Iatrogenic factors, such as polypharmacy and prescription cascade, are some of the main causes of delirium in the elderly. We present a case of delirium of months of evolution that improved after applying a pharmacological de-prescription strategy.

To report a case and review the available literature on the concepts of prescription cascade and de-prescription in delirium in the elderly.

A 92-year-old woman with a history of cerebrovascular accidents and no psychiatric history or dementia was admitted to a psychogeriatric clinic due to disorientation, delusions of harm and gait apraxia. Several months earlier she had required admission to the general hospital for agitation. In view of the suspicion of delirium, an exhaustive examination and complementary tests were performed, including a neuropsychological assessment and a brain scan (Image 1).

The patient had previously received multiple high-dose psychotropic drugs (Gabapentin, trazodone, Zolpidem, Quetiapine), which had reduced the agitation but had not resolved the problem. Organic causes were treated in a multidisciplinary team (pressure ulcers), together with a gradual tapering of medication. Although underlying vascular dementia was diagnosed, the patient’s gait and cognitive status improved, with a significant impact on her autonomy and quality of life.

Despite an extensive literature on the subject, delirium in the elderly remains an under-diagnosed medical condition, especially the hypoactive subtype, just as cascade prescribing remains common. It is important to raise awareness among specialists in training to prevent and diagnose it.

No significant relationships.

The majority of researchers agree that transgender people have an increased burden of mental disorders compared to the general population. However, it is strongly suggested that transgender people still do not receive mental health care that they need.

To assess the mental health care needs of transgender people living in Russia.

An anonymous online survey was conducted throughout November 2019. 588 transgender adults living in all Federal Districts of Russia (mean age 24.0±6.7) were included in the final analysis.

It was found that 308 respondents (52.4%) had visited mental health professional prior to gender transition. 150 people (25.5%) reported to had been diagnosed with a mental disorder before gender transition, and a further 77 respondents (13.1%) indicated that they had been diagnosed with a mental disorder after transition began. 157 people (26.7%) received treatment from a mental health professional. 222 respondents (37.8%) had experience of taking medication off-prescription to improve mental wellbeing. 464 people (78.9%) reported being in need of psychological care. 289 people (49.1%) indicated that they were experiencing barriers in obtaining psychiatric (psychotherapeutic, psychological) care, which was associated with a perceived need for psychological support (OR=4.33 [95% CI: 2.49;7.80], p<0.001), being diagnosed with a mental disorder prior to gender transition (OR=2.19 [95% CI: 1.30;3.77], p=0.004), poorer housing conditions (OR=0.86 [95% CI: 0.79;0.93], p<0.001).

Our research shows that there is a high perceived need for qualified mental health care for transgender people in Russia.

No significant relationships.

There is now compelling evidence that migrant groups in several countries have an elevated risk of developing psychotic disorders.

To identify risk factors for psychosis in immigrant population.

case report and Computerised literature search of MEDLINE and PUBMED and PsycINFO databases was performed using the keywords: immigration, psychosis, schizophrenia.

Mrs AM is 22 years old, Ivorian, without any personal or family psychiatric history, married and mother of an 11 months old baby.

Because of the poor socio-economic conditions, she immigrated illegally to tunisia 3 months ago, accompanied by her husband, leaving her child in her native country. since then, she has been working in cleaning jobs with very low salaries and several conflicts in the workplace, which pushed AMto leave the job. One month before her admission, according to her husband, she became isolated, distrustful, she often watches herself in the mirror, refuses to take a shower, with some bizarre behaviors and persecutory words, then she became aggressive with her husband andneighbors, hence her admission.

The interview revealed a dissociative and delusional syndrome, vague and poorly systematized, with hallucinatory and intuitive mechanisms. In view of the subsequent evolution, the diagnosis of schizophrenia was retained. After stabilization under antipsychotic drugs, the patient asked to be repatriated to join her child.

The evidence is still thin, and there is a clear need for further research to replicate and extend findings linking specific aspects of the social environment and risk of psychosis in migrant groups.

No significant relationships.

