We present the case of a male patient, 47 years old, diagnosed with schizophrenia, that was admitted at our hospital presenting a confusional state, with agitation, motor discoordination and difficulty breathing. At the blood analyses there was evidence of an increase in cardiac enzymes. The clinical manifestations had begun 5 days before, with slight leucocytosis showing in a routine blood test made after initiating clozapine, followed by fever, vomiting and progressive impairment of general clinical state.

To describe a case of clozapine-induced myocarditis, which is a known, but rare, side effect of clozapine and to do a brief review of the existing knowledge on this matter.

The authors undertook an article review using PubMed database and a thorough analysis of the clinical case.

The hypothesis of clozapine-induced myocarditis was the main diagnosis considered since the beginning, nevertheless, a thorough clinical examination and complementary tests were made and all the previous psychopharmacological treatment was suspended. The final diagnosis was based on the clinical presentation (fever, vomiting, shortness of breath, confusion and impairment of general state), the elevation of CRP, PCT and TnI and findings on echocardiogram that suggested myocarditis (moderate systolic dysfunction of the left ventricle due to global hypokinesia and a non dilated left ventricle).

The clinical manifestations observed, the results of the complementary diagnostic tests and the review of the existing literature, allowed to make the diagnosis of clozapine-induced myocarditis. We find of considerable importance to continue to publish and study this matter as it is still insufficiently known.

No significant relationships.

Previously, environmental vulnerability for schizophrenia assessed through exposome score for schizophrenia (ES-SCZ) was associated with the risk for psychosis development.

The current study aims to investigate the longitudinal association between ES-SCZ and symptom severity in individuals with first episode psychosis (FEP) to understand how environmental exposures affect illness course.

Baseline and 1-month follow-up assessments were available for 225 individuals with FEP from the Athens FEP Research Study. The Positive and Negative Syndrome Scale (PANSS) was used to measure clinical features. In accordance with previous reports, the ES-SCZ was calculated by summing log-odds weighted environmental exposures (childhood adversities, winter birth, and cannabis use). To model the course of clinical features over time the effects of the ES-SCZ-by-time interaction, ES-SCZ, and time were analyzed with multilevel regression analyses. Age, sex, and education were added as covariates

The analyses of change of PANSS total score over time indicated that clinical features decreased from baseline to the 1-month follow-up assessment. The association between ES-SCZ and PANSS total score were not statistically significant. The analyses of the PANSS total score over time indicated an ES-SCZ-by-time interaction (B = 2.82 [95% CI 0.28; 5.35], P-value = 0.029), meaning the decrease of the PANSS total score over time were dependent on ES-SCZ and individuals with high ES-SCZ showed less improvement

The findings show that the total environmental predisposition to schizophrenia (ES-SCZ) not only increases the risk for psychosis development but may also influences the illness course.

No significant relationships.

Internet addiction disorder (IAD) is characterized by an individual’s inability to control his/her Internet use, which may result in marked distress and functional impairment. Systematic reviews show that excessive screen-time is negatively associated with well-being and positively associated with reduced quality of life in young people. There is growing evidence that IAD is related to comorbidities such as depression but relatively little is known about fatigue in adolescents with IAD.

Accumulating evidence suggests that fatigue is a central component of IAD. Depression is also related to IAD. However, there is a lack of evidence regarding whether there is a strong correlation between the severity of IAD and the rate of depression. Our objectives were to describe depression and fatigue in adolescents diagnosed with IAD.

Study included 94 participants with IAD and 88 controls, all aged 12–17 years. Depression was assessed by the Beck Depression Inventory Scale (Georgian version), and fatigue by the Pediatric Quality of Life Initiative (Georgian version) multidimensional fatigue scale.

Adolescents with severe IAD are 5.63 times more likely to show symptoms of moderate or severe depression than children with mild or moderate Internet addiction. Those with severe IAD showed 6.62 times more cognitive fatigue, 7.81 times higher sleep/rest fatigue and 11.11 times higher general fatigue than children with mild and moderate Internet addiction.

