) from December 2021. The observership placement had a particular academic focus, the essence of which was investigating psychotherapy training among ECPs in Ukraine, and to examine how it is included in psychiatry training. The sharing of this example of virtual observership shows that it is possible and feasible high-quality and affordable distance learning for ECPs. This training format can be useful not only during quarantine restrictions, but also in conditions of limited travel opportunities.

None Declared

Eating disorders severely impair psychosocial functioning, physical health, and quality of life. In particular, Anorexia Nervosa has the highest mortality rate among all psychiatric diseases. Other Specified Feeding or Eating Disorders have the highest lifetime prevalence with weighted means of 7.64% for women. Eating disorders are considered hard-to-treat, and studies have indicated that people suffering from eating disorders prefer low-threshold interventions compared to traditional mental health care. International studies show promising results of internet-based interventions for Other Specified Feeding or Eating Disorders.

To test the effectiveness of an internet-based psychologist-guided cognitive behavioral treatment program (I-TREAT) to reduce eating disorder symptoms in Danish adolescents and adults with Other Specified Feeding or Eating Disorders.

This study is a randomized controlled trial with two arms: 1) an intervention group and 2) an active control group. Participants are adolescents from the age of 15 or above, as well as adults, diagnosed with Other Specified Feeding or Eating Disorders. The intervention group receives the I-TREAT program while the control group receives self-guided mindfulness exercises. I-TREAT comprises 12 text-based treatment sessions with psychoeducation and treatment-related tasks, based on cognitive behavioral therapy and elements of compassion-focused therapy. The treatment duration is approximately 12 to 36 weeks. Videos, pictures, and animations support the treatment content and the program is accessible by web-browser and app. A specialist in eating disorders guides the patient through treatment with task-related feedback and asynchronous written communication. Patients will answer questionnaires regarding eating disorder symptoms, quality of life, and motivational states before, during, and after treatment, with follow-up measures at 3, 6, and 12 months. We expect to include 63 patients to each group and commence recruitment in August 2023. Preliminary results from a feasibility study on I-TREAT show good evaluations from clinicians and patients (N=30).

No results have yet been obtained. The results will be submitted to international scientific journals and presented at conferences.

The internet-based cognitive behavioral treatment program I-TREAT may be a promising tool for effectively treating adolescents and adults with Other Specified Feeding or Eating Disorders in Denmark.

None Declared

Thyroid disorders can present with psychiatric symptons similar to depression, and, at the same time, certain treatments, like litio, can cause changes in thyroid function. Given, therefore, the importance for the treatment and care of patients, the study of thyroid function is one of the parametres that should be requested in patients with psychiatric pathology.

To study the frequency of thyroid disorders in patients who where admitted to a psychiatric short stay unit.

Retrospective descriptive observational study is carried out in the acute stay unit of a psychiatric hospital. As a sample, all patients admitted to the unit over a period of three months. During admission, their sociodemographic data, the treatment they receive and their diagnosis are recorded. Secondly, blood test are performed whith differents parameters, including TSH values.

In the total sample of 172 patients, 8 of them have TSH abnormalities. 7 of them, all women, present hypothyroidism values.

A single male patient presented values of hyperthryroidism.

According to the present study, 4,6% of the patients present alterations at the TSH at admission, although except in one case, the values were not markedly altered.

The thyroid study at admission allows detecting cases of altered TSH that are amenable to treatment and monitoring.

None Declared

Depression is one of the most common psychiatric disorders causing considerable economic burden. However, the current treatment as usual, pharmacotherapy and psychotherapy, provides unsatisfactory treatment outcome for majority of the patients and in most cases fails to prevent treatment resistance and chronicity. tDCS, has emerged as a new neuromodulation treatment and has shown efficacy in depressed patients. To provide important insight to the payers, the cost-utility of tDCS in comparison to treatment as usual, should be clarified.

None Declared

There is growing evidence on the prevalence of neuropsychiatric disorders in patients suffering from COVID-19. On Hospital del Mar, a multidisciplinary post-COVID unit was created in May 2020 for COVID-19 patients.

Explain the functioning of the Post-COVID Psychiatry Functional Unit and the sociodemographic and clinical characteristics of treated patients.

The Post-COVID Unit assessed all patients treated for COVID at Hospital del Mar. Patients referred by their primary care center for persistent post-COVID symptoms were also treated.

