Patients with mental illness experience a substantial inequity when facing cancer treatment compared to patients without mental illness. They have a higher cancer mortality and are less likely to be referred for treatment following clinical guidelines. The cancer treatment can exacerbate mental symptoms, which may lead to discontinuation of the treatment. Other relevant specialities such as psychiatry and general practice are rarely involved.

In this qualitative case study, the needs, barriers and facilitators of providing high quality, patient-centered care to patients with cancer and pre-existing mental illness were explored. Emphasis was on patients’ experiences of being in the field between oncology, psychiatry, general practice and the municipality.

The study was anchored at the Department of Oncology, Lillebaelt Hospital, Vejle and data collection took place from January to June 2023. Through purposeful sampling five patients with cancer from adult psychiatric setting were included. Field studies were carried out inspired by the framework of Spradley, and involved following the patients during visits to the department of oncology and in the psychiatric setting. Formal interviews were performed using semi-structured interview guides inspired by Kvale and Brinkmann. Patient files were examined focusing on the awareness of the psychiatric diagnosis and treatment and communication between the departments and sectors.

Our analysis showed one major theme: “Complexity on many levels”, and five subthemes: “The impact of the cancer trajectory on mental illness”, “The structure follows the disease, not the patient”, “Fragmentation of the health care system”, “Patient vulnerability” and “Importance of the patient-professional-relationship”. Barriers included lack of a systematic approach to the patient group in the health care system and sparse collaboration between departments and sectors. The cancer trajectory often led to severe worsening of the psychiatric illness, resulting in psychiatric hospitalisation. Facilitators were specialized coordinators at the hospital or municipality, relatives, patients’ resources and health professionals approaching the patient as a person rather than a disease. Final results will be ready for presentation at the conference.

Despite intentions of reducing inequality, the Danish health care system is still not equipped to sufficiently help patients with cancer and pre-existing mental illness through their cancer treatment. This study will highlight relevant target points, paving the way for a new, feasible care model that improves continuity and patient-centered care for patients with cancer and mental illness.

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Valproic acid (VPA) has been used in clinical practice since the 60’s, with a relatively favourable safety and efficacy profile. Pancreatitis, hepatotoxicity and teratogenicity are the most significant adverse drug reactions. VPA is also known for causing hyperammonemia, which may be asymptomatic or can present with encephalopathy. VPA-induced hyperammonemic encephalopathy (VHE) is a serious but reversible condition, which requires high clinical suspicion for diagnosis. It may occur acutely or after chronic use of VPA.

Review how frequent is for valproic acid to cause hyperammonemic encephalopathy, signs to watch out for and how it can be treated.

Presentation of a patient’s case and review of existing literature, in regards to encephalopathy caused by valproic acid as a result of ammonia elevation.

In the case displayed here, the patient is diagnosed of hyperammonemic encephalopathy after being treated with valproic acid as treatment for borderline personality disorder.

Reviewing literature, cases of hyperammonemia are rarely reported as VPA-induced, probably because this increased level of ammonia in blood can vary between asymptomatic, and clinically relevant levels. Symptomatology due to VPA-induced hyperammonemia include: lethargy, impaired consciousness, focal neurological signs and symptoms and increased seizure frequency. More rare described symptoms are: aggression, ataxia, asterixis, vomiting and coma.

There are multiple treatment modalities for patients diagnosed with VHE, the primary treatment being the discontinuation of VPA. Other treatments frequently used are Lactulose and Carnitine.

VHE is a rare occurrence, however can have fatal outcomes if not recognized and managed in time. Physicians should be vigilant while initiating Valproate therapy to patients. Clinicians should consider the possibility of VHE in patients with unexplained altered mental status, regardless of the duration of VPA therapy. A timely diagnosis is essential to prompt effective treatment, thus ensuring the patient’s safety and decreasing the length of hospitalisation and the cost of care in hospitals.

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The sexual health of the elderly presents certain particularities to be taken into consideration in the doctor-patient rapport. The aim of our study was to assess physicians’ knowledge and attitudes towards sexuality in the elderly in Tunisia and to determine variables associated with the level of knowledge and the nature of attitudes in this population.

The aim of our study was to assess physicians’ knowledge and attitudes towards sexuality in the elderly in Tunisia and to determine variables associated with the level of knowledge and the nature of attitudes in this population.

A descriptive and analytical study was conducted among specialists and medical residents of all specialties, practicing in Tunisia and recruited anonymously online. We included questions on socio-demographic data, medical specialty and medical training of physicians as well as a French translation of the Aging Sexual Knowlesge and Atttidues Scale (ASKAS). We determined correlations between the socio-demographic and medical training variables and the ASKAS score among participants.

