What defines any addiction, including alcohol dependence? Other than the accepted definitions from WHO, ICD or DSM, addiction is characterized by constant returns to alcohol consumption. Whether called relapse or lapse (slip), the truth is that patients - once abstinence is initiated - return to drinking in a matter of months (50% within 3 months, 65% within 6 months and 80% within 1 year). So why are we looking for total abstinence when treating patients with alcohol dependence, when the results are so poor? Should we look at this complex and intricated problem with monochrome lenses? Black or white? Couldn’t a more moderate approach present with better results? I think that a more reasonable response to this problem could be controlled drinking. Not just as an intermediate goal when seeking life long abstinence, but as a stand-alone indication, as an ultimate treatment goal. Are we looking to get healthy patients, with good social lives and satisfying quality of lives patients or are we just looking to obtain abstinence? Sure, alcohol should be forbidden to those with severe co-morbidities related to alcohol consumption (who could only worsen) should the consumption persist, but should all patients fall under the same category? Should total lifetime abstinence and relapse prevention remain the gold standard when treating this burden, even with emerging pharmacotherapy? Although additional pharmacotherapy for alcohol dependence exists, physicians may be reluctant to prescribe them, therefore they are severely underutilized. We should break barriers and rethink the way we treat this pathology, from medication to end-goals.

Raise awareness in the way we currently treat alcohol dependence among physicians, showing that a more considerate and moderate approach could be more beneficial, rather than a lifetime abstinence goal.

Relevant papers were selected for review from literature, from both sides of the treatment approach spectrum

Although controlled drinking is accepted by a wide selection of physicians specializing in alcohol dependency treatment and studies have shown that pharmacotherapy for alcohol dependence works, current treatment guidelines (including EMA) still recommend total abstinence as an ultimate goal.

The presentation is not intended to draw definitive conclusions, just raise awareness regarding the way we view and treat alcohol dependence.

None Declared

Delirium is common and is associated with many adverse short-term consequences as increased hospital costs, health care complications, and increased mortality. Long-term cognition consequences on delirium have not been well synthesized and quantified.

Our study aims to determine the relationship between an episode of delirium and subsequent dementia and death over five years.

Postoperative delirium, previous psychiatric disorders, mental health service use, and death data collected from a cohort of inpatients diagnosed with delirium that requires psychiatric attendance in a general hospital were analyzed. Between 2009 and 2011, we started a follow-up of 91 patients aged 65 years or older at baseline for 60 months.

Five patients (5.4%) were diagnosed with dementia previously. During the first year, 35 patients without previous dementia (40.6%) died. More than half of the one-year survivors (27; 52.9%) were diagnosed with dementia at the follow-up. Differences in age (79,5 vs 80.3; Z=-0.07; p=0.93), survival time (54.8 vs 48.8;Z=1.30;p=0.19), postoperative delirium rates (74%vs66.6%; χ2=0.33, DF=1, p=0.56) and mental disorder antecedents were not found. Patients with dementia after delirium were more likely to be attentive in mental health services (48.1vs16.6%; χ2=5.666, DF=1, p=0.017).

In our study, delirium is an important risk marker for dementia and death and is significantly associated with the long-term cognitive decline in surgical and non-surgical patients. Subsequent follow-up in mental health service could help detect dementia after episodes of delirium and lead to fewer potentially harmful interventions such as hospitalization or antipsychotic medication. An important question to determine is whether delirium is simply a risk marker for dementia or whether the delirium could cause neuronal damage leading to dementia.

None Declared

Tardive dyskinesia is finally diagnosed, it is a drug-induced hyperkinetic movement disorder associated with the use of dopamine receptor blocking agents, including first and second generation antipsychotic drugs, metoclopramide and prochlorperazine. Typically, the first-generation antipsychotics with increased dopamine D2 receptor affinity are affiliated with a higher risk of inducing tardive dyskinesia.

The most common manifestations of TD involve spontaneous movements of the mouth and tongue, but the arms, legs, trunk, and respiratory muscles may also be affected. Less commonly, the prominent feature is dystonia involving a focal area of the body such as the neck. TD can be irreversible and lifelong, with significant negative impacts on psychological health and quality of life.

Clinical review and treatment approach for tardive dyskinesia.

Clinical case and literature review.

