Mental health problems have a substantial economic impact across the world. Those who have their problems detected may receive therapies (usually medication or psychological) or who packages of care (for example, early intervention or residential support). Some problems are transient while others will remain across the life course. Costs are closely associated with care received and it may be that costs need to rise in order to provide adequate support. Economic costs also occur due to lost opportunities such as work and leisure. This talk will summarise recent estimates of the cost of mental health problems in a number of countries.

Establishing total costs does not tell us how to use limited resources. This requires the use of economic evaluation methods such as cost-effectiveness and cost-utility analyses. There is a growing evidence base from such evaluations for many psychological and pharmacological interventions and recent key findings will be discussed. The need for long-term, life course approaches to economic evaluation of mental health interventions will be proposed.

None Declared

Dissociative identity disorder (DID) is a debilitating and controversial psychiatric disorder with a lifetime prevalence estimated around 1,5%. It remains underdiagnosed despite recognition in international classification of mental disorders. In fact, based on the DSM-5 criteria, DID is characterised by two or more distinct personality states that coincide, with fluctuating consciousness and changing access to autobiographical memory. The aetiology of DID has long been debated with recent neuroimaging evidence supporting the trauma model of this condition.

The aim of this presentation is to describe the case of a young female diagnosed with DID related to childhood trauma.

We also conducted a literature review in order to discuss the aetiology of the disorder. The following keywords were searched through the pubmed website: dissociative identity disorder, trauma, aetiology.

We report the case of a 20 years old female with no past medical, nor psychiatric history. However, she had a family history of an uncle and an aunt with chronic psychosis. Her father died when she was 8, thus she lived with her mother and her brother and two sisters. She was a brilliant student and started engineering studies. She has no particular personality trait. She was raised within a strict religious family with little time dedicated to leisure activities. Importantly, since the age of 10, she was exposed to her mother’s religious extremist and threatening discourses, related to death and “grave’s torture” and comprising many cultural beliefs. She seeks for psychiatric care complaining of “soliloquy” that became remarkable by her relatives. On psychiatric evaluation she presented daily fluctuating consciousness during at least one hour, in which she switches identity toward the daughter of a famous singer. This alter was having pleasant activity with her mother and was singing and hanging out most of the time. No particular triggers were identified. The trouble started by the age of 14 then worsened gradually and became an unvoluntary phenomenon with significant distress. She had no depressive nor psychotic nor anxiety or obsessive symptoms. Her sleep and appetite were not disturbed. She met DSM-5 diagnostic criteria for DID and was referred to a trained psychiatrist for adequate psychotherapy management.

We exposed a rare case of a young student complaining of soliloquy since the age of 14 that was diagnosed with DID subsequent to a particular childhood trauma which consisted in exposure to threatening religious and cultural beliefs about life after death told by her mother. This unique case emphasises the trauma model of DID, where the nature of the trauma influences the clinical expression of DID. Given the recent neuroimaging evidence, DID can be framed as a chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress.

None Declared

Hyperprolinemia is defined by high proline levels of blood and its primary type consists on a metabolic disorder that is the result of a number of different genetic defects affecting the degradation of proline. The complex relationship between this disease and different psychiatric phenotypes has been an important subject of study in recent years, suggesting a “common psychiatric phenotype” (Namavar et al. Am J Med Genet B Neuropsychiatr Genet 2021; 186(5), 289-317), though its exact characteristics are yet to be determined. A higher prevalence of psychotic disorders (Guo et al. Metab Brain dis 2018; 33 89-97) explained through altered glutamate metabolism, autism spectrum disorders, developmental delay and intellectual disability has been proposed.

To describe the case of a patient, recently diagnosed of hyperprolinemia type I, presenting a conduct disorder alongside with ADHD, oppositional defiant disorder and an unspecified pervasive developmental disorder.

We present the case of a 15-year-old male that has received follow-up care by our mental health services. The patient was born preterm (35+5 weeks) and required reanimation, oxygen therapy, antiretroviral therapy (biological mother was HIV positive) and pharmacological therapy with phenobarbital (in order to treat methadone withdrawal syndrome). It was adopted nationally when he was 18-month-old and experimented an adequate development during his first years, only highlighting slight psychomotor restlessness and distinctive facial features. During the next years, he receives diagnosis of ADHD (with little to no registered response to amphetamine derivatives), oppositional defiant disorder, social pragmatic communication disorder and fetal alcohol syndrome.

