Type I bipolar disorder (BDI) is characterized by a chronic evolution, with recurrent mood episodes that severely disrupt the overall functionality and quality of patients’ life. An adequate maintenance treatment is necessary to prevent relapses and to improve the functional prognosis of these patients.

To find data regarding the most evidence-based therapeutic strategies in the maintenance phase of BDI.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “type I bipolar disorder” AND “mood stabilizers” AND “antipsychotics” AND “anticonvulsants”. All papers published between January 2000 and August 2021 were included.

The main recommendation is to continue in the maintenance phase the same medication that has proven its efficacy and tolerability in the acute phase. In BDI the most evidence-supported pharmacological approaches for the maintenance phase were lithium, valproate, lamotrigine, and carbamazepine as anticonvulsants/mood stabilizers, as well as olanzapine, quetiapine, and aripiprazole as antipsychotics. Lithium and valproate have been associated with positive influence over neuroplasticity, while antipsychotics have considerably higher metabolic adverse events. Monotherapy is recommended, but drugs associations are frequently met in clinical practice. There are no consistent data about the superiority of one class over the other, but lithium has a proven effect of decreasing the suicide rate in this population.

Both anticonvulsants and antipsychotics are used in the maintenance phase of the BDI, without significant differences in the efficacy rates. However, benefits and risks should be weighted for each class and each individual agent recommended.

No significant relationships.

Drug-induced liver injury is one of the leading causes for acute liver failure and drug withdrawal after marketing approval. One important risk factor is the extent of exposure of the hepatocytes to a substance, either by high doses or by long-term medication. In many psychiatric diseases, like schizophrenia long-term use of drugs is common. However, systematic data on the hepatotoxic potential of antipsychotics is scarce.

To perform an explorative analysis of pharmacovigilance data on the risk of hepatotoxicity related to the use of antipsychotics.

We conducted an explorative case/non-case study based on data from VigiBase for 30 antipsychotics marketed in the European Union. Reporting odds ratios were calculated for antipsychotics associated with the SMQ “Drug related hepatic disorders - comprehensive search” and the SMQ “Drug related hepatic disorders - severe events only”.

We found several associations of antipsychotics with drug-induced liver injury including associations with severe events. 17/30 antipsychotics were associated with “Drug related hepatic disorders - comprehensive search”, and for 10/30 substances were associated with severe hepatic events.

Several antipsychotics are associated with the risk for hepatotoxic side effects, even severe ones. Further research is warranted on patient and substance-dependent risk factors.

No significant relationships.

In human society increased aggressiveness is one of the main social and health problems. Immune cells have a regulatory effect on the central nervous system functions, including regulation of behavior.

The aim of the study was to investigate the effect of in vitro neuroleptic-modulated immune cells transplantation on behavioral phenotype and brain cytokines in aggressive syngeneic recipients.

(CBAxC57Bl/6) F1 aggressive male mice, developed in conditions of social confrontation, were undergoing the transplantation of syngeneic immune cells with in vitro chlorpromazine-modulated functional activity. Recipient’s behavioral phenotyping was performed using modern hardware and software complex EthoVision XT. The brain cytokines content was assessed by ELISA.

It was found that repeated experience of aggression, accompanied by victories, leads to a change in male mice behavior, which manifests itself by increased motor activity, irritability, severe anxiety, and the appearance of stereotypies. Transplantation of chlorpromazine-modulated splenocytes in aggressive recipient was accompanied by decreased motor activity in the Open Field, increased open arm activity in Plus Maze, reflects anti-anxiety behavior; decreased time spent close to the partition and the total duration of attacks after removal of the partitionin in resident-intruder test, reflects decreased aggressive motivation. Behavioral changes in recipients were accompanied with cytokines brain changes: decreased IL-1β, IL-2, IL-6, INFγ in the hippocampus; increased IL-4 and decreased INFγ in the hypothalamus; decreased IL-1β in the frontal cortex.

Chlorpromazine - modulated immune cells have a positive aggressive behavior editing effect being involved in the central mechanisms underlying the development of aggressive reactions.

No significant relationships.

Women experiencing postpartum mental illness have unique needs. Psychiatric Mother Baby Units (MBUs) can provide specialist in-patient care for mothers without separation from their baby. Since 2018, an innovative Mother-Baby Day Hospital (MBDH) have been developed and implemented in a public hospital in Spain, directed at the intensive, integral, and multidisciplinary treatment.

The aim of the present study was to obtain preliminary data regarding its effectiveness in postpartum women with affective and anxiety disorders.

