Following the protracted duration of the coronavirus pandemic, the Serbian health system now faces a period of mid- and long-term health consequences in patients that have recovered from the acute phases of infection.

A 57-year-old woman presented at a psychiatric examination complaining of forgetfulness, listlessness, fatigue, insomnia, low mood, and decreased efficacy in daily activities, two months after infection with the SARS-CoV-2 virus. The clinical picture of acute COVID-19 infection was accompanied by an elevated body temperature, a cough, an increases of CRP, and X-ray verified bilateral pneumonia with band-like speckled shadows of milk glass density. Before infection, she was vaccinated with 3 doses of the Sinopharm Covid-19 vaccine.

The following examinations were made: MRI of endocranium, HDRS, laboratory examination, and neuropsychological testing.

MRI of endocranium (figure 1): extensively cortico-subcortical lesions extensively within both cerebral hemispheres, dominantly in the temporo-insular regions, in association with partial parenchymal defects and a high degree of atrophy - the overall morphology corresponds to chronic encephalopathy, which is of non-specific morphology; HDRS score of 24; elevated serum levels of IgM, IgG, albumin in serum 7.05 (35-55), albumin in cerebrospinal fluid 812.0 (0-35), albumin index 115.8 (<9.0); IEF: oligoclonal bands in CSF and serum; neuropsychological testing: decrease in general mental activity and visuoperceptive and visuospatial ability. Due to the temporal connection between infection with the SARS-CoV-2 virus and presented symptoms, the patient was diagnosed with post-acute COVID-19 encephalopathy.

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A meticulous follow-up post-acute SARS-CoV-2 infection monitoring and care could decrease mortality and prevent debilitating neurological and other burdens, especially in risk groups.

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Depression can be considered to be a common psychological response to adversity or loss from which an individual may recover quickly based on a natural resilience mechanism. In major depressive disorder, however, we see that biopsychosocial factors exist that can prevent this natural resilience mechanism from taking effect.

To investigate neurotransmitter pathways linked with antidepressant response, genetic epidemiological studies and a literature assessment of biopsychosocial factors were conducted.

Newly admitted patients with a depressive episode according to the criteria of ICD-10 (F32 or F33) who had not been on antidepressant medication for at least 6 months were recruited. More than half the patients have never been treated with antidepressant medication during their entire life. The patients’ depression was of at least moderate severity as measured by the Hamilton’s Depression Rating Scale (HAMD-17).

To determine the effect of adrenergic pathway genes to antidepressant response, the outcome was measured by the difference in HAMD-17 score between entry and two weeks of treatment after two and four weeks of treatment and entry and four weeks of treatment. Multiple linear regression was conducted to identify the independent factor associated with ΔHAMD-17 between the three time periods, including age, sex, depression diagnosis, type of antidepressant taken and selected SNPs.

Literature assesement utilised a snowball technique, building on prior literature reviews conducted. The selection of included literature was determined by the authors.

The Tomosk cohort was mainly women, with less than 20% of patient being male. The cohort was dynamic thus the number of participants involved in each investigation varied. Most patients took SSRIs, specifically sertraline, paroxetine, escitalopram, fluoxetine and fluvoxamine. Comparing the medication taken, ΔHAMD-17 was significantly more improved in participants taking tricyclic antidepressants at 0 - 2 weeks and 0 - 4 weeks.

From our literature assesment, we determined that targeted therapy can undermine the influence of biopsychosocial factors and allow natural resilience to bring depression to an end. Many mental activities is not exclusively individual, but depends on the sociocultural context as people are part of a community.

Depressive disorders can be understood as a rather habitual dysregulation of human behavior which, unlike normal behavior, is not limited by natural resilience in time and severity. Our investigations looked at polymorphisms impacting serotonergic, dopaminergic and adrenergic neurotransmissions and enzymes.

While some associations were found, it did not match our literature findings. For future investigation, epidemiological and pathogenetic biological psychiatric research should be aimed at identifying biopsychosocial factors that frustrate the natural recovery process.

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Patients with systemic lupus erythematosus (SLE) have cognitive dysfunctions as a neuropsychiatric manifestation, associated with disabling symptoms. However, the presence of other medical or psychiatric comorbidities can delay or lead to a misdiagnose.

To present a case of a patient with diagnostic difficulty in the face of multiple medical and neurocognitive comorbidities.

Description of a case report.

19-year-old female, Mexican, unemployed, with incomplete high school, with medical history of preterm birth by cesarean at 30 weeks due to placenta previa, history of early puberty, 4 years evolution of focal epilepsy, 1 year evolution of hypothyroidism and mild depression.

