Currently, in addition to their frequent use in community medicine, the use of antidepressants is a fundamental pillar of pharmacological treatments used in psychiatry. Due to this frequent use, we must be aware of the possible side effects, in particular the SIADH produced in this clinical case by SSRIs. There are already described cases of this association including other antidepressants and many different types of drugs.

To review the current literature on the management of this pathology when it is secondary to the use of frequently used drugs such as SSRIs.

We report the case of a 64-year-old woman hospitalised in the psychiatric department for malnutrition secondary to unspecified eating disorder (ED). During admission, treatment with sertraline was started with ascending doses up to 100mg, subsequently producing slight edema with the following analytical results: plasma Na: 123 mEq/L (135-145), plasma osmolarity: 250 mOsm/kg (275-300), urinary Na: 174 mEq/L (>40), fulfilling diagnostic criteria for SIADH.

Afterwards, we reduced sertraline until discontinuation and started treatment with water restriction and urea (30 grams/24 hours) during admission and after discharge. During admission, we observed disappearance of the edema and partial improvement of the analytical values (Na:131 mEq/L), which were normalised with home treatment of daily urea.

The precise prevalence of SIADH from the use of SSRIs is unknown, it is known that patients older than 65 are at higher risk of developing severe hyponatraemia in the first 5 weeks after initiation. Similarly, treatment with water and urea restriction, together with discontinuation of SSRIs, appears to be sufficient.

SSRIs can cause SIADH a reversible but potentially life-threatening pathology, and we need to be aware of this possibility especially in the older population and being able to handle it

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As a response to the COVID-19 pandemic, in March 2020 a shift to remote consulting for routine primary care and outpatient appointments was instructed. With the aim to inform whether and how remote consultations should continue post-pandemic, the London NIHR Applied Research Collaborations (ARCs) conducted a research-grade evaluation of the impact of this shift in London, focusing on cardiology and mental health as exemplar pathways.

Quantitative methodology aimed to explore patterns of healthcare use, efficiency, and clinical outcomes using de-identified patient-level health records datasets in North-West London and South London.

Qualitative interviews with clinicians and patients with experience in remote consultations sought to develop a more in-depth understanding of the experience of the move to remote consulting.

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The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health.

The objective of this study was to describe the sociodemographic and medical characteristics, psychoactive substances use of a sample of users with sexualized drug use (chemsex) attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You”.

A cross-sectional descriptive analysis of a sample of users attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You” was performed.

230 participants were included. Most common drugs used during sexual intercourse were: mephedrone, cocaine, poppers, GHB and methamphetamine. The frequencies of substances consumed during sex were: mephedrone (95%), methamphetamine (80%), GHB (92.2%), ketamine (52%), poppers (alkyl nitrites) (95%), cocaine (89 .7%), speed (amphetamine sulfate) (49.6%) and drugs for erectile dysfunction (86%). 61.3% reported having practiced slamsex intravenous substance use at some time in their life, being a habitual practice at the time of collecting information for 50.7%. The most frequent genitally transmitted infections were: syphilis, chlamydia and gonorrhea. Users reported having been diagnosed with the following genitally transmitted infections: hepatitis B virus (7.4%), hepatitis A virus (18.6%), syphilis (69.6%), human papillomavirus (16 %), herpes (9.4%), chlamydia (43%), gonorrhea (60.5%) and candidiasis (9.7%).

Slamsex and STIs are usually reported in our sample. Interventions for chemsex users must include a colaborative model which includes professionals from different areas, including internists and emergency physicians, psychiatrists, psychologists, nurses, social workers and sexologists.

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One of the most significant changes to society came with the advent of social media, and with it a cultural shift in whom people consider their actual friends. The cultural influence of entertainment figures is not a new phenomenon; however, there has a revolution in the way celebrities interact with their fans, specifically in the Korean Pop (Kpop) industry. In contrast with musicians who release an album and then disappear into mysterious obscurity, Kpop stars constantly interact with fans through meet and greets, live streams, variety tv shows, and most importantly, through social media. With a concomitant rise in parasocial interactions and relationships, Kpop blurs the line between what constitutes pathological delusions and healthy fan activity.

