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.

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.

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.

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.

Catatonia is a state of apparent unresponsiveness to external stimuli in a person who is awake. More common in patients with unipolar major depression or bipolar disorder. Common signs: immobility, rigidity, mutism, posturing, excessive motor activity, stupor, negativism, staring, and echolalia. We will discuss a case of a 23 year old male with schizophrenia presented with catatonia and decompensation of his schizophrenia in the context of medication non-compliance. We will discuss findings from litrature pertaining to catatonia and treatment strategies.

- To discuss catatonia, its incidence in different psychiatric disorders. - To discuss literature pertaining to catatonia. - To discuss different treatment strategies

- Case study

- Signs of catatonia: immobility, mutism, withdrawal and refusal to eat, staring, negativism, posturing, rigidity, waxy flexibility/catalepsy, stereotypy, echolalia, or echopraxia, verbigeration. - Diagnosis: Clinical, Lorazepam challenge. Bush-Francis Catatonia Rating Scale (BFCRS) - BFCR scale is used as the screening tool. If 2 of the 14 are positive, prompts further evaluation and completion of the remaining 9 items. - Differential Diagnosis include; Neuroleptic Malignant Syndrome, Serotoninergic Syndrome, Malignant Hyperthermia, Akinetic Mutism, Delirium, Parkinson’s disease. - Lorazepam can be scheduled at interval doses until the catatonia resolves. - ECT in combination with benzodiazepines is used to treat malignant catatonia. - Possible complications are Physical trauma, malignant catatonia (autonomic instability, life-threatening), dehydration, pneumonia, pressure ulcers due to immobility, muscle contractions, DVT, PE

Psychiatrists need to be diligent in evaluating patients with Catatonia for other comorbid psychiatric conditions, addressing these conditions and conducting a thorough assessment and prompt treatment.

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.

No significant relationships.

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.

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.

Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a cost-effective solution in those circumstances in which the current mental health services and infrastructure are not able to properly accommodate the patients’ needs. However, mental health workforce is often poorly theoretical/practical trained in digital psychiatry and in delivering remote consultations safely and effectively, not being common to own curricula-specific training requirements in digital psychiatry and skills.

Our aim is evaluating the level of training, knowledge, experience and perception regarding the topic of digital psychiatry in a sample constituted by medical students, psychiatry trainees and early career psychiatrists from WHO South-East Asia and Western Pacific Regions (APAC).

A web-based international cross-sectional survey was carried out to specifically investigating digita psychiatry in APAC regions.

An overall lack of theoretical and/or practical training on new digital tools and digital health interventions in psychiatry has been observed. The level of training influences knowledge background, which, in turn, influences young professionals’ perceptions and opinions regarding digital psychiatry and interventions in mental health.

Implementing psychiatry training programs may significantly improve the level of knowledge and use of digital tools in mental healthcare. Moreover, mental health services and infrastructures should be properly adapted to the digital era, considering the overall weak and heterogeneous technical support and equipment, issues of internet connectivity and other administrative related challenges observed in APAC.

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.

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.

Being a victim of work-related upper extremity injuries is a source of physical damage and mental damages. Psychological distress related to this type of accident is usually underestimated.

Evaluate anxiety and depression among victims of work-related upper extremity injuries.

We conducted a 10-month cross-sectional analysis on workers consulting for an Impairment Rating Evaluation after an upper extremity injury due to an occupational accident. We collected socio-professional data, characteristics and outcomes of the accident. Anxiety and depression were evaluated by the Hospital Anxiety and Depression scale. The pain was evaluated by a Visual Analogue Scale.

Our population consisted of 90 cases of work-related upper-extremity injuries. The mean age was 43.10 and the sex ratio 3.7. The most represented category was blue-collar workers (71.1%). Medical history of chronic diseases was reported in 23% of cases and 3.3 % had mental health antecedent. Dominant upper limb injuries were found in 62% of cases. Hand and wrist injuries were the most affected part (63%), and 33.3% had fingers’ injuries. The prevalence of anxiety and depression were 31.1% and 20% respectively. About thirty-one per cent rated their current pain greater than or equal to 8. Both anxiety and depression were positively correlated with male gender (p= 0.001, p=0.007) and shoulder injuries (p=0.001, p=0.018). Depression was correlated to fingers’ injuries and pain (p=0.002).

The studied population present an important rate of anxiety and depression. Assessing Mental health after upper extremities injuries are necessary to prevent serious mental illness and to promote a successful return to work.

No significant relationships.

Mood disorders are common psychiatric illnesses with major disability and mortality and it is estimated that 8% to 20% of the population experience a depressive episode at some point in their lives.

To find out the prevalence of cognitive impairment among patients with Mood Disorders i.e, Major Depressive Disorder (MDD) and Bipolar Mood Disorder (BMD), etc. and to find out the status of cognitive impairment with clinical variables of Mood Disorders.

This was a descriptive cross-sectional study conducted among the patients attending both the inpatient and outpatient departments of the National Institute of Mental Health, Dhaka. The duration of the study was fourteen months starting from July 2011 to September 2012. A total of one hundred and thirty-three (n=133) patients who fulfilled the inclusion-exclusion criteria were selected.

The mean age of onset of mood disorder was 30.1± 10.7years.60.2% were male and 39.8% were female respondents. Cognitive impairment was found among 43.6% of the respondents. A substantial proportion of the study population was found to have cognitive impairment. In this study, the cognitive status of the respondents was not associated with the duration of illness (p>0.5).

So assessment of cognitive status should be an essential part of the management of this group of people.

No significant relationships.