She began her symptoms 4 years ago, characterized by an abrupt onset of memory disturbances, decreased concentration, poor academic performance, infantile behavior, need for affection, alternated with irritability periods, verbal and physical aggression, repetitive and erratic behavior. She went to multiple specialists with different therapeutic approaches without clinical improvement. In 2020, she was referred to our service for evaluation, evidenciating a mild depressive episode and psychotherapeutic treatment was started.

Mental and neurological examination without alterations, normal vital signs, at physical examination: malar rash, oral ulcers, alopecia. Labs: increased erythrocyte sedimentation rate, normocytic anemia, leukopenia, rest normal. An electroencephalogram was requested, without alterations. Simple brain MRI was performed (Figure 1).

Psychological (figure 2) and Neuropsychological tests (table 1) were performed, showing alterations in memory recall and inhibitory control.

Due to the symptoms presented by the patient, SLE was suspected, and rheumatology evaluation was requested, integrating a diagnosis of incomplete SLE, and started treatment. The patient presented symptomatic improvement in cognitive symptoms and systemic signs. Likewise, a genetic evaluation was requested, without meeting the criteria for a genetic syndrome. The patient continues with symptomatic improvement and multidisciplinary treatment.

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Neurocognitive alterations are one of the most frequent manifestations of neurolupus, although its diagnosis and treatment may be delayed in the absence of clinical suspicion, mainly in multi-comorbid patients.

In the case, the patient presented multiple diseases that can explain a picture of neurocognitive impairment, such as epilepsy, depression, hypothyroidism. However, in these cases, a multidisciplinary approach is imperative, requiring to rule out the different causes of the patient’s symptoms.

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Mothers of preterm babies that were hospitalized in Neonatal Intensive Care Unit (NICU), might react with anxiety due to the extremely challenging circumstances. From maternal point of view, after a sudden, high-risk and traumatic birth that has recently occurred, their fragile preterm babies are in an intimidating medical environment, separated from them and are at high-risk of morbidity and mortality. Those circumstances, accompanied by great uncertainty, provoke perceptions of control such as locus of control and maternal self-efficacy, which are both known as central in evoking anxiety.

The proposed presentation examines the mediating effect of maternal self-efficacy in the association between locus of control and anxiety, among mothers of hospitalized babies in the NICU, above and beyond gestational age and mothers’ socio-economic status.

The participants in the present study were 128 Israeli mothers of 208 NICU hospitalized preterm babies. They completed self-report questionnaires regarding their background variables, internal locus of control, maternal self-efficacy, and anxiety.

The analysis showed that while gestational age and mothers’ socio-economic status were controlled, internal locus of control had a significant and positive effect on maternal self-efficacy, and that maternal self-efficacy had a significant and negative effect on mothers’ anxiety. Finally, the direct negative effect of internal locus of control on anxiety decreased with the inclusion of maternal self-efficacy. Altogether, the model explains 26.2% of the variance in maternal anxiety.

The results demonstrate the central role of senses of control in reducing the levels of anxiety experienced by mothers while their preterm babies are NICU hospitalized. fessionals’ interventions with preterm mothers should focus on supporting and encouraging perceptions of internal control as well as promote positive self-perception regarding their ability to succeed in mothers’ tasks. Higher internal perception of control will lead to higher maternal confidence in their ability to perform as mother, which in turn will reduce their anxiety levels. These outcomes may potentially benefit not only the preterm mothers themselves, but also their babies through higher levels of maternal engagement and responsibility as well as through better maternal functioning and subjective well-being. These will impact infants in the short and long run, in terms of physical, cognitive and emotional development.

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Psychoneuroimmunology is a discipline that has emerged over the past decades as a broad interdisciplinary field that closely observes the relationship between the psychological state, the nervous system, the endocrine system, and the immune system. The natural aging process leads to alterations in the immune functions, involving lymphocyte dysregulation, and therefore leading to a higher risk of developing coronary artery diseases, infectious diseases or even cancer.

The aim of our inquiry is to evaluate the existing body of work with a focus on studies that observed the intricate connections between psychosocial factors and immunity.

We performed a systematic review on PubMed and a targeted literature search concentrating on all the factors involved in immunosenescence and their consequences.

The causality between emotional stressors (acute or chronic), lack of social support, adverse life events, coping mechanisms, personality traits, as well as endocrine changes and multiple age-related pathologies is often undeniable. Other relevant factors include nutrition, sleep, physical activity and substance use. As people grow older, they face a number of psychosocial stressors, such as retirement, social isolation, loss of independence, low income, a decrease in productivity and also somatic comorbidities. These factors, together with an age-related decline in immune function, can constitute not only a psychosocial disadvantage of the elderly, but also a risk factor able to trigger further deterioration of the immune system.

