The challenge for primary care physicians (PCPs) is keeping up to date in managing major depressive disorder (MDD) and psychiatric emergencies.

We evaluated whether an online educational video lecture directed at PCPs, could improve knowledge and confidence regarding management of psychiatric emergencies associated with MDD.

Educational effect was assessed using a 3-question repeated pairs, pre/post assessment survey. A paired-samples t-test was conducted to assess overall number correct and confidence change. A McNemar’s test was conducted to assess question-level significance. P values < 0.05 are statistically significant. Cohen’s d test was used to estimate the magnitude of effect of education. The activity launched on 8 April 2021, and preliminary data analysed as of 24 June 2021.

511 PCPs participated in the programme, of which 86 PCPs completed the pre- and post-assessment test. An average overall correct response rate of 28% pre- increased to 64% post- (129% relative increase, P<0.001; Cohen’s d = 1.13). Knowledge on the burden of suicide and MDD improved from 23% pre- to 87% post- (278% relative increase,P<0.001). Knowledge regarding clinical data for novel therapies for use in psychiatric emergencies improved from 29% pre- to 50% post- (72% relative increase, P<0.01). Knowledge regarding signs of suicidal intent in patients with MDD improved from 31% pre- to 53% (71% relative increase, P<0.001) following education.

This study demonstrates the positive effect of online medical education on PCPs’ knowledge and confidence in contemporary management of psychiatric emergencies associated with MDD in Europe.

The results of this study were derived from an educational programme which was developed through independent educational funding from Janssen Neuroscience

Breast cancer (BC) is the most common cancer in women all over the world. Its physical consequences and psychosocial distress had adverse effect on quality of life (QOL).

Evaluate the QOL among women with BC.

Descriptive cross-sectional study of BC patients, carried out during a period of 5 years. Socio-demographic and medical data was collected based on a pre-established synoptic sheet. The European Organization for Research and Treatment Quality of Life Questionnaires (EORTC QLQ-C30) and EORTC QLQ-BR23 were used to assess the QOL.

A total of 100 patients were included. The mean age was 52 ± 8 years. The mean overall health score was 77.5 ± 25.5. The mean scores of physical and emotional functioning were 82 ± 25.1 and 90 ± 19.5 respectively. The QLQ-BR23 objectified a body image score of 63 ± 23.9, an average score for sexual functioning of 87.3 ± 22 with loss of sexual enjoyment in 75% of cases. The increase in mean overall health score and physical functioning was significantly associated with type of treatment (p = 0.01). The mean score of emotional functioning was correlated with the feeling of support (p = 0.04). The increase in the patient’s body image score was significantly associated with age (p <10-3), marital status (p = 0.01) and having had a mastectomy (p <10-3).

Our results underline the importance of psychosocial care, which must be an integral part of oncological care in women with BC, in order to improve their quality of life.

No significant relationships.

Rumination is a transdiagnostic risk factor to psychopathology that has mostly been studied in relation to depression (Nolen-Hoeksema, 1991). However, rumination may also occur in response to positive events and emotions (Feldman et al., 2008), and may be a protective factor as it is associated with higher positive affect (Harding et al., 2017).

We aimed to examine ruminative response to positive affect (RPA) in daily life and explore its relationship with daily positive and negative affect. We hypothesized that daily positive and negative affect would be associated with daily RPA even after controlling for trait-level RPA and depressive rumination.

We carried out a daily diary study with university students (n=178). After filling out the baseline survey assessing trait-level rumination, participants had to answer short surveys online about their daily affect and daily rumination every evening for 10 consecutive days. We analyzed our data with multilevel regression in R.

In line with our expectations, daily RPA was significantly associated with daily positive (β=0.16) and negative affect (β=-0.07), while trait-level rumination scores were not significantly associated with daily positive and negative affect. The within-person relationship was stronger between RPA and positive affect (β=0.17) than the between-person relationship (β=0.09). Daily and trait-level rumination were weakly correlated (r=0.218-0.284).

Under ecologically valid conditions, we found that daily rumination was more important in daily affective experiences than trait-level rumination. Understanding whether one’s current affect is more strongly associated with trait-level, state-level or even contextual factors may yield better intervention strategies for affective disorders.

No significant relationships.

Pseudologia fantastica is a psychiatric phenomenon that occurs equally in men and women (1). The condition was first described in 1891 and contains fantasized events (2). Most of the time the fantasized events are not entirely unbelievable. They are based upon blurred fantasy and reality and are stable over time (1,3).