• • To learn the assessment and management of patients with anorexia nervosa

• • To understand changes in management to address suicidality in patients with anorexia nervosa

• • To understand influences by media in perpetrating certain body types in impressionable adolescents

Patient is a 19 year-old Hispanic female with a Past Psychiatric History of Bipolar Disorder, who was brought in by EMS due for agitation and disorganized behavior. Patient presented manic, labile, and her delusions extended to beliefs that the Kpop group EXO has been communicating with her through morse code in their videos, and that certain members would wink at her through the computer screen in real time. The patient’s BMI at the time of admission was 15.4, and she continued to compare her own body to Kpop idols.

Patient shared a lifetime mix of both shame and trauma concerning her eating habits, with multiple incidents that may have contributed to her fear of eating, and simultaneously into her becoming obsessed with the Kpop group (“2018 and COVID were a miracle for me. I got closer to EXO”). Patient denies looking ugly or fat and seems mostly satisfied with her current appearance.

With social isolation growing due to the pandemic, online parasocial relationships are becoming an increasingly normal part of people’s lives. We discuss a case where an unhealthy obsession with Kpop contributed to body dissatisfaction, and the precipitating factors that lead to these circumstances, as well as the challenges that are present in helping these adolescents and young adults in coping with social media use. As such, it is important to discuss the challenges faced by psychiatrists who must be sufficiently aware of the ever-changing face of contemporary cultural landscape when forming an accurate diagnosis.

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The social representations linked to bipolar disorder remain until today marked by unpredictability, danger and aggressiveness.

The objectives of this study were to identify clinical and socio-demographic characteristics of a group of patients with bipolar disorder who had committed a heteroaggressive act and to establish the relationship between these characteristics and the risk of recurrence of violence

We conducted a descriptive and analytical study, including the files of 30 patients with bipolar disorder and hospitalized for heteroaggressive behavior.

We collected the data related to the socio-demographic, anamnestic and clinical characteristics of the patients.

The average age of patients was 40.87 years, with extremes ranging from 25 to 62 years. The patients were mostly male (60%), living in urban areas (80%) and single (60%). 66,67% of patients in our sample were professionally active.

Half of the patients in our study were consumers of alcohol or cannabis. The majority of patients were on sodium valproate (66.7%), a long-acting neuroleptic (60%) and a benzodiazepine (56.7%).

Heteroaggressive behavior was in most cases physical (63.3%), having taken place in the patient’s home (66.67%) and directed towards a family member in an impulsive context (53.33%). 63.3% of patients reoffended their act of violence.

We found statistically significant correlations between the recurrence of heteroaggressive behavior and advanced patient age (p=0.01), male sex (p=0.05), illiteracy (p=0 .04) and unemployment (p=0.04).

Our study also showed that the recidivism of violence was significantly correlated with the criminal history of the patients (p=0.04) as well as the consumption of alcohol and cannabis (p=0.01). The number of recurrences was proportionally correlated to the duration of consumption.

Recurrence of violence was also significantly higher in patients with psychiatric comorbidity (p=0.01) and poor treatment compliance (p=0.04).

Finally, the number of recurrences of heteroaggressivity was proportionally correlated to the number of hospitalizations (p= ˂10¯³).

Heteroagressive behavior in patients with bipolar disorder is not only attributable to mental illness but also to the intertwining of several risk factors. The prevention of violence requires the identification and management of these risk factors.

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The association between insight, stigma and self-concept has been considered as a potential predictor of poor clinical outcomes and global functioning in psychosis. In patients with delusional disorder (DD), the effects of stigma and self-stigma have been poorly explored.

Our main goal was to systematically review studies addressing stigma and self-stigma in DD to assess whether these phenomena have an impact on clinical symptoms.

A systematic review was conducted through PubMed and Google Scholar databases from inception to 2022 (PRISMA guidelines). Search terms: (Stigma OR self-stigma) AND (“delusional disorder” OR psychosis OR paranoia). Studies were considered eligible if they included patients with DD.

A total of 875 records were retrieved, from which 18 were included.

Stigma: (1) Stigma is associated with poor quality of life, poor adherence to medications and acceptation of diagnosis. (2) Support at workplaces would improve stigma and discrimination in DD. (3) Poor interpersonal competence may increase stigma experience in DD.

