Schizophrenia is associated with harmful health effects such as oxidative stress from heavy metal exposure. We considered the relationship between genes and heavy metals in association with oxidative stress and then investigated the association between serum α- klotho and copper and cadmium exposure among schizophrenia patients in western India.

To investigated the association between serum α- klotho and copper and cadmium exposure among schizophrenia patients in western India.

100 individuals participated out of which 50 were diagnosed with schizophrenia, severity was assessed by using PANSS score and 50 were taken as controls using General health questionnaire. Serum Klotho levels were estimated using ELISA. Serum Cadmium (Cd) and Serum Copper (Cu) was estimated using Atomic Absorption Spectrophotometry.

The mean ± SD levels of Serum Cd, Serum Cu and serum Klotho were 1.05 ± 0.55 μg/dl, 135.5 ± 51.25 μg/ml and 62.9 ± 35.1 ng/ml respectively in the patients and 0.23 ± 0.17 μg/dl, 147.9 ± 25.42 μg/ml and 78.6 ± 34.6 ng/ml respectively in controls. The differences in Serum Cd, Serum Cu levels and Klotho levels among the study group were highly significant (p <0.05).

Both Cu and Cd levels were significantly raised in schizophrenic patients compared with controls. Serum klotho levels showed a statistically significant decreasing trend with increasing cadmium levels. These results suggest that cadmium levels may be associated with the serum klotho levels which may be associated with decreased cognition in schizophrenia.

None Declared

Evidence on neonatal withdrawal syndrome following antidepressant intrauterine exposure is limited, particularly for antidepressants other than selective serotonin reuptake inhibitors (SSRIs).

To ascertain whether maternal antidepressant treatment may be associated with withdrawal syndrome in neonates, investigating the comparative reporting between individual antidepressants and classes.

We performed a case/non-case pharmacovigilance study, searching reports of withdrawal syndrome in newborns in the VigiBase, the WHO database of suspected adverse drug reactions. Disproportionality analysis was performed, estimating reporting odds ratio (ROR) and the Bayesian information component (IC). Antidepressants were compared to all other medications, to methadone, and within each class of antidepressants (SSRIs, tricyclics (TCA) and other antidepressants). Antidepressants were ranked in terms of clinical priority, based on a semiquantitative score.

We retrieved 406 reports of neonatal withdrawal syndrome in 379 neonates related to 15 antidepressants. Compared to all other drugs, disproportionate reporting was detected for antidepressants altogether (ROR: 6.18, 95%CI:5.45-7.01), for TCAs (10.55, 95%CI:8.02-13.88), other antidepressants (ROR: 5.90, 95%CI:4.74-7.36) and SSRIs (ROR: 4.68, 95%CI:4.04-5.42). All antidepressants showed a significant disproportionality, apart from bupropion (figure 1). We did not find any disproportionate reporting for any antidepressant compared to methadone. The clinical priority ranking showed moderate clinical priority for all antidepressants, with the exception four, that had a weak one (figure 1). Most frequently reported symptoms were respiratory symptoms (n=106), irritability/agitation (n=75), tremor (n=52) and feeding problems (n=40).

Image:

Exposure to antidepressants in utero is associated with moderate signals of disproportionate reporting for neonatal withdrawal syndrome for most antidepressants. Clinicians should pay extra attention to neonates with antidepressant-treated mothers.

C. Gastaldon: None Declared, E. Arzenton : None Declared, E. Raschi: None Declared, O. Spigset: None Declared, D. Papola: None Declared, G. Ostuzzi: None Declared, U. Moretti: None Declared, G. Trifirò Grant / Research support from: he was the scientific director of a Master program on pharmacovigilance, pharmacoepidemiology and real-world evidence which has received non-conditional grant from various pharmaceutical companies; he coordinated a pharmacoepidemiology team at the University of Messina until Oct 2020, which has received funding for conducting observational studies from various pharmaceutical companies (Boehringer Ingelheim, Daichii Sankyo, PTC Pharmaceuticals). He is also scientific coordinator of the academic spin-off “INSPIRE srl” which has received funding for conducting observational studies from contract research organizations (RTI Health Solutions, Pharmo Institute N.V.)., Consultant of: has served in the last three years on advisory boards/seminars funded by SANOFI, Eli Lilly, AstraZeneca, Abbvie, Servier, Mylan, Gilead, Amgen, Speakers bureau of: has served in the last three years on advisory boards/seminars funded by SANOFI, Eli Lilly, AstraZeneca, Abbvie, Servier, Mylan, Gilead, Amgen, C. Barbui: None Declared, G. Schoretsanitis Consultant of: Dr. Schoretsanitis has served as a consultant for HLS Therapeutics and Thermo Fisher Scientific.