During a telephone interview, they received the PHQ-4 questionnaire to identify psychiatric symptoms. If the score was => 3, the patient was referred to the Post-COVID Psychiatry Unit.

Initial contact was established by a mental health nurse, who collected a clinical history and administered three scales: PHQ-9, GAD-7 and PCL-5. A descriptive sociodemographic and clinical data analysis of patients treated by the Post-COVID Psychiatry Unit is carried out.

The sample consists of 149 patients who have been treated for positive PHQ-4 from July 2020 to April 2021. The majority were women (71%) and averaged 50.2 years old (SD = 12.3). In terms of the severity of COVID-19 infection, 45.6% needed hospitalization.

The mean score of the psychiatric symptom scales was 11.12 points on the PHQ-9 (SD=5.4) (1-4: minimal depression, 5-9: mild, 10-14: moderate, 15.19: moderately severe, 20-27: severe), 9.43 (SD=5.1) points in the GAD7 (cutoff point>=10) and 2.99 (SD=4) in the PCL5 (cutoff point>6).

39.5% patients of the sample were visited by psychiatry/psychology, of these 33.6% met psychiatric diagnostic criteria, the most frequent being an Adjustment disorder (15.40%), followed by Major Depressive Disorder (8.7%), Anxiety Disorder (4.7%) and other diagnoses (4.7%).

Patients treated in the Post-COVID Unit were mainly middle-aged women, the most common symptomatology being mild depressive symptoms.

None Declared

Antipsychotics (AP) are used as the primary pharmaceutical treatment for schizophrenia. Randomised clinical trials (RCT) show that the initiation of AP treatment often induces side effects such as substantial weight gain and metabolic disturbances, including an increased risk of type-2 diabetes (DM). However, the limitations of RCTs are often small cohorts that only represent a minority of patients with schizophrenia seen in everyday clinical settings leading to selection bias. Many RCTs are also limited by a short follow-up time, as evaluation of metabolic disturbances requires months to years of observation.

Within a large cohort of real-world patients with long-term follow-up, we aim to study the differential metabolic side effects of specific antipsychotic drugs.

We performed a retrospective cohort study using the electronic patient record system “MidtEPJ”, which contains data from blood samples and medication usage from all patients registered with a schizophrenia diagnosis (ICD-10 code DF20) in the central region of Denmark from 2016-2022. Patients were followed from September 2016 (for patients with a schizophrenia diagnosis before this date) or their first schizophrenia diagnosis. The exposure is treatment with AP medication. Outcomes of interest are the development of DM, defined as a diagnosis of DM or usage of anti-diabetic medication, and changes in HbA1c, glucose, and cholesterol levels (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol and triglycerides). We performed cox regression analyses to study the associations between specific AP compounds with the differential risk for developing DM and changes in metabolic markers.

We identified 4909 individual patients with a schizophrenia diagnosis from October 1st, 2016, to September 30th, 2022. AP was subscribed to 4609 of these patients. The results will be presented at the 2023 EPA Congress.

Our results will be discussed at the conference.

None Declared

Mental healthcare represents a significant issue for the Healthcare System [1]: one of the major causes is the high heterogeneity in the provision of care, due to the differences among the Departments of Mental Health (DMHs).

To identify the predictors of an adequate treatment for patients with severe mental disorders (SMDs), both at an individual and structural level, the latter considering the major features of the Psychiatric Operative Units (POUs), in the Italian region Lombardy.

Healthcare Utilization Databases, collecting data on the services provided to beneficiaries of the National Health Service (NHS), have been used to retrieve data.

Patients that during 2015 were resident in Lombardy; suffered from depressive, bipolar or schizophrenic disorder; were in contact with the DMHs, have been identified.

Adequateness of treatment has been evaluated according to the Minimally Adequate Treatment (MAT) [2,3]: a combination of psychiatric visits and specific pharmacological treatment, or psychotherapeutic sessions. Having received a MAT has been assessed during a one-year period.

Predictive factors have been classified into two hierarchical levels: individual (first) level and structural (second) level. At the first level, clinical and socio-demographics characteristics have been evaluated for each patient. At the second level, the organizational structure of each POU has been examined: the number of patients taken in care, number of community-care facilities, and hours worked by each class of healthcare providers (psychiatrists, nurses, psychologists, psychosocial staff).

A log-binomial model has been used to evaluate the association between the first-level factors and having received a MAT; a multilevel log-binomial model for the second-level factors considered the hierarchical structure of data.