Self-stigma: (1) Women show higher level of self-stigma than men. (2) Higher rates of psychiatric hospitalizations and higher severity of symptoms associated with greater degree of self-stigma. (3) Suicidal ideation was associated with negative self-schema but not self-stigma, particularly in patients with persecutory delusions. (4) Self-stigmatization negatively associated with quality of life. (5) Depressive symptoms associated with higher levels of self-stigma. (6) Promotion interventions should address self-stigma content.

Further longitudinal studies are needed to test the influence of stigma and self-stigma on adherence to follow-up and specific interventions to improve them.

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In the last 70 years there has been a massive change in rural versus urban distribution of the population (in the 1950’s only 30 % of the population had been living in urban areas, whereas in 2021 more than 55% were living in urban areas). This mass migration of the rural population, high density cities, traffic noise, severe pollution, high competition have made their mark on mental health, increasing the risk for various illnesses (schizophrenia). On the other hand, rural areas experience high rates of suicide, depression and a lack of access to the mental health workforce.

The goal of this research is to identify the effects of the rapid urbanization on the mental health in rural versus urban areas, as well as the impact of modernization in rural areas.

For this we performed a literature search that synthesizes the newest research on the rural and urban mental health. Review type articles were excluded.

Results show a high frequency of schizophrenia, mood disorders or addictive disorders in urban areas and depression or alcohol dependence in rural areas. However, the improvement of the living conditions (such as Council of the Europe Development Bank), infrastructure, roads, water supply, bridges, sewerage networks have made their mark , modernizing rural economy. On the other hand existing barriers to mental health (desire to receive care, shortage of professionals in mental healthcare, lack of anonymity in treatment seeking, affordability or transportation to care, or even resources to learn) still remain to be addressed.

The modernization of rural areas hasn’t changed the stigma for mental health. There is a need for increasing awareness on the impact of urbanization on mental health.

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“Rust is one of the cruellest games on Steam, and that’s what makes it so compelling.” (PC Gamer) Rust is a multiplayer-only survival video game. It’s full release was in 2018. The average age of a player is between 17 and 40 years. However, one must question the age group that enters the game and continues to play. This presentation will focus on adolescence, gaming addiction, insomnia, and the developing brain.

Rust is a game of round-the-clock survival in the wilderness whereby players must manage the basic essence of human need to “stay alive”. However, it requires a player to be present for a consistent duration of time, or risk “dying”. What does this mean for an adolescent, entering their final two years of school? What is their focus? How does this potentially affect the development of the young mind, still vulnerable to an immediate (real) world moulding a brain from adolescence to young adulthood?

Questions regarding adolescent epigenetics, insomnia and addiction erupt in mental health when Rust and other international multiplayer survival games capture and imprison the mind of our youth.

The WHO added “gaming disorder” to the 2018 International Classification of Diseases. But the APA manual, the DSM-5, did not. The University of New Mexico suggests that 6-15% of all gamers exhibit signs and symptoms consistent of addiction. In an article published in February 2019 BioPsychoSocial Medicine states: ‘Across studies, the presence of International Gaming Disorder (IGCD had a negative effect on sleep and schoolwork in minors … Brain imaging studies indicate that impaired cognitive control in minors with IGD is associated with abnormal function in the prefrontal cortex and striatum.’

Today we ask: of the 83.5% of online gamers and 3.9% of youth reporting problematic behaviour are we Rusted beyond Repair?

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Chronic diseases are a public health problem and high prevalent on depressed patients.

To describe the sociodemographic characteristics and the quality of life of a sample of depressed patients with hypertension and oder diabetes as comorbidity.

It is the baseline evaluation of 361 persons participating in a clinical trial that studies the effectiveness of a psychoeducational intervention for this type of patients.

Persons with moderate or severe depression and with hypertension and or diabetes attending 8 primary care centers in Santiago were invited to participate .

The sample consisted of 361 study participants,the majority female(89.97%).The mean age was 59.81 years(de=10.28),with an age range observed from 26 to 83 years.Most of the participants had primary(35,91%)or secondary (43.21%)education level.More than a third of the participants reported houshold chores(34.09%) and a quarter were working for income(28.41%).About half of the participants were married(44.48%).The mean PHQ-9 score was 18.73(sd=2.81).Most of the participants had a previous diagnoses of depression(60.39%).The sample obtained an average of 34.99 points(sd=20.82) in the mental health component of the 12-item Short Form Health Survey indicative of poor quality of life related to mental health.