There is a variety of specialized outpatient and residential Alcohol and Other Drugs (AOD) services, but research on outcomes of these services is limited. Given the chronic, relapsing nature of AOD problems, there is a need for longitudinal research on outcomes after treatment in various AOD services.

Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) are hardly used in the AOD field but provide excellent tools and a framework to monitor progress and outcomes in these services based on experiences of service users.

The objectives of the OMER-BE study are to:

1. Assess and compare patient characteristics at baseline in various treatment modalities

2. Test and prepare the routine measurement of PROMs and PREMs in AOD services using a self-report tool

3. Assess patient-reported experiences qualitatively in various treatment modalities for AOD patients

The overall goal is to continuously assess and improve AOD services.

We have set up a naturalistic, longitudinal cohort study for which we will engage and follow up 250 AOD users as they present themselves in selected AOD services in four different treatment modalities (outpatient non-pharmacological treatment, outpatient substitution treatment, residential psychiatric treatment and therapeutic communities for addictions).

Sociodemographic and clinical factors and PROMs will be assessed at baseline. PROMs and PREMs will be assessed at 45-, 90- and 180-days follow-up. The questionnaires that will be used during the baseline and follow-up assessments are based on the ICHOM Standard Set for Addictions (ICHOM SSA, 2020), a set of brief validated questionnaires to measure and monitor treatment outcomes routinely in AOD services.

Following the 6-month follow-up we will perform a qualitative study in a subset of N=20 participants (5 per treatment modality). These participants will be invited to take part in an in-depth interview with one of the researchers, where the following topics will be discussed: treatment history, recovery experiences, helping and hindering factors in recovery, and experiences with different treatment modalities.

47 participants have been recruited in the OMER-BE study up until October 2022. 38 (81%) of the participants were born male, 9 (19%) were born female. The average age of participants is 33, with ages ranging from 19 to 47 years old.

Preliminary findings will be presented at the congress.

Further recruitment of study participants up to a total of 250 will be undertaken until the end of 2023.

The OMER-BE study aims to assess and improve AOD services by using a self-report tool, measuring PROMs and PREMs.

None Declared

There is evidence that cerebral myelination is impaired in schizophrenia. The purpose of this study is to find the myelin content changes in the brain structures of patients with early-stage schizophrenia using the macromolecular proton fraction (MPF) method, and also to evaluate the differences in the myelination of these structures.

To measure MPF in the brain structures of schizophrenia patients

Forty-five subjects, 22 controls (10m+12f, 31.6±9.7 y.o.) and 23 schizophrenia patients (F20.0, 11m+12f, 31.5±5.1 y.o.). Philips Achieva dStream 3T MRI scanner, standard head coil. The magnetization transfer (TR=20 ms, TE=4.60 ms, FA=10°), T1-weighted (TR=20 ms, TE=4.60 ms, FA=20°) and PD-weighted (TR=20 ms, TE=4.60 ms, FA=4°) were acquired. The MPF maps were reconstructed using home-made software. In FSL, non-brain structures were removed and MPF maps were registered to a standard MNI152 1 mm atlas. Harvard Oxford Cortical and Subcortical atlases were used to select areas of interest. T-test was used in search for between-group differences.