Age-associated alterations of the immune response represent a complex concept. Given that we are dealing with the phenomenon of aging in the general population, the field of psychoneuroimmunology can make a significant contribution in establishing the different mechanisms through which seniors can cushion the impact of stressors in regards to health and illness. Therefore, we can pave the way for an individualized approach and support for patients, as well as provide better therapeutic outcomes.

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The pandemic is an undeniably stressful factor on a planetary scale. Life meaning, specific meaning-life orientations, and aspects of locus of control mediate one’s relationship to one’s life circumstances. Thus, the noetic part of human existence can relate to the perception of the pandemic.

The study aimed to examine the relationship between life-meaning orientations and nonspecific emotional reactions in HIV-infected patients during the second wave of the pandemic.

The data were collected from February to July 2021 using a Google form we developed. Fifty-nine HIV-positive patients participated in the study. We used the Purpose-in-Life Test to examine life-meaning orientations and the DASS-21 to diagnose depression, anxiety, and stress. Both questionnaires were adapted for use in Russia.

We obtained the following mean values on the PiLT scales: “general index of life meaningfulness” — M = 94.39±19.71; “goals in life” — M = 30.80±7.75; “life process” — M = 26.93±6.66; “life performance” — M = 23.69±6.66; “locus of control — Me” — M = 19. 61±5.05; “locus of control — life” — M = 25.90±7.43. All PiLT scales had statistically significant negative correlations with depression, anxiety, and stress, except “life process,” which was not associated with anxiety (rxy = -0.215, p > 0.05).

In the COVID-19 pandemic, life meaningfulness, ability to manage life, and freedom of choice may be considered as predictors of emotional well-being among patients living with HIV. The method of the existential psychotherapy can be effective apply among this group of patients.

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Cleft lip and palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Individuals with a cleft of the lip and/or palate (CL/P) differ from their peers due to their facial appearance, hearing and speech problems, in addition, it causes psychosocial impacts among affected children. However, among untreated adults, it seems that psychological sequelae can be major and life limiting.

The purpose of this study is to assess Algerian untreated young CL/P patients psychological and lifestyle issues.

This is a survey-based cross-sectional study conducted during August- October 2022 in Algeria through an online survey which is a self-administered questionnaire ( SAQ). The study target population were young individuals ( age between 17 and 30) with untreated or partially treated clef lip and palate confitions. The questionnaire consisted of 10 multiple questions including a demographic section, evaluating patients satisfaction, lifestyle, psychological problems related to their conditions and limitations due to it. All participants provided their informed consent prior to their participation. The Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyse the collected data.

Final sample size consisted in 207 responses. The mean age of the participants was 24.3± 3 years. Findings showed that slightly more that three fourths (75,9%) of participants reported that they are unsatisfied of their life because of their CL/P condition. Among 120 uneducated participants, (67%) of them reported thay they abandoned school because of their appearance. For P <0.001, suicide thoughts were higher among female participants (38%) than male participants (9%). Almost half of respondents (49.4%) presented strong immigration desires due to their education, relationships and psychosocial health issues.

The psychological impact of cleft lip and palate in adults appears to be disturbing, chronic and life-limiting. Urgent approaches to ensure the early management of cleft lip and palate in Algeria remain mandatory. Increasing the number of specialized maxillofacial services seems to be a good first step.

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Forensic psychiatrists, as well as other mental health professionals, provide the legal system with clinical information and assessments concerning the offenders’ functioning, mental state and capacities at the time of the alleged offense and/or trial. These forensic assessments play a crucial role in court, influencing subsequent decision-making on sentencing, placement, or treatment of mentally disordered offenders.

Determining criminal responsibility at the time of arrest

Exploring the role of psychiatric disposals in different countries.

The information was primarily gathered through written sources: peer review articles, reports, and legislation. A literature search was performed in PubMed and PsycINFO using the following keywords: criminal responsibility (reports/evaluations), pre-trial assessment,psychiatric expert, (forensic) psychiatric assessment, sanity evaluation and insanity defense. Additional articles were identified through reference lists This resulted in 36 peer review articles and nine reports or book chapters. In addition, a leading expert (i.c. psychiatrist) from every country was contacted for providing information and validating the information from this article pertaining to their country. They suggested eight more articles or book chapters. The respondents represent the authors of this article.

See table.