Depressed patients with chronic diseases ,users of primary care clinics, have poor quality of life,so it is urgent to review care protocols to achieve better health results.

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Hyperprolactinemia is a commonly encountered adverse effect of antipsychotic medication. Short and long-term repercussions of high prolactin, such as amenorrhea, sexual dysfunction, osteopenia and increased cardiovascular risk carry significant burden and may compromise therapeutic adherence. Despite its serious practical implications, hyperprolactinemia is still underscreened and its management neglected.

To review current clinical guidelines regarding the management of hyperprolactinemia associated with the use of antipsychotics, reflecting upon the importance and need to share the management of this risk with an endocrinology expert.

We performed a literature review to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia (British Association of Psychopharmacology [BAP], NICE, Maudsley Prescribing Guidelines, Royal Australian and New Zealand College of Psychiatrists), published over the last ten years, with a particular focus on its physical risks.

Most guidelines do not recommend routine monitoring of prolactin levels in asymptomatic patients. NICE and BAP guidelines have suggested measuring the baseline prolactin level, but have not specified follow-up monitoring, while Maudsley guidelines have. Management strategies depend on factors such as sex, age, as well as the clinical manifestations that ensue. Different treatment strategies have been described, such as decreasing the dose of the antipsychotic, switching antipsychotics, adding aripiprazole or adding dopaminergic agonists. Referral to an endocrinology specialist should be made if the aetiology is unclear, prolactin levels continue to rise despite some intervention, the hyperprolactinaemia is severe (>3000 mIU/L) or there is suspected/confirmed pituitary adenoma. Further physical implications of having hyperprolactin are to be dressed by the endocrinology expert, namely those on bone metabolism, gonodal function and cancer risk.

Given the widespread use of antipsychotics and the need to have psychotic patients stabilized (sometimes with a lack of effective alternative), early detection and shared management of hyperprolactinemia are instrumental towards assisting both clinician’s and patients’ decision-making, be it towards lowering prolactin levels or managing its risk without compromising the antipsychotic’s efficacy.

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In recent years, new concepts have been proposed to discriminate between healthy (adaptive) and unhealthy (nonadaptive) self-esteem. Among them, Yamasaki et al. (2017) proposed the concepts of “autonomous” and “heteronomous” self-esteem. As they underscored that autonomous self-esteem needs to be nonconsciously assessed, several nonconscious assessment methods have been developed using implicit association tests (IATs). However, any IAT has not been developed for younger children, even though it is necessary to measure autonomous self-esteem in early childhood because it is largely formed in early developmental stages.

The aim was to develop an IAT to measure autonomous and heteronomous self-esteem for 1st-grade elementary school children. In order to standardize it, the validity and reliability were examined.

Participants were 1st-grade children in a public elementary school in Japan. The final sample included 55 children (35 boys and 20 girls). Their two home-room teachers participated to evaluate the children. The IAT was administered twice, around four weeks apart. The original paper-and-pencil version of the IAT was developed based on the IAT by Yokoshima et al. (2021). In this test, the implicit association between two kinds of stimuli, category (e.g., “myself”) and attribute (face pictograms expressing high and low self-esteem), is measured in terms of accuracy and speed. The evaluation by teachers was conducted using 7-point Likert scales (“not true at all” to “very true”). The evaluation items were “this child proactively does what he or she wants to do alone or with friends for autonomous self-esteem and “this child is competitive and concerned with the consequences of other children” for heteronomous self-esteem.

The test-retest reliability was calculated using correlational analyses of the two measurements. The correlation was significantly positive, r = .70, p < .01. To examine the validity, the children were divided into high and low groups based on the cut-off scores (over 1 SD above the mean and under 1 SD below the mean). Statistical analyses showed that the evaluated scores were significantly higher in Group High than in Group Low regarding the characteristic of autonomous self-esteem, t (19) = 3.87, p < .01, d = 1.62, and that they were significantly higher in Group High than in Group Low for the characteristic of heteronomous self-esteem, t (19) = 3.14, p < .01, d = 1.32.