We included 74 physicians in the study. Sixty-two percent of the doctors surveyed sometimes asked elderly patients about their sexuality (N=46) and the rest of the doctors never mentioned the subject during a medical consultation (N=28). The major obstacles reported when discussing sexuality with the elderly were: a feeling discomfort related to sexuality considered a taboo subject (77%), lack of information and skills (51%) and the duration and setting of the medical consultation considered inadequate (45%). The mean score for the knowledge subcategory of the Aging Sexual Knowledge and Atittudes Scale (ASKAS) was 68.49±5.5 and for the attitudes subcategory was 83.74±4.2. These results indicated a moderate level of knowledge and moderate to negative attitudes.

There was a significant and negative correlation between age and the ASKAS knowledge subcategory score (r= -0.75, p=0.026), as well as a significant positive correlation between the knowledge and attitudes subcategories scores and sexology training (p<0.001).

The correlation between the knowledge score and the attitudes score was significant, positive, and good (r=0.788, p<0.001): the lower the level of knowledge, the more negative the attitudes regarding elderly sexuality.

There are several gaps in the knowledge and perceptions of Tunisian physicians regarding the sexuality of older subjects. Theoretical teaching and practical anti-ageing training for health professionals are needed.

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Literature evidences indicates that adults with attention-deficit/hyperactivity disorder (ADHD) are struggling with executive functions deficiencies, organization in time deficits, low sleep quality, and poor quality of life (QoL). However, it is not clear how those factors associate and interact with each other.

This study aims to compare those factors as well as the relationships between them, among adults with and without ADHD using structural equations modeling (SEM).

Sixty-nine adults with ADHD and 52 matched controls (ages 20-46) completed the Behavior Rating Inventory of Executive Function-adult version (for executive functions), Time Organisation and Participation Scale (for organization-in-time), Mini Sleep Questionnaire (for sleep quality), and Adult ADHD Quality of Life questionnaire (for QoL).

Compared to adults without ADHD, adults with ADHD showed significantly poorer executive functions, organization-in-time, sleep quality and QoL. The SEM indicated that sleep quality and organization-in-time domains mediated the relationship between executive functions abilities and QoL. This SEM explained 79% of the QoL variance for adults with and without ADHD.

Understanding the role of organization-in-time and sleep quality as mediators between executive functions and quality of life emphasize the unique challenges of adults with ADHD, which deals with deficiencies at those factors. Those findings call for including these factors in evaluation and intervention processes to improve QoL and this population’s global health.

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Despite the importance of electroconvulsive therapy (ECT) as treatment, it remains one of the most controversial and misunderstood treatments. Negative media representations, primitive practice in the past and fear for electricity results in fear that extends beyond other therapies. Research on the perspective and role of informal caregivers (IC) in the process of ECT is limited. Most research focuses on relatives’ attitude or knowledge of ECT measured with questionnaires. However, profound understanding of their perspective can facilitate the role of physicians (or psychiatrists) in guiding patients and their IC through the decision-making process of ECT.

The aim of this study was to describe the perspective of informal caregivers in the decision-making process in ECT treatment.

A qualitative phenomenological study was set up. Semi-structured interviews were held with IC of patients who are treated with ECT. Purposive sampling was based on maximum variation. All interviews were fully transcribed and thematic analyses took place. Trustworthiness was guaranteed by e.g. researcher triangulation

In nine interviews were held with partners, children and parents of patients. The interviews had a mean duration of 102 minutes and interviewing proceeded until saturation of the most important themes was reached. During the interviews it became clear that the decision-making process of ECT is strongly influenced by the illness-trajectory and context of living with the mental health problems of the patient. IC describe their life and that of the patient as ‘trying to survive’. The proposal of ECT is seen as a way out of this unendurable situation. The perceived responsibility of the IC in the informed consent process to ECT adds to this burden. The IC worry, feel uncertain and fear to do wrong. Nonetheless ECT seems to be a beacon of hope. Trust in the psychiatrist as a competent professional who wants the best for the patient seems more important than having an answer to all of their questions. After the ECT has been started, IC establish a framework to evaluate the side-effects and effectiveness of ECT. This framework is based on how they experience the patient in daily life and on what they define as ‘the patient becoming a bit more himself again’. IC weigh the effects and side-effects to support the continuation of ECT. However, if patients clearly express that they experience side-effects that are too hindering, IC follow the patient if he or she wants to stop ECT.

Our study gives an insight in the perspective of the IC of patients undergoing ECT. It could be helpful for IC if the psychiatric team repeats information stepwise and takes the burden of responsibility perceived by the IC into account. The framework used by IC to evaluate the effects of ECT could be a valuable addition to the clinical evaluation of the ECT treatment.

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Substance use disorder is a common comorbidity with bipolar disorder, having implications on its diagnosis, treatment adherence, and number of hospitalizations. Understanding the particular characteristics of this population is of the utmost importance to improve clinical outcomes.

