Honoraria, advisory board, or consulting fees from Angelini, Astra Zeneca, Bristol-Myers Squibb, Gedeon Richter Bulgaria, Innova-Pharma, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer, and Pierre Fabre, for services not related to this abstract

Sexual assault is a major problem in Tunisian society. There is no definitive typology of the characteristics of those who sexually assault. A great diversity of sexual aggression behaviors and different motivations can be described.

It is about a retrospective survey, achieved from data of Medical Expertise of the sexual offenders achieved in psychiatric departement of hospital of mahdia. This study revealed 18 cases during the period from January 2010 to December 2020.

The objective of the work was to describe the epidemiological and criminological profile of the sexual assaults.

Mean age of the sample was 40 years [30-61]. Aggressors were almost exclusively males, have medium socioeconomic status and without a regular job. Fifty percent of the perpetrators had a psychiatric diagnosis: bipolar disorder (27.7%), schizophrenia (11.1%), antisocial personality disorder (5.5%) and intellectual disability (5.5%). Indecent assault (27.7%) was the most frequent aggression then the rape (22,2%). Thirty three per cent of the victims were minor.Among these expertised patients, 72% were considered responsible for their actions and only one was considered irresponsible.

Studies on the characteristics of sexual offenders have concluded to the profile of the young, single and unemployed male, but it can’t be a commun profile.

No significant relationships.

While alcohol-induced psychotic disorder (AIPD) is a well-recognised clinical disorder, relativery little is known about aspects such as epidemiology, course and treatment of the condition. Current evidence suggests AIPD can be clinically distinguised from alcohol-withdrawal delirium and schizophrenia. AIPD is associated with high comorbidity with other psychiatric disorders, high re-hospitalization and mortality rate, namely suicidal behaviour.

The objetive of the study was to examine the correlates, clinical features, psycopathology, and short-term response in an inpatient sample with alcohol-induced psychotic disorder, predominant hallucinations (ICD-10 F10.52) admitted to Centro Hospitalar Psiquiátrico de Lisboa.

We collected retrospectively data from all admitted patients to our Alcohol Unit between January 2010 and January 2020 with the diagnosis of AIPD. The exclusion criteria were: presence of preexisting psychotic disorder, delirium, or other substance use disorders. We characterized our sample in Demographic categories, Clinical categories, Treatment and Short-term course.

A total of 113 subjects were included in the study. The prevalance of alcoholic hallucinosis was found to be 1.3% of all patients who received inpatient treatment. Most individuals reported auditory hallucinations, that iniciated when they decrease their alcohol intake, and 1 in 4 had past episodes of AIPD.

There are specific challenges in studiyng AIPD, such as the relatively rarity of the disorder, its often transient nature and high levels of comorbidity. A high degree of recurrence and morbidity indicates a need to prevent, and intervene early with an abstinent-oriented management goal.

No significant relationships.

Premenstrual dysphoric disorder (PMDD) is included for the first time in the last edition of DSM within affective disorders. It is necessary that 5 of a list of 11 symptoms (lability, irritability, depressed mood, anxiety, lethargy, being out of control or physical symptoms among others) appear in the majority of menstrual cycles but must be only present during the week before menstruation improving after its onset. It has a prevalence of 1,8-5,8% and it is associated to significant functional impairment. SSRIs are indicated as first-line treatment in severe symptoms.

To review about premenstrual dysphoric disorder and its psychopharmacological treatment.

We carry out a literature review about premenstrual dysphoric disorder, accompanied by a clinical description of one patient treated with sertraline.

44 years old female referred to our outpatient mental health service due to anxious and depressive symptoms. She had presented abdominal pain, anxiety, obsessive thoughts, sadness, emotional lability, apahty, anergy, uncontrolled impulse, irritability and vociferous attitude with verbal agressiveness only the week before menstruation during several years. These symptoms interfered negatively in her relationships. We started sertraline treatment with ad integrum clinical recovery after two menstrual cycles. 6 months later we indicated to take sertraline only the week before menstruation, maintaining stability.

1) It is important to consider premenstrual dysphoric disorder as a possible diagnosis in women with premenstrual discomfort symptoms. 2) It might be consider as a depressive disorder. 3) Antidepressant treatment should be considered in women with disabling symptoms.

