Tardive dyskinesia is usually persistent, irreversible involuntary movement of the tongue, lips, face, trunk and extremities in patients taking long-term dopaminergic antagonist drugs. Although it is mostly associated with the use of neuroleptics, cases of tardive dyskinesia existed before the discovery of these agents. Patients with schizophrenia and other neuropsychiatric disorders are particularly at risk for tardive dyskinesia because they are exposed to neuroleptics and anticholinergic agents for longer periods than healthy individuals. Free radicals are thought to be probably involved in the pathogenesis of tardive dyskinesia. Vitamin E is a fat-soluble antioxidant, and it is thought to be effective in the treatment of antipsychotic-associated tardive dyskinesia, as it has a cytotoxic free radical-binding effect.

In this poster presentation, it was aimed to evaluate the clinical results of the treatment of tardive dyskinesia with high-dose vitamin E in four inpatients with serious mental illness and long-term antipsychotic use. In addition, the treatment of tardive dyskinesia will be discussed in the light of current literature data.

In the case report, there are three patients with schizophrenia and one with mild mental retardation. They were treated with 1600 IU of vitamin E per day. The patients continued their vitamin E treatment for 90 days. The severity of tardive dyskinesia of the patients was measured by Abnormal Involuntary Movement Scale (AIMS).

At the end of the 90 day treatment, the AIMS measurements of the subjects decreased 72,7%, 73,3%, 72,2% and 80% respectively.

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In our clinic, we observed that patients using long-term typical antipsychotics were prescribed antipsychotics in unindicated situations or in high doses, patients with high risk for tardive dyskinesia were not taken into consideration when planning treatment, and we encountered cases of tardive dyskinesia despite the widespread use of atypical antipsychotic drugs in hospitalized patients. The use of benzodiazepines is restricted especially in elderly individuals due to their side effects and the risk of addiction in long-term use. Although the clinical importance of vitamin E is unknown, it is preferred because it can be used with a low risk of side effects, considering that it can prolong bleeding time. Although the results of a review of tardive dyskinesia treatment do not suggest that vitamin E reliably improves tardive dyskinesia symptoms, our experience shows that patients benefit from vitamin E treatment. In this regard, there is a need for studies that will be conducted with a large sample and compare the effectiveness of vitamin E with the treatments known to be effective in tardive dyskinesia.

None Declared

With the increasing push to legalize cannabis in Western nations, there is a need to gauge the potential impact of this policy change on vulnerable populations, such as those with mental illness, including schizophrenia, mood and anxiety disorders.

Understand the effects of cannabis in people with mental illness and the impact of policies legalizing cannabis in societies.

Literature review performed on PubMed and Google Scholar databases, using the keywords “cannabis”, “mental health”, “psychiatry”.

Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer.

There’s a need to provide a reconciliation of the addiction vulnerability and allostatic hypotheses to explain addiction comorbidity in mentally ill cannabis users, as well as to further aid in developing a rational framework for assessment and treatment of problematic cannabis use in these patients.

None Declared

According to the United Nations World Drug Report 2019, there are an estimated 53 million opioid users[1]. Health problems, social problems associated with this abuse are the result of a complex interaction between psychoactive substances, the patient and the environment. There are two main approaches in the treatment - aimed at complete abstinence from the use of a psychoactive substance and substitution maintenance therapy using methadone and buprenorphine [2]. This is due to the pharmacological effects of narcotic substances, the dynamics of physiological processes and the general state of health with the systematic use of psychoactive substances.

The problem of the use of narcotic substances must be considered not only as a physiological problem, but also as a problem of a person resorting to drugs in a specific social situation. In this case, curative and rehabilitation work acquires new content and new opportunities. The emergence of addiction depends on two main reasons: on the one hand, these are certain specific personality traits of a person, formed primarily by the family, and on the other hand, external factors such as the influence of friends, curiosity, life difficulties experienced and other personal problems. The greatest danger of the formation of drug addiction occurs in the case of simultaneous exposure to both groups of causes.

The study interviewed 123 patients aged 23 to 45 years (109 men and 14 women) diagnosed with opioid addiction. Of these, 17 patients with a period of abuse of up to three years and 105 - longer than three years, respectively. Personality disorders were assessed using the 16-factor Cattell Personality Questionnaire for the study of personality traits [3], the multi-aspect MMPI methodology (mini-mult) [4], and the Luscher color choice method [5].