Our aim is to analyze the sociodemographic characteristics of the patients in the inpatient unit of a tertiary hospital and to reflect on its impact on treatment. Our study looks over a 3-year period, and all patients analyzed have a dual diagnosis of both bipolar disorder and substance use disorder.

We collected, retrospectively, data from the hospital platform and analyzed it on SPSS Statistics 26, along with a literature review.

In the analyzed period of 3 years, there were 2384 hospitalizations in the Coimbra’s University Hospital psychiatric ward, and 88 hospitalizations were coded with a dual diagnosis of bipolar disorder and substance use disorder.

Regarding gender distribution, 41% of the patients were female and 49% of the patients were male, with a mean age of 47 years.

There were 12 patients who were re-hospitalized once (7 of them were men) and 6 who were re-hospitalized twice (4 of them were men) during the analyzed period.

At the time of hospitalization, 60.5% of male patients were single, 21.1% were divorced, and only 15.8% were married, while female patients were mainly married (35.7%) and only 28.6% were single.

Female patients had more frequent support from social and community institutions (17.9% vs 5.3% in men) while 2.6% of men had no support from family or institutions.

Regarding education, more men accomplished high school education (21.1% vs 17.9% in women) and university education (18.4% vs 14.3%). In our sample, there were 3.6% of women who were illiterate.

During their lifetime, female patients were hospitalized around 5 times and men around 3.7 times, despite the fact that the mean age of female patients on their first hospitalization was 36 years, and in male patients, it was 34 years.

Treatment adherence is more significant in female patients (70.3% vs 69.2% in men), even though women maintain active substance abuse more frequently (42.9 vs 39.5%).

Male and female patients have different backgrounds and different support either in spouses, family, or social institutions. These nuances may play an important role in the number of re-hospitalizations, treatment adherence, and maintenance of abstinence.

Taking these aspects into consideration may help improve clinical outcomes.

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Recently there have been increased acceptance of complementary and alternative medicine (including traditional medicines) not only among laypersons but also various medical specialities. Ayurveda is one such, that originated at least in 3000 BC in the Indian subcontinent. Ayurveda aims at not only treating diseases but also maintaining optimum health. Psychiatry branch of Ayurveda recommends the use of both medicines and psychotherapy. Past papers on Ayurvedic psychotherapy have limitations in terms of semantics, conveying relevance and practical implementation. To tide over such limitations, we review concepts of psychotherapy in the Ayurveda texts Charaka Samhita (CS), Sushruta Samhita (SS), Ashtanga Hridaya (AH) and their commentaries from the original Sanskrit texts, in light of RDoC framework. The approaches derived can be used not just for therapy but also as mental health promotion.

1. 1. To delineate approaches to psychotherapy from Ayurveda classics and their commentaries, which are useful for both mental health promotion and therapy.

2. 2. To view the components of Ayurvedic psychotherapy approaches in terms of RDoC constructs/subconstructs.

Relevant chapters were scanned in the texts CS, SS, AH and their commentaries for descriptions of psychotherapy. Consequently, its components were compared with the definitions of constructs and subconstructs of RDoC to identify similarities.

Only CS and AH had descriptions on psychotherapy, among which, one out of the four described in CS and the only one in AH was suitable for our purpose. The components of these models with relevant counterparts (single or combined) are tabulated in Table 1.Table 1

Thus, CS and AH provide a 5-dimensional and a 3-dimensional approach to psychotherapy respectively (with its components having correlates with few RDoC constructs or subconstructs) which can be explored clinically and evaluated, for therapy and mental health promotion purposes.

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This case report elaborates an unconventional approach to the management the use of clozapine, typically used in treatment-resistant Schizophrenia, in a 17-year-old female patient with treatment-resistant Conduct Disorder, Attention Deficit and Hyperactivity Disorder and Intellectual Disability.

The aim is to demonstrate the potential effectiveness and applicability of clozapine in treating severe, treatment-resistant behavioral problems associated with Conduct Disorder, even without the presence of psychosis, by detailing the clinical course, treatment strategy and outcome of this unique case.

A 17-year old female patient was referred to inpatient clinic due to escalating aggression towards her family members and risky sexual behaviors despite undergoing treatments before as risperidone, haloperidole, olanzapine, lithium, clonidin or aripipirazole. She was running away from home repeatedly and under the risk of sexual abuse. After comprehensive clinical and psychopathological assessment, a decision was made to initiate treatment with clozapine, closely monitoring the patient for adverse effects, and assessing its impact on the patient’s aggressiveness and other behavioral problems. During her stay, clozapine dose titrated to 250 mg/day in addition to her current treatment as amisulpiride 800 mg/day and valproic acid 500 mg/day. Atropine solution as mouthwash used for salivary hipersecretion. No other side effects observed. Cognitive and behavioural therapy interventions made for anger management and impulsivity. Also focused on family-based interventions about establishing healthy boundaries.