No significant relationships.

This study is about the clinical uses of three antidepressants( escitalopram, desvenlafaxine, vortioxetine) in the treatment of anxioun depression.

The purpose of this study was to compare the efficacy and safety of escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in the acute treatment of anxious depression.

Patients (n=189) with DSM5 major depression and high levels of anxiety were evenly randomized to escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in a six-week, randomized, rater-blinded, head to head comparative trial. Changes in overall depressive and anxiety symptoms were assessed.

Patients demonstrated similar baseline-to-endpoint improvement in HAMD and HAMA total scores. Patients also demonstrated similar response rate and remission rate in HAMD and HAMA. In analysis of individual HAMD and HAMA items, desvenlafaxine had greatly reduced scores for anxiety somatic (p=0.013), hypochondriasis (p=0.014), cardiovascular symptoms (p=0.005), respiratory symptoms (p=0.013) compared to escitalopram or vortioxetine. Each treatment were well tolerated with no significant differences.

These results showed no significant differences in efficacy and tolerability of escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in this subtype of patients with anxious depression during the acute phase treatment.

No significant relationships.

No significant relationships.

Treatment adherence, is defined as “the extent to which a person’s behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with the agreed recommendations from a healthcare provider.” The course of patients with mental health is habitually chronic and based on an indefinite continuation of treatment to sustain remission and prevent relapses. Treatment adherence issues are the main obstacles in the management of these patients

The aim of the present study was to evaluate treatment adherence in patients with mental health and the demogrphic and clinical factors associated with it.

It was a cross-sectional study conduced at the department of Psychiatry A at Razi Hospital.The validated arabic version of Morisky-Green test was used to assess medication adherence. The patients were considered as adherent if they answered ‘No ’ to all questions

60 patients were included, with a sex ratio M / F of 0.47. Patients were treated for bipolar disorder type1 in 45% of cases, schizophrenia in 28.3% of cases, schizoaffective disorder in 10% of cases and depressive disorder in 6.7% of cases. 50% of included patients had Moderate level of adherence, 35% were considered as non- adherent and only 13.3% had high adherence. The reported reasons for treatment discontinuation were insight (50%), financial problems (26.9%), side effects (15.4%) and unavailability of drugs (7.7%). The Morisky-Green test score were not correlated neither to the nature of the psychiatric disorder nor to multiple medication.

We found a high proportion of nonadherence in patients with mental illness.

No significant relationships.

The overlap between imagery and perception has long fascinated philosophers and scientists. Many scientists considered how the mind is capable of constructing an internal world without intervention of the external environment. Descriptions of their core characteristics often draw attention to differential features, but other currents reveal that many of these are shared rather than unique and differential.

The authors aim to analyse and discuss conceptualisation, similarities and differences of imagery and perception at the level of phenomenology, at the intersection with other psychopathological concepts, and thus reassemble them within a common framework.

A brief literature review was developed based on relevant works containing subject matter most relevant to the topic.

Perception is conceived as a transformation of raw sensory stimuli into sensory information that is then decoded into meaningful at the cortical level. Imagery, in turn, corresponds to the internal mental representation of the world, actively drawn from memory. The differentiation between these concepts at a phenomenological level is analysed and discussed. Additionally, their individual role is evaluated in the pshycopathological expression of alterations of perception such as hallucinations, pseudohallucinations, pareidolic illusions, abnormal imagery, sensory deprivation and also of dreams, in an analytical perspective of integration and simultaneous conceptual differentiation.

Understanding imagery, its nature and formal characteristics is required for better recognising the nature of perceptions and related psychopathological alterations, as well as the mechanisms uniting these concepts. Further research is needed as these entities represent features of useful clinical and diagnostic significance.

No significant relationships.

No significant relationships.

Anxiety disorders are frequent comorbidity in patients with schizophrenia. Their frequency in late-onset psychosis is unknown.

We aimed to study life-time anxiety disorders as well as other psychiatric pathology in patients with late-onset schizophrenia (LoS) and late-onset delusional disorder (LoDD).

