Nowadays Social Networks (SN) are used not only in a playful way but also as a ‘health’ means of communication. The Pro-Ana and Pro-Mia accounts or profiles -whereby Eating Disorders are advocated as a ‘lifestyle’- increased by 300% over the last decade.

To analyze Instagram Pro-Ana and Pro-Mia accounts and compare them with Pro-Ana and Pro-Mia Blogs.

A non-computerized research of Pro-Ana and Pro-Mia Blogs and Instagram profiles was performed. Accepting a risk of Alpha=0.05 and Beta=0.15 in a two-tailed test, 29 subjects were required in each group to detect a difference equal to or greater than 0.2 units. The common standard deviation is assumed to be 0.25. Publication averages, photos, opening years, WhatsApp links and number of followers were analysed and compared. Transversal descriptive study.

Blogs: 100% had no groups in other SN, 33.33% had been opened for more than 3 years, 30% included personal pictures, 16.67% contained Ana in their title, 53.3% named other Blogs. Instagram: 56.67% included personal pictures, 13.33% mentioned WhatsApp groups, 73.33% had a public profile, 43.33% contained ‘Ana’ in their user name and 53.33% had more than one hundred followers.

These tools are constantly adapting to the times in which they coexist. There has also been a current increase in Instagram profiles. This study shows a greater linkage to WhatsApp groups on Instagram than on Blogs, together with a higher number of followers, ease of ownership and difficulty of control.

No significant relationships.

The current stage of research on mental disorders is associated with the use of system approaches to the development of the scientific foundations of psychiatric care.

Approach to solving problems that arise in the diagnosis of psychopathological conditions, assessing their severity, as well as evaluating the effectiveness of psychosocial treatment and rehabilitation.

Clinical, psychometric, system analysis methods and algorithms of the Analytical Hierarchy Process (AHP) [1] were used.

When assessing a patient’s condition and behavior, it is necessary to make decisions (diagnosis, development of treatment and rehabilitation plans) based on heterogeneous information (genetic, neuronal and environmental, involving individual characteristics, as well as family and social context). This information is hierarchically organized and includes quantitative and qualitative data. Exposure at each of these different levels can affect the onset and course of the disease, and therefore should be considered in primary prevention and subsequent psychosocial therapy and rehabilitation of patients. Analysis of the problems of assessing psychopathological states and related psychosocial problems shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing the initial information. The main advantages of the AHP include the use of the relationship scale (fundamental scale) for processing heterogeneous data based on expert, clinical information.

The approach provides correct integration of heterogeneous characteristics when considering diagnostic procedures, psychosocial therapy and rehabilitation.1. Mitikhin V.G., Solokhina T.A. S.S. Korsakov Journal of Neurology and Psychiatry, 2019, 2: 49-54. doi:10.17116/jnevro201911902149

Coronavirus disease (COVID-19) is a contagious disease. Its potential psychological impact could involve fear of being contaminated by germs and dirt, which may lead to washing hands repeatedly until harm the skin.

To explore the incidence of Obsessive-Compulsive Disorder (OCD) symptoms during COVID-19 pandemic among the Saudi general population, and to explore its correlation with stress and the associated factors.

A cross-sectional survey of a sample consisting of 2909 participants was conducted during COVID-19 outbreak consists of socio-demographic characteristics, Perceived Stress Scale (PSS) and The Brief Obsessive–Compulsive Scale (BOCS).

Most participants were female (73.9%) with university level or above (81%) and were disciplined with quarantine (75.6%). New onset symptoms of obsessive thoughts (worries about germs, dirt and viruses), and compulsive behavior (excessive hand washing) were reported by 57.8% and 45.9% of the participant. Participants who developed these symptoms only during CODIV-19 pandemic were significantly higher than asymptomatic participants or those who developed symptoms before the pandemic (p-value< 0.000). New onset symptoms were significantly more among participants with high stress (57.5% and 51.4%; p-value <0.000). Some sociodemographic characteristics were significantly associated with new onset OCD symptoms such as age group (40-49 years), employee in non-medical field, housewives, students, being disciplined and spending more days in quarantine (p- value<0.000, p-value<0.047, p-value<0.012, p-value<0.015).

This study revealed a significantly higher prevalence of high perceived stress in respondents with new onset OCD symptoms. This implies that bio disaster is associated with a high psychological morbidity which needs interventional programs.