14 drug addicts (82%) with a period of abuse of less than 3 years were characterized by impulsivity, reduced stress resistance, risk appetite; in 83 drug addicts (79%) with a period of abuse longer than 3 years, persistent psychosocial maladjustment, communication difficulties, conflicts were detected, social norms were disregarded, increased readiness for open manifestation of aggression; 14 women (100%) had features of mental rigidity, disregard for social norms, conflict, impulsiveness; 88 men (81%) had emotional instability, excitability, hostility.

The formation of opioid dependence is influenced by both the psychophysiological characteristics and the pathopsychological changes that occurred during the use of a psychoactive substance.

Addiction therapy should include a psychological analysis of risk factors.

Selection of psychological options for social adaptation that contribute to the maximum possible realization of the individual’s potential, will increase the effectiveness of substitution therapy and accelerate the resocialization of drug addicts.

None Declared

The new type of postmodern art can be interpreted from the point of view of self expression polarized between: art - art-therapy, ludic, occupational therapy - religion. The computer becomes the new medium after the impact of television, and by integrating computers into the network, their communication function has become more prevalent than that of data processing. Contemporary visual arts bring together, in different degrees of relationship and fusion, fields of art that until now were understood and practiced more individually. Multimedia and mixed media technology, which has evolved into meaningful visual representations, incorporates the science behind human perception and knowledge.

The purpose of art in art-therapy, in this context, is not an exercise of the already acquired knowledge upon the artistic material, but a discovery of the yet unknown. Art-based therapies, as nondirective methods, attempt to visualize past traumatic experiences and harmonize the individual with himself and with others.

In the preventive activities, we include all activities involving nonverbal communication and holistic engagement of people in creative activities, specific to visual arts (plastic, decorative design, and multimedia).”Beneficiaries can create their own images with which they want to interact, to arrange their environment…We experiment with art-specific ways to make interdisciplinary exchanges and cultural interferences using the universal language of visual arts along with intercultural elements and religious ecumenism” . The child expresses various issues related to his feelings, like the search of his identity, the generated anxieties, the family and professional environment, the situations of neglect and abuse. For the same purpose, as a complement to activities in nature camps, where education/art therapy takes place in the artist’s studio, special care must be taken to create an evocative and stimulating work environment.

We detect hidden capacities through the specific means of the visual arts with the aim of providing the freedom to follow one’s own destiny, encouraging the joy of creatively manifesting at multiple levels of difficulty in any activity. Harmonizing cultural differences develop self-esteem, tolerance, resilience, and necessary adaptation to the conditions of a multiethnic society.

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There is an equidistant trialogue and circular relations between art, religion, and science, without any specific supremacy. This can offer up from the start the possibility of a lasting harmonization, of information transfers and professional enhancements to support new developments, uplifting the human being through positive reorientations and beneficial recoveries.

None Declared

An institutional ethical committee receives patients’ complaints regarding ethical side of physicians’ work, behavior and communication.

This case report presents an example of unethical communication by a psychiatrist toward patients serving a prison sentence, who sought a psychiatrist’s examination. The main objectives were to evaluate the physician’s insight into objections as well as adherence to ethical rules and regulations defined by ethical code, law and other related acts. Identity and other identification data have been modified in relation to the real case for confidentiality.

The case of a written anonymous complaint to the institutional ethical committee and the psychiatrist’s statement on the patients’ accusations were taken as data source.

Prisoners seeking psychiatrist’s help complained about the behavior of their attendant prison psychiatrist and stated that he insulted and humiliated them, shouted at them, was telling them horrible things (like “you are going to dye slowly”), was talking about them behind their back, ignored their disturbances, listened to several patients at the same time and revealed their diagnoses in front of other patients. The physician denied all the accusations in his feedback report, but stated that there have been conflicts with these patients. He concluded that he wondered why he could not communicate with them more roughly, that there was too much work to do and a lack of time. Furthermore, he worked too much for a small fee and he did not respect their problems while they constantly asked for something, and thus that they made a burden to the health system. Finally, he would not have even respond to an anonymous report.

In the presented case, there were many violations of ethical regulations and legal provisions. The psychiatrist made serious mistakes and misjudgments about numerous regulations of the Law on medical practice’s Article 21 regarding medical confidentiality (“Official Gazette” no. 117/08), Physician’s Oath Latest Version 2017, amended at the 68th Assembly of the World Medical Association as well as the Croatian Code of Medical Ethics and Deontology („Official Gazette” no. 55/08, pages 1-7, Article 1, paragraphs 1,2,3,4,5,6, Article 2, paragraphs 1,2,14, Article 8, paragraphs 1,2, Article 9, paragraph 12, Article 10, paragraphs 1,2) regarding obligation to preserve the noble tradition of the medical profession by maintaining high standards of professional work and ethical behavior toward the patient, respecting the patient’s rights in physical and mental aspects, taking care of his personal dignity and securing a medical secret. Additional efforts must be made by various stakeholders in health care so that ethical postulates are more strongly embodied in everyday physician’s work, without arbitrary interpretations.

