Antidepressants that offer a rapid onset of action without requiring chronic use are greatly needed in both major depressive disorder (MDD) and postpartum depression (PPD). Zuranolone is an investigational, oral, neuroactive steroid and GABAA receptor positive allosteric modulator in clinical development as a 2-week treatment course for MDD and PPD.

To present the efficacy and safety of zuranolone vs placebo in Phase 2 and 3 trials.

In the studies presented (Table 1), improvements in depressive symptoms were assessed by least-squares mean (LSM) using a mixed-effects model for repeated measures on the change from baseline (CFB) at Day 15 in the 17-item Hamilton Rating Scale for Depression total score (HAMD-17; primary endpoint for all trials) and the Montgomery–Åsberg Depression Rating Scale (MADRS; secondary endpoint) following a 14-day treatment course of once-daily zuranolone.

Compared with placebo, zuranolone treatment led to rapid improvements in depressive symptoms across clinical trials, with significant improvements (LSM treatment difference [SE] in CFB) in HAMD-17 and MADRS scores at Day 15 in 3 of the 4 trials (Table 2). Common treatment-emergent adverse events (≥5% in zuranolone treatment arms) were headache, somnolence, dizziness, nausea, sedation, diarrhea, upper respiratory tract infection, and fatigue (Table 3). No incidences of loss of consciousness or excessive sedation were observed.

Across the completed studies in the zuranolone clinical trial program, patients receiving zuranolone consistently experienced improvement in depressive symptoms following a 2-week treatment course. Treatment with zuranolone was generally well tolerated with a consistent safety and tolerability profile.

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

The anticonvulsant m-Cl-BHM is promising for the pathogenetically directed thrapy does not cause negative effects.

Investigation of the effect of m-Сl-BHM on “immunochemical homeostasis” in rats with experimental alcoholism.

m-Cl-BHM was injected at a dose of 100 mg/kg (1/20 LD50) for 5 and 30 days into the stomach of male Wistar rats who preferred alcohol according to the screening conditions and kept for 10 months. in free access to a 15% ethanol solution, which made up the group of “heavy drinkers” (HD). Phenobarbital was administered at a dose of 25 mg/kg (1/20 LD50).

The features of the monooxygenase system of cytochrome P450 of the liver and ECT in the lymphoid organs of rats were studied at different periods of administration of m-CL-BHM -5 and 30 days. to HD rats. m-CL-BHM has an inducing effect on the monooxygenase system of the liver, causes phase changes in the lymphoid organs and ECT. Long-term administration of m-CL-BHM caused a depletion of the cellular composition of lymphoid organs, a decrease in ECT of spleen cells and peritoneal exudate, these changes were less pronounced compared with phenobarbital. The activation of the immune system inversely regulates the production of enzymes of the cytochrome system, since the concentration of low molecular weight targets is sharply reduced with the help of antibodies. m-Cl-BHM metabolites conjugated to endogenous macromolecules form a full-fledged stimulus for the immune system.

Neuroimmune response to the introduction of m-CL-BHM is significant in behavioral disorders associated with alcoholism and the correction of this condition.

No significant relationships.

Bipolar Disorder (BD) is a disorder in which cognitive function is relatively preserved but social functioning is markedly impaired. Interestingly, studies on BD show that the patients have a strong desire for social rewards. Hypersensitivity to social rewards in BD has not yet been sufficiently examined through experimental methods, although recent studies have pointed out that their reward hypersensitivity is the cause of symptoms and dysfunction.

The purpose of this study was to investigate whether patients with BD are hypersensitive to social rewards using the social value capture task.

Groups of 25 BD and healthy control (HC) each completed the social value attention capture task. This task consists of a practice phase in which associative learning of social rewards with specific stimuli occurs, and a test phase in which the stimuli associated with rewards appear as distractors during the participants performing a selective attention task. We also recorded event-related potential (ERP) in the practice phase in order to investigate BDs’ cortical activity for social reward.

showed significantly decreased accuracy rate and increased reaction time in the high social reward-associated distractor trials of the test phase in the BD compared to the HC. As a result of analysis in ERP components, P3 amplitude for social reward was significantly greater in the BD than the HC.