A 3% decrease in myelination in schizophrenia was observed in whole cerebral cortex p = 0.03) and cerebral white matter (p=0.02). Trends to cortical demyelination were found: paracingular cortex (p=0.06), anterior (p=0.1) and posterior cingulate cortex (p=0.07). No myelination disorders were detected in the cerebellum.

Image:

Image 2:

Image 3:

To our knowledge, the absence of cerebellar myelination disorders in patients at an early-stage schizophrenia is reported for the first time, while the observed decrease in cerebrum myelination in schizophrenia is consistent with the previous findings. The difference in myelination between cerebellum and cerebrum may help to characterize the dynamics of the pathological process and provide additional information for understanding the biological mechanisms of the development of schizophrenia.

Grant RSF 20-15-00299 (partially).

None Declared

Bipolar Disorder (BD) has been suggested to be a risk factor for development of Parkinson Disease. Psychiatric drugs used as standard treatment of BD includes many drugs that are known to induce drug-induced parkinsonism (DIP).

Clinical differentiation between PD and DIP is a clinical and scientific crucial result. It might be aided by functional neuroimaging of the dopaminergic nigrostriatal pathway.

Twenty consecutive BD patients with parkinsonism were clinically assessed and underwent 123I-ioflupane dopamine transporter SPECT. Imaging data of BD patients with pathological nigrostriatal pathway were further compared to a population of de-novo PD patients.

Four BD patients had abnormal scans; they had higher putaminal binding ratio and putamen-to-caudate ratios than PD patients, despite similar motor symptom burden.

in our initial results, up to 20% of BD patients with parkinsonism might have an underlying dopaminergic deficit, which is higher than excepted in the general population. This evidences supports that BD represents a risk factor for subsequent development of neurodegenerative parkinsonism.

None Declared

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, and in the majority of patients persists into adulthood. There is a lack of data regarding the risks of ADHD medication during pregnancy and breastfeeding. While some women may be able to discontinue without adverse effects, others may experience significant functional impairment. Due to the rising number of ADHD medication prescribed to women at child-bearing age, it is important to determine which medications can be considered relatively safe in pregnancy and lactation.

We aim to review recent evidence on the risks of stimulant and non-stimulant treatment in pregnancy and lactation.

Literature review on the topic through PubMed and Google Scholar using the search terms: “ADHD”, “ADD” , “Pregnancy”, “Lactation OR breastfeeding”, “Stimulants”, “Methylphenidate OR Amphetamine OR lisdexamfetamine OR atomoxetine OR modafinil”. Only original research papers written in English were included.

We identified twelve studies investigating the use of ADHD medication in pregnancy and four studies regarding lactation. Most of the studies did not find an elevated risk for congenital malformations by treatment with methylphenidate or medical amphetamines during pregnancy. A report suggested a moderate risk for congenital defects in infants exposed to modafinil in utero. The teratogenic effects of atomoxetine and guanfacine have not been investigated. Regarding lactation, only case reports and case series were found. Methylphenidate seems to be safe, with little transfer into breast milk and no reported adverse effects for the baby. Amphetamines transfer into breast milk and reach relatively high concentrations, and although the overall risk for intoxication seems to be low it cannot be fully excluded.

Prescription of ADHD medication to pregnant and lactating women should be considered after an individual risk-benefit estimation. In severe cases, when medication cannot be discontinued, the overall risk for adverse outcomes seem to be relatively low. More higher quality studies are needed on the topic.

None Declared

Schizophrenia (SZ) is an inherited mental illness that affects 1% of the world’s population. Schizophrenia is a common functional psychosis with some unifying features that appears to have a universal distribution. Much of the research on SZ seeks to identify physiological, biochemical, or genetic features that differ between patients and healthy individuals. Biochemical factors represent an imbalance of certain biochemical substances in the brain, especially neurotransmitters. Early studies focused on the brain biochemistry of patients with SZ in terms of dysregulation of the neurotransmitter network. There is evidence that elevated dopamine concentrations are associated with positive symptoms (i.e., hallucinations, delirium) of the disease. For example, L-DOPA decarboxylase (DDC) is an enzyme involved directly in dopamine and serotonin synthesis and indirectly in noradrenaline synthesis. Therefore, the DDC gene can be considered a candidate gene for schizophrenia and its activity is a good candidate for functional analysis via epigenetic repression.