None Declared

Depressive symptoms occur in different phases of psychosis, including prodromal, acute and post-psychotic. Post-psychotic depression (PPD) is a phenomenon that presents as a diagnostic and therapeutic challenge. Having been ascribed various descriptions in the past, PPD has been used in a broad manner to describe depressive symptoms that appear in patients with history of psychosis. PPD unveils itself as a separate nosological entity, differing from the adverse effects typically associated with antipsychotics, the negative symptoms of psychosis, and other psychiatric disorders that present with both psychotic and depressive symptoms (e.g. bipolar disorder, schizoaffective disorder, or psychotic depression).

The authors present a case of a 64 year-old man hospitalized due to inaugural psychosis with persecutory and grandiose delusions as well as auditory hallucinatory activity, who began to develop a depressive clinical picture whilst under treatment. A brief discussion on post-psychotic depression, from its clinical presentation to its treatment and implications in prognosis is also presented.

A brief non-systematized literature review using the Pubmed platform as well as presentation of a clinical case.

Depressive complaints are a common complication of psychotic episodes, with the literature estimating that approximately a quarter of psychotic patients present with PPD. Although typically described in association with schizophrenia, recent literature describes PPD occurring alongside other psychotic presentations, including first-episode psychosis. A division between affect and psychosis has been attempted in terms of psychiatric classification, however, the blurred lines between the two continue to contribute to difficulties in differential diagnosis. This becomes a challenge when distinguishing between extrapyramidal symptoms associated with antipsychotics, negative symptoms (i.e apathy, abulia and alogia) and psychiatric disorders with affective-psychotic overlap. Having only recently been considered a distinct clinical entity in psychiatric classification systems, research on its etiology, course, treatment and prognosis are scarce. In regards to the previously described patient, a depressive disorder whilst in treatment for psychosis was identified, and through early recognition of the symptoms treatment with an antidepressant was initiated with favourable response.

PPD is a relatively common phenomenon which is gaining more attention in recent literature. As classifications have begun to consider PPD as a distinct clinical entity, as well as unifying defining criteria, further studies can be developed so as to clarify aspects which remain to be defined. The clinician should be aware of this entity as well as the potentially confounding symptom presentations, so as to provide adequate early treatment thus contributing to improved patient outcomes.

None Declared

Psychobiotics are a group of probiotics that affect the central nervous system related functions and behaviors mediated by the gut-brain-axis via immune, humoral, neural, and metabolic pathways to improve not only the gastrointestinal function but also the antidepressant and anxiolytic capacity.

An assessment of psychobiotic and anti-anxiety effects a probiotic supplement containing Lactobacillus Plantarum CECT7485 and Lactobacillus Brevis CECT7480 (PLANTARUM) in patients with anxiety undergoing treatment with selective serotonin reuptake inhibitors (SSRI) antidepressants.

Sixty patients with mixed anxiety and depressive disorder (according to ICD-10 diagnostic criteria F41.2) were included in an 8-week open label study. Thirty participants received either SSRI antidepressants with PLANTARUM at a dose of 1.0 × 109 CFU once per day and thirty patients received SSRI antidepressants only. The severity of anxiety symptoms was assessed using Hamilton Anxiety Rating Scale (HAM-A) and General Anxiety Disorder Scale (GAD-7).

After 8 weeks intervention, a significant reduction of HAM-A total score (from 37,8±5,3 to 23,6±4,4) was detected in patients with anxiety who prescribed SSRI antidepressants and PLANTARUM (p˂0,05), compared with participants who didn’t receive probiotics (p>0,05). Also, a significant reduction of GAD-7 total score (from 21,7±3,3 to 12,5±2,4) was detected in patients with anxiety symptoms who received SSRI antidepressants and PLANTARUM (p˂0,01), compared with patients who didn’t intake probiotics (p>0,05).

The present data illustrated that probiotic supplement PLANTARUM is a feasible for adjunctive to SSRI antidepressants intervention for anxiety treatment.

None Declared

The cerebellum has been implicated in cognitive, affective and motor functions, including emotion regulation, executive control and sensorimotor processing. In schizophrenia, cerebellar dysfunction has been associated with treatment resistance and clinical features. However, few studies have been focused on delusional disorder (DD).