During his first hospital admission, a neuropediatrician was contacted to study the patient and recommended for a metabolic screening to be done, where high blood levels of proline were detected (940.1μmol/L). After this, a procedure of massive exome sequencing of genes that were known to be related to alterations in the metabolism of proline was conducted, finding the mutation c.[1357C>T] in the gen PRODH. This translates to an amino acid replacement in the protein proline dehydrogenase (p.[Arg453Cys]; [Arg453Cys]), which has been studied (Bender et al. Am J Hum Genet 2005; 76 409–420) that it reduced its activity in a 70%, making it a very probable cause of the hyperprolinemia.

There is still scarce evidence of the psychiatric phenotypes presented in patients with hyperprolinemia. Further research is needed in order to accurately define the complex relationship between this metabolic disorder and its effect on the central nervous system.

None Declared

The reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society.

To evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society.

An initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field)

Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10.

500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81±1.43) and the lowest for the Digitalization line (7.18±1.92). In the Action Lines, the highest score was for Suicide (9.03±11.5) and the lowest for Elder people (8.04±1.94).

Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040)

Image:

Image 2:

Highest transversal priority for the MH Strategy was Humanization of Mental Health Services, and the most critical action was Suicide prevention. Professionals, Scientific societies and Users considered more important research, innovation and training compared with other society groups, whereas the less important areas for the users were digitalization and prevention users. These priorities will help to design the implementation and schedule for the lines of the Mental Health Strategy in Castilla y León.

None Declared

The transition to college life can be a stressful period for young adults, and coping strategies can involve changes in eating behaviors.

The aim of this study was to assess the prevalence and correlates of eating disorder risk among Tunisian university students.

We conducted a cross-sectional descriptive and analytical study among 144 university students in Tunisia. Data were collected using an online questionnaire spread throughout social media (Facebook), using the Google Forms® platform.

Attitudes, feelings and behaviors related to eating were measured using “Eating Attitudes Test” (EAT-26) in order to assess the eating disorder risk.

The mean age of our population was 23.38±3.27 years. More females (73.6%) than males (26.4%) participated in the study. Among them, 10.4% were followed for chronic somatic disease while 11.1% suffered from mental illness. Tobacco, alcohol and cannabis use was noted respectively in 12.5%, 3.5% and 3.5% of cases.

The mean score EAT-26 was 20.45. According to this scale, 32,6% of participants were at high risk of eating disorders.

EAT-26 scores were higher in females (21.23) than males (16.95%), without a significant relationship.

Users of psychoactive substances were more likely to present higher EAT-26 scores (p=0.012), especially the use of alcohol (p=0.005) and weed (p=0.024).

EAT-26 scores were significantly higher among students with a prior history of depression.

Our study highlighted a high prevalence of eating disorder risk in university students. Implementation of public health policies are required, and psychological intervention and health awareness programs would effectively prevent the eating disorder risk.

None Declared

Chronic alcohol use is related to alcoholic cerebellar degeneration that is caused by B1 (thiamine) deficiency and associated with the degeneration of Purkinje cells in the cerebellar cortex.

This report aims to present a case with cerebellar ataxia and tremor due to alcoholic cerebellar degeneration that is unexpectedly regressed after starting piracetam infusion treatment in the inpatient Alcohol and Drug Addiction Research, Treatment and Education Center (AMATEM).

We investigated the case prospectively. The patient was informed and consent was obtained.

A 57-year-old, divorced, retired, male with alcohol use disorder for 48 years (mostly high alcohol, cologne for 2 years) presented to our hospital with upper and lower limb tremors and balance problems for 2 years. Neurological examination revealed dysmetria, cerebellar tremor, hypoesthesia of lower extremities, ataxia so he was unable to tandem-walk. CIWA-Ar score:13. The blood test, including hemogram, biochemical, HbA1C, TFT, serum copper and ceruloplasmin levels, results were all normal. Diazepam 50 mg was started and titrated down by 5 mg per day and discontinued, 600 mg parenteral and 250 mg p.o thiamine initiated for 3 days and continued orally, propranolol 20 mg/day and ecopirin 100 mg/day were continued. Cranial CT, cranial MRI, and EMG were ordered.The patient was consulted to the neurologist for movement disorder.