Adolescence: a state of mental fragility, where psychiatric disorders may debut, where have been reported several cases of toxidermy, encephalopathy and neuropsychiatric disorder related to ivermectin treatment (excluding organicity, substance abuse or medication) (1). It has effect on the dopaminergic system with an alteration on glycoprotein P leading to high levels of ivermectin causing neurotoxicity (2). In this poster, we discuss the case of a 14 y/o´s psychosis to ivermectin

Presentation of a clinical report

14 years old woman. Background: father with schizophrenia. Comorbility: None. Initially, presented to ER with 2 week of treatment to ivermectin 6mg for pediculosis; presenting first psychotic episode. She presented first clinical outbreak of psychosis characterized by mystical-religious, erotomaniac, harm and reference delusions, auditory and visual hallucinations adding isolation, abulia, apathy, dialogued soliloquies, and spontaneous crying. No prior psychiatric treatment.

In hospitalization: elevated indirect and direct bilirubins and hiponatremia; neuroimaging studies are reported normal. Haloperidol 7.5 mg/day is indicated and parkinsonism is presented. Treatment is changed to olanzapine 15mg/day with notorious improvement. Diagnostic impression: Acute polymorphic psychotic disorder with symptoms of schizophrenia

Possible causes were analyzed, finding a relationship with ivermectin treatment. This case makes evident the importance of conducting in-depht evaluations and finding risks factors for psychosis.

No significant relationships.

Individuals with substance use disorders are considered unpredictable and violent by the public. Besides, health care workers (HCW) may have negative attitudes towards them, despite their knowledge about addiction; which is related to lower quality of care. In Turkey, addiction service users are predominantly male, over ninety percent; while women make up a large percentage of psychiatrists.

The present study aims to evaluate if the HCWs level of stigma towards individuals with substance use disorder changes due to gender and mental health sector experience of the HCWs.

Within an online survey, participant HCWs answered Attitudes Towards Treatment of Substance Use Disorders Scale, Substance Addiction Stigmatization Scale, Alcohol Addiction Stigmatization Scale; in addition to sociodemographic questions.

Three hundred ninety-eight HCWs were included in the analyses. 22.7% of them (n=91) were recruited in mental health sector. Mental health care workers had lower levels of stigma towards individuals with alcohol use disorders (14.78 vs 16.21, p=0.048) and substance use disorders (14.21 vs 20.09, p<0.001) and, lower levels of stigma towards addiction treatments (20.89 vs 23.93, p=0.007). Among mental health care workers, women scored higher numbers of stigmatization towards alcohol use disorder and addiction treatments (16.26 vs 12.98, p=0.003; 23.84 vs 17.29, p<0.001). On the other hand, women and men in other HCWs groups did not differ from each other in terms of stigmatization measurements (See Figure 1)

The gender of mental health care workers may be related to stigmatization towards addictive disorders. Future research should evaluate underlying factors.

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.

Previous studies have found substantial weight gains in forensic mental health patients (FMHP) during hospitalisation. However, previous studies have not compared in- and outpatients, thus the weight change could be a general change over time. Research on the association between proportional hospitalization time (PHT) and weight change is lacking.

To investigate the association between time hospitalized and weight change among FMHP.

Retrospective cohort study including FMHP with schizophrenia or bipolar disorder treated in the Region of Southern Denmark between 01jan2016 and 06apr2020. Patient characteristics and data on body weight was extracted from electronic medical records. The association between PHT and weight change per year was analyzed using linear regression. PHT was determined between each measurement as the total number of days hospitalized divided by the total number of days. Analyses were adjusted for gender, age, smoking, and antipsychotic medication.

The cohort included 328 FMHP, of which 91% were diagnosed with schizophrenia. PHT had a significant positive dose-response association with weight change, with an estimated difference of +4.0 kg/year for FMHP who were hospitalized 100% of the time, compared to FMHP who were exclusively treated as outpatients. The associations were different for FMHP belonging to different categories of BMI at baseline (test for interaction; p=0.006). Underweight hospitalized FMHP had the largest difference in weight gain compared to FMHP treated outside hospitals (+18.0 kg/year, p=0.006), and the difference was smallest in obese FMHP (+2.3 kg/year, p=0.21).

PHT was positively associated with weight change among FMHP.

No significant relationships.