Our main purpose was to review the evidence available on cerebellum abnormalities and dysfunctions in patients with DD.

A systematic review was conducted through PubMed, Scopus and ClinicalTrials.gov (inception-June 2022) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) directives. The following search terms were used: cerebellum OR cerebellar AND (“delusional disorder” AND paranoia). Reference lists from included studies were hand-checked to find other potential relevant papers.

Six studies were included from a total of 119 retrieved records (PubMed: 52, Scopus: 66, ClinicalTrials.gov: 1). Study 1:Patients with DD somatic type (n=14) presented a decreased gray matter volume in cerebellar lobules compared to healthy controls (HC) (n=32, left lobule VIIIa) and non-somatic DD (n=18, lobule V). Cerebellar volumes did not seem to differ between HC and non-somatic DD. Study 2:Abnormalities of voluntary saccadic eye movements, linking frontal and cerebellar functions, were found in DD patients (n=34) compared to HC (n=40). Study 3: Abnormal smooth pursuit eye movements in DD (n=15) compared with HC (n=40) and similar to schizophrenia (n=40). Case reports (n=3): DD associated with Dandy-Walker variant (partial vermian hypoplasia), unruptured intracerebral aneurysm of basilar artery, and megacisterna magna.

Cerebellar deficits in patients with DD has been reported, particularly in those presenting somatic delusional contents.

None Declared

Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Young people with ADHD experience poorer outcomes than their peers across multiple domains, with treatment shown to reduce these risks. Evidence shows that young people with ADHD can experience multiple challenges when seeking access to healthcare. Debates over how to tackle a ‘failure of healthcare’ for ADHD often include reorganisation of services, including better provision of adult ADHD services, and an expanded role for primary care. However, adult services remain patchy and primary care practitioners feel unsure about how to support young people at this vulnerable stage in their lives, reporting needs for more evidence-based guidance. There is also a lack of national level understanding of the different models, and pathways of care for young people with ADHD aged 16 to 25, hindering efforts to improve access to care and optimise outcomes for this underserved group. Research into this area needs to be guided by people with lived experience of ADHD and informed by perspectives from a range of stakeholders.

Aim: To use collaborative research methods to provide an evidence-base by mapping current services. Then co-produce guidance to improve and better co-ordinate healthcare for young people aged 16-25 with ADHD.

Methods: A national survey about mental health service provision for adults with ADHD (informed by people with lived experience) was developed and distributed. Evidence from this survey stimulated research into primary care service provision, consisting of three interlinked studies guided by research advisory groups of people with lived experience and healthcare professionals

None Declared

The UEMS (or European Union of Medical Specialists) is a non-governmental organisation representing 40 national associations of medical specialists and operating through 43 Specialist Sections. The Psychiatry Section’s purpose is to promote the highest standard of care for people who are affected by mental health problems in Europe through postgraduate training and continuing medical education of psychiatrists. It is responsible for developing the European Training Requirements (ETR) for the Specialty of Psychiatry through an iterative process that involved consulting national psychiatric associations, trainees, patient and carer organisations, EPA and WPA. Because medical education and the practice of psychiatry are continually evolving, it is intended that the ETR will be seen as a living document that will be periodically reviewed and amended.

In 2016, the Section approved an Annex to the competency framework covering learning outcomes of knowledge, skills and professionalism required for the care of refugees and asylum seekers. Last year, the Section undertook a major update and revision of the ETR and these learning outcomes have now been fully incorporated.

In this presentation, I am going to outline the specific requirements related to the care of refugees and asylum seekers. They relate to knowledge of traumatic stress, transcultural psychiatry and health promotion and social inclusion; intercultural communication skills, detailed history taking with reference to the impact of adverse events and psychoeducational skills; and professionalism, including awareness of own world view, respecting culture, ethnic and religious difference.

None Declared

Major Depressive Disorder is a frequent and disabling condition. More than 20% of patients do not respond to pharmacotherapy alone, so there is the need to find alternative strategies in order to potentiate the drugs. Therapeutic alternatives include repetitive Transcranial Magnetic Stimulation (rTMS), which has shown an antidepressant effect in the last decades.

Comparison of the efficacy of accelerated repetitive Transcranial Magnetic Stimulation (aTMS) treatment (4 sessions/day for 5 days) with the standard rTMS protocol treatment (1 session/day for 4 weeks), using the FDA-approved parameters.