Disgust is a basic emotion characterized by the feeling of revulsion and evoked by unpleasant stimuli such as contaminated food, poor hygiene and contact with sick or dead organisms. Disgust is a contributing factor to the development of several mental disorders including anxiety disorders (AD). Several studies have tried to explore the relationship between disgust and eating disorders (ED), with heterogeneous findings. Subjects with ED showed a heightened level of disgust sensitivity (DS) when compared with healthy controls (HC).

Our study aims to evaluate levels of disgust and anxiety in ED, AD and HC in order to assess associations between these two emotions.

We enrolled 74 patients admitted to Psychiatric Unit of Careggi, 41 with diagnosis of Eating Disorder, 33 with Anxiety Disorders, and 40 healthy controls. We administered to all groups: Zung Anxiety Scale (ZSAS) and Disgust Propensity and Sensitivity Scale-revised (DPSS-r).

Both patients with anxiety disorders and eating disorders showed higher levels of disgust propensity and sensitivity than healthy controls. Moreover, there was no significant differences in anxiety, Disgust Propensity (DP) and Disgust Sensitivity levels between patients with eating disorders and anxiety disorders. Among healthy controls there was a significant association between DS and Anxiety levels (B: 0.579, T:3,416 p:0,001).

Anxiety and disgust are typical emotions of anxiety disorders and eating disorders. However, they are increased both in anxiety and eating disorders and they are associated in healthy controls. The nature of this association needs to be deeply investigated.

No significant relationships.

ECT is a potentially life-saving treatment for patients with severe or treatment resistant depression. Cognitive function disturbances following ECT are generally transient, but could be of longer duration in some cases

To assess the cognitive side effects in patients with affective disorders treated with a course of electroconvulsive therapy (ECT).

Cognitive functions of patients who undergo ECT was assessed prior to start of treatment, midway of the course of treatment and after end of the course of treatment using Montreal Cognitive Assessment (MoCA). We did a retrospective analysis of MoCA scores of 15 patients who received bilateral ECT in 2017-2018. In order to assess the efficacy of ECT in the treatment of their illness, we did a retrospective analysis of Montgomery Asberg Depression Rating Scale (MADRS) scores of 18 patients who received bilateral ECT in 2017-2018

Only 7% of the patients who underwent ECT in our sample did have significant cognitive decline as per their MoCA scores. 28% of patients achieved complete remission in their depressive symptomes. 22% of patients continued on maintenance treatment. 95% of patients showed significant improvement in their symptoms following treatment with ECT where there symptoms reduced to either mild or minimal depressive symptoms.

Cognitive side effect was not a significant side effect in our sample of patients. We did see an improvement in cognitive function in a significant number of the sample of patients as they progressed with treatment, which coincided with improvement in their affective symptoms.

Investigating family member’s attitudesabout schizophrenia is an important step in its management. They likely influence the family’s help-seeking decisions and affect both adherence with biomedical interventionsand social integration of the patients.

Describe families’ beliefs about the symptoms and the treatments of schizophrenia.

We led a transversal study including 32 relatives of patients with schizophrenia (DSM 5). We collected data for both patients andrelatives. We asked relatives to respond by “yes/no/I am not certain” to the questionnaireincluding items dealing with symptoms and optimal cures forschizophrenia.

The mean age of the relatives was 60.8 years; 71.9% were parents; 37.5% were illiterate; 46.9% reported having another family member with a mental disorder (MD) and 15.5% of relatives were able to label the term “schizophrenia”. Nine participants (28%) believed that the patient makes shame to the family’s member and 72% of them was convinced that patient is dangerous.The majority of participants (90.6%) provedthe need for drugs and 65.6% attested the utility of psychotherapies.However, they believed innon-medical practices such as reading Holy Koran verses (87.5%), charity and exorcism (62.5%). Family history of MD was correlated to traditional practices (p=0.038). The belief that patient is dangerous and that he makes shame were associated with advanced age of relatives (p=0.000 and 0.037 respectively). Significant correlationwas found betweennon medical practices and erratic follow-up (p=0.043).

This study points outthe need to improve the psychoeducation of family members of persons with schizophrenia.

The global pandemic of corona virus has brought on the imperative of swift organisational changes within mental health care institutions. Outpatient psychiatric care system with all its complex features was organized online. Patient’s adjustment to different modality of treatment, and their benefit, was of our primary concern. Mental health professionals had many challenges in this process as well. Couple of months into providing this form of treatment, we were interested in therapist experience.

The aim of this study was to highlight challenges faced by the various mental health professionals that were a part of interdisciplinary team at University Psychiatric Hospital Vrapče.

