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

None Declared

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

Schizoaffective Disorder is frequently associated with somatic and addictive comorbidities. This association can change the expression of the disease as well as its prognosis. In addition, this association can affect many functional and psychosocial aspects that can lead to impaired quality of life (QOL) and overall functioning of patients.

the aims of this work were to study the impact of somatic and addictive comorbidities on QOL and global functioning of patients followed for schizoaffective disorder.

This is a cross-sectional study carried out at the psychiatric consultation of the University Hospital of Mahdia for a period of 6 months. The evaluation of the QOL was made using a generic instrument for measuring quality of life: the SF-36 in its version in literary Arabic using the Global Evaluation of Functioning scale .

fifty-two patients with schizoaffective disorder were included in the study. The age of the patients varied from 29 to 62 years with an average of 38 years. The sex ratio (M/F) was 1.6. Singles accounted for 46.2%. Somatic comorbidities were found in 30.8% of patients. Diabetes ranked first (13.5%) followed by arterial hypertension (9.6%) then epilepsy (3.8%). Addictive comorbidities were noted in 63.5% of patients. Tobacco, alcohol and Cannabis were the most consumed substances with respective rates of 57.7; 28.8 and 13.5%. The evaluation of the QoL of the patients revealed that 80.8% of the patients had scores attesting to an altered QoL. Regarding the evaluation of global functioning by EGF, (65.4%) of patients had a score of less than 70 attesting to an impairment of global functioning. The analytical study of correlation between the dimensions of the SF-36 and somatic comorbidities found that dimension D1 (physical activity) is significantly influenced by somatic comorbidities (10-4). The deterioration in the global functioning of the patients was not correlated with the presence of somatic comorbidities (p=0.28). The change in QoL was not correlated with the consumption of psychoactive substances (0.32 for alcohol and p=0.23 for drug addiction).

It is accepted that the objectives of the management of patients suffering from schizoaffective disorder go beyond the remission of clinical symptoms to the improvement of QoL and socio-professional functioning. Larger-scale work is needed to study the influence of comorbidities associated with schizoaffective disorder on these dimensions.

None Declared

The underlying neurobiology of early-life stress (ELS)-induced major depressive disorder (MDD) is not clearly understood. miRNAs, a subclass of noncoding RNAs, are estimated to regulate 20-90% of genes in the genome. Previous studies identify differences in miRNA expression following MDD and ELS, but there is limited research on a direct link between changes in serotonin signaling and miRNAs in response to ELS.

In this study, we used MS and environmental enrichment to study serotonin signaling in the PFC and its regulation by miRNAs. Because women are more likely to develop MDD, but there is no strong evidence of sex differences in the experience of ELS, we were interested to test for sex differences. We hypothesized that genes in the serotonin signaling pathway would be altered by ELS and potentially recovered by enrichment.

We used maternal separation (MS) as a rodent model of ELS and tested whether microRNAs (miRNAs) target serotonin genes to regulate ELS-induced depression-like behavior and whether this effect is sex dependent. We also examined whether environmental enrichment prevents susceptibility to depression- and anxiety-like behavior following MS and whether enrichment effects are mediated through serotonin genes and their corresponding miRNAs.

MS decreased sucrose preference, which was reversed by enrichment. Males also exhibited greater changes in forced swim climbing and escape latency tests only following enrichment. Slc6a4 and Htr1a were upregulated in the frontal cortex following MS. In male MS rats, enrichment slightly reversed Htr1a expression to levels similar to control rats. miR-200a-3p and miR-322-5p, which target SLC6A4, were decreased by MS, but not significantly. An HTR1A-targeting miRNA, miR-320-5p, was also downregulated by MS and showed slight reversal by enrichment in male animals. miR-320-5p targeting of Htr1a was validated in vitro using SHSY neuroblastoma cell lines.

Altogether, this study implicates miRNA interaction with the serotonin pathway in ELS-induced susceptibility to depression-related reward deficits. Furthermore, because of its recovery by enrichment in males, miR-320 may represent a viable sex-specific target for reward-related deficits in major depressive disorder.

None Declared

Rapid-acting therapies remain an unmet need in the treatment of major depressive disorder (MDD) and postpartum depression (PPD). Zuranolone (ZRN) is being evaluated as a once-daily, oral, 14-day treatment for adult patients with MDD and PPD.

To evaluate the efficacy (assessed by Montgomery–Åsberg Depression Rating Scale [MADRS]) and safety of ZRN versus placebo across clinical studies with MDD and PPD.