We aimed to create a cellular model with a deregulated DDC gene.

We constructed two lentiviral vectors, one expressing the dCas9-KRAB-MeCP2 repressor under the control of a synthetic tetracycline inducible promoter, and the other carrying a cassette expressing two sgRNAs with spacers against the DDC promoter. The SH-SY5Y cell line was sequentially stably transduced with both lentiviral constructs, and cells carrying both constructs were selected by the fluorescence of the GFP and RFP reporter proteins encoded in the lentiviral construct backbones.

Methyl-sensitive real-time PCR followed by high-resolution fusion showed methylation of the DDC promoter. Correspondingly, real-time PCR showed a two-fold decrease in DDC expression in SH-SY5Y during tetracycline-induced expression of the CRISPR repressor.

We developed a cellular model to study the contribution of DDC deregulation to SZ-related molecular mechanisms.

None Declared

Post-traumatic stress disorder, following stress of a particular intensity, is often related to the perception of childbirth as a traumatic event requiring the optimization of follow-up and the interest of early detection.

To determine the factors associated with post-traumatic stress disorder related to childbirth.

This is a longitudinal prospective analytical study carried out in the obstetrics gynecology department of the Tahar Sfar Mahdia hospital. The study population was women who gave birth during the study period from March 15, 2020 to September 15, 2020. We used a pre-established questionnaire including sociodemographic and clinical characteristics as well as a psychometric part containing the psychiatric scale for screening for post-traumatic stress disorder.

Our sample included 120 women. The average age was 28.2±5.3.Five participants (4.2%) had a psychiatric history .

Thirty-five patients (29.1%) had a pathological obstetric history. However, fifteen patients (12.5%) were hospitalized during their pregnancies. Psychometric assessment revealed a prevalence of PTSD at 5.8% with PTSD symptomatology in 18.4% of women.

Twenty-two patients (18.3%) described the childbirth as painful and traumatic.

The frequency of PTSD was higher in women with a history of abortion (6.9%)

Postpartum PTSD was statistically associated with a low level of education (p=0.02), postpartum complications (p=0.05) and sex of the newborn (p=0.01)

The detection of factors associated with postpartum posttraumatic stress disorder seems to be essential for comprehensive and multidisciplinary management of women at risk.

None Declared

Traditional bullying and cyberbullying behaviors represent a serious problem in our schools with deterious effects on youths.

The aim of our study is to determine the relationship between school bullying and cyberbullying among tunisian adolescents.

Adolescents enrolled in middle and high schools in Tunis, Tunisia were surveyed about their experiences of traditional bullying and cyberbullying. This study was developed by the Child Psychiatry Department of Mongi Slim Hospital, (Tunis,Tunisia). Approval of the ethic commitee of the Hospital was obtained.

The total number of participants in our study was 935 adolescents. The average age was 14.2 years with a slight female predominance (54%) and a sex-ratio of 0.85.

The results revealed that 32 % of the students were victims of both cyber and traditional bullying, while 26 % of the students bullied others in both cyber and physical environments. Compared to female students, male students were more likely to be bullies and victims in both physical and cyber-environments.

Cyberbullying and traditional bullying may not be two separate phenomena, but rather two sides of the same coin. Reducing bullying is an important issue to deal with, wheatear it happens online or offline.