BD patients exhibit behavioral and physiological hypersensitivity to social rewards that might contribute to social dysfunction.

No significant relationships.

SIDS is the sudden, unexpected and unexplained death of a baby. Safe sleeping practices can help to reduce a baby’s risk of SIDS. At the Coombe Wood Mother & Baby Unit (MBU), it was found that many patients were opting to co-sleep with their babies which contradicts safe sleeping guidelines.

To improve patient awareness of the condition SIDS and to implement an interactive training session improving awareness of safe sleeping practices for babies. To improve patients’ confidence in implementing safe sleeping practices for their babies; thus reducing the risk of SIDS occurring.

The Lullaby Trust™ is a charity that raises awareness of SIDS and provides expert advice on safe sleep for babies. An interactive training session for patients was organised by incorporating published materials from The Lullaby Trust™, facilitated by medical and occupational therapy staff on the MBU. The participants filled out a pre-training and post-training questionnaire to test the effectiveness and quality of the training session.

The participants’ average level of confidence in knowing and applying safe sleeping practices for their babies doubled following the training session (from 2.3→4.8 and 2.6→5 respectively, with 5 meaning “Very Confident.”) The average level of knowledge of SIDS also increased from 1.6→4.4 (with 5 meaning “A Lot” of Knowledge.)

We were surprised at the low level of knowledge and confidence the patients had regarding safe sleeping practices for their babies. This project shows how interactive, ward-based training can be an effective way to engage and stimulate patients into improving the safety of their baby care.

No significant relationships.

Psychiatry has typically underserved indigenous people and immigrants. Indigenous people have different ways of viewing mind and mental health and conventional Euro-American psychiatry has not always acknowledged that.

We wanted to modify conventional psychiatric approaches to better serve our indigenous population. We worked together to determine what that would be, gained feedback from indigenous patients and practitioners, and wanted to describe what we learned in an autoethnographic fashion.

We engaged each other, indigenous practitioners within the community and indigenous patients in an ongoing discussion of how psychiatry should change to be relevant to indigenous people. We monitored our own process in an autoethnographic fashion.

1. The typical DSM (Diagnostic and Statistical Manual) or ICDA (International Classification of Diseases) categories were difficult to apply to the lives of many of these patients, given the high levels of trauma both experienced and transmitted epigenetically (inter-generational trauma). A power-threat-meaning framework appeared to be a more useful adjunct to these classifications along with trauma-informed perspectives. 2. Conventional cognitive behavior therapy was less accepted given its emphasis on rational thinking, while narrative approaches were more successful, given the widespread uses of stories and storytelling in these cultures and the emphasis on relationship as more important than rationality. 3. Trained peer counselors were very helpful. 4. Bringing culture (language, songs, ceremonies, elders, arts) into treatment was highly desirable.

Psychiatric services to indigenous and immigrant communities should focus on empowerment through community-based, participatory methods, facilitating local problem solutions, and involving traditional elders, local government, and other stakeholders.

No significant relationships.

Obesity has increased worldwide and concerns comorbidity in patients with schizophrenia, and is linked to a high mortality rate in this group. Although bariatric surgery is the gold standard treatment for refractory obesity, it rarely is indicated for subjects with schizophrenia due to psychotic symptoms recurrence.

Report weight-loss outcome and psychopathology changes over 36 months follow-up of 5 patients with schizophrenia submitted to bariatric surgery.

Patients have been followed for 36 months. Clinical and anthropometric assessments such as percentage of excess weight loss (EWL) and body mass index (BMI) have been performed at 6, 12, 24, and 36 months follow-up. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychopathology status. Wilcoxon test was used to assess statistical differences.

The sample included four female and one male subject, with BMI at baseline 42,81± 5,66. The results of BMI and EWL over time are described in Table 1. A significant statistical difference was found between BMI at baseline and at T6, T12, T24, and T36 (p<0,05). EWL was higher at T12 ( compared with T6), but not different from other measurements. PANSS scores at the baseline were 7,7 ± 1,6 for a positive domain, 8,7 ± 2,3 for a negative domain, and 19,2 ± 6 for general psychopathology, with no statistically significant differences during the follow-up.

Despite the small sample, bariatric surgery has been shown a safe and efficient refractory obesity treatment in patients with schizophrenia.