This study showed that the newly developed IAT for lower-grade children includes high reliability and validity. Hereafter, this test can be utilized at schools to assess autonomous and heteronomous self-esteem. As schools are interested in enhancing healthy and adaptive self-esteem, this tool will be an effective assessment method to ascertain how autonomous self-esteem is cultivated.

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Infliximab is a tumor necrosis factor-alpha (TNF-α) inhibitor commonly used in the treatment of autoimmune disorders such as rheumatoid arthritis and ankylosing spondylitis. An increased risk of opportunistic infections, malignancy, and neurodegenerative diseases have been widely documented as adverse effects of IFX therapy. Few reports exist serving the notice of new-onset psychiatric symptoms linked to IFX treatment, such as suicidal behaviors in adults and elderly patients, as well as psychosis in an adolescent. Psychiatric side effects while under IFX treatment are reported to be rare.

Here, we present a case of a female with bipolar disorder who developed a long-standing depressive episode with suicidal thoughts after her fourth infusion of infliximab for her ankylosing spondylitis

Retrospective life chart was created, including infliximab infusion.

Montgomery Asberg Depression Scale was applied at time of hospitalisation and discharge.

The Naranjo Adverse Drug Reaction Probability Scale was applied.

A 55 year old female with ankylosing spondylitis and bipolar disorder was treated with IFX for 8 months. During this period, a total of 4 infusions were administered and AS symptoms were well responding to the treatment. Patient describes the onset of depressive symptoms such as anhedonia and insomnia after the infusion of third IFX infusion, gradually progressing to loss of function and suicidal thoughts and hospitalization in a psychiatry clinic.

The patient had a history of bipolar disorder for 10 years with recurrent manic and depressive episodes, 4 hospitalisations and 1 cure of ECT.

Patient was on sertraline, maprotiline and diazepam at the time of hospitalization. We started treatment with aripiprazole, quetiapine and valproate, followed for 4 weeks as an inpatient, consulted with rheumatology treatment options and neurology for demyelinating disorders, no pathology was discovered. Rheumatology suggested the continuation of IFX infusion under psychiatric control. Fifth dose of IFX infusion was administered and patient was discharged after euthymic mood was established and insomnia and suicidal thoughts were deteriorated. Upon follow up, depressive symptoms recurred and lamotrigine was added for augmentation.

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Although there is very scarce evidence that IFX causes psychiatric symptoms, there are few clinical trials too, showing evidence that TNF-alpha inhibitors may improve depressive symptoms. While we need more information and evidence to support the ideas of TNF alpha inhibitors effects on human neuropsychology, it is of great importance for especially patients with psychiatric history to be closely watched while administering the product, at least to minimize unintended adverse events.

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Despite the rapid increase in disability and death due to Parkinson’s disease and associated psychiatric comorbidities (psychosis, depression, cognitive impairment, anxiety), the quest for a clear pathophysiological mechanism and treatment remains elusive. Numerous studies aim to identify a metabolomic fingerprint for PD and new, promising biomarkers are discovered with implications beyond neurodegenerative diseases, such as novel markers as predictors of bipolar type in depressed patients.Changes in neuronal microenvironment employ electrochemical techniques, such as cyclic voltammetry, used in both animal and human models of PD to monitor dopamine (DA) alterations in vivo, with high spatial and temporal resolution.

Our aim is to investigate the latest scientific literature on PD and associated neuropsychiatric disorders and review the applications cyclic voltammetry has in recent technological advances in the field.

To gain a broad understanding of the subject, we have consulted multiple scientific literature databases (PubMed, Google Academic, Science Direct) using the keywords “cyclic voltammetry, Parkinson’s disease, psychiatric disorders, dopamine” and included original research articles published in the last 10 years

The first in situ measurement of DA release in the human brain has been demonstrated in a sequential investment task, with implications for future research in decision-making behavior.

One study combines cyclic voltammetry and wireless telemetry for in vivo recording of changes in extracellular levels of DA, with high temporal and spatial resolution.

Disulfide nanorod-graphene-β-cyclodextrin nanocomposites biosensors have been succesfully used in detecting DA in rodent brain and human blood serum samples, with implications for minimally invasive measuring techniques.