Thirty-three mothers and their babies with affective or anxiety disorders attended to MBDH CLINIC-BCN participated in the study. All women were assessed at admission, discharge, and 3 months follow-up. Primary outcomes were depression (EPDS) and anxiety symptoms (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs).

At discharge, 100% of women no longer met the full criteria for the main diagnosis (PSR≥5). Significant improvements from admission to discharge were achieved in depression and anxiety symptoms, mother infant bonding and functional impairment. Clinical significance was also calculated. After treatment, mothers had greater autonomy for care their babies. Similar results were observed at 3 months follow-up. The MBDH was rated by mothers as an excellent quality program and they would recommend it.

This study found that multidisciplinary intervention at MBDH for postpartum women with affective or anxiety disorders is effective, not only for maternal psychopathology but also for maternal care and bonding. It is imperative to develop specialized devices that integrate the care of the dyad by professionals specialized in perinatal mental health.

No significant relationships.

No significant relationships.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized with ritualized behavior, difficulties in communication/ social interaction, restricted interests, and sensitivity to external stimuli. The ASD has gained attention in recent years, however it’s still difficult in geropsychiatric setting to identify high-functioning ASD, especially when patients’ coping mechanisms are successful. Not to determine high-functioning ASD structure in older age can lead to wrong diagnosis and inappropriate treatment trials.

The aim of this presentation is to emphasize the importance of the evaluation of ASD-structure in old-age-psychiatry through the case study of a 65-years-old man.

One case report from the inpatient unit of a psychiatric clinic in Lower Saxony, Germany will be presented.

Case: The patient was referred to our acute-psychiatric-ward due to delusional thoughts, depressive symptoms and lorazepam dependency. Delusional disorder was diagnosed in the outpatient-setting since he had interpreted some external stimuli in an eccentric way. During the therapeutic process, some features of high-functioning ASD such as social difficulties, dislike of change and repetitive/restrictive habits were prominent. Developmental history of the patient and the Autism-Spectrum-Quotient-50 also supported the clinical diagnosis of the ASD. Delusional disorder was excluded, and the therapy organized according to the structure characteristics of the high-functioning ASD which yielded to significant amelioration of depressive symptoms and increased perceived life quality of the patient.

Although coping mechanisms of the patients can be successful, identifying high-functioning ASD-structure even in an old-age can be quite helpful in diagnostic/therapeutic processes. An elaborate discussion of the subject through contemporary literature will be presented.

No significant relationships.

Depression and anxiety disorders are among the most prevalent forms of mental illness, with antidepressants frequently used to treat them. Unfortunately, prescription of antidepressant medication is often inexact and relies on a long trial-and-error process.

Using machine Learning (ML) algorithms on readily obtainable clinical and demographic data of individuals diagnosed with depression with anxiety symptoms, we hypothesized that we will be able to derive models which will enable a more accurate treatment selection, focusing on relief from anxiety symptoms.

Patients’ data from the Sequenced Treatment Alternatives to Relieve Depression (START*D) were filtered to include only those who have considerable anxiety symptoms. We then analyzed these patients’ response patterns, focusing on their anxious symptomology. Then, feature selection algorithms were applied to select the most predictive features for anxiety relief. Finally, we trained three ML models for three antidepressants: citalopram, sertraline and venlafaxine, using a training set of participants, and validated them on naïve validation and test datasets. These ML models were then compiled to create a predictive algorithm.

Validating the algorithm on the validation and test sets, our algorithm achieved a balanced accuracy of 64.8% (p<0.001), 79.2% (p<0.001) and 78.03% (p<0.001) for citalopram, sertraline and venlafaxine, respectively.

Our findings support applying ML to accumulating data to achieve an improvement in the treatment of mood disorders. The algorithm we developed may be used as a tool to aid in the choice of antidepressant medication, specifically for depressed patients who exhibit prominent anxiety symptoms.

Dekel Taliaz is the founder and CEO of Taliaz and reports stock ownership in Taliaz. Amit Spinrad and Roni Zoller serve as data scientists in Taliaz.

Cushing’s syndrome is a hormonal disorder caused by chronic exposure to excess glucocorticoids, either exogenous or endogenous. The bronchial carcinoid tumor is an extremely rare origin, described in less than 1% of cases. The most frequent psychiatric symptoms are depression and anxiety, with manic and psychotic symptoms being less frequent. Psychotic symptoms are difficult to manage, as they are usually resistant to antipsychotic treatment, which is why it is considered an indication for medical treatment of Cushing’s syndrome.

To give visibility to this type of psychotic disorders of organic origin to deepen their study as well as raise awareness among professionals dedicated to clinical care with the intention of improving their prevention.