33 patients affected by Major Depressive Episodes treated with either Fluvoxamine or Venlafaxine were enrolled. Patients were randomly assigned to the two protocol groups: standard rTMS protocol (15 patients) and aTMS protocol (18 patients). In the standard protocol, patients received 1 rTMS session/day for 4 weeks, while in the aTMS protocol they received 4 rTMS sessions/day for 5 days. Symptomatological improvement was evaluated through MADRS, BDI-II and SSI rating scales administered on day: 0, 1, 2, 3, 4, 5, 14, 21, 28, 56. The study is single-blind, since the clinical rater was unaware of the treatment protocol group. Response and remission rates were calculated, defined respectively as a reduction ≥50% in the MADRS score and a MADRS score <10.

The analysis was carried out on 32 patients (18 in the aTMS group and 14 in the rTMS group). ANOVA for repeated measures shows a statistically significant difference in the MADRS scores on day 5 (p=0.001) and on day 56 (p=0.037). Regarding the BDI-II evaluation, the differences were not fully statistically significant on day 5 and not significant on day 56. No statistically significant differences between the two protocols were observed in the SSI assessment. The aTMS and rTMS response rates were respectively 84.6% vs 45.5% on day 28 (p=0.043) and 92.3% vs 45.5% on day 56 (p=0.012). The aTMS and rTMS group remission rates were respectively 76.9% vs 18.2% on day 28 (p=0.004) and 69.2% vs 36.4% on day 56 (p=0.107). Concerning side effects, no statistically significant differences were observed between the two groups.

Treatment with aTMS seems faster and more effective than treatment with standard rTMS in improving the clinical condition in patients with Major Depressive Episodes, allowing to treat patients in just 5 days instead of 4-6 weeks, without impacting on side effects and tolerability.

None Declared

During the COVID-19 pandemic the internet has become an important medium for learning and communication for university students. Increased time spent online during the pandemic is a significant risk factor for the development of internet addiction (IA) in this population.

This study aimed to investigate the influence of pandemics on IA among Croatian university students and to evaluate the characteristics of IA during the pandemic in comparison to pre-pandemic time.

Two cross-sectional studies, one in April 2016 and another in April 2022 were conducted. As part of these studies, a validated, anonymous questionnaire that contained questions regarding demographic data, as well as Young’s Internet Addiction Test, was self-administered to a cross-faculty representative student sample of the University of Osijek in Eastern Croatia.

The study sample included 1602 university students (810 in the year 2016 and 792 in the year 2022), the median age was 21 years (interquartile range 20-22), 34.5% males, and 65.5% females. There was no statistically significant difference in the median age of the two students’ samples (p=0.234). The main reasons for internet usage were learning and faculty assignments (25.0%), social networking and entertainment (71.0%), and online gaming (4.0%), and there was no statistically significant difference between observed students’ samples (p=0.075). The overall prevalence of IA in 2016 was 41.4% and 39.8% in 2022 but this difference was not statistically significant (p=0.542). The proportions of students with mild, moderate, and severe IA in 2016 were 32.8%, 8.4%, and 0.1% respectively, while in 2022 they were 27.4%, 11.9%, and 0.5%, and observed differences were statistically significant (p=0.011).

The COVID-19 pandemic has changed the pattern of IA among Croatian university students where proportions of students with moderate and severe IA were significantly higher in comparison to pre-pandemic time. To successfully manage this important public health challenge during the pandemic and post-pandemic time specific preventive measures intended for this population should be developed.

None Declared

Gender dysphoria is defined as a multisystemic medical condition in which a person has a marked mismatch between their biological sex and the gender with which they identify.

To highlight the psychological impact and social repercussions of gender dysphoria and to discuss the different aspects of management aimed at optimising a better quality of life for these patients.

We describe the clinical cases of 5 patients followed at the child psychiatry department and the adolescent diagnostic centre of agdal, who were diagnosed with gender dysphoria.

Clinical vignette:

• - A.B: 15-year-old patient, followed in our training for a recurrent depressive disorder comorbid with borderline personality and gender dysphoria. This patient is a victim of school bullying altering his psychosocial functioning and generating thoughts of death.

• - H.A: 16 year old patient, followed in our training for gender dysphoria comorbid with adrenal hyperplasia, indicating feminization surgery.

• - I.D: 17 year old female patient, victim of sexual assault, admitted to our training for suicide attempt. She presents a gender dysphoria, comorbid with a borderline personality.

• - C.G: 22 year old patient, followed in our training for gender dysphoria comorbid with a panic disorder. She is a patient describing an anxious experience with dysthymia.