We present a case of possible pseudologia fantastica to raise awareness about this phenomenon and possible treatment.

A literature search in English was performed using Pubmed with the following MeSh terms ‘pseudologia fantastica’.

We present a 20-year old women diagnosed with an intellectual disability (IQ=80) and a post traumatic stress disorder. She received treatment in an outpatient setting for a couple of years. The patient was treated by EMDR therapy and individual therapy sessions. She rejected other forms of therapy or any medication. During the treatment her symptoms were getting worse. The symptoms contained an increase of nightmares and moments of dissociation. The patient was telling she wasn’t able to eat, sleep and function on a daily basis. In individual sessions she reported life-events which worsened over time including; being a victim of rape, seeing her rapist in the subway, being touched and chased by a stranger on her bicycle. Literature search shows that confrontation is one of the treatment methods for this phenomenom.

The treatment of a patient with pseudologia fantastica requires attention for details and acknowledging the possibility of fantasized events, confronting techniques and maintaining an alliance between patient and therapist (2,4).

No significant relationships.

Mixed depressive states portend greater rates of impulsivity, attempted suicide, treatment resistance, and poorer outcome than non-mixed forms of depression. The neurocognitive bases of such affective states have not been defined yet.

This work represents an attempt to clarify the neuropsychology underlying mixed depressive states.

Thirty subjects with affective disorders with mixed depression (MxD), 54 subjects with non-mixed depression (nonMxD), 73 euthymic subjects (Eu) and 93 healthy comparisons (HC) underwent a neurocognitive battery including the Trail-Making Test (TMT), the Controlled Word Fluency Test (WFT) and the Semantic Fluency Test (SFT), the Wisconsin Card Sorting Test (WCST, the Rey Auditory Verbal Learning Test RAVLT, the Rey-Osterrieth Complex Figure Test ROCFT, the Raven’s Progressive Matrices (RPM), and the Interference Component of the Stroop Test (ST). Between-group differences were performed through multiple one-way analyses of variance. Post-hoc analyses were performed using Tukey post-hoc tests.

HC performed better than the three patient groups in all the aforementioned neurocognitive tests. Eu performed better in RPM, TMT, SFT than nonMxD, and better on ST WCST than both nonMxD and MxD. MxD showed better performances in RPM, TMT-A, WCST than nonMxD, and more errors and less reaction times in the ST than nonMxD.

Mixed depressive states are characterized by enhanced attentional resources and greater set shifting abilities than non-mixed depressive states. On the other hand, they have less cognitive control than non-mixed depression. Such findings might explain some typical features observed in subjects with mixed depression, such impulsivity, suicidality, emotional reactivity and behavioral dyscontrol.

No significant relationships.

Psychosomatic illnesses correspond to physical symptoms (with or without objectivable organic lesions), that psychological factors such as stress and personality type, would have a potential effect on their appearance, evolution and / or worsening. These psychosomatic conditions are quite common but difficult to diagnose. Doctors from different specialties are consulted by the patients and multiple examinations and investigations are run by specialists in order to get to the final diagnosis. These psychosomatic conditions may appear under different types of illnesses : respiratory (asthma), dermatological (psoriasis, eczema), digestive (gastric ulcer, ulcerative colitis, Crohn’s disease), cardiovascular (arterial hypertension, infarction), neurological (migraine)…

Study management modalities of psychosomatic disorders through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

From the results observed in the patients recruited in this study, we retain the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social ; we also retain the essential role of the psychiatrist in the management of these psychosomatic disorders, both in preventive and curative terms, by allowing a better understanding of the interactions between physical and mental health.

psychosomatic conditions are quite common but difficult to diagnose and the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social is crucial.

No significant relationships.

The concept of motivation pervades our professional and personal lives. Motivation is almost impossible to be observed directly, it is a construct for the interpretation of a behaviour that “calls the attention”.

This work reviews the current available data on the phenomenological description of motivation and the abnormalities of motivation.

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “motivation”, “psychopathology”, “phenomenology”.

Abnormalities in motivation may involve diminution or exacerbation. Anhedonia is the absence of pleasure in relation to usually pleasurable activities, it occurs in depression and schizophrenia where the pleasurable intrinsic motivation that acts as incentive for behaviour may be lost. In mania it may be increased so that mundane activities become unduly fascinating and rewarding.

Countless theories have been proposed to explain human motivation but each sheds light on specific aspects of motivation, neglecting others. This diversity creates confusion because most theories have areas of conceptual overlap and disagreement. To facilitate the development of studies, an agreement should be achieved on an operational definition of motivation.