A description of a clinical case is made, accompanied by a bibliographic review on psychosis of endogenous corticosteroid origin.

We describe the case of a 44-year-old woman who was admitted to the charge of Internal Medicine due to Cushing’s syndrome. During her admission, she presented a debut of positive psychotic symptoms, so the liaison psychiatry team followed her up. She was diagnosed with an ACTH-secreting lung carcinoid tumor.

This entity should be taken into account in cases of atypical psychosis in patients with compatible phenotypic characteristics.

No significant relationships.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound worldwide impact on health. Acute Confusional Syndrome (ACS) is the most common neuropsychiatric complication in COVID-19 infection.

Describe the characteristics of the admited patients attended by the liaison psychiatry service for acute confusional syndrome during the COVID 19 pandemic. Sociodemographical and clinical variables were descrived.

We conducted an observational, descriptive study. All patients attended by the liaison psychiatry service of Hospital del Mar, between February and April 2020, with ACS diagnosis were included.

We included 62 patients with acute confusional syndrom; 35 were men (56.5%), and mean age was 71.71 years (standard deviation [SD]:11.345). The mean duration of admision stay was 41.19 days [SD: 38.039]. The mean number of consultations carried out was 6.5 [SD: 5.422]. 52.5% of our sample of our sample had confusional symptoms for 8 days. 50 patients presented complications during admission (80.6%), of which 43 patients developed infectious complications (69.4%). 59 patients had a history of chronic diseases (95.2%). 54 patiens (88.5%) had potencial risk factors associated with acute confusional syndrome including: isolation in 24 (39.3%), active infection in 46 (74.2%), hypoxemia in 25 (40.3%), previous cognitive impairment in 15 (24.6%)

Acute Confusional Syndrome mainly affects people with risk factors such as isolation, active infection and hypoxemia (which in turn are symptoms of Covid-19).

No significant relationships.

Bipolar disorder is related with functional impairment in euthymia. The contribution of biological functions such as sleep, sexual functioning; or the presence of obesity on this loss remain understudied.

The aim of this work was to study the influence of biological determinants in context with clinical and demographical determinants of functioning in a 3-year cohort of euthymic BD patients.

In this multicentric study 67 euthymic adult bipolar outpatients were followed during three years. Functioning was assessed with FAST, insomnia severity with Oviedo Sleep Questionnaire (OSQ) and, sexual functioning with Changes on Sexual Functioning Questionnaire (CSFQ-14) and obesity was expressed as body mass index (BMI). The basal effect of sleep, sexual functioning and obesity (Time 0) on FAST (Time 3) was analyzed with a mixed ordinal regression model including time effect, age, sex, number of manic and depressive episodes, euthymia length, and comorbidity with personality disorder. Change in functioning (Time 3 to 0) was analyzed in another mixed model also considering the difference in biological determinants (Time 3 to 0) and the presence of mood episodes during the period.

A basal worse sexual functioning, a higher severity of insomnia and a higher BMI predicted a worse functioning at three years (p=0.005, p=0.043, p=0.05 respectively). Regarding FAST difference from Time0 to 3, only having a manic episode related to an impairment on functioning (p=0.027).

Sexual functioning, quality of sleep and BMI are predictors of functioning in euthymia in BD. Manic episodes in the following contribute to impairments on functioning more than depressive episodes.

No significant relationships.

MBRP has become an established treatment in the field of addiction, but implementing the program in an outpatient setting remains a challenge.

We investigated the feasibility of MBRP in an naturalistic outpatient setting and the effect of mindfulness on underlying factors of addiction.

All patients treated between 2015 and 2019 in the MBRP program at Brugmann University Hospital and Addiction Center Enaden were eligible to participate. Patients were asked to fill in a questionnaire about underlying factors of SUD in the domains of pleasure, emotion regulation, stress, relationship with others and relationship with oneself as well as the effect of the completed training on these factors.

Of the 147(74 F) recruited patients; 32 patients completed the questionnaire. The study population differed in terms of substance (mainly alcohol but also cocaine, cannabis, heroine) as well in their aims towards the substance (reduce, stop or maintaining abstinence). Participation of at least 4 of the 8 sessions was 63 % and overall satisfaction of patients was high. We found a positive effect of mindfulness on all of the underlying factors for SUD. Underlying factors of SUD, as well as the effect of mindfulness on these factors showed strong individual variation. The most frequently observed negative effect was acute craving; 1 patient became acute suicidal.

MBRP is feasible and has a clinical relevant impact on underlying factors of SUD. Negative effects were also observed and should be carefully monitored.

No significant relationships.

No significant relationships.