A 54-year-old male comes due to involuntary movements of a month of evolution in the tongue and lips that “he cannot control” and generates significant discomfort and anxiety. He reports occipital headache and at the level of both temporomandibular joints that does not wake him up at night or change its characteristics with postural changes. Reviewing the treatment describe that the patient was in treatment for at least 6 months without being able to specify the end of treatment (January to June 2021) Clebopride-Climethicone. This finding inclines the diagnosis towards an orolingual dyskinesia probably secondary to Orthopramides. Discharge was decided with treatment and follow-up in Neurology and Psychiatry consultations.

The diagnosis and management of tardive dyskinesia are best made with an interprofessional team. In most cases, the primary clinician may suspect the diagnosis during follow-up. Movement disorders like tardive dyskinesias are frequently aggravated by the use of drugs that block dopamine. In susceptible patients, even a single dose of an anti-dopaminergic drug can quickly develop disabling movement disorders.

Currently the american academy of neurology recommends few treatments such as tetrabenazine or clonazepam. The first treatment for tardive dyskinesia has recently been approved, such as Velbazine, a vesicular monoamine transport type 2 (VMAT2) inhibitor, the extent of its use remains to be seen.

None Declared

During the COVID-19 pandemic, there has been a peak of occupational dermatoses associated with Personal Protective Equipment (PPE) among healthcare workers (HCWs). The resulting dermatological damage might have an impact on the quality of life.

We aimed to evaluate the dermatological life quality of the HCWs due to PPE use.

The study was conducted in a group of HCWs from Hedi Chaker hospital in Sfax, Tunisia. Data were gathered between march and may 2021 using a self-administered questionnaire including socio-professional characteristics, evaluation of skin lesions, evaluation of the infection-prevention practices and the Arabic version of the Dermatology Life Quality Index (DLQI).

Our sample was composed of 190 HCWs. The respondents’ mean age was 32.5 ± 6.5 years and 54.7% were female. The average job tenure was 6.6 ± 5.8 years. Doctors represented 22.1 %, nurses 13.6% and cleaning staff 64.3 % of participants. The prevalence of skin lesions due to PPE among HCWs was 51.6%. The mean time of mask use was 15.4 ± 9.1 hours. The daily hand washing frequency was >10 times/day in 85.3 % of participants. The mean DLQI score was 3.3 ± 4.3. According to this index, it was found that these skin lesions had no effect, small effects, moderate effects and very large effects on the lives of 43.9%, 34.7%, 12.2%, and 9.2% of participants, respectively. The DLQI was correlated with hand washing frequency (p = 0.014, r = 0.204) and the time of mask use ( p = 0.038, r = 0.172).

Skin lesions among HCWs are frequent during the covid-19 pandemic. These lesions influence the quality of life of the HCWs. This risk gets higher with excessive preventive measures. It is critical to provide training on the prevention of skin lesions associated with PPE wearing and hand hygiene before and during the period of use of preventive measures.

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Stroop test iteration performances and metabolism of tryptophan (TRP) via serotonin (5-HT) and kynurenine (KYN) have both been associated with suicidal behaviors. This study aims to probe their possible interactions.

We explored the association of the performances on the Emotion Inhibition Subtask (EIS) of the Brief Assessment of Cognition for Affective Disorder and the plasmatic levels of 5-hydroxytryptophan (5-HTP), 5-HT, KYN, melatonin (MLT) among subjects with Lifetime Suicidal Ideation (LSI) vs non-LSI, and with Lifetime Suicide Attempts (LSA) vs non-LSA.

Using R studio, we employed: 1) the t-test for parametric data and the Wilcoxon test for non-parametric data; 2) Linear Modeling to probe the associations of EIS performances with MLT, KYN, 5-HTP or 5-HT plasmatic levels.

In a sample comprising 45 individuals affected by Bipolar Disorder, we found a statistically significant difference for the Color Naming (CN, image 1) and the Neutral words (NW) subtasks among LSA vs non-LSA. In LSI vs non-LSI, only the NW retained significance, but not the CN. A significant association emerged between CN and 5-HTP in LSI but not in non-LSI (image 2). Similarly, in LSA, an association was found between CN and 5-HTP, but not in non-LSA (image 3). No statistically significant difference emerged among groups regarding gender composition, age, pharmacological therapy, Body Mass Index, Hamilton Depression Rating Scale, Young Mania Rating Scale, or Clinical Global Impression scale - Severity.

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We found that the plasmatic levels of the metabolites of TRP via 5-HT were correlated to some EIS performances. These findings may represent a hypothesis-generating platform for further investigations.

None Declared

Cross-sectional data has shown that compassion for self and from others may be a protective factor for greater psychosocial wellbeing in the COVID-19 pandemic whilst fears of compassion act as a risk factor for experiencing mental health difficulties.