No significant relationships.

The integration of Motivational Interviewing (MI) with behavioural and psychological interventions for the treatment of obesity has the potential to improve health-related outcomes of patients in the long-term.

Our objective is to examine the usability of a VR embodiment tool for treating obesity.

Fourteen participants (6 healthy and 8 with morbid obesity) with a desire to make lifestyle changes were randomly assigned to the experimental group (EG) and the control group (CG). Participants from the EG engaged in a virtual self-conversation aiming at understanding their own motivation to make lifestyle changes. Using the body swapping technique, participants were embodied alternately in their own virtual representation and in their counsellor’s body. To better guide this virtual self-conversation, participants were previously trained on MI skills. Participants from the CG were embodied in their own virtual bodies and participated in a “scripted dialogue” with a virtual counsellor who gave them practical recommendations about how to achieve lifestyle changes. A mixed-methods design was used, involving a semi-structured interview examining users´ satisfaction with the virtual experience, as well as self-report questionnaires, including readiness to change habits, body ownership, and system usability.

Participants showed high usability of the platform with higher scores among participants from the EG compared to the CG. Levels of body ownership were satisfactory, with no differences between groups.

Through the integration of MI in the VR context with the patient being properly trained to carry out his/her own motivational self-conversation, we will provide an important advance in the psychological treatments of obesity.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 951930

No significant relationships.

A 9-year-old girl under pediatric follow-up since the age of 4 years after diagnosis of neurofibromatosis type 1

To present a case of neurofibromatosis and ADHD comorbidity to raise awareness of the importance of screening for neurodevelopmental disorders.

Case report and literature review

The patient had an adequate control and follow-up of the disorder with periodic check-ups and magnetic resonance imaging during her follow-up. She was referred due to symptoms of inattention with failure to perform exams and impulsivity in interpersonal relationships, affecting her social functioning. In addition, the patient presented simple motor tics of eye contraction and shoulder elevation. The patient was diagnosed with attention deficit hyperactivity disorder together with tic disorder. She was treated with stimulant medication with worsening of tics and marked hyporexia. Therefore, medication with guanfacine was started up to 4 mg per day, adjusted by weight. With this dose there was a control of the tics, with improvement of the symptoms of inattention and impulsivity. In different spheres an improvement in their functionality was observed, with improvement in mood, self-esteem and academic performance.

Neurofibromatosis type 1 is a rare monogenic disorder with a varied presentation (ophthalmologic, dermatologic and predisposition to tumor development). Patientshave been shown to present with symptoms of inattention and executive function impairment, along with other neurodevelopmental disorders such as autism spectrum disorders, learning disabilities or intellectual disability. The literature shows that up to 60% of them has ADHD criteria.

No significant relationships.

Antisocial disorder is characterised by difficulty to adapt to social norms that normally rule different aspects of the person’s conduct in adolescence and adulthood. According to DSM-V, this disorder’s prevalence stands between 0.2% and 3%, and is more frequent in men.

Numerous studies have been made about the influence between the environment and genetics for the development of this disorder, finding in several patients a punctual mutation of the monoamine oxidase gen (MAOA); although impulsive behaviour has also been associated to the 5-HT tranporte gene (5-HTT), and the protein coding gene for Tryptophan Hydroxylase TPH1

The hospital admission for these patients must be made when there’s autoregressive or hetero aggressive behaviour, suicide attempts, psychotic symptoms, or symptoms that generate important repercussions in the person’s normal functions. Nevertheless, is important to identify during the hospitalization the improvement possibilities of these patients in order to make drug or psychotherapy adjustments; in the case that we don’t observe treatment benefits, the patient will be released from the hospitalization

The main treatment is psychotherapy.

There’s not much evidence of drug use in this disorder, however, mood stabilizers, antidepressants, atypical antipshychotics and benzodiazepines are used for rage control, impulsiveness, anxiety and aggressiveness.

No significant relationships.