In summary, it appears that there are distinct differences between the abovementioned countries with respect to criminal responsibility assessments. Although Canada is considered a pioneer with regard to forensic mental health, Britain, the Netherlands and Sweden appear to have a well-established system in conducting these assessments. In Sweden the system is very strict, meaning that all reports are delivered by a governmental agency with their own staff. The court orders the report from the agency and not from the experts.

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Every pregnancy and birth is unique, and despite this, few studies exist on the condition of pregnant women with mental disorders.

This study analyzes the impact of prevalent mental disorders in pregnant women to determine which clinical or socio-demographic characteristics significantly impact pregnancy.

This retrospective and naturalistic cohort study is based on the medical records of 99 patients managed in a university hospital. All patients had an ICD-10 mental disorder (psychiatric and/or substance use disorders) diagnosed before pregnancy.

Only 24.2% of the pregnant women had no adverse outcomes throughout pregnancy, labor, and delivery. The remaining mothers had violence issues, and mothers with psychotrauma were likelier to have stillborn babies. Pregnant women with mental disorders were less keen to screen for Down’s syndrome and more likely to have artificial delivery in case of comorbid drug addiction and alcohol use disorder (AUD). Anonymous birth and placement of newborns were related to substance abuse and pre-pregnancy AUD comorbidities or AUD alone before pregnancy. Besides, four clinical characteristics were found to be predictive of adverse pregnancy outcomes: young maternal age (β=-1,15,p<.03), late-term first contact with the maternity hospital (β=0.08,p<.02), advanced term of delivery (β=4.01,p<.03), and a history of psychiatric disorders associated with an AUD but without smoking before pregnancy (β=-1,07,p<.03). Despite all, pregnant women had a relatively sustained follow-up of their pregnancies.

Mental disorders have a negative impact on pregnancy. More studies should be promoted to raise the attention of professionals to manage and improve women’s pregnancy and motherhood with psychiatric conditions.

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Data regarding mental health problems in the prelingual deaf population is scarce. There is evidence that factors related to minority stress can contribute to mental illness in that population. In psychiatry, communication is key, however, most clinicians are not trained to communicate with the Deaf. Moreover, psychiatrists are often not aware of particularities in the psychopathology of these patients.

We aim to review important aspects of psychiatric evaluation of prelingual Deaf patients.

Non-systematic review of recent literature regarding Deaf mental health and mental illness.

Data regarding prevalence of mental illness in the Deaf population is mostly obtained from small studies and suggest an increased burden of mental illness and significant barriers to mental health care. Psychiatry research regarding Deaf patients is about 40 years behind research on the hearing population. While communicating with a Deaf patient, clinicians should consider the preferred communication modality. Sign-language interpreters should have specific mental health training, although that is not the case for many countries. Clinicians should keep communication simple, use short sentences, concrete examples and visual aids.

The mental status examination will have particularities, such as: 1) facial expressions have a specific role in sign languages and may not relate to affect; 2) There is a need to distinguish between language dysfluency and thought disorder 3) voice hallucinations may manifest as somatic or visual hallucinations; the occurrence of pure auditory hallucination in the prelingual Deaf is controversial. 4) the Deaf have little access to health information and are likely to demonstrate poor literacy on mental health matters.

More studies regarding the mental health issues of the Deaf population should be conducted. Raising awareness among clinicians about the needs of Deaf population is an important step to improve their access to help and treatment.

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Although the role of SARS-CoV2 pandemic on psychiatric Emergency Department (ED) encounters, has been analysed, few studies have focused on the pandemic influence on patients’ characteristics and admission rates in a psychiatric ward.

The aim of this cross-sectional study is to analyse characteristics of patients admitted in the psychiatric ward of “San Salvatore” Hospital in L’Aquila (Italy) in a three-year timeframe, from 2019 to 2021, and evaluate the impact of COVID-19 pandemic on admission trends over the course of these three years.

We collected data regarding 1115 patients from the hospital discharge summaries (Scheda di Dimissione Ospedaliera, SDO) of “San Salvatore” Hospital. Patients were sorted according to diagnosis, year of admission and age range. Comparison of mean values from each group was attained using the Student’s t-test, while percentages and ratios were compared by means of the Chi-Square test.