Animal studies use cyclic voltammetry to monitor changes in DA levels in cerebrospinal fluid and plasma of mouse models of PD and investigate DA metabolism, release, uptake and receptor sensitivity in Knock-out mice, with implications for the diurnal variation of extracellular DA tone and release.Furthermore, a human alpha-synuclein-expressing mouse model of PD exhibited increased extracellular DA concentrations, decreased DA uptake and relieved paired-stimulus depression.

Cyclic voltammetry is a powerful tool in the expansion to humans of electrochemical recording techniques in PD. The final aim is to investigate DA neuron physiology before neurodegeneration onset and to measure neurotransmitter release in real time.

None Declared

Stigma continues to be the main obstacle to the improvement of mental health care and to a life of good quality for people with mental disorders or with the experience of a mental disorder. It affects all that is related to mental illness, not only the person who has the disorder but also the institutions in which people with mental disorders receive treatment, treatment means, such as medications, staff working in mental health care and the family of the person with mental disorder.

Recent years have witnessed effective programs against stigma in various countries and it would be logical to expect that work against stigma will be a crucial part of mental health programs. This unfortunately is not the case.

The presentation will focus on interventions that have been successful in reducing stigmatisation or its consequences and propose action to reduce stigma.

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Bipolar disorder (BD) is a chronic and recurrent mental condition characterized by mood fluctuations between hypomania or mania and depression, with high level of burden and mortality rates (Hayes et al., 2015). Subsyndromal mood symptoms, including residual depression, mania and/or anxiety, are major risk factors for episodic relapses after mood stabilisation (Samalin et al., 2016). A psychological protective mechanism against the occurrence of these maladaptative mood symptoms is dispositional mindfulness (DM). DM refers to paying purposeful attention to present moment experiences with a curious, non-judgmental and accepting attitude (Radford et al., 2014). DM has been barely assessed in BD and there is very little evidence on the relationship between DM, residual mood symptoms and quality of life

To explore associations between DM, residual mood symptoms and quality of life in individuals with BD

After informed consent, a total of 94 adults (Mean age= 45.57 years, 41.50% Male) with diagnosis of BD according to DSM-5 criteria, in full or partial remission,were recruited from the Bipolar and Depressive Disorders Unit at the Hospital Clinic of Barcelona. The ethical committee approved this study. Dispositional mindfulness was assessed using the Mindfulness Attention Awareness Scale (MAAS).The presence of residual depressive symptoms was assessed with the Hamilton Depression Rating Scale (HDRS), residual mania symptoms were assessed with the Young Mania Rating Scale(YMRS), and anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale (HAM-A). The subjective quality of life was assessed with the Quality of Life in Bipolar Disorder Questionnaire (QoL-BD). Pearson correlations were carried out and the level of significance was set at p<0.05

DM was negatively related to residual depressive symptoms (r= -0.283; p=0.009) and to anxiety symptoms (r=-0.345; p<0.001), and positively related to quality of life (r=0.433; p<0.001), but not related to residual manic symptoms in BD

Our preliminary data suggest that BD patients with higher levels of DM may experience less depressive and anxiety subsyndromal symptoms and perceived higher quality of life. No associations were detected regarding mania symptoms. These findings support the use of mindfulness training as an adjunct therapy to pharmacotherapy to reduce residual mood symptoms and improve quality of life in patients with BD

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Polydrug use studies mention demographic and socioeconomic factors that may influence this problem. One of them is the existence of psychiatric comorbidity; Rentrop’s study (Rentrop et al., 2014) finds in a sample of 50 patients that all patients had at least one axis I disorder, 90% at least one axis II disorder, which may compromise the outcome of detoxification and dehabituation treatments (Rentrop et al., 2014). Another study found that 44.9% of patients admitted to a psychiatric unit are polydrug users (Karam et al., 2002).

To study the possible association of polydrug use with psychiatric comorbidity in patients admitted to a general hospital and presenting drug use.

We made a descriptive retrospective study through the use of electronic medical records. The drug use history was obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.

More cases of poly-consumption together with psychiatric comorbidity are found than expected in the χ² Test, with significant results (χ² = 27.2; p<0.001). The mean age of the patient with poly-consumption and psychiatric comorbidity is 34.9 years.

