Catatonia is one of the most common severe motor syndromes, with an estimated prevalence among psychiatric inpatients of about 15 %. Benzodiazepines and electroconvulsive therapy (ECT) are the most widely studied treatment methods recommended as first-line therapy. We present the case of a 55-year-old female patient with paranoid schizophrenia and severe life-threatening catatonia who remitted under a short series of rTMS.

s. Introduction

The point of resting motor threshold (RMT) for the musculus rectus femoris was determined for the left hemisphere. A straight line 3 cm anterior and parasagittal from that point defined the SMA. A total of three sessions, each with 1000 pulses at intensity 66 % of the RMT, were performed within 24 and 120 hours apart. Stimulation protocol was set to 1Hz in the area of the left SMA with 25 series of 40 pulses, pulse width 25 ms, angle of attack 45°. Hardware: MagVenture, 8-coil “cool-B65 butterfly-shaped coil from Medtronic.

Within 24 hours after the first session, a marked improvement of catatonic symptoms like independent locomotion and verbal communication was recognized. One week after the whole rTMS treatment, a food intake without a gastric tube was possible.

The present case demonstrates that pronounced catatonia may be successfully treated with inhibitory rTMS. Our results underline the importance of non-invasive brain stimulation as a valuable addition to the existing treatment spectrum for catatonia. Future research is empowered to path the way for a significant expansion of treatment.

No significant relationships.

Metabolic side effects of psychotropic medications are a major drawback to patients’ effective treatment. Among the mechanisms underlying their development, DNA methylation may be involved.

The aim of this study was to estimate DNA methylation changes occurring secondary to psychotropic treatment and evaluate associations between 1-month metabolic changes and baseline DNA methylation or 1-month DNA methylation changes, using an epigenome-wide approach.

Seventy-nine psychiatric patients recruited as part of PsyMetab study, who started a treatment with either an antipsychotic, a mood stabilizer or mirtazapine were selected. Epigenome-wide DNA methylation was measured using the Illumina Methylation EPIC BeadChip at baseline and after one month of treatment.

A global methylation increase was observed after 1 month of treatment, which was more pronounced in patients whose weight remained stable (i.e., <2.5% weight increase). Epigenome-wide significant methylation changes were observed at 52 loci in the whole cohort and at one site, namely cg12209987, located in an intergenic region within an enhancer, specifically in patients who underwent important early weight gain (i.e., ≥5% weight increase) during the same period of treatment (p<5*10-8). Multivariable analysis confirmed an association between an increase in methylation at this locus and weight gain in the whole cohort (p=0.004). Epigenome-wide association analyses failed to identify any significant link between other metabolic changes (e.g. glucose or lipid levels) and methylation data.

These findings give new insight into the mechanisms of psychotropic drug-induced weight gain. With improved understanding of the metabolic side effects, the use of precision medicine with epigenetics may become possible

No significant relationships.

Bipolar disorder (BD) is a mental illness marked by extreme swings in the mood, energy, and thinking. Although it’s not an official symptom of the disease, some research suggests that it also may affect the empathy.

To investigate empathic responding in patients with BD in euthymic state of illness and to determine associated factors.

A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”.

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. 78.2% of patients had a good adherence to treatment. 60.3% of them had residual depressive symptoms during eutymia. QCAE total score was 72.49. (Maximum possible score 124) Cognitive empathy score was 43.21. (Maximum possible score 76) Affective empathy score was 29.36. (Maximum possible score 48) Affective empathy was associated with female gender (p=0), good adherence to treatment (p=0.01) and residual depressive symptoms (p=0.001).

Our study shows that bipolar patients have fairly good levels of empathy. However, in order to better substantiate empathy in BD, comparative studies seem necessary.

No significant relationships.

Histamine intolerance (HI) is a disorder associated with an impairment of ability to metabolize ingested histamine. The incidence of HI in general population is 1-3%. Clinical manifestation of HI contains nonspecific predominantly gastrointestinal, but also extraintestinal symptoms. HI could be primary with genetic predisposition, or secondary with lower activity of diaminooxidase (DAO) without positive genetic screening.