A significant reduction in aggressive behavior was noted under the treatment of clozapine. The patient’s overall conduct and interaction with family improved remarkably. The treatment was well-tolerated except sialorrhea, leading to a successful integration back into her family and community.

This case highlights the potential of clozapine as a viable treatment option for managing severe, treatment-resistant behavioral problems in patients with conduct disorder, even in the absence of psychosis. A randomized-controlled trial showed that clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents(Juárez-Treviño et al. Clin Psychopharmacol Neurosci. 2019;17(1):43-53). While it necessitates careful monitoring due to its side-effect profile, this unconventional use of clozapine may open up new avenues for the management of treatment-resistant conduct disorder, thereby improving patient outcomes and quality of life. Further controlled studies are warranted to ascertain the safety and efficacy of this approach.

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he present study investigates irritable bowel syndrome in mental health professionals and the characteristics of psychosocial factors that affect this.

The present study selected an irritable bowel syndrome group among 291 mental health professionals based on the Rome III criteria, and investigated demographic variables. The Hospital Anxiety Depression Scale (HADS), Psychosocial Well-being Index (PWI), and Korean Occupational Stress Scale (KOSS) were used to evaluate psychosocial factors. An independent t-test and chi-square test were used to determine differences between the groups, and a logistic regression analysis was used to determine the odds ratio (OR) of IBS based on occupational stress. SPSS 21.0 (IBM Statistical Package for the Social Sciences 21.0) was utilized for all statistics.

Differences in demographic variables based on IBS group were not statistically significant. Depressive symptoms (t = -4.767, p<0.001) and anxiety (t = -4.068, p<0.001) were higher in the IBS group, and psychosocial well-being was lower (t = 2.288, p<0.05). The OR of IBS based on depressive symptoms was 5.737 (95% CI = 2.24–14.69). There were significant differences in occupational stress based on IBS within the subordinate domains of physical environment (t = -3.160, p<0.01), job demand (t = -3.273, p<0.01), interpersonal conflict (t = -2.295, p<0.05), job security (t = -3.005, p<0.01), and lack of reward (t = -2.046, p<0.05). The OR of IBS based on the subordinate domains of occupational stress was 3.708 (95% CI = 1.20-11.41) in physical environment, and 3.759 (95% CI = 1.33-10.56) in job demand.

The results of the present study verify that psychosocial factors in mental health professionals have a close correlation with IBS. Accordingly, improvements in both IBS symptoms and quality of life should occur through proactive intervention in these variables.

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Important goals of substitution therapy include: reducing the desire to use opioids - methadone enters the brain with a minimal euphoric effect, reduce the desire to use opioids, allowing to avoid the risk of overdose and control their addiction; prevention of withdrawal syndrome; improving the quality of life - can contribute to the restoration of patients, allowing them to return to a normal life, improve their social, professional and family situation; reducing the risk of transmission of infections HIV and hepatitis; reducing crime - control addiction can reduce related crime and to illicitly obtain opioids; psychosocial support helps patients develop coping strategies and increases their chances of long-term recovery.

The goal of substitution therapy is not to completely get rid of addiction, but it can help stabilize the patient’s life and facilitate the recovery process.

Many patients receiving MT also have mental disorders such as cognitive decline, depression, anxiety, PTSD, or even bipolar disorder. These conditions can greatly affect the course and results of treatment.They may also have problems with employment, housing, family conflicts, and legal issues.

In the course of the study, 134 patients aged 26 to 64 years (105 men and 29 women) with a diagnosis of opioid addiction and receiving methadone therapy were examined. Of them, 48 patients had a period of stay at MT of up to three years and 86 – more than three years. The Montreal Cognitive Scale (MoCA) was used to assess comorbid cognitive impairments. The WHOQOL-BREF questionnaire was used to assess the quality of life.

The range of indicators of cognitive functions varied from 21 to 29 points (average - 25.3). 61 patients (46%) showed a result of 26 and above, indicating the absence of cognitive impairment, 51 patients (38%) received from 24 to 21, indicating moderate cognitive impairment. 22 patients (16%) had borderline indicators.

When assessing the level of quality of life, indicators of physical and psychological components varied from 12 to 31; self-perception in the range from 10 to 27 points; microsocial support from 3 to 14 points; social well-being from 11 to 36. In general, the level of satisfaction with the quality of life was in the range of 38-83%.

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Opioid addiction therapy should be consist of an assessment of physical and psychological status, comorbid disorders, quality of life, etc. We can see, MT does not significantly affect the cognitive functions. The differences in the assessment of the quality of life were noted in the components of microsocial support and social well-being, which indicates the vulnerability of patients in these areas. Duration of opioid dependence, availability of psychosocial support, presence of comorbid conditions affect the quality of life. It is important that treatment is tailored to individual needs of patients.

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While chronic inflammation and enhanced imbalance of pro- and antioxidant, including glutathione-dependent, systems contribute substantially to pathogenesis of mental disorders in old age, extent of oxidative stress and degree of inflammatory processes severity are varying among patients with late onset schizophrenia.