The assessment of social and emotional wellbeing (SEWB) among Aboriginal people in Australia and elsewhere is complex and challenging task. A culturally appropriate tool for screening SEWB among Aboriginal adults known as the Here and Now Aboriginal Assessment (HANAA) has been developed and evaluated. The HANAA is based on exploring key domains of Aboriginal concept of SEWB and is based on a yarning process aimed to initiate a semi-structured interview that covers each domain. Over the last ten years the HANAA has been widely used by Aboriginal mental health service providers around Australia and elsewhere.

There have been multiple requests by service providers for a similar tool to be developed for young Aboriginal people. The aim of this study was to develop a youth version of the HANAA.

A Working Group was established to guide the development of the youth HANAA. This work included discussion of assessment domains, prompt words and other adolescent specific considerations that were needed. The evlauation process was also discussed.

The adult version of HANAA was well accepted by participants. Reliability was good with kappa agreements between Aboriginal and non-Aboriginal interviewers ranging from 0.5 to 1.0. Agreement between interviewers and treating clinicians on ecommended course of action was good.

Based on the previous field test results, it is expected that the youth HANAA will also be a culturally appropriate and useful tool which can be used by a range of service providers with differing levels of mental health training to assess SEWB among young Aboriginal people.

No significant relationships.

Professionals in the inpatient care of burdened children and adolescents are confronted with high demands in their daily work. The job satisfaction can be affected negatively, if these professionals do not have the necessary resources to carry out their work.

In a study as part of the accompanying research of an online course called “Trauma informed Care”, the connection between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction were investigated on a sample of N = 543 professionals working in the (inpatient) care of children and adolescents.

In order to quantify the connections between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction, correlations and a multiple regression were calculated.

Moderate to strong correlations were identified between personal resources and job satisfaction among the professionals. The regression model revealed self-efficacy to be the most important predictor of job satisfaction. Self-care was also identified as an important predictor. Less importance could be ascribed to emotional competence. Action competence showed no effects in the regression model.

The results indicate the importance of personal resources for job satisfaction an their targeted promotion in order to increase job satisfaction and thus counteract the tendency of fluctuation and shortage of professionals in the area of child and youth welfare.

No significant relationships.

Delusional disorder (DD) is defined by the presence of one or more delusions, of at least one month’s duration, in the absence of prominent hallucinations or other symptoms of schizophrenia. Although functioning may not be markedly impaired, the delusion(s) or its ramifications may have a significant impact in the patient’s life. With a life-time prevalence of 0.18%, DD is still neglected in terms of approved treatment recommendations.

We present the case of a patient diagnosed with DD and discuss the treatment of DD according to current evidence.

Relevant clinical information was extracted from the patient’s clinical process. A non-systematic review was made in Pubmed database with the terms “Delusional Disorder” and “Treatment”.

Male, 76 years old, divorced, living alone, autonomous. First admitted at age 62 in our inpatient psychiatry ward for a persecutory delusion regarding his neighbors. He was discharged with the diagnosis of DD and started a follow-up in a mental health community team. He abandoned treatment and psychiatric consultation after 9 years. During 17 years he moved home more than 10 times due to a progressive dynamism of the delusion, leading to recent marked behavior changes towards his neighbors. He is again admitted in our inpatient psychiatry ward.

This case illustrates the impact that untreated DD can have on its patients. Although consensus using antipsychotics, there are still insufficient studies to make evidence-based recommendations to treat people with DD. Further research is needed in this sense.

No significant relationships.

The current situation caused by restrictive measures related to the COVID-19 pandemic provokes the high level of aggressiveness and all forms of domestic violence. These results in mental health problems.

The purpose of this study was to find out the consequences of domestic violence against women and to identify psychological problems and mental disorders in women.

A cohort of 18 females was examined by psychiatrists and psychologists. All women turned to specialists at the Moscow Institute of Psychiatry for help.

All women were victims of violence by their husbands and partners. Lockdown situation associated with COVID 19 pandemic has exacerbated the problem of domestic violence. Clinical assessment has revealed different depressive symptoms, anxiety, fear, suicidal tendencies forming the clinical picture of adjustment disorder (2 cases), acute reaction to stress (3 cases), post-traumatic stress disorder (2 cases), depressive episode (8 cases), eating disorders behavior in the form of bulimia and anorexia (3 cases).

The research has revealed that domestic abuse against women associated with lockdown situation during the COVID 19 pandemic often results in psychological and long-term mental health problems. In these cases, prevention is needed to combat violence against women with the participation of public health specialists, psychologists, psychiatrists, sociologists.

No significant relationships.

The National Institute of Mental Health describe the main symptoms of bipolar disorder as alternating episodes of high and low mood. Changes in energy levels, sleep patterns, ability to focus, and other features can dramatically impact a person’s behavior, work, relationships, and other aspects of life. Most people experience mood changes at some time, but those related to bipolar disorder are more intense than regular mood changes, and other symptoms can occur. Some people experience psychosis, which can include delusions, hallucinations, and paranoia.

Through this research we aimed to identify all the special features of bipolar depression which will help the clinical psychiatrists in easier diagnosis and management of the disorder.

Literature review (PubMed)

Clinical Characteristics in Favour of Bipolarity in Depression: psychomotor retardation, history of psychotic depression,history of psychotic depression shortly after giving childbirth, frequent catatonic symptoms, atypical depressive features, severe impairment in interpersonal relationships, inconsistency in business life, history of hypomania, mania or mixed episode,common feeling of numbness and anhedonia; less common sadness and feelings of guilt, mood instability, volatility in temperament, frequent change in affect, daydreaming during the episode and daily life, short duration of depression <3 months, poor cognitive functions during depressive episode, generally similar symptom severity during the day and night etc.

This leads to misdiagnosis of bipolar depression as unipolar depression, which in turn leads to delayed correct diagnosis and treatment and may severely affect the patient’s entire life.

No significant relationships.