This study aims to evaluate the prevalence of HI by patients with anxiety disorders. HI can imitate anxiety symptoms, therefore we predict higher prevalence HI in patients with anxiety disorders than in general population.

It is observational cross-sectional study on cohort of anxious patients for detecting the prevalence of HI. Patients were screened by scale for histamine intolerance questionnaire. Patients with positive questionnaire were examined for serum DAO and genetically examined.

113 patients fulfilled the HI questionnaire. From this cohort 35.4% (40 subjects) were positive at screening. Biomarkers of HI were screened only in case of positivity in this questionnaire. Table No. 1: Results of our study from cohort with positive screening, 35.4 % (40 subjects).

This pilot study shows that the prevalence of HI could be higher in group of patients with anxiety disorders than in general population. For further confirmation other studies with control group and larger cohort should be done.

No significant relationships.

Immune mediated inflammatory processes are involved in the aetiopathogenesis of bipolar disorder (BD) and weight associated comorbidities. Tryptophan breakdown via indoleamine 2,3-dioxygenase-1 (IDO-1) along the kynurenine axis concomitant with a pro-inflammatory state was found more active in BD but also associated with overweight/obesity.

Aims of our study were to investigate 1.) the tryptophan metabolism in BD compared to mentally healthy controls, 2.) differences in weight classes, 3.) in a longitudinal setting, dependent on the incidence of BD episodes and euthymia.

At the Medical University Graz anthropometric and clinical data as well as peripheral tryptophan and kynurenine were assessed in serum samples of 226 individuals with BD and 142 controls. For 75 individuals with BD a longitudinal assessment with three samples was performed. Serum concentrations of tryptophan and kynurenine were determined by reverse-phase high-performance liquid chromatography. The kynurenine/tryptophan was used as a proxy for IDO-1 activity.

showed a higher kynurenine/tryptophan ratio in BD compared to controls and in overweight compared to normal weight persons. Levels remained stable over time. In the longitudinal course, no differences were found between individuals who were constantly euthymic or not as well who had an illness episode or none.

Findings indicate that IDO-1 activity might constitute more a trait and not a state marker of BD. Accelerated tryptophan breakdown along the kynurenine axis may be further facilitated by overweight. This may increase the risk of accumulation of neurotoxic metabolites which impacts BD symptomatology, cognition, and somatic comorbidities.

No significant relationships.

No significant relationships.

We present the case of a 48-year-old female patient diagnosed with schizoaffective disorder whose father passed away recently. The patient was facing an appalling mourning which was expressed in the form of behavior disorder and positive psychotic symptoms. Mourning is a natural reaction to the loss of a loved one which involves an internal world transformation, affecting both images of the self and the perceived environment.

To analyse the guidelines for mourning approach in chronic psychotic patients.

A case report is presented alongside a review of the relevant literature regarding mourning in patients with chronic psychotic conditions.

Accepting the loss, working through disruptive emotions, adjusting to a world without the deceased and finding an enduring connection with the loved one are the four tasks of mourning described by Worden. In our case, the patient was immersed in the first two tasks. Difficulties in accepting the loss, tolerating harmful emotions and establishing new affective links were observed, as well as massive projection of unbearable emotions such as sadness, anger, fear and guilt. The available literature identifies these idiosyncrasies as common in the grief processing in patients with chronic psychotic disorders.

In patients with psychosis, difficulties in symbolization, emotional processing and social bonding could have repercussions in the development of grief. However, these features do not imply a pathologic mourning. Tolerating mourning as a normal reaction in psychotic patients is needed, even if the patient expresses non-typical symptoms such as acute psychosis symptoms, hallucinations or behavior disorder.

No significant relationships.

Previous studies have shown elevated levels of depressive symptoms in parents of children with ASD. However, few studies have assessed depressive symptoms in neurotypical ASD-siblings and most have done so, within a broad age range, while studies focusing on a certain developmental stage (middle childhood in particular) using a self-report depression-specific assessment tool are sparse.