Depressive episodes are associated with higher morbidity, mortality (mostly suicidality. Despite the high prevalence and the devastating impact of this condition, there is a long‐standing debate about its treatment, particularly about the use of antidepressants. International guidelines and expert consensus recommend to avoid AD for bipolar depression, or to use AD with caution and as second line treatment only if the depressive episode shows poor response to mood stabilizers (MS) and to some second generation antipsychotics (SGA) (cariprazine, lurasidone, quetiapine and olanzapine combined with fluoxetine) in monotherapy and in combination. Contrary to the advice of guidelines and experts, 50%–80% of acute bipolar depressive episodes are treated with AD in everyday clinical practice.

To evaluate the effectiveness and the safety of AD acute treatment in patients with bipolar depression

Literature review (PubMed)

Short‐term safety, switching and suicidality did not differ significantly, and no suicide attempt was observed. Concerning long‐term safety, patients with bipolar depression had a significant reduction of depressive and total recurrences during the first year.

Acute AD treatment of bipolar depression is effective in the short term and safe in the short‐ and long‐term

No significant relationships.

Approximately 15% of pregnant women suffer from a mental illness, however only half of them accept psychopharmacological treatment. One of the reasons for refusing treatment is the stigma attached to it.An important part of functional recovery is defining identity. This identity is multifactorial and is defined by several variables, one of them being gender.Several studies on motherhood in women with mental illness define the importance of a mothering identity, providing meaning and values. We present the case of a 39-year-old woman, mother of a two-year-old child, undergoing follow-up at a psychiatric clinic for recurrent depressive episodes and a history of two suicide attempts ten years ago. Currently stable in treatment with escitalopram 10 mg and lorazepam 1 mg if necessary.The woman refers the desire to abandon treatment after realizing that she is pregnant again. Therapeutic accompaniment is decided. The social worker from the obstetric service communicates with the psychiatric service to question the woman’s ability to care for a child with her psychiatric history.

Determine the stigma of mental illness, including among healthcare workers.

The woman makes her decision with full judgment. The patient is accompanied during pregnancy without incident, with clinical stability.

After delivery, the patient decides to resume psychopharmacological treatment.

Having a mental illness does not determine a woman’s ability to be a mother. As long as it is agreed with the psychiatrist, patients have the right to make decisions about their treatment.

No significant relationships.

Tinnitus is an auditory perception of a “phantom” nature with highly changing features. There is an established correlation between anxiety, depression, sleep disorders and tinnitus.

To evaluate the prevalence of sleep disorders and emotional disorders during tinnitus and their correlation to the severity of the symptomatology

A descriptive cross-sectional study of 60 patients consulting for subjective tinnitus. For each patient we collected epidemiological data and performed an ENT and general examination, an audiometric and psychoacoustic evaluation and a psychometric evaluation. To evaluate the severity of the tinnitus we used the visual analog scale VAS and the subjective tinnitus severity test (STSS). Disability was assessed by the Tinnitus Handicap Inventory (THI). Anxiety and depression were assessed by: the Hamilton anxiety Rating scale and the Beck depression inventory.

The prevalence of emotional disorders was: 21.7% for depression, 48.33% for generalized anxiety disorder, 11.67% for dysthymia, 5% for agoraphobia 16.67% for panic disorder and 1.67% for social phobia. The intensity of tinnitus was correlated with more panic disorder (p=0.008). Subjective severity of tinnitus was correlated with disability (p=0.0001), awareness of tinnitus in relation to sleep duration (p=0.006) and disturbed sleep (p=0.047). Disability was correlated with subjective tinnitus severity (p=0.0001), panic disorder (p=0.0007), generalized anxiety disorder (p=0.033), and poor sleep quality (p=0.005).

Our results emphasize the importance of emotional disorders as well as sleep disorders in chronic “tinnitus”. These disorders should be systematically investigated and eventually treated in order to optimize the management of the patients.

No significant relationships.

Bipolar disorder in later life is a complex & confounding neuropsychiatric syndrome with diagnostic & therapeutic challenges.

To assess the clinical characteristics of late onset bipolar disorder and to compare with adult onset bipolar disorder and to compare the medical co morbidity between age, sex matched healthy control group.

It was a hospital based, observational, analytical and cross-sectional study conducted over 2 and half years. The patients > 60 years presenting with manic features after satisfying the inclusion and exclusion criteria were the study group. Control group -1 was selected from adult onset bipolar disorder. YMRS, MMSE, SCID were applied for both. Control group -2 was selected from age, sex, education matched normal population and the three groups were compared for co morbidity. Secondary mania cases are excluded from the study.