In 5 completed Phase 2/3 placebo-controlled randomised studies of once-daily ZRN 30 or 50 mg in adults with MDD or PPD, improvement in depressive symptoms was assessed at Day 15 (end of 14-day treatment) by change from baseline in MADRS total score and the percentage of patients achieving MADRS response (≥ 50% improvement from baseline in total score) and remission (total score ≤ 10). Safety was assessed throughout.

Patients in the ZRN arm achieved improvements in depressive symptoms, as assessed by MADRS. Improvements in MADRS total score at Day 15 were observed in all 5 studies and were nominally significant (p < 0.05) versus placebo in 4 studies (Fig. 1). Percentage of patients achieving response and/or remission in the ZRN arm was numerically greater than placebo in all MDD studies and significantly greater than placebo in the PPD studies (Fig. 2 and 3). ZRN was generally well tolerated with consistent safety and tolerability profiles across studies. The most common treatment-emergent adverse events (≥5 % in ZRN treatment arm) were headache, somnolence, dizziness, nausea, sedation, diarrhea, upper respiratory tract infection, fatigue, and COVID-19.

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In the 5 completed clinical studies, rapid improvement in depressive symptoms assessed by MADRS was observed across studies of adults with MDD and PPD who received a 14-day treatment of once-daily ZRN. In all studies, ZRN was generally well tolerated. These data support further development of ZRN as a potential oral, rapid-acting treatment for patients with MDD or PPD.

The MDD-201B, MOUNTAIN, and ROBIN studies were sponsored by Sage Therapeutics, Inc.; the WATERFALL and SKYLARK studies were sponsored by Sage Therapeutics, Inc. and Biogen Inc. Medical writing and editorial support were provided by MediTech Media, Ltd, and funded by Sage Therapeutics, Inc. and Biogen Inc.

A. Clayton Shareolder of: Royalties from Ballantine Books/Random House, the Changes in Sexual Functioning Questionnaire, and Guilford Publications; and restricted stock in Euthymics, Mediflix LLC, and S1 Biopharma., Grant / Research support from: Daré Bioscience, Janssen, Otsuka, Praxis Precision Medicines, Relmada Therapeutics, Inc., and Sage Therapeutics, Inc, Consultant of: AbbVie, Inc., Brii Biosciences, Inc., Fabre-Kramer, Janssen Research & Development, LLC, Mind Cure Health, Ovoca Bio plc, Praxis Precision Medicines, PureTech Health, Reunion Neuroscience (formerly Field Trip Health) S1 Biopharma, Sage Therapeutics, Inc., Takeda/Lundbeck, Vella Bioscience, Inc., and WCG MedAvante-ProPhase, K. Deligiannidis Shareolder of: Royalties from an NIH employee invention outside of the submitted work. , Grant / Research support from: Received grants from from NIH and Vorso Corporation. Grants awarded to Zucker Hillside Hospital/Feinstein Institutes for Medical Research during the conduct of the brexanolone injection and zuranolone clinical trials (Sage Therapeutics), Consultant of: Sage Therapeutics, Inc., Brii Biosciences, Inc., and GH Research Ireland Limited, J. A. Ramos-Quiroga Grant / Research support from: The Department of Mental Health chaired by him received unrestricted educational and research support from the following companies in the last 3 years: Janssen-Cilag, Shire, Oryzon, Roche, Psious, and Rubió. Dr Ramos-QuirogaReceived travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Rubió, Shire, Takeda, Shionogi, Bial, and Medice., Consultant of: Was on the speaker’s bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Technofarma, Rubió and Raffo in the last 3 years., Speakers bureau of: Was on the speaker’s bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Technofarma, Rubió and Raffo in the last 3 years., R. Lasser Shareolder of: May hold stock and/or stock options of Sage Therapeutics, Inc. , Employee of: Employee of Sage Therapeutics, Inc., A. Sankoh Shareolder of: May hold stock and/or stock options of Sage Therapeutics, Inc., Employee of: Employee of Sage Therapeutics, Inc. , B. Leclair Shareolder of: May hold stock of Biogen Inc., Employee of: Employee of Biogen Inc., M. Kotecha Shareolder of: May hold stock of Biogen Inc., Employee of: Employee of Biogen Inc., J. Doherty Shareolder of: May hold stock and/or stock options of Sage Therapeutics, Inc., Employee of: Employee of Sage Therapeutics, Inc.

Headache is associated with a wide spectrum of comorbid, statistically and biologically related pathological processes. A person with headache is more likely to have a psychological disorder than the rest of the general population, even more so if the headache is chronic. Psychiatric comorbidity has been shown to act as a risk factor in the chronification of headache and may contribute to increased disability. Anxiety and mood disorders are the psychiatric comorbidities that most influence aspects of the disease such as prognosis, response to treatment and even quality of life.