42 patients with LoS (age 64,1±9,2, 12% males) and 15 patients with LoDD (n=15; age 69,9±10,9, 14% males ) underwent clinical assessment (PANSS, HDRS-17), cognitive examination (MMSE, MoCA), structured interviewing on life-time pathology. Control group included 24 subjects with no signs of depression or psychosis (age 58,1±10,8, 50% males). Kruscal-Wallis and χ2statistic was used.

Patients with LoS and LoDD had higher frequency of social phobia (50% and 30% compared to 16,7 in control group, χ2 (2)= 6,834, p= 0,033) and more animal phobias (KW χ2 (2)=15,536, p<0,001). The number of habitual anxiety reaction was increased in LoS but not LoDD patients compared to controls (KW χ2 (2)=7,275, p= 0,026) with more severe motor (KW χ2 (2)=8,516, p= 0,014), vegetative (KW χ2 (2)=8,633, p= 0,013 and ideatory symptoms (KW χ2 (2)=6,969, p= 0,031) of anxiety. There was no group difference in life-time frequency of depression. Patients and controls had similar rate of complicated grief, but controls had often no reaction in response to loss and LoS patients responded to loss with manifestation of psychosis (χ2 (6)= 14,473, p= 0,025).

Social phobia and other anxiety disorders are frequent in late-onset psychosis. Symptoms of generalized anxiety are more specific to LoS than to LoDD.

No significant relationships.

Mental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.

This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.

MHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.

A total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).

This study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.

No significant relationships.

Borderline Personality Disorder (BPD) is a pervasive pattern of impulsiveness, emotional dysregulation, and difficult interpersonal relationships. Several studies showed that its onset depends on the combination of biological and psychosocial factors, particularly between biological vulnerabilities and traumatic experiences during childhood.

We aimed to explore the mediators of the effects of childhood trauma in BPD vulnerability.

We conducted a literature review using “PubMed” database and keywords “borderline personality disorder”, “childhood trauma”, “hypothalamic-pituitary-adrenal axis”, “stress”, adverse childhood experiences”.

Several studies showed that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders, with a range between 30 and 90% in BPD patients. All types of abuse and neglect happen to be significantly associated with BPD features. Besides, the exposure to multiple types of maltreatment through multiple development periods increased the severity of BPD. Several studies highlighted the role of alterations in Hypothalamic-Pituitary-Adrenal axis, in neurotransmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD. Besides, morphological changes in several BPD brain areas and in particular in those involved in stress response have also been incriminated.

Our findings regarding the role of childhood trauma in the development of BPD would help identify and develop early intervention services for a vulnerable population. The critical role of psychotherapy in treating individuals with early life stress may partially explain why the prevailing empirically validated treatments for BPD are psychotherapeutic.

No significant relationships.

The COVID-19 pandemic can affect the mental health of health and social care workers (HSCWs) who are frontline workers in this continuous crisis. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and deleterious psychiatric consequences such as depression and anxiety symptoms.

To examine associations between exposure to PMIEs, MI symptoms, depression, and anxiety symptoms. We also aim to assess the moderating role of thwarted belongingness in these associations.

A sample of 243 Israeli HSCWs completed online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021.

About one-third (33.6%) of the sample met the criteria for major depressive disorder, 21.5% met the criteria for generalized anxiety disorder, and 19.1 % reported comorbidity of depression and anxiety. A moderated-mediation model shows that high thwarted belongingness intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and depression and anxiety symptoms. Importantly, the indirect effect of exposure to PMIEs on both depression and anxiety symptoms via MI symptoms existed only among those with high levels of thwarted belongingness.

The study’s findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the contribution of MI to possible mental health consequences. Clinicians should be aware of the importance of high thwarted belongingness in depression and anxiety sequelae of exposure to PMIEs among HSCWs.

No significant relationships.

Aripiprazole LAI is approved for the treatment of schizophrenia in adults. Recently, Europe and Canada approved the use of the two-injection start (TIS) regimen: two separate injections of 400 mg long-acting aripiprazole along with a single 20 mg dose of oral aripiprazole. Aripiprazole showed efficacy in the treatment of adolescents with acute schizophrenia in several controlled trials, leading to its approval for 13-17 year-old adolescents with schizophrenia by the EMA. However, the LAI formulation still remains off-label in adolescents.