MRI appearance of the cortical sulcus, fissure, cisterna, and cerebellar folia were obvious. The ventricular system was assessed as ecstatic secondary to atrophy. Therefore the alcoholic cerebellar degeneration was diagnosed and increased propranolol to 30 mg/day dose. Furthermore iv infussion piracetam was empirically started at secuencely dose of 60 g/day for 3 days, 45 g/day for 3 days, 30 g/day for 3 days. Upper and lower limb tremor disappeared and ataxa regressed after the treatment was arranged.

Image:

Image 2:

Image 3:

Several authors proposed that serotonergic system among other neurotransmitters in the cerebellum might be affected in ACD. Recent studies investigating the use of buspirone in the treatment of ataxia has showed positive results (1-3).

The mechanism of action of the piracetam is unclear. Supposed that piracetam binds to the polar head groups of membrane bilayers and induces distinct changes in membrane structure. Its actions in the nervous tissue include indirect modulation of several neurotransmitter systems, neuroprotective and anticonvulsant effects and positive influence on neuronal plasticity.

In conclusion, we suggest that high dose piracetam has a potential antiataxic effect in ACD.

Cessation of drinking and nutritional supplementation are the only treatments available for ACD. However, gait does not improve in most patients. Pysical therapy, canes, walkers, and wheelchairs are helpful in maintaining mobility (4). Similarly, we observed that the patient’s need for care has been continuing.

None Declared

Self-harm (SH) is common, in particular among young people. It can be seen in a wide range of psychiatric disorders, ranging from anti-social personality disorders to schizophrenia and mood disorders. In the extreme, self-harm can be functionally life-threatening. Such is the case of phlebotomy, emasculations and self-amputation. The severity of certain damage and the urgency of an initial somatic treatment contribute to make self-harm one of the most frequent reasons for intervention in liaison psychiatry.

Through our case series and a literature review, we tried to describe the socio-demographic and psychopathological characteristics of the self-harmers and to identify the specificities of their management in liaison psychiatry.

It is a descriptive cross-sectional study, in the psychiatric department of a general hospital in Rabat, concerning patients evaluated for SH with or without other psychiatric manifestations. The data collected are analysed using the statistical software ‘JAMOVI’. Patients seen in psychiatric consultations, in medical-surgical emergencies or in liaison psychiatry for SH were included. Patients already hospitalized in psychiatry were excluded.

35 patients were recruted of who 65.7% were male. 68.6% were single. 51.4% had a low socio-economic level and 42.9% had an average level. 48.6% had a psychiatric history of which 22.9% had attempted suicide. Abuse was present in 34.3%, family separation in 22.9%, death of a parent in 20% while no patient reported sexual abuse. The most common method used was a razor blade in 57.1% of cases. The most mutilated site was the forearms in 65.7%, following a frustration in 60% and a conflict situation in 25.7%. 48.6% were hospitalised (34.5% in psychiatry, 5.6% in intensive care and 5.6% in otorhinolaryngology).

Self-harm is a frequent pathological behaviour whose incidence is increasing. Understanding the psychological and biological basis of self-harm will help to improve the management of these patients and prevent the recurrence of this dangerous behavior and its complication by suicide.

None Declared

Denial of pregnancy is the phenomenon where a woman fails to recognize or accept her pregnancy at >20 weeks gestational age. It associates with increased morbidity and mortality of mother and child, and can be classified as non-psychotic or psychotic. There is fewer medical literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data regarding incidence nor approved interventions or treatment.

To describe this unfamiliar entity in order to be able to perform a proper diagnosis and thus prevent possible negative outcomes.

We present a case report alongside a narrative literature review on the topic.