• - L.K: 23-year-old patient, followed in our training for gender dysphoria. He is a patient who would have been a victim of verbal and physical aggression generating a post-traumatic stress disorder having had a significant impact on his socio-professional life.

Primary care physicians need to be aware of gender-related disorders and the importance of early recognition of these emerging disorders. A multidisciplinary approach is needed to manage these disorders.

None Declared

In the current psychopharmacological panorama, the variety of substances capable of inducing an acute psychotic episode and which have entered the habits of drug addicts has rapidly increased. Here we will take the example of nitrous oxide, which in addition to its medical use as a volatile anesthetic, has many applications in the food and automotive industries.Nitrous oxide is today the 7th most popular drug in the world for its euphoric effects.

The objective of our work is therefore to present through a case report, where the psychiatric symptoms are important, an overview of the psychiatric effects of the recreational use of nitrous oxide, to sensitize the clinicians, and to finally discuss the implications for psychiatric practice in terms of prevention and screening.

Case report: To better discuss this infrequent disorder, we will report here the case of a 25-year-old French tourist, with no particular psychiatric or medical history, who was brought back to our training emergency room by the authorities for treatment of psychomotor instability. , verbalization of delusional remarks and insomnia evolving for approximately 02 days, following an excessive and isolated use of nitrogen peroxide bombs, in a festive setting in Marrakech.

The psychiatric interview objectified a dissociative syndrome, a delusional syndrome of persecution and mystical-religious, a hallucinatory syndrome, with impaired judgment and insight. A complete biological assessment, a cerebral TDM as well as a search for drugs in the urine were requested, returned without particularities.

The patient was put on antipsychotics and anxiolytics, with very good clinical evolution and complete resolution of symptoms after 02 days.

Nitrous oxide (N2O; laughing gas) is used clinically as a safe anesthetic (dentistry, ambulance, childbirth) and is appreciated for its anti-anxiety effect. Over the past five years, its recreational use has rapidly increased, particularly in the world of dance and festivals.

Side effects of N2O include transient dizziness, dissociation, disorientation, loss of balance, impaired memory and cognition, and weakness in the legs. In cases of poisoning, accidents such as tripping and falling can occur.

Some fatalities have been reported due to asphyxia (hypoxia). Heavy or sustained use of N2O inactivates vitamin B12, resulting in functional vitamin B12 deficiency and initially causes finger numbness, which can later progress to peripheral neuropathy and megaloblastic anemia. The use of N2O does not appear to be addictive.

Given the generally modest use of N2O and its relative safety, there is no need for legal action. However, (potential) users should be informed of the risk of neurological and hematological effects related to vitamin B12 deficiency in case of intensive use.

None Declared

We all live in a global world where all cultures have their own unique identity, a sense of belonging, and pride. In the same way I am proud to be part Sindhi culture which is originated from Indus Valley civilization. It’s a 5 thousand years old civilisation.It gave me food for thought and an opportunity to take a lead in to do a project which will not only help my college but to more than 50 million of SINDHI speaking people living across the world. As most of Siddhis live in Pakistan, India, UAE, some of them have migrated and settled in USA, Canada, UK, Australia and Ireland.

It gave me food for thought and an opportunity to take a lead in to do a project which will not only help my college but to more than 50 million of SINDHI speaking people living across the world. As most of Siddhis live in Pakistan, India, UAE, some of them have migrated and settled in USA, Canada, UK, Australia and Ireland

I contacted someone in the mental health information office at Royal College of Psychiatrist and expressed my interest to help the college by contributing one more language to the college website which will be my native language SINDHI. As I wanted to translate leaflets of Royal College about various common mental health disorders in SINDHI language which would benefit more than 50 million people across the world. As they would be able to read about common mental health disorders in their own language which will help them to understand that conditions in a better way and will reduce the stigma and will encourage them to get the right help which they need and deserve.

We started working together on the project and agreed that I will do writing and he will do proof reading for it. We completed the project and handed back it over to the college representatives dealing with leaflets in other languages. After about one month’s hard work, we were lucky enough to get out a leaflet translation published by Royal College of Psychiatrist. It was a proud moment for me being a psychiatrist to help me patients and being a SINDHI to be able get my mother tongue published on Royal College website. I couldn’t have asked for more. Its not the end of this story, as we will continue to work with our college to translate more leaflets and contribute to society and to the college being a proud member of Royal College of Psychiatrist UK.