IAD can lead to depression and fatigue, which can affect adolescent’s psychological and social well-being. Mechanisms for prevention and ongoing support are needed for adolescents and their families.

No significant relationships.

Since March2019, successive waves of the COVID-19pandemic have challenged the mental health of frontline healthcare workers, who have been shown in numerous studies to be at increased risk for characterized psychiatric disorders. However, healthcare professionals who were not directly involved in the care of patients withCOVID-19 were often not investigated. In Morocco, the literature dealing with the psychological impact of the pandemic on backline health professionals is still scarce.

The purpose of our survey is to assess the stress, anxiety, and depression of health workers who were not on the front lines of care forCOVID-19 patients.

It is a survey developed on googleforms and disseminated via social networks targeting groups of health professionals in Morocco, during June2020. We used the DASS21 scale(depression, anxiety and stress scale with21 items). The results were analyzed using the JAMOVI application.

out of80 participants: 54%are men, 56%are aged between 31 and 40years old, 38%have been in practice for less than 5years of exercise, 66%are married, 41%are specialists 36%are residents and 21%are nurses, 44% work in psychiatric ward. Psychiatric symptoms: 64%have worries, 64% tired, 63% irritability, 59% sadness, 53% insomnia and 51% somatic complaints. 6.3%report substance use. DASS-21: 50%of participants have depression (7.5%mild, 26.25%moderate, 11.25%severe, 5%extremely severe), 48.75%have Anxiety (7.5%mild, 25%moderate, 8.25%severe, 7.5%extremely severe) and 30%report Stress (8.75%mild, 15%moderate, 6.25%severe, 0%extremely severe).

The high level of job stress during the early months of the pandemic exposed health workers who were not on the front line of care forCOVID-19 patients to an increased risk of psychological decompensation.

No significant relationships.

Despite the high interest in affective aspects of endogenous depression, the question of overvalued ideas remains unclear.

To determine the clinical features of depression with overvalued ideas in the context of slow progressing schizophrenia.

The study involved 102 people, including 62 women and 40 men diagnosed with slow progressing schizophrenia, with moderate or severe depression, with the predominance of overvalued ideas (F21 in ICD-10). The control group had 110 people with similar distrubution by sex and age all diagnosed with a depressive state formed in the context of slow progressing schizophrenia, without overvalued ideas. Research methods were mainly clinical-psychopathological and clinical-catamnestic.

In the majority of observations (62.5%) in the comparison group, showed a uncomplicated form of depression, only limited to affective level. In the (37.5%) left, depression was characterized by a structural polymorphism, in addition to affective disorders, there were other psychopathological syndromes observed. In the main group, an inverse relationship was observed: uncomplicated depression in 29.2% of cases, while the overwhelming majority of cases (70.8%) experienced atypical depressions, disharmony of the affective triad, as well as an increase in the concomitance of neurotic and psychopathic symptoms were observed.

The cohort of patients with slow progressive schizophrenia with depression is heterogeneous, while the features of the course of the disease correlate both with the presence or absence of overvaluated formations in the picture of depression, and with the features of the modification of the overvaluated ideas during the disease.

No significant relationships.

Schizophrenia is socially significant mental disorder characterized by early onset and high time and financial expenditure on treatment. Antipsychotics (APs) are highly effective against positive and negative symptoms, but at same time have a wide range of adverse drug reactions (ADRs). APs efficiency and safety are variable and depend on characteristics of genetically determined mechanisms (transportation, biotransformation, and elimination).

Investigation role of pharmacogenetic testing (PhGT) on example of clinical case of severe ADRs in 47-year-old woman with schizophrenia.

Patient’s medical history analysis; clinical observation; biochemical serum analysis; therapeutic drug monitoring; PhGT.