72115 patients have been identified: 33974 (47.1%), 28407 (39.4%) and 9734 (13.5%) suffering from depressive, schizophrenic or bipolar disorder respectively; 45.4% of them (32773 patients) received a MAT.

Compared with patients affected by depression, those with bipolar or schizophrenic disorder show a higher probability of receiving a MAT (+23%, +11% respectively).

Patients living alone have a lower probability of receiving a MAT, unlike patients with a higher level of education or employment, underlining the social burden related to SMDs.

Organizational features have proven significant: centres with a higher activity volume and with more community-care facilities seem more likely to guarantee MAT. Moreover, the higher the hours worked by psychiatrists, nurses and psychologists, the higher the probability of providing MAT.

Patients with SMDs are still untreated in an appropriate way. Results highlight the importance of the community-care facilities, as well as of the composition of the multidisciplinary teams working there.

None Declared

Various comorbid conditions can worsen the morbidity and mortality of schizophrenia, and this is the case for depression, especially through suicidal behaviors and cardiometabolic impairments. There is a scarcity of summarizing data on depressive symptoms and disorders among schizophrenia patients living in Africa.

The aim of this meta-analytic review was to estimate the prevalence of depression in people living with schizophrenia in Africa.

We systematically searched for relevant articles published from inception to July 05, 2022, in PubMed/MEDLINE, EMBASE, and African Journals Online. We appraised the risk of bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for studies reporting prevalence data, and estimated the pooled prevalence of depression among patients with schizophrenia using a random-effects meta-analytic model. We performed meta-regression and subgroup analyses to assess potential mediators of our estimates. We based the report of our findings on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (2020). We registered our protocol in PROSPERO (CRD42022315717).

From 791 initial records, 10 studies were finally included in our qualitative and quantitative syntheses (Figure 1). These studies encompassed 2265 patients with schizophrenia (male-to-female ratio = 1.94), and were conducted between 2001 and 2019, in Egypt (n = 1/10), Ethiopia (n = 4/10), Morocco (n = 1/10), Nigeria (n = 1/10), South Africa (n = 2/10), and Tunisia (n = 1/10). The mean age of participants ranged from 33.8 to 49.2 years, and the most used tool was the Calgary Depression Scale for Schizophrenia (n = 4/10). The pooled prevalence rate of depression was 23.93% (95% CI: 19.43% – 28.73%), with substantial heterogeneity (I² = 84%). The prevalence of depression significantly varied according to screening tool used. The frequencies for Northern and Sub-Saharan Africa were respectively 31.9% (95% CI: 24.8% – 39.5%) and 21.1% (95% CI: 16.7% – 25.9%), with a significant difference between these subgroups (Figure 2). A higher prevalence of depression was associated with a lower percentage of schizophrenia patients with high education levels. Among schizophrenia people with depression (n = 250), 46.04% (95% CI: 30.07% – 62.42%) reported past or current suicide behaviors. The risk of bias was low for three studies, moderate for two studies, and high for five studies. The certainty was very low, and we found no publication bias.

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Approximately one in every four schizophrenia patients living in Africa was positively screened for depression. This review draws health professionals’ attention caring people with schizophrenia, and calls for further studies with a harmonization of screening tool, a better representativity of some subregions, and the assessment of key potential factors such as perceived stigma and self-stigma.

None Declared

Adolescence is considered as a particularly vulnerable period for body image disturbance. Body esteem is defined as the self-evaluation of one’s own body or appearance.

Validate the Body Esteem Scale for Adolescents and Adults (BESAA) in Tunisian adolescents.

We conducted a cross-sectional study among adolescents who attend Tunisian high school from 11 October 2021 to 11 November 2021.

We translated the BESAA into dialectal Tunisian Arabic based on the translation back-translation method. The validity of the scale was evaluated through content validity, reliability and construct validity. We used the Arabic version of Rosenberg Self Esteem Scale as an external validator.

We recruited 340 adolescents aged between 12 and 19 years’ old. The translated version was considered satisfactory. The internal consistency showed a good result with a Cronbach Alpha of 0,830. The correlation between items and subscales demonstrated statistically significant and logical results. Statistically significant correlations were found between the BESAA and its external validator the Rosenberg Self Esteem Scale (r= 0,422; p< 0,01). The exploratory analysis related three factors similarly to the original version of the questionnaire and in confirmatory analysis. The scale demonstrated good model fit statistics as follow: Comparative fit index= 0,87; goodness of fit index=0,81; adjusted goodness of fit index=0,77; Root Mean Square Error of Approximation=0,1 and Standardized Root Mean Square Residual=0,09.