Mean age at onset was 67.4 years. 63.3% of our patients were female. H/O psychiatric illness in family is more in control group (53.3%) than in study group (26.7%) (p=0.035). 86.6% patients present with irritability. 73.3% patients were presented with aggression. Control group –irritability=90%, aggression=75% The difference is not statistically significant. Scoring of each symptom showed significant difference. It means presence & severity of delusion is significantly more in young bipolar control group.(p=0.035 for % score, p=0.015 for mean SAPS score). 70% presented with co morbidities.

Geriatric mania shows mixed presentation compared to early onset disease. Psychotic features are more common. Late onset mania is less associated with family history. Common co morbidities are DM, HTN, Hypothyroidism, neurologic disorders.

No significant relationships.

No significant relationships.

GABAa-receptors proved to be the molecular targets of ethanol on immune and nervous cells, potentiating alcohol influence. ortho-Fluoro-benzonal is known to be a circular urea derivative and an artificial ligand of GABA/BD-receptor and thus a potential candidate drug for alchoholism treatment.

We have shown the alcohol motivation decrease under ortho-fluoro-benzonal influence in experiment. The investigation of molecular mechanisms and functional targets of this substance is an important step in understanding of molecular pathogenesis and approaches to managing alcohol addiction.

Splenocytes from male (CBAxC57Bl/6) F1 mice in a state of alcohol dependence owing to 6-month 10% ethanol exposure were aseptically obtained and cultured in presence of GABA, ortho-fluoro-benzonal and mitogens (LPS or concanavalin A). Proliferative activity of immune cells in vitro was estimated by means of radioactive 3H-thymidine incorporation.

The intact animals’ splenocytes revealed increased spontaneous proliferation, increased T-mitogen stimulated and decreased B-mitogen stimulated proliferation in the presence of ortho-fluoro-benzonal. The immune cells from alcoholized animals, demonstrating increased spontaneous proliferative activity and weaken susceptibility to the mitogens, showed normal response patterns, except B-mitogen response case, under ortho-fluoro-benzonal inluence. Addition of GABA into the cultures didn’t cancel most positive effects of ortho-fluoro-benzonal inluence, proving existence of their GABAaR-independent pathways, mediated by other barbiturate receptors in addition to GABAaR-dependent ones.

Immunomodulating properties of artificial GABA receptor ligand, ortho-fluoro-benzonal, in vitro has been shown. The compound may correct immune cells dysregulation caused by chronic ethanol exposure, so the original anticonvulsant has promise in the treatment of alcoholism.

The authors have not supplied a conflict-of-interest statement.

Internet gaming has become a topic of interest since it has positive but also negative effects.

To explore the relationship between internet gaming, aggression and psychological distress in young adults.

229 Portuguese subjects (55.5% females), with a mean age of 21.13 years old (SD = 2.075, range: 18-29) filled in the Internet Gaming Disorder Scale-Short Form, the Buss-Perry Aggression Questionnaire, and the Depression, Anxiety and Stress Scales-21.

The total score of internet gaming was of 15.90 (SD=6.32), 79.9% (n=183) of the sample used to play videogames and 24.5% (n=56) spent more than ten hours playing a week. Internet gaming was correlated with physical aggression (r=.23**), anger (r=.31**) and hostility (r=.35**); and with depression (r=.36**), anxiety (r=.28**), and stress (r=.31**). A Mann Whitney U test revealed significant differences in internet gaming disorder levels of males (Md=130.75, n=102) and females (Md=102.35, n=127), U=4871.000 z=-3.232, p=.001, r=4.49.

Internet gaming disorder is associated with aggression and psychological distress, and males presented higher internet gaming disorder levels. Future studies are needed to explore the bidirectional relationships between gaming disorder, aggression and psychological distress.

No significant relationships.

The use of nasogastric-tube feeding (NGT) in the treatment of Anorexia Nervosa (AN) in children and adolescents is recommended by current guidelines. Nonetheless, the literature lacks studies assessing prognostic factors for modifications of AN-specific psychopathology treated with NGT.