No significant relationships.

Obsessive-Compulsive Disorder (OCD) was recently (in 2015) associated with suicidal risk, regardless of depression or other mental disorders, but it is a disorder with great heterogeneity, and the subtypes involved in this risk have not yet been clarified.

To verify which patterns of OCD symptoms are more associated with suicidal risk, other possible risk factors and better treatment options evidenced in the literature.

Literature review with predefined search criteria and keywords in electronic databases (Pubmed, Virtual Health Library and Cochrane) between 2015 and 2020. Identification, analysis, calculation and synthesis of the results were carried out in a descriptive and qualitative manner.

Twenty five articles were included. Obsessions of unacceptable thoughts pattern, perfectionism traits and alexithymia are important predictors of suicidal risk. Compulsions were not associated with suicide. Depression is the comorbidity with the greatest impact on suicidal ideation. Better socioeconomic status, education, and female gender are protective factors for mortality. The method chosen for attempts is preferably non-violent (drug intoxication). Treatments derived from cognitive behavioral therapy are currently being investigated further, and in addition to the evidence for the use of selective serotonin reuptake inhibitors, antipsychotics have been used as an adjuvant.

Unacceptable thoughts play an important role in suicide resulting from OCD, and the absence of compulsive behavior may be correlated to suicide risk. Treatment directed at cognitions seems relevant. Further studies are needed to clarify the appropriate approach in this subtype of the disease.

No significant relationships.

Lurasidone is an atypical antipsychotic used in the treatment of schizophrenia and bipolar depression. Both indications are approved by the FDA nowadays, whereas in Europe it is only approved for schizophrenia. Lurasidone has been barely studied for the treatment of acute mania, nonetheless it is sometimes used off-label.

A case of a patient with a manic episode treated with lurasidone is presented, in order to provide further evidence on this topic.

The patient is a 43 year-old-woman with diagnosis of type I bipolar disorder, personality disorder and borderline intellectual functioning, resident in our Hospital’s long-stay psychiatric rehabilitation unit. She was previously under treatment with venlafaxine 75 mg/day, valproate 1500 mg/day and levomepromazine 25 mg on demand; remaining stable for months. The patient presented an episode consisting on agitation, irritability, verbiage, tachyphase, verbal aggressiveness and behavioral disturbances. Psysical restraint was needed for one day long and zuclopenthixol acetate 50 mg IM was administered twice within 5 days for the acute agitation. Venlafaxine was immediately withdrawn and lurasidone was progressively introduced up to 111 mg daily.

Approximately 3 weeks after the treatment adjustment, the patient reached the psychopatological stabilty.

Antidepressive withdrawal and introduction of Lurasidone were effective to treat the acute manic episode in this patient. It has been previosuly suggested that lurasidone caused improvement in emergent manic symptoms in patients with bipolar depression, and in subsyndromal hypomanic symptoms in patients with mixed features of depression. However, no studies have been made yet to evaluate the efficacy of lurasidone in acute mania.

I received financing from Angelini Pharma, Casen Recordati, Janssen, Exeltis and Otsuka.

Nitrous oxide (NO), also known as “laughing gas” is a colorless gas used as an anesthetic, a propellant in some foods, an engine performance enhancer and a recreational drug. When inhaled, it is known to provoke a rapid feeling of euphoria or excitement for a short period of time, dissociative phenomena and sometimes laughter. As its fellow anesthetic agent and NMDA-receptor antagonist, ketamine, NO is being studied for its possible therapeutic profile in treatment resistant major depression (TRMD).

TRMD is a serious illness, that urges for effective alternative treatments. In that regard, we explored the recent studies conducted in these patients, using NO in different dosages when compared to placebo.

The authors revised the published literature about this topic, selecting relevant articles with the topic words: “Depression”, “Treatment Resistant Major Depression” and “Nitrous Oxide” in scientific data base.

Since 2018, at least two randomized clinical trials have demonstrated that NO has considerable antidepressant effects in TRMD, when compared to placebo. Investigators noted that these positive effects where maintained at least for two weeks after a single 1-hour inhalation. In a more recent study, scientists compared different NO concentrations (25% vs. 50%) concluding that the 25% concentration had similar efficacy with a lower risk of adverse effects.

There appears to be encouraging results when treating patients with TRMD with NO in a 25% concentration. Nonetheless, there is need for further investigation, namely through studies that compare NO with other valid TRMD treatments and not only versus placebo.

No significant relationships.