Revealing various phenotypes in patients with late onset schizophrenia basing on measurement of activity levels for blood glutathione-dependent enzymes and inflammation markers and analysis of their links with clinical features of the patients.

Of 59 studied women patients 34 were with late onset (after 40 years) and 25 with very late onset (after 60 years) schizophrenia or schizophrenia-like psychoses (F20; F22.8; F25; F23; F06.2 by ICD-10). 34 mentally healthy women elder than 50 years comprised controls. Glutathione reductase (GR), glutathione-S-transferase (GST), neutrophil elastase (NE), and α1-roteinase inhibitor (α1-PI) activities were measured in blood. PANSS, CDSS and CGI-S were used to assess the severity of psychotic symptoms, depression and treatment effectiveness.

In the whole group of patients, GR was lower (p<0.05), and α1-PI was higher (p<0.0001) than in control group. Clustering the patients by their biochemical and immunological signs revealed two clusters (C1, n=34, and C2, n=25) significantly differing by GST (p<0.0001), NE (p<0.0001), and α1-PI (p<0.001) activities. As compared with controls, GST and α1-PI were higher (p<0.05 and p<0.0001), and NE was lower (p<0.05) in C1. As compared with controls, GR activity was lower (p<0.05), NE activity was higher (p<0.001), and α1-PI activity was much higher (p<0.001) in C2. Patients of C1 and C2 did not differ in age, diagnosis, severity of the disease, but differed in clinical features of the course of the disease: significantly more patients with very late onset schizophrenia (76%) were met in C1 (χ2=13.41, p<0.001). Also, different clinical-biological correlations were found in these clusters. Particularly, negative correlations of baseline NE activity with PANSS general psychopathology subscale scores (R=-0.39, p<0.05) and with total PANSS scores (R=-0.39, p<0.05) were found in C1. Positive correlation of GST activity with PANSS positive subscale score was found in C2 (R=0.43, p<0.05).

The revealed clusters differ in the extent of the glutathione antioxidant system impairment and in levels of the immune response markers. The revealing of the patient subgroups on the basis of biological markers reflecting impairments in metabolic and immune systems can represent interest in the search for individual treatment approaches.

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This section will be destinated to the presentation of specific cases of patients with bipolar disorder admitted to our acute psychiatric ward. For each case, sociodemographic, clinical and environmental characteristics will be described and pharmacological treatment discussed. In addition, predictive and protective factors for mood relapses will be identified, and then, prospective information regarding their clinical prognosis will be provided in order to discuss with the attendees the impact of the mentioned factors on clinical outcomes.

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Pediatric Bipolar Disorder (BPD) is a chronic psychiatric disorder that alters normal and psychological development processes among patients. Although cognitive deficits in BPD have identified in recent studies, little is known about the developmental trajectory of these deficits. DMDD is a newly defined diagnosis included in the DSM-V. Since it added a new dimension to the clinical spectrum but few studies conducted on DMDD, there are some conflicting discussions in the literature about how to distinguish this disorder from other childhood psychiatric disorders and how to treat it.

The aim of this study was to determine the phenomenological and neuropsychological differences between children and adolescents with a diagnosis of BPD (Pediatric Bipolar Disorder), DMDD (Disruptive Mood Dysregulation Disorder), and children and adolescents who are genetically at high risk for Bipolar Disorder (BD), and healthy controls (HCs) who do not have any psychiatric diagnosis, to investigate endophenotypes that may be predictive for BD.

Our study sample consists of four groups, the BPD group (n=30), the Risk group (n=25), the DMDD group (n=36), and the Healthy Control group (n=29). All participants were evaluated by the “Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Now and Lifetime Pattern (K-SADS-PL)”. “Young Mania Rating Scale/Parent Form (YMRS-ABF), Conner’s Parent Rating Scale (CPRS-48), Child and Adolescent Behavior Rating Scale (CBCL)” scales were filled by parents, and “Child Depression Inventory (CDI), Youth Self-Report Form for 11-18 Years Olds (YSR)” scales were filled by children and adolescents. Neurocognitive test battery was applied to each participant: Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), Stroop Color and Word Test (SCWT), Trait Making Test A and B sections (TMT-A/B), California Verbal Learning Test-Child version (CVLT-C).

While it was determined that the cases in the BPD and DMDD groups performed significantly worse in CPT, SCWT, CVLT-C, TMT A/B tests compared to healthy controls, it was found that the subjects in the Risk group performed worse at the CPT test than healthy controls. In addition, the cases in the BPD, Risk and DMDD groups reported more clinical and behavioral problems than the healthy controls.