Grief and bereavement are commonplace in clinical practice but have become a more pervasive issue because of the coronavirus 2019 pandemic. Consequently, the need for investigations, learning, and education about complicated grief and prolonged grief have been highlighted. Meanwhile, film-based teaching resources concerning grief care have been employed to complement curricula in medical education.

To explore how the grieving experience can be better communicated and mitigated, and explain how a film-based resource can be applied to improve the understanding of this issue.

We reviewed and analyzed the meaning and cause of complicated, prolonged, disenfranchised grief, as well as related experiences (e.g., survivor guilt) featured in selected films. We discussed the interpretation of these films with medical students and faculty, based on a previously described approach [1].

We recaptured the roles of empathic communications and resilience skills in grief care. They bring a sense of coherence (SOC) or meaning to life by prompting the sharing of grief experiences, helping to reconstruct and contextualize a person’s loss, and assuaging feelings of worthlessness and hopelessness. Incidentally, recent studies have suggested that complicated and prolonged grief involves alterations in brain functioning of the reward system.

This film-based approach utilizes vicarious experiences to better understand grief management. It allows the learner to more easily recognize that SOC, flexible situation-adjusted empathy, and the sharing of resources for improved communication to promote self-care are essential for patients, their families, as well as psychiatrists themselves. [1] Sondheimer, A. The life stories of children and adolescents. Acad Psychiatry. 2000:24(4):214–24.

No significant relationships.

The ongoing pandemic of coronavirus disease 2019 (COVID-19) has made a serious public threat worldwide. The first case in the Republic Croatia was reported on 25th February 2020 and the first case in Psychiatric hospital Ugljan was diagnosed on 3rd December 2020. To maximize protection and prevent spreading to other patients, COVID-infected-individuals were isolated. This poster will describe treatment outcomes of COVID 19 in Psychiatric hospital Ugljan.

This rapid review summarizes outcomes of COVID-19 infected psychiatric patients with mild disease severity to provide synthesized evidence to support policy decision making.

PubMed, Medline, PsychINFO were systematically searched from January 2021 for COVID-19, with studies describing epidemiology, treatment and outcomes in various long-term care facilities. Studies were excluded if they did not report clinical evidence.

In the time of COVID-19 breakthrough in psychiatric hospital, in December 2020 328 patients were hospitalized of whom 44 tested positive for SARS-CoV-2 infection: of 307 hospitalized patients in January 2021 36 tested positive for SARS CoV-2. By that time, there were no treatment options available, so we focused on repurposing efficacy of the currently used drugs. Five patients needed admission to ICU, we reported one death from coronavirus disease 2019 in that period.

The COViD-19 pandemic has highlighted extreme vulnerability of psychiatric patients who reside in long-term care psychiatric hospitals and there is an urgent need for evidence-based policy that can protect adequately psychiatric patients.

No significant relationships.

The uncertainty of COVID-pandemia, vital danger and disruptions in the habitual social contacts can be paralleled to the experiences of severe emotional stress and violence, usually found in the people with Borderline Personality Disorder. Both can be regarded as hampering the ability to categorize and express thoughts, feelings and experiences. The implementation of distant forms of psychological counseling may accentuate the mentalization deficiency.

To develop a theoretical framework for an empirical typology of impairments of mentalization.

The model of consciousness proposed by L.S. Vygotsky was used for theoretical generalization of the levels of categorical structures of mentalization observed in previous empirical studies.

The following structures were identified: (1) the syncretic type of mentalization with low differentiation and complexity of object representations, their negative affective tone, autistic, chaotically mutable motivation and low emotional investment in relationships were described in patients with schizotypal disorders; (2) the “complex” type, with literal, non-generalized, field-dependent and rigid, or unstable, representation of the self, others and relationships as a result of the “fusion” of cognitive representations with the current emotional states. Similar types of mentalization were previously described in people with BPD and self-harming behavior (Sokolova, Laisheva, 2017).

The ’syncretic’ and ’complex’ types of mentalization produce affective-cognitive distortions of the image of a psychotherapist, hamper the understanding of the conditional and metaphorical character of the therapeutic process, render difficult the de-traumatization of the unbearable experiences, and lessen the effectiveness of consultations of people with BPD.