We report the case of a 39-year-old caucasian woman, foreign, undomiciled, with an advanced pregnancy, who was admitted to a Psychiatry in-patient unit due to psychotic symptoms such as mistrust and delusions. She showed scarce collaboration during assessment and did not give any plausible information about her identity. Her birthplace and prior medical records were therefore unknown. Apparently, she had no family nor social support network. Despite the obvious signs, she did not recognize being pregnant and showed great irritability when asked; her responses ranged from claiming she was suffering from a gastric tumor and making delusional attributions of symptoms clearly related to the pregnancy to partially acknowledging her state but refusing to answer any questions on the matter. Blood work showed no significant abnormalities and obstetric ultrasound revealed a low risk 35 weeks pregnancy.

With an estimated prevalence of 1:475 in general population, denial of pregnancy is not as rare as it may seem. The psychotic variant, however, is rather uncommon. Typically, women with psychotic pregnancy denial have prior history of major mental illness, most frequently schizophrenia, and suffer from extreme psychosocial vulnerability. They usually present previous or anticipated child custody loss, which hampers the process of developing antenatal attachment behaviours. Psychotic denial does not associate with concealing, since these women are mentally detached from the gestation and tend to create delusional explanations to their pregnancy symptoms. Not all of them show complete denial, some being able to acknowledge it, though mostly in an inconsistent way. These patients often fail to seek prenatal care or are noncompliant, they are at greater risk of drug exposure, and some are unable to recognize symptoms of labour, all of which increases the rate of negative outcomes for mother and baby, including neonaticide.

Psychotic denial is a rare diagnosis which should be properly assessed due to its clinical implications and the need to prevent potential negative outcomes for mother and baby.

None Declared

Disruptive Mood Dysregulation Disorder (DMDD) is a new disorder that has been added to the category of mood disorders in the fifth Diagnostic and Statistical Manual of Mental Disorders to distinguish chronic non-periodic irritability from the periodic irritability of bipolar disorder. The main characteristic of DMDD is chronic and severe irritability. Because it is a new diagnostic entity, little research has been done on it and the literature on the subject is still expanding.

The purpose of this review article is to gather information on new therapies for the treatment of this disorder in children and adolescents.

The studies related to the treatment of DMDD were collected and analyzed. This study retrieved related articles from PubMed, SpringerLink, ScienceDirect, NCBI, The American Journal of Psychiatry, and EBSCO. Use keywords “disruptive” AND “mood” AND “dysregulation” AND “disorder” OR “Treatment” AND “DMDD” OR “Drug” AND “mood” AND “disorder” OR “Treatment” AND “SMD” OR “Treatment” AND “BP” OR “Treatment” AND “ADHD” OR “Antidepressant” OR “Mental”AND “Stabilizer” OR “temper” AND “outburst” OR “aggressive” AND "antipsychotics.

To date, no medication has been approved by the FDA to treat EDD. Because there are no treatment standards, drug therapy focuses on the primary symptoms of EDD, such as severe chronic irritability, temper tantrums, and comorbidities, such as ADHD. Currently, medications used by clinicians to treat patients with EDD include antidepressants (fluoxetine, sertraline, citalopram), stimulants (methylphenidate), anxiolytics mood stabilizers (sodium valproate) and antipsychotics (haloperidol, risperidone, aripiprazole in combination with methylphenidate in ADHD-EDD comorbidity), atomoxetine, guanfacine, and amantadine.

To date, no medication has been approved by the FDA to treat EDD. Because there are no treatment standards, drug therapy focuses on the primary symptoms of EDD, such as severe chronic irritability, temper tantrums, and comorbidities, such as ADHD. Currently, medications used by clinicians to treat patients with EDD include antidepressants (fluoxetine, sertraline, citalopram), stimulants (methylphenidate), anxiolytics mood stabilizers (sodium valproate) and antipsychotics (haloperidol, risperidone, aripiprazole in combination with methylphenidate in ADHD-EDD comorbidity), atomoxetine, guanfacine, and amantadine.

As a new diagnosis, treatment guidelines for DMDD are still unclear. Preliminary results from this study suggest that clinicians tend to prescribe a variety of psychotropic medications. This heterogeneity in treatment choices may reflect the fact that these patients are on a bridge between disruptive behavior disorders (including ADHD) and mood disorders. The relative merits or demerits of these treatment choices should be evaluated in further studies.