Between January 2019 and December 2021, 1115 patients were admitted in our psychiatric ward. In 2020, during pandemic outbreak, we observed a reduction of the number of admissions, with 351 patients. Although no statistically significant differences were found regarding patients’ gender or age, we observed a higher number of male patients admitted during all three years (male/female ratio: 231/171 in 2019, 217/134 in 2020 and 192/170 in 2021). Admission rates of patients aged between 18 to 30 years were higher during 2020 and 2021, conversely in the previous year the most represented group were patients aged between 41 to 50 years. Regarding diagnostic categories, percentages remained relatively steady during the three years. Nevertheless, it was possible to observe a slight reduction of Schizo-Psychotic disorders (175/402; 45,53% in 2019, 135/351; 38.46% in 2020 and 119/362; 32,87% in 2021) and a slighter reduction of Personality disorders percentages (49/402; 12,19% in 2019, 37/351; 10,54% in 2020 and 36/362; 9,94% in 2021). Conversely, results showed an increase in admission of patients with substance use disorder: 24 out of 402 patients (5,97%) in 2019, 32 out of 351 patients (9,12%) in 2020, and 46 out of 362 patients (12,71%) in 2021.

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Despite biases due to the one-site evaluation, the strength of the present study relies in the retrospectively cross-sectional observation design conducted to evaluate a three-year timeframe, spanning throughout the pandemic. The sharp reduction of admissions rates in 2020, is in line with other data regarding ED accesses’ trends during pandemic. Increasing rates of admission of patients between 18 and 30 years could be a result of a stronger impact of the pandemic on young people’s mental health. Moreover, increasing trends of admission of patients with substance abuse disorders may be potentially addressed to distress symptoms brought by the pandemic.

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Non-invasive brain stimulation protocols are effective treatments for depressive episodes. Although the cognitive adverse effects of electroconvulsive therapy (ECT) are well documented, evidence regarding the cognitive effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) is mixed.

The aim of this study was to synthesize research on the cognitive effects of non-invasive brain stimulation protocols and to differentiate between studies of major depressive disorder (MDD), bipolar depression and mixed populations.

Following a systematic literature search of multiple electronic databases, a series of meta-analyses were conducted to estimate standardized mean differences (SMD) between pre- and post-treatment cognitive functioning across nine cognitive domains. Where possible, SMDs were estimated separately for MDD, bipolar depression and mixed populations. In studies that included both patients with MDD and bipolar depression, the percentage of patients with a diagnosis of bipolar depression was tested as a potential moderator.

More than 150 treatment arms were included in the analyses. For ECT, we observed a small decline in language functioning and a decrease in autobiographical memory scores. There was no evidence of pre-post differences across other cognitive domains. For rTMS and tDCS, small to moderate cognitive improvements were observed for several cognitive domains, for example for executive functioning. Across most analyses, between-study heterogeneity was high and could not be accounted for by differences between MDD, bipolar depression or mixed populations.

There was limited evidence that differentiation between studies of MDD, bipolar depression and mixed populations accounted for between-study heterogeneity in analyses of pre-post differences in cognitive functioning. Given that most studies included both patients with MDD and bipolar depression, this finding should be treated as preliminary. Across all the treatment protocols examined, more data are needed to investigate the cognitive effects of non-invasive brain stimulation in patients with bipolar depression.

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Severe mental illnesses such as schizophrenia, bipolar disorder and depressive disorder are common worldwide and often have a chronic course.

Due to psychiatric ( for example : substance use disorders ) and somatic ( for example : obesity, cardiovascular disease, diabetes ) comorbidities, mortality is higher in these patients than in the general population.Viral diseases are, in addition to cardiovascular diseases and metabolic alterations, among the most common somatic comorbidities in people with severe mental illness.

The objective of our work was to study the prevalence of vaccination against the viral hepatitis B virus in these patients.

For this purpose, we conducted a cross-sectional study of 200 patients hospitalized in the emergency department of our training center. First, we collected sociodemographic and clinical data on patients admitted to psychiatric emergencies: sex, age, diagnosis, duration of evolution, history (medical and surgical, psychiatric, suicide attempts, problematic substance use, previous incarceration). In a second step, we tested for anti-HBS antibodies.

the majority of our patients were male, the first diagnosis was schizophrenia.

92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.

Several patients reported having unprotected sex.

58% of patients were vaccinated against hepatitis B, these patients were young for the most part. the majority of our patients were male, the first diagnosis was schizophrenia.92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.Several patients reported having unprotected sex.58% of patients were vaccinated against hepatitis B, these patients were young for the most part.

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Psychotic symptoms have long been known to show up earlier in life, typically during adolescence and early adulthood. Late Onset Psychosis (LOP), in which symptoms start between 40 and 60 years of age, and Very Late Onset Psychosis (VLOP), in which onset of symptoms happens after 60 years of age, although classically rare, have had a growing prevalence in the last decades.

To access the definition and main etiologies of LOP and VLOP, based on the current literature.