There is a significant deterioration in the areas of continuous attention, processing speed, cognitive flexibility, response prevention, verbal memory and working memory in the BPD and DMDD groups, and in the continuous attention area in the Risk group compared to healthy controls. Prospective follow-up and imaging studies using larger samples and a larger neurocognitive test battery in the future will better reveal the neuropsychological characteristics of the BPD, Risk and DMDD groups.

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Anxiety is the most prevalent disease in the world. Symptoms of anxiety disorders affect everyone. The symptoms are worse after a long period of time and more severe disease than normal. A study was conducted to support the assumption that it is an opportunity to improve healthcare services.

1. 1. Anxiety disorders of doctors and medical specialists of Selenge Province General Hospital

2. 2. Determine the relationship between certain factors and certain factors of anxiety disorders

The GAD7, SRQ20, and PHQ9, sleep system detection questionnaire methods issued by WHO for doctors of primary health care institutions were analyzed by analytical research snapshot model from 03.15 to 04.05, 2023.03.22. /1/01 was obtained and the survey was conducted.

In the study, 23-65-year-olds received medical care, and the average life expectancy was 37.05 years. 30% (27) of the respondents did not have anxiety disorders, 36.67% (33) had mild anxiety disorders, 18.89% (17) had moderate anxiety disorders, and 14.44% (13) had severe health problems. 6.67% (6) of the respondents had no depression, 10% (9) had very mild depression and could cope on their own, 24.44% (22) had moderate depression and could cope, and 27.78% (25) with healthy depression. 24.44% (22) had major depressive disorder and 6.67% (6) had major depressive disorder. According to correlation analysis, GAD7 score with SRQ20 stress score r=0.76 and PHQ9 mood score with r=0. the inverse association was statistically significant at p=0.00. PHQ9 depression score had a strong effect on SRQ20 stress score r=0.74, p=0.00, and GAD7 score r =0.46, p=0.0000. r=-0.40, p=0.00 had a moderate inverse relationship with age, and r=-0.24, p=0.00 had a weak inverse relationship with age. In linear regression analysis, the GAD7 anxiety disorder score increased by 48.8% (p=0.00) when fixed at one, which was statistically significant. In logistic regression analysis, PHQ9 depression score increased by 35.08% (p=0.01) per entry. In composite logistic regression analysis, the PHQ9 depression score was statistically significant OR=4.07 (p=0.01) multiplied by one.

Doctors and medical professionals include psychological health research, testing, treatment, psychological counseling, and health care. Anxiety disorders are related to stress, depression, satisfaction, and age, while depressive disorders are anxiety disorders.

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Cerebral palsy refers to a heterogeneous group of non-progressive neurodevelopmental disorders manifesting in infancy or childhood and varying in severity. It characterized by impaired motor function, sensation, and depressed intellectual abilities. Functional limitations in patients with cerebral palsy may result in chronic dependency, thereby compromising caregivers’ mental health and interfering with the integrity of the family structure.

This study aimed to determine the different factors affecting the mental health of caregivers of children with cerebral palsy and to raise awareness among healthcare providers.

A cross-sectional study was conducted among caregivers of children with cerebral palsy in National Guard Health Affairs-Jeddah, Saudi Arabia, using the Depression Anxiety Stress Scale-21, a validated questionnaire assessing: depression, anxiety, and stress. This questionnaire was used to assess the mental health of the caregivers. In addition, factors reflecting child’s health condition, such as visual impairment, number of emergency department visits, and number of Pediatric Intensive Care Unit admissions were reported to investigate the impact on the caregiver’s mental health.

The sample included 40 caregivers, of which 72.5% were mothers. According to the Depression Anxiety Stress Scale-21 score, 12.5% (n = 5) of the caregivers had moderate depression scores, 10% (n = 4) revealed extremely severe depression, and 10% (n = 4) showed moderate anxiety. Furthermore, 12.5% (n = 5), 15% (n = 6), and 7.5% (n = 3) of the caregivers have scored as moderate, severe, and extremely severe stress levels, respectively. Caregivers’ depression, anxiety, and stress scores were significantly (p ≤ 0.05) associated with the impact of vision of their dependent children, frequent hospital admissions, and frequent emergency department visits. Increased Pediatric Intensive Care Unit admissions in the past year were also significantly associated with higher caregiver anxiety scores.

To the best of our knowledge, the dimension of caregivers’ stress and anxiety and their association with the children’s dependency level is not well documented in our region. Caregivers of children with cerebral palsy reported having mental health challenges associated with the children’s vision, frequent need for acute medical care, and hospital admissions.

Healthcare workers should provide early and proactive planning of medical and social support for children and their families using a family-centered approach.

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Beaumont Hospital is the National Neurosurgical Centre in Ireland. Due to the high numbers of referrals from Neurology and Neurosurgery, The Department of Psychiatry established a specialist Neuropsychiatry inpatient Liaison service and a weekly Neuropsychiatry outpatient clinic. Many of the referrals that the service receive involve the management of delirium. Delirium is a common medical complication, particularly in neurosurgical settings. Delirium causes significant symptom burden which can lead to distress to all involved and impacts quality of life.