To analyse the results of the implementation of a joint consultation between the headache unit and the liaison psychiatry programme.

To evaluate the efficacy of interdisciplinary intervention in patients diagnosed with resistant headache.

We performed a descriptive analysis of the database of patients included in the headache programme including data on neurological diagnosis, psychiatric diagnosis, type of intervention, referral to psychiatric consultation and number of subsequent revisions.

Diagnoses related to anxious and depressive symptomatology are the most common diagnoses in patients diagnosed with treatment-resistant headache.

In most of the patients analysed in the database a single joint intervention was necessary.

Referral to mental health consultations from the programme did not lead to an increase in urgent demands with a clinical correlation in terms of diagnostic orientation

Joint intervention in the management of these patients has been found to be beneficial in the reinterpretation of symptoms and progressive desensitisation to fear of chronic illness.

Training in symptom detection at the psychopathological level is important for professionals from other areas as well as training in interviewing skills.

More studies are needed to analyse the outcome of joint interventions in patients with difficult-to-manage chronic diseases and their comorbidities.

None Declared

Delusions and hallucinations are common in schizophrenia and related psychotic disorders and they are frequently reported at the first admission to psychiatry departments.

The study aims to examine the themes and frequency of delusions and hallucinations in first admitted patients.

Information was collected retrospectively from selected medical files of patients who were admitted for the first time to the department of psychiatry "A" of the university hospital Hedi Chaker, in Sfax, during the years 2020 and 2021.

Ninety patients were included in our study. Their mean age was 34.79 ± 11.4 years, with a sex ratio (M/F) = 1.3. They reached high school in 51.1% of the cases. Half of the patients were smokers, 30% used alcohol and 16.7% used cannabis.

The average age of onset of the disorders was 30.36 years, and the duration of evolution of the illness before hospitalization was 56.54 days. The most common reason for hospitalization was environmental violence (62.5%). The diagnosis of schizophrenia was retained in 32.2% of the cases, and that of bipolar disorder in 23.3% of the cases.

At initial presentation to the ward, 72.2% of patients were found to have delusional beliefs. The most commonly held delusions were delusions of persecution (62.2%), reference (28.9%) bewitchment (27.8%) and grandiosity (26.7%) with changes of behavior in 34.4 % of the patients in response to their delusional beliefs.

Hallucinations reported by 43.3% of the patients were mainly auditory (30%), visual (20%) and 15.6% reported hearing internal voices. Olfactory hallucinations were only reported by 3.3% of the patients.

Delusions of persecution and reference appear to be the main delusional themes in this patient group. Auditory hallucinations were also commonly reported.

A better awareness of clinical presentations of the first admitted patients may aid early identification of the illness and engagement of the patients in the treatment process.

None Declared

Delusion of pregnancy (DP) is a heterogeneous symptom that can emerge from different neuropsychiatric syndromes, including schizophrenia, bipolar disorders, but also major neurocognitive disorder (MND). According to the Diagnostic and Statistical Manuel of Mental Disorders-5 (DSM-5), DP is an unspecified type of delusional disorder present in the spectrum of schizophrenia and other psychotic disorders This type of delusion, which can affect both sexes, may have numerous determinants to its genesis and may last decades to resolve.

We aim to present a case and review of DP and its association with dementia/MND, hyperprolactinemia and galactorrhea.

Non-systematic literature review and case report, based on the search for titles and/or abstracts of articles that address both DP and dementia, and DP and hyperprolactinemia/galactorrhea, including articles published between 2010 and 2022 in English.

A 71-year-old female patient was admitted to the Psychiatric unit due to a change in usual behavior in the past 6 months: insomnia, anterograde amnesia, delusions of ruin and persecutory and, for the past month, the belief of being pregnant with twins, supported by the galactorrhea she presented after starting Risperidone prescribed by her Family Doctor weeks prior. Shortly after admission, the patient also revealed hearing her fetuses’ voices. DP vanished briefly after admission due to the combination between the change of Risperidone to Aripiprazole (a prolactin-sparing antipsychotic) and psychotherapy to help deconstruct the patient’s cognitive misinterpretations. She was furthermore diagnosed with Alzheimer’s disease and Memantine was started.

This patient, according to Bera et al. (Bera et.al. Indian J Psychol Med 2015;37:131-7) is part of the 28.6% of patients more than 50 years of age who present DP, 6.0% that report having twins and 8.3% that report hearing voices of their fetuses. No data was found correlating DP and MND directly. Hyperprolactinemia and its consequent galactorrhea represent one of the many explanations behind DP, especially in suggestible demented patients that easily misinterpret somatic sensations, in which delusional thoughts are frequent and contribute to the morbidity.