To assess potential prognostic affecting improvement in AN-specific psychopathology in children and adolescents hospitalized for AN, treated with NGT.

Retrospective study assessing young inpatients with AN, treated with NGT. Considered outcomes (admission vs discharge) were AN-specific psychopathology (Eating Disorder Inventory-3 (EDI-3): Drive for Thinness (DT); Body Dissatisfaction (BD); Eating-Disorders Risk (EDRC)) and body-mass index (BMI). Considered potential predictors were demographics, duration of untreated illness (DUI), severity (admission BMI), diagnoses, early vs late (0-7 vs 8+ days after admission) start of NGT, drugs). Models for specific contributions of predictors related to outcomes were assessed with analysis of covariance (ANCOVA).

Fifty-three inpatients (F=53, mean age 15.1±2.0 years) were enrolled. Both higher DT (F(1,22)=15.07, p<0.001) and BD improvement (F(1,22)=7.73, p=0.011) were predicted by lower admission BMI. Higher BMI improvement was predicted by lower admission BMI (F(1,47)=10.39, p<0.001) and age (F(1.47)=6.12, p=0.011. AN subtypes, comorbidities, antidepressants, and different antipsychotics did not predict any outcome.

In this study, greater improvement in AN-specific psychopathology (DT and BD) and weight in patients treated with NGT was predicted by lower admission BMI. These results suggest that young patients with greater severity may highly benefit from NGT. These findings, if confirmed in wider and controlled samples, could help in optimizing the treatment with NGT in young inpatients with AN.

No significant relationships.

The Covid-19 pandemic profoundly affected delivery and accessibility of mental health care services at a time when most needed. The OPTIMA Mood Disorder Service, a specialist bipolar disorder service, adapted group psychoeducation programme for delivery on-line.

We report the feasibility of creating a digital psychoeducation programme.

The OPTIMA ten session group psychoeducation programme was converted into a ‘Digital’ intervention using video-conferencing. Sessions offered a range of key topics, derived from the initial Barcelona Group Psychoeducation Programme. At the time of writing, OPTIMA had fully completed two 10 session digital courses.

A total of 12 people (6 in each group) consented to be part of a service evaluation of the digital groups. Just over half of the participants were women (7/12; 58.3%) and one identified as being non-binary (8.3); remaining participants were men. Age of participants ranged from 25 years to 65 years (Mean=42.3; SD=13.1). Data showed a high level of engagement (77%) All participants reported some improvement with a mean Bipolar Self-Efficacy scale (BPSES) post-group score of 105.6 (SD=14.8). At group level, this change was not statistically significant (F (1, 15) = 0.71, p=0.41). At an individual level, two out of five showed a reliable change index >1.96.

Delivering a ‘digital’ group psychoeducation programme was possible due to careful planning and programme development. There was good uptake from service users suggesting it is a feasible approach with preliminary evidence of clinical benefit.

No significant relationships.

Bipolar disorder (BD) is a severe mental illness (SMI) with an estimated lifetime prevalence of around 1%, starting in young adulthood and progressing with acute episodes. Although there is no significant prevalence difference between the sexes, the course of the disorder may be more problematic in women, due to hormonal and reproductive factors. Moreover, hypersexuality and impulsive sexual behaviour can manifest as part of a manic or hypomanic episodes, with devastating effects on the physical and emotional health of these patients.

To highlight the pertinent issues related to sexual and reproductive health of women with BD.

A non systematic review of the literature from the last 10 years was carried out using the electronic databases, Pubmed and Google Scholar. The literature search was confined to papers written in English. The keywords ‘sexual health’, ‘reproductive health’, were combined with ‘bipolar disorder’ and ‘women’.

The literature points to an increased incidence of unsafe sexual practices (unprotected sex, multiple sexual partners, trading sex) as well as poor reproductive and sexual health (increased risk of sexually transmitted diseases, high risk of unwanted pregnancies and abortions, low use of contraceptives, menstrual and fertility problems). Female patients with BD are also more likely to report history of sexual abuse.

Attention and counseling regarding effective contraception, planning a pregnancy and risk of sexually transmitted diseases, among others, should be an integral part of health care received by all women with bipolar disorder.

No significant relationships.