Our BESAA version can be reliably used to conduct further studies and researches on body esteem in the Tunisian population.

None Declared

Spinal cord injuries are known to have physical damage. They are often accompanied by urinary and fecal incontinence, disorders of tenderness, neuropathic pain and motor deficits. Therefore they have a serious impact on physical, mental and social health.

The objective of our work was to assess sexual function and quality of life in men with spinal cord injuries.

This is a cross-sectional study enrolling patients with spinal cord injuries followed at the physical medicine consultation and/or urology department of Sahloul teaching Hospital during the period from January 2016 to January 2018.

This study enrolled 21 patients. Mean age was 45.62 ±15.79 years. Thirteen patients were married, and nine had a primary school level of education. Thirteen patients worked as building workers. The cause of the spinal cord injury was traffic accident in 12 cases. The overall IIEF 15 was 15.57±7.46. Thirteen patients had erectile dysfunction which was rated severe in five patients. The average MSQ was 27.52 ± 26.32 with 10 patients very dissatisfied. The overall SF-36 score was 31.71± 26.16. We found a statistical correlation between quality of life impairment and sexuality impairment in almost all dimensions and especially impairment of physical activity (r²=+0.783 p<0.001) and impairment of perceived health.

The impairment of sexual function is a serious health problem in patients with spinal cord injury. It has a serious impact in the quality of life that justify specific interventions.

None Declared

Bipolar Mood Disorder (BD) and Obsessive-Compulsive Disorder (OCD) are psychiatric conditions that frequently co-occur and express a challenging phenomenology for treatment and diagnosis, since obsessive-compulsive symptoms tend to fluctuate according to mood phases of BD patients. Understanding the shared psychopathology of this comorbidity has relevant implications for the treatment of these patients, and the hypothesis that BD and OCD would have a shared neurobiology is currently being discussed. Most studies of this comorbidity have examined differences between BD and BD/OCD patients or between OCD and BD/OCD patients. This study aimed to analyze in detail the clinical, phenomenological and psychopathological characteristics of patients with BD, OCD, and BD/OCD.

This study aimed to analyze in detail the clinical, phenomenological andpsychopathological characteristics of patients with BD, OCD, and BD/OCD.

This study consisted of a sample of 21 BD patients, 21 OCD patients and 21 BD/OCD patients who underwent the application of the MINI, Y-BOCS, DY-BOCS, HAM-D, HAM-A, YMRS, of Sensory Phenomena (USP), as well as questions about sociodemographic characteristics, personal and family psychiatric history. We performed the YBOCS scale asking patients with BD to respond 3 times the scale: in the current time (during euthimya) and retrospectively for previous manic or depressive episodes.

BD/OCD group had a higher rate of having stopped working due to comorbid disorders, a higher history of family suicide attempt and completed family suicide, a higher prevalence of substance use disorder in the family, and a higher prevalence of hoarding symptoms. In the BD sample, 47,6% had obsessive-compulsive symptoms. The presence of OCD conferred a higher prevalence of sensory phenomena. Patients reported a 19% (median, 0.19, range -1.00 to 1.88) worsening of OCD during depression, and a 9.5% worsening (median, 0.095, range of -1.00 to 1.36) during the manic phase.

The results suggest that BD/OCD patients have greater loss of functionality, higher rates of hoarding symptoms, family history with greater suicidality and higher rates of substance use disorder (SUD) and worsening of OCD in both mania and depression. The psychopathological findings of this study allow us to conclude that BD/OCD patients have higher morbidity.

LIMITATIONS: Small size sample and possible recall bias in the interview, as questions wereasked retrospectively.

None Declared

Autism spectrum disorder (ASD) is a highly heritable neurodevelopmental disorder affecting 1-2% of the population worldwide. Recent large-scale whole-exome sequencing (WES) studies identified hundreds of rare, highly penetrant genetic variations associated with ASD. Many of these genetic variations underlie particular genetic syndromes characterized by a variety of congenital anomalies in addition to the core ASD symptoms. Recently, we reported about certain ultrasonography fetal anomalies (UFAs) associated with later development of ASD (Regev et al. Brain 2022).

To identify genetic mutations associated with UFAs in children with ASD.