We used self-assessment scales to assess mental health professionals experience and to recognize some of the possible difficulties in this process. We have examined satisfaction with available technology, suitability of different psychotherapeutic background when providing online treatment, therapists competencies for this kind of treatment and levels of perceived stress. Mental health treatment comprised individual and group approach, and was provided by interdisciplinary teams of psychiatrists, clinical psychologists, social workers, social pedagogues, psychiatric nurses, and work therapists.

The results show differences between professional’s psychotherapy background, educational level and previous experience in perceived efficiency and experienced stress in the process of providing online treatment.

The findings of this study have proven that professionals perceive technical, organisational standards, previous experience, and education to be important for their efficiency. This should be taken into account when developing standards in online treatment within mental health institutions.

No significant relationships.

Chronic diseases have often been associated with depression or other psychiatric conditions. Despite the fact that renal transplantation offers children a chance at a better life, it could also raise some challenges. Dealing with a severe medical condition such as chronic renal disease and multidrug therapy with potential long term side-effects from the early years of life can affect a child’s emotional and social development.

Reporting a case which represents a challenge in treating an adolescent with depression and renal failure.

Case Report

A 15 year old male with multiple admissions (between the ages of 12 and 15) for recurrent feelings of inadequacy and worthlessness due to his appearance, impaired social skills, hostility towards society, suicide ideation and aggressive behaviour. Moreover, his medical history includes CRS (congenital renal disease), kidney transplant at the age of 2 followed with transplant rejection in 2019. Currently he is under haemodialysis and multiple drug prescriptions associated with his severe medical condition which interferes with the psychotropic treatment.

This case quests what the better choice of intervention is for depression associated with aggressive behavior in a child with kidney failure and with no significant improvement in psychotherapy?

The present aimed to examine the mental health conditions of children, ages 7-11 years, living in conditions of war and conflict conditions in two districts of a Nagorno-Karabakh, Azerbaijan.

The study surveyed teachers of 617 primary school children (mean age 8.9, SD 1.24; 50.7% female) across nine schools in Agdam and Karabakh districts.

The children were evaluated with the previously validated Azerbaijani version of the Strengths and Difficulties Questionnaire (SDQ) Teacher Form. The total difficulty and five subscale scores (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior) were assessed.

About a third of children (32.7%) had abnormal total scores, and a fifth (21.4%) were in borderline range. The SDQ subscale scores included emotional problems (19.4%); conduct problems (20.3%), hyperactivity/inattention (12.2%), peer relationship problems (31.1%), and pro-social behavior difficulties (13.1%). Boys had higher level of difficulties than females (p<.01) with a negative correlation of children’s school performance with maternal education.

The findings of the study show that more than half of the children living in the war zone in Azerbaijan have significant mental health problems. The psychological effects of the war environments have a profund effect on child development and education and need to be revisited under the United Nations Sustainable Development Goals. These include the provision of implicit supports in terms of their emotional, behavioral, psychosocial development and education of children and protection of children from wars, conflicts, and persecution.

No significant relationships.

Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait.

Assess the possibility that symptoms of emotional dysregulation should be considered as core diagnostic feature of ADHD.

It’s a cross sectional study, including 60 children with ADHD and 60 children without ADHD ranging from 6 to 19 years of age (mean age 10.43 years). We defined moderate emotional dysregulation if a child had an aggregate cut-off score of ˃180 on the Anxiety/Depression, Aggression, and Attention scales of the CBCL and severe emotionaldysregulation if a child had an aggregate cut-off score of ˃ 210. This profile was selected because of its conceptual congruence with the clinical concept of emotionaldysregulation.

Sixty-three percent of children with ADHD had a severe emotional dysregulation versus 12% of controls (P˂0.001). Emotional dysregulation was associated with elevated rates of hyperactivity and impulsivity : Ninety-six percent of the children with hyperactivity-impulsivity, according to the Conners scale, had emotional dysregulation. With a significant correlation between emotional dysregulation and hyperactivity-impulsivity (p = 0.001). Also all children with attentional disorders exhibited emotional dysregulation and a significant correlation between emotional dysregulation and inattention has been found in both groups (p=0.000).

Emotional dysregulation is now known to play a causal role regarding ADHD symptomatology. It should therefore be included in future theoretical models of ADHD, as well as in clinical practice when identifying the major impairments in this diagnostic group and when deciding therapeutic strategies.

In the midst of a global pandemic with a rising death toll, the children´s mental health can be easily overlooked in the country’s response. But this overlook would have devastating consequences for years to come.