The current study sought out to explore the natural fluctuation of compassion (for self, for others and from others) and of fears of compassion (for self, for others and from others) across time during the COVID-19 pandemic in a multinational community sample.

Data from 4057 participants from 21 countries was collected at 3 time points during the pandemic (baseline, 3 months and 6 months). Other than demographic variables, participants completed the Compassionate Engagement and Action Scales and the Fears of Compassion Scales. Multilevel latent growth modelling was used to investigate the main aims.

There was a significant increase in compassion for self and from others, whilst compassion for others remained unchanged throughout the 3 time points [Chi square 349.30(df=50) p< .001; RMSEA .035; CFI .93; TLI .91; SRMR (within) .043; SRMR (between) .70]. Fears of self-compassion and compassion for others significantly reduced throughout the pandemic whilst fears of compassion from others remained stable [Chi square 406.57(df=50) p< .001; RMSEA .038; CFI .96; TLI .94; SRMR (within) .042; SRMR (between) .35].

The findings from this study seem to suggest that in a period of shared suffering people from multiple countries and nationalities tend to become more compassionate and less afraid of and resistant to compassion for and from others.

None Declared

Antipsychotics are medications with an array of FDA approved indications in the field of psychiatry including Schizophrenia, Bipolar Mania, Bipolar Depression, Maintenance treatment for Bipolar Disorder, Schizoaffective Disorder, as well as an Adjunct treatment in Unipolar Depression and Tic disorders, among other indications for non-adult patients. Antipsychotics are widely used in psychiatric inpatient units throughout the United States, and globally. We observed trends of antipsychotic use in 3 different adult inpatient units with the same patient demographics located within one inner city hospital in the Bronx over a period of 4 months. We correlated the choice of antipsychotic to the prescribing physician’s period of training/date of graduation from psychiatry residency and reported the results.

Identify the choice of antipsychotics used by different psychiatrists.

Correlate the dates of each psychiatrists residency training to the antipsychotics they chose.

Identify whether the psychiatry residency training accuried in different decades has influenced psychiatrics to pick certain antipsychotics.

We obtained the dates of psychiatric residency training for each of 3 psychiatrists (Physicians 1, 2 and 3) assigned to one of 3 different inpatient psychiatric units which share the same patient demographics in an inner-city hospital in the Bronx. We obtained a record of total psychiatric inpatient hospitalizations from February 10th 2022 to June 10th 2022 in all 3 psychiatric inpatient units. The principal diagnoses for the total hospitalizations (300 patients) were reviewed and patients with diagnoses that do not have FDA approval for antipsychotic use were excluded. Among the remaining patients (267) we compared antipsychotic prescription trends and grouped patients according to antipsychotic of choice. We then correlated the antipsychotic of choice groups to one of three units/prescribing physician and the years of psychiatry residency training. The trends for antipsychotic of choice were compared to training dates and presented in a table.

Physician 1 who trained from 1980 to 1984 prescribed: 87% HALDOL and 13 % Chlorpromazine. Physician 2 who trained from 1992 to 1996 prescribed: 91 % PALIPERIDONE and 9% Risperidone. Physician 3 who trained from 2003 to 2007 prescribed: 60 % ABILIFY and 40% Olanzapine.

The physician with the earliest graduation date used mainly HALDOL, a first-generation antipsychotic, to treat disorders with FDA approval for antipsychotic use. The physician with the most recent graduation date, used mainly ARIPIPRAZOLE, a third-generation antipsychotic, to treat disorder with FDA approval for their use. The physician with a graduation date between them, used mainly (PALIPERIDONE), a second-generation antipsychotic to treat the disorders.

None Declared

Major Depressive Disorder is a common psychiatric diagnosis among elderly patients with cancer. More than 10% of cancer patients suffer from Depression, which negatively impacts their quality of life. Mood symptoms are treated pharmacologically with antidepressant medications, while psychotic symptoms are treated with antipsychotic medications. Electroconvulsive Therapy may be initiated early for psychotic depression.

The objective of this case is to present a patient with Major Depressive Disorder, who developed psychotic symptoms after a diagnosis of malignancy, and to suggest early initiation of Electroconvulsive Therapy for treatment.