We conducted a cross-sectional study of all children diagnosed with ASD registered at the Azrieli National Centre for Autism and Neurodevelopment (ANCAN) who have both fetal ultrasound and WES data. We used an integrative in-house bioinformatics pipeline specifically designated to identify gene-disrupting variants (GDVs) in a panel of >1200 genes associated with ASD according to SFARI gene database. Then, we compared the prevalence of GDVs in these genes between children with and without UFAs. Finally, we applied the Gene Analytics tool to disrupted genes in children with specific fetal anomalies to identify biological pathways associated with both ASD and these fetal anomalies.

Overall, 115 ASD children were included in this study, of which 49 (42.6%) of them had UFAs in their ultrasound scans (Figure 1). Children with and without UFAs did not differ in their sociodemographic and clinical characteristics except for a significantly lower proportion of males in the UFA group (63.4% vs. 84.8%, respectively; p=0.011). Notably, children with UFAs were more likely to carry GDVs in ASD genes than their counterparts even after adjustment to the sex differences between the groups (aOR=2.27, 95%CI: 1.05-4.93), and this association was the most prominent with GDVs in the most notable ASD genes (i.e., those with SFARI gene score=1). Also, the study shows higher prevalence of children with GDVs in most anatomical systems, with UFAs in fetal size (14.8% vs. 1.6%, p=0.012, cases vs. controls) and the head&brain (16.7% vs. 4.9%, p=0.040, cases vs. controls) being the most prominent (Figure 2). In addition, children with UFAs had significantly more co-occurring mutations, and the number of mutations in a single fetus was significantly correlated with the number of UFAs (r=0.20, p=0.035).

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Our findings suggest distinct genetic mechanisms for ASD subtypes that are characterized by unique UFAs. These findings may form a basis for future prenatal screening approaches for ASD using both ultrasound and genetic testing. Our findings suggest distinct genetic mechanisms for ASD subtypes that arecharacterized by unique UFAs. These findings may form a basis for future prenatal screening approaches for ASD using both ultrasound and genetic testing.

None Declared

Schizophrenia is a severe mental disorder mainly caused by genetic risk factors. Many studies have demonstrated that both multiple genetic variants and rare mutations are associated with schizophrenia risk. The next step is to study the causal effect of the gene on the phenotype. Recently, a large family-based study identified de novo mutations, which may increase liability to schizophrenia (Rees et al 2020). In particular, a mutation in the GABA transporter (SLC6A1) gene (rs756927822 C/T) was identified in one patient from our subsample.

Here, we present a case report of this patient and describe the procedure of derivation of induced pluripotent stem cells (iPSCs) from fibroblast cultures.

Clinical, psychometric and neuropsychological methods were used. iPSCs were derived from patients’ and both unaffected parents’ fibroblasts. Human fibroblasts, cultured in fibroblast medium, are infected with lentivirus vectors expressing the transcription factors Oct4, Sox2, c-Myc, and KLF4. All iPSCs were immunocytochemical stained for intracellular (Oct4, Sox2) and extracellular (SSEA4, Tra-1-81, Tra-1-60) pluripotency markers. An qPCR analysis for pluripotency markers (TDGF1, Sox2, Oct4, REX1, LIN28, NANOG, KLF4, GDF3, DPPA4, DNMT3) was performed. All four iPSC lines formed embryoid bodies before the differentiating into three germ layers. Differentiation was confirmed by immunostaining for mesoderm (aSMA), ectoderm (Nestin, Desmin) andendoderm (FoxA2, Pax6) markers.

A 47-year-old male patient was presented to psychiatry at the age of 16. There was no personal or family history of psychiatric disorder, the premorbid functioning was normal, the patient had no somatic diseases, showed high performance in sport (mountain skiing). On his first admission, he was diagnosed with schizoaffective psychosis. The patient showed signs of mania and catatonia. Neuropsychological testing revealed a decrease of cognitive functioning (short-term and associative memory). The patient was followed up for more than 20 years. The diagnosis was changed for schizophrenia at the age of 43 years. There was a deterioration in cognitive function (the apparent decrease in performance on neurocognitive tests (attention, memory, executive functions) from the first examination (1997) till last one (2019). The patient refused or was not able to perform most of the tasks. During follow-up, the patient shows good adherence to treatment.

For this patient, obtained lines might be valuable for investigating the disease mechanisms and screening candidate drugs.