The objective of this research is to compare children’s physical and mental development before, during and after the situation of social isolation caused by the pandemic of COVID-19.

The parents/guardians of 100 children aged between 0 and 5 years and 11 months old were asked to answer questions based on the ASQ-3 (Ages and Stages Questionnaire III), containing questions related to Communication, Gross Motor, Fine Motor, Problem Solving, and Personal-Social and ASQ- SE (Ages and Stages Questionnaires Social-Emotional) addressing issues of self-regulation, compliance, social-communication, adaptive functioning, autonomy, and affect. In addition, behavioral issues related to children’s mental health will be included, such as: aggressiveness, insomnia, lack of appetite, apathy, sadness, tiredness, lack of interest, hyperactivity, manias, tantrum, morning among others. Child development data will be collected before and during quarantine / isolation and later, in a second stage, after the end of social isolation.

The data will be analyzed in order to characterize child behavior before, during and after the period of social isolation, correlating the different areas of child development, especially mental health.

As argued, socially isolated children are at increased risk of health problems in adulthood. Furthermore, studies on social isolation have demonstrated that a lack of social relationships negatively impacts the development of the brain’s structure.

No significant relationships.

Health care professionals are particularly concerned with burnout

This study aimed to evaluate the the factors predisposing to occupational burnout

This was a cross sectional study including health care professionals in medical oncology working in public hospitals in Tunisia. It was carried out from 15 January 2019 to 15 June 2019. Health profeessionals were asked to answer the Maslach –Burnout Inventory Test.

The mean age was 34 ± 6.7 years [23 - 57]. The sex ratio was 0.22. Our study population included 37 doctors (53%) and 33 nurses (47%). The inappropriate working conditions mentioned by the participants were as follows: The requirementss of patients and their families (91.5%), the lack of resources (87%), overwork found (83%), unsatisfactory effort- salary ratio (83%) and the reduced number of staff (77%). Several Burn-out factors mentioned by the participants were significantly associated with a high emotional exhaustion syndrome: overwork, poor service organization, lack of resources, lack of time, lack of recognition, conflicts with colleagues, lack of communication, unsatisfactory salary - effort ratio, assaults by patients. Several factors were positively and significantly associated with a high depersonalization score: overwork, poor service organization, small number of staff, lack of resources, lack of respect, lack of recognition. The global burnout associating the achievement of the three dimensions was significantly associated with overwork, lack of recognition, conflicts with colleagues and assault by patients.

Burnout has become a major issue in Tunisian medicine. If left untreated, burnout epidemic may continue to worsen, to the detriment of patients and doctors

People suffering from chronic diseases, especially epilepsy, are more likely to suffer from neurobehavioral disorders, like psychotic states. Postictal psychosis (PIP) is one of these potentially serious complications, that classically follows exacerbations of seizures.

The present paper aimed to study the clinical and therapeutic aspects of PIP.

We report a case of PIP, which involved a patient hospitalized in psychiatry department, and discuss it in light of the relevant literature.

We report the case of a 27-year-old man, with medical history of generalized epilepsy which was well stabilized under treatment (carbamazepine 600 mg/day). The patient was hospitalized for dangerous behaviors after having experienced 2 episodes of seizure activity in context of poor therapeutic adherence. Psychiatric assessment revealed a psychomotor instability, a pressured speech and hallucinatory behavior. There were no delirium symptoms. Neurological examination showed no localization signs, and cerebral imaging was normal. The patient was treated with benzodiazepines (Diazepam), associated to antipsychotics (Haloperidol). His antiepileptic drug was quickly reintroduced. After 48 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days.

The short-term prognosis of PPI is often favorable, compared to other psychotic disorders. However, more severe psychiatric disorders can potentially develop in the long-term, raising diagnostic and therapeutic difficulties. Thus, a good collaboration between psychiatrists and neurologists is highly desirable in order to better adapt the treatment.

No significant relationships.

Research is needed to explore whether cognitive flexibility may account for potential gender differences after mindfulness-based interventions.

To compare the effectiveness of Acceptance and Commitment Therapy (ACT) versus a Mindfulness-based Emotional Regulation (MER) intervention on cognitive flexibility according to gender.