Ms G is a 68-year-old female who presented with low mood, worries, poor sleep, anhedonia and suicidal ideation. She complained of abdominal bloatedness and was reviewed by Gynaecology, who discovered a large ovarian mass, likely malignant in nature. Within days of the diagnosis, the patient developed nihilistic delusions, believing that her body was decaying and filled with poison. She was distressed and worried that the poison would spread to others around her. Risperidone was initiated and uptitrated, with limited improvement. As early surgical removal of the ovarian tumour was advised, it was essential that the patient’s mental state be quickly stabilised. She was hence initiated on Electroconvulsive Therapy (ECT). The patient underwent a total of 11 sessions of ECT. She was initially started on daily sessions, and the frequency gradually tapered.

The patient’s mental state improved. She was then continued on oral medications, and discharged home well to proceed with her Gynaecological surgery.

This is a case of Major Depressive Disorder with psychotic symptoms that emerged after a diagnosis of malignancy. This case illustrates the importance of routine screening for psychotic symptoms, including nihilistic delusions, in elderly patients with Major Depressive Disorder who are newly diagnosed with cancer. It may be beneficial to consider early Electroconvulsive Therapy when treating such patients.

None Declared

Haploinssufficiency of AUTS2 gene has been associated with a syndromic form of neurodevelopmental delay called AUTS2 Syndrome (AUTS2S). It is characterized for having attention/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), mild global development delay (GDD) and intellectual disability (ID). Clinicians also reported microcephaly, feeding difficulties, generalized hypotonia and ptosis.Due to its great variability, the AUTS2 Syndrome Severity Scoring System (ASSS) was established to assess the severity of the syndrome presentation. It is based on 32 characteristics including items of growth, feeding, neurodevelopment and congenital anomalies.

At the molecular level, the AUTS2 gene consists of 19 exons that are divided into a non-conserved N-terminal region and a conserved 3’ terminal end. There is a short isoform expressed primarily in the brain that initiates at an alternative transcription site and includes the last 11 exons. Variants that disrupt this final part of the gene have been associated with a severe phenotype.

To describe and compare 3 patients affected with AUTS2 syndrome using the ASSS.

(1) Case series: Comparison of the patients diagnosed with AUTS2 Syndrome using the AUTS2 Syndrome Severity Score.

(2) Narrative review of the AUTS2 syndrome and the genotype-phenotype correlation through PubMed database (1990-2020). Key terms: “AUTS2”, “AUTS2 syndrome”, “ADHD”, “neurodevelopmental disorder”, “autism”.

1 (ASSS score: 12). Interstitial duplication long arm of chromosome 7. Characteristics: microcephaly, GDD, ASD features, ADHD, auditory hypersensitivity. Finger flexion and syndactylia, arched eyebrows, palpebral fissures, epicanthus, nares, micrognathia, narrow mouth.

2 (ASSS score: 13). Pathogenic variant exon 9. Characteristics: GDD, feeding problems, ID, ASD features, auditory hypersensitivity, ADHD, hypotonia, cerebral anomalies, hypertelorism, anteverted nostrils, broad nasal bridge, micrognathia, low-set ears, narrow mouth.

3 (ASSS score: 13). Pathogenic variant exon 16. Characteristics: ID, short stature, feeding problems, auditory hypersensitivity, ADHD, hypotonia, umbilical hernia, hypertelorism, proptosis, short palpebral fissures, epicanthus, prominent nasal tip, anteverted nares, low-set ears.

Currently, 65 patients with pathogenic variants in AUTS2 are described in the literature. Significantly higher ASSS values have been found in patients with pathogenic variants affecting the 3’ end of the gene. Further research is needed, since genetic diagnosis of affected patients contributes to improved clinical protocols and personalized treatment.

None Declared

The suicide rate in the elderly population is the highest of all ages in Korea. Suicide prevention programs specialized in the elderly are scarce.

We evaluated the effect of the suicidal prevention program named “Nae-an-ae” (means to love oneself), which was specifically designed for the conditions of the community dwelling elderly.

The subjects were those who agreed to participate in the Nae-an-ae program among those evaluated as suicide high-risk groups according to the 2021 Jeollanam-do Mental Health Survey. The program consisted of five sessions of simple activities that could be practiced in daily life along with knowledge transfer through education on emotion recognition, stress management, sleep and relaxation, pain and exercise, and depression. This program was conducted by social workers or nurses working at each local community mental health and welfare center. We evaluated the Geriatric Depression Scale-Short Form Korean Version (GDS-SF), suicidal ideation, satisfaction with life scale (SWLS) and brief resilience scale (BRS) which were measured before and after the program and compared them with the control group.

A total of 276 participated in the program, 226 were in the control group. In the program participating group, the frequency of suicidal ideation was significantly decreased from 36.2% to 11.6% after the program. GDS-SF, SWLS and BRS were significantly decreased in active group than control group.