The clinical case of a woman with schizophrenia who has been noted to be unresponsive to APs for some years after schizophrenia onset. She was found to be homozygous for nonfunctional SNVs CYP2D6*4 and CYP2C9*2, heterozygous for CYP1A1*2A, which was reason for complete shutdown of isoenzymes 2D6, 2C9 and 1A1 activity and development of ADRs in use of initial doses of several APs, as well as for an increase in severity of ADRs with schizophrenia positive symptoms aggravation with an even slower titration of APs daily dose not only with polytherapy, but also with monotherapy. So, not recommented APs for patient: aripiprazole, haloperidol, zuclopenthixol, cariprazine, quetiapine, paliperidone, risperidone, thioridazine, sertindole, asenapine, alimemazine, chlorpromazine, etc. (CYP2D6); haloperidol, clozapine, olanzapine, perphenazine, promazine (CYP2C9); carefully: haloperidol, olanzapine, perospirone (СYP1A1).

This rare case demonstrates PhGT importance before APs therapy, because the patient had very high risk AP – induced ADRs. She needed PhGt before APs use, but not after severe ADRs during 12 years.

No significant relationships.

Social intelligence (SI) and creativity (Cr) are resources to develop adaptive coping strategies and positive emotions that can help combat feelings of fragility and vulnerability caused by uncertainty during primary career self-determination as the developmental task in late adolescence.

The aim of the study was to compare SI and Cr of students with high and low level of tolerance for uncertainty (TU) during two last years in the middle school.

Participants were 200 students (15-17 years old). The level of TU was estimated by Budner’s scale (Kornilova, 2010). Social intelligence was assessed by O’Sullivan & Guilford’s Tests, creativity was measured by CAP. In addition, we estimate career adapt-abilities applied to present and prospective future career decisions.

Two contrast clusters based on TU level were analysed. The level of SI and Cr were various within each group. There appears to be an association between TU and career adapt-abilities (at r ∼ .37, p < .05). Mostly female students with low level of TU and above average scores on SI and Cr demonstrate the effective coping strategy dealing with stress (at r ∼ .45, p < .01) emotionally focus on nearest professional future, seek social support. Coping strategy of students with high TU, SI and Cr is focusing on nearest and distant professional future, on task-oriented content and the social status of the future profession. They are open to new career experience and flexibility in the use of future professional skills (at r ∼ .56, p < .001).

Employing their SI and Cr give new opportunities to understand and prevent the development of stress and provide age-specific support to prospective students during primary career self-determination.

Research is supported by the Russian Humanitarian Research Foundation, project No. 18-013-01067.

The COVID-19 related restrictions such as social distancing forced the search for feasible alternatives to the provision of care for patients with severe mental illness (SMI), with services opting for teletherapy as an substitute of face-to-face treatment.

To examine the implementation of teletherapy (telephone, videoconference) with patients with SMI during the COVID-19 first wave, and explore its associations with reduced hospitalisations after the first wave was over.

We performed a retrospective assessment of 270 records of patients visiting fifteen outpatient mental health services across Spain during 2020. We retrieved sociodemographic and clinical data, including modality of received therapy (in-person, telephone, videoconference) in three time points (before, during and after the first COVID-19 wave) and hospitalisation rates two, four and six months later.

During the first wave, services implemented teletherapy (telephone and videoconference) extensively, whilst they reduced face-to-face therapy, though this returned to previous levels after the first wave. Hospitalisations two months later did not differ between patients who received teletherapy, and those who did not (p=.068). However, hospitalisations were lower for the first group of patients four (p =.004) and six months later (p <.001). Multilevel analyses suggested that receiving teletherapy by videoconference during the first wave was the factor that protected patients most against hospitalisations six months later (OR=0.25; p=.012).

Our findings suggest that teletherapy plays a protective role against hospitalisations, especially when face-to-face therapy is not feasible. Therefore, it can be considered a valid alternative to ensure continuity of care to patients with SMI.