To demonstrate the efficacy and safety of the TIS regimen of aripiprazole LAI formulation in a 16 year-old adolescent with schizophrenia.

We evaluated the symptoms of schizophrenia and general severity by means of the PANSS and CGI scales. The scales were administered at hospital admission, after 3 weeks, 5 weeks, and at 4-weeks follow-up.

At the admission the patient PANSS total score was 136, the CGI score of 7. Aripiprazole was started and up-titrated to 30 mg/day. After 3 weeks, the positive symptoms were significantly reduced; due to the persistence of negative symptoms, clozapine 100 mg/day was added. At week 5 the PANSS total score decreased to 81. Due to poor insight we proposed aripiprazole LAI with the two-injection start. One month later, global functioning and illness insight improved; PANSS score was 43, CGI score 2. There was no evidence of akathisia or other side effects.

Aripiprazole LAI showed good efficacy and tolerability in an adolescent with schizophrenia. The two-injection start regimen was a safe and viable option.

No significant relationships.

In patients submitted to refractory epilepsy surgery, psychiatric comorbidity is high (affecting 1 in every 3 patients), with descriptions of improvement, worsening and emergence of de novo psychopathology.

Identifying the prevalence of psychopathology and associated risk factors in a group of patients submitted to refractory epilepsy surgery.

Retrospective observational study. Non systematic literature review.

We observed 42 patients, 45.2% female and 54.8% male, with an average age of 46.5 years (SD±11.6). The average age of presentation of epilepsy was 18.8 years (SD±12.7), 97.6% with temporal lobe epilepsy and 2.4% with parietal lobe epilepsy, 50% in each hemisphere. 19% had surgical complications and 40.5% had post-surgical recurrence of crisis. 45.2% presented with pre-surgical psychopathology (33.3% affective disorders, 16.7% anxiety disorders, 2.4% psychotic disorders, 2.4% neurodevelopmental disorders and 2.4% substance use disorders). Post-surgically, 50% improved, 20.8% maintained and 29.2% worsened their psychopathology and 21.4% had de novo psychopathology. We didn’t find associations between the analyzed variables and the worsening or appearance of de novo psychopathology.

The worsening or appearance of de novo psychopathology is a well known phenomenon in patients submitted to refractory epilepsy surgery. In our sample there were cases of improvement, maintenance, worsening and emergence of de novo psychopathology, however we weren’t able to identify the factors associated with these different outcomes. Our study was retrospective and had a small sample, as limitations. Further, better-designed studies are necessary to identify risk factors for psychiatric disorders, allowing their effective prevention and treatment.

No significant relationships.

Since the beginning of the pandemic, 4,745,519 cases, 396,878 hospitalizations and 82,884 deaths with COVID-19 have been reported in Spain. As of August 24, 2021, 76.4% of Andalusians over 12 years of age have the complete vaccination regimen.

Main: to calculate the prevalence of COVID 19 infection, clinical evolution, and vaccination rate in a population of patients diagnosed with dual bipolar disorder. Secondary: compare these data with those obtained inpatients diagnosed with non-dual bipolar disorder.

Retrospective descriptive study. The study population is made up of patients diagnosed with dual bipolar disorder and non-dual bipolar disorder (according to DSM 5 criteria). Infection, admission, death, and vaccination data were obtained from the patient’s medical history.

Of the 7 patients diagnosed with dual bipolar disorder, the prevalence of COVID 19 infection, since the beginning of the pandemic is 0% and of the 21 patients diagnosed with non-dual bipolar disorder the prevalence is 9.51% (2/21). Of the patients with COVID 19 infection, none required hospital admission and no deaths occurred. The vaccination rate in the group of patients with dual bipolar disorder is 85,71% (6/7) and in the group of non-dual bipolar disorder is 61.91% (13/21), no finding statistically significant differences between both groups.

In our study the prevalence of COVID 19 infection inpatients diagnosed with dual bipolar disorder is 0% and the vaccination rate is 85.71%. While in patients with non-dual bipolar disorder the prevalence is 9.51%, there were no admissions, no deaths and the vaccination rate is 61.91%.