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These findings showed that “Nae-an-ae” program was found to affect not only the control of suicide risk factors such as depression but also positive factors such as life satisfaction and resilience.

None Declared

Lamina-specific alterations of inhibitory circuitries have been considered the crucial pathogenesis of perceptual, cognitive and behavioral symptoms presented in schizophrenia and mood disorders. Especially, with emerging evidences indicating the close lamina-specific relationship between synaptic defects and γ-Aminobutyric acid (GABA)-related gene dysfunctions, it has been suggested the mRNA dysregulations of Tyrosine kinase B (TrkB) and Glutamate decarboxylase 67 (GAD67) could particularly be implicated in middle and deep layers of neocortex of patients with major psychiatric disorders.

Giving inquiries of whether defects of these mRNA levels in Orbitofrontal cortex (OFC) would be involved as lamina-specific patterns in individuals with schizophrenia and mood disorders.

We examined mRNA levels of BDNF, TrkB and GAD67 in each OFC layer I through VI. We analyzed data from postmortem brain tissue of the Stanley Neuropathology Consortium Integrative Database (SNCID). SNCID consists of 15 subjects in each of four groups (schizophrenia, bipolar disorder, major depression without psychotic features, and unaffected controls). All groups were matched for age, sex, race, brain pH and post-mortem interval.

We found TrkB mRNA levels to be significantly reduced in layer VI in both groups with schizophrenia (25.8%) and bipolar disorder (35.7%) compared with controls. GAD67 mRNA levels were also significantly reduced in layer III and IV in patients with schizophrenia (23.4% and 22.7%, respectively) and bipolar disorder (31.2% and 24.9%, respectively) compared with controls. Individuals with major depression showed only trends toward decreased mRNA levels of GAD67 in layer III and IV and of TrkB in layer VI compared with controls. TrkB mRNA levels in layer VI were significantly correlated with GAD67 mRNA levels in layer III (ρ=0.581, p=0.037) and IV (ρ=0.857, p<0.001) in subjects with bipolar disorder, but not in those with schizophrenia. When analyzed with partial correlation controlling the effects of pH and PMI, significance of correlation remained only between GAD67 mRNA in layer IV and TrkB mRNA in layer VI in individuals with bipolar disorder (ρ=0.768, p=0.006).

The resulting lamina-specific decreases in inhibitory tone across layers of OFC may contribute to the unrestrained irritability and violent behaviors in common shared by both patients with schizophrenia and bipolar disorder. Nonetheless, our findings indicate the obvious correlations between lamina-specifically altered TrkB and GAD67 mRNA levels in OFC might be a candidate for endophenotype of bipolar disorder.

None Declared

Adapted physical activity (APA) has beneficial neurobiological impact but the underlying pathophysiological mechanisms remain poorly described. APA is currently recognized as an adjuvant therapy to antipsychotic treatments in patients with schizophrenia (SCZs) to reduce the severity of negative symptoms and cognitive impairment. SCZs exhibit hippocampal N-acetylaspartate (NAA) reduction, a marker of neuronal viability and integrity whose concentrations can be assessed by proton magnetic resonance spectroscopy (1H-MRS).

The purpose of this study was to evaluate the impact of remote physical activity (e-APA) via the web on the NAA relative variations in the left hippocampus in SCZs compared to a patient control group benefiting from an health education program (HE). This study concerns one of the secondary objectives of the PEPsy V@SI study co-financed by the Pierre Deniker Foundation, the European Union and the Normandy Region within the framework of the FEDER/FSE 2014-2020 operational program.

Thirty-five SCZs were randomized in the e-APA active group or in the control group (HE). Participants received the interventions during 16 weeks, with two visioconference sessions per week. A 1H-MRS sequence positioned on the left hippocampus (MRI-3T) was acquired before and after both interventions. Absolute NAA concentrations in the left hippocampus were obtained using Osprey software after partial volume correction. After checking the quality criteria, the spectra of 6 SCZs in the e-APA group and 8 SCZs in the HE group were analyzed. To test the difference between interventions on the NAA relative variations, a Wilcoxon-Mann-Whitney test and effect size were performed. Paired Wilcoxon tests were used in each group before and after the interventions.

No significant difference was found in NAA relative variations in the left hippocampus between the e-APA group and the HE group (p = 0.18), although the effect size was 0.38 (considered as moderate). However, a trend towards an increase of NAA was observed in the e-APA group (before intervention: 12.08 International Units (I.U); after: 13.81 I.U) (p = 0.06) but not in the HE group (before intervention: 13.75 I.U ; after: 13.85 I.U) (p = 0.84).