No significant relationships.

Electro-convulsive Therapy (ECT) has been considered a useful for the treatment of depression and other affective disorders, however it is considered as a last resort given the risks and possible adverse effects.

The objective of this review is to assess the use of ECT (in terms of efficacy and tolerability) for patients diagnosed with bipolar disorder and how it can be compared with other treatments more commonly used to treat this disorder.

A search was carried out in Medline and in the Virtual Health Library as well as in the Trripdatabase with the search terms “Bipolar disorder”, “Bipolar Depression”, “ECT”, “ECT treatment” and “Mania” in English and narrowing the search to the last 5 years. 8 articles were included for the review after applying inclusion and exclusion criteria.

A favorable and well tolerated response was observed when applied ECT on patients with Bipolar disorder, especially the elderly populations. It was observed that the administration of unilateral and bilateral ECT are both equally effective. A better response was detected to ECT compared to newer treatments like ketamine, as well as lower suicide rate when ECT was used compared to other treatments.

ECT is considered an effective and safe treatment for Bipolar Disorder and should be taken into account not only as a last resort. Even so, given the limitations observed, it is necessary to carry out further investigation on the matter.

No significant relationships.

The cerebellum is often overlooked when evaluating neuropsychiatric disorders. Lately, evidence has increased for the existence of cerebellar connections -generally in relation to vermis and posterior lobe- with cortical areas related to pathophysiology of psychiatric disorders. The cerebellar affective cognitive syndrome, also known as Schmahmann syndrome, has even been described with an evaluation scale.

Case report of a patient suffering a manic episode in context of single right cerebellar metastasis derived from ovarian tumor.

A non-systematic literature review was conducted on PubMed database on cerebellum pathology related to psychiatrics disorders. The clinical case report was prepared through the review of the patient´s clinical record.

The authors introduce the case of a 50-year-old woman, diagnosed with high-grade serous ovarian tumor, with single right cerebellar metastasis of 42mm, who was admitted to oncology due to behavioral alteration, with no prior psychiatric history. The patient showed hyperthymic mood, with speech scanned but fluid, manifesting intense well-being and ideation of mystical-religious and megalomaniac content. Haloperidol up to 7.5mg/8 hours and clonazepam 2 mg/8 hours were prescribed, switching haloperidol to olanzapine up to 25mg/day after several days, since the symptoms did not improve. Valproic acid 500 mg/24 hours was also added. Progressive improvement was seen, without worsening of motor symptoms or instability. The CCAS scale (Cerebellar Cognitive Affective/Schmahmann syndrome) was performed, with a positive result (10/10) being> 3 definitive CCAS.

The relationship between cerebellum and neuropsychiatric disorders is still partly unknown, requiring more research to be able to carry out specific diagnoses and treatments for patients.

No significant relationships.

Many psychotropic drugs can induce weight gain with differences in their metabolic risk profiles (i.e. high, medium or low-risk).

To compare the weight evolution of patients switching versus patients keeping their psychotropic drugs with different risk-profiles.

Data for patients switching or keeping the same drug were obtained from the Psyclin (from 2007 to 2015) and Psymetab (2007- 2019) cohort studies, conducted at the Lausanne University Hospital, Switzerland. Patients either switched from a high to a low-risk, a high to a medium-risk, a medium to a low-risk drug, or for a drug with the same risk category. Patients not switching either kept a high, medium or low-risk drug. The evolution of weight is currently being analyzed using a linear mixed-effect model.

Preliminary results showed that switching from a high to low-risk molecule had the strongest impact on weight changes. The analysis being ongoing, the quantitative results will be presented at the congress.

Switching from a high-risk to a low-risk molecule is likely to have the strongest impact on weight changes.

No significant relationships.

Stress is part of the daily life of many people, especially in Western countries. Recent studies have shown that cortisol has been listed as the primary hormone linked to stress. Currently, to measure cortisol values there are only tests that quantify it at a determined time point, without taking into account its variability and its changing pattern over time, depends on the circadian rhythm and other stress-related factors.