It was published on RCPSYCH website in translation section

I contributed one more language to RCPSYCH webiste through my work

MY TRANSLATION WORK WAS PUBLISHED ON OFFICIAL WEBSITE OF ROYAL COLLEGE OF PSYHCIATRIST UK

IT WAS WIDLEY APPRECIATED BY WIDER COMMUNITY AND CURRENT AND EX DEAN OF ROYAL COLLEGE OF PSYCHIATRIST https://www.rcpsych.ac.uk/mental-health/translations/sindhi/depression-sindhi

None Declared

The Crisis Response Team (CRT) is an interprofessional collaboration between the Singapore Police Force (SPF) and the Mental Health Helpline (MHH) of the Institute of Mental Health (IMH). Supported by a multidisciplinary team comprising of the SPF, IMH psychiatrists, community psychiatric nurses and crisis counsellors, and community partners, this intervention aims to support suicidal individuals, depending on their risk severity, residing in the community.

To present the CRT work process and to explore the characteristics and outcomes of suicide-related cases referred.

In this descriptive research study, a quantitative approach is adopted. An Excel file shared across the helpline counsellors is used to collate information of the referred cases. Data collected from October 2021 to August 2022 were evaluated using the IBM SPSS Statistics for Windows v28.0. Descriptive statistics were used to summarise the characteristics and outcomes of the cases.

Figure 1 shows the CRT work process. To standardise the method of assessing both suicide ideation and behaviour, the Columbia-Suicide Severity Rating Scale (C-SSRS) is utilised. As compared to other suicide ideation and behaviour scales, the C-SSRS has demonstrated good convergent and divergent validity, high sensitivity and specificity for suicidal classifications, and moderate to strong internal consistency (Cronbach’s α: 0.73 - 0.95) (Posner et al. AJP 2011; 168(12) 1266-1277). A total of 3,386 suicide-related cases was referred. The age range of the suicide-related cases range from 8 – 97 years old (M = 36, SD = 17.33). Of these 3,386 cases, 627 cases were discharged back to their family members/employer/friend/partner and with follow-up check-in calls by the MHH counsellors, 416 cases were sent to the restructured hospitals for organic workup, 2,268 cases were brought back to IMH, 55 cases were discharged back to the SPF for further investigation, and 20 cases warranted CRT home visit activations. Figure 2 shows the total number of referred cases and outcome of these cases in each month.

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The CRT intervention could mitigate suicide risk and pressure on the mental health system (i.e., reduce unnecessary emergency room visits and hospital admissions), create greater mental health awareness, and facilitate individuals’ connection to mental healthcare services (i.e., in hospitals and/or in the community) as evidenced by the increasing number of cases referred, and increased collaboration with the various stakeholders, ensuring timely intervention and necessary follow-ups thereafter.

None Declared

When we think of multiple sclerosis (MS), we usually talk about the sensory and motor symptoms of the disease and their impact on the functioning of the individual affected. However, this disability can lead to a wide range of symptoms, including psychological and cognitive manifestations that also have a significant impact on the quality of life of patients

To estimate the incidence of psychiatric disorders in patients with MS.

A cross-sectional descriptive study that interested MS patients referred to the occupational pathology consultation of the Charles Nicolle Hospital, during the period from July 1, 2020, to September 30, 2022. The data collected concerned the characteristics of the disease. The detection of psychiatric disorders was studied through a validated self-questionnaire GHQ-12 (General Health Questionnaire).

The study population consisted of 26 cases. The average age was 38 ± 9 years. A predominance of females was noted in 77% of cases. Eight patients (31%) were smokers. Nine cases (47%) had a relapsing-remitting form and six cases (32%) had a primary progressive form. All patients were on disease-modifying therapy. The average duration of the disease was 6 ± 3 years. The average duration of work during the illness was 4 years [one year-12 years]. The average duration of work stoppage in the last 12 months of activity was 63 days [2-240 days], of which 54% was long-term sick leave. The mean GHQ-12 score was 4.38 [0-10]. Twenty patients (77%) had psychological disorders.

This study shows the high frequency of psychiatric disorders in our MS patients. The role of the neuropsychologist is therefore often crucial in the care of these patients.

None Declared

The metaverse is a digital world created using different technologies like virtual reality (VR), augmented reality (AR), cryptocurrency and the internet.

Interest in the metaverse has grown in recent months in different fields and it could have potential application in the treatment of mental health disorders.

To gain a better understanding of metaverse and to explore its possible applications on mental health.

Review of recent literature about the implications of the metaverse users in mental health.

Metaverse is a virtual universe where people can interact with other users, objects, and environments personifying an avatar. VR, AR and mixed reality (MR) have been used in the treatment and diagnosis of various mental health disorders for last years.