Our results showed a NAA significant increase in SCZs after an e-APA program, indicating a beneficial impact of e-APA on neuronal viability that might reflect an hippocampal plasticity. However, this increase did not differ significantly between active and control groups probably due to a weak statistical power.

L. Metivier: None Declared, F. Briend: None Declared, M. Tréhout: None Declared, L. Bigot: None Declared, G. Quarck: None Declared, A. Herbinet: None Declared, E. Leroux: None Declared, S. Dollfus Consultant of: Fabre,Gedeon,Roche and Takeda, inivited Conferences by Lundbeck, Otsuka, Janssen ; at contracts with Prophase MedAvances and NeuroCogTrials

A try to protect people diagnosed with dementia, from the COVID virus, during pandemic period could easily lead to isolation and hinder them to reach the needed medical care.

Research question refer to accessibility during pandemic to psychiatric services of patients with dementia.

The consultations of patients with dementia of an outpatient setting where analyzed before (2019-2020) and during pandemic (2020-2021). We evaluate the consultations frequency, characteristics of patients, comorbidities and treatment changes.

A total number of 965 consultation (493/472) were analyzed. There was no statistically significant difference between the number of consultations before and during the pandemic, which means that the patients had access to medical assistance with the same frequency as before the pandemic. (p=0.63) There was no statistically significant difference in different environment groups (urban/rural). (p= 0.53) Telemedicine (videoconference) and phone consultation where also used during pandemic period. 63,6% of those in rural area chosed telemedicine and 9% phone consultation. Significantly more patients from the urban area were consulted on-site during the Covid pandemic. (p=0.04) Despite the risk, patients with comorbidities had visited more often the hospital during the COVID-19 pandemic. (p=0.012) In 39 % of cases there was worsen evolution and a drug change: most frequent add it a hypnotic or an antipsychotic.

The accessibility of the psychiatry clinic during the pandemic was at all times possible for dementia patients. Telemedicine ensured an ongoing consultation flow for the patients.

None Declared

Phenibut is a synthetic γ-aminobutyric acid (GABA) agonist used to treat symptoms of mental disorders like anxiety and insomnia. The substnce is licensed and widely used in Russia. Its recreational use is increasing in many countries as it is easily accessible online. In a recent years, several case reports of phenibut intoxication and withdrawal have been published worldwide.

We present a case report of intoxication with phenibut in a patient with psychoactive substances use disorder on regular methadone substitution therapy.

A 40-year-old male was hospitalized for the first time in the psychiatrc ward due to intoxication with phenibut. Before admission, he was confused, with incoherent speech. Bradypnea and somnolence were observed. A urine screening test was positive for methadone and benzodiazepines, while there was no information on phenibut intake at that time. After receiving naloxone, the patient became, agitated and haloperidol was introduced.

The main symptoms of phenibut intoxication, which have also been described in other cases, are cardiovascular effects, insomnia, anxiety, agitation, hallucinations, and reduced level of consciousness. In our case, a more heterogeneous clinical picture of intoxication was observed, due to the simultaneous use of methadone and other PAS.

The availability of various synthetic substances available online is constantly increasing. Their use is most common in the population with substance use disorders, in patients on substitution therapy and in patients with mental disorders in general. The clinical picture of intoxication can thus be very diverse and atypical, which requires increased attention from clinicians.

None Declared

Schizophrenia, a chronic and complex psychiatric pathology, can be isolated. However, it can be associated with other comorbidities and thus be accompanied by addictive behaviors that complicate their management.

The objectives of our study were to estimate the prevalence and identify the characteristics of addictive behaviors in patients with schizophrenia.

A retrospective study of 151 patients with schizophrenia hospitalized in the psychiatry department of Taher Sfar University Hospital in Mahdia from January 2017 to December 2021.

The mean age of the patients was 39.8 ± 11.23 years, with a predominance of the 36-45 age group (38.4%). All patients were male. Three quarters of the patients (75.5%) were users of psychoactive substances (PAS): nearly three quarters (72.8%) were addicted to tobacco, more than one third (39.7%) were addicted to alcohol, more than one quarter (29.1%) were addicted to cannabis and nearly one quarter (26.5%) were addicted to other PAS. In more than half of the cases (54.4%), the age of onset of substance use was between 16 and 25 years. The use of PAS preceded the onset of schizophrenia in 62.3% of cases. The relationship with the entourage was marked by hetero-aggressiveness in 77.5% of patients, withdrawal from the entourage in 16.6% of patients and conflict in 5.3% of patients. The impact on the relationship with oneself was marked by self-aggressiveness in 18.5% of patients. Concerning the professional impact, three quarters of the patients (76.1%) had to stop working. The majority of patients (84.1%) continued their usual treatment, while 15.2% of patients stopped it. Only one patient required an increase in dose.