None Declared

Assistance to people suffering serious mental illnesses has undergone large variations in the last twocenturies. After World War II, The community became a new destination for them.But hardly anyone knew how to cope with mental illness in thecommunity. Thus, several initiatives arose in the US. Both social work and psychiatry,moved towards a pragmatic point of view by the rising tide of patients seeking help: initiatives trying to providesolutions to themost basic needs of patients: accommodation, food,medical care, takingof medication, etc. By the 1970s, Mary Ann Test and LeonardStein had proven the effectiveness of theirLife Coaching in Madison, Wisconsin. In 1981 his program is disseminated by several states under the name of Assertive TreatmentCommunity and thus spread throughout the United Statesand Canada, Australia and Europe. Psychiatry has recognized it as the program that got the most for supporting the community model. 50 years later the basics of the TAC model remain more or less thesame. But home interventions caused a continuous conflict in the ethical field notwell addressed…

WHY IS AN ACT team a fertile ground for ethicalconflicts?This approach is coercive or assertive?There are several reasons. There is a specific ETHICAL ENVIRONMENT in THE ACT team

1.“Diffusion of Responsibility”-

2. Mutual confirmation bias:

3. There is a tendency to think that professionals areethical by nature.

4. Biased search for information when problems arise.

Sources are sought to confirm us before clarifying whathappened

5. A special tendency to conformism.

6.Repetitive responses.

We will analyze the main ethical conflicts arising in ACT teams:

1. CONFLICTS OF AUTONOMY

2. PRIVACY AND CONFIDENTIALITY ISSUES

3. CONFLICTS OF DUTIES

4. ASSERTIVENESS VERSUS COERCION

The great challenge is knowing how and when to intervenewith patients with variable decision-making capacity orwithout any insight, as well as the impact on theirautonomy. It is an exercise both in art and inphenomenological training: Because there are subtledeficits, difficult to appreciate, but there are otherdeficits that are obvious.

The challenge: balancing the needs and safety of thecommunity with the needs and safety of the individual.ACT teams staff must juggle both perspectives, whilemaintaining a therapeutic alliance.

The continuous contact with the patient in an ACT teamgives, especially to clinicians, a privileged place ofobservation to act correctly in those situations and to be asupport so that whoever arrives lacking in affectivity orwith relational problems could grow until reaching a moreprudent and competent judgment.

WHAT COULD HAPPEN IF WE TRAIN PROFESSIONAL IN BIOETHICS MORE IN PATIENT´S RIGHTS, A FIELD FOR LAWYERS??

None Declared

Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. It causes generalized muscle weakness that may include the respiratory muscles, potentially leading to a medical emergency known as a myasthenic crisis. Several medications, including some antipsychotics, have been shown to worsen myasthenia gravis symptoms.

We aim to summarize the current knowledge on the use of psychopharmacological treatments in patients with MG.

Non-systematic review of the literature was performed in PubMed/Medscape database. Case report of a patient who was admitted and treated in our inward patient unit.

We present a clinical case of a 64-year-old man diagnosed with Bipolar Disease at the age of 18 and recently diagnosed with MG (he was hospitalized in Neurology Department, pyridostigmine was introduced and lithium was reduced to half dose). Three months later he was admitted to the emergency department due to behavior and speech disorganization, persecutory delusional ideas, insomnia and caregiver exhaustion. During his hospitalization lithium was increased to 1200 mg. At day 8 of admission the patient started to show weakness of neck extensor muscles, due to that he was evaluated by neurology, lithium was stopped and haloperidol was increased resulting in clinical improvement.

Psychotropic choice in patients with MG can be challenging due to their anticholinergic properties that can exacerbate MG symptoms with potential deterioration to a myasthenic crisis. There is a great need for evidence-based data on the safety and efficacy of psychotropic medications in MG.

None Declared

The use of electroconvulsive therapy (ECT) as a treatment for psychotic disorders is well-documented and effective. Despite the fact that ECT is often used, the precise neurobiological mechanisms supporting its effectiveness are still incompletely understood. Over the pastyears, extensive research on primates, rodents, and humans has begun to clarify the effects of electroconvulsive seizures (ECS) and ECT on neurotransmission systems such the dopaminergic system.

The aim of this paper is to search evidence in the literature regarding the effects of ECT on the dopamine system.

In order to write this article, we searched for information in the most important scientific articles from the Google Scholar and Pubmed databases regarding the effects of ECT on the dopaminergic system.