This study aimed to investigate the depressive symptoms of Greek school-age neurotypical siblings of individuals with an Autism Spectrum Disorder through a self-reported questionnaire.

The sample included 85 school-age neurotypical ASD-siblings (8-13 years old). The Children’s Depression Inventory (CDI) and a demographics questionnaire were administered to all participants.

Results showed that a considerable percentage of the sample (15.3%) scored twice as high as the mean score. ASD-siblings in the present study scored higher (mean total score in CDI was 7.24±6.27) than children of similar age and nationality. Further, 5.9% of the siblings in the present study exhibited severe depressive symptoms (using 19 as a threshold) whereas 12.9% of ASD-siblings scored above 15 and therefore should be further evaluated by mental health services.

The results of the present study documents a relatively high prevalence of depressive symptoms in neurotypical siblings of individuals with ASD. ASD-siblings showed higher levels of depressive symptoms compared to normative data. This is the first study addressing depressive symptoms in siblings of autistic children conducted in the Greek cultural context. The present study highlights the need for the development and implementation of appropriate and effective interventions within the Greek healthcare system for ASD-siblings.

No significant relationships.

Peer Support Work can be an effective way to support patients and their participation also in psychiatric populations. Unlike in general psychiatry there is less experience with peer support work in forensic mental health inpatient settings. Characteristics different from general psychiatry, e.g., regarding safety, might be a reason for the delay of their implementation.

We aim to present the implementation of a peer support worker in a forensic mental health setting for addicted offenders. We address reservations of staff before the implementation and their development during the first year. The perspective of patients about their experiences is taken into consideration. The development of the peer support workers position and tasks is demonstrated.

Focus groups and interviews were conducted with several groups of people, amongst them employees of several professions, patients and the peer support worker of the clinic. Interviews and focus groups were recorded and transcribed for thematic analysis.

Reservations of staff comparable to these found in general psychiatry occurred in the forensic mental health professionals. These could be diminished during the first year. Most of the patients were able to accept and trust the peer support worker, in some cases after initial mistrust. The peer support worker felt accepted in the team and was able to develop a routine as well as own tasks.

The experiences from one year testified that implementation of peer support work into a forensic mental health inpatient setting is possible. Further patient outcomes are to be explored but the current results are promising.

No significant relationships.

Previously, we conducted a statistical case-control study of adolescent Hikikomori patients in Japan using the Parental Assessment of Psychological, Behavioral and Environment Scales. That study did not reveal any pathologies specific to Hikikomori patients. On the other hand, environmental factors such as “lack of communication between parents” and “overuse of the Internet” were shown to be significant predictors of Hikikomori severity.

In this study, using the same methodology as our previous study in Japan, we conducted a case-control study in France. The following questions were examined : (1) whether the pathology of Hikikomori patients in Japan and France is the same, and (2) whether the environmental factors associated with the severity of Hikikomori are the same in Japan and France.

Using CBCL and our original scales, we descriptive-statistically compared clinical and subclinical psycho-behavioral characteristics of adolescent Hikikomori patients and a control group. In addition, environmental factors that make Hikikomori more severe were clarified by multiple regression analysis.

The results showed that there was no difference in the pathology of Hikikomori between Japan and France. On the other hand, the statistical predictors of Hikikomori severity were “lack of communication between parents and children” and “Lack of communication with the community,” which differed from those in Japan.

Although it is safe to assume that Japanese and French Hikikomori’s pathology is generally the same, different strategies may be needed to prevent the onset of Hikikomori and to stop it from becoming severe.

No significant relationships.

Animal studies have shown that the simultaneous blockade of α1b-noradrenergic receptors and 5HT2A-serotonergic receptors strongly decreases alcohol intake. In addition, recent clinical studies have indicated that the selective α1b antagonist prazosin could be effective on alcohol use reduction in alcohol-dependent subjects.