This study was carried out in a Mental Health Unit in Spain (Colmenar Viejo, Madrid). Firstly, 80 adult patients with anxiety disorders were randomized according to the score on the Acceptance and Action Questionnaire-II (blocking factor), of whom, 64 patients decided to participate (mean age = 40.66, S.D. = 11.43; 40 females). Each intervention was weekly, during 8 weeks, guided by two Clinical Psychology residents. A 2x2x2 mixed ANOVA (pre-post change x intervention type x gender) was conducted, with Sidak-correction post hoc tests. The dependent variable was the score on TMT-B.

A natural logarithmic transformation was conducted to correct violation of normality and homoscedasticity assumptions. No statistically significant differences were observed on age or gender between interventions. No statistically significant interaction effect was observed between pre-post change x intervention x gender [F(1, 52) = .014, p = .907]. An interaction effect was observed between pre-post change x intervention [F(1, 52) = 4.180, p = .046; statistical power observed = 52%]: while TMT-B improved after ACT (p = .001; Cohen’s d = 0.607), there were no changes after MER (p = .367; Cohen’s d = 0.097).

These medium effect-size results confirm previous findings of our research team indicating cognitive flexibility improves after ACT but not after MER.

No significant relationships.

Available evidence shows that countries may shield their population’s exposure and vulnerability to mental health risks during and after an economic recession by strengthening their policies and reorienting their budgets. Populations’ mental health protection during economic crises can only be achieved by the policies of different sectors. Social protection, social programmes and social safety nets proved to be fundamental buffers against inequalities in mental health. Several actions have proven to be effective in this area, including measures to improve social protection, reduce income inequalities, and mitigate the impacts of unemployment. To address the negative consequences of unemployment, active labour market programmes, including special programmes for unemployed young people and families, programmes to promote the employment of people with disabilities, and debt relief programmes should be implemented. The response of the health system is critical. During and after economic recessions, it is fundamental to ensure the responsiveness and effectiveness of the mental health system. To attain this goal, mental health services that are closer to the populations and that facilitate the early identification of mental health problems and the implementation of integrated interventions should be strengthened. The latter is a crucial approach to tackle the mental health problems that more often worsen in periods of economic instability, such as depression, suicidal behaviour and heavy drinking. A special attention should also be dedicated to strengthening the network of community-based mental health services, promoting the integration of mental health in primary care, and enhancing the coordination between mental health services and social care.

No significant relationships.

Currently, our understanding remains limited of how co-occurring bipolar disorder and attention deficit hyperactivity disorder (ADHD) should be treated.

To evaluate the impact of central stimulant treatment on self-injurious behaviour in patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD.

Retrospective cohort study (LiSIE) into effects and side-effects of lithium as compared to other mood stabilisers. Here, using a mirror-image design, we compared suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after central stimulant treatment start.

Of 1564 eligible patients, 206 patients met inclusion criteria; having a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD at first central stimulant initiation. In these, suicide attempts and non-suicidal self-injury events decreased significantly within both 6 months (p = 0.004) and 2 years (p = 0.028) after central stimulant start. After multiple adjustments, this effect was preserved 2 years after central stimulant start (OR 0.63, 95% CI; 0.40 – 0.98, p = 0.041).

Central stimulant treatment may reduce the risk of self-injurious behavior in patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD. However, to reduce the risk of manic switches, concomitant mood stabilising treatment remains warranted.

Michael Ott has been a scientific advisory board member of Astra Zeneca Sweden, Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018 and EAPM 2016, Luleå, Sweden): Astra

The psychopathological causes that advise against a bariatric surgical procedure include any state that puts at risk the modification of habits and beliefs regarding eating behavior, wich condition weight loss and health improvement.

To Study the psychiatric profile of patients rejected for bariatric surgery at the Complejo Hospitalario Asistencial de León (León, Spain).

Retrospective observational study. All patients for whom bariatric surgery procedure has been contraindicated for psychopathological reasons are included. 145 patients were evaluated in the context of the protocol for bariatric surgery. The following diagnostic scales were used as support: Salamanca Questionnaire, Plutchik Impulsivity Scale, Attitudes towards change in patients with eating disorders (ACTA), Bulimia Investigatory Test Edinburgh e, and European Quality of Life-5 Dimensions.

41 Patients were rejected for psychiatric reasons (28.28%). The most frequent diagnoses are impulse control disorder (39%), followed by eating disorder (27%). Other diagnoses found are: depressive disorder (10%), adjustment disorder (5%), personality disorders, intellectual disability and generalized anxiety disorder (3%) 78% of them are women.

Uncontrolled psychiatric pathology is a contraindication to bariatric surgery. Impulse control disorder and eating disorder are related to overweight and obesity, so a diagnosis and treatment are necessary prior planning surgical procedure. Psychopathological variables determine the success of bariatric surgery procedures and it is mandatory to consider them in the process.