No significant relationships.

Long-acting injectable (LAI) antipsychotics and community treatment orders (CTOs) are used in patients with schizophrenia to improve treatment effectiveness through adherence.

Understanding healthcare resource utilization (HRU) and associated costs, and medication adherence in patients with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA) LAI initiation may guide strategies to optimize health.

A retrospective observational single-arm study using administrative data from Alberta was performed. Adults with schizophrenia who initiated SGA-LAI (index date) were included. Medication possession ratio (MPR) was determined; paired t-tests were used to examine differences in HRU and costs ($CDN) between the 2-year pre-index period and 2-year post-index period. Stratified analysis by presence or absence of an active CTO during the pre-post periods was performed.

Among 1,211 patients who initiated SGA-LAIs, MPR was greater post-index (0.84) compared with pre-index (0.45; 95% confidence interval [CI] 0.36, 0.41). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p<0.001); total all-cause HRU costs were $33,788 lower post- versus pre-index ($40,343 [standard deviation, SD $68,887] versus $74,131 [SD $75,941], 95% CI [-$38,993, -$28,583]), and total mental health-related HRU costs were $34,198 lower post- versus pre-index ($34,205 [SD $63,428] CDN versus $68,403 [SD $72,088] CDN, 95%CI [-$39,098, -$29,297]). Forty-three percent had ≥1 active CTO during the study period; HRU and costs varied according to CTO status.

SGA-LAIs are associated with improved adherence, and lower HRU and costs however the latter vary according to CTO status.

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this abstract: SD and MS have no competing interest to declare. LR, SK, KW, and KM are members of the Real-World Evidence

This research aims to enrich the reflection on the current affairs and is an invitation to think about worrying phenomena in youngsters: self-injuries or cuts. A focused study was conducted on twenty young people

This ris a reflection oabout worrying phenomena in youngsters: self-injuries or cuts. We try to figure out the underlying cause of such behaviour

Through a qualitative methodology, using clinical interview and questionnaire, we try to find the constitutive elements of self-injuries or cuts, considering three levels of analysis: Sociocultural, individual, and family changes. We examined twenty cases

It appeared in the analysis that one of the triggers of the cutting phenomenon was related to experiences of rejection of significant figures, which is lived by the young person as a situation of abandonment that generates high amounts of anguish. This distressing experience generates a sensation of lack of control, appearing as unregulated affections, which they are unable to handle or manage. The intense anxiety is carried through the body, being an act of attack to the body, provokes physical pain an emotional relief

Young people’s subjective perception of the maternal figure is that of a dominant, controlling and demanding personality, which hinders an adequate differentiation process. With respect to the description that the young people make of themselves, we see that they refer to a marked emotional lability and the presence of dysthymic experiences. It appeared in the analysis that one of the triggers of the cutting phenomenon was related to experiences of rejection or separation of significant figures.

No significant relationships.

Cognitive insight is a relatively recent concept referring to the ability, not only to reassess unusual experiences objectively after corrective feedback but also to distance oneself from them and it seems to be specifically altered in schizophrenia. Yet, despite its importance in the understanding of psychotic symptoms, this process has never been studied in the North African population.

Therefore, this paper aims to compare cognitive insight performances between two Tunisian psychiatric populations and to explore its relationship with other cognitive processes.

The study population comprised 17 participants with schizophrenia, 9 with bipolar disorder, and 30 healthy controls. The groups were paired for age, education level, and socioeconomic status. We assessed depression, global executive functioning, verbal episodic memory, metamemory (online and offline), and cognitive insight. The latter was evaluated by the Beck Cognitive Insight Scale.

The results showed that, compared to the other groups, participants with schizophrenia obtained a lower self-reflectiveness score and a higher self-certainty score, resulting in a significantly lower composite index. These findings seem to indicate the alteration of cognitive insight in schizophrenia. However, no significant differences were found between the other two groups. Moreover, correlational analyses showed that cognitive insight components were only associated with metamemory indices which proved to be the best predictors of this ability, along with the global executive score.

In conclusion, our data seems to corroborate the international literature reporting a cognitive insight deficit in schizophrenia. However, further research is needed in order to better understand the specific processes underlying this metacognitive function.