The COVID-19 pandemic poses a threat particularly to the elderly. Although the current vaccination strategy is recognized as an adequate measure to reduce mortality, it still raises concerns about its efficacy and safety.

Assessment of worries and attitudes among Tunisian elderly towards the pandemic.

A descriptive cross-sectional study on a sample of 50 consultants in a geriatric service, aged between 65 years and over. A questionnaire was formulated based on the recommendations of WHO and INEAS.

The average age of our population is 74.6 years. The participants were mainly female, retired (76%) and with low educational attainment. Most of the elderly reported that they respected the wearing of the mask in public (90%) and washing their hands regularly (92%). Social distancing was respected by only 44% of the participants. Concerning the vaccine registration, we noted that 48% of the subjects expressed their willingness to register on the Evax.tn platform. On the other hand, 15 people expressed their refusal to receive the anti-Covid vaccine. We noted that only 22% had a dose of the Covid-19 vaccine. Only 4% of the respondents did not have concerns about new variants of the virus. About half (52%) of the subjects expressed significant concern about an increased risk of virulence and mortality due to the new variant. Vaccination was considered ineffective by most of the participants (70%).

Addressing worries about vaccine would be an important step to accept it among Tunisian elderly. Adequate information strategy is essential to change attitudes during the pandemic.

No significant relationships.

This study was founded by Janssen Pharmaceutical Companies of Johnsson and Johnsson. I, as scientific advisor/consultant have received honoraria as I have participated in conceptualization, investigation, validation and writing this lecture.

The diagnosis of leukemia in a child is traumatic life experience that negatively affects parents and especialy the mother which is the “caregiver” who assists and coordinates all stages of treatment.

To determine the prevalence of psychological distress among mothers of tunisian children with leukemia and to investigate their coping strategies.

A cross-sectional study was conducted at Aziza Othmana hospital department of pedo-oncology in Tunisia between June and July 2021. HADS scale was used to estimate the prevalence of anxiety and depression and coping strategies were measured via arabic version of the brief cope scale.

We included 31 mothers, their middle age was 41 years old. In this study we didn’t include mothers with psychiatric history. Acute lymphoblastic leukemia was the most frequent type of cancer in our sample (94%). The middle age of the children was 10 years old and all of them were under chemotherapy. Clinically significant levels of anxiety and depression were reported by 58% and 49% of mothers, respectively. In our study, 81% of the participants practiced prayer and all mothers turned to religion as a coping strategy. Approach coping styles (especially acceptance and planning) were more frequently used than avoidant coping styles (especially substance use and denial).

Mothers are profoundly affected by a child’s cancer diagnosis, they should have early assessment of their mental health needs to have access to appropriate interventions.

No significant relationships.

Structured clinical interviews are the gold standard for assessing mental health. However limited resources may allow the use of only self-report questionnaires. In the context of emergency, such as terrorist attacks, the performance and thresholds of such tools still unclear.

We investigated the performance of the Posttraumatic stress disorder CheckList Scale (PCL-S) and of the Hospital Anxiety and Depression scale (HADS), both compared to the MINI Interview, among civilians and first responders involved in terrorist attacks.

The data came from the IMPACTS survey which was conducted from 6-10 months among civilians (N=190) and first responders (N=232) after the January 2015 terrorist attacks in the Paris Region, France. Sensitivity and specificity of the PCL-S and HADS were estimated by the ROC curve, and the optimal threshold was defined using the Youden index.

Regarding the PCL-S: for civilians and first responders respectively, the overall AUC was 0.947 and 0.899, and the optimal threshold were 38.5 and 39.5. Regarding the HADS-D: for civilians and first responders respectively, the overall AUC was 0.908 and 0.617 and the optimal thresholds were 7.5 and 1.5. For the HADS-A for civilians and first responders respectively, the overall AUC was 0.823 and 0.717, the optimal threshold were 9.5 and 6.5.

In the context of a terrorist attack, compared to the MINI, our study underlined satisfactory performance of the PCL-S and the HADS-D in screening for PTSD and depression respectively, while the screening of anxiety using the HADS-A was unsatisfactory.

No significant relationships.

Cancer and its treatments have been shown to have a negative psychological effect on many cancer patients. One of these effects is often described as body image disturbance.

To assess body image in cancer patients and its association with clinical variables.

This was a cross-sectional study, conducted over 1 month, involving 100 cancer patients followed in the oncology department at the Habib Bourguiba University Hospital in Sfax (Tunisia). All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction.