Attention deficit hyperactivity disorder, eating disorders, anxiety, phobias and post-traumatic stress disorder have been already benefited from VR. Also, there are results to treat persecutory delusions in psychosis. On the other hand, we know that to spend a significant amount of time playing 3D immersive games and using social media, could lead to insecurity, anxiety, depression and behavioural addiction.

The lack of evidence and these risks could be limitations to implement Metaverse for the therapeutic management of mental health.

Many companies have already started to develop virtual mental health clinics with mental health professionals serving patients in real time, some spaces have already offer group therapy sessions. Other immersive spaces have also been created for practising mindfulness, meditation, or yoga.

The new technologys have changed the way that we socialise, work, and interact, even the way that we receive medical treatment. The metaverse could prove useful in the management of the mental health disorders that have already benefited from VR, but at the same time we could potentially lead to the worsening of others.

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Depression continues to be a leading cause of disability worldwide. Despite the availability of several classes of antidepressants, a third of patients do not recover from their depression. Deep brain stimulation (DBS) is an invasive treatment approach that was found to be effective in the treatment of Parkinson’s Disease and presents as an alternative to standard antidepressant therapy for people with treatment-resistent depression (TRD).

We aimed to compare the use of DBS to standard antidepressant therapy and decipher whether DBS can be used for TRD. In addition, electroconvulsive therapy (ECT), a current brain stimulation method administered for TRD, was contrasted with DBS.

A narrative review of the current literature concerning DBS application and TRD was conducted to evaluate whether standard antidepressant therapy was as effective as psychosurgical intervention. Emphasis on TRD-associated DBS was noted.

The studies discussed found that DBS was an effective treatment option for TRD, however, the results were limited due to the studies being conducted in small sample sizes and using DBS in combination with antidepressant therapy. Nonetheless, the concomitant use of DBS and antidepressants demonstrated to be an effective treatment for TRD, highlighting the potential benefit of DBS in inducing remission in TRD. DBS has a wider range of complications compared to ECT as it involves a more invasive neurosurgical approach to implant the device. On comparing the cost of the devices between the 2 studies, DBS costs approximately three times more than ECT.

The spectrum of depressive disorders is known to affect multiple regions of the brain. A more cohesive approach would be a comprehensive study using DBS in multiple brain regions while incorporating blinded controls. In summary, DBS could be a viable treatment addition for TRD, but more thorough studies are needed to deduce its true efficacy. Future collaborative studies investigating the efficacy of DBS over ECT in TRD may assess further therapeutic potential.

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The types of Electronic-Based Therapy & Intervention are spreading rapidly, especially after the onset of COVID, and several authors are dealing specifically with digital psychology and psychiatry, implementing new techniques and methodologies (Festa, Martinotti, 2022).The latest technological innovations related to metaverse and holography are emerging as new digital mediums and a reflection on their potential in the psychological field is urgent. Telepsychology, which currently uses text, audio and video-based communication as a medium, will see the way to relate to the patient with the “new digital presence” amplified at 360 degrees. This will of course revolutionize some aspects of classic psychological intervention: “physical proximity” will have a completely different meaning. New technologies through the digital medium have the power to cancel space, thus allowing the intervention to be separated from the sharing of the same physical environment. The first great epochal upheaval produced by new technologies in the field of the psychological profession is precisely this: psychological intervention no longer necessarily coincides with the sharing of the same physical space, space and intervention becoming independent.

We will soon and increasingly refer to associations, national and international professional associations and institutions that deal with the subject, such as the American Psychological Association, the International Society for Mental Health Online, the Online Therapy Institute, to have guidelines on best practice with respect to psychological performance online. This will be accompanied by specific training courses for clinicians who decide to work using technological tools and courses related to telepsychology and the development of a professional online identity.

Holographic technology will revolutionize our “internal and external world”, and it is the task of psychological science to cultivate questions and provide answers both on the impact that this technology will have on the life of the average man and on the possibilities of use for our profession. The distance of the real world from the digital one is getting smaller with each passing day.

Our habits, our way of working, having fun have changed in different ways and in a very short time. Our physical, cognitive and sensory boundaries have expanded and our way of life has “evolved”.

We find ourselves passing through and going through a phase, which began in the 1980s, which is not without shadows and settles into mass cultural aspects. The contradictions, abnormal uses and abuses of technology, but which accompany every innovative transformation and which we should gradually manage wisely, are also typical of this phase. We will see what the future holds!

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