ECT and electroconvulsive shock are linked to enhanced dopamine release and dopamine receptor modification. Human studies show that ECT activates the dopamine system. In a study by Rudorfer et al., it was discovered that ECT increased the amount of homovanillic acid (HVA), a marker of dopamine turnover, in the cerebrospinal fluid (CRF). One important study indicates that monkeys given a brief clinical course of ECT (six sessions only) exhibit significant changes in dopaminergic presynaptic neurotransmission, with baseline function returning to quadratic (‘inverted U’ shape) by six weeks of the last ECT treatment. According to single-unit electrophysiological methods, repeated electroconvulsive shock to rats causes a subsensitivity of dopamine autoreceptors in the substantia nigra. Since effects identical to those reported with repeated treatment were also detected when a single electroconvulsive shock was followed by an acceptable treatment-free interval, this decreased sensitivity is time-dependent.

The results support the idea that ECT boosts the dopamine system and can be an effective strategy in the management of psychotic disorders.

None Declared

Current clinical guidelines recommend the use of clozapine for the treatment of refractory schizophrenia, present in up to a third of patients with this disease. Despite the evidence, the data point to low prescription, underdosing, and delayed initiation.

The objective of the study is to elucidate which factors may interfere in clozpine prescription.

This is a cross-sectional observational study, carried out using a survey designed specifically for it.

It was answered online by seventy psychiatrists affiliated with the Catalan Society of Psychiatry.

More than half admitted having prescribed two or more antipsychotics without having previously ruled out pseudorefractoriness through depot treatment. 70% recognized the need for monitoring as the main prescription barrier, while the main reason for withdrawal was its adverse effects. The most alarming was considered agranulocytosis, with drooling, drowsiness and weight gain being the most reported.

Statistically significant differences (p=0.031) were found in relation to the years of experience and the device where clozapine was preferred to be started: <10 years in hospital, 10-20 years in partial hospitalization and >20 years outpatient office.

Statistically significant differences were observed in the preference of the device for its initiation depending on the usual work device: hospitalization (p<0.000) and partial hospitalization (p=0.046) preferred to schedule it from their respective devices, without any preference in consultations.

The level of experience and the most reported side effect were statistically significant: for the newest psychiatrists it was weight gain (p=0.031), without presenting differences in the rest of the groups.

Clozapine is the psychoactive drug of choice in refractory schizophrenia, so efforts should be devoted to reducing prescription barriers, offering training on its management and innovating forms of monitoring to promote its use.

None Declared

An inpatient suicide is a tragic event that, despite not very prevalent, should not be overlooked. It occurs in 250 in 100 000 psychiatric hospital admissions (which represents a suicide risk fifteen times greater than general population) and in 1.7-1.9 in 100 000 in general hospitals (4-5 times greater risk). Together they constitute 5-6% of all suicides.

The purpose of the authors is to explore the epidemiology, the risk factors and the prevention of suicide in inpatient setting.

A brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.

The risk was higher at admission (first week) and immediately after discharge (first 24 hours, up to two weeks).

It was found to be correlated to pour staffing, an increased number of patients with severe mental illnesses and accessibility to lethal means. Many risk factors were identified, some of them specific to context. Risk Factors at admission in a psychiatric hospital – personal or familiar suicide history, schizophrenia or mood disorder, alcohol use, involuntary admission, living alone, absence from the service without permission. Later till discharge - personal suicide history (or attempts after admission), relational conflicts, unemployment, living alone, lack of discharge planning and lack of contact in the immediate post-discharge period. In General Hospitals – chronicity and severity of somatic disease, poor coping strategies, psychiatric comorbidities and lack of liaison psychiatry.

Strategies to prevent inpatient suicide should take in environmental modification (specific to environment and specific to patient – as planned levels of supervision), optimisation of the care of the patients at suicidal risk, staff education and involvement of families in care. There are few studies on the efficacy of pharmacotherapy on reducing suicidal ideation in inpatients (just for clozapine and ketamine); some psychotherapies show promising results. The post-suicide approach cannot be neglected, whether in supporting the family, the team involved and even other patients.