Cocktail is a double-blind, randomised, parallel-group, three-arm, multicentre, placebo-controlled phase 2 proof-of-concept study aiming at demonstrating the superiority of a 12-week treatment with the KT110 combination of cyproheptadine (8 mg/day or 12 mg/day) and prazosin (5 mg/day or 10 mg/day) over placebo on the reduction of total alcohol consumption.

The study two main inclusion criteria are a DSM5 diagnosis of severe alcohol use disorder and a WHO high-risk drinking risk level. The primary endpoint is the change from baseline (4 weeks preceding randomization) to the end of treatment (Weeks 9-12) in the mean quantity of alcohol consumed per day in the three groups. Daily alcohol consumption is determined using the Timeline Follow Back, automatically be filled in on the basis electronic patient reported outcomes platform. The 12-week treatment period is followed by a 4-week post-treatment follow-up.

One hundred and eighty patients are planned to be randomized 1:1:1 into the two treatment groups. Enrollment of patients started in November 2019, and will end in July 2021.

In this communication, we will present the rationale for the development of the KT110 combination of cypropheptadine and prazosin for the treatment of alcohol use disorders, as well as the main features of the Coctkail study. ClinicalTrials.gov identifier: NCT04108104.

Member of advisory boards, DSMB, or steering committees, speaker honoraria or consultancy for Bioprojet, D&A Pharma Ethypharm, and Kinnov Pharmaceuticals, Lundbeck, and Pfizer D&A Pharma, Ethypharm, Kinnov Pharmaceuticals, Lundbeck, and Pfizer.

No significant relationships.

Schizophrenia is heterogeneous in terms of symptoms and outcome, but neurobiology of this heterogeneity is not well-studied. Local correlation analysis of fMRI data provides a measure of local coherence, i.e., average correlation between BOLD-signal in a voxel and its neighbours. Local correlation is a promising approach, and it seems important to find links between local brain coherence and schizophrenia outcome.

We aimed to compare brain local coherence between schizophrenia patients with varied long-term outcomes and healthy controls (HC).

Patients with chronic schizophrenia spectrum disorders (37 males, mean age 41.5±5.5) and HC (17 males, mean age 38±7.7) underwent resting-state fMRI (3T). Cluster analysis based on PANSS and PSP allowed us to allocate patients into two subgroups (N = 13/24). The second subgroup had significantly more marked negative and general psychopathology symptoms and worse functioning than the first subgroup. Local coherence in the brain was compared between clinical subgroups and HC (ANOVA, p<.001 voxelwise, p[FDR]<.05 clusterwise).

Local coherence in the paracingulate gyri bilaterally ({-2; 58; 14}; 2712 mm3) differentiated the groups. Post hoc analysis revealed decreased local coherence in the subgroup with poorer outcome compared to HC, along with the absence of differences between the subgroup with better outcome and HC. There were no differences between clinical subgroups.

Hypoactivity of the cingulate cortex is related to negative symptoms (Bersani et al., 2014). Their severity, in turn, is strongly associated with outcome. Thus, local coherence in the cingulate cortex may be one of the factors which underlie outcome heterogeneity.

No significant relationships.

The use of coercive measures in Medicine represents a controversial issue. Even when they comply with all rules and procedures and are enacted with the intention to address the health needs of the patient, and/or protect the patient and/or others, they always represent an infringement of fundamental personal rights and require strong ethical justification.

In Psychiatry the debate around coercive measures has led to a theoretical impasse, as the attempt to solve an ethical dilemma may expose mental health care to other ethical challenges and questions of competing rights. At the same time, the ongoing debate has contributed to raise the awareness that coercive practices are over-used, and mental health care is in need of a profound transformation towards recovery-oriented systems of care.