None Declared

Homicide is the most serious, radical and irreversible criminal act. It arouses a multitude of questions and fears. Committed by women, the homicide seems more unusual and weird.

Our objective is to describe the circumstances of the homicide committed by Tunisian women

This study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise and involved female accused subjects.We have collected all the criminal expert reports carried out over a period of 24 years (from January 1, 1998 to December 31, 2021)

This study included 21 women who committed homicide.The majority of victims of homicide or attempted homicide (85.6%) belonged to the family circle of the accused.Five women (23.8% ) committed this act against their children and four women (19.1%) committed this act against their husbands.The means most used in homicide and its attempt were immolation (23.8%), strangulation (23.8%) and blows (23.8%).

Among those charged with homicide or its attempt, seven (33.3%) presented a personality disorder, 14.3% a depressive disorder, 14.3% a moderate intellectual disability, 4.8% a schizophrenia and 4. 8% mild intellectual disability.

This female criminality, in particular homicide, would find their explanations in different factors and the existence of a mental disorder at the origin of deviant behavior in women seems to be a significant factor in the determinism of such behavior. Much effort remains to be made to apply preventive measures.

None Declared

Recent longitudinal studies point towards the existence of a positive relationship between cannabis use and violence in people with severe mental disorders. However, the existence of a dose-response relationship between the frequency and/or the severity of cannabis use and violence has seldom been investigated.

This study aimed to determine if a dose-response relationship between cannabis use and violence exists in a psychiatric population.

This observational study was conducted at the Institut universitaire de santé mentale de Montréal (Montréal, Canada). A total of 98 outpatients (81 males and 17 females, all over 18 years of age) with severe mental disorders were included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (non-users, occasional, regular, and frequent users, assessed using the Time-Line Follow-Back and confirmed with urinary testing) and violence was investigated, as well as the association between the severity of cannabis use (measured using the Cannabis Use Problems Identification Test – CUPIT) and violent behaviors.

Cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, psychiatric diagnoses, impulsivity and use of alcohol and stimulants, odds ratios were of 1.91 (p <0.001) between each frequency profile, and 1.040 (p <0.001) for each increase of one point of the severity of cannabis use score (0 to 79).

Image:

These findings have important implications for clinicians, demonstrating that cannabis use may have serious adverse consequences in a psychiatric population. Nevertheless, the mechanisms underlying this association remain unclear.

None Declared

Functional impairment (FX) screening tools could potentially be used in resource-limited settings to identify adolescents who need mental health support.

Culturally adapted, isiXhosa versions of FX questions and the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression (MDD) and anxiety (GAD) among adolescents (10-19 years) in South Africa.

Adolescents were recruited from the general population and from nongovernmental organizations working with those in need of mental health support. The PHQ-9 and GAD-7 were previously culturally adapted, translated into isiXhosa, and administered to 302 adolescents (10-19 years old, 56.9% female), and three culturally adapted items were asked to assess functional impairment regarding problems that 1) interfere with activities/relationships at home, 2) interfere with activities at school/work, and 3) cause any issues with peers. FX items were dichotomized into at least some impairment (“sometimes” and “often”) and no impairment (“rarely” and “never”). The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) was administered by trained clinicians as the gold standard measures for MDD, GAD, and FX. To assess criterion validity against a clinician’s diagnosis, we used total PHQ-9 and GAD-7 scores as well as combined FX and PHQ-9 and GAD-7 scores to construct receiver operating characteristic curves, and calculated the area under the curve (AUC) for each test as well as other psychometric properties.

In the sample, 32.1% and 17.9% of adolescents screened positive for moderate to severe MDD and GAD respectively with the culturally adapted PHQ-9 and GAD-7. Among adolescents, 39.7%, 37.1%, and 29.1% reported at least some impairment at home, school, and among peers respectively. Spearman correlations between the three items (Cronbach’s Alpha = 0.69) ranged from 0.35-0.53, and kappa statistics ranged from 0.18-0.47. For the culturally adapted PHQ-9, the AUC was 0.86 for the full sample. A score of >=10 had 97% sensitivity and 75% specificity for detecting MDD. For the culturally adapted GAD-7, the area under the curve was 0.69, and cutoff scores with an optimal sensitivity-specificity balance were low (>=6) and had 76% sensitivity and 69% specificity for detecting GAD. For the combination of the culturally adapted PHQ-9 with the FX questions, the AUC was 0.80 for the sample, and a score of >=10 had 77% sensitivity and 83% specificity for detecting adolescents with MDD. For the combination of the culturally adapted GAD-7 with the FX questions, the AUC was 0.68, and a score >=6 had 70% sensitivity and 76% specificity for detecting adolescents with GAD.