The assumption of the predictive and preventive value of the risk assessment has been under scrutiny. Depressed mood and a prior history of self-harm are well-established independent risk factors for inpatient suicide; however they lose their predictive value due to their high prevalence. Up to 70% of inpatients who committed suicide didn’t express suicidal ideation on the previous interviews. Most effective measures to prevent suicide are environmental modifications and staff education approaches, giving appropriate responses to each patient’s circumstances.

There is a paucity of literature on suicide in this setting. It should become a priority in national programs of Suicide Prevention.

None Declared

Autism spectrum disorder is a heterogeneous group of disorders that affects virtually every population, regardless of their ethnic or socioeconomic origin. In recent years, the attention of researchers has been drawn to the participation of the oxytocinergic and vasopressinergic systems in the development of autism spectrum disorders. A relatively large number of studies have investigated the association of SNPs in these genes with the development of ASD, however, there is a lack of studies in the literature focusing on their actual effect on expression and on the effect of their expression on the risk of ASD.

The aim of this study was to assess the levels of expression of OXTR and AVPR1a genes and evaluate their links with both risk of ASD and genotypes of the most studied polymorphisms.

The study included 132 people, 77.5% of whom were male (n = 100). 113 participants (85.6%) were diagnosed with autism spectrum disorders confirmed by the ADOS-2 test conducted by a certified diagnostician. In this group, men constituted 76.1% of the population (n = 77). The remaining 28 people did not have a diagnosis of autism spectrum disorders, and in the ADOS-2 study they obtained the result below the cut-off level. The mean age in the whole group was 14.4 years (95% CI: 13.92-14.93).

Significant decrease in expression of the OXTR gene was found in case of rs53576 where presence of the alternative allele (G) was linked to the 20% decrease in expression (2^(-ΔΔCt) = 0.8). In case of AVPR1a alternative allele (T) of SNP rs10877969 was linked to the 20% increase in the gene expression(2^(-ΔΔCt) = 1.197). SNPs rs2254298 (2^(-ΔΔCt) = 0.97) and rs7294536 (2^(-ΔΔCt) = 0.97) did not influence expression of the appropriate genes in significant way. In comparison between the test and control group in participants with confirmed diagnosis of ASD 13% lower expression of AVPR1a was found (2^(-ΔΔCt) = 0.87).

Genotype of SNPs rs53576 and rs10877969 significantly influenced the levels of expression of the genes OXTR and AVPR1a respectively. In case of rs2254298 and rs7294536 observed effects were negligible. Presence of ASD diagnosis was linked to the 13% lower expression of AVPR1a. Abnormalities in AVPR1a expression seem to be more important for the development of autistic traits than the more attention-grabbing gene abnormalities for the oxytocinergic system.

None Declared

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

Attention Deficit Hyperactivity Disorder (ADHD) is the second most common psychiatric disorder in childhood, affecting 5-7% of the child population. The same disorder in adults is less documented and is estimated at 2.5% of the population. The mothers of children with ADHD are 24 times more likely to develop ADHD than mothers of children without ADHD. About 17% of mothers of children with ADHD meet criteria for the disorder themselves. The core symptoms of ADHD are inattention, hyperactivity and impulsivity.

The objective of this e-poster is to describe the effects of the mother’s ADHD on her parenting role

The current poster is based on the bibliographic reviews of papers via the ‘PubMed’ search engines.

In some studies mothers with ADHD may use ineffective discipline methods in order to limit their children.The mothers with ADHD often have difficulties with executive functions such as planning, organizing and implementing goals and with self-control. Characteristically, in a study with a sample of mothers with children aged 3-6 years were observed difficulties in defining the boundaries of the children, unstable behavior and low self-esteem. Additionally, mothers with ADHD may have difficulty forming and maintaining social relationships and this have a negative effect on children’s social skills. The maternal role is influenced by when the mother suffers from depression, anxiety, uses alcohol or psychotropic substances. In addition, her role is influenced by when there are problems in the marital relationship or she is a single parent. The reactions of the mother with ADHD may be influenced not only by whether she has ADHD but also by whether or not her child has been diagnosed with ADHD. The mother with ADHD and child with ADHD has to deal not only with her own symptoms but also with her child’s symptoms. The coexistence of the specific disorder in both may cause increased levels of stress to the mother. Nevertheless, some research reports that these mothers show empathy towards their children, i.e. they have a more positive and supportive behavior, they are more protective, less irritable and less frustrating (similarity-fit hypothesis). In other studies mothers with ADHD worsen their children’s symptoms with their behavior (similarity-misfit hypothesis). There is a significant correlation between the mother’s ADHD and the child’s emotional, behavioral and social functioning.