No significant relationships.

Bipolar disorder is a recurrent chronic disorder characterised by fluctuation of mood state. Recent studies focused on the involvement of adenosine and the purinergic system in the pathophysiology of bipolar disorder.

We aimed to investigate the difference in (SUA) levels between different phases of relapse and remission period.

For this aim a prospective study was conducted during six months at Razi psychiatric Hospital in Tunisia with patients diagnosed with BD The socio-demographic, clinical data were gathered from patient and a psychometric assessment using YMRS and Beck scale was employed. Uric acid level was studied during relapse and remission period.

Among 30 consentent patients included in the study : 65.7% were women, The age of the participants varied between 22 and 65 years old. Uric acid level at the relapse varied between 328 and 499 mmol/L and level of controlled value at the remission period which is eight weeks under treatment varied between 137 and 307 mmol/L. Patients under antipsychotic treatment were 55.9% the other were under lithium or mood stabilizer. There is no significant difference between patients with bipolar disorder type I or II neither for the molecule chosen for treatment (p<0.05).

Bipolar disorder is a chronic psychiatric disease which needs to be regulary controlled. Uric acid levels were higher in manic or depressive phases as compared with euthymia phase. Uric acid could be used as a trait marker in bipolar disorder and help psychiatrist to monitor patients and to adjust treatment in order to avoid relapsing.

No significant relationships.

Somatic symptoms with the heterogeneous character that are not fully explained by a medical condition are common in bipolar disorder (BD) which might interfere with the choice of treatment, health care utilization, medical costs as well as functionality.

The purpose of this study was to evaluate somatic symptoms in remitted type 1 BD and to examine the association of somatization, functionality, and childhood trauma which is a known mediator of adult somatization.

After excluding patients with medical comorbidities, 61 patients diagnosed with BD type-1 according to the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) participated in the study. We required at least 8 weeks of remission and confirm it with Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Somatization Scale, Functioning Assessment Short Test (FAST) and Childhood Trauma Questionnaire (CTQ) were administered to the participants.

Somatization scores were significantly correlated with CTQ (r=.310, p=.016), FAST- total (r=.307, p=.016), FAST-financial issues (r=.357, p=.005) and FAST-interpersonal relationships (r=.320, p=.012) subscale scores while inversely correlated with years in education (r=-,305, p=.017). When a partial correlation was run to determine the relationship between somatization and functioning whilst controlling for childhood trauma, there was no statistically significant correlation between somatization and functioning (p=.076).

Our study suggests childhood trauma may have a major influence on the relation between somatization and functionality in patients with type- 1 BD. When addressing physical symptoms in patients with type-1 BD, an integrated approach including childhood trauma should be considered.

No significant relationships.

Somnambulism or sleepwalking could be explained by dysfunction in the regulation of slow-wave sleep. It may be caused by drugs; in the literature, cases of somnambulism that occurred by olanzapine and lithium have been reported.

Discuss the association between somnambulism and Hydroxyzine.

We will discuss the case of a patient with bipolar disorder treated with olanzapine and lithium who experienced episodes of somnambulism after adding Hydroxyzine.

A 42-year-old woman, with no history of somnambulism, followed in our department for a bipolar disorder type 1, treated with 750 mg of lithium and 20 mg of olanzapine. During her usual control, she reported insomnia Hydroxyzine was added at the dose of 50 mg. At the next medical appointment, she said that her husband had noticed that she waked up at night and she eats, she ambulates and searches things. Episodes that the patient did not remember. She was tranferd to the neurolgic departement. She did a neurological exam, an electroencephalogram, and a brain scan, witch were normal. The polysomnography confirmed the diagnosis. The neurologist retained the diagnosis of somnambulism induced by Hdroxizine regarding the chronology of the symptoms. The somnambulism ceased after stopping Hydroxyzine.

Lithium and olanzapine were associated with the occur of somnambulism, but hydroxyzine had never been reported as a somnambulism drug inducing. Drug interaction may explain this phenomenon.

No significant relationships.

No significant relationships.