Psychiatric comorbidity in patients with polydrug use may be overlooked (Kruckow et al. 2016). Identifying patients with dual diagnosis is important given that these patients suffer decreased treatment compliance and life expectancy compared with single-diagnosis patients (Kruckow et al., 2016).

Rentrop, M., Zilker, T., Lederle, A., Birkhofer, A., & Hörz, S. (2014). Psychiatric comorbidity and personality structure in patients with polyvalent addiction. Psychopathology, 47(2), 133–140. https://doi.org/10.1159/000351784

Kruckow, L., Linnet, K., & Banner, J. (2016). Psychiatric disorders are overlooked in patients with drug abuse. Danish medical journal, 63(3), A5207.

None Declared

Folie a deux, also known as shared psychotic disorder or induced delusional disorder, is a rare mental disorder that was first described in France in the late 19th century and was referred to delusions shared between two individuals in close relationship. The concept has evolved and according to ICD-10 the following criteria for the diagnosis is phenomenology-based only.

To describe a clinical case and review the existing evidence on folie a deux.

Clinical case and non-systematic review of the literature, from the last 15 years, on folie a deux. For this research, the keywords “folie a deux”, “shared psychotic disorder” and “induced delusional disorder” were used in the MEDLINE/PubMed database.

The clinical case presented refers to a 56-year-old female patient with no known psychiatric history. The patient stated that 5 years ago when his mother died, neighbors began to persecute her and her sister. She was medicated with a second-generation antipsychotic without total remission of symptoms. Generally, in folie a deux there is a close and prolonged relationship between the inducer and the receptor, as described in this case. We considered that the sister is the active subject. The delusion is persecutory, the most common in this disorder. The patient kept her job until she was hospitalized and as described in the literature patients with folie a deux maintain their functionality, which is responsible for the underdiagnosis of this disorder. The fact that the current evidence is based on case reports reflects the underdiagnosis and rarity of this disorder.

This clinical case highlights the challenging diagnosis and difficulty in treating this condition. Patients can be diagnosed many years after the onset of symptoms, which may not resolve with treatment. Much information, as prevalence, natural history, and optimal treatment, is lacking on folie a deux, and the etiology remains unknown. As such, prospective studies should be carried out to help understand this disorder.

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Choroid plexus (CP) is a physiological barrier, producing cerebrospinal fluid (CSF), neurotrophic, and inflammatory factors. It’s also involved in the neuro-immune axis, facilitating the interplay between central and peripheral inflammation, allowing trafficking of immune cells. Coherently, CP enlargement has been found in psychiatric diseases characterized by inflammatory signature. Although CP volume correlates with central microglia activation in major depressive disorder (MDD), it’s never been directly associated with peripheral markers in mood disorders.

Examine CP volume in mood disorders and healthy controls (HC) in relation to clinical features and peripheral inflammatory markers.

CP volume was extracted with FreeSurfer in 72 HC and 152 age- and sex-matched depressed patients: 79 BD and 73 MDD. Plasma analytes in patients were collected through immunoassay technology (Bioplex). We tested for the effect of age by group on CP volume. Then we focused on the interaction between illness duration and diagnosis in predicting CP volume. After testing the effect of specific analytes by diagnosis, we calculated moderated moderation models (SPSS, PROCESS) setting each analyte as independent variable, CP volume as predicted variable and illness duration and diagnosis as moderators. We get the effects’ significance with the likelihood ratio statistic, always controlling for age, sex, and intracranial volume.

Patients were comparable in illness duration and severity. CP volume is differentially distributed through groups (right: p=0.04; left: p<0.01), with higher volumes in the clinical groups. Age by group significantly predict right CP volume (p=0.01). Also, duration of illness differently predicts right CP volume in MDD and BD (p=0.03) (Figure1). Then, given the significant interaction effect of IL13 (p=0.02) and IL1ra (p=0.01) in predicting right CP, we run the moderated moderation model. Longer illness duration has an effect in strengthening the opposite predicting value of IL1ra (ΔR2=0.03, p<0.01) on right CP volume in MDD and BD (Figure2).

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Our findings propose CP as a proxy of inflammation in depression, being significantly predicted by peripheral immune markers in MDD and BD. In particular, the signature of inflammation in depression, could represent the neurotoxic load of the disease over the illness, with a worse effect in BD, with possible disruption of brain barriers permeability and an opposite effect of tightening and central segregation in MDD. Further analyses are needed to better elucidate this neurobiological mechanisms across mood disorders.