Non-systematic review of literature using the terms “late onset psychosis” and “very late onset psychosis”. Case report of a patient who was admitted and treated in our inward patient field.

51-year-old female patient. She is divorced (two previous marriages) and has two daughters (26 and 16, respectively). She was brought by police officers because of behavior problems at the shelter where she was living. She was evicted from the house she was living in because of delay in paying the rent. On observation, she verbalizes persecutory and prejudicial delusions and auditory hallucinations on the 2nd and 3rd person (commenting voices) with at least 5 years of duration. She was hospitalized for almost 3 months, with slow but progressive clinical improvement on haloperidol 7,5mg/day. At the date of discharge, she did not spontaneously verbalize her symptoms, although she did not recognize them as delusional. Recent studies have shown that the prevalence of Schizophrenia in the typical age range is 75-80%, which means that an important proportion of diagnosis is made after that age span. Primary causes of LOP and VLOP are schizophrenia (of late onset), schizophrenia-like very late onset psychosis, delusion disorder, unipolar depression with psychotic symptoms and bipolar disorder. Secondary causes should also be considered, such as delirium, dementia (Alzheimer’s, Lewi bodies and vascular), and substances abuse; even more rare, other conditions should be considered, as cerebrovascular accident, encephalitis, epilepsy, and multiple sclerosis.

LOP and VLOP have been a growing diagnosis in the past decades. In the assessment of these patients, we must consider the importance of secondary etiologies besides the primary psychiatric ones. Primary psychosis is a diagnosis of exclusion, and the clinician must rule out secondary causes. Recent data point out these symptoms as markers for an increased risk of dementia in these patients. Further research involving individuals with LOP and VLOPs is required to increase the evidence base for treatment and improve outcomes of care.

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Autism Spectrum Disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests (APA, 2013 DSM 5th ed.).

A 22-years old male outpatient affected by Autism Spectrum Disorder (Level 3) and severe ID presented serious challenging behaviors. The patient did not suffer from other psychiatric or neurologic pathologies. The patient did not have constipation or diarrhea or painful symptoms. The patients assumed carbamazepine (modified release) 800 mg/day (blood dosage 6,8 microgram/ml), clonazepam 2,5 mg/ml 15 drops/day, lorazepam 7,5 mg/die.

Due to the onset of challenging behaviors risperidone was introduced. At the dosage of 2 mg/day, the patient reached a discrete control of challenging behaviors. After stopping risperidone because of oculogyric crisis, the patient started to assume valproic acid (chronic formulation) up to 1000 mg/day. After three weeks the patient presented an increase in the blood dosage of ammonium. After the drug stop, the patient began to re-present challenging behaviors. The authors decided to add topiramate at a dosage of 25 mg per day. After three days, the patient began to present nocturnal urinary incontinence. Topiramate was stopped and Gabapentin was introduced in the treatment up to the dosage of 900 mg/day. Lorazepam was gradually tapered off until the intake was terminated, and clonazepam was reduced to 5 drops/day taken at bedtime. The dosage of carbamazepine remained stable.

Table 1.Behavior Problems Inventory subscales scores

According to the GABAergic hypothesis of ASD, inhibitory signaling of GABA within and between cortical minicolumns appears to be altered. This alteration would result in information processing with high discrimination between correlated stimuli rather than a generalization of them (Casanova et al. Neuroscientist 2003; 9: 496-507). Gabapentin is a ligand of the auxiliary alpha-2-delta subunit site of voltage-dependent calcium channels and acts as an inhibitor of the channel (Sills Curr Opin Pharmacol 2006; 6 (1):108-13). The altered expression of alpha-2-delta 1 or alpha-2-delta 3 can cause a chronic imbalance between arousal and inhibition that is quite characteristic of ASD (Nelson et al. Neuron 2015;87:684-698). The authors want to speculate on a hypothetical function of gabapentin in remodeling the expression of alpha-2-delta subunits in people with autism and the processing of neural information.

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The fact that nurses do not have a voice in the treatment decision of patients and that there is no framework about futile treatments can cause some psychological problems such as depression, burnout and moral distress (Yildirim et al., 2018). If not managed properly, moral distress leads to decreased job satisfaction, increased nurse turnover rates and intent to change the working area or leave the profession (Vieira & Doedato & Mendes, 2021).

This study aimed to explore the nurses’ attitudes towards futile treatments and its relationship with the moral distress, intention to leave the job and the other personal factors.