The implementation and dissemination of alternatives to coercive practices is an essential component of such transformation. Relevant research has provided tools and documented successful practices, and initiatives aimed at making these resources available and adapted to different contexts are being promoted by international organizations, professional associations and associations of users and carers.1

The profound transformation of current mental health care towards recovery-oriented systems of care requires resources and shared goals among the different stakeholders. Integrated and personalised care pathways, respect of human rights, shared decision making, and involvement of users and carers are essential components of this transformation.

No significant relationships.

The inconsistency of the available empirical data on personal and situational predictors of effective coping allows us to make an assumption about the presence of mediating variables. Their search can be centered both on the inclusion of parameters of a higher socio-cognitive level in the analysis, and on the procedural characteristics of coping, one of which is proactivity in coping. The construct of mindfulness satisfies both of these requirements.

The purpose of this study was to identify cross-cultural differences in the relationship between proactive coping strategies and the level of mindfulness

Five Facet Mindfulness Questionnaire (“eastern” awareness), Scale of Mindfulness (“western” awareness), Proactive Coping Invertory. The sample was N = 452 (residents of Russia and Uzbekistan, age 18-25)

For Russians and Uzbeks, the indicators of “western” awareness are associated with the attitude to potential difficulties as a source of positive experience and with reflection in case of their occurrence of possible behaviors, cognitive assessment of their own resources and prediction of results, as well as with such a proactivity strategy as the search for instrumental support. Intercultural differences were noted in terms of “eastern” awareness: for Uzbeks, they are associated with a proactive coping strategy, and for Russians – with reflexive coping.

Mindfulness has the potential of meta-cognitive function in a situation of assessing possible life difficulties and choosing proactive coping strategies.

No significant relationships.

The COVID-MENTA Screening Program was developed to monitor the mental health of frontline healthcare professionals and identify those at high risk for suicide at the Kiskunhalas Mobile Disease Control Hospital.

Our post hoc analysis aimed to investigate the association between psychological distress and suicide ideation based on passively collected data during the screening work.

A sample of 50 healthcare professionals was analyzed from 167 participants in the COVID-MENTA Screening Program between the second and third waves of the COVID-19 pandemic. Data collection was performed during the breaks of healthcare professionals at work. Half of the group (N=25) perceived severe distress (scored > 5/10 on Distress Thermometer). The crisis monitoring application was based on Klonsky and May’s 3-step theory (2015) and was built by adapting the questions on the appropriate international scales (Psychache Scale, Beck’s Hopelessness Scale, Interpersonal Needs Questionnaire, Suicide Capacity Scale). The tool can stratify the current suicide risk into seven levels.

Spearman’s Rank Correlation was used for statistical analysis. There was a significant positive correlation between the psychological distress and the suicide risk (r (48) = 0,43, p < 0,01).

Our findings supported the hypothesis of the study that the risk of suicide rises with the increase of the level of distress. The application has been proved effective in ecological conditions, helping in several cases to screen individuals currently at increased risk for suicide, allowing us to intervene in a timely and effective manner.

No significant relationships.

Mental health professionals’ derogatory attitudes towards patients diagnosed with borderline personality disorder (BPD) may negatively affect treatment outcomes.

We aimed to identify a) negative attitudes exhibited by mental health professionals towards BPD patients and b) the effects of disgust propensity and disgust sensitivity on theses negative attitudes.

Mental health professionals (N = 136) completed questionnaires on attitudes towards BPD patients, disgust propensity/sensitivity, and sociodemographic variables.

Significant differences in negative attitudes toward BPD patients based on gender, marital status, occupational subgroup, educational level, psychotherapy training, level of exposure to BPD patients, and political ideology were found. Results suggested BPD patients are viewed by mental health professionals as ineffective, incomprehensible, dangerous, unworthy, immoral, undesirable to be with, and dissimilar to the mental health professionals. Moreover, disgust propensity and the pathogen component of disgust sensitivity were associated with stronger negative attitudes towards BPD patients.

The findings emphasize the importance of mental health professionals’ awareness of the emotion of disgust as a relevant factor to their negative attitudes towards BPD patients.

No significant relationships.