The aim was to improve the rates of referrals for delirium presentations and referral rates overall from Neurology and Neurosurgery. The neuropsychiatry service have implemented a delirium protocol for all medical and surgical teams in Beaumont Hospital. This protocol can be accessed through the Beaumont hospital phone app, or on site on each ward. For this reason, delirium can be managed by medical teams in the first instance. If this is not successful, neuropsychiatry can be contacted for further advice or review of patients with more complicated presentations.

The neuropsychiatry service receives referrals through the Patient Information Profile Explorer system which is accessed through the Beaumont Hospital online portal. In the event of an urgent referral, neurology or neurosurgery teams can contact the neuropsychiatry service directly by phone. Referrals are logged on the team referral log book, and details of the referral are recorded along with diagnosis and management. Data was collected retrospectively from the PIPE and log book to measure the rates and reasons for referrals over a one year period. Rates and details of referrals were initially recorded between July-December 2022. An educational intervention was provided where psychoeducation was provided to junior hospital doctors during protected teaching times and further education was provided over the phone when referrals were discussed between team members. Rates and details of referrals were then recorded between January-July 2023.

There was a reduction in referrals when comparing the two six month periods. There were 115 neuropsychiatry referrals from July to December 2022 and 78 referrals from January to July 2023. Rates of delirium referrals also reduced from 31% to 25% after psychoeducation was provided to junior doctors.

This audit highlights the importance of communication and education for medical and surgical trainees in the management of delirium. There is a high rate of turnover of junior doctors throughout the year in Beaumont Hospital. For this reason, it is imperative that continued education is provided to allow them to follow the delirium protocol independently before seeking tertiary service assistance. Ultimately, early and rapid intervention of delirium can have a positive impact on patient care and prognosis

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Emotional burnout refers to a syndrome caused by chronic stress. The formation of emotional burnout may lead to persistent changes in cognitive activity and particularly in memory and attention.

As the power of human EEG-spectrum components varies significantly under cognitive testing, the aim of our study was to investigate the dynamics of changes of EEG parameters under a memory task depending on the severity of burnout.

42 healthy volunteers (students aged 18 to 24 years) participated in this study. EEG was registered over a period of 3 minutes during the rest state and 10 minutes during a verbal memory task. The spectral power density (SPD) of all frequencies from 0.2 to 35 Hz was estimated. The Mann-Witney criterion was carried out for the comparison of the independent data samples. The correlations were estimated using the Spearmen’s coefficient correlation. In order to determine the stages of burnout we used the test “Syndrome of emotional burnout” (by Boyko), adapted for students.

We observed variations in parameters of EEG during memorizing and retention phases depending on the intensity of the burnout. The intensity of the Exhaustion stage varied inversely with SPD in alpha3 (parietal and temporal regions), beta1 (parietal regions) and beta2 (parietal, right occipital and temporal regions) during the memorizing phase. The formation of the Exhaustion stage of burnout was accompanied by a decrease in alpha3 (parietal, left occipital and right temporal regions), beta1 (parietal, occipital and left temporal regions) and beta2 (parietal regions) during the retention phase.

Our data indicate that short-term memory depends on the emotional state of subjects.

None Declared

Cognitive impairment associated with schizophrenia (CIAS) is an important unmet need as there are no effective treatments available. Iclepertin (BI 425809), a glycine transporter-1 inhibitor, has been shown to improve CIAS in Phase II trials, and Phase III trials are underway.

The ongoing CONNEX-X extension study aims to collect additional safety data relating to iclepertin treatment in patients with CIAS.

CONNEX-X (NCT05211947/1346-0014) is a multinational, multicentre, open-label, single-arm extension study in patients with CIAS who completed 26 weeks of treatment (iclepertin 10 mg or placebo) in one of 3 Phase III CONNEX parent trials (NCT04846868/1346-0011, NCT04846881/1346-0012, NCT04860830/1346-0013). An estimated 1400 clinically stable outpatients will be treated (iclepertin 10 mg daily) for 1 year, irrespective of previous treatment (iclepertin/placebo). Patients are excluded if any of the following circumstances occur during the parent study and up to Visit 1 of CONNEX-X: suicidal behaviour or ideation (type 5 on the Columbia-Suicide Severity Rating Scale), diagnosis with moderate/severe substance use disorder, diagnosis other than schizophrenia (according to Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition), development of any condition preventing participation, a haemoglobin level decrease (>25% or <100g/L from baseline in parent trial) or haemoglobinopathies. The primary endpoint is the occurrence of treatment-emergent adverse events. The secondary endpoints include change from baseline (CfB) in Clinical Global Impressions-Severity (CGI-S) and CfB in haemoglobin. Further efficacy endpoints include CfB in MATRICS Consensus Cognitive Battery (MCCB) overall composite T-score, CfB in Schizophrenia Cognition Rating Scale total score and CfB in Virtual Reality Functional Capacity Assessment Tool (VRFCAT) total times.