None Declared

Oxidative stress is the main characteristic of several diseases including Bipolar Disorder (BD). The involvement of oxysterol derivatives has recently been reported. In this study, the involvement of oxidative stress in the alteration of cholesterol in PTB patients will be evaluated.

To assess the association of oxidative stress and oxysterol profiles in subjects with BD and compare them to healthy physical and mental controls.

This is a case-control study involving subjects with BD. Selected based on DSM-5 criteria, an assessment of positive and negative symptoms was performed using the Positive and Negative Syndrome Scale (PANSS). Controls included in this study were matched to patients by age and gender. For all patients and control. Eight parameters of oxidative status were assessed: plasma ferric reducing capacity (FRAP), carbonyl proteins (PC), protein products of advanced oxidation (AOPP), reduced glutathione (GSH), total thiols, malondialdehyde (MDA ), glutathione peroxidase activity (GSH-Px) and catalase activity (CAT) analyzed by colorimetric methods. In addition, six cholesterol derivatives: oxysterols are measured by ULPC MS/MS.

This study included 33 patients with BD and 40 controls. Plasma GSH levels were significantly reduced in patients compared to controls (p < 0.001). Moreover, MDA, AOPP, PC and GSH-Px activity were significantly increased in patients compared to controls (p=0.005; p=0.003; p<0.001 and p=0.05, respectively). Significantly higher levels were observed for cholestane-3β, 5α, 6β-triol, 27-hydroxycholesterol (27-OHC), and cholestanol in patients with PTB. The concentration of 24(S)-hydroxycholesterol (24-OHC) was significantly lower in patients compared to controls. 25-OHC was positively and significantly correlated with CAT and GSH-Px activities (p=0.035 and p=0.010). 27-OHC was negatively and significantly correlated with MDA (p=0.014). Binary logistic regression revealed an association between the parameters: 27-OHC, 24-OHC, PC and MDA and the occurrence of PTB (OR = 1.007, 95% CI= 1.002-1.013), (OR = 0.956; 95% CI = 0.927 – 0.986), (OR = 39.925; 95% CI = 1.101 – 44.483) and (OR = 4.238; 95% CI = 1.091 – 16.466), respectively.

Our data support the relationship between disruption of redox homeostasis and oxidation of lipids and cholesterol in BD.

None Declared

Patients with unipolar major depression often present with symptoms of anxiety. Presentations with high levels of anxiety, restlessness, and somatic correlates of anxiety can be clinically identified as anxious depression. The comorbidity of anxious and depressive symptoms is a marker of poor prognosis, with greater risk of relapse and increased suicidal risk.

Brief review of the role of pregabalin in the treatment of major depressive disorder (MDD), based on a case study.

Consultation of the clinical record and brief review of the literature on this subject.

We present the case of a 25-year-old woman, with no past psychiatric history, admitted to a psychiatric consultation with depressive symptoms, and marked anxiety and somatic complaints, such as restlessness, palpitations, gastrointestinal discomfort. She fulfilled diagnostic criteria for Major depressive disorder (MDD), and was initially treated with sertraline 50 mg, with partial response, but maintenance of prominent anxious symptoms with important functional impairment. Then, we raised the dose of sertraline to 100 mg and added pregabalin 50 mg, with up-titration to 150 mg per day, divided in three doses. We observed rapid response, particularly on the anxious symptoms, and subsequently on the patient functionality.

The anxiety symptoms can increase in the first days of treatment with a selective serotonin reuptake inhibitor, which is the first-line therapy for major depression. Those are particularly difficult to treat, resulting often in treatment resistance and functional impairment. Pregabalin has a proven rapid-onset anxiolytic effect, with less cognitive and motor effects and less risk for dependence than benzodiazepines. It has demonstrated efficacy for the treatment of generalized anxiety disorder, but the use for patients with MDD has not been clearly studied.

Although the evidence on this subject is sparse, pregabalin augmentation of antidepressants could be an adequate option for the treatment of depression, allowing a faster action on the anxiety symptoms, especially on the first weeks of treatment, without some of the risks of the benzodiazepines.

None Declared