No significant relationships.

Public Health England published a report in 2017 on Obesity in Secure Mental Health units. A key finding was that not only is obesity and overweight more prevalenr in the population detained within mental health secure units (reported rates of up to 80%) than in the general population (around 60%), patients appear to be more at risk of weight gain when they are detained.

1.To implement a traffic light system on food and confectionaries sold at the shop at a Medium secure hospital. 2. Provide healthier food options at the shop by using traffic light system as a visual aid 3. To achieve weight reduction and promote healthy life style choices in patients admitted to our medium secure Forensic unit

1.Buying a new till system which is able to quantify what type of food is sold 2.Labelling food sold using traffic light system 3. Calculate the types of food sold following a three- month period after implementation.

/Intended Outcome Traffic light system provides a visual aid to patients in choosing healthier food Patients in our medium secure unit achieve a reduction in their weight Traffic light system can be replicated/ adopted by other secure hospitals

The purpose of this research is to implement a traffic light system on food sold at a shop in our medium secure unit and that this will help improve food choices in the unit.

No significant relationships.

No significant relationships.

Research of COVID-19-Pandemic mental health impact focus on three groups: the general population, (2) so called vulnerable groups (e.g. individuals with mental disorders) and (3) individuals suffering COVID-19 including Long-COVID syndromes.

We investigate whether individuals with a history of depression in the past, react to the COVID-19 pandemic with increased depressive symptoms.

Longitudinal Data stem from the NAKO-Baseline-Assessment (2014-2019, 18 study centers in Germany, representative sampled individuals from 20 to 74 years) and the subsequent NAKO-COVID-Assessment (5-11/2020). The sample for analysis comprises 115.519 individuals. History of psychiatric disorder was operationalized as lifetime self-report for physician-diagnosed depression. Depressive symptoms were measured with the PHQ 9.

Mean age of the sample at baseline was 49.95 (SD 12.53). It comprised 51.70 women; 14 % of the individuals had a history of physician-diagnosed depression. Considering a PHQ-Score with cut-off 10 as a clinical relevant depression, 3.65 % of the individuals without history of depression and 24.19 % of those with a history of depression were depressed at baseline. The NAKO-COVID-Assessment revealed 6.53 % depressed individuals without any history of depression and a similar rate of 23.29 % in those with history of depression.

In contrast to that what we expected, individuals with a history of a physician-diagnosed depression, did not react with increasing depressiveness during the first phase of the pandemic in Germany. Several reasons could be discussed. Whether there medium and long-term impact remains open.

No significant relationships.

The spread of media multitasking in the modern world determines researcher’s interest in studying the neurocognitive development features of children who strive to act in this mode since childhood (Minear et al., 2013; Uncapher et al., 2016).

The aim is to study neuropsychological profiles of children and adolescents with single-tasking and multitasking.

Quasi-experiment was conducted among 154 children of three age groups (7-10; 11-13; 14-16) and included simultaneous tasks performance on a computer and a smartphone. Neuropsychological indicators were studied (Akhutina, 2016): programming and control, serial organization, visual and auditory-speech memory, neurodynamics. The behavior social modeling and executive functions were studied with WISC (Information and Comprehension subtests) and Dots-test (Akhutina et al., 2017). The multitaskers groups were identified according to the number of returns to tasks: single-taskers (42.9%), single-taskers with multitasking elements (1-2 returns) (40.9%), multitaskers (3 and more returns) (16.2%).

The number of multitaskers increased by adolescence. In children aged 7-10 single-taskers were more productive than multitaskers in programming, switchability, the volume of auditory-speech and visual memory, neurodynamics. They performed Dots-test faster. At the age of 11-13, multitaskers had higher scores on the Comprehension subtest and higher verbal activity when composing a story. Regulation and switchability errors in multitaskers aged 11-13 were episodic. At the age of 14-16 multitaskers were more productive in some parameters of switchability.

In primary school single-taskers have a neurocognitive advantage, but by adolescence differences are leveled, and in some parameters multitaskers are ahead of single-taskers. The study was funded by RFBR, project No. 19-29-14181.