This study has a descriptive and correlational design, carried out with 425 nurses, between April-May 2021 in Istanbul. The data were collected using a Personal Information Form, The Nurses’ Attitudes Towards Futile Treatment Scale(NATFTS), Moral Distress Scale(MDS) and Intention to Leave Scale (ILS). Personal Information Form: The form consists of 22 questions including the socio-demographics and professional characteristics. The Nurses’ Attitudes Towards Futile Treatment Scale (NATFTS): The scale was developed by Yildirim et al. in 2019, consisting of 18 items and uses a 5-point likert type scale.Moral Distress Scale(MDS):The scale, developed by Hamric (2012), adapted to Turkish by Karagözoğlu et al. (2017), consisting of 21 expressions, was designed to measure the level of moral distress in nurses. Intention to Leave Scale (ILS):The scale was developed by Wayne et al. (1997), and adapted to Turkish by Avcı ve Küçükusta(2008) in the form of 5 items. The data were analyzed by using descriptives, Kruskal Wallis test, Independent Samples t- test and ANOVA, Pearson Correlation analysis on SPSS 25.0 for Windows. For significance, p < .05 and 95% CI were assumed in the data analysis.

A moderate negative correlation was found between NATFTS score and the ILS score (r=-0.356, p<0.001). Nurses who think that futile treatments should be applied under the strict rules have less tendency to leave their jobs. On the other hand, there was a lower positive level of correlation between NATFTS score and the MDS score (r=0.295, p<0.001). That is, nurses who think that futile treatments should be applied under the strict rules have a higher level of moral distress. A low-level negative of relationship was found between the MDS score and the ILS score (r=-0,260, p<0,001). As the level of moral distress increases, the tendency to leave work decreases.

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It is believed that educating nurses and strengthening them psychologically will prevent them from experiencing moral distress, increase job satisfaction and reduce intention to leave (Cicolini et al., 2014). Considering the negative effects of ethical dilemmas about futile treatments on health professionals, it is recommended that legal regulations be made on the subject and institutions determine their own protocol.

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Neuroticism has societal, mental and physical health relevance, with an etiology involving genetic predisposition, psychological influence, and their interaction.

To understand whether the association between polygenic risk score for neuroticism (PRS-N) and neuroticism is moderated by affective well-being.

Data were derived from TwinssCan, a general population twin cohort (age range=15-35 years, 478 monozygotic twins). Self-report questionnaires were used to measure well-being and neuroticism. PRS-N was trained from the Genetics of Personality Consortium (GPC) and United Kingdom Biobank (UKB). Multilevel mixed-effects models were used to test baseline and changes in well-being and neuroticism.

Baseline wellbeing and neuroticism were associated (β=-1.35, p<0.001). PRSs-N were associated with baseline neuroticism (lowest p-value: 0.008 in GPC, 0.01 in UKB). In interaction models (PRS x wellbeing), GPC PRS-N (β=0.38, p=0.04) and UKB PRS-N (β=0.81, p<0.001) had significant interactions.

PRSs-N were associated with changes in neuroticism (lowest p-value: 0.03 in GPC, 0.3 in UKB). Furthermore, changes in wellbeing and neuroticism were associated (β =-0.66, p<0.001). In interaction models (PRS x change in wellbeing), only UKB PRS-N had a significant interaction (β=0.80, p<0.001).

Interaction between polygenic risk, wellbeing and neuroticism, were observed regarding baselines measures and change over time. Depending on the analysis step, the direction of the effect changed.

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Lithium, a mood stabilizer, is a commonly prescribed and effective treatment for bipolar affective disorder. It´s excreted almost exclusively by the kidneys with a half-life primarily determined by renal function. Chronic intoxication results from an insidious accumulation of lithium in a chronically medicated patient (due to a reduction in renal function secondary to volume depletion, a new medication, et cetera). Patients often present with neurologic findings, including tremor, ataxia, dysarthria, confusion and neuromuscular excitability.

The objective of this report is to describe a clinical case of lithium neurotoxicity (myoclonus and encephalopathy), along with a review of the literature on the topic.

We describe a case of lithium neurotoxicity, along with a brief non-systematic review of the literature on lithium toxicity. We conducted a PubMed bibliographic search using keywords such as “lithium intoxication”, “lithium neurotoxicity”, “lithium encephalopathy” and “lithium intoxication treatment”.