Darier-White disease (DD) is a rare genodermatosis of dominant autosomic inheritance characterized by the keratinization of epidermis, nails and mucous membrane. It leads to the formation of papules and brown hyperkeratotic plaques, mainly in seborrheic areas. The disease is associated with a mutation on the ATP2A2 gene, mapped in the 12q23-24 chromosome. There is known a relationship between DD and neuropsychiatric diseases, such as bipolar disorder, depression and schizophrenia.

To discuss the relationship between DD and neuropshychiatric disorders.

We report the case of a patient with diagnosed schizophrenia, alcohol and cannabis dependence who presented skin lesions.

The physical exploration of our patient revealed cutaneous lesions and we pointed the diagnostic towards DD. Afterwards, a cross-consultation was done with the dermatology experts. During the physical exploration, the patient shows confluent hyperkeratotic papules, dominant on the sides and center of back and hands, together with nail injuries (see images). The diagnostic was confirmed through anatomic pathology. The patient was treated with 10 mg/day of Acitretin together with emollients twice a day, which improved the patient clinical status and signs. The patient remained stable at a psychiatric standpoint. After 3 years of treatment, the patient keeps the same medication but with a reduced dose of 5 mg/day, with a 70% decrease of the initial hyperkeratotic lesions.

Previous studies concludes that mutations in the ATP2A2 gene, in addition to causing DD, confer susceptibility to neuropsychiatric features.These case report highlight the need for clinicians to asses and recognize neuropsychiatric symptoms in DD.

No significant relationships.

One of the main concepts of mental health promotion is proactivity, rather than reactivity. As psychiatrists we must be the first line of mental health advocacy and to do so we must share clear messages and take definitive actions.

Inventing a cause that raises mental health awareness in the society. Afterwards creating a page in the social media that uses common language and which represents the main concepts of mental health and also targets prevention and treatment of mental disorders. Taking part in sport events that have the potential to increase the social awareness and reaching national media in order to popularize the cause.

First came creation of a page in the social media. Afterwards came the preparation of video materials and e-posters on the following topics: mental health, stigma, myths and facts about mental disorders, early trauma, mental disorders. The materials were posted and “boosted”. All this was accompanied by numerous media events and interviews on national media. In order to garner more attention there were two participations in a 750km bike ultra marathons.

The complex approach of the cause „I ride with you” (Az Karam s teb) led to the establishment of a popular page in the social media. Within 1 year the page got 1500 followers. The page content was shared 733 times. There were 12 national media appearances. All these numbers represent a small but significant step in mental health promotion.

In order to promote healthy “mental environment” we must use diverse and contemporary approaches.

No significant relationships.

Age at onset of pediatric bipolar spectrum disorder (BSD) is an important marker of a more severe form and a highly heritable mood/mental disorder.

Here, we report a familial Tunisian BSD follow-up study showing a very early onset of the BSD at the neonatal period.

A 28-year-old female and her 30-year old sister were referred for genetic and psychological assessments due to recurrent depressive episodes.

Psychological assessment revealed a BSD type II with episodes of hypomania for both patients. The 30-year old sister presented a mixed form of BSD coupled with autistic traits, hyposomnia and obsessive-compulsive behaviors. Intellectual and cognitive abilities were without concerns. Familial history revealed BDS among paternal relatives including the brothers’ and sisters’ father as well as all their uncles offspring’s, and their grandparents, who were consanguineous. The depressive mood was a common sign in the three generations. Personal history revealed significant signs of a very early onset of the disorder since the neonatal period for the two sisters as well as for their four paternal cousins who also presented BSD features. Familial risk of BSD in this family correlates with a variably higher personal risk of other psychiatric disorders such as anxiety, drug abuse, personality disorders, and autism spectrum disorder.

Environmental conditions, familial care and educational level have a strong correlation with the severity and the efficiency of cognitive management of BSD and its psychiatric comorbidities. BSD is highly heterogeneous and polygenic and personalized management has considerable clinical repercussions benefits.

No significant relationships.