While the culturally adapted FX questions didn’t enhance the assessment of MDD and GAD among adolescents in South Africa, these items still provide an opportunity to measure FX in different settings.

None Declared

Breast cancer is the most frequently encountered malignant tumor among women in Tunisia and in the world. The quality of sexual life of patients with breast cancer is impaired by multifactorial mechanisms.

The aim of our study was to determine the factors associated with sexual disorders in patients followed for breast cancer.

Cross-sectional analytic study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We collected sociodemographic and clinical data with an assessment of sexuality (FSFI), marital satisfaction (MAT), psychological profile (HAD) and quality of life (SF36).

Fifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention, which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. The mean score of the FSFI questionnaire in our study was 17.25. Eleven patients (73.3%) had an FSFI score below 26.55. We found negative correlations between age and FSFI score (r=-0.622; p=0.013). We noted statistically significant negative correlations between FSFI and HAD-D (r=-0.606; p=0.017) and FSFI and HAD-a (r=-0.707; p=0.01) as well as significant correlations between FSFI and the following items: RE (r=0.84p=0.000), SF (r=0.684 p=0.005), GH (r=0.671 p=0.006) and MCS (r=0.788 p=0.000).

Focusing on a small sample of patients followed for breast cancer, our study provides an assessment of the sexual function in its various areas and shows how sexuality is deeply intertwined with other sections of medical management.

None Declared

Worldwide, stress and burnout continue to be a problem among teachers, leading to anxiety and depression. Burnout may adversely affect teachers’ health and is a risk factor for poor physical and mental well-being. Determining the prevalence and correlates of stress, burnout, anxiety, and depression among teachers is essential for addressing this public health concern.

To determine the extent of the current literature on the prevalence and correlates of stress, burnout, anxiety, and depression among teachers

This scoping review was performed using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Relevant search terms were used to determine the prevalence and correlates of teachers’ stress, burnout, anxiety, and depression. Articles were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Data Base), APA PsycINFO, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), Scopus Elsevier and ERIC (Education Resources Information Center). The articles were extracted, reviewed, collated, and thematically analyzed, and the results were summarized and reported.

When only clinically meaningful (moderate to severe) psychological conditions among teachers were considered, the prevalence of burnout ranged from 25.12% to 74%, stress ranged from 8.3% to 87.1%, anxiety ranged from 38% to 41.2% and depression ranged from 4% to 77%. The correlates of stress, burnout, anxiety, and depression identified in this review include socio-demographic factors such as sex, age, marital status, and school (organizational) and work-related factors including the years of teaching, class size, job satisfaction, and the subject taught.

Teaching is challenging and yet one of the most rewarding professions, but several factors correlate with stress, burnout, anxiety, and depression among teachers. Highlighting these factors is the first step in recognizing the magnitude of the issues encountered by those in the teaching profession. Implementation of a school-based awareness and intervention program is crucial to resolve the early signs of teacher stress and burnout to avoid future deterioration.

None Declared

The covid 19 pandemic was a period of uncertainty. This uncertainty was sustained even after the advent of the vaccine against covid 19. Several concerns have emerged related to the vaccine and health care workers were at the centre of this uncertainty.

Study intolerance of uncertainty and vaccine hesitancy among health care workers in relation to covid 19 vaccination

This is a descriptive study conducted by a questionnaire posted on social networks using Google Forms targeting groups of health professionals before the launch of the vaccination campaign in Tunisia from January 16, 2021 to March 6, 2021.

We collected sociodemographic data and the attitudes of health care workers about COVID 19 vaccination. We used Intolerance of Uncertainty Scale short form (IUS 12) to evaluate the intolerance of uncertainty related to COVID 19 vaccine

Our study included 168 health care workers represented mainly by medical personnel (81% of the respondents). The average age was 34 ±10 years and sex ratio was 0.22.