Currently, 460 patients have been enrolled and randomised from the parent trials with 0% screening failures (-80% roll-over rate, 30 August 2023). Current study status, including recruitment, screening failures and data collection experiences, are presented.

Patient enrolment rates from the CONNEX trials to the CONNEX-X open-label extension study are stable. CONNEX-X will allow the exploration of long-term safety, as well as descriptive analyses of cognitive and functional endpoints of iclepertin in the treatment of CIAS.

Boehringer Ingelheim

C. Reuteman-Fowler Employee of: Boehringer Ingelheim Pharmaceuticals, Inc., Z. Blahova Employee of: Boehringer Ingelheim RCV GmbH & Co. KG, S. Marder Consultant of: Boehringer Ingelheim Pharma GmbH, Merck, Biogen and Sunovion, S. Ikezawa Consultant of: Boehringer Ingelheim Pharma GmbH, Lundbeck, Takeda Pharma, Sumitomo Dainippon Pharma, Employee of: International University of Health and Welfare, Mita Hospital, Tokyo, Japan, P. Falkai Consultant of: Boehringer Ingelheim Pharma GmbH, Boehringer Ingelheim Pharma advisory board

The EDE-Q-7 Portuguese version presented good reliability and validity in Portuguese women fro the general population (Pereira et al. 2022).

The aim of our study was to analyse the psychometric properties of the EDE-Q-7 in a sample of Portuguese women during the perinatal period.

Participants were 346 women with a mean age of 31.68 of years old (± 4.061; range: 18-42). 160 were pregnant (second or third trimester) and 186 were in the post-partum (mean baby´s age=4.37 months (± 2.87; range: 1-12). They answered an online survey including the Portuguese version of the EDE-Q-7 and of the Screen for Disordered Eating/SDE.

Confirmatory factor analysis (CFA) presented adequate fit, in pregnancy (χ2/df=; RMSEA=, p<.001; CFI=; TLI=; GFI=), postpartum (χ2/df=; RMSEA=, p<.001; CFI=; TLI=; GFI=) and considering both – perinatal period (χ2/df=2.7998; RMSEA=.0722, p<.001; CFI=.9709; TLI=.9444; GFI=.9761). The Cronbach’s alpha coefficients were >0.90 for the total and approximately .70 for the three factors - Dietary restraint, Shape/weight overvaluation and Body dissatisfaction. All the items contributed to the internal consistency and presented high internal consistency. Pearson correlations between factors and total scores were significant, positive and high, as well as between the EDE-Q-7 measures and SDE (>.60 with the total; >.40 with the factors), in pregnancy, postpartum and considering both periods.

Presented sound psychometric properties across the perinatal period, the EDE-Q-7 and can be very useful to evaluate the presence and severity of eating disorders symptoms in women in pregnancy and post-partum.

None Declared

Apathy in endogenous depressions is a complex mental phenomenon (it is characterized by indifference and loss of interests, reduced incentives and motivation, decreased mental and physical activity). Apathy becomes the cause of pronounced social maladaptation and untimely seeking medical help. Different depressions vary in psychopathological features of apathy, in addition, there are also different dimensions of the general dynamics of endogenous disease.

Study of the features of the course of schizophrenia, in which apathetic depressions develop with episodic and persistent type of dynamics

The study included 36 patients (15 men, 21 women, average age 34.9 years) with schizophrenia. In 17 cases, apathetic depressions occurred as short-term episodes, in 19 cases, depression took a persistent (close to chronic) course.

Schizophrenia with an episodic type of dynamics of apathetic depressions was characterized by: the predominance of cases with early onset of the disease; alternation of apathetic and other type depressions; equal occurrence of mono- and bipolar types of desease; low severity of negative symptoms and slight changes in social and labor functioning. Apathy has always been present during the whole lenght of depression, its picture was dominated by a motivational decline. The studied cases were prognostically favorable. The features of the course of schizophrenia with chronic apathetic depression were: hyperthymic (10 out of 19 observations) and sensitive schizoid (6 out of 19 observations) premorbid personality; bipolar forms of the disease (94.7%, p < 0.05); the predominance of apathetic depression over other depression types, atypical form of depression; short duration of remissions; frequent course of the disease with the presence of only apathetic depressions (12 out of 19, 63.1%, p < 0.05); significant severity of negative symptoms. Apathy occupied only as a part of the duration of the state, as a rule, after anxiety depression. The picture of apathy was dominated by a decrease in initiative or motivation. This clinical group is the most prognostically unfavorable.

Schizophrenia, occurring with the presence of persistent forms of apathetic depression, has a greater impact on the functioning of patients and has a less favorable prognosis.

None Declared