The Covid-19 pandemic has highlighted the urgency for innovative vaccine strategies since the best of vaccines cannot be useful if people do not accept vaccinations. The current situation suggests that vaccinology has been ignored in the medical curriculum and needs more representation in teaching.

What, where and how vaccinology is taught during medical studies in Heidelberg and development of an interdisciplinary revised syllabus and practice-oriented teaching methods.

Curricular mapping of courses on the topic of “vaccination”, defining new learning objectives for designing innovative teaching units in consultation with teachers and students, redevelopment and updating of teaching materials.

In preliminary work, an OSCE has been created by students. Initial findings on the status of teaching on vaccinations and related communication skills in medical schools of Germany with respect to student needs and the national guidelines on learning goals for future physicians are submitted in journal ‘Vaccine’. In collaboration with the elective track Digital Medicine, two tele-OSCEs, an online knowledge quiz on vaccination education and a corresponding evaluation tool will be developed in WS 2021/22. Students will learn how to create modern teaching methods and evaluate them scientifically, using a concrete and relevant topic as an example, and will gain an insight into teaching.

The findings will be integrated into the Heidelberg medical school curriculum (HeiCuMed) on a long-term basis by developing a comprehensive interdisciplinary module ‘Vaccination and Vaccines’, which can either be integrated into various existing courses (e.g. virology, medical Communication, global health, etc) or as a separate elective interprofessional course.

No significant relationships.

Naming and comprehension are standing amog the basic language functions, which allow individuals to realize the communication domain of language. Naming and comprehension imparements are well-studied (Sebastian et al., 2018) in most affected patient groups (for example aphasia patients), but at the same time schizophrenia process may cause it’s specific language disorders (Andreasen et al., 1985). Adolescent age is a very sensitive period in the context of beginning of schizophrenia.

The purpose of present study was to identify which language imparement (naming or comprehension) is the most affected in adolescent non-psychotic schizophrenia in this age. Also, authors were aimed at the check of selected tool sensitivness to schizophrenia patients

Subjects of present study were patients with schizophrenia of Moscow psychiatry clinic (n=20, mean age=14,4), subdivided by DS (F20.xx, F21.xx) and syndromes (national Russian psychiatric subdivision inside the DS). All DS and syndromes were additionally qualified by the clinical professional. Following methods were used: medical history analysis (expert diagnosisqualification, syndromic analysis), Test “Quantative Language Assessment in Aphasia” (QLAA) (Tsvetkova et al., 1981), statistical analysis. QLAA consists from the 4 subtests: naming of objects (NO), actions (NA); comprehension of objects (CO), actions (CA). Answers were quantified by the 3-mark scale (0-0,5-1).

Mean QLAA NO = 14,5; NA = 14,5; CO = 16; CA = 19. Ingroup comparison using U-criteria showed that differences between NO and CA are the most significant (p<0.05). Differences in all other pairs are not so significant.

language comprehension is studied group of adolescent patients with schizophrenia is the most affected language domain

No significant relationships.

As it is well known, diabetes and depression are highly prevalent conditions and affect significantly overall health (Egede & Ellis,2010). This presentation aims to describe the impact of a chronic disease (diabetes) on mental health and its comorbidity with depression. Additionally, it presents the psychotherapeutic process and beneficial effects of coaching on an adolescent patient.

The current study tries to present the comorbidity and interaction between diabetes and depression. It explores the therapeutic path followed, so that the patient could cope effectively with the comorbidity of these diseases and break the vicious circle of sadness that he had been into.

A case study of an adolescent with diabetes is presented. It depicts how the sudden appearance and diagnosis of diabetes led to depressive impasse and cancellation of his dream to become a pilot. The role of coaching is described.

Through monthly coaching the young adolescent discovered his hidden talents and thus he was able to redirect his professional goals and to design a pathway that would lead to the fulfillment of his new life plans. Working closely together with his therapist, step by step, his depressive symptoms were diminished and anti-depressive medication was reduced gradually. Consequently, his diabetes was well regulated, and his overall health was radically improved.

Psychotherapeutic coaching is proved to be appropriate for patients with comorbidity in order to cope effectively with their chronic disease and discover new meaning in their own lives. Last, but not least, self-management skills and diabetes education are required in addition to psychological interventions.

No significant relationships.

Covid-19 does not only have repercussions on the physical level, representing a new way of life, both individually and in society. The pandemic results in invisible consequences for the population’s mental health.

This study aimed to explore the consequences of Covid-19 on mental health in Portugal with a view to understanding and promoting the well-being and happiness of the Portuguese.