These results showed that half of the patients were female, and 70% of them were married. Their mean age was 51.96 years with extremes ranging from 41 to 60 years. Their level of education did not exceed primary school in 61% of cases, and 68% of them were unemployed. A total of 58% of patients received chemotherapy and 44%, 25%, and 11% of persons were affected by breast, digestive and cavum cancer, respectively. Impaired body image was noted in 81% of cases with an average BIS score of 15.39. An altered body image was statistically correlated with female sex (p = 0.005), absence of professional activity (p = 0.032), and the presence of anxiety-depressive symptoms (p = 0.008).

In this study most of the cancer patients had body image disturbances. Therefore, it is to the health team and nurses that take the concept of body image more serious and make use of some interventions to minimize the possible side effects.

No significant relationships.

It is known that early withdrawal can lead to a worsening of mental health. This is particularly relevant for depressive patients with clinical high-risk for psychosis (CHR) for whom the recommended duration of treatment has not been established.

Analyze the actual treatment duration of depressive patients at CHR after their discharge from hospital and compare it with the group of depressive patients without CHR.

A comparative study of 124 depressive patients with CHR and 27 depressive patients without CHR was conducted within a year after discharge from hospital to assess the therapy duration and treatment compliance.

Within a year after discharge only 12.1% depressive patients with CHR and 29.6% ones without CHR continued to receive the therapy. The average duration of treatment after discharge was 7.4 months in the first group and 11.7 months in the second group. The majority of patients stopped treatment for the following reasons (in descending order of importance): lack of awareness of their mental condition (51.9% vs 40.3%), side effects (38.7% vs 11.1%), and negative attitudes towards the treatment on the part of patients’ immediate family members (8.9% vs 7.4%).

It has been found out that depressive patients with CHR are less likely to follow medical prescriptions than ones without CHR, they are more likely to have the lack of awareness of their mental condition, they are more likely to have side effects of the therapy. These findings require the development of a universal approach to the treatment of such patients after discharge from hospital.

No significant relationships.

Adrenal insufficiency is a rare medical condition which can occur in children. Parents, being the primary support and support for the child, are generally involved in the care of their sick child.

To estimate the prevalence of anxiety symptoms and associated factors in parents of children with adrenal insufficiency.

This is an analytical cross-sectional case-control study over a period of 4 months in 2019, carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital. We used an anonymous questionnaire that included a socio-demographic fact sheet and the Hamilton anxiety scale for exploring anxiety symptoms.

A total of 38 parents of children with Adrenal insufficiency and 38 control parents participated in the study. The current age of the child was between 1 and 16 years old with an average of 9.1 and standard deviation of 4.22 For the assessment of anxiety, 55.3% of the parents had a score greater than 20 attesting to the presence of an anxiety symptomatology. In addition, only 26.3% of control parents presented anxious symptoms. There is a significant difference between the two populations (p = 0.010 OR = 3.459). Anxiety was associated with having a child with SI (OR=3.4), female gender (OR=4.2), unemployment (OR=6.33), and low socioeconomic status.

Parents have a considerable burden in the care and management of their child with a chronic illness, which takes time and a lot of patience. Detecting anxiety symptoms in this population will help them manage it.

No significant relationships.

No significant relationships.

Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder.

We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.

The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.

Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.

Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

No significant relationships.

Female gender is associated with a lower risk for aggressive behaviour and violent offending. Well established risk factors for aggressive behaviour are alcohol and other substance use, but previous studies focused mainly on male offenders and the general population. However, for therapeutic and prognostic reasons it is important to understand pathways to female offending.

To examine a sample of female forensic-psychiatric inpatients regarding the association of alcohol (AUD) and other substance use disorders (SUD) with violent offending (homicide, assault, robbery).

We conducted a retrospective cohort study of 334 female patients discharged before 01.01.2019 from a secure psychiatric hospital in Germany.

In total, 72% of the patients with AUD committed a violent crime, leading to admission to secure psychiatric treatment. In comparison a statistically significant lower rate (19%) of the SUD group was convicted of violent offending. Over 70% of the participants with AUD had a family history of AUD, and over 83% experienced physical violence in adulthood. We found no group differences (AUD vs. SUD) regarding aggressive behaviour during inpatient treatment.

According to our results, AUD compared to other SUD, is a significant risk factor for violent offending in women. A family background with AUD and a history of physical abuse might function as a risk factor for both: developing an AUD and violent offending. The comparable rates of aggression in both groups during inpatient treatment suggest that abstinence is a protective factor.

No significant relationships.