None Declared

Autism is neurodevelopmental disorder with a heterogeneous presentation of symptoms, which include disturbances in sensory, motor and cognitive processes, among which social cognitive impairments and social interaction difficulties play prominent role. Despite the fact that these impairments can lead to lifelong disability and difficulties in everyday functioning, their neurobiological basis remains largely unknown. Neural oscillations in the gamma band have been shown to be an important candidate neurobiological marker of higher order cognitive processes and social interactions. Yet, alterations of gamma oscillations in ASD have received little attention in the literature.

The aim of the current study was to investigate resting state gamma oscillations in the EEG in order to delineate alterations in ASD as compared to typically developing (TD) subjects in the intrinsic activity of the neural networks that have been linked to social cognitive functioning.

Resting-state EEGs were obtained in an ongoing study investigating ASD (N=19) and TD subjects (N=15), based on eyes closed condition. EEGs were recorded using a 128-channel BioSemi system. EEG absolute power was investigated in the gamma 30-48Hz frequency band.

Gamma activity was significantly (p<0.05) diminished in multiple brain regions in ASD as compared TD subjects. The diminished gamma activity had a distinctive topographical distribution, which included the left and right inferior temporal gyrus, the right superior temporal gyrus, the TPJ and the right extrastriate areas. Additionally, we found a hemispheric asymmetry in the occipital brain areas with a decrease of gamma activity on the right and an increase in the left hemisphere as compared to TD.

Diminished gamma activity in the above brain areas may represent a cortical dysfunction which can be present due to a reduced capacity to process socially relevant information and a decreased capacity to omit irrelevant stimuli.

Funding: Hungarian Brain Research program,#NAP2022-I-4/2022

None Declared

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or reduction of speech, has a wide differential diagnosis. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. Mutism is typically associated with catatonia, usually in schizophrenia, but also depression, bipolar disorder, intoxication, and neurological conditions.

To describe a case of mutism without catatonia.

We describe a clinical case of a patient admitted to our psychiatric inpatient unit with mutism as the presenting symptom. The literature on this subject is also selectively reviewed.

A 49-year-old woman was found mute at home by her brother and brought to our emergency room. Not a word had come out of his mouth for the past month. She would show up at the restaurant where she worked as a waitress and do her job, but she didn’t talk. As a result, she had been fired. Her routine daily chores and her vegetative functions were maintained. She had no prior history of medical or psychiatric illness or substance abuse. In addition to the mutism, the patient showed an important psychomotor restlessness and performed repetitive hand movements suggestive of occupational delirium. There was no rigidity, stupor, negativism, catalepsy, echosymptoms or any other catatonic symptomatology.

She was then admitted to our inpatient unit, where a complete blood test, EKG, brain CT, brain MRI, EEG and a lumbar puncture with biochemistry and neuroimmunology studies were performed, none of them showing any abnormalities.

The clinical presentation suggested the diagnosis of either a psychotic disorder or a major depressive episode.

The patient was then started on olanzapine up to 20 mg/d, fluoxetine up to 20 mg/d and lorazepam up to 6 mg/d. Due to persistence of symptomatology despite pharmacological treatment, she was started on Electroconvulsive Therapy (ECT). At the time of issuance of this report, 7 bilateral ECT courses have been carried out and absolute mutism persists. Although she has presented an improvement of the anxiety and the repetitive behaviors noted on admission have disappeared, she hasn´t resumed speaking.

Mutism occurs in a number of conditions, both functional and organic, and an accurated diagnosis is important for the management. One must perform a thorough physical and systemic examination to rule out organic causes for mutism. An observation for some time period may be warranted and should be done to reach final diagnosis in our case.

None Declared

Deep brain stimulation (DBS) of brain circuits involved in mood regulation is a novel tool that is being investigated as a potential treatment for some of the most severe patients with mood disorders. At UTHealth Houston, we have had an ongoing clinical trial with DBS of the medial forebrain bundle (MFB).

Our preliminary results suggest effects in alleviating depressive symptoms in this very severe, refractory patient group.

In this presentation, we will review our latest findings, and will also discuss the potential effects of the MFB stimulation on measures of suicidality in this patient population.

None Declared

The neuroleptic malignant syndrome is a rare but potentially the most dangerous complication of neuroleptic use. The first descriptions of this disorder were given by Delay and colleagues in the 1960s, calling it “hypertonic akinetic syndrome” and characterizing it with hyperthermia, extrapyramidal symptoms, altered mental status, and autonomic dysfunction. Current knowledge unequivocally shows that NMS most often occurs with the use of first-generation antipsychotics, especially in parenteral form. After the appearance of this disorder, the usual practice is to transfer the patient to monotherapy with clozapine, excluding antipsychotics from the chemical group that led to NMS.