The study included 111 young people and adults, aged between 18 and 58 years (M= 21.81, SD= 5.34), with 43.7% males and 52.7% females. A sociodemographic questionnaire was applied to all participants, as well as the Échelle de Mesure des Manifestations du Bien-Être Psychologique (ÈMMBEP; Massé et al., 1998 - Portuguese translation by Monteiro, Tavares & Pereira, 2012) which translates into a response scale 5-point Likert type, with five subscales, including happiness. In addition, a semistructured interview with data collection instruments was administered.

The results obtained demonstrate the negative impact of Covid-19 on the level of well-being, regardless of the participant’s gender or age.

The data presented point to the need to sensitize individuals to the risk of the pandemic in terms of mental health, thus increasing society’s awareness of the psychological effects of this new global disease. Therefore, coping mechanisms are essential to promote well-being and successfully overcome the pandemic.

No significant relationships.

The COVID-19 pandemic and the lockdown brought about a sense of fear and anxiety around the globe. This phenomenon led to both short and long term psychosocial and mental health implications for children and adolescents.

To evaluate the effect of COVID-19 pandemic on hospital admissions for suicidal ideation in a Portuguese adolescent and young adult psychiatry service.

We conducted a single-center, retrospective study including adolescent and young adult patients (15-25 years old) admitted to our service with suicidal ideation within a year before and a year after the declaration date of SARS-CoV-2 disease as a pandemic. Patients were divided in two groups: Group A - patients admitted before the pandemic (March 11, 2019 and March 11, 2020) and Group B – patients admitted after the pandemic declaration (March 12, 2020 and March 12, 2021). The groups characteristics and outcomes were assessed and compared.

A total of 647 admissions were assessed (Group A, n= 372 and Group B, n=275). Demographic characteristics were similar between groups. 75 patients (vs 25 patients) were admitted with suicidal ideation in the year before the pandemic. There was a lower proportion of patients admitted with suicidal ideation during the year after the pandemic year - OR 0.374 (95% CI 0.228-0.614, P<0.001).

Our study showed a decrease in admissions for suicidal ideation in this service in the year after the pandemic. More studies are needed to understand the factors that may justify this decline and evaluate the longer effects of this pandemic in mental health.

No significant relationships.

Although integrated community care programs specifically tailored to patients with severe mental illness (SMI) are available, recent studies show that these programs are not always provided to the population which would benefit the most from it.

Aims of this study were the selection of clinical and psychosocial characteristics and the development of a screening algorithm indicating the need for integrated community care services in people with mental disorders.

Data of an observational longitudinal study including N=511 participants has been used to examine the hypothesized determinants. At baseline, self-reported empowerment has been assessed via the EPAS and psychosocial impairment and perceived needs have been rated by research workers via the HoNOS and the CAN, respectively. Use of integrated community care services was defined as at least four appointments with service providers over six months and has been recorded via the CSSRI twelve to 18 months after baseline. Mixed-effects regression analyses have been performed to test the predictive value of the hypothesized determinants and marginal predictions were used to define cut-offs for the assessment tool.

EPAS, HoNOS and CAN scores each proved to be significant predictors for using integrated community care services. Cut-off scores for each predictor are presented, forming practical assessment guidelines for future studies.

A screening tool and an algorithm for the identification of mentally ill patients who can be expected to benefit from integrated community mental health care programs is available for the German health care system.

No significant relationships.

No significant relationships.

Based on the results showing that there are more alcoholics in the low-income bracket, case management (CM) for such cases was initiated in 2011. As a result, the treatment failure rate was identified between 43-44% based on the WHO criteria.

We investigated the predictive factors for the treatment failure to maximize successful CM treatment.

Thirty-nine subjects from Sasang-gu and Saha-gu treated by four social workers using CM were included in this study. Failure was defined when the level of risk was maintained or increased as per the WHO criteria. The clinical characteristics of the subjects including their age and gender were collected.

Typically, 17 (43.6%) subjects demonstrated treatment failure by the CM (TF). Compared with the subjects who were treated successfully (n=22; TS), TF maintained abstinence in shorter periods in terms of the longest abstinent period compared with TS while CM (28.24±.99 vs. 76.82±.27, p=.025). The higher population in TF did not make an effort to quit drinking compared with TS while CM (41.2% vs.13.6%, p=.051). Also, more TF stayed with their family members compared with TS (58.8% vs. 31.8%, p=.092).

The results showed that shorter abstinence periods and the absence of efforts initiated to quit drinking while CM, and living with family members were the predictive factors for failure in treating alcoholics by the CM. It is presumed that influencing patients to quit drinking and encouraging them to abstain for longer periods are crucial to attaining successful treatment.

No significant relationships.