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A variety of dimensions of psychopathology are observed in psychosis. However, the validation of clinical assessment scales, and their latent variable structure, is often derived from cross-sectional rather than longitudinal data, limiting our understanding of how variables interact and reinforce one another.

Using experience sampling methodology (ESM) and analytic approaches optimised for longitudinal data, we assess potential latent variables of commonly-reported symptoms in psychosis, and explore the temporal relationship between them.

N=36 participants with a diagnosis of schizophrenia or schizoaffective disorder provided data for up to one year, as part of the Sleepsight study. Using a smartphone app, participants self-reported clinical symptoms once daily for a mean duration of 323 days (SD: 88), with a response rate of 69%. Symptoms were rated using seven-point Likert scale items. Items included symptoms traditionally implicated in psychosis (feeling “cheerful”, “anxious”, “relaxed”, “irritable”, “sad”, “in control”, “stressed”, “suspicious”, “trouble concentrating”, “preoccupied by thoughts”, “others dislike me”, “confused”, “others influence my thoughts” and “unusual sights and sounds”). We used a sparse PCA (SPCA) model to identify latent variables in the longitudinal data. SPCA has previously been applied to longitudinal ESM data, and was developed to achieve a compromise between the explained variance and the interpretability of the principal components. We then used a multistage exploratory and confirmatory differential time-varying effect model (DTVEM) to explore the temporal relationship between the latent variables. DTVEM generates a standardised β coefficient reflecting the strength of relationship between variables across multiple time lags. Only significant lags (p<0.05) are reported here.

The SPCA analysis identified five latent variables, explaining 61.4% of the total variance. Tentative interpretation of the SPCA loadings suggested these latent variables corresponded to i) cognitive symptoms, ii) feeling in-control, iii) thought interference and perceptual disturbance, iv) irritability and stress and v) paranoia. Time lag analysis revealed an effect of feeling in-control on subsequent cognitive symptoms (β=-0.19), and of cognitive symptoms on subsequent thought interference and perceptual disturbance (β=0.14). Irritability and stress was also associated with subsequent cognitive symptoms (β=0.09).

Using longitudinal data, we employ novel methodology to identify potential latent symptoms among commonly reported symptoms in psychosis. We identify five latent symptoms, and elucidate important temporal relationships between them. These findings may inform our understanding of the psychopathology of psychosis, potentially offering data-driven simplification of clinical assessment and novel insights for future research.

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The COVID-19 pandemic has taken a great toll on world population in the last 2 years across different groups. Women in pregnancy and in the perinatal period are especially vulnerable to sources of stress, with repercussions on their own mental health and on the wellness of the newborn.

We aimed at assessing the impact of COVID-19 related stress on women’s psychosocial status and evaluate the potential development of anxiety or depressive symptoms in our cohort.

From March 2020 to November 2020, our hospital was appointed as an HUB for treating pregnant women positive for Sars-CoV-2 infection. Sociodemographic and clinical data were collected, and patients were delivered different self-report psychometric tests such as the GHQ-12, CD-RS, MSPSS, UCLA-8, ISI, IES-6 and DASS-21. We identified two main types of stressors in our population. Being diagnosed with a pregnancy complication, having an ectopic pregnancy or a spontaneous abortion were identified as pregnancy-related stressors. On the other hand, infections or deaths among partners or relatives were defined as covid-related stressors. Scale scores were compared considering main sociodemographic data and possible stressors, both pregnancy-related and covid-related, that may affect women’s mental health. Fisher exact test, Chi square Test and Student’s T test were used when appropriate.

Among 98 women with complete data at baseline, 21,3% suffered from at least mild anxiety, 21% suffered from at least mild depression, and 41% experienced at least mild stress according to the DASS-21 scale. Moreover, 26,4% reported PTSD symptoms according to the IES-6 scale. Women who experienced a stressor were more likely to report psychiatric symptoms, even more so when exposed to a pregnancy-related stressor. Being Caucasian, a personal psychiatric history or a familial psychiatric history correlated with scoring positive to a higher number of scales. Regarding DASS-21, high total scores in this scale correlated with being Caucasian and having had previous deliveries. More specifically, being Caucasian, older age, previous deliveries and a positive psychiatric history correlated with a higher score in the depression subscale. A positive psychiatric history and a familial psychiatric history correlated with higher scores in the anxiety subscale, while being hospitalized at a late gestational age correlated with lower scores in this section. Scoring above the cut-off of the DASS stress subscale correlated with a positive psychiatric history, a positive familial psychiatric history, being Caucasian, and with an older age of the women in the sample.