The reported study was funded by RFBR, project No. 19-29-14181.

Nursing students’ attitudes towards mental illness will affect their perception about caring patients with mental illness and their willingness to work in the field of mental health. Evidence supported that contact with recovery patients can change people’s perception of mental illness.

The study aims to explore the undergraduate nursing students’ encountering experience with recovery patients as educators.

A qualitative study using purposive sampling was conducted with undergraduate nursing students in southern Taiwan. Content analysis was used to identify the students’ experience as encountering with the recovery patient as an educator.

As recovery patients participated in class, sharing their recovery journey and learning with students to produce a recovery story, it provided recovery patients and students an equal and mutually beneficial partnership. Four main themes about undergraduate nursing students’ attitudes were identified as. (1)Changing the mindset to patients with mental illness — We are human beings. There’s not much difference between us. (2)Turning positive attitudes towards patients with mental illness — We can compose a better life together! (3)Closing the distance between students and patients with mental illness — I am willing to be close to you. (4)Reflecting and growing in self-understanding and values — I am recovered, too.

This study found that the strategy of recovery patients as educators can improve future nurses’ attitudes towards mental illness, help them deeply learn about patient’ recovery journey. It might beneficial to help students developing their competency in patient-centered care. Future study could examine the effect of the recovery patients as educators.

No significant relationships.

Despite the high prevalence of substance use disorders, the majority of affected individuals do not seek any medical help or receive treatment targetting mainly symptoms of intoxication, withdrawal or general medical conditions due to chronic use of psychoactive substances. Patients with substance use disorders are more likely to remain undiagnosed regarding other psychiatric illnesses. Electronic patient-reported outcomes (ePRO) provide an easy-to-use instrument for detailed assessment at low economic cost.

To assess patients’ attitude towards self-reporting of symptoms related to substance use, mood, anxiety, quality of sleep, medication intake, social performance, and psychotic symptoms.

Mobile application consisting of seven questionnaires (Mood, Anxiety, Substance Use, Sleep, Medication, Social Activity and Various symptoms) was offered for use to patients with substance use disorder. Enrolled subjects were encouraged to use the app to report their actual condition in accordance with their own willingness and lifestyle.

Throughout the study a total of 1077 completed questionnaires were submitted, of which 193 (17.9%) were on mood, 188 (17.5%) - on substance use, 187 (17.4%) – on sleep, 155 (14.4%) – on anxiety, 139 (12.9%) – on medication intake, 111 (10.3%) – on psychotic symptoms, and 104 (9.7%) – on social performance.

Our research revealed that patients with substance use disorder are likely to share concerns regarding variety of psychiatric symptoms besides these attributed to their primary diagnosis. Implementation of ePROs can be a valuable tool for in-depth assessment and subsequent meeting the needs of such patients.

No significant relationships.

Frontal lobe syndrome (FLS) is a clinical condition characterized by personality and behavioral changes that usually occur after a traumatic brain injury (TBI). The main features of this syndrome are related to the deterioration of basic functions of the frontal lobe. Substance use disorder (SUD) is rare but also serious comorbiditiy seen after TBI.

In this case report, we aimed to discuss a case who developed SUD after TBI.

Case report

A 40-year-old male patient with history of using cannabis, methamphetamine, synthetic cannabinoid was admitted to our alcohol and substance use disorders research and treatment centre (AMATEM) inpatient unit for detoxification. He has reported that he was injured by a car accident five years ago, had a surgery and was hospitalized for a few months, and started to use substance to relieve pain. According to the medical records, the left frontal and temporoparietal regions were affected. He reported no history of substance abuse before injury, no previous history of psychiatric admission. Personality and behavior changes had been observed after TBI. In the first examination he had depressed mood and loss of interest. Sertraline (gradually titrated up to 150 mg/d) and risperidone (1 mg/d) were started. Also N-acetylcysteine (1,200 mg/d) was added to reduce craving and drug-seeking behaviours for four weeks.

Frontal lobe syndrome and TBI may differ in terms of clinical presentations. Substance use may be a way to cope with mental, cognitive or behavioural changes, psychosocial stressors, anxiety, sleep problems or pain after TBI.

No significant relationships.