A women aged 81 was brought to the emergency department by her daughter following 1 week of asthenia, diarrhoea, periods of confused speech and involuntary movements. In the previous week, the patient had been diagnosed with COVID-19. Her past medical history is significant for bipolar affective disorder, hypertension, diabetes mellitus, dyslipidemia and asthma. The patient has been treated with following drugs: lithium carbonate (no recent change of dose and previous serum levels around 1mmol/L), quetiapine, lisinopril, metformin, simvastatin, formoterol and budesonide. On the first examination, she had an exuberant multifocal myoclonus. Posteriorly, she became somnolent, with language impairment (verbal perseveration, echolalia) and dysarthria. Investigations revealed renal impairment (creatinine 1,5 mg/dL, blood urea nitrogen 42 mg/dL) and supratherapeutic lithium levels (lithium serum level 1,7 mmol/L). Computed tomography scan of the brain was negative for acute injuries. The electroencephalogram showed triphasic waves (1-1,5 Hz). Encephalopathy secondary to lithium intoxication was diagnosed (probably in the context of acute kidney injury precipitated by hypovolaemia – diarrhoea). Lithium was stopped and intravenous isotonic fluids were given. After 1 week, her myoclonus resolved and over the following week the other signs resolved as well. The patient was later discharged to her daughter’s home, with follow-up neurology and psychiatry visits.

Both reversible and irreversible neurotoxicity related to lithium have been reported, specially occurring alongside chronic intoxication. If not addressed, impaired consciousness can lead to coma and death. A high clinical suspicion is needed for prompt diagnosis and treatment (intravenous fluids and sometimes haemodialysis are warranted).

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Medical school can be highly stressful and demanding, and negatively impact the well being of the students. Identifying sources of stress and a better understanding of the ways medical students cope can be helpful towards finding ways to increase the quality of life and efficiency of future physicians.

We sought to assess what the main sources of stress and coping strategies are for medical students, as well as how year and socio demographic factors like gender influenced the coping strategies used.

We have performed a cross-sectional study on 489 medical students from Romania that have been asked to complete a survey which included the most common sources of stress, as well as the COPE inventory to assess what are the strategies that students use for coping with stress. Descriptive and comparative analysis of the data was performed using R software.

Most students have reported stress related to learning and the academic setting. The high volume of material to be learned is by far the greatest source of stress for medical students, followed by weekly schedule and methods of examination. First year students are more preoccupied with accommodation and lack of recreational activities, while, comparatively, sixth year students tend to perceive the academic process itself as more stressful. The coping methods used most by medical students are active coping, planning, and positive reinterpretation of stressful events. Fortunately, the least used way of coping with stress is alcohol / drug use, as well as denial and behavioral disengagement, the latter two being associated with poorer academic performance. Compared to their older colleagues, first year students tend to turn more to religion and denial to cope with stress, while sixth year students show more acceptance and active coping mechanisms. Women are more focused on emotions, and tend to use venting more, as well as using emotional support more often than men, while men turn more to humor and psychoactive substances than women do.

The profile of stress sources and coping strategies of medical students differs by year of medical school and is influenced by socio demographic factors. Certain maladaptive coping strategies may affect an individuals’ academic success, yet most students are using active, problem-focused strategies to deal with stress.

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Clozapine is well known for its unique efficacy in treatment-resistant schizophrenia and to reduce violent behaviour. Unfortunately, life-threatening adverse reactions including ileus, myocarditis and agranulocytosis can hinder its use. In this context, some clinicians may be reluctant to initiate clozapine in patients who are prone to these adverse drug reactions.

To describe a complex clozapine initiation despite the presence of serious adverse effects and contraindications. The management of these adverse events, using effective multidisciplinary team leadership strategies, will also be described.

A case report will be presented. The challenges faced while using clozapine and strategies implemented to pursue the use of this medication will be described.

A young black man with severe first episode psychosis was admitted to the early intervention outpatient clinic in Québec, Canada. Multiple aggression and critically disorganized behaviour prompted patient transfer to a specialized long-term care unit. Given the severity of the resistant disease and after a shared decision-making process with the family, clozapine was introduced despite ethnic neutropenia (down to 0,2 X 109/L) and idiopathic cerebral lesions. Both gave rise to multiple concerns. A specific hematological surveillance protocol was designed. Facing multiple severe neutropenia episodes, the use of prophylactic granulocyte colony-stimulating factor (300 mcg SC weekly) was added after literature review and a favourable consult of both pharmacist and hematologist. Cardiac enzyme elevation also requested specialized investigation and follow-up. Specialized educators, social workers, and nursing all needed to be deeply involved in the treatment process and team coordination requested strong team building capacities. After 6 months, the patient is now taking clozapine 325 mg daily and his symptomatology has sufficiently reduced to allow hospital leave. The patient is now engaged in his recovery process.

Using an evidence-based approach, promoting expertise from multiple healthcare professionals, and allowing a substantial amount of time to develop team cohesion were all crucial elements of this success story.

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