In conclusion, mothers with ADHD may experience difficulties in all developmental stages of their children. Therefore, the treatment of the disorder (medication and cognitive-behavioral psychotherapy) is necessary in order to improve the mothers’ symptoms, the mental condition of their children and the family’s quality of life.

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.

None Declared

Architecture is a particular art as well as a transversal science that evolves according to multiple variables that call upon, aesthetics, sociology, political science, technology, history, cultures, economy, tourism, as well as the satisfaction of human needs and the physical/psychological health. It addresses the four senses of human and it humbly configures man’s environment, constitutes the set or the framework in which he evolves and in which he becomes an actor, both overwhelming and magical as Aldo Rossi says (1981).

We aim through this review to show how does architecture affect human mental health wellbeing and what can we do to create a therapeutic architecture.

We comprehensively review the scientific literature using Pubmed database and other search platforms such as Google scholar to state the relationship between architecture and human mental health wellbeing and to delineate the meaning of architecture therapy in the field of mental disorders.

Our bibliographic research revealed that Architecture and mental health are directly linked and that the concept of therapeutic architecture or architectural therapy has been generated in 1984 by Roger Ulrich, Professor of Architecture at the Centre for Health Design in Sweden to designate the influence of the environment on the healing and recovery process of patients. In fact, Architecture has the ability to create meaningful spaces. Churches, mosques and cathedrals planned centuries ago are a testament to architectural wonders, as they evoke a sense of magnificence, royalty, glory, serenity and tranquility. The intriguing details of these spaces were meant to induce positive feelings and emotions and are considered architectural masterpieces to this day, as they continue to fascinate humans around the world. In the other hand, many studies showed the positive effect of nature (therapeutic horticulture) and exposure to the outdoors; towards distraction from stress and anxiety levels of patients in a Health care setup. Recent studies analyzed how Architecture and interior design (safety and security, noise and external stressors, space and interior layout, nature, lighting and atmosphere, art, community, etc…) are important not only for the well-being of patients in health care centers, but also for humans in general in their living environments.

Mental health is impacted by different aspects of architecture and design. Incorporating elements such as natural lighting, open floor plans, private and open community spaces, artwork, safety procedures, and nature/views of nature, provides a supportive environment for the mental well-being and the treatment of mental disorders.

None Declared

Working in a care setting is characterised by an increased mental and physical load. During their professional life, personnel in this sector can develop essentially degenerative pathologies, which could influence their professional career as well as their psychological balance.

We aimed to evaluate the impact of chronic pathologies on the prevalence of anxiety and depression among this group.

We conducted a cross-sectional study in hospitals in Sfax using a self-administered questionnaire. This questionnaire evaluated socio-demographic, professional, and clinical characteristics as well as an evaluation of the degree of anxiety and depression by the HAD questionnaire.

Our population consisted of 120 participants. The average age was 37 years, with a female predominance (a sex ratio of 0.69). The chronic pathologies found in the participants were mainly diabetes (18%), high blood pressure (4%), and rheumatic disease (6.7%). The average anxiety score was 8.18± 3.5 and that of depression was 9.02± 3.5. Certain depressive and anxious signs were found in 28.4% and 23.6% of participants, respectively. Although the average scores for anxiety and depression were higher in the subgroup of personnel with chronic pathologies (respectively, 9.8 versus 9.04 and 9.3 versus 8.46), these differences were not statistically significant (p > 0.05).

Physical and mental health are both important to ensure a balanced life. Having good control of somatic illness can improve mental health.

None Declared