No significant relationships.

Bipolar disorder is presumed to involve difficulties in emotion regulation. However, little is known about the specific emotion regulation profile associated with this disorder.

To study emotion regulation in bipolar patients in remission phase and to determine the factors correlated with it.

A cross-sectional, descriptive and analytical study of 30 patients followed for bipolar disorder in remission, at the psychiatric outpatient clinic at the Hédi Chaker University Hospital in Sfax. We used a socio-demographic and clinical data sheet and the Cognitive Emotion Regulation Questionnaire (CERQ) which assesses cognitive strategies (maladaptive and adaptive) for regulating emotion.

The mean age of the patients was 43.77 years, the sex ratio was 0.5. Bipolar I disorder was diagnosed in 93% of patients. A good adherence to treatment was found in 86.7% of cases and a good social integration in 40%. The mean total score of the adaptive CERQ was 66.73 and the most used adaptive strategy was acceptation (mean score =13.87), while the mean total score of the maladaptive CERQ was 36.7 and the most used maladaptive strategy was self blame (mean score =9.47). Adaptive cognitive emotion regulation was predominant in 93.3% of patients. It was significantly correlated with good adherence to treatment (p = 0.047) and good social integration (p = 0.026).

Our patients with euthymic bipolar disorder showed a satisfying level of adaptive emotion regulation strategies. A cognitive remediation seems important to embetter this capacity and improve the income of the disease.

No significant relationships.

Suicide attempts are common in individuals with schizophrenia. These actions are marked by a greater lethality, due to the use of more violent means in particular the intentional ingestion of rodenticides.

To describe the gravity of the heamatological disorders revealing suicide attempts by a rodenticides in patient with schizophrénia.

We repport the case of a patient who present a haematological disorders after an rodenticide intoxication.

A 41-year-old man with schizophrénia since 2011 was brought to the department of psychiatry in july 2020 for behavioral disorders. On arrival, the patient was oriented but reticent and refuse to tell his full story. On examination, his vital signs were normals, and he did not show any externalized bleeding. Bilogical tests revealed the prothrombin time (PT) was <10% with an isolated and unexplained fall in vitamin K-factors. The etiological investigation was negative. Later,the patient admitted attempted suicide by taken 4 rodenticide packages orally three days prior admission to hospital. The initial treatment with intravenous vitamin K almost daily is effective. An improvement in PT (35%) and vitamin K-dependent factors was observed after one week of treatment. A Normalization of hemostasis disorders was obtained after two weeks of treatment.

It is imperative to suspect rodenticide intoxication in patient with scizophrenia with an isolated and an explained deficiency of vitamin K dependent factors. The particularity of this intoxication lies in the dangerous and prolonged side effects making the curative treatment difficult and long.

No significant relationships.

Lorazepam is a benzodiazepine derivative that is globally used for the therapy of anxiety and insomnia.

The objective of our work was to show that Lorazepam can be a cause of unexpected liver injury even though it is a rare entity.

We reported the case of a patient who had a Drug-Induced Liver Injury (DILI) under Lorazepam. We performed a literature review based on a PubMed search with the following keywords: “Lorazepam,DILI”.

A 20 year-old-Tunisian woman was hospitalized in the psychiatry department of the hospital of Nabeul in Tunisia for a brief psychotic episode.She had a DILI under Olanzapine, Chlorpromazine and Lorazepam, which conducted us to interrupt her treatments except for the Lorazepam(5mg/day). The hepatic tests went back to normal even under Lorazepam. Few days later, the liver enzymes increased again to reach very high levels. Extensive workup was negative for other causes of liver injury, including viral hepatitis A, B, C and E.; capillary electrophoresis of serum proteins was normal; Exhaustive immunological tests were performed searching for auto immune hepatitis(anti-smooth muscle antibodies, anti-LKM1, anti-LC1, anti-SLA/LP) primary biliary cholangitis(anti-mitochondrial antibodies, anti-GP210, anti-sp100) and other antibodies like antinuclear antibodies were negative. Liver biopsy showed polymorphic inflammatory infiltrate including some eosinophilic polynuclear cells and rare vaguely epitheloid macrophages, with necrotico-inflammatory foci in the lobules, all of which were consistent with DILI. Lorazepam was discontinued and within 10 days her liver enzymes decreased and completely normalized.

Lorazepam, with an unknown action mechanism, can be a cause of DILI.

No significant relationships.