However, there are isolated reports of the occurrence of this syndrome in patients on concomitant therapy of clozapine with lithium salts.

The main objective is to present possible case of NMS in patients with concomitant use of clozapine and lithium

Case report: M. K., born in 1984, graduated from high school, unmarried, without permanent employment. In 2003, after the parenteral application of Depo preparation, he developed NMS. He was hospitalized at the Institute of Psychiatry in Belgrade when he was diagnosed with psychosis of the schizophrenic cycle. After discharge from the hospital, stable clinical remission persists with maintenance therapy with clozapine. In July 2018, after a short stay abroad, he developed a pronounced behavioral disorganization and was forced to be admitted to our institution.

On admission and in the initial phase of hospital treatment, the clinical picture is dominated by intense psychomotor restlessness, acoustic hallucinatory experiences, dysphoric-euphoric mood, and uncontrolled verbal and physical aggression towards medical staff and other patients. He was treated with clozapine, which was gradually titrated up to 600 mg daily, with benzodiazepine support (lorazepam 10 mg p.d.) without significant improvement, medical sedation, and lithium salts were introduced into the therapeutic protocol.

Immediately afterward, psychomotor inhibition occurs, accompanied by somnolence, mild hypotension, sinus tachycardia, and subfebrile temperatures, without signs of muscle stiffness. Lab. analysis of CpK 628, other findings within reference values. Excluded psychopharmaceuticals from the therapeutic protocol, introduced detox. procedures and III generation cephalosporins, after which the patient’s condition stabilizes.

It is important to bare in mind the possibility of NMS in patients with concomitant use of clozapine and lithium

None Declared

Many psychiatric illnesses have been linked to the gut microbiome, with supplements such as probiotics showing some efficacy in alleviating the symptoms of some psychiatric illnesses. Though probiotics alone have been found to be efficacious in alleviating the symptoms of psychiatric illnesses, the combination of probiotics and first-line psychotropic medications has not been investigated as thoroughly.

The primary objective of this review was to evaluate the current literature investigating the effects of adjuvant probiotic or synbiotic administration in combination with first-line psychotropic treatments for psychiatric illnesses.

A systematic search of four databases was conducted using key terms related to treatments for psychiatric illnesses, the gut microbiome, and probiotics. All results were then evaluated based on specific eligibility criteria. The salient outcome measures from the studies that met this eligibility criteria were then extracted and analysed.

Eight studies met eligibility criteria and were analysed for reported changes in outcome measures used to assess the symptoms of psychiatric illness and the tolerability of treatment. All Major Depressive Disorder (MDD) (n=5) and Generalized Anxiety Disorder (GAD) (n=1) studies found adjuvant probiotic or synbiotic treatment to be more efficacious in improving the symptoms of psychiatric illness than the first-line treatment alone or with placebo. The schizophrenia studies (n=2) found adjuvant probiotic treatment to have no significant difference in clinical outcomes, but it was found to improve the tolerability of first-line antipsychotics.

The findings of the studies included in this review suggest the use of adjuvant probiotic treatment with selective serotonin reuptake inhibitors (SSRIs) for MDD and GAD to be superior to SSRI treatment alone. Probiotic adjuvant treatment with antipsychotics could be beneficial for improving the tolerability of the antipsychotics, but these findings do not suggest that adjuvant probiotic treatment would result in improved clinical outcomes for symptoms of schizophrenia.

None Declared

The glutamatergic system plays an important role in the neurobiology of schizophrenia. A lot of number of variants in the GRIN genes have been found in patients with various neuropsychiatric disorders (Myers et al. F1000Res 2019; 8(F1000 Faculty Rev) 1940). GluN2A, encoded by the GRIN2A gene, is the most abundant of the GluN2 NMDA receptor subunits in the mammalian CNS. Clinical symptoms of schizophrenia vary among individuals. The GRIN2A gene has previously been shown to be associated with early onset schizophrenia (Poltavskaya et al. Life (Basel) 2021; 11(10) 997).

The aim of the study was to identify associations of the GRIN2A gene rs11644461 polymorphism with features of the course of schizophrenia.