Sixty percent (60%) of population were hesitant in front of the COVID 19 vaccine.

This hesitancy was explained in 90% of cases by the insecurity of the new COVID19 vaccine. Thirty-seven percent (37%) doubted the efficacy of these vaccines and 22% trivialized COVID19 by expressing the worthlessness of preventing this disease.

The mean score for intolerance of uncertainty was 26.57 ± 9.68 and a median of 26. The minimum score was 10 and the maximum score was 50. We found a significant association between intolerance of uncertainty and vaccine hesitancy (p=0.034). Subjects with higher uncertainty intolerance scores were less hesitant in front of COVID19 vaccination.

Intolerance of uncertainty is a consideration when introducing a new covid 19 vaccine to health care workers and in a pandemic context

None Declared

EMDR therapy is a brief form of trauma-focused therapy for PTSD. This therapeutic technique was first used by Francine Shapiro in the United States in 1987. EMDR combines exposure imagination, cognitive and psychoanalytical techniques. Designed to treat psychological trauma, emotional shock and grief, EMDR can also be used to treat neurotic problems such as phobias, anxiety and depression.

EMDR therapy can be used at any age and can be adapted to children, adolescents, adults and the elderly unless contraindicated.

In the pediatric population, several studies have shown that EMDR therapy has a remarkable effectiveness on several pathologies and particularly on PTSD.

Translated with www.DeepL.com/Translator (free version)

EMDR therapy is a brief form of trauma-focused therapy for PTSD. This therapeutic technique was first used by Francine Shapiro in the United States in 1987. EMDR combines exposure imagination, cognitive and psychoanalytical techniques. Designed to treat psychological trauma, emotional shock and grief, EMDR can also be used to treat neurotic problems such as phobias, anxiety and depression. EMDR therapy can be used at any age and can be adapted to children, adolescents, adults and the elderly unless contraindicated.In the pediatric population, several studies have shown that EMDR therapy has a remarkable effectiveness on several pathologies and particularly on PTSD. Translated with www.DeepL.com/Translator (free version)

Present the indications of EMDR therapy in children and demonstrated its effectiveness in the management of psychiatric disorders in this population.

This is a systematic review of the literature. The databases used are “PubMed” and “Google Scholar”. No language restrictions were applied.

The following keywords were entered: EMDR, Child. Recent articles published in English or “systematic reviews, meta-analyses or reviews” were included.

From this review of the literature, we note that:

EMDR is a psychotherapy that has been shown to be effective in improving the symptoms of various pathologies in children, including PTSD, major depressive disorders, intellectual disability, anxiety disorders, as well as behavioral disorders

However, the studies are still few in number and also have methodological limitations: they were exploratory studies of relatively small samples.

EMDR therapy is mentioned in the described guidelines as “promising”, as the fact that it yields positive results in a short period of time and that these results continue in follow-up studies has increased the interest in using EMDR in children.

Nevertheless, larger sample sizes are recommended in future studies to better establish the effectiveness of EMDR therapy in children.

None Declared

Religiosity and spirituality are resources, frequently used by patients as a strategy against chronic diseases. Islam is the fastest growing monotheistic religion whose belief is based on the unity of God and devotion to God’s will, gratitude, and satisfaction with God’s provision. Despite many researches have proven mostly positive correlation between religion and health, there is a lack of them directed to a single religion.

To provide an overview of the most recent researches that have examined the role of Islam religion in cancer treatment.

PubMed database was screened using the keywords, “Islam, religion, cancer, treatment”.

Patients expressed a lack of religiosity/spirituality support and it is connected to a significantly lower quality of life compared to those who adequately addressed their spiritual needs. The study which included 800 Muslim cancer patients showed that cancer patients (82.8%) prayed more than non-cancer individuals (72.5%). Many Muslim patients do not consider disease as a penance, but rather, as a redemption of sins, because they have trust and faith in God’s will. There are studies postulating the positive effects of fasting on cancer treatment.