This randomized clinical trial of the Hospital Clínic de Barcelona proposes to study the utility of accumulated hair cortisol concentration (HCC) as a measure to correlate the levels of this hormone over time with the stress suffered by the patient.

Patients are classified into two groups: a control group and an intervention group. In the second group, the participants will follow a mindfulness-based cognitive therapy (MBCT) with the aim of reducing stress and, consequently, cortisol levels.

The purpose of this study is to validate the utility of HCC in order to, retrospectively, obtain cortisol secretion curves as a measure of the level of stress of each individual and personalize the treatments. Simultaneously, we intend to present new perspectives for treatment in psychiatric disorders where stress predominates, such as generalized anxiety disorder (GAD) or major depression (MD), which are becoming increasingly important in our society.

HCC contributes to the practice of personalized medicine as it allows us to detect cortisol exposure in the months prior to obtaining the capillary sample, and thus to draw the trend of this hormone over time.

No significant relationships.

Elderly people have always presented physiological changes and suffered from many diseases. There are few studies focused on this growing particular population, especially with mental pathologies. Thus, psychiatric hospitalization of the elderly population is more frequent nowadays.

The aim of this study is to establish the socio-demographic characteristics of elderly patients hospitalized in psychiatry.

Retrospective and descriptive study over a period of 20 years and 6 months on patients aged over 65 years old hospitalized in the psychiatry “B” department of the Hedi Chaker University hospital in Sfax, Tunisia, for a psychiatric disorder, selected according to the DSM 5 diagnosis criteria.

The number of records identified was 62, out of 4019 patients (15.4%). The mean age of patients was 71.1 years old and the sex ratio (Male / Female) = 0.67. Patients were originally from Sfax in 58.1% and from rural areas in 58.1% of cases. Most of patients (78.4%) were living at least with one member of their family. They were married in 53.2% of cases. The average number of children was 5.21. The majority of patients were illiterate (61.3%) and never had a professional activity in 45.2% of cases. Social coverage concerned 96.8% of our sample.

Elderly patients hospitalized in our department were mainly illiterate, females and living with their family. Despite everything, family involvement in care is still necessary for this category of patients.

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.

Workplace conditions have a documented effect on employee health including sleep. Occupational stress and burnout are more frequent among penitentiary personnel than the general population.

The aim of the current study was to examine the phenomenon of insomnia and its relationship with occupational burnout in a sample of Polish prison officers.

The study was carried out on a sample of Polish prison officers using the Athens Insomnia Scale (AIS), the Coping Orientation to Problems Experienced (COPE), and the Oldenburg Burnout Inventory (OLBI).

showed that the Polish prison officers exhibited early symptoms of insomnia. Sleep disorders had a significant role in developing occupational burnout. Coping strategies such as help-seeking and engagement were revealed to have a mediating role in the relationship between insomnia and occupational burnout dimensions. The coping strategy of help-seeking was the only predictor of insomnia.

The results can constitute a significant argument for health promotion campaigns highlighting sleep hygiene directed at penitentiary personnel. A research model created for the purposes of future studies would allow for measuring the frequency of health behaviors, including the general category of preventive behaviors. The study warrants continuation.

No significant relationships.

We will present experience developing a system for monitoring training placements in psychiatry and community paediatrics, and how this was expanded to provide an automated anonymised MSF for trainers for annual appraisal and will identify trainers in need of additional support and other post/training programme issues. The session will be of interest to educators and medical education leads with practical tips and lessons learnt over the last 8 years since the system was first developed.

The system was also used to identify trainers in need of additional support and other post/training programme issues.

We used an electronic system to gain the infromation as stated in the introduction.

Over the last 8 years we have collected data using this system. the results for our trust will be displayed annoymously but the system is the ficus of this presenation.