This study was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki 1975). 805 patients with schizophrenia (ICD-10: F20) were included. Clinical examination and diagnostic evaluation were performed using the Positive and Negative Syndrome Scale (PANSS). From the general group of patients, 2 subgroups were distinguished according to the PANSS survey: 391 patients with leading negative symptoms and 414 patients with leading positive symptoms. Also 2 subgroups were distinguished from the general group of patients: 398 patients with a continuous course of schizophrenia and 257 patients with episodic schizophrenia. Genotyping was performed by real-time PCR.

An association of the C rs11644461 GRIN2A allele with the continuous course of schizophrenia was revealed (p<0,047). The rs11644461 polymorphism was not associated with the leading symptoms of the disease (positive or negative). At the same time, the values of the total score on the PANSS scale differed statistically significantly in carriers of different genotypes for this polymorphism. The sum of PANSS scores (Me [Q25 – Q75]) in carriers of the TC rs11644461 genotype was statistically significantly higher (106 [92–113]) than in carriers of the CC genotype (101 [87–108]) (p=0.006).

According to the results obtained, carriers of the TC rs11644461 GRIN2A genotype have a higher severity of schizophrenia symptoms according to the PANSS scale than carriers of the CC genotype. Also in the present study, it was shown that the C allele rs11644461 GRIN2A is associated with the continuous course of schizophrenia, which indicates the contribution of this locus to the formation of the course of the disease.

E. Poltavskaya Grant / Research support from: Russian Science Foundation # 21-15-00212, O. Fedorenko Grant / Research support from: Russian Science Foundation # 21-15-00212, E. Kornetova Grant / Research support from: Russian Science Foundation # 21-15-00212, I. Pozhidaev Grant / Research support from: Russian Science Foundation # 21-15-00212, D. Paderina Grant / Research support from: Russian Science Foundation # 21-15-00212

Relapse prevention is critical because psychopathology and functionality can worsen in patients with schizophrenia because the repeated episodes and we have strong evidence of antipsychotics efficacy for relapse prevention, but nonadherence rates in patients with schizophrenia are very high, even in comparison with other illness. The literature speaks of average rates of 42% in schizophrenia. For that, long-acting injectable antipsychotics (LAIs) are considered important treatment option, but they are underutilized (Taipale et al. Schizophrenia Bulletin 2017; 44, 1381–1387) (Garcia et al. J Clin Psychopharmacol 2016; 36(4)355-371).

There is extensive clinical trial evidence for the use of paliperidone palmitate 1-month (PP1M) and paliperidone palmitate 3-month (PP3M) formulations for maintaining treatment continuity and preventing relapses and risk of hospitalizations in patients with schizophrenia. (Najarian et al. Int J Neuropsychopharmacol 2022; 25(3) 238-251).

Paliperidone palmitate 6-month (PP6M) formulation is a presentation that provides a dosing interval of once every six months. It is the first and only antipsychotic to be administered twice a year.

The principal aim of this study was to evaluate the effectiveness, safety, and tolerability of the PP6M in people with non-acute schizophrenia in a naturalistic psychiatric outpatient setting

Sample: 22 patients diagnosed with schizophrenia (DSM 5 criteria) that started treatment with PP6M after being stabilized with PP1M (N:10) or PP3M (N:12) (the treatment dose was not changed in the four months before study inclusion)

The mean dose of PP6M was 822.727 mg

Bimonthly, the following evaluations were performed during a follow-up period of 4 months:

The Clinical Global Impression-Schizophrenia scale (CGI-SCH)

Treatment adherence, concomitant medication, adverse events and the number of hospitalizations and emergency visits

Efficacy values: Percentage of patients who remained free of admissions at the end of 4months of follow-up.

Other evaluation criteria: Percentage of patients who never visited the emergency department at the end of 4 months of follow-up, average change from baseline visit to the final evaluation as assessed by score obtained on the following scale: GSI-SCH, treatment adherence rate and tolerability.

The percentage of patients who remained free of admissions at the end of the 4 months was 100% and the percentage of patients who never visited the emergency department at the end of 4 months was 100 %

Mean variations from baseline scores at 4 months were: (-0.21 ±0.31) on the GCI-SCH.

The rate of adherence to treatment with PP6M after 4 months was 100%.

Tolerability was good. None of the patients experienced an adverse event.

In our study, we found that short-term treatment with paliperidone palmitate 6-month formulation is effective and well tolerated in clinical practice conditions

None Declared