Our results underline the burden of the COVID-19 pandemic on women in pregnancy and in the perinatal period. Tailored interventions should be staged to provide adequate care to this particularly sensitive population, for the wellbeing of both the mother and the child.

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Wernicke’s encephalopathy (WE) is a severe neuropsychiatric syndrome resulting from thiamine deficiency (vit B1) wich is often associated with chronic alcoholism. The classical presentation is characterized by ophtalmoplegia, ataxia and confusion.

Unfortunately, WE is still underdiagnosed because it may not always show up with a classical presentation in one hand, and could also be seen in other non alcoholic condition in an other hand which delay diagnosis and managment of early proper treatement

This case highlights the importance of considering atypical presentations of Wernicke’s encephalopathy, it’s medical etiologies and the importance of improving diagnosis to manage early treatement

We reported a case of a pregnant women who consulted for alterated mental status , asthenia and occurs to have Wernicke’s encephalopathy due to hyperemesis gravidarum

Mrs X is a 35-year-old pregnant women with a past medical history of a cesarian, an hospitalisation in third month of this pregnancy for vomits, no known psychiatric illness or history of substance abuse. She was brought to the gynecology emergency department for asthenia and altered mental status. MRS X, was lethargic, had not eaten for several days, vomiting for more than a month. On the medical evaluation she appeared confused, disoriented, and unresponsive to verbal or manual redirection and prompting. She had also ataxia and gait incoordination. Laboratory testing was remarkable for lactic acidosis (blood lactate concentration lipasemia and normal electrolyte levels, cerebrospinal fluid (CSF) culture was unremarkable.

A brain MRI was done and showed FLAIR signal abnormalities around the third ventricle and periaqueductal, suggesting Gayet-Wernicke encephalopathy. Thiamine (vit B1) 500mg thrice a day was administrated for the next days in associtation with vitamin B6.

Wernicke encephalopathy (WE) is an acute reaction to thiamine deficiency which usually presents with a classical triad. However, Clinicians tend to ignore WE in other non-alcoholic clinical settings and the diagnosis becomes even more difficult when thiamine deficiency presents with unusual neuropsychiatric signs and symptoms like catatonia. This case highlights the importance of considering atypical presentations of WE, it’s medical etiologies and the necessity of a complete medical evaluation and appropriate investigations to make prompt diagnosis and early management.

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age-related macular degeneration (AMD) is an ocular disease involving central vision. It is one of the mainreasons of vision loss in people over 50. Seeing non-existing faces or shapes are described in AMD. Symtoms of visualhallucinations that occur as a result of vision loss is known as Charles Bonnet syndrome (CBS). These patients haveintact cognition, do not have hallucinations in any other sensory modalities, and retain insight into the unreal nature oftheir hallucinations.

the aim of this work is analizing ethiology, demographic characteristics, clinica features and treatment inpatients with AMD and visual hallucinations

a literature search using electronic manuscripts available in PubMed database published during the last ten years with further description and discussion of a single-patient clinical case.

in different studies in patients diagnosed with AMD, the reported prevalence ranges between 15 up to 39percent. Patients with more significant vision loss may be more likely to experience visual hallucinations. In large caseseries, mean age is 70 to 85 years. Hallucinations can last few minutes or several hours. On average, people experiencethese hallucinations on and off for about 3 years. Those who experience hallucinations tend to see multiple types ofimages, particularly people and faces.The diagnosis of CBS is made when visual hallucinations occur in patients withvision loss in the absence of psychosis, delirium, or other causes.

There is no specific treatment for CBS: optimal ocular care, education and differents techniques to manage hallucinations(changing your lighting conditions and environment, blinking frequently or moving your eyes side-to-side rapidly whilekeeping your head still…). Antidepressants, anticonvulsants, anxiolytics and low-dose of antipsychotics have been used for CBS with positiveeffects in previous reports, but the efficacy of these drugs in the treatment is somewhat questionable and should bereserved for those who exhibit high levels of distress and have not responded to conventional intervention.

Case report: 80-years old woman who presented with a 4 month history of hallucinations and legally blind from AMD. Aworkup for other pathological causes of visual hallucinations was negative.

CBS is an under-recognized and under-reported disorder that involves visual hallucinations in visuallyimpaired individuals. It requires a multidisciplinary approach from neurologists, psychiatrists, general practitioners andophthalmologists. New studies are needed in order to understand its clinical presentation and to improve its management.

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