The advantages of the system are that it runs throughout the year (so covers each post and placement), has high trainee response rates, has no selection bias (compared with some other MSF systems) and the results are embedded within local quality systems and individual consultant appraisals. The data that the system collects can help provide robust evidence when investigating concerns that might only arise periodically (for example through the annual GMC trainee survey in the UK). We believe that this system will be applicable for doctors providing training in other countries and empowers the improvement of psychiatric training for the profession.

No significant relationships.

Obsessive-compulsive disorder (OCD) is a chronic and impairing condition included in the DSM-5 Obsessive-Compulsive Spectrum Disorders. Despite psychopharmacological and psychotherapeutic measures, there are patients who remain refractory to different therapeutic strategies.

The authors aim to present different alternatives in approach, treatment and management of refractory OCD, based on a review of the existing literature.

Analysis of the data about this subject, considering the review articles and the case reports published at current time and highlighting the most essential topics, concerning the latest developments in the area.

Therapeutic options are presented, including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and ablative neurosurgery.

The treatment of OCD represents a great challenge in clinical practice. Despite the advances accomplished by a more extensive knowledge of the disease and a burden of new techniques in the last decades, more treatment strategies are needed, especially for patients with non-response to conventional treatment.

No significant relationships.

during the study period (08/02/2021 – 11/05/2021) the Centre of Psychiatry in the Jahn Ferenc South-pest Hospital (CP-JFSH) was one of the two psychiatric wards in Budapest, specialized for the treatment of COVID-19 infected psychiatric patients.

the aim of the study was to survey the characteristics and evaluate the outcome of the COVID-19 infected psychiatric patients treated in the CP-JFSH.

retrospective analysis of the files of COVID-19 infected psychiatric patients admitted to the CP-JFSH in a 3 month period. In addition to demographic data, diagnostic distribution, co-morbidities, date of infection, method of detection of the virus, presence of pneumonia, severity of infection, outcome, treatment, vaccination data were evaluated.

in the study period 124 COVID-19 infected psychiaric patients were admitted to the CP-JFSH. The gender distribution was aproximately equal, the mean age of the patients was 62.8+/-15.7 years. Majority of the patients suffered from major neurocognitive disorder followed by schizophrenia spectrum disorder. Most common co-morbidities were cardiovascular diseases and diabetes. Pneumonia was present in 41% of the patients. Majority of the patients were already infected at the time of admission, detected with the first PCR examination and haven’t been vaccinated yet. Thirty-one percent of the patients suffered from moderate to severe COVID-19 illness. COVID-19 specific therapy (favipiravir, remdesivir, fluvoxamin) was introduced in 57%. Mortality was 12% while the relaps rate 4%.

comparing with inpatient mortality rate published in the literature, mortality rate was higher among psychiatric patients, underlining the need for special attention of this population.

No significant relationships.

Social media networks are becoming omnipresent in our lives, and more and more available to everyone including patients with mental illnesses.

Our study aimed to examine the prevalence of social media use in individuals with schizophrenia and schizoaffective disorder, and to examine the association of severity of symptoms with social media use.

A total of 38 patients with schizophrenia or schizoaffective disorder were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax, Tunisia. Socio-demographic information as well as details about their social media use were collected from all the patients. Severity of schizophrenia symptoms was assessed on the Positive and Negative Syndrome Scale (PANSS). A logistic regression was used to explore the association between social media use and clinical characteristics of the participants.

Of the 38 study participants, 23.7% used social media. Facebook was the most popular social media site. The number of social media users were highest among participants aged 21–30 years old, married participants, residents of an urban region, employed participants and patients with a tertiary education level. Age and PANSS negative score were significantly and negatively associated with social media use.

Less than one fourth of patients with schizophrenia and schizoaffective disorder use social media and may be suitable candidates for treatment programs supported by social media platforms , especially those of a young age and a low severity of negative symptoms .

No significant relationships.