Muslim cancer patients are more religious and spiritual than the non-cancer Muslim population, and they are in need of spiritual support with the aim to reduce depression, anxiety, and stress. Health care professionals may encourage the patients to use their religious beliefs to cope with the challenges of therapy.

None Declared

Clinical case description.

A 44-year-old male, with paranoid schizophrenia, polydrug addict and IVDU since he was 14 years old. Live alone. He is brought by the Local Police for heteroaggressiveness when he was arrested for trespassing and resisting authority. He has presented 14 hospital admissions and therapeutic communities for detoxification since 2000.

1. To analyze the causes of abandonment of treatment

1. 1. Complete medical history

2. 2. Blood test with hormone profile

3. 3. PRAEQ Questionnaire

Absence of child psychopathology until the age of 6, at which time his parents separate and he becomes introverted, with solitary activities and distractions. On examination, the patient is restless. Psychotic contact. Delusional speech centered on ill-structured ideas of harm, persecution and grandiose, being difficult to explore due to lack of collaboration on the part of the patient, who only accepts treatment with aripiprazole 5 mg due to sexual dysfunction with the rest of the treatments.

During his admission, he has evolved from a very unstructured delusional theme and social isolation, with lax and tangential speech and refusal to take any treatment except aripiprazole, towards a cooperative, trusting attitude, with attenuation of his delusional ideation, with appropriate, organized and releasable. Treatment with IM aripiprazole is agreed upon for discharge.

Clinical judgement: Paranoid schizophrenia (F20.0)

With this case, we intend to remember that antipsychotics affect different spheres of the patient’s life that can hinder adherence to treatment, and that we often do not take into account. In this specific case, Abilify Maintena is useful because it does not cause sexual dysfunction, which facilitates treatment adherence and greater patient involvement, which gives us greater opportunities for social integration.

None Declared

In the last decade, neuroplasticity has become largely accepted in the etiology and treatment of mood disorders. Animal models of depression showed that severe stress downregulates many forms of plasticity, resulting in an inhibition of long-term potentiation (LTP), a facilitation of long-term depression (LTD) and an impairment of synaptic transmission. Essentially all treatments for mood disorders, including the rapid acting antidepressant ketamine, promote neuroplasticity and plasticity plays a critical mechanistic role in recovery. Therefore, a targeted intervention of LTP/LTD pathways by small molecules or highly specific RNA therapeutics could lead the way to novel and fast acting antidepressants. For instance, an RNA-based modulation of N-methyl-d-aspartate receptor subunits rescued LTP and exerted rapid antidepressive effects in mice models of depression. The translation of such principal, the rescue of plasticity as an antidepressive intervention, from rodents to humans is an ongoing challenge. However, various indirect assessment methods of plasticity in humans, like visually evoked (VEP) potentials and transcranial magnetic stimulation (TMS)-based paired associative stimulation paradigms revealed an impairment of plasticity in depressed humans, which was found corrected after effective treatment.

None Declared

Parents have significant genetic and environmental influences, which are known as intergenerational effects, on the cognition, behavior, and brain of their offspring. These intergenerational effects are observed in patients with mood disorders, with a particularly strong association of depression between mothers and daughters.

The main purpose of our study was to investigate female-specific intergenerational transmission patterns in the human brain among patients with depression and their never-depressed offspring.

We recruited 78 participants from 34 families, which included remitted parents with a history of depression and their never-depressed biological offspring. We used source-based and surface-based morphometry analyses of magnetic resonance imaging data to examine the degree of associations in brain structure between four types of parent-offspring dyads (i.e. mother-daughter, mother-son, father-daughter, and father-son).

Using independent component analysis, we found a significant positive correlation of gray matter structure between exclusively the mother-daughter dyads within brain regions located in the default mode and central executive networks, such as the bilateral anterior cingulate cortex, posterior cingulate cortex, precuneus, middle frontal gyrus, middle temporal gyrus, superior parietal lobule, and left angular gyrus. These similar observations were not identified in other three parent-offspring dyads.

The current study provides biological evidence for greater vulnerability of daughters, but not sons, in developing depression whose mothers have a history of depression. Our findings extend our knowledge on the pathophysiology of major psychiatric conditions that show sex biases and may contribute to the development of novel interventions targeting high-risk individuals.

None Declared