Subjects suffering from schizophrenia are particularly vulnerable to addictions, mainly to tobacco and alcohol. They are thus a group more at risk of the deleterious effects of psychoactive substances and of the aggravation of the clinical and psychosocial evolution of their psychiatric disorders. Measures for early detection and treatment of their addictive behaviors even before the onset of schizophrenia should be proposed.

None Declared

Bipolar disorder (BD) is a chronic hereditary disorder. Trial and error principles and long period of untreated disorder mandate further research. Relatively recent advances in statistical computing and techniques introduced Polygenic risk scores (PRS) as predictors of the genetic susceptibility to diseases. Although they provide an estimate of the risk of developing specific pathologies, they are a genome-wide measure. PRS do not provide specific information on the biological meaning of the variants. The use of subsets of risk variants (limited to one or few related biological pathways) to calculate pathway-PRS (pPRS) may provide an estimate of the functioning of specific molecular cascades.

In the present study we calculated pPRS and tested them as potential predictive factors which, together with other clinical/environmental features, may estimate the treatment outcome of BD individuals in a clinical realistic treatment environment.

1538 BD (41.39+/-12.66 years, 59.17% females) individuals from STEP-BD were included in the analysis. A latent class analysis identified three groups of patients according to the YMRS and MADRS scores variations during ˜ 1 year (308.47+/-293.83 days YMRS, 357.78+/-367.76 days MADRS). A GWAS analysis with clinical covariates provided the input for pPRS calculation. SNPs with best nominal significance and biologic relevance were prioritized through GTEx. A molecular pathway analysis (MPA) based on the interaction network of drugs used for treatment provided the genetic data needed for pPRS calculation. A Neural network was built using pPRS as features together with other variables (including Sex, Age, Scores at baseline) to predict the 3 groups previously identified. Performance was evaluated through 5-fold cross-validation, Python, R and Bash served for environments. Gene Ontology, ReactomePA and Bioconductor were key packages together with Cytoscape, Plink, impute and gtool.

Ten biological networks were retrieved from MPA: 1)GO:0016705 + GO:0016641, 2)GO:0019585, 3)GO:003018, 4)GO:0099589 + GO:1904014, 5)GO:0015464 + GO:1905144, 6)GO:0004935 + GO:0004364 + GO:00031690, 7)GO:1903351 + GO:1903350, 8)GO:0016917 + GO:0007214, 9)GO:0008066 + GO:0007215, 10)GO:0048016. Risk variants within the genes contained in each group were used to compute pPRS. The ten pPRS were used to compute a neural network to predict treatment outcomes.

BD treatment is influenced by socio-demographic, clinical and genetic factors. To tackle this complexity, we tried to implement an approach where the multivariate analysis encompasses clinical analysis and the biologic background of treatment response. As a result, we can infer through a hypothesis-free approach potential pathways whose alterations may estimate treatment. At the time of writing the analyses are still undergoing, the final results will be presented and discussed at the congress.

None Declared

Wenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS).

To review the current literature on the management of WKS in a patient with anorexia nervosa.

We report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory.

An adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum.

If the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivors

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With the rapid ageing of societies in Europe and worldwide, the issues of social functioning and mental well-being of older adults gain importance and call for effective care solutions. Among the non-pharmacological options, modern technologies are a promising direction. The use of humanoid social robots, at least in selected areas of care for community-dwelling older people, is one of the possibilities to cope with both their mental problems and the increasing shortage of qualified caregivers.

We thus investigated which prospective areas of care are scored best by older subjects and their professional caregivers.

Opinions of older people (60+; no severe cognitive impairment), living in the community, and their professional caregivers about a robot in care for older adults were collected using the mixed-methodology Users’ Needs, Requirements and Abilities Questionnaire (UNRAQ), after a 90-150 minute interaction with the TIAGo robot (PAL Robotics, Spain).

The robot as a companion of an older person was scored better by older adults than caregivers (p<0.01). Similar results were obtained for the statements The robot could decrease the sense of loneliness and improve the mood of the elderly person (p<0.01), The robot should detect the owner’s mood (p<0.05), and The robot should accompany the owner in everyday activities (p<0.01).

Our results, reflecting the opinions and preferences of various stakeholders, indicate a high general acceptance of a robot in care for older people. The indication of best-scored areas provides clues for the robot’s designers as well as those involved in the implementation of robotic solutions in care and their introduction into the lives of older adults.

None Declared

A relatively large number of studies of the efficacy of rTMS on tinnitus have been conducted. LF stimulation of the auditory cortex in combination with HF stimulation of the DLPFC, has shown efficacy in reduction of symptoms (especially loudness and anxiety).

To launch a protocol to examine the efficacy of Cool-B65 coil LF rTMS combined with H7-deep coil HF rTMS, in the treatment of idiopathic, chronic, normo-acoustic tinnitus disorder, informed by the assessment of efficacy of rTMS on idiopathic, chronic tinnitus disorder. Preliminary results will be presented.

We first conducted a meta-analysis of randomized sham-controlled, double-blind trials to access the efficacy of rTMS on idiopathic, chronic tinnitus disorder. We are now planning an industry-independent, single-center, prospective, randomized sham-controlled, two-arms, double-blind superiority clinical trial with concealed allocation and masked independent outcome assessment.

Population of this study will include Outpatients diagnosed for ≥ 12 months and ≤ 5 years with persistent, subjective, normo-acoustic tinnitus disorder of at least moderate severity defined by the THI score ≥ 38, both unilateral and bilateral, both genders, and with no hearing loss, age 18-65 years, with the tinnitus treatment unchanged for at least one months. Exclusion criteria will be: organically caused tinnitus and organic brain lesion, objective tinnitus, severe hearing loss or Menier’s disease, middle ear disease, diagnosed mental disorder, suicidality, alcohol or drugs addictions, clinically relevant neurological disorder and standard rTMS exclusion criteria. Population will include 52 in HR rTMS H7-coil arm, and 52 in sham control arm. Adjusted median of differences in instruments measuring tinnitus, annoyance, distress, anxiety, and depression will be used as an outcome.

The Cool-B65 coil LF rTMS (1Hz) placed over the auditory cortex combined with H7-deep coil HF rTMS (10Hz) placed over mPFC, applied for 15 days, is expected to have superior efficacy on tinnitus symptoms measured by the overall THI score, then the SHAM passive coil.

We are conducting a theoretically founded study, with an empirically founded patient-oriented approach. We are expecting that H7-coil in stimulating auditory cortex and mPFC may be a possible alternative target for HF rTMS of the DLPFC.

None Declared

The use/abuse of Information and Communication Technologies (ICT) has become a topic of great interest in recent years. With advances in technology, today’s population spends a great deal of screen time (ST) making watching television (TV), using computers, smartphones, or playing video games a central component of their daily lives. These studies have analyzed the psychological impact of technological exposure or abuse, such as aggressive behaviors, anxiety, depression and other mental problems.

The main objective of this study is to explore the differences between men and women and the abusive use of social networks, technologies, pathological gambling and other addiction problems in primary care.

This study is an observational study conducted within the framework of primary care in the Spanish region of Aragon. The population of the study were participants of 35-74 years old, had been receiving care from the Aragon Health Service. Recruitment is shown at figure 1. Sociodemographic, quality of life, personal factors on health behaviour, social support, lifestyle patterns and chronic comorbid pathology variables were collected during the period 2021–2023. The project was approved by the Clinical Research Ethics Committee of Aragon Nº PI20/302. The comparisons by sex were carried out using a Student T-test or chi squared test to analyse differences.

There are significant differences in the abuse of new technologies between men and women. 25.20% of men (CI 95% 18.26-33.25) compared to 13.41% of women (CI 95% 8.85-19.25) make abusive use of the Internet, with statistically significant differences. In the same way, men present greater abuse of video games (6.25% of men (CI 95% 3.0-11.45) compared to 3.05% of women (CI 95% 1.17-6.55).

Analysing the differences by sex in dependence if it is an urban or rural population. Significant differences in the abuse of new technologies between men and women are present in the urban population, while in the rural population these differences are not observed

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Gender modifies the ways in which technologies are used, so that men have a more problematic use of video games and the Internet than women. On the other hand, in relation to emotional symptoms, it was observed that women presented more anxiety and less satisfaction with life than men. The evaluation of abuse of new technologies cts should be incorporated into health services to improve people’s ability their self-care, the level of knowledge of managing their disease and their physical, mental and social health.

None Declared